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Home effiCienCy RebAtes The Los Angeles Department of Water and Power is continuing its residential Consumer Rebate Program (CRP) to promote energy-efficient products. This program is designed to both educate and encourage LADWP residential customers to purchase and install qualifying products in their homes. Qualifying Product categories: Refrigerators, Room Air Conditioners, Windows, Pool Pumps and Motors, Central Air Conditioning Systems, Cool Roofs and Whole House Fans. CONFIRM REBATE ELIGIBILITY BEFORE MAkING YOUR PURCHASE. Complete this application after both purchasing and installing your high efficiency product or recycling your refrigerator/freezer and receive a rebate. All applications must be postmarked within 12 months of purchase or recycling date. See inside for details, or visit our website at www.ladwp.com/crp Consumer Rebate Program (CRP) Application HOW TO APPLY: After the improvements are installed: Read, sign and date the Terms and Conditions section of the Rebate Application. Read the Product Description Requirements found on Part B of the Rebate Application. Complete the application (Part A and B). Send the required documentation (listed below) with the completed rebate application to: LADWP Rebate Processing Center P.O. Box 51111, Room 1019 Los Angeles, CA 90051-0100 All applications must be postmarked within 12 months of purchase or recycling date. For your records, please make a copy of all documents (including your application) before mailing. TO APPLY, YOU MUST SUBMIT:   1. Complete Rebate Application Part A and Part B must be complete. Must be signed and dated. Detach at perforation and retain this page for your records. 2. Original Proof of Purchase such as Invoice or Receipt that includes: Retailer name, business address and phone number Itemized description of each product, including manufacturer, product make and model number(s) Purchase Date Date of delivery or installation date (must be included on your application in Part B). If you hired a contractor for Windows, Central Air Conditioning, Cool Roofs and/or Whole House Fans: An Original Home Improvement Contract* must be submitted as proof of purchase and a copy of the permit must be included. * Home Improvement Contract (HIC) The Contract must be signed and dated by both you and your licensed contractor. Windows contract must contain the dimensions for each window. Central Air/heat invoice or contract must include the complete condenser, evaporative coil and furnace model numbers. To confirm your contractor’s license status, contact the Contractor State Licensing Board (CSLB) at 1-800-312-CSLB (1-800-312-2752) or www.cslb.ca.gov. 3. A copy of your LADWP bill (Page 1) 4. Additional documentation required for the following products: Energy Star Refrigerator and/or Energy Star Air Conditioner † Energy Guide Label Refrigerator/Freezer Recycling † The pick-up confirmation sheet given to you by ARCA, Inc. Low-E Dual Pane Windows † National Fenestration Rating Council (NFRC) label from each window. If label is not available, please submit the Manufacturer’s order confirmation sheet. The manufacturer’s order confirmation sheet must be on the manufacturer’s letterhead and include: The specific U-Factor of .35 or less and a Solar Heat Gain Coefficient (SHGC) of .30 or less. 5. Pool Pump/Motor Invoice must clearly show purchase date and model# of the pool pump/motor and the automatic controller. 6. Provide a stamped, self-addressed envelope with your application if you would like the original receipt(s), invoice and/or contract returned. 7. For Online Purchases: † Print and send the order confirmation. † Send a copy of the signed and dated delivery confirmation sheet.      