2008 Tax Rebate Check Schedule

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					                      SMALL BUSINESS LIGHTING ** 2008.1a **                                                 Puget Sound Energy
                            Rebate Pre-approval Form                                                 Commercial Energy Efficiency Program
                                                                                                                                              PSE USE ONLY
                                 Rate Schedule 24 & 08 Facilities Only
                 All Projects Must Be Pre-approved Prior To Commencement Of Work!
   2008 Update:
              All 4' T8 lamps and Electronic Ballasts, including lamps and ballasts contained within a new fluorescent lighting
              fixture, proposed for installation on this project shall be designated as "High Performance" or "Reduced Wattage"
              by the Consortium for Energy Efficiency (CEE). Lists of all "Qualifying" lamps and ballasts can be found on CEE's
              website at: http://www.cee1.org/com/com-lt/com-lt-main.php3
Project / Facility Information
   Project Name:                                                                     Electric Account #:
 Project Address:
 On-site Contact - Name & Title:                                                    Phone #:                              Email or Fax #:
Hours of Operation:                            Will building permit or major remodel be part of this project?   Yes:                    No:
Project Comments:
Customer Information                           Check here if Customer Info is the same as Project Info and skip to next section.
 Electric Customer's Name:
Complete Mailing Address:
Contact Name:                                                         Phone #:                                  Fax #:
Email Address:
Send PSE pre-approval letter to:                Name:                                 Address:
Installation Information
Project materials to be installed by (check one box):       Lighting / Electrical Contractor:            In-house Personnel:
  Contractor/Vendor's business name:                                              Contact Name:                                    Phone #:
   Disposal of hazardous lighting waste will be performed by:       Contractor                   Vendor                Customer
  Proof of proper lighting waste disposal shall include both the PSE Lighting Waste Disposal Form AND either a Certificate of Disposal, Bill Of Lading or
  a receipt of disposal expense will be accepted if the pre-printed Logo and Name of the Government Approved Hazardous Waste Facility is clearly visible.
Total Rebate Amount, Pages 3 & 4:                $0        #DIV/0!         Estimated Annual kWh Saved, Pages 3 & 4:         0                                     8/4/10

Rebate Check Recipient
  **Check to be sent to:  Contractor                Vendor              (PSE's "Assignment of Funds" form is required), or Customer
 Rebate check payee (Name on account for check deposit):
 The PSE "Assignment of Funds" form is used when the Customer wishes to have the rebate check sent directly to either the Contractor or Vendor.
 **If no selection is made from the three Rebate Check Recipient choices above, the rebate check will be sent to the Customer.

                       ** Version 2008.1a **
                                                                                                                                                             Page 1 of 4



  3005 4/06
How To Participate:
Step 1. Obtain PSE Pre-Approval                                                 Project Name:           0                                         Acct #: 0

                Check to make sure pages 1 thru 4 of this application are complete                      (pages 1 thru 4 constitute application)
                Make and keep a copy for your records

                Mail your completed and signed 4-page application to:                                   Puget Sound Energy
                                                                                                        Small Business Lighting Rebate
                    Or Fax this application, with cover, to:             425.456.2731                   PO Box 90868 EST-10W
                                                                                                        Bellevue, WA 98009-0868

    When Pre-approved, PSE will mail a Letter of Pre-approval, along with signed pages 3 and/or 4 of this pre-approval form.
          Funding availability is subject to annual program budgets. Payment is guaranteed on pre-approved projects if installed within 90 days.

Step 2. Complete installation within 90 days of pre-approval.
                   If a delay becomes apparent, please contact your PSE representative.

Step 3. Submit completion paperwork for payment


                "In-house" installations - Please circle, or distinctly identify, each line on vendor's receipt that applies to this lighting project.

               Hazardous Waste "Bill of Lading," PSE's "Lighting Waste Disposal form" and, if needed, PSE's Assignment of Funds form.


                                              Program guidelines and additional information can be found at:
                   www.pse.com/solutions/forbusiness/pages/comRebates.aspx?tab=2&chapter=1 - or by dailing 1.800.562.1482 then Option 1.

Customer Agreement - Signature Required

              By signing below, customer agrees to comply with all applicable State and Local electrical code and permitting requirements and also the
              Small Business Lighting Rebate "Guidelines and Recommendations." Customer agrees to properly dispose of all lighting project lamp and ballast
              hazardous waste in accordance with local laws and PSE's program requirements. Customer is solely responsible for determining adequate lighting
              levels and timely payment of contractors and/or vendors. PSE, at its option, will be granted access to inspect the lighting system prior to, during
              and after this proposed lighting retrofit. Customer agrees to the existing and proposed lighting as being accurately described on pages 3 and 4 of
              this application. Puget Sound Energy has not and does not make any promise, warranty or representation with respect to any savings in energy
              consumption from Conservation Measure(s).

