1 Project Information. 2 Building Type. 3 Trade Ally/Contractor Information. Appalachian Power Commercial Program HVAC and VFD Rebate Worksheet

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1 Appalachian Power Commercial Program HVAC and VFD Rebate Worksheet Before you start Instructions: Complete all relevant information for your project. Include with complete application package. The HVAC Worksheet should be completed for new construction projects exceeding code and for retrofit of existing HVAC equipment. New equipment baseline efficiency is presented in the tables in this worksheet). Certain projects are considered custom and are not eligible for the HVAC prescriptive rebate. Examples of custom projects include process cooling equipment, projects estimated to save over 250,000 kwh/year, and projects involving HVAC system redesign. Refer to the rebate application for pre-approval requirements for custom projects. All equipment must exceed baseline equipment efficiency, as determined by equipment specification sheets and AHRI ratings where applicable. Please refer to Section 8 for eligible equipment efficiency. Submit your application The following documents must accompany the HVAC worksheet in a complete application: spec sheet Itemized invoice showing model number Rebate application Completed HVAC rebate worksheet (this form) W9 for payee Questions? Call Project Information Retrofit New Construction Zip Code (project location): 2 Building Type Arena/Auditorium/Convention Center/Theater Auto Related Bakery Banks, Financial Centers Church College - Classes/Administrative College - Dormitory Commercial Condos Convenience Stores Dining: Casual Dining: Cafeteria / Fast Food Entertainment Exercise Center Fast Food Restaurants Fire Station (Unmanned) Food Stores Gymnasium/Performing Arts Hospitals Industrial - 1 Shift Industrial - 2 Shift Industrial - 3 Shift Laundromats Lodging (Hotels/Motels) Lodging - Residential (except Nursing) Mall Concourse Medical Offices Multi-Family (Common Areas) Museum/Library Nursing Homes Office/Retail/Courthouse Parking Garages & Lots Penitentiary Police / Fire Stations (24 Hr) Post Office Pump Stations Refrigerated Warehouse Retail Small Services Schools Transportation Warehouse (Not Refrigerated) Waste Water Treatment Plant Workshop 3 Trade Ally/Contractor Information Business Name: Contact Name: Phone: Business Address: City: State: Zip Code: Appalachian Power HVAC & VFD Rebate Worksheet 1 of 5

2 4 HVAC: Air Conditioners, and Rooftop Units PROJECT INFORMATION COOLING DATA HEATING DATA EXISTING NEW EXISTING NEW Type Category and Mfgr & Model Age (years) (Tons or Btu/h) EER (if known) SEER/IEER (if known) Mfgr & Model (Tons or Btu/h) EER SEER/IEER (Btu/h) New (Btu/h) HSPF EX: 1 Air Cooled HP <65,000 Btu/h (<5.4 tons) 123ABC 10 24,000 Btu/h XY 24,000 Btu/h SEER 24,000 24, <65,000 Btu/h (<5.4 tons) 65,000 and <135,000 Btu/h ( tons) 135,000 and <240,000 Btu/h ( tons) 240,000 and < 760,000 Btu/h (20-63 tons) 760,000 Btu/h (>64 tons) Air Cooled HP <65,000 Btu/h (<5.4 tons) Appalachian Power HVAC & VFD Rebate Worksheet 2 of 5 Packaged Terminal Units (PTACs) Packaged Terminal Units (PTACs) Air Cooled HP 65,000 to <135,000 Btu/h ( tons) Air Cooled HP 135,000 and <240,000 Btu/h ( tons) Air Cooled HP 240,000 Btu/h ( 20 tons) Geothermal (Ground Source Heat Pump >135,000 Btu/h (>11 tons) Air Conditioning < 24,000 Btu/h, cooling mode only (< 2 tons) Heat Pump < 24,000 Btu/h, cooling & heating mode (<2 tons)

3 5 Chiller Projects PROJECT INFORMATION EXISTING COOLING DATA NEW COOLING DATA Chiller Type Predominant Load Type : Full - Always fully loaded, or Partial Existing Model Existing Age (years) Existing (tons) New Model New Rated Cooling (tons) New FULL Load Cooling Efficiency New PART Load Cooling Efficiency EX: 1 Air Cooled <150 tons Partial HYT DFR EER 4.1 EER Air Cooled <150 tons EER EER Air Cooled 150 tons EER EER Water Cooled (Positive Displacement / Recip.) <75 tons kw/ton kw/ton Water Cooled (Positive Displacement / Recip.) 75 tons and <150 tons kw/ton kw/ton Water Cooled (Positive Displacement / Recip.) 150 tons and <300 tons kw/ton kw/ton Water Cooled (Positive Displacement / Recip.) 300 tons kw/ton kw/ton Water Cooled (Centrifugal) <150 tons kw/ton kw/ton Water Cooled (Centrifugal) 150 tons and <300 tons kw/ton kw/ton Water Cooled (Centrifugal) 300 tons and <600 tons kw/ton kw/ton Water Cooled (Centrifugal) 600 tons kw/ton kw/ton Appalachian Power HVAC & VFD Rebate Worksheet 3 of 5

