Prescriptive Progrm Rebte Appliction Check the pproprite progrm box for your rebte. OID Internl Use Only Cooling FSO (Fluid System Optimiztion) Foodservice Equipment Heting Lighting Motors & Drives Customer Informtion Xcel Energy premises numbers: Electric: nd/or Gs: Compny Nme Dte submitted Instlltion ddress City Stte ZIP Miling ddress City Stte ZIP (For rebte if different from instlltion ddress) Contct Nme (PRINT) Phone Contct Emil* Fx Equipment loction description (REQUIRED) The totl project cost: $ (Acceptble expenses include equipment nd lbor nd do not include tx, freight or shipping costs.) Customer Signture Dte This signture is required from the individul tied to the Xcel Energy premises number herein. By signing here, I cknowledge the informtion in this ppliction is ccurte nd complete. I confirm I hve red, gree with nd understnd the terms nd conditions on pge 2 of this ppliction. I lso uthorize Xcel Energy to provide copy of the project prepprovl notifiction to the equipment supplier or vendor so s to expedite the project process. Alterntive Rebte Recipient Complete this section only if the customer wnts the rebte check to go to someone other thn the customer contct tied to the premises number bove. Compny Nme Contct nme Address Phone City Stte ZIP I uthorize the bove compny to receive the rebte check for this project. Customer Signture Dte Xcel Energy ccount representtive nme Signture Trde Prtner Informtion (Vendor/Contrctor Informtion) Compny Nme Trde Prtner ID# Contct Nme (PRINT) Address City Stte ZIP Contct emil* Phone *By providing your emil ddress, you re grnting Xcel Energy permission to send updtes or questions vi emil regrding this project s well s future emils regrding our progrms nd services. PAGE 1 OF 6 15-06-406 06/2015 CRS 2044
Qulifying Customers Xcel Energy Prescriptive Rebte progrms re vilble to Xcel Energy business electric nd/or gs customers tht instll qulifying equipment in Xcel Energy s Minnesot service territory. How to Apply for Rebtes 1. Fill out the rebte ppliction (for ech instlltion ddress). 2. Attch copy of the pid, itemized invoice(s). Be sure tht the quntity, mke, model number nd unit price of ech item ppers on the invoice. 3. Mke copy of this document for your records. 4. If you hve questions plese contct your Xcel Energy ccount mnger or one of our energy efficiency specilists to discuss nd/or complete the project ppliction form. 5. You cn emil your completed project pperwork to: energyefficiency@xcelenergy.com, fx to: 1-800-311-0050, or mil to: Energy Efficiency Specilist, Business Solutions Center, P.O. Box 8, Eu Clire, WI 54702-0008. 6. Once completed pperwork is submitted, rebte pyments re usully mde in six to eight weeks fter the rebte ppliction hs been processed. Custom Efficiency Rebte Progrm Equipment tht is not eligible for prescriptive rebtes cn be submitted through the Custom Efficiency progrm. Prepprovl through the Custom Efficiency progrm is required before the purchse nd instlltion of equipment. The Custom Efficiency rebte ppliction nd progrm detils cn be found t xcelenergy.com/customefficiency. Rules nd Requirements All equipment must be new. Used or rebuilt equipment is not eligible for rebte. Equipment must meet progrm specifiction requirements nd be purchsed, instlled nd operting prior to submitting n ppliction for rebte. Xcel Energy reserves the right to withhold pyment for products tht do not meet the requirements. Rebtes cnnot exceed 60 percent of the project cost (including equipment