Fillable COMMERCIAL WATER SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL WATER SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities)

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COMMERCIAL WATER SOURCE HEAT PUMPS 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
TEAMING UP TO SAVE YOU MONEYTTETEATEAMTEAMITEAMINTEAMINGTEAMING TEAMING UTEAMING UPTEAMING UP TEAMING UP TTEAMING UP TOTEAMING UP TO TEAMING UP TO STEAMING UP TO SATEAMING UP TO SAVTEAMING UP TO SAV ETEAMING UP TO SAV E TEAMING UP TO SAVE YTEAMING UP TO SAVE YOTEAMING UP TO SAVE YOUTEAMING UP TO SAVE YOU TEAMING UP TO SAVE YOU MTEAMING UP TO SAVE YOU MOTEAMING UP TO SAVE YOU MONTEAMING UP TO SAVE YOU MONETEAMING UP TO SAVE YOU MONEY
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
TABLE 1 – Existing Cooling Equipment Types
Code Equipment Description
UT-1 Rooftop/Packages AC: Less than or equal to 65,000 BTU/hour (5.4 Tons)
UT-2 Rooftop/Packages AC: 65,001 – 134,999 BTU/hour (5.4 – 11.2 Tons)
UT-3 Rooftop/Packages AC: 135,000 – 239,999 BTU/hour (11.2 – 20 Tons)
UT-4 Rooftop/Packages AC: 240,000 – 759,999 BTU/hour (20 – 63.3 Tons)
UT-4 Rooftop/Packages AC: 760,000 BTU/hour and greater (63.3+ Tons)
PTAC Packaged Terminal Units (all sizes)
PTHP Packaged Terminal Heat Pump Units (all sizes)
*Efficiency Ratings by AHRI (www.ahridirectory.org):
AFUE = Annual Fuel Usage Efficiency
COP = Coefficient of Performance
EER = Energy Efficiency Rating (low speed)
HSPF = Heating Seasonal Performance Factor
SEER = Seasonal Energy Efficiency Rating
SECTION D. REBATE INFORMATION – WATER SOURCE HEAT PUMPS
Project Type:
o
RETROFIT
o
NEW CONSTRUCTION
EXISTING (OLD) SYSTEM (if applicable):
COOLING HEATING
Code Size of Unit Rated Efficiency Equipment Type Rated Input Rated Efficiency
(Table 1) (Tons) (enter value, then check (Furnace, Boiler, etc.) (BTU’s) (enter value, then check
SEER* or EER*) HSPF* or AFUE*)
1.
o SEER o HSPF
o EER o AFUE
2.
o SEER o HSPF
o EER o AFUE
3.
o SEER o HSPF
o EER o AFUE
4.
o SEER o HSPF
o EER o AFUE
5.
o SEER o HSPF
o EER o AFUE
6.
o SEER o HSPF
o EER o AFUE
7.
o SEER o HSPF
o EER o AFUE
2
TABLE 2 – Water Source Heat Pumps – Qualifying Efficiencies and Rebate Schedule
Code
Qualifying Equipment
Minimum Base Rebate Efficiency Bonus**
Efficiency ($/Ton) Rebate ($/Ton)
WSHP-1 less than 17,000 BTU/hour 13.2 EER $70 $5
WSHP-2 equal to or greater than 17,000 BTU/hour 13.2 EER $70 $5
**Efficiency Bonus Rebate provides an additional incentive for each 0.1 EER above the Minimum Efficiency.
NEW SYSTEM:
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Code
Manufacturer
Model
Size^
Qty.
Annual
Annual
Minimum
AHRI
Equipment
Base
Base
Eligible
Efficiency
Efficiency
Total
(Table 2)
Name
Number
(Tons)
Cooling
Heating
Efficiency
EER
Cost
Rebate
Rebate
Efficiency
Bonus Rebate
Bonus Rebate
Rebate
Hours
Hours
(Table 2)
Rating*
($/Ton)
(D x E x K)
Bonus
($/Ton)
(M x N)
(L + O)
(Table 3)
(Table 3)
(Table 2)
(I – H)
(Table 2)
x (
D
x E)
x 1
0
1.
$
$70
$
$5
$
$
2.
$
$70
$
$5
$
$
3.
$
$70
$
$5
$
$
4.
$
$70
$
$5
$
$
5.
$
$70
$
$5
$
$
6.
$
$70
$
$5
$
$
TOTAL REBATE AMOUNT
$
3
*
Ef
f
i
ci
ency
R
ati
ngs
b
y
AHR
I
(www.
ahri
d
i
rectory.
org):
SEER
=
Seas
on
al
En
ergy Ef
f
i
ci
en
cy R
at
i
n
g; EER
=
En
ergy Ef
f
i
ci
en
cy R
at
i
n
g
^
Cool
i
ng
Tons
=
B
T
U/
h
our
c
ool
i
n
g
c
apac
i
ty
÷
12,000
Q
ual
i
f
yi
ng
W
ater
Source
Heat
Pum
p
e
f
fic
ie
n
c
y
ratin
gs
are
de
te
rm
in
e
d
us
i
n
g
th
e
A
i
r
Con
diti
on
in
g,
H
e
ati
n
g,
an
d
Re
frige
ration
In
s
titute
’s
(A
H
RI)
dire
c
t
ory,
w
h
ic
h
m
a
y
b
e
foun
d
at
w
w
w.ah
ri
di
re
c
t
ory.org.
EER
ratin
g
i
s
at
A
H
RI/
ISO
1
3256-1
c
ool
in
g
c
on
di
ti
on
s
of
86˚
F
e
n
te
rin
g
wate
r
te
m
pe
rature
an
d
80.6˚
F
dry
b
ul
b
/
66.2˚
F
we
t
b
ul
b
e
n
te
rin
g
air
te
m
pe
rature
(wate
r
l
oop
h
e
at
pum
p).
A
copy
of
the
m
anuf
acturer’s
appl
i
cab
l
e uni
t
rati
ng
m
ust
accom
pany
thi
s
appl
i
cati
on.
TABLE 3 – GUIDELINES FOR COOLING AND HEATING HOURS
Business Type Cooling Hours Heating Hours
Convenience Store 986 1,546
Education – Community College 785 1,616
Education – Primary 408 1,916
Education – Secondary 563 2,098
Health/Medical – Clinic 865 1,830
Health/Medical – Hospital 1,298 2,054
Lodging 754 1,934
Manufacturing 589 1,144
Office – Low Rise 446 1,610
Office – Mid Rise 651 1,793
Office – High Rise 1,263 1,760
Other/Miscellaneous 729 1,739
Restaurant 652 1,530
Retail – Large Department Store 686 1,444
Retail – Strip Mall 574 1,393
Warehouse 409 1,533
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 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. EQUIPMENT ELIGIBILITY REQUIREMENTS
Equipment must be new. Eligible high-efficiency heat pumps must meet or exceed The Utility’s minimum efficiency requirements
as identified in Tables 2, 4, and 6 according to its qualifying equipment description/category.
Qualifying water source heat pump efficiency ratings are determined using the Air Conditioning, Heating, and Refrigeration
Institute’s (AHRI) directory, which may be found at www.ahridirectory.org. Efficiency rating (EER) is at AHRI/ISO 13256-1 cooling
conditions. A copy of the manufacturer’s applicable unit rating must accompany this application. Eligible water source heat
pumps must replace cooling equipment of lesser efficiencies and of equivalent or greater cooling capacity (Tons or BUT/hour)
to qualify for a rebate.
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
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COMMERCIAL WATER SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities)

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