Section A: CUSTOMER INFORMATION. Customer Name Electric Account Number Rate Application Number. Facility Address City State Zip Code

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1 Commercial & Municipal Retrofit 2015 Lighting Rebate Section A: CUSTOMER INFORMATION Customer Name Electric Account Number Rate Application Number Facility Address City State Zip Service Location Identification Mailing Address (if different from above) City State Zip Contact Person/Title Telephone Number Incorporated? (Check one.) Yes No Exempt Please Assign Payment to Contractor. Customer Signature: Additional Information Rebate Payment Preference (Check one.) Check Bill Credit Pay Contractor Section B: CONTRACTOR INFORMATION Contractor Name Contact Person/Title (Print) Contact Person Signature Mailing Address City State Zip Telephone Number Additional Information Incorporated? (Check one.) Section C: DOCUMENT APPROVALS Yes No Exempt PRE-INSTALLATION INSPECTION Utility Signature Date PRE-APPROVAL OFFER Technical Review - Utility Signature Date Utility Signature Date Amount of Rebate Offer ($) Offer Valid Through: By signing and dating below, customer accepts this rebate offer and agrees to the Utility Terms and Conditions available from your Utility. Pursuant to a Commission order, customers also agree that the utility alone may capture all kw and kwh savings and any ISO-NE capacity payments resulting from this energy efficiency project. This agreement is contingent upon continued approval and authorization by the Commission to recover said amounts from the System Benefits Charge. The rebate, in conjunction with all other sources of funding, cannot exceed the total project cost. Customer Signature: Date: POST-INSTALLATION INSPECTION Utility Signature Date Total Project Cost ($) Amount of Rebate ($) Customer Signature Date MANAGEMENT APPROVAL Utility Signature Date Form RLR15 05/15

2 EXISTING LIGHTING RETROFIT LIGHTING INCENTIVE WORKSHEET NEW LIGHTING Location / Room / Area Lighting Type (from Table 1) Lamps per Lamp Wattage Number of Annual Hours (Table A) Example: Parking Lot High Pressure Sodium ,345 90L Lighting Type (from Table 1) Lamps and - Lamps per Lamp Wattage Number of per ($) Total ($) $150 $1,200 LIGHTING TOTAL Location / Room / Area Lighting Control (Table A-1) Number of Controls LIGHTING CONTROLS INCENTIVE WORKSHEET Lighting Type (from Table 1) Lamps per Lamp Wattage Number of Controlled Annual Hours without Controls Annual Hours Reduced with Controls % Power Reduction for Daylight Dimming per Unit (Table A1) ($) Example: Conference Room 1 6 T8 HP - 4 Foot , N/A $50 $300 Example: Reception 3 8 Lamps & ,200 N/A 50% 0 Total ($) CONTROL TOTAL LIGHTING AND CONTROL TOTAL TABLE 1: LIGHTING TYPES Biaxial - 2 Foot Low Voltage Halogen LVH T12-4 Foot T12VHO - 4 Foot T8-3 Foot T8 HP - 4 Foot Low Power Ballast Compact Fluorescent CF Mercury Vapor MV T12-5 Foot T12VHO - 8 Foot T8-4 Foot T8 HP - 4 Foot High Power Ballast High Pressure Sodium HPS Metal Halide MH T12-6 Foot T5-2 Foot T8-5 Foot T8 Tandem Wired - 4 Foot Incandescent I Metal Halide Track Lighting MHT T12-8 Foot T5-3 Foot T8-8 Foot T8 Tandem Wired - 8 Foot Exit Signs X Quartz/Halogen - Q T12HO - 4 Foot T5-4 Foot T8 HP - 2 Foot T8 HP Tandem Wired - 4 Foot Lamps & T12-2 Foot T12HO - 6 Foot T5 HO - 4 Foot T8 HP - 3 Foot Other--Describe Low Pressure Sodium LPS T12-3 Foot T12HO - 8 Foot T8-2 Foot T8 HP - 4 Foot Form RLR15

