TM A Nicor Gas program Business rebate application Commercial food service Complete steps 1-7 for the rebate(s) you are applying for. All fields are required unless otherwise noted. Need help? Call us at 877.886.4239 (M-F, 8 a.m. to 5 p.m.) or email info@nicorgasrebates.com. Before you start: Once you are done: Submit your application: Review the eligibility details, requirements and terms and conditions throughout the application to verify that you are eligible for a rebate. Collect all required to complete your application. Mail your signed application and the required documentation to: Nicor Gas Attn: energysmart 14-90587 P.O. Box 540071 El Paso, TX 88554-0071 Applications are due within 90 days of installation or by June 30, 2015, whichever comes first. After your rebate application is completed and approved, you will receive your rebate check in approximately six to eight weeks. 1 2 Higher rebates Building type This is a(n): Find out if you re eligible for higher rebates The rebates mentioned on the following application are the standard rebate amount available to Nicor Gas business customers.* If you are a multi-family building owner or a small business owner, look for an icon that identifies higher rebates that are available to you. If you are not a multi-family building owner or small business owner, you are only eligible for standard rebate amounts. MF The building has permanent or semi-permanent residential tenants and is an apartment/ condominium, college/university dormitory, assisted living facility, or retirement community consisting of five units or more with a bathroom and kitchen in unit. Are you applying for multi-family rebates? Yes No SB The business uses less than 60,000 therms of natural gas annually, is independently owned and operated and has fewer than 10 locations (check to see if your business is eligible by calling 877.886.4239). Are you applying for small business rebates? Yes No Existing facility Multi-family Small business New construction Multi-family MF Apartment/condo Assisted living Assembly College/university - campus buildling Exterior Garage K-12 school - elementary K-12 school - high school Medical - healthcare clinic Medical- hospital Restaurant - small Restaurant - quick-serve (fast food) Restaurant - mid-sized Restaurant - large institutional Retirement community Grocery store Miscellaneous Retail/Service - strip mall College/university - dormitory Grocery - convenience Heavy and light industry Office - low-rise Office - mid-rise Retail/Service - dept. store Warehouse Hotel/motel Office - high-rise *Current Nicor Gas business customers on all rate classes, except public entities (taxpayer-funded facilities) and self-directed customers, are eligible to participate in energysmart. 1 of 5
3 Account and customer Nicor Gas account number Business/Account holder name Please write the first 10 digits of your account number. Do not include dashes. Installation address City State ZIP code check payable to: Account holder Landlord Contractor Circle member Mailing address (if different) City State ZIP code Applicant contact first name Applicant contact last name Site contact first name Site contact last name 4 Contractor Contractor business name Address City State ZIP code 5 Applicant signature I certify that the participant has not received/will not receive a rebate for the same product or equipment from more than one Illinois investor-owned utility or third-party energy efficiency program offering rebates or financing funded with ratepayer funds, with the exception of qualifying joint ComEd incentive offerings. I certify that the energy-efficient product or service was paid for as reflected on the receipt and described in this rebate application. I certify that all is true and correct, and that I have met all program requirements as outlined in the general program qualifications section. I understand and agree to the terms and requirements for which I am submitting this rebate application, as outlined on pages 1 through 5. I understand rebate amounts are applied based upon verification of provided on this application. Applicant signature Print applicant name Date Promo code (if applicable) 2 of 5
6 Product Ovens ENERGY STAR convection oven $400 Combination oven $900 Rack oven - single $700 Rack oven - double $1,400 width < 25 inches width 25 inches $1,000 Infrared rotisserie oven Convection oven ENERGY STAR rated with a Cooking Efficiency 44% utilizing ASTM standard 1496. Must have an Idle Energy Consumption Rate 13,000 Btu/h. Combination oven Natural gas combination convection/steam oven. Cooking Efficiency 40% utilizing ASTM F2861. Rack ovens Baking Energy Efficiency 50% utilizing ASTM standard 2093. Single and double ovens are eligible. paid per oven. Cooking Efficiency 42% utilizing ASTM standard F1817. Must have an Idle Energy Consumption Rate 57,000 Btu/h. s are paid, based on conveyor width (< 25 inches or 25 inches). s for multi-deck ovens are paid per qualifying deck. Infrared rotisserie oven Must utilize infrared burners. Broilers Infrared upright broiler Infrared charbroiler Infrared salamander broiler Must utilize infrared burners. Check one qualifying product per category. If applying for more than one type of equipment, complete and submit additional copies of this page as needed. * The Total install cost, is the total purchase price of an individual piece of equipment, including the cost of the equipment, materials and external labor. Total install cost must be itemized by each equipment/product installed and entered in the chart above. The itemized contractor invoice must include the Total install cost, itemized by each qualifying equipment/product on the invoice. If self-installed only the cost of the equipment may be used. 3 of 5
