LIGHTING EQUIPMENT 2017 IOWA FOR YOUR BUSINESS REBATE APPLICATION

Transcription

1 LIGHTING EQUIPMENT 2017 IOWA FOR YOUR BUSINESS REBATE APPLICATION MidAnierican ENERGY OBSESSIVELY, RELENTLESSLY AT YOUR SERVICE. Instructions: Fill out form completely and sign. Attach itemized invoices and supporting documentation, if applicable. Failure to complete the required sections and provide documentation will result in denial of claim. must be purchased between Jan. 1, 2017, and Dec. 31, must be installed and operating prior to submission of fnal rebate application. Commercial new construction projects are not eligible for prescriptive lighting rebates through this program. All commercial new construction projects must participate in the Commercial New Construction program in order to receive lighting rebates. Industrial new construction projects are eligible. Rebates cannot exceed 70 percent of the installed cost (materials and reasonable labor). You will receive the lesser of the rebate amount listed or 70 percent of installed cost. Installed cost includes contractor labor only and does not include internal labor. Rebate application must be submitted within six months of dealer invoice for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. Rebate applications received after six months of dealer invoice are not eligible for rebates. Custom : If specifc equipment you intend to purchase and install is not listed, it may qualify under Nonresidential Custom Systems. However, custom projects must be preapproved by MidAmerican Energy prior to purchase and installation of equipment or system. See the Nonresidential Custom Systems application for details. SECTION 1 (REQUIRED) Name on account Installation address Customer Information Self-installed q Yes q No I SECTION 2 (REQUIRED) My facility had an energy assessment in the following program (check if applicable): q Industrial q Agribusiness q Commercial q Multifamily Housing q No assessment has been completed Date assessment completed (month/year) Building size [sq. ft. (area)] City State ZIP Phone MidAmerican Energy Company account number (found on bill; frst seven digits only) LJLJLJLJLJ-LJLJ~~~ Mailing address (if different than installation address) I I Year building was constructed Do you: q Own q Rent this building The new equipment is for: q Replacement of existing equipment q New installation (new to facility) q New construction Is facility where equipment will be installed conditioned? (check one) q Cooled only q Heated only q Not cooled or heated q Both heated and cooled If facility is heated, what fuel type is used? (check one) q Natural gas (furnace) q Electric (resistance heating) q Propane q Natural gas (boiler) q Electric (heat pump) City State ZIP Contact name I I Title address* *This address only will be used for communication regarding this rebate application. Your address never will be shared and you can unsubscribe at anytime. Page 1 of 14

2 SECTION 2 CONT. (REQUIRED) installed in what type of facility? (check one) Industrial MEC Use Only Agriculture MEC Use Only q Offce small 4 foors OS q Apparel manufacturing IND q Corn farming AG q Offce large > 4 foors OL q Chemical manufacturing IND q Dairy cattle and milk production DF q Offce government small 4 foors OS q Computer/electronic product manufacturing IND q Hog facility HF q Offce government large > 4 foors OL q Electrical equipment, appliance/component IND q Soybean farming AG q Offce public order and safety small 4 OS manufacturing foors q Food/beverage/tobacco product IND q All other animal production AG q Offce public order and safety large > 4 foors OL manufacturing q Furniture and related product manufacturing IND q All other miscellaneous crop farming AG q Pharmacy and drug store small <30k RS square feet q Leather and allied product manufacturing IND q Pharmacy and drug store large >30k RL square feet Commercial MEC Use Only q Machinery manufacturing IND q Public assembly events/conventions/casinos HY q Apartment, halfway house MF small <30k square feet q Nonmetallic mineral product manufacturing IND q Public assembly events/conventions/casinos HY q Condo MF large >30k square feet q Oil and gas extraction; mining IND q Religious worship/church RE q Convenience store/gasoline station CV q Paper manufacturing; printing and related IND q Restaurant fast food RST support activities q Dealership small <30k square feet RS q Personal and laundry services IND q Restaurant full service RST q Dealership large >30k square feet RL q Petroleum and coal products manufacturing IND q Retail small <30k square feet RS q Financial institution small <30k square feet OS q Plastics and rubber products manufacturing IND q Retail large >30k square feet RL q Financial institution large >30k square feet OL q Primary metal/fabricated metal product IND q Retail department store small <30k RS manufacturing q Grocery store and supermarket GR square feet q Textile mill and textile product mill IND q Retail department store large >30k RL q Healthcare (outpatient) HC square feet q Transportation equipment manufacturing IND q School elementary ED q Healthcare (inpatient, including hospital, HS q Utility IND nursing home, senior care facility) q School jr. high ED q Healthcare senior housing - individual MF q Warehouse and storage IND apartment q School high school ED q Health club/exercise facility small <30k RS q Warehouse large refrigerated IND square feet q School college, university and professional ED q Health club/exercise facility large >30k RL school q Wood product manufacturing IND square feet q School lodging (school/dorm) MF q Library ED q Miscellaneous manufacturing IND q Service small <30k square feet RS q Lodging hotel LO q Other industrial O q Service large >30k square feet RL q Lodging motel LO q Truck stop CV q Mixed use O q Warehouse and storage WH-C q Other - commercial O q Warehouse large refrigerated WH-C Page 2 of 14

