LIGHT EMITTING DIODE (LED) TRAFFIC SIGNALS INCENTIVE APPLICATION
PSE ENERGY CONSERVATION SCHEDULE 257
This application is available to all cities, counties and state agencies with electricity provided by Puget Sound
Energy for traffic signals.
TAX STATUS (Check one)
Corporation Non–Corporation Exempt TAX ID
Attach a list of intersection addresses and corresponding PSE account numbers for each intersection.
NAME OF PSE CUSTOMER ACCOUNT PHONE NUMBER
NAME OF CONTACT PERSON, TITLE FAX NUMBER
MAILING ADDRESS OF CONTACT PERSON CITY STATE ZIP CODE
Caution: Read product requirements on the back of this application before completing the information below. Contact your PSE Program Mgr. at 425-456-2936 to verify availability of funding. Applications will be accepted on a first–come, first–served basis through December 2007 or until funds are depleted.
LIGHT EMITTING DIODE (LED) TRAFFIC SIGNALS
TYPE OF SIGNAL MAXIMUM WATTAGE TOTAL QUANTITY INCENTIVE PSE INCENTIVE ESTIMATED UNIT
PERMITTED PURCHASED A AMOUNT/UNIT B COST - D C = A x B 12” Red Ball 25 watts $ 10.00 each
15 watts $ 10.00 each 12” Red Arrow
15 watts $ 10.00 each 8” Red Ball
10 watts $ 10.00 each Red Ped. Crossing Signal
15 watts $ 20.00 each 12” Green Ball
15 watts $ 20.00 each 8” Green Ball
15 watts $ 20.00 each 12” Green Arrow
25 watts $ 5.00 each Yellow Module – Any Size* *Yellow signals only eligible if replaced with red and green Total: modules in the same signal head.
REBATE CHECK SHOULD BE MADE PAYABLE TO: CHECK BOX IF SAME AS ABOVE ADDRESS
MAILING ADDRESS CITY STATE ZIP CODE
AGREEMENT CLAUSE As a qualified Puget Sound Energy (PSE) customer, I certify that I meet all Schedule 257 Program requirements and that all information that I have supplied fro my application is true and correct. I certify that I have read and understand the requirements set forth in the program procedures and application forms and that I agree to abide by those requirements. I understand that program participation is conditional upon PSE’s pre-installation acceptance of my application and the PSE makes program commitments only through pre-installation written acceptance by way of a properly signed and countersigned LED Application and Agreement. CUSTOMER SIGNATURE PRINT NAME DATE
PSE, MANAGER ENERGY EFFICIENCY SERVICES PRINT NAME DATE
ENERGY CONSERVATION SCHEDULE 257
How to qualify for the Puget Sound Energy Energy–Efficiency Incentive
1. Product Requirements
; Red, green and pedestrian signals are eligible for rebates in all locations. Yellow LED modules are only eligible
for rebates when replaced in conjunction with an upgrade to LED of a red and a green incandescent lamp in the
same signal head at the same time. Yellow signals placed into signal heads with exsisting red and green LED
modules are not eligible for rebate.
; To be eligible for an incentive, all light emitting diode (LED) traffic signals must have wattages less than or equal
to the maximum permitted wattages listed in the table in Summary of Signal Replacements. ; Signals must operate with a Power Factor (PF) > 0.90 and Total Harmonic Distortion (THD) < 20%.
; All equipment must be new. Used or rebuilt equipment is not eligible.
; Products must meet a minimum specification based on ITE (Institute of Transportation Engineers) Standards.
; Fill in all information requested on this application. Note: Be sure to attach a list of intersection addresses with
corresponding wattage reduction and PSE account number, if known, for each intersection. ; Please use PSE LED Incentive Calculation worksheets to document PSE account number(s) and exact quantities
retrofitted under each account.
; For metered intersections, use Form 1.
; For non-metered intersections, use Form 2 or substitute your own intersection list, including all information
requested on the worksheets. Your Program Manager can email you this worksheet.
; To estimate your incentive, multiply the total quantity purchased, column A, times the incentive amount per unit,
column B, and write in the amount in column C.
; Submit application to PSE. Funds are not reserved for your project until you receive a countersigned
agreement from PSE. In order to receive your rebate payment at the end of the project, you must meet all
; Within 90 days of project acceptance, you must submit a purchase order. If this is not received, the
application may be invalidated and the money allocated to other customers.
; When the project is complete, send a copy of your invoices and any additional supporting documentation to the
PSE Program Manager.
; Write the estimated unit cost for each item in the estimated unit cost, column D. Do not include installation costs. ; Attach this LED application and list of intersection addresses (keep a copy for your files) and return to:
LED Signal Rebates, Program Manager, EST-10W
Puget Sound Energy
P.O. Box 90868
Bellevue, WA 98009–0868
3. Terms and Conditions
; You must contact the PSE Program Manager at (425) 456-2936 to confirm funding availability.
; By offering incentives, PSE implies no warranty for this technology.
; In applying for the rebate program, the customer assumes sole responsibility for determining the appropriateness
of the technology for use in their existing traffic signal–controlled intersections.
; Customers shall purchase and install equipment to satisfy the requirements of their individually adopted