Commercial Lighting Rebate Application by Y7xT503

VIEWS: 20 PAGES: 10

									                                                                                                                             Commercial Lighting Rebate Application                                                                                            CFL & CMH Screw-ins
                                                                                                                                                                                                                                                                   LED Exit Signs
                                                                                                                                             Rev. 2012.1C                                                                                                Integral LED Fixtures and Lamps
                                                                                   For Commercial & Industrial Customers (schedules 24, 25, 26, and 31 - all other schedules must call 425-424-6458 for approval)                                                Lighting Controls
                                                                                      Commercial lighting rebates are not eligible for dwelling units        Call 1-800-562-1482 for rate schedule confirmation                                                   Low Wattage T8
                                                                                     For common area projects in multifamily facilities (5+ attached units), please contact 1-866-997-9767 for more information
                                                 PSE only pays for product that are installed and saving energy at the project location. Customer/Contractor/Vendor will submit this form after all products are installed.
                                                 Contractor/Vendor using PSE Assignment of Funds Form will confirm that the products are installed. Please use the Assignment of Funds tab in this application only.

                                                                                                                                                                                          Facility Contact
                                                  Facility Name:                                               Facility Contact:                              Title:                                                                       Facility Contact Email:
                                                                                                                                                                                                   Phone#
                                                                                                                                                                                                                                         PSE Electric Account or
                                      Facility Physical Address:                                                             City:                        State:                                      Zip
                                                                                                                                                                                                                                                         meter#:
                                                                                                                                                                                                                                          Payee Name as should
                                        Facility Mailing Address:                                                            City:                        State:                                      Zip
                                                                                                                                                                                                                                               appear on check:

                                      Payment Mailing Address:                                                               City:                        State:                                      Zip                                           Attention To:

                                                                                              Contractor/Vendor                                  Contractor/Vendor Email
              Name of Contractor/Vendor supplying product:                                                                                                                                                                 Date of Application:
                                                                                                       Phone #:                                                 address:
                                         Required facility and/or payment information missing. Please verify that all facility and payment information has been entered before proceeding to measures section of rebate application.
                                                                                                                                                                                        Original Wattage New Wattage Per
CFL, Ceramic Metal Halide, LED                                                                                                                                                              Per Sign           Sign      kWh Savings                 Rebate per
(Choose from Drop Down Menu to select measure type-                                                             Quantity                 Manufacturer                  Model Number                                       (Estimated                                 Rebate Per Measure
                                                                                                                                                                                       (ONLY IF LED EXIT   (ONLY IF LED      Avg.)
                                                                                                                                                                                                                                                        unit
(See Signature Page for Terms and Conditions)
                                                                                                                                                                                             SIGN)          EXIT SIGN)

                                                                                                                                                                                                                                           0             $0                   $0

                                                                                                                                                                                                                                           0             $0                   $0

                                                                                                                                                                                                                                           0             $0                   $0

                                                                                                                                                                                                                                           0             $0                   $0
                                                                                                             Total Measures                                                                                                           Total kWh                          Total Rebate
                                                TOTALS:
                                                                                                                    0                                                                                                                 Savings
                                                                                                                                                                                                                                            0                               $0.00

Low Wattage T8 (Group Re-Lamp Only)                                                                                                                                                     Low Wattage T8       Floor Number(s)          kWh Savings    Rebate per
(Choose from Drop Down Menu to select measure type)                                                             Quantity                 Manufacturer                  Model Number                           (Only if re-lamping      (Estimated                    Rebate Per Measure
                                                                                                                                                                                           Location          certain entire floors)       Avg.)
                                                                                                                                                                                                                                                        unit
(See Signature Page for Terms and Conditions)

                                                                                                                                                                                                                                           0             $0                   $0

                                                                                                                                                                                                                                           0             $0                   $0

                                                                                                                                                                                                                                           0             $0                   $0
                                                                                                             Total Measures                                                                                                           Total kWh                          Total Rebate
                                                TOTALS:
                                                                                                                    0                                                                                                                 Savings
                                                                                                                                                                                                                                            0                               $0.00
                     Lighting Controls
                     (List Location Below)                                Number of Controls                  Total Watts
                                                                                                                                                                        Post-control      Pre-control          Post-Control           kWh Savings    Rebate per
                                                                     (Use separate line for each sensor    Controlled (Add up        Pre-control hours/year                                                                            (Estimated                    Rebate Per Measure
                                                                        unless multiple sensors are        all of wattage for all                                       hours/year      kWh/per control        kWh/control                Avg.)
                                                                                                                                                                                                                                                        unit
                                                                       controlling the same lighting)             controls)


