Fillable Form 2021: Residential central air conditioning & central (Mass Save)

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Form 2021: Residential central air conditioning & central (Mass Save)

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2021
Residential central air
conditioning & central
heat pump rebate form
WE ARE MASS SAVE®:
WE ARE MASS SAVE®:
2021 residential central A/C & central heat pump rebates
Save with rebates on central A/C & central heat pump equipment purchased and installed between January 1, 2021 and
December 31, 2021.
Rebate not to exceed purchase price. Limit three (3) rebates per electric meter.
STANDARD CENTRAL A/C & CENTRAL HEAT PUMP
Equipment Type Efficiency Requirements Rebate Amount
1
Central Air Conditioning AHRI SEER ≥ 16, EER ≥ 13 $50 per ton
Central Heat Pump Refer to Heat Pump Qualified Products List at MassSave.com/HPQPL $250 per ton
FUEL OPTIMIZATION REBATES
Equipment Type
Efficiency
Requirements
Primary Fuel Type
Additional
Requirements
Rebate Amount
1
Central Heat Pump
Refer to Heat
Pump Qualified
Products List at
MassSave.com/HPQPL
Oil or Propane
Integrated Controls
2
required unless
central heating system is removed.
3
Refer to
Integrated Controls Qualified Products List at
MassSave.com/ICQPL
Electric Resistance
Heat
900 kWh dierence between sum of 3
winter-usage and 3 lowest-usage months
$1,250 per ton
Integrated
Controls
2
Add-on to existing
central heat pump
Oil or Propane
Refer to Integrated Controls Qualified
Products List at MassSave.com/ICQPL
Up to $500 per
indoor unit, max
of $1,500
1
Actual tons are calculated based on AHRI cooling capacity divided by 12,000 BTUs. Rebate amount based on actual tons.
2
Integrated Controls are either approved control packages or dual fuel thermostats that switch between a heat pump and a central heating system.
3
The Sponsors of Mass Save® do not recommend fully replacing existing central heating systems with heat pump equipment. Customers that choose to do so may access the Fuel Optimization
incentive levels without the installation of an integrated control.
Please see Terms & Conditions for full requirements. Cannot be combined with other rebate for same equipment.
INTEGRATED CONTROLS
Integrated Controls are either approved control packages or dual fuel thermostats designed to automatically switch
between a heat pump and a conventional heating system at a pre-set temperature, creating a more ecient way to heat a
home. As each home’s heating need is unique, work closely with your contractor to determine whether Integrated Controls
are a good fit.
NEXT STEPS
1. Work with a licensed HVAC professional to determine which equipment is right for your home.
Before installation, consider the following:
Did you work with a measureQuick Trained Contractor?
measureQuick Trained Contractors make sure equipment is installed to manufacturer specifications.
Systems that are properly installed work at peak eciency, increasing the comfort and savings in your home.
Visit MassSave.com/FindaContractor to find a measureQuick Trained Contractor. For more information,
visit MassSave.com/CentralAC
2. Interested in 0% financing?
Apply for a Mass Save HEAT Loan prior to installing your equipment. Learn more at MassSave.com/HEATLoan
3. Oers valid only for residential electric customers in MA where the Mass Save Electric Heating and Cooling
Program is oered by Cape Light Compact, Eversource, National Grid and Unitil.
