Fillable COMMERCIAL HEAT PUMP PROGRAMMABLE THERMOSTATS REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL HEAT PUMP PROGRAMMABLE THERMOSTATS REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL HEAT PUMP PROGRAMMABLE THERMOSTATS 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
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2
TABLE 2 – GUIDELINES FOR COOLING & HEATING HOURS
Business Type Heating Hours
Convenience Store 1,546
Education – Community College 1,616
Education – Primary 1,961
Education – Secondary 2,098
Health/Medical – Clinic 1,830
Health/Medical – Hospital 2,054
Lodging 1,934
Manufacturing 1,144
Office – Low Rise 1,610
Office – Mid Rise 1,793
Office – High Rise 1,760
Other/Miscellaneous 1,739
Restaurant 1,530
Retail – Large Department Store 1,444
Retail – Strip Mall 1,393
Warehouse 1,533
TABLE 1 – REBATE SCHEDULE
Code Installation & Programming
Rebate
PT1-20 By Contractor 50% of cost, up to $50
PT2-20 By Other 50% of cost, up to $50
SECTION D. REBATE INFORMATION – HEAT PUMP PROGRAMMABLE THERMOSTATS
Programmable thermostat must control a heat pump.
Programmable thermostat must replace an existing thermostat to qualify for a rebate (new construction projects are not eligible).
If a Building Automation System is present, it must not be used to control heat pump operation.
1
ASHP = Air Source Heat Pump
GSHP = Ground Source Heat Pump
2
Rebate cannot exceed 50% of the installed cost of the programmable thermostat.
Enter 50% of the Total Installed Cost in this field if applicable.
HEAT PUMP
P ROGRA M M A B L E T H E R M O S TAT
R E B AT E
A
Type of
Heat Pump
Controlled
1
B
Rated
Cooling
Capacity
C
Rated
Heating
Efficiency
D
Installation &
Programming
E
Code
(Table 1)
F
Manufacturer
G
Model
H
Annual
Heating
Hours
(Table 2)
I
Qty
J
Installation
Date
K
Total
Installed
Cost
L
Rebate
2
(
Table 1
)
o
ASHP
o
GSHP
o
___________ TONS
o
UNKNOWN
o
___________ HSPF
o
___________ COP
o
UNKNOWN
o
BY CONTRACTOR
o
BY OTHER
1
$
$
o
ASHP
o
GSHP
o
___________ TONS
o
UNKNOWN
o
___________ HSPF
o
___________ COP
o
UNKNOWN
o
BY CONTRACTOR
o
BY OTHER
1 $ $
o
ASHP
o
GSHP
o
___________ TONS
o
UNKNOWN
o
___________ HSPF
o
___________ COP
o
UNKNOWN
o
BY CONTRACTOR
o
BY OTHER
1 $ $
TOTAL
$
REBATE IS LIMITED TO
50% OF INSTALLED COST, UP TO $50
SECTION E. TERMS AND CONDITIONS
1. ELIGIBILITY
R
ebates 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 new equipment installation
to verify rebate eligibility. The Utility reminds you to follow all local permitting and building code ordinances.
4. INSTALLATION AND REBATE AMOUNTS
Qualifying energy-efficient equipment installed and operational within six (6) months of the date of purchase are eligible for
rebate. Additional time may be granted subject to The Utility’s pre-approval. In no case will the rebate paid by the Utility
exceed 50% of the installed cost of the programmable thermostat.
5. INVOICE AND PAYMENT
When the purchase and installation is completed, the Customer must notify the Utility and submit original invoices specifying
the quantity and price of all materials purchased, the date ordered, installation costs, and applicable taxes. Proof of installation
by a contractor must be included to receive the higher rebate amount shown in the Rebate Schedule. After satisfactory review
of the invoices and on-site verification, a rebate check or bill credit will be issued to the Customer. Please allow 60 days from
the date of on-site inspection for delivery of payment
.
6. EQUIPMENT ELIGIBILITY REQUIREMENTS
Incentive is for the installation of programmable thermostats used to control air source and ground source heat pump operation.
Eligible programmable thermostats must be new. Programmable thermostat must replace an existing thermostat to qualify for
a rebate. New construction installations are not eligible. If a building automation system is present in the building, it must not
be used to control the operation of the heat pump controlled by the new programmable thermostat.
7. 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.
8. 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.
9. 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.
10. 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 55060-0800 Rochester, MN 55906-2813
507.433.8886 507.451.2480 507.280.1500
www.austinutilities.com www.owatonnautilities.com www.rpu.org
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COMMERCIAL HEAT PUMP PROGRAMMABLE THERMOSTATS REBATE APPLICATION (Owatonna Public Utilities)

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Completed 8 June 2021

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