SRP Business Solutions: Electric Technology Rebates Forklift Rebate Application (Customer)

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Caitlin Singleton
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SRP Business Slutins: Electric Technlgy Rebates Frklift Rebate Applicatin (Custmer) Instructins: Fill ut this rebate applicatin cmpletely and sign.

1 SRP Business Slutins: Electric Technlgy Rebates Frklift Rebate Applicatin (Custmer) Instructins: Fill ut this rebate applicatin cmpletely and sign. Attach required dcumentatin: all invices shwing dates f payment. Failure t cmplete this frm and prvide dcumentatin will result in yur applicatin being returned r denied. Rebates will be paid upn prf f invice, delivery f equipment, and prcessing f applicatin. Please cmpleted applicatins t etechrebates@srpnet.cm. If yu prefer t apply nline, visit srpetechrebates.cm. T be eligible fr the frklift rebate, the custmer must: Be a Salt River Prject (SRP) nn-residential electric custmer with an accunt in gd standing. Purchase r lease a class 1 r 2 electric frklift between Octber 9, 2017 and April 30, Electric frklifts must replace an internal cmbustin unit OR be an expansin t an existing fleet OR be a first-time frklift purchase. Electric equipment replacing existing electric equipment des nt qualify fr this prgram. Leased electric frklifts withut a buyut clause are eligible fr a prrated rebate at the rate f annual length f cntract divided by 10 and multiplied by $1,000. Fr example, a fur-year lease is eligible at the rate f 10 divided by 4, r.4, multiplied by $1,000, resulting in a $400 rebate. Leased electric frklifts with a buyut clause are eligible fr the full rebate. Used electric frklifts are eligible fr a prrated rebate based n the age f the frklift. Used frklifts must be 2015 mdels r newer. Prrated rebate is calculated based n a 10-year life expectancy. Fr example, a 2-year ld frklift is eligible fr 80 percent f the rebate. Dealer dem equipment r remanufactured equipment sld with a new warranty is eligible fr the full rebate. Frklifts must remain in use in the SRP service area. Equipment shipped t ther facilities utside the SRP service area d nt qualify. Prvide all valid invices and valid serial numbers fr all frklifts claimed. Submit this cmpleted rebate applicatin within the prgram timeframe f Octber 9, 2017 and April 30, SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 1

2 A. Custmer Infrmatin Cmpany Receiving Rebate: Primary Cntact Persn: Address: Phne Number: SRP Electric Accunt Number: SRP Accunt Service Address Street Address: City: State: ZIP: B. Dealer Infrmatin (if applicable) Yur frklift dealer may receive a dealer award f up t $100 per frklift. Dealer Award Paid t: Dealer Cmpany Sales Persn (If this payment methd is selected, sales persn must prvide a cmpleted W9 frm) End-Use Custmer Cmpany Sales Persn Name: Sales Persn Cmpany: Address: Street Address: City: ZIP: State: Phne: C. Rebate Reassignment (if applicable) Yu may chse t reassign yur rebate payment t yur dealer, which will be reflected as an instant rebate n yur invice. I am authrizing the payment f the rebate t the third party cmpany named, and I understand that I will nt be receiving the rebate payment frm the prgram. I als understand that my release f the payment t the third party named belw des nt exempt me frm the applicable prgram requirements. Rebate Amunt: Authrized by: Custmer Name: Custmer Signature: SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 2

3 Check Shuld be Made Payable t: Payee Name: Mailing Address: City: State: ZIP: Payee Signature: D. Equipment Infrmatin NEW EQUIPMENT Purchase Type: New Owned New Leased with Buy Out Clause New Leased withut Buy Out Clause fr a Term f Years Used, Mdel Year: Installatin Type: Replacing Internal Cmbustin Unit Expanding Existing Fleet Installing New Equipment Replacing Electric Unit (Des Nt Qualify) Charge Type: Cnventinal Rapid/Opprtunity Please fill ut the fllwing. If additinal rm is needed, please attach a supplemental table with the required infrmatin. Class Quantity Manufacturer (1 r 2 Serial Cst per Rebate Mdel are Number Unit Amunt eligible) Ttal Rebate $ SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 3