Once all of the above criteria are met, you should receive your check within six months. Expect further delays for incomplete applications and/or if an inspection is required. LADWP reserves the right to inspect/confirm products and their installation. If you have any questions, you may call LADWP's Rebate Processing Center toll free at 1-800-374-2224. Office Hours: Monday-Friday 7:00AM-4:00PM Consumer Rebate Program (CRP) Application A Part Please complete Part A and Part B of this application. Mail the application with your documents to: LADWP Rebate Processing Center, P.O. Box 51111, Room 1019, Los Angeles, CA 90051-0100. ALL APPLICATIONS MUST BE POSTMARKED WITHIN 12 MONTHS OF PURCHASE DATE. Incomplete and incorrect applications cannot be processed. Please call 1-800-374-2224 if you have any questions. APP# (office use only) Please TYPE or PRINT. SECTION 1: PROPERTY AND LADWP ACCOUNT INFORMATION Please provide your LADWP account information and the address where your home improvement product(s) will be installed. The installation address must be in the LADWP service area to qualify. LADWP Account Number Applicant (check one) † Owner † Renter Property Type (check one) † Detached Single Family † Attached Home (up to four-plex) † Condo/Townhome † Mobile Home † Apartment LADWP Account Holder Name (first and last name as it appears on your LADWP bill) Installation or Pick-Up Address City Daytime Area Code and Phone Number Evening Area Code and Phone Number Unit or Apartment Number State Zip Code CA Best Time to Call SECTION 2: PAYMENT RELEASE AUTHORIZATION (if applicable) SKIP THIS SECTION IF REBATE CHECK WILL BE MADE PAYABLE TO ACCOUNT HOLDER. Complete this section only if payment will be made to someone other than the LADWP account holder. I am authorizing this payment of my rebate to the third party (“Payee”) named below and I understand that I will not be receiving the rebate check from LADWP. If “Payee” is a business, requested tax information must be provided. I also understand that my release of the payment to the “Payee” does not exempt me from the rebate requirements outlined in this application. AUTHORIZED BY: LADWP Account Holder Name (first and last name as it appears on your LADWP bill) Signature CHECK SHOULD BE MADE PAYABLE TO: Payee: Individual/Business Name* Payee Mailing Address City State Zip Code Unit or Apartment Number Phone Number Date *If Payee is a Business, please provide EITHER the Employee Identification Number (EIN)/Federal Tax ID or Social Security Number in the appropriate space below. EIN or Federal Tax ID Social Security Number Tax Status: (check one) † Corporation † Partnership † Individual/Sole Proprietor † Exempt (Tax exempt, non-profit) Consumer Rebate Program (CRP) Application A Part Consumer Rebate Program (CRP) terms and Conditions 1.  have met all program requirements, I have attached a copy I of permits required (if any), and I am in compliance with my state/county/city governments’, property owner’s and /or homeowner’s association requirements in my area regarding local conditions, restrictions, codes, ordinances, rules and regulations prior to installation. Measures pertaining to new pools or new construction do not qualify for a rebate. to me on IRS Form 1099 unless I have checked corporation or exempt from reporting tax status. I understand that I should consult my tax advisor concerning the taxability of rebates. LADWP is not responsible for any taxes that may be imposed as a result of my receipt of this rebate. T 8.  he rebate amount cannot exceed the purchase price nor can I receive a rebate for the same item or equipment from more than one California electric or gas utility. Customers may not receive more than one (1) LADWP rebate for any qualifying product. 9.  agree that the selection, purchase, installation and ownership/ I maintenance of the item(s) and measure(s) listed in this application are my sole responsibility, and that the supplier or installer of these item(s) and measure(s) is not an agent or representative of LADWP. I also understand that LADWP makes no warranty whether expressed or implied, including warranty of merchantability or fitness for any particular purpose, use, or application of the item(s) or measure(s). I agree that LADWP has no liability whatsoever concerning (1) the quality, safety and/or installation of the item(s) or measure(s), including their fitness for any purpose, (2) the estimated savings of the item(s) or measure(s), (3) the workmanship of any third parties, (4) the installation or use of the item(s) or measure(s) including, but not limited to, effects on indoor pollutants, or (5) any other matter with respect to the Consumer Rebate Program. I agree that in no event shall LADWP’s liability for property loss or damage resulting from its activities under this application exceed the total rebate amount paid to me under this application. 