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					                                                                                                                                                                                                                                                                                                                                                                        05/21/2009
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                                                                                                                                                              DLC SSL Product List Submission Form (Version 2010_05_12)

Application Policies:
1) All blank (white) fields are required to be filled out.
2) If any data provided by the manufacturer is missing, unclear, insufficiently documented, or determined from a test that was performed incorrectly, then the application will be returned. The manufacturer will have the opportunity to resubmit the application
ONE TIME with all issues rectified. If after a second review, the application is still incomplete, then the application will be denied. The manufacturer will have the option to submit a new application along with the required fee. For this reason, we recommend
that the application be filled out by a person with sufficient technical knowledge of lighting products and testing such as a lighting engineer, and that the applicant read the application guidelines thoroughly.
3) If an application is returned due to insufficient documentation, an explanation will be provided in the "comments" field. If this explanation is unclear to the applicant, he or she may contact the reviewer for a brief clarification, but the reviewer is unable to
provide detailed explanation of testing procedures.


                                                                                                    Company                                                                            Submission Date
                                                                                                        Brand
             Application Contact




                                                                                               Contact Name
                                                                                                      Address
                                                                                                        Phone
                                                                                                           Fax
                                                                                                         Email
                                                                                                     Website


                                                                                                                                                    Luminaire Data


                                                                                   Submitted Model Number
                                                          (The model number must specify a unique product
                                                                      including one set of options and trim.)
                                                        Select the intended application for this evaluation
                                                        (Category, click on the cell and pick one from the
                                                                      drop-down list to the right of the cell)
                                                           If the submitted product is appropriate for multiple
                                                               categories, you must submit one application for
                                                                                               each category.

                                                           Description of accessories used during testing

                                                                                       LED drive current (A)
                                                                                  LED package part number
                                                                   (Manufacturer should use an identifier or
                                                         combination of identifiers that indicate a single LED
                                                        package and this should be used consistently within
                                                               an application and within an LM-80 or lumen
                                                           maintenance report. The identifier can include a
             Model Information




                                                         model number, part number, product code, ordering
                                                                                     code, stock number, etc.)
                                                                                              Rated CCT (K)

                                                        If you want to include any other model (call it “family model”) in the same product family as                                                       LED package Part           Rated CCT
                                                        the submitted model, this “family model” must be identical to the submitted model except                                     Family Model Number
                                                                                                                                                                                                                Number                     (K)
                                                        for the following two scenarios:
                                                        1. The “family model” exterior housing has a different color
                                                        2. The “family model” uses the same LED package model as the submitted model but the
                                                        LED package has a different phosphor that produces a higher CCT value than the submitted
                                                        model
                                                        3. The "family model" is a refrigerated case end mounted fixture that is symmetric with the
                                                        opposite end mounted fixture. (e.g.If the application is for the right end fixture, the left end
                                                        fixture is a family member.)
                                                        The applicant has to provide proof that the difference between the “family model” and the
                                                        submitted model is limited to the above two scenarios. Any other difference from the
                                                        submitted model constitutes a different product family. Please list all detailed “family
                                                        model” numbers separately in the data fields to the right, and please note that when the
                                                        “family model” is listed in the Qualified Product List, it will carry the same data values as
                                                        the submitted model, which is intended to be the worst case of the product family.

                                                                  If including other "family models" together with the submitted model, please explain why you think the
                                                                                                  submitted model represents the lowest luminous efficacy of the family
                                                                                                                                                                                                                                                         Data Source
                                                                                                                                                                                                                                       Data Source      (Page number
                                                                                        Photometric and Electrical Data                                                                  Data Value                 Unit                (Name of         where data is
                                                                                                                                                                                                                                      Attached File)     shown in the
                                                                                                                                                                                                                                                         attached file)
                                                                                                                                                                           Rated                                     lm
                                                                                        Light Output (lm)
                                                                                                                                                        Measured using LM-79                                         lm
                                                                                                                                                                           Rated                                    lm/W
                                                                               Luminous Efficacy (lm/W)
                                                                                                                                                        Measured using LM-79                                        lm/W
             Photometric and Electrical Data




