MT 2018 ILLINIS FR YUR BUSINESS REBATE APPLICATIN Instructions: Fill out form completely and sign. Attach itemized invoices and supporting documentation, if applicable. Failure to complete the required sections and provide documentation will result in denial of claim. must be purchased between Jan. 1, 2018, and Dec. 31, 2018. must be installed and operating prior to submission of final rebate application. Rebates cannot exceed 50 percent of the installed (materials and reasonable labor). You will receive the lesser of the rebate amount listed or 50 percent of installed. Installed includes contractor labor only and does not include internal labor. Rebate application must be submitted within six months of dealer invoice, or by Dec. 31, 2018, whichever comes first, for the equipment/ material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/ material purchased. Rebate applications received after Dec. 31, 2018, are not eligible for rebates. Custom : If specific equipment you intend to purchase and install is not listed, it may qualify under Nonresidential Custom Systems. However, custom projects must be preapproved by MidAmerican Energy prior to purchase and installation of equipment or system. Projects must be completed within six months of preapproval. See the Nonresidential Custom Systems application for details. SECTIN 1 (REQUIR) Name on account Installation address Customer Information Self-installed q Yes q No City State ZIP Phone MidAmerican Energy Company account number (found on bill; first seven digits only) Mailing address (if different than installation address) City State ZIP Contact name Title Email address* *This email address only will be used for communication regarding this rebate application. Your email address never will be shared and you can unsubscribe at anytime. SECTIN 2 (REQUIR) Year building was constructed Building size [sq. ft. (area)] Do you: q wn The new equipment is for: q Replacement of existing equipment q New installation (new to facility) q New construction q Rent this building 1 Page 1 of 5
SECTIN 2 CNT. (REQUIR) installed in what type of facility? (check one) Industrial MEC Use nly Commercial MEC Use nly q Apparel q Apartment, halfway house q Chemical q Condo q Computer/electronic product q Convenience store/gasoline station CV q Electrical equipment, appliance/component q Food/beverage/tobacco product q Furniture and related product q Leather and allied product q Machinery q Nonmetallic mineral product q il and gas extraction; mining q Paper ; printing and related support activities q Personal and laundry services q Petroleum and coal products q Plastics and rubber products q Primary metal/fabricated metal product q Textile mill and textile product mill q Transportation equipment q Utility q Warehouse and storage q Warehouse large refrigerated q Wood product q Miscellaneous q ther industrial q Dealership small <30k q Dealership large >30k q Financial institution small <30k q Financial institution large >30k q Grocery store and supermarket q Healthcare (outpatient) q Healthcare (inpatient, including hospital, nursing home, senior care facility) q Healthcare senior housing - individual apartment q Health club/exercise facility small <30k q Health club/exercise facility large >30k q Library q Lodging hotel q Lodging motel q Mixed use q ther - commercial q ffice small 4 floors q ffice large > 4 floors q ffice government small 4 floors q ffice government large > 4 floors q ffice public order and safety small 4 floors q ffice public order and safety large > 4 floors GR HC HS L L Agriculture q Corn farming q Dairy cattle and milk production q Hog facility q Soybean farming q All other animal production q All other miscellaneous crop farming MEC Use nly DF HF q Pharmacy and drug store small <30k q Pharmacy and drug store large >30k q Public assembly events/conventions/casinos small <30k q Public assembly events/conventions/casinos large >30k q Religious worship/church q Restaurant fast food q Restaurant full service HY HY RE T T q Retail small <30k q Retail large >30k q Retail department store small <30k q Retail department store large >30k q School elementary q School jr. high q School high school q School college, university and professional school q School lodging (school/dorm) q Service small <30k q Service large >30k q Truck stop CV q Warehouse and storage WH-C q Warehouse large refrigerated WH-C 2 Page 2 of 5
