Fillable Residential rebate application instructions (Minnesota Energy Resources)

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Residential rebate application instructions (Minnesota Energy Resources)

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Minnesota Energy Resources
Residential
rebate application instructions
Here’s what you’ll need to get started:
• MinnesotaEnergyResourcesaccountnumber for
home
• Customerandcontractorcontactinformation
• Proofofpurchase
• Additionalequipmentorservicedocumentation
Applying for your rebate is easy!
Reviewthechecklistbelow,complete,print,sign
theapplication,andsubmit.
Checklistforcompletingyourapplication
o Read the terms and conditions to determine if
you are eligible for a rebate.
o Verify the installed equipment or service meets
the eligibility guidelines. All equipment and
services require proof of purchase and may need
additional documentation. See proof of purchase
requirements and review the "Terms & Conditions"
on Page 2 of this form to ensure all program
criteria are met.
o Purchaseandinstall qualifying equipment or
service. The rebate application must be received
within 60 days of installation. Work with your
contractor to complete and submit the application.
o Complete all numbered steps in the application.
Note: providing your e-mail address will expedite any issues
with your application.
o
o
Print,signanddate the application.
Mail your completed application and
documentation.
Note: only the pages with numbered steps (pages 3 and
4 of this document) need to be submitted.
Proof of purchaserequirements:
Retailer/contractordatedreceiptorinvoicemustbe
attachedandreflecttheproduct(s)andorservice(s)
listed on the application and must include:
• Retailer/contractorname,addressand
phone number
• Customername
• Installationaddress
• Product(s)orservice(s)detailsincluding:
– Quantity
– Manufacturer
– Model number
– Purchase price for each product or service
– Installationcosts(if applicable)
–
Installationor service date(if installed by contractor)
We cannot process your application without proof of
purchase that contains all information specified
above.
Ifinformationismissing,applicationwillbereturned.
Mail:
Minnesota Energy Resources
1377 Motor Parkway, Suite 401
Islandia,NY11749
Need help?
Please call us at: 866-872-0052, option 1
Email: merc@appliedenergygroup.com
cashrebatesnow.com
Your rebate check will be mailed approximately four to six
weeks after we receive a completed, eligible application
including all required documentation.
Page1
o Keep a copy for your records.
Minnesota Energy Resources
Residential
terms and conditions
General terms and conditions
This program oers financial incentives for the purchase and installation of new natural gas equipment. Applications will be processed
on a first-come, first-served basis. To qualify for rebates, an applicant must meet the following eligibility requirements:
•
•
•
•
Misrepresentation
MakingfalsestatementsonanyMinnesotaEnergyResourcesapplicationispunishablebylaw.Anypersonwhoknowinglyfilesan
applicationcontainingmateriallyfalseinformationorwhopurposelyconcealsinformationcommitsafraudulentactthatsubjects
suchpersontocriminalandcivilpenalties.MinnesotaEnergyResourcesshallhavetherighttorecoverpaymentsmadeinreliance
on fraudulent or misrepresented information. This section shall not limit other remedies that may be available for the filing of false or
fraudulent applications.
Verification
Incompleteapplicationswillbedelayed.Afterapproval,pleaseallowfourtosixweeksfordeliveryoftherebatecheck.MinnesotaEnergy
Resourcesreservestherighttoinspectandverifyanyworkbeforeand/orafterissuingrebates.
Tax information
Rebatesmaybesubjecttofederaland/orstateincometaxreporting.Applicantisresponsibleforcontactingaqualifiedtaxadvisorto
determinetaxliability.MinnesotaEnergyResourcesisnotresponsibleforanytaxconsequencesoftheMinnesotaEnergyResources
rebate program.
Disclaimer
MinnesotaEnergyResourcesdoesnotguaranteethatinstallationofimprovementsforrebateswillresultinreducedenergyusageor
demand,orincostsavings.TheCustomerwillholdharmlessMinnesotaEnergyResourcesanditsoicers,directors,shareholders,agents,
employees,andrepresentativesfromallclaims,liabilities,fines,interest,costs,expenses,anddamagesincurredbytheCustomer,forany
damage,injury,death,lossordestructionofanykindtopersonsorproperty,totheextentthedamage,injury,death,lossordestruction
arises out of or is related to the conduct, negligence, willful misconduct, misrepresentation, breach of warranty or other breach of this
applicationformonthepartofMinnesotaEnergyResources.
Page 2
BeacurrentresidentialMinnesotaEnergyResourcescustomerorpropertyownerfortheinstallationaddressassociatedwiththe
account number provided. Furthermore, the equipment and/or measures installed and rebated must be installed at the property
associated with this account number and must reduce use of natural gas energy.
For equipment rebates, all equipment must be new. Refurbished or homemade systems are not eligible. Equipment installed
under manufacturer warranty replacement does not qualify for a rebate.
Toavoiddelay,afinal,itemizedreceiptforallmaterialandlaborrelatedtotheequipmentandinstallationmustbeattachedtothis
rebateapplication.Estimatesandproposalswillnotbeaccepted,unlessattachedtoreceiptreflectingtheidenticalamount.
