2017 Commercial & Industrial Program C&I Lighting Prescriptive Rebate Application

Transcription

1 MEMBER INFORMATION Member Name Company Name Mailing Address City State ZIP Phone Electric Cooperative/REMC Name (MUST be completed) Electric Cooperative/REMC Account Number (MUST be completed) Check will be mailed to this address unless an alternate address is provided below. INSTALLATION SITE INFORMATION Site Name Contact Name Company Name Site Address City State ZIP Phone Mobile Type of Business Where Equipment Was Installed Operating Hours Per Year Installation Completion Date ALTERNATE ADDRESS FOR MAILING INCENTIVE CHECK Contact Name Business Name Address City State ZIP Phone SUBMITTING AN APPLICATION Applications and supporting documents may be submitted one of the following ways: Fax to (317) to Mail to POWER MOVES Program, 7301 Georgetown Rd, Ste 198, Indianapolis, IN Please make and keep a copy of the application and supporting documents for your records. We cannot process applications if required documentation/information is not included. Please read this application carefully and include all information requested, including specification sheets and invoices. Not submitting requested documents will significantly delay processing and may disqualify your application. 1 of 7

2 Compact Fluorescent Lamps Equipment Type Replacing Unit Hours Screw-in Compact Fluorescent Lamp ( 30 watts) Screw-in Compact Fluorescent Lamp ( watts) Compact Fluorescent Fixture (must be hardwired and contain pin-based CFL lamps) Incandescent Lamp Lamp $1.50 Incandescent Lamp Lamp $3.00 Incandescent Lamp Fixture $10.00 Actual CFL Wattage Quantity Space Heated or Cooled s are based on a one-for-one replacement of incandescent lamps/fixtures with compact fluorescent lamps/fixtures. s for screw-in CFL and LED lamp replacements will be capped at 100% of their invoiced cost. Lighting Occupancy Sensors Equipment Type Replacing Unit Actual Wattage Controlled by Sensors Hours Quantity Space Heated or Cooled Occupancy Sensors Wall-Mounted (must control a minimum of 75 watts) Occupancy Sensors Ceiling-Mounted (must control a minimum of 175 watts) Occupancy Sensors Fixture-Mounted (must control a minimum of 75 watts) Manual Control Sensor $15.00 Manual Control Sensor $30.00 Manual Control Sensor $15.00 May be wall- or ceiling-mounted, passive infrared, ultrasonic, or dual technology sensors which are permanently installed. Program start ballasts are recommended for longer life with occupancy sensors. Linear Fluorescent Equipment Type Replacing Unit Quantity Hours 1-2 Lamp 4 ft High Performance T8 Lamp and Ballast Upgrade (low ballast factor) 3-4 Lamp 4 ft High Performance T8 Lamp and Ballast Upgrade (low ballast factor) Reduced Wattage 4ft T8 (lamp only; 28 watts or less) Actual watts installed: 1-4 Lamp High Bay T5HO or HPT8 Fixture 5-8 Lamp High Bay T5HO or HPT8 Fixture 1-8 Lamp High Bay T5HO or HPT8 Fixture 1-2 Lamp 4 ft T12 Fixtures Fixture $ Lamp 4 ft T12 Fixtures Fixture $15.00 Standard 4 ft T8 Lamp (32 watt) Lamp $0.50 HID Fixture <500 watts Fixture $30.00 HID Fixture <500 watts Fixture $40.00 HID Fixture 500 watts Fixture $50.00 Actual No. of Lamps per Fixture Space Heated or Cooled s are based on a one-for-one retrofit of lamps and ballast in linear fluorescent fixtures or complete replacement of linear fluorescent or High Bay fixtures. Fluorescent systems must include product specifications for lamps and ballasts. All High Performance T8 systems must meet CEE specifications (see All 1-4 lamp HPT8 fixtures that are not High Bay need to be CEE listed with a low ballast factor. All reduced wattage lamps and ballasts must be CEE listed. 2 of 7

