Prescriptive Lighting Rebate Application

2017 Commercial Rebate Program Prescriptive Lighting Rebate Application (Member Information Input Page) WrightHennepin Cooperative Electric Assn., P.O. Box 330, Rockford, MN 55373 Ph: 7634773000 Business Member Information Business name Billing address Phone Installation address (if different from above) Account number Contact name Email Vendor Information Vendor name Vendor address City, State, ZIP Vendor contact name Email City State ZIP Phone Phone The undersigned does hereby certify that 1) The undersigned, and not the cooperative, is solely responsible for the accuracy of the information contained in this application, 2) all rules of the Lighting Rebate program have been followed, and 3) the installation is complete. Further, the undersigned acknowledges that nothing contained in the application shall impose any liability on the cooperative for the work performed and information presented by the member s engineer, contractor or vendor. Wright Hennepin Cooperative Electric Association will be referred to hereafter in this application as "the Member signature Date How to Apply for all WH Commercial Lighting Rebate Programs: 1. Complete the applicable rebate forms, including all pertinent information. (please note all warranty information, rules, and qualifications on the rules and information tabs per relevant forms) 2. Forward the applicable completed application forms, including copies of relevant project invoices (if available at time of submittal) to a WH commercial key account representative for review. 3. The cooperative's subsequent approval is required, to ensure payment of applicable rebate incentive. 4. The member must apply for applicable rebate incentive, no later than November 1st, 2017.

2017 Lighting Retrofit Rebate Program: Page 1 of Rules and Qualifications WrightHennepin Cooperative Electric Assn., P.O. Box 330, Rockford, MN 55373 Ph: 7634773000 Specific Rules and Qualifications The cooperative offers rebates to qualifying members who purchase and install qualifying energyefficient lighting products in existing buildings. If the system configuration does not fit one of the prescriptive rebates shown, the project may still qualify for a rebate through the Custom Energy Rebate program. The Custom Energy Rebate requires review and approval by the participating member cooperative. Illuminating Engineering Society (IES) light levels are recommended. 1. Fluorescent T8 or T5 Lamps with Electronic Ballast Rebates based on installed equipment of oneforone replacement of incandescent fixtures, fluorescent T12 lamps controlled by magnetic ballasts, or other fixture type that produce similar kw savings. 2. Fluorescent Super T8 Lamps with Electronic Ballast Rebate based on installed equipment of oneforone replacement of incandescent fixtures, fluorescent T12 lamps controlled by magnetic ballasts, or other fixture type that produce similar kw savings. Super T8 systems must meet the following CEE criteria: Lamps must produce at least 3,100 initial lumens; have a colorrendering index of (CRI) 81; have mean lamp lumens of per watt 90 for instant start ballast or 88 for programmed rapid start ballast; a lamp life of 24,000 hours (at 3 hrs/start); and have lumen maintenance of 94%. Ballasts must have a ballast efficacy factor (BEF) at least as high as the factors shown in the tables below. t Start Ballast (BEF) Lamps Low (BF 0.85) Normal (0.85<BF 1.0) High (BF 1.01) 1 3.08 3.11 N/A 2 1.60 1.58 1.55 3 1.04 1.05 1.04 4 0.79 0.80 0.77 Programmed Rapid Start Ballast (BEF) Lamps Low (BF 0.85) Normal (0.85<BF 1.0) High (BF 1.01) 1 2.84 2.84 N/A 2 1.48 1.47 N/A 3 0.97 1.00 N/A 4 0.76 0.75 N/A 3. Lowwattage T8 Lamps Rebates are based on the installation of 4ft T8 lamps 28W or less. Rebate is based on the number of lamps. Example A: Replace a 4lamp 4ft. T12 fixture with a 4lamp 4ft. T8 fixture with 28W T8 lamps; Rebate equals the T12 to T8 fixture retrofit rebate of $13 plus the lowwattage T8 rebate of $2.00 ($.50 x 4) for a total rebate of $15.00. Example B: Remove standard 32W 4ft. T8 lamp from a fixture and install a 28W T8 lamp. Rebate equals $0.50. 4. Highbay Fluorescent T8 and T5HO Lamps with Electronic Ballast Rebates are based on oneforone replacement of various wattage HID fixtures including mercury vapor, high pressure sodium, metal halide, pulse start metal halide, or other fixture type that produce similar kw savings. See table on inputs page for examples. Highbay fluorescent T8, T8 VHO, and T5 HO of various lamp quantities must maintain corresponding lumen output and produce kw savings based on their respective replacements. Fixtures must meet the following conditions: Lumen maintenance >90% Fixture efficiency >80% Fixtures must have reflectors Fixtures with individual automatic controls installed qualify to receive additional rebate per fixture. 5. Compact Fluorescent Fixtures (CFLs) Rebates are based on oneforone replacement of incandescent fixtures with new hardwired (dedicated) or modular fixtures containing pin based CFLs. For fixtures that house more than one lamp, the rebate is based on the total fixture wattage. (i.e., one fixture that houses (2) 18W CFLs would be rebated as (1) 36W CFL fixture). Screw based CFLs qualify at lower monetary levels. 6. Industrial MultiCompact Fluorescent Fixtures Rebates are based on oneforone replacement of metal halide or fluorescent T12 lamps controlled by magnetic ballasts. 7. High Pressure Sodium (HPS) Fixtures Rebates are based on oneforone replacement of incandescent, metal halide, or mercury vapor fixtures. High pressure sodium lamp wattage must be lower than existing lamp wattage. 8. PulseStart Metal Halide (PSMH) Fixtures Rebates are based on oneforone replacement of incandescent, mercury vapor, high pressure sodium, or metal halide fixtures. Pulsestart lamp wattage must be lower than existing lamp wattage.

