Fillable Form 2021: Residential geothermal heat pump rebate form (Mass Save)

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Form 2021: Residential geothermal heat pump rebate form (Mass Save)

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Residential geothermal
heat pump rebate form
2021
WE ARE MASS SAVE®:
ENERGY STAR
®
CERTIFIED GEOTHERMAL HEAT PUMP
Equipment Type
Product Type
Efficiency
Requirements
2
Primary
Fuel Type
Rebate
Amount
3
EER COP
Geothermal (Water-to-Air)
Closed Loop Water-to-Air 17.1 3.6
Oil or
Propane
$2,000
per ton
Open Loop Water-to-Air 21.1 4.1
Geothermal (Water-to-Water)
Closed Loop Water-to-Water 16.1 3.1
Open Loop Water-to-Water 20.1 3.5
Geothermal (DGX) DGX 16 3.6
Models must meet or exceed the energy eciency ratio (EER) and coecient of performance (COP) values in the tables above.
Actual tons are calculated based on AHRI cooling capacity divided by 12,000 BTUs. Rebate amount based on actual tons.
2
ENERGY STAR certified specifications and products can be found on the ENERGY STAR website, here:
https://www.energystar.gov/products/heating_cooling/heat_pumps_geothermal
3
Rebate for Geothermal Heat Pump not to exceed $15,000.
The outdoor installation configuration of (WLHP), (GLHP), or (GWHP) must be noted on the Contractor Invoice. Please note the
type clearly using the AHRI definition below.
Water-loop Heat Pump Application (WLHP). A WSHP using liquid circulating in a common piping loop and functions as a heat
source/heat sink. The temperature of the water is usually mechanically controlled within a temperature range of 15°C [59°F] to
40°C [104°F].
Ground-loop Heat Pump Application (GLHP). A Water Source Heat Pump (WSHP) using a liquid circulating through a
subsurface piping loop placed in horizontal trenches, vertical bores, or submerged in a body of surface water. The temperature
of the liquid is related to the climatic conditions and may vary from –5°C [23°F] to 40°C [104°F].
Ground-water Heat Pump Application (GWHP). A WSHP using water pumped from a well, body of surface water, or reclaimed
water supply. The temperature of the water is related to the climatic conditions and may vary from 5°C [41°F] to 25°C [77°F] for
deep wells.
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
2021 residential geothermal heat pump rebates
Save with rebates on geothermal heat pump equipment purchased and installed between January 1, 2021 and December 31, 2021.
Rebate not to exceed $15,000.
NEXT STEPS
1. Study up — Find out about license and insurance requirements for contractors in your state. And before you call a contractor, know
the model of your current system and its maintenance history. Also make note of any uncomfortable rooms. This will help potential
contractors better understand your heating needs.
2. Ask for referrals — Ask friends, neighbors and co-workers for contractor referrals. You can also contact local trade organizations for
names of members in your area.
3. Call references — Ask contractors for customer references and call them. Ask about the contractor's installation or service
performance and if the job was completed on time and within budget
4. Interested in 0% financing?
Apply for a Mass Save HEAT Loan prior to installing your equipment. Learn more at MassSave.com/HEATLoan
5. Install a qualifying system at a property with an active residential electric account located in a Cape Light Compact,
Eversource, National Grid or Unitil territory.
6. 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
WE ARE MASS SAVE®:
2021 residential geothermal heat pump rebate form
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
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 ❍: *A copy of your most recent oil or propane bill
*Required Fields/Documents
Residential Electric Utility or Energy Eciency Provider:* Cape Light Compact Eversource National Grid Unitil
Account Holder Name:*
Electric Account Number:* Do you own or rent your home? Own Rent
Installation Address:* City:* State:* ZIP Code:*
(must match the residential electric account address)
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.
CUSTOMER INFORMATION (FILL CIRCLES COMPLETELY)
MA
MAILING ADDRESS FOR REBATE (IF DIFFERENT FROM ABOVE)
Payee Name: Phone Number: Email:
Address: City: State: ZIP Code:
Pre-Existing Heating Fuel Type: Oil Propane
Not valid for New Construction
NEW EQUIPMENT INSTALLED (ALL SURVEY QUESTIONS AND FIELDS MUST BE FILLED OUT)
ENERGY STAR Certified Geothermal Heat Pump Equipment Installed (CANNOT APPLY FOR MULTIPLE REBATE OFFERS FOR SAME EQUIPMENT INSTALLATION)
Rebate Type Rebate Amt.
Install Date
AHRI Certified
Reference Number
# of Tons
(1 Ton =
12,000 BTUs)
Customer
Rebate
(Rebate Amt. x
# of Tons)
Fuel Optimization Geothermal HP
$2,000 per ton
Fuel Optimization Geothermal HP
$2,000 per ton
Type of equipment removed: Forced hot water or steam system Forced hot air system
I have elected to remove my oil or propane
central heating system. Yes No
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
click to sign
signature
click to edit
TERMS AND CONDITIONS
Equipment Requirements
All rebated geothermal heat pumps must be ENERGY STAR certified and
qualified, listed with and certified by the Air Conditioning, Heating, and
Refrigeration Institute (AHRI), and meet the program EER and AHRI outdoor
unit configuration requirements (where applicable).
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 existing residential electric
customers in MA where the Mass Save Heating and Cooling Program is oered
by Cape Light Compact, Eversource, National Grid and Unitil.
Rebate Limitations: This rebate is only available to existing account holders
and is not eligible for New Construction projects. 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.
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, AHRI outdoor unit configuration, 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, t
he 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.
FOR ADDITIONAL INFORMATION, VISIT MASSSAVE.COM/REBATES OR CALL 800-232-0672.
WE ARE MASS SAVE®:
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Completed 22 July 2021

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