Massachusetts

National Grid HighEfficiency Heating, Water Heating and Controls Program Save money, improve comfort and ensure a cleaner environment with energy savings offers for residential natural gas heating and hot water customers from National Grid.

High-Efficiency Heating Equipment High-Efficiency Water Heaters Programmable Thermostats Weather-Sensitive Outdoor Boiler Reset Controls No Cost In-Home Energy Assessment

1.800.292.2032

www.nationalgridus.com/maheat

Use this form to apply for any of the equipment rebates listed below. Follow these steps to receive a rebate for the equipment listed below: 1) 2) 3)

Consult a licensed contractor to determine what equipment will be installed and that the new equipment will qualify for the listed rebates. Your licensed heating contractor should install eligible high-efficiency equipment between January 1, 2012 and December 31, 2012. Review, complete and return this rebate application with a dated contractor invoice by January 31, 2013. Please make sure your invoice includes: a) The type of equipment installed with the complete equipment manufacturer and model number(s) b) AFUE for heating equipment, Energy Factor or Thermal Efficiency for water heating equipment c) Contractor’s name and address d) Contractor’s license number Mail application and documentation to:

National Grid High-Efficiency Heating Equipment Rebate (MA) • Offer # H943801 • PO Box 130013 • El Paso, TX 88513-0013

Please call 1-800-292-2032, e-mail [email protected] or visit nationalgridus.com/maheat if you have any questions. You may track the status of your rebate by visiting www.smartenergy-zone.com/nationalgrid.

2012 Residential Energy Efficiency Rebates for Massachusetts Customers PRODUCT

REBATE $25/ea.

Limit two per household. May be self-installed or contractor installed. Rebate cannot exceed purchase price. Must submit a dated receipt and original UPC code from the package.

$225

HIGH-EFFICIENCY NATURAL GAS WARM AIR FURNACE AFUE* Rating 96% or greater with Electronic

$800

Commutated Motor

AFUE* Rating 95% or greater with Electronic

$500

Commutated Motor

HIGH-EFFICIENCY NATURAL GAS BOILER Hot water boiler with an AFUE* Rating of 96% or greater Hot water boiler with an AFUE* Rating of 90% or greater

A factory-assembled, packaged unit including fans or blowers that transfer heat between two isolated air streams. Must be a natural gas heating customer; excludes portable units

$500

HIGH-EFFICIENCY WATER HEATERS**

AFTER MARKET OUTDOOR BOILER RESET CONTROLS Add on unit attached to a natural gas forced hot water boiler

REBATE

HEAT RECOVERY VENTILATOR

REPLACEMENT THERMOSTATS 7-day programmable thermostats

PRODUCT

$1,500 $1,000

On-demand tankless water heater with an Energy Factor $800 of .95 or higher and electronic ignition On-demand tankless water heater with an Energy Factor of .82 or higher and electronic ignition

$500

Condensing gas water heater with 95% thermal efficiency or greater

$500

Indirect water heater connected to a natural gas forced hot water boiler

$400

Storage tank type gas water heater with an Energy Factor of .67 or greater

$100

COMBINED HIGH-EFFICIENCY BOILER AND WATER HEATING UNIT Combined condensing boiler and on-demand $1,200 water heating unit with an AFUE* Rating of 90% or greater; must be considered one unit by manufacturer * AFUE = Annual Fuel Utilization Efficiency ** Participants do not need to be a gas heating customer to be eligible for water heater rebates.

Residential Natural Gas Equipment Rebate Application Please review terms and conditions. Form must be completed entirely. If eligible, you are entitled to only one rebate per category listed in bold below. You are not entitled to an additional GasNetworks rebate.

Please mail completed rebate form and required documentation to: National Grid High Efficiency Heating Equipment Rebate (MA) • Offer # H943801 • PO Box 130013 • El Paso, TX 88513-0013 CUSTOMER INFORMATION (all information required) Account Holder’s Name: ________________________________________________________________________________________ E-Mail: _________________________________________________________________________

r Existing Dwelling r New Construction

—

National Grid Gas Account Number:

—

National Grid Electric Account Number:

Installation Address: _______________________________________ City: _____________________ State:_____ Zip: _____________ Mailing Address: __________________________________________ City: _____________________ State:_____ Zip: _____________ (where equipment was installed)

Name of person to whom rebate should be made payable:________________________________ Phone: ____________________ (If different from installation address listed above)

CONTRACTOR INFORMATION (all information required) Heating Contractor Name: __________________________________________ Gas Permit Number: __________________________ Gas Fitter/Plumber License Number: ______________________________________________________________________________ (For High-Efficiency Heating/Water Heating Equipment Rebate)

Street: ____________________________________ City: ______________________ State: __________ Zip: ____________________ Business Phone:

______________________________________________________________________________________________

HIGH-EFFICIENCY NATURAL GAS FURNACE REBATE ENERGY EFFICIENCY MEASURE

(Information required if this equipment is installed)

MODEL NUMBER

MANUFACTURER

AFUE

INSTALLED DATE

REBATE AMOUNT

Natural Gas Furnace with Electronic Commutated Motor > 96% AFUE

$800

Natural Gas Furnace with Electronic Commutated Motor > 95% AFUE

$500

Prior Unit’s Fuel Type:

❐ Gas

❐ Oil

❐ Electric

❐ Propane

❐ New Construction

ANTICIPATED REBATE AMOUNT

TOTAL REBATE

HIGH-EFFICIENCY NATURAL GAS BOILER/WATER HEATING UNIT REBATE (Information required if this equipment is installed) ENERGY EFFICIENCY MEASURE

MANUFACTURER

MODEL NUMBER

AFUE

INSTALLED DATE

REBATE AMOUNT

Natural Gas Hot Water Boiler > 96% AFUE*

$1,500

Natural Gas Hot Water Boiler > 90% AFUE*

$1,000

Combined Condensing Boiler with On-Demand Water Heater > 90% AFUE*

$1,200

Prior Unit’s Fuel Type:

EE4587 (11/12) MA

❐ Gas

❐ Oil

❐ Electric

❐ Propane

❐ New Construction

ANTICIPATED REBATE AMOUNT

TOTAL REBATE

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Residential Natural Gas Equipment Rebate Application Continued Please review terms and conditions. Form must be completed entirely.

HIGH-EFFICENCY NATURAL GAS WATER HEATER REBATE ENERGY EFFICIENCY MEASURE

MANUFACTURER

MODEL NUMBER

(Information required if this equipment is installed) INSTALLED COST

INSTALLED DATE

REBATE AMOUNT

On-Demand Tankless Water Heater > .95 Energy Factor with Electronic Ignition

$800

On-Demand Tankless Water Heater > .82 Energy Factor with Electronic Ignition

$500

Condensing Gas Heater > 95% Thermal Efficiency

$500

Indirect Water Heater

$400

High-Efficiency Storage Water Heater > .67 Energy Factor

$100

Prior Unit’s Fuel Type: ❐ Gas ❐ Oil ❐ Electric ❐ Propane ❐ New Construction Energy Factor/Thermal Efficiency:_____________________________________________

HEAT RECOVERY VENTILATOR REBATE ENERGY EFFICIENCY MEASURE

ANTICIPATED REBATE AMOUNT

TOTAL REBATE

(Information required if this equipment is installed)

MANUFACTURER

MODEL NUMBER

INSTALLED DATE

QUANTITY

REBATE AMOUNT

ANTICIPATED REBATE AMOUNT

$500

Heat Recovery Ventilator

TOTAL REBATE

AFTER-MARKET OUTDOOR BOILER RESET CONTROL REBATE PRESCRIPTIVE ENERGY EFFICIENCY MEASURE

MANUFACTURER

MODEL NUMBER

(Information required if this equipment is installed)

INSTALLED DATE

QUANTITY

After Market Outdoor Boiler Reset Control

REBATE AMOUNT

ANTICIPATED REBATE AMOUNT

$225 TOTAL REBATE

7-DAY PROGRAMMABLE THERMOSTAT REBATE PRESCRIPTIVE ENERGY EFFICIENCY MEASURE

MANUFACTURER

7-Day Programmable Thermostat Limit two thermostats per account. Rebate not to exceed the purchase price.

Please submit UPC code from thermostat package. Installation of Thermostat: ❐ Self-installed ❐ Contractor-installed

(Information required if this equipment is installed)

MODEL NUMBER

INSTALLED DATE

PURCHASE QUANTITY PRICE

REBATE AMOUNT

ANTICIPATED REBATE AMOUNT

$25/each TOTAL REBATE

Where did you hear about this program? r Sales Rep/Account Executive r Heating Contractor r Energy Auditor r Equipment Supplier r Trade Show r Print Advertising r Internet r Radio/TV r Direct Mail r E-Mail r Other __________________________

Work Completion and Rebate Validation. I hereby affirm the Energy Efficiency Equipment has been installed by a licensed contractor. I acknowledge that all work is subject to on-site work verification and inspection as may be required by state and local law and by National Grid. I am aware of and agree to the Terms & Conditions stated on the last page of this application and am attaching copies of (1) itemized proof of purchase for programmable thermostats and (2) contractor invoices for the installation of high-efficiency heating equipment, water heating equipment and/or outdoor boiler reset controls.

