Agricultural Lighting and Equipment Rebate Form

How to apply

� Read the Terms and Conditions to determine if you are eligible for a rebate.

� Verify that the product(s) you are going to purchase and install meet the eligibility requirements listed in the corresponding product section, or contact us.

� Purchase and install qualifying product(s) during the rebate eligibility term (January 1, 2018 - June 30, 2018).

� Complete and sign the application.

� Include a copy of your invoice(s) as proof of purchase.

� Submit completed application form and invoice(s).

Need help?For more information or to confirm

eligibility, call 888-921-5990 or email

[email protected].

Efficiency Vermont and Burlington

Electric Department can help finance

your project at a low rate with no

collateral down. Please call us for

more information.

Please note:This rebate form is no

longer applicable for new

construction projects.

Contact us today to enroll

your project and maximize

impact and incentives.

In this form, you can find rebate information for:

› LED Lighting

› Heat Recovery Units

› Variable Frequency Drives

› Agricultural Energy Efficiency Loans

› Efficient Ventilation Fans

Efficiency Vermont and Burlington Electric Department offer technical assistance and rebates to help businesses make cost-effective improvements. We also partner with distributors to offer discounted products in their stores. Please contact us with any questions or for additional assistance.

Agricultural Lighting and Equipment Rebate FormValid January 1, 2018 - June 30, 2018

Don’t forget to include a copy of your invoice(s)

Agricultural Lighting & Equipment Rebate Form

Rebate Payee InformationStep 2

Customer Information & AgreementStep 1

Agricultural Lighting & Equipment Rebate Form: January 1, 2018 - June 30, 2018 Page 2

I certify that the “Payee Information” above, including Federal Tax ID Number, is correct to the best of my knowledge. I acknowledge that as Payee I am responsible for any tax liability associated with my receipt of the rebate payment.

PAYEE SIGNATURE (if different from customer)

Payee’s Federal Tax ID Number (TIN) — check one and provide EIN/TIN or SSN:

Corporation or Tax-Exempt Organization (provide TIN) City, County, or State Dept., Govt. or Agency (provide TIN) Other (provide EIN/TIN or SSN)

Employer Identification Number

or

Social Security Number

Rebate check payable to (must match EIN/TIN or SSN below):

Contact information same as above

Contact Name:

Mailing Address:

City/Town: State: Zip:

I certify that all equipment for which I am requesting a rebate has been installed, that I meet the eligibility requirements of this rebate program, and that all information submitted as part of this application, including proof of purchase and Federal Tax ID Number, is correct to the best of my knowledge. I agree to the terms and conditions listed on the back of this form.

CUSTOMER SIGNATURE (required even if rebate is going to vendor) Date

Business Name: Contact Name/Title:

Installation Address: City/Town: State: Zip:

Mailing Address (if different): City/Town: State: Zip:

E-mail Address: Telephone #:

Check to receive energy-saving offers and updates via e-mail.

New construction projects cannot use this rebate form. Call Efficiency Vermont for more information.

Electric Utility Account # (of installation location)Electric Utility Company

Project #

For Internal Use W


LED Lighting1Eligibility Requirements• LED fixtures must be new and qualified by DesignLights Consortium® (DLC).

Visit www.efficiencyvermont.com/qualified-lighting to search for a specific product. Please make sure your product is qualified by DLC by clicking on the Details button located next to the products listed in the link above.

• This rebate form should be used for fixtures being installed INSIDE an agricultural facility EXCEPT in the following situations:

∞ For LED fixtures to be installed in exterior locations, and LED mogul screw-base replacements for HID lamps, please go to www.efficiencyvermont.com/commerciallightingform to utilize the Efficiency Vermont Commercial Lighting Rebate form.

∞ For LED products to be installed for plant growing applications, please contact Efficiency Vermont to inquire about potential custom incentives.

• Products should be appropriately rated for the application in which they are going to be installed. Consult with manufacturer specification sheet for warranty applicability.

Fill Out Below

LED Installation Location*

LED Manufacturer

LED Model #

Fixture Lumen Output

# of Hours

Lights are on per

Day

Installation Date

A =Quantity of New Fixtures

B = Rebate/ Fixture

A x B = Rebate

Amount

*e.g., milking parlor Total Rebate Section 1 $

Fixture Lumen Output

Rebate

<6,000 lumens $60

6,001 - 16,000 lumens $150

>16,000 lumens $225

Any retrofit kit $25

*Lumens are based on the values reported by DLC.

Eligibility Requirements• Also known as a Fre-Heater®, pre-heater, or Therma-Stor® for the hot water system.

• Farm must milk at least 35 cows.

• For information on natural gas services and rebates, contact Vermont Gas Systems at 802-863-4511x321.

• Please contact Efficiency Vermont for biomass-fired hot water systems or for heat recovery units for farm types other than dairy.

Fill Out Below

# of Cows Milked

How Often is Milk Picked up?

(daily or every other day)

Total Bulk Tank Capacity

(gallons)

Type of Hot Water

System

Gallons of water

used/ wash cycle

Installation Date

A =Quantity

of New HRUs

B = Rebate/HRU

A x B = Rebate

Amount

n oiln propane

n kerosenen electric $1,250

n oiln propane

n kerosenen electric $1,250

Total Rebate Section 2 $

2 Heat Recovery Units (HRU)

Product and Rebate InformationStep 3


Agricultural Energy Efficiency LoanEfficiency Vermont is proud to partner with VSECU to provide loans to Vermont farmers for qualifying energy efficiency improvements. If you would like to participate in the Agricultural Energy Efficiency Loan Program, please contact Efficiency Vermont for loan information before starting your project. Please note: A loan cannot be provided if equipment has already been purchased.

