Efficiency_Smart_Business_Energy_Rebates

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					     This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                                                 2012 BUSINESS ENERGY
                                                                                                                 REBATES
                                                                                                                 Table of Contents




OVERVIEW & PROCESS FORMS                                                                                                     PAGE

       Table of Contents                                                                                                           1

 •     Application Process                                                                                                         2

 •     Application Checklist                                                                                                       3

 •     Terms & Conditions                                                                                                      4&5

 •     Customer Information & Agreement                                                                                            6


REBATE WORKSHEETS                                                                                                            PAGE
 •     Commercial Lighting Rebate Worksheet                                                                                        7

 •     LED Lighting Rebate Worksheet                                                                                               8

 •     Heating and Cooling Rebate Worksheet                                                                                        9

 •     Compressed Air Rebate Worksheet                                                                                            10

 •     Motors Rebate Worksheet                                                                                                    11

 •     Refrigeration Rebate Worksheet                                                                                             12

 •     Food Service and Other Measures Rebate Worksheet                                                                           13


                                                  Document Version 2a: 3/12/2012 Page 1 of 13
    This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                                                   2012 BUSINESS ENERGY
                                                                                                                   REBATES
                                                                                                                   Application Process


Efficiency Smart provides rebates as an incentive for businesses to install new , energy-efficient
equipment. To receive your rebate(s), follow these simple steps:



                                                                                         STEP 2
                      STEP 1
                                                                                 Install eligible energy
                 Check project and
                                                                                 efficient equipment or
                equipment eligibility
                                                                                 perform project work




                                                                                       STEP 3
                     STEP 4
                                                                               Submit application and
             Receive rebate payment
                                                                                accompanying rebate
                within 45 days of
                                                                            documentation within 60 days
              completed application
                                                                                of project completion




                                                                       Step 1: Check project and equipment eligibility

• Projects must be a new facility improvement that results in a permanent reduction in electrical
  energy usage (kWh).

•     All installed equipment must meet or exceed the specifications given in the Efficient Products
      Technical Specifications document and be installed in facilities that are served by American
      Municipal Power, Inc. (AMP) utilities participating in the Efficiency Smart program. Customers
      must have a valid municipal utility account.


                                                                       Step 2: Install equipment or perform project work

•     Install the eligible measures on your project and collect all documentation for application
      submission. Documentation includes, but is not limited to: PAID detailed,
      dated invoices for the purchase and installation of the measures; dated receipts and/or
      canceled checks; contractor contact information; and product technical specification
      sheets.

                                                                       Step 3: Submit Application

• Submit the rebate application within 60 days of the project’s completion with project
  Please see application checklist on the next page for a listing of required documents.

• The Efficiency Smart Team will review your application. For some projects, an inspection will be
  required. If an inspection is required, you will be contacted for scheduling.

• Incomplete applications will not be processed until all necessary documentation is received.

• Completed applications, rebate worksheets, and required documentation can be submitted by
  email, fax or mail.
                                                     Submit your application to:


                                  Mail:                  Efficiency Smart
                                                   1111 Schrock Road, Suite 203
                                                      Columbus, Ohio 43229


                                  Fax:                       (614) 785-0217


                                  E-mail:           rebate@efficiencysmart.org

        For more information, v isit our w ebsite (w w w .efficiencysmart.org) or call 877-889-3777.

                                                                       Step 4: Receive rebate payment

• The Efficiency Smart Team will send rebate checks within 45 days of receipt of all required final
  documentation and project verification, as necessary.

                                              Document Version 2a: 3/12/2012 Page 2 of 13
      This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                                                                              201
                                                                                                                                              2
                                                                                                                                              BUSI




                                              APPLICATION CHECKLIST
                                                       Required Documents


                                 Customer Information and Agreement Page

                                 Completed Rebate Worksheet Form(s)

                                 Itemized Invoices

                                 Receipts and/or Proof of Payment

                                 Technical Specifications (cut sheets)
                                 Please see last tab for an example of required documentation.
                                 Efficiency Smart may request additional information such as electricity bills.

                                                        Rebate Worksheets


                                 Lighting

                                 LED Lighting

                                 HVAC

                                 Compressed Air

                                 Motors

                                 Refrigeration

                                 Food Service, Vending & Other Measures

Application Date:

Project Completion Date:

                             * Incomplete applications will delay processing and incentive payment
                                        * Please complete forms for above checked boxes



                                       Please fill out below if this is a revised submittal:

       SUBMITTAL DATE:
       APPLICATION NUMBER (IF KNOWN):




                                                    1111 Schrock Road, Suite 203
                                                       Columbus, OH 43229
                                                        Phone: (877) 889-3777
                                                       www.efficiencysmart.org

                                                  Document Version 2a: 3/12/2012 Page 3 of 13
                This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).


                                                                                                                                2012 BUSINESS ENERGY REBATES
                                                                                                                                Terms & Conditions




TERMS AND CONDITIONS (PAGE 1)
Efficiency Smart is a program of energy efficiency services offered to a network of public power communities that are
members of American Municipal Power Inc. (AMP). AMP is offering prescriptive incentives (rebates) under the Efficiency
Smart Business Energy Rebates program to facilitate the implementation of cost-effective energy efficiency improvements for
non-residential (commercial and industrial) customers. Funds are limited and subject to availability. Details of this program,
including rebate levels, are subject to change without notice.

Program Effective Dates
Efficiency Smart rebates are offered until December 31 of each program year, unless allotted funds are depleted prior to this
date. The 2012 Efficiency Smart program dates and application submittal requirements are as follows:

• Projects with a final completion date before January 1, 2011 are not eligible for an incentive through this application
process. If the project was completed in 2011, it will be reviewed under 2012 program guidelines.
• All 2012 Efficiency Smart program projects must be completed by December 31, 2012, and applications received no later
than January 31, 2013. Projects not completed by December 31, 2012 will be considered for the 2013 program year and
subject to the terms and conditions approved for that year.

Program and Project Eligibility
The Efficiency Smart Business Energy Rebates program offers rebates for common commercial and industrial efficient
measures with documented energy savings including lighting, HVAC, motors, compressed air, refrigeration, food service, and
more. Program rebates are available to non-residential customers served by participating Efficiency Smart municipal utilities
in AMP's service area with annual electric usage between 20,000 kWh and 500,000 kWh. Commercial and Industrial
customers with annual electrical usage over 500,000 kWh may qualify for Efficiency Smart's Custom Program. Entities with
multiple locations, or divisions of large corporate or municipal entities, please call 1-877-889-3777 to determine if you
qualify for the Business Energy Rebates Program or the Efficiency Smart Custom Program.



