Business Energy Rebates Application

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1 Business Energy Rebates Application Business Energy Rebates make it easy and affordable for you to select energy efficient products for your business. and mail-in rebates are available for energy efficient products purchased and installed in non-residential buildings in Nova Scotia. You may choose to finance your products as 24 interest-free payments on your power bill in lieu of rebates. Depending on your energy consumption, you may qualify for additional incentives. Complete your Business Profile at efficiencyns.ca, prior to submitting your application, to find out if you qualify. Please note: rebates and financing are not typically available on products where in-store rebates are available at participating distributors. Pre-Approval Pre-approval of your rebate amount is recommended for all rebate applications, however pre-approval is required when applying for financing; prior to purchasing solar and water heating products; or for products with a total rebate amount greater than $15,000. Check here for products you have purchased and installed within the last 90 days. Required Documentation: Completed application and applicable worksheets Official detailed quote (or invoice if products have been installed) Copy of a recent electric bill Manufacturer product specification sheet(s) Please ensure all documentation is sent to Efficiency Nova Scotia by the date on your pre-approval notification. Documentation received by a later date may result in the expiration of your rebate or financing pre-approval and you may be required to re-apply. Submit your completed application along with supporting documents to: (Please note that we cannot accept high risk attachments such as ZIP, EXE or files that exceed 10MB.) Company Information Mail: Efficiency Nova Scotia 230 Brownlow Ave., Suite 300 Dartmouth, NS B3B 0G5 Attention: Business Energy Rebates Fax: Attention: Business Energy Rebates Company Name: Contact Name: Phone: Position: Fax: Contact I would like to receive communications (tips, promotions, etc.) from Efficiency Nova Scotia. (You may withdraw your consent at any time.) Mailing Address Installation Address (if different than above)

2 Business Energy Rebates Application Form 2 Installation Information Date or Expected Date of Installation: Company Installing Products: Installer Contact Name: Installer Position: Installer Phone: Installer Rebate Information Without assistance from Efficiency Nova Scotia, would you have: Installed any energy efficient equipment? Yes No Installed significantly less energy efficient equipment? Yes No Postponed the installation of equipment by more than two years? Yes No Payment Information Total Rebate Requested: (total from all worksheets) Choose how you would like to receive your rebate: (check one) Direct Deposit: Cheque: Attach a void cheque or a direct deposit form from your bank to have your rebate deposited directly into your bank account. Fill out the information below to have your rebate sent to you as a cheque. Make cheque payable to: Where would you like your rebate cheque sent to? Company Address Facility Address Other Address (Please fill in below) Electricity Service Provider Nova Scotia Power Account Number(s) OR Meter Number(s): Service Address(es)