2017 Lighting Retrofit Rebate Program: Page 2 of Rules and Qualifications WrightHennepin Cooperative Electric Assn., P.O. Box 330, Rockford, MN 55373 Ph: 7634773000 9. Ceramic Metal Halide Fixtures Rebates are based on oneforone replacement of incandescent, halogen, mercury vapor, high pressure sodium, metal halide, or pulsestart metal halide fixtures. Ceramic metal halide lamp wattage must be lower than existing lamp wattage. 10. Reflectors Rebates are for permanently installed reflectors that have a minimum fouryear manufacturer s product warranty, are U.L. approved and result in the permanent removal of fluorescent lamps from the existing fixture. 11. Automatic Controls Occupancy Sensors, Photocells. Automatic controls must be permanently installed wall or ceiling mounted, passive infrared, ultrasonic, or dual technology sensors. With the exception of individually mounted fixture sensors, rebates apply to controlling a specific area (i.e. not each fixture). 12. LED Exit Signs Rebates are based on oneforone replacement of the entire incandescent exit sign to LED exit sign. CFL exit signs do not qualify. Warranty Information Rebate qualifications do not imply any representation or warranty of such equipment, design or installation by the cooperative. The cooperative shall not be responsible or liable for any personal injury or property damage caused by this equipment. The cooperative does not guarantee that a specific level of energy or cost savings will result from the implementation of energy conservation measures or the use of products funded under this program. In no event shall the cooperative be liable for any incidental or consequential damages. Other Important Program Rules 1. Installation must be complete before rebate funds will be issued. 2. Members and vendors must submit itemized equipment invoices, along with rebate application and worksheet, to the cooperative. To ensure that the equipment installed meets the cooperative s performance standards, these invoices must itemize labor charges, quantity and price of the equipment installed, as well as information regarding the manufacturer and model numbers for all lamps, ballasts and fixtures included in the rebate. 3. The cooperative reserves the right to conduct random inspections of installations. 4. The member is responsible for checking with the cooperative to determine whether funding is available and to verify program parameters. 5. Project must comply with all program specific rules and qualifications. 6. The maximum rebate amount shall be the lesser of 50 percent of the project cost or as determined by the cooperative. 7. Qualifying members must apply for rebates no later than November 1st, 2017.

