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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES

THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.


This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

SECTION 1: CUSTOMER LEGAL INFORMATION Company Legal Name: Legal Mailing Address: Tax Identification Number (Complete ONE only, must be 9 digits): FEIN: ____ ____ ____ ____ ____ ____ ____ ____ ____ OR SSN: ____ ____ ____ ____ ____ ____ ____ ____ ____ City: State: Zip Code: Owner Name (Corporations excluded)

Business Classification of Customer (Check ONE only. Required for all businesses, including non-profits.): q Corporation q Partnership q Sole Proprietorship-Individual q LLC q Other ______________________ SECTION 2: PAYMENT INFORMATION Make Incentive Check Payable to: Make Check to:
q Company q Business Owners Legal Name (Only if Sole Proprietor) q Alternate Address (complete below):

q Trade Ally (Complete Section 4)

q Company Legal Address

q Job Site Address

Attention to: Zip Code:

Alternate Pay Address: SECTION 3: JOB SITE INFORMATION Job Site Name: Job Site Street Address (physical location): City: Electric Provider at Job Site: Natural Gas Provider at Job Site: Project Installation/Service Date: State:

City:

State:

Customer Project Contact Name: Customer Project Contact E-mail:

WI

Zip Code:

Customer Project Contact Telephone: Electric Provider Primary Acct #: Natural Gas Provider Primary Acct #:

Describe Building Use (e.g.: Food processing plant):

For questions about this application contact: q Customer Contact q Trade Ally

SECTION 4: TRADE ALLY INFORMATION (See Trade Ally information section on the Program Information and Requirements page.) Trade Ally Name: Trade Ally Street Address: Trade Ally Contact Name: Tax Identification Number (Complete ONE only if receiving payment, must be 9 digits): FEIN: ____ ____ ____ ____ ____ ____ ____ ____ ____ OR SSN: ____ ____ ____ ____ ____ ____ ____ ____ ____ City: Contact Telephone: State: Zip Code:

Contact E-mail:

Business Classification of Trade Ally (Check ONE only): q Corporation q Partnership q Sole Proprietorship-Individual q LLC q Other__________ SECTION 5: CUSTOMER SIGNATURE (Please read and sign.)
Certification: The following certifications are required in order for this form to substitute for the IRS form W-9. Under penalty of perjury, I certify that: n The number shown on this form is the correct taxpayer identification number. n I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. n I am a U.S. citizen (includes a U.S. resident alien). The undersigned agrees that the stated energy-efficient measure(s) was (were) installed at the job site address listed above as part of the Focus on Energy Program. I have read and agree to the Terms and Conditions within this application. To the best of my knowledge, the statements made on this application are complete, true and correct, and I have submitted the appropriate supporting documentation to receive an incentive. qI temized Invoice Attached

Customer Signature:

Customer Name (Print):

Date:
Send or fax form to corresponding mail or e-mail address.

SECTION 6: APPLICATION SUBMITTAL Select the program that best describes your organization (check ONE only).
qB  usiness Incentive Program (Customers include but are not limited to businesses, farms, schools, local governments, small to midsized healthcare and hospitality businesses) Focus on Energy Incentives 2923 Marketplace Drive, Suite 108 Fitchburg WI 53719-5320 Fax: 608.467.1417 E-mail: BIPapps@focusonenergy.com
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qL  arge Energy Users Program (Qualifying customers consistently have energy utility bills over $60,000 per month. Typical Large Energy Users include paper and pulp, food processing, foundries, large hospitals, etc.) Focus on Energy Incentives 5609 Medical Circle, Suite 201 Madison WI 53719 Fax: 608.277.2947 E-mail: LEUapps@focusonenergy.com

qC  hain Stores and Franchises Program (Limited to chain and franchise retail, restaurants, grocery, convenience stores) Focus on Energy Incentives 211 S. Paterson Street, Suite 170 Madison WI 53703 Fax: 608.310.6909 E-mail: CSFapps@focusonenergy.com

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

INSTRUCTIONS FOR COMPLETING THIS FORM PLEASE READ nn The specifications for eligible equipment are listed within each lighting technology on this form. If the technology you are installing is specified differently than how it is listed on this form, please call 800.762.7077 to verify eligibility. Custom incentives are available for many technologies not listed. Some technologies require additional information that must be filled in under Specifications and Required Information column. Replacements are one for one unless otherwise specified. nn Manufacturer specification sheets are required for all new lighting fixtures, retrofit kits, and control systems. nn This form must accompany an itemized invoice with quantity, manufacturer, model number, date and cost for each piece of equipment for which an incentive is expected. High Performance T8 (HPT8) and Reduced Wattage T8 (RWT8) systems require manufacturer and model number for ballast and lamps to appear on invoice. Please fill in blanks for all items you are requesting an incentive for. Incomplete applications or invoices can significantly delay processing of incentive. Replaced equipment must be removed from service. nn Except for exterior lighting options included on page 8-11, outdoor lighting projects are NOT eligible for prescriptive incentives, but may be eligible for custom incentives. nn ALL CUSTOM INCENTIVES MUST BE PRE-APPROVED BY Focus on Energy PRIOR TO EQUIPMENT PURCHASE. nn Installed light levels are expected to meet current IESNA recommendations and comply with all applicable Federal, State or Municipal electrical, safety and energy codes. Fixtures and retrofit kits must be UL listed. Compliance is the responsibility of the installer. nn Purchases that have received Focus on Energy discounts at retailers are not eligible for incentives on this application. nn Retrofit incentives qualify for projects implemented on existing buildings; the basis of the incentive is a one-for-one replacement of the lighting fixture being replaced. LIGHTING INCENTIVE GENERAL REQUIREMENTS nn Equipment not eligible for prescriptive incentives may be eligible for custom incentives. Contact an Energy Advisor for more details at 800.762.7077. nn Any project with an expected incentive exceeding $25,000 must receive written approval before project initiation or equipment purchase. Projects with expected incentives of $10,000 or more may request preapproval. REPLACEMENT LAMPS Replacement Lamps (Integral Ballast/Driver) CFL, Cold Cathode, Ceramic Metal Halide and LED nn One for one replacement of incandescent only. CFL or LED lamp must contain integral ballast/driver. Other replacements may be eligible for custom incentive. nn LED products must appear on ENERGY STAR LED Bulbs qualified product list. Lists can be found at focusonenergy.com/business/lighting.aspx. nn Other lamps may be considered for custom incentives, please call 800.762.7077 for assistance. Rebated bulbs may not be used for resale or giveaway type promotions. Equipment Type CFL/Cold Cathode Lamps CFL Reflector Flood Lamps High Wattage CFL Lamps CMH Integral Ballast Lamps ENERGY STAR LED Lamps ENERGY STAR LED Lamps Specifications and Required Information Replace incandescent lamps (100W or less) with CFL or cold cathode screw-in lamps up to 30W Replace incandescent flood lamps (100W or less) with CFL flood lamps with integrated reflector up to 30 Watts. Screw base CFLs only. Replace incandescent lamp (greater than 100W) with high wattage CFL from 33-115 Watts. Medium Edison screw base CFLs only. Retrofit existing 70-100W incandescent flood or spot lamps with 25W Ceramic Metal Halide reflector lamp with integrated ballast. Replace existing Incandescent Lamp 40W Wattage Replaced: _______________________________________________ LED Manufacturer/Model: __________________________________________ Replace existing Incandescent Lamp 41W to 120W Wattage Replaced: _______________________________________________ LED Manufacturer/Model: __________________________________________ Incentive Limited to 50% of cost $2/Lamp $4/Lamp $5/Lamp $15/Lamp Quantity Subtotal