3 SECTION 3 (REQUIRED) Complete all felds for each piece of equipment purchased and installed. LED Screw-in Lamps and LED Retroft Kit Downlights ENERGY STAR certifed screw-in LED lamps and LED retroft downlights are eligible for instant rebates at the time of purchase from participating distributors. For a list of participating retailers and distributors, visit or call LED Troffer Fixtures and Retroft Kits (Design Lights Consortium Qualifed Product List Required) Rebates are based on a one-for-one replacement of existing linear fuorescent troffer systems. The Eligible DLC primary use designations: program accepts LED troffer fxtures, wrap fxtures and retroft kits. Linear ambient (or strip ) fxtures are 1 x 4, 2 x 2 and 2 x 4 luminaires for ambient Lamp-style retroft kits for linear panels not eligible in this category. With preapproval before purchase or installation, they may qualify through lighting of interior commercial spaces (1 x 4, 2 x 2 and 2 x 4 troffers) the Nonresidential Custom Systems program. Retroft kits for 1 x 4, 2 x 2 and 2 x 4 Linear retroft kits for 1 x 4, 2 x 2 and luminaires for ambient lighting of interior 2 x 4 luminaires commercial spaces Integrated retroft kits for 1 x 4, 2 x 2 and 2 x 4 luminaires 1 x 4 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer 1,500- X $60/fxture = 6,000 Size/ LED Troffer and 2 x 4 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation Wrap Fixture manufacturer 3,000- X $60/fxture = Replace fuorescent 7,500 T8 and T12 existing fxtures; Troffers must replace like-sized 2 x 2 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation fxtures; for example, manufacturer a 1 x 4 must replace 2,000- X $60/fxture = 5,000 a 1 x 4. Retroft Kit for LED 2 x 4 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation Troffer Fixtures manufacturer Replace fuorescent 3,000- X $40/fxture = 7,500 T8 and T12 existing fxtures. Troffers must replace like-sized 2 x 2 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation fxtures; for example, manufacturer a 1 x 4 must replace 2,000- X $40/fxture = 5,000 a 1 x 4 1 x 4 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer 1,500- X $40/fxture = 6,000 Page 3 of 14

