Fillable GROCERY PRE-APPROVAL AND FINAL APPLICATION (ComEd)

Fill Online, Printable, Fillable, Blank GROCERY PRE-APPROVAL AND FINAL APPLICATION (ComEd) Form

Use Fill to complete blank online COMED pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

GROCERY PRE-APPROVAL AND FINAL APPLICATION (ComEd)

On average this form takes 17 minutes to complete

The GROCERY PRE-APPROVAL AND FINAL APPLICATION (ComEd) form is 8 pages long and contains:

  • 3 signatures
  • 13 check-boxes
  • 50 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your ComEd forms online.

BROWSE COMED FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
The ComEd
®
Energy Efciency Program offers incentives to help Grocery facilities save money and energy by
improving the efciency of their equipment. The Grocery offering provides technical services and assistance in
identifying, assessing, and implementing energy efciency measures.
How to Apply
1. Check project and equipment eligibility
• All proposed equipment must meet or exceed specications described in the Grocery Incentive Guide
2. Submit a pre-approval application
• A pre-approval application is required for all projects. Submit a separate application for each ComEd account
number.
• Required documents include (but are not limited to):
- Completed application, with Estimated Cost & Savings (pages 2 and 3 of this application)
- W-9 form for payee (Customer or Service Provider)
- Specication sheets for proposed equipment
- Quote or project proposal
- Measure Detail spreadsheet
• Wait until your application is approved before removing equipment and starting your project. You will receive
a reservation letter stating that your project has been approved and the total incentive reserved.
3. Install equipment or perform project work
• The incentive reservation allows 60 days to complete your project and submit the nal application. Contact
the program team if you think your project will require more than 60 days.
4. Submit nal application documents
• Required documents include (but are not limited to):
- Completed application, with Final Cost & Savings (page 4 of this application)
- Specication sheets for installed equipment (if different from pre-approval)
- Dated and itemized invoices listing the type and appropriate quantities of installed equipment
- Measure Detail spreadsheet (nal)
5. Receive incentive payment
• When your nal application is approved by the program team, an incentive check will be mailed to you or your
Energy Efciency Service Provider (must be in good standing to receive incentive payments).
• Effective January 1, 2018, the ComEd Energy Efciency Program will be responsible for verifying
that an installing contractor is certied by the ICC for the installation of applicable measures
prior to any incentives or rebate payout.
• Prior to any incentive or rebate payout, the ComEd Energy Efciency Program is responsible for
verifying that an Energy Efciency Service Provider or installing contractor is certied, and
recertied by the ICC by June 1st each year, for the installation of applicable measures. This does
not apply to customers who choose to self-install the applicable measure(s). Information
concerning ICC certication and recertication requirements, instructions and rules can be
found at: ICC EE Installer Certication.
Applications should be submitted by ONE of the following methods:
• Submit your application and documents to your Account Manager.
• Questions? Visit ComEd.com/Grocery, email BusinessEE@ComEd.com
or call 855-433-2700.
2
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
CUSTOMER INFORMATION
CUSTOMER NAME APPLICATION DATE
INSTALLATION SITE NAME (IF DIFFERENT FROM COMPANY NAME) SQ. FT. (COVERED BY THIS APPLICATION)
CONTACT PERSON PHONE NUMBER
EMAIL FAX NUMBER
INSTALLATION SITE STREET ADDRESS CITY STATE ZIP
MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP
ELECTRIC COMPANY NAME COMED ELECTRIC ACCOUNT NUMBER (OR SUBMIT COPY OF ELECTRIC BILL)
PROJECT INFORMATION
BUILDING TYPE (SELECT ONE): GROCERY RETAIL STORE CONVENIENCE STORE WAREHOUSE OTHER: _________________
EXPECTED START DATE EXPECTED COMPLETION DATE
PAYMENT METHOD (W-9 FORM – REQUIRED)
CHECK PAYABLE TO: CUSTOMER SERVICE PROVIDER/INSTALLER
CUSTOMER TAX ID NUMBER SERVICE PROVIDER TAX ID NUMBER
3
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
SERVICE PROVIDER/INSTALLER INFORMATION
SERVICE PROVIDER/INSTALLER MAKE INCENTIVE CHECK PAYABLE TO ATTENTION TO/CONTACT PERSON
ICC CERTIFICATION NUMBER
STREET ADDRESS CITY STATE ZIP
PHONE NUMBER EMAIL
ESTIMATED COST & SAVINGS (PRE-APPROVAL APPLICATION)
ESTIMATED MATERIALS COST ESTIMATED KWH SAVINGS
ESTIMATED LABOR COST
ESTIMATED THERM SAVINGS, IF
AVAILABLE
TOTAL ESTIMATED COST FINAL INCENTIVE REQUESTED
Project Installation Information
Please complete and sign on page 8
