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APPLICATION mINNesOTA

Cooling Efficiency
cooling equipment rebate application
Business Customer Information

Opportunity ID:__________

Company name _________________________________________________________________________ Date submitted ____________________ Mailing address ___________________________________________________ City ______________________ State ______ ZIP______________ Installation address (if different)______________________________________ City ______________________ State ______ ZIP______________ County where installed (Required for processing.) _______________________ Contact name (print) _______________________________________________ Day phone ( ________) ___________________________________ Email* ____________________________________________________________________
Check this box if you do not want to receive emails from Xcel Energy regarding our programs and services.

Xcel Energy electric premises number ____________________________________________________________ Please indicate the primary use** for this location: Office Retail Lodging Education - community college Education - secondary college Education - university

Health/medical - clinic

Health/medical - hospital

Other _______________________________________________________

**Chillers used for non-space conditioning must go through our Custom Efficiency program and be preapproved prior to purchase. I verify the information on this application is correct and request consideration for participation in this program. Customer signature X _____________________________________________________________________ Date ___________________________ Customer hereby certifies that: 1. the customer, and not Xcel Energy is solely responsible for the accuracy of the information contained in this application; 2. all installation is complete and operational prior to submitting rebate; and 3. all rules of this Xcel Energy program have been followed. Further, the customer acknowledges that participation in this rebate program shall impose no liability on Xcel Energy. In particular, Xcel Energy shall not be liable for the work performed by the customers engineer, contractor or vendor. Xcel Energy account manager _______________________________________________________________________________________________

Alternative Rebate Recipient


Note: Complete this section only if customer wants rebate check to go to someone other than the company tied to the account number: Company name ________________________________ Contact name _________________________________ Phone ( ______) ________________ Address _________________________________________________________ City ______________________ State ______ ZIP______________ I authorize the above company to receive the rebate check for this project. Customer signature X ____________________________________________________________________ Date ___________________________

HVAC Contractor Information


Contractor name __________________________________________ Contractor contact name ___________________________________________ Contractor Address ________________________________________ City ____________________________ State ______ ZIP _________________ Daytime phone ( ______ ) ____________________________ Fax ( _____ ) _________________________ Email* ________________________________________________________________________________ Trade Ally ID (optional) ______________
Check this box if you do not want to receive emails from Xcel Energy regarding our programs and services.

FOR OFFICE USE ONLY. DO NOT WRITE IN THE SPACE BELOW. Sales representative ______________________________________________ ID # __________________ Date _________________Sector ___________________ kW/revenue calculations. Sales reps, please complete the cooling calculator along with the application. Rebate Ops Signature ____________________________________ Date ______________ Marketing Review (optional) ___________________________________
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APPLICATION mINNesOTA

Rebate Rules and Requirements

Qualifying Customers
he Xcel Energy Cooling Efficiency program is available to Xcel Energy business electric customers in Minnesota. T

Cooling Efficiency Rebate Rules


ebate plans are available to existing Xcel Energy direct-billed electric R commercial and industrial customers in Minnesota only. ustomers have 12 months from the equipment invoice date to apply for a Cooling C Efficiency rebate. o rebates will be given for equipment or designs that do not comply with N Xcel Energy Cooling Efficiency program rebate rules or local, state or federal regulations. his rebate form and these standards go into effect 06/01/2009 and supersede T all previous program materials. This rebate program will be in effect for an indefinite period, but is subject to 60 days notice of change or cancellation. The customer is responsible for checking with Xcel Energy to determine whether the program is still in effect. cel Energy reserves the right to inspect installations before and after X issuing rebates. cel Energy is not responsible for any lost, late, stolen, ineligible, illegible, X misdirected or postage-due mail. All completed submissions become the property of Xcel Energy and will not be returned. Warning - Fraudulent submission of forms may result in federal prosecution for mail fraud under 18 USC sections 1341, 1342. cel Energy will issue rebates in the form of checks, not utility bill credits. X Xcel Energy will issue rebates when the total amount is greater than or equal to $5. Rebate items must be installed on the Xcel Energy electric account listed on the application. All equipment must be new; used or rebuilt equipment is not eligible for a rebate. Rebates cannot exceed 60 percent of the project cost (including equipment and labor). The minimum rebate is $5. Once completed paperwork is submitted, incentive payments are usually made in six to eight weeks. Xcel Energy will issue rebates in the form of checks, not utility bill credits. Equipment must meet the technical requirements listed in this application form. Xcel Energy reserves the right to withhold payment for products that do not meet the requirements. Xcel Energy reserves the right to inspect customer facility(ies) for installation of materials listed on this rebate application and will need access to survey the installed project. Customer should keep a sample of any/all types of equipment removed, for a period of three (3) months after receiving a rebate from Xcel Energy. If the inspection finds that you didnt comply with program rules and standards, any rebate you have received must be returned to Xcel Energy. Xcel Energy reserves the right to publicize your participation in this program, unless you specifically request otherwise. Xcel Energy reserves the right to refuse payment and participation if the customer or contractor violates program rules and procedures. Xcel Energy is not liable for rebates promised to customers as a result of a contractor misrepresenting the program. Contact our Business Solutions Center at 1-800-481-4700 or bsc@xcelenergy.com for more information.

