HEATING NATURAL GAS FURNACES, BILE AND ECM FURNACE FANS 2018 IWA FR YUR BUSINESS REBATE APPLICATIN Instructions: 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, 2018, and Dec. 31, 2018. Equipment must be installed and operating prior to submission of final rebate application. s cannot exceed 50 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount listed or 50 percent of installed cost. Installed cost includes contractor labor only and does not include internal labor. application must be submitted within six months of dealer invoice, or by Dec. 31, 2018, whichever comes first, 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 Dec. 31, 2018, are not eligible for rebates. Custom Equipment: If specific 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. Projects must be completed within six months of preapproval. See the Nonresidential Equipment Custom Systems application for details. SECTIN 1 (REQUIR) Name on account Customer Information Self-installed q Yes q No Installation address City State ZIP Phone MidAmerican Energy Company account number (found on bill; first seven digits only) Mailing address (if different than installation address) City State ZIP 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. SECTIN 2 (REQUIR) Year building was constructed Building size [sq. ft. (area)] Do you: q wn The new equipment is for: q Replacement of existing equipment q New installation (new to facility) q New construction q Rent this building Page 1 of 5
SECTIN 2 CNT. (REQUIR) Equipment installed in what type of facility? (check one) Industrial MEC Use nly Commercial MEC Use nly q Apparel manufacturing q Apartment, halfway house q Chemical manufacturing q Condo q Computer/electronic product manufacturing q Convenience store/gasoline station CV q Electrical equipment, appliance/component manufacturing q Food/beverage/tobacco product manufacturing q Furniture and related product manufacturing q Leather and allied product manufacturing q Machinery manufacturing q Nonmetallic mineral product manufacturing q il and gas extraction; mining q Paper manufacturing; printing and related support activities q Personal and laundry services q Dealership small <30k q Dealership large >30k q Financial institution small <30k q Financial institution large >30k q Grocery store and supermarket q Healthcare (outpatient) q Healthcare (inpatient, including hospital, nursing home, senior care facility) q Healthcare senior housing - individual apartment q Health club/exercise facility small <30k GR HC HS q Petroleum and coal products manufacturing q Health club/exercise facility large >30k q Plastics and rubber products manufacturing q Library q Primary metal/fabricated metal product manufacturing q Textile mill and textile product mill q Transportation equipment manufacturing q Utility q Warehouse and storage q Warehouse large refrigerated q Wood product manufacturing q Miscellaneous manufacturing q ther industrial q Lodging hotel q Lodging motel q Mixed use q ther - commercial q ffice small 4 floors q ffice large > 4 floors q ffice government small 4 floors q ffice government large > 4 floors q ffice public order and safety small 4 floors q ffice public order and safety large > 4 floors L L Agriculture q Corn farming q Dairy cattle and milk production q Hog facility q Soybean farming q All other animal production q All other miscellaneous crop farming MEC Use nly DF HF q Pharmacy and drug store small <30k q Pharmacy and drug store large >30k q Public assembly events/conventions/casinos small <30k q Public assembly events/conventions/casinos large >30k q Religious worship/church q Restaurant fast food q Restaurant full service HY HY RE T 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 CV q Warehouse and storage WH-C q Warehouse large refrigerated WH-C Page 2 of 5
SECTIN 3 Complete all fields for each piece of equipment purchased and installed. HEATING - Natural Gas Furnaces AHRI Certified You must be a MidAmerican Energy nonresidential natural gas customer to qualify. Equipment must be AHRI Certified, <225 MBtuh with an AFUE of 95 and above. q Natural gas furnace rebate = $300/unit AHRI reference number AFUE Capacity (MBtuh) + = ECM furnace fan installed q Yes q No If yes, submit electronically commutated motors furnace fan information below Serial number Electronically Commutated Motors Furnace Fan AHRI Certified You must be a MidAmerican Energy nonresidential electric customer to qualify. Equipment must be AHRI Certified. Furnace fan must be installed on new qualifying furnace with AFUE 95 and above; <225 MBtuh, add-on fans only, May not be built into system and CEE air handling ratio must be <0.02. q Efficient fan motor rebate = $50/fan Furnace AHRI reference number AFUE of furnace CEE air handling ratio <0.02 q Yes q No + = Furnace brand name Furnace model number Furnace serial number Equipment Natural gas boiler < 300 MBtuh HEATING - Natural Gas Boilers AHRI Certified Qualifying Efficiency (check one) (per new equipment) Capacity of New Unit in MBtuh q 0.87-0.899 AFUE $4 x = q 0.900-0.949 AFUE $5 x = q 0.95 AFUE and above $6.50 x = Total With preapproval before purchase or installation, boilers 300 MBtu may qualify under Nonresidential Equipment Custom Systems. AHRI reference number AFUE Serial number + = For more details, view the AHRI 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.) Control 1 Installed X $25/unit = Total Programmable thermostat controls q Furnace q Boiler q Central air conditioner q Heat pump Control 2 Installed X $25/unit = Total Programmable thermostat controls q Furnace q Boiler q Central air conditioner q Heat pump Destratification 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. Equipment Type Destratification fan, high volume, low speed Qualifying Efficiency Horizontal mounted, 20-foot minimum fan diameter, VSD controlled no additional VSD rebate Installed Total X $1,000/fan = Fan diameter in feet Serial number 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. In 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 SIGN THE NEXT PE Page 4 of 5
Specific Terms and Conditions nparticipants must be commercial or industrial customers with facilities located in MidAmerican Energy Company s Iowa service territory. nmidamerican Energy Company must provide the primary electricity and/or natural gas to the equipment at the facility for which the rebate is being paid. ntransportation gas customers with daily metering are ineligible for natural gas incentives. However, customers with monthly metering under the Monthly Metered Transportation Service natural gas tariff are eligible for energy incentives. nequipment installed as a replacement unit, retrofit or in new construction is eligible. n based on actual equipment rating in Btuh at AHRI-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. nfor prescriptive rebates, the rebate payment cannot exceed 50 percent of the installed cost (reasonable labor and material/equipment - reasonableness to be determined by MidAmerican Energy Company). Installed cost includes contractor labor only and does not include internal labor. nequipment must be purchased between Jan. 1, 2018, and Dec. 31, 2018. Equipment must be installed and operating prior to submission of final rebate application. n application must be submitted within six months of dealer invoice, or by Dec. 31, 2018, whichever comes first, 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 Dec. 31, 2018, will not be eligible for rebates. nallow 4 6 weeks for rebate processing, excluding on-site verification time, if needed. General Terms and Conditions Important: Before completing and signing this form, please read the General Terms and Conditions located in the 2018 Iowa 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. It certifies that all information in this application is correct and equipment installed at the indicated location. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before issuing payment. Customer signature Date Dealer name Installer/Dealer Information Phone Address Fax City State ZIP Contact name Email address Installer/Dealer Agreement I certify that all equipment and installation information provided on this application is correct and accurate. Installer/dealer signature Date Before you submit your form: oofill out this form completely. ooattach a copy of the itemized sales receipt or invoice. ooinclude documentation listed in the instructions. oosign the Customer Agreement section. Send completed forms to: Mail: MidAmerican Energy Company P.. Box 4628 Des Moines, IA 50305-4628 Fax: 515-244-8825 Email: rebateapplications@midamerican.com For MidAmerican Energy Use Project # Project # Received date Method: E M F I Assessment # Assessment date KAM-BAM Sector type total amount $ For more information call 800-894-9599 or go to www.midamericanenergy.com/ee. Page 5 of 5