                Customer Signature:                                                                                                    Date:

                 Please Print Name:


                                                                                                                                                               Page 2 of 4
  3005 4/06
                                                                                                       PSE Electric Account #:                     0                                           0
                     SMALL BUSINESS LIGHTING REBATE ( 2008.1a )                                    Project / Business Name:                        0
                            Rate Schedule 24 or 08 Facilities Only                  8/4/10
              All 4' T8 lamps and Electronic Ballasts, including lamps and ballasts contained within a new fluorescent lighting fixture, proposed for
              installation on this project shall be designated "High Performance" or "Reduced Wattage" by the Consortium for Energy Efficiency (CEE).
              Lists of all "Qualifying" lamps and ballasts can be found on CEE's website at: http://www.cee1.org/com/com-lt/com-lt-main.php3
                                                                                                            Existing   Proposed    Annual
          ting                                                        d
                                                                   ose
                                                                                                 Fixture                                      Rebate per    Rebate per    kWh         kWh           kWh
                           Eligible Rebate Measures
     Exis
                                                                                                            Fixture     Fixture   Hours per                                                                kW Saved
                                                              Prop
                                                                                                 Count                                         Fixture       Measure     Existing   Proposed       Saved
                                                                                                             Watts       Watts     Fixture
 Section I:   INCANDESCENT BULB, FIXTURE & EXIT SIGN REPLACEMENTS
                                          Screw-in CFL, less than 26 watts
a. Incandescent screw-in bulb, any wattage
                                                  Energy Star Listed                                                                             $3            $0           0          0             0       0.00
b. Incandescent screw-in bulb,            Screw-in CFL, 26 to 40 watts
     75 watts or greater                          Energy Star Listed                                                                             $6            $0           0          0             0       0.00
c. Incandescent screw-in bulb,            Screw-in CFL, greater than 40 watts
     150 watts or greater                         Energy Star Listed                                                                            $12            $0           0          0             0       0.00
d. Incandescent fixture,                  New CFL fixture or hardwired kit with
     100 watts or less combined               replaceable lamp, 25 total input watts or less                                                    $35            $0           0          0             0       0.00
e. Incandescent fixture,                  New CFL fixture or hardwired kit with
     100 watts or greater combined           replaceable lamp, 26 total input watts or more                                                     $55            $0           0          0             0       0.00
f. Incandescent fixture,                  New Linear fluorescent fixture, one or two-Lamp
     120 watts or greater combined                and one electronic ballast                                                                    $70            $0           0          0             0       0.00
                                          New LED Exit Sign (not kit) Energy Star listed
g. Exit Sign: Incandescent or CFL lamp(s)
                                            **Find listed Exit Signs at: www.energystar.gov                                                     $50            $0           0          0             0       0.00
 Section II: HIGHER WATTAGE INCANDESCENT & "HIGH INTENSITY DISCHARGE" FIXTURE REPLACEMENTS
a. Incandescent or Mercury Vapor fixture  New "HID" Fixture ("high intensity discharge"):
     greater than 175 input watts         HPS or MH (50-100W).                                                                                  $90            $0           0          0             0       0.00
b. "High Intensity Discharge" fixture     Pulse Start Metal Halide - Must have greater than
     Primarily Metal Halide               25% input wattage reduction.                                                                          $125           $0           0          0             0       0.00
c. "High Intensity Discharge" fixture
                                          New CFL fixture greater than 40 input watts
     greater than 100 input watts                                                                                                               $110           $0           0          0             0       0.00
d. "High Intensity Discharge" fixture
                                          New CFL fixture greater than 80 input watts
     greater than 175 input watts                                                                                                               $130           $0           0          0             0       0.00
e. Incandescent or "HID" fixture          New Four-lamp F32T8 fixture with reflector and
     greater than 175 input watts         electronic ballast(s).                                                                                $110           $0           0          0             0       0.00
f. "High Intensity Discharge" fixture     New Six-Lamp F32T8 fixture with electronic
     Greater than 400 input watts         ballasts.                                                                                             $225           $0           0          0             0       0.00
g. "High Intensity Discharge" fixture     New Four-Lamp F54T5HO fixture with electronic
     Greater than 400 input watts         ballast(s).                                                                                           $225           $0           0          0             0       0.00
   In-house installation rebate limited to 100% of materials cost up to measure amount.            0           0          Rebate Due - Page 3                 $0            0          0             0       0.00
                                                                                                                                                                          kWh         kWh           kWh
                                                                                                                                                                                                           kW Saved
PSE Pre-approval: Authorized Signature ___________________ Date ________________                  Estimated Annual kWh/$ Savings:                 0            $0        Existing   Proposed       Saved
                                                                                                                                                           Page 3 of 4      0          0                   #DIV/0!




