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APPLICATION COLOrAdO

Compressed Air Efficiency
No Loss air draiN aNd variabLe speed drive (vsd) compressor
All pages of this completed application form and copies of all invoices must be provided before Xcel Energy will issue a No Loss Air Drain and/or VFD compressor rebate. See page 2 for program requirements.

Business Customer information
Company name _______________________________________________________________________________ Date submitted ____________

Building address ________________________________________________ City _________________________ State ______ ZIP _________ Installation address (if different) ____________________________________ City _________________________ State ______ ZIP _________

Contact name (print) ______________________________________________________________________________________________________ Phone ______________________________________________________ E-mail* ___________________________________________________
* By providing your e-mail address, you are granting Xcel Energy permission to send further e-mails regarding our programs and services.

Are you an ISOC customer at this premise?

n Yes

n No

Xcel Energy electric premise number: _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
I verify the information on this application is correct and request consideration for participation in this program.

Customer signature X __________________________________________________________________________ Date _____________________
Customer hereby certifies that: 1. the customer, and not Xcel Energy is solely responsible for the accuracy of the information contained in this application; 2. all installation is complete and operational prior to submitting rebate; and 3. all rules of this Xcel Energy program have been followed. Further, the customer acknowledges that participation in this rebate program shall impose no liability on Xcel Energy. In particular, Xcel Energy shall not be liable for the work performed by the customer’s engineer, contractor, or vendor.

Xcel energy account manager X ________________________________ Date ____________ Email ________________________@xcelenergy.com

Alternative rebate recipient
Note: Complete this section only if customer wants rebate check to go to someone other than the company tied to the account number:

Company name (Alternate Recipient) ___________________________________________________________________________________________ Contact name ______________________________________________________ phone _____________________________________________

Address _______________________________________________________ City _________________________ State ______ Zip _________
I authorize the above company to receive the rebate check for this project.

Customer signature X __________________________________________________________________________ Date _____________________

Contractor information
Contractor/Vendor name __________________________________________ Contractor contact name ___________________________________ Invoice Number: _________________________________________________________________________________________________________ Contractor address ______________________________________________ City _________________________ State ______ ZIP _________ Daytime phone__________________________________________________ Fax _____________________________________________________ E-mail* _________________________________________________________________________________________________________________
* By providing your e-mail address, you are granting Xcel Energy permission to send further e-mails regarding our programs and services.

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13-01-431 | 02/2013 | CRS 2094

compressed air efficiency NO LOss AIr drAIN ANd vArIAbLe sPeed drIve (vsd) COmPressOr

APPLICATION COLOrAdOO

rules and requirements
Qualifying Customers • The Compressed Air Efficiency program is available to Xcel Energy electric business customers in Colorado that purchase and install qualifying No Loss Drains or factory integrated Variable Frequency Drive (VFD) Compressors between 10 and 49 horsepower. no Loss Air drain rules 1. Xcel Energy offers a cash rebate of $200 per new no loss air drain. 2. Drains on inlet modulation or load/no load systems with < 2 gal/CFM storage are not eligible. Compressor rebate rules Xcel Energy offers a cash rebate starting at $1,000 and up to $7,000 to customers for VFD Compressors (10hp – 49hp): Compressor Size 10 HP 15 HP 20 HP 25 HP 30 HP 40 HP early replacement new Capacity, or restoral (of a working load/no-load
of non-working compressors

number, nominal efficiency %, horsepower and rpm. Xcel Energy may confirm specifications to determine eligibility and rebate amounts. • Rebates will not exceed 60% of the project cost. Xcel Energy will issue a rebate in the form of a check, not a utility bill credit. terms and Conditions • Warranties are between the customer and the equipment manufacturer(s). Xcel Energy makes no warranties, expressed or implied, with respect to equipment operation, material, workmanship or manufacturing. • Xcel Energy 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. • Xcel Energy shall not be liable for any incidental or consequential damages. • cel Energy is not responsible for the disposal of equipment replaced as a X result of this program. • Xcel Energy is not responsible for any lost, late, stolen, ineligible, illegible, misdirected or postage due mail. All completed submissions become the property of Xcel Energy and will not be returned. Notifications related to program changes and continuation will be posted on our Internet site. The customer is responsible for verifying program parameters: – Call Business Solutions Center at 1-800-481-4700 – Visit xcelenergy.com; or – Email energyefficiency@xcelenergy.com • Xcel Energy reserves the right to: 1. Conduct a random audit of your project before or after issuing a rebate. Please note the following: a) Audits may be performed up to one year after the rebate has been received by the customer. b) he customer agrees to provide reasonable access to inspect the T installation 2. Adjust, deny, or request a return of rebate amount if Xcel Energy finds that the application does not comply with Xcel Energy rules and qualifications. 3. Publicize your participation in this program, unless you specifically request otherwise. • Fraudulent submission of this form may result in federal prosecution for mail fraud under18 USC sections 1341, 1342.

