LIGHTING EQUIPMENT 2016 IOWA FOR YOUR BUSINESS REBATE APPLICATION FORM. Customer Information

Transcription

1 LIGHTING EQUIPMENT 2016 IOWA FOR YOUR BUSINESS REBATE APPLICATION FORM Instructions: Fill out form completely and sign. Attach supporting documentation: itemized invoice(s), if applicable, etc. Failure to complete the form and provide documentation could result in claim being delayed, returned or denied. must be purchased between Jan. 1, 2016, and Dec. 31, must be installed and operating prior to submission of final rebate application. application must be submitted within six months of dealer invoice for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. applications received after six months of dealer invoice will not be eligible for rebates. Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at Company name on bill Customer Information Mailing address (if different than installation address) Installation address City State ZIP City State ZIP Phone Self-installed q YES q NO Contact name Title MidAmerican Energy Company account number (found on bill; first seven digits only) address My facility had an energy assessment in the following program (check if applicable): q Industrial q Multifamily Housing q No assessment has been completed q Commercial q Agribusiness Date assessment completed (month/year) installed in what type of facility? (check one) q Lodging q School/college q Restaurant q Office q Hospital q Manufacturing q Warehouse q Retail q Convenience store q Fast food q Agribusiness q Multifamily housing q Other This new equipment is for: q Replacement q New installation q New construction Linear Fluorescent Lighting (for existing systems only; must be 800 series lamps) Standard T-8 and Ballast, Including U-Bend and 8 ft. High Output T-8 and Ballast (replacing T-12 lamp and magnetic ballast systems) 8 T-12 or 8 T-8 lamps can be replaced using two 4 T-8 fluorescent lamps or two 4 linear LED lamps. Bulb Length/Installed Model # Brand/ 2 X 2 lamp/u-bend/electronic ballast x $12 = 2 X 1 lamp/electronic ballast x $12 = 2 X 2 lamp/electronic ballast x $12 = 2 X 3 lamp/electronic ballast x $12 = 2 X 4 lamp/electronic ballast x $12 = 4 X 1 lamp/electronic ballast x $12 = 4 X 2 lamp/electronic ballast x $12 = 4 X 3 lamp/electronic ballast x $12 = 4 X 4 lamp/electronic ballast x $12 = 8 X 1 lamp/electronic ballast x $12 = 8 X 2 lamp/electronic ballast x $12 = 8 X 3 lamp/electronic ballast x $12 = Page 1 of 7

2 Linear Fluorescent Lighting (for existing systems only; must be 800 series lamps) continued Standard T-8 and Ballast, Including U-Bend and 8 ft. High Output T-8 and Ballast (replacing T-12 lamp and magnetic ballast systems) 8 T-12 or 8 T-8 lamps can be replaced using two 4 T-8 fluorescent lamps or two 4 linear LED lamps. Bulb Length/Installed Model # Brand/ 8 X 4 lamp/electronic ballast x $12 = 8 X 1 lamp/high output electronic ballast x $12 = 8 X 2 lamp/high output electronic ballast x $12 = 8 X 3 lamp/high output electronic ballast x $12 = 8 X 4 lamp/high output electronic ballast x $12 = Reduced Wattage T-8 and Ballast (replacing T-12 lamp and magnetic ballast systems) Lighting must meet the CEE reduced-wattage T-8 specification. Cannot be combined with any other T-8 fixture or lamp rebate. Bulb Length/Installed Model # Brand/ 4 X 1 lamp/electronic ballast x $13.50 = 4 X 2 lamp/electronic ballast x $13.50 = 4 X 3 lamp/electronic ballast x $13.50 = 4 X 4 lamp/electronic ballast x $13.50 = Reduced Wattage T-8 (replacing standard T-8 lamp mounted below 15 ft.) Lighting must meet the CEE reduced-wattage T-8 specification. Cannot be combined with any other T-8 fixture or lamp rebate. Bulb Length/Installed Model # Brand/ 4 lamp only x $3.25 = T-5 High-Bay (replacing HID mounted 15 ft. or higher) Bulb Length/Installed Model # Brand/ 46 X 3 lamp/electronic ballast x $21.50 = 46 X 4 lamp/electronic ballast x $21.50 = 46 X 5 lamp/electronic ballast x $21.50 = 46 X 6 lamp/electronic ballast x $21.50 = 46 X 7 lamp/electronic ballast x $21.50 = 46 X 8 lamp/electronic ballast x $21.50 = T-8 High-Bay (replacing HID mounted 15 ft. or higher) Bulb Length/Installed Model # Brand/ 4 X 3 lamp/electronic ballast x $8.50 = 4 X 4 lamp/electronic ballast x $8.50 = 4 X 5 lamp/electronic ballast x $8.50 = 4 X 6 lamp/electronic ballast x $8.50 = 4 X 7 lamp/electronic ballast x $8.50 = 4 X 8 lamp/electronic ballast x $8.50 = Page 2 of 7

