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Commercial LED Lighting Equipment

888-921-5990 • www.efficiencyvermont.com Efficiency Vermont supports the installation of energy-efficient

light-emitting diode (LED) lighting through financial rebates. To receive your rebates, follow these simple steps:

1. Determine your equipment’s eligibility.

Review the product specifications on pages 2 & 3.

Confirm that your equipment is listed on Efficiency Vermont’s

“LED Eligible Products List,” available at www.efficiencyvermont.com/led.

2. Complete this application.

Fill out the worksheet on page 4.

Calculate your total rebate and enter the amount in the space provided.

Read and sign the “Terms & Conditions” on page 5.

Please check to make sure you’ve provided all information requested.

Incomplete information will delay the processing of your application.

3. Return your completed application with your proof(s) of purchase.

Enclose the sales receipt(s) or invoice(s) itemizing your new equipment.

The proof of purchase must indicate the date and place of purchase, as well as the size, type, manufacturer, and model or part number of the equipment.

All electric utility customers except those in Burlington: Send this completed application with your receipt(s) to Efficiency Vermont, Rebate Coordinator, 255 S. Champlain St., Burlington, VT 05401-4894.

Customers served by the Burlington Electric Department: Send this completed application with your receipt(s) to Energy Services Area, Burlington Electric Department, 585 Pine St., Burlington, VT 05401.

Where applicable, all lighting installations are required to comply with the Vermont commercial energy code. For more information, see

http://publicservice.vermont.gov/energy-efficiency/ee_commstandards.html.

USE THIS FORM ONLY IF...

You are requesting rebates for new construction or equipment

replacement projects totaling less than 10,000 square feet. Please contact Burlington Electric Department at 802-865-7342 prior to purchase for approval for all new construction projects.

You have fewer than 100 rebate-eligible items to submit.

NOTE:

REBATES ExCEEDIng $2,500 REqUIRE PRE-APPRoVAL BY

EFFICIEnCY VERmonT oR BURLIngTon ELECTRIC DEPARTmEnT PRIoR To PURChASE. Call the Efficiency Vermont Rebate Coordinator at 888-921-5990, ext. 1003 for instructions.

WHAT’S NEW

• Rebates for outdoor pole/

arm-mounted parking and roadway fixtures, including decorative fixtures, have increased to $300.

• Rebates for parking garage and canopy fixtures have increased to $300.

• Rebates for track lighting fixtures have increased to $150.

• A $30 rebate will be available for qualifying LED screw- and pin-based lamps and bulbs beginning early 2010. Products must be listed on Efficiency Vermont’s “LED Eligible Products List” to qualify.

2010 REBATE APPLICATION

NON-LED LIGHTING

WORK WITH

EFFICIENCY VERMONT

There may be other opportunities to save money and energy, such as with hVAC, motors, and refrigeration. Please contact Efficiency Vermont’s Rebate Coordinator at 888-921-5990, ext. 1003 or info@efficiencyvermont.com.

• Please see the “Commercial Lighting Rebate Application”

for rebates on non-LED lighting products.

• Custom rebates may be available

for other energy-efficient lighting

technologies. Contact Efficiency

Vermont for details.

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Install a new

ENERGY STAR qualified LED recessed or surface/

pendant-mounted downlight fixture.

$50 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 35 lumens per watt.

minimum light output of 345 lumens for downlights 4" or smaller. minimum light output of 575 lumens for downlights 5" or larger. Cannot be combined with any other Efficiency Vermont offer, including

$30 LED Downlight instant coupon available at some lighting showrooms.

Recessed & Surface/Pendant-Mounted Downlight Fixtures

Outdoor Pole/Arm-Mounted Parking or Roadway Fixtures Install a new LED pole- or arm-

mounted parking lot or roadway light fixture.

$300 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.”

Product must be DesignLights approved.

minimum luminaire efficacy of 50 lumens per watt. minimum light output of 1,000 lumens.

Outdoor Pole/Arm-Mounted Decorative Parking or Roadway Fixtures

Install a new LED decorative type pole- or arm-mounted parking lot or roadway light fixture.

$300 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.”

Product must be DesignLights approved.

