COING EQUIPMENT 2018 ILLINOIS FOR YOUR BUSINESS REBATE APPLICATION Instructions: Fill out form completely and sign. Attach itemized invoices and supporting documentation, if applicable. Failure to complete the required sections and provide documentation will result in denial of claim. Equipment must be purchased between Jan. 1, 2018, and Dec. 31, 2018. Equipment must be installed and operating prior to submission of final rebate application. s cannot exceed 50 percent of the installed (materials and reasonable labor). You will receive the lesser of the rebate amount listed or 50 percent of installed. Installed includes contractor labor only and does not include internal labor. application must be submitted within six months of dealer invoice, or by Dec. 31, 2018, whichever comes first, for the equipment/ material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. applications received after Dec. 31, 2018, are not eligible for rebates. Custom Equipment: If specific equipment you intend to purchase and install is not listed, it may qualify under Nonresidential Equipment Custom Systems. However, custom projects must be preapproved by MidAmerican Energy prior to purchase and installation of equipment or system. Projects must be completed within six months of preapproval. See the Nonresidential Equipment Custom Systems application for details. SECTION 1 (REQUIR) Name on account Customer Information Self-installed q Yes q No Installation address City State ZIP Phone MidAmerican Energy Company account number (found on bill; first seven digits only) Mailing address (if different than installation address) City State ZIP Contact name Title Email address* *This email address only will be used for communication regarding this rebate application. Your email address never will be shared and you can unsubscribe at anytime. SECTION 2 (REQUIR) Year building was constructed Building size [sq. ft. (area)] Do you: q Own q Rent this building The new equipment is for: q Replacement of existing equipment q New installation (new to facility) q New construction Page 1 of 6
SECTION 2 CONT. (REQUIR) Equipment installed in what type of facility? (check one) Industrial MEC Use Only Commercial MEC Use Only q Apparel manufacturing q Apartment, halfway house q Chemical manufacturing q Condo q Computer/electronic product manufacturing q Convenience store/gasoline station CV q Electrical equipment, appliance/component manufacturing q Food/beverage/tobacco product manufacturing q Furniture and related product manufacturing q Leather and allied product manufacturing q Machinery manufacturing q Nonmetallic mineral product manufacturing q Oil and gas extraction; mining q Paper manufacturing; printing and related support activities q Personal and laundry services q Dealership small <30k q Dealership large >30k q Financial institution small <30k q Financial institution large >30k q Grocery store and supermarket q Healthcare (outpatient) q Healthcare (inpatient, including hospital, nursing home, senior care facility) q Healthcare senior housing - individual apartment q Health club/exercise facility small <30k GR HC HS q Petroleum and coal products manufacturing q Health club/exercise facility large >30k q Plastics and rubber products manufacturing q Library q Primary metal/fabricated metal product manufacturing q Textile mill and textile product mill q Transportation equipment manufacturing q Utility q Warehouse and storage q Warehouse large refrigerated q Wood product manufacturing q Miscellaneous manufacturing q Other industrial O q Lodging hotel q Lodging motel q Mixed use q Other - commercial q Office small 4 floors q Office large > 4 floors q Office government small 4 floors q Office government large > 4 floors q Office public order and safety small 4 floors q Office public order and safety large > 4 floors LO LO O O Agriculture MEC Use Only q Pharmacy and drug store small <30k q Corn farming q Dairy cattle and milk production q Hog facility q Soybean farming q All other animal production q All other miscellaneous crop farming DF HF q Pharmacy and drug store large >30k q Public assembly events/conventions/casinos small <30k q Public assembly events/conventions/casinos large >30k q Religious worship/church q Restaurant fast food q Restaurant full service HY HY RE T T q Retail small <30k q Retail large >30k q Retail department store small <30k q Retail department store large >30k q School elementary q School jr. high q School high school q School college, university and professional school q School lodging (school/dorm) q Service small <30k q Service large >30k q Truck stop CV q Warehouse and storage WH-C q Warehouse large refrigerated WH-C Page 2 of 6
SECTION 3 Complete all fields for each piece of equipment purchased and installed. Size Category Small < 65 MBtuh Large 65-240 MBtuh Central Air Conditioners - AHRI Certified Equipment efficiencies to be rated according to test procedures and standard rating conditions as specified in 2012 IECC. For ductless minisplits, Qualifying Efficiency 15-15.9 SEER 16-16.9 SEER 17+ SEER 12-12.4 EER 12.5-12.9 EER 13 + EER (per unit installed) 100/ton 300/ton 20/ton 37.50/ton refer to the Heat Pumps/Ductless Minisplits application. Equipment 1 Unit Size* (actual cooling tonnage rounded to nearest tenth of a ton) Outdoor unit manufacturer Outdoor unit model number Outdoor unit serial number Total Indoor unit manufacturer Indoor unit model number Indoor unit serial number Equipment Total installed Equipment 2 Size Category Qualifying Efficiency (per unit installed) Unit Size* (actual cooling tonnage rounded to nearest tenth of a ton) Total Small < 65 MBtuh 15-15.9 SEER 16-16.9 SEER 17+ SEER 100/ton 300/ton Large 65-240 MBtuh 12-12.4 EER 12.5-12.9 EER 13 + EER 20/ton 37.50/ton Outdoor unit manufacturer Outdoor unit model number Outdoor unit serial number Indoor unit manufacturer Indoor unit model number Indoor unit serial number Equipment Total installed * is based on actual equipment rating in Btuh at AHRI rating conditions. Divide Btuh by 12,000 to calculate unit size in tons. Packaged Terminal Air Conditioners - New Construction - AHRI Certified (Packaged terminal heat pumps are not eligible.) Minimum Qualifying Efficiency EER > 13.8 35/ton Serial number Equipment Total installed Packaged Terminal Air Conditioners - Replacement Units - AHRI Certified (Packaged terminal heat pumps are not eligible.) Minimum Qualifying Efficiency EER > 10.9 35/ton Serial number Equipment Total installed For more details, view the AHRI directory at www.ahridirectory.org. Page 3 of 6
