2009 Cash Reward Claim Form - Iowa: Water Heater

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2009 CASH REWARD CLAIM FORM — IOWA

WATER HEATER
You must complete all information to avoid claim denial or processing delays
IMPORTANT: Please read “Terms and Conditions” and “Release and Indemnity” before completing this form. All references to the utility providing the cash rewards are
to Interstate Power and Light Company (IPL), an Alliant Energy company, hereinafter referred to as IPL. This form must be completed and signed by the installing
dealer. Retain a copy for your records.
CUSTOMER INFORMATION
Person or Company Receiving Cash Reward Mailing Address (if different than installation address)
Installation Address City State ZIP
City State ZIP
IPL Acct. No. (at installation address) Name on IPL Acct.
Contact Person Phone No.

( )
Residential Building Type Approximate Year Building Was Constructed (required)
❒ Single-Family ❒ Manufactured Home ❒ Apt./Condo (3+ Units)
Non-Residential Building Type (check only one)
❒ Type #1 ❒ Type #2 ❒ Type #3 ❒ Type #4 ❒ Type #5 ❒ Type #6

Convenience Store Apt./Condo (3+ Units) Church Education Industrial Agriculture
Grocery Hospital Health Clinic Office Farm Building
Restaurant Lodging Warehouse Retail
Other Commercial
Tax Status
❒ Residential ❒ Sole-Proprietor* ❒ Partnership* ❒ Government ❒ Non-Profit ❒ Corporation ❒ Religious
*If sole-proprietor or partnership, you must provide a Social Security or Federal Tax ID number and the associated legal name listed on the document.
SSN or Fed. Tax ID: Legal Name:
WATER HEATER INFORMATION

Brand Name Model No. Serial No.
Water Heater Type Tank-Type Tank Size (min. 40 gallons)
❒ Natural Gas (min. EF = 0.62) ❒ Electric (min. EF = 0.93)

Energy Factor (EF)
❒ Natural Gas Condensing ❒ Natural Gas Tankless (min. EF = 0.80)
(Thermal Efficiency 90% or greater)
Date Equipment Installed Water Heater Total Installed Cost Cash Reward (see cash reward table on reverse side, 3 units max.)
$ $
DEALER INFORMATION
Dealer ID No. Dealership Name
Address City State ZIP
Dealer Signature Phone No. Date
( )
CUSTOMER RELEASE - PLEASE READ BEFORE SIGNING

I certify that I have purchased the equipment described on this cash reward claim form and that it has been installed at the service address indicated. I agree to the terms and conditions
stated on the back of this form. Copy of itemized sales receipt with date of purchase must accompany this form.
Customer Signature Date

Donate your cash reward to IPL’s Hometown Care
Energy Fund and help local families in need (tax
deductible). ❒ Yes ❒ No
75-0297 ECRM158636 REV. 2 01/09
Cash Reward - Water Heaters Natural Gas Water Heaters
Electric Water Heaters Qualifications: Minimum 40 gallon tank or greater for tank-type
Qualifications: Minimum 40 gallon tank or greater for tank-type Cash reward: Energy Factor 0.62 or greater - $75 per unit
Energy Factor 0.93 or greater Energy Factor 0.80 or greater for tankless models - $300 per unit
Cash Reward: $50 per unit Thermal Efficiency 90% or greater for condensing
models - $300 per unit
GENERAL TERMS AND CONDITIONS

IMPORTANT: Please read the following information before completing the Cash Reward Claim form on the reverse side.
1. Participants must be retail customers of IPL in Iowa.
2. IPL must supply the primary energy to the equipment for which the cash reward is being paid.
3. New equipment must be installed on the premises and must not be purchased for resale.
4. IPL reserves the right to inspect and verify the installation.
5. IPL reserves the right to meter the specified equipment or process, at no cost to the customer, to determine the actual energy saved for up to 18 months after installation.
6. Cash Rewards apply to new and replacement installations of qualified equipment. In replacement situations, the efficiency of the equipment installed must be higher than that of
the equipment removed.
7. Customers are responsible for ensuring that equipment installed for this program meets all applicable codes, standards, and regulatory requirements.
8. IPL does not guarantee that installation of high-efficiency equipment will result in reduced usage or demand, or in cost savings.
9. IPL makes no warranties, expressed or implied, with respect to any equipment purchased and/or installed including, but not limited to, any warranty of merchantability or fitness
for a particular purpose.
10. In no event shall IPL be liable for any incidental or consequential damages.
11. IPL does not endorse any particular manufacturer, product, or system design in promoting this cash reward program. Listing a product does not constitute an endorsement, nor
does it imply that unlisted products are defective in any way.
12. IPL reserves the right to modify or end this cash reward program at any time without prior notice.
13. This program is effective January 1, 2009 through December 31, 2009 and is subject to periodic review by IPL.
14. Any purchase of energy efficient equipment must occur between January 1, 2009 and December 31, 2009 to qualify for cash rewards. Receipt must show retail equipment cost.
Installation of energy-efficient equipment must occur between January 1, 2009 and February 28, 2010.
15. IPL reserves the right to contact customers who participate in the cash reward programs for surveys to monitor and evaluate program performance.
16. Claim forms must be submitted within 90 days of installation.
17. Claim forms postmarked after March 31, 2010 will be denied.
SPECIFIC TERMS AND CONDITIONS

