HEATNG NATURAL GAS FURNACES, BE AND ECM FURNACE FANS 2017 LLN FR YUR BUSNESS REBATE APPLCATN,..~ MidAmerican ENERGY BSESSVELY, RELENTLESSLY AT YUR SERVlCE nstructions: Fill out form completely and sign. Attach itemized invoices and supporting documentation, if applicable. Failure to complete the required sections and provide documentation will result in denial of claim. Equipment must be purchased between Jan. 1, 2017, and Dec. 31, 2017. Equipment must be installed and operating prior to submission of fnal rebate application. s cannot exceed 70 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount listed or 70 percent of installed cost. nstalled cost includes contractor labor only and does not include internal labor. application must be submitted within six months of dealer invoice for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. applications received after six months of dealer invoice are not eligible for rebates. Custom Equipment: f specifc equipment you intend to purchase and install is not listed, it may qualify under Nonresidential Equipment Custom Systems. However, custom projects must be preapproved by MidAmerican Energy prior to purchase and installation of equipment or system. See the Nonresidential Equipment Custom Systems application for details. SECTN 1 (REQUR) Name on account nstallation address Customer nformation Self-installed q Yes q No City State ZP Phone MidAmerican Energy Company account number (found on bill; frst seven digits only) Mailing address (if different than installation address) LJLJLJLJLJ-LJLJ~~~ City State ZP Contact name Title Email address* *This email address only will be used for communication regarding this rebate application. Your email address never will be shared and you can unsubscribe at anytime. SECTN 2 (REQUR) My facility had an energy assessment in the following program (check if applicable): q ndustrial q Agribusiness q Commercial q Multifamily Housing q No assessment has been completed Date assessment completed (month/year) Building size [sq. ft. (area)] Year building was constructed Do you: q wn q Rent this building The new equipment is for: q Replacement of existing equipment q New installation (new to facility) q New construction Page 1 of 5
SECTN 2 CNT. (REQUR) Equipment installed in what type of facility? (check one) ndustrial MEC Use nly Commercial MEC Use nly q Apparel manufacturing ND q Apartment, halfway house MF q Chemical manufacturing ND q Condo MF q Computer/electronic product manufacturing ND q Convenience store/gasoline station CV q Electrical equipment, appliance/component manufacturing ND q Dealership small <30k q Food/beverage/tobacco product manufacturing ND q Dealership large >30k q Furniture and related product manufacturing ND q Financial institution small <30k q Leather and allied product manufacturing ND q Financial institution large >30k q Machinery manufacturing ND q Grocery store and supermarket GR q Nonmetallic mineral product manufacturing ND q Healthcare (outpatient) HC q il and gas extraction; mining ND q Healthcare (inpatient, including hospital, nursing home, senior care facility) HS q Paper manufacturing; printing and related support ND q Healthcare senior housing - individual apartment MF activities q Health club/exercise facility small <30k q Personal and laundry services ND q Petroleum and coal products manufacturing ND q Health club/exercise facility large >30k q Plastics and rubber products manufacturing ND q Library q Primary metal/fabricated metal product manufacturing ND q Lodging hotel L q Textile mill and textile product mill ND q Lodging motel L q Transportation equipment manufacturing ND q Mixed use q Utility ND q ther - commercial q Warehouse and storage ND q ffce small 4 foors q Warehouse large refrigerated ND q ffce large > 4 foors q Wood product manufacturing ND q ffce government small 4 foors q Miscellaneous manufacturing ND q ffce government large > 4 foors q ther industrial q ffce public order and safety small 4 foors q ffce public order and safety large > 4 foors Agriculture MEC Use nly q Pharmacy and drug store small <30k q Corn farming AG q Pharmacy and drug store large >30k q Dairy cattle and milk production DF q Public assembly events/conventions/casinos small <30k HY q Hog facility HF q Public assembly events/conventions/casinos large >30k HY q Soybean farming AG q All other animal production AG q Religious worship/church RE q All other miscellaneous crop farming AG q Restaurant fast food T q Restaurant full service T q Retail small <30k q Retail large >30k q Retail department store small <30k q Retail department store large >30k q School elementary q School jr. high q School high school q School college, university and professional school q School lodging (school/dorm) q Service small <30k q Service large >30k q Truck stop q Warehouse and storage q Warehouse large refrigerated MF CV WH-C WH-C Questions about the forms or need assistance with the forms? Call our energy effciency representatives at 800-894-9599. Page 2 of 5 1774832775 090717
