Commercial Lighting Rebate Form - LIMITED TIME BONUS
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Rebate Form Valid January 1 – June 30, 2015
Commercial
Lighting
LIMITED TIME BONUS
20% bonus on select
fixtures + fixture mounted
controls. See following
pages for details.
888-921-5990 • www.efficiencyvermont.comSteps to Getting Your Rebate: Need-to-Know Info:
• Customer is responsible for the proper disposal/
recycling, including all associated costs, of any waste
1. Confirm that equipment is eligible. generated as a result of this project. All fluorescent lamps
2.
Purchase and install new eligible contain mercury and pre-1979 ballasts contain PCBs. For a
equipment. list of licensed lamp recycling and ballast disposal companies,
visit www.mercvt.org.
3. Sign and submit completed rebate • For more information or to confirm eligibility, visit
form and invoice. www.efficiencyvermont.com/businesslighting
or call 888-921-5990.
Submit completed form and invoice to: • Prefer to submit online? Visit
https://efficiencyvermont.com/lighting-rebates.
Mail: Efficiency Vermont
c/o Rebate Coordinator • Limited Time—20% bonus on LED fixtures plus controls!
128 Lakeside Ave., Suite 401 Customers can obtain a 20% rebate bonus when they
Burlington, VT 05401 purchase qualifying LED troffer, highbay, and exterior pole
Fax: 802-658-1643 mount fixtures with fixture-mounted occupancy and/or
daylight controls. The bonus is applied to both the fixture and
E-mail: rebatecoordinator@efficiencyvermont.com
control rebate. See sections 1, 2 and 3 for qualifying products.
For Burlington projects, submit form to: •B
urlington Electric Department (BED)
Burlington Electric Department
administers efficiency programs for the
c/o Energy Services Area City of Burlington, including the rebates
585 Pine St., Burlington, VT 05401 listed on this form. For more information,
call 802-865-7342.
Section 1 CUSTOMER INFORMATION & AGREEMENT
(Required)
Business Name Contact Name/Title
Address (of installation location) City/Town State Zip
Mailing Address (if different) City/Town State Zip
Telephone # E-mail Address
Electric Utility Company Electric Utility Account # (of installation location)
Is equipment installed in a new construction building? n Yes n No
If yes, provide building sq. ft. If over 10,000 sq. ft., call 888-921-5990 (see Terms & Conditions).
I certify that all equipment for which I am requesting a rebate has been installed, that I meet the eligibility requirements of this rebate program, and that
all information submitted as part of this application, including proof of purchase and Federal Tax ID Number, is correct to the best of my knowledge.
I agree to the terms and conditions listed on the back of this form.
SIGN HERE
CUSTOMER SIGNATURE (required even if rebate is going to vendor) Date
Section 2 REBATE PAYEE INFORMATION
(Required) Rebate check payable to (must match EIN/TIN or SSN below):
Payee’s Federal Tax ID Number (TIN) — check one and provide EIN/TIN or SSN:
n Contact information same as above
n Corporation or Tax-Exempt Organization (provide TIN)
n City, County, or State Dept., Govt. or Agency (provide TIN)
n Other (provide EIN/TIN or SSN) Contact Name
Employer Identification Number Social Security Number Mailing Address
or
City/Town State Zip
I certify that the “Payee Information” above, including Federal Tax ID Number, is correct to the best of my knowledge.
I acknowledge that as Payee I am responsible for any tax liability associated with my receipt of the rebate payment.
For Internal Use W
SIGN HERE
Project #
PAYEE SIGNATURE (if different from customer)
888-921-5990 • www.efficiencyvermont.com/businesslighting Commercial Lighting • Page 2See requirements and rebate amounts and then fill in form below.