$5/Lamp

$10/Lamp

Reduced Wattage Replacement Lamps Lamp Only nn Relamp existing T8 fixtures with CEE listed Reduced Wattage 4' T8 (straight or U shaped) lamps, or Reduced Wattage T8' (RWT8) lamps as listed below. nn Relamp existing T5 or T5HO fixtures with Reduced Wattage 4' T5 or T5HO lamps as listed below. nn Relamp existing CFL or HID fixtures with Reduced Wattage alternatives as listed below. nn Unless noted below, these lamp only incentives may be combined with fixture incentives found in the other sections of this application Equipment Type 4' T8 Reduced wattage CEE listed 8' T8 Reduced wattage 4' T5 Reduced wattage 4' T5HO Reduced wattage Specifications and Required Information Replace existing 4' 32W T8 lamps with: q 25W 4' T8 q 28W 4' T8 (Cannot be combined with 4' RWT8 system incentives listed on page 4) Replace existing 8' 59W T8 lamps with: q 49W 8' T8 q 51W 8' T8 q 54W 8' T8 Replace existing 4' 28W T5 lamps with: q 26W 4' T5 Replace existing 4' 54W T5HO lamps with: q 44W 4' T5HO q 49W 4' T5HO q 51W 4' T5HO q 47W 4 T5HO q 50W 8' T8 Incentive $1/Lamp $1/Lamp $1/Lamp $1/Lamp Quantity Subtotal

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

REPLACEMENT LAMPS (continued) Equipment Type Reduced Wattage CFL Pin-based Lamps Reduced Wattage HID Direct Replacement Lamps (does not require new ballast) 18W replacement: q 14W q 15W q 16W Specifications and Required Information Replace existing pin-based CFL lamps with Reduced Wattage alternative: 26W replacement: q 21W q 23W 32W replacement: q 27W q 28W 42W replacement: q 33W q 38W $1/Lamp Incentive Quantity Subtotal

Replace existing standard HID lamps with Reduced Wattage alternative PSMH or CMH lamps. Installation area: q Interior q Exterior q Parking Garage 1000W replacement: q 83OW 400W replacement: q 33OW q 360W 320W replacement: q 260W 250W replacement: q 220W q 205W 175W replacement: q 150W q 145W $10/Lamp

INTERIOR LIGHTING AND CONTROLS Interior Fixtures CFL, Low-Wattage Ceramic Metal Halide (CMH) and LED nn Install permanently-wired new fixtures replacing incandescent fixtures. New fixtures include housing, trim, reflector, lens, (plus heat sink, driver and light source for LED). Replacement lamps are not eligible for these incentives. nn LED products must appear on one of the following qualified product lists (product type must match category for listing and indicate that it is intended for commercial use): ENERGY STAR Qualified product list for Commercial LED Downlights or Accent Lights categories, OR the DesignLights Consortium (DLC) qualified product list for Track or Monopoint Directional fixtures, OR be listed on the Focus on Energy qualified product list for LED Downlight over 19W. nn A manufacturers specification sheet must be attached to this application when submitted. Low voltage and other decorative LED fixtures do not qualify for this incentive but may be considered for custom incentives. Please see http://www.focusonenergy.com/business/efficient-equipment for more information. Equipment Type Pin-based CFL Fixtures CMH Fixtures 20-70W LED Fixtures 18 Watts or Less ENERGY STAR Qualified or DLC Listed LED Fixtures 19W or Greater ENERGY STAR Qualified DLC Listed or Focus QPL Specifications and Required Information Replace incandescent fixtures with permanentlywired, new fixtures containing pin-based CFL lamps. Replace incandescent fixtures with permanentlywired, new fixtures containing qualified CMH lamp and electronic CMH ballast. ENERGY STAR Commercial Listed q Downlight q Accent Light Incandescent Wattage Removed___________ Incandescent Wattage Removed___________ Incentive $15/Unit $25/unit Quantity Subtotal

Replace 60-100W incandescent with qualified LED fixture: (check one) DLC listed q Track or Monopoint Directional Fixture $15/unit

Replace incandescent fixture greater than 100W OR HID 50W to 100W (lamp) with: (check one) ENERGY STAR Commercial Listed: q Downlight q Accent Light DLC listed : q Track Fixture Focus QPL: q Downlight

$30/unit

Linear Fixtures 2' x 4' High Performance Troffers Fluorescent and LED nn Install a new High Performance Troffer 2' x 4' recessed fixture replacing an existing 2' x 4' recessed troffer fixture containing 3 or 4 lamp 4' T8 or T12 lamps. nn Please reference qualified product list at focusonenergy.com/business/efficient-equipment or call 800.762.7077 to verify eligibility. Requirements for Linear Fluorescent Products nn T8 lamps and ballast must be listed on CEE High Performance or Reduced Wattage T8 list to qualify. T5 fixtures must contain 2 F28T5 lamps (T5HO are not eligible for prescriptive incentives). nn Must be a new fixture or complete retrofit unit incorporating advanced lighting distribution and high performance lensing. nn Specular reflector kits are not eligible for this incentive. nn Fixture efficiency must be 80% or greater and must appear on qualified product list. Requirements for LED Products nn LED products must be DLC listed as Linear panel (2' x 4' troffer), consume 55 watts, and produce 4000 lumens to qualify for this incentive and must utilize a diffuse or translucent lensing material. nn The following product types do not qualify for this incentive but may be eligible for custom incentives: DLC listed LED Troffer retrofit kits (including lamp-style and integrated-style), LED linear replacement lamps (tubes), and other LED troffer configurations (1' x 4', 2' x 2'). Please see focusonenergy.com/business/lighting.aspx for more information. Equipment Type
2 lamp F28T5 2' x 4' High Performance Troffer 2 lamp HPT8 or RWT8 2' x 4' High Performance Troffer DLC listed LED 2' x 4' Troffer 55W, 4000 lumens
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Specifications and Required Information


Fixture Model #_____________________________________________________ Fixture Model #_____________________________________________________ Ballast Model#____________________ Lamp Model #______________________ Fixture Model #_____________________________________________________

