Get Started:

1. Verify Customer and Product Eligibility Before Installing: Read complete list of requirements on Pages 3-4 View a list of qualifying products online 2. Collect Nicor Gas Account Number and Contractor Invoice 3. Complete this application in full, or apply online at NicorGasRebates.com/home

2011 - 2014
Home Energy Efficiency Rebate Program Application
Thank you for your interest in the Nicor Gas Energy Efficiency Program! Please follow the steps outlined below to ensure that your application is eligible for submission. Make a copy of your completed application and supporting documentation to retain for your records.
Need help? Contact us at 877.886.4239
Monday through Friday 7:00 a.m. 7:00 p.m.

Step 1: Verify Eligibility

Read the complete list of requirements on Pages 3 and 4 to ensure that your installation is eligible for Program rebates. If you meet the requirements, please complete Steps 2 and 3 (Pages 1 and 2) using the tips and guidance provided on the left, and mail all required documentation to the address listed in the bottom left corner.
Promo Code (if applicable)

Ready to Submit?
n Page 1 is complete with the Account Holders signature n Page 2 is complete with all product/equipment information n Contractor Invoice is attached and contains all requirements:
- Equipment Make, Model & Serial Number - Total Installed Cost (itemized by qualifying equipment) - Installation & Purchase Dates (if different) - Payment Terms, Balance Due of Zero, or Paid in Full Stamp - Professional Contractor Information (if applicable) - Any rebate-specific invoice requirements listed on Page 3

Step 2: Enter Your Information and Sign Below

Account Holder Information

Nicor Gas Account Number

Prefix (Mr., Mrs., Ms.)

First Name

Last Name

Installation Information

Installation Address

City

State

Zip Code

Application Contact Information

Contact First Name

Contact Last Name

Contact Email

Contact Phone

Contractor Information

Contractor Business Name

Phone

Email

Address

City

State

Zip Code

Mailing Address for Rebate Check

Make Check Payable To*

Mailing Address

City

State

Zip Code

q Account Holder q Contractor q Landlord I certify that the participant has not received/will not receive a rebate for the same product or equipment from more than one Illinois investor owned utility or third-party energy efficiency program offering rebates or financing funded with ratepayer funds. I certify that the energy-efficient product or service was paid for as reflected on the receipt and described in this rebate application. I certify that all information is true and correct, and that I have met all Program requirements as outlined in the General Program Qualifications section. I understand and agree to the terms and requirements for which I am submitting this rebate application, as outlined on Pages 1 through 4.
This is q an existing home q new construction Applicant Signature Print Applicant Name Date

Submit your completed application and invoice:

Nicor Gas Energy Efficiency Program 3800 Watt Avenue, Suite 105 Sacramento, CA 95821-2672
06012012ResApplication

NOTE: Incentives are taxable and if greater than $600 in a calendar year will be reported to the IRS unless you are exempt. If you have exceeded a total of $600 in rebates, a W-9 form will be requested if applicable.
* Payee: The Program allows the check to be made out to any one of the following: Account Holder, Contractor or Landlord. Please review all requirements listed on Page 4. If you are the Account Holder and wish the rebate check to be made out to you, please complete all of the required fields in the rebate application, provide the required supporting documentation listed on Pages 3 and 4 of this rebate application, and have the Nicor Gas account holder sign on Page 1 as the Applicant. The check may also be made out to the Landlord (who is not the account holder) or the installing Contractor (offering an Instant Discount). Please review all requirements outlined on Page 4 for applications submitted by a Landlord or Contractor. The Nicor Gas account holder must sign the applicable Customer Release Form if the check is being made payable to the Landlord or Contractor.
The Nicor Gas Energy Efficiency Program is a multi-year program funded by Nicor Gas ratepayers in compliance with state law through a small charge identified on customer bills as Energy Program.

