Prescriptive Program Rebate Application

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Check the appropriate program box for your rebate.

Cooling FSO (Fluid System Optimization) Foodservice Equipment Heating Lighting Motors & Drives

Xcel Energy premises numbers: Electric: ___________________________________ and/or Gas: ________________________________________ Company Name __________________________________________ Date submitted ___________________________________________________ Installation address ______________________________________ City ____________________________ State ________ ZIP _____________ Mailing address _________________________________________ City ____________________________ State ________ ZIP _____________

Contact Name (PRINT) ________________________________________________________ Phone ________________________________________ Contact Email* _______________________________________________________________ Fax ________________________________________ Equipment location description (REQUIRED) _______________________________________________________________________________________ ________________________________________________________________________________________________________________________ The total project cost: $ ____________________________________________________________________________________________________

Customer Signature ______________________________________________________________________ Date ____________________ This signature is required from the individual tied to the Xcel Energy premises number herein. By signing here, I acknowledge the information in this application is accurate and complete. I confirm I have read, agree with and understand the terms and conditions on page 2 of this application. I also authorize Xcel Energy to provide a copy of the project preapproval notification to the equipment supplier or vendor so as to expedite the project process.

Complete this section only if the customer wants the rebate check to go to someone other than the customer contact tied to the premises number above.

Company Name ___________________________________________________ Contact name ________________________________________ Address ______________________________________________________ Phone _________________________________________________ City __________________________________________________________ State _________________________ ZIP_____________________ I authorize the above company to receive the rebate check for this project.

Customer Signature _____________________________________________________________________________ Date ___________________

Xcel Energy account representative name ________________________________________ Signature _____________________________________

Company Name _______________________________________ Trade Partner ID# ___________________________________________________ Contact Name (PRINT) _______________________________________________________________________________________________________ Address _______________________________________________ City ____________________________ State ________ ZIP _____________ Contact email* _________________________________________________ Phone ___________________________________________________ Customer Information

Alternative Rebate Recipient

Trade Partner Information (Vendor/Contractor Information)

OID __________________

Prescriptive Program Rebate Application

(For rebate if different from installation address)

Internal Use Only

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Qualifying Customers

Xcel Energy Prescriptive Rebate programs are available to Xcel Energy business electric and/or gas customers that install qualifying equipment in Xcel Energy’s Minnesota service territory.

How to Apply for Rebates

1. Fill out the rebate application (for each installation address).

2. Attach a copy of the paid, itemized invoice(s). Be sure that the quantity, make, model number and unit price of each item appears on the invoice. 3. Make a copy of this document for your records.

4. If you have questions please contact your Xcel Energy account manager or one of our energy efficiency specialists to discuss and/or complete the project application form.

5. You can email your completed project paperwork to:

energyefficiency@xcelenergy.com, fax to: 1-800-311-0050, or mail to: Energy Efficiency Specialist, Business Solutions Center, P.O. Box 8, Eau Claire, WI 54702-0008.

6. Once completed paperwork is submitted, rebate payments are usually made in six to eight weeks after the rebate application has been processed. Custom Efficiency Rebate Program

Equipment that is not eligible for prescriptive rebates can be submitted through the Custom Efficiency program. Preapproval through the Custom Efficiency program is required before the purchase and installation of equipment.

The Custom Efficiency rebate application and program details can be found at xcelenergy.com/CustomEfficiency.

Rules and Requirements

• All equipment must be new. Used or rebuilt equipment is not eligible for a rebate.

• Equipment must meet program specification requirements and be purchased, installed and operating prior to submitting an application for a rebate. Xcel Energy reserves the right to withhold payment for products that do not meet the requirements.

• Rebates cannot exceed 60 percent of the project cost (including equipment and labor).

• A signed application and detailed installation invoice(s) must be completed and submitted to Xcel Energy within 12 months (24 months for motors, VFDs, and constant speed motor projects) of the invoice date.

• Xcel Energy is not responsible for any lost, late, stolen, ineligible, illegible, misdirected or postage-due mail.

• All completed submissions become the property of Xcel Energy upon receipt and will not be returned.

• Xcel Energy will issue a rebate in the form of a check.