o I acknowledge that pursuant to Section 16-128B of the Illinois Public Utilities Act, ComEd cannot issue
certain incentives or rebates unless it is provided with:
1. Certication that measures were self-installed by the ComEd customer, or
2. Evidence that applicable measures were installed by an installer certied with the Illinois Commerce
Commission.
As a ComEd customer, select how your project will be installed:
o I will use my own staff to self-install my project.
o I will use an Energy Efciency Service Provider, contractor or subcontractor to install my project where the
incentive per measure is less than $300.
o I will use an ICC Certied Energy Efciency Service Provider, contractor or subcontractor to install my
project where the incentive per measure is $300 or greater.
4
FINAL COST & SAVINGS (FINAL APPLICATION)
FINAL MATERIALS COST FINAL KWH SAVINGS
FINAL LABOR COST FINAL THERM SAVINGS, IF AVAILABLE
TOTAL FINAL COST ACTUAL COMPLETION DATE
TOTAL INCENTIVE REQUESTED
If there are any changes between pre-approval and final approval, please use this space to provide details:
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
5
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
Terms and Conditions
Commonwealth Edison Company (ComEd) offers Grocery incentives under the ComEd Energy Efciency Program.
These incentives are available to eligible non-residential facilities (grocery stores, retail stores, convenience stores
and warehouses) for the implementation of cost-effective energy efciency improvements.
Program Effective Dates
Program incentives are offered until approved funds are exhausted or December 31 of each program year, whichever
comes rst. The effective program dates are January 1, 2021, through December 31, 2021.
Subsequent program year budgets and plans will be made available toward the end of the existing program year. At
the current time, ComEd has a commitment to provide this program through December 31, 2021.
Program and Project Eligibility
The program offers incentives, technical services and whole-building solutions to help businesses use energy more
efciently. Program incentives are available to non-residential customers within the ComEd service territory who pay
into the Energy Efciency Pricing Performance (Rider EEPP) and receive their electricity over ComEd wires,
regardless of retail electric supplier. Funds are limited and subject to availability.
Under the Future Energy Jobs Act, customers who had an account with a peak demand of 10MW or higher during the
12 months ending December 2018 will not contribute to, nor participate in, the ComEd Energy Efciency Program.
Project requirements under the program include the following:
• Projects must involve new equipment installed at an existing facility that results in a permanent reduction in
electrical energy usage (kWh).
• Equipment must be installed and operational.
• Replaced equipment must be permanently removed. All removed materials, including lamps and ballasts
containing polychlorinated biphenyls (PCBs), must be permanently taken out of service and disposed of in
accordance with local codes, applicable laws and regulations, and all applicable permits and inspections must
be obtained and completed. Resale of replaced equipment is expressly forbidden.
• Any measures installed at a facility must be sustainable and provide 100 percent of the energy benets as
stated in the application for the life of the product. If the customer ceases to be a delivery service customer of
ComEd, or removes the equipment or system at any time during the life of the product—without having
replaced the equipment or system with an equally or more energy-efcient equipment or system during that
time—the customer may be required to return a prorated amount of incentive funds to ComEd.
Projects that are NOT eligible for an incentive include, but are not limited to, the following:
• Projects that involve peak-shifting (and not kWh savings)
• Projects that repair or replace existing equipment with like equipment
• Projects receiving funding for the same equipment through any other Energy Efciency Portfolio (EEP)
programs offered by ComEd, Ameren, Nicor, Peoples Gas or North Shore Gas
• Used and/or refurbished equipment
Publicity of Customer Participation
The customer grants to ComEd the right to use and reference for promotional and regulatory purposes the customer’s
participation in the offering, the details of the energy efciency project and the energy savings, the amount of
incentives paid to the customer, and any other information relating to the customer’s participation in the offering.
6
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
Incentive Payment Limits
The total incentive paid through the Grocery offering cannot exceed 100 percent of the total project cost. If additional