Page 1 of 4

Reminders: Complete all fields for the rebate you are applying for. Unless noted, all fields are required. Verify the make, model and serial number entered are correct, complete and legible. Rebate-Specific Requirements: Pipe Insulation: Must be combined with another qualifying equipment/product (cannot be submitted alone). Indirect Water Heater: Must be installed on (added on or integrated into) a qualifying High Efficiency Boiler. Programmable Thermostat: If self-installed, certify you have installed the thermostat per all requirements on Page 3 and 4 and it is currently operational. Complete System Replacement Rebates: Complete System Replacement rebates are available to current residential delivery customers of both Nicor Gas and ComEd (Commonwealth Edison). Complete all fields in the second table if you are applying for a Complete System Replacement Rebate. Do not enter furnace information in the first table. Include the AHRI Certified Reference Number - Ask your installing contractor for assistance, or visit NicorGasRebates.com/csr.

New rebate offerings available for qualifying purchases and installations completed November 19, 2012 through May 31, 2013. Refer to the last page of this application for more information.

Step 3: Enter Product Information

Equipment/Product High-Efficiency Furnace
AFUE** > 95%

Rebate Amount $250

Installed Date

Total Installed Cost*

Make

Model

Serial Number

High-Efficiency Furnace
AFUE** > 92%

$200

High-Efficiency Boiler RESIDENTIAL EQUIPMENT

AFUE** > 95%

$450

High-Efficiency Boiler
AFUE** > 90%

$350

Indirect Water Heater

Must be combined with a qualifying high-efficiency boiler

$100

Storage Water Heater

Energy Factor > 0.67

$200 Insulation Type $10 Insulation Thickness Linear Feet Installed

Hot Water Pipe Insulation

Minimum 6 feet
Must be submitted with another rebate

q Fiberglass q Foam q Calcium Silicate

Manufacturer/Make Model Self-Installers: Certify Installation

Programmable Thermostat High Performance Windows

$20 $1.50 per square foot Manufacturer

q Thermostat is installed per Program

requirements on residential-sized natural gas equipment and is currently operational.

Total Square Footage Installed

Quantity of Windows Installed

Complete System Replacement Rebates - Available to Customers of Nicor Gas and ComEd
ComEd Account Number:
New High-Efficiency Equipment Rebate Equipment Amount Purchase Date Installed Date Total Installed Cost* Dwelling Type:

Single-Family Attached

Single-Family Detached

Multi-Family

Manufactured Home

Make

Model

AHRI Certified Ref. # +

Serial Number

Evaporator Coil
(Indoor Unit)

Central AC (CAC):

$250
(for complete CAC system)

Condenser Unit
(Outdoor Unit)

Central AC (CAC):

High-Efficiency Furnace

$200 or $250
(based on efficiency)

n/a

Old/Existing Furnace and CAC Condenser Unit The Condition and Estimated Age fields are required for this application.
Please enter the make, model, size and efficiency if available.

Equipment CAC - Condenser Furnace

Condition
q Operable q Inoperable q Operable q Inoperable

Estimated Age (Yrs)

Make

Model

Capacity (Btuh)

Efficiency
SEER AFUE

* The Total Installed Cost, is the total purchase price of an individual piece of equipment/product, including the cost of the equipment/product, materials and external labor. Total Installed Cost must be itemized by each equipment/product installed and entered in the charts above for each rebate you are applying for. The Itemized Contractor Invoice must include the Total Installed Cost,itemized by each qualifying equipment/product on the invoice. **AFUE = Annual Fuel Utilization Efficiency
+

The evaporator and condenser coil combination must be AHRI Certified, with the AHRI Certified Reference Number entered above as shown in the AHRI Database, available at www.ahridirectory.org.

The ComEd Smart Ideas Central Air Conditioning rebate is funded by ComEd customers in compliance with IL Public Act 95-0481.

Please use an additional copy of Page 2 if applying for more than one rebate of the same type.