nd lbor). A signed ppliction nd detiled instlltion invoice(s) must be completed nd submitted to Xcel Energy within 12 months (24 months for motors, VFDs, nd constnt speed motor projects) of the invoice dte. Xcel Energy is not responsible for ny lost, lte, stolen, ineligible, illegible, misdirected or postge-due mil. All completed submissions become the property of Xcel Energy upon receipt nd will not be returned. Xcel Energy will issue rebte in the form of check. Progrm rules, requirements nd offer re subject to chnges t ny time. Xcel Energy s prescriptive rebte progrms re subject to 60 dys notice of cncelltion. Chnges or notifictions will be posted t xcelenergy.com/ Rebtes. The customer nd trde prtner re responsible for contcting n energy efficiency specilist to determine whether the progrm is still in effect nd to verify progrm prmeters. Cll 1-855-839-8862 or emil energyefficiency@xcelenergy.com. Xcel Energy reserves the right to refuse pyment nd prticiption if the customer or contrctor violtes progrm rules nd procedures, or locl, stte or federl regultions. Xcel Energy is not lible for rebtes promised to customers s result of misrepresenttion of the progrm. Xcel Energy s cceptnce of the ppliction does not gurntee pyment of rebte. Xcel Energy retins the right to limit rebtes or to mke djustments to correct incentive clcultions if necessry. Energy svings clcultions re estimtes nd my vry from ctul results. Wrrnty Informtion Xcel Energy does not endorse ny prticulr mnufcturer, product or system design by offering these rebtes. Xcel Energy will not be responsible for ny tx libility imposed on the customer s result of the pyment of rebtes; does not expressly or implicitly wrrnt the performnce of instlled equipment (contct your contrctor for detiled equipment wrrnties). Xcel Energy is not responsible for the proper disposl/recycling of ny wste generted s result of this project; is not lible for ny dmge cused by the opertion or mlfunction of the instlled equipment; nd does not gurntee tht specific level of energy or cost svings will result from the implementtion of energy conservtion mesures or the use of products funded under these progrms. Xcel Energy reserves the right to conduct rndom on-site inspection of your project before or fter issuing rebte. The customer grees to provide resonble ccess to inspect the instlltion. On-site inspections my be performed up to one yer fter the dte the rebte check is issued. If Xcel Energy finds tht the ppliction does not comply with Xcel Energy rules nd qulifictions, ny rebte mount my be djusted, denied or subject to return. PAGE 2 OF 6 15-06-406 06/2015 CRS 2044
Plese indicte the primry use* for this loction: Office Retil Lodging Eduction - community college Eduction - secondry school Eduction - university Helth/medicl - clinic Helth/medicl - hospitl Dt center Other *Chillers used for non-spce conditioning (process cooling) must go through our Custom Efficiency progrm nd be prepproved prior to purchse. County of instlltion REBATE LEVELS AND REQUIREMENTS BASELINE REBATE INCREMENTAL REBATE Minimum efficiency Bse rebte per ton Increment Incr. rebte per ton Anti-swet Heter Controls $60/door Chillers Air Cooled 9.7 FLV EER $8 $1.50 per FLV+, $.75 per IPLV 12 IPLV SEER bove bse Chillers VFD Retrofit.01 kw/ton $1.50 per IPLV below bse Chillers Wter Cooled < 150 tons (Centrifugl) > 150 tons (Centrifugl) < 150 tons (Screw/Scroll) 150 300 tons (Screw/Scroll)** DX Units (rooftop, split systems nd condensing units) < 