3 Table A: Lighting Systems s Description 10F* Fluorescent Re-lamp and Re-ballast 10L 20F* Linear Tubes Fluorescent High Efficiency Interior & Per $10 $5 Per Tube T-5 lamps or CEE qualified New High Performance /Reduced Wattage (HP/RW) T-8. Each fixture is composed of an electronic ballast and up to 4 lamps. Only one incentive may be counted per fixture. Multiple fixtures served by a single ballast are only eligible for one incentive. linear tubes** Reference Commercial & Industrial Retrofit Instructions Eligibility Requirements 10,11,12,13 for additional guidance for the use of 10L Your utility may require removal or replacement of existing ballast. lamps are required to be listed by Design Lights Consortium 1x4, 2x2 and 2x4 Prismatic Lensed 83% for 2x4 with two or three T-8 or T-5 lamps 75% for 2x2 with two T-8 or T-5 lamps Per Tube 27 Parabolic Louver 80% for 2x4 or 2x2 (2" to 3" deep cells) with two T-8 or T5 lamps 75% for 2x4 (2" to 3" deep cells) with three T-8 or T5 lamps 20L High Efficiency Interior & $60 Recessed Indirect/Direct 75% for 2x4 with two T-8 or T-5 lamps; 70% for 2x2 with two T-8, T-5, or for 2x4 with three T-8, T-5. Eligible 3 lamp fixtures are limited to a low power ballast factor < x4, 2x2 and 2x4 Prismatic, Parabolic, Recessed Direct and Recessed Indirect fixtures

4 21F* Description Fluorescent High Efficiency Linear Indirect/Direct Pendant Per 80% for an indirect pendant fixture with two T8 or T5 lamps or one T5HO lamp. may have a down-light component of no greater than 45%. with a down-light component must incorporate glare limiting louvers or a perforated cover shielding the lamps. Ceiling finish must be white and unobstructed 21L Linear Indirect or Indirect Pendant $75 may have a down-light component of no greater than 45%. with a down-light component must incorporate glare limiting louvers or a perforated cover shielding the lamps. Ceiling finish must be white and unobstructed 22F* Fluorescent Advanced Recessed 80% for Slot, 1x4 advanced glare reducing diffuser fixture with one or two T8 or T5 lamps, or one T5HO lamp. 80% for 2x2 advanced glare reducing diffuser fixture with one or two T8, T5 or T5HO lamps 85% for 2x4 advanced glare reducing diffuser fixture with one or two T8 or T5 lamps, or one T5HO lamp. 22L Advanced Recessed $60

5 Description 30F* Fluorescent Industrial/Commercial Per 4 ft. and 8ft. T5 or T8 85% for Industrial Reflector fixture with one or two T-8 or T-5 lamps (up to 20% up-light); 83% for Commercial Grade Wraparound fixture with one or two T-8 or T-5 lamps. Applies to fixtures installed at 16 feet or less above the floor. Only one incentive may be counted per fixture. Eight foot and multiple fixtures served by a single ballast are only eligible for one incentive L Industrial/Commercial $60 4 ft. and 8ft. industrial/commercial strip or wrap fixtures. Applies to fixtures installed 16 feet or less above the floor. Only one incentive may be counted per fixture. 31F* Fluorescent Clean Room Rated or Vapor Tight 1x4 or 2x4 : -75% for Clean Room fluorescent fixture with up to three T-8 or T-5 lamps. -70% for Vapor Tight fluorescent fixture with up to three T-8 or T-5 lamps L Clean Room Rated or Vapor Tight $75 1x4 or 2x4

6 Description Per F* Fluorescent Stairwell with integral Occupancy sensor controls - 75% for Stairwell fluorescent fixture with up to three T-8 or T-5 lamps. To be eligible for incentives, fixtures must be installed in an 8,760 hour stairwell application with integral occupancy sensor control, setting lights to 50% output or less in control mode (not occupied). Not eligible for additional control incentive 23 L Stairwell with integral Occupancy sensor controls $75 To be eligible for incentives, fixtures must be installed in an 8,760 hour stairwell application with integral occupancy sensor control, setting lights to 50% output or less in control mode (not occupied). Not eligible for additional control incentive 27 40F* Fluorescent High and Low Bay High Intensity imum wattage is 96 watts. efficiency must be to 80%. Recommended mounting height > 16 feet above the floor. High Intensity Fluorescent fixtures incorporate a number of lamp technologies that include T- 8, T-5, T-5HO T8 fixtures must have high power ballast L High and Low Bay High Intensity & $125 imum wattage is 45 watts to 149 watts. Recommended mounting height is > 16 feet above the floor L High and Low Bay High Intensity & $175 imum wattage is 150 watts. Recommended mounting height is > 16 feet above the floor. 150