Page 2 of 4

Rebate Requirements and Qualifications:

General Rebate Requirements Equipment and products must be new and installed by a professional contractor (unless otherwise noted) according to all applicable building, local and state codes, and manufacturer specifications. Equipment and products must be installed and operational prior to submittal of this application at the address listed on Page 1. Equipment must be purchased and installed June 1, 2011 - May 31, 2014, unless otherwise noted. Rebate-Specific Requirements High-Efficiency Furnaces
AFUE > 95% AFUE > 92% AFUE > 95% AFUE > 90%

Required Documentation 1. Itemized Contractor Invoice/Proof of Payment Receipt which includes: Equipment make, model and serial number Total installed cost (itemized by qualifying equipment) Purchase date and installation date (if purchased and installed on different dates) Total number of units installed Professional contractors business/company name, address and phone number (if installed by a professional contractor) Balance due of zero, paid in full stamp, or payment terms Any rebate-specific invoice requirements: Furnaces: Include the discharge air configuration (either Upflow, Downflow, or Horizontal). Pipe Insulation: Include the insulation type, thickness and total linear feet installed. Windows: Include the window dimensions, quantity of each and total square footage of qualifying windows installed. 2. Completed and signed rebate application 3. Additional Supporting Documentation: Windows: NFRC Label or Manufacturer Specification Sheet for each window type installed Pipe Insulation: Manufacturer Specification Sheet

New equipment must have an AFUE > 92% or > 95%. Furnaces with an AFUE > 95% must be ENERGY STAR qualified. The rebate amount is determined by the efficiency (AFUE) rating of the qualifying furnace. New equipment must meet ENERGY STAR standards with an AFUE > 90% or > 95%. Only residential-sized boilers with an input capacity < 300 MBTUH are eligible. Boilers must include an outdoor-air reset control (integrated or added to the system), unless the supply temperature does not exceed 140oF. The rebate amount is determined by the efficiency (AFUE) rating of the qualifying boiler. New indirect water heater must be added on or integrated into a new high-efficiency boiler that qualifies for a High-Efficiency Boiler Rebate (above). Indirect water heater and space heating boiler must be installed at the same time, and be included on the same invoice. Addition of an Indirect Water Heater onto an existing boiler does not qualify. Indirect water heater must be used for all domestic water heating for the whole home (point-of-use units are not eligible). Indirect water heater must be purchased and installed June 1, 2012 - May 31, 2014. New equipment must meet ENERGY STAR standards with an Energy Factor > 0.67. Instantaneous (tankless) water heaters are not eligible. Insulation thickness must be 0.75 inches or greater. Fiberglass, foam or calcium silicate insulation types qualify. Must be added to uninsulated pipes of a natural gas domestic hot water system. Electric and propane water heater pipe systems are not eligible. Minimum of 6 linear feet must be installed. Minimum qualifying pipe diameter is 0.75 inches. Rebate application must contain another qualifying product. New construction is not eligible. Pipe insulation must be purchased and installed June 1, 2012 - May 31, 2014. New thermostat must be capable of maintaining separate programs for weekdays and weekends, with at least two temperature settings for each program. Thermostat must be installed on system with residential-sized natural gas space heating equipment with Input Capacity < 300 MBTUH. Thermostat must be installed according to manufacturer specifications. Professional installation is not required, but is strongly encouraged. New construction is not eligible. Thermostat must be purchased and installed June 1, 2012 - May 31, 2014. Must have U-Value < 0.20 and be rated by the National Fenestration Rating Council (NFRC). Replacement glass (adding glass to an existing frame) and window films do not qualify. New construction is not eligible. Windows must be purchased and installed June 1, 2012 - May 31, 2014.

High-Efficiency Boilers

Indirect Water Heaters

Storage Water Heaters

Energy Factor > 0.67

Hot Water Pipe Insulation

(Must be included on an application with another qualifying product)

Programmable Thermostats High Performance Windows

Complete System Replacement Requirements Combined Rebates from ComEd & Nicor Gas for Central Air Conditioning (CAC) & Furnace Replacements
Participation in the Complete System Replacement requires that all General Program Qualifications listed on Page 4 of this application be met, unless otherwise noted below, in addition to the following requirements:
Participant must be a current residential delivery service customer of Commonwealth Edison (ComEd). Application must be postmarked (or submitted online) no later than 90 days after the initial installation date, or by June 15, 2013, whichever comes first. All equipment, including the furnace, evaporator coil and condenser unit, must be included on the same invoice. Offer is valid for qualifying equipment purchased and installed June 1, 2012 - May 31, 2013, or until funds are depleted. Installation of a qualifying high-efficiency furnace and CAC unit must be completed at the same time by the same installing contractor. The furnace must be fully installed and operational prior to submittal of this application. If installation is completed in the winter months (November through April) and the condenser unit cannot be placed, the furnace and evaporator coil must be installed at the same time. The condenser unit must have installation planned for the spring.

