Installation address City State ZIP. Complete all felds for each piece of equipment purchased and installed. Natural Gas Furnace Information I I

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1 HEATNG AND COOLNG 2017 OWA FOR YOUR HOME REBATE APPLCATON ~~ MidAmerican ENERGY OBSESSVELY, RELENTLESSLY AT YOUR SSWCE. nstructions: Fill out application completely and sign. Attach supporting documentation: itemized invoice(s), SAVE test results/contractor report, EnergyGuide label(s), if applicable, etc. Failure to complete the required sections and provide documentation will result in denial of claim. Equipment must be purchased and installed between Jan. 1, 2017, and Dec. 31, Rebate applications must be postmarked by March 31, 2018, to qualify for 2017 rebates. Rebate applications for equipment/materials purchased in 2017, postmarked after March 31, 2018, will not be eligible for rebates. Applications for central air conditioners installed after Oct. 1, 2017, can be submitted up to Sept. 30, 2018, if pre-enrolled by Dec. 31, SECTON 1 (REQURED) Name on account Customer nformation Mailing address (if different from installation address) nstallation address City State ZP City State ZP Phone address* *This address only will be used for communication regarding this rebate application. Your address never will be shared and you can unsubscribe at any time. MidAmerican Energy Company account number (found on bill; frst seven digits only) LJLJLJLJLJ-LJLJ~~~ Self-installed q YES q NO The equipment is installed in what type of home? q Single-family home (1-2 residential units in a building) q Multifamily home (3 or more residential units in a building) q Manufactured home Year home was built: Home square footage: Number of bedrooms in home: q 1 q 2 q 3 q 4 q 5 The new equipment is for: q Replacement of existing equipment q New installation q New construction The home where the equipment is installed is: What fuel type is used to heat the home? q Both heated and cooled q Heated only q Natural gas q Electric q Other SECTON 2 Complete all felds for each piece of equipment purchased and installed. Natural Gas Furnace nformation You must be a MidAmerican Energy residential natural gas customer to qualify. Equipment must be AHR Certifed, <225 MBtuh with an AFUE of 95 or greater. Furnace must be installed with a SAVE rating of excellent to be eligible for rebate. q Natural gas furnace rebate = $700 Date installed AHR reference number SAVE score AFUE Capacity (MBtuh) ECM furnace fan installed q Yes q No f yes, submit energy-effcient furnace fan motor information below Manufacturer/brand name Model number Serial number Energy-Effcient Furnace Fan Motor nformation You must be a MidAmerican Energy residential electric customer to qualify. Equipment must be AHR Certifed. Furnace fan must be installed on new qualifying furnace with AFUE 95 or above; <225 MBtuh, add-on fans only. May not be built into system and CEE air handling ratio must be <0.02. q Effcient fan motor rebate = $60 Date installed Furnace AHR reference number AFUE of furnace CEE air handling ratio <0.02 q Yes q No Furnace brand name Furnace model number Furnace serial number Page 1 of 5

2 Air-Source Heat Pump nformation Must be SAVE certifed (excellent rating) and meet either qualifying effciency level; units 65 MBtuh; AHR Certifed (coil and condenser must match). Cooling (SEER) Rebate Heating (HSPF) Rebate Total Rebate (cooling plus heating rebates) q SEER rebate = $550 q HSPF rebate = $25 + = q SEER 16 and above rebate = $750 q HSPF 9 and above rebate = $50 Date installed AHR reference number SAVE score Supplemental heat: $ $ $ q Electric resistance + = q Natural gas q Other q None SEER HSPF Cooling capacity (MBtuh) ndoor Heating capacity (MBtuh) Ground-Source Heat Pump nformation Must be SAVE certifed (excellent rating) and meet either qualifying effciency level; must be AHR Certifed; <135 MBtuh. Documentation of capacities must be included in addition to ENERGY STAR certifcation. The capacity and effciency rating will be determined using the full heating load and partial cooling load for multistage equipment. Cooling (EER) Rebate Heating (COP) Rebate Total Rebate (cooling plus heating rebates) q EER rebate = $1,200 q COP rebate = $200 q EER rebate = $1,800 + q COP rebate = $400 = q EER 23 and above rebate = $2,400 q COP 5 and above rebate = $600 Date installed AHR reference number Desuperheater: Voltage: if dual voltage q Yes q No Supplemental heat: q Electric resistance q Natural gas q Other q None Manufacturer/brand name Heating capacity Cooling capacity MBtuh and COP full MBtuh and EER full Heating capacity Cooling capacity MBtuh and COP partial MBtuh and EER partial Model number q Open loop q Water loop q Ground loop q Water to air q DGX q Closed loop q Ground water q Water to water Serial number SAVE score REMEMBER TO SGN THE LAST PAGE Page 2 of 5