7 50L Description Down Light & Per Eligible Down Lights are required to be less than 25 watts and hardwired or GU-24 (pin) base. Screw Base Down Light are also eligible. Replacement lamps not eligible L Hardwired Track Heads or Mono- Point Directional track heads hardwired installations only, replacement lamps not eligible L Directional and Omni-directional Replacement Lamps $5 Eligible Integral replacement lamps with screw or pin base Lamps must operate a minimum of 2,000 hours annually. Eligible lamps are required to be listed by Energy Star Pre-Qualified list For more information see L Exit $5 All materials and assembled units shall comply with all applicable codes and standards including (but not limited to) Federal/State/Local building, fire, and electrical codes, and may require designated egress lighting to comply with such codes. Exit sign retrofit kits are not eligible L Cooler, Freezer, or Refrigerated 3 & 4 $40 are required to be required to be listed by Design Lights Consortium 14 61L Cooler, Freezer, or Refrigerated 5 & 6 $55 are required to be required to be listed by Design Lights Consortium 23

8 70L Description Garage & Canopy & Per $75 Low Bay for Garages and Canopies watts L Garage & Canopy & $100 Low Bay for Garages and Canopies greater than 99 watts L Exterior Wall, Post, Ground, and Arm Mount Floods and & $75 Wattage range is 25 watts to 99 watts Must be automatically controlled to avoid daylight operation L Exterior Wall, Post, Ground, and Arm Mount Floods and & $100 imum wattage is 100 watts Must be automatically controlled to avoid daylight operation L Pole Mounted Parking, or Roadway & $150 Wattage range is 45 watts to 149 watts Must be automatically controlled to avoid daylight operation L Pole Mounted Parking, or Roadway & 0 imum wattage is 150 watts Must be automatically controlled to avoid daylight operation L New & fixture categories not covered under other codes, or fixtures that do not meet minimum watt reduction in other codes. or ENERGY STAR. 20 Linear Tubes (T8 style) not eligible in code 99L

9 *Note: All T8 fluorescent fixtures must have High Performance T8 or Reduced Wattage (HP or RW) lamp & ballast systems or T5 lamp and ballast systems to be eligible for a fluorescent incentive (F*). For detailed eligibility requirements and a list of qualifying High Performance T8 or Reduced Wattage (HP or RW) lamp & ballast systems, go to CEE s web site at **Note: NHSaves and its sponsor utilities do not warrant or accept any liability whatsoever in respect of any 4ft or 2ft Linear Replacement Lamps that receive incentives through our energy efficiency programs. Customers are responsible for the proper modification and installation of 4ft and 2ft Linear Replacement Lamps in existing fixtures in accordance with manufacturer s instructions. Customers should be aware that this may void fixture warranty. Customers are responsible for proper labeling of all modified existing fixtures. It is the responsibility of the lighting installers to meet current Illuminating Engineering Society standards for light levels, light distribution, uniformity and lighting quality for all installations that use these prescriptive technologies.

10 Please note that only one incentive control strategy will be approved per fixture/area. Also consider using program start CEE qualified, parallel wired ballasts for all appropriate control product codes on T8 lighting to ensure longer lamp life over instant start ballasts. Table A-1: Lighting Control s Description Controlled Wattage 1 Remote Mounted Occupancy Sensor $50 per control Comply with manufacturer s coverage recommendations. No manual ON overrides. 90 (total) 2 Wall mounted Occupancy/Vacancy Sensors per control Occupancy Sensors must operate as Automatic On, and Automatic Off or Manual On and Off. Sensors are wall mounted devices only. Not recommended in multi stall restrooms, locker rooms, stairwells or rooms of greater than 250 square feet. 45 (total) 3 Daylight Dimming System and/or Occupancy Controlled Step-Dimming System per fixture Daylight: Must have continuous dimming or adjust to a minimum of 4 levels. Typical lamping is either a 28 or watt T8 lamps. Step-Dimming: Ballast must be automatically controlled based on occupancy. Power consumption in low mode must not exceed 60%. 45 (per fixture) 4 Integral High Bay Occupancy Control Systems per fixture Fluorescent Ballast or Drivers must be automatically controlled based on occupancy. Systems with manual ON or override switches are not eligible. Occupancy sensors are integral (built into) or permanently attached to each fixture. 45 (per fixture) 5 Photocell Sensors per control Photocell sensor for exterior lighting systems, or lighting circuit, that would otherwise operate on 24 operate on 24 hours a day, 7 days a week (8,760 hours annually) 30 (total) 05/15