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Connecticut Energystar form for Rebates
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Company Name (please print) Contact
Service Address
City State Zip
Mailing Address
City State Zip
Electric Utility (check one) Electric Account Number (as stated on bill)
n CL&P n UI
Company Name Contact
Mailing Address
City State Zip
Customer Information
Contractor Information
FOR COMMERCIAL AND INDUSTRIAL CUSTOMERS: Valid for all Connecticut Light & Power (“CL&P”), United Illuminating (“UI”), Connecticut Natural Gas Corporation (CNG), Southern Connecticut Gas Company (SCG) or Yankee Gas Services Company (YGS) commercial & industrial customers (“Customer”) who purchase and install eligible kitchen equipment (“Equipment”) on or after January 1, 2013 through December 31, 2013. All rebate applications (“Application”) and required documentation must be received no later than December 31, 2013. Rebate cannot exceed 50% of the total Equipment cost. Used or rebuilt equipment is not eligible for a rebate incentive. ENERGY STAR® requirements for commercial kitchen equipment are available at www.energystar.gov.
TO APPLY FOR YOUR REBATE, READ THE PROGRAM TERMS AND CONDITIONS ON REVERSE BEFORE PROCEEDING.
INSTRUCTIONS: Please fill out this Application completely, truthfully and accurately and mail it together with an invoice and manufacturer’s specification sheet itemizing the purchased Equipment’s make, model and size and date of purchase (UI, SCG and CNG customers ONLY must also include a completed and signed UI Substitute W9 form available at www.uinet.com/hvac) to:
2013 ConneCtiCut KitChen equipment RebateFoR CommeRCiaL & inDuStRiaL CuStomeRS
Gas Company (check one) Gas Account Number (as stated on bill)
n Yankee Gas Services Companyn Connecticut Natural Gasn Southern Connecticut Gas
Telephone Fax
Employer Identification Number Incorporated
n Yes n No n Exempt
Telephone Fax
Employer Identification Number
CL&P and YGS Customers: C&I Commercial Kitchen Rebate c/o Connecticut Light & Power P.O. Box 270 Hartford, CT 06141-0270
or UI, SCG & CNG Customers: C&I Commercial Kitchen Rebate c/o United Illuminating Company 180 Marsh Hill Road, Mailstop AD-2AOrange, CT 06477
By signing this form below, I certify that all of the information described on this Application and all documents provided with this Application are accurate and true and that I have read and understand the 2013 Kitchen Equipment Rebate for Commercial & Industrial Customers TERMS AND CONDITIONS on page 3 of this form. By signing this Application, I further certify that the qualifying Equipment will be installed for use in the Connecticut address stated.
Sign Here
New Equipment Information
Equipment Type Manufacturer and Model Number
ARebate Amount per
Unit (see table)
BQuantity of
Units
Equipment Rebate(A x B)
Rebate Total $
1
Customer Signature (required) Date
n Credit Customer’s Account n Check to Customer n Check to Contractor
Incentive Payment Method
FOR UTILITY USE ONLY
Project ID Database ID Number Approved Rebate Approving Program Manager
Post-Inspection Date Inspector
Required Inspection
Measure Information: Please review Eligibility Requirements below. Include appropriate documentation.
