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RESIDENTIAL CENTRAL AIR MAINTENANCE $50 REBATE APPLICATION

EFFECTIVE JULY 1, 2012 OR WHILE FUNDS LAST


For residential electric utility customers of Hawaii, Lanai, Maui, Molokai and Oahu. INSTRUCTIONS: Fill out steps 1 through 3 COMPLETELY and LEGIBLY. Submit application within sixty (60) days of invoice or sales receipt date. Please allow 6 to 8 weeks depending on seasonal fluctuation of demand processing. Rebates for this program are available while funding lasts. S t e p 1 . F i l l o u t Ap p l i c a n t U t i l i t y Ac c o u n t a n d P a ye e I n f o r m a t i o n .
Electric Contract ID:
Contract ID is located on the top right corner of your electric bill.

Rebate to be paid to:

Account Holder at Installation Address

Contractor

Account Holders Name listed on Electric Bill (Check will be made out to this name or Servicing Contractor):

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Address where the Central Air Conditioning Maintenance was done: City: Daytime Phone: Alternate Phone: State: Unit #:

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Zip:

HI (
Email Address:

By providing my email, I am opting in to receive energy-saving tips and information from Hawaii Energy.

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Cooling system must run a minimum of 15 minutes to be accurate.
Model No __________________ System Size___________ tons INDOOR UNIT Supply DB _____________ F Supply WB_____________ F Return DB _________ F Return WB _________ F Refrigerant: ______________ Charge Required (Y / N):_________lbs__________ OUTDOOR UNIT Supply air dry bulb temperature pre __________ / _________ post F Return air dry bulb temperature pre __________ /__________ post F Suction Pressure __________________ pre / _____________ post PSIG Liquid Pressure ___________________ pre / _____________ post PSIG Vapor-line temperature _____________ pre / _____________ post F Liquid-line temperature _____________ pre / _____________ post F Compressor _____________________ pre / _____________ post Amps Compressor _____________________ pre / _____________ post Volts Superheat temperature ____________ pre/ ______________ post F ___________ Clean condenser coil ___________ Inspect and tighten wiring connections ___________ Check for proper clearance around condenser ___________ Check insulation on refrigerant lines ___________ Lubricate motor and bearings (if applicable) ___________ (Y / N) Combed condenser coil fines Service Date_ _________________________________

Coil Leaving Face Temperature ___________________ F Sub-Cooling______________________ F Fan __________________ pre / __________________ post Amps Fan __________________ pre / __________________ post Volts Evaporator coil condition __________________________________ Blower wheel condition ___________________________________ _________ Inspect and tighten all electrical connections _________ Lubricate motor and bearings (if applicable) _________ Inspect contactors, relays, and safeties _________ Clean Evaporator _________ Cleanout condensate pan, drain, trap and pump sump _________ Check belt wear and adjust fan belts (if applicable) _________ Inspect ductwork for leaks / failed insulation. _________ Inspect thermostat for proper operation and calibration

Servicing Contractor ___________________________________ Technicians Signature__________________________________


S t e p 2 . S i g n Ag r e e m e n t C l a u s e (Make sure you have read the Terms and Conditions on the back of this form.)
By signing below, I acknowledge that I have read, understand and agree to the Terms and Conditions of this Rebate Application as detailed on the front and back of this Application. Electric Account Holders Signature: ____________________________________________________ Date:
Rebates are not guaranteed, are available on a first-come, first-served basis and are subject to the availability of funds without notice.

Step 3. Mail completed and signed application.


Mail completed and signed application with a copy of the ORIGINAL sales receipt to:

Hawaii Energy | P.O. Box 3920 | Honolulu, HI | 96812-3920 Phone: 808-537-5577 or 877-231-8222
Hawaii Energy is a rate-payer funded conservation and efficiency program administered by SAIC under contract with the Hawaii Public Utilities Commission serving the island of Hawaii, Lanai, Maui, Molokai and Oahu.
MA2012-WEB

RESIDENTIAL CENTRAL AIR MAINTENANCE $50 REBATE APPLICATION


EFFECTIVE JULY 1, 2012 OR WHILE FUNDS LAST
Central Air Conditioning Maintenance Rebate Guidelines
A $50 central air conditioner maintenance rebate is given when maintenance is provided by a Hawaii Energy registered C52 contractor. To receive a rebate, you must include a full cost invoice on the contractors letterhead and the Contractors Air Conditioner Maintenance Checklist (completed by the contractor). The invoice MUST state Central A/C Maintenance. Central air conditioning maintenance rebates are limited to one per 12-month period, per address. Ductless split air conditioners and window air conditioners maintenance are not eligible for this rebate.