4 6 Ductless Mini-Split Heat Pump NEW DUCTLESS MINI-SPLIT EQUIPMENT INFORMATION COOLING DATA HEATING DATA New Mfgr & Model Existing Cooling Type New (Btu/h or Tons) New Cooling Efficiency (SEER) Existing Heating Type (check one) New (Btu/h) New HSPF (if relevant) EX: 1 AAA100 12, , Central AC No Cooling Packaged Terminal AC Packaged Terminal HP Room AC Electric Furnace Electric Resistance No Heat Non-Electric Heat Packaged Heat Pump Central AC No Cooling Packaged Terminal AC Packaged Terminal HP Room AC Electric Furnace Electric Resistance No Heat Non-Electric Heat Packaged Heat Pum 7 VFD for HVAC PROJECT INFORMATION Appalachian Power HVAC & VFD Rebate Worksheet 4 of 5 Type of Motor Controlled Fan Type (check one) Motor Size (total hp controlled by VFD) Motor Nameplate Efficiency (at full load) # Motors Controlled by VFD Motor Configuration VFD Manufacturer and Model # EX: Air Handler Unit Constant Volume 10 hp 88.5% 1 Single AA1234 Air Handler Unit Constant Volume Air Foil/Backward Incline Air Foil/Backward Incline w/inlet Guide Vanes Forward Curved Forward Curved w/inlet Vanes Chilled Water Pump Single Hot Water Pump 1. Projects limited to VFDs mounted on air handler fans, chilled or hot water pump. All other VFD applications are custom. 2. Must be a new VFD installlation motors which are previously controlled by VFDs are not eligible for rebates. 3. VFD projects expected to achieve 250,000 kwh are custom. Single Duplex Duplex

5 8 Eligibility All equipment must exceed the equipment efficiency baseline as presented below: AIR-SOURCE AIR CONDITIONERS AIR-SOURCE HEAT PUMPS Type and Cooling Baseline Heating Baseline Type and Cooling Baseline Heating Baseline < 65,000 Btu/h 13.0 SEER <65,000 Btu/h 13.0 SEER 7.7 HSPF 65,000 and <135,000 Btu/h 11.2 SEER / 11.4 IEER 65,000 and <135,000 Btu/h 11.2 SEER / 11.4 IEER 3.3 COP 135,000 and <240,000 Btu/h 11.0 EER / 11.2 IEER 135,000 and <240,000 Btu/h 10.6 EER / 10.7 IEER 3.2 COP 240,000 and < 760,000 Btu/h 10.0 EER / 10.1 IEER 240, EER / 9.6 IEER 3.2 COP 760,000 Btu/h 9.7 EER / 9.8 IEER PACKAGED TERMINAL SYSTEMS ELECTRIC CHILLERS Type and Cooling Baseline Heating Baseline Type and Size Part and Full Loads Must Exceed PTAC (Cooling) (0.213 X Cap / 1000) EER <150 tons Full Load: EER IPLV: EER PTHP (0.213 x Cap / 1000) EER (0.026 * CAP / 1000) COP Air Cooled Chillers 150 tons Full Load: EER IPLV: EER < 75 tons Full Load: 0.78 kw/ton IPLV: kw/ton Appalachian Power HVAC & VFD Rebate Worksheet 5 of 5 DUCTLESS MINI-SPLIT HEAT PUMPS Type and Cooling Baseline Heating Baseline <65,000 Btu/h or 5.4 tons 14 SEER / 12 EER 8.2 HSPF Water Cooled Positive Displacement or Reciprocating Chiller Water Cooled Centrifugal Chiller 75 tons and <150 tons Full Load: kw/ton IPLV: kw/ton 150 tons and <300 tons Full Load: kw/ton IPLV: kw/ton 300 tons Full Load: kw/ton IPLV: kw/ton <300 tons Full Load: kw/ton IPLV: kw/ton 300 tons and <600 tons Full Load: kw/ton IPLV: kw/ton 600 tons Full Load: kw/ton IPLV: kw/ton