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APPLICATION mINNesOTA

How to Apply for Rebates


1. Fill out the rebate application. (All information needs to be supplied before a rebate check can be issued.) 2. Mail or fax completed and signed rebate form along with the original paid invoices and manufacturers spec sheet(s) to: Xcel Energy, Rebate Operations, P.O. Box 829, Minneapolis, MN 55440-0829, Fax: 612-330-5675

REBATE LEVELS AND REQUIREMENTS


Anti-sweat Heater Controls Chillers Air Cooled Chillers VFD Retrofit Chillers Water Cooled < 150 tons (Centrifugal) > 150 tons (Centrifugal) < 150 tons (Screw/Scroll) 150300 tons (Screw/Scroll)* EC Motors (Electronically Commutated Motor) Refridgerated Display Cast (Medium Temp) Freezer Display Case ( Low Temp) Walk-in Refridg. (Medium Temp) Walk-in Freezer (Low Temp) 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 Plate and Frame Heat Exchanger

BASELINE REBATE
Minimum efficiency

INCREMENTAL REBATE
Base rebate per ton Increment Incr. rebate per ton

n/a 9.7 FLV EER 12 IPLV SEER

$60/door $8

n/a 0.1 EER .01 kW/ton

n/a $1.50 per FLV+ , $.75 per IPLV 0.1 EER above base $1.50 per IPLV 0.01 kW/ton below base $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 n/a n/a n/a n/a $5 $5 $5 $5 $5

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 n/a n/a n/a n/a 13.5 SEER 10.8 EER 10.7 EER 10.2 EER 9.6 EER Wet Bulb Temperature 52 F and >45 F 45 F and >40 F 40 F and >35 F 35 F
10.8 EER

$15 $15 $15 $15


$40 $40 $70 $70

0.01 kW/ton 0.01 kW/ton 0.01 kW/ton 0.01 kW/ton n/a n/a n/a n/a 0.1 SEER 0.1 EER 0.1 EER 0.1 EER 0.1 EER

$75 $75 $75 $75 $75 $300 $240 $180 $120 $75 $20 $75 $150/door (freezer) $100/door (cooler)

PTAC Rooftop Unit Economizer Water Source Heat Pump Zero Loss Energy Doors

0.1 EER n/a 0.1 EER n/a

$5.00 n/a $5 n/a

Enthalpy and CO2 control 13.2 EER Case Temperature to 0 F = Freezer 1 F - 35 F = Cooler

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.

Warranty Information
Warranties are between the customer and the equipment manufacturer(s). Xcel Energy makes no warranties, expressed or implied, with respect to equipment operation, material, workmanship or manufacturing. Xcel Energy 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 this program. In no event shall Xcel Energy be liable for any incidental or consequential damages. Xcel Energy is not responsible for the disposal of motors replaced as a result of this program.

PLEASE ALLOW 6-8 WEEKS FOR REBATE CHECK TO ARRIVE.