Products include acorn and post-top decorative type outdoor light fixtures. minimum luminaire efficacy of 40 lumens per watt.

minimum light output of 1,000 lumens.

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Install a new ENERGY STAR qualified LED screw- or pin-based lamp/bulb.

$30 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Eligible products include PAR, mR, decorative candelabra, and

standard A-style lamps.

Product must carry the EnERgY STAR label.

LED Screw- and Pin-Based Lamps/Bulbs 1

ALL PRODUCTS MUST BE LISTED ON

EFFICIENCY VERMONT’S “LED ELIGIBLE PRODUCTS LIST”

TO QUALIFY FOR REBATES THROUGH THIS PROGRAM.

What are LEDs?

Light-emitting diode (LED) lighting is an exciting, rapidly evolving technology that produces light in a whole new way.

LEDs are small light sources that become illuminated by the movement of electrons through a semiconductor material, more akin to computer chips than to light bulbs.

The heat from an LED is conducted through the back of the fixture, rather than radiated in all directions as with other light sources. The proper dissipation of this heat is key to effective LED performance.

The LED is the only light source that is inherently directional and does not require a reflector to direct light, offering increased energy savings in directional applications.

In select directional applications, LEDs can offer energy savings of more than 50% versus fluorescent or hID, and more than 75% savings versus incandescent lighting.

Not all LED lighting is created equal.

While LEDs are already beginning to surpass the quality and efficiency of existing lighting technologies, such as incandescent and some fluorescent, LED performance varies widely.

Testing by the U.S. Department of Energy has shown wide variability in performance of LED products, with some products not meeting the ratings listed by the manufacturer.

only well-designed LED products using the latest in LED technology, and applied in the right applications, will provide the energy, lighting quality, and long-life benefits of LEDs.

Look for the EnERgY STAR

®

label, awarded to select LED fixture types that meet strict efficiency, quality, and lifetime criteria.

E fficiency Vermont’s “LED Eligible Products List”

For some of the categories featured on this form, there may not yet be products listed on Efficiency Vermont’s

“LED Eligible Products List.” This will change throughout 2010 as manufacturers release new products and

obtain the testing required to meet EnERgY STAR and DesignLights™ Consortium performance standards.

Efficiency Vermont will be updating the “LED Eligible Products List” on a regular basis as new products become qualified.

only products listed on the “LED Eligible Products List”

are eligible for rebates from Efficiency Vermont.

Manufacturers: Products must be qualified by ENERGY STAR or DesignLights to be placed

on Efficiency Vermont’s “LED Eligible Products List.”

For more information, visit www.energystar.gov or www.designlights.org, or call Efficiency Vermont toll-free at 888-921-5990.

For a copy of the “ LED Eligible Products List” or for additional information on LEDs, please call Efficiency Vermont toll-free at 888-921-5990 or visit www.efficiencyvermont.com/led.

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Outdoor Wall-Mounted Area Fixtures (Wall Packs)

Parking Garage or Canopy Fixtures

Install a new LED parking garage or canopy fixture.

$300 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.”

Product must be DesignLights approved.

minimum luminaire efficacy of 56 lumens per watt. minimum light output of 2,000 lumens.

Bollard Fixtures

Install a new ENERGY STAR qualified LED bollard type fixture.

$150 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 35 lumens per watt.

Outdoor Step Light Fixtures

Install a new ENERGY STAR qualified LED outdoor step light fixture.

$25 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 20 lumens per watt. minimum light output of 50 lumens.

Undercabinet Shelf-Mounted Task Light Fixtures Install a new ENERGY STAR qualified

LED undercabinet task light fixture.

$15/Foot Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 29 lumens per watt. minimum light output of 125 lumens per foot.

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Refrigerated Case Light Fixtures Install a new LED refrigerated case light fixture.

$150/Door Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.”

Product must be DesignLights approved.

minimum luminaire efficacy of 35 lumens per watt. minimum light output of 100 lumens per foot. minimum L70 lifetime of 50,000 hours.

14 Install a new

ENERGY STAR qualified LED recessed or surface/

pendant-mounted downlight fixture.

$50 Rebate

Install a new LED wall-pack type fixture.

$150 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.”

Product must be DesignLights approved.

minimum luminaire efficacy of 40 lumens per watt. minimum light output of 300 lumens.