Controls (Programmable thermostat for all heating and/or cooling sources. MidAmerican Energy must provide energy source controlled by the programmable thermostat for which the rebate is being paid.) Install date Control 1 Number of Units Installed X 25/unit = Total Programmable thermostat controls q Furnace q Boiler qcentral air conditioner qheat pump Equipment Total installed Control 2 Install date Number of Units Installed X 25/unit = Total Programmable thermostat controls q Furnace q Boiler qcentral air conditioner qheat pump Equipment Total installed Destratification Fans MidAmerican Energy must provide the natural gas to the heating source at the facility for which the rebate is being paid. Electric-only customers may qualify under Nonresidential Equipment Custom Systems. Equipment Type Destratification fan, high volume, low speed Qualifying Efficiency Horizontal mounted, 20-foot minimum fan diameter, VSD controlled no additional VSD rebate Number of Units Installed Total X 1,000/fan = Install date Fan diameter in feet Equipment Total installed Serial number Specific Terms and Conditions nparticipants must be commercial or industrial customers with facilities located in MidAmerican Energy Company s Illinois service territory. nmidamerican Energy Company must deliver the fuel to the equipment at the facility for which the rebate is being paid. nequipment installed as a replacement unit, retrofit or in new construction is eligible. nfor cooling equipment a manufacturer s specification sheet with the rated EER or SEER must accompany the application. n based on actual equipment rating in Btuh at AHRI-rating conditions. To convert Btuh to tons, divide the Btuh by 12,000. For example, if you are converting 24,000 Btuh into tons, divide by 12,000. The result is 2 tons. nfor prescriptive rebates, the rebate payment cannot exceed 50 percent of the installed (reasonable labor and material/equipment - reasonableness to be determined by MidAmerican Energy Company). Installed includes contractor labor only and does not include internal labor. nequipment must be purchased between Jan. 1, 2018, and Dec. 31, 2018. Equipment must be installed and operating prior to submission of final rebate application. n application must be submitted within six months of dealer invoice, or by Dec. 31, 2018, whichever comes first, for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. applications received after Dec. 31, 2018, will not be eligible for rebates. nallow 4 6 weeks for rebate processing, excluding on-site verification time, if needed. General Terms and Conditions Important: Before completing and signing this form, please read the General Terms and Conditions located in the 2018 Illinois For Your Business rebate booklet or at www.midamericanenergy.com/ee. REMEMBER TO SIGN THE NEXT PE Page 4 of 6
Disclaimer MidAmerican Energy Company does not guarantee that installation and operation of high-efficiency equipment will result in reduced usage or in savings. MidAmerican Energy Company makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to, any warranty of merchantability or fitness for a particular purpose. In no event shall MidAmerican Energy Company be held liable for any incidental or consequential damages or injuries resulting from defective equipment or installation. MidAmerican Energy Company reserves the right to cancel or change these programs at any time. MidAmerican Energy Company s acceptance of this application does not guarantee payment of rebate. Customer Agreement My signature indicates consent to and agreement with all program terms and conditions. It certifies that all information in this application is correct and equipment installed at the indicated location. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before issuing payment. Customer signature Date Dealer name Installer/Dealer Information Phone Address Fax City State ZIP Contact name Email address Installer/Dealer Agreement I certify that all equipment and installation information provided on this application is correct and accurate. Installer/dealer signature Date Before you submit your form: oofill out this form completely. ooattach a copy of the itemized sales receipt or invoice. ooinclude documentation listed in the instructions. oosign the Customer Agreement section. Send completed forms to: Mail: MidAmerican Energy Company P.O. Box 4628 Des Moines, IA 50305-4628 Fax: 515-244-8825 Email: rebateapplications@midamerican.com For MidAmerican Energy Use Project # Project # Received date Method: E M F IO Assessment # Assessment date KAM-BAM Sector type total amount For more information call 800-894-9599 or go to www.midamericanenergy.com/ee. Page 5 of 6
Invoice(s) submitted must include itemized quantity, price, manufacturer s make and model numbers and product codes for each material item and original equipment manufacturer specification sheets. Itemized invoices are the key to fast processing of rebate forms. Sample Invoice Date: January 31, 2018 INVOICE #: 25000 Include project codes and/or item numbers SHIP TO: XYZ Company 234 Jersey St. Des Moines, IA 50309 555-123-4567 Specify the quantity for each item Identify manufacturer s part information TO: XYZ Company 234 Jersey St. Des Moines, IA 50309 555-123-4567 PO number: Bill Terms: 2% of Net 30 ITEM QTY DESCRIPTION RATE INSTALL AMOUNT GWK500 1 Ground-source heat pump 5,000 1/2/2018 5,000.00 HDPE pipe 750ft. Loop piping 3.00/ft. 1/2/2018 2,250.00 Labor 1 Installed ground-source heat pump with closed loop List price for each item and total 2,000 1/2/2018 2,000.00 Travel Travel 64 64.00 Local sales tax 6% 555.00 Total 9,869.00 Note labor and other expenses separately from material s Give accurate description of work completed Page 6 of 6