Save energy at home residential gas rebate form

Transcription

1 Upstate New York Save eergy at home residetial gas rebate form Save moey, improve comfort ad esure a cleaer eviromet with eergy savigs offers for residetial atural gas heatig customers from Natioal Grid. High-Efficiecy Heatig Equipmet Water Heaters Programmable Thermostats Boiler Reset Cotrols Thermostatic Radiator Valves Pipe Isulatio Takless Water Heaters

2 High-Efficiecy Residetial Gas Equipmet Icetives TO APPLY: 1. Refer to to determie if your equipmet meets the program requiremets. Equipmet must be istalled by a qualified professioal. 2. Complete this rebate applicatio form or go to atioalgridy to complete ad submit your applicatio olie. All required iformatio must be either submitted olie or postmarked withi 60 days of your rebate reservatio, but o later tha 12/31/ Submit olie or mail the followig required items: Completed ad siged applicatio Copy of the equipmet s Air Coditioig, Heatig ad Refrigeratio Istitute (AHRI) certificate (if applyig for a boiler, water heater or furace rebate). Dowload a certificate from or ask your cotractor for oe. Copy of a paid-i-full ad dated work order/ivoice/receipt that idetifies: Equipmet or measure istalled Quatity istalled Labor costs Material costs Maufacturer Model umber Paid i Full or Zero Balace Istaller ame (if cotractor istalled) To view a example of a ivoice, please visit 4. Mail to: New York High-Efficiecy Heatig Equipmet Rebate (UNY) Offer# H P.O. Box El Paso, TX EE4587 (7/14) UNY Res Gas Heatig

3 High-Efficiecy Residetial Gas Equipmet Icetives PROGRAM DETAILS To check the status of your icetive, please visit This program is available for istallatios completed betwee 1/1/ ad 12/10/14. Applicatios must be submitted olie or postmarked withi 60 days of your rebate reservatio, but o later tha 12/31/14. Issuace of icetives for completed applicatios is cotiget upo program availability. Check frequetly for program updates ad istallatio extesios. Qualified equipmet must be coected to a Natioal Grid gas meter ad be o firm residetial gas rate SC 1 ad pay the System Beefits Charge (SBC). Customer caot receive a icetive from Natioal Grid ad a icetive from NYSERDA for the same equipmet. Natioal Grid does ot edorse the products listed i the AHRI Directory or makes ay represetatios, warraties or guaratees as to, ad assumes o resposibility for, the products listed i the directory. All icetives are give o a per-uit basis. All icetives are subject to chage without otice. For questios, please call PRODUCT Hot Water Boilers Codesig boiler AFUE 1 > 90% ratig $560 Hot water boiler AFUE 1 > 85% ratig $350 Steam Boilers Steam boiler with electroic igitio AFUE 1 > 82% ratig $350 Furaces Furace AFUE 1 > 94% ratig & ECM 2 motor $420 Furace AFUE 1 > 92% ratig & ECM 2 motor $280 Furace AFUE 1 > 90% ratig $140 Water Heaters O-Demad Takless Water Heater 3 (Istataeous) > 0.82 Eergy Factor $225 O-Demad Takless Water Heater 3 (Istataeous) > 0.87 Eergy Factor $450 Idirect water heater attached to a atural gas ENERGY STAR hot water boiler with > 85% AFUE 1 $210 Codesig Gas Water Heater (40 gallos or greater ad > 90% Thermal Efficiecy) $200 Eergy Star Rated Stad Aloe Water Heater/Storage (40 gallo or greater ad > 0.67 Eergy Factor) $100 Gas Domestic Water Heater Wrap - Tak Isulatio (limit 2 per gas accout) up to $10 Cotrols Boiler reset cotrol: add o uit attached to a forced hot water boiler $70 Thermostatic radiator valves (limit 20 per gas accout) $50 Cotractor or self-istalled 7-day programmable thermostats (limit 2 per gas accout) up to $25/each Pipe Isulatio Space heatig (for steam or hot water boilers) (limit 100 liear ft.) $0.75 per liear ft. for fiberglass; $0.50 per liear ft. for foam Domestic water heatig (for hot water supply lie oly) (limit 12 liear ft.) 1 AFUE = Aual Fuel Utilizatio Efficiecy 2 ECM = Electroic Commutated Motor 3 Istall date 07/01/14-12/31/14 EE4587 (7/14) UNY Res Gas Heatig $0.50 per liear ft. for foam Additioal eergy efficiecy services may be available from the New York State Eergy Research ad Developmet Authority. For more iformatio, visit Customers are ot eligible to receive fiacial rebates for the same eligible measure from NYSERDA ad Natioal Grid. Offer available to customers that reside i Upstate New York where atural gas is available. Natioal Grid high-efficiecy equipmet rebates are available for both existig gas heatig ad oil to gas coversio customers, regardless of equipmet maufacturer