Equipment-Specific Requirements High-Efficiency Furnace A qualifying furnace that meets all requirements listed above must be included on Page 2 to be eligible for the Complete System Replacement rebate.

Required Documentation

Central Air Conditioning Unit

Itemized Contractor Invoice(s) or Proof of Purchase Receipt(s) for the furnace and CAC installation consisting of: Equipment make, model and serial number for the furnace, condenser and evaporator New equipment must have a Seasonal Energy Efficiency Ratio (SEER) of 14.5 or greater. The evaporator coil and condenser unit Total installed cost (itemized by the furnace cost and complete combination must be AHRI Certified (Visit www.ahridirectory.org to verify certification). Equipment must be replacing existing, CAC cost) CAC equipment used for the same purposes, one for one. Equipment additions to a residential dwelling, which are not replacing Total number of units installed existing CAC equipment, are not eligible for rebates. New construction is not eligible. CAC must be purchased and installed during Purchase date and installation date (including estimated the Program offering period, June 1, 2012 - May 31, 2013. The rebate amount of $250 is for the complete CAC unit, including both completion date if Condenser cannot be placed until spring) the evaporator coil and condenser unit. All other requirements listed on Page 3 Page 3 of 4

General Program Qualifications:

Participant Eligibility You are only eligible to participate in the Home Energy Efficiency Rebate Program (Program) if you are:
A current residential customer of Nicor Gas. Installing qualifying energy-efficient products or equipment in a residential dwelling used as the occupants primary residence.

Program Terms and Conditions

Funds are limited and applications are processed on a first-come, first-served basis. Program is subject to change and may end without prior notice. Please allow approximately 2 weeks for your completed application to be processed. Incomplete applications cannot be processed. Failure to complete the rebate application in full and provide the required supporting documentation will either delay the payment process or result in your application being denied. Maintain a copy of your rebate application and all supporting documentation. The Program is not responsible for items (i.e., rebate applications, supporting documentation, and/or rebate checks) lost or damaged in the mail. Contractors are eligible to have the rebate signed over to them. Contractors receiving rebates are not eligible for any other incentives for the same products. Contractors must submit the hard copy application (with the exception of eligible Contractor Circle Members). If you do not own the property where this equipment is installed, as a tenant you are responsible for obtaining the property owners permission to install the equipment for which you are applying for a rebate. Your submission of this application indicates that you have obtained this permission. Rebate incentives may not exceed the total purchase price of the energy efficient equipment. The only costs eligible for incentives are: materials, equipment, and external labor. All equipment installations are subject to verification inspection by the Program Administrator to ensure that the equipment is properly installed and operating. Participants must allow, if requested, the Nicor Gas Energy Efficiency Program or a Program representative reasonable access to their home to verify the installed equipment. Nicor Gas, Contract and Program Administrators disclaim any and all liability, loss or damage, and make no guarantees related to: Participation in the Program, including use or installation of the equipment; Loss or delay of rebate check in the mail; and Any taxes that may be imposed as a result of participation in the Program.

