Fillable COMMERCIAL STEAM TRAP REPLACEMENT REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL STEAM TRAP REPLACEMENT REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL STEAM TRAP REPLACEMENT 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
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.
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
NO MINIMUM EFFICIENCY REQUIREMENTS
REBATE: 35% OF REPAIR/REPLACEMENT STEAM TRAP EQUIPMENT COST; STEAM TRAP SURVEY REQUIRED
Project Type:
o
NEW CONSTRUCTION
o
RETROFIT
NEW EQUIPMENT REBATE
A B C D E F G H I J K L
Qty. Manufacturer Model Steam Trap Steam Trap Boiler Operating Boiler Trap Equipment Unit Equipment Cost Rebate Total
Name Number Pipe Size Orifice Diameter Steam Pressure Efficiency Type** Input Rating (excluding Amount Rebate
(inches) (inches) (PSIG*) Rating (%) (check one) (MBtuh) taxes & labor) (J x .35) (A X K)
1. o F&T o Bucket
2. o F&T o Bucket
*Enter the typical operating steam pressure at the trap. This is often less than the maximum rated pressure of the trap or boiler.
**Orifice-only traps do not qualify for a rebate.
5. 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
PLEASE PRINT ON RECYCLED PAPER 0121
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COMMERCIAL STEAM TRAP REPLACEMENT REBATE APPLICATION (Owatonna Public Utilities)

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Completed 8 June 2021

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