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Standard HVAC/Water Heaters Application

Eligibility To be eligible, the equipment must be new and must be installed at a business or commercial/industrial building including Not-for-Profit organizations. Public buildings (local governments, public school districts, community colleges, etc.) are not eligible for the Ameren Illinois ActOnEnergy Business Programs, but are encouraged to contact the Illinois Department of Commerce and Economic Opportunity (DCEO) at www.illinoisenergy.org for incentive opportunities. To be eligible for electric incentives, applicants must be a non-residential electric customer of Ameren Illinois (electric delivery service rates DS2, DS-3, DS-4, or DS-5) and have a Rider EDR surcharge on their Ameren Illinois bill. To be eligible for gas incentives, applicants must be a non-residential gas customer of Ameren Illinois (gas delivery service rates GDS-2, GDS-3, GDS-4, or GDS-5) and have a Rider GER surcharge on their Ameren Illinois bill. The incentives offered through the Ameren Illinois ActOnEnergy Business Programs are intended to support the installation of energy efficiency projects that require the installation of new, premium-efficiency or high-performance equipment. All equipment must meet minimum performance criteria, as listed on the application form, to be eligible for incentives. Effective Dates To be eligible for the incentives shown on this application form, the project Estimated Completion Date (ECD) must be on or after June 1, 2012. The project must be completed by May 31, 2013. Pre-Approval Pre-approval is required before any commitment to project installation or purchase is made (including generating purchase orders) for Standard Program projects requesting more than $10,000 in incentives. Do not purchase your equipment until you have received your preapproval notice from the program. If your incentive request is less than $10,000, you may elect to complete and submit all required documentation after project completion. Projects have up to 120 days to complete. All required documentation must be received by the program within 30 days of project completion. Limitations and Incentive Caps You may receive up to $600,000 of incentive money for electric-saving projects and an additional $600,000 for gas-saving projects per program year (June 1st through May 31st), per facility (see the Terms and Conditions). Stockpiles of equipment are not allowed. All incentivized equipment must be installed and operational. Incentives for Standard or New Construction applications are capped at the project cost, which includes material cost and external labor cost (Internal labor is not considered in the project cost).

Instructions Step 1: Complete and sign the Standard HVAC/Water Heaters Application form, as required. Submit the Application form and all required documentation as indicated to the program via email, fax, or hard copy. You will receive an e-mail within 48 hours confirming we received your application. Step 2A >$10,000: Applications requesting more than $10,000 in incentives will undergo a technical review by program staff, during which time additional information may be requested. Upon completion of the technical review, a pre-approval notice will be issued. Step 2B >$10,000: Once you have received notice of pre-approval, purchase and install the proposed equipment. Upon completion of your project (all equipment installed and operational), carefully review the initial application and note any changes to the equipment types/quantities that may have occurred during construction.

Step 2 if <$10,000: Applications requesting $10,000 or less in incentives may request to reserve funds and receive a nontechnical review and an Estimated Incentive Letter. If your incentive request is less than $10,000, you may elect to complete and submit all required documentation after project completion. Projects have up to 120 days to complete. All required documentation must be received by the program within 30 days of project completion.

Step 3: Within 30 days of project completion, submit a complete, signed Incentive Payment Request form along with equipment invoices showing the date, place of purchase, model/part numbers, and unit costs of all equipment. See the Required Documentation section for further details. Your application will be reviewed and an incentive payment check mailed within 60 days of approval. Step 4: Upon receipt of completion documentation, ActOnEnergy staff may conduct a post installation inspection for verification purposes. Please note: Detailed, step-by-step instructions, FAQs, and other helpful information are available on the program website in the Application Guide (http://www.actonenergy.com/portals/0/business/forms/application-guide.pdf) Please contact program representatives with any questions via email at ActOnEnergyBusiness@Ameren.com or call toll free 1.866.800.0747. Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 1 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Please contact program representatives with any questions via email at ActOnEnergyBusiness@Ameren.com or call toll free 1.866.800.0747.

Customer and Project Information


Ameren Illinois Customer Information
Company Name W-9 form is required documentation Click here for a blank W-9 form

Red indicates a required field. Ameren Illinois Electric Account Number:* Ameren Illinois Natural Gas Account Number:*
*Both electric and gas account numbers are required if you are an Ameren Illinois electric and gas customer.

Tax ID (SSN/FEIN)

Mailing Address Contact Name E-mail Address Physical Installation Address (if different than above) Installation Address City Phone

City Title Ext. Fax

State

Zip

State
ILIL

Zip

Check one:

Owner

Tenant (If tenant, please complete the Landlord Consent Form) Name of Referring Contractor or Program Ally

Name(s) of the person(s) who referred you to the ActOnEnergy Business Program for this project: Name of Ameren Illinois or ActOnEnergy Employee

Contractor/Program Ally Information


Company Name Mailing Address E-mail Address Phone (if applicable) Contact Name City Ext Fax Title State IL Zip

Facility/Project Description
Facility Type (check one): Restaurant Warehouse Office high rise Office mid rise Office low rise Convenience Healthcare clinic Hospital Elementary Religious facility Retail strip mall Retail department store High school College/university Manufacturing Facility Lodging Hotel/Motel Multiple (please include an itemized description of the work that will be done at each facility type) Miscellaneous/Grocery Miscellaneous/unknown

Facility Size (total interior square feet served by the account number provided above):

Project Description (check one): Replacement of Failed Equipment Replacement of Operating Equipment(retrofit) Process Improvement Tune-Up

Newer application versions posted to the ActOnEnergy website supersede all previous versions. The revision number is listed in the footer of each page. If you received pre-approval, the version of the application that was available at the time you submitted your pre-approval application will apply. If you did not obtain pre-approval, the version of the application that corresponds with the invoice dates of your equipment purchases will apply.