3 Business Energy Rebates Application Form 3 Interest Free Financing (for Nova Scotia Power customers only) If you are a Nova Scotia Power customer, you may choose to finance your project in lieu of rebates with up to 24-interest free payments on your power bill, subject to Nova Scotia Power credit approval. CHECK HERE IF YOU WOULD LIKE TO APPLY FOR FINANCING. I consent to Efficiency Nova Scotia providing my information to Nova Scotia Power in order to enable Nova Scotia Power to carry out credit checks (may include Equifax reporting), to determine if I am eligible for financing. I also consent to Nova Scotia Power using other information available to them to assess the credit application and to administer financing. Terms and Conditions I hereby consent and acknowledge that: a) Rebates are for new equipment only, cannot be combined with any other Efficiency Nova Scotia offer and are subject to change without notice. b) Program funding is limited and will be allocated by Efficiency Nova Scotia in a manner that best serves the intent of funding. To be eligible for rebates: products must be installed in a non-residential building serviced by a Nova Scotia electric utility and products installed must reduce electrical consumption. c) Efficiency Nova Scotia may at its sole discretion, approve or reject any rebate at any time. d) Cogeneration, self-generation, demand-limiting, power factor correction and fuel switching are not eligible for rebates. e) Pre-approval is required for financing and prior to purchase for a total rebate amount greater than $15,000. f) The Applicant must submit the following to be eligible for rebates: (1) Business Energy Rebates Application, (2) Applicable Worksheets, (3) Proof of Purchase, (4) Manufacturer Specification Sheets, (5) A copy of an electric bill showing the Nova Scotia Rate Code and other information deemed necessary by Efficiency Nova Scotia to adequately review the rebate request. g) Proof of Purchase includes invoice(s) indicating the size, type, manufacturer, model or part number, purchase date, and vendor of the efficient equipment. Efficiency Nova Scotia reserves the right to verify sales transactions. h) The Applicant will provide Efficiency Nova Scotia with reasonable access to the Installation Address to inspect the product installation. Efficiency Nova Scotia reserves the right to withhold, revise or reclaim any rebate until it has performed a satisfactory post-installation verification. i) Efficiency Nova Scotia may require the sharing and exchange of information between Efficiency Nova Scotia and third parties such as the Applicant s electricity provider. In applying and receiving rebates, the Applicant hereby irrevocably consents to the release, use, storage and exchange of information between Efficiency Nova Scotia and necessary third parties, including, but not limited to name(s), addresses, electricity usage history, credit reports, and phone number, for the purposes of administering rebates. j) Efficiency Nova Scotia does not guarantee the performance of installed equipment expressly or implicitly. k) Efficiency Nova Scotia does not endorse any particular manufacturers, products, or system designs in promoting this program. l) Allow 60 days for delivery of payment. Submitting an application form with incomplete or missing information will delay processing of payment. m) Maximum payment will not exceed 50 per cent of the equipment purchase price. Applicants and/or contractors are responsible for all costs associated with sales tax, installation, and disposal/recycling. Applicant is responsible for any tax liability of rebate payment. n) Rebates can only be paid directly to the end-user. o) I certify that all equipment for which I am requesting a rebate has been installed within the last 90 days (unless applying for pre-approval), that the products meet the eligibility requirements for rebates, and that all information submitted as part of this application, including proof of purchase, is correct to the best of my knowledge. p) Efficiency Nova Scotia is a franchise operated by EfficiencyOne, official Licensee of the Province of Nova Scotia. By completing and submitting this form, I agree to release my personal information to the current and successive holders of the Efficiency Nova Scotia franchise. q) By completing and submitting this form, I hereby consent to the purposes for which Efficiency Nova Scotia

4 Business Energy Rebates Application Form 4 is collecting, using and disclosing personal information as set out in Efficiency Nova Scotia s Privacy Policy. More information on Efficiency Nova Scotia s Privacy Policy can be found online, efficiencyns.ca/privacy-policy or by , By signing below, I agree to the above terms and conditions and confirm the information provided is complete and accurate. / / Signature DD MM YYYY X Name (Please Print) X Title (Please Print) X ENS V2

5 Quote and Invoice Guidelines A quote or invoice from your distributor, retailer and/or contractor is required to complete your application. To avoid unnecessary delays to your application, please ensure your quote of invoice contains the information outlined below Quantity of product(s) Manufacturer Model number Material cost per unit Labour as a separate line item, if applicable Sample Invoice Date: (Date) Vendor: (Name) (Company Name) (Street Address) (City, Province Postal Code) (Phone) Sold to: (Name) (Company Name) (Street Address) (City, Province Postal Code) (Phone) Invoice #: (Number) Quantity Description Unit Price Net Amount 10 Manufacturer: ABC Lighting Inc. Model #: ABC-LED19T8L4-885 $25.00 $ N/A Labour $ $ Subtotal $ HST $75.00 Total Due $ ENS V2

6 Business Energy Rebates Lighting Application The following tables list the product requirements and rebates available for energy efficient lighting technologies. Either in-store or mail-in rebates are available for lighting products. For mail-in rebates, complete the application information on the last page. For more information please visit our website efficiencyns.ca/ber. LED Technologies (Indoor) Decorative lamp Includes common decorative shaped lamps such as chandelier and candle lamps ENERGY STAR certified General use lamp Includes omnidirectional lamps such as A lamps and globes ENERGY STAR certified Reflector (directional) lamp ENERGY STAR certified Examples include R, BR, MR, PAR lamp shapes Downlight Includes recessed, surface, pendant, ceiling mounted s, downlight solid state retrofit kit, inseperable solid state s and wall sconces ENERGY STAR certified High-bay Project replacing existing energy efficient lighting may not be eligible. We recommend pre-approval New construction projects are eligible Design Light Consortium (DLC) certified Low-bay Includes retrofit kits Stairwell and passageway Used to replace non-dimmable stairwell fixture Dims to < 25% full output when no occupants are detected Operates 24/7 All $3 All $5 Small ( 20) $5 Large (> 20) $ lm $12 1,000 2,999 lm $25 3,000 lm $50 10,000 19,999 lm $130 20,000 29,999 lm $200 30,000 39,999 lm $300 40,000 54,999 lm $400 55,000 lm $550 5,000 9,999 lm $30 10,000 lm $50 All $55 1x1 troffer Luminiares for ambient lighting for interior $10 1x2 troffer commercial spaces $15 Includes retrofit kits 1X4 troffer All $30 2X2 troffer $30 2X4 troffer $40 Linear ambient Includes DLC category: direct linear ambient s and linear ambient s with indirect components. Includes retrofit kits. 2,499 lm $10 2,500-4,999 lm $20 5,000-9,999 lm $30 10,000 lm $50

