COMMERCIAL COMPRESSED AIR LEAK CORRECTION REBATE APPLICATION
SECTION A. CUSTOMER INFORMATION (please print)
Account Name Doing Business As (if different from Account Name)
Installation Address City State Zip Code
Mailing Address (if different from above) (rebate check will be mailed here) City State Zip Code
Account Number
o
Send us a rebate check.
o
Apply rebate to our account.
(Rebates $75 and under will be applied to your account. If a box is not checked a bill credit will automatically be issued.)
Type of Business:
o
Church
o
Government
o
Grocery
o
Health
o
Industrial
o
Lodging
o
Multi-family
o
Office
o
Restaurant
o
Retail
o
School
o
Other___________________________
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_________________________
SECTION B. CONTACT INFORMATION (please print)/CUSTOMER SIGNATURE
ATTENTION:
ALL INVOICES OR RECEIPTS AND ALL SPECIFICATION SHEETS MUST BE INCLUDED WITH
YOUR FULLY-COMPLETED AND SIGNED APPLICATION OR APPLICATION WILL BE RETURNED.
( )
Contact Name (rebate check will be mailed to contact) Daytime Phone Number
Email
I certify that all the information in the application (including any associated worksheets) is correct to the best of my knowledge. I have read and
agree to the Terms and Conditions on the back of this application booklet. I understand that if any equipment in conjunction with this application
is
ordered, purchased, or installed before approval from The Utility is received, the proposed project may not qualify for a rebate.
Customer’s Signature Date
o
Check here if you DO NOT give us permission to use your business name in advertising our CONSERVE & SAVE
®
programs.
SECTION C. CONTRACTOR/VENDOR INFORMATION (please print)
Company Name
Address City State Zip Code
( )
Contact Name Daytime Phone Number
Email
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OFFICE USE ONLY Date Received:____________________
Inspected (Date & Initials): Pre:__________________ Post:___________________
Approval & Date:_____________________________________
Internal Account Number:_____________________________
TOTAL REBATE:
$
MN
MN
MN
MS
click to sign
signature
click to edit
FOLLOW-UP LEAK SURVEY INFORMATION REBATE
H I J K L M N
Who Performed Date Performed Number of % of Leaks Repaired CFM Reduction Rebate per Total
Leak Survey? (repairs & follow-up Leaks (J ÷ G) from Compressor HP Rebate
(check one) within 60 days of “F”) Repaired (must be minimum of 50%) Repaired Leaks (Table 3) (C x M)
o Self o Contractor
SECTION D. REBATE INFORMATION
Project Restrictions: – Leak surveys must be conducted with an ultrasonic leak detector.
– Initial and follow-up survey results must be included with rebate form.
– Follow-up survey must be completed within six months of the initial leak survey.
– The follow-up survey must document that at least 50% of the leaks have been repaired.
SECTION E.TERMS AND CONDITIONS
1. ELIGIBILITY
Rebates are available to non-residential electric customers of Austin Utilities, Owatonna Public Utilities, and Rochester Public Utilities (herein referred to as The
Utility). All products must be in use in facilities in The Utility service territory.
2. APPLICATION
Program is offered January 1 through December 31 of the respective calendar year. Due to limited funding, this rebate offer can be changed or withdrawn
at any time without notice and is available on a first-come, first-serve basis. The entire rebate application must be read and filled out completely or
application will be returned.
3. INSPECTION AND VERIFICATION
The Utility reserves the right to inspect the customer’s facility through on-site visits before and after leak repairs to verify rebate eligibility. The Utility reminds you to
follow all local permitting and building code ordinances.
4. INVOICE AND PAYMENT
When leak repairs are completed, the customer must submit leak surveys with the dates they were conducted and the results. The follow-up survey must be
completed within six months of the initial leak survey. After satisfactory review of the application and surveys, a rebate check or bill credit will be issued to the
customer. Vendors or contractors are not eligible to receive their customer’s rebate. Please allow 6-10 weeks from the date of application submission for delivery
of rebate check or bill credit. The Utility reserves the right to apply the rebate to past due accounts.
5. EQUIPMENT AND REBATE ELIGIBILITY REQUIREMENTS
Customers are eligible to receive a rebate for repairing compressed air leaks if they meet the following requirements:
a) Customers must have a total of at least 10 horsepower of air compressors (excluding backup units) that operate at least 2,000 hours per year.
b) Customers must document and verify they have repaired at least 50% of the compressed air leaks identified during their leak survey.
c) Customers must complete repairs and perform follow-up leak survey within 60 days of initial survey.
A rebate will not be paid more than once per year for repairing the same leak.
6. TAX INFORMATION
The Utility will not be responsible for any tax liability imposed as a result of the rebate payment(s). Customers are advised to consult their tax advisors for details.
7. DISCLAIMER
The Utility does not guarantee that the implementation of energy-efficient measures or use of the equipment purchased or installed pursuant to this program
will result in energy or cost savings. The Utility makes no warranties, expressed or implied, with respect to any equipment purchased or installed including, but
not limited to, any warrant of merchantability or fitness for purpose. In no event shall The Utility be liable for any incidental or consequential damages.
Customers are solely responsible for the proper disposal of existing equipment. Consult the Minnesota Pollution Control Agency (MPCA) office for details at
800.657.3864.
8. ENDORSEMENT
The Utility does not endorse any particular vendor, manufacturer, product, or system in promoting this rebate program. Listing a vendor or product does not
constitute an endorsement, nor does it imply that unlisted vendors or products are deficient or defective in any way.
9. PRIVACY
Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners and also may be used in our
advertising efforts with your permission as granted in Section B of this rebate application.
RETURN COMPLETED APPLICATION AND REQUIRED DOCUMENTATION TO YOUR UTILITY PROVIDER:
Austin Utilities Owatonna Public Utilities Rochester Public Utilities
Attn: Rebate Processing Attn: Rebate Processing Attn: Rebate Processing
1908 14th St NE PO Box 800 4000 E River Rd NE
Austin, MN 55912-4904 Owatonna, MN 55060 Rochester, MN 55906-2813
507.433.8886 507.451.2480 507.280.1500
www.austinutilities.com www.owatonnautilities.com www.rpu.org
PLEASE PRINT ON RECYCLED PAPER 1218
AIR COMPRESSOR INFORMATION INITIAL LEAK SURVEY INFORMATION
A B C D E F G
Compressor Type Control Type Total Compressor HP Annual Hours of Who Performed Date Number of
(Enter Code (Enter Code (excluding backups) Compressor Operation Leak Survey? Performed Leaks
from Table 1) from Table 2) (minimum 10 HP total) (minimum 2,000) (check one) Identified
o Self o Contractor
TABLE 3 (use value in Column K to determine rebate)
Description Rebate per HP
At least 50% of leaks repaired
$4
A
t least 60% of leaks repaired
$5
A
t least 70% of leaks repaired
$6
At least 80% of leaks repaired
$7
At least 90% of leaks repaired
$8
100% of leaks repaired
$9
TABLE 1
Code Compressor Type
SA Single-Acting Reciprocating Air Compressor
D
A
D
ouble-Acting Reciprocating Air Compressor
L
I
L
ubricant-Injected Rotary Screw Compressor
LF Lubricant-Free Rotary Screw Compressor
C Centrifugal Compressor
TABLE 2
Code Control Type
IVM Inlet Valve Modulated
V
D
V
ariable Displacement
V
SD
V
ariable Speed Drive