Incentive
$10/Fixture $10/Fixture $15/Fixture

Quantity

Subtotal

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

INTERIOR LIGHTING AND CONTROLS (continued) Bi-Level Stairwell/Passageway Fixtures nn Replace existing 2 lamp 4' fluorescent fixture with complete, new linear fluorescent or LED fixtures manufactured with fixture-integrated occupancy sensors that control the individual fixture. nn New fluorescent fixtures must contain Programmed-Start electronic ballasts and if fixtures contain 4' T8 lamps, must be CEE listed HPT8 or RWT8 to qualify. nn LED fixtures must be DLC listed as Stairwell or Passageway category and operate at 55W in high/occupied state.. nn Must include a passive infrared and/or ultrasonic occupancy sensor with a fail-safe feature (fails in on position in case of sensor failure). nn Fixtures must operate in low-standby light level during vacancy and switch to full light output upon occupancy. The fixture cannot exceed 50 percent of full wattage during unoccupied periods. nn Fixtures whose settings can be overridden are not eligible. Screw-in lamps are not eligible. These fixture incentive MAY NOT be combined with additional incentives for Controls, Fixtures or Linear Fluorescent system upgrades. nn A manufacturers specification sheet must be attached to this application when submitted. Equipment Type Linear Fluorescent Stairwell or Passageway Fixture Specifications and Required Information Fixture Model #_________________________________________________ Incentive $15/Fixture $20/Fixture Quantity Subtotal

DLC Listed LED Stairwell or Passageway Fixture Fixture Model #_________________________________________________

LED Dock Light Fixture nn Install a LED dock light fixture replacing an incandescent loading dock fixture. Must be a complete replacement luminaire unit, including housing, trim, optics, lens, heat sink, driver and LED light source (may be installed on existing swing arm). Must be listed on the LED qualified dock light product list posted at focusonenergy.com/ business/efficient-equipment. nn Please indicate wattage of incandescent replaced and weekly hours of use in spaces provided on page below. Equipment Type LED Dock Light Fixture Specifications and Required Information Incandescent /halogen wattage replaced (Check one): q 75W q 90W q 150W q 300W Incentive $25/Fixture Quantity Subtotal

q Other: ____________________________ Hours used per week: ________ Lighting Controls Occupancy Sensors (Non-High Bay) nn Install Ultrasonic or Passive Infrared sensor controlling non-high bay fixture types. Socket based occupancy sensors do not qualify. nn Rapid or programmed start ballasts are recommended for fluorescent fixtures to extend lamp life. nn Sensors may control more than one fixture. nn Timers do not qualify for prescriptive incentives, but may be eligible for custom incentives. nn A manufacturers specification sheet must be attached to this application when submitted. Equipment Type Fixture Mounted Sensor Specifications and Required Information Quantity of sensors controlling 200W or less each _______________________ Quantity of sensors controlling over 200W each _________________________ Wall Mounted Sensor Quantity of sensors controlling 200W or less each _______________________ Quantity of sensors controlling over 200W each _________________________ Quantity of sensors controlling 500W or less each _______________________ Ceiling Mounted Sensor Quantity of sensors controlling 501-1000W each ________________________ Quantity of sensors controlling over 1000W ____________________________ $15/Sensor $7.50/Sensor Incentive $5/Sensor Quantity Subtotal

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

INTERIOR LIGHTING AND CONTROLS (continued) 4' Linear Fluorescent High Performance T8 (HPT8) or Reduced-Wattage T8 (RWT8) Systems Replace 4' T12, or upgrade standard T8 system with a 4' High Performance T8 (HPT8) OR 4' Reduced Wattage T8 (RWT8) system. Lamps & ballast must meet the guidelines below or system will not qualify for ANY incentive. Please call 800.762.7077 with any eligibility or product qualification questions prior to initiating project. nn All components (ballasts and lamps) must be CEE listed. High Performance T8 and Reduced Wattage T8 qualified product lists posted at focusonenergy.com/ business/efficient-equipment. Requirements for HPT8 Systems nn High Performance T8 systems must contain high lumen, long life F32T8 lamps and be listed on CEE High Performance T8 list. nn Must be paired with LOW ballast factor (BF) ballast (0.78 Ballast Factor) from the CEE High Performance T8 OR Reduced Wattage T8 qualified product lists. nn HPT8 paired with normal BF or high BF may qualify for custom incentives. Please call 800.762.7077 to speak with a representative. Requirements for RWT8 Systems nn Reduced Wattage T8 systems must contain 25W or 28W T8 (straight or U shaped) lamps and be listed on CEE Reduced Wattage T8 lamp list. nn Qualified lamps (above) must be paired with either a NORMAL OR LOW Ballast Factor ballast from the CEE High Performance T8 OR Reduced Wattage T8 qualified product lists nn This incentive MAY NOT be combined with the Reduced-wattage T8 replacement lamp incentive on page 2. Equipment Replaced/ Upgraded Specifications and Required Information HPT8 System 32W HPT8 with CEE listed LOW Ballast Factor Ballast Lamp Model# _______________ Ballast Model# _____________________ 4' 1 Lamp T12 or Standard T8 System RWT8 System with CEE listed NORMAL Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _______________ Ballast Model# _____________________ RWT8 System with CEE listed LOW Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _______________ Ballast Model# _____________________ HPT8 System 32W HPT8 with CEE listed LOW Ballast Factor Ballast Lamp Model# _________________ Ballast Model# ___________________ 4' 2 Lamp T12 or Standard T8 System RWT8 System with CEE listed NORMAL Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _________________ Ballast Model# ___________________ RWT8 System with CEE listed LOW Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _________________ Ballast Model# ___________________ HPT8 System 32W HPT8 with CEE listed LOW Ballast Factor Ballast Lamp Model# _________________ Ballast Model# ___________________ 4' 3 Lamp T12 or Standard T8 System RWT8 System with CEE listed NORMAL Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _________________ Ballast Model# ___________________ RWT8 System with CEE listed LOW Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _________________ Ballast Model# ___________________ HPT8 System 32W HPT8 with CEE listed LOW Ballast Factor Ballast Lamp Model# _________________ Ballast Model# ___________________ 4' 4 Lamp T12 or Standard T8 System RWT8 System with CEE listed NORMAL Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _________________ Ballast Model# ___________________ RWT8 System with CEE listed LOW Ballast Factor Ballast q 4' 25W T8 q 4' 28W T8 Lamp Model# _________________ Ballast Model# ___________________ $7/Fixture $6/Fixture $6/Fixture $5/Fixture $5/Fixture Incentive $3/Fixture $3/Fixture Quantity Subtotal

$4/Fixture

$4/Fixture

$4/Fixture

$5/Fixture

$6/Fixture

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

INTERIOR LIGHTING AND CONTROLS (continued) Delamping Incentive Permanently Reduce the Number of 4' Fluorescent Lamps in Upgraded Fixtures nn This offer is in addition to the above measure where the number of fixtures is staying the same pre- and post- retrofit, but one or more lamps are permanently removed from the fixture. nn Overall wattage in each fixture must be reduced and must include system upgrade to HPT8 or RWT8 as listed above if replacing T12 system. Projects that include a change in fixture quantity may qualify for custom incentives. Please call 800.762.7077 to speak with a program representative. nn If existing fixture type is T8 with compatible electronic ballast, then ballast replacement/upgrade is not required, but must include HPT8 or RWT8 lamp installation. nn Removal of lamps in non-operational fixtures does not qualify. nn Focus on Energy reserves the right to complete a pre-inspection prior to issuing a Reservation Code. Reservation Code is required. nn Contact 800.762.7077 to speak with a program representative. Reservation Code____________ Existing Lamps/Fixture q 4 Lamp q 3 Lamp q 2 Lamp Existing Fixture Type q T12 q T8 q T12 q T8 q T12 q T8 Proposed Lamps/Fixture q 3 Lamp q 2 Lamp q 1 Lamp q 2 Lamp q 1 Lamp q 1 Lamp Replacement System Type q RWT8 q HPT8 q RWT8 q HPT8 q RWT8 q HPT8 $2/ Lamp Removed Quantity of Fixtures Upgraded Total Number of Lamps Removed per Fixture Incentive Subtotal