Project Requirements
• Projects must involve a facility improvement that results in a permanent reduction in electrical energy usage (kWh).
• Projects that are NOT eligible for an incentive include, but are not limited to the following:
      • Fuel switching (e.g. electric to gas or gas to electric);
      • Changes in operational and/or maintenance practices or simple control modifications not involving capital
         expenditure;
      • On-site electricity generation;
       • Projects involving gas-driven equipment in place of or to replace electric equipment (such as a chiller);
       • Projects focused primarily on power factor improvement;
       • Projects that involve peak-shifting (time of day savings) (and not kWh savings);
       • Renewable energy generation.

• Any measures installed at a facility must be sustainable and provide 100% of the energy benefits as stated in the application
for a period of at least five (5) years or for the life of the product, whichever is less. If the customer ceases to be a delivery
service customer of the municipal utility served by AMP or removes the equipment or systems at any time during the period,
the customer may be required to return a prorated amount of incentive funds to Efficiency Smart. Exceptions may apply for
customers upgrading to more efficient products at their own expense.
• All equipment must be new; used or refurbished equipment is NOT eligible for an incentive.
• All installed equipment must meet state, federal, or local codes and requirements.
• Projects must be installed on the municipal utility electric account listed on the application.
• Equipment must be purchased, installed, and operating (or capable of operating in the case of seasonal uses) prior to
submitting a rebate application.
                                                             Document Version 2a: 3/12/2012 Page 4 of 13
                This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                                                                 2012 BUSINESS ENERGY
                                                                                                                                 REBATES
                                                                                                                                 Terms & Conditions




TERMS AND CONDITIONS (PAGE 2)
Incentive Payments
The total incentive payment shall be the lesser of: 1) The calculated incentive as approved by Efficiency Smart, or 2) 50% OF
THE ELIGIBLE PROJECT COST (the eligible project cost does not include consulting fees, equipment rental, forms
processing, recycling, etc.). The incentive also cannot be more than 100% of the cost of a single energy efficient material
purchase price (as documented on the invoice). For example, if you are applying for a rebate for a screw base induction bulb
that costs $9 and the set rebate for that item is $10, you will be eligible for a $9 rebate for the screw bulb if it meets the
technical criteria.

Equipment must be purchased and installed before payment is issued. Allow 45 days for delivery of payment. Submitting an
application with incomplete or missing information will delay check processing and delivery. Providing false information or
altered documents will lead to cancellation of this and future rebate applications, as well as the requirement to return any and
all rebates issued.

Rebate Application
The rebate application must be submitted within 60 days of project completion. Project documentation, such as copies of
dated PAID invoices for the purchase and installation of the measures and product technical specification sheets, must be
included with the application. The location or business name on the invoice must be consistent with the application
information. Applications should be submitted no later than December 7, 2012 for the 2012 program year. The project invoice
should provide sufficient detail to separate the project cost from the cost of other services such as repairs and building code
compliance. Efficiency Smart reserves the right to request additional supporting documentation as deemed necessary to
confirm eligibility and verify savings.


Application Review Process
Incomplete applications will not be processed. Applicants are encouraged to call our Customer Support Specialists at 877-889-
3777 if they have any questions about documentation requirements.

Inspections
Efficiency Smart reserves the right to inspect all projects to verify compliance with the program rules and verify the accuracy
of project documentation. This may include pre-installation and/or post-installation inspections, detailed lighting layout
descriptions, metering, data collection, interviews, and utility bill data analyses. The customer must allow access to project
documents and the facility where the measures were installed for a period of five years after receipt of incentive payment by
Efficiency Smart.

Tax Liability
Rebates are taxable and, if more than $600, will be reported to the IRS unless the customer is exempt. Efficiency Smart is not
responsible for any taxes that may be imposed on your business as a result of your receipt of this incentive.


Confidentiality
All customer, vendor, and/or contractor information supplied to Efficiency Smart will be kept confidential and will not be shared
with any person or organization unless the person or organization is subcontracted by Efficiency Smart. Confidentiality terms
would extend to the subcontractor.


Disclaimer
Efficiency Smart does not guarantee the energy savings and does not make any warranties associated with the measures
eligible for rebates under this program. Efficiency Smart has no obligations regarding, and does not endorse or guarantee, any
claims, promises, work, or equipment made, performed, or furnished by any contractors or equipment vendors that sell or install
energy efficiency measures. Efficiency Smart is not responsible for the proper disposal/recycling of any waste generated as a
result of this project. Efficiency Smart is not liable for any damage caused by the operation or malfunction of the installed
equipment. Please ensure that proper care is taken to dispose of any equipment that may contain hazardous materials.



                                                             Document Version 2a: 3/12/2012 Page 5 of 13
                                       This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).


                                                                                                                                                   2012 BUSINESS ENERGY REBATES
                                                                                                                                                   Customer Information & Agreement




Company Name                                                      Contact Name/Title (where measures are installed)              Telephone #                                    Fax #


Address (of installation)                                         Town/City & State                                              ZIP Code                                       E-mail Address


Mailing Address (if different)                                    Town/City & State                                              ZIP Code                                       Building Sq. Ft.


Electric Utility                                                  Utility Account #                                              Project Sq. Ft.                                Installation Date (ex: June 24, 2012)

If the application is being completed by a third party and/or rebate processor, enter contact information below.



Company Name                                                      Contact Name/Title (of third party representative)             Telephone #                                    E-mail Address



Is this a New Construction/Major Renovation Project?                                   Yes                             No

A major renovation involves major HVAC renovation, significant envelope modifications, and major
interior rehabilitation that usually requires facility shut down.

What equipment have you upgraded?                                                      Lighting                        LED Lighting                         Compressed Air                          HVAC

                                                                                       Motors                          Refrigeration                        Food Service & Other Measures


Please provide a brief overview of the completed project: For example "A lighting retrofit project replacing 11 4L T12 fixtures with 10 2L T5 high bay fixtures"




Total Project Cost:         (Please fill in $ amount-only eligible project
costs)



Total Calculated Incentive:            (Calculated from worksheets)                                         $0.00
Amount before 50% cap applied



Total Eligible Incentive:                                                                                   $0.00
Maximum incentive will not exceed 50% of the project cost



If you would like the rebate to be paid to a third party, a company official must sign below. I certify that I am authorized to assign payment to the designated third party.


