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Business rebate application
Steam traps
A Nicor Gas program
TM
Rebates available for qualifying steam traps purchased and installed or repaired June 1, 2015 to May 31, 2016.
Complete steps one through seven for the rebate(s) you are applying for. All fields are required.
Need help? Call us at 877.886.4239 (M-F, 8 a.m. to 5 p.m.) or email info@nicorgasrebates.com.
Before you start:
Once you are done:
Receive your rebate:
Review the eligibility details,
requirements and terms and conditions
throughout the application to verify
that you are eligible for a rebate.
Collect all required information to
complete your application.
Applications must be postmarked
within 90 days of installation or by
June 30, 2016, whichever comes
first. Mail your signed application and
contractor installation invoice to:
After your rebate application is
completed and approved, you
will receive your rebate check in
approximately six to eight weeks.
1
Nicor Gas
Attn: energySMART 15-22514
P.O. Box 540071
El Paso, TX 88554-0071
Find out if you’re eligible for higher rebates
Higher rebates
The rebates mentioned on the following application are the standard rebate amount
available to Nicor Gas business customers.* If you are a multi-family building owner or
a small business owner, look for an icon that identifies higher rebates that are available
to you. If you are not a multi-family building owner or small business owner, you are only
eligible for standard rebate amounts.
MF
Multi-family
The building consists of five units or more, has permanent or semi-permanent residential
tenants, and is an apartment/condominium, assisted living facility or retirement home.
Are you applying for multi-family rebates?
SB
Yes
No
Small business
The business uses less than 60,000 therms of natural gas annually, and is either owned/
operated by an individual or is a non-profit or religious organization. Franchisees owning more
than 10 locations will be reviewed on a case-by-case basis for small business eligibility (check
to see if your business is eligible by calling 877.886.4239).
2
Are you applying for small business rebates?
Yes
No
Building type
Assembly (theater, hall, arena)
Hospital (CAV, econ)**
Office - high-rise (10+ floors, VAV, econ)**
College/university
Hospital (VAV, econ)**
Office - high-rise (10+ floors, FCU)**
Convenience
Hospital (FCU)**
Office - mid-rise (5-9 floors)
Elementary school
Hotel/motel (guest room only)
Office - low-rise (up to 4 floors)
Garage
Hotel/motel (common area only)
Religious facility
Common area
Grocery
Hotel/motel (common area/guest room)
Restaurant
In-unit
Healthcare clinic
Manufacturing facility
Retail - department store
High school
Movie theater
Retail - strip mall
Hospital (CAV, no econ)**
Office - high-rise (10+ floors, CAV, no econ)**
Warehouse
Multi-family MF
High-rise (5 stories or more)
Mid-rise (up to 4 stories)
Assisted living
New equipment impacts:
Unit number:
Office - high-rise (10+ floors, CAV, econ)**
*Current Nicor Gas business customers on all rate classes, except public entities (taxpayer-funded facilities) and self-directed customers, are eligible to participate in energySMART, a Nicor Gas program.
**Please see page five for additional information on this building type.
energySMART Business rebate application | Steam traps | 052015
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3
Account and
customer
information
Nicor Gas account number
Please write the first 10 digits of your account number.
Include any leading zeros but do not include dashes.
Business/account holder name
Installation address
City
State
ZIP code
Make check payable to:
Account holder
4
5
Landlord
Contractor Circle member
Mailing address (if different)
City
State
Applicant contact first name
Applicant contact last name
Phone number
Email address
Site contact first name
Site contact last name
Phone number
Email address
ZIP code
Contractor business name
Contractor
information
Applicant
signature
Contact first name
Contact last name
Address
City
Phone number
Email address (if available)
State
ZIP code
I certify that the participant has not received/will not receive a rebate for the same service, product or
equipment from more than one Illinois investor-owned utility or third-party energy efficiency program offering
rebates or financing funded with ratepayer funds, with the exception of qualifying joint ComEd incentive
offerings. I certify that the energy-efficient product, equipment, or service was paid for as reflected on the
invoice or receipt and described in this rebate application. I certify that all information is true and correct, and
that I have met all program requirements as outlined in the terms and conditions. I understand and agree to
the terms and conditions and requirements for which I am submitting this rebate application, as outlined on
pages one through six. I understand rebate amounts are based upon verification of information provided on
this application.
