Call 401-574-9106 or visit energy.ri.gov/efficiency/BI for more info!

Efficient Heating Equipment Rebate Application

Improve comfort and save money

with energy saving offers for:

High Efficiency Furnaces and Boilers

On-Demand Water Heaters

High Efficiency Free Standing and

Indirect Water Heaters

An energy

efficiency program

brought to you by:

How to Apply

Verify that the equipment qualifies for a rebate by consulting with a licensed contractor

and reviewing the qualification table on the back of this page.

Purchase the qualified equipment and have a licensed contractor install it. Have the

licensed contractor sign this application when the work is completed.

Obtain an invoice from your contractor containing the following information: quantity

installed, equipment manufacturer, model numbers, size in MBH or gallons, date and

location of installation, total installation costs, contractor's name and address, and an

indication of “paid in full” or “zero balance”.

Complete this 3 page application. Attach a copy of your invoice and the equipment’s

spec sheet indicating its efficiency to this application. Mail, or scan and email, these

documents to the Rhode Island Office of Energy Resources (details on back). After

your application is processed, you will receive your rebate check in the mail within 4 to

6 weeks.

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Heating Equipment Rebate Application (pg 1) The Rhode Island Office of Energy Resources (OER) is offering mail -in rebates for energy efficient heating and hot water equipment. Only Block Island homeowners and businesses may apply. A licensed contractor must install the system and sign this 3 -page application. Only qualifying equipment models are eligible. See qualifying equipment and rebate amounts below.

To apply, please fill out this form and mail it with all required documentation to

RI Office of Energy Resources Attn: Becca Trietch One Capitol Hill, 4th Floor Providence, RI 02908

Forms must be received by OER within thirty (30) days of equipment installation. Rebates will be available through the end of 2016 or until funds are fully committed, whichever comes first. Please allow 4 to 6 weeks for a rebate check to arrive via mail.

For more info call 401-574-9106

Or visit energy.ri.gov/efficiency/BI

Scan a completed form with required documentation and email it to becca.trietch@energy.ri.gov

OR

QUALIFYING PRODUCTS FOR PROPANE APPLICATIONS # OF

UNITS REBATES (check all that apply)

High Efficiency Furnace with EC motor AFUE ≥ 95% (≤ 150 MBH) □ $300

High Efficiency Furnace with EC motor AFUE ≥ 97% (≤ 150 MBH) □ $600

□ $1,000 (≤ 300 MBH)

Condensing Boiler AFUE ≥ 90%

□ $2,000 (301-500 MBH)

Condensing Boiler AFUE ≥ 95% (≤ 300 MBH) □ $1,500

Condensing Unit Heater AFUE ≥ 90% Thermal Efficiency (≤ 300 MBH) □ $750

On Demand Tankless Water Heater with Electronic Ignition EF ≥ .82 □ $500

On Demand Tankless Water Heater with Electronic Ignition EF ≥ .94 □ $800

Indirect Water Heater EF ≥ .82 (30 to 75 gallons) □ $400

Condensing Stand Alone Tank ≥ 95% Thermal Efficiency (75-300 MBH) □ $500

Energy Star Freestanding Water Heater EF ≥ .67 □ $100

EC stands for electronic commutated. AFUE stands for Annual Fuel Utilization Efficiency. MBH stands for one thousand BTUs per hour and should be based on the unit’s input. EF stands for Efficiency Factor. The rounding up of efficiency ratings is not accepted. If your propane boiler or furnace is larger than 500 MBH, please call the phone number below.