4 OLD EQUIPMENT If replacing an Internal Cmbustin Unit, please prvide the fllwing infrmatin. If additinal rm is needed, please attach a supplemental table with the required infrmatin. Fuel Type (Prpane/ Diesel) Mdel Mdel Year Hrse pwer Estimated Annual Hurs f Operatin Serial Number Rebate Applicatin Dcumentatin The required dcumentatin fr rebate applicatins must be delivered t ICF OR be submitted via Sightline in rder fr a custmer t receive the rebates. Custmer acknwledges and agrees that the dcumentatin fr the applicable rebate applicatin must be submitted within the prgram timeframe f Octber 9, 2017 and April 30, Custmer agrees t prvide the fllwing fr each equipment fr which custmer seeks a rebate fr (cllectively, the Dcumentatin ): (i) a cmpleted rebate applicatin, (ii) manufacturer, class, mdel and serial numbers f the installed equipment, (iii) equipment invices. ICF shall verify dcumentatin meets prgram requirements within thirty (30) days f receipt and will ntify custmer f any discrepancies. Rebate Payments Custmer acknwledges that rebates are paid directly by ICF in accrdance with the ICF-SRP Agreement. Custmer shall receive payment directly frm ICF within fur (4) t six (6) weeks after submitting r uplading dcumentatin and receipts, r verificatin by ICF f the applicatin and required data, prvided the custmer has submitted all required dcumentatin in a timely manner and all prgram requirements have been met. Terms and Cnditins Imprtant: This frm is t be read, signed, and submitted with the FY18 Frklift Rebate Applicatin. Salt River Prject ffers the SRP Business Slutins Electric Technlgy Rebate Prgram ( ET Prgram ) t prvide custmers with rebates t facilitate the installatin f qualifying equipment r electrical infrastructure. The fllwing terms and cnditins apply t the prgram: SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 4

5 1. SRP has cntracted ICF, Inc. ( ICF ) t act as the Prgram Administratr and authrizes ICF t administer the Electric Technlgy rebate prgrams including such activities, but nt limited t; review, prcessing, and apprval f custmer applicatins; pre and pst inspectins f custmer facilities and prject infrmatin requests frm custmer; measurement and verificatin activities; and issuing rebate checks. 2. Funds are limited and ET Prgram applicatins are accepted n a first-cme, firstserved basis. The FY18 ET Prgram is effective frm Octber 9, 2017 thrugh April 30, 2018 ( Effective Perid ). 3. SRP allws custmers t participate in multiple prgrams subject t an annual rebate cap, which is the maximum rebate amunt a custmer is eligible t be paid fr the prgram year. Fr FY18, the rebate cap is $300,000 per custmer fr all SRP Business Slutins prgrams in aggregate. A custmer is defined as a hlder f a single accunt, multiple accunts in aggregate r crprate accunts. Fr purpses f rebate caps, a custmer wh is the hlder f multiple accunts r crprate accunts with a single SRP custmer identificatin number will be cnsidered a single custmer. 4. Rebates pursuant t participatin in the ET Prgram may result in taxable incme t the Custmer, even if Custmer des nt directly receive a payment. Custmer shuld cnsult his r her wn tax advisr with respect t the tax treatment f rebates prvided pursuant t participatin in the ET Prgram. 5. The SRP Electric Technlgy prgram website describes the custmer and equipment eligibility requirements, rebate infrmatin, and prgram participatin prcess fr custmers participating in the ET Prgram. Custmer must read and cmply with the cnditins utlined n this applicatin and the current prgram website at incrprated herein by reference. 6. T be eligible fr rebates thrugh the ET Prgram, the participant must: a. Be a current SRP nn-residential retail electric custmer. b. Submit a cmpleted Frklift Rebate Applicatin and any supplemental dcumentatin that may be requested t verify eligibility. c. Purchase and install qualifying equipment at the Custmer s Accunt Service Address listed n this applicatin. d. Abide by the prgram rules, eligibility requirements, and rebate levels in effect at the date f equipment installatin. e. Prvide a valid tax identificatin number. 7. Custmer is slely respnsible fr the selectin f equipment r infrastructure t be installed r implemented and fr the selectin f a third party service prvider r Electric Technlgy Alliance Participant ( Custmer Cntractr ) t cmplete the installatin and implementatin f any equipment r measures. SRP and ICF make n representatins and prvide n warranty r guaranty with respect t the design, manufacture, cnstructin, safety, perfrmance r effectiveness f the newly installed equipment, including any warranties f merchantability r fitness fr a particular purpse. Respnsibility fr delivery and wrkmanship related t any equipment r services the custmer prcures exclusively rests with the cntractr r retailer selected by the custmer. SRP and ICF assume n respnsibility fr versight f cntractr services r SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 5