SECTIONS 1–2: LED LIGHTING
Code Installation # of Hours Manufacturer Model # Corresponding A= B= AxB=
(see pages Date Lights are Lighting Quantity Rebate Total Rebate
4–5)
on per Week Control Code (or Total Fixture (see pages 4–5) Amount
(if bonus applies) Length) of Products
Total Rebate Sections 1–2 $
SECTION 3: LIGHTING CONTROLS
Code Installation # of Hours Lights are A= Corresponding B= AxB=
(see page 6) Date on per Week Quantity of LED Lighting Code Rebate per Control Total Rebate Amount
(before controls) Controls Products (if bonus applies) (see page 6)
*Efficiency Vermont or BED will calculate final bonus amount Expected Bonus Amount for Qualifying LED Lighting & Controls* $
on eligible fixtures and fixture mounted lighting controls . In the
event of a discrepancy between the final amount and the expected
amount, you will be contacted by the Rebate Coordinator. Total Rebate Section 3 $
SECTION 4: Fluorescent lighting
Code Installation # of Hours # of A= B= AxB=
(see page 7) Date Lights are on Lamps Quantity of Rebate Total Rebate Amount
per Week per Fixture Lighting Products (see page 7)
Total Rebate Section 4 $
REBATE FORM TOTAL Sections 1 – 4 $
888-921-5990 • www.efficiencyvermont.com/businesslighting Commercial Lighting • Page 31 interior LED LIGHTING
Eligibility Requirements
•P
roducts must be qualified by ENERGY STAR® or DesignLights Consortium® (DLC).
• For qualifying products, visit www.efficiencyvermont.com/ledproducts.
• Rebates cannot be combined with any other offer, including LED instant coupons
available at some lighting retailers.
• Rebates do not apply when products are used in exterior applications, or when
application is not appropriate for lighting category.
Eligible
Code Type DLC or Energy Star Category Specification Rebate for
Bonus*
Screw- or Pin-based Instant off rebates available through
n/a LED Replacement n/a SMARTLIGHT. For information, visit n/a
Lamps www.efficiencyvermont.com/smartlight.
ENERGY STAR - Downlight Pendant, • Includes recessed, pendant, surface mount and
DOWNLIGHT Downlight Surface Mount, Downlight retrofit kits.
1.1 $30
Fixtures Recessed, Downlight Solid State • Can be used in exterior applications if
Retrofit damp-location rated.
TRACK Lighting DLC Only - Track or Mono-Point $50 per
1.2 • Excludes screw- and pin-based products.
Fixtures Directional Luminaires head
UNDER CABINET ENERGY STAR - Under Cabinet,
$15 per
1.3 Shelf-Mounted Under Cabinet Shelf-Mounted Task
foot
Task Fixtures Light
DLC - Vertical Refrigerated Case
REFRIGERATED $15 per
1.4 Luminaires, Horizontal Refrigerated • Horizontal or vertical.
CASE Fixtures foot
Case Luminaires
DLC - Vertical Refrigerated Case
FREEZER CASE $15 per
1.5 Luminaires, Horizontal Refrigerated • Horizontal or vertical.
Fixtures foot
Case Luminaires
DISPLAY CASE $15 per
1.6 DLC - Display Case Luminaires
Fixtures foot
SURFACE and DLC - Linear Ambient Luminaires:
• Any combination of Indirect/Direct. $10 per
1.7 SUSPENDED Indirect, Indirect/Direct, Direct/Indi-
• Includes linear strip and recessed slot fixtures. foot
LINEAR Fixture rect, Direct
• Includes recessed, surface mount, and
2' x 2' TROFFER DLC - 2x2 Luminaires for Ambient
1.8
Fixtures Lighting of Interior Commercial Spaces
retrofit kits. $50 √
• For LED replacement lamps, see 1.11.
• Includes recessed, surface mount, and
2' x 4' TROFFER DLC - 2x4 Luminaires for Ambient
1.9
Fixtures Lighting of Interior Commercial Spaces
retrofit kits. $60 √
• For LED replacement lamps, see 1.11.
• Includes recessed, surface mount, and
1' x 4' TROFFER DLC - 1x4 Luminaires for Ambient
1.10
Fixtures Lighting of Interior Commercial Spaces
retrofit kits. $50 √
• For LED replacement lamps, see 1.11.
2' and 4' LED DLC - Four-Foot Linear Replacement • Electrical modification to existing fixture
$5 per
1.11 Replacement Lamps, Two-Foot Linear Replacement may be required; consult with an electrician.
lamp
Lamps (Tubes) Lamps • Not for use on T12 magnetic ballasts.
DLC - High-Bay Luminaires for
Commercial and Industrial Buildings,
HIGH- & LOW-BAY
1.12
Fixtures
Low-Bay Luminaires for Commercial • Includes retrofit kits. $115 √
and Industrial Buildings, High-Bay Aisle
Luminaires
*Eligible for additional 20% of rebate amount when combined with a control specified in Section 3. Each fixture must be combined with one control.
888-921-5990 • www.efficiencyvermont.com/businesslighting Commercial Lighting • Page 42 exterior LED LIGHTING
Eligibility Requirements
• Products must be qualified by DesignLights Consortium® (DLC) for Rebates.