Rebate Data Input: Lighting Systems Retrofit WrightHennepin Cooperative Electric Assn., P.O. Box 330, Rockford, MN 55373 Ph: 7634773000 Business Name: Air Conditioned (Y/N) s 0 Watts $/Unit Quantity Rebate Hrs/Yr Energy Star or DLC Qualified : Interior LED lamps (includes screw or pin) LED 2x4 Troffer LED 2x2 Troffer LED 2x4 Troffer (retrofit kit) LED 2x2 Troffer (retrofit kit) LED 4/ tubular lamp 5W or less $4.00 $ 6W10W Replaces Incandescent, Halogen, CFL or Fluorescent Lamps with an Energy Star qualified that 11W20W uses 38 times less energy (e.g. a 10W LED replaces 30W80W). $10.50 $ 21W30W $14.50 $ 19W40W Replaces T12 or T8 lamp $21.00 $ 15W30W Replaces T12 or T8 system $14.50 $ 19W40W Replaces T12 or T8 lamp $16.00 $ 15W30W Replaces T12 or T8 system $9.50 $ 18W or less Replaces T12 or T8 lamps $5.00 $ Refrigerator/Freezer LED Lighting LED Case Lamp 5'6' Replaces T12 or T8 system with LED Case Lighting $40.00 $ s Watts $/Unit Quantity Rebate Hrs/Yr Energy Star or DLC Qualified : Exterior & Interior Commercial LED fixtures (including downlights, recessed cans, pendants and surface mounted fixtures) 25W or less Replaces Incandescent, Halogen, CFL or Fluorescent $16.00 $ 26W50W Lamps with an Energy Star qualified LED fixture that uses 36 times less energy (25W LED fixture replaces $20.00 $ 51W75W 75W150W) $24.00 $ Energy Star or DLC Qualified (Equivalent may be approved by cooperative) : Exterior & Interior Commercial LED fixtures; wallpacks, soffit, canopy, hibay / lobay and pole mount 40W or less Replace 36 x HID $28.00 $ 41W80W Replace 36 x HID $48.00 $ 81W120W Replace 36 x HID $72.00 $ 121W200W Replace 36 x HID $96.00 $ 201W250W Replace 36 x HID $112.00 $ LED exit sign (retrofit only) LED Exit Sign (retrofit only) 8W or less Replace Incandescent Exit Sign

Flourescent Fixture Lighting Retrofit Rebate (continued) $/Unit Quantity Rebate Hrs/Yr HID Fixture Fluorescent T5 Lamps Fluorescent T8 Lamps Fluorescent Super T8 Lamps 3lamp T8VHO, 46 lamp T5HO, 68 lampt8 6lamp T8VHO, 8lamp T5HO, 1216 lamp T8 8lamp T8VHO, 10lamp T5HO, 1820lamp T8 Automated control / fixture (photo/motion) Hardwired or Modular Compact Fluorescent Fixtures (does not include screwbase CFL's) ScrewBase Compact Fluorescent Lights Industrial MultiCFL Fixtures 4 ft. 4 ft. 5 ft. to 8 ft. Replace HID 1000W lamp systems > 56W 2 lamp 1 lamp Replace HID 310400W lamp systems Controls hibay fluorescent fixture > 56W 33W to 56W 19W to 32W 18W 33W to 56W 19W to 32W 18W LowWattage Fluorescent T8 Lamps 4 ft., 28W 1 lamp 2lamp T5HO, 3lamp T5HO, 4lamp T8 4 ft. 5 ft. to 8 ft. 2 lamp 1 lamp Replace HID 150250W lamp systems Replace HID 750W lamp systems Replace T12 or metal halide systems $13.50 $ $9.00 $ $13.00 $ $13.00 $ $13.00 $ $13.00 $ $0.50 $ $29.00 $ $52.00 $64.00 $ $80.00 $ $4.00 $ $20.00 $ $17.00 $ $13.00 $ $6.50 $ $5.00 $ $3.00 $ $1.50 $ $26.50 $ $ $/Unit Quantity Rebate Hrs/Yr High Pressure Sodium Fixtures PulseStart Metal Halide Fixtures 251W 151W 250W 150W 750W 320W 749W 176W 319W 175W 251W $36.00 $ $24.00 $ $16.00 $ $56.00 $ $48.00 $ $36.00 $ $23.00 $ $60.00 $

Photocell Ceramic Metal Halide Fixtures Reflectors Automatic Controls (hard wired) (Must be permanently installed) Ceiling Mount Occupancy Sensor Wall Mount Occupancy Sensor Fixture Mount Sensor (> 120 W fix.) 151W 250W 51W to 150W 50W Must result in permanent removal of lamps from the existing systems. Hours of operation % Operating hour reduction ** *Apply the total wattage of all controlled fixtures associated with total control quantity **Apply hour reduction based on difference between hour used w/out controls & hours w/ control type ***Required Information. Must enter total project cost to determine rebate. $40.00 $ $28.00 $ $20.00 $ sq. ft. $1.00 $ sq. ft. $1.00 $ Connected $/Unit Quantity Rebate Hrs/Yr reduced** Total kw* $11.00 $ $20.00 $ $11.00 $ $4.00 $ ***Project Cost Total Rebate $

