Office Use Only Rebate

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Residential Air Conditioner and Evaporative Cooler Rebate Application
Customer Information
Utility Account # (if known) First Name Installation Address City Mailing Address (if different) City State Zip Date Last Name Email (optional) State Zip Phone

Month/Year:

Please complete both pages of this form and sign. All information is required to process rebate(s).

Home Information Year Built Type of Dwelling Square Footage (conditioned space only) Site-Built Home Manufactured Home

Contractor Information
Company Name Business Phone Address City Contact Name Business Fax Email (optional) State Zip

City Building Permits Energy efficiency projects may require City building permits; please check with the City of Gridley Building Department at 530-846-3632 prior to beginning work. Qualifying Energy Efficiency Improvements and Rebates Central air conditioner and evaporative cooler models must meet the following minimum efficiency requirements to qualify for rebates: AIR CONDITIONERS Type of System Requirements Rebate Central AC Min. 14.5 SEER $50 per Ton Central AC Min. 15.0 SEER $100 per Ton Central AC Min. 16.0 SEER $150 per Ton Central AC Min. 19.0 SEER $225 per Ton Evaporative Cooled Central AC Min. 14.0 EER $300 per Ton
Type of Equipment Direct Evaporative Cooler Direct/Indirect Evaporative Cooler Indirect Evaporative Cooler EVAPORATIVE COOLERS* Requirements Replacing a split-system AC unit (less than 13.0 SEER) Replacing a split-system AC unit (less than 13.0 SEER) Replacing a split-system AC unit (less than 13.0 SEER) Rebate $300 per 1,000 sq.ft. $400 per 1,000 sq.ft. $200 per 1,000 sq.ft.

*Evaporative Coolers must be permanently installed (window mounted units are not eligible).
Rebates will not exceed 100% of installed cost.
© Efficiency Services Group, LLC. All Rights Reserved. Rev. 7/12

Equipment Information Central Air Conditioner Check one Direct/Indirect Evaporative Cooler
.

Direct Evaporative Cooler Indirect Evaporative Cooler Serial No.

Brand Tons Cooling Capacity (AHRI Rating)
1 ton = 12,000 Btu AHRI cooling capacity

Model SEER Rating

(Btu) Indoor Unit Model No.
(Evaporator)

Outdoor Unit Model No.
(Condenser)

AHRI Reference No. _____________________________________________________________________________ Equipment must be AHRI certified to qualify for rebates – contractor must supply the AHRI Reference Number.

Upon signing this agreement, customer acknowledges the following: Gridley Municipal Utilities (GMU) reserves the right to inspect completed work and installed measures. Rebates will be paid only on work that meets GMU specifications. Customer certifies that they are familiar with, and agree to, the standards regarding this program. GMU disclaims any warranty, whether expressed or implied, for any materials or labor associated with installation, maintenance, repair, or any energy savings associated with the measures. GMU will not accept any liability resulting from participation in this program. This rebate offer may be changed or discontinued at any time by GMU. I understand the above and certify that I am a customer of GMU and that the eligible energy efficiency measures were installed at the location indicated on this application.

CUSTOMER SIGNATURE

DATE

Mail original completed rebate application, copies of all invoices/receipts, and additional qualification information (if applicable) to: Gridley Municipal Utilities Attn: Energy Efficiency Rebates 253 Polaris Avenue Mountain View, CA 94043

Rebate applications must be submitted within six (6) months of installation to qualify. Allow 8–10 weeks for processing.

Call 1-888-883-9879 to learn about additional energy efficiency programs.

© Efficiency Services Group, LLC. All Rights Reserved.

Rev. 7/12

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