Non-Residential Conservation Incentive Program - Application for Natural Gas Efficiency Measure Incentives

Performance-Based Incentives

1. Complete the National Fuel Non-Residential Conservation Incentive Program Application; review the terms and conditions and sign the application form.

2. Include the following items:

   - Copy of facility’s National Fuel utility bill*:

   *required

   - Specification sheets for all equipment proposed for installation*:

   *required

   - Contractor invoice*:

   *required

   - W-9 (Request for Taxpayer Identification Number and Certification)*:

   *required

3. Complete the Project Description.

4. Submit this application and supporting documents online. If desired, you can mail the supporting documents to:

   C.J. Brown Energy, P.C.

   4245 Union Road, Suite 204

   Buffalo, NY 14225

   Attn: NRCIP

   Email:NFRebateHelp@cjbrownenergy.com

   Phone:1-844-365-3493

Applicant Information

All fields must be completed. Payment will be issued to the applicant.

City*

*required

Facility Information

Location where conservation measures were installed (if different from above).

City*

*required

AgriculturalCollege/UniversityCommercial/Wholesale/RetailData CenterGovernmentHealthcareHospitalityIndustrialK-12 SchoolMultifamily (5 units or more)Not-for-ProfitOther

Utility Information

National Fuel Account Number*

*required

Project Description

Performance Based

PB Anticipated Project Construction Start Date*

*required

*Applications for Performance-Based (PB) projects must be submitted either before or within 90 days of contracting the project.

Please include information describing the project in detail.*

This information should include (but is not limited to) baseline equipment and efficiencies, operating schedules, proposed equipment and efficiencies, etc. Does this replace existing equipment? If yes, list equipment and estimated age of equipment below. Please attach additional pages if required. Performance-based incentives are determined by multiplying $15 times the annual gas savings in Mcf. Rebate cap of $100,000 per project, per program year.

*required

Project Description File Attachment

Performance-Based Incentives

Performance-based incentives are determined as follows:

• Strategic: $25.00 / McF Saved per Year

• Conditional Neutral¹: $25.00 / McF Saved per Year

A rebate cap of $50,000 per program year for “Conditional Neutral” incentives and $100,000 for “Strategic” incentives, not to exceed
$150,000 in total incentives. Based on the examples below, this project is (check as applies)*:

StrategicConditional Neutral

*required

¹Eligible equipment must meet the Gas Combustion Equipment Significant Efficiency Gain criteria on page 3. Only project sites that meet the Building Characteristics or Building Use criteria on page 4 would be eligible. Note that due to limited funding available for Conditional Neutral Measures, incentive levels may be modified or terminated at any point in a program year. See Terms & Conditions on page 5.

Examples

Strategic

• Air Leakage Sealing

• Insulation-Opaque Shell

• Energy and Heat Recovery Ventilator

• Pipe Insulation

• Duct Insulation

• Smart Thermostats

Conditional Neutral

• Steam Trap - Other Application

• Steam Trap Monitoring - Other Applications

• Steam Trap - Survey

• Condensing Hot Water Boiler

• Hot Air Furnaces

• Steam Boiler

Gas Combustion Equipment Significant Efficiency Gain

Gas combustion equipment will be considered to have a significant efficiency gain in retrofit applications if its performance meets
one of the following criteria:

Domestic hot water (DHW) production or steam or hot water space conditioning:

YesNo

*required

YesNo

*required

YesNo

*required

Forced air space conditioning:

YesNo

*required

YesNo

*required

YesNo

*required

Other process equipment:

YesNo

*required

YesNo

*required

Building Characteristics

YesNo

*required

YesNo

*required

YesNo

*required

YesNo

*required

Building Use

YesNo

*required

YesNo

*required

Agreement to Terms and Conditions

Applicant Information

Applicant/Company Name

*required

Facility Information

Facility Name

Required unless same as applicant

*required

Terms and Conditions

1. To be eligible for a rebate, Customer understands that: (a) they must have an active meter serviced by National
   Fuel Gas Distribution Corporation (“National Fuel”) in National Fuel’s Western New York service territory for the
   installation address and, (b) the product(s) Customer has installed must qualify as described on the Rebate
   Application Form and be designed and installed to reduce the consumption of the energy distributed to them by
   National Fuel at the installation address. Customer understands they must complete an application for each
   installation address. For installations at locations with multiple meters, please attach a separate sheet indicating
   gas account number and/or meter number with eligible equipment for that account number or meter.
   “Install/installation” means complete installation such that the product(s) is/are fully functional at the time the
   rebate application is submitted.

2. All eligible measures must be installed by a licensed contractor, or a contractor that can supply you with
   either a Federal ID number, or a Business Certificate

3. A rebate cap of $50,000 per program year for "Conditional Neutral" incentives and $100,000 for "Strategic"
   incentives, not to exceed $150,000 in total incentives.

4. Resale products, products leased, rebuilt, rented, received from insurance claims, won as a prize, or new parts
   installed in existing products do not qualify. All applications are processed on a first-come, first-served basis.
   INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. Resubmitted information/documentation is processed
   on a first-come, first-served basis based on a new receipt date. This program may be modified or terminated
   at any time without prior notice. If the amount of a rebate changes during the course of the program, the
   installation date will be used to determine product eligibility and rebate amount.

5. For Performance Based rebate, Customer acknowledges the application must be submitted 90 days prior to contracting
   the project, and prior to any demolition, removal of existing equipment, or installation of new equipment.

6. For the Pre-Qualified rebate, Customer acknowledges that those seeking reimbursement must apply within 90 days of
   signing the application, and applications for the Pre-Qualified projects must be submitted within 90 days of
   installation.

7. Customer will allow, if requested, a National Fuel representative reasonable access to the install address to
   verify the product has been purchased and is installed before a rebate is paid. Customer understands that a rebate
   will not be paid if they refuse to participate in any required verification. Customer understands that National Fuel
   may contact the qualifying product vendor and/or installer, if needed, to verify purchase and/or installation and
   may provide Customer’s name and/or address to complete this verification.

8. Customer has installed qualifying product(s) and understands the energy efficiency level of the qualifying
   product(s) determines the rebate amount. A single gas-fired piece of equipment that provides two functions (e.g.,
   heat and hot water) is only eligible for one rebate (the higher amount). The rebate amount cannot exceed the
   cost of procurement and installation of the qualified product.

9. Customer agrees that selection/purchase/installation/ownership/maintenance are their sole responsibility and that
   National Fuel makes no warranties (express or implied). Customer waives claims against National Fuel and related
   parties arising out of activities conducted by or on behalf of National Fuel in connection with rebate applications.

10. Customer is responsible for meeting all program requirements and complying with local
    codes/ordinances/rules/regulations.

11. If Customer’s property is not owned by Customer, Customer is solely responsible for obtaining property owner
    permission. Customer’s signature indicates they have received such permission.

12. I understand that National Fuel is not responsible for items lost or destroyed in the
    mail/transit.

13. Customer authorizes sharing of participant-customer information and/or project-level information with New York
    State Department of Public Service Staff and NYSERDA (including agents/representatives) consistent with their
    responsibilities including evaluation/measurement activities.

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