Applicant signature
Date
energySMART Business rebate application | Steam traps | 052015
Print applicant name
Promo code (if applicable)
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6
Product
information
Collect the following information for the product(s) installed. Verify your invoice/
receipt is legible and includes each product’s complete manufacturer, model number
and install date. If you installed or repaired more than one type of steam trap,
complete and submit additional copies of pages as necessary.
Steam traps
Check one:
Purchase date
Install date
$300
Total installed cost* (per trap)
# traps repaired/replaced
$300
Manufacturer
Model
Rebate
Industrial/process
steam trap ≥ 15 psig
per trap
Dry cleaner steam
trap ≥ 15 psig
per trap
Commercial
steam traps
per trap
$50
SB
Steam system
Operating pressure
$100
Annual hours of operation
Boiler efficiency
psig
per trap
Additional steam traps
Purchase date
Install date
Industrial/process steam trap
≥ 15 psig
Total installed cost* (per trap)
# traps repaired/replaced
Dry cleaner steam trap
≥ 15 psig
Manufacturer
Model
Check one type:
Commercial steam traps
Steam system
Annual hours of operation
Operating pressure
Boiler efficiency
psig
Check one type:
Purchase date
Install date
Industrial/process steam trap
≥ 15 psig
Total installed cost* (per trap)
# traps repaired/replaced
Dry cleaner steam trap
≥ 15 psig
Manufacturer
Model
Commercial steam traps
Steam system
Operating pressure
* The “Total installed cost,” is the total purchase
price of an individual piece of equipment,
including the cost of the equipment, materials
and external labor. “Total install cost” must be
itemized by each equipment/product installed
and entered in the chart above. The itemized
contractor invoice must include the “Total install
cost,“ itemized by each qualifying equipment/
product on the invoice. If self-installed only the
cost of the equipment may be used.
energySMART Business rebate application | Steam traps | 052015
Annual hours of operation
Boiler efficiency
psig
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Attach
supplemental
documents
Copy of the itemized invoice(s) or proof of purchase. Must include:
Professional contractor information (if installed by a professional contractor)
Installation and purchase dates (if different)
Equipment manufacturer and model
Total installed cost (itemized per each piece of qualifying equipment)
Payment terms (for example: balance due of zero, financing terms or paid in-full stamp)
Instant discount requirements for Contractor Circle members: Total rebate amount
provided as an instant discount off the total purchase price clearly labeled as Nicor
Gas or energySMART rebate and customer signature
Steam trap survey
Industrial/process steam traps and dry cleaner steam trap applications only.
Record of a third party steam trap survey must be submitted with your rebate application
that includes all of the required information listed below. If work is done internally and a
survey is not conducted, a program representative must be present to inspect failed traps
prior to completing the steam trap repair/replacement.
Survey must include:
• Customer business name
• Site address where survey was completed
• For each steam trap:
• Steam trap location
• Steam trap function status
• Steam system pressure
Eligibility requirements
General requirements for all steam trap rebates
• S
team trap repairs and/or replacements must be completed and/or installed on an existing boiler for non-residential use, except for multi-family customers.
Improvements must be made on equipment installed in a non-residential space with an active Nicor Gas account. Improvements must be completed/installed
at the site address listed on this application. Rebates are paid on per steam trap and will not exceed the cost of the repair/replacement. Equipment must be
purchased and installed June 1, 2015 through May 31, 2016, unless otherwise noted.
Industrial/process steam traps ≥15 psig
Commercial steam traps
• New steam traps must replace and/or steam trap repairs must be made on
existing, failed steam traps, one for one. Existing traps must be failed leaking
or blow-through. Blocked traps do not qualify.
• Rebate available for all steam systems. New steam traps must replace existing
steam traps, one for one. Repairs must be made on existing steam traps.
• Orifice- and venturi-type traps are not eligible for steam trap rebates
• Record of a third party steam trap survey must be submitted with your rebate
application that includes all of the required information listed in step 6. If work
is done internally and a survey is not conducted, a program representative
must be present to inspect failed traps prior to completing the steam trap
repair/replacement.
• To qualify for the industrial/process steam trap rebate, system must have
operating pressure ≥ 15 psig.
