R01 Control COMMONWEALTH OF PUERTO RICO ARRA - STATE ENERGY PROGRAM € BUILDING ENERGY EFFICIENCY RETROFIT PROGRAM m Rebate Reservation Form by AF ‘Sood ia aif Ml or Hand Di 6 note Poetic ature acing Ary Fl forms in block eter (apa care Nor Tower, 16 oor = Send form Ro wit al required documents none 235 areal oor enoe ‘mania envelope Cenc Ingest the revoitoet wl be perormedtaconmeral or government facitys L]commarcl Cl esverananah PESTennon ae sate a ote rai Phone Taz Gir Sane Tp code Fiore ee eee strate anal eer preston or sve wi/iear | Ttlsyem Cos [6 Tageced neta [5 “iar nears “aunty ee stalerinformatonsorm{Rt2)——] Prerject Enere Aut formation form 3} Retort Meares For R08) every sigs sumer Form(s} Baling Peto eri Cleneray ance Crjet vce astaion Dover rot ot Ovens (Chua sice eee vey as Cirent agreenerraptcate) {Beating ownars content epee Glowersvaitie Creentatet Good standing ith cAA(Govenment nts) C1 UstefEqlmentto be Replaced and ew Ealment ‘opto Creation "Thereby cay hte fama conoed herein adn etaced and Scuments wba a ad caret a ot he ‘etolriesives wi be perfre esate. 1 Terevft measures istaed wit cpl wh e tae Eery Maram Rept. 1+ Terevopt measures west pemarem ote ated proposed rectors. + Featty tet hve eo andrstood a ogee wth he eat Eney Progam Regus. [eplean? Spntore ae Gunes Siotr: ate Tins oer oD Gon a in GETSR02 Conia COMMONWEALTH OF PUERTO RICO [ARRA - STATE ENERGY PROGRAM BUILDING ENERGY EFFICIENCY RETROFIT PROGRAM Installer Information Form ene ae he revo poet wil be prorat near (a) Ra or Doe iae ear ice of System Installation: loco codes and regains. berformeda the indeated proposed project dies. The retrofit projet willcmply withthe Stte Energy Program Regulation + The etvoft projet wl be installed permanent tthe ineated proposed project ede. 1+ leery thot have ead understood and agree withthe tote Energy Program Regulation, (sler Wome) erty that the retrofit proect described herein will comply with + hereby erty that the infomation contained herein i tre ond coret and thatthe work deseribed herein wl be Inter Spore: ateR03 Conair COMMONWEALTH OF PUERTO RICO. Aff STATE ENERGY PROGRAM BUILOING ENERGY EFFICIENCY RETROFT PROGRAM ae? Pre-Project Energy Audit Information Form AF General Information Tissue was pefrmedata conmerclorgorenmentlicty: CJeommercal Cl eevernments nn oy stat Deceit: or ae {ype of rede and cn Pane Rime ulna! oy stat Dpcose = EE Equipment hw Parentage cx econo Fans, Pomp and Misceaneo Palos ‘other Building Energy Density (kw/f) Auditor Certification: hereby cel thatthe fenton above strand cote. uo’ Stare: ate:[ARRA.- STATE ENERGY PROGRAM ANF | COMMONWEALTH OF PUERTO RICO BUILDING ENERGY EFFICIENCY RETROFIT PROGRAM Retrofit Measures Form Indah revott witb pefomes ata conmeror goverment fy Dlearerest goverment ExIstng Equipment Retrofitted Equipment Deserition Equipment Consumption ‘Quantity ‘Rerage Operating Pod hours month) Total Consumption (kWh/ month) sled description of his method Existing Equipment Retrofitted Equipment Description qupmant Consumption ‘uantiy “Average Operating Pela fours /month) otal Consumption (kwh/ month) Tndude a detaled description of his method =) Existing Equipment Retrofitted Equipment Description aunt Consumption ‘Quantity ‘erage Operating Period Tours month Total Consumption (kivh/ month) Taide a detaled description of thismethod ‘ake as many copies as requiredR05 antral Num: JANE ll (=) COMMONWEALTH OF PUERTO RICO [ARRA.- STATE ENERGY PROGRAM BUILDING ENERGY EFFICIENCY RETROFIT PROGRAM Energy Savings Summary Form Indah revolt witb pefoed oo conser goverment fi Dleammeest goverment TOTAL "Energy Rate shall be the base rate (kWh price) paid by Applicant inthe last PREPA invoice plus $0.15, corresponding to the fuel surcharge. Simple Payback Analysis | Total Monthly Savings ($) Total installed Eligible Measure Cost ($)