Appalachian Power Commercial Program - …

1 Customer/Company Name (as it appears on your electric bill):Taxpayer ID# (SSN/FEIN):Tax Status:Contact Person:Phone:Fax:Email: Mailing Address: City:State:Zip Code:1 Customer and Contact Information2 Utility InformationBefore you startSubmit your applicationOnce you are doneReview the eligibility detail requirements, and terms and conditions located at the end of the application to verify that you are eligible for a rebate. Collect all required information to complete your may participate in this Program with standard and custom projects. Standard projects involve replacing existing equipment to high energy efficiency models.

2 Common standard projects include lighting and HVAC upgrades. New buildings with only one energy efficiency project fall into the standard projects involve installing energy efficient systems in buildings under renovation, additions and new construction. Custom projects include energy efficiency upgrades not included in the standard Program ; and new buildings with more than one type of energy efficiency project. Custom projects require and required documents are due within 60 days of installation. After your rebate application is completed and approved you will receive your rebate check in approximately 4-6 submitting finial applications please be sure to include these documents.

3 Rebate Application Rebate Worksheet(s) with project implementation details Project Documentation (as required) itemized invoices, equipment specifications, engineering reports, modeling output, photographs W-9 (LLC, individual, partnership, property management companies)Submit your application and required documents one of three Take Charge Business ProgramPost Office Box 4909 Charleston, WV 25364 Fax:304-935-4852 Questions? Call 877-428-5427 Rebate ApplicationAppalachian Power Commercial Program Appalachian Power Commercial Program Rebate Application 1 of 5 Utility Company: Appalachian Power Company dba American Electric Power in West Virginia Wheeling Power Company dba American Electric Power in West VirginiaUtility Account #:3 Location Information (where equipment will be installed)4 Project InformationLocation of InstallationUtility Company.

4 Appalachian Power Company dba American Electric Power in West Virginia Wheeling Power Company dba American Electric Power in West VirginiaUtility Account #: Same Mailing AddressFacility Name:Installation Address:City:State:Zip Code:Square Footage:Year Built:Total Project Cost:Project Start Date:Estimated Project Completion Date Standard Project Custom (New Construction) Custom (Renovations/Additions)Project Description: Appalachian Power Commercial Program Rebate Application 2 of 55 Rebate Payee Information Who receives the rebate? Customer Contractor (fill out the section below if paying to the contractor)Complete this section ONLY if incentive payment is to be paid to an entity other than the customer listed on the Customer and Contact Information (section 1).

5 I authorize the payment of the incentive to the third party named below and understand that I will not receive the incentive payment from Wheeling Power Company or Appalachian Power Company. I also understand that my release of the payment to a third party does not exempt me from the Program requirements outlined in the measure specifications, Terms and Conditions, and Final Payment by:Date: / /Account Holder SignaturePrint Name: For custom projects, Wheeling Power Company or Appalachian Power Company will pay the lesser of: 1) the final calculated incentive as approved by Wheeling or Appalachian Power Company or 2) an incentive payment not to exceed $ saved up to 50% of the project s cost for each project submitted.

6 Incentives may be capped at $150,000 per customer per calendar year depending on availability of funds and based on the final review calculated incentive amount. For standard projects, rebates are based on the Program s per unit measure cost, not to exceed $ saved up to 50% of the project s cost for each project submitted. Incentives may be capped at $150,000 per customer per calendar year depending on Applicant SignatureI hereby certify that:1. The information contained in this application is accurate and All rules of the incentive application have been I have read and herby agree to the Appalachian Power Company Commercial Program terms and conditions and Program rules and equipment eligibility requirements as stated on this form.

7 4. The project was installed and operational on (date): name:Signature:Date: / / Appalachian Power Commercial Program Rebate Application 3 of 57 Rebate Worksheet Lighting Food service equipment Refrigeration HVAC and VFDs for HVAC applications Water heating LED traffic signals Custom (New Construction, Renovations) Please check your project type and attach rebate worksheet(s) that matches your project description. Appalachian Power Commercial Program Rebate Application 4 of 5 TERMS AND CONDITIONSA ppalachian Power Company and Wheeling Power Company both dba American Electric Power (collectively referred to herein as Appalachian Power ) offer energy efficiency rebates to facilitate the implementation of cost-effective energy efficiency improvements for non-residential accounts.

8 Please note that funds are limited and subject to availability. Program Effective DatesThe Appalachian Power Commercial and Industrial (C&I) Program offers rebates for qualifying energy efficiency projects until approved funds are exhausted or December 31, 2017, whichever comes first. The effective dates of the current Appalachian Power C&I Program and application submittal requirements are as follows: All Appalachian Power C&I Program projects must be completed and Final Applications received no later than December 1, 2017 in order to qualify for rebates identified in this application.

9 Program and Project EligibilityThe Appalachian Power C&I Program offers rebates for some of the more common energy efficiency measures. Program rebates are available under The Appalachian Power C&I Program to include non-residential accounts served on Appalachian Power in West Virginia s regulated retail rates. Qualifying projects must be installed in a facility in Appalachian Power s electric service territory. These rebates are available to all non-residential customers who pay into the Energy Efficiency and Demand Response Cost Recovery rider and receive their electricity over Appalachian Power wires.

10 A customer may neither apply for nor receive rebates for the same product, equipment or service from more than one be eligible for Implementation rebates, customers must implement the entire measure detailed in this application. There will be no partial Implementation requirements under the Appalachian Power C&I Program include the following: Project must be completed at an existing facility with a permanent reduction in electrical energy usage (kWh). Customer must be a non-residential customer of Appalachian Power Facility must have a peak demand of at least 125 kW as recorded by Appalachian Power within the last 12 months.