Replace or Retrofit 8' T12 Fixtures with 4' HPT8 or RWT8 Systems nn Replace or retrofit standard 8' T12 systems with 4' High Performance T8 or Reduced Wattage T8 systems in configurations described below. Please read carefully. If fixture configuration is not one for one replacement, or differs from line items please call 800.762.7077 for assistance. nn All components (ballasts and lamps) must be CEE listed. High Performance T8 OR Reduced Wattage T8 qualified product lists posted at focusonenergy.com/ business/efficient-equipment. nn 4' Reduced Wattage T8 lamps are eligible to claim additional incentive from page 2. nn Please indicate check appropriate boxes below to indicate lamp and ballast type installed and list model numbers for each in blanks provided (check ballast factor as defined by CEE qualified products list category). nn LOW ballast factor ballast used to replace 8' HO or VHO systems requires a customer sign off on the light level, see below. Equipment Type Specifications and Required Information CEE listed NORMAL Ballast Factor Ballast with: q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ CEE listed LOW Ballast Factor Ballast with: q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ CEE listed NORMAL Ballast Factor Ballast with: q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ CEE listed LOW Ballast Factor Ballast with: q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ CEE listed Ballast: q HIGH Ballast Factor q NORMAL Ballast Factor q LOW Ballast Factor LAMP: (Check one) q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ CEE listed Ballast: q HIGH Ballast Factor q NORMAL Ballast Factor q LOW Ballast Factor LAMP: (Check one) q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ CEE listed Ballast: q HIGH Ballast Factor q NORMAL Ballast Factor q LOW Ballast Factor LAMP: (Check one) q HPT8 32W q RWT8 25W q RWT8 28W Lamp Model# __________________ Ballast Model# ____________________ Incentive $5/Fixture Quantity Subtotal

2 Lamp 4' T8 System Replacing 8' 1 Lamp T12

$6/Fixture $10/Fixture

4 Lamp 4' T8 System Replacing 8' 2 Lamp T12

$11/Fixture

2 Lamp 4' T8 System Replacing 8' 1 Lamp T12HO 4 Lamp 4' T8 System Replacing 8' 2 Lamp T12HO 4 Lamp 4' T8 System Replacing 8' 2 Lamp T12VHO

$10/Fixture

$20/Fixture

$40/Fixture

LIGHT LEVEL CERTIFICATION (For replacing 8' T12 HO or VHO with low ballast factor T8) I agree that the low ballast factor ballast lighting is adequate without the need for additional task lighting. Customer Signature: Customer Name (Print): Date:

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

HIGH BAY LIGHTING AND CONTROLS High Bay/Low Bay Lighting Fluorescent, Metal Halide, Induction or LED Fixtures nn Replace High intensity discharge (HID) lamp wattages listed with permanently wired, high/low bay fixture or retrofit kit in one of the technologies listed below. nn Please read carefully. If fixture configuration is not one-for-one replacement, or differs from line items please call 800.762.7077 for eligibility. nn Fixture mounting height must be 12' for indoor applications. nn High bay fluorescent fixtures must include specular/mirror or white reflector system for correct photometric distribution for high/low bay use. nn All products must be intended for use in High Bay or Low Bay applications. Manufacturers specification sheet is required and must indicate that it is intended for high/low bay use. nn LED product eligibility limited to products that appear on Design Lights Consortium qualified products list in a High Bay or Low Bay product category. nn Must be permanently wired. Screw-based lamp retrofit products of any technology are not eligible for this incentive, but may be considered for a custom incentive please call 800.762.7077 for assistance. nn Product categories listed below do not imply equivalency all installations are expected to meet current IESNA recommendations for delivered light level and uniformity. Compliance is the responsibility of the installer. Equipment Type Specifications and Required Information Pulse Start or Ceramic Metal Halide High Bay fixture (Check one): q 125W q 140W q 150W Induction High Bay fixture (Check one): q 120W or q 125W q 150W or q 165W Replacing 250 399W HID (lamp wattage) High bay fluorescent 155W total fixture Watts (Check one): q 4 lamp T8 q 2 lamp T5HO q 3 lamp T5HO q Other T8 or T5HO 155W total fixture Watts (List type and wattage)__________________________________________ DLC listed LED High Bay fixture 155W total fixture Watts (List wattage)_________________________________________________ Pulse Start or Ceramic Metal Halide High Bay fixture (Check one): q 250W q 270W q 315W q 320W Induction High Bay fixture (Check one): q 250W or q 300W Replacing 400W HID (lamp wattage) High bay fluorescent 365W total fixture Watts (Check one): q 8 lamp T8 q 6 lamp T5HO q Other T8 or T5HO 365W total fixture Watts (List type and wattage)__________________________________________ DLC listed LED High Bay fixture 365W total fixture Watts (List wattage)________________________________________________ Pulse Start or Ceramic Metal Halide High Bay fixture (Check one): q 200W or q 210W q 220W Induction High Bay Fixture: q 200W Replacing 400W HID (lamp wattage) High bay fluorescent 250W total fixture Watts (Check one): q 6 lamp T8 q 4 lamp T5HO q Other T8 or T5HO less than 250 Watts (List type and wattage)__________________________________________ DLC listed LED High Bay fixture 250W total fixture Watts (List wattage):_________________________________________________ Pulse Start or Ceramic Metal Halide High Bay fixture: q 575W Induction High Bay Fixture: q 750W High Bay fluorescent 800W total fixture Watts (Incentive is per HID fixture replaced. If replacing one HID with two high bay fixtures, wattage must be within specified range) (Check one): q (two) 6 lamp T5HO fixtures/HID replaced q Other T8 or T5HO between 500W and 800W (List type and wattage)___________________________________________ q One DLC listed LED High Bay fixture 800W total fixture Watts q Two DLC listed LED High Bay fixture 800W total fixture Watts (List wattage) _________________________________________________
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Incentive

Quantity

Subtotal

$35/Fixture Replaced

$35/Fixture Replaced

$60/Fixture Replaced

Replacing 1000W HID (lamp wattage)

