Commercial and Industrial LED Retrofit Lighting Rebate 2017 Rebate Application Business Member Information Connexus Energy 14601 Ramsey Blvd NW Ramsey, MN 55303 ConnexusEnergy.com 763.323.2600 Company name Date submitted Billing address City State ZIP Installation address (if different) City State ZIP Account number Contact name (print) Phone E-mail Vendor Information Vendor name Vendor contact name Vendor address City State ZIP Phone Fax E-mail The undersigned does hereby certify that 1) The undersigned, and not the cooperative, is solely responsible for the accuracy of the information contained in this application, 2) all rules of the LED Lighting Rebate program have been followed, and 3) the installation is complete. Further, the undersigned acknowledges that nothing contained in the application shall impose any liability on the cooperative for the work performed and information presented by the member s engineer, contractor or vendor. Connexus Energy will be referred to hereafter in this application as the cooperative. I verify the information on this application is correct and request consideration for participation in this program. Member signature Date How to Apply for This Rebate 1. All rebate applications with a rebate amount >$2,500 require pre-approval by Connexus Energy. Follow Steps 2 through 6 below, and submit the application to the address listed. Members will be notified of acceptance/rejection of rebate applications within 30 days of submitting the application to Connexus. 2. Fill out and sign the Business and Vendor Information sections, page 1. 3. Fill out the Equipment and Rebate Information section, pages 3-4. 4. Attach a copy of the paid, itemized invoice(s). Be sure that the quantity, make model number, and unit price appears on the invoice. Sending inadequate invoice documentation or incomplete/incorrect forms will delay the rebate payment and could result in denial of the rebate application. 5. Make a copy of this document for your records. 6. Mail completed form, along with a copy of your Form W-9 Request for Taxpayer Identification Number and Certification by November 17 to Connexus Energy, 14601 Ramsey Blvd., Ramsey, MN 55303. Application # page 1 Rev 7/17
Specific Rules and Qualifications The cooperative offers rebates to qualifying members who purchase and install qualifying energy-efficient LED lighting products. Illuminating Engineering Society (IES) light levels are recommended. 1. LED interior lamps and downlight luminaires/fixtures must be ENERGY STAR or DesignLights Consortium (DLC) qualified. The lists of ENERGY STAR qualified products are available at energystar.gov/sslpartners. Lamps are listed under the section Partner Resources for LED Lamps. Luminaires/ fixtures are listed under Partner Resources for LED Fixtures. 2. The ENERGY STAR list of qualified luminaires includes a variety of products. In order to qualify for the prescriptive rebates for LED downlight luminaires/fixtures, the product must be listed as Commercial or Both in the Application column of the ENERGY STAR product list. In addition, the product description in the Product Type column must include the word Downlight. 3. ENERGY STAR does not have a qualified products list for LED canopy or soffit lighting or LED refrigerated case lighting (therefore, an ENERGY STAR rating is not required for those specific prescriptive rebates). 4. For exterior LED canopy and soffit lights eligibility, the member must be replacing Metal Halide fixtures only. 5. Illuminating Engineering Society (IES) light levels are recommended. Warranty Information Rebate qualifications do not imply any representation or warranty of such equipment, design or installation by the cooperative. The cooperative shall not be responsible or liable for any personal injury or property damage caused by this equipment. The cooperative does 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. In no event shall the cooperative be liable for any incidental or consequential damages. Other Important Program Rules 1. Installation must be complete before funds will be issued for the rebate. 