2017 NEC VHD Incentive Form NEC VFD Incentive Step 1 of 2 50% Section A: CUSTOMER INFORMATIONCustomer Name * Required First Last Facility Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this the mailing address? * RequiredYesNoMailing Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Electric Account Number * RequiredRate * RequiredApplication NumberService Location IdentificationEmail * Required Contact Person * Required First Last Title * RequiredPhone * RequiredIncorporated * RequiredYesNoExemptIncentive Payment Preference * RequiredCheckBill CreditPay ContractorPlease Assign Payment to ContractorCustomer SignatureAdditional InformationSection B: CONTRACTOR INFORMATIONContact Person * Required First Last Contact Title * RequiredContractor Name * RequiredContact Person SignatureMailing Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email * Required Phone * RequiredAdditional InfoIncorporated * RequiredYesNoExemptSection C: DOCUMENT APPROVALSBy signing and dating below, customer accepts this Incentive offer and agrees to the Utility Terms and Conditions available from your Utility. Pursuant to a Commission order, customers also agree that the utility alone may capture all kW and kWh savings and any ISO-NE capacity payments resulting from this energy efficiency project. This agreement is contingent upon continued approval and authorization by the Commission to recover said amounts from the System Benefits Charge. The Incentive, in conjunction with all other sources of funding, cannot exceed the total project cost.Customer SignatureDate - must be mm/dd/yyyy format Vendor quote or proposals * Required File uploadAccepted file types: pdf, doc, docx.Allowed file extensions - pdf doc docx. Incentive WorksheetFacility Type (check one) College/University School K-12 Multi-Family Hotel/Motel Healthcare Warehouse Restaraunt Retail Grocery Offices ROW 1Motor HP * Required357.5101520Fan/Pump IDArea ServedEx.: AtriumApplication Code * RequiredSFA - Supply fan on supply air handlerSFP - Supply fan on VAV packaged HVAC unitRFA - Return fan on return air handlerRFP - Return fan on VAV packaged HVAC unitBEF - Building exhaust fanPEF - Process exhaust fanHEF - Fume hood exhaust fan & makeup air fanHWP - Heating hot water pumpWWP - Circ pump for water source heat pump loopFWP - Boiler feed water pumpCWP - Chilled water pumpBDF - Boiler draft fanHYP - Hydraulic pumpWTP - Water supply or wastewater treatment pumpRAS - RAS pump in wastewater treatment plantCTF - Cooling tower fanPCP - Process cooling pump- VFD's on VAV boxes over 10HP are NOT eligible for Incentives - Forward curve fans with inlet guide vanes are not eligible for a VFD Incentive. Other VFD applications may be eligible for a Custom Incentive.Controlling Paramenters * RequiredDP - Pressure DifferentialDT - Temperature DifferentialDF - Flow DifferentialOtherSpecify * RequiredMotor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.500-1800-1900-11000-11125-11575-1Incentive * RequiredDo you have another to submit?YesNorow2ROW 2Motor HP * Required357.5101520Fan/Pump IDArea ServedEx.: AtriumApplication Code * RequiredSFA - Supply fan on supply air handlerSFP - Supply fan on VAV packaged HVAC unitRFA - Return fan on return air handlerRFP - Return fan on VAV packaged HVAC unitBEF - Building exhaust fanPEF - Process exhaust fanHEF - Fume hood exhaust fan & makeup air fanHWP - Heating hot water pumpWWP - Circ pump for water source heat pump loopFWP - Boiler feed water pumpCWP - Chilled water pumpBDF - Boiler draft fanHYP - Hydraulic pumpWTP - Water supply or wastewater treatment pumpRAS - RAS pump in wastewater treatment plantCTF - Cooling tower fanPCP - Process cooling pump- VFD's on VAV boxes over 10HP are NOT eligible for Incentives - Forward curve fans with inlet guide vanes are not eligible for a VFD