4. Upon completion of installation, apply for a rebate by submitting all required documentation online at
MassSave.com/Rebates or by mail to Mass Save Residential Heating & Cooling Program, P.O. Box 2528,
Manchester, CT 06045
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
❍ ❍
❍
❍ ❍ ❍
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FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
2021 residential central A/C & central heat pump rebate form
1. To receive your rebate faster, submit online at MassSave.com/Rebates
2. By mail, send all required documentation to Mass Save Residential Heating & Cooling Program, P.O. Box 2528, Manchester, CT 06045
REQUIRED DOCUMENTS*
1. *Completed and signed application. 2. *Copy of your most recent electric utility bill. 3. *Contractor’s invoice including:
*Equipment Make *Coil and Condenser Model Numbers *Size in Tons *Installation Date and Address *Total Install Cost and Proof of Payment
*Contractor Information Fuel Optimization rebates only: *A copy of your most recent oil or propane bill, or additional electric bills for electric resistance
displacement customers
*Required Fields/Documents
CUSTOMER INFORMATION (FILL CIRCLES COMPLETELY)
Residential Electric Utility or Energy Eciency Provider:* Cape Light Compact Eversource National Grid Unitil
Account Holder Name:*
Electric Account Number:* Is this property primarily occupied by the owner or a renter? Owner Renter
Installation Address:
(must match the residential electric account address)
* City:* State:*
MA
ZIP Code:*
Phone Number: Email:
Customer Signature: Date:
I certify that all information is correct to the best of my knowledge and that I adhere to all terms and conditions of this rebate.
MAILING ADDRESS FOR REBATE (IF DIFFERENT FROM ABOVE)
Payee Name: Phone Number: Email:
Address: City: State: ZIP Code:
NEW EQUIPMENT INSTALLED
(ALL SURVEY QUESTIONS AND FIELDS MUST BE FILLED OUT)
Pre-Existing Heating Fuel Type: Electric Resistance Heat Oil Propane Gas None
Standard Central A/C & Central HP Equipment Installed (CANNOT APPLY FOR MULTIPLE REBATE OFFERS FOR SAME EQUIPMENT INSTALLATION)
Rebate Type Rebate Amt.
Install
Date
AHRI
Reference #
Integrated Control Model Number(s)
(not applicable for standard rebates, electric heat or
full oil/propane displacement)
# of Tons
(1 Ton =
12,000 BTUs)
Customer
Rebate
(Rebate Amt. x
# of Tons)
Standard Central A/C
$50 per ton
n/a
Standard Central HP
$250 per ton
n/a
Standard Central HP
$250 per ton
n/a
Fuel Optimization Central HP
$1250 per ton
Fuel Optimization Central HP
$1250 per ton
I have elected to remove my oil or propane
central heating system.
Type of equipment removed: Forced hot water or steam system Forced hot air system
Yes No
Note: The Sponsors of Mass Save do not recommend fully displacing existing central heating system with heat pump equipment.
Integrated Controls
(ADD-ON TO EXISTING HEAT PUMP INSTALLATION)
Fuel Type
Integrated Control Model Number(s)
(Not applicable for electric heat or full displacement)
Install Date
# of Indoor Units
(3 unit max)
Customer
Rebate
Oil Propane
$
Oil Propane
$
CONTRACTOR INFORMATION
Note: All contractor information contained in this section is required on the contractor’s invoice.
Company Name:* Contact Person:*
City:* State:* ZIP Code:*
Phone Number:* Email:*
Please allow 6–8 weeks for processing. For more information, to confirm eligibility or to check the status of your rebate,
call
800-232-0672 or email ask@efi.org
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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click to sign
signature
click to edit
TERMS AND CONDITIONS
Equipment Requirements
All rebated central air conditioning (A/C) units/systems or heat pumps must
be qualified, listed with and certified by the Air Conditioning, Heating, and
Refrigeration Institute (AHRI), and meet the program SEER, EER and HSPF
requirements (where applicable). The condenser and the evaporator coil
must be new and replaced together. The condenser and coil are separate
components in a split A/C or heat pump system but, for rebate purposes, are
considered one unit. All units must have a thermostatic expansion valve (TXV)
or electronic expansion valve (EXV) to qualify for rebate.
