2012 BROWARD COUNTY
BUSINESS
APPLIANCE REBATE APPLICATION
For a limited time, Broward County small to medium sized businesses and residents are encouraged to participate in
the ENERGY SENSE Appliance Rebate Program. Our goal is to reduce the County’s overall energy consumption while
stimulating the economy and saving rebate participants money on their utility bills. By purchasing a new qualifying
ENERGY STAR refrigerator or ENERGY STAR clothes washer to replace a less efficient unit, you can receive a rebate
for $150 or $250. Rebates will be offered on a first-come, first served basis. The program will close on March 16,
2012 or when all funds are exhausted, whichever comes first.
START HERE – PLEASE READ THIS FIRST
How to Apply
1) Review Program Eligibility on pages 3 and 4.
2) Purchase a qualifying ENERGY STAR refrigerator or clothes washer on/after December 17, 2011 from a
retailer. Check product eligibility at www.energystar.gov . Online purchases are excluded and will not qualify
for a rebate.
3)
Recycle/ dispose of the old appliance, if the appliance retailer does not offer this service. It may not be
resold, donated, or put back into service.
4) Complete a free Florida Power & Light (FPL) Business Energy Evaluation online at www.FPL.com or call 1-877748-4233 to schedule an evaluation with a FPL representative.
5) Complete the application form and gather the required documentation to include in your application packet.
Please do not staple application materials. Application packets must include:
□ Complete, Dated, and Signed Application (please do not submit pages 3 and 4)
□ Original Purchase Receipt (photocopies will not be accepted)
□ Photocopy of most recent FPL utility bill (The business name and address must match the application)
□ FPL Business Energy Evaluation page showing the business address (completed after August 1, 2011)
6) Mail the complete application packet to the address below. The application packet must be postmarked no
later than Friday, March 16, 2012 to be eligible for the rebate. The rebate program will close on March 16,
2012 or when all funds are exhausted, whichever comes first.
Please allow 8-12 weeks after the application deadline for the delivery of your
rebate check from Broward County.
SEND FORMS TO:
Natural Resources Planning and Management Division
ATTN: Energy Sense Appliance Rebate Program
115 S. Andrews Ave., Suite 329H
Fort Lauderdale, FL 33301
For questions related to the Business rebate program call 954-357-8659 or e-mail energysense@broward.org.
For more information about Broward County’s Appliance Rebate Programs or to obtain a residential rebate
application, please visit www.broward.org/gogreen and click REBATE PROGRAMS.
Funding for the Energy Sense program is made possible by an Energy Efficiency and Conservation Block Grant
through the American Recovery and Reinvestment Act.
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2012 BROWARD COUNTY
BUSINESS
APPLIANCE REBATE APPLICATION
Please provide all requested information, including support documents, to ensure timely processing of
your rebate check.
1. APPLICANT INFORMATION
Business Name
Owner/Principal First Name
Last Name
Business Mailing Address
City
Zip Code
Business Phone #
Cell Phone #
Email Address
NAICS Code OR Type of Business (describe)
2. APPLIANCE INFORMATION
Eligible Appliance
Additional Requirements
Amount
New ENERGY STAR Refrigerator*
Volume between 7.75 ft³ and 19.99 ft³
$150
Volume is 20 ft³ or larger
$250
$150
New ENERGY STAR Clothes Washer
Manufacturer/Brand
Model Number
Check ONE box
Purchase Price (without sales tax)
Serial Number (of new appliance)
Age of OLD appliance (in years)
Note: A list of eligible USEPA ENERGY STAR Qualified Products may be found at www.energystar.gov. Purchase of an ineligible product will
result in disqualification for a rebate.
*ENERGY STAR stand alone freezers and compact “mini” refrigerators are excluded from the rebate program.
