Commercial Refrigeration Rebate Form

Commercial Refrigeration
Rebate Form
Valid July 1, 2016 - December 31, 2016
In this form, you can find rebate
information for:
›› Evaporator Fan
Motors and Controls
›› Door/Frame Heater
Controls
›› Refrigerator & Freezer
Case Light Sensors
›› Refrigerator & Freezer
LED Case Light Fixtures
›› ENERGY STAR®
Ice Machines
How to apply
…… Read the Terms and Conditions to determine if you are eligible
for a rebate.
…… Verify that the product(s) you are going to purchase and install
meet the eligibility requirements listed in the corresponding
product section, or contact us.
…… Purchase and install qualifying product(s) during the rebate
eligibility term (July 1, 2016 to December 31, 2016).
…… Complete and sign the application. If you prefer to submit
online, visit https://rebates.efficiencyvermont.com/refrigeration.
…… Include a copy of your invoice(s) as proof of purchase.
…… Submit completed application form and invoice(s).
›› Display Case
Strip-Curtain &
Continuous Covers
›› Reach-In Refrigerators
& Freezers
Efficiency Vermont and Burlington
Electric Department offer technical
assistance and rebates to help
businesses make cost-effective
improvements. We also partner
with distributors to offer discounted
products in their stores. Please
contact us with any questions or for
additional assistance.
Need help?
For more information or to confirm eligibility,
call 888-921-5990 or email [email protected].
Efficiency Vermont and Burlington Electric Department can help
finance your project at a low rate with no collateral down. Please
call us for more information.
Commercial Refrigeration
Rebate Form
Step 1
Don’t forget to include
a copy of your invoice(s)
Customer Information & Agreement
Business Name:
Contact Name/Title:
Installation Address:
City/Town: State: Zip:
Mailing Address (if different):
City/Town:
State: Zip:
E-mail Address:
Telephone #:
 Check to receive energy-saving offers and updates via e-mail.
Electric Utility Company
Is equipment installed in a new construction building?
If yes, provide building sq. ft.
Electric Utility Account # (of installation location)
 Yes
 No
If over 10,000 sq. ft., call 888-921-5990 (see Terms & Conditions).
I certify that all equipment for which I am requesting a rebate has been installed, that I meet the eligibility requirements of this rebate
program, and that all information submitted as part of this application, including proof of purchase and Federal Tax ID Number, is
correct to the best of my knowledge. I agree to the terms and conditions listed on the back of this form.
CUSTOMER SIGNATURE (required even if rebate is going to vendor)
Step 2
Date
Rebate Payee Information
Rebate check payable to (must match EIN/TIN or SSN below):
 Contact information same as above
Contact Name:
Mailing Address:
City/Town:
State:Zip:
Payee’s Federal Tax ID Number (TIN) — check one and provide EIN/TIN or SSN:
 Corporation or Tax-Exempt Organization (provide TIN)
 City, County, or State Dept., Govt. or Agency (provide TIN)
Employer Identification Number
 Other (provide EIN/TIN or SSN)
Social Security Number
or
I certify that the “Payee Information” above, including Federal Tax ID Number, is correct to the best of my knowledge.
I acknowledge that as Payee I am responsible for any tax liability associated with my receipt of the rebate payment.
For Internal Use
PAYEE SIGNATURE (if different from customer)
Commercial Refrigeration Rebate Form: 7/1/2016 - 12/31/2016
W
Project #
Page 2
Step 3
Product and Rebate Information
Refrigeration Temperature Codes
Please refer to this table when filling out sections below
1
Temperature Code
Designation
Refrigerated Space Temperature
LT
Low Temperature
< 25° F
MT
Medium Temperature
25° - 40° F
HT
High Temperature
41° - 65° F
Evaporator Fan Motors
Eligibility Requirements
∞∞Motors must be brushless DC (e.g., BPM, ECM®, ICM).
∞∞For walk-in coolers: Replacement installations for motors < 1 horsepower (HP).
∞∞Replacement installations for motors on case, reach-in, or warehouse applications.
∞∞NOT eligible: synchronous motors. Call Efficiency Vermont for more information.
Fill Out Below
Application
Installation
Date
Motor Being Replaced
(check type and enter quantity)
Temperature
Code
A=
Quantity of
Motors
(from table above)
n PSC
n Shaded Pole
n PSC
n Shaded Pole
Walk-in Coolers or
Refrigerated Warehouse
Merchandising Case
or Reach-In Cooler
AxB=
Rebate
Amount
B=
Rebate/
Motor
$100
$20
Total Rebate Section 1 $
2
Evaporator Fan Motor Controls
Eligibility Requirements
∞∞Minimum 4 fans or 250 watts per control.