4 Complete this form to apply for a icetive. Icetives are available to both eligible existig gas heatig ad oil to gas coversio customers, regardless of equipmet maufacturer. Oe Gas Accout Number per form. Some restrictios may apply. Icetive offers are subject to chage without otice. Please review terms ad coditios. Form must be completed i its etirety. Submit olie or mail completed form with all required documets to: Natioal Grid UNY Residetial Gas-Heatig Equipmet Icetives Offer# H P.O. Box El Paso, TX Please make sure your ivoice icludes: Equipmet or measure(s) istalled Quatity istalled Istaller ame ad address Equipmet, labor & istallatio costs Maufacturer Model umber Paid i full or zero balace CUSTOMER/ACCOUNT HOLDER INFORMATION FORM MUST BE COMPLETED IN ITS ENTIRETY. CHECK ONE: I M AN EXISTING NATURAL GAS HEATING CUSTOMER I M CONVERTING FROM OIL/PROPANE TO NATURAL GAS HEATING GAS ACCOUNT NUMBER AT INSTALLATION ADDRESS WEB SUBMISSION ID (IF APPLICABLE) ACCOUNT HOLDER FIRST NAME ACCOUNT HOLDER LAST NAME INSTALL ADDRESS CITY STATE ZIP ADDRESS PHONE APPROXIMATE AGE OF HOME (IN YEARS) NUMBER OF PEOPLE IN HOUSEHOLD or more PAYEE INFORMATION ADDITIONAL PROCESSING TIME MAY BE REQUIRED IF ACCOUNT HOLDER IS DIFFERENT THAN PAYEE NAME PAYEE FIRST NAME (if differet tha above) PAYEE LAST NAME MAILING ADDRESS (if differet tha above) CITY STATE ZIP ADDRESS PHONE HOW DID YOU HEAR ABOUT THIS PROGRAM: (Place a x i the appropriate ballot box). Heatig Cotractor Eergy Auditor Equipmet Supplier Trade Show Sales Rep/Accout Executive Equipmet Iformatio Prit Advertisig Iteret Radio/TV Direct Mail/ Other CONTRACTOR INFORMATION THIS NAME MUST ALSO APPEAR ON THE CONTRACTOR INVOICE. CONTRACTOR COMPANY NAME CONTACT NAME STREET ADDRESS CITY STATE ZIP ADDRESS PHONE CUSTOMER: Please sig the Work Completio ad Icetive Validatio sectio. It is required to validate your rebate submissio. EE4587 (7/14) UNY Res Gas Heatig

5 Complete this form to apply for a icetive. Complete all the fields for the measure(s) you are istallig. Iclude this same iformatio o your ivoice. EQUIPMENT INFORMATION TYPE(S) OF SPACE HEATING EQUIPMENT MANUFACTURER MODEL NUMBER AFUE RATING TOTAL BTU INPUT 4 INSTALL TOTAL Codesig Boiler AFUE > 90% ratig $560 Hot Water Boiler AFUE > 85% ratig $350 Steam Boiler - electroic igitio AFUE > 82% $350 Furace AFUE > 94% ratig & ECM motor $420 Furace AFUE > 92% ratig & ECM motor $280 Furace AFUE > 90% ratig $140 TYPE(S) OF WATER HEATING EQUIPMENT MANUFACTURER MODEL NUMBER ENERGY FACTOR (EF) OR THERMAL EFFICIENCY (TE) RATING TOTAL BTU INPUT OF HEATING SYSTEM 4 TOTAL GALLONS (water heaters) INSTALL TOTAL O-Demad Takless Water Heater 3 (Istataeous) > 0.82 Eergy Factor N/A $225 O-Demad Takless Water Heater 3 (Istataeous) > 0.87 Eergy Factor N/A $450 Idirect water heater attached to atural gas Eergy Star hot water boiler with AFUE > 85% N/A $210 Codesig water heater (40 gallos or greater ad > 90% Thermal Efficiecy) Eergy Star rated stad aloe water heater (40 gal or greater & > 0.67% Eergy Factor) N/A $200 N/A $100 Gas Domestic Water Heater Wrap - Tak Isulatio (limit 2 per accout #) N/A N/A up to $10 each 3 Istall date 07/01/14-12/31/14 4 BTU of Heatig System (Heatig system capacity is measured i thousads of BTU, British Thermal Uits) EE4587 (7/14) UNY Res Gas Heatig