Incentive. Other VFD applications may be eligible for a Custom Incentive.Controlling Paramenters * RequiredDP - Pressure DifferentialDT - Temperature DifferentialDF - Flow DifferentialOtherSpecify * RequiredMotor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.500-2800-2900-21000-21125-21575-2Incentive * RequiredDo you have another to submit?YesNorow3ROW 3Motor HP * Required357.5101520Fan/Pump IDArea ServedEx.: AtriumApplication Code * RequiredSFA - Supply fan on supply air handlerSFP - Supply fan on VAV packaged HVAC unitRFA - Return fan on return air handlerRFP - Return fan on VAV packaged HVAC unitBEF - Building exhaust fanPEF - Process exhaust fanHEF - Fume hood exhaust fan & makeup air fanHWP - Heating hot water pumpWWP - Circ pump for water source heat pump loopFWP - Boiler feed water pumpCWP - Chilled water pumpBDF - Boiler draft fanHYP - Hydraulic pumpWTP - Water supply or wastewater treatment pumpRAS - RAS pump in wastewater treatment plantCTF - Cooling tower fanPCP - Process cooling pump- VFD's on VAV boxes over 10HP are NOT eligible for Incentives - Forward curve fans with inlet guide vanes are not eligible for a VFD Incentive. Other VFD applications may be eligible for a Custom Incentive.Controlling Paramenters * RequiredDP - Pressure DifferentialDP - Temperature DifferentialDF - Flow DifferentialOtherSpecify * RequiredMotor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.500-3800-3900-31000-31125-31575-3Incentive * RequiredDo you have another to submit?YesNorow4ROW 4Motor HP * Required357.5101520Fan/Pump IDArea ServedEx.: AtriumApplication Code * RequiredSFA - Supply fan on supply air handlerSFP - Supply fan on VAV packaged HVAC unitRFA - Return fan on return air handlerRFP - Return fan on VAV packaged HVAC unitBEF - Building exhaust fanPEF - Process exhaust fanHEF - Fume hood exhaust fan & makeup air fanHWP - Heating hot water pumpWWP - Circ pump for water source heat pump loopFWP - Boiler feed water pumpCWP - Chilled water pumpBDF - Boiler draft fanHYP - Hydraulic pumpWTP - Water supply or wastewater treatment pumpRAS - RAS pump in wastewater treatment plantCTF - Cooling tower fanPCP - Process cooling pump- VFD's on VAV boxes over 10HP are NOT eligible for Incentives - Forward curve fans with inlet guide vanes are not eligible for a VFD Incentive. Other VFD applications may be eligible for a Custom Incentive.Controlling Paramenters * RequiredDP - Pressure DifferentialDP - Temperature DifferentialDF - Flow DifferentialOtherSpecify * RequiredMotor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.500-4800-4900-41000-41125-41575-4Incentive * RequiredDo you have another to submit?YesNorow5ROW 5Motor HP * Required357.5101520Fan/Pump IDArea ServedEx.: AtriumApplication Code * RequiredSFA - Supply fan on supply air handlerSFP - Supply fan on VAV packaged HVAC unitRFA - Return fan on return air handlerRFP - Return fan on VAV packaged HVAC unitBEF - Building exhaust fanPEF - Process exhaust fanHEF - Fume hood exhaust fan & makeup air fanHWP - Heating hot water pumpWWP - Circ pump for water source heat pump loopFWP - Boiler feed water pumpCWP - Chilled water pumpBDF - Boiler draft fanHYP - Hydraulic pumpWTP - Water supply or wastewater treatment pumpRAS - RAS pump in wastewater treatment plantCTF - Cooling tower fanPCP - Process cooling pump- VFD's on VAV boxes over 10HP are NOT eligible for Incentives - Forward curve fans with inlet guide vanes are not eligible for a VFD Incentive. Other VFD applications may be eligible for a Custom Incentive.Controlling Paramenters * RequiredDP - Pressure DifferentialDP - Temperature DifferentialDF - Flow DifferentialOtherSpecify * RequiredMotor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.500-5800-5900-51000-51125-51575-5Incentive * RequiredIncentive TotalNumber * RequiredTotal potential NEC VHD incentive