Other kitchen equipment ENERGY STAR commercial steamer $950 ENERGY STAR griddle $250 Quantity width < 18 inches width 18 inches per vat $550 per vat Pasta cooker $200 Pre-rinse spray valve** $25 Bottom-finned stock pot* $25 ENERGY STAR commercial steamer ENERGY STAR rated, with a Cooking Efficiency 38%. Both five and six pan units are eligible. ENERGY STAR griddle ENERGY STAR rated, with a Heavy Load Cooking Efficiency 38% utilizing ASTM standard F1275. Idle Energy Consumption Rate 2,600 Btu/h per square foot of cooking surface. ENERGY STAR rated, with a Heavy Load Cooking Efficiency 50% utilizing ASTM standard F1361 or F2144. is paid per vat, based on vat width: <18 inches or 18 inches. Pasta cooker Must be a dedicated pasta cooker, as determined by the manufacturer. Equipment will be approved on a case by case basis by review of the product specifications. Pre-rinse spray valve Spray valves must be installed in commercial kitchens. New spray valves must have a flowrate 1.25 gpm at 60 psi. Only single valve sprayers are eligible. Bottom-finned stock pot New commercial-grade bottom-finned stock pot, capacity 18-40 quarts. Stock pot must be National Sanitation Foundation (NSF) certified. Stock pot must be purchased and used in a kitchen facility that is commercially licensed by the state of Illinois. Residential uses and commercial facility kitchenettes are not eligible. Check one qualifying product per category. If applying for more than one type of equipment, complete and submit additional copies of this page as needed. * The Total install cost, is the total purchase price of an individual piece of equipment, including the cost of the equipment, materials and external labor. Total install cost must be itemized by each equipment/product installed and entered in the chart above. The itemized contractor invoice must include the Total install cost, itemized by each qualifying equipment/product on the invoice. If self-installed only the cost of the equipment may be used. ** not needed 7 Equipment Attach supplemental documents Copy of the itemized invoice(s) or proof of purchase. Must include: make, model and serial number Total install cost (itemized per each piece of qualifying equipment) Installation and purchase dates (if different) Payment terms (For example: balance due of zero, financing terms, or paid-in-full stamp) Professional contractor (if installed by a professional contractor) 4 of 5
energysmart rebate qualifications Participant eligibility You are only eligible to participate in energysmart ( program ) if you are either: A current commercial customer of Nicor Gas and completing qualifying services in a non-residential space with an active Nicor Gas account. Public (taxpayer-funded) entities and self-directed customers are not eligible. OR A current residential customer of Nicor Gas in a multi-family building that has permanent or semi-permanent residents. Multi-family buildings are limited to apartments, condominiums, assisted living facilities, retirement community facilities, or college/ university dormitories consisting of five units or more. Completing qualifying services in a multi-family residential space with an active Nicor Gas account. Installation requirements Your installation of high efficiency natural gas equipment/product or completion of a qualifying service ( equipment ) is eligible for a rebate if: It meets all equipment-specific, energy efficiency and program requirements outlined in this application form. Services are conducted conforming to all applicable building, local and state codes, and manufacturer specifications. It is replacing existing natural gas equipment used for the same purposes (applicable only to installations completed in existing facilities). Equipment additions to a nonresidential space, where equipment did not previously exist, or installation of qualifying equipment in a new facility, are eligible for program rebates if all other program qualifications are met. Natural gas equipment replacing electric equipment, and electric equipment replacing natural gas equipment are not eligible. It is installed by a qualified individual, conforming to all applicable building, local and state codes and manufacturer specifications. Equipment installations must adhere to applicable environmental, health and safety regulations, and equipment must be properly ventilated (if applicable). Professional installation is strongly recommended to ensure the efficient and proper functioning of equipment but is not required. It is installed and operational prior to submittal of this application at the address listed on the application. It is installed in a property owned by the applicant, or the applicant has received permission from the property owner to install the equipment. It is completed during the program offering period: June 1, 2014-May 31, 2015. Application requirements To be considered complete and eligible for rebates, all applications must: Be postmarked (or submitted online) no later than 90 days after the install date, or by June 30, 2015, whichever comes first. Include itemized contractor invoice(s) or proof of purchase receipt(s) consisting of: Equipment make, model and serial number (serial number is not required if the product does not have a dedicated serial number). Total installed cost (itemized by qualifying equipment). Purchase date and install date (if purchased and installed on different dates). Total number of units installed. Professional contractor s business/company name, address and phone number (if installed by a professional contractor). Balance due of zero, paid-in-full stamp, or payment terms. Include all documentation listed on page 5. Be signed by the Nicor Gas account holder, or include a customer release form signed by the account holder. Please note: If rebate