5.5 nominl tons 5.5 11.3 nominl tons 11.4 19.9 nominl tons 20.0 63.3 nominl tons > 63.3 nominl tons EC Motors (Electroniclly Commutted Motor) Refrigerted Disply Cse Freezer Disply Cse ( Low Temp) Wlk-in Refrigertor Wlk-in Freezer Energy Recovery Ventiltors*** Must improve on ASHRAE 90.1 2004 bseline by 0.016 kw/ton 0.74 FLV kw/ton, 0.63 IPLV kw/ton 0.67 FLV kw/ton; 0.58 IPLV kw/ton 13.5 SEER 10.8 EER 10.7 EER 10.2 EER 9.5 EER 60%Totl Cooling Effectiveness 60% Heting Sensible Effectiveness $40 $40 $1 per CFM $1 per CFM 0.1 SEER Pckged Terminl Air Conditioner 10.8 EER Plte nd Frme Het Exchnger (with cooling tower for use of free cooling) Wet Bulb Temperture 52 F nd >45 F 45 F nd >40 F 40 F nd >35 F 35 F Rooftop Unit Economizer Enthlpy nd CO 2 control $20 Wter Source Het Pump 13.2 EER Zero Loss Energy Doors Cse Temperture to 0 F = Freezer 1 F 35 F = Cooler Rebtes summrized bove re subject to full progrm eligibility nd prticiption requirements. **If screw/scroll chiller is lrger thn 300 tons, the chiller my still qulify, but the rebte will be bsed on 300-ton chiller. ***Heting rebte only vilble to Xcel Energy nturl gs heting customers. Invoices must be dted on or fter October 1, 2014. $300 $240 $180 $120 $2 per FLV+, $1.50 per NPLV below bse $2 per FLV+, $1.50 per IPLV below bse 0/door (freezer) $100/door (cooler) PAGE 3 OF 6 15-06-406 06/2015 CRS 2044
ANTI-SWEAT HEATER CONTROLS * No. of doors Mnufcturer Model no. Type of Control Rebte clcultion Totl rebte Cooler Freezer No. of doors x $60 = $ CHILLERS AIR COOLED No. of units Mnufcturer Model no. Full Lod Tons/unit FLV/EER IPLV/SEER Totl rebte (Bse: $8 x tons = $ ) + [Efficiency: (FLV $1.5 x x tons = $ ) + IPLV $0.75 x b x tons = $ )] = $ [Equipment EER (from vendor) Min. qulifying EER (from tble of minimum qulifying criteri)] /.1 b [Equipment IPLV or SEER (from vendor) Min. qulifying IPLV or SEER (from tble of minimum qulifying criteri)] /.1 CHILLERS - VFD RETROFIT No. of units Mnufcturer Model no. Tons/unit* IPLV (previous) IPLV (post) Totl rebte (IPLV $1.5 x tons = $ ) [Previous IPLV kw/ton - Post IPLV kw/ton (design conditions)]/.01 *chiller tons CHILLERS CENTRIFUGAL No. of units Mnufcturer Model no. Full Lod Tons/unit FLV (kw/ton) NPLV (kw/ton) Totl rebte (Bse: x tons = $ ) + [Efficiency: FLV $2 x x tons = $ ) + NPLV $1.5 x b x tons = $ )] = $ [Min. qulifying FLV kw/ton Equipment FLV kw/ton (design conditions)]/.01 b [Min. qulifying NPLV kw/ton Equipment NPLV kw/ton (design conditions)]/.01 CHILLERS ROTARY OR SCROLL No. of units Mnufcturer Model no. Full Lod Tons/unit FLV (kw/ton) IPLV (kw/ton) Totl rebte (Bse: x tons = $ ) + [Efficiency: FLV $2 x x tons = $ ) + IPLV $1.5 x b x tons = $ )] = $ [Min. qulifying FLV kw/ton (from tble of minimum qulifying criteri) Equipment FLV kw/ton (from vendor)] /.01 b [Min. qulifying IPLV kw/ton (from tble of minimum qulifying criteri) Equipment IPLV kw/ton (from vendor)] /.01 DX UNIT No. of units Mnufcturer Model no. Nominl Tons/unit EER/SEER A/N Coil* Totl rebte (Bse: x tons = $ ) + (Efficiency: x x tons = $ ) = $ (Bse: x tons = $ ) + (Efficiency: x x tons = $ ) = $ [Equipment EER or SEER (from vendor) Min. qulifying EER or SEER (from tble of Min. Qulifying Criteri)] / 0.1 *A/N Coil model is required for units <5.5 tons only. ENERGY RECOVERY VENTILATORS No. of units Mnufcturer Model no. CFM Heting Effectiveness Cooling Effectiveness Equipment EER ERV Pressure Drop Totl rebte Heting rebte is only vilble to Xcel Energy nturl gs heting customers. Invoices must be dted on or fter October 1, 2014. PAGE 4 OF 6 15-06-406 06/2015 CRS 2044
