Commercial, Industrial, and Public Energy Efficiency Incentive Form

Commercial IPEEI Form

Facility Name(Required)

Facility Site Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Contact(Required)

Title of Contact(Required)

Phone(Required)

Email(Required)

Building Square Footage

HVAC Type(Required)

Customer Payment Release Information

Name of Facility Authorized Representative(Required)

Representative Phone Number(Required)

Representative Email(Required)

Payee Tax ID, EIN, SSN:(Required)

Mailing Address for Rebate Check(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Signature of Facility Representative (type name)(Required)

Incentive Information

A. Pre-approval by SUB is required for your project to be eligible for incentives. Before removal of old equipment & purchase of new, SUB must verify pre-existing equipment, approve proposed equipment, & determine eligibility to accurately estimate your incentive, & to offer suggestions to maximize your incentive & cost savings. Final incentive amount is determined by verification of equipment at final inspection.

B. Standard Incentive amounts will be adjusted by the following formulas: if Standard Incentive is in this range: then Adjusted Incentive is Calculated by this formula:

$0 – $10,000 No change to Standard Incentive

$10,000 – $50,000 $5,000 + 50% × Standard Incentive

$50,000 – $200,000 $20,000 + 20% × Standard Incentive,

$200,000 – $400,000 $40,000 + 10% × Standard Incentive

SUB pays the calculated Adjusted Incentive. This applies cumulatively to all projects of all types at one location for 2 years that receive SUB incentives

C. Lighting incentives are determined using BPA’s Online Lighting Calculator (OLC) customized for SUB. Standard Incentives are subject to adjustment as stated above. Upgrades of existing fluorescent lighting utilize COMcheck as a baseline in the OLC as a New Construction project. Contact SUB to apply for lighting incentives or if you want access to the OLC for projects in Springfield and Glenwood.

D. Other Measures listed in BPA’s current Implementation Manual may be eligible for incentives. Please contact SUB for access to the Implementation Manual and to confirm availability & amount of incentive. SUB program offerings may differ significantly from BPA’s & are subject to change without notice. Standard Incentives are subject to adjustment as stated above.

Terms and Conditions

A. Scope of Work: Participant agrees to have Measures installed in accordance with SUB Program Requirements, & as described, specified, & quantified in the following required documents provided by contractor &/or Participant: • Description of Measures to be installed detailed on contractor’s or vendor’s bid, quote, proposal or estimate. • Manufacturer spec. sheets identifying equipment as DesignLights Consortium® or ENERGY STAR® qualifying.

B. Timely Completion: SUB shall reserve incentive funds for no more than 4 months after SUB approves application. If installation is not complete, or disposal certification or invoice are not provided within 4 months, incentive funds will be reallocated & unavailable for this project. Contact SUB in writing in advance to request extension.

C. Inspection: Participant acknowledges & allows access by SUB staff or official designee to conduct on-site inspections & Measurement & Verification of installed Measures.

D. Award of Funds: Upon final inspection & verification of approved Measures & upon receipt of project invoices (labor & materials) & disposal certification (if applicable), SUB agrees to award payment in the amount indicated by the current version of SUB’s Lighting Calculator (less adjustments) or SUB’s offering for the measures in BPA’s most current Implementation Manual (less adjustments.) The incentive payments may be limited 1) to not exceed 50% of the total installed cost of the Measures, & 2) to not exceed the stipulated maximum $/kWh limit.

E. Taxability of Incentives: SUB may be required by law to report any incentive amount to the Internal Revenue Service. Please consult your tax professional on the tax issues of receiving a SUB incentive. SUB is not responsible for any tax liability as a result of any incentive paid.

F. Guarantee/Warranty: Participant acknowledges that SUB makes no guarantee or warranty whatsoever, express or implied, as to the fitness, design or capability of the material, equipment or workmanship in any product or installation.

G. Hold Harmless: Participant hereby agrees, on behalf of self and/or company, corporate officers, employees, agents, assigns & successors of interest, to hold harmless, indemnify & defend SUB, & its officials, employees, agents & assigns from & against any & all actions, causes of action, claims, damages & costs arising out of, or in any way connected with, the provision of design assistance & financial assistance for the project subject to this Agreement.

H. Permits & Codes: Participant agrees to secure permits & comply with all applicable federal, state, & local codes & requirements in the design & installation of energy efficient Measures. Where permits are required, installation must be approved by appropriate building officials. Participant agrees to maintain compliance documents on file & make them available for review if requested. Participant acknowledges SUB’s right to contact appropriate federal, state, or local jurisdictions regarding environmental, health, & safety matters related to participating Energy Efficiency projects.

I. Distribution of Benefits: Participant relinquishes & grants to SUB all credits, reductions, offsets, reporting rights & savings pertaining to carbon, CO2, greenhouse gases, emissions, kWh energy, efficiency & any other related environmental benefits. Participant’s sole benefit is any reduced energy cost resulting from Measures.

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