                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                                                                                                                                                                                          0.00                                $0
                                                                            Total Measures                                                                                                                                             Total kWh                         Total Rebate
                            TOTALS:
                                                                                   0                                                                                                                                                    Savings
                                                                                                                                                                                                                                           0                                $0.00
                                                                         Grand Total Measures                                                                                                                    Grand Total kWh Savings                   Grand Total Rebate
                        GRAND TOTALS:
                                                                                  0                                                                                                                                         0                                     $0.00
Email an Excel version to:                                          commercialrebates@pse.com                                 To mail application: Puget Sound Energy Attn: Commercial Lighting Rebates                           For help with this form, please contact
                                                                                                                                                     PO Box 90868 M/S BOT-O1H Bellevue, WA 98009-0868                              an Energy Advisor at 1-800-562-1482
4719 07/11                                                                                                Estimated kWh Savings:                             0                                          Rebate Amount:         $0.00
                                               PSE Commercial Lighting Rebate Program
                                                      Terms and Conditions
                                                         Signature Page

Qualifying Customers
Qualifying customers for the commercial lighting rebate program include Puget Sound Energy electric customers on commercial rate schedules, other than
retail wheeling customers. Retail wheeling customers may utilize their Sch 258 Large Power User Self-Directed Program incentive allocation for commercial
lighting rebates through the Sch 258 RFP process.

Compact Fluorescent Lamps (CFL) & Cold Cathode
Qualifying CFL products are required to be ENERGY STAR® listed. Specialty Lamp categories are the following: dimming, three-way, reflector, candelabra,
globe, and cold cathode lamps (cold cathode lamps do not have to be ENERGY STAR® Qualified, but must have at least a two year warranty and produce at
least 35 lumens per Watt)
Non- Qualifying lamps for this Program:
• Pin based lamps (unless they are coupled with an adapter)
• Any non-screw in lamps or lamps specific to a certain type of specialty non-CFL fixture
Incentives for installation of these energy saving products are available through other Business Energy Management programs.
Qualifying List:    http://www.energystar.gov/index.cfm?fuseaction=cfls.display_products_excel

LED Exit Signs
LED Exit Signs must have at minimum a 5 year Warranty, be 5 Watts or less, and replace existing incandescent or CFL Exit Signs to qualify for a rebate.

Ceramic Metal Halide (CMH)

Qualifying CMH products must be self ballasted screw-in type certified by Underwriters Laboratories (UL) or another nationally recognized testing laboratory.

Integral Light Emitting Diode (LED)
Qualifying Integral LEDs are recessed down light fixtures or retrofit products or integral LED lamps which are ENERGY STAR® qualified or on the Utility
Qualified list held by the Lighting Design Lab. If the product is on the ENERGY STAR® qualified list for Commercial Fixtures or Integral LED Lamps, the
product is automatically qualified. If the product is not on the ENERGY STAR® Qualified list, the customer or contractor must follow the procedures
for qualification listed on the Lighting Design Lab Website:                                           http://www.lightingdesignlab.com/LED-List/index.html
Qualifying Lists: Energy Star Integral LED List:               http://www.energystar.gov/index.cfm?fuseaction=iledl.display_products_excel
                  Energy Star Recessed Can LED List:           http://www.energystar.gov/index.cfm?fuseaction=ssl.display_products_com_excel
                  Lighting Design Lab List:                    http://www.lightingdesignlab.com/LED-List/LDL_LED_lamp_list.pdf

Low Wattage T8
Qualifying Low Wattage T8s are 25-28 Watt 4’ T8 Lamps which are CEE listed and are part of a group re-lamp to convert the facility to a more efficient lamp
stock. PSE's Low Wattage T8 Rebate is a “one time only” rebate opportunity. A search will be made in PSE's project database prior to any new rebate being
paid. If a low Wattage T8 rebate is found on the same account or at the same address further research will be conducted to determine eligibility (e.g. re-lamp
of an additional building served by a common meter, a different floor, etc.) Repeat applications in the same spaces are not eligible.
• Group relamping of ALL T8 lamps in the building or on an entire floor must occur.
• Note – reduced wattage lamps will also reduce light output. Do not do this conversion if you perceive your space is currently underlit.
• Note – reduced wattage lamps are not designed to run in ambient temperatures below 60 degrees F.
• Fluorescent light bulbs contain a very small amount of mercury, do not place used fluorescent lamps in the garbage. For proper disposal methods
contact the State of Washington Department of Ecology at http://www.ecy.wa.gov/ecyhome.html

Qualifying List:        http://www.cee1.org/com/com-lt/RW-lamps-ballasts.xls

Lighting Controls
Qualifying Lighting Controls are commercial grade occupancy sensors and/or timers.