6 fr any claims the Custmer might have against the Custmer Cntractr, the manufacturer, r the retailer with regard t the energy efficiency services r measures implemented under the ET Prgram. 8. Custmer hereby authrizes and acknwledges that SRP may disclse Custmer s infrmatin relating t a Custmer Applicatin (including the entirety f its cntents), and any ther infrmatin related t the Custmer s participatin in the Prgram t ICF and Electric Technlgy Alliance Participants, as applicable, and any ther third party utilized by SRP fr the purpses f prcessing the Custmer s Applicatin, t verify r audit prgram recrds r system installatin, peratin and results, r as required t cmply with state and/r federal law, fraud preventin, regulatin, and ther legal actin. In thse cases, SRP, ICF, and authrized third parties shall cmply with all legal requirements f the jurisdictin f the individual whse Custmer data wuld be disclsed befre making such disclsure. 9. Any persn wh knwingly files an applicatin cntaining any materially false infrmatin r wh purpsely r misleadingly cnceals infrmatin subjects such persn t criminal and civil penalties. Any and all funds determined t have been acquired n the basis f inaccurate r fraudulent infrmatin must be returned t SRP. Any custmer fund t be engaged in fraudulent activity r misrepresentatin f any kind will be remved frm the ET Prgram. This sectin shall nt limit ther remedies that may be available fr the filing f a false r fraudulent applicatin, including, but nt limited t, referral t law enfrcement authrities. 10. Ntwithstanding anything in these Terms and Cnditins t the cntrary, in n event will SRP, ICF, r their agents, cnsultants r subcntractrs be liable hereunder fr any type f damages, whether indirect, special, incidental, cnsequential, exemplary, reliance r punitive (even if advised f the pssibility f such damages), including, withut limitatin, lss f use r lss f prfits, whether in cntract, indemnity, warranty, strict liability r trt, including negligence f any kind. Custmer waives any claims it might have against SRP r ICF. 11. Custmer, at its wn expense, is respnsible fr meeting all requirements and cmplying with all lcal and state laws and cdes cncerning the ET Prgram, including withut limitatin, the installatin and maintenance f eligible equipment. Custmer shall, at its wn expense, btain and maintain licenses and permits needed t install eligible equipment. Failure t btain and maintain necessary licenses and permits cnstitutes a material breach f Custmer s bligatins under these Terms and Cnditins. 12. SRP, ICF, r their respective agents, cnsultants, and subcntractrs shall nt have any respnsibility fr the discvery, presence, handling, remval, r dispsal f r expsure f persns t hazardus materials f any kind in cnnectin with Custmer's facility, including withut limitatin, asbests, asbests prducts, PCBs, r ther txic substances. Custmer shall dispse f replaced equipment in accrdance with lcal, state, r federal cdes and regulatins and cannt reinstall the equipment in anther lcatin. SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 6

7 13. The terms and cnditins set frth herein cnstitute a cmplete statement f the Terms and Cnditins applicable t this prmtin, and supersede all prir representatins r understandings, whether written r ral. SRP shall nt be bund by r be liable fr any statement, representatin, prmise, inducement r understanding f any kind that is nt set frth herein. SRP reserves the right t change r cancel this prmtin r its terms and cnditins at any time. Signature and Certificatin I certify that the equipment described in this rebate applicatin has been installed at the service address indicated. I agree t the terms and cnditins stated in this applicatin. Signature Name (Printed) Date SRP Business Slutins Electric Technlgy Prgram Applicatin _Frklift_Custmer 11/2017 7

AusNet Electricity Services Pty Ltd. Information Sharing Protocol and Register

AusNet Electricity Services Pty Ltd Infrmatin Sharing Prtcl and Register 1 BACKGROUND This is AusNet Electricity Distributin Pty Ltd s ( DNSP s) infrmatin sharing prtcl, and infrmatin sharing register,