Outdoor Pathway Light Fixtures Install a new ENERGY STAR qualified LED outdoor pathway light fixture.

$25 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 25 lumens per watt. minimum light output of 100 lumens.

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Wall-Wash Light Fixtures

Install a new ENERGY STAR qualified LED wall-wash fixture.

$30 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 40 lumens per watt. minimum light output of 575 lumens.

Track Lighting Fixtures

Install a new LED directional track lighting fixture.

$150 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.”

Product must be DesignLights approved.

Screw-in/screw-based products are not eligible. minimum luminaire efficacy of 30 lumens per watt. minimum light output of 250 lumens per head.

Portable Desk/Task Light Fixtures Install a new ENERGY STAR qualified LED portable desk or task light fixture.

$25 Rebate

Product must be listed on Efficiency Vermont’s “LED Eligible Products List.” Product must carry the EnERgY STAR label.

minimum luminaire efficacy of 29 lumens per watt. minimum light output of 200 lumens per head.

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TOTAL REBATE REQUESTED $

________________________

Product Category Manufacturer Name Model

Number

Lumen Output (if available)

# of Hours Operated

per Week Quantity X

Rebate =

Sub-Total

LED Screw- and Pin-Based Lamps/Bulbs

$30

$30

$30

Recessed & Surface/Pendant- Mounted Downlight Fixtures

$50

$50

$50

Outdoor Pole/Arm-Mounted Parking or Roadway Fixtures

$300

$300

$300

Outdoor Pole/Arm-Mounted Decorative Parking or Roadway Fixtures

$300

$300

$300

Outdoor Wall-Mounted Area Fixtures (Wall Packs)

$150

$150

$150

Parking Garage or Canopy Fixtures

$300

$300

$300

Bollard Fixtures

$150

$150

$150

Outdoor Step Light Fixtures

$25

$25

$25

Outdoor Pathway Light Fixtures

$25

$25

$25

Wall-Wash Light Fixtures

$30

$30

$30

Track Lighting Fixtures

$150

$150

$150

Portable Desk/Task Light Fixtures

$25

$25

$25

Undercabinet Shelf-Mounted Task Light Fixtures

$15/foot

$15/foot

$15/foot

Refrigerated Case Light Fixtures

$150/door

$150/door

$150/door 6

4

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C om m er ci al L E D L ig h ti n g E q u ip m en t 2 0 10 R E B A T E A P P L IC A T IO N

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888-921-5990 • www.efficiencyvermont.com

COMPLETE PAGES 4 AND 5 OF THIS FORM & SUBMIT WITH YOUR PROOF(S) OF PURCHASE.

In order to qualify for rebates, products must be listed on Efficiency Vermont’s “LED Eligible Products List,” available at www.efficiencyvermont.com/led.

2010 REBATE APPLICATION • COMMERCIAL LED LIGHTING EQUIPMENT

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Corporation (TIN not needed)

Tax-Exempt Organization (TIN not needed)

City, County, or State Dept., Govt. or Agency (TIN not needed)

All Others (please provide TIN at right)

255 S. Champlain St., Suite 7 • Burlington, VT 05401-4894 888-921-5990 toll-free • 802-658-1643 fax

www.efficiencyvermont.com

Company Name Contact Name/Title Telephone # E-mail Address

Address (of installation) Town/City & State ZIP Code Building Sq. Ft.

Mailing Address (if different) Town/City & State ZIP Code Fax #

Electric Utility Utility Account # Project Sq. Ft. Installation Date

REBATE OFFER: This rebate program covers equipment purchased and installed in 2010. Details of this program, including rebate levels, are subject to change without notice.

ELIGIBILITY: Rebates through this program are available to business customers of electric utilities in Vermont. Contact Burlington Electric Department at 802-865-7342 for all Burlington projects. Do not use this form for projects larger than 10,000 sq. ft. or if you have more than 100 rebate-eligible items to submit.

Instead, call Efficiency Vermont at 888-921-5990, ext. 1003 for approval and/or custom rebates.

ELIGIBLE EQUIPMENT: Equipment must be new to qualify for rebates.