3 Lighting Controls Controlled Occupancy sensor for all type lamps, wall-remote-fixture mounted (minimum 20W). x $0.10/watt controlled = Lighting Timer or Clock (commercial grade) x $35 = For occupancy sensors installed on lighting systems other than those listed, please use the Nonresidential Custom Systems form. High-Efficiency Metal Halide Interior and Exterior New Wattage Model # Brand/ Metal Halide s (pulse start) x $60 = Metal Halide s watts, replacing 400 watts Metal Halide s watts, replacing 400 watts x $20 = x $20 = LED s Interior and Exterior Must be DesignLights Consortium qualified. Must replace high-intensity discharge fixtures in existing systems. New construction is eligible. New Replaced New Model # sized as < 100 watts HID equivalent x $50 = sized as watts HID equivalent x $75 = sized as watts HID equivalent x $100 = Exit Sign < 2 watts, existing building only replacing incandescent or fluorescent sign x $50 = Municipal-Owned LED Roadway s Must be DesignLights Consortium qualified. Must replace high-intensity discharge fixtures in existing systems. See specific terms on Page 6. New Replaced New Model # sized as < 100 watts HID equivalent x $50 = sized as watts HID equivalent x $75 = sized as watts HID equivalent x $100 = Page 3 of 7

4 LED Troffer Hanging or Pendant Style and Surface Mounted s - Interior Only (replacing T-8 & T-12 fluorescent, retrofit and new construction are eligible) Must be DesignLights Consortium qualified. / Size Wattage New Replaced New Model # LED Troffer 1 x W x $70/fixture = LED Troffer 2 x W x $70/fixture = LED Troffer 2 x W x $70/fixture = LED Troffer Retrofit Kit 1 x W x $50/kit = LED Troffer Retrofit Kit 2 x W x $50/kit = LED Troffer Retrofit Kit 2 x W x $50/kit = LED Wrap and Strip s - Interior Only (replacing T-8 & T-12 fluorescent, retrofit and new construction are eligible) Must be DesignLights Consortium qualified. / Size Wattage New Replaced New Model # LED Wrap Style 4 length 12-82W x $70/fixture = LED Strip Style 4 length W x $70/fixture = Linear LED s - Interior (utilizing existing pin sockets, 8 T-12 or 8 T-8 lamps can be replaced using two 4 T-8 fluorescent lamps or two 4 linear LED lamps, retrofit and new construction are eligible) Must be DesignLights Consortium qualified. 8 T-12 or 8 T-8 lamps can be replaced using two 4 T-8 fluorescent lamps or two 4 linear LED lamps. / Size New Replaced New Model # LED Linear s replacing T-12 4 only x $15/lamp = LED Linear s replacing T-8 4 only x $12.50/ lamp = Page 4 of 7

5 LED s - Interior (all socket types) Must be ENERGY STAR certified, replacing incandescent or halogen lamps. Replacing CFLs does not qualify. s may not be purchased through point-of-purchase program. Wattage New Replaced Old Type (circle one) New Model # Interior LED s < 5 watts x $5/lamp = Interior LED s watts x $7/lamp = Interior LED s watts x $10/lamp = Interior LED s > 20 watts x $15/lamp = LED Traffic Lights (continue on additional sheets if necessary) Account Number Traffic Light 12 Red Ball x $25 = Traffic Light 12 Green Ball x $125 = Traffic Light 12 Green Arrow x $75 = Traffic Light 12 Don t Walk x $25 = LED Lighting for Freezer/Cooler Case Doors or Open Cases Must be DesignLights Consortium qualified or LED Lighting Facts listed. Must replace existing fluorescent systems. New construction is eligible. New Replaced New & Model # Annual Operating Hours (per unit installed) LED Lighting for Case Doors x $75 = LED Lighting for Open Cases x $75 = Page 5 of 7

