National Grid High- Efficiency Heating, Water Heating andControls Program

1.800.292.2032 www.nationalgridus.com/maheat

Massachusetts

High-Efficiency Heating Equipment

High-Efficiency Water Heaters

Programmable Thermostats

Weather-Sensitive Outdoor Boiler Reset Controls

No Cost In-Home Energy Assessment

Save money, improve comfort and ensure a cleaner environment with energy savings offers for residential natural gas heating and hot water customers from National Grid.

Follow these steps to receive a rebate for the equipment listed below:

1) Consult a licensed contractor to determine what equipment will be installed and that the new equipment will qualify for the listed rebates.

2) Your licensed heating contractor should install eligible high-efficiency equipment between January 1, 2012 andDecember 31, 2012.

3) Review, complete and return this rebate application with a dated contractor invoice by January 31, 2013.

Please make sure your invoice includes:a) The type of equipment installed with the complete equipment manufacturer and model number(s)b) AFUE for heating equipment, Energy Factor or Thermal Efficiency for water heating equipmentc) Contractor’s name and addressd) Contractor’s license number

Mail application and documentation to:

National Grid High-Efficiency Heating Equipment Rebate (MA) • Offer # H943801 • PO Box 130013 • El Paso, TX 88513-0013

Please call 1-800-292-2032, e-mail ngridinfo@smartenergy-zone.com or visit nationalgridus.com/maheatif you have any questions.

You may track the status of your rebate by visiting www.smartenergy-zone.com/nationalgrid.

Use this form to apply for any of the equipment rebates listed below.

2012 Residential Energy Efficiency Rebates for Massachusetts Customers

* AFUE = Annual Fuel Utilization Efficiency** Participants do not need to be a gas heating customer

to be eligible for water heater rebates.

PRODUCT REBATEPRODUCT REBATE

REPLACEMENT THERMOSTATS7-day programmable thermostats $25/ea. Limit two per household. May be self-installed orcontractor installed. Rebate cannot exceed purchase price. Must submit a dated receipt and original UPC code from the package.

AFTER MARKET OUTDOOR BOILER RESET CONTROLSAdd on unit attached to a natural gas forced $225hot water boiler

HIGH-EFFICIENCY NATURAL GAS WARM AIR FURNACEAFUE* Rating 96% or greater with Electronic $800 Commutated Motor

AFUE* Rating 95% or greater with Electronic $500Commutated Motor

HIGH-EFFICIENCY NATURAL GAS BOILERHot water boiler with an AFUE* Rating of 96% or greater $1,500Hot water boiler with an AFUE* Rating of 90% or greater $1,000

HEAT RECOVERY VENTILATORA factory-assembled, packaged unit including fans $500 or blowers that transfer heat between two isolated air streams. Must be a natural gas heating customer; excludes portable units

HIGH-EFFICIENCY WATER HEATERS**

On-demand tankless water heater with an Energy Factor $800of .95 or higher and electronic ignition

On-demand tankless water heater with an Energy $500Factor of .82 or higher and electronic ignition

Condensing gas water heater with $50095% thermal efficiency or greater

Indirect water heater connected to a natural $400gas forced hot water boiler

Storage tank type gas water heater with an $100Energy Factor of .67 or greater

COMBINED HIGH-EFFICIENCY BOILER AND WATER HEATING UNITCombined condensing boiler and on-demand $1,200water heating unit with an AFUE* Rating of 90%or greater; must be considered one unit by manufacturer

Please mail completed rebate form and required documentation to:

National Grid High Efficiency Heating Equipment Rebate (MA) • Offer # H943801 • PO Box 130013 • El Paso, TX 88513-0013

Please review terms and conditions. Form must be completed entirely. If eligible, you are entitled to only one rebate per category listed in bold below. You are not entitled to an additional GasNetworks rebate.

Account Holder’s Name: ________________________________________________________________________________________

E-Mail: _________________________________________________________________________ r Existing Dwelling r New Construction

National Grid Gas Account Number:

National Grid Electric Account Number:

Installation Address: _______________________________________ City: _____________________ State:_____ Zip: _____________

Mailing Address: __________________________________________ City: _____________________ State:_____ Zip: _____________

Name of person to whom rebate should be made payable:________________________________ Phone: ____________________

(where equipment was installed)

Residential Natural Gas Equipment Rebate Application

(If different from installation address listed above)

CUSTOMER INFORMATION (all information required)

CONTRACTOR INFORMATION (all information required)

Heating Contractor Name: __________________________________________ Gas Permit Number: __________________________

Gas Fitter/Plumber License Number: ______________________________________________________________________________

Street: ____________________________________ City: ______________________ State: __________ Zip: ____________________

Business Phone: ______________________________________________________________________________________________

(For High-Efficiency Heating/Water Heating Equipment Rebate)