is to be paid directly to the installing contractor (for an instant discount) or a landlord (who is not the account holder), application submissions must meet all requirements listed in the instant discount requirements and landlord applicant requirements sections below. Use separate applications if applying for multiple equipment or products installed by different contractors. Online applications must: Be submitted online at apply.nicorgasrebates.com (do not mail this form). Be accompanied by a copy of the Itemized Contractor Invoice/Proof of Purchase Receipt and all rebate-specific required documentation. Instant discount requirements If rebate is being paid directly to the installing contractor, contractor must submit: Copy of customer job order/invoice showing the rebate amount deducted from the total purchase price, signed by customer. Completed and contractor-signed rebate application, with account holder-signed customer release form verifying product(s) installed and releasing payment to the contractor (account holder-signed rebate application will be accepted in place of a customer release form). The Nicor Gas account holder must sign either the rebate application or a customer release form, in addition to the contractor invoice. Customer release forms are available for download at nicorgasrebates.com/contractor-circle. The contractor invoice must clearly show the full rebate amount as a deduction off the customer s purchase price. It is the installing contractor s sole responsibility to verify customer, product and installation eligibility prior to providing an instant discount. Contractor assumes all liability by providing the rebate as an instant discount. The online application system for instant discounts is limited to Contractor Circle members. Visit nicorgasrebates.com/contractor-circle for more or to enroll in the Contractor Circle. Program Terms and Conditions Funds are limited and applications are processed on a first-come, first-served basis. Program is subject to change and may end without prior notice. Please allow approximately six to eight weeks for processing and mailing of your rebate payment. Incomplete applications cannot be processed. Failure to complete the rebate application in full and provide the required supporting documentation will either delay the payment process or result in your application being denied. Maintain a copy of your rebate application and all supporting documentation. The program is not responsible for items (i.e. rebate applications, supporting documentation, and/or rebate checks) lost or damaged in the mail. Contractors are eligible to have the rebate signed over to them. Contractors receiving rebates are not eligible for any other incentives for the same products. Contractors must submit the hard copy application (with the exception of eligible Contractor Circle members). If you do not own the property where this equipment is installed, as a tenant you are responsible for obtaining the property owner s permission to install the equipment for which you are applying for a rebate. Your submission of this application indicates that you have obtained this permission. incentives may not exceed the total purchase price of the energy-efficient equipment. The only costs eligible for incentives are: materials, equipment and external labor. All equipment installations are subject to verification inspection by the program administrator to ensure that the equipment is properly installed and operating. Participants must allow, if requested, energysmart or a program representative reasonable access to their facility to verify the installed equipment. Any customer receiving a rebate check may be contacted by an evaluator to verify service/equipment installation or be asked to complete a customer survey. If contacted, your participation is required as a part of program participation. Nicor Gas, contract and program administrators disclaim any and all liability, loss or damage and make no guarantees related to: Participation in the program, including use or installation of the equipment. Loss or delay of rebate check in the mail. Any taxes that may be imposed as a result of participation in the program. Landlord participant requirements If you are applying for a rebate for a property you own, but the Nicor Gas account number is in your tenant s name, provide the following: Page 2: Include your tenant s account number, name and. Select Landlord under check payable. Include your name under Application contact. Copy of the itemized contractor invoice/proof of purchase receipt, signed by the purchaser. All applicable purchase invoices and required documentation, as listed on this application. Completed rebate application, signed by the applicant and a customer release form - landlord applicants signed by the Nicor Gas account holder. Customer release forms can be found at nicorgasrebates.com. Payee Payee: The program allows the check to be made out to any one of the following: Nicor Gas account holder, contractor or landlord. Please review all requirements listed on this page. If you are the account holder and wish the rebate check to be made out to you, please complete all of the required fields in the rebate application, provide the required supporting documentation listed on this page of the rebate application and have the Nicor Gas account holder sign on page 2 as the Applicant. The check may also be made out to the landlord (who is not the account holder) or the installing contractor (offering an instant discount). Please review all requirements outlined on this page for applications submitted by a landlord or contractor. The Nicor Gas account holder must sign the applicable customer release form if the check is being made payable to the landlord or contractor. 5 of 5