         3005 4/06
                                                                                                                   PSE Electric Account #:                        0                                           0
                     SMALL BUSINESS LIGHTING REBATE ( 2008.1a )                                                 Project / Business Name:                          0
                                    Rate Schedule 24 or 08 Facilities Only                8/4/10
            All 4' T8 lamps and Electronic Ballasts, including lamps and ballasts contained within a new fluorescent lighting fixture, proposed for
            installation on this project shall be designated as "High Performance" or "Reduced Wattage" by the Consortium for Energy Efficiency (CEE).
            Lists of all "Qualifying" lamps and ballasts can be found on CEE's website at: http://www.cee1.org/com/com-lt/com-lt-main.php3
                                                                                                                        Existing   Proposed       Annual
         tin    g          Eligible Rebate Measures                                    se     d              Fixture                                         Rebate per    Rebate per    kWh         kWh           kWh

     Exis                                                                         ropo
                                                                                                                        Fixture     Fixture      Hours per                                                                kW Saved
                                                                                                             Count                                            Fixture       Measure     Existing   Proposed       Saved
 Section III:
                                                                   P
              4' & 8' FLUORESCENT - "High Perfomance" Lamps & Ballast Retrofits Only
                                                                                                                         Watts       Watts        Fixture


a. F40 T12, One or two-lamp fixture with    "Lamp-for-lamp": F32T8 lamp(s). Low Ballast Factor
            one magnetic ballast            ballast required.                                                                                                  $50            $0           0          0             0       0.00
b. F40 T12, Three or four-lamp fixture with "Lamp-for-lamp": F32T8 lamps. Low Ballast Factor
            two magnetic ballasts           ballast required.                                                                                                  $55            $0           0          0             0       0.00
c. F40 T12, Four-lamp fixture with two      Reduce lamps to Two F32T8 lamps and one electronic
            magnetic ballasts               ballast.                                                                                                           $60            $0           0          0             0       0.00
 Section IV: 4' & 8' FLUORESCENT - New Linear "High Performance" T8 Fixtures & Conversion Kits (NRTL-listed)
a. F40 T12, One or two-lamp fixture,               One or Two F32T8 lamp(s). Low Ballast Factor      Kit                                                       $50            $0           0          0             0       0.00
            one magnetic ballast                   required                                          New                                                       $50            $0           0          0             0       0.00
b. F40 T12, Three or four-lamp fixture,            Lamps reduced to two or three F32T8               Kit                                                       $70            $0           0          0             0       0.00
            magnetic ballasts                      "Low Ballast Factor" ballast recommended          New                                                       $70            $0           0          0             0       0.00
c. F96 T12, One lamp fixture,                      Two F32T8 lamps and one electronic ballast. "Low Kit                                                        $70            $0           0          0             0       0.00
             one magnetic ballast                  Ballast Factor" ballast required                 New                                                        $70            $0           0          0             0       0.00
d. F96 T12, Two lamp fixture,                                                                        Kit                                                       $85            $0           0          0             0       0.00
                                                   Two F32T8 lamps and one electronic ballast.
            one magnetic ballast                                                                     New                                                       $85            $0           0          0             0       0.00
e. F96 T12, Two lamp fixture, one                  Four F32T8 lamps and one electronic ballast. "Low Kit                                                       $70            $0           0          0             0       0.00
            magnetic ballast                       Ballast Factor" ballast required                  New                                                       $70            $0           0          0             0       0.00
f. F96 T12 HO, Two lamp high-output                                                                  Kit                                                       $90            $0           0          0             0       0.00
                                                   Four F32T8 lamps and electronic ballast.
            fixture, one magnetic ballast                                                            New                                                       $90            $0           0          0             0       0.00
g. F96 T12 HO, Two-lamp high-output                Four F32T8 lamps with reflector and one            Kit                                                      $95            $0           0          0             0       0.00
            fixture, one magnetic ballast          electronic ballast                                New                                                       $95            $0           0          0             0       0.00
 Custom      "Custom"                  Describe:                                                                                                                 0            $0           0          0             0       0.00
 Analysis    total cost                Describe:                                                                                                                 0            $0           0          0             0       0.00
                                                                                                                       Conncted                    Post
                                                                                                                                   Pre-Control               Rebate per    Rebate per    kWh         kWh           kWh      Use
      Lighting Controls                                                                                     Quantity    Load /
                                                                                                                        Wattage
                                                                                                                                     Hours
                                                                                                                                                  Control
                                                                                                                                                  Hours
                                                                                                                                                              Control       Measure     Existing   Proposed       Saved   Reduction