GFK

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HIGH-EFFICIENCY NATURAL GAS FURNACE REBATE (Information required if this equipment is installed)

ENERGY EFFICIENCY MEASURE

ANTICIPATEDREBATEAMOUNT

MANUFACTURER MODEL NUMBER AFUE

TOTAL REBATE

Natural Gas Furnace withElectronic Commutated Motor > 96% AFUE

INSTALLEDDATE

Prior Unit’s Fuel Type: ❐ Gas ❐ Oil ❐ Electric ❐ Propane ❐ New Construction

Natural Gas Furnace withElectronic Commutated Motor > 95% AFUE

REBATEAMOUNT

$800

$500

HIGH-EFFICIENCY NATURAL GAS BOILER/WATER HEATING UNIT REBATE (Information required if this equipment is installed)

ENERGY EFFICIENCYMEASURE

ANTICIPATEDREBATEAMOUNT

MANUFACTURER MODEL NUMBER AFUE

TOTAL REBATE

Natural Gas Hot Water Boiler> 96% AFUE*

INSTALLEDDATE

Prior Unit’s Fuel Type: ❐ Gas ❐ Oil ❐ Electric ❐ Propane ❐ New Construction

REBATEAMOUNT

$1,500

$1,000Natural Gas Hot Water Boiler> 90% AFUE*

Combined Condensing Boilerwith On-Demand Water Heater

> 90% AFUE*$1,200

EE4587 (11/12) MA

Residential Natural Gas Equipment Rebate Application Continued

Qualifying equipment installed between 1/1/12 and 12/31/12 is eligible. Rebate form and required documentation must be postmarked by 1/31/13. One accountnumber per form. Some restrictions may apply. Rebate offers are subject to change without notice. Projects greater than ten (10) units of equipment require pre-approval. Pre-approval can be obtained by e-mailing ngridinfo@smartenergy-zone.com

Where did you hear about this program? r Sales Rep/Account Executive r Heating Contractor r Energy Auditor r Equipment Supplierr Trade Show r Print Advertising r Internet r Radio/TV r Direct Mail r E-Mail r Other __________________________

Work Completion and Rebate Validation.I hereby affirm the Energy Efficiency Equipment has been installed by a licensed contractor. I acknowledge that all work is subject to on-site work verificationand inspection as may be required by state and local law and by National Grid. I am aware of and agree to the Terms & Conditions stated on the last page of this application and am attaching copies of (1) itemized proof of purchase for programmable thermostats and (2) contractor invoices for the installation ofhigh-efficiency heating equipment, water heating equipment and/or outdoor boiler reset controls.

Customer Signature: ____________________________________________________ Date: ________________________________

Please review terms and conditions. Form must be completed entirely.

EE4587 (11/12) MA GFK

HIGH-EFFICENCY NATURAL GAS WATER HEATER REBATE (Information required if this equipment is installed)

ENERGY EFFICIENCYMEASURE

ANTICIPATEDREBATEAMOUNT

MANUFACTURER MODEL NUMBER

TOTAL REBATE

On-Demand Tankless Water Heater > .95 EnergyFactor with Electronic Ignition

INSTALLEDDATE

Prior Unit’s Fuel Type: ❐ Gas ❐ Oil ❐ Electric ❐ Propane ❐ New ConstructionEnergy Factor/Thermal Efficiency:_____________________________________________

REBATEAMOUNT

$800

$500

$500

On-Demand Tankless Water Heater > .82 EnergyFactor with Electronic Ignition

Condensing Gas Heater > 95% Thermal Efficiency

Indirect Water Heater

High-Efficiency Storage WaterHeater > .67 Energy Factor

$400

$100

HEAT RECOVERY VENTILATOR REBATE (Information required if this equipment is installed)

ENERGY EFFICIENCYMEASURE

ANTICIPATEDREBATEAMOUNT

MANUFACTURER MODEL NUMBER

TOTAL REBATE

INSTALLEDDATE

REBATEAMOUNT

$500Heat Recovery Ventilator

QUANTITY

INSTALLEDCOST

AFTER-MARKET OUTDOOR BOILER RESET CONTROL REBATE (Information required if this equipment is installed)

PRESCRIPTIVE ENERGY EFFICIENCY MEASURE

ANTICIPATEDREBATEAMOUNT

MANUFACTURER MODEL NUMBER

TOTAL REBATE

INSTALLEDDATE

REBATEAMOUNT

$225After Market Outdoor BoilerReset Control

QUANTITY

7-DAY PROGRAMMABLE THERMOSTAT REBATE (Information required if this equipment is installed)

PRESCRIPTIVE ENERGY EFFICIENCY MEASURE

ANTICIPATEDREBATEAMOUNT

MANUFACTURER MODEL NUMBER

TOTAL REBATE

INSTALLEDDATE

REBATEAMOUNT

$25/each7-Day Programmable ThermostatLimit two thermostats per account. Rebate not to exceed the purchase price.