3 Ceramic Metal Halide Lamps Equipment Type Replacing Unit Actual CMH Wattage Ceramic Metal Halide Lamp ( 150 watts) Incandescent Lamp Lamp $40.00 Hours Per Week Quantity s are based on a one-for-one replacement of incandescent lamps with Ceramic Metal Halide lamps. Accent lighting, flood lighting, or down lighting in an interior installation also qualify. Signs & Signals Equipment Type Replacing No. of Watts Installed LED, T-1, or Electroluminescent Exit Signs Incandescent Exit Sign Sign $6.00 LED Auto Traffic Signal Incandescent Signal Ball or Arrow Unit Quantity Hours $12.50 LED Pedestrian Signal Incandescent Signal Signal $25.00 s are based on a one-for-one replacement of existing exit signs with LED, T-1, or Electroluminescent exit signs. Exit signs must be equal to or less than 8 watts including the power supply for the battery backup. CFL exit signs do not qualify for an incentive. LEDs-EXTERIOR Equipment Type Replacing No. of Watts Installed Make/ Model Unit Quantity Hours LED Pole/Arm-Mounted Area and Roadway Luminaires Exterior HID Pole/Arm-Mounted Area and Roadway Luminaires Exterior Head $50.00 LED Wall-Mounted Area Luminaires Exterior HID Wall-Mounted Area Luminaires Exterior Head $35.00 LED Canopy Luminaires Exterior Canopy Luminaires Exterior Head $50.00 LED Parking Garage Luminaires LED Lighting for Refrigeration Cases HID Parking Garage Luminaires Head $50.00 T8 Refrigeration Lighting Door $45.00 s are based on a one-for-one replacement of existing lighting fixtures with LED fixture. All LED fixtures must appear on a DesignLights Consortium listing. Visit designlights.org. 3 of 7

4 LEDs - INTERIOR Equipment Type Replacing Number of Watts Installed LED Screw-In ( 15W) (ENERGY STAR only) LED Screw-in (>15W) (ENERGY STAR only) LED Screw-In ( 15W) (ENERGY STAR only) Make/Model Unit Quantity Hours Per Week Incandescent Lamp $3.00 Incandescent Lamp $5.00 CFL Lamp $3.00 All screw-in LEDs must be ENERGY STAR qualified LED Commercial 175W HID Fixture Fixture $75.00 LED Low-Bay Fixture 250W HID Fixture Fixture $ LED High-Bay Fixture 320W HID Fixture Fixture $ LED 2x2 Troffer Light Fixture (not retrofit kit) Fluorescent fixture Fixture $40.00 LED 2x4 Troffer Light Fixture (not retrofit kit) LED 1x4 Troffer Light Fixture (not retrofit kit) LED Pin based and Linear Tube 4' Lamp (DLC-listed only) Fluorescent fixture Fixture $50.00 Fluorescent fixture Fixture $ ' T-8 Linear Fluorescent Lamp Lamp $3.00 * In order to qualify for an incentive, pin-based LEDs and tubular LEDs (TLED) must appear on the Design Lights Consortium (DLC) Qualified Products List found at and must include an integrated driver compatible with a fixture s existing ballast. * TLED measures can be installed as replace on burn-out or as a retrofit to existing, operational lamps. * LED Retrofit kits are not eligible for a prescriptive incentive, but may qualify under our C&I Custom Program which requires Program pre-approval prior to purchase. * LED screw-in lamps must be ENERGY STAR qualified. * s for screw-in LED lamp replacements will be capped at 100% of their invoiced cost. Delamping (Interior) Type of Lamps/Fixtures Being Removed Quantity of Lamps/Fixtures Being Removed Amount of Watts Being Removed per Watt Removed $0.10 This rebate for delamping is not to be used with other lighting incentives. For example: If you are replacing 65 fixtures with 65 new fixtures, you are not eligible for this delamping incentive. However, if you are replacing 65 fixtures, with only 50 new fixtures, you may use this delamping incentive on the 15 fixtures that have been permanantly removed. Delamping requires a permanent removal of lamps, ballasts and sockets in the system being rebated. By submitting this form, you are granting permission for POWER MOVES to verify removal at their discretion. 4 of 7

5 Signature Submission of this form verifies that the applicant has provided accurate information to participate in the program. Applicant further certifies that: 1. All rules and requirements of this program have been followed. 2. Applicant is a non-residential member of an electric cooperative member of Wabash Valley Power Association. 3. The rebate equipment has been installed and operational prior to submission of this application 4. A member electric cooperative of the Wabash Valley Power Association is providing the electric service to the installation site address listed on this application. 5. Applicant understands and agrees that neither Wabash Valley Power Association nor its member electric cooperatives assumes any responsibility or liability arising out of or related to applicant s participation in the POWER MOVES program. 6. Applicant will allow inspection of the rebated equipment (if requested). 7. Applicant understands applicant will not receive a rebate if applicant s contractor fails to provide the requested documentation for the equipment installed in the applicant s facility. If signing in a capacity other than an individual capacity, the individual signing below hereby represents and warrants that s/he is duly authorized to execute and deliver this application on behalf of the applicant. Applicant Signature: Date: Requested: 5 of 7