$60/Fixture Replaced

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

HIGH BAY LIGHTING AND CONTROLS (continued) Equipment Type Specifications and Required Information High bay fluorescent 500W total fixture Watts (Incentive is per HID fixture replaced. If replacing one HID with two high bay fixtures, wattage must be within specified range.) (Check one): q 6 lamp T5HO q 8 lamp T5HO q 8 lamp T8 q 10 lamp T8 q (two) 4 lamp T5HO fixtures/HID replaced q (two) 6 lamp T8 fixtures/HID replaced q Other T8 or T5HO less than 500 Watts (List type and wattage)__________________________________________ q One DLC listed LED High Bay fixture 800W total fixture Watts q Two DLC listed LED High Bay fixture 800W total fixture Watts (List wattage)________________________________________________ High Bay Occupancy Sensor Control nn Add ultrasonic or passive Infrared sensor to control high bay fixtures listed above. May be either high/low OR on/off controls as listed below. nn Sensors may control more than one fixture; please indicate wattage controlled per sensor in space provided. nn Socket based occupancy sensors do not qualify. Timers do not qualify for prescriptive incentives, but may be eligible for custom incentives. nn Control costs must be itemized separately on invoice. Incentive may not exceed purchase price of controls. Incentives may NOT be combined with any other control incentive. nn A manufacturers specification sheet must be attached to this application when submitted. Equipment Type Add High/Low Control Add Fixture Mounted On/Off Occupancy Control Specifications and Required Information Total Wattage Controlled __________________________________________ Incentive $15/Controlled Fixture Quantity Subtotal Incentive Quantity Subtotal

Replacing 1000W HID (lamp wattage)

$100/Fixture Replaced

Total Wattage Controlled __________________________________________

EXTERIOR LIGHTING AND CONTROLS Exterior and Parking Garage Bi-Level Controls nn Controls must be occupancy or occupancy schedule based and may include dimming, stepped dimming, or high-low ballast controls nn If a passive infrared and/or ultrasonic occupancy sensors are used to control light level, it must have a fail-safe feature (fails in on position in case of sensor failure). nn Fixtures must operate in low-standby light level during periods of low occupancy. The fixture cannot exceed 50% of full wattage during unoccupied periods. Fixtures whose settings can be overridden are not eligible. nn A manufacturers specification sheet for all bi-level control components must be submitted with this application Equipment Type Exterior Lighting Bi-Level Controls Specifications and Required Information Wattage of Fixtures Controlled ____________________________ Wattage of Fixtures Controlled: ____________________________ Control type: (Check one) q Dimming q Stepped Dimming q High/Low Control type: (Check one) q Dimming q Stepped Dimming q High/Low Incentive $10/Controlled Fixture Quantity Subtotal

Parking Garage Bi-Level Lighting Controls

$10/Controlled Fixture

Exterior Lighting: Twist Lock/Fixture-Mounted Photocell with Integrated Timer or Wireless Remote Schedule Control nn Incentive is for installing fixture-mounted twist lock or other schedulable lighting controls on exterior lighting to reduce the run hours of the connected fixtures during periods of low/no occupancy during overnight hours. nn Eligibility limited to HID, LED, induction, and fluorescent technologies nn The scheduled controls must turn the fixtures off for a minimum of 4 hours per night. nn Controls may also incorporate an occupancy sensor override for security/safety lighting if necessary. nn Incentive may be combined with exterior bi-level controls (above) if settings are programmed to utilize both scheduled reduction in hours and bi-level control. nn A manufacturers specification sheet and control setting documentation must be attached to this application when submitted. Equipment Type Twist Lock or Other Fixture Mounted Photocell with Integral Timer Wireless Remote-Based Schedulable Controls Specifications and Required Information Wattage of Fixtures Controlled: __________________________ Wattage of Fixtures Controlled: __________________________ Incentive $10/Controlled Fixture Quantity Subtotal

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

EXTERIOR LIGHTING AND CONTROLS (Continued) Pole-Mounted Exterior Lighting Fixtures LED, Induction, and Pulse Start or Ceramic Metal Halide (CMH) or Linear Fluorscent To qualify for incentive, complete luminaire unit including housing, trim, reflector, lens, heat sink, driver or ballast, and light source must be installed. Retrofit projects must replace existing HID fixtures with qualified, complete luminaire unit or hardwired retrofit kit. Manufacturer specification sheet is REQUIRED. nn LED products must appear on Design Lights Consortium (DLC) qualified products list, and must be listed within the category for which they are being installed. Lists can be found at focusonenergy.com/business/efficient-equipment. nn Project must result in at least a 40% wattage reduction from existing HID fixtures for all LED fixture types. nn Product categories listed below do not imply equivalency all installations are expected to meet current IESNA recommendations for delivered light level and uniformity. Compliance is the responsibility of the installer. nn Other fixtures may be considered for custom incentives, please call 800.762.7077 for assistance. Equipment Replaced/Upgraded Specifications and Required Information Induction Pole Mounted Fixture or Retrofit: q 35W-55W 70-100W HID Linear Fluorescent Pole Mounted Fixture 60 watts of the following configurations (Check one): q 4' 2 Lamp T8 q 4' 2 Lamp T8 DLC listed LED Pole Mounted Roadway or Decorative Fixture or Retrofit (Outdoor Pole/Arm-Mounted /Area Category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Pole Mounted Fixture or Retrofit: q 100W Induction Pole Mounted Fixture or Retrofit: q 100W 150W or 175W HID Linear Fluorescent Pole Mounted Fixture 120 watts of the following configurations (Check one): q 4' 3 Lamp T8 q 4' 2 Lamp T5HO q 2' 4 Lamp T5HO DLC listed LED Pole Mounted Roadway or Decorative Fixture or Retrofit (Outdoor Pole/Arm-Mounted /Area Category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Pole Mounted Fixture or Retrofit (Check one): q 125W q 140W q 150W Induction Pole Mounted Fixture or Retrofit (Check one): q 120-125W q 150W q 165W 250W HID Linear Fluorescent Pole Mounted Fixture 155 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC listed LED Pole Mounted Roadway or Decorative Fixture or Retrofit (Outdoor Pole/Arm-Mounted /Area Category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Pole Mounted Fixture or Retrofit (Check one): q 200W q 210W q 220W Induction Pole Mounted Fixture or Retrofit (Check one): q 200W q 225W q 250W 400W HID Linear Fluorescent Pole Mounted Fixture 250 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC listed LED Pole Mounted Roadway or Decorative Fixture or Retrofit (Outdoor Pole/Arm-Mounted /Area Category listed): Model #: __________________________ Installed Wattage: _________________ $60/Fixture $50/Fixture $50/Fixture $40/Fixture $40/Fixture $20/Fixture $15/Fixture Incentive Quantity Subtotal