• Orifice- and venturi-type traps are not eligible for steam trap rebates.
Dry cleaner steam trap ≥15 psig
• N
ew steam traps must replace and/or steam trap repairs must be made
on existing, failed steam traps, one for one on a steam system located in a
laundromat or dry cleaner. Steam traps on a space heating system are not
eligible. Existing traps must be failed leaking or blow-through. Blocked traps
do not qualify.
• Record of a third party steam trap survey must be submitted with your
rebate application that includes all of the required information listed in step
7 above. If work is done internally and a survey is not conducted, a program
representative must be present to inspect facility’s steam trap testing
protocols prior to completing the steam trap repair/replacement.
• To qualify for the dry cleaner steam trap rebate, system must have operating
pressure ≥ 15 psig.
• Orifice- and venturi-type traps are not eligible for steam trap rebates.
energySMART Business rebate application | Steam traps | 052015
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Building type guide—detailed description of building ventilation system types
Help us understand how your building is ventilated. If you’re applying for a rebate in a hospital or high-rise office
building, choose the building type on page one that corresponds with that ventilation system type.
Have questions? Call us at 877.866.4239
Building ventilation guide
Description
System to select:
Constant air volume ventilation (CAV), no economizer
Air distribution system does not contain variable frequency drives or variable air volume dampers.
System does not have the ability to utilize an economizer for free cooling. Likely to be an older system.
CAV, no econ
Constant air volume ventilation (CAV) and economizer
Air distribution system does not contain variable frequency drives or variable air volume dampers.
System has the ability to utilize an economizer for free cooling.
CAV, econ
Variable air volume ventilation (VAV) and economizer
Air distribution system contains variable frequency drives or variable air volume dampers.
System has the ability to utilize an economizer for free cooling.
VAV, econ
Fan coil unit (FCU) for ventilation
System has units that consist of a heating or cooling coil and a fan. Each fan coil unit serves the space
where it is installed or multiple spaces.
energySMART Business rebate application | Steam traps | 052015
FCU
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energySMART rebate terms and conditions
Participant eligibility
You are eligible to participate in the energySMART (“program”) if you are either:
• A current commercial customer of Nicor Gas and complete qualifying services
(“services”) or complete installation of qualifying equipment/products (“equipment”
or “products”) in a non-residential space with an active Nicor Gas account. Public
(taxpayer-funded) entities and self-directed customers are not eligible.
OR
• It is the installing contractor’s sole responsibility to verify customer, product/
equipment and installation/service eligibility prior to providing an instant
discount. Contractor assumes all liability by providing the rebate as an instant
discount.
• A customer may be contacted by energySMART to verify any of the information
provided on the rebate application or invoice prior to payment of a rebate to a
contractor for an instant discount.
• A current residential customer of Nicor Gas in a multi-family building that has
permanent or semi-permanent residents. Multi-family buildings consist of five
or more units and are limited to apartments, condominiums, assisted living
facilities, and retirement community facilities.
• Any dispute from a customer regarding receipt of a rebate as an instant
discount will be investigated by Nicor Gas and contractor payees are subject
to payment adjustments in the event a customer has not received the full and
correct rebate amount as an instant discount.
Installation requirements
• Contractor is responsible for providing the full and correct rebate amount for
a qualifying product/equipment and/or services. Contractor must provide
an additional discount or reimbursement to the customer if needed prior to
processing of a rebate application if the full and correct rebate amount was not
originally provided to the customer.
Your installation of qualifying high efficiency natural gas equipment/product or
completion of a qualifying service is eligible for a rebate if:
• It meets all specific, energy efficiency and program requirements outlined in
this application form;
• Services are conducted conforming to all applicable building, local and state
codes, and manufacturer specifications;
• For existing facilities, the qualifying natural gas equipment is replacing existing
natural gas equipment used for the same purposes;
• For new facilities, including new construction and projects involving a major
remodel or demolition and renovation, qualifying equipment is eligible for
program rebates if all other program qualifications are met;
• Natural gas equipment replacing electric equipment and electric equipment
replacing natural gas equipment are not eligible;
• It is installed by a qualified individual, conforming to all applicable building,
local and state codes and manufacturer specifications. All installations
must adhere to applicable environmental, health and safety regulations and
equipment must be properly ventilated (if applicable). Professional installation
is strongly recommended to ensure the efficient and proper functioning of
equipment but is not required;
• It is installed and operational prior to submittal of this application at the
address listed on the application;
• It is installed in a property owned by the applicant, or the applicant has
received permission from the property owner to install the equipment; and
• It is completed during the program offering period: June 1, 2015–May 31, 2016.