Name                                                                                         Title                                                                    Date


Signature

Please make check payable to:
                                      Contact Name                                           Address                                                                  Company


                                      E-mail Address                                         Telephone Number

                                                        Request for Federal Tax Payer Identification Number (TIN) -- REQUIRED (please select one)

                       Corporation (TIN not needed)                 Tax-Exempt Organization (TIN not needed)                             City, County, or State Dept., Govt. or Agency (TIN not needed)


                                                                                                Social Security number                                   Employer Identification Number
                       All Others (please provide TIN at right)




I certify that I meet the eligibility requirements of this program and that all statements made on this application, including invoices/receipts, are correct to the best of my
knowledge. I agree to the terms and conditions set forth above.

                                                                                                                                                   For Internal Use




                              Customer's Signature                                           Date                                                  Efficiency Smart Approval                       Tracking #

                                                                                 Document Version 2a: 3/12/2012 Page 6 of 13
                                               This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                                Company Name:
                                                                                                Contact Name:
                                                                                                Installation Date:
                                                                                                                                                                                                                    2012
                                                                                                                                                                                                                    BUSINE
                                                                                                                                                                                                                    SS


                                                                    Click here to view the Commercial Lighting Equipment Specifications
                                                                             Click here for Commercial Lighting Equipment Specifications


                                                           Equipment Type                                            # of LAMPS per        # of Hours          Fixture           # of Fixtures      Rebate           Rebate
                                                                                                                        Fixture (A)       Operated per    Efficiency %     (if         (B)         Amount (C)      Calculated
                                                                                                                        (if applicable)      Week             available)                                           (A x B X C)
                            High-Performance T8 (HPT8) Fluorescent Fixtures (Please check technical specifications for detailed performance characteristics)
                            For a list of eligible T8 products, please visit: Consortium for Energy Efficiency (http://www.cee1.org/com/com-It/com-It-main.php3)
                                                                                                                                                       n/a                                             x $7            $0
                            Relamp/Reballast, Retrofit or Replacement T12 to HPT8 ($7/lamp)                                                            n/a                                                             $0
                                                                                                                                                                                                       x $7
                                                                                                                                                       n/a                                             x $7            $0
                                                                                                                                                       n/a                                             x $5            $0
                            Relamp/Reballast, Retrofit or Replacement T12 to Reduced Wattage T8 ($5/lamp)                                              n/a                                                             $0
                                                                                                                                                                                                       x $5
                                                                                                                                                       n/a                                             x $5            $0
                            Relamp/Reballast T8 to HPT8 ($2/fixture)                                                                                   n/a                                             x $2            $0
                            Retrofit Metal Halide (MH) to HPT8 or T5HO High-Bay or Low-Bay Fluorescent Fixtures

                            150W MH to 2-lamp T5HO (program/rapid start ballast) or HPT8 ($7/lamp)                             2                                                                       x $7            $0
                            150W MH to 3-lamp HPT8 ($7/lamp)                                                                   3                                                                       x $7            $0
                            250W MH to 3-lamp T5HO (program/rapid start ballast) ($8/lamp)                                     3                                                                       x $8            $0




 FLUORESCENT LIGHTING
                            250W MH to 4-lamp HPT8 ($8/lamp)                                                                   4                                                                       x $8            $0
                            400W MH to 4-lamp T5HO ($10/lamp)                                                                  4                                                                      x $10            $0
                            400W MH to 6-lamp T5HO or HPT8 ($10/lamp)                                                          6                                                                      x $10            $0
                            New HPT8 andT5 Fluorescent Fixtures ("New" is defined as a non-refurbished fixture placed where no fixture had previously been)
                            New HPT8 Troffer/Wrap, Industrial/Strip, or Indirect Fixture: >80% Fixture                                                 0                                                               $0
                                                                                                                                                                                                      x $15
                            Efficiency ($15/lamp up to $45/fixture)
                            New HPT8 High-Bay w/ High BF Ballast: >85% Fixture Efficiency                                                                                                                              $0
                                                                                                                                                                                                      x $15
                            ($15/lamp up to $60/fixture)
                            New T5 Troffer/Wrap Fixture: >85% Fixture Efficiency                    ($6/lamp up                                                                                                        $0
                                                                                                                                                                                                       x $6
                            to $36/ fixture)
                            New T5 Industrial/Strip, Indirect Fixture: >80% Fixture Efficiency ($5/lamp up to                                                                                                          $0
                                                                                                                                                                                                       x $5
                            $30/fixture)
                            New T5 High-Bay Fixture: >90% Fixture Efficiency                       ($10/lamp with                                                                                                      $0
                                                                                                                                                                                                      x $10
                            new ballast only up to $60/fixture)
                            New Pin-Based (Hard-W ired) Compact Fluorescent Fixtures (all rebates per fixture-does not include standard screw based fixtures)
                            New Compact Fluorescent Fixture ≤ 20 watts
                                                                                                                              n/a                                n/a                                  x $25            $0
                            New Compact Fluorescent Fixture > 20 watts                                                        n/a                                n/a                                  x $50            $0




LIGHTING
                            Ceramic Metal Halide Track & Recessed Fixtures (all rebates per fixture)




   HID
                                                                                                                                                              Wattage
                            Under 100 watts                                                                                   n/a                                                                                      $0
                                                                                                                                                                                                      x $20
                            100 - 150 watts                                                                                   n/a                                                                                      $0
                                                                                                                                                                                                      x $25
                            Specialty Lighting Products (all rebates per bulb)




 OTHER LIGHTING & SENSORS
                            Screw-Base Induction Bulb
                                                                                                                                                                 n/a                                  x $10            $0
                            Integrated Ballast Metal Halide PAR Bulb
                                                                                                                                                                 n/a                                  x $20            $0
                            Occupancy Sensors (all rebates per sensor)
                                                                     um
                            Remote-Mounted Occupancy Sensor: Minim 175 watts Controlled                                                                          n/a                                  x $40            $0
                                                                um
                            Wall-Mounted Occupancy Sensor: Minim 175 watts Controlled                                                                            n/a                                  x $30            $0
                                                                   um
                            Fixture-Mounted Occupancy Sensor: Minim 75 watts Controlled                                                                          n/a                                  x $20            $0
                            Daylight Sensors (all rebates per sensor)
                                                                    um
                            Remote-Mounted Daylight Sensor: Minim 75 watts Controlled                                                                            n/a                                  x $60            $0
                                                                   um
                            Fixture-Mounted Daylight Sensor: Minim 45 watts Controlled                                                                           n/a                                  x $30            $0
                            Lighting Density (New Construction)