6 Complete this form to apply for a icetive. Complete all the fields for the measure(s) you are istallig. Iclude this same iformatio o your ivoice. EQUIPMENT INFORMATION (cotiued) TYPE(S) OF CONTROLS EQUIPMENT MANUFACTURER MODEL NUMBER BTU OF HEATING SYSTEM 4 AT THE TIME OF A HEATING SYSTEM REPLACEMENT OR CONVERSION? INSTALL TOTAL Thermostatic Radiator Valves (limit 20 per gas accout) N/A N/A $50 Thermostat q Cotractor-istalled q Self-istalled Yes No up to $25/each Boiler reset cotrol: Add o uit attached to a forced hot water boiler Yes No $70 If applyig for a thermostat or outdoor boiler reset cotrol rebate: AGE OF REPLACED HEATING UNIT: Years TYPE OF HEATING SYSTEM: Furace Steam boiler Hot water boiler TYPE OF HEATING/COOLING SYSTEM: Gas heat, cetral air coditioig Gas heat, o cetral air coditioig To qualify for the rebate, programmable thermostat(s) must cotrol the home s primary heatig system. 3 BTU of Heatig System (Heatig system capacity is measured i thousads of BTU, British Thermal Uits) TYPE(S) OF INSULATION EQUIPMENT TYPE OF INSULATION PIPE DIAMETER (NOMINAL INCHES) PIPE MATERIAL 5 APPLIANCE WHICH PIPE CONNECTS TO: PIPE INSULATION THICKNESS (LINEAR FEET) INCENTIVE Pipe isulatio Space Heatig (for steam or hot water boilers) (limit 100 liear ft.) $0.75 per liear ft. for fiberglass; $0.50 per liear ft. for foam Foam Fiberglass 3/4 1 1/4 1 1/ /2 or more Copper Steel Steam Boiler Hot Water Boiler 1/2 1 1/2 2 liear ft. Pipe isulatio Domestic Water Heatig (for hot water supply lie oly) (limit 12 liear ft.) $0.50 per liear ft. for foam Foam 3/4 or less 1 1/4 or more Copper Steel Domestic Water Heatig 1/2 1 1/2 2 liear ft. 5 No-metallic pipe is ot eligible for a icetive. WORK COMPLETION AND INCENTIVE VALIDATION I hereby affirm the Eergy Efficiecy Equipmet idicated above has bee istalled. I ackowledge that all work is subject to o-site work verificatio ad ispectio as may be required by federal, state ad local law ad by Natioal Grid. I am aware of ad agree to the Terms ad Coditios stated o the reverse side of this applicatio ad am attachig copies of itemized proofs of purchase ad ivoices for the istallatios performed. I hereby authorize the Compay to release my eergy use iformatio to Eergy Efficiecy Program Sposors ad System Beefits Charge (SBC) program admiistrators ad/or its desigee, ad I uderstad that such iformatio will be kept cofidetial ad used oly for the purposes of program evaluatio ad determiig eligibility ad eergy savigs. I uderstad that I may be cotacted i the future by Natioal Grid or its desigee to evaluate my experiece with this program ad/or to collect o-site data eeded to measure the eergy saved by this equipmet. NAME (PRINT) CUSTOMER SIGNATURE X EE4587 (7/14) UNY Res Gas Heatig

