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									City of Fort Collins Utilities Photovoltaic System Rebate Application

Application Form for Solar Electric Rebates

General Customer and Project Information
Complete this application to apply for rebates for solar programs. Please fill out the General Customer and Project Information form (Pages 1 and
2) and the Signature page.
Customer Eligibility

Customers must be a Fort Collins Utilities electric customer. See project tab (Page 2) for additional requirements.

       *Fort Collins Utilities may request a site visit at any time to confirm the accuracy of the project and reserves the right to determine the final
eligibility and rebate
Customer Name:                                                                                  Account Number:

Customer Address:                                                                               Project Address:
                                                                                                (if different)
City, State, Zip:                                                                               City, State, Zip:

Telephone:                                                                                      E-mail:
How did you hear about our rebates?                                                             Submitting more than one project?

Utilities Contact Information
For questions or to submit an application for approval or payment, please contact Fort Collins Utilities:
                                                                                                                                Please be sure to direct all correspondence to
Fort Collins Utilities                                Phone:       970-221-6700
                                                                                                                                         Energy Services Rebates
PO Box 580                                            Fax:         970-221-6619
Fort Collins, CO 80522                                E-mail:                                       Application Version:           2011.05, 2/1/2011

Fort Collins Photovoltaic System Rebate Application

Part 1 Rebate Reservation
For Utilities use only:                                                             0                                                                 (Pick One)
                                                    Approval Code:                                   0                              Residential
     Date/Time Received:
            Reviewed by:                                                                                  Date:

Estimated Project Schedule and Rebate Amount
                    Start date:                                                                             Est. Completion date:

     Estimated Rebate Amount = DC Watts X $1.25 up to a max of $3,750 (RES) or $12,500 (COM'L)                      Est. Rebate:

Installer Contact Information
Contractor Name:                                                                        Project Contact Name:
Contractor Address:                                                                     Project Contact Phone:
City, State, Zip:                                                                       Certifications:
Telephone:                                                                              E-mail:

Installation Information and Required Docs Checklist
                      o Total system size:                                                                                          DC Watts
                      o Installation cost before rebate:                                                                            Dollars
                      o Mounting (roof or ground):
                      o Azimuth / Tilt
                      o PVWATTS estimated annual production:                                                                        AC kWh
                      o Estimated percentage of optimal                                                                             Percent

                                  Scan and attach the following documents:              Participant Check-off                       Utilities "Received" Check-off
                                  o System layout and one-line electrical diagram                   o                                      o
                                  o PVWATTS performance estimate                                    o                                      o
                                  o Shading analysis (if needed)                                    o                                      o
                                  o Installer system quotation                                      o                                      o
                                  o Signature page with Affadavit of Lawful
                                  Presence                                                          o                                      o

Project Eligibility
o Fort Collins Utilities electric customer
o Rebates are for new grid-tied installation with new equipment installed by a licensed contractor – no D-I-Y systems and no add-on equipment to
already installed systems. Contractor must provide a minimum five year warranty and obtain proper construction permits. (see Calif. Solar Initiative
for eligible equipment list)
o Residential system size between 500 Watts and 10kW (Commercial system size between 500 Watts and 25kW)
o System must meet Utilities Interconnection Standards. Please also review Net Metering/Interconnection Agreement, Rebate Agreement and Solar
REC Contract which you will be required to sign to obtain a permit to operate and final rebate payment.
o System orientation must achieve minimum of 90% of estimated ideal annual output ( as estimated by PVWATTS).
o System cannot be shaded between 9 a.m.-3 p.m. (Installer should provide shading analysis if there is any question on this item)
o System must be installed within six months of rebate reservation (Dates to be coordinated with Colorado GEO rebates, as needed).
o The customer is required to obtain an energy audit and provide documentation of such with Part 2 of the rebate application.