4 LED Hanging/Suspended Linear Fixtures with Indirect Components (DLC QPL Required) Linear ambient (or strip ) fxtures are not eligible in this category. With preapproval before purchase or installation, they may Eligible DLC primary use designation: qualify through the Nonresidential Custom Systems program. Linear ambient luminaires with indirect component Size/ 3,000-30,000 New brand/manufacturer New model number Actual lumens/fxture New Watts Rebate calculation X $60/fxture = Refrigerated LED Case Lighting 5- and 6-Foot Doors (DLC QPL Required) Rebates are based on replacement of T12 or T8 linear 5- to 6-foot fuorescent refrigerated case door lighting with 5- to 6-foot LED Eligible DLC primary use designations: refrigerated case door strip lighting. Rebates are per door, not per lamp. Linear LED tube lights do not qualify for this rebate. With Horizontal refrigerated case luminaires preapproval before purchase or installation, they may qualify through the Nonresidential Custom Systems program. The Vertical refrigerated case luminaires program adopts the DLC defnition: Strip lights in refrigerator cases vertically mounted along refrigerator case door mullions. Category Refrigerated case luminaires only covers complete luminaires with all necessary components. Replacement lamps currently are not eligible under this category. Cooler Case New brand/manufacturer New model number New Watts Rebate calculation q 5-foot door q 6-foot door X $75/door = Replace fuorescent T12 or T8 systems with LED case lighting Freezer Case New brand/manufacturer New model number New Watts Rebate calculation q 5-foot door q 6-foot door X $75/door = Replace fuorescent T12 or T8 systems with LED case lighting Page 4 of 14

5 LED High- and Low-Bay Fixtures and Retroft Kits (DLC QPL Required) Rebates are based on a one-for-one replacement of HID equipment. Rebates are available for new LED high- and low-bay Eligible DLC primary use designations: lighting. Strip, wrap or fxtures classifed as linear ambient do not qualify for this rebate. With preapproval before purchase or Low-bay luminaires for commercial and industrial buildings installation, they may qualify through the Nonresidential Custom Systems program. High-bay must be installed 15' or High-bay luminaires for commercial and industrial buildings higher. High-bay aisle luminaires Retroft kits for low-bay luminaires for commercial and industrial buildings This program adopts the DLC defnition for high- and low-bay fxtures: Pendant, recessed, or surface-mounted fxtures specifc Retroft kits for high-bay luminaires for commercial and industrial buildings for indoor ceiling spaces. This program adopts the DLC defnition for high- and low-bay retroft kits: Integrated-style kits that replace all refectors and optical systems of existing luminaires; not screw-in lamps intended as HID replacements. LED Low-Bay Fixtures <10,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer HID system X $135/fxture = replacement LED High-Bay <15,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation Fixtures manufacturer X $135/fxture = HID system replacement 15,001- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation 20,000 manufacturer X $150/fxture = >20,000- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation 30,000 manufacturer X $200/fxture = >30,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer X $325/fxture = Retroft Kit for LED <10,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation Low-Bay Fixtures manufacturer X $40/fxture = HID system replacement (cont. on next page) Page 5 of 14

6 LED High- and Low-Bay Fixtures and Retrofit Kits (DLC QPL Required) Rebates are based on a one-for-one replacement of HID equipment. Rebates are available for new LED high- and low-bay Eligible DLC primary use designations: lighting. Strip, wrap or fixtures classified as linear ambient do not qualify for this rebate. With preapproval before purchase or Low-bay luminaires for commercial and industrial buildings installation, they may qualify through the Nonresidential Custom Systems program. High-bay must be installed 15' or High-bay luminaires for commercial and industrial buildings higher. High-bay aisle luminaires Retrofit kits for low-bay luminaires for commercial and industrial buildings This program adopts the DLC definition for high- and low-bay fixtures: Pendant, recessed, or surface-mounted fixtures specific Retrofit kits for high-bay luminaires for commercial and industrial buildings for indoor ceiling spaces. This program adopts the DLC definition for high- and low-bay retrofit kits: Integrated-style kits that replace all reflectors and optical systems of existing luminaires; not screw-in lamps intended as HID replacements. Retrofit Kit for LED High-Bay Fixtures HID system replacement <15,000 New brand/ New model number manufacturer Actual lumens/fixture New Watts Rebate calculation X $40/fixture = 15,001- New brand/ New model number 20,000 manufacturer Actual lumens/fixture New Watts Rebate calculation X $50/fixture = >20,000- New brand/ New model number 30,000 manufacturer Actual lumens/fixture New Watts Rebate calculation X $80/fixture = >30,000 New brand/ New model number manufacturer Actual lumens/fixture New Watts Rebate calculation X $120/fixture = Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at Page 6 of