SECTIN 3 Complete all fields for each piece of equipment purchased and installed. pen Drip-Proof Motors 1800 RPM Motors - Three-Phase nly Minimum 3,000 annual operating hours required. Total calculation labor Total calculation labor Total calculation labor Totally Enclosed Fan-Cooled Motors 1200 RPM Motors - Three-Phase nly Minimum 3,000 annual operating hours required. Total calculation labor Total calculation labor Total calculation labor 3 Page 3 of 5
Totally Enclosed Fan-Cooled Motors 1800 or 3600 RPM Motor speed (RPM) Total calculation labor Motor speed (RPM) Total calculation labor Motor speed (RPM) Total calculation labor For additional motors, submit on a separate sheet. Specific Terms and Conditions nparticipants must be commercial or industrial customers with facilities located in MidAmerican Energy Company s Illinois service territory. nmidamerican Energy Company must deliver the electricity to the equipment at the facility for which the rebate is being paid. n installed as a replacement unit, retrofit or in new construction is eligible. Motors for spare inventory are eligible for rebates. nrebates are available for Premium Efficiency, 1 to 500 horsepower, three-phase general purpose motors. Premium Efficiency motors must have a greater efficiency than NEMA Premium, NEMA Standards Publication MG-1-2006 Table 12-12, 600 volts or less. nrebates for fractional horsepower motors are not available. nminimum 3,000 annual operating hours required. na manufacturer s specification sheet with efficiency ratings of the product(s) installed must accompany the application. Itemized and dated invoices from the contractor must accompany the application. nfor prescriptive rebates, the rebate payment cannot exceed 50 percent of the installed (reasonable labor and material/equipment - reasonableness to be determined by MidAmerican Energy Company). Installed includes contractor labor only and does not include internal labor. n must be purchased between Jan. 1, 2018, and Dec. 31, 2018. must be installed and operating prior to submission of final rebate application except for motors purchased for spare inventory. nrebate application must be submitted within six months of dealer invoice, or by Dec. 31, 2018, whichever comes first, for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. Rebate applications received after Dec. 31, 2018, will not be eligible for rebates. nallow 4 6 weeks for rebate processing, excluding on-site verification time, if needed. General Terms and Conditions Important: Before completing and signing this form, please read the General Terms and Conditions located in the 2018 Illinois For Your Business rebate booklet or at www.midamericanenergy.com/ee. REMEMBER T SIGN THE NEXT PE 4 Page 4 of 5
Disclaimer MidAmerican Energy Company does not guarantee that installation and operation of high-efficiency equipment will result in reduced usage or in savings. MidAmerican Energy Company makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to, any warranty of merchantability or fitness for a particular purpose. In no event shall MidAmerican Energy Company be held liable for any incidental or consequential damages or injuries resulting from defective equipment or installation. MidAmerican Energy Company reserves the right to cancel or change these programs at any time. MidAmerican Energy Company s acceptance of this application does not guarantee payment of rebate. Customer Agreement I certify that I have purchased the equipment described on this form and that it has been installed or placed in inventory at the service address indicated. I agree to the terms and conditions associated with this form. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before issuing payment. Customer signature Date Dealer name Installer/Dealer Information Phone Address Fax City State ZIP Contact name Email address Installer/Dealer Agreement I certify that all equipment and installation information provided on this application is correct and accurate. Installer/dealer signature Date Before you submit your form: oofill out this form completely. ooattach a copy of the itemized sales receipt or invoice. ooinclude documentation listed in the instructions. oosign the Customer Agreement section. Send completed forms to: Mail: MidAmerican Energy Company P.. Box 4628 Des Moines, IA 50305-4628 Fax: 515-244-8825 Email: rebateapplications@midamerican.com For MidAmerican Energy Use Project # Project # Received date Method: E M F I Assessment # Assessment date KAM-BAM Sector type Rebate total amount $ 5 For more information call 800-894-9599 or go to www.midamericanenergy.com/ee. Page 5 of 5