Advanced Energy Rebuild Program Application

Application/Payee Information

Applicant/Payee Name

Applicant Federal Tax ID (or Social Security) #

Type

Payee Address

City

State Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

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Project Information

Project Address

City

State Select a SateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

County

Project Contact

Contact Email

Contact Phone Number

Contact Alternate Phone Number

Permitting Agency

Permitting Date

Construction Start Date

Estimated Construction Completion Date

While every project participating in the program needs a HERS Rater for verification purposes, it is not required to have identified this person at the time of the application. If you do not have HERS rater currently on your project, please fill out TBD in the HERS Rater fields.

HERS Provider CheersCalcerts

HERS Rater Company

HERS Rater Name

HERS Rater Email

Energy Consultant (CEA) Name

Energy Consultant (CEA) Email

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Please upload the following documents:

Title 24 CF1-R documentation authored and signed by a 2016 Title 24 code CEA

Energy model file (.bld or .ribd). Please convert this file to a .zip, or your application will not go through.

Complete set of construction plans, including architectural, mechanical, and electrical pages

Letter, account statement, service application, or any documentation issued by PG&E verifying the project address is or will be receiving gas and/or electric service from Sonoma Clean Power or PG&E

A completed IRS W-9 form

Housing Type Custom HomeProduction HomeDuplexesTownhomeMultifamily

Market Rate or Affordable Housing? Market RateAffordable Housing

Is propane being provided to the project?

Is this an all-electric project?

Please check any other programs you are participating in

GENERAL INSTRUCTIONS AND REQUIREMENTS

1. Funds are limited and will be reserved on a first-come, first-served basis to projects that meet the Programs’ requirements. No payments will be made for any energy-efficient upgrades installed without prior written approval program staff. No projects will be accepted after drywall has been installed in enrolled units.
2. Complete one form per project. Incentive payments are available only to owners, builders or developers named on this Incentive Application unless the program staff allows the submission of a Payment Release Form. Please ask program staff for details.

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APPLICANT AGREEMENT
I, the undersigned, agree that:

1. I have read and understand and agree to abide to the programs’ rules, requirements and terms and conditions set forth in this Application and on the main program website.
2. The information that I have supplied on this Application is true, correct and complete.
3. This project is not receiving duplicate funding from multiple utility sponsored energy efficiency programs for the same measures and associated fuels.
4. I agree to permit the Utility to discuss all aspects of this project with my Energy Consultant and/or HERS Rater.
5. I understand that this application is valid for 36 months from date of utility acceptance.

Applicant Name

Company Name

Title

Electronic Signature

Date