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 2 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Incentive Calculation Section
Eligibility Criteria:
Existing Equipment may not have had standing maintenance contract or tune-up within the past 36 months Complete tune-up, as specified in- Tune-up Certification Incentive is limited to 50% of the tune-up cost, excluding replacement parts BPC21: Minimum 3-ton unit Unitary, rooftop, and split systems only

Air Conditioner Tune-Ups

Measure Code

Description

Capacity in Tons (A)

Incentive (B)

Calculated Incentive (AxB) (C)

Tune-up Cost (D)

50% of Tune-up (D*0.50) (E)

Requested Incentive Lesser of (C)or (E)

BPC21

Air Conditioner Tune-Up

$25/ton cooling

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 3 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Eligibility Criteria:
BPC2: Existing: Can be a new installation or replacement of an existing unitary or split air source heat pump up to 65,000 Btuh input with a new unit of equivalent size New: Unitary or split air source heat pump up to 65,000 Btuh input (replacing unit of equivalent size) with minimum 15 SEER BPC4: Existing: Can be a new installation or replacement of an existing unitary or split air source heat pump 65,000 to 134,999 Btuh input with a new unit of equivalent size New: Unitary or split air source heat pump 65,000 to 134,999 Btuh input (replacing unit of equivalent size) with minimum 12 EER

Unitary and Split Air Conditioning Systems and Air Source Heat Pumps

BPC25: Existing: Can be a new installation or replacement of an existing unitary or split air source heat pump 135,000 to 239,999 Btuh input with a new unit of equivalent size New: Unitary or split air source heat pump 135,000 to 239,999 Btuh input (replacing unit of equivalent size) with efficiency rating greater than 12 EER BPC6: Existing: Can be a new installation or replacement of an existing unitary or split air source heat pump 240,000 to 759,999 Btuh input with a new unit of equivalent size New: Unitary or split air source heat pump 240,000 to 759,999 Btuh input (replacing unit of equivalent size) with minimum 10.8 EER / 12.0 IPLV BPC8: Existing: Can be a new installation or replacement of an existing unitary or split air source heat pump 760,000 or more Btuh input with a new unit of equivalent size New: Unitary or split air source heat pump 760,000 or more Btuh input (replacing unit of equivalent size) with minimum 10.2 EER / 11.0 IPLV

Measure Code

Description

New Unit Efficiency Rating

Actual New Unit kBtuh

Number of Units Installed (A)

Incentive (B)

Incentive Requested (A x B)

BPC2

Up to 65,000 Btuh input, minimum 15 SEER

______________ SEER Rating

$50/unit installed

BPC4

65,000 to 134,999 Btuh input, minimum 12 EER

______________ EER Rating

$50/unit installed

BPC25

135,000 to 239,999 Btuh input, greater than 12.0 EER

______________ EER Rating EER IPLV

$150/unit installed

BPC6

240,000 to 759,999 Btuh input, minimum 10.8 EER / 12.0 IPLV

____________ EER/IPLV Rating EER IPLV

$300/unit installed

BPC8

760,000 or more Btuh input, minimum 10.2 EER / 11.0 IPLV

____________ EER/IPLV Rating

$500/unit installed

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 4 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Eligibility Criteria:
BPC12: Existing: Can be a new installation or replacement of any size existing air-cooled chiller New: New equipment must be air-cooled only (no water cooled) and must have efficiency rating better than 9.562 EER / 12.5 IPLV EER BPC26: Existing: Can be a new installation or replacement of any size existing air-cooled chiller New: New equipment must be air-cooled only (no water cooled) and must have efficiency rating better than 9.562 EER / 12.75 IPLV EER

Air-cooled Chillers

Measure Code

Description

Actual New Unit Size in Tons

Actual New Unit IPLV Rating

Peak efficiency of New Equipment Expressed as Full Load EER


(may be listed as EER on chiller)

HVAC System

Number of Units Installed (A)

Incentive (B)

Incentive Requested (A x B)

BPC12

Up to 150 tons

CV (Constant volume) VAV (variable air volume) Uses Air-side Economizers (free cooling)

$500/unit installed

BPC26

150 tons and larger

CV (Constant volume) VAV (variable air volume) Uses Air-side Economizers (free cooling)

$500/unit installed

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 5 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Eligibility Criteria:
BPC30: Replacing an existing unit Minimum EER rating: 10 All EER values must be rated at 95 degrees outdoor dry-bulb temperature BPC27: New installation Minimum EER rating: 11 All EER values must be rated at 95 degrees outdoor dry-bulb temperature

Measure Code

Description

PTAC/PTHP Units

New unit cooling capacity (kBtuh)

New unit heating capacity (kBtuh)


(not needed for PTHP units)

PTAC or PTHP installed


PTAC PTHP PTAC PTHP PTAC PTHP PTAC PTHP PTAC PTHP PTAC PTHP PTAC PTHP PTAC PTHP PTAC PTHP

Actual new unit EER rating

Actual new unit COP rating for PTHP units


(not required/available for PTAC units)

Number of Units installed (A)

Incentive (B)

Incentive Requested (A x B)

10-10.99 EER

$10/unit installed $15/unit installed $20/unit installed $30/unit installed $35/unit installed $5/unit installed $15/unit installed $20/unit installed $25/unit installed

11-11.99 EER

BPC30

PTAC/PTHP less than 65 kBtuh, replacement

12-12.99 EER

13-13.99 EER

14+ EER

11-11.99 EER

BPC27

PTAC/PTHP less than 65 kBtuh, new installation

12-12.99 EER

13-13.99 EER

14+ EER

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 6 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Eligibility Criteria:
New installations only Must drive a variable load Used in conjunction with pumping or air handling applications VFDs may be used for the following (other uses may apply under the Standard VFD program or the Custom program): hot water pump, chilled water pump, constant volume fan, inlet guide vanes fan, forward curved fan, forward curved inlet guide vanes fan) May not control motor over 500 hp Must be installed on an AC motor (DC motors are not eligible) Redundant/backup units do not qualify Incentive may not exceed 75% of the project cost Installations of new equipment with VFDs which are required by IECC 2012 are not eligible for incentives.