                                                                                                                      Type of Fixture                         Hours of           Building Square   Total Reduced
                                                    Lighting Density (New Construction)                                                   Building Type                                                                          $0.35
                                                                                                                        (i.e.: 4' T8)                        Operation                 Feet             Watts        $0.00
                                                             $0.35/reduced watt


                                                                                        SUB-TOTAL                                                                                                                   $0.00
                                                                                                Document Version 2a: 3/12/2012 Page 7 of 13
                                         This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).
                                                                   Company Name:
                                                                    Contact Name:
                                                                   Installation Date:

                                                                                                                                       2012 BUSINESS ENERGY REBATES
                                                                                                                                       LED Lighting Rebate Worksheet


                                                               LED products must be ENERGY STAR or Design Lights approved to qualify for rebates:

                                                                       Click here to view the Design Lights Qualified Products List

                                                        Click here to view the ENERGY STAR Qualified Commerical LED Lighting Products List

                                                               Click here to view all ENERGY STAR Qualified LED Lighting Products List

                                                                                                                                                      # of Hours
                                                                                                                             Lumen Output                                           Rebate      Rebate Calculated
                  Product Category                         Manufacturer Name              Model Number    Wattage                                      Operated     Quantity (A)
                                                                                                                              (if available)                                       Amount (B)        (A x B)
                                                                                                                                                      per Week

ENERGY STAR® Directional or                                                                                                                                                          x $20             $0
Omnidirectional LED Screw- and Pin-                                                                                                                                                  x $20             $0
Based Lamps/Bulbs (PAR, MR, etc.)                                                                                                                                                    x $20             $0
ENERGY STAR® Standard or Decorative                                                                                                                                                  x $20             $0
LED Screw- and Pin-Based Lamps/Bulbs (A-                                                                                                                                             x $20             $0
Style, Globe, etc.)                                                                                                                                                                 x $20              $0
                  ®
ENERGY STAR Recessed &                                                                                                                                                              x $50              $0
Surface/Pendant-Mounted                                                                                                                                                             x $50              $0
Downlight Fixtures                                                                                                                                                                  x $50              $0
                                                                                                                                                                                    x $250             $0
Outdoor Pole/Arm-Mounted
                                                                                                                                                                                    x $250             $0
Parking or Roadway Fixtures
                                                                                                                                                                                    x $250             $0
Outdoor Pole/Arm-Mounted                                                                                                                                                            x $250             $0
Decorative Parking or                                                                                                                                                               x $250             $0
Roadway Fixtures                                                                                                                                                                    x $250             $0
                                                                                                                                                                                    x $135             $0
Outdoor Wall-Mounted Area
                                                                                                                                                                                    x $135             $0
Fixtures (Wall Packs)
                                                                                                                                                                                    x $135             $0
                                                                                                                                                                                    x $200             $0
Parking Garage or Canopy Fixtures                                                                                                                                                   x $200             $0
                                                                                                                                                                                    x $200             $0
                                                                                                                                                                                    x $100             $0
                  ®
ENERGY STAR Bollard Fixtures                                                                                                                                                        x $100             $0
                                                                                                                                                                                    x $100             $0
                                                                                                                                                                                    x $25              $0
ENERGY STAR® Outdoor
                                                                                                                                                                                    x $25              $0
Step Light Fixtures
                                                                                                                                                                                    x $25              $0
                                                                                                                                                                                    x $25              $0
ENERGY STAR® Outdoor
                                                                                                                                                                                    x $25              $0
Pathway Light Fixtures
                                                                                                                                                                                    x $25              $0
                                                                                                                                                                                    x $100             $0
ENERGY STAR® Wall-Wash
                                                                                                                                                                                    x $100             $0
Light Fixtures
                                                                                                                                                                                    x $100             $0
                                                                                                                                                                                    x $100             $0
Track Lighting Fixtures                                                                                                                                                             x $100             $0
                                                                                                                                                                                    x $100             $0
                                                                                                                                                                                    x $15              $0
ENERGY STAR® Portable
                                                                                                                                                                                    x $15              $0
Desk/Task Light Fixtures
                                                                                                                                                                                    x $15              $0
                  ®                                                                                                                                                                 x $15              $0
ENERGY STAR Undercabinet
                                                                                                                                                                                    x $15              $0
Shelf-Mounted Task Light Fixtures
                                                                                                                                                                                    x $15              $0
                                                                                                                                                                                    x $50              $0
Refrigerated Case Light
                                                                                                                                                                                    x $50              $0
Door Fixtures (per Door)
                                                                                                                                                                                    x $50              $0
LED, T-1 or Electroluminescent                                                                                                                                                      x $20              $0
Exit Signs (Signs must be replacing an existing                                                                                                                                     x $20              $0
incandescent exit sign. New or retrofit signs can be
used.)
                                                                                                                                                                                    x $20              $0
                                                                                                                                                                                    x $30              $0
LED Pedestrian Signals                                                                                                                                                              x $30              $0
                                                                                                                                                                                    x $30              $0
                                                                                                                            Type of Signal
                                                                                                                       Use Drop Down Option or
                                                                                                                       Write In One of the Below
                                                                                                                       12” Red Ball-Always Changing
                                                                                                                             12” Red Ball-Flashing
                                                                                                                           12” Yellow Ball-Flashing
                                                                                                                        8” Red Ball-Always Changing
                                                                                                                              8” Red Ball-Flashing
                                                                                                                            8” Yellow Ball-Flashing   # of Hours
                                                                                                                                                                      Quantity      Rebate      Rebate Calculated
                  Product Category                         Manufacturer Name              Model Number     Wattage                                     Operated
                                                                                                                                 12” Red Arrow                          (A)        Amount (B)        (A x B)
                                                                                                                                12” Green Arrow       per Week
                                                                                                                                12” Yellow Arrow
                                                                                                                                  8” Red Arrow
                                                                                                                                 8” Green Arrow
                                                                                                                                 8” Yellow Arrow
                                                                                                                               “Hand” Don’t Walk
                                                                                                                                   “Man” Walk
                                                                                                                         Bi-Modal Walk/Don’t Walk


                                                                                                                                                                                     x $30             $0
LED Traffic Signals                                                                                                                                                                  x $30             $0
                                                                                                                                                                                     x $30             $0


                                                                             SUB-TOTAL                                                                                                                $0


                                                                                        Document Version 2a: 3/12/2012 Page 8 of 13
                                                                        This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                           Company Name:
                                                                           Contact Name:
                                                                          Installation Date:

                                                                                                                                                                                  2012 BUSINESS ENERGY REBATES
                                                                                                                                                                                  Heating & Cooling Rebate Worksheet


                                                                                                      Click here to view the HVAC Equipment Specifications


                                              HVAC Equipment Size or Type                      Manufacturer         Model          Serial Number                                   Unit Size                                 Customer       Rebate Calculated
                                                                                                                                                      SEER/IEER         EER                     # of Units Installed (B)
                                                                                                  Name             Number              (for all                                   (# of Tons)                              Rebate/Ton (C)      (A x B X C)
  UNITARY & SPLIT SYSTEM AC




                                                                                                                                 equipment listed)                                    (A)
                                                                                                                                                                                                                               x   $35              $0
                              AC < 65,000 Btu/H (Split)                                                                                                                                                                        x   $35              $0
                                                                                                                                                                                                                               x   $35              $0
                                                                                                                                                                                                                               x   $35              $0
                              AC < 65,000 Btu/H (Packaged)                                                                                                                                                                     x   $35              $0
                                                                                                                                                                                                                               x   $35              $0
                                                                                                                                                                                                                               x   $40              $0
                                                                                                                                                                                                                               x   $40              $0
                              AC > 65,000 Btu/H (Split & Packaged)                                                                                                                                                             x   $40              $0
                                                                                                                                                                                                                               x   $40              $0
                                                                                                                                                                                                                               x   $40              $0
                                                                                                                                                                                                                               x   $40              $0
CONTROLS &




                                                                                                                                                           n/a           n/a           n/a                                  x $200/unit             $0
                              Integrated Dual Enthalpy Economizer Controls
  PUMPS




                                                                                                                                                           n/a           n/a           n/a                                  x $200/unit             $0
                                                                                                                                                           n/a           n/a           n/a                                  x $200/unit             $0
                                                                                                                                                                                                                               x $80                $0
                              Water Source Heat Pump                                                                                                                                                                           x $80                $0
                                                                                                                                                                                                                               x $80                $0
                                                                                               Manufacturer         Model          Serial Number       CV or VAV    Economizer     Unit Size                                 Customer       Rebate Calculated
                                                                                                                                                                                                # of Units Installed (B)
                                                                                                  Name             Number              (for all          Reheat        (Y/N)      (# of Tons)                              Rebate/Ton (C)      (A x B X C)
                                                                                                                                 equipment listed)     (CV/VAV)                       (A)
                              Air Cooled Chillers                                                                                                                                                                              x   $25              $0
                              Electric Operated                                                                                                                                                                                x   $25              $0
                                                                                                                                                                                                                               x   $25              $0
                              Water Cooled Chillers (Reciprocating)                                                                                                                                                            x   $25              $0
  CHILLERS




                              Electric Operated                                                                                                                                                                                x   $25              $0
                                                                                                                                                                                                                               x   $25              $0
                              Water Cooled Chillers (Centrifugal)                                                                                                                                                              x   $25              $0
                              Electric Operated                                                                                                                                                                                x   $25              $0
                                                                                                                                                                                                                               x   $25              $0
                              Water Cooled Chillers (Rotary Screw, Scroll)                                                                                                                                                     x   $25              $0
                              Electric Operated                                                                                                                                                                                x   $25              $0
                                                                                                                                                                                                                               x   $25              $0
                                                                                               Manufacturer         Model          Serial Number                                   Unit Size      # of Units    Louvere      Customer       Rebate Calculated
                                                                                                                                       (for all       SEER/IEER         EER       (# of Tons)
                                                                                                  Name             Number                                                                       Installed (B)    d (Y/N)   Rebate/Ton (C)      (A x B X C)
                                                                                                                                 equipment listed)                                    (A)

                              SEHA Tier 1 Room Air Conditioners                                                                                                                                                              x $25/unit             $0
OTH
 ER




                              For qualifying products, visit:                                                                                                                                                                x $25/unit             $0
                              http://www.cee1.org/resid/seha/rm-ac/rm-ac-main.php3                                                                                                                                           x $25/unit             $0


                                                                                                         SUB-TOTAL                                                                                                                                $0

                                                                                                                  Document Version 2a: 3/12/2012 Page 9 of 13
                                                      This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                          Company Name:
                                                                                          Contact Name:
                                                                                         Installation Date:
                                                                                                                                                                                2012 BUSINESS ENERGY
                                                                                                                                                                                REBATES
                                                                                                                                                                                Compressed Air Rebate


                                                                                      Click here to view the Compressed Air System Equipment Specifications


                                                       Air Compressor Manufacturer                                              Air Compressor Hours       Air Compressor       Quantity    Rebate      Rebate Calculated
                                                                                               Air Compressor Model
                                                                                                                                of Operation per Year     Horsepower (HP)         (A)      Amount (B)        (A x B)




    VARIABLE FREQUENCY DRIVE (VFD)
                                                                                                                                                             10 - 14             x $1,200
                                                                                                                                                             15 - 19             x $1,500

         SCREW COMPRESSORS
                                                                                                                                                             20 - 24             x $2,000
                                                                                                                                                             25 - 29             x $2,200                      $0
                                                                                                                                                             30 - 34             x $2,500
                                                                                                                                                             35 - 39             x $2,800
                                                                                                                                                               40                X $3,100
                                                                                                                                                             10 - 14             x $1,200
                                                                                                                                                             15 - 19             x $1,500
                                                                                                                                                             20 - 24             x $2,000
                                                                                                                                                             25 - 29             x $2,200                      $0
                                                                                                                                                             30 -34              x $2,500
                                                                                                                                                             35 - 39             x $2,800
                                                                                                                                                               40                x $3,100
                                                                                                                                                        TOTAL VFD SCREW COMPRESSOR REBATE:                     $0
    AIR RECEIVERS/TANKS FOR LOAD/NO-LOAD




                                                                                                                                                           Air Compressor
                                                       Air Compressor Manufacturer        Air Compressor      Air Compressor    Air Compressor Hours        Horsepower &        Quantity    Rebate      Rebate Calculated
                                                                                               Model                HP          of Operation per Year   Minimum Tank Size (in     (A)      Amount (B)        (A x B)
         SCREW COMPRESSORS (10-40 HP)




                                                                                                                                                               gallons)