6 Specific Terms and Conditions nparticipants must be commercial or industrial business customers with facilities located in MidAmerican Energy Company s Iowa service territory. nmidamerican Energy Company must provide the primary electricity to the equipment at the facility for which the rebate is being paid. none-for-one replacement only. Lighting redesigns where the quantity of lamps or fixtures is changed may be eligible for a rebate through Nonresidential Custom Systems. ns cannot exceed 70 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount or 70 percent of installed cost. n must be purchased between Jan. 1, 2016, and Dec. 31, must be installed and operating prior to submission of final rebate application. n application must be submitted within six months of dealer invoice for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. applications received after six months of dealer invoice will not be eligible for rebates. na minimum of 1,000 annual operating hours required. nallow 4 6 weeks for rebate processing. nfor Municipal-Owned LED Roadway s: Must be municipal-owned fixtures on a metered or unmetered circuit. Municipal-owned fixtures > 400 watts HID equivalent, see Nonresidential Custom Systems. Municipalities wishing to replace MidAmerican Energy Company roadway fixtures can find more information at cityled@midamerican.com or call General Terms and Conditions Important: Before completing and signing this form, please read the General Terms and Conditions located in the 2016 For Your Business rebate booklet or at Custom If specific equipment you intend to purchase and install is not listed, it may qualify under Nonresidential Custom Systems. Call MidAmerican Energy Company at with questions about application procedures, qualifying projects, incentives or verification procedures. Disclaimer MidAmerican Energy Company does not guarantee that installation and operation of high-efficiency equipment will result in reduced usage or in cost savings. MidAmerican Energy Company makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to, any warranty of merchantability or fitness for a particular purpose. In no event shall MidAmerican Energy Company be held liable for any incidental or consequential damages or injuries resulting from defective equipment or installation. MidAmerican Energy Company reserves the right to cancel or change these programs at any time. MidAmerican Energy Company s acceptance of this application does not guarantee payment of rebate. Customer Agreement My signature indicates consent to and agreement with all program terms and conditions. It certifies that all information in this application is correct and was performed at the indicated location. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before and after issuing payment. Customer signature Date Dealer name Installer/Dealer Information Phone Address Fax City State ZIP Contact name address Installer/Dealer Agreement I certify that all equipment and installation information provided on this application is correct and accurate. Installer/dealer signature Date Before you submit your form: oofill out this form completely. ooattach a copy of the itemized sales receipt or invoice. ooinclude documentation listed in the instructions. oosign the Customer Agreement section. Send completed forms to: Mail: MidAmerican Energy Company P.O. Box 4628 Des Moines, IA Fax: rebateapplications@midamerican.com Page 6 of 7

7 Invoice(s) submitted must include itemized quantity, price, manufacturer s make and model numbers and product codes for each material item and original equipment manufacturer (OEM) specification sheets. Itemized invoices are the key to fast processing of rebate forms. Specify the quantity for each item Identify manufacturing part information P.O. NO. TERMS BILL 2% NET 30 Item Qty Description Rate Installed Amount LED16WCW 100 Acme ENERGY STAR certified 16W LED lamp $35 2/20/2016 $3,500 Detailed project codes LEC27W Acme ENERGY STAR certified 27W LED lamp $125 2/20/2016 $3,125 List price for each item and total HD B Blue wire nut /20/2016 $32 Installed ENERGY STAR certified LED lamps and downlights Note labor and other expenses separately from other materials 1 $448 $448 Travel 0 Travel $64 $64 Environmental Fee 1 Environmental Fee $82.11 $82.11 Local Tax 7.50% $ Thank you for your business. Please remit payment to Rate Lighting Company $7, Good description For more information call or go to Page 7 of 7