InvestSmart Business Energy Upgrades

InvestSmart Business Energy Upgrades
Custom Application
Application Instructions
This application is required for participation in InvestSmart Business Energy Upgrades for Custom projects with qualifying measures
not found in the Lighting or Standard Programs. Complete participation information and eligibility specifications are included in the
Customer Participation Manual, available at jea.com/investsmart.
This application packet contains the following forms:
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•
•
•
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General Information
Building Information
Rebate Payment Information
Terms and Conditions
Rebate Worksheet
To participate in InvestSmart Business Energy Upgrades, please review the following steps:
1. Read the Customer Participation Manual for a complete description of program eligibility requirements and the participation process.
2. Read the Terms and Conditions included in this packet.
3. Complete the following forms included with this application packet:
• General Information – Include all required customer and account information.
• Building Information – Include the facility type and operational characteristics that the energy efficiency measure(s) will be applied to.
• Rebate Payment Information – Rebates will be mailed to customer’s electric account billing address. If the customer would prefer the check to be designated to someone other than the customer, complete the Payment Release Information.
• Terms and Conditions – Sign and date. Signing this form accepts the terms and conditions of InvestSmart Business Energy Upgrades.
• Rebate Worksheet – Include all required information including: savings calculations, supplemental documentation, and eligible project costs.
4. Purchase and Install qualifying equipment after receiving written approval from JEA. Equipment and measure eligibility is listed in the Equipment Catalog and in the Customer Participation Manual, available at jea.com/investsmart.
5. Notify JEA of the completed project by submitting a Custom Installation Notice available for download at jea.com/investsmart.
6. Retain a copy of all completed application forms and all required documentation, such as invoices and product specifications. Submitted applications will become the property of JEA.
7. Application forms and required documentation may be submitted online at jea.com/investsmart or may be emailed to investsmart@jea.com
For more information contact us at:
InvestSmart Business Energy Upgrades
6620 Southpoint Drive South, Suite 630
Jacksonville, FL 32216
Online: jea.com/investsmart | Phone: (888) 345-4609 | Email: investsmart@jea.com
General Information
Important: Please allow 4-6 weeks for your application processing following complete documentation submittal. Written approval by JEA
for Custom measures rebates is required prior to equipment purchase and installation. Rebates will not be paid for ineligible or incomplete
applications.
_____________________________________________________________________________________________________________________
Business Name (as it appears on JEA Bill)
_____________________________________________________________________________________________________________________
JEA Account Number(s) where measure(s) to be installed
_____________________________________________________________________________________________________________________
Address where measure(s) to be installedCityStateZip
_____________________________________________________________________________________________________________________
Contact NamePhone NumberFax NumberEmail
_____________________________________________________________________________________________________________________
Contact Address (if different from the installation address) City
State
Zip
JEAISCAP20150101
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InvestSmart Business Energy Upgrades
Custom Application
General Information, continued
_____________________________________________________________________________________________________________________
Federal Tax ID (EIN) or Social Security number (Must be 9 digits)
Business Classification (Check ONE. Required for all businesses, including non-profits)
Corporation
Partnership
Sole Proprietor/Individual
LLC
Other (Please Describe): ___________________________
Building Information
Automotive Facility
Hotel
Police/Fire Station
Convention Center
Library
Post Office
Court House
Manufacturing Facility
Religious Building
Dining: Bar Lounge/Leisure
Motel
Retail
Dining: Cafeteria/Fast Food
Motion Picture Theater
School/University
Dining: Family
Multi-Family Housing
Sports Arena
Dormitory
Museum
Town Hall
Exercise Center
Office
Transportation
Gymnasium
Parking Garage
Warehouse
Health Care - Clinic
Penitentiary
Workshop
Hospital
Performing Arts Theater
Other _____________________
Building Size (sq. ft.) : ________________________
Number of Floors: ___________________________
Temperature Set-points:
Year Built: __________________________________
Heating:
Cooling:
Percent Conditioned: _________________________
Occupied
________ F
________0F
Annual Operating Hours: ______________________
Un-Occupied ________0F
________0F
0
How did you hear about InvestSmart Business Energy Upgrades?