incentives are provided to the project from other public sources (such as the State Energy Program [SEP} or Illinois
Clean Energy Community Foundation [ICECF]), the combined ComEd and other public source incentives cannot
exceed 100 percent of the total project cost. The contractor labor costs can be considered in the project cost. Internal
customer labor costs cannot be included in the project cost.
Application Review Process
A pre-approval application is required for all projects. Funds are reserved for the project when ComEd receives a
complete pre-approval application and determines that the project meets the program eligibility requirements.
Approval of a pre-approval application is not a guarantee that the nal application will be approved or a guarantee of
an incentive payment.
ComEd will review nal applications for eligibility and completeness. Project documentation, including dated invoices
for the purchase and installation of the measures and product specication sheets, is required. To qualify for 2020
incentives, nal applications must be submitted no later than 30 days from project completion, or December 15, 2020,
whichever date comes rst. The location or customer name on the invoice must be consistent with the application
information. The project invoice must provide sufcient detail to separate the project cost from the cost of other
services, such as repairs and building code compliance. ComEd reserves the right to request additional supporting
documentation as deemed necessary to ensure measure eligibility and verify that the expected energy savings will
occur. I acknowledge and understand that it is necessary for ComEd to store, use and share the information contained
in this application, as well as information collected in connection with this project. Therefore, I hereby authorize
ComEd to collect, store and consider customer data for its internal and Program purposes and to share the customer
data with third-party vendors/contractors who are doing work on ComEd’s behalf.
Requested information could include equipment purchase dates, installation dates, proof that the equipment is
operational, proof that customer has not received incentives from other sources for the same project, manufacturer
specications, warranty information and proof of customer co-payment.
Any customer who submits an incomplete application will be notied of deciencies upon review of the application;
the application will not be processed until all information is received.
ComEd may need to conduct inspections both before and after standard project implementations to verify equipment
and operation conditions. The applicant is required to submit a pre-approval application while the existing equipment
is still in operation to allow ComEd the opportunity to verify the existing equipment.
Inspections
ComEd reserves the right to inspect all projects to verify compliance with program rules and the accuracy of project
documentation. This may include pre-installation and/or post-installation inspections, detailed lighting layout
descriptions, metering, data collection, interviews and utility bill data analyses. Upon reasonable notice by ComEd,
the customer must allow access to project documents and the facility where the measures were installed for a period
of ve years after receipt of an incentive payment by ComEd.
Tax Liability
Incentives may be taxable under federal and state tax codes and, if more than $600, will be reported to the IRS unless
the customer provides acceptable proof that it is exempt from payment of such applicable taxes. In any event, ComEd
is not responsible for any taxes that may be imposed on your business as a result of your receipt of an incentive, or for
providing legal or accounting advice regarding such. Customer should consult with its tax accountant or advisor
regarding potential tax liability.
7
Disputes/Governing Law
This application shall be exclusively governed by and interpreted in accordance with the laws of the State of Illinois.
Any litigation between the parties shall be prosecuted only in the state or federal courts located in Cook County,
Illinois.
Toxic Materials
Neither ComEd, nor its consultants, contractors and/or subcontractors, shall have any responsibility for the discovery,
presence, handling, removal, disposal of, or exposure to hazardous materials of any kind in connection with customer’s
facility, including without limitation, asbestos, asbestos products, PCBs or any other toxic substances.
Limitations Of Liability
The customer shall independently evaluate any advice or information offered by ComEd related to estimates of
electricity savings or program costs and is solely responsible for the selection and implementation of Energy