VFD on HVAC Motors

Measure Code

Description

Capacity (total hp) (A)

Incentive (B)

Motor Efficiency

Load Factor

Use
Hot water pump Chilled water pump

Facility Type

Calculated Incentive (AxB) (C)

VFD Project Cost (D)

75% of Project Cost (D)x0.75 (E)

Requested Incentive Lesser of (C) & (E)

______%* ________%
*Load factor=ratio of actual load to motors maximum load rating. Enter 80% if unknown.

Constant volume fan Inlet guide vanes fan Forward curved fan Forward curved inlet guide vanes fan Other VFD uses may apply under the Custom program

BPC20

Variable Frequency Drive on HVAC Motors

College/university Grocery Heavy industry Hotel/motel Light industry Medical Office Restaurant Retail/service School - (K 12) Warehouse Other

$90/hp controlled
______%*
*Load factor=ratio of actual load to motors maximum load rating. Enter 80% if unknown.

Hot water pump Chilled water pump Constant volume fan Inlet guide vanes fan Forward curved fan Forward curved inlet guide vanes fan Other VFD uses may apply under the Custom program

_______%*

College/university Grocery Heavy industry Hotel/motel Light industry Medical Office Restaurant Retail/service School - (K 12) Warehouse Other

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 7 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application

Eligibility Criteria:
Cannot have had standing maintenance contract or tune-up within the past 36 months Complete tune-up, as specified in Tune-up Certification Up to 100% of the tune-up cost, excluding replacement parts

Size Range Measure Code Description Type


Space heat Process boiler Space heat Process boiler Space heat Process boiler Space heat Process boiler Space heat Process boiler BPH1 Gas Boiler Tune-up Space heat Process boiler Space heat Process boiler Space heat Process boiler Space heat Process boiler

(in kBtuh input)


Up to 299 kBtuh 300-499 500-999 1,000-1,699 1,700-1,999 2,000-2,999 3,000-4,499 4,500-6,999 7,000-10,000 10,001+

Actual Unit Size kBtuh

Size Range (qty of units) (A)

Incentive (B)
$100 $150 $250 $450 $600 $800 $1,000 $1,600 $2,400 Custom

Calculated Incentive (AxB) (C)

Tune-up Cost (D)

Requested Incentive
Lesser of (C) and (D)

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Gas Boiler Tune-Up

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Standard HVAC/Water Heaters Application


Eligibility Criteria:
New equipment must be listed on the AHRI website: http://www.ahridirectory.org/ahridirectory/pages/home.aspx
Boilers: New natural gas fueled, hot water or steam boiler replacing existing hot water or steam natural gas fueled boiler. Boiler must be used for at least 80% space heating (not process). New equipment must have the following performance ratings: BPH3: Hot water boiler 85% minimum efficiency; steam boiler 83% minimum efficiency (AFUE or thermal efficiency (TE)) BPH4: Hot water boiler 93% minimum efficiency; steam boiler 91% minimum efficiency (AFUE or thermal efficiency (TE)) Furnaces: New natural gas fueled furnace; can be a new installation or replacement of an existing natural gas fueled furnace. New equipment must meet the following requirements to be eligible: BPH6 Minimum 92% AFUE, BPH7 Minimum 94% AFUE

Gas Boiler and Furnace Replacement

Measure Code

Description

Type

Mfg and Model of New Equipment

Size Range (kBtuh input) Up to 299

New Unit Size (in kBtuh input)

Actual AFUE or TE of new unit _____% _____% _____% _____% _____%

Quantity (A)

Incentive (B) $90 $230 $430 $800 $1,000 Custom $300 $800 $1,500 $2,650 $3,600

Incentive Requested (A x B)

BPH3

Gas Boiler Replacement (Hot water 85% minimum efficiency; steam 83% minimum efficiency)
(To apply for incentives for units over 2,000 kBtuh input, use the Custom application)

Existing System: steam hot water boiler New System : steam hot water boiler

300-499 500-999 1,000-1,699 1,700-1,999 2,000+ Up to 299

BPH4

Gas Boiler Replacement (Hot water 93% minimum efficiency; steam 91% minimum efficiency)
(To apply for incentives for units over 2,000 kBtuh input, use the Custom application)

_____% _____% _____% _____% _____%

Existing System: steam hot water boiler New System: steam hot water boiler

300-499 500-999 1,000-1,699 1,700-1,999

2,000+

Custom

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 9 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Gas Boiler and Furnace Replacement (continued)
Measure Code Description Type
Is the space airconditioned Yes No Is the space airconditioned Yes No Is the space airconditioned Yes No Is the space airconditioned Yes No

Mfg and Model of New Equipment

Size Range (kBtuh input) 40-140 141-225

New Unit Size (in kBtuh input)

Actual AFUE or TE of new unit _____%

Quantity (A)