Account Executive
Newspaper Ad
Vendor/Contractor
Bill Insert
JEA Electronic Newsletter
Other
Magazine Ad
JEA Website
Rebate Payment Information
Mail rebate check to: JEA Billing Address
Other (complete release below)
Check should be payable to:
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Payee: Business Name
Contact Phone Number
____________________________________________________________________________________________________________________
Payee Mailing Address
City
State
Zip
______________________________________________________
Rebate check reference (15 character maximum)
Important: Complete this section only if rebate check is to be directed to someone other than the customer indicated on Page 1.
I AM AUTHORIZING THIS REBATE PAYMENT TO THE THIRD PARTY NAMED BELOW AND I UNDERSTAND THAT I WILL NOT BE RECEIVING THE
REBATE PAYMENT CHECK FROM JEA. I ALSO UNDERSTAND THAT MY RELEASE OF PAYMENT TO THE THIRD PARTY DOES NOT EXEMPT ME
FROM THE REBATE REQUIREMENTS OUTLINED IN THE APPLICATION.
___________________________________________________________________________________________________________________
Authorized by (please print)
Signature of Authorized
Date
JEAISCAP20150101
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InvestSmart Business Energy Upgrades
Custom Application
Terms and Conditions
JEA is implementing InvestSmart Business Energy Upgrades to provide customers with rebates to facilitate the installation of qualifying Custom energy
efficiency measures. The following terms and conditions apply to the program:
1. To qualify for rebates through InvestSmart, the participant must:
a. Be a commercial or industrial JEA electric customer as stated in the Customer Participation Manual
b. Purchase and install qualifying Custom measures which appear in the Custom Equipment Catalog and/or do not appear in the Lighting
Worksheet or Standard Equipment Catalogs, and are not specifically excluded in either
c. Submit a completed Custom Application, a dated copy of the paid invoice, and any other documentation specified in the Custom Equipment
Catalog
d. Abide by the program rules, eligibility requirements, and rebate levels in effect on the date of equipment installation. JEA retains the right to
make final determination of customer eligibility
2. Failure to provide any of the required information, including signatures, forms, or other requested documentation, will result in the return of the
Custom Application.
3. Rebates may exceed the approved amount reserved by JEA from the originally approved Custom Application only when funds remain in the budget
and no other projects have been placed on a waitlist for participation.
4. One rebate check will be issued per approved Custom Application as specified on the application.
5. Qualifying measures, as defined in the Equipment Catalog that receive rebates under InvestSmart Business Energy Upgrades may not receive
purchase and installation rebates or credits under any other JEA program.
6. JEA will enforce a $100,000 rebate cap per customer per program year across all InvestSmart programs.
7. JEA, at its sole discretion, may inspect the associated facility prior to or after approving the Custom Application. The inspection may include a
telephone survey and/or site visit. Customers must allow JEA and their sub-contractors reasonable access to the relevant facility during normal
business hours for inspection purposes.
8. For quality control JEA at its sole discretion, may conduct site visits and/or telephone surveys to evaluate and/or monitor the rebated measures
at any time up to two years after work is completed. Such visits may include the installation of temporary monitoring equipment. Customers must,
and hereby agree to, allow JEA and their sub-contractors reasonable access to the associated facility during normal business hours for these
evaluations and/or monitoring equipment installations.
9. InvestSmart procedures, requirements, and rebate levels are subject to change or cancellation without notice.
10. JEA makes no representations and provides no warranty or guaranty with respect to the design, manufacture, construction, safety, performance,
effectiveness, or otherwise of the newly installed equipment, including any warranties of merchantability or fitness for a particular purpose.