Efficient Ventilation FansRebates are available for select, qualifying fans purchased and installed between 1/1/2018 and 9/30/2018. An Agricultural Ventilation Pre-Qualification Form must be completed and submitted to Efficiency Vermont for pre-approval to verify project eligibility, cost-effectiveness, and rebate amounts.

The Agricultural Ventilation Pre-Qualification Form and more information about project eligibility requirements can be found here: www.efficiencyvermont.com/agventilationform.

4 Variable Frequency Drives (VFD) on Maple Sap Vacuum Pump

Eligibility Requirements• Sap Vacuum Pump must run 24 hours per day during maple sugaring season.

• Pump motor must be 7.5 HP or greater.

Fill Out Below

Hours/Day Pump Runs

(during sugaring season)

Days/Year Pump Runs

(on average)

Pump Motor

HP

Installation Date

A =Quantity of New VFDs

B = Rebate/VFD

A x B = Rebate

Amount

$300

$300


Variable Frequency Drives (VFD) on Milk Vacuum Pump

Eligibility Requirements• Farm must milk at least 50 cows.

• Pump motor must be 5 Horsepower (HP) or greater.

• If you milk goats, contact Efficiency Vermont to inquire about custom rebates.

Fill Out Below

# of Cows Milked

Milking Setup(parlor, tie stall, or robot)

Pump Motor

HP

Installation Date

A =Quantity of New VFDs

B = Rebate/VFD

A x B = Rebate Amount

$1,125

$1,125


3


Mail to:Mail: Efficiency Vermont c/o Rebate Coordinator 128 Lakeside Ave., Suite 401 Burlington, VT 05401

Fax: 802-658-1643

E-mail: [email protected]

Burlington projects, submit form to:

Mail: Burlington Electric Department c/o Energy Services Area 585 Pine Street Burlington, VT 05401

Fax: 802-865-7500

E-mail: [email protected]

Burlington Electric Department (BED) administers efficiency programs for the City of Burlington, including the rebates listed on this form. For more information, call 802-865-7342.

Need help?For more information or to confirm eligibility, visit

www.efficiencyvermont.com or call 888-921-5990.

Please note: Equipment must be installed in an agricultural building that has active service from the electric utility grid. Rebates listed on this form are NOT available if the agricultural building is powered by a generator or off-grid. The Electric Utility Account in which the equipment is connected must be provided in Step 1: Customer Information & Agreement.

Submit Form and InvoiceStep 4

www.efficiencyvermont.com128 Lakeside Avenue, Suite 401Burlington, VT 05401888-921-5990 © 2018 Efficiency Vermont

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1. REBATE is for new equipment purchased and installed between January 1, 2018 and June 30, 2018 by agricultural customers of Vermont electric utilities, except that rebates are not available to the following customers: IBM, GlobalFoundries, Omya, and electric utility companies. Equipment must be installed within the state of Vermont in an agricultural facility. Rebate forms must be postmarked or received by July 31, 2018. Rebate offer is subject to change without notice and may not be combined with any other offer.

2. LIMITATIONS: This form cannot be used for any project involving more than 250 individual items subject to rebate, or for any project involving new construction. For information on such projects, please call Efficiency Vermont (or Burlington Electric Department for projects within the City of Burlington).

3. PROOF OF PURCHASE: Invoice(s) must include the quantity, size, type, manufacturer, model or part number, purchase date, and vendor of the efficient equipment. All sales transactions and installations are subject to verification and inspection. By signing this form, the customer consents to allow Efficiency Vermont (or, within the City of Burlington, Burlington Electric Department) 1.) to access the equipment for purposes of verification and inspection, and 2.) to disclose the customer’s information (including but not limited to the customer’s information included on this form and information on the invoices(s)) to the vendor and/or contractor who sold or installed the equipment to verify equipment purchase/installation and to collect additional information about the equipment and its installation.

4. LIMITATION OF LIABILITY: Performance of installed equipment is not guaranteed expressly or implicitly.

5. ENDORSEMENT: No particular manufacturers, products, or system designs are endorsed through this program.

6. PAYMENT: Allow 60 calendar days for delivery of payment. Incomplete or missing information will delay processing of rebate form and payment.

7. MAXIMUM PAYMENT For lighting equipment listed in Section 1 of this form, maximum payment will not exceed 100% of the equipment purchase price, and customer is responsible for all other costs including sales tax, installation, disposal/recycling, and any tax liability associated with the rebate payment. For agricultural equipment listed in Sections 2, 3, and 4 of this form, maximum payment will not exceed 100% of the equipment purchase price, installation cost, and freight cost; customer is responsible for all other costs including sales tax, disposal/recycling, and any tax liability associated with the rebate payment.

8. CAPACITY CREDITS/ENVIRONMENTAL CREDITS: In accepting these financial incentives, the customer agrees that Efficiency Vermont (or, for customers within its service territory, Burlington Electric Department) holds the sole rights to any electric system capacity credits and environmental credits associated with the energy efficiency measures for which incentives have been received.

Terms & Conditions

Documents

Agricultural Lighting and Equipment Rebate Form