COMMERCIAL KITCHEN EQUIPMENT 2017 IOWA FOR YOUR BUSINESS REBATE APPLICATION

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. Equipment must be purchased between Jan. 1, 2017, and Dec. 31, 2017. Equipment must be installed and operating prior to submission of final rebate application. Rebates cannot exceed 70 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount listed or 70 percent of installed cost. Installed cost includes contractor labor only and does not include internal labor. Rebate application must be submitted within six months of dealer invoice 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 six months of dealer invoice are not eligible for rebates. Custom Equipment: If specific equipment you intend to purchase and install is not listed, it may qualify under Nonresidential Equipment Custom Systems. However, custom projects must be preapproved by MidAmerican Energy prior to purchase and installation of equipment or system. See the Nonresidential Equipment Custom Systems application for details.

SECTION 1 (REQUIRED)

Customer Information

Name on account

Self-installed

q Yes q No Installation address

City

State

ZIP

State

ZIP

Phone

MidAmerican Energy Company account number (found on bill; first seven digits only) Mailing address (if different than installation address)

City

Contact name

Title

Email address*

*This email address only will be used for communication regarding this rebate application. Your email address will never be shared and you can unsubscribe at anytime.

SECTION 2 (REQUIRED) My facility had an energy assessment in the following program (check if applicable):

q Industrial

q Agribusiness

q Commercial

q Multifamily Housing

Date assessment completed (month/year)

Building size [sq. ft. (area)]

Year building was constructed

Do you:

q Own

q No assessment has been completed

q Rent this building

The new equipment is for:

q Replacement of existing equipment

q New installation (new to facility)

q New construction

Is space where equipment will be installed conditioned? (check one)

q Cooled only

q Heated only

q Not cooled or heated

q Both heated and cooled

q Other

If space is heated, what fuel type is used? (check one)

q Natural gas

q

Electric

q Other

Page 1 of 5 Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at 800-894-9599.

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SECTION 2 CONT. (REQUIRED)

Equipment installed in what type of facility? (check one)

Industrial

MEC Use Only

Commercial

MEC Use Only

q

Apparel manufacturing

IND

q

Apartment, halfway house

MF

q

Chemical manufacturing

IND

q

Condo

MF

q

Computer/electronic product manufacturing

IND

q

Convenience store/gasoline station

CN

q

Electrical equipment, appliance/component manufacturing

IND

q

Dealership

RS

q

Food/beverage/tobacco product manufacturing

IND

q

Financial institution

OF

q

Furniture and related product manufacturing

IND

q

Grocery store and supermarket

GR

q

Large refrigerated warehouse

IND

q

Healthcare (outpatient)

HC

q

Leather and allied product manufacturing

IND

q

Healthcare (inpatient)

HS

q

Machinery manufacturing

IND

q

Health club/exercise facility

FC

q

Nonmetallic mineral product manufacturing

IND

q

Library

ED

q

Oil and gas extraction; mining

IND

q

Lodging - hotel

HO

q

Paper manufacturing; printing and related support activities

IND

q

Lodging - motel

MO

q

Personal and laundry services

IND

q

Mixed use

O

q

Petroleum and coal products manufacturing

IND

q

Office – small

OS

q

Plastics and rubber products manufacturing

IND

q

Office - government - small

OS

q

Primary metal/fabricated metal product manufacturing

IND

q

Office public order and safety – small

OS

q

Textile mill and textile product mill

IND

q

Office – large

OL

q

Transportation equipment manufacturing

IND

q

Office – government - large

OL

q

Utility

IND

q

Office - public order and safety - large

OL

q

Warehouse and storage

WH

q

Pharmacy and drug store

RT

q

Warehouse - large refrigerated

IND

q

Public assembly

HY

q

Wood product manufacturing

IND

q

Religious worship/church

RL

q

Miscellaneous manufacturing

IND

q

Restaurant - fast food

RSF

q

Other

O

q

Restaurant – full service

RSS

q

Retail - small

RS

q

Retail - large

RL

q

Retail – department store

RL

q

Retirement home, nursing home, assisted living

MF

q

School - elementary

SE

q

School - jr. high

SJH

q

School - high school

SJH

q

School - college, university and professional school

ED

q

School - lodging (school/dorm)

MF

q

Service

RS

q

Truck stop

CV

Agriculture

MEC Use Only

q

Corn farming

AG

q

Dairy cattle and milk production

DF

q

Hog facility

HF

q

Soybean farming

AG

q

All other animal production

AF

q

All other miscellaneous crop farming

AG

Page 2 of 5 Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at 800-894-9599.