∞∞Controls must ensure fan energy is reduced by 70% when no refrigerant flows through the evaporator.
∞∞Turn fans off or reduce fan air flow to ensure 70% energy reduction.
Fill Out Below
Temperature Code
(from table above)
Installation
Date
# of Fans
Controlled
A=
Rebate/Controller
B=
Rebate Amount
$550
$550
Total Rebate Section 2 $
Commercial Refrigeration Rebate Form: 7/1/2016 - 12/31/2016
Page 3
3
Door/Frame Heater Controls
Eligibility Requirements
∞∞Must be humidity-based (anti-sweat) controls using a humidity sensor.
∞∞Must be retrofit to existing units.
Fill Out Below
Temperature
Code
Installation
Date
(from table on page 3)
A=
Quantity of Doors
B=
Rebate/Door
AxB=
Rebate Amount
$50
$50
$50
Total Rebate Section 3 $
4
Refrigerator & Freezer Case Light Sensors
Eligibility Requirements
∞∞For use on interior LED or fluorescent equipment.
∞∞Minimum of 3 doors per sensor.
∞∞Companion switches for wireless sensors are not eligible for rebates.
∞∞NOT eligible: lighting sensors used in new construction, including renovations required to meet the 2015
Vermont Commercial Building Energy Standards (CBES).
Fill Out Below
Application
# of Hours Lights
are on/Week
(before controls)
Installation
Date
Refrigerator or Freezer
Case Sensors
A=
Quantity of Controls
B=
Rebate/Control
AxB=
Rebate Amount
$40
Total Rebate Section 4 $
Commercial Refrigeration Rebate Form: 7/1/2016 - 12/31/2016
Page 4
5
Refrigerator & Freezer LED Case Light Fixtures
Eligibility Requirements
∞∞Product must be qualified by DesignLights Consortium® for rebates.
To verify a product is qualified, visit www.designlights.org/QPL.
∞∞Horizontal and vertical doors are eligible.
Fill Out Below
Installation
Date
Manufacturer
# of Hours
Lights are
on/Week
Model #
A=
Total Fixture
Length
B=
Rebate/Foot
AxB=
Rebate Amount
(feet)
$10
$10
$10
Total Rebate Section 5 $
6
Energy Star® Ice Machines
Eligibility Requirements
∞∞Units must be listed on the ENERGY STAR certified products list, available at
www.energystar.gov/productfinder/product/certified-commercial-ice-machines/results.
Ice Machine Type
Harvest Rate
(batch or continuous)
(lbs ice/day)
Ice Making Head (IMH)
Remote Condensing Unit (RCU)
Self-Contained Unit (SCU)
Equipment Code
Rebate
< 450
≥ 450
< 1,000
≥ 1,000
< 175
7.1
7.2
7.3
7.4
7.5
$50
$75
$50
$75
$50
≥ 175
7.6
$75
Fill Out Below
Equipment
Code
(from table above)
Installation
Date
Ice Machine
Type
Make
Model #
Serial #
A=
Quantity
B=
Rebate/Ice
Machine
AxB=
Rebate Amount
n Batch
n Continuous
n Batch
n Continuous
Total Rebate Section 6 $
Commercial Refrigeration Rebate Form: 7/1/2016 - 12/31/2016
Page 5
7
Display Case Strip-Curtains & Continuous Covers
Eligibility Requirements
∞∞Eligible covers are PVC, metal, or equivalent curtains.
∞∞Installed on open, multi-deck (merchandise) coolers.
∞∞Rebate is based on length (in feet) of case covered.
Fill Out Below
Temperature Code
(from table on page 3)
MT & HT only
Application
A=
Length
Installation Date
(check one)
(linear feet)
B=
Rebate/Foot
n Strip Curtain
n Continuous
$6
n Strip Curtain
n Continuous
$6
AxB=
Rebate Amount
Total Rebate Section 7 $
8
Reach-In Refrigerators & Freezers
Eligibility Requirements
∞∞Eligible units are high-efficiency, ENERGY STAR certified commercial reach-in units that meet the
ENERGY STAR V3.0 specification.
∞∞Units must be listed on the ENERGY STAR certified products list, available at
www.energystar.gov/productfinder/product/certified-commercial-refrigerators-and-freezers/results.
Appliance Codes
Transparent
Glass Door
Freezer
Solid Door
Freezer and
Refrigerator Rebate
Transparent
Glass Door
Freezer and
Refrigerator Rebate
Capacity
Solid Door
Freezer
Solid Door
Refrigerator
Transparent
Glass Door
Refrigerator
< 15 cu. ft.