7 LED Linear Replacement Lamps (DLC QPL Required) Rebates are based on one-for-one replacement of fluorescent lamps with LED linear replacement lamps listed on the DLC QPL. Eligible DLC primary use designations: Two 4' LED lamps cannot replace one 8' lamp. Replacement lamps ( Plug and Play ) (UL Type A) Internal driver/line voltage lamp-style retrofit kits (UL Type B) This program adopts the DLC definitions: Two-lamp external driver lamp-style retrofit kits (UL Type C) Replacement lamps (UL Type A). Products in this category employ lamp holders to connect to the fixture being retrofitted and are Three-lamp external driver lamp-style retrofit kits (UL Type C) designed to be plug and play replacements for fluorescent lamps. That is, products in this category can operate off an existing Four-lamp external driver lamp-style retrofit kits (UL Type C) fluorescent ballast and do not require mechanical or electrical changes to the fixture. Note that due to testing considerations, at Dual mode internal driver (UL Type A or B) this time only products that can operate off electronic instant start ballasts are eligible. Replacement lamps designed to operate off existing magnetic ballasts, or other types of electronic ballasts, are not eligible. Dual mode internal driver lamps (UL Type A/B) are allowed in this category if installed as a plug and play operating off existing fluorescent ballast. Internal-driver/line voltage linear lamp-style retrofit kits (UL Type B) and external-driver lamp-style retrofit kits (UL Type C) must utilize existing pin sockets. /specifications LED Linear Tube New brand/manufacturer New model number Type A, 4' 4' T12, T8 and T5 fluorescent replacement lamps LED Linear Tube New brand/manufacturer New model number Type B and Dual Mode Type A/B, 4 4' T12, T8 and T5 fluorescent replacement lamps LED Linear Tube New brand/manufacturer New model number Type C, 4 4 T12, T8 and T5 fluorescent replacement lamps New Watts Rebate calculation X $5/tube = New Watts Rebate calculation X $5/tube = New Watts Rebate calculation X $5/tube = Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at Page 7 of

8 LED Wall Pack Fixtures (DLC QPL Required) Rebates are based on one-for-one replacement of HID wall packs with LED fxtures rated for exterior use. Replacement LED Eligible DLC primary use designations: wall pack fxtures must be used for building exteriors or inside parking garages and must be attached to a wall. The program Outdoor full cut-off wall-mounted area luminaires adopts this DLC defnition: Typically walkway or security lights affxed to building wall. May be box-shaped. Outdoor noncut-off and semicut-off wall-mounted area luminaires Building Exterior <10,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer Replace HID systems. X $50/fxture = Replacement LED wall pack fxtures must be used for building exteriors. 10,001- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation must be 15,000 manufacturer hardwired and rated X $75/fxture = for exterior use. >15,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer X $100/fxture = Parking Garage <10,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer Replace HID systems. X $50/fxture = Replacement LED wall pack fxtures must be used for building exteriors. 10,001- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation must be 15,000 manufacturer hardwired and rated X $75/fxture = for exterior use. >15,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer X $100/fxture = Is parking garage where equipment will be installed conditioned? (check one) q Cooled only q Heated only q Not cooled or heated q Both heated and cooled If parking garage is heated, what fuel type is used? (check one) q Natural gas (furnace) q Natural gas (boiler) q Electric (resistance heating) q Electric (heat pump) q Propane Page 8 of 14

9 Ceiling-Mounted LED Parking Garage Fixtures (DLC QPL Required) Eligible parking garage structures need to be either underground or semi-enclosed above ground. The lighting within the garage must operate 24 hours a day. Rebates are based on a one-for-one replacement of HID equipment (including mercury vapor, high-pressure sodium, metal halide or pulse-start metal halide). LED retroft kits are not available for prescriptive rebates. With preapproval before purchase or installation, they may qualify through the Nonresidential Custom Systems program. The program adopts the DLC defnitions: Ceiling-mounted luminaires for use outdoors or in locations open to elements in multideck garages. Eligible DLC primary use designation: Parking garage luminaires Ceiling-Mounted <5,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation LED Parking manufacturer Garage Fixtures X $135/fxture = Replace HID systems; parking garage must be illuminated 24/7. 5,001- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation 15,000 manufacturer X $200/fxture = >15,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer X $400/fxture = Is parking garage where equipment will be installed conditioned? (check one) q Cooled only q Heated only q Not cooled or heated q Both heated and cooled If parking garage is heated, what fuel type is used? (check one) q Natural gas (furnace) q Natural gas (boiler) q Electric (resistance heating) q Electric (heat pump) q Propane Page 9 of 14 Questions about the forms or need assistance with the forms? Call our energy effciency representatives at

