Fillable COMMERCIAL HEATING EQUIPMENT REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL HEATING EQUIPMENT REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL HEATING EQUIPMENT REBATE APPLICATION
1. CUSTOMER INFORMATION (please print)
Account Name Account Number
Installation Address City State Zip Code
Mailing Address (if different from installation address) (rebate check will be mailed here) City State Zip Code
Doing Business As (if different from Account Name)
o
Apply rebate to our account. (Rebates $75 and under will be applied to account.)
o
Send us a rebate check.
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_________________________
2. 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.
( )
o
Home
o
Cell
o
Other:
Contact Name (rebate check will be mailed to contact) Contact Phone Number
Email
By typing my first and last names in the box below, I am signing this document and 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 con-
junction 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.
3. CONTRACTOR/VENDOR INFORMATION (please print)
Company Name Contact Name
Address City State Zip Code
( )
Daytime Phone Number Email
OFFICE USE ONLY
Date Received:__________________________________
Inspected (Date & Initials): Pre:_______________________ Post:________________________
Approval:____________________________________________
Date:_______________________________________________
A/N:_________________________________________________
TOTAL REBATE:
$
MN
MN
MN
MS
4. REBATE INFORMATION – COMMERCIAL BOILERS (100,000–12,500,000 Btu)
MINIMUM EFFICIENCY REQUIREMENTS: 85% OR HIGHER THERMAL EFFICIENCY
REBATES: 85% EFFICIENCY: ($170 PER 100,000 BTUH INPUT) + $25 PER 100,000 BTUH INPUT X (NEW EFFICIENCY RATING – 85)
88% EFFICIENCY: ($270 PER 100,000 BTUH INPUT) + $25 PER 100,000 BTUH INPUT X (NEW EFFICIENCY RATING – 88)
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
EXISTING EQUIPMENT
NEW EQUIPMENT REBATE
A B C D E F G H I
Unit Unit Qty. Manufacturer Model Boiler Btuh Equipment Cost Total
Size Efficiency Name Number Efficiency Rating Input (excluding Rebate
(%) taxes & labor) (see calculations above)
1.
$ $
2. $ $
5. REBATE INFORMATION – INDIRECT WATER HEATERS
MINIMUM EFFICIENCY REQUIREMENTS: MUST BE INSTALLED WITH A BOILER THAT HAS AN EFFICIENCY OF GREATER THAN OR EQUAL TO 90%
REBATE: $250
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
INDIRECT WATER HEATER INFORMATION BOILER INFORMATION REBATE
A B C D E F G H I J K
Qty. Manufacturer Model Storage Sq. Ft. Gallons / Applicable Thermal Btuh Unit Total Rebate
Name Number Capacity Served by 1000 sq ft / Days Efficiency Input Rebate Amount
(if applicable) (if applicable) (gallons) Water Heater Day (Table 1) (Table 1) (%) Amount (A x J)
$250 $
TABLE 1: ANNUAL HOT WATER USE DATA
Building Type Applicable Days/Year Gallons /1,000 sq ft/day
Small Office 250 2.3
Large Office 250 2.3
Fast Food Restaurant 365 549.2
Sit-Down Restaurant 365 816.0
Retail 365 2.0
Building Type
continued Applicable Days/Year Gallons /1,000 sq ft/day
Grocery 365 2.2
Warehouse 250 1.0
Elementary School 200 5.7
Jr./High School/College
200 17.1
Health 365 342.0
Building Type
continued Applicable Days/Year Gallons /1,000 sq ft/day
Motel 365 100.0
Hotel 365 30.8
Other Commercial 250 0.7
Industrial Site Specific Site Specific
6. REBATE INFORMATION – INFRARED; UNIT OR DUCT HEATERS
MINIMUM EFFICIENCY REQUIREMENTS: INFRARED: LOW INTENSITY TUBE TYPE
UNIT OR DUCT – NON-CONDENSING: 83% OR GREATER THERMAL EFFICIENCY
UNIT OR DUCT – CONDENSING: 88% OR GREATER THERMAL EFFICIENCY
REBATE: INFRARED: $250
UNIT OR DUCT – NON-CONDENSING: $200 PER UNIT (NOT TO EXCEED 25% OF EQUIPMENT COST)
UNIT OR DUCT – CONDENSING: $300 PER UNIT (NOT TO EXCEED 25% OF EQUIPMENT COST)
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
EXISTING EQUIPMENT
NEW EQUIPMENT REBATE
A B C D E F G H I J
MBtuh Unit Qty. Manufacturer Model Equipment Thermal Equipment Cost Rebate Total
Input Efficiency Name Number Input Rating Efficiency (excluding per Heater Rebate
(MBtuh) Rating (%) taxes & labor) (C x I)
1.