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APPLICATION mINNesOTA

ANTI-SWEAT HEATER CONTROLS*


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

_______ No. of doors x $60 =

*Invoices must be dated on or after June 1, 2012


CHILLERS AIR COOLED
No. of units Manufacturer Model no. Full Load Tons/unit FLV/EER IPLV/SEER Item rebate

(Base: $8 x ___ tons = $___ ) + [Efficiency: (FLV $1.5 x ___ a x ___ tons = $___ ) + IPLV $0.75 x ___ b x ___ tons = $___)] = $ __________
a b

[Equipment EER (from vendor) Min. qualifying EER (from table of minimum qualifying criteria)] /.1 [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) Item rebate

(IPLV $1.5 ____ a x ____tons = $___ ) [Previous IPLV kW/ton - Post IPLV kW/ton (design conditions)]/.01 *chiller tons
a

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

(Base: $15 x ___ tons = $___) + [Efficiency: FLV $2 x ___ a x ___ tons = $___ ) + NPLV $1.5 x ___ b x___ tons = $ ___ )] = $ __________
a b

[Min. qualifying FLV kW/ton (xcelenergy.com/CoolingEfficiency) Equipment FLV kW/ton (design conditions)]/.01 [Min. qualifying NPLV kW/ton (xcelenergy.com/CoolingEfficiency) 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) Item rebate

(Base: $15 x ___ tons = $___) + [Efficiency: FLV $2 x ___ a x ___ tons = $___ ) + IPLV $1.5 x ___ b x___ tons = $ ___ )] = $ __________
a b

[Min. qualifying FLV kW/ton (from table of minimum qualifying criteria) Equipment FLV kW/ton (from vendor)] /.01 [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 Coil* 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 or SEER (from vendor) Min. qualifying EER or SEER (from table of Min. Qualifying Criteria)] 0.1 *A Coil model is required for units <5.4 tons only.

ECONOMIZERS
Model number Manufacturer RTU tons/unit Enthalpy controlled? CO2 Controls purchased?

Yes
(Base: $20 x____ RTU tons x ______ no. of units = $__________ total rebate)

No __ Initials

Yes

No __ Initials

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APPLICATION mINNesOTA

EC MOTORS (ELECTRICALLY COMMUTATED MOTORS)


Section A - ECMs that replaced shaded pole motors within refrigerated display cases. Line #
1 2 3 4 End use function Refrigerated Display Case (Medium Temp) Refrigerated Display Case (Medium Temp) Refrigerated Display Case (Medium Temp) Refrigerated Display Case (Medium Temp) Manufacturer Model # Rebate $40 $40 $40 $40 Qty Rebate x Qty = Total Rebate

Section B - ECMs that replaced shaded pole motors within low temperature (freezer) display cases. Line #
5 6 7 8 End use function Freezer Display Case (Low Temp) Freezer Display Case (Low Temp) Freezer Display Case (Low Temp) Freezer Display Case (Low Temp) Manufacturer Model # Rebate $40 $40 $40 $40 Qty Rebate x Qty = Total Rebate

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 #
9 10 11 12 Function / FAN SIZE Walk-in Refrig. (Medium Temp) Walk-in Refrig. (Medium Temp) Walk-in Refrig. (Medium Temp) Walk-in Refrig. (Medium Temp) More than 15 or Less than 15 More than 15 or Less than 15 More than 15 or Less than 15 More than 15 or Less than 15 Manufacturer Model # Rebate $70 $70 $70 $70 Qty Rebate x Qty = Total Rebate

Section D - ECMs that replaced shaded pole motors within walk-in freezers. Line #
13 14 15 16 Function / FAN SIZE Walk-in Freezer (Low Temp) Walk-in Freezer (Low Temp) Walk-in Freezer (Low Temp) Walk-in Freezer (Low Temp) More than 15 or Less than 15 More than 15 or Less than 15 More than 15 or Less than 15 More than 15 or Less than 15 Manufacturer Model # Rebate $70 $70 $70 $70 Qty Rebate x Qty = Total Rebate

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

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APPLICATION mINNesOTA

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 *Load/Tons displaced by heat exchanger **Wet bulb temperature heat exchanger is used instead of a chiller F ***Balance point of building F. Default is 20 F. If data center or process load, use -26 F. in qualifying NPLV kW/ton (xcelenergy.com/CoolingEffiiciency) Equipment NPLV kW/ton (design conditions)]/.01

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 1F to 35 F. *Invoices must be dated on or after June 1, 2012.

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. *Invoices must be dated on or after June 1, 2012.

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.

xcelenergy.com | 2013 Xcel Energy Inc. | Xcel Energy is a registered trademark of Xcel Energy Inc. | Northern States Power Company-Minnesota, Northern States Power Company-Wisconsin, Xcel Energy Companies. | 12-11-425 | 01/13 | CRS 2044