10 Exterior LED Fuel Pump Canopy Fixtures (DLC QPL Required) Rebates are based on one-for-one replacement of HID canopy fxtures with LED fxtures rated for exterior use. The program adopts the DLC defnition: Ceilingmounted luminaires for use outdoors or in locations open to elements in gas station canopies. must be hard-wired and rated for exterior use. Fixtures can be installed in either the canopy or sofft of the gas station building structure. Eligible DLC primary use designation: Fuel pump canopy luminaires Exterior LED <5,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation Fuel Pump manufacturer Canopy Fixtures X $135/fxture = Replace HID systems 5,001- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation 15,000 manufacturer X $200/fxture = >15,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer X $400/fxture = LED Outdoor Area Lighting (DLC QPL Required) Rebates are based on one-for-one replacement of exterior HID fxtures with LED fxtures rated for exterior use. Eligible DLC primary use designations: Architectural food and spot luminaires Bollards Landscape/accent food and spot luminaires Outdoor pole/arm-mounted area and roadway luminaires Outdoor pole/arm-mounted decorative luminaires Stairwell and passageway luminaires LED Outdoor <10,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation Area Lighting manufacturer X $50/fxture = Replace HID systems 10,001- New brand/ New model number Actual lumens/fxture New Watts Rebate calculation 30,000 manufacturer X $75/fxture = >30,000 New brand/ New model number Actual lumens/fxture New Watts Rebate calculation manufacturer X $150/fxture = Page 10 of 14

11 Municipal-Owned LED Roadway Fixtures (DLC QPL Required) Municipal-owned fixtures on a metered or unmetered circuit. SL rate code is not eligible for rebates. Replaced wattage greater than 400 watts does not qualify for this rebate. With preapproval before purchase or installation, they may qualify through the Nonresidential Custom Systems program. Municipalities wishing to replace MidAmerican Energy roadway fixtures can find more information at cityled@midamerican.com or call Eligible DLC primary use designation: Outdoor pole/arm-mounted area and roadway luminaires Municipal-Owned LED Roadway Fixtures Replace roadway HID systems; < 400 watts <10,000 New brand/ New model number manufacturer 10,001- New brand/ New model number 120,000 manufacturer Actual lumens/fixture New Watts Rebate calculation X $50/fixture = Actual lumens/fixture New Watts Rebate calculation X $75/fixture = LED Exit Signs < 2 watts New brand/manufacturer New model number Rebate calculation Existing building only replacing incandescent or fluorescent sign X $25/fixture = Occupancy Sensors Occupancy sensors may be wall- or ceiling-mounted, including passive infrared, ultrasonic or dual technology sensors. Occupancy Sensor New brand/manufacturer New model number Rebate calculation Minimum 45 watts controlled; rebate level is based on controlled load (watts)/sensor. $0.10/watt X controlled = Total watts controlled Rebate Total Lighting Timer or New brand/manufacturer New model number Total watts Rebate calculation Clock controlled Commercial-grade only X $35/unit = Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at Page 11 of

12 LED Traffic Lights 12" Red Ball New brand/manufacturer New model number New Watts Rebate calculation X $25/unit = 12 Green Ball New brand/manufacturer New model number New Watts Rebate calculation X $50/unit = 12 Green Arrow New brand/manufacturer New model number New Watts Rebate calculation X $40/unit = 12 Don t Walk New brand/manufacturer New model number New Watts Rebate calculation X $25/unit = Page 12 of 14 Questions about the forms or need assistance with the forms? Call our energy efficiency representatives at