Installation Requirements Your installation of high-efficiency natural gas equipment or products is eligible for a rebate if:
It meets all equipment-specific, energy efficiency, and Program requirements outlined in the application form. It is purchased new. Resale equipment, new parts installed in existing equipment, or equipment that is leased, rebuilt, rented, received from insurance claims, received from a warranty or won as a prize do not qualify. It is replacing existing, natural gas equipment used for the same purposes (applicable only to installations completed in existing facilities; does not apply to pipe insulation, programmable thermostats or high performance windows). Equipment additions to a residential space, where equipment did not previously exist, or installation of qualifying equipment in a new facility, are eligible for Program rebates if all other Program qualifications are met, unless otherwise noted (new construction is not eligible for High Performance Window, Pipe Insulation, Programmable Thermostat and Complete System Replacement rebates). Natural gas equipment replacing electric equipment, and electric equipment replacing natural gas equipment, are not eligible. Equipment is installed by a professional contractor conforming to all applicable building, local and state codes, and manufacturer specifications (Programmable Thermostats do not require professional installation). Equipment is installed and operational prior to submittal of this application at the address listed on the application. It is installed in a single-family dwelling, or a multi-family dwelling of three units or less. It is installed in a property owned by the applicant, or the applicant has received permission from the property owner to install the equipment. It is purchased and installed during the Program offering period: June 1, 2011 - May 31, 2014 (with the exception of indirect water heaters, hot water pipe insulation, high performance windows and programmable thermostats, which must be purchased and installed June 1, 2012 or later).

Application Requirements To be considered complete and eligible for rebates, all applications must:
Be postmarked (or submitted online) no later than 90 days after the installation date, or by June 30, 2014, whichever comes first. Include Itemized Contractor Invoice(s) or Proof of Purchase Receipt(s) consisting of: Equipment/product make, model and serial number (if equipment/product has a serial number) Total installed cost (itemized by qualifying equipment) Purchase date and installation date (if purchased and installed on separate dates) Professional contractors business/company name, address and phone number (if installed by a professional contractor) Balance due of zero, paid in full stamp, or payment term Any other rebate-specific requirements, as noted on Page 3 Be signed by the Nicor Gas account holder, or include a Customer Release Form signed by the account holder. Please Note: If rebate is to be paid directly to the installing contractor (for an Instant Discount) or a landlord (who is not the account holder) application submissions must meet all requirements listed in the Instant Discount Requirements and Landlord Applicant Requirements sections, below.

Complete System Replacement Terms and Conditions

By signing on Page 1 and completing Page 2 for a Complete System Replacement rebate, the Applicant is agreeing to all terms and conditions and certifies that he/she has met all qualifications listed on this rebate application. The Program reserves the right to request a signed release form from the ComEd account holder, agreeing to all Program requirements and terms and conditions, if the applicant is not the ComEd account holder. If you are applying for a rebate for a property you own, but the electric account number is in your tenants name, include your tenants ComEd account number on Page 2. By signing and submitting this application, as a ComEd customer you are agreeing to allow contractors and vendors access to your installation data (excluding sensitive customer information). The rebates for the high-efficiency furnace and the CAC unit will be paid on separate checks.

Use separate applications if applying for multiple equipment or products installed by different contractors. Online applications must:
Be submitted online at: NicorGasRebates.com (do not mail this form). Be accompanied by a copy of Itemized Contractor Invoice/Proof of Purchase Receipt and all rebate-specific required documentation.

Instant Discount Requirements If rebate is being paid directly to the installing contractor, contractor must submit:
Copy of customer job order/invoice showing the rebate amount deducted from the total purchase price, signed by customer. Completed and contractor-signed rebate application, with account holder-signed Customer Release Form verifying product(s) installed and releasing payment to the contractor. (Account holder-signed rebate application will be accepted in place of a Customer Release Form.)

Landlord Participant Requirements If you are applying for a rebate for a property you own, but the gas account number is in your tenants name, provide the following:
Page 1: Include your tenants account number, name and information. Select Landlord under Make Check Payable. Include your name under Application Contact Information. Copy of the Itemized Contractor Invoice/Proof of Purchase Receipt, signed by the purchaser. All applicable purchase invoices and required documentation, as listed on this application. Completed rebate application, signed by the applicant and a Customer Release Form - Landlord Applicants signed by the Nicor Gas account holder. Customer Release Forms can be found on the Apply Now page at NicorGasRebates.com/home.

Instant Discount Requirements:

The Nicor Gas account holder must sign the Itemized Contractor Invoice and either the rebate application or a Customer Release Form. Customer Release Forms are available for download at NicorGasRebates.com/contractor-circle. The contractor invoice must clearly show the full rebate amount as a deduction off the customers purchase price. It is the installing contractors sole responsibility to verify customer, product and installation eligibility prior to providing an Instant Discount. Contractor assumes all liability by providing the rebate as an Instant Discount. The online application system for Instant Discounts is limited to Contractor Circle Members. Visit NicorGasRebates.com/contractor-circle for more information or to enroll in the Contractor Circle.