Responsibility for delivery and workmanship related to any equipment or services the customer procures exclusively rests with the contractor or
retailer selected by the customer. JEA assumes no responsibility for oversight of contractor services. All work shall be performed in accordance
with local, state, and federal codes. All required permits associated with this project are the sole responsibility of the Contractor. The Contractor
shall provide all applicable permit numbers.
11. The terms and conditions set forth herein constitute a complete statement of the Terms and Conditions applicable to InvestSmart Business
Energy Upgrades and supersede all prior representations or understandings, whether written or oral. JEA shall not be bound by or be liable for
any statement, representation, promise, inducement or understanding of any kind that is not set forth herein. JEA reserves the right to change or
cancel InvestSmart Business Energy Upgrades or its terms and conditions at any time.
12. Use of Environmental Attributes: Customer may not use or report on Environmental Attributes associated with installation of qualifying equipment
or its operation that in any way would compromise the ability of JEA to utilize the project energy savings for regulatory reporting purposes.
Customer may claim that it is facilitating the production of the Environmental Attributes attributable to the qualifying equipment as long as (and at
the same time) Customer states the installation of the qualifying equipment was made possible with funding from JEA.
By signing below, applicant acknowledges and agrees that:
• I have read and understand all Terms and Conditions of this form and the customer eligibility, measure eligibility, and participation procedures for
InvestSmart Business Energy Upgrades in the Customer Participation Manual, and Custom Equipment Catalog.
• I certify as the building owner or owner’s authorized representative that all the information contained within this application is true and factual.
• I am 1) providing a correct taxpayer identification number on this form, 2) not subject to backup withholding, and 3) am a US person (including US
Resident Alien).
• The undersigned applicant shall defend, protect, indemnify and hold harmless JEA, its board members, officers, directors, managers, associates, employees, servants, and agents (the “Indemnified Parties”) against all claims, losses, expenses, damages, demands, judgments,
causes of action, suits, and liability of every kind and character whatsoever (“claims”) arising out of or incident to, or related in any way to,
directly or indirectly, Applicant’s participation in InvestSmart Business Energy Upgrades; provided however, that Applicant shall not be required to
indemnify and hold harmless any Indemnified Party against claims adjudicated to have been caused by the Indemnified Party’s gross negligence
or willful misconduct.
Business Name: ________________________________________________________________________________________
Signature: ______________________________________________
Date: ________________________________
Name (please print) : _____________________________________
Title: _________________________________
JEAISCAP20150101
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InvestSmart Business Energy Upgrades
Custom Application
Rebate Worksheet
Important: This form is to be completed and submitted as part of the Custom Application. Attach additional sheets as necessary.
Parameter
Measure 1
Measure 2
Measure 3
Project type
(Retrofit or New Construction)
Estimated Installation Date
Dealer/Contractor Name
Energy Efficiency Measure
(type and description)
Estimated baseline usage
(kWh/yr)
Estimated post-retrofit use
(kWh/yr)
Estimated savings
(kWh/yr)
Estimated annual operating hours
Estimated installation costs ($)
Estimated rebate
Total Rebate ($) $
$
(# of Measures x Measure Rebate)
$
For each energy efficiency measure listed, please list all assumptions and show all formulas used to calculate the estimated energy
savings. In addition, please provide descriptions of all variables used in these formulas and example calculations for each measure.
Please attach copies of site plans identifying the location of each identified energy efficiency measure. For alterations to mechanical
or electrical systems, one line schematic drawings are required. Drawings shall include existing and post-retrofit conditions clearly
outlining the scope of work. Please attach documentation detailing eligible project costs. Electronic copies of all files, spreadsheets,
or computer simulation input files should be included with this application.
Please list contractors/vendors used for
the installation of this project:
Application Checklist
Before submitting this application please verify the following:
Did you read and understand the eligibility requirements in the Equipment Catalog?
Have you included a dated sales invoice?
Did you attach any additional documentation listed in the Equipment Catalog?
Did you include your account number?
Did you sign the Terms and Conditions Form?
JEAISCAP20150101
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