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NOTE: If submitting more than 5 Solutions complete and attach the Custnnlhed Solution page from the Multiple Site/Solutnn Worksheet at www.seeonlineappoom
<br />Solution Baseline Installed Incentive Project
<br />Line# Code Usage Usage Savings Rate Cost Incentive Amount
<br />kWh _ _ kWh kWh
<br />d i kW 1 kW
<br />Than I
<br />kWh kWh j - - -- i kWh _
<br />2 kW _ kW kW�
<br />That i Thm Thm l
<br />kWh
<br />kWh I kWh �
<br />4 kW� jkW ' - kW
<br />Than Thm Thm ,
<br />�� f kWh kWh
<br />5 kW I,— kW I ___ kW
<br />Thm
<br />Total Energy Savings (kWh): Total On -Peak Reduction (kW):
<br />Total Project Cost ($): Calculated Savings Incentive;
<br />NOTE: For projects requiring M&V, attach any required baseline or post -Installation measurements and analysis, as specified in your approved MV plan.
<br />A. Form of Payment:
<br />B. Payee Information: (cream cwmmar, teak mT,xkP vRed RM P")
<br />PrywC,¢bnttl Buvmp Name PIIenEon blmlY arNui,Mbmpuma ma. a,eel Td
<br />em,pe,ry/eus'maaM'fn9AEEms city 54b Zp Lode
<br />CmrslPl,maNumrer Cmhd EiAiA6lres
<br />C. Tax Identification Type:
<br />Fe lTax I Mmpbyer In Nunta(anySatitl Seanry Nwn (SSN) ftO.rvNxrder TU St.
<br />F�enplRersm
<br />D. Utility Bill Credit: 3• y.
<br />£wYxlmAnlNwEe cn..AmASIN.v
<br />Attach the following supporting documentation with this Installation Report:
<br />❑ Verification data as evidence of implementation,
<br />❑ Updated savings calculations, where applicable.
<br />❑ Copies of invoices(orimplementagon, as proofof the Customers implementation costs.
<br />❑ RCx Training Completion Fan, including the training agenda, training materials, list of attendees, and measure persistence strategies.
<br />See the RCx Program Guidelines for more information on these items.
<br />Section 7 � To be completed only if you are i:ec;ru9s'tlng,bn HVAC Rebate:
<br />t. HVAC Permit fif reauired). If a permit and/or proof of permit closure is required for HVAC installationlreplacement, I have provided the permit number and/or permit closure
<br />documentation. (If no permit is required, leave this section blank) Permit # Agency
<br />2 Contractor Cerfification. If a Contractor or Trade Professional was used for any HVAC installation/replacement. this section must be completed by the contractor.
<br />❑ By checking this box, I ceNfy I am a licensed contractor and have followed applicable permitting requirements and, if required, that the HVAC permit information above is correct
<br />S5,u0vedLaOe]m Nmneiobse Pmrl dei
<br />Installationldpeiatioin, Sthterill and Signature:
<br />Check appropriate boxes:
<br />❑ No changes to the proposed solutions have been made since the Project Application Review and Approval, and the Customer or Trade Professional verifies that the
<br />Application approved savings calculations are correct.
<br />❑ Due to changes to the proposed measures, appropriate adjustments in the savings calculations have been made. For measures with changes made during installation, use
<br />this section, and Sections 4 an page 2, to calculate the revised installed energy usage, energy savings, peak demand reduction, and incentives. Attach the appropriate
<br />calculation backup: the output from the Estimation Software, Calculated Energy Savings Total or the calculation sheets that document the engineering calculations.
<br />I, the Customer or Trade Professional below, certify that (1) the Energy Efficiency Solutions have been completely installed, functionally tested and proven capable of operating and being
<br />maintained to perform in conformity with their design intent, and (li) that a licensed contractor was used, where applicable, and all applicable permitting requirements for this installation
<br />were followed. The installation date of operation of the Energy Efficiency Solutions and any required monitoring data collection per approved M&V plan, are also certified.