15 - < 30 cu. ft.
30 - < 50 cu. ft.
SFA
SFB
SFC
SRA
SRB
SRC
GRA
GRB
GRC
GFA
GFB
GFC
$200
$200
$250
$250
$250
$300
50 - < 80 cu. ft.
SFD
SRD
GRD
GFD
$300
$400
Fill Out Below
Appliance
Code
Model #
(from table above)
Installation
Date
A=
Quantity of
Refrigerators
or Freezers
B=
Rebate/
Refrigerator
or Freezer
AxB=
Rebate Amount
Total Rebate Section 8 $
Commercial Refrigeration Rebate Form: 7/1/2016 - 12/31/2016
Page 6
Step 4
Submit Form and Invoice
Mail to:
Mail:
Fax:
Efficiency Vermont
c/o Rebate Coordinator
128 Lakeside Ave., Suite 401
Burlington, VT 05401
Prefer to submit online?
Visit https://rebates.efficiencyvermont.com/refrigeration
802-658-1643
E-mail: [email protected]
Burlington projects, submit form to:
Mail:
Burlington Electric Department
c/o Energy Services Area
585 Pine Street
Burlington, VT 05401
Fax:
802-865-7500
Burlington Electric Department (BED) administers
efficiency programs for the City of Burlington,
including the rebates listed on this form.
For more information, call 802-865-7342.
E-mail: [email protected]
Need help?
For more information or to confirm eligibility, visit
www.efficiencyvermont.com or call 888-921-5990.
Commercial Refrigeration Rebate Form: 7/1/2016 - 12/31/2016
Page 7
EV-3598-0716-RNAX
For your reference
We recommend either making a copy of this form for your records,
or noting your rebate total and date submitted below.
REBATE FORM TOTAL $
DATE SUBMITTED
Terms & Conditions
1.
REBATE is for new equipment purchased and installed between July 1, 2016
and December 31, 2016 by commercial, industrial and agricultural customers
of Vermont electric utilities, except that rebates are not available to the
following customers: IBM, GlobalFoundries, Omya, and electric utility
companies. Equipment must be installed within the state of Vermont
in a commercial, industrial or agricultural facility. Rebate forms must be
postmarked or received by January 31, 2017. Rebate offer is subject to
change without notice and may not be combined with any other offer.
2. LIMITATIONS: This form cannot be used for any project involving more than
250 items for which rebates are sought; for information on such projects,
please call Efficiency Vermont (or Burlington Electric Department for projects
within the City of Burlington). This form also cannot be used for any project
involving new construction within the City of Burlington, or for any project
outside the City of Burlington involving new construction of greater than
10,000 sq. ft.; please call Burlington Electric Department or Efficiency
Vermont, respectively, for information on such projects.
3. PROOF OF PURCHASE: Invoice(s) must include the quantity, size, type,
manufacturer, model or part number, purchase date, and vendor of the
efficient equipment. All sales transactions and installations are subject to
verification and inspection. By signing this form, the customer consents to
allow Efficiency Vermont (or, within the City of Burlington, Burlington Electric
Department) 1.) to access the equipment for purposes of verification and
inspection, and 2.) to disclose the customer’s information (including but not
limited to the customer’s information included on this form and information
on the invoices(s)) to the vendor and/or contractor who sold or installed
the equipment to verify equipment purchase/installation and to collect
additional information about the equipment and its installation.
4. LIMITATION OF LIABILITY: Performance of installed equipment is not
guaranteed expressly or implicitly.
5. ENDORSEMENT: No particular manufacturers, products, or system designs
are endorsed through this program.
6. PAYMENT: Allow 60 calendar days for delivery of payment. Incomplete or
missing information will delay processing of rebate form and payment.
7. MAXIMUM PAYMENT will not exceed 100% of the equipment purchase
price. Customer is responsible for all costs associated with sales tax,
installation, and disposal/recycling. Customer is responsible for any tax
liability associated with rebate payment.
8. CAPACITY CREDITS/ENVIRONMENTAL CREDITS: In accepting these
financial incentives, the customer agrees that Efficiency Vermont (or, for
customers within its service territory, Burlington Electric Department) holds
the sole rights to any electric system capacity credits and environmental
credits associated with the energy efficiency measures for which incentives
have been received.
www.efficiencyvermont.com
128 Lakeside Avenue, Suite 401
Burlington, VT 05401
888-921-5990
© 2016 Efficiency Vermont