Agreement:

I have read and understand the terms and conditions stated above. I attest that all information provided in this application is accurate and truthful, that I satisfy
the terms and conditions stated above, and that I agree to adhere to them. I understand that if I do not adhere to the terms and conditions above, or have
otherwise not complied with the requirements of this program, my application for a rebate may be disqualified and no rebate paid. I understand that PSE
provides rebate incentives for retrofit measures that are designed to save energy in the facility listed on the application, but I understand and acknowledge that
estimated energy savings are not guaranteed and such projected energy savings may not result from such retrofit measures. I, the customer, am solely
responsible for meeting applicable code requirements, for the proper disposal of all waste material, including proper disposal of CFLs, for determining the
adequacy of any installation, and for all payments to contractors and/or suppliers. I understand that PSE may inspect the existing and/or retrofitted lighting and
that it does so on a regular basis, and I hereby agree not to unduly or unreasonably limit PSE's ability to conduct any such inspections.


Authorized Signature:                                                                                                      Date:
                                            PSE Commercial Lighting Rebate Program
                                                   Assignment of Funds
                                                      Signature Page


PROJECT NAME                                                           PSE ACCOUNT NUMBER


OWNER OR PROPERTY MANAGER NAME (ASSIGNOR)


CONTACT NAME                                                           CONTACT PHONE NUMBER


MAILING ADDRESS




COMPANY NAME (ASSIGNEE)


CONTACT NAME                                                           CONTACT PHONE NUMBER


MAILING ADDRESS


FEDERAL TAX ID NUMBER (OR SOCIAL SECURITY NUMBER)




Puget sends a 1099 to IRS and the Assignee for payments totaling more than $600 per calendar year for businesses that are not corporations.

Puget Sound Energy is hereby authorized to pay the above Assignee 100% of the rebate amount due the customer as a result of satisfactory participation in
PSE’s Small Business Lighting Rebate Program. I understand the incentive funds will be paid after Puget Sound Energy has approved the installation of
authorized energy conservation measures at the business/PSE account listed above.

    *** By signing below the ASSIGNOR agrees to install/have installed ALL lamps provided by the ASSIGNEE
                                        within two weeks of delivery.

       Dated this                                    day of                                         , 20


            Signature of ASSIGNOR                                                     Printed Name of ASSIGNOR



 *** By signing below the ASSIGNEE agrees to submit for payment of PSE Rebate once all lamps, shown on the
   application and confirmed on the invoice, are installed at the project site. If the owner is installing the lamps,
              include a letter from owner confirming that the lamps are installed with the application.

       Dated this                                    day of                                         , 20


            Signature of ASSIGNEE                                                      Printed Name of ASSIGNEE


                                                                     PSE USE ONLY

PROJECT NAME


REBATE AMOUNT


PSE REP                                                                DATE
 hat are not corporations.

 a result of satisfactory participation in
gy has approved the installation of



 rovided by the ASSIGNEE




once all lamps, shown on the
wner is installing the lamps,
 the application.
                         Number of Controls
                        (Use separate line for each                                              Pre-control
Lighting Controls         sensor unless multiple
                                                      Total Watts   Pre-control   Post-control
                                                                                                  kWh/per
                                                                                                               Post-Control   kWh Savings        Rebate Per
(List Location Below)                                 Controlled    hours/year    hours/year                   kWh/control    (Estimated Avg.)    Measure
                        sensors are controlling the                                                control
                              same lighting)


                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
                                                                                                                                   0.00             $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
0.00   $0
**Double Clic
Please only c
in PSE rebat
**Double Click on image to left to access W-9 form.
Please only completed if have not previously participated
in PSE rebate program.
                                                                                   Puget Sound Energy's Commercial Lighting Rebates
                                                                                                   (See Commercial Lighting Application to apply for rebates)