Review the equipment eligibility requirements on pages 1-3 to ensure eligibility before completing this form. Rebates for LED equipment systems apply only to those listed on Efficiency Vermont’s “LED Eligible Products List.”

This list is available at www.efficiencyvermont.com/led. Equivalent products must be pre-approved by Efficiency Vermont. Contact Efficiency Vermont for information about additional equipment not listed on this form that may qualify for custom rebates.

PROOFS OF PURCHASE: Sales receipt(s) or invoice(s) itemizing the new equipment and indicating the size, type, manufacturer, model or part number of the fixture, lamps, ballasts or control, purchase date, and vendor must accompany each rebate application.

PAYMENT: Equipment must be purchased and installed before payment is issued. Falsifying any information may lead to cancellation of this and future rebate applications, a claim by Efficiency Vermont for the return of any rebate, and/or referral for prosecution. Allow 45 days for delivery of payment.

Submitting an application with incomplete or missing information will delay check processing and delivery. Efficiency Vermont will not pay more than 100%

of the material purchase price shown on the invoice.

APPROVAL & VERIFICATION: Rebates exceeding $2,500 require pre-approval by Efficiency Vermont before purchase. Efficiency Vermont reserves the right to verify sales transactions and to inspect all installations.

TAX LIABILITY: Efficiency Vermont is not responsible for any tax liability imposed on the customer for rebate payments.

Efficiency Vermont Approval

For Internal Use

Tracking # or

ENDORSEMENT: Efficiency Vermont does not endorse any particular manufacturers, products, or system designs in promoting this program.

Equipment listed on the “LED Eligible Products List” is not endorsed by Efficiency Vermont, and the omission of any products from the list does not in any way imply that they are defective.

DISPOSAL: The customer/contractor is responsible for the proper disposal/

recycling, including all associated costs, of any waste generated as a result of this project, including the disposal of fluorescent lamps (which contain mercury) and ballasts suspected of containing PCBs. (Any fluorescent ballast dated pre-1979 should be considered to contain PCBs unless otherwise labeled.) For a list of licensed lamp recycling and ballast disposal companies, contact Efficiency Vermont or visit www.mercvt.org.

SAFETY & BUILDING CODES: The customer/contractor agrees that each measure complies with all federal, state, and local safety, building, and environmental codes, and that all necessary permits have been obtained. All products must be UL-listed and installed per manufacturer’s instructions.

CUSTOMER ASSURANCES: If the facility is leased or managed by customer, customer must obtain written permission from owner to install new equipment.

CONFIDENTIALITY: All customer, vendor, and/or contractor information supplied to Efficiency Vermont will be kept confidential and will not be shared with any person or organization.

DISCLAIMER OF WARRANTIES: Efficiency Vermont does not warrant the performance of any equipment either expressly or implicitly. Contact your supplier or contractor for details regarding equipment warranties.

CAPACITY CREDITS/ENVIRONMENTAL CREDITS: In accepting these financial incentives, the customer agrees that Efficiency Vermont holds the sole rights to any electric system capacity credits and/or environmental credits associated with the energy efficiency measures for which incentives have been received. These credits will be used for the benefit of Vermont ratepayers.

Contact Efficiency Vermont for details on other eligible measures and services, or for answers to any questions you may have about equipment eligibility for this program. Call Efficiency Vermont’s Rebate Coordinator toll-free at 888-921-5990, ext. 1003.

I certify that I meet the eligibility requirements of this program and that all statements made on both sides of this application, including invoices/

receipts, are correct to the best of my knowledge. I agree to the terms and conditions set forth above.

Customer’s Signature Date

TERMS & CONDITIONS

CUSTOMER INFORMATION & AGREEMENT

COMPLETE PAGES 4 AND 5 OF THIS FORM & SUBMIT WITH YOUR PROOF(S) OF PURCHASE.

Is this a New Construction/Major Renovation Project?

Yes

No

Beyond lighting, what other equipment are you currently upgrading/looking to upgrade?

Compressed Air

HVAC

Motors

Refrigeration

Please make check payable to:

Request for Federal Tax Payer Identification Number (TIN) — REQUIRED (please select one)

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255 S. Champlain St., Suite 7 Burlington, VT 05401-4894

2010 REBATE APPLICATION

Commercial LED Lighting Equipment

References

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