2017 New Construction Lighting Rebate: Rules and Qualifications WrightHennepin Cooperative Electric Assn., P.O. Box 330, Rockford, MN 55373 Ph: 7634773000 Specific Rules and Qualifications The cooperative offers rebates to qualifying members who purchase and install qualifying energyefficient lighting products in newly constructed buildings. If the system configuration does not fit one of the prescriptive rebates shown, the project may still qualify for a rebate through the Custom Energy Rebate program. 1. Fluorescent T5 Lamps with Electronic Ballast Rebate based on the installation of fluorescent T5 controlled by electronic ballasts. 2. Fluorescent Super T8 Lamps with Electronic Ballast Lamps: produce at least 3,100 initial lumens; colorrendering index (CRI) 81; mean lamp lumens per watt 90 for instant start ballast or 88 for programmed rapid start ballast; lamp life 24,000 hours (at 3 hrs/start); and lumen maintenance 94%. Ballast must have a ballast efficacy factor (BEF) at least as high as the factors shown in the tables below. Instant Start Ballast (BEF) Lamps Low (BF 0.85) Normal (0.85<BF 1.0) High (BF 1.01) 1 3.08 3.11 N/A 2 1.60 1.58 1.55 3 1.04 1.05 1.04 4 0.79 0.80 0.77 Programmed Rapid Start Ballast (BEF) Lamps Low (BF 0.85) Normal (0.85<BF 1.0) High (BF 1.01) 1 2.84 2.84 N/A 2 1.48 1.47 N/A 3 0.97 1.00 N/A 4 0.76 0.75 N/A 3. Lowwattage T8 Lamps Rebate based on the installation of 4ft T8 lamps less than or equal to 28W. Rebate is based on the number of lamps. 4. Highbay Fluorescent T8 and T5HO Lamps with Electronic Ballast Rebate Eligible 6, 8lamp T5 or 4lamp T5 HO systems. Highbay fluorescent T8 6 or 8lamp and highbay fluorescent, T5HO 4lamp fixtures must meet the following minimum eligibility criteria: Total fixture wattage < 240W Lumen maintenance >90% Initial lumens 20,000 Fixtures must have reflectors Fixture efficiency >80% 5. Compact Fluorescent Fixtures (CFLs) Rebates are available for new hardwired (dedicated) or modular fixtures containing pin based CFLs. For fixtures that house more than one lamp, the rebate is based on the total fixture wattage. (i.e., one fixture that houses (2) 18W CFLs would be rebated as (1) 36W CFL fixture. Screwbased (integral) CFLs do not qualify. 6. High Pressure Sodium (HPS) Fixtures Rebate is based on installation of HPS fixtures less than or equal to 150W. 7. Pulse Start Metal Halide (PSMH) Fixtures Rebate is based on the installation of a PSMH fixture. 8. Ceramic Metal Halide Fixtures Rebate is based on the installation of a ceramic metal halide fixture. 9. LED Rebates Rebate is based on the installation of a like delivered lumen output lamp / fixture based on typically used technology (refer to ranges on rebate sheet). The cooperative offers rebates to qualifying members who purchase and install qualifying energyefficient LED lighting products. Energy Star and Design Lights Consortium (DLC) are recognized approving agencies for LED lamps and fixtures. LED interior lamps and downlight luminaires/fixtures must be ENERGY STAR or DLC qualified. The lists of ENERGY STAR qualified products are available at energystar.gov/ssl Partners. Lamps are listed under the section Partner Resources for s. Luminaires/ fixtures are listed under Partner Resources for LED Fixtures. The ENERGY STAR list of qualified luminaires includes a variety of products. In order to qualify for the prescriptive rebates for LED downlight luminaires/fixtures, the product must be listed as Commercial or Both in the Application column of the ENERGY STAR product list. In addition, the product description in the Product Type column must include the word Downlight. ENERGY STAR does not have a qualified products list for LED canopy or soffit lighting or LED refrigerated case lighting (therefore, an ENERGY STAR rating is not required for those specific prescriptive rebates. See DLC for qualifying guidelines). For exterior LED canopy and soffit lights eligibility, the member must be replacing HID fixtures only. If the system configuration does not fit one of the prescriptive rebates shown, the project may still qualify for a rebate through the Custom Energy Rebate program. The Custom Energy Rebate requires review and approval by the participating member cooperative. Illuminating Engineering Society (IES) light levels are recommended. A project falling below recommended levels may be denied rebate.

