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? * Required Yes No Mailing 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 * Required Rate * Required Application Number Service Location Identification Email * Required Contact Person * Required First Last Title * Required Phone * RequiredIncorporated * Required Yes No Exempt Incentive Payment Preference * Required Check Bill Credit Pay Contractor Please Assign Payment to Contractor Customer SignatureAdditional Information Section B: CONTRACTOR INFORMATIONContact Person * Required First Last Contact Title * Required Contractor Name * Required Contact Person Signature Mailing 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 Info Incorporated * Required Yes No Exempt Section 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 Signature Date - must be mm/dd/yyyy format MM slash DD slash YYYY Vendor quote or proposals * RequiredAccepted file types: pdf, doc, docx, Max. file size: 1 GB.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 ID Area Served Ex.: 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 * Required Motor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.Hidden500-1Hidden800-1Hidden900-1Hidden1000-1Hidden1125-1Hidden1575-1Incentive * RequiredDo you have another to submit? Yes No Hiddenrow2ROW 2Motor HP * Required357.5101520Fan/Pump ID Area Served Ex.: 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 * Required Motor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.Hidden500-2Hidden800-2Hidden900-2Hidden1000-2Hidden1125-2Hidden1575-2Incentive * RequiredDo you have another to submit? Yes No Hiddenrow3ROW 3Motor HP * Required357.5101520Fan/Pump ID Area Served Ex.: 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 * Required Motor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.Hidden500-3Hidden800-3Hidden900-3Hidden1000-3Hidden1125-3Hidden1575-3Incentive * RequiredDo you have another to submit? Yes No Hiddenrow4ROW 4Motor HP * Required357.5101520Fan/Pump ID Area Served Ex.: 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 * Required Motor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.Hidden500-4Hidden800-4Hidden900-4Hidden1000-4Hidden1125-4Hidden1575-4Incentive * RequiredDo you have another to submit? Yes No Hiddenrow5ROW 5Motor HP * Required357.5101520Fan/Pump ID Area Served Ex.: 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 * Required Motor EfficiencyAnnual hours of Operation * RequiredVFD’s must operate a minimum of 2,000 hours per year to be eligible for an Incentive.Hidden500-5Hidden800-5Hidden900-5Hidden1000-5Hidden1125-5Hidden1575-5Incentive * RequiredIncentive TotalNumber * RequiredTotal potential NEC VHD incentive