                                                                                                                                                                           Rated                                     W
                                                                                           Input Power (W)
                                                                                                                                                        Measured using LM-79                                         W
                                                                                                                                                                           Rated                                      V
                                                                                           Input Voltage (V)
                                                                                                                                                        Measured using LM-79                                          V
                                                                                                                                                                           Rated                                      A
                                                                                           Input Current (A)
                                                                                                                                                        Measured using LM-79                                          A
                                                                                                                                                                           Rated                                  unitless
                                                                                              Power Factor
                                                                                                                                                        Measured using LM-79                                      unitless
                                                                                                                                                                           Rated                                      K
                                                                                                      CCT (K)
                                                                                                                                                        Measured using LM-79                                          K
                                                                                                                                                                           Rated                                  unitless
                                                                                                          CRI
                                                                                                                                                        Measured using LM-79                                      unitless
                                                                                    Off-state power (W)                                                    Off-state power (W)
                                                                                                                                                                                                                     W
                                                                                                                                                                                                                                                         Data Source
Please read through "ENERGY STAR® Manufacturer’s Guide for Qualifying Solid State Lighting Luminaires – Version                                                                                                                        Data Source      (Page number
2.0", available at www.energystar.gov/ia/partners/manuf_res/downloads/ENERGYSTAR_Manufacturers_Guide_v2.pdf,                                                                             Data Value                 Unit                (Name of         where data is
in order to understand the technical terminology and process for lifetime evaluation                                                                                                                                                  Attached File)     shown in the
                                                                                                                                                                                                                                                         attached file)
                                                                                                                                                       Rated Life to L70 (hours)                                     hrs
                                                                                                                                   L70 lifetime determination statement:
                                                                                           Explain how the rated life was determined by filling in "option 1" or "option 2"                                "option 1" or "option 2"
                                                                                                                                               Manufacturer Warranty (years)                                         yrs
                                                                                                                                                                                                                                                         Data Source
                                                                                             Lifetime determination.                                                                                                                   Data Source      (Page number
                                                                                                                                                                                         Data Value                 Unit                (Name of         where data is
                                                                                     Use either Opition 1 or Option 2 below                                                                                                           Attached File)     shown in the
                                                                                                                                                                                                                                                         attached file)
                                                                                                          LED Package/Module 6000-hour Lumen Maintenance at T55°C:
                                                                                        This is the lumen maintenance when the manufacturer-specified Temperature
                                                                                Measurement Point (TMP) for "LED case temperature" were kept at 55°C, and the LED                                                    %
                                                                                 was driven at a current equal to or greater than the LED drive current in the luminaire
                                                                                                          LED Package/Module 6000-hour Lumen Maintenance at T85°C:
                                                                                        This is the lumen maintenance when the manufacturer-specified Temperature
                                                                                Measurement Point (TMP) for "LED case temperature" were kept at 85°C, and the LED                                                    %
                                                                                 was driven at a current equal to or greater than the LED drive current in the luminaire
                                                                                                         Tx --- 3rd temperature in LM-80 selected by manufacturer (°C):
                                                                                 This is the temperature at the Temperature Measurement Point (TMP) selected by the                                                  °C
                                                                                                                       manufacturer to represent customer's application
                                                                                                          LED Package/Module 6000-hour Lumen Maintenance at Tx°C:
             Lifetime Data




                                                                                        This is the lumen maintenance when the manufacturer-specified Temperature
                                                          Option 1:             Measurement Point (TMP) for "LED case temperature" were kept at Tx°C, and the LED                                                    %
                                                         Compliance              was driven at a current equal to or greater than the LED drive current in the luminaire
                                                           through
                                                                                           LED package part number as shown in the above lumen maintenance report:
                                                         Component
                                                                                  This part number needs to match the LED package part number show in the product                                                 unitless
                                                         Performance
                                                                                                                            literature for the submitted fixture model