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Commercial Refrigeration Equipment Rebate:

q Refrigerator – transparent door cabinet (ENERGY STAR®): $500

q Freezer – solid door cabinet (ENERGY STAR): $75

q Refrigerator – solid door cabinet (ENERGY STAR): $35

q Anti-sweat heater controls for refrigerator/freezer transparent door cabinets: $50/door

Install date

Manufacturer/brand name

Number refrigeration/freezer doors for anti-sweat rebate:

Model number

Serial number

Size (cubic feet)

Total cost calculation +

=

Equipment cost

Contractor labor cost

Total installed cost

Refrigerated LED Case Lighting 5- and 6-Foot Doors (DLC QPL Required) Rebates are based on replacement of T12 or T8 linear 5- to 6-foot fluorescent refrigerated case door lighting with 5- to 6-foot LED refrigerated case door strip lighting. Rebates are per door, not per lamp. Linear LED tube lights do not qualify for this rebate. With preapproval before purchase or installation, they may qualify through the Nonresidential Equipment Custom Systems program. The program adopts the DLC definition: Strip lights in refrigerator cases vertically mounted along refrigerator case door mullions. Category only covers complete luminaires with all necessary components. Replacement lamps currently are not eligible under this category. Annual operating hours of equipment

Eligible DLC primary use designations: n Horizontal refrigerated case luminaires n Vertical refrigerated case luminaires n Refrigerated case luminaires

Date of installation

Equipment Cooler Case

q q

5-foot door 6 -foot door Replace fluorescent T12 or T8 systems with LED case lighting Freezer Case

q q

5-foot door 6 -foot door Replace fluorescent T12 or T8 systems with LED case lighting

New brand/ manufacturer

New model number

New wattage

Watts replaced

X

DLC product ID

New brand/ manufacturer

New model number

Qty

New wattage

Watts replaced

Total cost calculation

Rebate calculation

$75/door Rebate

+

=

X Qty

= Contractor labor cost

Total installed cost

Total cost calculation

Rebate calculation

DLC product ID

Equipment cost

Total

$75/door Rebate

=

+ Total

Equipment cost

= Contractor labor cost

Total installed cost

Ice Makers Air-Cooled Remote Condensing or Ice - Making Head (ENERGY STAR) Manufacturer/brand name

Quantity Installed

Install date

Rebate x

Model number

Serial number

Total Rebate =

Total cost calculation + Equipment cost

= Contractor labor cost

Total installed cost

Page 3 of 5 Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at 800-894-9599.

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Commercial Cooking – Hot Food Holding Cabinet Rebate:

q Hot food holding cabinet – electric (ENERGY STAR); full-size only: $400

Install date

Manufacturer/brand name

Cooking efficiency rating (watts/cu. ft.)

Model number

Annual operating hours

Serial number

Total cost calculation

Volume (cu. ft.)

+

=

Equipment

Contractor

Total installed

cost

labor cost

cost

Commercial Cooking – Other Rebate:

q Convection oven – natural gas (ENERGY STAR): $100 q Conveyor oven – natural gas with thermostatic control and a cooking efficiency rating ≥ 42%: $675 q Infrared upright broiler – natural gas with a cooking efficiency rating of ≥ 34%: $1,350 q Salamander broiler – natural gas with a cooking efficiency rating ≥ 34%: $125 q Steam cooker – natural gas (ENERGY STAR): $650

Install date

Manufacturer/brand name

Total cost calculation +

Model number

Serial number

=

Equipment

Contractor

Total installed

cost

labor cost

cost

Cooking efficiency rating

Motors Rebate:

q ECM – Display case fan: $75 Electronically commutated motors (ECM) must replace standard efficiency shaded pole evaporator fan motors in refrigerated display cases. q High-efficiency evaporator fan motor for walk-in coolers/freezers: $40 Electronically commutated motors (ECM) must replace standard efficiency shaded pole evaporator fan motors in walk-in coolers or walk-in freezers. q Demand controlled ventilation for kitchen range hoods: $400/range hood fan HP (100% both fuels; 70% gas-only; 30% electric-only) Requires temperature or optic sensors and VSD. No added VSD rebate. ENERGY STAR; see www.energystar.gov/emergingtech for qualifying products.

