Engineering Services Application

Engineering Services Application
RETROFIT OR NEW CONSTRUCTION
2016 Engineering Services
ALL FIELDS ON THIS PAGE ARE REQUIRED TO COMPLETE YOUR APPLICATION.
Indicate Program Administrator for Application: 
Cape Light Compact  Eversource  National Grid  Unitil
 Berkshire Gas Company  Columbia Gas of Massachusetts  Liberty Utilities
CUSTOMER/ACCOUNT HOLDER INFORMATION
COMPANY NAME
CONTACT PERSON
INSTALL SITE
PHONE
APPLICATION DATE
FAX NUMBER
EMAIL ADDRESS
SQUARE FEET (COVERED BY THIS APPLICATION)
STREET ADDRESS
CITY
STATE
ZIP
MAILING ADDRESS (IF DIFFERENT)
CITY
STATE
ZIP
ELECTRIC COMPANY NAME
ELECTRIC ACCOUNT NUMBER
GAS COMPANY NAME
GAS ACCOUNT NUMBER
BUILDING TYPE (PLEASE PLACE “X” IN APPROPRIATE BALLOT BOX)
 ASSEMBLY
 AUTOMOTIVE
 BIG BOX
 COMMUNITY COLLEGE
 DORMITORY
 FAST FOOD
 FULL SERVICE RESTAURANT
 GROCERY
 HEAVY INDUSTRIAL
 HOSPITAL
 HOTEL
 LARGE REFRIGERATED SPACE
 LARGE OFFICE
 LIGHT INDUSTRIAL
 MOTEL
 MULTI STORY RETAIL
 MULTIFAMILY HIGH-RISE
 MULTIFAMILY LOW-RISE
 OTHER:
 RELIGIOUS
 K-12 SCHOOL
 SMALL OFFICE
 SMALL RETAIL
 UNIVERSITY
 WAREHOUSE
PAYMENT METHOD (PAYEE MUST SUBMIT A W-9 FORM)
PAYMENT TO:
CUSTOMER

 VENDOR/INSTALLER
CHECK PAYABLE TO: CUSTOMER — TAX ID# (REQUIRED)
VENDOR/INSTALLER — TAX ID# (REQUIRED IF RECEIVING INCENTIVE)
CUSTOMER COMPANY TYPE:
VENDOR COMPANY TYPE:
 INC.  NOT INCORP.  EXEMPT
 INC.  NOT INCORP.  EXEMPT
ENGINEER INFORMATION
ENGINEERING FIRM
CONTACT NAME
STREET ADDRESS
CITY
PHONE
EMAIL ADDRESS
STATE
ZIP
PROGRAM
 NEW CONSTRUCTION
 RETROFIT
 SMALL BUSINESS
END USE (check all that apply)
 LIGHTING
 HVAC
 MOTOR
 VARIABLE SPEED DRIVES  ENERGY MANAGEMENT SYSTEM
 PROCESS
 OTHER:
 REFRIGERATION
 COMPRESSED AIR
PROJECT INFORMATION
BRIEFLY DESCRIBE PROJECT:
2016 Engineering Services
Retrofit or New Construction
Page 1 of 4
Rev. 11/19/2015
Engineering Services Project Information and Deliverables
Detailed proposal must include a brief description of the following for each Energy Efficiency Measure (EEM):
•Existing Systems and proposed changes (retrofit)
•Base case / code assumptions and proposed system (New Construction)
•Estimated study cost per task
•Estimated hours to complete each task and the staff assigned to each task
•Estimated schedule to complete each task
•Proposed methodology for analysis
•Estimated potential energy savings
After approval, Engineer will supply the Program Administrator (PA) with the following deliverables:
•Draft report for review & comment (include estimated costs, energy and demand savings by EEM)
•Final report (both hard copy and electronic copy) upon sign off of Draft Report
•Electronic copies of all appendices, building simulation outputs and any additional supporting documentation
•Completed Energy Efficiency Program application forms
•Completed MRD (Minimum Requirements Document)
TERMS AND CONDITIONS
1.Customer Eligibility
The Program is available to all non-residential customers in the service territory of either Berkshire Gas Company, or Cape Light Compact, or Columbia Gas of Massachusetts,
or National Grid, or Liberty Utilities, or NSTAR Electric & Gas Corporation, or Unitil, or Western Massachusetts Electric Company, (“the PA”) that contribute to the energy
conservation fund.
