Fillable Simplified Lighting Rebate Form For Small Commercial Customers (Owatonna Public Utilities)

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Simplified Lighting Rebate Form For Small Commercial Customers (Owatonna Public Utilities)

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SECTION A. 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___________________
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.
( )
o
Home
o
Cell
o
Other:
Contact Name (rebate check will be mailed to contact) Contact 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.
Date Received:________________________
Inspected (Date & Initials): Pre:________________________ Post:________________________
Approval & Date:______________________ Internal Account Number:______________________
OFFICE
USE
ONLY
TOTAL
REBATE $
2
SECTION C.
Must include one package for each bulb/fixture type with manufacturer logo, model number, and wattage.
LED BULBS & FIXTURES
To verify DesignLights™ Consortium (DLC) qualified products, go to www.designlights.org. To verify ENERGY STAR
®
qualified products,
REBATE: SEE TABLES ON PAGE 3
go to
www.energystar.gov. Applications that do not include manufacturer and model numbers will be processed as non-DSL/ENERGY STAR
®
qualified.
OLD EQUIPMENT NEW EQUIPMENT
A B C D E F G H I J K L
Old Bulb/ New Bulb/Fixture New Bulb/ New Bulb/ Code Annual Is This Total Rebate per Total
Old Bulb/Fixture
Fixture Manufacturer Fixture Fixture (see Qty. Hours of Space Air Price Bulb/Fixture* Rebate*
Description
Wattage Name Model Number Wattage table) Operation Conditioned? (without tax) (see table) (G x K)
1.
o
YES
$ $ $
o
NO
2.
o
YES
$ $ $
o
NO
3.
o
YES
$ $ $
o
NO
4.
o
YES
$ $ $
o
NO
5.
o
YES
$ $ $
o
NO
* Rebate cannot exceed 50% of the cost of bulb or fixture.
BUSINESS LIGHTING REBATES – LED BULBS & FIXTURES
click to sign
signature
click to edit
LED BULBS:
ENERGY STAR
®
/DESIGNLIGHTS™ CONSORTIUM QUALIFIED
Retrofit New Construction
Description
C
ode
R
ebate
C
ode
R
ebate
Non-Linear:
L
ED BULB: less than 10 watts
1
700
5
0% of cost; $5 max
1
701
5
0% of cost; $5 max
LED BULB: 10 to less than 20 watts
1702
50% of cost; $7 max
1703
50% of cost; $7 max
L
ED BULB: 20 to less than 100 watts
1
560
5
0% of cost; $20 max
1
561
5
0% of cost; $20 max
L
ED BULB: 100 to less than 200 watts
1
562
5
0% of cost; $40 max
1
563
5
0% of cost; $40 max
L
ED BULB: 200 watts or greater
1
564
5
0% of cost; $60 max
1
565
5
0% of cost; $60 max
L
inear:
L
ED BULB: shorter than 46"
1
708
5
0% of cost; $5 max
1
709
5
0% of cost; $5 max
L
ED BULB: 46” or longer
1
710
5
0% of cost; $7 max
1
711
5
0% of cost; $7 max
LED FIXTURES/LUMINAIRES/RETROFIT KITS: NON-
ENERGY STAR
®
/NON-DESIGNLIGHTS™ CONSORTIUM QUALIFIED
Description
Retrofit New Construction
Code Rebate
New Construction lighting
must be DLC or ENERGY STAR
®
rated to qualify for a rebate.
Fluorescent to LED:
LED FIXTURE/LUMINAIRE/RETROFIT KIT: less than 25 watts
1488
50% of cost;
$15 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 25 to less than 50 watts
1490
50% of cost;
$28 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 50 to less than 100 watts
1492
50% of cost;
$44 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 100 to less than 150 watts
1494
50% of cost;
$61 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 150 to less than 200 watts
1496
50% of cost;
$85 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 200 watts or greater
1498
50% of cost;
$109 max
HID, Incandescent, or Halogen to LED:
LED FIXTURE/LUMINAIRE/RETROFIT KIT: less than 25 watts
1540
50% of cost;
$18 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 25 to less than 50 watts
1542
50% of cost;
$55 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 50 to less than 100 watts
1544
50% of cost;
$87 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 100 to less than 150 watts
1546
50% of cost;
$121 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 150 to less than 200 watts
1548
50% of cost;
$169 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 200 watts or greater
1550
50% of cost;
$217 max
3
LED BULBS: NON-ENERGY STAR
®
/NON-DESIGNLIGHTS™ CONSORTIUM QUALIFIED
Retrofit New Construction
Description
Code Rebate
