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$OUIItf R'4 CAUFORMA Energy Management Solutions Incentives <br />ED I S O N' Application for Business Customers <br />-S VA7710YetCustomized Installation Report <br />An U)FSOR INTI <br />UPN#: ;361-17-0501007913SA#: _ 3-000-1335-40 _ Customer Ref.: Ross Annex Parking Garage Lighting <br />, - -- - - - - ---- - <br />Customer Name: City of Santa Ana Trade Professional: IThe Energy Coalition <br />After your project is Installed and operational, Input the project installation commencement and completion dates in the fields provided in Section 3. Review the <br />Information from yourAppllcatiun Approval Letter. If nothing has changed, and the information in Customized Solutions and Energy Savings incorrect, complete <br />and sign Section 8 on page 2 of this Installation Report (IR) Form. If any Information differs from Section 1 of this page or your Application Approval Letter, use <br />Section 4 on page 2 of this IR Form to Indicate the change. Then, mark the appropriate check box in section 8 on page 2 of this IR Form. If any Payment <br />Information differs from Section 2 on page 1 of this IR Form, complete Section 5 on page 2. Review Sections 6 and 7 on page 2 of this IR Form and complete if <br />applicable. Sign and return both pages to SCE at one of the addresses below. <br />Business Incentives E-mail: Businesslncentives@sce.com <br />Southern California Edison Fax: (626) 633-3243 <br />P.O. Box 800 Questions: Contact your Account Manager <br />Rosemead, CA 91770-0800 or call (626) 635-6015 <br />NOTE; If submitting more than 5 Solutionscompleteand attach the Custon¢ed Sdufiw pagefrom the MulfipL Silerolution Worksheetatx ..wenrmeapp.cao <br />Lineg <br />Solution Baseline Installed- Approved Incentive Project <br />Code Usage Usage Savings Rate Cost <br />Incentive Amount <br />828.4 ,kWh 4462 kWh 3822 kWhf$ 017-- <br />1 <br />LT 17492 018 kW 01 _ kW 0.08 k—W--tt($ 15009 I $ 4783.44 <br />_.. <br />$ 76.98 <br />_ �___ _LThm _ _.. i That _ 0.00 1 Thm t FALSE <br />___i92 <br />266299 1 kWh 18466.1 kWh , 10163.8 , kWh $ 0.17 <br />2 <br />LT -47463 3.27 _ , kW -2.11 i kW 1.16 kW �$ 150.09 $ 23,878.88 <br />$ 1,901.95 <br />Thm ,; Thm ! 0.00 Than , FALSE <br />T <br />j kW kWW� kW <br />3 <br />-'--- -- — Thm_!_ _ ^Thm <br />j kWh j kWh kWh -[- <br />4 <br />kW - - _,. kW i _ ._ kW : a <br />Thm,-"Thm{ `Thm i <br />IkWh! _ <br />kW <br />) <br />5 <br />kW i <br />Thm - Thm 1 Thm j——d <br />Total Approved" Total Approved <br />10,546.00 1.24 <br />Energy Savings (kWh): _ _ _ _ On -Peak Reduction (kW): i _ . - _ _ _ _ --, J <br />Total Project Cost ($): $28,662.32Calculated Savings Incentive: .$1,978.82 <br />'includes Project Call Adjustment(IhVchcable) �_ _ _ <br />NOTE: For projects requiring M&V, attach any required basegne or postinstallation measurements and analysis, as specified your approved M&V plan. <br />Section 2 - Payment Information: (As indicated on the Application) <br />A. Form of Payment: _ _ Check to Customer <br />B. Payee Information: IcmamcsWm0.it4l;k IrChi,binna>®yj- <br />- City of Santa Ana- <br />PryesGabnetlew5ewxememlm�Iti,Nwe�titewamama>tieal rh _ _ <br />... _ _ __ � <br />- <br />.. __ . <br />20 Civic Center PI, M+11 � Santa An CA i 92701 <br />CmpeqBmNmaraplfina MNess C,y amm Zµ Cola <br />714-647-5008 lazuilar@saota-ana.org <br />CmtaiRmeNUMe, Lmmq ELalAE6® <br />C. Tax Iden00cation Type: Federal Tax ID 956000785 _ _ _Tax _M <br />.. reEaelTa iNEm4biTrm NmAe(Eeryaotivl Seann NwnEerls5N7 Wm4fimAm NumEer Tevs.auNe <br />D. Utility BIII Credit: 3. , 2-.... _aemmcnoom,xunae <br />sevieti®:nx,mde; <br />InstallationDates: <br />Comptete both dates: <br />Installation Commencement Date: Installation Completion Date: <br />2 J U _3o RmAp02017 <br />