21-05-527 MN-Res OpenPrgms app P02.pd

Application Minnesota MN Residential HVAC Rebates Completed Improvement Checklist Furnace/Boiler Water heater Mini-split heat pump Smart thermostat Account information Xcel Energy account number where unit was installed ___________________________________________ Phone ____________________________ Account holder name (as shown on your utility bill) __________________________________________________________________________________ Installation address ____________________________________________ City____________________________ State______ ZIP____________ Email address _____________________________________________________________________________________________________________ Mailing address (if different) ______________________________________________________________ County ___________________________ Account holder signature _________________________________________________________________ Date _____________________________ Rebate payment option (if no option is chosen, the rebate will default to a check) Check (rebate check will be mailed) Bill credit (rebate will be applied as a credit to the Xcel Energy account) Direct deposit (ACH Payments are available to customer with Auto Pay enrolled in My Account) Alternate rebate recipient (if applicable) Rebate recipient name: __________________________________________________________________ Phone ____________________________ Address _________________________________________________________________________________________________________________ Account holder signature _________________________________________________________________ Date _____________________________ I authorize the above party to receive the rebate in the form of a rebate check Home information Home: New construction Existing home Home type: Single family Townhome Condo/apartment Number of bedrooms (for water heaters) ___________________________ Heating source (prior to replacement): Natural gas Electric resistance Cooling source (prior to replacement): Central AC/Air source heat pump Air source heat pump Ground source heat pump Ground source heat pump Evaporative cooling Other None Contractor information Company name ____________________________________________________________________________________________________________ Primary rebate contact person _____________________________________________________________ Primary phone ______________________ Address _________________________________________________________________________________________________________________ Xcel Energy contractor ID number ______________________________ Contractor email ________________________________________________ Contractor signature ____________________________________________________________________ Date _____________________________ Furnace or boiler Installation date ________________________ Manufacturer _____________________________________________________________________ Model number __________________________ Serial number _______________________________ Size or capacity (BTU) ___________________ Efficiency (AFUE) ______________________________________________ AHRI certificate number _________________________________________ Page 1 of 4 21-05-527 MN Residential HVAC Rebates Application Minnesota Natural gas water heater Installation date ________________________ Manufacturer _____________________________________________________________________ Serial number ________________________________________________ Size or capacity (gallons) ________________________________________ Model number __________________________ Draw pattern: Medium draw High draw Uniform Energy Factor (UEF) ___________________________________________________________________________________________________ Equipment type: Natural gas storage tank Natural gas tankless Mini-split heat pump Installation date ________________________ Manufacturer _____________________________________________________________________ HSPF_________________________________ Heating BTUH _______________________________ SEER________________________________ EER__________________________________ AHRI certificate number ________________________ Cooling BTUH _________________________ Outdoor unit model number ______________________________________ Outdoor unit serial number _______________________________________ Indoor unit model number________________________________________ Indoor unit serial number ________________________________________ Mini-split heat pump will be used for: Cooling and heating Cooling only Heating only Number of indoor units________________ Smart thermostats Smart thermostat serial number/MAC ID ____________________________ Mfg and Model number _________________________________________ Thermostat Price must be listed on invoice Page 2 of 4 21-05-527 MN Residential HVAC Rebates Application Minnesota Rebate details Xcel Energy issues rebates in the form of checks or utility bill credits. ACH payments are available to customers enrolled in Auto Pay through My Account. Xcel Energy is not responsible if your contractor provided inaccurate information about the amount and/or conditions of the actual rebate or equipment eligibility. Qualifying account holders For the following types of equipment, customers must have residential electric service with Xcel Energy: central air conditioners, heat pumps and heat pump water heaters. For the following types of equipment, customers must have residential natural gas service with Xcel Energy: natural gas furnaces, natural gas boilers, and natural gas water heaters. To be eligible for the Smart Thermostat offering, participants must be a residential customer of Xcel Energy. For customers with only electric service with Xcel Energy, participants must have central air conditioning and/or electric heating as their primary heat source. For customers with only gas service with Xcel Energy, participants must have natural gas heating as their primary heat source. Customers with electric and gas service with Xcel Energy are eligible if they meet either of these requirements. Rebates for new home construction