                                                                           In-situ measured hottest LED case temperature (°C) at the Temperature Measurement Point
                                                                                                                      (TMP) specified by LED package manufacturer:
                                                                           This temperature needs to come from the luminaire's in-situ test report performed by a UL-                                                °C
                                                                                  approved laboratory, measured at the same Temperature Measurement Point (TMP)
                                                                                  specified by LED package manufacturer as in the LM-80/Lumen Maintenance report
                                                                                                  LED package manufacturer's Maximum Rated LED case temperature:
                                                                                This is the highest allowed temperature at the Temperature Measurement Point (TMP)                                                   °C
                                                                                                                              specified by LED package manufacturer
                                                                               Interpolated 6000-hour Lumen Maintenance for luminaire using Component Performance:
                                                                                  Please refer to Page 22-23 of "ENERGY STAR® Manufacturer’s Guide for Qualifying
                                                                                     Solid State Lighting Luminaires – Version 2.0" for details on how this interpolation                                            %
                                                                                                                                            calculation should be done.
                                                                                                                                    Luminaire Light Output at 0 hours (lm):
                                                                                                                                                                                                                     lm
                                                          Option 2:                              This is the light output from an LM-79 report of the luminaire at 0 hours
                                                         Compliance                                                             Luminaire Light Output at 6000 hours (lm):
                                                           through                     This is the light output from an LM-79 report of the luminaire after 6000 hours of                                            lm
                                                          Luminaire                                    continuous operation in the appropriate UL1598/153 environment
                                                         Performance
                                                                                               6000-hour Lumen Maintenance for luminaire using Luminaire Performance                                                 %
      LED package




                                                                                                                                                    LED Package Manufacturer                                      unitless
         Data




                                                                                                                                                     LED Package Part Number                                      unitless

                                                                                                                               LED Package Date of Manufacture/Purchase                                         mm/dd/yyyy
                                                                                                                                                                                                            Luminaire model                              Data Source
                                                                                                                                                                                                              number/LED               Data Source      (Page number
                                                                                               Document checklist                                                                            Y/N              package part              (Name of         where data is
                                                                                                                                                                                                           number as Shown in         Attached File)     shown in the
                                                                                                                                                                                                               Document                                  attached file)
                                                           Manufacturer's product sheet attached? If yes, give the luminaire model number as shown in the document:
                                                        LM-79 Test Report containing light output and efficacy data attached? If yes, give the luminaire model number
                                                                                                                                            as shown in the document:
                                                        LM-79 Test Report containing color data (CCT and CRI) attached? If yes, give the luminaire model number as
                                                                                                                                               shown in the document:
                                                           LM-79 Test Report containing electrical data (Input Voltage, Input Current, Power, Power Factor) attached? If yes, give
                                                                                                                           the luminaire model number as shown in the document:
                                                                                    LM-80 test report (data table and chart) attached? If yes, give the LED package part
             Product Sheet and Test Reports Checklist




                                                                                                                                      number as shown in the document:
                                                                                   LM-80 test report showing relative light output over time at minimum of three temperatures
                                                                               measured at the LED package manufacturer-specified Temperature Measurement Point (TMP)
                                                                             and at a drive current greater than or equal to the measured current of the LED package, array, or
                                                                                module used in the luminaire. Following the LM-80 standard, the three TMP temperatures are
                                                                               55C, 85C, and a third temperature selected by the manufacturer. The graph must have time on
                                                          Option 1:        the x-axis, from 0 to 6000 hours, and lumen maintenance on the y-axis from 0 to 100%. The graph
                                                         Compliance            must show three lumen depreciation curves, one for each temperature. Each curve must have
                                                           through          data points at least every 1000 hours. The lumen maintenance at the In Situ temperature must be
                                                                                                                                           marked on the graph at 6000 hours.
                                                         Component
                                                         Performance           In situ temperature measurement test (ISTMT) report attached? If yes, give the luminaire
                                                                                                                             model number as shown in the document:
                                                                              ISTMT report requires information of the measured temperature at the TMP of the hottest LED in
                                                                             the luminaire and a photograph documenting the actual temperature measurement location (e.g.
                                                                                                                                       where the thermocouple is attached)

                                                                               A schematics/photograph from the LED package manufactuer showing the specified TMP
                                                                                location attached? If yes, give the LED package part number as shown in the document:

                                                          Option 2:        LM-79 Test report at 0 hours attached? If yes, give the luminaire model number as shown in
                                                         Compliance                                                                                      the document:
                                                           through         LM-79 test report at 6000 hours after continuous operation in the appropriate ANSI/UL1598-
                                                          Luminaire                04 environment attached? If yes, give the luminaire model number as shwon in the
                                                         Performance                                                                                         document:
                                                                                   IES file attached? If yes, give the luminaire model number as shown in the document:


Manufacturer's                                                                                                                                                                                                                                          DLC General
 Comments                                                                                                                                                                                                                                                Comments