Eligible Refrigeration Equipment
Equipment Type Qualification Rebate $ / Unit
Refrigerator, Solid Door, Self Contained30 – 49.9 cubic feet
ENERGY STAR®$175
50 cubic feet or larger $300
Freezer, Glass Door, Self Contained30 – 49.9 cubic feet
ENERGY STAR$1150
50 cubic feet or larger $1975
Freezer, Solid Door, Self Contained
Less than 15 cubic feet
ENERGY STAR
$125
15 – 29.9 cubic feet $200
30 – 49.9 cubic feet $200
50 cubic feet or larger $500
Ice Machines (Ice Making Head units only)
Harvest Rate
ENERGY STAR
101–200 lbs/day $50
201–300 lbs/day $50
301–400 lbs/day $75
401–500 lbs/day $75
501–1000 lbs/day $75
1001–1500 lbs/day $100
Greater than 1500 lbs/day $100
Eligible Food Holding Equipment
Equipment Type Qualification Rebate $ / Unit
Electric Hot Food Holding Cabinets
1/2 Size
ENERGY STAR
$650
3/4 Size $975
Full Size $900
Eligible Sanitation Equipment
Equipment Type Qualification Rebate $ / Unit
Pre Rinse Spray Valve Note: Building must have Electric or Gas Hot Water
CEE (www.cee1.org) $40
Low Temp Electric or Natural Gas DishwasherNote: Building must have Electric or Gas Hot Water
Under Counter
ENERGY STAR
$300
Door type $1,200
Single Tank Conveyor $125
High Temp Electric or Natural Gas DishwasherNote: Building must have Electric or Gas Hot Water or Unit must have Electric or Gas Hot Water Booster
Under Counter
ENERGY STAR
$750
Door type $375
Single Tank Conveyor $200
Eligible Cooking Equipment
Equipment Type Qualification Rebate $ / Unit
Electric Convection Oven ENERGY STAR $350
Natural Gas Convection Oven ENERGY STAR $500
Electric Fryer ENERGY STAR $200
Natural Gas Fryer ENERGY STAR $750
Electric Griddle ENERGY STAR $400
Natural Gas Griddle ENERGY STAR $450
Electric Steam Cooker ENERGY STAR $1,125
High Efficiency Natural Gas Steamer ENERGY STAR $750
2
Energize Connecticut – programs funded by a charge on customer energy bills. C0212 Rev. 02/13
REBATE OFFER: The rebate is for qualifying commercial kitchen equipment purchased and installed on or after January 1, 2013 through December 31, 2013. Rebate levels are subject to change or cancellation without prior notice. This application form with required documentation must be received no later than December 31, 2013. Completed and signed applications or a letter of intent must be submitted within 30 days of the equipment installation to be eligible for rebates.
MAXIMUM PAYMENT: The Utilities reserve the right to cap incentive amounts. Contact your participating utility representative or the appropriate utility company’s Program Administrator for details.
ELIGIBILITY: Natural Gas Rebates are available to industrial, commercial, and institutional customers on firm gas rates. Electric Rebates are available to commercial and industrial electric service customers of CL&P/UI. Equipment must be installed in the service territory of the participating utility. Eligible systems are ENERGY STAR® approved equipment that meets the cooking efficiency requirements.
PROOF OF PURCHASE: An invoice itemizing the purchased equipment must accompany each rebate application form. The invoice copy must indicate the equipment type, size, make and model, serial number of the system and date of purchase. UI, SCG and CNG customers ONLY must also include a completed and signed UI Substitute W9 form available at www.uinet.com/hvac.
APPLICATION FORM: This application must be filled out completely, truthfully and accurately. The customer or their authorized representative must sign, date, and submit the application along with the invoice, and manufacturer’s equipment performance sheet stating the cooking energy efficiency.
PAYMENT: Please allow a minimum of 30 days for rebate payment processing after receipt by the program administrator(s) of fully completed application materials and receipts. Payment processing may take longer if information is missing on the application.
APPROVAL AND VERIFICATION: Your participating utility reserves the right to verify sales transactions and to have reasonable access to your facility to inspect the equipment installed prior to or after issuing rebates.
ENDORSEMENT: Your participating utility does not endorse any particular manufacturer, contractor, product or system design in promoting this Initiative.
TAX LIABILITY: Your participating utility is not responsible for any tax liability that may be imposed on the customer or contractor as a result of the payment of rebates. All customers must include their Federal Tax Identification number or Social Security number as part of this application to receive a rebate. UI, SCG and CNG customers ONLY must also include a completed and signed UI Substitute W9 form available at www.uinet.com/hvac.
WARRANTIES: YOUR PARTICIPATING UTILITY DOES NOT WARRANT THE PERFORMANCE OF INSTALLED EQUIPMENT, EXPRESSLY OR IMPLICITLY. The participating utility makes no warranties or representation of any kind, whether statutory, expressed or implied, including, without limitations, warranties of merchantability, or fitness for particular purpose regarding equipment or services provided by a manufacturer or vendor. Contact your contractor or equipment manufacturer regarding equipment performance and warranties.