3. Additional Information (Check One)
A. My old appliance was disposed/recycled by/at:
Bulk Trash Pick-up
Retailer
Landfill
Transfer Station
Other, please describe ______________________________________
B. Did the Rebate Program influence your decision to purchase an ENERGY STAR appliance?
Yes
No
C. RESPOND ONLY IF REQUESTING A CLOTHES WASHER REBATE- What type of Water Heater does your business have?
Electric
Gas
Solar
I don’t know
Other, please describe________________________
4. BUYER’S SIGNATURE
By signing this form, I certify that the information provided on this rebate application and in its supporting
documents is accurate, that I meet the eligibility requirements of the Broward County Business Appliance Rebate
Program, and that I have read, understand, and agree to comply with the program terms and conditions. I affirm that
the new appliance replaced an existing appliance which has been permanently taken out of service and been
properly disposed.
Applicant’s Required Signature
Date
Please retain a copy of the application packet for your records
Funding for the Energy Sense program is made possible by an Energy Efficiency and Conservation Block Grant
through the American Recovery and Reinvestment Act.
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2012 BROWARD COUNTY
BUSINESS APPLIANCE REBATE
TERMS AND CONDITIONS
1. Program Eligibility
 The rebate program will close on March 16, 2012
To qualify for a rebate, the applicant must meet the
or when all funds are exhausted, whichever comes
following criteria:
first.
 Must be a legitimate small to medium- sized business
 Must pay sales tax on appliance purchased, unless
physically located in Broward County with a valid
business is a non-profit and proof of non-profit
Broward County address. Qualifying appliances must
status is provided.
be purchased and installed for business use in
2. Rebate Restrictions
Broward County. Small to medium sized businesses
 Rebates are awarded on a first-come, first-served
are defined as non-governmental entities using less
basis.
than 500 kwD as displayed on Florida Power & Light
 Rebates will be awarded based on the order in
utility bill, with one of the following allowable rate
which completed applications are received
code classifications designations: General Service
(postmark date on application).
Non-Demand (GS-1), General Service Demand (GSD Limit one rebate per person and business.
1), General Service Non-Demand Time of Use (GST-1),
 Individuals who previously received a rebate as a
or General Service Demand Time of Use (GSDT-1).
result of the 2011 Broward County Appliance
Applicant must provide proof of business location to
Rebate Program are ineligible for the 2012
include a copy of the business’ most recent Florida
Appliance Rebate Program.
Power & Light utility bill with the same business name
 Rebates are limited to one appliance per rebate.
and address as on the application. Post Office Boxes
are ineligible.
 Rebates are not guaranteed and require full
compliance of the governing rules to be issued. If
 Must purchase a new ENERGY STAR residential
each of the program requirements are not
refrigerator or clothes washer based on the current
satisfied, the applicant gives up rights to the rebate
list of eligible USEPA ENERGY STAR Qualified Products
and those rebate funds will no longer be available
found at www.energystar.gov.
to the applicant. The rights to a rebate or a rebate
 Must replace an existing appliance of the same type.
application may not be transferred or sold.
 Must dispose/recycle the existing appliance according
 Waiting list applicants will only receive rebates if
to federal/state/local laws and regulations. The
funds become available from unused reserved
existing appliance must not be resold, donated or put
rebates or disqualified rebate applications.
back into service. Recycling methods for existing
 Purchase of ineligible product will result in
appliances is available at www.broward.org/gogreen
disqualification for a rebate.
and click REBATE PROGRAMS.
 Original purchase receipt submitted with the
 Must make the purchase of eligible products during
application must include: make and model of
the rebate offer period on or after December 17,
appliance; amount paid for appliance; date of
2011.
purchase; and retailer name where purchase was
 Must install the appliance at the business listed on
made. Photocopies will not be accepted in lieu of
the rebate application form, prior to submittal of the
original receipt.
rebate application. Applications must include
 Original purchase receipt must include a valid
appliance serial numbers.
model number for the applicable ENERGY STAR
 Must mail a complete rebate application packet to the
Product.
address specified on the rebate application form by
 Internet-based purchases are ineligible.
