Installation address City State ZIP

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1 HEATING AND COOLING 2017 ILLINOIS FOR YOUR HOME REBATE APPLICATION Instructions: Fill out application completely and sign. Attach supporting documentation: itemized invoice(s), SAVE test results/contractor report, EnergyGuide label(s), if applicable, etc. Failure to complete the required sections and provide documentation will result in denial of claim. Equipment must be purchased and installed between Jan. 1, 2017, and Dec. 31, Rebate applications must be postmarked by March 31, 2018, to qualify for 2017 rebates. Rebate applications for equipment/materials purchased in 2017, postmarked after March 31, 2018, will not be eligible for rebates. Applications for central air conditioners installed after Oct. 1, 2017, can be submitted up to Sept. 30, 2018, if pre-enrolled by Dec. 31, SECTION 1 (REQUIRED) Name on account Customer Information Mailing address (if different from installation address) Installation address City State ZIP City State ZIP Phone address* *This address only will be used for communication regarding this rebate application. Your address never will be shared and you can unsubscribe at any time. MidAmerican Energy Company account number (found on bill; first seven digits only) Self-installed q YES q NO The equipment is installed in what type of home? q Single-family home (1-2 residential units in a building) q Multifamily home (3 or more residential units in a building) q Manufactured home Year home was built: Home square footage: Number of bedrooms in home: q 1 q 2 q 3 q 4 q 5 The new equipment is for: q Replacement of existing equipment q New installation q New construction SECTION 2 (REQUIRED) Home Characteristics - Heating, Cooling and Water Heating Existing Heating Equipment Found in Your Home Fuel Type Size/Capacity (Btuh) Qty System Age Existing Efficiency Rating q Furnace AFUE q Boiler AFUE q Resistance q Air-source heat pump q Ground-source heat pump COP Existing Cooling Equipment Found in Your Home Fuel Type Size/Capacity (Btuh) Qty System Age Existing Efficiency Rating q Central air conditioner q Room air conditioner q Air-source heat pump q Ground-source heat pump EER EER Existing Water Heating Equipment Systems Found in Your Home q Water heater Fuel Type Size/Gallons Qty System Age Existing Efficiency Rating EF Page 1 of 5

2 SECTION 3 Complete all fields for each piece of equipment purchased and installed Natural Gas Furnace Information You must be a MidAmerican Energy residential natural gas customer to qualify. Equipment must be AHRI Certified, <225 MBtuh with an AFUE of 95 or greater. Furnace must be installed with a SAVE rating of excellent to be eligible for rebate. furnace rebate 700 Date installed AHRI reference number SAVE score AFUE Capacity (MBtuh) ECM furnace fan installed q Yes q No If yes, submit energy-efficient furnace fan motor information below Manufacturer/brand name Model number Serial number Energy-Efficient Furnace Fan Motor Information You must be a MidAmerican Energy residential electric customer to qualify. Equipment must be AHRI Certified. Furnace fan must be installed on new qualifying furnace with AFUE 95 or above; <225 MBtuh, add-on fans only. May not be built into system and CEE air handling ratio must be <0.02. q Efficient fan motor rebate 60 Date installed Furnace AHRI reference number AFUE of furnace CEE handling ratio <0.02 q Yes q No Furnace brand name Furnace model number Furnace serial number Air-Source Heat Pump Information Must be SAVE certified (excellent rating) and meet either qualifying efficiency level; units 65 MBtuh; AHRI Certified (coil and condenser must match). Cooling () Rebate Heating () Rebate Total Rebate (cooling plus heating rebates) q rebate 550 q rebate 25 q 16 and above rebate 750 q 9 and above rebate 50 Date installed AHRI reference number SAVE score Supplemental heat: resistance q Other (MBtuh) (MBtuh) Page 2 of 5