                                                                                           List of Technical Requirements by DLC for Each Luminaire Category (More categories will be added as DLC expands into more SSL luminaire categories)
                                                                                                                                                                                                                                       Data Source
                                                                                                                                                                                                               Data Source            (Page number                                         Not Tested to
                                                                             Parameter                                                                                                                                                                      Data          Insufficiently                  Failed to                        Comments
                                                                                                                                         Requirement                                  Measured values       (Name of Attached          where data is                                        Appropriate                  OK
                                                                                                                                                                                                                                                           Missing        Documented                     Meet Criteria
                                                                                                                                                                                                                   File)               shown in the                                          Standard
                                                                                                                                                                                                                                       attached file)
                                                        Minimum Light Output
    Area and Roadway Luminaires




                                                                                                                                            1000 lm
    1. Outdoor Pole/Arm-Mounted




                                                        Maximum Light Output                                                                   N/A

                                                                                                                                =100% 0-90º, <10 % 80-90º
                                                        Zonal Lumen Requirements
                                                                                                                             plus meet IES Type I, II, III, IV, or V

                                                        Minimum Luminaire Efficacy                                                          50 lm/W

                                                        Allowable CCTs                                                                      <6500K

                                                        Minimum CRI                                                                            50

                                                        Lumen maintenance at 6000 hours                                                      95.8%

                                                        Minimum Light Output                                                                1000 lm
    2. Outdoor Pole/Arm-Mounted
        Decorative Luminaires




                                                        Maximum Light Output                                                                   N/A

                                                        Zonal Lumen Requirements                                                        > = 95% 0-90º

                                                        Minimum Luminaire Efficacy                                                          40 lm/W

                                                        Allowable CCTs                                                                      <6500K

                                                        Minimum CRI                                                                            50

                                                        Lumen maintenance at 6000 hours                                                      95.8%

                                                        Minimum Light Output                                                                 300 lm
    3. Outdoor Wall-Mounted Area




                                                        Maximum Light Output                                                                   N/A
             Luminaires




                                                        Zonal Lumen Requirements                                                 = 100% 0-90º, <10% 80-90º

                                                        Minimum Luminaire Efficacy                                                          40 lm/W

                                                        Allowable CCTs                                                                      <6500K

                                                        Minimum CRI                                                                            50

                                                        Lumen maintenance at 6000 hours                                                      95.8%

                                                        Minimum Light Output                                                                2000 lm
            4. Parking Garage Luminaires




                                                        Maximum Light Output                                                                   N/A

                                                        Zonal Lumen Requirements                                              > = 20% 60-70º, >= 15% 70-80º

                                                        Minimum Luminaire Efficacy                                                          56 lm/W

                                                        Allowable CCTs                                                                      <6500K

                                                        Minimum CRI                                                                            50

                                                        Lumen maintenance at 6000 hours                                                      95.8%

                                                        Minimum Light Output                                                                 250 lm
    Directional Lighting Fixtures
       5. Track or Mono-point




                                                        Maximum Light Output                                                                   N/A

                                                        Zonal Lumen Requirements                                                        > = 85% 0-90º

                                                        Minimum Luminaire Efficacy                                                          30 lm/W

                                                        Allowable CCTs                                                     2700K, 3000K, 3500K, 4000K, 5000K

                                                        Minimum CRI                                                                            50

                                                        Lumen maintenance at 6000 hours                                                      95.8%

                                                        Minimum Light Output                                      Center-mounted*: > =100 lm/ft; End-mounted**: >= 50 lm/ft
            6. Refrigerated Case Lighting




                                                        Maximum Light Output                                                                   N/A


                                                        Zonal Lumen Requirements                                                         >= 95% 0-80º

                                                        Minimum Luminaire Efficacy                                                          35 lm/W

                                                        Allowable CCTs                                               2700K, 3000K, 3500K, 4000K, 4500K and 5000K

                                                        Minimum CRI                                                                            70

                                                        Lumen maintenance at 6000 hours                                          95.8% AND 5-year warranty

                                                        Minimum Light Output                                                      End-mounted**: >= 50 lm/ft
            7. Display Case Lighting




                                                        Maximum Light Output                                                                   N/A

                                                        Zonal Lumen Requirements                                                         >= 95% 0-80º

                                                        Minimum Luminaire Efficacy                                                          35 lm/W

                                                        Allowable CCTs                                               2700K, 3000K, 3500K, 4000K, 4500K and 5000K

                                                        Minimum CRI                                                                            75

                                                        Lumen maintenance at 6000 hours                                          94.1% AND 3-year warranty




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