• Xcel Energy reserves the right to conduct a random on-site inspection of your project before or after issuing a rebate. The customer agrees to provide reasonable access to inspect the installation. On-site inspections may be performed up to one year after the date the rebate check is issued. If Xcel Energy finds that the application does not comply with Xcel Energy rules and qualifications, any rebate amount may be adjusted, denied or subject to return.

• Program rules, requirements and offer are subject to changes at any time. Xcel Energy’s prescriptive rebate programs are subject to 60 days notice of cancellation. Changes or notifications will be posted at xcelenergy.com/ Rebates. The customer and trade partner are responsible for contacting an energy efficiency specialist to determine whether the program is still in effect and to verify program parameters. Call 1-855-839-8862 or email energyefficiency@xcelenergy.com.

• Xcel Energy reserves the right to refuse payment and participation if the customer or contractor violates program rules and procedures, or local, state or federal regulations. Xcel Energy is not liable for rebates promised to customers as a result of misrepresentation of the program.

• Xcel Energy’s acceptance of the application does not guarantee payment of rebate.

• Xcel Energy retains the right to limit rebates or to make adjustments to correct incentive calculations if necessary. Energy savings calculations are estimates and may vary from actual results.

Warranty Information

• Xcel Energy does not endorse any particular manufacturer, product or system design by offering these rebates.

• Xcel Energy will not be responsible for any tax liability imposed on the customer as a result of the payment of rebates; does not expressly or implicitly warrant the performance of installed equipment (contact your contractor for detailed equipment warranties).

• Xcel Energy is not responsible for the proper disposal/recycling of any waste generated as a result of this project; is not liable for any damage caused by the operation or malfunction of the installed equipment; and does not guarantee that a specific level of energy or cost savings will result from the implementation of energy conservation measures or the use of products funded under these programs.

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REBATE LEVELS AND REQUIREMENTS

BASELINE REBATE_{Minimum efficiency} _{Base rebate per ton Increment}INCREMENTAL REBATE_{Incr. rebate per ton}

Anti-sweat Heater Controls n/a $60/door n/a n/a

Chillers – Air Cooled 9.7 FLV EER

12 IPLV SEER

$8

0.1 EER $1.50 per FLV+ , $.75 per IPLV 0.1 EER above base

Chillers – VFD Retrofit .01 kW/ton $1.50 per IPLV

0.01 kW/ton below base Chillers – Water Cooled

< 150 tons (Centrifugal) > 150 tons (Centrifugal) < 150 tons (Screw/Scroll) 150–300 tons (Screw/Scroll)**

Must improve on ASHRAE 90.1 2004 baseline by 0.016 kW/ton 0.74 FLV kW/ton, 0.63 IPLV kW/ton 0.67 FLV kW/ton; 0.58 IPLV kW/ton

$15 $15 $15 $15 0.01 kW/ton 0.01 kW/ton 0.01 kW/ton 0.01 kW/ton $2 per FLV+, $1.50 per NPLV 0.01 kW/ton below base $2 per FLV+, $1.50 per IPLV 0.01 kW/ton below base DX Units (rooftop, split systems and condensing units)

< 5.5 nominal tons 5.5 – 11.3 nominal tons 11.4 – 19.9 nominal tons 20.0 – 63.3 nominal tons > 63.3 nominal tons 13.5 SEER 10.8 EER 10.7 EER 10.2 EER 9.5 EER $75 $75 $75 $75 $75 0.1 SEER 0.1 EER 0.1 EER 0.1 EER 0.1 EER $5 $5 $5 $5 $5 EC Motors (Electronically Commutated Motor)

Refrigerated Display Case (Medium Temp) Freezer Display Case ( Low Temp) Walk-in Refrigerator (Medium Temp) Walk-in Freezer (Low Temp)

n/a n/a n/a n/a $40 $40 $70 $70 n/a n/a n/a n/a n/a n/a n/a n/a

Energy Recovery Ventilators*** 60%Total Cooling Effectiveness

60% Heating Sensible Effectiveness

$1 per CFM

$1 per CFM n/a n/a

Packaged Terminal Air Conditioner 10.8 EER $75 0.1 EER $5

Plate and Frame Heat Exchanger (with a cooling tower for use of free cooling)

Wet Bulb Temperature

≤

52 °F and >45 °F

≤

45 °F and >40 °F

≤

40 °F and >35 °F

≤

35 °F $300 $240 $180 $120 n/a n/a

Rooftop Unit Economizer Enthalpy and CO₂ control $20 n/a n/a

Water Source Heat Pump 13.2 EER $75 0.1 EER $5

Zero Loss Energy Doors

Case Temperature

≤

to 0 °F = Freezer 1 °F–35 °F = Cooler

$150/door (freezer)

$100/door (cooler) n/a n/a

Rebates summarized above are subject to full program eligibility and participation requirements.