                                                                                                                                               10 (240)             x $350
                                                                                                                                               15 (400)             x $525
                                                                                                                                               20 (500)      0      x $700
                                                                                                                                               25 (660)      0      x $900                                     $0
                                                                                                                                               30 (660)      0      x $900
                                                                                                                                              35 (1,060)     0     x $1,200
                                                                                                                                              40 (1,060)     0     x $1,200
                                                                                                                                               10 (240)      0      x $350
                                                                                                                                               15 (400)             x $525
                                                                                                                                               20 (500)      0      x $700
                                                                                                                                               25 (660)             x $900                                     $0
                                                                                                                                               30 (660)             x $900
                                                                                                                                              35 (1,060)     0     x $1,200
                                                                                                                                              40 (1,060)           x $1,200
                                                                                                           TOTAL AIR RECEIVER/TANK FOR LOAD/NO-LOAD SCREW COMPRESSOR REBATE:                                   $0

                                                        Cycling Refrigerator Dryer                                              Air Compressor Hours         Dryer Size         Quantity    Rebate      Rebate Calculated
                                                                                          Cycling Refrigerator Dryer Model
                                                              Manufacturer                                                      of Operation Per Year       (CFM Capacity)        (A)      Amount (B)        (A x B)
(up to 300 CFM capacity)
THERMAL MASS DRYERS
 CYCLING REFRIGERATED




                                                                                                                                                       0 -25 CFM             x $50
                                                                                                                                                      26 - 50 CFM            x $75
                                                                                                                                                     51 - 100 CFM           x $100                             $0
                                                                                                                                                    101 -150 CFM            x $125
                                                                                                                                                    151 - 300 CFM           x $175
                                                                                                                                                       0 -25 CFM    0        x $50
                                                                                                                                                      26 - 50 CFM            x $75
                                                                                                                                                     51 - 100 CFM   0       x $100                             $0
                                                                                                                                                    101 -150 CFM    0       x $125
                                                                                                                                                    151 - 300 CFM           x $175
                                                                                                                               TOTAL CYCLING REFRIGERATED THERMAL MASS DRYER REBATE:                           $0

                                                                                                                                Air Compressor Type
                                                                                                                                                                                Quantity    Rebate      Rebate Calculated
                              (Timed drains are not




                                                      Condensate Drain Manufacturer           Condensate Drain Model              (MBD, VFD, LNL1,      System Pressure (psi)
NO-LOSS




                                                                                                                                                                                  (A)      Amount (B)        (A x B)
DRAINS




                                                                                                                                     LNL3, LNL5)
                                    eligible)




                                                                                                                                                                                       x $150                  $0
                                                                                                                                                                                       x $150                  $0
                                                                                                                                                                                       x $150                  $0
                                                                                                                                                                    TOTAL NO-LOSS DRAIN REBATE:                $0
                                                                                                                                Air Compressor Type       Air Compressor
AIR NOZZLES
ENTRAINING




                                                           Nozzle Manufacturer                     Nozzle Model                                                                 Quantity    Rebate      Rebate Calculated
                                                                                                                                  (MBD, VFD, LNL1,       Hours of Operation
                                                                                                                                                                                  (A)      Amount (B)        (A x B)
                                                                                                                                     LNL3, LNL5)              Per Year
    AIR-




                                                                                                                                                                                   x $10                       $0
                                                                                                                                                                                   x $10                       $0
                                                                                                                                                                                   x $10                       $0
                                                                                                                                                   TOTAL AIR-ENTRAINING AIR NOZZLE REBATE:                     $0


                                                                                             SUB-TOTAL                                                                                                        $0
                                                                                                    Document Version 2a: 3/12/2012 Page 10 of 13
                                                                                   This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                                            Company Name:
                                                                                             Contact Name:
                                                                                            Installation Date:
                                                                                                                                                                                                                                                                    2012
                                                                                                                                                                                                                                                                    BUSINESS
                                                                                                                                                                                                                                                                    ENERGY

                                                                                                                    Click here to view the Motor & Variable Frequency Drive Specifications


                                           ODP DRIP-PROOF (ODP) & TOTALLY ENCLOSED, FAN-COOLED (TEFC) MOTORS
ENCLOSED, FAN-COOLED (TEFC) MOTORS
  OPEN DRIP-PROOF (ODP) & TOTALLY




                                              Motor Manufacturer                                                  Open Drip-Proof (ODP) or Totally       Annual Run Hours                                             Horsepower (HP)     # of HP      Rebate        Rebate Calculated
                                                                             Model #                RPM                                                                                  Function & Location
                                                                                                                    Enlosed Fan Cooled (TEFC)          (Minimum 2,000 hours)                                           Motor Range          (A)      Amount   (B)         (A x B)

                                                                                                                                                                                                                            1 -5                      x $5
                                                                                                                                                                                                                          7.5 - 20                    x $4                  $0
                                                                                                                                                                                                                          25 - 100                    x $3
                                                                                                                                                                                                                         125 - 200                    x $2
                                                                                                                                                                                                                            1 -5                      x $5
                                                                                                                                                                                                                          7.5 - 20                    x $4                  $0
                                                                                                                                                                                                                          25 - 100                    x $3
                                                                                                                                                                                                                         125 - 200                    x $2
                                                                                                                                                                                                                            1 -5                      x $5
                                                                                                                                                                                                                          7.5 - 20                    x $4                  $0
                                                                                                                                                                                                                          25 - 100                    x $3
                                                                                                                                                                                                                         125 - 200                    x $2
                                                                                                                                                                                                                                        TOTAL MOTORS REBATE:                $0
                                           VARIABLE FREQUENCY DRIVES
                                                    Equipment Controlled by VFD                 Rated Motor                           Hours of        Baseline Control Strategy        Proposed Control Strategy                         # of VFDs     Rebate        Rebate Calculated
                                                                                                                 Motor Efficiency                      (check one strategy box                                        Horsepower (HP)
                                            (Supply Fan, Return Fan, Exhaust Fan, Chilled       Horsepower                            Operation                                          (check one strategy box                             (A)     Amount   (B)         (A x B)
                                              W ater Pump or Heating Hot W ater Pump)              (HP)                                                      with an "x")                     with an "x" )
                                                                                                                                                               Constant volume                Differential pressure          3                      x $500
                                                                                                                                                                                                                             5                      x $750
         VARIABLE FREQUENCY DRIVES (VFD)