Incentive (B) $300 $600

Incentive Requested (A x B)

BPH6

Gas Furnace Replacement (92% AFUE min)

_____ % 40-140 _____ % 141-225 _____ % $800 $400

BPH7

Gas Furnace Replacement (94% AFUE min)

Eligibility Criteria:
BPWH3: May be new installation or replacement of gas commercial-grade tanked water heater having 50 or more gallon storage capacity with a new gas water heater of the same capacity Existing unit must have an energy factor less than or equal to 0.60, or water heater is five or more years old Multiple new units may be installed to meet the demands supplied by the existing tanked unit Must be listed on the AHRI web site (tankless models can be found in the residential section of the web site)* OR be ENERGY STAR certified Instantaneous water heater with 5 or more GPM output at 70 F temperature rise Each new unit must meet minimum of 50 kBtuh input New units between 50 and 200 kBtuh input must have energy factor greater than 0.62 New units larger than 200 kBtuh input must have thermal efficiency rating better than 80% BPWH4: Replace gas commercial-grade tanked water heater having 50 or more gallon storage capacity with a new gas water heater of the same capacity Existing unit must have an energy factor less than or equal to 0.60, or water heater is five or more years old Existing unit must have input greater than or equal to 75 MBTUH The new unit must have thermal efficiency greater than or equal to 90% and equivalent storage capacity to unit being replaced Must be listed on the AHRI web site BPWH5: May be new installation or replacement of gas commercial-grade tanked water heater having 50 or more gallon storage capacity with a new gas water heater of the same capacity Existing unit must have an energy factor less than or equal to 0.60, or water heater is five or more years old Existing unit must have input greater than or equal to 75 MBTUH New equipment must be gas powered with equivalent storage capacity to unit being replaced, thermal efficiency must be greater than or equal to 88%, and listed on the AHRI web site o Less than 80 gallon capacity max 989 Btuh losses OR o 80-99 gallon capacity max 1,107 Btuh losses OR o 100 or more gallon capacity max 1,084 Btuh losses o

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Gas Water Heaters

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 10 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Measure Code Description Capacity of existing water heater Existing Quantity of Units Capacity of new water heater Quantity of Units (A) kBtuh Input Efficiency rating of new Unit(s) Unit Incentive (B)
Incentive Requested (A x B)

BPWH3

High Efficiency Tankless Water Heater (Gas)

________ gal

N/A

____________ Existing Unit(s)

____________ Energy Factor* ___________ Thermal Efficiency*

$300/heater

BPWH4

High Efficiency Condensing Tanked Water Heater (Gas)

50-79 gal

50-79 gal ____________ Existing Unit(s) ____________ Energy Factor* $300/heater ___________ Thermal Efficiency*

80-99 gal

80-99 gal

100+ gal

100+ gal

BPWH5

High Efficiency Tanked Water Heater (Gas)

$150/heater

*If both ratings are not available, please provide at least one. Call 1.866.800.0747 if you need assistance.

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 11 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Eligibility Criteria: Electric Water Heaters
May be new installation or replacement of existing electric commercial-grade water heater having 50 or more gallon storage capacity and input wattage between 12 and 54 kW with a new electric water heater of the same capacity Existing unit must have an energy factor less than or equal to 0.90, or water heater is five or more years old Standby loss is calculated as a percentage of annual energy usage Must be listed on AHRI website: http://www.ahridirectory.org/ahridirectory/pages/home.aspx, note that tankless models may be in the residential section BPHW1: New unit must have an energy factor >=0.95 and a minimum thermal efficiency of 0.98, less than 3% standby loss BPHW2: New unit must have an energy factor of >= 0.98 with greater than 5GPM output at a 70 F temperature rise Multiple new units may be installed to meet the demands supplied by the existing tanked unit

Electric Water Heaters

Measure Code

Description

Capacity of new water heater

Actual gpm Input

Quantity of Units Installed (A)

Unit Incentive (B)

Incentive Requested (A x B)

50-79 gal High Efficiency Tanked Water Heater (Electric)

BPWH1

80-99 gal

$150/heater

100+ gal

5-9.99 gpm High Efficiency Tankless Water Heater (Electric) 10-14.99 gpm

BPWH2

$300/heater

15+ gpm

TOTAL HVAC INCENTIVE

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

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Standard HVAC/Water Heaters Application

Tune-Up Project Completion Certifications


Business owner (Ameren Illinois customer) must sign the statement below: Within the past 36 months, I have not had a tune-up or maintenance/service agreement for the HVAC equipment at this site. Print Name _______________________________________________Title _____________________________________________

Ameren Illinois customer signature _________________________________ Date (mm/dd/yy) _____________________________ (This portion of the form must be printed and signed, in-person, by the customer. Electronic signatures will not be accepted.)

Contractor/technician certification required upon project completion and due with Incentive Payment Request. By signing this certificate, I attest that equipment listed below has been tuned in a professional manner and tuned to optimize efficiency to the fullest extent, including the requirements listed below. Further, I have confirmed that the customer does not currently have, nor within the past 36 months has had, a tune-up or maintenance/service agreement with any contractor or firm for their HVAC equipment. Print Name ______________________________________________ Title _____________________________________________

Contractor/Technician Signature ___________________________________ Date (mm/dd/yy) _____________________________ (This portion of the form must be printed and signed, in-person, by the individual who performed the tune-up services. Electronic signatures will not be accepted.)