$20/Fixture

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

EXTERIOR LIGHTING AND CONTROLS (Continued) Wall-Mounted Exterior Lighting Fixtures - LED, Induction, Linear Fluorescent and Pulse Start or Ceramic Metal Halide (CMH) or Linear Fluorescent To qualify for incentive, complete luminaire unit including housing, trim, reflector, lens, heat sink, driver or ballast, and light source must be installed. Retrofit projects must replace existing HID fixtures with qualified, complete luminaire unit or hardwired retrofit kit. Manufacturer specification sheet is REQUIRED. nn LED products must appear on Design Lights Consortium (DLC) qualified products list, and must be listed within the category for which they are being installed. Lists can be found at focusonenergy.com/business/efficient-equipment. nn Project must result in at least a 40% wattage reduction from existing HID fixtures for all LED fixture types. nn Product categories listed below do not imply equivalency all installations are expected to meet current IESNA recommendations for delivered light level and uniformity. Compliance is the responsibility of the installer. nn Other fixtures may be considered for custom incentives, please call 800.762.7077 for assistance. Equipment Replaced/Upgraded Specifications and Required Information Induction Wall-Pack Fixture or Retrofit: q 35W-55W 70-100W HID Linear Fluorescent Wall-Pack Fixture 60 watts of the following configurations (Check one): q 4' 2 Lamp T8 q 4' 2 Lamp T8 DLC Listed Wall Mounted LED Fixture or Retrofit (Outdoor Wall-mounted Area Luminaires Category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Wall-Pack Fixture or Retrofit: q 100W Induction Wall-Pack Fixture or Retrofit: q 100W 150W or 175W HID Linear Fluorescent Wall-Pack Fixture 120 watts of the following configurations (Check one): q 4' 3 Lamp T8 q 4' 2 Lamp T5HO q 2' 4 Lamp T5HO DLC Listed LED Wall Mounted Fixture or Retrofit (Outdoor Wall-mounted Area Luminaires Category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Wall-Pack Fixture (Check one): q 125W q140W q 150W Induction Wall-Pack Fixture or Retrofit (Check one): q 120-125W q 150W q165W 250W HID Linear Fluorescent Wall-Pack Fixture 155 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC Listed LED Wall Mounted Fixture or Retrofit (Outdoor Wall-mounted Area Luminaires Category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Wall-Pack Fixture or Retrofit (Check one): q 200W q 210W q 220W Induction Wall-Pack Fixture or Retrofit: (Check one): q 200W q 225W q 250W 400W HID Linear Fluorescent Wall-Pack Fixture 250 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC Listed LED Wall Mounted Fixture or Retrofit (Outdoor Wall-mounted Area Luminaires Category listed): Model #: __________________________ Installed Wattage: _________________ $60/Fixture $50/Fixture $50/Fixture $40/Fixture $40/Fixture $20/Fixture Incentive $15/Fixture Quantity Subtotal

$20/Fixture

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

EXTERIOR LIGHTING AND CONTROLS (Continued) Parking Garage and Low Canopy Exterior Lighting Fixtures LED, Induction, Linear Fluorescent and Pulse Start or Ceramic Metal Halide (CMH) or Linear Fluorescent To qualify for incentive, complete luminaire unit including housing, trim, reflector, lens, heat sink, driver or ballast, and light source must be installed. Retrofit projects must replace existing HID fixtures with qualified, complete luminaire unit or hardwired retrofit kit. Manufacturer spec sheet is REQUIRED. nn LED products must appear on Design Lights Consortium (DLC) qualified products list, and must be listed within the category for which they are being installed. Lists can be found at focusonenergy.com/business/efficient-equipment. nn Project must result in at least a 40% wattage reduction from existing HID fixtures for ALL LED fixture types, nn Product categories listed below do not imply equivalency all installations are expected to meet current IESNA recommendations for delivered light level and uniformity. Compliance is the responsibility of the installer nn Other fixtures may be considered for custom incentives, please call 800.762.7077 for assistance. Required Existing Equipment Information Existing Fixture Type:_______________________ Wattage: ______________ Hours of Operation: q Dusk to Dawn Equipment Replaced/Upgraded Specifications and Required Information Induction Parking Garage or Low Canopy Fixture or Retrofit: q35W-55W 70-100W HID Linear Fluorescent Parking Garage or Low Canopy Fixture 60 watts of the following configurations (Check one): q4' 2 Lamp T8 q4' 2 Lamp T8 DLC listed LED Parking Garage or Low Canopy Fixture or Retrofit (Parking garage category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Parking Garage or Low Canopy Fixture or Retrofit: q 100W Induction Parking Garage or Low Canopy Fixture or Retrofit: q 100W 150W or 175W HID Linear Fluorescent Parking Garage or Low Canopy Fixture 120 watts of the following configurations (Check one): q 4' 3 Lamp T8 q 4' 2 Lamp T5HO q 2' 4 Lamp T5HO DLC listed LED Parking Garage or Low Canopy Fixture or Retrofit (Parking garage category listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Parking Garage or Low Canopy Fixture or Retrofit (Check one): q 125W q 140W q 150W Induction Parking Garage or Low Canopy Fixture or Retrofit (Check one): q 120-125W q 150W q 165W Linear Fluorescent Parking Garage or Low Canopy Fixture 155 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC listed LED Parking Garage or Low Canopy Fixture (Parking garage category listed): Model #: __________________________ Installed Wattage: _________________ $50/Fixture $40/Fixture $40/Fixture $20/Fixture $15/Fixture q Other:____________________(hours/day) Quantity Subtotal

Incentive

$20/Fixture

250W HID

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

EXTERIOR LIGHTING AND CONTROLS (Continued) Fuel and High Canopy Exterior Lighting Fixtures - LED, Induction, Linear Fluorescent and Pulse Start or Ceramic Metal Halide (CMH) or Linear Fluorescent To qualify for incentive, complete luminaire unit including housing, trim, reflector, lens, heat sink, driver or ballast, and light source must be installed. Retrofit projects must replace existing HID fixtures with qualified, complete luminaire unit or hardwired retrofit kit. Manufacturer spec sheet is REQUIRED. nn LED products must appear on Design Lights Consortium (DLC) qualified products list, and must be listed within the category for which they are being installed. Lists can be found at focusonenergy.com/business/efficient-equipment. nn Project must result in at least a 40% wattage reduction from existing HID fixtures for ALL LED fixture types, nn Product categories listed below do not imply equivalency all installations are expected to meet current IESNA recommendations for delivered light level and uniformity. Compliance is the responsibility of the installer nn Other fixtures may be considered for custom incentives, please call 800.762.7077 for assistance. Equipment Replaced/Upgraded Specifications and Required Information Pulse Start or Ceramic Metal Halide Fuel Canopy or High Canopy Fixture or Retrofit: q 100W 150W or 175W HID Induction Fuel Canopy or High Canopy Fixture or Retrofit: q 100W Linear Fluorescent Fuel Canopy or High Canopy Fixture 120 watts of the following configurations (Check one): q 4' 3 Lamp T8 q 4' 2 Lamp T5HO q 2' 4 Lamp T5HO DLC listed LED Fuel Canopy or High Canopy Fixture or Retrofit (Fuel canopy listed): Model #: __________________________ Installed Wattage: ________________ Pulse Start or Ceramic Metal Halide Fuel Canopy or High Canopy Fixture or Retrofit (Check one): q 125W q 140W q 150W 250W HID Induction Fuel Canopy or High Canopy Fixture or Retrofit (Check one): q 120-125W q 150W q 165W Linear Fluorescent Fuel Canopy or High Canopy Fixture 155 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC listed LED Fuel Canopy or High Canopy Fixture or Retrofit (Fuel canopy listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Fuel Canopy or High Canopy Fixture or Retrofit (Check one): q 200W q 210W q 220W 320W or 400W HID Induction Fuel Canopy or High Canopy Fixture or Retrofit (Check one): q 200W q 225W q 250W Linear Fluorescent Fuel Canopy or High Canopy Fixture 250 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC listed LED Fuel Canopy or High Canopy Fixture or Retrofit (Fuel canopy listed): Model #: __________________________ Installed Wattage: _________________ $60/Fixture $50/Fixture $50/Fixture $40/Fixture $40/Fixture $20/Fixture Incentive Quantity Subtotal

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY.
This application expires March 31, 2014. Return signed, completed application and itemized invoice postmarked within 60 calendar days of project installation, unless an earlier date is specified by Focus on Energy. Focus on Energy incentives are subject to change. Please visit focusonenergy.com/business to ensure you are using the most current form. Questions: Call 800.762.7077. Send us your feedback: focusonenergy.com/survey.