Customer Signature: ____________________________________________________ Date: ________________________________ Qualifying equipment installed between 1/1/12 and 12/31/12 is eligible. Rebate form and required documentation must be postmarked by 1/31/13. One account number per form. Some restrictions may apply. Rebate offers are subject to change without notice. Projects greater than ten (10) units of equipment require pre-approval. Pre-approval can be obtained by e-mailing [email protected] EE4587 (11/12) MA

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National Grid Massachusetts Residential Energy Efficiency Equipment Program Terms & Conditions 1. Rebates - Subject to these Terms and Conditions, this program is offered by Boston Gas Company, Colonial Gas Company and Essex Gas Company d/b/a National Grid (“the Company” or “National Grid”). The Company, through its contractual Vendor, Helgeson Enterprises, (the “Vendor”), will pay rebates to eligible customers in the Company’s Service Territory, for the purchase and installation of the equipment/products described in this literature and within this application. 2. Customer Eligibility - Equipment installed between 1/1/12 and 12/31/12 is eligible. Equipment must have been installed at the installation address listed on this application and the required documentation listed must be postmarked no later than 1/31/13. Applicant must be a National Grid residential gas heating customer to be eligible for the high-efficiency heating, programmable thermostat and outdoor boiler reset control rebates specified in this form. Applicant must be a National Grid residential gas or residential electric customer to qualify for the high-efficiency water heating rebates specified in this form. Check nationalgridus.com/maheat frequently for program updates. 3. Post-Installation Work Verification - The Company reserves the right to perform a verification of the specified installation. If the Company and/or Vendor determines that the equipment was not installed in a manner that is consistent with program guidelines, the Company and/or Vendor may require that the installation be modified before making any rebate payments. The cost of such modifications is the responsibility of the customer. I hereby authorize the Company to release my energy use information to Energy Efficiency Program Sponsors (EEPS) and System Benefit Charge (SBC) program administrators and/or their designee. I understand that such information will be kept confidential and used only for the purpose of determining program eligibility and energy savings. 4. High-Efficiency Heating, Water Heating and Boiler Reset Control Rebates - All installations must be completed in conformance with state and local code requirements by properly licensed contractors. 5. Proof of Proper Installation - As part of his/her application, the Customer is required to submit dated copies of all paid invoices documenting the installation (including all materials, labor and equipment invoices) which reflect the actual cost of purchasing and installing the equipment. 6. Indemnification - Customer shall defend, indemnify and hold harmless the Company and its officers, directors, employees, agents, servants and assigns from and against any and all losses, claims, demands and/or liability for damage to property, injury or death of any person, or any other liability incurred by the Company, including all expenses, legal or otherwise, arising out of or related to the equipment or installation, except to the extent attributable to the negligence of Company. In no event shall Company’s liability to Customer exceed the rebate amounts. 7. Limited Scope Review - The scope of review by the Company, Vendor and their Inspector of the installation of the equipment is limited solely to determine whether rebates are payable. It does not include any kind of safety or code review and should not be relied upon as one. 8. Rebate Amounts - The Company will provide rebates for approved heating, water heating, thermostat or boiler reset control equipment, up to rebate amount indicated in the program literature and within this application. Projects greater than ten (10) units require a pre-approval from the Company. E-mail [email protected] to inquire about pre-approval. 9. Payment - The Company, through the Vendor, expects to make rebate payments to eligible customers within 45 days of a satisfactory work verification. The Customer must refund any rebate made to the extent the contractor or equipment does not satisfy program requirements. The Company reserves the right to change or terminate rebate offers without notice. 10. No Warranties - The Company and the Vendor do not endorse, guarantee or warrant any particular contractor, manufacturer or product installation. The Company and the Vendor do not make any representation of any kind regarding the results to be achieved by the equipment or the adequacy or safety of such equipment. 11. Changes in the High-Efficiency Heating, Water Heating, Thermostat(s) or Boiler Reset Control Program - Equipment Incentive Program/Tax Liability Conditions and details of the High-Efficiency Heating and Water Heating Incentive Program are subject to change without prior notice and rebate offers may increase or decrease over time. The Company reserves the right to modify or terminate the Program without notice. Participants of the Program may be subject to tax liability for the value of goods and services received through the program pursuant to state or federal income tax codes. The Company is not responsible for any tax liability which may be imposed as a result of receipt of the rebate by the Customer. 12. Contractor Insurance - The Company is not responsible for any damage that may be caused by or arise out of an installation of any equipment. The customer is responsible for selecting contractors who are qualified and carry adequate insurance coverage.

National Grid is one of the largest investor-owned energy companies in the world. In the US, we serve nearly 5 million electric and 3.4 million gas customers in Massachusetts, New York and Rhode Island. Save energy and money with our award winning efficiency programs. Visit www.powerofaction.com/efficiency.

EE4587 (11/12) MA

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