HVAC Equipment - please complete a row for each unit serviced: Indicate AC or Boiler Capacity For AC Units tons For Boilers - kBtuh

Manufacturer

Model

NOTE: Tune-up incentives have the following limitations. Maximum of 50% of the tune-up costs for cooling measures, and 100% of the tune-up costs for heating measures Please do not include any replacement part costs in the tune-up cost The cost of added refrigerant (Freon) may be included.
Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 13 AOE HVAC & Water Heaters App PY5_Rev6

Standard HVAC/Water Heaters Application


Required Tune-up Work
In order to receive incentives under this program, applications must be accompanied by project documentation as specified below. The specified supplemental information must be included with the Incentive Payment Request form (Final Paperwork Submission).
Gas Boiler Tune-up (BPH1) General Requirements: Include a copy of the dated contractor invoices that detail the work performed to identify tune-up items, test results including preand post-tune-up combustion efficiency, pre- and post-tune-up CO and O2 test results, as well as additional labor and parts to improve/repair furnace performance. The cost of tune-up should be detailed on the invoice, as well as the date of the tune-up. Gas-Boiler Tune-ups (BPH1) shall include (as applicable): Clean fireside surfaces. Inspect all refractory. Patch and wash coat as required. Inspect gaskets on front and rear doors, and replace as necessary. Seal and close front and rear doors properly. Clean low and auxiliary low water cut-off controls, then re-install using new gaskets. Clean plugs in control piping. Remove all hand hole and man hole plates. Flush boiler with water to remove loose scale and sediment. Replace all hand hole and man hole plates with new gaskets. Open feedwater tank manway, inspect and clean as required. Replace manway plate with new gasket. Clean burner and burner pilot. Check pilot electrode and adjust or replace. Clean air damper and blower assembly. Clean motor starter contacts and check operation. Make necessary adjustments to burner for proper combustion. Perform all flame safeguard and safety trip checks. Check all hand hole plates and man hole plates for leaks at normal operating temperatures and pressures. Troubleshoot any boiler system problems as requested by on-site personnel. Measure combustion efficiency using an electronic flue gas analyzer Adjust airflow and reduce excessive stack temperatures Adjust burner and gas input, manual or motorized draft control Check for proper venting Complete visual inspection of system piping and insulation Check safety controls Check adequacy of combustion air intake Air Conditioner Tune-up (BPC21) Include a copy of the dated contractor invoices that detail the work performed to identify tune-up items, test results including refrigerant pressures, temperature drop across the indoor coil, fan and compressor measurements, as well as additional labor and parts to improve/repair air conditioner performance. The cost of tune-up should be detailed on the invoice, as well as the date of the tune-up. Air Conditioner Tune-ups (BPC21) shall include (as applicable): Check refrigerant charge Identify and repair leaks if refrigerant is low Measure and record temperature drop at indoor coil Clean condensate drain line Clean outdoor coil and straighten fins Repair damaged insulation suction line Change air filter Measure and record blower amp draw Measure and record condenser fan motor amp draw Measure and record refrigerant pressures Clean and straighten indoor and outdoor fan blades Clean indoor coil with spray-on cleaner and straighten Measure and record compressor integrity (MOhm)

Checking here indicates you have provided the Ameren Illinois customer a copy of receipts indicating the required work (listed above) was performed during this tune-up. (This application is incomplete until this box is checked.) This portion of the form must be printed and signed, in-person. Electronic signatures will not be accepted. Service Company Name: _______________________________________________________________________________________ Technician Name: ________________________________________ Title _______________________________________________ Technician signature: ______________________________________ Date _______________________________________________ Technician phone: _____________________________ Technician Email: _______________________________________________

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

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Standard HVAC/Water Heaters Application