EXTERIOR LIGHTING AND CONTROLS (Continued) Exterior Flood Lighting Fixtures - LED, Induction, Linear Fluorescent and Pulse Start or Ceramic Metal Halide (CMH) or Linear Fluorescent To qualify for incentive, complete luminaire unit including housing, trim, reflector, lens, heat sink, driver or ballast, and light source must be installed. Retrofit projects must replace existing HID fixtures with qualified, complete luminaire unit or hardwired retrofit kit. Manufacturer spec sheet is REQUIRED. nn LED products must appear on Design Lights Consortium (DLC) qualified products list, and must be listed within the category for which they are being installed. Lists can be found at focusonenergy.com/business/efficient-equipment. nn Project must result in at least a 40% wattage reduction from existing HID fixtures for ALL LED fixture types, nn Product categories listed below do not imply equivalency all installations are expected to meet current IESNA recommendations for delivered light level and uniformity. Compliance is the responsibility of the installer nn Other fixtures may be considered for custom incentives, please call 800.762.7077 for assistance. Equipment Specifications and Required Information Incentive Quantity Subtotal Replaced/Upgraded Induction Floodlight Fixture or Retrofit: q 35W-55W 70-100W HID Linear Fluorescent Floodlight Fixture 60 watts of the following configurations (Check one): q 4' 2 Lamp T8 q 4' 2 Lamp T8 DLC Listed LED Floodlight Fixture or Retrofit (Architectural flood and spotlighting listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Floodlight Fixture or Retrofit: q 100W Induction Floodlight Fixture or Retrofit: q 100W 150W or 175W HID Linear Fluorescent Floodlight Fixture 120 watts of the following configurations (Check one): q 4' 3 Lamp T8 q 4' 2 Lamp T5HO q 2' 4 Lamp T5HO DLC Listed LED Floodlight Fixture or Retrofit (Architectural flood and spot lighting listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Floodlight Fixture (Check one): q 125W q 140W q 150W Induction Floodlight Fixture or Retrofit (Check one): q 120-125W q 150W q 165W Linear Fluorescent Floodlight Fixture 155 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC Listed LED Floodlight Fixture or Retrofit (Architectural flood and spot lighting listed): Model #: __________________________ Installed Wattage: _________________ Pulse Start or Ceramic Metal Halide Floodlight Fixture or Retrofit (Check one): q 200W q 210W q 220W Induction Floodlight Fixture or Retrofit (Check One): q 200W q 225W q 250W Linear Fluorescent Floodlight Fixture 250 watts of the following configurations (Check one): q 4' 4 Lamp T8 q 2' 4 Lamp T5HO DLC Listed LED Floodlight Fixture or Retrofit (Architectural flood and spot lighting listed): Model #: __________________________ Installed Wattage: _________________ $60/Fixture $50/Fixture $50/Fixture $40/Fixture $20/Fixture $15/Fixture $20/Fixture

$40/Fixture

250W HID

400W HID

TOTAL INCENTIVE REQUESTED: Incentives not to exceed cost of the product.

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY. FOCUS ON ENERGY PROGRAM INFORMATION AND REQUIREMENTS
Any project with an expected incentive exceeding $25,000 must receive written approval BEFORE project initiation or equipment purchase. Check the Focus on Energy Web site at focusonenergy.com/business or call 800.762.7077 for more information.

Prescriptive Incentives

Custom Incentives

If your project does not fit the descriptions on this prescriptive incentive application form, it may qualify for a custom incentive which requires approval prior to project initiation and ordering equipment or issuing purchase orders. Direct inquiries to 800.762.7077 or visit focusonenergy.com/business.

Trade Ally Information

A Trade Ally represents the company who provided/installed the equipment for a project or performed the service for which a customer is seeking an incentive. Trade Allies who have signed an agreement with Focus on Energy are allowed to enjoy certain program benefits, one of which is to receive direct payment of incentives at your request. Incentives can only be paid directly to a Trade Ally if they have completed and submitted a Trade Ally Application. The FEIN and Business Classification of the Trade Ally is required IF you received your incentive as a credit on your invoice, whereby the incentive is paid directly to the Trade Ally. In this scenario, the credit must be clearly labeled as the Focus on Energy incentive and deducted from the amount due. If your project was completed by more than one Trade Ally (example, equipment was purchased from one Trade Ally but installed by another Trade Ally) and the incentive is being paid to you the customer, please enter the information of the Trade Ally who installed your equipment in Section 4: Trade Ally Information. If the equipment was self-installed, please enter the information of the Trade Ally from whom you purchased the equipment. Focus on Energy works with eligible Wisconsin residents and businesses to install cost effective energy efficiency and renewable energy projects. Focus on Energy information, resources and financial incentives help to implement projects that otherwise would not get completed, or to complete projects sooner than scheduled. Its efforts help Wisconsin residents and businesses manage rising energy costs, promote in-state economic development, protect our environment and control the states growing demand for electricity and natural gas.

FOCUS ON ENERGY GENERAL TERMS AND CONDITIONS


This is a Focus on Energy program application for use by eligible applicants (Applicant). Shaw Environmental and Infrastructure, Inc. is the Program Administrator for Focus on Energy (Program Administrator) and bound by contract to Statewide Energy Efficiency and Renewable Administration, Inc. (SEERA). The Program Administrator, Focus on Energy and the Applicant may be individually referred to herein as a Party and collectively as the Parties.

Section 1. Incentive Offer:

This Application covers products purchased and installed between April 1, 2013 and March 31, 2014. Applications must be postmarked within 60 calendar days of installation and no later than May 31, 2014. The sum of all Focus on Energy prescriptive and custom incentives for participants in the Business Incentive Program and Large Energy Users Program is limited to $200,000 per project and $400,000 per customer per calendar year. The sum of all Focus on Energy prescriptive and custom incentives for participants in the Chain Stores & Franchises Program is limited to $250,000 per project and $500,000 per customer per calendar year. Applicants should maintain a copy of this application for their personal records. Incomplete applications will be returned and will not be processed. This application must have complete information and be submitted with proof of purchase such as invoices that clearly itemize the product(s) and/or services(s) received. Purchase orders, proposals and quotes are not considered proof of purchase..