should be negotiated between the builder and resident or new home buyer to determine who receives the rebate. Participants understand they are not eligible to receive additional rebates for the same improvement through a different Xcel Energy Rebate program. Application details Account holder applications must be postmarked no later than September 30 of the year following installation of qualified equipment. Applications must include complete contractor information and information about the equipment including but not limited to manufacturer name, model number and serial number. In addition to this rebate application, send Xcel Energy a dated purchase receipt/ invoice that includes a description of what was purchased and the cost. A proposal or estimate are not acceptable forms for proof of purchase. Please visit us at xcelenergy.com/HomeRebates or call 800-895-4999 for more information. All information on the receipt or invoice must precisely match the information on the rebate application or the application will be returned. We reserve the right to conduct random inspections to verify installation of the rebated equipment at the address indicated on the front of this form. Your assistance is appreciated. Some equipment must be listed on the AHRI site (ahridirectory.org, residential section) to be eligible for a rebate. Submitting an AHRI certificate with your application and invoice is highly recommended because AHRI list changes frequently. AHRI certificates that are printed and sent in with the rebate application will be honored even if the equipment is no longer listed on the website. Limitations Rebates are only available for purchases of new qualified equipment; used or pre-owned equipment are not eligible for the rebate. Our rebate programs may be cancelled or modified with 30 days notice. Xcel Energy reserves the right to refuse payment and participation if the account holder or contractor violates program rules and procedures. Xcel Energy is not liable for rebates promised to account holder as a result of a contractor misrepresenting the program. Xcel Energy reserves the right to refuse payment if the customer violates terms. Xcel Energy does not expressly or implicitly warrant the performance of installed equipment. Special promotions During special promotions for this program, it is the account holder/contractor's responsibility to ensure all paperwork is postmarked by the deadline. Promotional rebate amounts will be automatically calculated by Xcel Energy. Help with forms If you have questions while filling out this form, please contact your contractor for assistance. Please allow up to eight weeks for your rebate to arrive. You can call 800-895-4999 for status of your application. Mail complete application materials to: Xcel Energy Rebate Operations P.O. Box 829 Minneapolis, MN 55440-0829 or Email (for submission only): residentialrebates@xcelenergy.com Subject line: MN Res HVAC + account number or address or Submit online: xcelenergy.com/digital_application Specific Equipment Requirements Rebate Table 1: see Qualifying account holders section for customer type eligibility requirements Equipment Criteria Rebate amount 95%+ AFUE $200 Gas Furnace, Existing Home 96%+ AFUE $300 97%+ AFUE $400 95%+ AFUE $100 Gas Furnace, New Home 96%+ AFUE $150 97%+ AFUE $200 85%+ AFUE $100 Gas Hot Water Boiler 90%+ AFUE $300 95%+ AFUE $400 Gas Storage Water Heater Gas Tankless Water Heater Mini-Split Heat Pump Smart Thermostat .64 UEF, Medium Draw; 55 gallons or less $75 .68 UEF, High Draw; 55 gallons or less $75 .87 UEF, Medium or High Draw $250 15+ SEER, 11+ EER, 9+ HSPF $300 15+ SEER, 11+ EER, 9+ HSPF with electric resistance heat as the existing primary heat source $600 ENERGY STAR®, eligible to enroll in AC Rewards (see website for eligible models) $50 Controlled Smart Thermostat enrolled in demand management Eligible thermostat, enrollment in AC Rewards (see website for details) $75 bill enrollment credit, $25 bill credit/year Note: Local, state or federal tax credits or rebates may also be available for energy-efficient home improvements. Ask your tax advisor or visit energystar.gov. SEER = Seasonal Energy Efficiency Ratio EER = Energy Efficiency Ratio HSPF = Heating Seasonal Performance Factor AFUE = Annualized Fuel Utilization Efficiency Page 3 of 4 21-05-527 MN Residential HVAC Rebates Application Minnesota Natural Gas Furnace or Hot Water Boiler Only equipment listed on ahridirectory.org is eligible for a rebate. Natural Gas Water Heaters Table 2: Storage Tank Draw Patterns Draw patterns First Hour Rating (FHR) storage tank Max Gallons per Minute (GPM) tankless Medium 51 to 75 gallons 2.8 to 4 High 75 gallons 4 or more Only equipment listed on ahridirectory.org, or on energystar.gov is eligible for a rebate. Indirect units and commercial water heaters are not eligible. Gas water heaters with a rated storage volume of more than 55 gallons are not eligible. Mini-Split Heat Pumps Because heat pumps may not operate effectively below certain temperatures, a backup heat source such as a natural gas furnace or boiler, or electric resistance heating, is needed. Only equipment listed on ahridirectory.org is eligible for a rebate. A rebate is paid for each condensing (outdoor) unit, not the number of indoor units. Mini-split air conditioners (cooling only) do not qualify. Mini-split heat pumps must be used for both cooling and heating. Smart Thermostats and AC Rewards Only smart thermostats that meet the ENERGY STAR® certification and are capable of communicating with Xcel Energy's demand response control programs, including AC Rewards are eligible for rebates. For a list of qualifying models, go to xcelenergy.com/acrewards. On the site, you will also find information to enroll your thermostat in AC Rewards to receive an initial $75 bill credit, plus another $25 bill credit annually. Maximum of one rebate per household. Residents of apartments or condominiums are not eligible.. xcelenergy.com | © 2021 Xcel Energy Inc. | Xcel Energy is a registered trademark of Xcel Energy Inc. | 21-05-527

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