LIMITATIONS OF LIABILITY: Your participating utility’s liability is limited to paying the rebate incentive specified. Participating utilities are not liable for any damages arising out of or resulting from participation in this rebate offer, including but not limited to loss of profits, loss of revenues, failure to realize expected savings, loss of data, loss of business opportunity, or similar losses of any kind, as well as any indirect, incidental, punitive, special, or consequential damages, or for any damages in tort connected with or resulting from participation in this Program.
ASSIGNMENT: The customer may assign the rebate payment to a qualified contractor by making the appropriate election on this form.
CUSTOMER’S CERTIFICATION: Customer certifies that he/she has purchased and installed the equipment listed above at the Service Address. Customer agrees that all information in this rebate application is true and conforms to all equipment eligibility requirements and these Terms and Conditions. Customer has verified that the units listed above have been installed correctly. There are no unusual noises or vibrations and all controls have been calibrated. Customer or customer’s representative has been instructed on how to operate and maintain this equipment and has received all the necessary operation and maintenance manuals.
CONTRACTOR CERTIFICATION: Contractor certifies that he/she installed the equipment listed above at the Service Address. Contractor has installed the listed equipment in accordance with all federal, state, and local guidelines. Contractor certifies that all Contractor Information listed is true and conforms to all equipment eligibility requirements and these Terms and Conditions. Contractor has verified that the units listed above have been installed correctly and that there are no unusual noises or vibrations and that all controls have been properly calibrated. Contractor has instructed Customer or Customer’s representative on how to operate and maintain the equipment.
ISO-NE CAPACITY PAYMENTS: By signing this document and as a condition to receiving a rebate pursuant to this program, the customer acknowledges and agrees that any and all payments, benefits and/or credits associated with or applicable to any CL&P or UI customer’s participation in the program that is the subject of this Agreement in connection with the ISO New England, Inc. Forward Capacity Market (“FCM”) or any currently existing or successor or replacement markets, (including, but not limited to, any and all transitional FCM credits or payments or any and all other capacity-related credits, payments and/or benefits for which such customer is eligible) shall be deemed as and form capacity payments, credits and/or benefits of CL&P or UI as applicable. The customer hereby assigns to CL&P or UI, as applicable, all of its right, title and interest in and to any and all such capacity payments, credits and/or benefits and shall take any and all action, including executing and delivering any and all documents and/or instruments, as requested by CL&P or UI, as applicable, to evidence the same. Forward Capacity Market means the market for procuring capacity pursuant to ISO-NE Tariff, FERC Electric Tariff No. 3, Section III, Market Rule 1, Section 13, any modifications to the Forward Capacity Market, or any successor or replacement market/capacity procurement process.
CLASS III CONSERVATION CREDITS: In accordance with the Department of Public Utility Control’s (“DPUC[s]”, now known as the Public Utilities Regulatory Authority or “Authority” ) September 29, 2008 decision in Docket No. 05-07-19RE01, DPUC Proceeding to Develop a New Distributed Resources Portfolio Standard (Class III) – 2007 Revisions, (as supplemented by the Department February 11, 2010 decision in Docket No. 05-07-19RE02), customer is not to receive or retain any Class III renewable energy credits in connection with the Connecticut Electric Food Service Equipment Rebate Program and customer hereby acknowledges and agrees the same. Customer further acknowledges and agrees that such credits shall be retained by either CL&P or UI (as the case may be) for the benefit of their customers through the Connecticut Energy Efficiency Fund. In the event that the Authority [DPUC] amends or modifies the allocation of Class III conservation credits as reflected in its September 29, 2008 decision, then the allocation of such credits utilized by either CL&P or UI (as the case may be) shall be the allocation in effect (per the applicable Authority [DPUC] decision) on the date that the customer submitted its Rebate Application documents to either CL&P or UI (as the case may be). Customer further acknowledges and agrees that customer is not to retain or receive any environmental credits or benefits that may be ascribed or attributed from time to time to customer’s participation in the Connecticut Electric Food Service Equipment Rebate Program and any and all such benefits or credits shall be retained by either CL&P or UI (as the case may be) for the benefit of their customers through the Connecticut Energy Efficiency Fund.
TERMS AND CONDITIONS
3
9223 REV. 2-13