All applications must be received within 60 days of installation.
Minnesota Energy Resources is not responsible if the dealer does not provide accurate information about the amount of a rebate or
equipment eligibility. It is the responsibility of the customer to ensure that the program requirements are met.
Where applicable, energy efficiency ratings must comply with those listed in the Air-Conditioning, Heating and Refirgeration Institute
(AHRI) Directory, ENERGY STAR, and the Home Ventilation Institute (HVI) for space heating and water equipment. Ratings can be found
by model number at www.ahridirectory.org, www.energystar.gov or www.hvi.org. Submitting an AHRI, ENERGY STAR or HVI certificate
with your application and invoice is highly recommended. These lists and directories for qualifying equipment are dynamic and change
frequently.
• Wereservetherighttorequestproofofpayment.Thiscanbeeitheracreditcardreceiptorstatementshowingthechargespaidtoyour
contractor, or a copy of the front and back of a cashed check made out to your contractor and showing the payee name, date and amount.
• Rebatecheckswillbemadepayabletocustomerorpropertyownershownonreceipt.Thismustmatchthecustomerorproperty owner
ofrecord.Installersorcontractorsarenoteligibletoreceivetheircustomer’srebates.
• Contractors performing work on their own properties must provide proof of purchase and payment.
• Ifyouarebuildingahome,youmustobtainaninvoicefromyourbuilderorheatingdealer.Onlyonerebateperpieceofequipment.
• Participants understand they are not eligible to receive a rebate for this improvement earned under a different Minnesota Energy
Resources program. Only one rebate per piece of equipment is permitted.
• Ifmorethanonemeasurewasinstalled,receiptmustitemizecostsforeachmeasure.
• Thisprogramissubjecttoregulatoryrulesandorders.MinnesotaEnergyResourcesreservestherighttochangeanyportionofthis
program or to end this program without notice.
• Allprojectsmustcomplywithapplicablefederal,stateandlocallawsandregulations,includingbuildingcodes.
•
•
We cannot process your application without proof of purchase. See page 1 of application for invoice requirements. We are unable to
accept applications that do not include all of the requested information. If information is missing, application will be returned.
Minnesota Energy Resources
Residential
new construction rebate application
Minnesota Energy Resources is a natural gas utility serving 179 communities across Minnesota. You must be a customer with an active account to participate.
All information must be filled out and proof of purchase attached to ensure processing. Mail to: Minnesota Energy Resources, 1377 Motor Parkway, Suite 401 Islandia, NY 11749
Check here if self-installed
______________________________________________
Company name
______________________________________________
Contact name
______________________________________________
Company street address
______________________________________________
City State ZIP code
______________________________________________
Telephone number
______________________________________________
email (will be used for rebate program notifications)
Please send me periodic rebate program alerts and updates.
STEP 3 Contractor/dealer information
______________________________________________
Street
______________________________________________
City State ZIP code
STEP 4
Customer agreement
By signing this application, I agree to the Terms and Conditions set forth on this application. I further acknowledge that I am authorized and hereby
grant Minnesota Energy Resources express permission to release to company partners the data provided in this application and other related
account information, such as consumption data, needed for the sole purpose of energy eiciency evaluation, reporting and program alerts.
I understand and agree that when participating in a Minnesota Energy Resources Energy Eiciency Program, I am solely responsible for the
selection of any contractor that will perform work. All contractual arrangements are solely between me and the contractor. I, the Customer, will hold
harmless Minnesota Energy Resources and its officers, directors, shareholders, agents, employees and representatives from all claims, liabilities,
fines, interest, cost, expenses, and damages incurred by me that arise out of my relationship with any contractor. If equipment is self-installed, I
certify that equipment was installed at the address shown. I certify that all information I provided in the application is correct.
Customer signature: ___________________________________________________________Date:
__________________________
STEP 1 Customer information
Minnesota Energy Resources account number located on
your gas bill:
City
______________________________________________
Telephone number
______________________________________________
email (will be used for rebate program notifications)
Signature required to process rebate.
This form is valid from January 1, 2021 - December 31, 2021.
Page 3
Mailing address:
(if different from installation address)
Rebate check payable to: _____________________________
Name must appear on invoice or account.
______________________________________________
Customer name (as it appears on bill)
Installation address:
______________________________________________
Street
______________________________________________
State Zip code
Only continue if you are a Minnesota Energy Resources natural gas customer.
STEP 2 Household information
Townhome/Condo
Manufactured
Four-plex
Single-family dwelling
Duplex Triplex
Multi-family dwelling (5 units or more)
Yes
Landlord
Homeowner
Is this a rental property?
Applicant is: Tenant
Year home was built: ______ Square footage: ______
How did you hear about this program? (Check all that apply):
Social media
Bill insert
In-home audit
Another customer
Contractor/retailer
Radio
Web
Email
Other ___________
Housing type (required):
No
Minnesota Energy Resources
Residential
new construction rebate application
STEP 5 Equipment information
Please complete all information for the installed equipment for which you seek a rebate.
