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COMMERCIAL WINDOW Rebate Application Promotion Dates: 01/01/2013 - 12/31/2013 PROGRAM RULES AND QUALIFICATIONS • • General Requirements Qualifying windows must be new. Products that are used, rebuilt, rented, leased, exchanged, won as a prize, get one free offer, or purchased at auction or online auction are not eligible. Applications for qualifying windows purchased & installed between Jan 1 - Nov 30 of the calendar year must be postmarked on or before Dec 31 of same calendar year to qualify for a rebate. Applications for qualifying windows purchased & installed between Dec 1 - Dec 31 of the calendar year must be postmarked on or before Jan 31 of following year to qualify for a rebate. Installation address must have CSU commercial electric or gas service and account must be in applicant’s name. This rebate is not retroactive. Purchasing qualifying windows does not guarantee approval of a rebate. Rebates are offered on a first come, first served basis and are subject to availability of funds. CSU account(s) for rebate participant must be current and nondelinquent (i.e. no past due balances) at the time the rebate application is processed or rebate will be denied. Should this be rectified within thirty (30) days from date on denial letter, please call 448-4800 to have your rebate application reviewed again. STEPS TO RECEIVE REBATE • • • • • • • • • • • • CSU is not responsible for lost, late, damaged, illegible, misdirected or postage-due applications. Landlords who participate in the rebate program for their rental property(ies) and who do not have an active account with CSU must complete and submit an IRS form W-9 with all other required documentation. Rebates are issued as a credit to the CSU service account and may take up to eight (8) weeks to process. Rebate application(s) must be complete and include the equipment worksheet and a copy of the purchase receipt(s). Incomplete applications, worksheets and/or those lacking a copy of the purchase receipt(s) will be denied. CSU reserves the right to verify compliance with these terms, including but not limited to a physical site review. If review deems qualifying equipment was not installed, CSU reserves the right to remove the non-complying participant from the program and the amount rebated will be charged back to the utility account. One (1) rebate available per customer account per year. All terms, conditions and rules of the program are subject to change. • • • Review rules and requirements on this application and sign the Acceptance of Terms. Purchase and install qualifying windows. Complete and sign application and include the following supporting documents: spreadsheet listing address and showing the number and size of windows installed; window sizes are REQUIRED on the LCF/invoice/receipt /contract/sticker(s) for verification of square footage; self installation: dated receipt(s) for calendar year professional installation: signed contract showing paid and date of installation for calendar year NFRC Label Certificate Form (see example at OR the ENERGY STAR® climate zone sticker(s) & The National Fenestration Rating Council sticker(s) showing the U-factor and SHGC rating (if stickers are submitted, one copy required for each different size window) Copy of valid Photo ID for proof of lawful residency (Sole Proprietors only) *Acceptable forms of a valid Photo ID include: Submit completed application form and all required documentation to: Colorado Springs Utilities Business Prescriptive Rebate 2855 Mesa Road Colorado Springs, CO 80904-1174 OR Email: [email protected] A Driver’s License from any state EXCEPT Hawaii, Illinois, Maryland, Nebraska, New Mexico, Utah, and Washington; Colorado Identification Card, U.S. Passport or a photo less than 20 years old along with Certificate of Naturalization or a Certificate of Citizenship. It is strictly prohibited and punishable by fine and/or imprisonment to photocopy Military IDs and Common Access Cards. (Title 18, U.S. Code, Part I, Chapter 33, Section 701) ACCEPTANCE OF TERMS Account holder hereby certifies that 1) The account holder is solely responsible for the accuracy of the application; 2) the account holder has read and understands the program rules and qualifications; and 3) all installation is complete and operational prior to submitting this application. Signature Required: DISCLAIMERS Date: WARRANTY DISCLAIMER: CSU makes no representations or warranties about any make or model of equipment, including any warranties of merchantability, fitness for a particular purpose or energy efficiency. This rebate program is subject to change and/or discontinuation without notice. CSU reserve the right to inspect installation premises or request additional information/documentation prior to rebate payment. CSU is not liable or responsible for any act or omission of any contractor whatsoever. LIMITATION OF LIABILITY: In no event shall CSU be liable to Rebate Participant or any third party for any special, incidental, indirect or consequential damages, including loss of profits, loss of use or cost of replacement equipment associated with replacement of equipment and management of resultant wastes. Nothing in the Rebate Program shall be interpreted to limit or prevent the protections afforded to CSU under the Colorado Governmental Immunity Act, C.R.S. § 24-10-101, et seq. Colorado Public (Open) Records Act (CORA) - Colorado Springs Utilities is an enterprise of the City of Colorado Springs, therefore, Colorado Springs Utilities’ records are public records open for inspection by any person at reasonable times, except as provided by the Colorado Public (Open) Records Act (CORA) or other laws. The CORA permits the denial of inspection of any records that contain personal and financial information of past or present users of public utilities. 1 COMMERCIAL WINDOW FOR REBATE OPERATIONS USE ONLY. DO NOT WRITE IN THIS AREA. Date Received: DENIAL Reason: COPE $ Rebate Amount APPROVED DENIED Promotion Dates: 01/01/2013 - 12/31/2013 Read all rebate rules and qualifications on this form. Incomplete Applications will be denied. REBT92 ACCOUNT HOLDER INFORMATION CSU Account #: Installation Address: Mailing Address: Account Name: (as shown on utility bill) City: City: State: State: CO Zip Code: Zip Code: Phone: (If different from installation address) Site Contact: Email: EQUIPMENT INFORMATION (required) Window rebate requirements (include NFRC label certificate form) New window qualifications: U-factor and Solar Heat Gain Coefficient (SHGC) OR Shading Coefficient:  U-factor ≤.32 AND (check one of the following)  SHGC ≤.28  Shading Coefficient =.32 NO sliding glass door rebates for commercial properties Please complete and attach a spreadsheet showing the following information: (window/sliding glass door calculator available at Address 123 Jones Rd, Apt 1 123 Jones Rd, Apt 1 123 Jones Rd, Apt 2 Total # of windows installed per unit A 1 1 1 SAMPLE Rebate Spreadsheet X (multiply) Width (inches)* / 12 B 36 / 12 = 3 36 / 12 = 3 36 / 12 = 3 X (multiply) Height (inches)*/ 12 C 48 / 12 = 4 24 / 12 = 2 24 / 12 = 2 = Total ft 2 AxBxC 1 x 3 x 4 = 12 1x3x2=6 1x3x2=6 24 *window/sliding glass door sizes are REQUIRED on the invoice/receipt/contract/sticker for verification of square footage Total Rebate Amount requested: $1.40 X SOLE PROPRIETORSHIP ONLY Total ft = Rebate amount $ 2 ($12,000 max) AFFIDAVIT OF LEGAL RESIDENCY IS REQUIRED UNDER COLORADO LAW I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit or prior to entering into a contract with the state. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. I swear/affirm under penalty of perjury under the laws of the State of Colorado that (check one): ___ I am a Unites States citizen, or ___ I am a Permanent Resident of the United States, or ___ I am lawfully present in the United States pursuant to Federal Law. ** Include a copy of your approved photo id ** Signature Required: Date: Employee Verification _________ Please consider a donation to Project COPE. All donations are tax deductible and 100 percent of donations go to families in need to help pay their utility bills. Please specify COPE donation amount: $ 2