2.Incentives
Subject to these Terms and Conditions (T&Cs), eligible Customers may qualify for incentives from the PA for the installation of those conservation measures (“EEMs”)
described within this Engineering Service Request that are approved by the PA.
3.Program Changes, Suspension & Cancellation.
The Program and these T&Cs may be changed by the PA at any time without notice. Pre-approved applications, however, will be processed to completion under the
Terms and Conditions in effect at the time of the pre-approval by the PA. Submission of a completed application does not entitle the Customer to program participation.
Entitlement to program participation can only occur after the PA has signed a copy of the application and granted pre-approval.
4.Customer Application and Analysis.
The PA reserves the right to reject or modify any calculations, based on the PA’s own analysis.
5.Pre-Approval and Pre-Installation
The PA is not bound to pay any potential incentives unless the PA pre-approves the EEMs proposed by the Customer and completes a satisfactory pre-installation survey of
the Customer’s facilities.
6.Authorization
The PA will have no obligation to pay incentives for any EEMs installed prior to the issuance of the PA’s written authorization.
7.Limited Scope of Review
Review of the design and installation of the EEMs is limited solely to determining whether program conditions have been met and shall not constitute an assumption by the
PA of any liability with respect to the EEMs.
8.Vendor Selection
The PA has the right not to allow a vendor or contractor to participate in this program.
9.Removal of Equipment
The Customer agrees, as a condition of participation in the program, to remove and dispose of the equipment being replaced by the EEMs in accordance with all laws, rules,
and regulations. The Customer agrees not to install any of this equipment in the service territory of the PA or its affiliates.
10.Review of Specifications, Submittals and Drawings
The Customer will provide the PA with a copy of the specifications for the construction of the Facility that will be provided to its construction contractors. Such specifications
must include the EEMs. The PA may refuse to pay incentives if the specifications do not adequately provide for installation of the EEMs consistent with good engineering and
energy-efficient design practices. Customer will, upon request by the PA, provide a copy of the as-built drawings and equipment submittals for the Facility. The PA may refuse
to pay incentives if the final submittals and drawingsdo not adequately reflect the installation of the EEMs consistent with the original design intent as identified on the
Customer application and worksheets.
11.Limitation of Liability
The PA’s liability under this agreement will be limited to paying the incentive specified in this agreement. Neither the PA nor any of its affiliates shall be liable to the Customer
for any direct, indirect, consequential or incidental damages regardless of the theory of recovery, caused by or arising from any activities associated with this program.
12.No Warranties
The PA does not endorse, guarantee, or warrant any particular manufacturer or product, and the PA EXPRESSLY DISCLAIMS ALL WARRANTIES, EXPRESSED OR IMPLIED,
INCLUDING THE WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE for any product or services. The Customer acknowledges that neither the PA
nor any of its consultants are responsible for assuring that the design, engineering and construction of the Facility or installation of the EEMs is proper or complies with any
particular laws (including patent laws), codes, or industry standards. The PA makes no representations or warranties of any kind regarding the results to be achieved by the
EEMs or the adequacy or safety of such measures.
13.Obligations of the Parties
Customer acknowledges that Vendor is not an agent, contractor or subcontractor of the PA, and is an independent contractor engaged by the Customer, and that the PA
does not manage or control the Vendor’s performance. The PA shall have no liability for Vendor’s failure or delay to perform, or for failure of the EEMs to function, or for any
personal injury (including death) or property damage caused by Vendor or the EEMs, and Customer agrees to waive and release all claims related to the foregoing against the
PA and its affiliates. The PA shall have no obligation to perform any of the Vendor’s work or to maintain, remove, repair or replace
the EEMs.
