Fillable 2021 NATURAL GAS EFFICIENCY REBATE APPLICATION

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2021 NATURAL GAS EFFICIENCY REBATE APPLICATION

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2021 NATURAL GAS EFFICIENCY REBATE APPLICATION
1
By typing my first and last names in the CUSTOMER SIGNATURE BOX below, I am signing this document and certify:
o
I have completely filled out Sections A and C
o
I have read, understand, and agree to the terms and conditions – Section B, #1
o
I have attached all support materials – Section B, #3-5
o
All equipment has been installed at the address listed in Section A
CUSTOMER SIGNATURE BOX__________________________________________________ Date_____________
SECTION A. CUSTOMER INFORMATION (please print)
Step 1:
Customer Name Account Number
Installation Address City State Zip Code
Mailing Address (if different from installation address) City State Zip Code
o
Home
o
Cell
o
Other:
Contact Phone Number (with area code) E-mail Address
Step 2:
o
Please apply rebate to my account.
o
Please send me a rebate check.
Rebates $75 and under will be applied to your account. If a box is not checked a bill credit will automatically be issued.
Step 3:
How did you hear about CONSERVE & SAVE
®
?
o
Billboard
o
Chamber of Commerce
o
Contractor
o
Newspaper
o
Radio
o
Retailer/Vendor
o
Social Media
o
TV
o
Utility Newsletter
o
Utility Representative
o
Utility Web Site
o
Other _______________________________________________
Step 4:
I am a: My building type is: I am a: My home/business is heated by: My water heating is:
o
Residential Customer
o
Single Family
o
Owner/Occupant
o
Electric
o
Electric
o
Commercial Customer
o
Multi- Family
o
Owner/Non-Occupant
o
Gas
o
Gas
buildings with 2 or more units
o
Renter
o
Don’t Know
o
Don’t Know
Allow 6-8 weeks
for processing.
Missing or incorrect
information will
increase the
processing time.
OFFICE USE ONLY o Gas o Electric o Water Total Rebate Amount:
Date Received__________________ Date Processed___________________
$
Appliance/Equipment ____________________________________________
ID____________________ Verified By____________________ FILE NAME:__________________________
MN
MS
MN
MS
SECTION C. CONTRACTOR/RETAILER INFORMATION (please print)
Contractor’s/Retailer’s Name Contact Person Phone Number (with area code)
Installer’s Name (write SELF if customer installed)
Type of Appliance/Equipment Installed
Contractor’s/Retailer’s Name Contact Person Phone Number (with area code)
Installer’s Name (write SELF if customer installed)
Type of Appliance/Equipment Installed
SECTION B. REBATE APPLICATION CHECKLIST
Use this checklist to complete the steps to receive your rebates:
o 1. Read the following terms and conditions to determine if you are eligible for a rebate:
• Only one service address per application.
• The Utility reserves the right to apply rebates to past due accounts. Rebates $75 and under will be applied to your account. Rebates
will not exceed the purchase price.
• Energy-efficient equipment must be connected to a natural gas service supplied by Austin Utilities or Owatonna Public Utilities and is
subject to inspection.
• Purchase and install
NEW
products. Reconditioned, refurbished, or second-hand equipment is not eligible for a rebate.
• Equipment installations must meet our Minimum Efficiency Requirements to qualify for a rebate.
• Due to limited funding, this rebate offer can be withdrawn at any time without notice. Applications will be processed on a first-come,
first-served basis. All applications from this year’s (2021) purchases must be received by March 31, 2022.
• Rebates can only be offered on equipment that is installed while funding is in effect. In the event our program is discontinued due to
depleted funds, we will not provide a rebate for items installed between the discontinued date and the end of that year.
o 2. Complete the application, making sure to fill out all required sections in detail. Allow 6-8 weeks for processing. Missing or incorrect
information will increase the processing time.
o 3.