Required information must be completed and submitted as part of application to be eligible for a rebate.
Please reference all rebate requirements prior to installation to ensure eligibility.
Invoice must list the qualifying equipment and correspond to the equipment listed on the application.
Make a separate entry for each measure installed. If more space is needed, please photocopy this form and submit with the
application.
This form is valid from January 1, 2021 - December 31, 2021.
Page 4
Other requirements
This form is designed for newly constructed homes. New construction is defined as a home built within the last two years. We
only honor one rebate per piece of equipment. Therefore, building contractors and home buyers should determine who applies
for and receives the rebate. If you are the home owner applying for the rebate, you must obtain an invoice from your builder or
subcontractor. Verify with your builder prior to submitting if your home participated in the Home Energy Excellence Program.
If your home was a Home Energy Excellence home, see chart below for rebate eligibility.
Equipment
Natural gas furnace
Natural gas furnace
Natural gas boiler
Integrated natural gas space and water heating system
Advanced thermostat or Wi-Fi enabled
Natural gas storage water heater
Natural gas tank or tankless water heater
Drain water heat recovery (DHR) device
Clothes washer
Dishwasher
Natural gas hearth/fireplace
Minimum eiciency
95% AFUE
97% AFUE
90% AFUE
92% AFUE
A
utomatic programming
or Wi-Fi enabled
ENERGY STAR® certified
ENERGY STAR® certified
Rebate
per unit
$200
$300
$200
$250
$50*
$125
$250
$300
$1
50
$45
$30
$75
Home Energy
Excellence rebate
eligibility list
no
no
no
no
yes
no
no
yes
ye
s
yes
yes
AFUE = Annual Fuel Utilization Efficiency; UEF = Uniform Energy Factor; SRE = Sensible Heat Recovery Efficiency; CFM = Cubic Feet per Minute
*
Rebate amount is 50 percent of total cost, up to maximum rebate listed above.
ENERGY STAR® certified
and .64 UEF
no
Natural gas storage water heater
ENERGY STAR® certified
and .82 UEF
ENERGY STAR® certified
and .87 UEF
• Limit one qualifying thermostat per gas service address.
• Thermostats must control natural gas-fired heating systems.
• If installed as part of a heating system, thermostats must be listed on the contractor’s invoice to be eligible for a rebate.
• Provide complete thermostat model number.
• Hearth product must be direct vented, sealed combustion, electronic ignition fireplace, insert or free-standing stove.
• Water heaters must be fueled by natural gas to be eligible for water heating, appliances and drain water heat recover devices rebates.
• Indirect water heaters are not eligible for rebate.
• HRV for furnaces must provide whole house ventilation. Performance is determined based on listed data within the HVI directory of
certified equipment.
A complete list can be found here: https://www.hvi.org/hvi-certified-products-directory/section-i-complete-product-listing/.
Heat recovery ventilation (HRV), whole home
no
$400
SRE above 65%, CFM 75
Electronic ignition
Space heating equipment
System Type:
Natural gas furnace Natural gas boiler
Integrated natural gas space
and water heating
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
_______________________________
Serial number
_______________________________
AFUE rating
_______________________________
Btu/h input
Minnesota Energy Resources
Residential
new construction rebate application (continued)
Natural gas hearth/fireplace
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
_______________________________
Serial number
EQUIPMENT INFORMATION
ENERGY STAR dishwasher
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
_______________________________
Serial number
ENERGY STAR clothes washer
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
_______________________________
Serial number
My clothes DRYER runs on:
Natural gas Electricity
This form is valid from January 1, 2021 - December 31, 2021.
Page 5
Thermostat
Type of thermostat: (select only one)
Original UPC code from box, complete model
number AND invoice must be submitted with
application form if self-installed.
ENERGY STAR Natural gas water
heaters Type: (select one)
Storage Tankless
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
_______________________________
Serial number
_______________________________
Rating: Uniform Energy Factor
_______________________________
Tank capacity (gallons for storage unit)
Drain water heat recovery
(DHR) device
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
_______________________________
Serial number
Advanced (automatic programming)
Wi-Fi enabled
STEP 6 Contractor certification agreement
I certify that the indicated installation was completed in compliance with the Terms and Conditions of the program at the address shown. I certify
that all information I provided in the application is correct.
Contractor/dealer signature: ____________________________________________________ Date: __________________________
I certify my water heater is fueled by
natural gas.
Mail to: Minnesota Energy Resources, 1377 Motor Parkway, Suite 401 Islandia, NY 11749
Limit one qualifying thermostat per gas service
address.
_______________________________
Manufacturer
_______________________________
Model number (must be on invoice)
Heat recovery ventilation
System type:
Furnace
Boiler
________________________________
Manufacturer
________________________________
Model number (must be on invoice)
________________________________
CFM
______________________________________________
SRE (must be above 65%)
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Completed 22 July 2021

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