                                              Lamp Type                            Rebate Amount                      Applicable Lamp Types                                                 Eligibility Requirements and other notes
                                                                                                           Specialty lamps include: dimming, three-way, reflector,
                             CFL: Screw-in, Specialty, less than 26 Watts                  $6             candelabra, globe, and cold cathode lamps (cold cathode
                                                                                                        lamps do not have to be ENERGY STAR® Qualified, but must
                                                                                                          have at least a two year warranty and produce at least 35
                            CFL: Screw-in, Specialty, 26 Watts to 39Watts                  $6                                  lumens per Watt
    CFLs




                                                                                                                                                                        CFLs are required to be ENERGY STAR® listed. Cold Cathodes do not have to be Energy Star
                                   CFL: Screw-in, less than 26 Watts                       $3                       Spiral/Twist CFLs and A-lamp Style                           Listed, but must produce at least 35 lm/Watt and a have a 2 year Warranty


                                  CFL: Screw-in, 26 Watts to 39 Watts                      $6                       Spiral/Twist CFLs and A-lamp Style


                           CFL: Screw-in, greater than or equal to 40 Watts               $12
Ceramic

 Halide
 Metal




                                                                                                                                                                       Qualifying CMH products must be certified by Underwriters Laboratories (UL) or another nationally
                                 CMH: Screw-in, 22 Watts to 28 Watts                      $25           Qualifying CMH products must be screw-in self ballasted type
                                                                                                                                                                                                      recognized testing laboratory.
Sign
LED
Exit




                                                                                                                                                                       LED Exit Signs must have at minimum a 5 year Warranty, be 5 Watts or less, and replace existing
                                              LED Exit Sign                               $50                                                                                               incandescent or CFL Exit Signs to qualify for a rebate.


                                               LED, MR 16                                 $15
                            LED, Integral or Recessed Down Light, Replacing
                                                 PAR20
                                                                                          $15
                                                                                                                    Directional: BR, ER, K, MR, PAR, R
                            LED, Integral or Recessed Down Light, Replacing
                                                                                          $20
    LEDs




                                        PAR30, PAR38, PAR40                                                                                                                        All LED products must be ENERGY STAR® or Lighting Design Lab listed
                               LED, Hard Wired Recessed Can Retrofit Kit                  $25
                                      LED, Integral Omnidirectional                       $15                      Omnidirectional: A, BT, P, PS, S, T, G

                                        LED, Integral Decorative                           $5                         Decorative: B, BA, C, CA, DC, F

                                                                                                                                                                         Customers are required to purchase 25-28 Watt 4’ T8 Lamps which are CEE listed as part of a
 Low Wattage




                                   Low Wattage T8, 25 Watts or less                        $1                                                                          group re-lamp to convert the facility to a more efficient lamp stock. PSE's Low Wattage T8 Rebate
                                                                                                                                                                        is a “one time only” rebate opportunity. A search will be made in PSE's project database prior to
     T8




                                                                                                                                                                         any new rebate being paid. If a low Wattage T8 rebate is found on the same account or at the
                                                                                                                                                                           same address further research will be conducted to determine eligibility (e.g. re-lamp of an
                                      Low Wattage T8, 26-28 Watts                          $1                                                                           additional building served by a common meter, a different floor, etc.) Repeat applications in the
                                                                                                                                                                                                           same spaces are not eligible.
Lighting




                                                                                                                                                                       Qualifying Lighting Controls are commercial grade occupancy sensors and/or timers. Please note
Control




                                     Lighting Control 100-199 Watts                       $40                                                                          that lighting controls on heat lamps are not eligible for this rebate.
   s




                                                                                                                                                                       Qualifying Lighting Controls are commercial grade occupancy sensors and/or timers. Please note
                                       Lighting Control >200 Watts                        $80                                                                          that lighting controls on heat lamps are not eligible for this rebate.

                            How to participate
                            Step 1. Check to see if your project is eligible
                         PSE customers in the electric service area on any commercial rate schedule are eligible for lighting controls rebates. If you have a question about whether your organization qualifies, please call a PSE energy
                         Advisor at 1-800-562-1482.
                         No pre-approval is needed. However, we ask that you make sure that the product you are using qualifies.
    How to Participate




                            Step 2. Complete the project

                            Step 3. Submit your application for payment
                         Complete the application form, including your PSE account number and signature
                               Prepare supporting documentation
                                   *Product cut sheets
                                   *Itemized invoice
                                   *Assignment of Funds Form (if contractor is the payee)
                               Make a copy for your records
                         E-mail the Excel version of the application and supporting documentation to: commercialrebates@pse.com
                               PSE will process your application when we receive it
                               Funding availability is subject to annual program budgets

								
To top