6 ALL applications must list contractor contact information: CONTRACTOR/INSTALLER INFORMATION Contact Name Business Name Address City State ZIP Phone Check here if project was self-installed Assignment of Payment to Third-Party C&I Members should complete this section if they would like to assign their incentive payment to their contractor. Program staff will contact member to verify this request. By signing below, I assign the full POWER MOVES incentive amount pursuant to this application to the Contractor/Installer designed above, and agree that such assignment can only be amended or modified in writing acknowledged by POWER MOVES /Wabash Valley Power Association, and further agree to hold harmless and indemnify Wabash Valley Power Association and its member cooperatives, employees and implementation contractors from any claim made for such incentive amount or from any loss resulting from the payment of the incentive amount to the assignee. C&I Member Signature: Written Name: Date: Phone Number: Amount Requested to be Paid to Third-Party: 6 of 7

7 This program can be changed or cancelled at any time at the sole discretion of Wabash Valley Power Association, with or without notice. Eligibility requirements Non-residential members of electric cooperatives participating in Wabash Valley Power Association s POWER MOVES energy efficiency programs. Please call your co-op to verify participation or see the list at Program eligibility requirements are subject to change or termination with or without notice at the sole discretion of Wabash Valley Power Association. Program parameters All rebated equipment must be new; used or rebuilt equipment is not eligible for an incentive. items must be installed on the electric cooperative account listed on this application. Rebated equipment must meet the technical specifications listed in this application form. Application procedures and deadlines Applications should be submitted within 60 days after the project completion date. An invoice and requested documentation must be included for the application to be considered complete. Rebated equipment must be installed and operational on or after January 1, 2017 and on or before December 31, All applications should be postmarked by February 28, Ability to confirm installation (right to conduct inspection) Pre-install inspection: Wabash Valley Power Association reserves the right to inspect the program participant s facility to verify that equipment meeting program qualifications exists prior to providing an incentive, and the program participant agrees to provide reasonable access to the premises for such purposes. Post-install inspection: Wabash Valley Power Association reserves the right to inspect the program participant s facility to verify that equipment matching the information provided on the program application has been placed in service at that facility, and the program participant agrees to provide reasonable access to the premises for such purposes. i. Post inspection, the program participant will have 30 days from the request date to submit any additional information requested by Wabash Valley Power Association. Failure to submit requested information may result in application rejection. ii. If any requested inspection finds the program participant or the program participant s contractor did not comply with program rules and standards, any incentive received must be returned to Wabash Valley Power Association within 60 days of notice of such noncompliance. Wabash Valley Power Association reserves the right to conduct an additional post-install inspection for program portfolio evaluation, measurement, and verification (EM&V) purposes. s received will not be affected by the results of this inspection. Payments The maximum total C&I prescriptive program incentive payment per membership is $25,000 per year. The incentive payment cannot exceed 75% of the total project cost. Self-labor cannot be included in total project cost. Approved incentive payments will be made via a check to the C&I member, unless member requests in writing that payment be made to a third-party. Wabash Valley Power Association reserves the right to withhold payment for products that do not meet the program requirements as determined within its sole discretion. Program funds are limited. s are available on a first-come, first-served basis, subject to application approval. amounts, thresholds, and offerings are subject to change or termination with or without notice at the sole discretion of Wabash Valley Power Association. Wabash Valley Power Association is not liable for incentives promised to members as a result of a contractor misrepresenting or not verifying the rules the program. Logo Program applicants and program participants may not use our logo or name without prior express written permission. Disclaimers Wabash Valley Power Association and its member cooperatives i. Do not endorse any particular manufacturer, product, or system design by offering these incentives; ii. Will not be responsible for any tax liability imposed on any program participant as a result of the payment of incentives; iii. Do not expressly or impliedly warrant the performance of any installed equipment; iv. Are not responsible for the handling, storage, treatment, transportation, or disposal of any waste generated as a result of any measures for which incentives have been applied for and/or received under this program nor any resultant environmental contamination related to the same; v. Are not liable for any damage caused by the operation or malfunction of the installed equipment; and vi. Do not guarantee that a specific level of energy or cost savings will result from the implementation of energy conservation measures or the use of products funded under this program. 7 of 7