7 Business Energy Rebates Lighting Application 2 LED Technologies (Indoor) cont d Refrigerated case Includes both horizontal or vertical lighting installed in refrigerator or freezer case. All $6/ft Wall-wash Illuminates walls in interior spaces 575 1,199 lm $10 1,200 lm $20 Track or mono-point directional Linear replacement lamp LED Technologies (Outdoor) Includes ceiling-mounted tracks or fixed single head lamps not eligible (such as PAR38) Designed to replace T8/T12/T5 fluorescent lamps All $15/head 2 foot $3 4 foot $6 Full-cutoff Includes retrofit kits 300 1,999 lm $15 wall-mounted area 2,000 4,999 lm $30 5,000 14,999 lm $60 Non-cutoff and semi-cutoff wallmounted area Flood and spot s Pole/arm mounted area Pole/arm mounted decorative We recommend pre-approval. Includes landscape, accent and architectural types Includes retrofit kits Includes retrofit kits Roadway lighting not eligible Includes retrofit kits 15,000 24,999 lm $100 25,000 lm $ ,999 lm $15 2,000-4,999 lm $30 5,000-14,999 lm $60 15,000-24,999 lm $100 25,000 lm $ lm $20 1,000 4,999 lm $40 5,000 14,999 lm $100 15,000 29,999 lm $200 30,000 49,999 lm $400 50,000 lm $600 1,000 4,999 lm $25 5,000 9,999 lm $60 10,000 24,999 lm $160 25,000 39,999 lm $300 40,000 54,999 lm $350 55,000 lm $500 1,000 1,999 lm $60 2,000 5,499 lm $75 5,500 lm $150

8 Business Energy Rebates Lighting Application 3 LED Technologies (Outdoor) cont d Parking garage Includes retrofit kits 2,000 6,499 lm $125 Projects replacing existing energy efficient lighting may not be eligible. We recommend pre-approval 6,500 lm $200 Fuel pump canopy LED replacement lamps for HID lamps Case lighting for sign retrofit applications Fluorescent Projects replacing existing energy efficient lighting may not be eligible. We recommend pre-approval Projects replacing HID lamps only Roadway lighting not eligible Minimum three year warranty Minimum 60 lumens per watt Undergone IES testing (LM-79 and LM-80 or equivalent) New construction projects are not eligible (retrofit only) Include pictures clearly showing the new LED case lighting installed in the sign 2,000 6,999 lm $80 7,000 lm $ ,999 lm $20 5,000-9,999 lm $40 10,000 lm $60 $2.50/ft RW T8 lamp (28W) CEE Approved $1.50 RW T8 lamp (25W) $2 Lighting Controls Occupancy sensor - For use with LED or fluorescent systems $25 wall-switch or fixture mounted The use of a program start ballast is recommended for fluorescent systems Occupancy sensor - ceiling or wall remote mounted $60 Occupancy sensor - exterior Daylighting controls - wall-switch or fixture mounted Daylighting controls - ceiling or wall remote mounted Other Lighting Techniques Fixture must automatically shut off during the day by using a timer, photo-sensor or similar technology For use with LED or fluorescent systems The use of a program start ballast is recommended for fluorescent systems $10 System commissioning is strongly recommended to ensure $10 maximum energy savings For use with LED or fluorescent systems $40 Photo-luminescent N/A $15 exit sign

9 Business Energy Rebates Lighting Application 4 For mail-in rebates, enter the product details in the table(s) below. To prevent unnecessary delays in the processing of your application, please complete all the information requested. Product 1 Product 2 Product 3 Product 4 Product ENS V6

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