or modulation compressor)*

$ 1,000 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 4,000

$ 4,000 $ 4,500 $ 5,000 $ 5,500 $ 6,000 $ 7,000

System requirements for all systems: 1. Equipment must be a new, rotatory type compressor with factory installed VFDs (Piston or reciprocating compressors do not qualify). 2. The equipment must be in service (not backup). 3. The total system must be less than 50 hp. System requirements for early replacement rebates: The new compressor must replace old compressor(s) that satisfies all of the following: • Load/unload compressor with less than two gallons of storage per CFM of compressor-rated capacity. • Modulator compressor with or without blow down. • Of equal or greater size than the new compressor. Custom efficiency rebate program Any compressor over 10hp that does not meet the above qualification rules, as well as any other energy saving measures, may be submitted for analysis under the Custom Efficiency program. The Custom Efficiency program requires preapproval before the equipment is purchased. Additional rebate rules • Installation must be complete before submitting rebate application. • Customers must submit their rebate application for rebates within 12 months from the purchase date on the invoice. • A copy of a dated invoice and manufacturer’s equipment specification sheet must accompany the rebate application. Please make sure that the supporting equipment information (model number) matches the rebate application. – The customer invoice must show quantity, model number, and hp. – The manufacturer’s specification sheet must show: manufacturer, model
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13-01-431 | 02/2013 | CRS 2094

compressed air efficiency NO LOss AIr drAIN ANd vArIAbLe sPeed drIve (vsd) COmPressOr

APPLICATION COLOrAdOO

A. nO LOSS Air drAin
Manufacturer Model # Qty (each) Xcel energy rebate Offer $200 rebate Amount (Internal Use Only)

1 2 3 4

New Removed New Removed New Removed New Removed

= ________________

$200

= ________________

$200

= ________________

$200

= ________________

total Xcel energy rebate =

$
rebate Amount (Internal Use Only)

Please mark invoices with row number to ensure that rebate operations matches the equipment description and rebate to the correct invoice.

B. neW integrAted VSd COMpreSSOr
Compressor installation Cost Cost Manufacturer Model # Compressor Hp Qty Xcel energy rebate Offer
n New Capacity or Restoral n Early Replacement n New Capacity or Restoral n Early Replacement n New Capacity or Restoral n Early Replacement n New Capacity or Restoral n Early Replacement n New Capacity or Restoral n Early Replacement n New Capacity or Restoral n Early Replacement

5 6 7 8 9 10

New Removed New Removed New Removed New Removed New Removed New Removed total Hp =

= ________________

= ________________

= ________________

= ________________

= ________________

= ________________

total Xcel energy rebate =

$

Please mark invoices with row number to ensure that rebate operations matches the equipment description and rebate to the correct invoice. email, fax, or mail completed application and all documents to: email: energyefficiency@xcelenergy.com fax: 1-800-311-0050 Mail: Xcel Energy DSM Specialists Business Solutions Center P.O. Box 8 Eau Claire, WI 54702 please allow 8 weeks for rebate check to arrive. (You can print additional or updated forms from our website at xcelenergy.com/ Rebates)
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fOr internAL USe OnLY Account Manager/ BSC Representative _________________________________________________ Date ___________________ Confirmed and complete: n Application n Invoice(s) n Specifications n Calculator sheet

Promo code ________________________________________________________ Rebate Operations Signature _________________________________________________________ Date ___________________

13-01-431 | 02/2013 | CRS 2094

compressed air efficiency NO LOss AIr drAIN ANd vArIAbLe sPeed drIve (vsd) COmPressOr

APPLICATION COLOrAdOO

xcelenergy.com | © 2013 Xcel Energy Inc. | Xcel Energy is a registered trademark of Xcel Energy Inc. | Public Service Company of Colorado, an Xcel Energy Company. 13-01-431 | 02/13 | CRS 2094