Indiana Residential Ground Source

INDIANA OFFICE OF ENERGY DEVELOPMENT

GUIDELINES FOR THE INDIANA RESIDENTIAL

ENERGY EFFICIENCY REBATE PROGRAM

Rebate Contact: Carmen Pippenger

Grant Specialist

101 W Ohio St., Suite 1250

Indianapolis, IN 46204

Fax: 317.232.8995

E-mail:

www.energy.in.gov

The Indiana Office of Energy Development (OED) is pleased to offer$250,000 in rebates for replacing an existing furnace, boiler,or water heater with an energy efficient unit in existing Indianaresidences. For more information about energy-efficient HVAC technology, please visit here. For more information on tankless hot water heaters, please visit here. The rebate programbegins January 20, 2009 and will run until program funding is exhausted or April 30, 2009. Pleaseread allprogram documents carefullybefore completing your application. Manyhomeowners will be eligible for additional rebates/tax incentives. Please check with your utility provider, www.energystar.gov, www.energytaxincentives.org, and www.dsireusa.org.

REBATE AMOUNT

Homeowners are eligible to apply for the rebate amount corresponding to the items installed. Please see the table below. Homeowners applying for the rebate are subject to the rules as outlined in this document. The Indiana Office of Energy Development reserves the right to deny the rebate if it is discovered that the project did not comply with program guidelines.

Product / Product Requirements / Rebate Amounts
Natural Gas or Propane Furnace / 90% AFUE or greater and Energy Star certified / $400
Oil Furnace / 85% AFUE or greater and Energy Star certified / $400
Natural Gas or Propane Residential Boiler / 85% AFUE or greater and Energy Star certified / $750
Natural Gas or Propane Storage Water Heater / Minimum .62 Energy Factor
Minimum 30 Gallon storage capacity and Energy Star certified / $150
Natural Gas or Propane Tankless Water Heater / Must have .82 Energy Factor or greater and Energy Star certified / $250

Remember, saving energy prevents pollution.

By choosing ENERGY STAR and taking steps to optimize the performance of your heating equipment, you are helping to prevent global warming and promoting cleaner air while enhancing the comfort of your home.

You may also be interested to know:

· Though these products can be more expensive to purchase up front, the cost difference will be paid back over time through lower energy bills.

· When buying new equipment, sizing and installation are as important as product quality.

· You can get better heating and cooling performance at home with ENERGY STAR home sealing (insulation and air sealing) and duct sealing.

· Consider regular maintenance to maintain your heating and cooling system performance.

APPLICATION ATTACHMENTS

· Printed and signed copy of application – Printed copy of application must be submitted with homeowner’s signature. Please provide the legal name of only one homeowner on the application. This name should correspond to the name provided on all rebate materials including the W-9 and Direct Deposit form.

· Vendor Information Form –State form that must be filled out by the homeowner to get into the state’s disbursement system and gives the homeowner’s banking information for the direct deposit of the rebate. Use the same legal name and corresponding Social Security number for the homeowner listed on the application. (See page 7 of this document for instructions on how to complete this form and page 8 for this form.)

· Copy of itemized invoice marked paid or show a zero balance from the installer that shows the manufacturer and model number of the unit(s) installed or copy of the receipt for purchase of the equipment you are claiming the rebate for if you are installing your own unit. If the receipt or invoice does not show the manufacturer and model number, please include a photocopy of an item that verifies the manufacturer and model number.

The Indiana Office of Energy Development reserves the right to inspect installations to ensure proper installation and that all conditions of eligibility are met.

ELIGIBILITY REQUIREMENTS

· Existing single family, primary residence homes located within the State of Indiana.

· The person claiming the rebate must be a valid Indiana resident.

· The applicant must have a maximum household income of $75,000 or less to receive the rebate. Household income is defined as the sum of adjusted gross income as reported on all tax returns filed in 2008 for the top two wage earners in the household.

· The system must be a replacement for an existing unit (i.e. not for new construction.)

· All equipment must be new.

· Equipment must be purchased and installed between January 20, 2009 and April 30, 2009. The rebate form and invoice(s) must be postmarked within 30 days of the appliance/product purchase and installation. (Rebate funds are limited and available on a first-come, first-served basis.)

· An eligible homeowner may receive one rebate per each eligible product category installed in their primary residence. For example, one rebate per homeowner for one installed furnace. That homeowner could also claim a rebate for one eligible water heater.

· The installed equipment must be Energy Star certified. Please visit the Energy Star website to check if your equipment is eligible.

· The installed system must meet or exceed the product requirements on the chart from page 2 of this document.

· The rebate application and materials must be complete and legible. Incomplete or illegible rebate forms will not be processed.

· Fax all requested materials to 317-232-8995 or email scanned copies to , or mail them to:

Indiana Office of Energy Development

Attn: Carmen Pippenger

101 W. Ohio St., Ste. 1250

Indianapolis, IN 46204

Disclaimers: The Indiana Office of Energy Development:

Does not endorse any particular manufacturer or system

Does not expressly or implicitly warrant the performance of the installed system

Is not liable for any damage caused by the operation or malfunction of the system

Reserves the right to change the program at any time without notice
Complete Application Requirements Checklist

All materials must be submitted to Carmen Pippenger via mail or fax as a packet after installation is complete.

¨ Printed and signed copy of rebate application (legal name of one homeowner).

