TO APPLY, FOLLOW THESE STEPS:1. Insulation and/or windows must be purchased and installed between January 1, 2018 and December 31, 2018. 2. Your primary heating source must be electric. Read the Terms and Conditions on the back of this form to ensure you qualify.3. Complete this form and send along within 90 days of purchase: Insulation: Purchase Receipt/Invoice Copy of insulation certificate Windows: Purchase Receipt/Invoice Window Specification Sheet (which includes U-Factor and sq. ft.)4. Homeowner and installer must sign and date the rebate form and email all attachments to SCL_SFWX@seattle.gov or mail to: Seattle City Light ― Wx Rebate, 700 5th Ave, Suite 3200, PO Box 34023, Seattle, WA 98124

INSTALLATION INFORMATION

Attic Insulation – Rebate of 50% of cost up to $500 maximum rebate

Existing R-Value: R0-R7 Post R-Value: R-38 or R-49 Sq. Ft.:

Existing R-Value: R8-R11 Post R-Value: R-38 or R-49 Sq. Ft.:-OR-

Date Installed: Cost (includes insulation material, labor and tax):

Wall Insulation – Rebate of 50% of cost up to $500 maximum rebate

Existing R-Value: R-0 (to qualify, no existing wall insulation must be present)

Post R-Value: R-11 or Greater Sq. Ft.:

Date Installed: Cost (includes insulation material, labor and tax):

Windows/Patio Doors – Rebate of $50 per window or patio door

Existing Windows/Patio Doors: Single Pane Double Pane with Metal Frame

Quantity of New Windows/Patio Doors:

Date Installed: Cost (includes window/door material, labor and tax):

Floor Insulation – Rebate of 50% of cost up to $200 maximum rebate

Existing R-Value: R0 Post R-Value: R-25 or R-30 Sq. Ft.:

Date Installed: Cost (includes insulation materials, labor and tax):

All information below is REQUIRED for processing. Please print in block letters.

CUSTOMER INFORMATION

Name Daytime Phone ( )

Installation Address

City State Zip

Mailing Address (if different)

City State Zip

Email Address (optional) Year Built Heated Area (sq ft)

Heating System Electric Furnace Zonal Electric Resistance Ductless Heat Pump

Fireplace/Wood or Pellet Stove Gas Furnace Oil Furnace Other (specify):

CONTRACTOR SIGNATURE

Installer Company Name Phone

Contractor Signature Date

By signing below, installer certifies that this form and any accompanying documentation are complete and accurate; that all measures associated with this project were completed as of the signature below; that all products were installed according to the manufacturer’s specifications required by Seattle City Light; and that the products are functional prior to submission of this rebate form.

weatherizationrebate

Please refer to the following terms and conditions prior to signing acceptance:

You must be a customer of Seattle City Light and the installation address is in the Seattle City Light service area. Existing single family residences (1-4 units) qualify. Primary space heating must be electric.

The installed insulation must meet the following qualifications:• A rebate of 50% of cost up to $500 maximum is available for insulation. Costs include materials, labor and tax. • Insulation must be purchased and installed between Jan. 1, 2018 through Dec. 31, 2018.• Installed in accordance with manufacturer’s specifications by a licensed contractor.• Contractor must certify existing and new levels of insulation and invoice must be itemized with the following: Sq ft., R-Value, and cost. A copy of insulation certificate must be submitted with this application.• Attic Insulation: Existing insulation must have R-11 or less and new insulation must be R-38 or R-49.• Wall Insulation: No existing wall insulation must be present and new insulation must be R-11 or greater.• Floor Insulation: Must have existing floor insulation of R-11 and new insulation must be R-30 or greater.

The installed windows/patio door must meet the following qualifications:• A $50 per window/patio door rebate is available for the replacement of existing single pane with any frame type or double pane with metal frames, to windows with a U-Factor rating of 0.30 or lower and patio doors with a U-Factor of 0.35 or lower. Windows and patio doors are defined by windows and frame, not just glass replacement. Existing double pane windows with vinyl frames do not qualify.• Windows/patio doors must be installed in a conditioned space. Windows/patio doors located in a garage do not qualify.• Windows must be contractor installed. A window specification sheet must document U-Factor and sq.ft of each window and/or patio door and be submitted with this application.

Seattle City Light (“SCL ”) will review the rebate request application (“Request”) and determine whether the installed insulation and/or window products qualifies for the rebate. If the installed product(s) qualify, SCL will mail the appropriate rebate within (60) days of SCL’s receipt of the Request. Only one rebate per measure is available per home. By signing this Request and accepting any rebate, Owner (1) represents and warrants that the product(s) has been installed in compliance with all applicable federal, state and local laws, codes, and ordinances, including all building energy and accessibility codes and in compliance with the procedures specified by SCL; and (2) acknowledges and agrees that: (a) SCL is a sponsor of the rebate program only and has not and does not make any representations or promises with respect to the product(s), the energy consumption, and/or energy savings from the installed product(s); and (b) that SCL MAKES NO IMPLIED OR EXPRESS WARRANTIES REGARDING THIS PROGRAM, ITS POLICIES, PROCEDURES, INSPECTIONS AND/OR ANY INSTALLED INSULATION AND/OR WINDOWS, AND SPECIFICALLY DISCLAIMS ANY WARRANTY OF MERCHANT ABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

seattle.gov/light/waterheater

OUR MISSIONSeattle City Light is dedicated to delivering customers affordable, reliable and environmentally responsibleelectricity services.

TERMS & CONDITIONS

ASSIGNMENT OF REBATE PAYMENT

Rebate funds belong to the individual homeowner. However, the homeowner may direct Seattle City Light to issue the rebate check to the contractor who performed the work. IF YOU WOULD LIKE US TO ISSUE THE REBATE CHECK TO YOUR CONTRACTOR, FILL OUT THIS SECTION. YOU MUST ALSO PROVIDE A COPY OF THE CONTRACTOR’S W-9 FEDERAL TAX ID NUMBER.

Payee Name Tax ID Number

Mailing Address

City State Zip

ACCEPTANCE OF TERMS & CONDITIONSOwner certifies that all information provided herein is true and correct. Owner acknowledges and accepts SCL’s right to inspect the installed products listed on the attached receipt/invoice. Owner acknowledges that the Rebate Program is a limited offer and subject to the availability of funds, and that rebate amounts may be subject to change.

Customer Signature Date