SECTN 3 Complete all felds for each piece of equipment purchased and installed. HEATNG - Natural Gas Furnaces AHR Certifed s cannot exceed 70 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount or 70 percent of installed cost. You must be a MidAmerican Energy nonresidential natural gas customer to qualify. Equipment must be AHR Certifed, <225 MBtuh with an AFUE of 95 or greater. q Natural gas furnace rebate = $700 nstall date AHR reference number AFUE Capacity (MBtuh) Equipment cost Labor cost $ + $ = Total installed cost ECM furnace fan installed $ q Yes q No f yes, submit electronically commutated motors furnace fan information below Serial number Electronically Commutated Motors Furnace Fan AHR Certifed You must be a MidAmerican Energy nonresidential 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 nstall date Furnace AHR reference number AFU E of furnace CEE air handling ratio <0.02 q Yes q No Equipment cost Labor cost Total installed cost $ + $ = $ Furnace brand name Furnace model number Furnace serial number HEATNG - Natural Gas Boilers AHR Certifed s cannot exceed 70 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount or 70 percent of installed cost. Qualifying Effciency Capacity of Equipment (check one) (per new equipment) New Unit in MBtuh Total q 0.87-0.899 AFUE $2.00 x = Natural gas boiler < 300 MBtuh q 0.900-0.949 AFUE $4.00 x = q 0.95 AFUE and above $5.00 x = With preapproval before purchase or installation, boilers 300 MBtu may qualify under Nonresidential Equipment Custom Systems. AHR reference number AFUE Serial number nstall date + = For more details, view the AHR directory at www.ahridirectory.org. Page 3 of 5
Controls (Programmable thermostat for all heating and/or cooling sources. MidAmerican Energy must provide energy source controlled by the programmable thermostat for which the rebate is being paid.) nstall date Control 1 nstalled X $25 = Total Programmable thermostat controls q Furnace q Boiler q Central air conditioner q Heat pump Control 2 nstall date nstalled X $25 = Total Programmable thermostat controls q Furnace q Boiler q Central air conditioner q Heat pump Equipment Type Destratifcation Fans MidAmerican Energy must provide the natural gas to the heating source at the facility for which the rebate is being paid. Electric-only customers may qualify under Nonresidential Equipment Custom Systems. Qualifying Effciency nstalled Total Destratifcation fan, high volume, low speed Horizontal mounted, 20-foot minimum fan diameter, VSD controlled no additional VSD rebate X $1,000 = nstall date Fan diameter in feet Serial number Disclaimer MidAmerican Energy Company does not guarantee that installation and operation of high-effciency 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 ftness 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. REMEMBER T SGN THE NEXT PAGE Page 4 of 5
Specifc Terms and Conditions Participants must be commercial or industrial customers with facilities located in MidAmerican Energy Company s llinois service territory. MidAmerican Energy Company must deliver the electricity and/or natural gas to the equipment at the facility for which the rebate is being paid. Equipment installed as a replacement unit, retroft or in new construction is eligible. based on actual equipment rating in Btuh at AHR-rating conditions. To convert Btuh to tons, divide the Btuh by 12,000. For example, if you are converting 24,000 Btuh into tons, divide by 12,000. The result is 2 tons. For prescriptive rebates, the rebate payment cannot exceed 70 percent of the installed cost (reasonable labor and material/equipment - reasonableness to be determined by MidAmerican Energy Company). nstalled cost includes contractor labor only and does not include internal labor. Equipment must be purchased between Jan. 1, 2017, and Dec. 31, 2017. Equipment must be installed and operating prior to submission of fnal rebate application. application must be submitted within six months of dealer invoice for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. applications received after six months of dealer invoice will not be eligible for rebates. Allow 4 6 weeks for rebate processing. General Terms and Conditions mportant: Before completing and signing this form, please read the General Terms and Conditions located in the 2017 llinois For Your Business rebate booklet or at www.midamericanenergy.com/ee. Customer Agreement My signature indicates consent to and agreement with all program terms and conditions. t certifes that all information in this application is correct and equipment installed at the indicated location. understand that MidAmerican Energy Company reserves the right to inspect and verify installation before issuing payment. Customer signature Date Dealer name nstaller/dealer nformation Phone Address Fax City State ZP Contact name Email address nstaller/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: o Fill out this form completely. o Attach a copy of the itemized sales receipt or invoice. o nclude documentation listed in the instructions. o Sign the Customer Agreement section. Send completed forms to: Mail: MidAmerican Energy Company P.. Box 4628 Des Moines, A 50305-4628 Fax: 515-244-8825 Email: rebateapplications@midamerican.com MidAmerican ENERGv BSESSVELY, RELENTLESSLY AT YUR SERVCE save somegreen- For more information call 800-894-9599 or go to www.midamericanenergy.com/ee. Page 5 of 5 1774832775 090717