$ $
2. $ $
2
3
10. REBATE INFORMATION – SMART THERMOSTATS
***(FOR THERMOSTATS THAT CONTROL ELECTRIC HEATING USE OUR ELECTRIC HVAC & WATER HEATING EQUIPMENT REBATE APPLICATION.)***
MINIMUM EFFICIENCY REQUIREMENTS: Thermostat must control primary natural gas heating system. If self-installed, original UPC code from box AND invoice must be attached to application form.
REBATE: WIFI ENABLED = $50 (REBATE CANNOT EXCEED THE COST OF THE THERMOSTAT.)
EQUIPMENT REBATE
A B C D E F G
Manufacturer Model Model Number of Units Date of Rebate Total
Name Name Number Installed Installation per Thermostat Rebate
$ $
7. REBATE INFORMATION – COMMERCIAL FURNACES – MUST BE 100,000 BTUH OR GREATER
NEW CONSTRUCTION – MINIMUM EFFICIENCY REQUIREMENTS: AFUE greater than or equal to 95% (AFUE=ANNUAL FUEL USAGE EFFICIENCY)
NEW CONSTRUCTION REBATES (PER 100,000 BTUH): 95% AFUE = $100 | 97% AFUE = $200
RETROFIT – MINIMUM EFFICIENCY REQUIREMENTS: AFUE greater than or equal to 92%
RETROFIT REBATES (PER 100,000 BTUH): 92% AFUE = $100 | 95% AFUE = $300 | 97% AFUE = $400
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
EXISTING EQUIPMENT
NEW EQUIPMENT REBATE
A B C D E F G H I
Unit Unit Qty. Manufacturer Model Rated Btuh Equipment Cost Total
Size Efficiency Name Number Efficiency Input (excluding Rebate
(AFUE %) taxes & labor) (see calculations above)
$ $
8. REBATE INFORMATION – 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 | Motor Wattage = Rated HP x 746^
Project Type:
o
NEW INSTALLATION
o
RETROFIT
NEW EQUIPMENT REBATE
A B C D E F G H I
Circulator Pump ^Size Qty. Manufacturer Model Date of ECM Circulator Cost Rebate Total Rebate
Type (Watts) Name Number Installation (excluding taxes & labor) per Pump (C x H)
o
Boiler
o
Domestic Hot Water $ $ $
9. REBATE INFORMATION – FURNACE FAN MOTORS – RETROFIT ONLY (ELECTRIC REBATE)
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
(AHRI=AIR-CONDITIONING, HEATING, AND REFRIGERATION INSTITUTE – WWW.AHRIDIRECTORY.ORG)
Project Type:
o
NEW FURNACE INSTALLATION
o
RETROFIT
EXISTING EQUIPMENT
NEW EQUIPMENT REBATE
A B C D E F G H I J
MBtuh Unit Qty. Manufacturer Model Equipment Thermal Equipment Cost Rebate Total
Input Efficiency Name Number Input Rating Efficiency (excluding per Motor Rebate
(MBtuh) Rating (%) taxes & labor) (C x I)
$ $ $
10. TERMS AND CONDITIONS
1. ELIGIBILITY
Rebates are available to non-residential natural gas customers of Austin Utilities or Owatonna Public Utilities (herein referred to as The
Utility). All products must be in use in facilities in The Utility service territory. Rebates are for installed
equipment only. Projects that involve
switching from one fuel type to another (fuel switching) are not eligible. Projects where the energy savings result from reduced production,
change in operating hours, or equipment retirement are not eligible
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-served basis. The entire rebate
application must be read and filled out completely or application will be returned. Data contained in the application or attached
materials must be sufficient to verify the costs and the energy savings described in the application
.
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 the purchase price of the
equipment. The maximum rebate amount is $75,000 per customer location per technology per year. The Utility can, at its sole discretion,
increase rebate amounts.
5. INVOICE AND PAYMENT
Following inspection and verification (see #3) and completed
installation, 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. After satisfactory
review of the application and invoices, a rebate check or bill credit will be issued to the customer. 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 rebates to past due accounts.
6. QUALIFYING EQUIPMENT
Eligible equipment must be brand new and must meet or exceed The Utility’s minimum efficiency requirements as identified on this rebate
form. Equipment is required to comply with all applicable codes and industry standards.
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 2 of this rebate application.
RETURN COMPLETED APPLICATION AND REQUIRED DOCUMENTATION TO YOUR UTILITY PROVIDER:
Austin Utilities Owatonna Public Utilities
Attn: Rebate Processing Attn: Rebate Processing
1908 14th Street NE P.O. Box 800
Austin, MN 55912 Owatonna, MN 55060
507-433-8886 507-451-2480
www.austinutilities.com www.owatonnautilities.com
or email: rebates@austinutilities.com or email: rebates@owatonnautilities.com
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COMMERCIAL HEATING EQUIPMENT REBATE APPLICATION (Owatonna Public Utilities)

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Completed 8 June 2021

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