1. Occupancy Sensor (incl. fixture mounted ) or Timer Control            Controlling 100W to 199W:                                                             $40            $0           0          0             0     #DIV/0!
2. Occupancy Sensor (incl. fixture mounted ) or Timer Control            Controlling 200W or more:                                                             $80            $0           0          0             0     #DIV/0!
   In-house installation rebate limited to 100% of materials cost up to measure amount.                        0                      Rebate Due - Page 4:                   $0            0          0             0       0.00
                                                                                                                                                                                         kWh         kWh           kWh
                                                                                                                                                                                                                          kW Saved
PSE Pre-approval: Authorized Signature ___________________ Date _______________                                Estimated Annual kWh/$ Savings
                                                                                                      Est. kWh saved                                             0           $0         Existing   Proposed       Saved
                                                                                                                                                                          Page 4 of 4      0          0                   #DIV/0!




         3005 4/06
                                   Small Business Lighting Rebate
                                        Custom Analysis Worksheet
            Project Name:   0                                           Acct #:           0




                                                  PSE USE ONLY
                                                  Informational Purposes Only




                                      Estimated kWh Saved:      0                        x.3 (kWh/$)    $0.00
                                                      Line 2    0
                                Line item cost from invoice:   $0                 x.7 (max incentive)   $0.00
                                                      Line 2   $0
                                                    REBATE AMOUNT                 (Minimum of above)    $0.00

                                  # of items to be justified:      0                          Line 2    $0.00
                                                      Line 2       0                          Line 2    $0.00
                                          COST PER ITEM:           0
                                                      Line 2       0                          Line 2    $0.00
                                               Reason for using Custom Analysis line(s):
                  Line 1:                                                                                       0

                  Line 2:                                                                                       0




3005 4/06
                                     Small Business Lighting Rebate Program
                                                Project Summary


            08/04/10




            RE:   Lighting Retrofit at:   0


            Cost:

            Contractor's proposed total bid price for this project:             (materials, labor, tax etc.)

            Your estimated PSE Rebate for this project:               $0.00

            Your estimated project cost after the PSE Rebate:          $0.00



            Savings:

            Your estimated electrical energy savings:                   0       kWh per year

            Your estimated electrical cost savings:                     $0      per year




            Financial Analysis:

            Your payback for this project including PSE rebate:       #DIV/0!   years

            The payback for this project excluding PSE rebate:        #DIV/0!   years
3005 4/06
                                                     Lighting Waste Disposal Form
                      Instructions to PSE customer and installing contractor: Please read, fill in, and sign at the bottom.

This form documents how lighting waste will be properly disposed of by PSE business customers particpating in the Small Business Lighting Rebate program. Suitable
documentation is provided though: 1) accurate counts, and 2) evidence that the installer practices proper disposal of lighting waste. When handing off waste to an approved
recycler, secure a Waste Disposal Certificate from the approved lighting waste recycler. Or, as an alternative to a certificate, obtain a receipt issued by a government
agency that transfers waste to a suitable recycler. Provide a copy of the “certificate” as back-up for this form.



Customer:     0                                                   Elec. Acct #:      0                                  Installer:    0



1. Lamp and Ballast Disposal

Number of LAMPS disposed of: 4-FT ______            8-FT _______ Mercury Vapor _______ Metal Halide_______ HPS _______

Number of BALLASTS without “no PCBs” on the ballast’s label: _________ (Note: All ballasts that may have PCBs must be documented and disposed of by
an approved recycler.)

Name and location of recycler or authorized handler: _________________________________

2. Authorized Signatures

I certify that the above information is true and accurate. All lamps and ballasts from this project will be disposed of in accordance with applicable federal,
state and local waste disposal regulations.

1. Lighting Installer or Vendor:                               2. PSE Customer:

                                                                                                                    Thank you for including a copy of your
                                                                                                                    recycler’s Bill of Lading or lighting
                                                                                                                    waste Certificate of Disposal
   Date:                                                       Date:

				
DOCUMENT INFO
Description: 2008 Tax Rebate Check Schedule document sample