**If screw/scroll chiller is larger than 300 tons, the chiller may still qualify, but the rebate will be based on a 300-ton chiller. ***Heating rebate only available to Xcel Energy natural gas heating customers. Invoices must be dated on or after October 1, 2014.

Please indicate the primary use* for this location:

Office Retail Lodging Education - community college Education - secondary school Education - university

Health/medical - clinic Health/medical - hospital Data center Other _________________________________________________ *Chillers used for non-space conditioning (process cooling) must go through our Custom Efficiency program and be preapproved prior to purchase. County of installation _______________________________________________________

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ANTI-SWEAT HEATER CONTROLS

*

No. of doors Manufacturer Model no. Type of Control Rebate calculation Total rebate

Cooler Freezer _______ No. of doors x $60 = $

CHILLERS – AIR COOLED

No. of units Manufacturer Model no. Full Load Tons/unit FLV/EER IPLV/SEER Total rebate

(Base: $8 x ___ tons = $___ ) + [Efficiency: (FLV $1.5 x ___ a_{x ___ tons = $___ ) + IPLV $0.75 x ___}b_{x ___ tons = $___)] = $ __________} a_{[Equipment EER (from vendor) – Min. qualifying EER (from table of minimum qualifying criteria)] /.1}

b_{[Equipment IPLV or SEER (from vendor) – Min. qualifying IPLV or SEER (from table of minimum qualifying criteria)] /.1}

CHILLERS - VFD RETROFIT

No. of units Manufacturer Model no. Tons/unit* IPLV (previous) IPLV (post) Total rebate

(IPLV $1.5 ____ a_{x ____tons = $___ )} a _{[Previous IPLV kW/ton - Post IPLV kW/ton (design conditions)]/.01}

*chiller tons

CHILLERS – CENTRIFUGAL

No. of units Manufacturer Model no. Full Load Tons/unit FLV (kW/ton) NPLV (kW/ton) Total rebate

(Base: $15 x ___ tons = $___) + [Efficiency: FLV $2 x ___ a_{x ___ tons = $___ ) + NPLV $1.5 x ___}b_{x___ tons = $ ___ )] = $ __________} a_{[Min. qualifying FLV kW/ton – Equipment FLV kW/ton (design conditions)]/.01}

b_{[Min. qualifying NPLV kW/ton – Equipment NPLV kW/ton (design conditions)]/.01}

CHILLERS – ROTARY OR SCROLL

No. of units Manufacturer Model no. Full Load Tons/unit FLV (kW/ton) IPLV (kW/ton) Total rebate

(Base: $15 x ___ tons = $___) + [Efficiency: FLV $2 x ___ a_{x ___ tons = $___ ) + IPLV $1.5 x ___}b_{x___ tons = $ ___ )] = $ __________} a_{[Min. qualifying FLV kW/ton (from table of minimum qualifying criteria) – Equipment FLV kW/ton (from vendor)] /.01}

b_{[Min. qualifying IPLV kW/ton (from table of minimum qualifying criteria) – Equipment IPLV kW/ton (from vendor)] /.01}

DX UNIT

No. of units Manufacturer Model no. Nominal Tons/unit EER/SEER A/N Coil* Total rebate

(Base: $75 x _____ tons = $ _______) + (Efficiency: $5 x _____a_{x _____ tons = $ ______________) = $_________}

(Base: $75 x _____ tons = $ _______) + (Efficiency: $5 x _____a_{x _____ tons = $ ______________) = $_________} a_{[Equipment EER or SEER (from vendor) — Min. qualifying EER or SEER (from table of Min. Qualifying Criteria)] / 0.1}

*A/N Coil model is required for units <5.5 tons only.

ENERGY RECOVERY VENTILATORS

No. of units Manufacturer Model no. CFM Heating

Effectiveness CoolingEffectiveness Equipment EER ERV Pressure Drop Total rebate Heating rebate is only available to Xcel Energy natural gas heating customers.

