Testing the NEC HVAC 2018 NEC HVAC Incentive Form MEMBER INFORMATIONElectric Account Number Member Name* First Last Facility Address 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? Yes No Mailing Address 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 Rate Application Number Member's Email Enter Email Confirm Email Contact Person First Last Title PhoneIncorporated Yes No Exempt Incentive Payment Preference Check Bill Credit Pay Contractor Please Assign Payment to Contractor Member SignatureAdditional Information Member Signature By signing and dating, member 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.Accept Terms & Conditons? Yes No CONTRACTOR INFORMATIONContact Person First Last Contact's Title Contractor Name Contact Person's Signature Mailing Address 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 Enter Email Confirm Email PhoneAdditional Info Incorporated? Yes No Exempt INCENTIVEBuilding Type Hospital Office Retail Store School Manufacturer / Model Number Quantity (D)*Unit TypePlease select oneI. Unitary AC and Split System (new condenser and new coil)II. Air to Air Heat Pump SystemsIII. Water Source Heat PumpsIV. Ground Water - Water Source Heat Pump Equipment (Open Loop)V. Ground Water - Water Source Heat Pump Equipment (Closed Loop)I. Tons for Unitary AC & Split Sys Tons are LESS than 5.4 Tons are GREATER THAN OR EQUAL TO 5.4 but LESS THAN 11.25 Tons are GREATER THAN OR EQUAL TO 11.25 but less than 20 Tons are GREATER THAN OR EQUAL TO 20 but less than 63 Tons are GREATER THAN OR EQUAL TO 63 New Condenser and New CoilI. Unit Size (tons) (A)*How many tons?I. BTUH for less than 5.4 tons BTUH is less than 65,000 Split System BTUH is less than 65,000 Packaged System Please choose the correct answerI. BTUH for EQUAL TO OR GREATER THAN 5.4 tons but LESS THAN 11.25 BTUH is EQUAL TO OR GREATER THAN 65,000 but LESS THAN 135,000 BTUH is less than 65,000 BTUH is GREATER THAN 135,000 Please choose the correct answerI. BTUH for 11.25 to 20 tons BTUH is EQUAL TO OR GREATER THAN 135,000 but less than 240,000 BTUH is less than 135,000 BTUH is greater than 240,000 Please choose the correct answerI. Min Efficiency - Split System EQUAL TO OR GREATER THAN 14.0 SEER but LESS THAN 15.0 SEER EQUAL TO OR GREATER THAN 12.0 EER but LESS THAN 12.5 EER LESS THAN 14.0 SEER LESS THAN 12.0 EER EQUAL TO OR GREATER THAN 15.0 SEER EQUAL TO OR GREATER THAN 12.5 SEER I. BTUH for 20 TO 63 BTUH is EQUAL TO OR GREATER THAN 240,000 but less than 760,000 BTUH is less than 240,000 BTUH is greater than 760,000 Please choose the correct answerI. BTUH for EQUAL TO OR GREATER THAN 63 BTUH is EQUAL TO OR GREATER THAN 760,000 BTUH is less than 760,000 Please choose the correct answerI. Min Efficiency - Packaged System EQUAL TO OR GREATER THAN 14.0 SEER but LESS THAN 15.0 SEER EQUAL TO OR GREATER THAN 11.6 EER but LESS THAN 12.0 EER LESS THAN 14.0 SEER LESS THAN 11.6 EER EQUAL TO OR GREATER THAN 15.0 SEER EQUAL TO OR GREATER THAN 12.0 EER I. Min Efficiency - 11.5 EER and 12.3 EQUAL TO OR GREATER THAN 11.5 EER and 12.3 IEER EQUAL TO OR GREATER THAN 12.0 EER and 13.0 IEER I. Min Efficiency - 10.3 eer AND 11.1 IEER EQUAL