Include a final, detailed copy of the original sales receipt, invoice, or picking slip showing the customer name, date of sale, manufacturer
name,
model number, size, and date of installation.
o 5. Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners
.
o 6. Mail completed forms and required documentation to your utility provider:
Austin Utilities Owatonna Public Utilities
Attn: Rebate Processing Attn: Rebate Processing
1908 14th St NE PO Box 800
Austin, MN 55912-4904 Owatonna, MN 55060-0800
507-433-8886 507-451-2480
www.austinutilities.com www.owatonnautilities.com
or email: rebates@austinutilities.com or email: rebates@owatonnautilities.com
2
FURNACES (AHRI=Air-Conditioning, Heating, and Refrigeration Institute – www.ahridirectory.org)
(AFUE=Annual Fuel Usage Efficiency)
NEW CONSTRUCTION – MINIMUM EFFICIENCY REQUIREMENTS: AFUE greater than or equal to 95%
NEW CONSTRUCTION REBATES: 95% AFUE = $100 | 97% AFUE = $200
RETROFIT – MINIMUM EFFICIENCY REQUIREMENTS: AFUE greater than or equal to 92%
RETROFIT REBATES: 92% AFUE = $150 | 95% AFUE = $300 | 97% AFUE = $400
Installation Type:
o
New Construction
o
Retrofit
Manufacturer’s Name: Model Name: Model #:
Heating Capacity (Btu/hr output): Rated Efficiency (AFUE %): Number of Units Installed:
AHRI Certified Reference #: Date of Installation:
Required – please include copy of AHRI Certificate.
SMART THERMOSTATS
MINIMUM EFFICIENCY REQUIREMENTS: Must control primary natural gas heating system. If self-installed, original UPC code from box AND invoice must be attached to application form
.
REBATES: WIFI ENABLED = $50
Manufacturer’s Name: Model Name: Model #:
Number of Units Installed: Date of Installation:
Do you have central air conditioning?:
o
Yes
o
No
OFFICE USE ONLY
Rebate Total: $___________________________
CENTRAL & MINI SPLIT AIR CONDITIONERING SYSTEMS (ELECTRIC REBATE - USE THIS FORM OR AN ELECTRIC REBATE FORM, BUT NOT BOTH)
MINIMUM EFFICIENCY REQUIREMENTS: SEER 14.5; Must be AHRI Certified. (SEER=Seasonal Energy Efficiency Rating)
REBATE: see chart below (AHRI=Air-Conditioning, Heating, and Refrigeration Institute – www.ahridirectory.org)
Equipment Type:
o
Central Air Conditioner
o
Mini Split System
Cooling Capacity (Tons): AHRI Certified Ref # (Required – please include copy of AHRI Certificate.):
Outdoor Unit Model #: Manufacturer’s Name: Rated Efficiency (SEER by AHRI):
Indoor Unit Model #: Manufacturer’s Name:
# of Units Installed: Date of Installation:
Rebate Total: $__________________________
3
2021 FURNACE AND CENTRAL A/C REBATES
FURNACE FAN MOTORS (ELECTRIC REBATE - USE THIS FORM OR AN ELECTRIC REBATE FORM, BUT NOT BOTH
)
RETROFIT EXISTING FURNACE FAN MOTOR – MINIMUM EFFICIENCY REQUIREMENTS: Must be Electronically Commutated Motor (ECM) or equivalent; documentation required.
RETROFIT EXISTING FURNACE FAN MOTOR ELECTRIC REBATE: $50
Manufacturer’s Name: Motor Model #:
Number of Units Installed: Date of Installation:
Do you have a central air conditioner?
o
YES (EXISTING)
o
YES (NEW)
o
NO
o
UNKNOWN
Have you attached the required documentation showing the
retrofit motor is an Electronically Commutated Motor (ECM) or equivalent?
o
YES
Cooling Capacity 14.5 15.0 16.0 17.0 18.0 19.0 20.0 21.0 22.0+
20,000 BTU/hr or less $100 $120 $140 $160 $180 $200 $220 $240
Over 20,000 BTU/hr $200 $220 $240 $260 $280 $300 $320 $340
20,000 BTU/hr or less – Rebate Formula: $100 + [(Actual SEER
–
14.5) x $20]; Over 20,000 BTU/hr – Rebate Formula: $200 + [(Actual SEER
–
14.5) x $20]
see
formulas
below
OFFICE USE ONLY
OFFICE USE ONLY
Rebate Total: $___________________________
OFFICE USE ONLY
Rebate Total: $___________________________
HEAT PUMPS
If you are heating and cooling your home with an electric heat pump, please use our Electric HVAC & Water Heating Equipment Rebate Application.