10.  lterations to properties in Historic Preservation Overlay Zones A (HPOZ), including window replacement, must conform to the requirements established for those districts. Contact the Planning Department for information on requirements and permits if your property falls in one of the HPOZs. 11. f a tenant, I am responsible for obtaining the property owner’s I permission to install the measure for which I am applying for a rebate. My signature on this application indicates I have obtained this permission. 12.  understand that LADWP is not responsible for items lost or I destroyed in the mail/transit. Initial 2.  o be eligible for a rebate, I understand that I must be a residential T customer with an active electric meter serviced by LADWP and that I am only eligible to receive rebates for energy-efficient items designed to reduce the consumption of the energy distributed to the installation address. New construction, new pools, and additions do not qualify for a rebate. 3.  unds are limited and rebates are not guaranteed. Applications are F accepted on a first-come, first-served basis. The program may be modified or terminated without prior notice. 4.  understand the item(s) must be new and installed in the LADWP I customer residence prior to submittal of this application. Resale units, units leased, rebuilt, rented, received from warranty insurance claims, won as a prize, or new parts installed in existing units do not qualify. 5.  his signed and dated application, original paid receipt(s), T invoice(s), or Home Improvement Contract, a copy of your LADWP bill (Page 1), and other required documentation must be sent to the LADWP Rebate Processing Center postmarked within 12 months of the purchase date printed on the sales receipt to be eligible for payment of a rebate. I 6.  will provide, if requested, an LADWP representative reasonable access to my residence to verify the installed item(s) I have purchased before a rebate is paid. I understand that a rebate will not be paid if I refuse a verification inspection. 7.  understand that under certain circumstances incentives may be I taxable and, if greater than $600, may be reported to the IRS unless I am exempt from reporting. LADWP may report my rebate payment I have read and understand the terms and conditions. I certify that the information I have provided is true and correct and the item(s) and/or equipment for which I am requesting a rebate meets the requirements listed on the rebate forms. Customer Signature (LADWP Customer of Record) Please sign in blue or black ink. Name (Please Print) Date Consumer Rebate Program (CRP) Application CRP Product Description and Requirements B a Part This section lists all of the energy efficient products that qualify for rebates. Please provide information about the product you have purchased in the spaces below. In addition to the rebates offered through this program, LADWP also provides rebates for High Efficiency Clothes Washers. For more information about our Clothes Washer Rebates, visit www.ladwp.com/rwr or call 1-888-376-3314. ENERGY STAR® RATED REFRIGERATOR Minimum 15 cubic foot. Energy Star® approved model. (A) QUANTITY For a list of qualifying products, go to www.energystar.gov. Limit one per household. (B) REBATE AMOUNT $65 Manufacturer: Limit 1 unit Model #: Purchase Date: Install Date: (A) x (B) TOTAL REBATE $ b REFRIGERATOR/FREEZER RECYCLING PROGRAM (RETIRE) Minimum 10 cubic foot/Maximum 27 cubic foot. Must be in working condition. Must be picked up by ARCA.