Terms and Conditions
1. DEFINITIONS: In addition to terms defined elsewhere herein, when any one of the following terms is used in these Terms and Conditions, wherein the first letter is written with a capital letter, then that term shall have the following definition. Words importing persons include corporation, and words importing only the singular include the plural and vice versa when the context requires. a) Ameren Illinois shall mean Ameren Illinois Company d/b/a Ameren Illinois. b) Application shall mean the Customer completed document used to apply for cash incentives, program Terms and Conditions, and any other appropriate application-specific documentation. c) Application Guide shall mean the downloadable file (Excel or PDF format) that includes: directions for completing the Application, Customer eligibility criteria, and any other appropriate documentation. d) Competitive Large Incentive Project shall mean incentives applied for by submitting the Competitive Large Incentive Project Application. Those applications will go through a competitive bidding process to determine which projects will be awarded incentives. e) Customer shall mean an Eligible Customer who has submitted an Application for incentive money using their Ameren Illinois account number. The Customer shall become a party to the agreement upon acceptance of Customers Application by Ameren Illinois. r) Custom Programs shall mean those projects associated with incentives that are not Standard Programs. See 1.m) below for a list of Standard Programs. g) EEM shall mean energy efficiency measures. h) Eligible Customers shall mean non-residential electric and/or gas Customers of Ameren Illinois. Each program has different eligibility requirements for Delivery Service rates (DS# for electric, GDS# for gas) to be eligible for that program. Refer to the specific program applications to determine if your business is eligible for that program. The Ameren Illinois incentive payments are awarded only to Eligible Customers for equipment that is owned by them and installed in the Ameren Illinois service area at the location that corresponds with the Ameren Illinois account number listed in the Application. All Eligible Customers are ultimately responsible for compliance with these Terms and Conditions. i) Facility shall mean a single premise that, in general, consists of a contiguous tract of land separated by nothing more than a street, alley, or railroad right-of-way, where all buildings and/or energyconsuming devices are owned by a single Customer. j) New Construction shall include construction of new buildings, change-of-use of existing buildings or land, and additions to existing buildings. k) Pre-approval shall mean written notification to Customer of a maximum pre-approved incentive amount through a Pre-approval Letter, which Ameren Illinois issues after review of the Customers Application. l) Qualifying Energy Efficiency Measures (EEMs) shall mean either (i) standard gas or electric EEMs (i.e., measures found on any of the Standard Programs applications: Lighting, VFD, HVAC, Specialty Equipment, Steam Trap, and Leak Survey and Repair); or (ii) measures eligible under the Custom Program approved by Ameren Illinois; (iii) measures found in the Retro-commissioning Program as identified in official program materials found on the ActOnEnergy website; or (iv) measures eligible under the New Construction Program approved by Ameren Illinois. Technologies that purport to save energy through reduction of voltage, demand, or power conditioning are not Qualifying EEMs. EEMs that displace electrical energy use or natural gas to another fuel (i.e., fuel switching proposals) are not Qualifying EEMs. Other than geothermal projects, renewable energy projects (solar, wind power, etc.) are also not eligible for incentives under this program. Unless explicitly pre-approved, EEMs must be new and covered by warranties. The HVAC and refrigeration tune-up program eligibility requirements are specified in their respective applications. Natural Gas (gas) incentives do not include propane or butane measures. m) Standard Programs shall mean those projects associated with Standard gas or electric EEMs. Standard Programs include the following: Lighting, VFD, HVAC, Specialty Equipment, Steam Trap and/or Leak Survey and Repair. See the ActOnEnergy website for applications for these programs (ActOnEnergy.com). 2. OWNERSHIP OF CAPACITY AND/OR ENVIRONMENTAL CREDITS: a) EEMs purchased and installed in part through incentives provided by this program are the property of the Customer, subject to any limitations contained within these Terms and Conditions. b) Notwithstanding the above, unless otherwise requested in writing by the Customer prior to installation of the EEMs, Ameren Illinois holds sole rights to any system capacity credits and environmental credits that may be associated with EEMs for which incentives from Ameren Illinois were received, and Ameren Illinois can dispose of these credits in any manner authorized by law or regulation. c) In no event shall activity associated with any energy or environmental credits noted in Section 2(b) result in interference with the Customers sole discretion to operate EEMs a s approved in his/her incentive award. 3. PRE-APPROVAL For all Applications, Ameren Illinois is not obligated to award any incentive payment unless Pre-approval is granted. Further, Ameren Illinois will not pay incentives for any EEMs ordered or any purchase order generated prior to the date of the Pre-approval Letter, UNLESS, the requested incentive is less than $10,000 on any Standard Program Application. Pre-approval reserves incentive funds for a period of 120 days from the date of the Pre-approval Letter. After 120 days Ameren Illinois may revoke the Pre-approval Letter and associated incentive funds, if in sole judgment of Ameren Illinois, satisfactory project progress has not been made. Ameren Illinois may at its sole discretion extend this 120 day deadline for Custom and New Construction projects, but only if ActOnEnergy staff are notified well in advance that additional time may be needed. 4. POST-INSTALLATION VERIFICATION: Ameren Illinois is not obligated to make any incentive payment until it has performed a satisfactory post-installation verification. This provision may be waived at the sole discretion of Ameren Illinois. 