SEER, EER (where applicable) and HSPF ratings (for heat pumps only) for
condenser, evaporator and air handler (if applicable) must be provided. Both
the Consortium for Energy Eciency (ceehvacdirectory.org) and the AHRI
directory (ahridirectory.org or call 703-600-0384) websites list SEER and EER
values. AHRI also provides AHRI numbers. For a qualified products list for
integrated controls, refer to MassSave.com/ICQPL. AHRI, SEER and EER rating
of outdoor condenser and indoor coil working together. One ton is equal to
12,000 BTUs. Rounding up of SEER, EER or HSPF ratings is not acceptable.
General Requirements
Application Form: This application must be filled out completely, truthfully,
and accurately. The customer must date and submit the completed application
along with all required documentation for specific rebates and/or incentives. By
submitting the rebate application, the customer agrees to abide by these Terms
and Conditions.
Time Limit: Qualifying units for equipment rebate must be purchased and
installed between January 1, 2021 and December 31, 2021. Applications must be
postmarked by January 31, 2022. Program is subject to change without prior
notice, including rebates and incentive levels.
Payments: From the time the application is processed and approved,
please allow 6–8 weeks for payment. Payment processing will take longer
if information or documentation is missing from the application. If payee
information is dierent from account holder information and the electric utility
provider is National Grid, additional processing time will be needed for payee
verification.
Geographic Requirements:
Oers valid only for residential electric
customers in MA where the Mass Save Electric Heating and Cooling
Program is oered by Cape Light Compact, Eversource, National Grid and
Unitil.
Rebate Limitations: This rebate may not be combined with any other utility or
energy eciency service provider oer for the same equipment. The limitation
does not apply to the HEAT Loan financing program. Other, non-Mass Save
rebates or incentives may also be used. Rebate amount not to exceed the
cost of equipment (excluding sales tax and all installation costs) and may be
subject to change without notice. Equipment installed in new construction is
not eligible if incentives have already been received through Renovations &
Additions or Residential New Construction.
Proof of Purchase: A copy of the customer’s invoice itemizing the purchased
equipment must accompany each rebate application form. The invoice must
indicate the equipment make, coil and condenser model numbers, size in tons,
installation date and address, total install cost and proof of payment.
Contractor Certification: Contractor certifies that installation and services
performed have been in accordance with all applicable municipal, state and
federal codes, standards and regulations, as well as program requirements
pertaining to the installed system.
Approval and Verification: The participating utility or energy eciency service
provider reserves the right to conduct field inspections to verify installations.
Tax Liability: Sponsors will not be responsible for any tax liability that may be
imposed on the customer or contractor as a result of the payment of rebates.
Endorsement: Sponsors do not endorse any particular manufacturer, product,
system design, or technology in promoting these oers.
Limitation of Liability: Sponsors and their rebate administrator’s liability is
limited to paying the rebate and incentive specified. Sponsors and their rebate
administrator are not liable for any consequential or incidental damages or for
any damages in tort connected with or resulting from participation in these
oers.
Warranties: SPONSORS DO NOT WARRANT THE PERFORMANCE OF
INSTALLED OR SERVICED EQUIPMENT, EXPRESSLY OR IMPLICITLY. Program
sponsors make no warranties or representations of any kind, whether
statutory, expressed, or implied, including, without limitations, warranties or
merchantability or fitness for a particular purpose regarding the equipment or
services provided by a manufacturer or vendor. Contact your contractor for
details regarding equipment performance and warranties.
Electric Benefits: Other than the energy cost savings realized by customer, the
program administrator is entitled to 100% of the benefits and rights associated
with the energy-ecient measures, including without limitation ISO-NE
products and all other attributes, credits or products associated therewith
under any regional initiative or federal, state or local law, program or regulation
or program, and customer waives, and agrees not to seek, any right to the
same.
Electric Resistance Heat Replacement Adder: To be eligible, customer
must show that electric resistance was used to heat their home all winter by
submitting an electric bill that shows a 900 kWh dierence between the sum of
the three winter-usage (Dec, Jan, Feb) and three lowest-usage months.
WE ARE MASS SAVE®:
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
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Completed 22 July 2021

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