¨ Copy of itemized invoice marked paid by the installer that shows the manufacturer and model number of the unit(s) installed or copy of the receipt for purchase of the equipment you are claiming the rebate for if you are installing your own unit. If the receipt or invoice does not show the manufacturer and/or model number, please include a photocopy of an item that verifies the manufacturer and model number.

¨ Vendor Information Form –State form that must be filled out by the homeowner to get into the state’s disbursement system and gives the homeowner’s banking information for the direct deposit of the rebate. Use the same legal name and corresponding Social Security number for the homeowner listed on the application. (See page 7 of this document for instructions on how to complete this form and page 8 for this form.)

Program Flow

Homeowner reads the rebate information fully and contacts OED with any questions.
Homeowner researches other incentives.
Homeowner purchases and installs unit in their primary residence between 1/20/09 and 4/30/09.
Within 30 days of purchase and installation, the homeowner submits the Vendor Information form, invoice/receipt, completed rebate application labeled as Indiana Residential Energy Efficiency Rebate Program Guidelines and Application via email, fax or U.S. Mail.

5. Full application is processed and the rebate is deposited into applicant bank account. (allow 8 weeks)

NOTE: Failure to submit application materials within 30 days of unit purchase and installation will render the homeowner ineligible for the rebate(s). Illegible or incomplete application packets will not be processed.

Fax all requested materials or email scanned copies, or mail them after the project has been completed to:

Carmen Pippenger

Indiana Office of Energy Development

101 W. Ohio St., Suite 1250

Indianapolis, IN 46204

Fax: 317-232-8995

Email:

Indiana Residential Energy Efficiency Rebate Application

Homeowner Information (Use one homeowner’s legal name)

Last Name / First Name / Phone / Email Address
Installation Address / City / Zip
County / Electric Utility / Heating Fuel Provider
I certify that my household income is $75,000 or less.

Replaced System Information (old equipment)

Furnace or Boiler / Manufacturer
Fuel / Est. Year Installed / Estimated Efficiency

Replaced System Information (old equipment)

Storage or Tankless Water Heater / Manufacturer
Fuel / Est. Year Installed / Estimated Efficiency

New Unit Information

Installed Equipment / Rebate / Brand and model number / Efficiency Rating / Date installed
Natural Gas Furnace / $400
Propane Furnace / $400
Oil Furnace / $400
Natural Gas Residential Boiler / $750
Propane Residential Boiler / $750
Natural Gas Storage Water Heater / $150
Propane Storage Water Heater / $150
Natural Gas Tankless Water Heater / $250
Propane Tankless Water Heater / $250

*Continue to the next page for signature*

Installer Information

Company Name / Phone / Email Address
Mailing Address / City / State
IN / Zip

The completed rebate form and a copy of the paid invoice(s) or copy of the receipt showing the purchase of equipment as well as manufacturer and model number of the installed unit, and a Vendor Information form must be provided to receive a rebate(s).See pages 2-4of this document for full program requirements.

I certify that I have purchased the product(s) indicated on this form, and the unit(s) is/are installed at the address indicated. I understand that random inspections may be conducted to verify installation according to the terms and conditions. I have read and understood the general eligibility, terms and conditions associated with this program. I acknowledge and agree that the Indiana Office of Energy Development does not warranty any equipment, nor will it be liable for any personal injury or property damage caused by the equipment.

Homeowner Signature / Date

REQUEST FOR VENDOR INFORMATION

THIS FORM APPLIES TO YOU, IF YOU ARE:

1) A U.S. person (including a U.S. resident alien); and

2) A person, business, or other entity who has or will receive a payment from the state; or

3) A state employee who has or will receive a payment, other than payroll, from the state.

PURPOSE OF FORM:

The Auditor of State of Indiana (Auditor) must have correct vendor information to make payments to vendors. This includes the vendor’s legal name, doing business as name (if any), address, Taxpayer Identification Number (TIN), entity type, and banking information. This form allows you to provide your correct name, address, TIN, entity type, and banking information. If you do not provide us with the information, your payments may be subject to federal income tax withholding. In addition, if you do not provide us with this information, you may be subject to a penalty imposed by the Internal Revenue Service per I.R.C. 6723.

Federal law on withholding preempts any state and local law remedies, such as any rights to a mechanic’s lien. If you do not furnish a valid TIN, we are required to withhold a percentage of our payment to you. Withholding is not a failure to pay you. It is an advance tax payment. You should report all withholdings as a credit for taxes paid on your federal income tax return.

INSTRUCTIONS:

1. Enter your legal name on the designated line. Your legal name is the one that appears on your Social Security Card. Enter your remit address on the next line, and leave the purchase order address blank.

2. Check the box indicating you are an individual and print your SSN in the space provided.

3. Check the appropriate box that indicates whether you are or are not a U.S. person.

4. Complete Section 1: Authorization

5. Have your financial institution complete Section 2: Financial Institution’s Approval. Your financial institution should return the completed form to you. A voided check may be provided in lieu of having your financial institution complete this section. Deposit slips will not be accepted.

6. Complete Section 3: Electronic Notification of Electronic Fund Transfer (EFT) Deposits, only if you choose to receive electronic EFT notifications by email. If this section is not completed, your notification will be sent by U.S. Mail to the remit address designated on the reverse side of this form.

7. Retain a copy of the completed form for your records.

8. Any form submitted without an authorized signature will be destroyed and will not be entered into the Auditor’s vendor file.

9. Include the Vendor Identification form in your packet with your application for the Indiana Energy Efficiency Residential Rebate and the invoice/receipt for the purchase and/or installation of your eligible equipment.