3 Ground-Source Heat Pump Information Must be SAVE certified (excellent rating) and meet either qualifying efficiency level; must be AHRI Certified; <135 MBtuh. Documentation of capacities must be included in addition to ENERGY STAR certification. The capacity and efficiency rating will be determined using the full heating load and partial cooling load for multistage equipment. Cooling (EER) Rebate Heating (COP) Rebate Total Rebate (cooling plus heating rebates) q EER rebate 1,200 q EER rebate 1,800 q EER 23 and above rebate 2,400 q COP rebate 200 q COP rebate 400 q COP 5 and above rebate 600 Date installed AHRI reference number Desuperheater: q Yes q No Voltage: if dual voltage Manufacturer/brand name Supplemental heat: resistance q Other MBtuh and COP full MBtuh and EER full MBtuh and COP partial Model number q Open loop q Water loop q Ground loop q Closed loop q Ground water MBtuh and EER partial q Water to air q DGX q Water to water Serial number SAVE score Ductless Minisplits Information To qualify, you must be a MidAmerican Energy electric customer and equipment must be AHRI Certified. < 65 MBtuh Equipment Cooling Rebate Total Rebate Ductless minisplit air conditioner q rebate 350 q rebate 550 q 16 and above rebate 750 Equipment Cooling Rebate Heating Rebate Total Rebate Ductless minisplit air-source heat pump q rebate 550 q 16 and above rebate 750 q rebate 25 q 9.0 and above rebate 50 Page 3 of 5

4 Central Air Conditioner Information To qualify, you must be a MidAmerican Energy electric customer and equipment must be AHRI Certified. Central air conditioner must be installed with a SAVE rating of excellent to be eligible for a rebate. Must be <65 MBtuh; coil and condenser must be an AHRI match. Provide furnace information if the furnace increases efficiency of air conditioner. q rebate 350 q rebate 550 q 16 and above rebate 750 Date installed AHRI reference number SAVE score Capacity (MBtuh) Furnace manufacturer/brand name Furnace model number (if applicable) Unit Manufacturer Model Number Serial Number ENERGY STAR Certified Room Air Conditioner Information You must be a MidAmerican Energy residential electric customer to qualify. Must be ENERGY STAR certified; does not need to be SAVE tested. q Room air conditioner rebate 35 Manufacturer/brand name CEER Capacity (Btuh) Date installed Model number Serial number Programmable Thermostat Information Must have two or more set-backs; Wi-Fi and smart thermostats qualify. MidAmerican Energy must provide the primary heating fuel to your home. Rebate amount cannot exceed equipment cost. q Programmable thermostat rebate 25 Date installed Manufacturer/brand name Model number Cost Programmable thermostat controls: q Furnace q Boiler q Central air conditioning q Heat pump q Resistance heat Heat Pump Water Heater Information For residential electric-only customers; not available to natural gas customers. Must be ENERGY STAR certified. q EF 2.4 and above, 55 gallons rebate 300 Water heater capacity (gallons) Energy factor (EF) AHRI number if listed Date installed Manufacturer/brand name Model number Serial number Is the heat pump water heater installed in a conditioned space q Yes q No REMEMBER TO SIGN THE NEXT PAGE Page 4 of 5

5 Specific Terms and Conditions nparticipants must be residential customers located in MidAmerican Energy Company s Illinois service territory. nmidamerican Energy Company must deliver the electricity and/or natural gas to the equipment for which the rebate is being paid. See specific equipment requirements to ensure your equipment qualifies. nin order to receive a furnace, air-source heat pump, ground-source heat pump or central air conditioner rebate, the equipment must be pre-enrolled and tested by an HVAC SAVE certified technician unless otherwise noted. nelectric customers who purchase a new natural gas furnace with an energy-efficient fan motor qualify for the 60 fan motor rebate. nmust be AHRI Certified or ENERGY STAR certified, as indicated. nallow 4 6 weeks for rebate processing. General Qualifications and Conditions Important: Before completing and signing this form, please read the General Qualifications and Conditions located in the 2017 Illinois For Your Home rebate booklet or at 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 I certify that I have purchased the equipment described on this form and that it has been installed at the service address indicated. I agree to the terms and conditions associated with this form. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before or after issuing payment. q I also authorize the rebate check to be payable to (name please print) instead of the name on account. Alternate payee address City Customer signature State ZIP Date Dealer name Installing Dealer Information Phone Address Fax City State ZIP Contact name address SAVE certified technician Date of SAVE verification address 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.» Include ARI/ISO-standard specification sheets.» Include documentation of GSHP capacities in addition to ENERGY STAR listing. ooinclude documentation listed in the instructions. oosign the Customer Agreement section. If a dealer installed the equipment, the dealer must sign the Dealer Agreement. Send completed forms to: Mail: MidAmerican Energy Company P.O. Box 4628 Des Moines, IA Fax: rebateapplications@midamerican.com Page 5 of 5