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COMMONWEALTH OF PUERTO RICO ARRA - STATE ENERGY PROGRAM

WIND ENERGY PROGRAM

Rebate Reservation 'Form

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Send Via Certifie.d Mail or Hand Deliver to:

WIND ENERGY PROGRAM

Puerto Rico Infrastructure Financing Authority Capital Center, North Tower, is" floor

235 Arterial Hostos Avenue

San Juan, Puerto Rico 00918·1454

Fill forms in block letter

Send form W-01 with all required documents in one manila envelope

Nates:

State:

Zip Code:

Name:

Address:

City:

System Rated Output

watts Expected Rebate

s

Other .Incentives:

Quantity

s

Estimate annual energy production or savings

KWH/Year . Total System

Required Documents Checklist:
D Installer Information Form (W-02.) D Site Sketch form (W-02._1) D Vendor Information Form (W-03)
D Wind Study Information Form (W-04) D Project Price Quotation D Rent Agreement (If Applicable)
D Owner's Valid ID D Wind Study D Owner's Proof of Ownership
D Certificate of Good Standing with EM (Government Entities Only) D Last six (6) Electric Utility Bills
Applicant Certification:
• I hereby certify that the information contained herein and in all attached documents submitted is true and correct and that the energy
system described herein will be installed at the Indicated location,
• The system Installed will comply with the State Energy Program Regulation.
• The system will be installed permanently at the indicated proposed project address.
• I certify that I have read, understood and ogree with the State Energy Program Regulation.
Applicant's Signature: I Date:
Owner's Signature: I Date:
*lnclude owner authorization letter to sign as owner representative W-02

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COMMONWEALTH OF PUERTO RICO ARRA - STATE ENERGY PROGRAM

WIND ENERGY PROGRAM

Installer Information Form

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Name:

Street:

City:

State:

Zip Code:

Email:

Phone:

EM License Number (Include copy of certificate):

Fax:

Proposed Project Address:
-----
Street:

City:
State:
Zip Code:
Description of Work to be Performed: • I, (Installer Name) certify that the installation of the wind power system will comply

with local codes and regulations.

• / hereby certify that the information contained herein is true and correct and that the energy system described herein will

be installed at the indicated proposed project address.

• The system to be installed will comply with the State Energy Program Regulation.

• The system will be installed permanently at the indicated proposed project address.

• I certify that I have read, understood and agree with the State Energy Program Regulation.

• I certify that the information included in the site sketch is true and correct.

Installer's Signature:

Date:

W-02.1

COMMONWEALTH OF PUERTO RICO ARRA - STATE ENERGY PROGRAM

WIND ENERGY PROGRAM

Installer Information Form - Site Sketch

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Site sketch shall clearly indicate and describe the intended location, size, capadty, average wind direction, wind obstructions, and connection ofthe new wind energy system,

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W-03

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COMMONWEALTH OF PUERTO RICO ARRA - STATE ENERGY PROGRAM

WIND ENERGY PROGRAM

Vendor Information Form

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General Vendor Information:
Name:
Street:

City:
State: Zip Code:
Emai.l: Phone:
Employer Identification Number (EIN): Fax:
Owner or Contact Person Information: Name:

Manufacturer*

Model

Capacity (W)

Quantity

- - - - -- ---- --- - - -

Equipment Warranties:

-- - --- - -

Vendor Agreement:

1, -> representative of _

(Vendor's Name)

(Company's Name)

Certify that:

• The equipment to be sold is new.

• The information contained herein is true.

• , have read, understood ond ogree with the State Energy Program Regulation.

• The product I represent/sell complies with ARRA Section 1605 - Buy American.

Vendor's Signature:

Date:

*Illclude supporting documentation from manufacturer showing where product is manufactured

W-04

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COMMONWEALTH OF PUERTO RICO ARRA - STATE ENERGY PROGRAM

SUN ENERGY PROGRAM

Wind Study Information Form

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Wind Study Company Information:
Name:
Street:

City:
State: Zip Code:
Email: Phone:
Employer Identification Number (EIN): Fax:
Proposed Project Address: Street;

City:

Wind Study Information:
Date Equipment Used Calibration
Start: Manufacturer: Date:
End: Model: Due Date:
-----~-- - - - -
Wind Study Results:
I. erg m In pee mp In pee ms In ower enslty m esource o en ra In ower' iass



I Certification Agreement: H ht ( I

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• I hereby certify that the in/ormation contained herein is true and correct and that the wind study included herein applies to the proposed project address.

• The wind study results obtained comply with the State Energy Program Regulation.

• I certify that I have read, understood and agree with the State Energy Program Regulation.

Signature:

Date:

Printed Name:

CI