                                                                                                                                                                                                      Flow                  7.5                    x $1,000
                                                                                                                                                           Air foil/backward incline
                                                                                                                                                                                                                            10                                              $0
                                                                                                                                                                                                                                                   x $1,200
                                                                                                                                                           Air foil/backward incline              Temperature             >10 -50                  x $1,700
                                                                                                                                                             w/ inlet guide vanes
                                                                                                                                                                                                                         >50 -100                  x $2,200
                                                                                                                                                                                                                        >100 - 150                 x $2,700
                                                                                                                                                               Constant volume                Differential pressure          3                      x $500
                                                                                                                                                                                                                             5                      x $750
                                                                                                                                                           Air foil/backward incline                  Flow                  7.5                    x $1,000
                                                                                                                                                                                                                            10                                              $0
                                                                                                                                                                                                                                                   x $1,200
                                                                                                                                                           Air foil/backward incline              Temperature             >10 -50                  x $1,700
                                                                                                                                                             w/ inlet guide vanes                                        >50 -150                  x $2,200
                                                                                                                                                                                                                           >100                    x $2,700
                                                                                                                                                               Constant volume                Differential pressure          3                      x $500
                                                                                                                                                                                                                             5                      x $750
                                                                                                                                                                                                      Flow                  7.5                    x $1,000
                                                                                                                                                           Air foil/backward incline
                                                                                                                                                                                                                            10                                              $0
                                                                                                                                                                                                                                                   x $1,200
                                                                                                                                                           Air foil/backward incline              Temperature             >10 -50                  x $1,700
                                                                                                                                                             w/ inlet guide vanes
                                                                                                                                                                                                                         >50 -100                  x $2,200
                                                                                                                                                                                                                        >100 - 150                 x $2,700
                                                                                                                                                                                                                                           TOTAL VFD REBATE:                $0



                                                                                                                             SUB-TOTAL                                                                                                                                      $0
                                                                                                                                     Document Version 2a: 3/12/2012 Page 11 of 13
                                                                                   This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                        Company Name:
                                                                         Contact Name:
                                                                       Installation Date:

                                                                                                                                                                                                    2012 BUSINESS ENERGY REBATES
                                                                                                                                                                                                    Refrigeration Rebate Worksheet



                                                                                                                         Click here to view the Refrigeration Equipment Specifications

                                            Continuous Covers & Strip-Curtains
                                                                                                                                                                                                                       Refrigeration Temperature Code
                                                                                                                                                                                                                               (Please"x" one)                    Rebate      Rebate Calculated
                                                                               Type of Equipment                                                              Horizontal Length in Feet (A)
    COVERS & CURTAINS




                                                                                                                                                                                                                         Low          Medium         High        Amount (B)        (A x B)
     DOORS, FRAMES,




                                                                                                                                                                                                                        <25◦ F       25◦ - 40◦ F   41◦ - 65◦ F
                                                                              Continuous Cover(s)                                                                                                                                                                   x $5             $0
                                                                                Strip-Curtain(s)                                                                                                                                                                    x $5             $0
                                            Zero Energy Doors & Frames (Reach-In Type)
                                                                                                                                                                                                                       Refrigeration Temperature Code
                                                                               Type of Equipment                                                                                                                               (Please"x" one)                    Rebate      Rebate Calculated
                                                                                                                                                                  # of Doors/Frames (A)
                                                                                                                                                                                                                         Low        Medium       High            Amount (B)        (A x B)
                                                                                                                                                                                                                        <25◦ F     25◦ - 40◦ F 41◦ - 65◦ F
                                                                                Cooler Doors(s)                                                                                                                                                                    x $75             $0
                                                                               Coolers Frame(s)                                                                                                                                                                    x $75             $0
                                            Evaporator Fan Motor Controls
                                                                                                                                                                                                                       Refrigeration Temperature Code
                                                                                                                                                                                                                               (Please"x" one)                    Rebate      Rebate Calculated
                                                                               Type of Equipment                                            # of Fans Controlled                       # of Controls (A)
        HEATERS, FANS & DEFROST CONTROLS




                                                                                                                                                                                                                         Low        Medium      High             Amount (B)        (A x B)
                                                                                                                                                                                                                            ◦        ◦    ◦     ◦    ◦
                                                                                                                                                                                                                        <25 F      25 - 40 F 41 - 65 F
                                                             Cooler (minimum 4 fans or 500 watts per control)                                                                                                                                                      x $500            $0
                                                             Freezer (minimum 4 fans or 500 watts per control)                                                                                                                                                     x $500            $0
                                            Door/Frame Heater Controls (Humidity-Based)
                                                                                                                                                                                                                       Refrigeration Temperature Code
                                                                               Type of Equipment                                                                                                                               (Please"x" one)                    Rebate      Rebate Calculated
                                                                                                                                            # of Fans Controlled                   # of Qualifying Doors (A)
                                                                                                                                                                                                                         Low        Medium       High            Amount (B)        (A x B)
                                                                                                                                                                                                                        <25◦ F     25◦ - 40◦ F 41◦ - 65◦ F
                                                                                     Cooler                                                                                                                                                                        x $35             $0
                                                                                     Freezer                                                                                                                                                                       x $35             $0
                                            Intelligent Defrost Controls
                                                                                                                                                                                                                       Refrigeration Temperature Code
                                                                               Type of Equipment                                                                             # of Evaporator                                   (Please "x" one)                   Rebate      Rebate Calculated
                                                                                                                                            # of Fans Controlled                                   # of Controls (A)
                                                                                                                                                                           Fans Per Controller                           Low        Medium       High            Amount (B)        (A x B)
                                                                                                                                                                                                                        <25◦ F     25◦ - 40◦ F 41◦ - 65◦ F
                                                              On walk-in freezer evaporator coils only.                                                                                                                                                            x $150            $0
                                                            (Minimum of three evaporator fans pers controller.)