TO OR GREATER THAN 10.3 EER and 11.1 IEER EQUAL TO OR GREATER THAN 10.6 EER and 12.1 IEER I. Min Efficiency - 65,000-135,000 EQUAL TO OR GREATER THAN 11.5 EER and 12.8 IEER but LESS THAN 12.0 EER and 13.8 IEER LESS THAN 11.5 EER and 12.8 IEER EQUAL TO OR GREATER THAN 12.0 EER and 13.8 IEER I. Min Efficiency - 10.2 EER and 11.4 IEER EQUAL TO OR GREATER THAN 10.2 EER and 11.4 IEER HiddenI. Incentive $30 (C)Please enter a number from 30 to 30.I. Total Estimated Incentive (E) @ $30HiddenI. Incentive $70 (C)*Please enter a number from 70 to 70.I. Total Estimated Incentive (E) @ $70HiddenI. Incentive $125 (C)*Please enter a number from 125 to 125.I. Total Estimated Incentive (E) @ $125HiddenI. Incentive $50 (C)*Please enter a number from 50 to 50.I. Total Estimated Incentive (E) @ $50HiddenI. Incentive $80 (C)*Please enter a number from 80 to 80.I. Total Estimated Incentive (E) @ $80II. Tons for Air to Air Heat Pump Systems Tons are LESS than 5.4 Tons are GREATER THAN OR EQUAL TO 5.4 but LESS THAN 11.25 Tons are GREATER THAN OR EQUAL TO 11.25 but less than 20 Tons are GREATER THAN OR EQUAL TO 20 II. Unit Size (tons) (A)*How many tons?II. BTUH for less than 5.4 tons BTUH is less than 65,000 Ductless Split System BTUH is less than 65,000 Split System BTUH is less than 65,000 Packaged System Please choose the correct answerII. BTUH for GREATER THAN OR EQUAL TO 5.4 but LESS THAN 11.25 BTUH is GREATER THAN or EQUAL to 65,000 but LESS THAN 135,000 BTUH is LESS THAN 135,000 BTUH is GREATER THAN 135,000 II. BTUH for GREATER THAN OR EQUAL TO 20 BTUH is GREATER THAN or EQUAL to 20,000 BTUH is LESS THAN 20,000 II. BTUH for GREATER THAN OR EQUAL TO 11.25 but LESS THAN 20 BTUH is GREATER THAN or EQUAL TO 135,000 but LESS THAN 240,000 BTUH is LESS THAN 135,000 BTUH is GREATER THAN 240,000 II. Min. Eff. for 5.4 to 11.25 The unit efficiency is GREATER THAN or EQUAL TO 11.1 EER and 3.4 COP but less than 12.0 EER and 3.4 COP Thu unit efficiency is less than 11.1 EER and 3.4 COP The unit efficiency is GREATER THAN or EQUAL TO 12.0 EER and 3.4 COP II. Min Efficiency - Split System EQUAL TO OR GREATER THAN 14.0 SEER and 8.5 HSPF but LESS THAN 15.0 SEER and 9.0 HSPF LESS THAN 14.0 SEER and 8.5 HSPF GREATER THAN 15.0 SEER and 9.0 HSPF II. Min Efficiency - Package System EQUAL TO OR GREATER THAN 14.0 SEER and 8.0 HSPF but LESS THAN 15.0 SEER and 8.5 HSPF LESS THAN 14.0 and 8.0 HSPF GREATER THAN 15.0 SEER and 8.5 HSPF II. Min. Eff. for 11.25 to 20 The unit efficiency is GREATER THAN or EQUAL TO 11.5 EER and 3.2 COP but less than 12.0 EER and 3.2 COP Thu unit efficiency is less than 11.1 EER and 3.2 COP The unit efficiency is GREATER THAN or EQUAL TO 12.0 EER and 3.2 COP II. Min. Eff. for 20 The unit efficiency is GREATER THAN or EQUAL TO 10.5 EER and 3.2 COP but less than 10.8 EER and 3.2 COP The unit efficiency is less than 10.8 EER and 3.2 COP The unit efficiency is GREATER THAN or EQUAL TO 10.8 EER and 3.2 COP II. Min. Efficiency - Air to Air The unit efficiency is GREATER THAN OR EQUAL TO 20.0 SEER and 9.6 HSPF BUT LESS THAN 25.0 SEER and 12.0 HSPF The unit efficiency is LESS THAN 20.0 SEER and 9.6 HSPF The unit efficiency is