March 16, 2012 (postmarked) in one mailing.
Application packets must include all information
 Based on purchase receipt, a maximum rebate will
requested on the rebate application form, including
be awarded equal to but not greater than the
supporting documents. The purchaser must sign and
amount requested on the application form.
date the application form.
Funding for the Energy Sense program is made possible by an Energy Efficiency and Conservation Block Grant
through the American Recovery and Reinvestment Act.
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2012 BROWARD COUNTY
BUSINESS APPLIANCE REBATE
TERMS & CONDITIONS
 Rebates will not be awarded for appliances purchased
provided by a retailer, installer, contractor, hauler, or
before the rebate offer period, December 17, 2011.
recycler.
 Rebates are subject to available funding. Due to grant  This program was prepared as an account of work
requirements, all rebate monies and issues must be
sponsored by an agency of the United States
expended/resolved by May 30, 2012. Any unresolved
Government. Neither the United States Government
issues/applications after this date will be ineligible for
nor any agency thereof, nor any of their employees,
rebates.
nor any of their contractors, subcontractors or their
 The purchase of products that are used, rebuilt,
employess, makes any warranty, express or implied,
rented, leased, exchanged, won as a prize, purchased
or assumes any legal liability or responsibilty for the
at auction or online auction, or replaced by insurance
accuracy, completeness, or third party’s use or the
plan are ineligible.
results of such of any information, apparatus,
product, or process disclosed, or represents that its
3. Public Records
use would not infringe privately owned rights.
Under Florida law, information/documents submitted
Reference herein to any specific commerical product,
by applicant will become public record and may be
process, or serivce by trade name, trademark,
subject to public disclosure.
manufacturer, or otherwise, does not necessarily
4. Verification of Installation
constitute or imply its endorsement,
Application/purchase may be subject to visual
recommendation, or favoring by the United States
inspection/verification of installation by Broward
Government or any agency thereof or its contractors
County. The applicant must provide Broward County, or
or subcontractors. The views and opinions of authors
agents of, with access to the business listed on rebate
expressed herein do not necessarily state or reflect
application form based upon reasonable written
those of the United States Government or any
notification. The County may deny or seek the return of
agency thereof.
payment to an applicant that refuses to provide the
 Broward County is not responsible for: lost, late,
County with access to the business to verify appliance
incomplete, damaged, misdirected, or postage due
installation.
requests/mail; electronic transmission errors;
technical, network, telephone equipment, electronic,
5. Purchaser Compliance Responsibilities
computer, hardware or software malfunctions;
The applicant is responsible for compliance with all
limitations of any kind; inaccurate transmissions of
requirements of federal, state, county, and city
or failure to receive rebate submission on account of
governments. Tenants are responsible for obtaining the
technical problems or traffic congestion on the
property owner’s permission to install the purchased
internet or at any website; or any combination
appliance, if needed. Any fraudulent activities are a
thereof.
violation of criminal and civil laws; Broward County
reserves the right to seek damages from rebate
applicant to the fullest extent of the law.
6. Endorsement
Broward County does not endorse any particular
appliance, retailer, manufacturer, installer, contractor,
hauler, or recycler that provides products or services
related to the Broward County Appliance Rebate
Program.
7. Disclaimer of Warranty & Limitation of Liability
Broward County makes no warranties, nor shall be
liable for damages regarding/related to: (1) the
appliance offered for sale or purchased, (2) services
8. Acknowledgement
Funding for the Energy Sense program is made
possible by an Energy Efficiency and Conservation
Block Grant through the American Recovery and
Reinvestment Act.This material is based upon work
supported by the U.S. Department of Energy, Office
of Energy Efficiency and Renewable Energy grant
agreement # DE-E000800 and the Florida
Department of Agriculture and Consumer Affairs
grant agreement # 17441.
Funding for the Energy Sense program is made possible by an Energy Efficiency and Conservation Block Grant
through the American Recovery and Reinvestment Act
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