                                            Outside Air Economizers For Coolers ≥ 1,000 Cubic Feet
                                                                                                                                       # of Evaporator   Size of                                                       Refrigeration Temperature Code
                                                         Type of Equipment                     Manufacturer            Model                                                   Compressor          # of Economizers            (Please"x" one)                    Rebate      Rebate Calculated
                                                                                                                                       Fans Connected   Cooler
                                                                                                                                                                               Horsepower                 (A)            Low        Medium       High            Amount (B)        (A x B)
                                                                                                                                        to Economizer (Cubic Feet)
                                                                                                                                                                                                                        <25◦ F     25◦ - 40◦ F 41◦ - 65◦ F
        MOTORS, ECONOMIZERS & COMPRESSORS




                                                       Hermetic Compressor                                                                                                                                                                                        x $1,250           $0
                                                        Scroll Compressor                                                                                                                                                                                         x $1,250           $0
                                            High-Efficiency ECM Evaporator Fan Motors

                                                                                                   Type of Motor Being Replaced                                                                                        Refrigeration Temperature Code
                                                                                                                                                                                                                               (Please"x" one)                    Rebate      Rebate Calculated
                                                         Type of Equipment                                                                                      # of Motors Controlled (A)
                                                                                                                                                                                                                         Low        Medium       High            Amount (B)        (A x B)
                                                                                                     PSC            Shaded Pole
                                                                                                                                                                                                                        <25◦ F     25◦ - 40◦ F 41◦ - 65◦ F
                                               In Walk-in or Refrigerated Warehouse                                                                                                                                                                                x $60             $0
                                                In Merchandising Case or Reach-ins                                                                                                                                                                                 x $30             $0
                                            Scroll Compressor(s)
                                                                                                                                                                                                                       Refrigeration Temperature Code
                                                                   Type of Equipment                                Horsepower                                                                                                 (Please"x" one)                    Rebate      Rebate Calculated
                                                                                                                                                                   # of Compressors (A)
                                                                                                                                                                                                                         Low        Medium       High            Amount (B)        (A x B)
                                                                                                                                                                                                                        <25◦ F     25◦ - 40◦ F 41◦ - 65◦ F
                                                                                                                         2                                                                                                                                         x $150            $0
                                                                                                                         3                                                                                                                                         x $150            $0
                                                            Walk-in Cooler Systems Only.                                 4                                                                                                                                         x $150            $0
                                                                                                                         5                                                                                                                                         x $150            $0
                                                                                                                         6                                                                                                                                         x $150            $0

                                            ENERGY STAR® Reach-in Refrigerators (15 up to 80 cubic feet) & Reach-In Freezers
FREEZERS & ICE MACHINES




                                                                                                                                                                                                    # of Refrigerators/Freezers (A)                               Rebate      Rebate Calculated
                                                                           Size of Refrigerator/Freezer                                    Refrigerator or Freezer
                                                                                                                                                                                           Solid Door                                Glass Door                  Amount (B)        (A x B)
    REFRIGERATORS,
     ENERGY STAR®




                                                                               15 - 30 cubic feet                                                                                                                                                                 x $200             $0
                                                                              > 30 - 50 cubic feet                                                                                                                                                                x $200             $0
                                                                              > 50 - 80 cubic feet                                                                                                                                                                x $250             $0
                                            ENERGY STAR® Ice Machines
                                                                                                                                                                                                                                                                  Rebate      Rebate Calculated
                                                                   Size of Ice Machine                                  Type of Ice Machine (Self Contained Unit, Ice Making Head or Remote Condensing Unit)                     # of Ice Machines (A)
                                                                                                                                                                                                                                                                 Amount (B)        (A x B)
                                                                     < 175 lbs/day                                                                                                                                                                                x $100             $0
                                                                     ≥ 175 lbs/day                                                                                                                                                                                x $175             $0


                                                                                                                          SUB-TOTAL                                                                                                                                                  $0
                                                                                                                                  Document Version 2a: 3/12/2012 Page 12 of 13
                                      This form is only for businesses that use less than 500,000 kWh of electricity per year (this is cumulative and includes all meters).

                                                                               Company Name:
                                                                                Contact Name:
                                                                               Installation Date:

                                                                                                                               2012 BUSINESS ENERGY REBATES
                                                                                                                               Food Service & Other Measures Rebate Worksheet


                                                            Click here to view the Food Service, Vending & Other Measures Specifications


                             Equipment Type                                                                                                                Quantity   Customer     Rebate Calculated   (A
                                                               Manufacturer Name                    Model Number     Serial Number        Unit Size
                                                                                                                                                             (A)      Rebate (B)           x B)

                                                                                                                                         # of Pans
                                                                                                                                                                       x    $400            $0
                           ENERGY STAR®                                                                                                                                x    $400            $0
                            Steam Cooker                                                                                                                               x    $400            $0
                                                                                                                                                                       x    $400            $0
                                                                                                                                                                       x    $400            $0
                                                                                                                                      Size in Cubic Feet

                                                                                                                                                                       x $250               $0
                           Hot Food Holding                                                                                                                            x $250               $0
                                Cabinet                                                                                                                                x $250               $0
  FOOD SERVICE EQUIPMENT




                                                                                                                                                                       x $250               $0
                                                                                                                                                                       x $250               $0
                                                                                                                                                                      x $1,250              $0
                                                                                                                                                                      x $1,250              $0
                           Combination Oven                                                    0                           0                                          x $1,250              $0
                                                                                                                                                                      x $1,250              $0
                                                                                                                                                                      x $1,250              $0
                                                                                                                                                                       x $350               $0
                                                                                                                                                                       x $350               $0
                            ENERGY STAR®
                                                                                                                                                                       x $350               $0
                           Convection Oven
                                                                                                                                                                       x $350               $0
                                                                                                                                                                       x $350               $0
                                                                                                                                                                       x $350               $0
                                                                                                                                                                       x $350               $0
                           ENERGY STAR®
                                                                                                                                                                       x $350               $0
                              Griddle
                                                                                                                                                                       x $350               $0
                                                                                                                                                                       x $350               $0
                                                                                                                                                                       x $150               $0
                                                                                                                                                                       x $150               $0
                           ENERGY STAR®
                                                                                                                                                                       x $150               $0
                               Fryer
                                                                                                                                                                       x $150               $0
                                                                                                                                                                       x $150               $0

                             Equipment Type                                                                           Installation   Vending Machine       Quantity   Customer     Rebate Calculated (A
                                                         Manufacturer Name of Controller            Model Number
                                                                                                                        Date(s)         Distributor          (A)      Rebate (B)           x B)
EQUIPMENT
 VENDING




                                                                                                                                                                        x   $50             $0
                                                                                                                                                                        x   $50             $0
                           Vending Machine                                                                                                                              x   $50             $0
                             Controllers                                                                                                                                x   $50             $0
                                                                                                                                                                        x   $50             $0
                                                                                                                                                                        x   $50             $0
SENSOR
 OTHER




                                                    Equipment Type                                                                          # of Sensors (A)          Customer     Rebate Calculated   (A
                                                                                                    # of Hours Operated per Week
                                                                                                                                                                      Rebate (B)            x B)
   S




                                         Plug-Load Occupancy Sensor                                                                                                    x $20                $0


                                                                        SUB-TOTAL                                                                                                           $0

                                                                                Document Version 2a: 3/12/2012 Page 13 of 13

				
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