• For qualifying products, visit www.efficiencyvermont.com/ledproducts.
• Rebates do not apply when products are used in interior applications, or when application
is not appropriate for lighting category.
• Fixtures leased from an electric utility company are not eligible.
Eligible
Code Type DLC Category Specification Rebate for
Bonus*
< 30 input watts $100
Outdoor POLE-MOUNTED Area DLC - Outdoor Pole/Arm-Mounted
2.1
Fixtures and RETROFIT Kits Area and Roadway Luminaires
≥ 30 input watts or ≥ 2,000 lumens $200 √
≥ 75 input watts or ≥ 5,000 lumens $300 √
< 30 input watts $100
Outdoor DECORATIVE AREA
DLC - Outdoor Pole/Arm-Mounted
2.2 or POST-TOP Area Fixtures ≥ 30 input watts or ≥ 2,000 lumens $200
Decorative Luminaires
and RETROFIT Kits
≥ 75 input watts or ≥ 5,000 lumens $300
< 30 input watts $100
PARKING GARAGE or
DLC - Parking Garage Luminaires,
2.3 CANOPY Fixtures and ≥ 30 input watts or ≥ 2,000 lumens $200
Fuel Pump Canopy Luminaires
RETROFIT Kits
≥ 75 input watts or ≥ 5,000 lumens $300
< 30 input watts $100
Outdoor WALL-MOUNT
DLC - Outdoor Wall-Mounted Area
2.4 Fixtures (including Wall Packs) ≥ 30 input watts or ≥ 2,000 lumens $150
Luminaires
and RETROFIT Kits
≥ 75 input watts or ≥ 5,000 lumens $200
< 30 input watts $100
2.5 BOLLARD Fixtures DLC - Bollards
≥ 30 input watts or ≥ 2000 lumens $175
Accent: < 1000 lumens $50
DLC - Landscape/Accent Flood
2.6 Outdoor FLOOD Light Fixtures and Spot Luminaires, Architectural Architectural: 1000 – 4000 lumens $100
Flood and Spot Luminaires
Architectural: > 4000 lumens $150
*Eligible for an additional 20% of rebate amount when combined with a control specified in Section 3. Each fixture must be combined with one control.
888-921-5990 • www.efficiencyvermont.com/businesslighting Commercial Lighting • Page 53 Lighting controls
3.1 Interior Dual Occupancy and Daylight Controls
Eligibility Requirements Code Type Specification
Rebate
per
Eligible
for
•F
or use on interior LED or fluorescent Sensor Bonus*
equipment.
Fixture Mounted
3.1a
Dual Sensor
• Minimum 30 watts controlled. $40 √
3.2 Interior Occupancy Controls
Eligibility Requirements Code Type Specification
Rebate
per
Eligible
for
•F
or use on interior LED or fluorescent Sensor Bonus*
equipment. Ceiling or Wall
• Hard-wired or wireless.
•W
hen used on fluorescent equipment, 3.2a Remote Mounted $75
• Minimum 150 watts controlled.
Sensor
program start ballasts are
recommended. Switch Mounted
3.2b • Minimum 60 watts controlled. $30
•C
ompanion switches for wireless Sensor
sensors are not eligible for rebates.
Fixture Mounted
3.2c
Sensor
• Minimum 30 watts controlled. $30 √
Refrigerated Case
3.2d • Minimum 3 doors per sensor. $40
Sensor
Freezer Case
3.2e • Minimum 3 doors per sensor. $40
Sensor
3.3 Interior Daylight Controls
Eligibility Requirements Code Type Specification
Rebate
per
Eligible
for
•F
or use on interior LED or fluorescent Sensor Bonus*
equipment.
Ceiling or Wall • Minimum 150 watts controlled.
3.3a $60
•T
o realize full energy savings potential, Remote Mounted
commissioning is recommended for
Switch or
daylight controls. 3.3b • Minimum 30 watts controlled. $30 √
Fixture Mounted
3.4 Exterior Lighting Controls
Eligibility Requirements Code Type Specification
Rebate
per
Eligible
for
• For use on exterior LED or induction Sensor Bonus**
equipment. Exterior
• Lights must be turned off or reduced by 3.4a Occupancy • Minimum 45 watts controlled. $40 √
Sensor
at least 50% during unoccupied times.
• Additional controls are required to
prevent daytime operation.
*Eligible for an additional 20% of rebate amount when combined with an interior fixture specified in Section 1. Each fixture must be combined with one control.