Motor No. 1

Install date

Manufacturer/brand name

Model number

Serial number

Total cost calculation + x $400/HP

=

Horsepower for range hood fan(s) Rebate:

Equipment cost

= Contractor labor cost

Total installed cost

Total rebate

q ECM – Display case fan: $75 Electronically commutated motors (ECM) must replace standard efficiency shaded pole evaporator fan motors in refrigerated display cases. q High-efficiency evaporator fan motor for walk-in coolers/freezers: $40 Electronically commutated motors (ECM) must replace standard efficiency shaded pole evaporator fan motors in walk-in coolers or walk-in freezers. q Demand controlled ventilation for kitchen range hoods: $400/range hood fan HP (100% both fuels; 70% gas-only; 30% electric-only) Requires temperature or optic sensors and VSD. No added VSD rebate. ENERGY STAR; see www.energystar.gov/emergingtech for qualifying products.

Motor No. 2

Install date

Manufacturer/brand name

Model number

Serial number

Total cost calculation + x $400/HP

=

Horsepower for range hood fan(s) Rebate:

Equipment cost

= Contractor labor cost

Total installed cost

Total rebate

q ECM – Display case fan: $75 Electronically commutated motors (ECM) must replace standard efficiency shaded pole evaporator fan motors in refrigerated display cases. q High-efficiency evaporator fan motor for walk-in coolers/freezers: $40 Electronically commutated motors (ECM) must replace standard efficiency shaded pole evaporator fan motors in walk-in coolers or walk-in freezers. q Demand controlled ventilation for kitchen range hoods: $400/range hood fan HP (100% both fuels; 70% gas-only; 30% electric-only) Requires temperature or optic sensors and VSD. No added VSD rebate. ENERGY STAR; see www.energystar.gov/emergingtech for qualifying products.

Install date

Manufacturer/brand name

Model number

Motor No. 3 Serial number

Total cost calculation + x $400/HP

Horsepower for range hood fan(s)

Equipment cost

=

= Contractor labor cost

Total installed cost

Total rebate

REMEMBER TO SIGN THE NEXT PAGE Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at 800-894-9599.

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Disclaimer

MidAmerican Energy Company does not guarantee that installation and operation of high-efficiency equipment will result in reduced usage or in cost 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.

Specific Terms and Conditions nnParticipants must be commercial or industrial customers with facilities located in MidAmerican Energy Company’s Iowa service territory. nnMidAmerican Energy Company must provide the primary electricity and/or natural gas to the equipment at the facility for which the rebate is being paid. nnTransportation gas customers with daily metering are ineligible for natural gas incentives. However, customers with monthly metering under the Monthly Metered Transportation Service natural gas tariff are eligible for energy incentives. nnFor prescriptive rebates, the rebate payment cannot exceed 70 percent of the installed cost (reasonable labor and material/equipment - reasonableness to be determined by MidAmerican Energy Company). Installed cost includes contractor labor only and does not include internal labor. nnFor equipment that requires ENERGY STAR® certification, visit www.energystar.gov/cfs and www.energystar.gov/emergingtech for information on qualifying commercial kitchen equipment. A manufacturer’s specification sheet with efficiency ratings of the product(s) installed must accompany the application. nnEquipment installed as a replacement unit, retrofit or in new construction is eligible. nnEquipment must be purchased between Jan. 1, 2017, and Dec. 31, 2017. Equipment must be installed and operating prior to submission of final rebate application. nnRebate application must be submitted within six months of dealer invoice 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 six months of dealer invoice will not be eligible for rebates. nnAllow 4 – 6 weeks for rebate processing.

General Terms and Conditions

Important: Before completing and signing this form, please read the General Terms and Conditions located in the 2017 Iowa For Your Business rebate booklet or at www.midamericanenergy.com/ee.

Customer Agreement My signature indicates consent to and agreement with all program terms and conditions. It certifies that all information in this application is correct and equipment installed at the indicated location. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before issuing payment. Customer signature

Date

Installer/Dealer Information Dealer name

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: o Fill out this form completely.

Send completed forms to: Mail:

MidAmerican Energy Company P.O. Box 4628 Des Moines, IA 50305-4628

Fax:

515-244-8825

o Attach a copy of the itemized sales receipt or invoice. o Include documentation listed in the instructions. o Sign the Customer Agreement section.

Email: [email protected]

Page 5 of 5 For more information call 800-894-9599 or go to www.midamericanenergy.com/ee.

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