7 High-Efficiecy Residetial Gas Equipmet Icetives TERMS & CONDITIONS 1. Rebates - Subject to these Terms ad Coditios, this program is offered by Niagara Mohawk Power Corporatio d/b/a Natioal Grid (the Compay or Natioal Grid ). The Compay, through its cotractual vedor (the Vedor ) will pay rebates to eligible customers i the Compay s Service Territory, for the purchase ad istallatio of the equipmet/products described i this literature ad withi this applicatio. 2. Customer Eligibility - New qualifyig equipmet istalled from 1/1/14 to 12/31/14 is eligible cotiget upo availability of fuds. It must have bee ew equipmet istalled at the istallatio address listed o this applicatio. Olie applicatios must be uploaded to withi 60 days of your rebate reservatio, but ot later tha 12/31/14. Mailed applicatios must be postmarked withi 60 days of your rebate reservatio, but o later tha 12/31/14. Customer must be a gas heatig customer of the Compay i Albay, Columbia, Fulto, Herkimer, Jefferso, Madiso, Motgomery, Oeida, Oodaga, Oswego, Resselaer, Saratoga, Scheectady, Warre or Washigto Couty i New York State. Check frequetly for program updates or istallatio extesios. 3. Post-Istallatio Work Verificatio - The Compay reserves the right to perform a verificatio of the specified istallatio. If the Compay ad/or Vedor determies that the equipmet was ot istalled i a maer that is cosistet with program guidelies, the Compay ad/or Vedor may require that the istallatio be modified before makig ay rebate paymets. The cost of such modificatios is the resposibility of the customer. The customer hereby authorizes the Compay to release their eergy use iformatio to eergy efficiecy program sposors ad System Beefits Charge (SBC) program admiistrators ad/or desigees, ad uderstads that such iformatio will be kept cofidetial ad used oly for the purposes of program evaluatio ad determiig program eligibility ad eergy savigs. 4. Istallatio Requiremets - All istallatios of heatig ad water heatig equipmet ad boiler reset cotrols must be completed i coformace with state ad local code requiremets by a cotractor to qualify. Customers are ot eligible to receive fiacial icetives/rebates for the same type of eligible measure from NYSERDA ad Natioal Grid. 5. Proof of Proper Istallatio - As part of his/her applicatio, the Customer is required to submit dated copies of all paid ivoices documetig the istallatio (icludig all materials, labor ad equipmet ivoices) which reflect the actual cost of purchasig ad istallig the equipmet. 6. Idemificatio - Customer shall defed, idemify ad hold harmless the Compay ad its officers, directors, employees, agets, servats ad assigs from ad agaist ay ad all losses, claims, demads ad/or liability for damage to property, ijury or death of ay perso, or ay other liability icurred by the Compay, icludig all expeses, legal or otherwise, arisig out of or related to the equipmet or istallatio, except to the extet attributable to the egligece of Compay. I o evet shall Compay s liability to Customer exceed the rebate amouts. 7. Limited Scope Review - The scope of review by the Compay ad the Vedor ad their ispector of the istallatio of the equipmet is limited solely to determie whether rebates are payable. It does ot iclude ay kid of safety or code review ad should ot be relied upo as oe. 8. Rebate Amouts - The Compay will provide rebates for approved heatig, water heatig, thermostat, pipe or water heatig tak isulatio, thermostatic radiator valve, or boiler reset cotrol equipmet, up to rebate amout idicated i the program literature ad withi this applicatio. 9. Paymet - The Compay, through the Vedor, expects to make rebate paymets to eligible customers withi 6-8 weeks of a satisfactory work verificatio. The customers must refud ay rebate made to the extet the cotractor or equipmet does ot satisfy program requiremets. 10. No Warraties - The Compay ad the Vedor do ot edorse, guaratee or warrat ay particular cotractor, maufacturer or product istallatio. The Compay ad the Vedor do ot make ay represetatio of ay kid regardig the results to be achieved by the equipmet or the adequacy or safety of such equipmet. 11. Chages i the Program - Equipmet Icetive Program/Tax Liability Coditios ad details of the program are subject to chage without prior otice ad rebate offers may icrease or decrease over time. The Compay reserves the right to modify or termiate the program without otice. Participats of the program may be subject to tax liability for the value of goods ad services received through the program pursuat to state or federal icome tax codes. The Compay is ot resposible for ay tax liability which may be imposed as a result of receipt of the rebate by the Customer. 12. Cotractor Isurace - The Compay is ot resposible for ay damage that may be caused by or arise out of a istallatio of ay equipmet. The customer is resposible for selectig Cotractors who are qualified ad carry adequate isurace coverage. 13. Eligible Measures - Oly measures icluded o this applicatio are eligible for rebates. The compay will ot provide rebate paymets for oeligible equipmet, substitutios or used equipmet. The Compay has the right to reject ay rebate applicatio with ieligible equipmet ot idicated o this form. 14. Paymets Assigable to a Third Party - (a) The Customer may request that the icetive be paid directly to a third party by so idicatig i the Program applicatio. Notificatio of third-party paymet will be set to the Customer upo submissio of the Program applicatio for the purpose of Customer cofirmatio. (b) If o paymet choice is made, the Compay will sed the icetive paymet directly to the Customer at the address idicated i the Program applicatio. Natioal Grid is oe of the largest ivestor-owed eergy compaies i the world. I the US, we serve early 5 millio electric ad 3.4 millio gas customers i Massachusetts, New York ad Rhode Islad. Save eergy ad moey with our award-wiig efficiecy programs. Additioal eergy efficiecy services may be available from the New York State Eergy Research ad Developmet Authority. For more iformatio, visit EE4587 (7/14) UNY Res Gas Heatig