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EC MOTORS (ELECTRONICALLY COMMUTATED MOTORS)

Section A - ECMs that replaced shaded pole motors within refrigerated display cases.

Line # End use function Manufacturer Model # Rebate Qty Rebate x Qty = _{Total Rebate}

1 Refrigerated Display Case (Medium Temp) $40

Section B - ECMs that replaced shaded pole motors within low temperature (freezer) display cases.

Line # End use function Manufacturer Model # Rebate Qty Rebate x Qty = _{Total Rebate}

5 Freezer Display Case (Low Temp) $40

Subtotal, Sections A & B

PLEASE NOTE: Each line of sections C&D MUST INDICATE if the ECM will drive an evaporator fan of more or less than 15 inches. Items that do not indicate the fan size cannot be rebated.

Section C - ECMs that replaced shaded pole motors within walk-in refrigerators.

Line # Function / FAN SIZE Manufacturer Model # Rebate Qty Rebate x Qty = _{Total Rebate}

9 Walk-in Refrig.

(Medium Temp) More than 15” or _{Less than 15”} $70

10 Walk-in Refrig.

11 Walk-in Refrig.

12 Walk-in Refrig.

(Medium Temp) More than 15” or _{Less than 15”}

$70

Section D - ECMs that replaced shaded pole motors within walk-in freezers.

Line # Function / FAN SIZE Manufacturer Model # Rebate Qty Rebate x Qty = _{Total Rebate}

13 Walk-in Freezer

(Low Temp) More than 15” or _{Less than 15”}

$70 14 Walk-in Freezer

(Low Temp) More than 15” or _{Less than 15”} $70

15 Walk-in Freezer

16 Walk-in Freezer

Subtotal, Sections C & D Grand Total, Sections A, B, C & D

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PACKAGED TERMINAL AIR CONDITIONERS (PTAC)

No. of units Manufacturer Model no. Tons/unit EER Item rebate

(Base: $75 x _____ tons = $ _______) + (Efficiency: $5 x _____a_{x _____ tons = $ ______________) = $_________}

(Base: $75 x _____ tons = $ _______) + (Efficiency: $5 x _____a_{x _____ tons = $ ______________) = $_________} a_{[Equipment EER (from vendor) — Min. qualifying EER (from table of Min. Qualifying Criteria)] / 0.1}

PLATE AND FRAME HEAT EXCHANGER

No. of units Manufacturer Wet bulb temp* Tons/unit ** Balance Point*** IPLV (kW/ton) Item rebate

Determine rebate at xcelenergy.com/CoolingEfficiency * Wet bulb temperature heat exchanger is used instead of a chiller °F

** Load/Tons displaced by heat exchanger

*** Balance point of building in °F. Default is 20 °F. If data center or process load, use -26 °F

ROOFTOP UNIT ECONOMIZER

No. of units Manufacturer Model Number RTU tons/unit Enthalpy controlled?* CO₂ Controls purchased?*

Yes No __ Initials Yes No __ Initials

(Base: $20 x____ RTU tons x ______ no. of units = $__________ total rebate) *Must have both enthalpy and CO2 to qualify for economizer rebate

WATER SOURCE HEAT PUMPS

No. of units Manufacturer Model no. Tons/unit EER Item rebate

(Base: $75 x _____ tons = $ _______) + (Efficiency: $5 x _____a_{x _____ tons = $ ______________) = $_________} a_{[Equipment EER (from vendor) — Min. qualifying EER (from table of Min. Qualifying Criteria)]/0.1}

ZERO LOSS ENERGY DOORS FOR COOLERS

No. of doors Manufacturer Model no. Rebate calculation Total rebate

_______ No. of doors x $100 = $

Cooler temperatures are 1 °F to 35 °F.

ZERO LOSS ENERGY DOORS FOR FREEZERS

No. of doors Manufacturer Model no. Rebate calculation Total rebate

_______ No. of doors x $150 = $

Freezer Door temperatures must be 0 °F or below.

TOTAL REBATES

No. of units Total rebates listed above

Xcel Energy retains the right to limit rebates or make adjustments to correct incentive calculations if necessary. Energy savings calculations are estimates and may vary from actual results.

Important: Copies of all invoices, specifications sheets and this completed application form are required before Xcel Energy can issue rebates. See Program Guidelines for additional information.