2. Members and vendors must submit itemized equipment invoices, along with rebate application and worksheet, to the cooperative. To ensure that the equipment installed meets the cooperative s performance standards, these invoices must itemize labor charges, quantity and price of the equipment installed, as well as information regarding the manufacturer and model numbers for all equipment included in the rebate. 3. The cooperative reserves the right to conduct random inspections of installations. 4. Rebate must comply with all program specific rules and qualifications. 5. The maximum rebate amount shall be the lesser of 50 percent of the project equipment cost or $100,000. 6. Rebate checks will only be issued to the member doing the project (i.e. checks will not be made out to contractors). 7. Qualifying members must apply for 2017 rebates no later than November 17, 2017. 8. Rebates under the Connexus Energy Rebate Program are offered on a first-come, first-served basis and are subject to project and member eligibility, and the availability of funds. page 2
Equipment and Rebate Information Business Name Air Conditioned (Y/N) Retrofit LED Lamps Watts $/Unit Quantity Rebate Hrs/Yr Screw & pin LED Lamp 5W or less $ 3.00 LED Lamp 6W-10W Replaces Incandescent, Halogen, CFLs $ 5.00 LED Lamp 11W-20W with minimum 2x wattage reduction $ 10.00 LED Lamp 21W-30W $ 15.00 Retrofit Fluorescent Lamps Low Wattage T8 Lamps 28W Lamp Replaces fluorescent lamps 4 length $ 0.55 LED Lamps Retrofit Rebate per Lamp LED Lamp Replaces T12/T8 linear tube 18W or less LED Case Lighting 2 4 Plug In Lamp (per lamp) $ 2.00 Hard Wired (per lamp) $ 4.00 Plug In Lamp (per lamp) $ 3.00 Hard Wired (per lamp) $ 6.00 Case Lamp 4-6 Refrigerator/Freezer $ 50.00 Note: Percentage reduction based on rebate for 2 lamps or 4 lamps/fixture. LED Fixtures Watts $/Unit Quantity Rebate Hrs/Yr Downlights, Recessed Cans, Pendants, & Surface Mounted LED Fixture 25W or less Replaces Incandescent, Halogen, CFL $ 20.00 LED Fixture 26W-50W or Fluorescent fixtures with minimum 2x wattages reduction $ 25.00 LED Fixture 51W-75W $ 30.00 Wallpacks, Soffits, Canopy, Hi-Bay/Lo-Bay, & Pole Mounted LED Fixture 40W or less $ 25.00 LED Fixture 41W-80W $ 45.00 Replaces HID with minimum 2x LED Fixture 81W-120W $ 75.00 wattage reduction LED Fixture 121W-200W $ 105.00 LED Fixture 201W-250W $ 120.00 LED Exit Signs Exit Sign 8w or less Replaces incandescent only $ 10.00 page 3
Equipment and Rebate Information Business Name Air Conditioned (Y/N) Compact Fluorescents $/Unit Quantity Rebate Hrs/Yr Screw & pin Hardwired or Modular CFL Fixtures Not Screw or Pin Screw or Pin Base CFLs Linear Fluorescent T5 Lamps with Electronic Ballasts T8 Lamps with Electronic Ballasts Super T8 Lamps with Electronic Ballasts Low-Watt T8 Lamps 4 28W Lamp $ 0.55 2L T5HO, 3L T5HO, 4L T8 3L T8VHO, 4-6L T5HO, 6-8L T8 6L T8VHO, 8L T8HO, 12-16L T8 8L T8VHO, 10L T5HO, 18-20L T8 Reflectors HID Fixtures High Pressure Sodium Pulse-Start Metal Halide Ceramic Metal Halide Automatic Controls Hours/ year* % reduction Total kw** Photocell $ 10.00 Ceiling Mount Occupancy Sensor $ 25.00 Wall Mount Occupancy Sensor $ 14.00 Fixture Mount Occupancy Sensor $ 5.00 *annual operating hours before controls LED Exit Signs $/Unit Quantity Rebate **total connected load (kw) to control LED Exit Signs Retrofit Only $ 10.00 ***Project Cost Total Rebate *** Required information. Must enter total project cost to determine rebate. Hrs/Yr reduced** Connexus Energy Representative page 4 Date
Lighting Retrofit Worksheet Business name: Completion of the LED lighting worksheet is required before rebate will be issued. Existing Lighting Number Watts/ Annual New Lighting Number Watts/ Annual Saved Saved System Fixtures Fixture Hours System Fixtures Fixture Hours kw kwh Total Example How to Complete the Form Existing Lighting Number Watts/ Annual New Lighting Number Watts/ Annual Saved Saved System Fixtures Fixture Hours System Fixtures Fixture Hours kw kwh Incadescent bulb 1 75 4000 LED Lamp 15 watt 1 15 4000 0.06 240 Halogen PAR 30 1 65 2500 LED Lamp PAR 30 downlight 1 11 2500 0.05 135 Refrigerated case, F60t12/Cw/Ho, 75 W 10 75 8000 LED case light 10 15 8000 0.60 4,800 Total 0.71 5157 page 5