Rebate Data Input: New Construction Lighting Systems WrightHennepin Cooperative Electric Assn., P.O. Box 330, Rockford, MN 55373 Ph: 7634773000 Business Name 0 Lighting project in air conditioned space (Y/N) > s Energy Star or Design lights Consortium qualified : Interior LED lamps (includes screw or pin) 5W or less 6W10W 11W20W 21W30W LED 4' tubular lamp 18W or less LED troffer 19W40W Refrigerator/Freezer LED Lighting LED Case Lamp 5'6' $/Unit Quantity Rebate Hrs/Yr $3.00 $ $6.50 $ $9.50 $ $4.00 $ $20.00 $ $32.00 $ 25W or less 26W50W 51W75W Energy Star or DLC Qualified (Equivalent may be approved by cooperative) : Interior & Exterior Commercial LED fixtures; wallpacks, soffit, canopy, hibay / lobay and pole mount s Energy Star or Design lights Consortium qualified : Interior & Exterior Commercial LED fixtures (including downlights, recessed cans, pendants and surface mounted fixtures) 40W or less 41W80W 81W120W 121W200W 201W250W $/Unit Quantity Rebate Hrs/Yr $13.50 $ $18.50 $ $22.50 $ $24.00 $ $40.00 $ $56.00 $ $84.00 $ $96.00 $ Fluorescent Fluorescent T5 Lamps Fluorescent Super T8 Lamps with Electronic Ballasts LowWattage Fluorescent T8 Lamps Hardwired or Modular Compact Fluorescent Fixtures (does not include screwbase CFL's) Highbay Fluorescent T8 Lamps with Electronic Ballasts Highbay Fluorescent T5 HO Lamps HID High Pressure Sodium PulseStart Metal Halide Fixtures Ceramic Metal Halide Fixtures 4 ft 4 ft. 2 lamp 5 ft to 8 ft 1 lamp 4 ft., 28W 1 lamp 33W to 56W 19W to 32W 18W 4 ft 6 and 8 lamp 4 ft. 6 and 8 lamp 4 ft 4 lamp 150W 750W 320W 749W 176W 319W 175W 251W 151W 250W 150W 2025W integrated CMH w/ electronic ballast $/Unit Rebate Hrs/Yr $2.00 $ $1.50 $ $2.00 $ $1.50 $ $2.00 $ $1.50 $ $0.50 $ $7.00 $ $4.50 $ $2.50 $ $12.00 $ $16.00 $ $12.00 $ $/Unit Rebate Hrs/Yr $5.50 $ $16.00 $ $10.50 $ $7.00 $ $5.50 $ $13.50 $ $9.00 $ $17.50 $ $6.50 $ Automatic Controls (Must be permanently installed) Hours of operation % Operating hour reduction** Connected kw* Total $/Unit Rebate Hrs/Yr reduced** Photocell Ceiling Mount Occupancy Sensor Wall Mount Occupancy Sensor Fixture Mount Sensor (> 120 W fix.) *Apply the total wattage of all controlled fixtures associated with total control quantity **Apply hour reduction based on difference between hour used w/out controls & hours w/ control type ***Required Information. Must enter total project cost to determine rebate. $5.50 $ $12.00 $ $5.50 $ $3.00 $ $0.00 *** Project Cost Total Rebate $

Lighting Retrofit Rebate Program: Energy Savings Estimate Data Input Page (This page not applicable to "New Construction" lighting rebate projects) Business Name 0 Note: Completion of this lighting worksheet is required before rebate can be issued. Preexisting Lighting System Type (i.e. fluorescent, HID, etc) # Fixtures Watts/ Fixture Estimated Annual Hours of Operation New Lighting System Type (i.e. LED fluorescent, HID, etc) # Fixtures Watts/ Fixture Estimated Annual Hours of Operation Estimated Saved kw Estimated Saved kwh Total Controls kw connected Hrs/Yr reduced Saved kwh Automatic Controls Photocell Ceiling Mount Occupancy Sensor Wall Mount Occupancy Sensor Fixture Mount Occupancy Sensor 0.000 0 0.000 0 0.000 0 0.000 0 Total