FOR THERMOSTATS THAT CONTROL ELECTRIC HEATING PLEASE USE OUR ELECTRIC HVAC & WATER HEATING EQUIPMENT REBATE APPLICATION.
4
2021 OTHER NATURAL GAS REBATES
WATER HEATERS (UEF=Uniform Energy Factor this can be found on the AHRI certificate)
STORAGE (TANK) WATER HEATERS – MINIMUM EFFICIENCY REQUIREMENTS: 0.64 UEF
(www.ahridirectory.org)
STORAGE WATER HEATER REBATES: 0.64 UEF = $125 | 0.80 UEF = $250
(AHRI=Air-Conditioning, Heating, and Refrigeration Institute)
INSTANTANEOUS (TANKLESS) WATER HEATERS – MINIMUM EFFICIENCY REQUIREMENTS: 0.82 UEF
INSTANTANEOUS WATER HEATER REBATES: 0.82 UEF = $200 | 0.91 UEF = $250
Equipment Type:
o
Storage (Tank) Water Heater
o
Instantaneous (Tankless) Water Heater
Manufacturer’s Name: Model Name: Model #:
Rated Storage Gallons: Rated Efficiency (UEF): Number of Units Installed:
AHRI Certified Reference #: Date of Installation: Rebate Total: $__________________________
Required – please include copy of AHRI Certificate.
BOILERS (AHRI=Air-Conditioning, Heating, and Refrigeration Institute)
MINIMUM EFFICIENCY REQUIREMENTS: AFUE greater than or equal to 85% (AFUE=Annual Fuel Usage Efficiency) (www.ahridirectory.org)
REBATES: 85% AFUE = $200 | 90% AFUE = $400 | 95% AFUE = $500 | BOILERS WITH INDIRECT FIRE WATER HEATER = $100 Additional
Manufacturer’s Name: Model Name: Model #:
Heating Capacity (Btu/hr output): Rated Efficiency (AFUE %): Number of Units Installed:
AHRI Certified Reference #: Date of Installation:
Required – please include copy of AHRI Certificate.
Indirect fire water heater included?
o
YES
o
NO
REQUIRED: Documentation on indirect fire water heater equipment
OFFICE USE ONLY
REPLACEMENT DOORS (Less than 50% Glass) (Retrofit only)
MINIMUM EFFICIENCY REQUIREMENTS: ENERGY STAR
®
rated for northern climate zone
Exterior entry door into a conditioned living space, not including storm doors.
REBATE: $25 per door
MUST INCLUDE NFRC LABEL FOR EACH DOOR TYPE AND SIZE.
o
NFRC Labels Included (Required) Date of Installation: __________________________________________
Primary Heating Fuel:
o
Natural Gas
o
Electric
o
Other: ______________________________________
Primary Cooling Type:
o
Central Air Conditioning
o
Room Air Conditioning
o
Air Source Heat Pump
o
Geothermal
o
None
Complete the following sections FOR EACH DOOR TYPE. Attach an additional sheet if necessary.
U-Factor: Manufacturer: Model:
Door Type: Height (inches): Width (inches):
# of Doors this Size:
o
X $25 per Door = _______________________ (Total Rebate)
ECM CIRCULATOR PUMPS
MINIMUM EFFICIENCY REQUIREMENTS: Must be a new Electronically Commutated Motor (ECM), DC brushless, or permanent magnet style. Must be >1/50 HP and <1 HP
(no greater than 750 Watts). Must be capable of variable speed operation and must include integrated controls that automatically modulate flow based on demand.