GREATER THAN OR EQUAL TO 25.0 SEER and 12.0 HSPF HiddenII. Incentive $30 (C)Please enter a number from 30 to 30.HiddenII. Incentive $50 (C)Please enter a number from 50 to 50.HiddenII. Incentive $80 (C)Please enter a number from 80 to 80.HiddenII. Incentive $70 (C)*Please enter a number from 70 to 70.II. Total Estimated Incentive (E) @ $30HiddenII. Incentive $125 (C)*Please enter a number from 125 to 125.HiddenII. Incentive $200 (C)*Please enter a number from 200 to 200.HiddenII. Incentive $300 (C)*Please enter a number from 300 to 300.II. Total Estimated Incentive (E) @ $50II. Total Estimated Incentive (E) @ $70II. Total Estimated Incentive (E) @ $80II. Total Estimated Incentive (E) @ $125II. Total Estimated Incentive (E) @ $200II. Total Estimated Incentive (E) @ $300III. Water Source Heat Pumps Tons are LESS THAN OR EQUAL TO 11.25 Tons are GREATER THAN 11.25 Choose the correct statementIII. Unit Size (tons) (A)*Please enter a number from 0 to 11.25.How many tons?III. BTUH for Water Source Heat Pumps BTUH is LESS THAN OR EQUAL TO 135,000 BTUH is GREATER THAN 135,000 Choose the correct statementIII. Min. Efficiency - Water Source Heat Pumps The Unit Efficiency is EQUAL TO OR GREATER THAN 14.0 EER and 4.6 COP The Unit Efficiency is LESS THAN 14.0 EER and 4.6 COP Choose the correct statementHiddenIII. Incentive @ $80 (C)Please enter a number from 80 to 80.III. Total Estimated Incentive (E)IV. Tons for Ground Water - Open Loop Tons are LESS THAN OR EQUAL TO 11.25 Tons are GREATER THAN 11.25 Choose the correct statementIV. BTUH for Ground Water - Open Loop BTUH is LESS THAN OR EQUAL TO 135,000 BTUH is GREATER THAN 135,000 Choose the correct statementIV. Min. Efficiency - Ground Water - Open Loop The Unit Efficiency is EQUAL TO OR GREATER THAN 18.0 EER and 4.0 COP The Unit Efficiency is LESS THAN 18.0 EER and 4.0 COP Choose the correct statementIV. Unit Size (tons) (A)*Please enter a number from 0 to 11.25.How many tons?HiddenIV. Incentive @ $150 (C)*Please enter a number from 150 to 150.IV. Total Estimated Incentive (E)V. Tons for Ground Water - Closed Loop Tons are LESS THAN OR EQUAL TO 11.25 Tons are GREATER THAN 11.25 Choose the correct statementV. BTUH for Ground Water - Closed Loop BTUH is LESS THAN OR EQUAL TO 135,000 BTUH is GREATER THAN 135,000 Choose the correct statementV. Min. Efficiency - Ground Water - Closed Loop The Unit Efficiency is EQUAL TO OR GREATER THAN 15.0 EER and 3.2 COP The Unit Efficiency is LESS THAN 15.0 EER and 3.2 COP Choose the correct statementV. Unit Size (tons) (A)*Please enter a number from 0 to 11.25.How many tons?HiddenV. Incentive $150 (C)*Please enter a number from 150 to 150.Sorry, based on your selections it does not qualify for an incentive.Does the proposal include either of these energy saving control options?* Yes - Dual Enthalpy Economizer Yes - Demand Control Ventilation No When installed with new & qualifying Tier 1 or 2 equipment.What Quantity?Estimated Incentive for Dual EnthalpyEstimated Incentive for Demand Control VentilationV. Total Estimated Incentive (E)CAPTCHAHiddenDOCUMENT APPROVALS Resources Program Terms & Conditions 2018 NEC HVAC Incentive Instructions