Conservation Measures (ECMs).
IN NO EVENT WILL ComEd, ITS CONSULTANTS, CONTRACTORS AND/OR SUBCONTRACTORS, BE LIABLE
FOR THE CUSTOMER’S FAILURE TO ACHIEVE A SPECIFIED AMOUNT OF ENERGY SAVINGS, THE
OPERATION OF CUSTOMER’S FACILITIES, OR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY
KIND IN CONNECTION WITH THIS AGREEMENT OR THE IMPLEMENTATION OF ECMs AT CUSTOMER’S
FACILITIES. IN NO EVENT WILL ComEd BE LIABLE TO THE CUSTOMER FOR ANY LOST PROFITS, LOST
SAVINGS OR INCIDENTAL, INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES, ARISING OUT OF THE
CUSTOMER’S PARTICIPATION IN THIS PROGRAM. THE STATE OF ILLINOIS EXEMPTS ITSELF FROM ANY
CLAIMS, DEMAND, AND ACTIONS BASED UPON OR ARISING OUT OF ANY SERVICES PERFORMED FOR
THE PROGRAM.
Each party hereby agrees to defend, indemnify and hold harmless the other party, its consultants, contractors and
subcontractors, and their respective ofcers, employees, agents, assigns, and successors-in-interest (“Indemnied
Parties”) from and against any third-party claims, damages, losses, liability, costs (including attorney’s fees and
expenses) for bodily injury to any person (including death resulting therefrom) and property damage arising out of or
in connection with the program, except to the extent such claims, damages, losses, liability and costs are caused by the
other party.
Disclaimer
ComEd, in its sole discretion, may change any of the terms and/or conditions of this program upon thirty (30) days
written notice to customer and/or Energy Efciency Service Provider.
ComEd does not guarantee that certain energy savings will be achieved and does not make any warranties associated
with the measures eligible for incentives under this program. ComEd has no obligations regarding, and does not
endorse or guarantee, any claims, promises, representations, or work made or performed, or equipment furnished or
installed by any contractors, subcontractors, or vendors that sell or install energy efciency measures.
The customer shall be entitled to the energy cost savings realized by the customer that result from the installation of
ECMs at the customer’s site. In consideration of the services provided by ComEd as part of this program, the
customer agrees that ComEd is entitled to 100 percent of the rights and benets associated with the measures,
including without limitation PJM products and all other attributes, credits or products associated therewith under
any regional initiative or federal, state or local law, program or regulation, and customer waives, and agrees not to
seek, any right to the same.
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
8
Terms and conditions apply. Offers are subject to change.
Actual savings will vary by customer’s energy usage and rate.
© Commonwealth Edison Company, 2021
The ComEd Energy Efficiency Program is funded in compliance with state law.
GROCERY PRE-APPROVAL AND
FINAL APPLICATION
January 1, 2021 through December 31, 2021
Final Approval Application Signature
I certify that the installation of the energy efficiency measures has been completed to my satisfaction and request
that the incentive specified in this application be paid. I also understand that my release of the payment to an Energy
Efficiency Service Provider/installer does not exempt me from the program requirements outlined in the measure
specifications and terms and conditions.
Check should go to customer
Check should go to Energy Efciency Service Provider/installer (page 2)
Pre-Approval Application Signature
I certify that all statements made in the application and appropriate documents are correct to the best of my
knowledge and that I have reviewed the measures proposed, and acknowledge that they are appropriate for the type
and purpose of the facility in which they will be installed. I also certify that I have read the Terms & Conditions in the
application and agree to them, including those provisions regarding warranties, and I further understand and
acknowledge that the offer to pay incentives is also subject to those Terms & Conditions.
Vendor/Installer Signature
I represent to the Company that I have reviewed the Measure Detail Report, attachments, and the measures
proposed. They are, in my professional opinion, appropriate for the type and purpose of the facility in which they will
be installed. The information contained in this application is true and accurate to the best of my knowledge.
CUSTOMER SIGNATURE (PRE-INSTALLATION)
SIGNATURE DATE
VENDOR/INSTALLER SIGNATURE (PRE-INSTALLATION)
SIGNATURE DATE
CUSTOMER SIGNATURE (POST-INSTALLATION)
SIGNATURE DATE
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

GROCERY PRE-APPROVAL AND FINAL APPLICATION (ComEd)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 July 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document