Food Service Worksheet

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					                              Alternative Energy Measures for the Hospitality Industry: Food Services




                                             Alternative Energy Measures for Food Services
Completing the Alternative Energy Measures - Food Service Worksheet: Fill in the appropriate fields in the worksheet. To calculate the TOTAL INCENTIVE for FRYERS and
GRIDDLES, multiply the INCENTIVE by the TOTAL CAPACITY of installed equipment and enter this amount in the TOTAL INCENTIVE row.

                                              Efficiency Levels and Incentive Levels for Energy Star® (1) Gas Fryers
                 Equipment Type                              Manufacturer                   Model #                 Count    Unit Incentive         Total Incentive
Energy Star® qualified           For replacement of
                                                                                                                              $1000 per fryer             $0
natural gas fryers                 electric fryers
                                                                          Additional Required Information
Reason: “E" = Efficiency Upgrade or "F" = Equipment Failure
Fuel Type: "G" = Natural Gas, "Z" = Other (Please Specify)
Estimated Operating Hours (Daily)
Estimated Operating Hours (Weekly)

                                          Efficiency Levels and Incentive Levels for Energy Efficient (2) Gas Griddles
                 Equipment Type                              Manufacturer                   Model #                 Count    Unit Incentive         Total Incentive

 2 foot gas griddle with a
                              For replacement of 2 foot
 minimum cooking energy                                                                                                       $850 per griddle            $0
                                   electric griddles
     efficiency of 38%




 3 foot gas griddle with a
                              For replacement of 3 foot
 minimum cooking energy                                                                                                      $1250 per griddle            $0
                                   electric griddles
     efficiency of 38%




 4 foot gas griddle with a
                              For replacement of 4 foot
 minimum cooking energy                                                                                                      $1650 per griddle            $0
                                   electric griddles
     efficiency of 38%




 5 foot gas griddle with a
                              For replacement of 5 foot
 minimum cooking energy                                                                                                      $2000 per griddle            $0
                                   electric griddles
     efficiency of 38%




 6 foot gas griddle with a
                              For replacement of 6 foot
 minimum cooking energy                                                                                                      $2400 per griddle            $0
                                   electric griddles
     efficiency of 38%


                                                                          Additional Required Information
Reason: “E" = Efficiency Upgrade or "F" = Equipment Failure
Fuel Type: "G" = Natural Gas, "Z" = Other (Please Specify)
Estimated Operating Hours (Daily)
Estimated Operating Hours (Weekly)

                                                               TOTAL ALTERNATIVE ENERGY MEASURE FOOD SERVICE INCENTIVE REQUESTED


The manufacturer and model numbers must be clearly indicated. In order to receive an incentive for FRYERS and GRIDDLES, you must submit
purchase INVOICES indicating model numbers and quantities with PROOF OF PAYMENT and PROOF OF REPLACEMENT of existing electric fryer or
griddle. For pre-approval, you must submit ESTIMATES indicating model numbers and quantities (required for pre-approval) for purchased equipment.
In either case, submit MANUFACTURER’S TECHNICAL CUT SHEETS demonstrating that the equipment meets the program requirements.

All applicants must submit PROOF OF REPLACEMENT of existing electric equipment in order to receive an incentive. You must submit THREE (3)
PHOTOGRAPHS indicating the front, back and nameplate of the existing electric fryer or griddle as PROOF OF REPLACEMENT.

Note (1) For a list of Energy Star® qualified fryers visit www.energystar.gov/ia/products/prod_lists/Fryers_prod_list.pdf


Note (2) Griddle efficiency levels based on FEMP Performance Requirements. Visit http://www1.eere.energy.gov/femp/pdfs/pseep_griddles.pdfin                           $0


Name of Applicant:

Name of Company:


         WORKSHEET