Page 4 of 4

HOME ENERGY EFFICIENCY REBATE PROGRAM

Additional offers to save more at home

Now there are even more ways to save money and energy with the Nicor Gas Energy Efficiency Rebate Program! Enjoy the benefits of natural gas efficiency in your home. You may experience increased comfort, lower utility bills and the peace of mind knowing you are using less energy. Equipment must be purchased and installed November 19, 2012 through May 31, 2013. LOOK FOR THE BEST VALUE BADGE The Home Energy Efficiency Rebate Program now offers new ways to save energy in your homeincluding more efficient products and value packages. Look for this badge on the rebate information page at NicorGasRebates.com/home to find offers that can bring you the best rebate, energy savings and utility bill savings!
EQUIPMENT TYPE EFFICIENCY REQUIREMENT REBATE AMOUNT

NATURAL GAS EQUIPMENT AND IMPROVEMENTS

High-Efficiency Furnace High-Efficiency Furnace 92% Annual Fuel Utilization Efficiency (AFUE) 95% AFUE $200/unit $250/unit

High-Efficiency Furnace High-Efficiency Boiler High-Efficiency Boiler Indirect Water Heater

97% AFUE; ENERGY STAR Most Efficient List 90% AFUE, ENERGY STAR qualified 95% AFUE, ENERGY STAR qualified Installed on or integrated into a qualifying high-efficiency boiler

$500/unit $350/unit $450/unit $100/unit

Storage Water Heater High-Performance Windows Hot Water Pipe Insulation Programmable Thermostats

ENERGY STAR qualified with Energy Factor 0.67 U-Value 0.20, rated by the National Fenestration Rating Council (NFRC) 6 linear feet of 0.75 inch thick insulation installed on natural gas hot water pipes Must be installed on residential natural gas space heating equipment

$300/unit $1.50/square foot installed $10/installation $20/unit

COMPLETE SYSTEM REPLACEMENT PROGRAM (for joint customers of Nicor Gas and qualified electric distributors only)
High-Efficiency Furnace and High-Efficiency Central Air Conditioner High-Efficiency Furnace and High-Efficiency Central Air Conditioner High-Efficiency Furnace and High-Efficiency Central Air Conditioner 92% AFUE AND 14.5 Seasonal Energy Efficiency Ratio (SEER) 95% AFUE AND 14.5 SEER 97% AFUE; ENERGY STAR Most Efficient List AND 14.5 SEER $600 $650 $750

VALUE PACKAGESSave even more with these bundles!

Efficient Equipment Bundle (Furnace, Central Air Conditioner, Storage Water Heater, Pipe Insulation and Programmable Thermostat) Efficient Equipment Bundle (Furnace, Central Air Conditioner, Storage Water Heater, Pipe Insulation and Programmable Thermostat) Efficient Equipment Bundle (Furnace, Central Air Conditioner, Storage Water Heater, Pipe Insulation and Programmable Thermostat) 92% AFUE; 14.5 SEER; 0.67 Energy Factor; 6' pipe insulation; Eligible Programmable Thermostat 95% AFUE; 14.5 SEER; 0.67 Energy Factor; 6' pipe insulation; Eligible Programmable Thermostat 97% AFUE/ENERGY STAR Most Efficient List; 16 SEER; 0.67 Energy Factor; 6' pipe insulation; Eligible Programmable Thermostat $1,000 $1,250 $1,500

Choose the rebate thats right for your home today. Visit NicorGasRebates.com/home or call 877.886.4239 to learn more.
For complete program rules, dates, and eligibility, visit NicorGasRebates.com/home. Offers are limited and subject to change. The Nicor Gas Energy Efficiency Program is a multi-year program funded by Nicor Gas ratepayers in compliance with state law through a small charge identified on bills as Energy Program.

112512_HEERNewOffers