Frequently Asked Questions


How do I qualify for the central air conditioning maintenance rebate? Hawaii Energy requires that only a licensed Hawaii C52 Air Conditioner Contractor, registered with and accepted by Hawaii Energy, provide the Hawaii Energy recommended maintenance work. Service invoice must list Hawaii Energy Maintenance Work. The rebate does not apply to ductless split air conditioners or window air conditioners. Can I still apply if the sales receipt is dated one year ago and I did not mail in my application? No. Hawaii Energy has a two month limit on service rebate applications; you would no longer qualify for the rebate.

Hawaii Energy Terms and Conditions


1) 2) Rebates: Subject to these Terms and Conditions, Hawaii Energy (the Program) will pay rebates for qualifying high efficiency appliances and service. Eligibility: a) An Applicant is a residential scheduled account holder of an electric utility on the islands of Hawaii, Lanai, Maui, Molokai and Oahu that contribute into the Public Benefits Fund where the electricity-saving energy efficiency measure has been installed. Rebates are awarded only to an eligible Account Holder. Applicants are ultimately responsible for the compliance of these Terms and Conditions. b) Qualifying Appliances and Service are those electricity-saving items that are identified in the Program applications and associated materials. All equipment must be new, meet Program specification requirements and be fully operable prior to rebate payment. c) Incomplete applications or missing supporting documents will be returned unprocessed. d) Rebate application must be received within two sixty (60) days of installation, unless otherwise specified in the application itself. e) Applications for newly constructed homes or new homes purchased with appliances or air conditioners do not qualify. Installation Verification and Data Collection: a) The Program may conduct an inspection to verify pre-installation conditions or confirm installation prior to rebate payment, at any time after receipt of applications and up to five (5) years after payment of rebates. b) The Applicant must provide reasonable access to the facility, the equipment, and related documentation and data. c) The Program may install metering devices on equipment for Program data collection, measurement and verification purposes. Compliance: The Applicant is responsible for abiding to all applicable laws, rules, and regulations, and for complying with all federal, state and local codes. Program Availability: Rebates are available on a first-come, first-served basis subject to the availability of funds. Program availability, Program terms and equipment eligibility may change without notice at any time at the discretion of the Program. Publicity: The Program reserves the right to publicize Applicants participation in the Program for promotional purposes unless the Applicant submits a written request to the Program. Disclaimers: a) The Program is not responsible for any tax liability imposed on the Applicant as a result of the payment of rebates. b) The Program does not expressly or implicitly warrant the performance of installed equipment, the quality of any contractors work, or that the equipment will result in any energy or cost savings. c) The Program is not responsible for the proper disposal or recycling of any waste generated as a result of this project. d) The Program does not endorse any particular market provider, manufacturer, product, labor or system design by offering these rebates. e) The Program does not guarantee that funding will be available for payment of rebates until this application is approved. Submission of the application does not warrant payment under any circumstances should the application not be approved or funding is unavailable. Indemnification and Limits of Liability: a) Applicant agrees to indemnify, hold harmless and defend the Program and the Programs administrators, overseeing entities, successors, assigns, agents, contractors, employees, officers and directors from any and all liability, claims, demands, causes of actions, losses, damages, deaths or injuries including reasonable attorneys fees and costs, whether in law or equity, now known or uncertain, form now until the end of time, arising out of or relating to the installation, use and maintenance of the equipment, designs, practices, or methods involved in this Applicants project. b) In no event shall either the Program or any other indemnified party be liable for any punitive, exemplary, special, indirect, incidental or consequential damages (including, but not limited to, lost profits, lost business opportunities, loss of use or equipment down time, and loss of or corruption to data) arising out of or relating to this Agreement, regardless of the legal theory under which such damages are sought. Entire Agreement: The entire agreement between the Applicant and the Program is composed of an approved, fully-executed application, these Terms and Conditions, and, as applicable, invoices, receipts and any and all such other documentation is required.

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Hawaii Energy is a rate-payer funded conservation and efficiency program administered by SAIC under contract with the Hawaii Public Utilities Commission serving the island of Hawaii, Lanai, Maui, Molokai and Oahu.
MA2012-WEB