A. Cash reward amount is limited to 50 percent of equipment cost minus any manufacturer or dealer rebates.
B. Total prescriptive water heater cash reward is limited to three units per customer account per year.
C. If a new water heater is installed in a newly constructed home, the customer may take advantage of the Water Heater cash reward or the New Home Construction cash reward,
but not both. The customer’s signature under the Customer Release acknowledges that the customer waives the New Home Construction cash reward.
RELEASE AND INDEMNITY

WHEREAS, IPL has entered into a Dealer Participation Agreement with Dealer on the reverse side of this document;
WHEREAS, the undersigned is Customer of the Participating Dealer and not a Customer of IPL for purposes of any transaction between Participating Dealer and Customer,
including purchase and/or installation of equipment;
WHEREAS, it is the intent of IPL and Dealer that no agency, joint venture or partnership between IPL and Dealer or Customer will be created as a result of the sale,
construction, installation and cash reward on the equipment or materials;
NOW, THEREFORE, for valid consideration, receipt of which is hereby acknowledged:
1. Customer and Dealer hereby agree to assume all risk of loss associated with the equipment and to defend, indemnify and hold harmless IPL, its agents, officers,
directors, employees and assigns, and to release same from any and all liabilities, claims, demands, actions and causes of action whatsoever arising out of or related to any loss,
damage or injury, including death, injury to persons or property, that may be sustained by the undersigned or a third party in connection with the installation, use or possession of
the above-mentioned equipment, or relating in any way to the Dealer Participation Agreement or any Cash Reward Claim.
2. WARRANTIES AND WAIVER. Customer acknowledges, warrants and agrees that the services, materials and equipment are suitable for its purposes and agrees that
it has had the opportunity to inspect said equipment and takes possession of same “AS-IS WHERE-IS without any warranties or representations whatsoever” other than any
applicable manufacturer’s warranties.
ustomer specifically acknowledges that IPL makes no representations or warranties of any kind as to the merchantability, fitness for a particular purpose, design or
C
condition of the equipment. Any warranty on the equipment shall be provided through the equipment manufacturer. IPL makes no representations or warranties of any
kind as to the installation or operation of the equipment by Dealer. IPL shall not be liable, in contract, tort, and strict liability or otherwise, whether or not resulting from
any of the foregoing or otherwise on account of any defect, whether hidden, latent or otherwise discoverable or undiscoverable respecting the equipment.
THE SUM TOTAL LIABILITY OF IPL TO CUSTOMER AND DEALER WITH RESPECT TO ANYTHING DONE IN CONNECTION WITH THE DEALER PARTICIPATION
AGREEMENT OR THE CASH REWARD CLAIM, WHETHER IN CONTRACT, TORT (INCLUDING NEGLIGENCE), OR UNDER ANY OTHER LEGAL THEORY SHALL NOT
EXCEED THE AMOUNT OF THE CASH REWARD.
IPL SHALL NOT IN ANY EVENT BE LIABLE FOR SPECIAL, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES, INCLUDING, BUT NOT LIMITED TO, LOSS OF
PROFITS OR REVENUE, LOSS OF USE OF SITE SYSTEMS OR PROPERTY, COST OF CAPITAL OR CLAIMS BY CUSTOMER OR DEALER OR DAMAGE TO CUSTOMER OR
DEALER’S PROPERTY OR ANY THIRD PARTY’S PROPERTY.
3. Customer and Dealer further acknowledge that IPL will not provide insurance coverage for the Customer or Dealer, and that it is the Customer and Dealer’s responsibility
to procure insurance coverage against any hazards relating to the equipment to protect persons and property.
Mail your completed Cash Reward Claim Form and sales receipts to: Energy Efficiency Programs
IPL
P.O. Box 351
Cedar Rapids, IA 52406-0351
Or fax to: (319) 786-4746. (If you fax your claim form, please do not mail to avoid possible duplication.)
Please allow up to eight weeks for receipt of your check after IPL has received your properly completed Cash Reward Claim Form and receipt.
If you have any questions, or would like additional forms, call: 1-866-ALLIANT (1-866-255-4268)
Visit us on the Web at: alliantenergy.com
75-0297 ECRM158636 REV. 2 01/09

2009 Cash Reward Claim Form - Iowa: Water Heater

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2009 CASH REWARD CLAIM FORM — IOWA

Installation Address City State ZIP

City State ZIP

IPL Acct. No. (at installation address) Name on IPL Acct.

Contact Person Phone No.

❒ Type #1 ❒ Type #2 ❒ Type #3 ❒ Type #4 ❒ Type #5 ❒ Type #6

WATER HEATER INFORMATION

Water Heater Type Tank-Type Tank Size (min. 40 gallons)

❒ Natural Gas (min. EF = 0.62) ❒ Electric (min. EF = 0.93)

Address City State ZIP

Dealer Signature Phone No. Date

CUSTOMER RELEASE - PLEASE READ BEFORE SIGNING

Customer Signature Date

GENERAL TERMS AND CONDITIONS

SPECIFIC TERMS AND CONDITIONS

RELEASE AND INDEMNITY

NOW, THEREFORE, for valid consideration, receipt of which is hereby acknowledged:

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