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Bergen's
Appliance Advantage
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The Village of Bergen and the Independent Energy Efficiency Program
(IEEP) are sponsoring this program to encourage Bergen Electric
residential customers to replace any needed appliances with ENERGY
STAR® appliances. This rebate is available for any purchase
made April 1, 2004 through September 30, 2004. To receive your rebate,
please fill out this form completely and mail it to the address
below with a copy of your dated sales receipt and a recent electric
bill showing that you are a customer of Bergen Electric.
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Mail to:
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IEEP Appliance Rebate Program
P.O. Box 2489
Syracuse, New York 13220-2489
(Do not include this form with your utility
bill payment)
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| Name: |
| Address: |
| City: |
State: |
Zip Code: |
| Contact Name: |
| Home Phone: |
Work Phone: |
| Bergen Electric Account Number: |
Social Security #:
(Customers who receive a reimbursement of $600
or more will be issued a 1099. Social Security # required for
all reimbursements over $600.) |
Inspections:
The IEEP may choose to inspect locations to verify satisfactory
completion of the projects, and to measure and verify energy savings.
Such inspections will be made at a time convenient to the applicant,
with advanced notice to the applicant. Misrepresentation of installation
location or measure eligibility may result in forfeiture of the
incentive award.
General Terms:
-The reimbursement is taxable as gross income. Customers
are responsible for any such tax implications associated with such
a reimbursement. The Village of Bergen and IEEP are not responsible
for any tax consequences associated with any payments.
-The Village of Bergen and IEEP assume no responsibility
for performance of equipment and equipment warranty.
- The equipment purchased must be installed within the Village
of Bergen Electric System territory.
-The customer relieves The Village of Bergen and IEEP of
any and all liability associated with this project.
I agree to the terms and conditions of this document.
I understand that I am fully liable for any tax consequence that
may arise from this reimbursement.
_____________________________________________________________________________
(Page 1)
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Bergen's Appliance Advantage
- Qualifying Measures Worksheet
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The Village of Bergen has evaluated and qualified
the following energy saving measures listed on this page. For the
appliance to be eligible it must meet the minimum qualifying standards.
If you have any questions or need any assistance, please feel free
to contact our sub contractor for this program, Honeywell DMC, Amy
Barry at (800) 263-0960 or amy.barry@honeywell.com.
To find out more about ENERGY STAR appliances or to check for qualifying
products, visit the ENERGY STAR website at: www.energystar.gov.
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Approved Measure
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Incentive Amount
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Standards / Efficiency Criteria
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Manufacturer
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Model #
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Qty
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Total
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Air Conditioner (Central Air)
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$50/ton
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ENERGY STAR Labeled
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-
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-
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-
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$
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Air Conditioner (Room)
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$75
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ENERGY STAR Labeled
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-
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-
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-
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$
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Attic Fan (Standard electric)
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$15
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Permanently mounted on roof or in attic
with automatic thermostat.
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-
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-
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-
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$
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Attic Fan (Solar powered)
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$100
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Permanently mounted on roof or in attic.
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-
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-
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-
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$
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Ceiling Fan
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$25
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ENERGY STAR Labeled
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-
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-
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-
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$
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Clothes Washer
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$100
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ENERGY STAR Labeled
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-
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-
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-
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$
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Dishwasher
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$50
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ENERGY STAR Labeled
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-
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-
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-
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$
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Electric Water Heater
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-
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Energy Factor must be:
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-
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-
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-
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$
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0-50 gallon
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$75
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.95 or greater
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-
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-
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-
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$
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51-100 gallon
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$100
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.92 or greater
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-
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-
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-
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$
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100 & above gal
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$125
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.91 or greater
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-
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-
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-
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$
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Programmable Thermostat
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$10
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ENERGY STAR Labeled
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-
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-
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-
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$
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Refrigerator
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$75
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ENERGY STAR Labeled
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-
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-
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-
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$
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Windows
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$25
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ENERGY STAR Labeled
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-
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-
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-
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$
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Grand Total
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$
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Incomplete information will delay or disqualify
your rebate. All rebates must be postmarked no later than October
31, 2004
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