14.Compliance with Laws
The Customer is responsible for obtaining any and all necessary licenses and permits related to the installation of EEMs and agrees to comply with all federal, state and local
laws and regulations with regard to installation of EEMs, including, but not limited to, M.G.L.c. 143, § 3L.
2016 Engineering Services
Retrofit or New Construction
Page 2 of 4
Rev. 11/19/2015
TERMS AND CONDITIONS (continued)
15.Miscellaneous
These Terms and Conditions and this program application constitute the entire agreement between the parties and supersede all other communications and representations.
Paragraph headings are for the convenience of the parties only and are not to be construed as part of these Terms and Conditions. If any provision of the Terms and
Conditions is deemed invalid by any court or administrative body having jurisdiction, such ruling shall not invalidate any other provision, and the remaining Terms and
Conditions shall remain in full force and effect in accordance with their terms.
16.Energy Benefits
The PA is entitled to 100% of the energy benefits associated with the EEMs, excluding the value of energy cost savings realized by the Customer, but including all rights to all
associated ISO-NE Energy, Capacity and Reserves Products, and the Customer agrees to provide the PA with such further documentation as the PA may request to confirm the
PA’s ownership of such benefits and Products.
Engineer Acknowledgement
PROPOSED ENGINEERING COST: I certify to the company that I will review the measures and calculations proposed in this study. They will be in my professional opinion
appropriate for the type and purpose of the facility in which they will be installed. The information contained in this study will be true, accurate
and complete to the best of my knowledge.
NAME (print) ENGINEER SIGNATURE DATE
Customer Acknowledgement (pre-approval)
PROPOSED CUSTOMER CONTRIBUTION: Payment shall be due whether the customer elects to pursue any of the energy savings opportunities identified. I certify that all statements
made in this application are correct to the best of my knowledge and that I have read and agree to the terms and conditions on the back of this
form including those provisions regarding warranties. I further understand and acknowledge that the offer to pay incentives is subject to those
Terms and Conditions.
NAME (print) CUSTOMER SIGNATURE DATE
FOR PROGRAM ADMINISTATORS ONLY
Approval
Electric
Gas
2016 Engineering Services
Retrofit or New Construction
Contribution
Date
Page 3 of 4
Program Manager
Rev. 11/19/2015
Table 1: Proposed Engineering Study - EEM summary
(A)
(B)
(C)
(D)
(E)
(F)
(G)
Analyst
Engineer
Sr. Engineer
Total EEM
Study Cost
$0.00
Estimated
Annual
Savings kWh
Estimated
Annual
Savings
Therms
Typical Simple
Payback Years
$0.00
Hourly Rate
$0.00
# of Hours (A)
# of Hours (B)
# of Hours (C)
2.0
10.0
15.0
100,000
5,000
2.0
1
$2,425
$0.00
2
$0.00
3
$0.00
4
$0.00
5
$0.00
6
$0.00
7
$0.00
8
$0.00
9
$0.00
10
$0.00
EEM #
EEM NAME
A. Energy Efficiency Measures
Example
Reduce minimum air changes per hour
$0.00
Subtotal: EEMs
B. Additional Itemized Expenses: Report Preparation, Site Visits, Meetings
Example
Miscellaneous
$1,000
1
2
3
4
5
Subtotal: Additional Itemized Expenses
GRAND TOTAL PROPOSAL
$0.00
NOTE: This an example format for the information required with a comprehensive study proposal. For columns (A) (B) and (C) input the title and hourly rate of each team member and the
number of hours per task below. Column (D) is the total cost to study each EEM. Estimated annual savings (E) and (F) should be order of magnitude (ex 10,000 kWh / 50,000 kWh / 100,000
kWh / 500,000 kWh etc.) and paybacks (G) based on typical costs. No detailed calculations are required for the initial proposal. If applicable, building modeling should be listed first with
no associated savings.
2016 Engineering Services
Retrofit or New Construction
Page 4 of 4
Rev. 11/19/2015
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