5. INCENTIVE PAYMENT AMOUNTS: a) Incentive caps (per program year (June 1 through May 31), for a facility) are defined as follows: i) Standard and Custom applications (including the Feasibility Study and Leak Survey and Repair), combined: Electric and Gas incentives are each capped at $600,000 with first $200,000 paid out at 100% and the remaining, up to $600,000, paid out at 50%. ii) Incentives awarded under the Competitive Large Incentive Project (CLIP), are capped at $500,000 for electric incentives, and $200,000 for gas incentives although, these numbers could be increased by up to 15% if you qualify for the early completion bonus. See the application for further criteria. These incentives do not count toward any of the other program incentive caps. iii) Incentives awarded under the Staffing Grant can be up to $80,000, but are capped at 40% of the value of the expected annual energy savings from the implemented projects. See the Staffing Grant Application for further criteria. These incentives do not count toward any of the other program incentive caps. iv) New Construction Lighting incentives are capped at $100,000. These incentives do not count toward any of the other program incentive caps. v) Retro Commissioning incentives are capped at $600,000 per facility, per program year. These incentives do not count toward any of the other program incentive caps. b) Ameren Illinois reserves the right to adjust and/or negotiate the incentive amount, based upon its independent assessment of appropriate savings or cost estimates. c) Once an incentive Application is approved, Ameren Illinois will pay no more than the approved incentive amount. d) ActOnEnergy reserves the right to cap incentives at $10,000 for Standard projects that did not obtain pre-approval. e) Incentives for Standard or New Construction applications will be capped at the project cost, which includes material cost and external labor cost (Internal labor is not considered in the project cost). Steam Trap Surveys are eligible for incentives when internal labor is used per the guidelines of the Steam Trap application. 6. MONITORING AND EVALUATION FOLLOW-UP VISITS: Customer grants Ameren Illinois and any of its agents, the right to make follow-up visits, inspections or surveys of the Customers facility during the 36 months following the completion date of the project at a time convenient to the Customer. 7. CHANGES IN/CANCELLATION OF THE PROGRAM: a) Ameren Illinois may change the program requirements, incentives, or these Terms & Conditions at any time without notice, including suspending acceptance of Applications, denial of Applications already received, or terminating the program. b) In the event of program change, Applications, which have been granted Pre-approval will be processed to completion under the Terms & Conditions in effect at the time of Pre-approval by Ameren Illinois. c) Cash incentives under the Ameren Illinois programs are offered on a first-come, first-served basis and are subject to project and Customer eligibility, and the availability of funds. 8. LIMITATION OF LIABILITY AND INDEMNIFICATION: a) AMEREN ILLINOIS' TOTAL LIABILITY TO CUSTOMER UNDER THESE TERMS AND CONDITIONS, OR ANY OTHER REQUIREMENT OF CUSTOMERS APPLICATION OR CONDITION OF INCENTIVE AWARD SHALL BE LIMITED TO PAYING THE INCENTIVE PAYMENTS SPECIFIED IN THE APPLICATION OR PRE-APPROVAL LETTERS. AMEREN ILLINOIS, ITS PARENT, AFFILIATES AND SUBSIDIARIES, AND THEIR DIRECTORS, OFFICERS, EMPLOYEES, OR AGENTS SHALL NOT BE LIABLE TO THE CUSTOMER OR FOR ANY DAMAGES IN TORT (INCLUDING NEGLIGENCE) CAUSED BY ANY ACTIVITIES ASSOCIATED WITH THIS APPLICATION; LOSS OF PROFITS OR REVENUE; LOSS OF USE OF CUSTOMER'S PROPERTY, EQUIPMENT OR POWER SYSTEM; INCREASED COSTS OF ANY KIND, INCLUDING BUT NOT LIMITED TO CAPITAL COST, FUEL COST AND COST OF PURCHASED OR REPLACEMENT POWER; OR ANY SPECIAL, INDIRECT, CONSEQUENTIAL OR INCIDENTAL DAMAGES WHATSOEVER. BY PARTICIPATING IN THE AMEREN ILLINOIS PROGRAM, CUSTOMER AGREES TO WAIVE ANY CLAIMS, EXCEPT AS PROVIDE IN THIS ARTICLE 8.a) ABOVE, AND FULLY RELEASES AMEREN ILLINOIS FROM ANY OTHER DAMAGES, OF ANY KIND. b) The Customer shall defend, protect, indemnify, and hold harmless Ameren Illinois, its parent, affiliate and subsidiaries, and their representative directors, officers, employees, and agents from and against all liabilities, losses, claims, damages, judgments, penalties, costs and expenses (including, without limitation, attorneys fee s and expenses) with respect to all demands, claims, suits, causes of action, and/or judgments for injuries, including death, to any person, of third parties, and for property damage incurred by or assessed against A meren Illinois arising out of or relating to Customers Application. 9. NO WARRANTIES: Ameren Illinois does not guarantee the energy savings and its parent, affiliates, employees, and agents do not make any representations or warranties of any kind regarding the results to be achieved by the EEMs or the adequacy or safety of such measures. Ameren Illinois and its parent, affiliates, employees, and agents do not endorse, guarantee, or warrant any particular manufacturer, contractor or product, and it provides no warranties, expressed or implied, including any implied warranty of merchantability or implied warranty of fitness for any product or services. Ameren Illinois has no obligations regarding and does not endorse or guarantee any claims, promises, work, or equipment made performed or furnished by any contractors or equipment vendors that sell or install EEMs. 10. CUSTOMER SHALL PAY ALL TAXES: Incentive payments received by the Customer under this Agreement may be taxable by the federal, state, and local government. The Customer is responsible for declaring and paying all such taxes. a) Except as expressly provided herein, if either Ameren Illinois or the Customer desires to modify these Terms and Conditions, the modification must be in writing and signed by an authorized representative of the party against which enforcement of the modification is sought. 11. CHOICE OF LAW AND DISPUTES. a) THESE TERMS AND CONDITIONS, OR ANY OTHER REQUIREMENT OF THE APPLICATION GUIDE OR CONDITION OF INCENTIVE AWARD WILL BE GOVERNED IN ALL RESPECTS BY THE LAWS, STATUTES, AND REGULATIONS OF THE STATE OF ILLINOIS. AMEREN ILLINOIS AND CUSTOMER HEREBY IRREVOCABLY AND UNCONDITIONALLY WAIVE ANY RIGHT EITHER SUCH PARTY MAY HAVE TO A TRIAL BY JURY OR TO INITIATE OR BECOME A PARTY TO ANY CLASS ACTION CLAIMS IN RESPECT OF ANY ACTION, SUIT OR PROCEEDING DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS PROJECT. b) Customer agrees that any dispute arising out of or related the workmanship or performance of an EEM or the adequacy or safety or such measure shall be resolved solely between the Customer and either the EEM contractor or equipment provider. c) The parties agree that, prior to instituting any litigation, the party initiating a dispute shall provide the other party with a written summary of the facts and claims constituting the dispute. Within thirty (30) day of receipt of this written summary, the representatives of the parties shall meet and attempt to resolve the dispute by good faith negotiations. If these negotiations are unsuccessful, than the party initiating the dispute may institute litigation.