Steps to Participate
o Step 1: Complete this reservation request. Be sure you receive confirmation of this rebate (and Colorado GEO rebates) before proceeding.
o Step 2: Install system within six months of the date the rebate reservation is issued. (Dates may be adjusted to accommodate GEO rebate schedule)
o Step 3: Submit Part 2 with required documentation to complete the rebate process. Payment will be issued by check to customer in approx. six weeks

Part 1 Required Documentation
o System Design Docs (site plan, layout, one-line, PVWATTS performance estimate)
o Installer Docs (system quotation)
o Scanned signature page including Affadavit of Lawful Presence
Fort Collins Photovoltaic System Rebate Application

Part 2 Request for Payment
                           Submit upon project completion.

For Utilities use only:                                                              0
                                                 Approval Code:                               0                               Residential                         0
                                                                                                                              Commercial                          0
     Date/Time Received:
            Reviewed by:                                                                          Date:

Solar Rebate Request for Payment Checklist
                                                                                          "Delivered"                               "Received"
                           o System Final One-Line and PVWATTS estimate                       o                                        o
                           o System Serial Numbers                                            o                                        o
                           o Final Building & Zoning Inspection                               o                                        o
                           o Utilities Functional Check and Permit to Operate                 o                                        o
                           o Signed Net Metering Agreement                                    o                                        o
                           o Signed Rebate Agreement                                          o                                        o
                           o Signed Solar REC Agreement                                       o                Final Cost              o
                           o Installers Final Invoice and Statement of Warranty               o                                        o
                           o Energy Audit Report                                              o                                        o
                           o Assignment of Rebate Form (if applicable)                        o                                        o

Energy Audit Information
Auditor Phone:
Auditor E-mail:
Date of Audit:                                                                                            For Utilities use only:
Auditor Certifications:                                                                                   PV FOM =                              0 kWh/kW/year
Audit Type:                                                                                               Cost FOM =                        $0.00 $/kW-DC

Final Installation Information
Date of Completion:
PV Panel Data:                                                                                                                (brand, model, power rating, quantity)
Inverter Data:                                                                                                                (brand, model, power rating, quantity)
                                                                  Performance Estimate:                                       PVWATTS annual kWh produced

Rebate Calculation

$1.25 per DC Watt up to 3kW for Residential systems or up to 10kW for Commercial systems (Includes $0.50 per Watt solar REC payment)

Installed System Size                                                                0 DC PTC nameplate rated capacity in Watts
Rebate Eligible Size                                                                 0 Watts

                                                                       Rebate Amount:                   0 Dollars

For Utilities use only:

OK to Pay Authorization:                                                                          Date:
                                           John Phelan, Utilities Energy Services Mgr.
Account Number:            11110000.573030.9080.11110800.C

Payee:                                                                               0
Mailing Address:                                                                     0
   Signature Page
  Please fill in this page, print, sign and date it, and return a scanned PDF copy.

Participant and Installer Certification

  Signature below indicates acknowledgement of program requirements and affirms that the
  documentation provided is true and accurate.

  Signature:                                                                   Date:

  Signature :                                                                  Date:

  Affidavit of Lawful Presence in the United States

                                                                     , swear and affirm under penalty of
              I,                                                    perjury under the laws of the State of
                                                                         Colorado that (check one):
          [     ] I am a United States citizen, or
          [     ] I am a Permanent Resident of the United States, or
          [     ] I am lawfully present in the United States pursuant to Federal law.

        I understand that this sworn statement is required by law because I have applied for a public
        benefit. I understand that state law requires me to provide proof that I am lawfully present in the
        United States prior to receipt of this public benefit. I further acknowledge that making a false,
        fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under
        the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute
        18-8-503 and it shall constitute a separate criminal offense each time a public benefit is
        fraudulently received.

   Signature:                                                        Date:

        You may be asked to provide identification in the form of:
             • Valid Colorado driver’s license
             • Valid Colorado identification card
             • United States military card or military dependent’s identification card
             • Native American tribal document
             • United States Coast Guard merchant mariner card

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