* (A) QUANTITY * ARCA: Appliance Recycling Center of America. To schedule an appointment call, 1-800-246-0441 or visit our website www.ladwp.com/retire. Limited to 2 units per year. (B) REBATE AMOUNT $50 per unit # of units picked up Pick Up Date: (A) x (B) TOTAL REBATE $ c VARIABLE SPEED OR VARIABLE FLOW POOL PUMP AND MOTOR* Must have a CA Title 20 qualifying programmable Controller unit (built-in or stand alone) to be eligible for rebate. Pool Pump and motor must be replaced to qualify. Above ground pools, pool cleaners, boosters, spas, ponds and decorative fountains do not qualify. For a list of qualifying models, go to www.ladwp.com/poolpump. * (A) QUANTITY (B) REBATE AMOUNT $500 variable speed only Manufacturer: Model #: Limit 1 unit (A) x (B) TOTAL REBATE Purchase Date: Install Date: $ For the Variable-Speed INTELLIFLO VS-3050 and the INTELLIPRO VS-3050 only: Controller make/model#: d ENERGY STAR® QUALIFIED* RESIDENTIAL WINDOW PRODUCTS Products must be installed in an air conditioned space and meet U-factor and Solar Heat Gain Coefficient (SHGC)** criteria on the current Energy Star® Climate Zone Map. Los Angeles is located in the South Central Zone as of January 4, 2010. The maximum U-factor for Windows, including sliding glass doors, is 0.35 and Skylights is 0.57. The maximum SHGC for all qualified window products is 0.30. Entry Door eligibility and criteria will be determined on a case by case basis. * Energy Star® (http://www.energystar.gov) reserves the right to change qualifications. ** The most energy efficient products have the lowest U-factor and SHGC where U-factor is a measure of heat flow through the window and SHGC is a measure of a window’s ability to absorb or reflect heat from the sun. (A) QUANTITY (B) REBATE AMOUNT $2.00 per sq ft of glass Purchase Date: sq ft # of windows/doors installed Install Date: (A) x (B) TOTAL REBATE $ B e ENERGY STAR® RATED AIR CONDITIONER Must be an Energy Star® approved model. Part Consumer Rebate Program (CRP) Application CRP Product Description and Requirements For a list of qualifying products, go to www.energystar.gov. (B) REBATE AMOUNT (A) x (B) TOTAL REBATE (A) QUANTITY $50 Manufacturer: # of units Model #: Purchase Date: Install Date: $ f ENERGY EFFICIENT CENTRAL SPLIT-SYSTEM AIR CONDITIONER OR HEAT PUMP Condenser must be rated 15 SEER* or greater. Permit(s) required. * SEER: Seasonal Energy Efficiency Rating (generally found on the specification sheet provided by the manufacturer). (A) QUANTITY Central Air Conditioner (split or packaged) (B) REBATE AMOUNT Tier 2 - $100 / Ton Tier 3 - $120 / Ton Tier 2 - 15 SEER, 12.5 EER Tier 3 - 16 SEER, 13 EER Tier 2 - 8.5 HSPF, 15 SEER, 12.5 EER Purchase Date: Install Date: Furnace Model #: (A) x (B) TOTAL REBATE Central Heat Pump (split or packaged) Tier 2 - $100 / Ton Manufacturer: Condenser Model #: # of units Evaporative Coil #: $ g WHOLE HOUSE FANS Whole house fans must be permanently installed in your home (connected to the framing) and must move at least 1,000 cubic feet of air per minute (CFM). The fan exhausts air from the living space into the attic, so it is important to make sure there is adequate attic ventilation to allow the air to easily escape. Care should be taken to avoid backdrafting combustion appliances that are installed in the conditioned space. Consult manufacturer’s specifications to determine the proper size fan prior to purchase. Limited to one rebate per residence. Permit(s) required. (A) QUANTITY (B) REBATE AMOUNT Permanent installation; must move at least 1,000 cubic feet of air per minute (CFM). Limit one per residence. Purchase Date: Install Date: (A) x (B) TOTAL REBATE $200 per unit Manufacturer: Model #: Limit 1 unit $ Does residence have central A/C? (informational only) h COOL ROOFS Cool roofs must meet the Solar Reflectance and Thermal Emittance requirements indicated below as rated by the Cool Roof Rating Council at www.coolroofs.org. Payment will be based on material being applied according to manufacturer specifications. Permit(s) required (except for liquid applied coating). (A) QUANTITY Low-slope ( 2:12) Steep-slope (> 2:12) Manufacturer: Model #: sq ft of cool roof Cool Roofs Rating Council Product ID: Does residence have central A/C? (informational only) Rev. 03/2012 (B) REBATE AMOUNT $0.30 per sq ft $0.30 per sq ft Initial Solar Reflectance 0.70 Thermal Emittance 0.85 Initial Solar Reflectance 0.40 Thermal Emittance 0.85 Purchase Date: Install Date: (A) x (B) TOTAL REBATE $