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

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Standard HVAC/Water Heaters Application


Required Documentation Checklists
All Applications
Before submitting your application, please be sure to include all required information and documents as listed below. Complete all fields in the Customer and Project Information Section (p. 2) Ensure that all qualifying equipment is entered in the Incentive Calculation Section (pp. 3-12) For Equipment incentives: Attach manufacturers cut sheets for all energy saving equipment for which you are requesting incentives. Please circle or highlight the information showing the equipment meets program technical requirements. For Tune-Up Incentives: Ensure that information and signatures required on pages 13 and 14 are complete and that the tune-up requirements have been satisfied as listed on page 14. Ensure the application is signed by the Ameren Illinois customer and the individual signing the form has checked the box indicating compliance with the Terms and Conditions. Signed W-9 form with Tax Identification Number associated with the incentive payee. Incentives WILL NOT be paid until a completed and signed W-9 has been received.

Applications Under $10,000


Standard applications requesting less than $10,000 in incentives do not require pre-approval and should submit a signed Incentive Request Form along with the required documentation above to receive payment.

Supplemental Documentation
There are several supplemental forms required for specific situations, as described below. All supplemental documentation can be found on the ActOnEnergy Business Programs website at www.ActOnEnergy.com/Forms. Landlord Consent Form (http://www.actonenergy.com/portals/0/business/forms/landlord-consent-form.pdf) is required if the Ameren Illinois customer is a tenant. Payment Release Authorization (http://www.actonenergy.com/portals/0/business/forms/payment-releaseauthorization.pdf) is required if the incentive is to be paid to a party other than the Ameren Illinois customer. Large Incentive Request Form (http://www.actonenergy.com/portals/0/business/forms/large-incentive-requestform.pdf) is required if the total requested incentive is over $25,000.

Customer Acknowledgment and Signature


I certify that all information provided is correct to the best of my knowledge, and I give the Companys permission to share my records with the Illinois Commerce Commission, or its contractors, who plan to evaluate my energy usage. Additionally, I will allow reasonable access to my property to verify the installation and performance of the Energy Efficiency Measures that are eligible for incentives under the Programs.
By checking this box and signing below, I certify that I have read, understood and agree to the Terms and Conditions (p. 15) listed above and that I am authorized to sign on behalf of the Ameren Illinois customer. Applications will not be accepted as complete unless this box is checked Project Estimated Completion Date: (mm/dd/yy) ___________________________________________________ Estimated Lead Time for Major Equipment (weeks) _________________________________________________ Total Incentive _______________________________________________________________________________ Print Name:____________________________________________ Title: _________________________________ Signature:_____________________________________________ Date: (mm/dd/yy) ______________________
Electronic signatures allowed and accepted by the Business Programs. Typing your name above constitutes a valid electronic signature.

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

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Standard HVAC/Water Heaters Application Incentive Payment Request Form


This form and required documentation should be submitted upon project completion. Project completion is defined by the Ameren Illinois ActOnEnergy Business Programs as all equipment installed and operable. The documentation required for submission with a signed Incentive Payment Request Form varies based on project size and the project scenario as described below. Required Documentation Checklists ALL PROJECTS Completed this form? (Signed by the Ameren Illinois customer and checked the box indicating compliance with the Terms and Conditions.) Changes since pre-approval? (If applicable, submit a written summary of the specific changes and the rationale for the changes.) Invoices submitted? (Must show the date, place of purchase, model/part numbers, quantities and unit costs of all equipment.) W-9 submitted? FOR PROJECTS THAT DID NOT RECEIVE PRE-APPROVAL All items required for ALL PROJECTS above, AND THE FOLLOWING: Customer and Project Information Section completed? Incentive Calculation Section completed? For Equipment incentives: Cut sheets with technical requirements highlighted? For Tune-Up Incentives: Additional information and signatures completed? Signed by the Ameren Illinois customer?

Customer Acknowledgment and Signature


I certify that all information provided is correct to the best of my knowledge, and I give the Compan ys permission to share my records with the Illinois Commerce Commission, or its contractors, who plan to evaluate my energy usage. Additionally, I will allow reasonable access to my property to verify the installation and performance of the Energy Efficiency Measures that are eligible for incentives under the Programs. By checking this box and signing below, I certify that I have read, understood and agree to the Terms and Conditions (p. 15) listed in the Application and that I am authorized to sign on behalf of the Ameren Illinois customer. Further, I confirm that the upgrades have been completed at the facility location as specified in the Customer and Project Information Section of the Application. Applications will not be accepted as complete unless this box is checked.
Company Name (Ameren Illinois Customer):_________________________________________________________________ Project Number (Pre-Approved Projects Only):_______________________________________________________________ Project Completion Date: (mm/dd/yy) _____________________________________________________________________ Print Name:______________________________________________________ Title:__________________________________ Signature:_______________________________________________________ Date: (mm/dd/yy) ______________________ Electronic signatures allowed and accepted by the Business Programs. Typing your name above constitutes a valid electronic signature.

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

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Standard HVAC/Water Heaters Application


Submit
Reset Form

INSTRUCTIONS:
After clicking Submit above, if a new email message appears with this completed form attached, attach your supporting documentation (cut sheets, W-9 form, signature page, etc) to the email and click send. You can then save a copy of the completed form to your hard drive if you wish. If a new email message does not appear, youll need to save this completed form to your desktop. Then, create a new email mes sage addressed to ActOnEnergyProjects@Ameren.com, attach the file you just saved as well as your supporting documentation (cut sheets, W-9 form, signature page, etc) to the email and click send. Individual attachments may not exceed 3 MB in size. The sum of all attachments may not exceed 10 MB, PDF documents can generally be reduced sufficiently by selecting Reduce File Size under the Document menu in Adobe Acrobat. Applications submitted electronically, using the submit button above, may be reviewed sooner.

Ameren Illinois, ActOnEnergy Business Program 300 Liberty Street, 5th Floor, Peoria, IL 61602 Toll Free: 1.866.800.0747 Fax: 1.309.677.7950 ActOnEnergy.com/Business

Submit applications to: ActOnEnergyProjects@Ameren.com General Inbox: ActOnEnergyBusiness@Ameren.com Page 18 AOE HVAC & Water Heaters App PY5_Rev6