<br />slg..s w �pk P^^n T& Dara
<br />2 5 b _ 10 a..AP,n amt
<br />_ kWh _
<br />3
<br />_kWh
<br />I kW � kW
<br />Thm Thm
<br />I —__
<br />rkW
<br />Than
<br />kWh
<br />kWh I kWh �
<br />4 kW� jkW ' - kW
<br />Than Thm Thm ,
<br />�� f kWh kWh
<br />5 kW I,— kW I ___ kW
<br />Thm
<br />Total Energy Savings (kWh): Total On -Peak Reduction (kW):
<br />Total Project Cost ($): Calculated Savings Incentive;
<br />NOTE: For projects requiring M&V, attach any required baseline or post -Installation measurements and analysis, as specified in your approved MV plan.
<br />A. Form of Payment:
<br />B. Payee Information: (cream cwmmar, teak mT,xkP vRed RM P")
<br />PrywC,¢bnttl Buvmp Name PIIenEon blmlY arNui,Mbmpuma ma. a,eel Td
<br />em,pe,ry/eus'maaM'fn9AEEms city 54b Zp Lode
<br />CmrslPl,maNumrer Cmhd EiAiA6lres
<br />C. Tax Identification Type:
<br />Fe lTax I Mmpbyer In Nunta(anySatitl Seanry Nwn (SSN) ftO.rvNxrder TU St.
<br />F�enplRersm
<br />D. Utility Bill Credit: 3• y.
<br />£wYxlmAnlNwEe cn..AmASIN.v
<br />Attach the following supporting documentation with this Installation Report:
<br />❑ Verification data as evidence of implementation,
<br />❑ Updated savings calculations, where applicable.
<br />❑ Copies of invoices(orimplementagon, as proofof the Customers implementation costs.
<br />❑ RCx Training Completion Fan, including the training agenda, training materials, list of attendees, and measure persistence strategies.
<br />See the RCx Program Guidelines for more information on these items.
<br />Section 7 � To be completed only if you are i:ec;ru9s'tlng,bn HVAC Rebate:
<br />t. HVAC Permit fif reauired). If a permit and/or proof of permit closure is required for HVAC installationlreplacement, I have provided the permit number and/or permit closure
<br />documentation. (If no permit is required, leave this section blank) Permit # Agency
<br />2 Contractor Cerfification. If a Contractor or Trade Professional was used for any HVAC installation/replacement. this section must be completed by the contractor.
<br />❑ By checking this box, I ceNfy I am a licensed contractor and have followed applicable permitting requirements and, if required, that the HVAC permit information above is correct
<br />S5,u0vedLaOe]m Nmneiobse Pmrl dei
<br />Installationldpeiatioin, Sthterill and Signature:
<br />Check appropriate boxes:
<br />❑ No changes to the proposed solutions have been made since the Project Application Review and Approval, and the Customer or Trade Professional verifies that the
<br />Application approved savings calculations are correct.
<br />❑ Due to changes to the proposed measures, appropriate adjustments in the savings calculations have been made. For measures with changes made during installation, use
<br />this section, and Sections 4 an page 2, to calculate the revised installed energy usage, energy savings, peak demand reduction, and incentives. Attach the appropriate
<br />calculation backup: the output from the Estimation Software, Calculated Energy Savings Total or the calculation sheets that document the engineering calculations.
<br />I, the Customer or Trade Professional below, certify that (1) the Energy Efficiency Solutions have been completely installed, functionally tested and proven capable of operating and being
<br />maintained to perform in conformity with their design intent, and (li) that a licensed contractor was used, where applicable, and all applicable permitting requirements for this installation
<br />were followed. The installation date of operation of the Energy Efficiency Solutions and any required monitoring data collection per approved M&V plan, are also certified.
<br />slg..s w �pk P^^n T& Dara
<br />2 5 b _ 10 a..AP,n amt
<br />
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