New Construction lighting
must be DLC or ENERGY STAR
®
rated to qualify for a rebate.
Non-Linear:
LED BULB: less than 10 watts
1704
50% of cost; $4 max
LED BULB: 10 to less than 20 watts
1706
50% of cost; $5 max
LED BULB: 20 to less than 100 watts
1594
50% of cost; $15 max
LED BULB: 100 to less than 200 watts
1596
50% of cost; $30 max
LED BULB: 200 watts or greater
1598
50% of cost; $50 max
Linear:
LED BULB: shorter than 46"
1718
50% of cost; $3 max
LED BULB: 46” or longer
1720
50% of cost; $5 max
LED FIXTURES/LUMINAIRES/RETROFIT KITS:
ENERGY STAR
®
/DESIGNLIGHTS™ CONSORTIUM QUALIFIED
Description
R
etrofit
N
ew Construction
C
ode
R
ebate
C
ode
R
ebate
Fluorescent to LED:
LED FIXTURE/LUMINAIRE/RETROFIT KIT: less than 25 watts
1578
50% of cost;
$25
max
1579
50% of cost;
$25
max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 25 to less than 50 watts
1580
50% of cost;
$32
max
1581
50% of cost;
$32
max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 50 to less than 100 watts
1582
50% of cost;
$50
max
1583
50% of cost;
$50
max
L
ED FIXTURE/LUMINAIRE/RETROFIT KIT: 100 to less than 150 watts
1
584
5
0% of cost;
$
70
m
ax
1
585
5
0% of cost;
$
70
m
ax
L
ED FIXTURE/LUMINAIRE/RETROFIT KIT: 150 to less than 200 watts
1
586
5
0% of cost;
$
97
m
ax
1
587
5
0% of cost;
$
97
m
ax
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 200 watts or greater
1588
50% of cost;
$125
max
1589
50% of cost;
$125
max
H
ID, Incandescent, or Halogen to LED:
L
ED FIXTURE/LUMINAIRE/RETROFIT KIT: less than 25 watts
1
520
5
0% of cost;
$
35 max
1
521
5
0% of cost;
$
35 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 25 to less than 50 watts
1522
50% of cost;
$63 max 1523
50% of cost;
$63 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 50 to less than 100 watts
1524
50% of cost;
$100 max 1525
50% of cost;
$100 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 100 to less than 150 watts
1526
50% of cost;
$139 max 1527
50% of cost;
$139 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 150 to less than 200 watts
1528
50% of cost;
$194 max 1529
50% of cost;
$194 max
LED FIXTURE/LUMINAIRE/RETROFIT KIT: 200 watts or greater
1530
50% of cost;
$249 max 1531
50% of cost;
$249 max
ENERGY STAR
®
AND DESIGNLIGHTS
™
CONSORTIUM REBATES
To qualify for ENERGY STAR
®
or DESIGNLIGHTS
™
CONSORTIUM (DLC) rebates you must provide documentation
showing the bulbs or fixtures qualify. DLC qualification must be provided on equipment specification sheets.
NON-ENERGY STAR
®
AND NON-DESIGNLIGHTS
™
CONSORTIUM REBATES
PLEASE PRINT ON RECYCLED PAPER 1219FILL
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SECTION D. TERMS AND CONDITIONS
1
. ELIGIBILITY
Rebates are available to non-residential electric customers of Austin Utilities and 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 –
extra bulbs/fixtures 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-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. Rebates $75 and under will be applied to your account. Recipients must be an electric customer of
Austin Utilities or
Owatonna Public Utilities. All applications from the previous year’s purchases must be received by March 31.
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 rebates to past due accounts.
Thank you for purchasing new energy efficient lighting
and applying for a CONSERVE & SAVE
®
rebate!
When purchasing new lighting continue to look
for the ENERGY STAR
®
and DLC labels.
These products qualify for higher rebates
because they have been tested for performance standards.
Return this completed rebate booklet, sales receipt, and proof of
ENERGY STAR
®
or DLC qualification (if applicable) to your utility.
Austin Utilities Owatonna Public Utilities
Attn: Rebate Processing Attn: Rebate Processing
1908 14th St NE PO Box 800
Austin, MN 55912-4904 Owatonna, MN 55060-0800
507.433.8886 507.451.2480
Talk2AU@austinutilities.com www.owatonnautilities.com
www.austinutilities.com
4
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Simplified Lighting Rebate Form For Small Commercial Customers (Owatonna Public Utilities)

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Completed 8 June 2021

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