3 Ductless Minisplits nformation To qualify, you must be a MidAmerican Energy electric customer and equipment must be AHR Certifed. < 65 MBtuh Equipment Cooling Rebate Total Rebate q SEER rebate = $350 Ductless minisplit air conditioner q SEER rebate = $550 q SEER 16 and above rebate = $750 ndoor Equipment Cooling Rebate Heating Rebate Total Rebate q SEER rebate = $550 q HSPF rebate = $25 Ductless minisplit air-source heat pump + = q SEER 16 and above rebate = $750 q HSPF 9.0 and above rebate = $50 ndoor Central Air Conditioner nformation To qualify, you must be a MidAmerican Energy electric customer and equipment must be AHR Certifed. Central air conditioner must be installed with a SAVE rating of excellent to be eligible for a rebate. Must be <65 MBtuh; coil and condenser must be an AHR match. Provide furnace information if the furnace increases effciency of air conditioner. q SEER rebate = $350 q SEER rebate = $550 q SEER 16 and above rebate = $750 Date installed AHR reference number SAVE score Capacity (MBtuh) Furnace manufacturer/brand name Furnace model number (if applicable) Unit Manufacturer Model Number Serial Number ndoor Page 3 of 5

4 ENERGY STAR Certifed Room Air Conditioner nformation You must be a MidAmerican Energy residential electric customer to qualify. Must be ENERGY STAR certifed; does not need to be SAVE tested. q Room air conditioner rebate = $35 Manufacturer/brand name CEER Capacity (Btuh) Date installed Model number Serial number 11 Programmable Thermostat nformation Must have two or more set-backs; Wi-Fi and smart thermostats qualify. MidAmerican Energy must provide the primary heating fuel to your home. Rebate amount cannot exceed equipment cost. q Programmable thermostat rebate = $25 Date installed Manufacturer/brand name Model number Cost $ Programmable thermostat controls: q Furnace q Boiler q Central air conditioning q Heat pump q Resistance heat Heat Pump Water Heater nformation For residential electric-only customers; not available to natural gas customers. Must be ENERGY STAR certifed. q EF 2.4 and above, 55 gallons rebate = $300 Water heater capacity (gallons) Energy factor (EF) AHR number if listed Date installed Manufacturer/brand name Model number Serial number s the heat pump water heater installed in a conditioned space q Yes q No REMEMBER TO SGN THE NEXT PAGE Page 4 of 5

5 Specific Terms and Conditions nparticipants must be residential customers located in MidAmerican Energy Company s owa service territory. nmidamerican Energy Company must provide the primary electricity and/or natural gas to the equipment for which the rebate is being paid. See specific equipment requirements to ensure your equipment qualifies. nn order to receive a furnace, air-source heat pump, ground-source heat pump or central air conditioner rebate, the equipment must be pre-enrolled and tested by an HVAC SAVE certified technician unless otherwise noted. nelectric customers who purchase a new natural gas furnace with an energy-efficient fan motor qualify for the $60 fan motor rebate. nmust be AHR Certified or ENERGY STAR certified, as indicated. nheating and cooling equipment (except ground-source heat pump) rebates are included in the comprehensive Residential New Construction rebate and not eligible for additional separate rebates. nallow 4 6 weeks for rebate processing. General Qualifications and Conditions mportant: Before completing and signing this form, please read the General Qualifications and Conditions located in the 2017 owa For Your Home rebate booklet or at Disclaimer MidAmerican Energy Company does not guarantee that installation and operation of high-efficiency equipment will result in reduced usage or in cost savings. MidAmerican Energy Company makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to, any warranty of merchantability or fitness for a particular purpose. n no event shall MidAmerican Energy Company be held liable for any incidental or consequential damages or injuries resulting from defective equipment or installation. MidAmerican Energy Company reserves the right to cancel or change these programs at any time. MidAmerican Energy Company s acceptance of this application does not guarantee payment of rebate. Customer Agreement certify that have purchased the equipment described on this form and that it has been installed at the service address indicated. agree to the terms and conditions associated with this form. understand that MidAmerican Energy Company reserves the right to inspect and verify installation before or after issuing payment. q also authorize the rebate check to be payable to (name please print) instead of the name on account. Alternate payee address City Customer signature State ZP Date Dealer name nstalling Dealer nformation Phone Address Fax City State ZP Contact name address SAVE certified technician Date of SAVE verification address Dealer Agreement certify that all equipment and installation information provided on this application is correct and accurate. nstaller/dealer signature Date Before you submit your form: oofill out this form completely. ooattach a copy of the itemized sales receipt or invoice.» nclude AR/SO-standard specification sheets.» nclude documentation of GSHP capacities in addition to ENERGY STAR listing. oonclude documentation listed in the instructions. oosign the Customer Agreement section. f a dealer installed the equipment, the dealer must sign the Dealer Agreement. Send completed forms to: Mail: MidAmerican Energy Company P.O. Box 4628 Des Moines, A Fax: rebateapplications@midamerican.com Page 5 of 5