Instructions: Complete this form and submit it to the serving electric utility. Boxes with bold outlines indicate BPA requirements. BUSINESS AND SITE INFORMATION Business Name Address Zip Type of Business Commercial Industrial Agricultural EXISTING EQUIPMENT INFORMATION Existing Equipment Information Heater 1 Heater 2 Heater 3 Heater 4 Yes Yes Yes Yes New or existing heater that does No (If project is No (If project is No (If project is No (If project is “No”, “No”, “No”, “No”, not have temperature or heater not eligible for not eligible for not eligible for not eligible for controls except for manual control incentives) incentives) incentives) incentives) NEW EQUIPMENT INFORMATION Retrofit Information Heater 1 Heater 2 Heater 3 Heater 4 Control manufacturer Control model number Number of Control Units The new control unit(s) is/are Yes Yes Yes Yes either by a dedicated controlled No (If project is No (If project is No (If project is No (If project is “No”, “No”, “No”, “No”, outlet or directly on the engine block not eligible for not eligible for not eligible for not eligible for incentives) incentives) incentives) incentives) heater Controls keep block heaters off when the ambient air temperature Yes Yes Yes Yes is above the temperature setting, and No (If project is No (If project is No (If project is No (If project is “No”, “No”, “No”, “No”, deliver only as much heat as not eligible for not eligible for not eligible for not eligible for incentives) incentives) incentives) incentives) necessary when the temperature drops below the setting INSTALLER INFORMATION Company Name Total Installed Cost (before rebate) including equipment, labor, permit and tax By signing this form, I confirm that the above information is correct to the best of my knowledge. Installer Signature Date
Instructions: Complete this form and submit it to the serving electric utility. Boxes with bold outlines indicate BPA requirements. BUSINESS AND SITE INFORMATION Business Name Address Zip Type of Business Commercial Industrial Agricultural EXISTING EQUIPMENT INFORMATION Existing Equipment Information Heater 1 Heater 2 Heater 3 Heater 4 New or existing heater that does not have temperature or heater controls except for manual control Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) NEW EQUIPMENT INFORMATION Retrofit Information Heater 1 Heater 2 Heater 3 Heater 4 Control manufacturer Control model number Number of Control Units The new control unit(s) is/are either by a dedicated controlled outlet or directly on the engine block heater Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Controls keep block heaters off when the ambient air temperature is above the temperature setting, and deliver only as much heat as necessary when the temperature drops below the setting Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) INSTALLER INFORMATION Company Name Total Installed Cost (before rebate) including equipment, labor, permit and tax By signing this form, I confirm that the above information is correct to the best of my knowledge. Installer Signature Date
Commercial_Vehicle_Block_Heater_Control_PIF_Oct2016.docx