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COMMERCIAL LIGHTING 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 Contact Name
Address City State Zip Code
( )
Daytime Phone Number Email
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
SECTION D. REBATE INFORMATION: LIGHTING EQUIPMENT
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
O L D S Y S T E M N E W S Y S T E M R E B A T E
A B C D E F G H I J K L M
Old Old Qty. New New Equipment LED or CFL Qty. Annual Is This Space Total Rebate Total Rebate
Equipment Equipment Equipment Manufacturer and Bulb/Fixture Hours of Space Type Equipment Cost Amount Amount
Code* Description Code* Model Number Wattage
Operation
#
Air (not including labor) per (G x L)
(if applicable) Conditioned? (Unit Cost x G) Equipment*
o Interior
1. o Yes o No o Exterior $ $ $
o Exterior 24/7
o Interior
2. o Yes o No o Exterior $ $ $
o Exterior 24/7
o Interior
3. o Yes o No o Exterior $ $ $
o Exterior 24/7
o Interior
4. o Yes o No o Exterior $ $ $
o Exterior 24/7
o Interior
5. o Yes o No o Exterior $ $ $
o Exterior 24/7
o Interior
6. o Yes o No o Exterior $ $ $
o Exterior 24/7
o Interior
7. o Yes o No o Exterior $ $ $
o Exterior 24/7
LIGHTING EQUIPMENT SUBTOTAL $
2
*For equipment codes and rebate amounts, please see the Tables included with this application or visit our web site
as listed on the back of this application. If using codes 1516–1531, include manufacturer and model # in column E.
Building Type Hours
24-Hour Facility 8,766
Exterior Lighting 4,903
Grocery/Supermarket 5,802
Health 5,095
Hospital 6,038
Hotel/Motel 3,044
Manufacturing 5,200
Office 4,439
Building Type Hours
Other/Miscellaneous 4,576
Restaurant 3,673
Retail 4,719
Safety or Code Required 8,766
School – College 3,540
School – Elementary 2,422
School – Secondary 4,311
Warehouse 4,746
TOTAL LABOR COST FOR
ALL LIGHTING IMPROVEMENTS
This is the total labor cost for installation of ALL
equipment listed on pages 2 and 3 Lighting
Equipment, LED Lighting in Enclosed Refrigerated
Display Cases, Occupancy Sensors, and Photocells.
$
#
Guidelines for Annual Hours of Operation if Actual Hours are Unknown:
SECTION E. REBATE INFORMATION: LED LIGHTING IN ENCLOSED REFRIGERATED DISPLAY CASES
Project Type:
o
NEW CASE
o
RETROFIT
C A S E I N F O R M AT I O N EXISTING LIGHTING L E D L I G H T I N G R E B AT E
A B C D E F G H I J K
Case Manufacturer/ Case Door Code Qty. Code LED Wattage Qty. Annual Total Equipment Cost Rebate Total Rebate
Description Quantity
(from Lighting (from Lighting per Strip Hours of (excluding labor) Amount Amount
(ex. “Zero Zone – pizza case #1”) (converted to LED) Tables)* Tables)* (watts) Operation
#
(Unit Cost x G) per Door* (B x J)
1. $ $ $
2. $ $ $
3. $ $ $
LED LIGHTING IN ENCLOSED REFRIGERATED
DISPLAY CASES SUBTOTAL
$
3
* For equipment codes and rebate
amounts, please see the Tables
included with this application
or visit our web site as listed
on the back of this application.
TOTAL LABOR COST FOR
ALL LIGHTING IMPROVEMENTS
This is the total labor cost for installation of ALL
equipment listed on pages 2 and 3 Lighting
Equipment, LED Lighting in Enclosed Refrigerated
Display Cases, Occupancy Sensors, and Photocells.
$
**Guidelines for % of Time Lights Are Off if Actual Hours are Unknown:
Sensor Type % of Time Lights Are Off
Occupancy Sensor – Wall Mount 30%
Occupancy Sensor – Ceiling Mount 30%
Photocell – Continuous Dimming 43%
Photocell – Multiple Step Dimming 35%
Photocell – On/Off 27%
SECTION F. REBATE INFORMATION: OCCUPANCY SENSORS/PHOTOCELLS
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
C O N T R O L L E D E Q U I P M E N T O C C U P A N C Y S E N S O R S / P H O T O C E L L S R E B A T E
A B C D E F G H I J K L M
Equipment Controlled Avg. Fixture Low-Wattage Qty. Controlled Annual Equipment Sensor/ Qty. Is This % of Time Total Cost Rebate Amount Total Rebate
Code* Equipment Wattage Fluorescent Lamps? by Sensors/ Hours of Code* Photocell Space Lights of Sensors/ per Sensor/ Amount
Description
(total wattage/
(if applicable) Photocells
Operation
#
Description Air Conditioned? Are Off** Photocells Photocell* (I x M)
# of fixtures)
1. o Yes o No o Yes o No $ $ $
2. o Yes o No o Yes o No $ $ $
3. o Yes o No o Yes o No $ $ $
4. o Yes o No o Yes o No $ $ $
OCCUPANCY SENSORS/PHOTOCELLS SUBTOTAL $
* For equipment codes and rebate amounts,
please see the Tables included with this
application or visit our web site as listed
on the back of this application.
#
Guidelines for
Annual Hours of Operation
If Actual Hours Are Unknown:
Building Type Hours
Food Service 6,205
4
SECTION G. 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. Rebates are for installed equipment only extra bulbs/ballasts are NOT
eligible. For lighting retrofit systems to be eligible, they must show a net reduction in kWh usage from that of the existing lighting system.
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 the purchase price of the equipment. The maximum rebate
amount is $100,000 per customer location per technology per year.
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. 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.
6. QUALIFYING EQUIPMENT
Ballasts:
To be eligible for a rebate, ballasts must meet the following requirements: 1) power factor greater than 90%, 2) U.L. approved, 3) class "A" sound ratings, 4)
total harmonic distortion (THD) less than 20%, 5) warranted by the manufacturer for three (3) years. The Utility reserves the right to require documentation
from a certified testing laboratory verifying ballast qualifications.
Reflectors:
To qualify as a reflector, white or specular metal reflectors must have a minimum reflectivity rating of 90%.
LED Lighting in Enclosed Refrigerated Display Cases:
Applicable to low and medium temperature enclosed display cases with access by customers (open display cases and closed rear-entry deli cases excluded
from this prescriptive program).
For existing case lighting replacement, LED lighting system must replace a fluorescent lighting system and the existing fluorescent fixture end connectors
and ballasts must be permanently removed and properly disposed of.
• For new cases, LED lighting system must be installed in lieu of a fluorescent lighting system.
• LED lighting system must be a permanently installed luminaire.
• LED lighting system color rendering index (CRI) must be equal to or greater than 70.
• LEDs must maintain no less than 70% of initial lumen output at 50,000 hours of operation.
• Manufacturer’s warranty must be a minimum of 3 years and must include luminaires, mounting hardware, power supplies, and LEDs.
• The power supply must meet the following requirements:
– Efficiency of at least 85% at 120 volts.
– Power factor of at least 0.9.
– Total harmonic distortion (THD) of 20% or less.
Exit Signs:
Only new exit signs that replace incandescent or CFL exit signs qualify. All new exit signs must meet UL-924 requirements. Exit signs must have a usage level
less than 5 watts. New exit signs must meet local fire codes. Retrofit kits are not eligible.
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 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