REBATES: <100 Watts = $50 | 100-499 Watts = $200 | 500-750 Watts = $600 (all rebates not to exceed 50% of cost)
HP=Horsepower
Project Type:
o
Retrofit
o
New Installation
Circulator Pump Type:
o
Boiler
o
Domestic Hot Water Size (Watts)^: Manufacturer’s Name:
Model #: ECM Circulator Cost:
Number of Units Installed: Date of Installation:
^Motor Wattage = Rated HP x 746
OFFICE USE ONLY
Rebate Total: $___________________________
OFFICE USE ONLY
Rebate Total: $___________________________
$0.00
5
2021 OTHER NATURAL GAS REBATES
CLOTHES DRYERS
MINIMUM EFFICIENCY REQUIREMENTS: ENERGY STAR
®
Rated Natural Gas Clothes Dryer
REBATE: $50
Manufacturer’s Name: Model #:
Number of Units Installed: Date of Installation:
CLOTHES WASHERS
MINIMUM EFFICIENCY REQUIREMENTS: ENERGY STAR
®
OR ENERGY STAR Most Efficient
®
ENERGY STAR REBATE: $25–$75 ($25 for electric + $25 for water + $25 for natural gas)
ENERGY STAR MOST EFFICIENT REBATE: $25–$90 ($40 for electric + $25 for water + $25 for natural gas)
Equipment Type:
o
ENERGY STAR
®
o
ENERGY STAR Most Efficient
®
Manufacturer’s Name: Model #:
Number of Units Installed: Date of Installation:
Type of Clothes Dryer:
o
Electric
o
Gas
o
Unknown
ELECTRONIC IGNITION HEARTH – NEW NATURAL GAS HEARTH INSTALLATIONS ONLY
MINIMUM EFFICIENCY REQUIREMENTS: Must be on-demand electronic ignition that is also a sealed combustion/direct vent unit.
REBATE: $75
Manufacturer’s Name: Model #:
Ignition Brand Name: Date of Installation:
OFFICE USE ONLY
Electric Rebate Total: $___________________
Water Rebate Total: $____________________
Gas Rebate Total: $______________________
OFFICE USE ONLY
Rebate Total: $___________________________
OFFICE USE ONLY
Gas Rebate Total: $______________________
SHOWERHEADS
MINIMUM EFFICIENCY REQUIREMENTS: WaterSense qualified
REBATE: $25 (not to exceed purchase price)
Water Heater Type:
o
Natural Gas
o
Electric
Manufacturer’s Name: Model #:
Quantity of Showerheads Purchased/Installed: Date of Installation:
(Rebates for a quantity of greater than three must be pre-approved)
Total Cost of Showerhead(s) (not including tax):
OFFICE USE ONLY
Rebate Total: $___________________________
6
Thank you for purchasing new, efficient appliances and equipment
and for applying for a CONSERVE & SAVE
®
rebate!
When purchasing new items, continue to look for the Energy Star
®
, Energy Star
®
Most Efficient, and WaterSense
®
labels.
By doing so, you will save energy, water, and money while ensuring product performance.
Austin Utilities and Owatonna Public Utilities may also offer a CONSERVE & SAVE
®
rebate on your purchase!
For a complete list of available rebates, amounts, and to download rebate applications with
minimum efficiency requirements and complete terms and conditions, visit your utility’s website:
www.austinutilities.com • www.owatonnautilities.com
ATTIC INSULATION (Retrofit only)
MINIMUM EFFICIENCY REQUIREMENTS: Must add a minimum of R19 with an ending R value of 44 or greater. All attic bypasses must be sealed prior to adding insulation.
REBATE: Self Installed or Contractor Installed: $125 (Rebate is capped at 50% of cost.)
CUSTOMERS WHO HAVE HAD A HOUSE CALL AUDIT AND INSTALLED INSULATION USING
A QUALIFIED CONTRACTOR SHOULD USE OUR HOUSE CALL AUDIT REBATE APPLICATION!
Installation Type:
o
Self-Installed
o
Contractor Installed
Were all attic bypasses sealed?
o
Yes
o
No
Description of Insulation Improvements:
Manufacturer & Type of Insulation Added:
Inches of Insulation Added: Square feet covered: Date of Installation:
Initial R-Value: _________ R-Value Added: _________ Total Ending R-Value (Initial + Added): _________
OFFICE USE ONLY
Rebate Total: $__________________________
Savings: _____________________________ccf
2021 OTHER NATURAL GAS REBATES
PLEASE PRINT ON RECYCLED PAPER 0121
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