Application requirements
To be considered complete and eligible for rebates, all applications must:
• Be postmarked (or submitted online) no later than 90 days after the install date,
or by June 30, 2016, whichever comes first;
• Include itemized contractor invoice(s) or proof of purchase receipt(s) consisting
of:
• Equipment manufacturer and model.
• Total installed cost (itemized per piece of qualifying equipment).
• Purchase date and install date (if purchased and installed on different
dates).
• Total number of units installed.
• Professional contractor’s business/company name, address and phone
number (if installed by a professional contractor).
• Balance due of zero, paid-in-full stamp, or payment terms.
PDF copies of the mail-in application and the online application system
for instant discounts is limited to Contractor Circle members. Visit
nicorgasrebates.com/contractor-circle for more information or to enroll in the
Contractor Circle.
Landlord participant requirements
If you are applying for a rebate for a property you own, but the Nicor Gas
account is in your tenant’s name, provide the following on the Account and
customer information section:
• Include your tenant’s Nicor Gas account number, name and address.
• Check the box to indicate the check will be made payable to the landlord and
write your name in the payee name fields.
By signing the application, the landlord represents that the account holder has
agreed to release payment of the rebate to the landlord.
Program terms and conditions
• Funds are limited and applications are processed on a first-come, first- served
basis. Program is subject to change and may end without prior notice.
• Please allow approximately six to eight weeks for processing and mailing of
your rebate payment. Incomplete applications cannot be processed.
• Failure to complete the rebate application in full and provide the required
supporting documentation will either delay the payment process or result in
your application being denied.
• Maintain a copy of your rebate application and all supporting documentation.
The program is not responsible for items (i.e. rebate applications, supporting
documentation, and/or rebate checks) lost or damaged in the mail. Contractors
must submit the hard copy application (with the exception of eligible
Contractor Circle members).
• If you do not own the property where this equipment is installed, as a tenant
you are responsible for obtaining the property owner’s permission to install
the equipment for which you are applying for a rebate. Your submission of this
application indicates that you have obtained this permission.
• Contractors are eligible to have the rebate signed over to them. Contractors
receiving rebates are not eligible for any other incentives for the same products.
• Include all required supporting documentation; and
• Rebate incentives may not exceed the total purchase price of the installed
equipment, products or services. The only costs eligible for incentives are:
materials, equipment and external labor.
• Please note: If rebate is to be paid directly to the installing contractor (for an
instant discount) application submissions must meet all requirements listed in
the “instant discount requirements” section.
• All equipment installations are subject to verification inspection by the
program administrator to ensure that the product/equipment is properly
installed and operating.
Instant discount requirements
• Participants must allow, if requested, energySMART or a program representative
reasonable access to their facility to verify the installed product/equipment.
If rebate is being paid directly to the installing contractor, the following instant
discount requirements apply:
• Instant discounts are limited to current Contractor Circle members that meet
all program requirements.
• Contractor Circle member must submit:
• A rebate application.
• A copy of the customer-signed invoice showing the rebate amount
deducted from the total purchase price and clearly labeled as a Nicor Gas
or energySMART rebate.
• The customer’s signature on the invoice verifies performance of a
qualifying service and/or installation of the product(s)/equipment, receipt
of the rebate as an instant discount and release of the rebate payment to
the contractor.
energySMART Business rebate application | Steam traps | 052015
• Any customer receiving a rebate check may be contacted by an evaluator to
verify product/equipment installation or services, or be asked to complete
a customer survey. If contacted, your participation is required as a part of
program participation.
• Nicor Gas, contract and program administrators disclaim any and all liability,
loss or damage and make no guarantees related to:
• Participation in the program, including use or installation of the product(s)/
equipment or receipt of services.
• Loss or delay of rebate check in the mail.
• Any taxes that may be imposed as a result of participation in the program.
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