EC MOTORS (ELECTRONICALLY COMMUTATED MOTORS) Section A - ECMs tht replced shded pole motors within refrigerted disply cses. Line # End use function Mnufcturer Model # Rebte Qty 1 Refrigerted Disply Cse $40 Rebte x Qty = Totl Rebte 2 Refrigerted Disply Cse $40 3 Refrigerted Disply Cse $40 4 Refrigerted Disply Cse $40 Section B - ECMs tht replced shded pole motors within low temperture (freezer) disply cses. Line # End use function Mnufcturer Model # Rebte Qty 5 Freezer Disply Cse $40 Rebte x Qty = Totl Rebte 6 Freezer Disply Cse $40 7 Freezer Disply Cse $40 8 Freezer Disply Cse $40 Subtotl, Sections A & B PLEASE NOTE: Ech line of sections C&D MUST INDICATE if the ECM will drive n evportor fn of more or less thn 15 inches. Items tht do not indicte the fn size cnnot be rebted. Section C - ECMs tht replced shded pole motors within wlk-in refrigertors. Line # Function / FAN SIZE Mnufcturer Model # Rebte Qty 9 Wlk-in Refrig. Rebte x Qty = Totl Rebte 10 Wlk-in Refrig. 11 Wlk-in Refrig. 12 Wlk-in Refrig. Section D - ECMs tht replced shded pole motors within wlk-in freezers. Line # Function / FAN SIZE Mnufcturer Model # Rebte Qty 13 Wlk-in Freezer Rebte x Qty = Totl Rebte 14 Wlk-in Freezer 15 Wlk-in Freezer 16 Wlk-in Freezer Subtotl, Sections C & D Grnd Totl, Sections A, B, C & D PAGE 5 OF 6 15-06-406 06/2015 CRS 2044
PACKAGED TERMINAL AIR CONDITIONERS (PTAC) No. of units Mnufcturer Model no. Tons/unit EER Item rebte (Bse: x tons = $ ) + (Efficiency: x x tons = $ ) = $ (Bse: x tons = $ ) + (Efficiency: x x tons = $ ) = $ [Equipment EER (from vendor) Min. qulifying EER (from tble of Min. Qulifying Criteri)] / 0.1 PLATE AND FRAME HEAT EXCHANGER No. of units Mnufcturer Wet bulb temp* Tons/unit ** Blnce Point*** IPLV (kw/ton) Item rebte * Wet bulb temperture het exchnger is used insted of chiller F ** Lod/Tons displced by het exchnger *** Blnce point of building in F. Defult is 20 F. If dt center or process lod, use -26 F ROOFTOP UNIT ECONOMIZER Determine rebte t xcelenergy.com/coolingefficiency No. of units Mnufcturer Model Number RTU tons/unit Enthlpy controlled?* CO 2 Controls purchsed?* (Bse: $20 x RTU tons x no. of units = $ totl rebte) *Must hve both enthlpy nd CO 2 to qulify for economizer rebte Yes No Initils Yes No Initils WATER SOURCE HEAT PUMPS No. of units Mnufcturer Model no. Tons/unit EER Item rebte (Bse: x tons = $ ) + (Efficiency: x x tons = $ ) = $ [Equipment EER (from vendor) Min. qulifying EER (from tble of Min. Qulifying Criteri)]/0.1 ZERO LOSS ENERGY DOORS FOR COOLERS No. of doors Mnufcturer Model no. Rebte clcultion Totl rebte No. of doors x $100 = $ Cooler tempertures re 1 F to 35 F. ZERO LOSS ENERGY DOORS FOR FREEZERS No. of doors Mnufcturer Model no. Rebte clcultion Totl rebte No. of doors x 0 = $ Freezer Door tempertures must be 0 F or below. TOTAL REBATES No. of units Totl rebtes listed bove Xcel Energy retins the right to limit rebtes or mke djustments to correct incentive clcultions if necessry. Energy svings clcultions re estimtes nd my vry from ctul results. Importnt: Copies of ll invoices, specifictions sheets nd this completed ppliction form re required before Xcel Energy cn issue rebtes. See Progrm Guidelines for dditionl informtion. xcelenergy.com 2015 Xcel Energy Inc. Xcel Energy is registered trdemrk of Xcel Energy Inc. Northern Sttes Power Compny-Minnesot nd Northern Sttes Power Compny-Wisconsin, Xcel Energy Compnies. 15-06-406 06/15