QUANTITY

Please submit UPC code from thermostat package.

Installation of Thermostat: ❐ Self-installed ❐ Contractor-installed

PURCHASEPRICE

1. Rebates - Subject to these Terms and Conditions, this program is offered by Boston Gas Company, Colonial Gas Company and Essex Gas Company d/b/a National Grid (“the Company” or “National Grid”). The Company, through its contractual Vendor, HelgesonEnterprises, (the “Vendor”), will pay rebates to eligible customers in the Company’s Service Territory, for the purchase and installation of the equipment/products described in this literature and within this application.

2. Customer Eligibility - Equipment installed between 1/1/12 and 12/31/12 is eligible. Equipment must have been installed at theinstallation address listed on this application and the required documentation listed must be postmarked no later than 1/31/13.Applicant must be a National Grid residential gas heating customer to be eligible for the high-efficiency heating, programmablethermostat and outdoor boiler reset control rebates specified in this form. Applicant must be a National Grid residential gas or residential electric customer to qualify for the high-efficiency water heating rebates specified in this form. Checknationalgridus.com/maheat frequently for program updates.

3. Post-Installation Work Verification - The Company reserves the right to perform a verification of the specified installation. If theCompany and/or Vendor determines that the equipment was not installed in a manner that is consistent with program guidelines, the Company and/or Vendor may require that the installation be modified before making any rebate payments. The cost of suchmodifications is the responsibility of the customer. I hereby authorize the Company to release my energy use information to EnergyEfficiency Program Sponsors (EEPS) and System Benefit Charge (SBC) program administrators and/or their designee. I understandthat such information will be kept confidential and used only for the purpose of determining program eligibility and energy savings.

4. High-Efficiency Heating, Water Heating and Boiler Reset Control Rebates - All installations must be completed in conformance with state and local code requirements by properly licensed contractors.

5. Proof of Proper Installation - As part of his/her application, the Customer is required to submit dated copies of all paid invoicesdocumenting the installation (including all materials, labor and equipment invoices) which reflect the actual cost of purchasing andinstalling the equipment.

6. Indemnification - Customer shall defend, indemnify and hold harmless the Company and its officers, directors, employees, agents,servants and assigns from and against any and all losses, claims, demands and/or liability for damage to property, injury or death ofany person, or any other liability incurred by the Company, including all expenses, legal or otherwise, arising out of or related to theequipment or installation, except to the extent attributable to the negligence of Company. In no event shall Company’s liability toCustomer exceed the rebate amounts.

7. Limited Scope Review - The scope of review by the Company, Vendor and their Inspector of the installation of the equipment is limitedsolely to determine whether rebates are payable. It does not include any kind of safety or code review and should not be relied upon as one.

8. Rebate Amounts - The Company will provide rebates for approved heating, water heating, thermostat or boiler reset controlequipment, up to rebate amount indicated in the program literature and within this application. Projects greater than ten (10) unitsrequire a pre-approval from the Company. E-mail ngridinfo@smartenergy-zone.com to inquire about pre-approval.

9. Payment - The Company, through the Vendor, expects to make rebate payments to eligible customers within 45 days of a satisfactorywork verification. The Customer must refund any rebate made to the extent the contractor or equipment does not satisfy programrequirements. The Company reserves the right to change or terminate rebate offers without notice.

10. No Warranties - The Company and the Vendor do not endorse, guarantee or warrant any particular contractor, manufacturer orproduct installation. The Company and the Vendor do not make any representation of any kind regarding the results to be achieved bythe equipment or the adequacy or safety of such equipment.

11. Changes in the High-Efficiency Heating, Water Heating, Thermostat(s) or Boiler Reset Control Program - Equipment IncentiveProgram/Tax Liability Conditions and details of the High-Efficiency Heating and Water Heating Incentive Program are subject to changewithout prior notice and rebate offers may increase or decrease over time. The Company reserves the right to modify or terminate theProgram without notice. Participants of the Program may be subject to tax liability for the value of goods and services received throughthe program pursuant to state or federal income tax codes. The Company is not responsible for any tax liability which may be imposedas a result of receipt of the rebate by the Customer.

12. Contractor Insurance - The Company is not responsible for any damage that may be caused by or arise out of an installation of anyequipment. The customer is responsible for selecting contractors who are qualified and carry adequate insurance coverage.

National Grid is one of the largest investor-owned energy companies in the world. In the US, we serve nearly 5 millionelectric and 3.4 million gas customers in Massachusetts, New York and Rhode Island. Save energy and money with ouraward winning efficiency programs. Visit www.powerofaction.com/efficiency.

National Grid Massachusetts Residential Energy Efficiency Equipment ProgramTerms & Conditions

EE4587 (11/12) MA GFK