13 Specifc Terms and Conditions Participants must be commercial or industrial customers with facilities located in MidAmerican Energy Company s Iowa service territory. MidAmerican Energy Company must directly provide the primary electricity to the equipment at the facility for which the rebate is being paid. One-for-one replacement only. Lighting redesigns where the quantity of lamps or fxtures is changed may be eligible for a rebate through Nonresidential Custom Systems. For prescriptive rebates, the rebate payment cannot exceed 70 percent of the installed cost (reasonable labor and material/equipment - reasonableness to be determined by MidAmerican Energy Company). Installed cost includes contractor labor only and does not include internal labor. Wattage and lumen output is based on DesignLights Consortium listing. Application must include DLC listing from the Qualifed Products List where DLC QPL required as is stated. For more information see Commercial new construction projects are not eligible for prescriptive lighting rebates through this program. All commercial new construction projects must participate in the Commercial New Construction program in order to receive lighting rebates. Industrial new construction projects are eligible. must be purchased between Jan. 1, 2017, and Dec. 31, must be installed and operating prior to submission of fnal rebate application. Rebate application must be submitted within six months of dealer invoice for the equipment/material purchased. The rebate will be based on the rebate schedule in effect on the date of dealer invoice for the equipment/material purchased. Rebate applications received after six months of dealer invoice are not eligible for rebates. A minimum of 1,000 annual operating hours required. Rebate checks will be issued to the building owner or account holder. Allow 4 6 weeks for rebate processing. General Qualifcations and Conditions Important: Before completing and signing this form, please read the General Qualifcations and Conditions located in the 2017 Iowa For Your Business rebate booklet or at Disclaimer MidAmerican Energy Company does not guarantee that installation and operation of high-effciency equipment will result in reduced usage or in cost savings. MidAmerican Energy Company makes no warranties, expressed or implied, with respect to any equipment purchased or installed, including, but not limited to, any warranty of merchantability or ftness for a particular purpose. In no event shall MidAmerican Energy Company be held liable for any incidental or consequential damages or injuries resulting from defective equipment or installation. MidAmerican Energy Company reserves the right to cancel or change these programs at any time. MidAmerican Energy Company s acceptance of this application does not guarantee payment of rebate. Customer Agreement I certify that I have purchased the equipment described on this form and that it has been installed at the service address indicated. I agree to the terms and conditions associated with this form. I understand that MidAmerican Energy Company reserves the right to inspect and verify installation before issuing payment. Customer signature Date Dealer name Contact name Address Installer/Dealer Information City State ZIP Phone address Fax Dealer Agreement I certify that all equipment and installation information provided on this application is correct and accurate. Dealer signature Before you submit your form: Send completed forms to: q Fill out this form completely. Mail: MidAmerican Energy Company q Attach a copy of the itemized sales receipt P.O. Box 4628 or invoice. Des Moines, IA q Include required documentation with Fax: each measure. q Sign the Customer Agreement section. rebateapplications@midamerican.com I Date Page 13 of

14 Example of DLC Primary Use Designations DLC Product ID Example of DLC Primary Use Designation Sample Invoice Date: January 31, 2017 INVOICE #: SHIP TO: XYZ Company 234 Jersey St. Des Moines, IA TO: XYZ Company 234 Jersey St. Des Moines, IA PO number: Terms: Net 25 Include project codes and/or item numbers Specify the quantity for each item Identify manufacturer s part information List price for each item and total ITEM QTY DESCRIPTION RATE SERVICE DATE AMOUNT LED30WCW 100 Acme 30W LED lamp $35 $3, DEC27W Acme 27W LED lamp $125 $3, HD B blue wire nut $0.16 $32.00 Installed LED lamps and downlights Subtotal $6, Local sales tax 7.5% $ Labor 1 Labor $448 1/2/2017 $ Travel 0 Travel $64 $0 Environmental Fee Environmental Fee $ /2/2017 $82.11 Total $7, Note labor and other expenses separately from material costs Give accurate description of work completed Page 14 of 14