**Eligible for an additional 20% of rebate amount when combined with an exterior fixture specified in Section 2. Each fixture must be combined with one control.
888-921-5990 • www.efficiencyvermont.com/businesslighting Commercial Lighting • Page 64 Fluorescent LIGHTING
4.1 High-Performance T8 (HPT8) Linear Fluorescent Systems
Eligibility Requirements
• HPT8 system = high-lumen or reduced-wattage lamp(s) + low ballast factor (BF) ballast.
• Lamp and ballast combinations must be listed on the Consortium for Energy Efficiency’s
(CEE) Qualifying Products List available at www.efficiencyvermont.com/HPT8products.
Rebate per fixture
Rebate per
Code Type Specification with Bi-level/
Fixture
Dimming Ballast
• Must use low ballast factor.
4.1a Relamp/Reballast to HPT8 • Must be an upgrade of an existing T8 or T12 $10 $20
system.
• Must use low ballast factor.
4.1b New HPT8 Fixture $10 $20
• Includes any HPT8 fixture type.
• Must use high ballast factor.
4.1c New HPT8 High-Bay Fixture • Fixture efficiency must be 85% or greater. $40 $50
• 4, 6, or 8 lamps only; call to inquire about other lamps.
4.2 T5 Linear Fluorescent Systems
Eligibility Requirements
• Fixture must utilize a T5 lamp/ballast system.
Rebate per fixture
Rebate per
Code Type Specification with Bi-level/
Fixture
Dimming Ballast
4.2a New T5 Fixture • Includes any T5 fixture type. $10 $20
• Fixture efficiency must be 90% or greater.
4.2b New T5HO High-Bay Fixture • 3, 4, or 6 lamps only; call to inquire about other lamp $25 $35
combinations.
Induction Lighting
Efficiency Vermont or BED incentives may be available for exterior projects utilizing induction lighting technology.
Projects must be enrolled with Efficiency Vermont or BED before purchase and installation, and incentives will be
determined on a case-by-case basis. For more information, visit www.efficiencyvermont.com/induction or call
888-921-5990. For BED projects, please call 865-7342.
888-921-5990 • www.efficiencyvermont.com/businesslighting Commercial Lighting • Page 7TERMS & CONDITIONS REBATE is for new equipment purchased and installed between January 1, 2015 and June 30, 2015 by customers of Vermont electric utilities, except that rebates are not available to the following customers: IBM, Omya, and electric utility companies. Equipment must be installed within the state of Vermont. Rebate forms must be postmarked or received by July 31, 2015. Rebate offer is subject to change without notice and may not be combined with any other offer. LIMITATIONS: This form cannot be used for any project involving more than 250 items for which rebates are sought; for information on such projects, please call Efficiency Vermont (or Burlington Electric Department for projects within the City of Burlington). This form also cannot be used for any project involving new construction within the City of Burlington, or for any project outside the City of Burlington involving new construction of greater than 10,000 sq. ft.; please call Burlington Electric Department or Efficiency Vermont, respectively, for information on such projects. PROOF OF PURCHASE: Invoice(s) must include the quantity, size, type, manufacturer, model or part number, purchase date, and vendor of the efficient equipment. All sales transactions and installations are subject to verification and inspection. The customer agrees to allow Efficiency Vermont (or, within the City of Burlington, Burlington Electric Department) access to the equipment for purposes of verification and inspection. LIMITATION OF LIABILITY: Performance of installed equipment is not guaranteed expressly or implicitly. ENDORSEMENT: No particular manufacturers, products, or system designs are endorsed through this program. PAYMENT: Allow 60 days for delivery of payment. Incomplete or missing information will delay processing of rebate form and payment. MAXIMUM PAYMENT will not exceed 100% of the equipment purchase price. Customer is responsible for all costs associated with sales tax, installation, and disposal/recycling. Customer is responsible for any tax liability associated with rebate payment. CAPACITY CREDITS/ENVIRONMENTAL CREDITS: In accepting these financial incentives, the customer agrees that Efficiency Vermont (or, for customers within its service territory, Burlington Electric Department) holds the sole rights to any electric system capacity credits and 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. 1 2 8 L a k e s i d e Av e . , S u i t e 4 0 1 • Burlington, VT 05401 • 888-921-5990 • w w w. e f f i c i e n c y v e r m o n t . c o m Printed using soy-based inks on paper that contains 100% recycled post-consumer waste and is 100% process chlorine free. EV-2534-0115-RwAX
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