Section 2. Marketing:

The Applicant shall not use Program Administrators or SEERAs corporate name, logo, identity, any affiliation, or any related logo including the Focus on Energy name, logo, or identity, for any marketing, advertising or solicitation without prior written consent of Focus on Energy. Such written consent may be withheld in Focus on Energys sole discretion. When referencing Focus on Energy involvement with any project, the Applicant shall collaborate with Focus on Energy to prepare any press release and to plan for any news conference and agrees to provide Focus on Energy, for its written approval prior to publication, a written copy of any advertisements or promotional material regarding this program prior to publishing any such advertisements or promotional material. Focus on Energy reserves the right to publicize the Applicants participation in the Focus on Energy program unless a written request is submitted to focusonenergy.marketing@shawgrp.com. Incentives are available on a first-come, first-served basis. This offer is subject to change or termination without notice at the discretion of Focus on Energy. Some Focus on Energy participating electric and/or natural gas providers have incentive programs outside of Focus on Energy. Customers of these providers might not qualify for incentives from both programs. These customers should check with their electric and/or natural gas provider to verify eligibility for dual incentives in order to comply with program rules. Focus on Energy excludes internal labor (i.e. non-contracted labor) for private companies or individuals when calculating total project costs. Applicants who are served by a participating electric provider but not a participating natural gas provider will only qualify for incentives for electric technologies. Applicants who are served by a participating natural gas provider but not a participating electric provider will only qualify for incentives for natural gas technologies. Applicants who have both a qualifying electric provider and a qualifying natural gas provider will qualify for incentives on both electric and natural gas technologies. Applicants who use Liquid Propane (LP) or other non-qualifying fuels will not qualify for incentives for any gas technologies. Focus on Energy reserves the right to change or discontinue this program at any time without notice. Focus on Energy also reserves the right to withhold incentive payment until identified problems with a project are resolved and to withhold or terminate an incentive payment due to any partys failure to follow any and all applicable terms and conditions, rules, or procedures. The acceptance of incentive applications and qualification of systems is determined solely by Focus on Energy and acceptance of this application does not guarantee payment of an incentive. In the event that SEERA terminates, for any cause, Program Administrators contract with SEERA, which terminates Program Administrators right to act as Program Administrator of the Focus on Energy Program, responsibility for this Application shall be transferred to the new Program Administrator.

Section 3. Program Discretion:

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LIGHTING INCENTIVE APPLICATION FOR BUSINESSES


THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY. FOCUS ON ENERGY GENERAL TERMS AND CONDITIONS
Focus on Energy, the Program Administrator, and SEERA (collectively for this section Focus on Energy) do not endorse any particular Trade Ally, manufacturer, product, system, or design by offering an incentive. Focus on Energy is not responsible for any tax liability imposed on the recipient as a result of the payment of incentives. Focus on Energy makes no representation or warranty, and assumes no liability with respect to the quality, safety, performance, or other aspect of any design, consulting, product, system, equipment, or appliance installed or received and expressly disclaims any such representations, warranties, and liability, including, but not limited to, any implied warranties of merchantability or fitness for a particular purpose. Focus on Energy does not guarantee that installation and operation of incentivized measures will result in reduced energy usage or in cost savings. Focus on Energy is not responsible for the proper disposal/recycling of any waste generated as a result of this project. Focus on Energy is not liable for any damages, including any incidental or consequential damages, arising out of the operation or malfunction of the products, equipment, or appliances, or the installation thereof.

Section 4. Disclaimers, Representations, and Warranties:

Section 5. Monitoring, Verification, Record Keeping, and Right to Inspect:

Focus on Energy evaluates program efficacy by monitoring energy use/production prior to and after installation of your energy efficiency or renewable energy project. Focus on Energy, and its designated representatives, shall have the right to monitor energy use/production prior to and after installation of the project or to perform an inspection of project records or the project itself to evaluate program efficacy for a period of two years from the date of incentive payment. The Applicants signature on this application provides Focus on Energy approval to obtain energy data directly from your electric and/or natural gas provider(s). The Applicant and its subcontractors shall maintain accurate records of the project work (e.g., installation records, invoices, and maintenance information) that is performed hereunder for a period of two years from the date of incentive payment.

Section 6. Indemnification:

Applicants agree to protect, indemnify, defend and hold harmless Focus on Energy, Program Administrator, SEERA, the State of Wisconsin and participating utilities, their respective affiliates, subsidiaries, parent companies, officers, directors, agents, and employees, against all losses, damages, expenses, fees, costs and liability arising from any program, design, consulting, product, system, equipment, or appliance. The Applicant agrees that such obligations under this section shall survive any expiration or termination of this Application and shall not be limited by any enumeration herein of required insurance coverage. To the maximum extent permitted by law, the Applicant agrees to limit Program Administrators liability to the Applicant for any reason to the total amount of the payments identified in this Agreement. This limitation shall apply regardless of the cause of action or legal theory pled or asserted. Applicant hereby expressly waives the right to specifically enforce this Application.

Section 7. Misrepresentation:

Making false statements on any Focus on Energy incentive application is punishable by law. Any person who knowingly files an application containing any materially false information or who purposely and misleadingly conceals information commits a fraudulent act that subjects such person to criminal and civil penalties. Any and all funds determined, in Focus on Energys sole discretion, to have been acquired on the basis of fraudulent or misrepresented information must be fully returned to the Focus on Energy program. Should the Applicant or its representative apply for and receive duplicate payment, Focus on Energy reserves the right to recover payments made in excess of the entitled incentive. This section shall not limit other remedies that may be available for the filing of false or fraudulent applications.

Section 8: Miscellaneous:

(1). Governing Law. This Application shall be governed, construed and enforced in accordance with the internal laws of the State of Wisconsin, without regard to any law of conflicts that may direct the application of the laws of another jurisdiction. The Applicant irrevocably submits to the original jurisdiction of the state and federal courts sitting in Madison, Wisconsin with regard to any controversy in any way relating to the execution, delivery or performance of this Application that is not resolved by Arbitration. Suits, claims or actions founded upon such controversies shall be brought or filed exclusively in such courts and nowhere else. The exclusive venue for any dispute or controversy arising under this Agreement shall be the Dane County, Wisconsin Circuit Court or the Federal District Court for the Western District of Wisconsin. (2) Compliance with Applicable Laws. The Applicant shall at all times comply with and observe all federal and Wisconsin state laws and published circulars, local laws, ordinances, rules and regulations which are in effect during the period of this Application and which in any manner affect the performance of this Agreement. This Application shall be construed and enforced, in accordance with the laws of the State of Wisconsin and the laws of the United States. All references to statutes or regulations contained in this Application shall be construed to include successors thereto. (3). Assignment. Focus on Energy may assign, transfer or convey this Application or any of Focus on Energys rights, obligations, interests or responsibilities hereunder, in whole or in part, without the consent of the Applicant. (4). Severability. If any provision of this Application is illegal, invalid, or unenforceable under present or future laws effective during the term of this Application, that provision shall be fully severable and this Application shall be construed and enforced as if the illegal, invalid, or unenforceable provision had never comprised a part of this Application. The remaining provisions of this Application shall remain in full force and effect and shall not be affected by the illegal, invalid, or unenforceable provision or by its severance. Furthermore, in lieu of such illegal, invalid, or unenforceable provision, this Application shall be reformed to include as a part of this Application a provision as similar in terms to the illegal, invalid, or unenforceable provision as may be possible and still be legal, valid, or enforceable. (5). Risk of Loss. Focus on Energy and Program Administrator at no time assumes risk of loss for any personal property of the Applicant. (6). Waiver. Failure or delay on the part of either party to exercise any right, power, privilege or remedy hereunder shall not constitute a waiver thereof. A waiver of any default shall not operate as a waiver of any other default or of the same type of default on a future occasion.

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