Call 401-574-9106 Or visit energy.ri.gov/efficiency/BI

for more information

Heating Equipment Rebate Application (pg 2)

CONTRACTOR INFORMATION

Contractor Name (First & Last): _________________________________________________________________________

Business Name: ________________________________________________________________________________________

Business Address: ____________________________________________________________________________________

Installation Address: __________________________________________________________________________________

Email: ____________________________________________________ Phone: _____________________________________

Installation Date: ______/_______/___________ Contractors Registration #:____________________________

Equipment was installed as: □ New Construction □ Replacement System □ Replaced Failed Equipment

□ Adding Heating to Existing System □ New or Additional Heating System

I hereby certify that I am a contactor that holds a valid contractor’s registration from the Rhode Island Contractor and Licensing Board and that I have installed the equipment listed on page 1 of this application at the installation address shown above. The attached invoices and spec sheets are for the equipment listed on page 1. To the best of my knowledge, all installed heating and/or hot water equipment listed on page 1 are operating according to the manufacturer’s specifications.

Contractor Signature ______________________________________________ Date______________________

IMPORTANT: Photocopy your entire submission for your records. To review the status of your application please call 401-574-9106 or email becca.trietch@energy.ri.gov. This application must be completed accurately and legibly in its entirety. Please be sure to include the appropriate invoices and spec sheets as part of this application. Incomplete applications will not be processed. Your invoice(s) must include the following: quantity installed, equipment manufacturer, model numbers, size in MBH or gallons, date and location of installation, total installation costs, contractor's name and address, and an indication of “paid in full” or “zero balance”. Spec sheets must indicate the efficiency of the installed equipment.

QUALIFYING PRODUCTS FOR OIL APPLICATIONS # OF

UNITS REBATES (check all that apply)

Indirect Water Heater EF ≥ .82 (30 to 75 gallons)

Must be replacing freestanding or tankless water heater □ $300

High Efficiency Furnace with EC motor AFUE ≥ 85% (≤ 150 MBH) □ $250

High Efficiency Boiler AFUE ≥ 86% (≤ 300 MBH) □ $500

EC stands for electronic commutated. AFUE stands for Annual Fuel Utilization Efficiency. MBH stands for one thousand BTUs per hour and should be based on the unit’s input. EF stands for Efficiency Factor. The rounding up of efficiency ratings is not accepted. If your oil boiler or furnace is larger than 300 or 150 MBH respectively, please call the phone number at the bottom of this page.

An energy

efficiency program

brought to you by:

Call 401-574-9106 Or visit energy.ri.gov/efficiency/BI

for more information

TERMS & CONDITIONS

Time Limit– Applications for qualifying equipment must be received by the Rhode Island Office of Energy Resources (OER) within thirty (30) days of equipment installation. Rebate levels are subject to change without prior notice and are subject to funding availability.

Geographic Requirements– Rebates are only available for homeowners and businesses with qualified facilities in the Town of New Shoreham.

Application Form– This application must be filled out completely, truthfully, and accurately.

Approval and Verification– OER reserves the right to verify and to have reasonable access to the building to inspect the system installed prior to issuing rebates.

Tax Liability– OER is not responsible for any tax liability that may be imposed on the customer or contractor as a result of the payment of rebates.

Endorsement– OER does not endorse any particular manufacturer, product, system design or technology.

Warranties & Limitation of Liability– OER does not warrant the performance of installed or serviced equipment, expressly or implicitly. OER’s liability is limited to paying the rebate specified.

Heating Equipment Rebate Application (pg 3)

CUSTOMER INFORMATION

Customer Name (First & Last): __________________________________________________________________________

Installation Address: ___________________________________________________________________________________

Mailing Address (if different): ___________________________________________________________________________

Email: ____________________________________________________ Phone: _____________________________________

Block Island Power Company Account Number: _________________________________________________________

I hereby request a rebate for the work listed on page 1 of this application. Attached are copies of all invoices and equipment spec sheets indicating efficiency. I certify that a licensed contractor has installed the listed equipment in accordance with the Program Terms and Conditions as described on this form. I understand that some restrictions may apply and rebate offers are subject to funding availability. Rebates will be reviewed and processed on a first-come-first-serve basis. OER reserves the right to reject any application not filled out completely, truthfully, and accurately.

Customer Signature ____________________________________________________ Date______________________