2017 Residential Incentives
Application Form
APPLICANT INFORMATION
Applicant Name:
Phone:
Email:
Mailing Address:
Street
City
Province
Postal Code
Province
Postal Code
Installation Address:
Street
City
City of Medicine Hat Utility Account #:
___ ___ ___ ___ ___ ___ - ___ ___ ___ ___ ___ ___ ___
□CHEQUE
I prefer my rebate as a:
Name on Account:
□CREDIT ON MY UTILITY ACCOUNT
As the Applicant you have the option to credit your City of Medicine Hat utility account with your rebate, rather than requesting payment by cheque which will be
mailed to the provided address. NOTE: Pending approval of this Rebate Application, the credit will appear on your next utility bill.
INCENTIVE TYPE
(complete all rebates that apply)
File Number:
Attic
Insulation
* Section to be
completed by certified
inspector
Insulation Location:
 HOUSE
Pre R-Value:
Initials:
R - _____
Post R-Value:
 GARAGE
$_________
Date of Post-evaluation:
_____________, 201__
Expected Rebate:
Initials:
R - _____
Date of Pre-evaluation:
Cost:
(before GST)
Covered Area:
______________, 2017
______ %
$_______________
(Maximum $500)
Required Documentation:  Completed Application Form  Detailed receipts or invoices showing proof of payment.
Drain Water
Heat
Recovery
Manufacturer and Model:
Heat Recovery Efficiency value:
Date of Installation:
Purchased from / Installed by:
$_________
Project Funding:
_________kW
Date of Installation:
 PURCHASE  LEASE
(Maximum $500)
Cost:
(before GST)
Expected Rebate:
______kW x $1,000 =
Purchased from / Installed by:
$_________
______________, 2017
* Permit required
$_______________
Required Documentation:  Completed Application Form  Heat Recovery Efficiency value from Natural Resources Canada
 Detailed receipts or invoices showing proof of payment  Final Plumbing Inspection from the City’s Safety Codes department.
System Size:
Solar
Electric
Expected Rebate:
$_________ x 50% =
______________, 2017
* Permit required
Cost:
(before GST)
$_______________
(Maximum $5,000)
Required Documentation:  Completed Application Form  Detailed receipts or invoices showing proof of payment
 Final Electrical Inspection from the City’s Safety Codes department
 Commissioning Report obtained from the City’s Electric Utility Department for applicable installations.
I have attached all of the Required Documentation to this Application Form:
 YES
 NO
I wish to receive HAT Smart program updates by email:
 YES
 NO
This rebate influenced my decision to complete this energy efficiency upgrade:
 YES
 NO
Applicant Signature:
Date:
I certify that I have read, understood and agree to comply with the Application Terms and Conditions listed on the back of this form. I understand that this
application shall be subject to approval by HAT Smart. A completed application is NOT a guarantee of eligibility for a rebate under the Program, nor payment of the
Rebate itself. Rebates are based on fully completed applications and issued on a first come, first served basis. An incomplete Application can result in a delay of
payment or no payment if Program funds have been exhausted.
For Office Use Only:
APPROVE 
DENY 
Rebate Amount:
Date:
Initials:
2017 Residential Incentives
Terms and Conditions
The following application terms and conditions (“Application Terms and Conditions”) establish the eligibility requirements
and related terms and conditions for an application to the HAT Smart Rebate Program (“Program”). The application shall be
subject to approval by HAT Smart. A completed application is neither a guarantee of eligibility for a rebate under the Program,
nor payment of the rebate itself, and is subject to the following Application Terms and Conditions:
1.
2.
3.
4.
5.
6.
7.
8.
Program eligibility requires that the Applicant perform qualifying
installations, replacements, and/or upgrades on or after January
1 and on or before December 31 of each program year. Deadline
for applications is noon on the last business day before January
7 of the following year, provided funding is still available. (I.E. if
qualifying installations, replacements, and/or upgrades are
completed and paid for in 2017, application deadline is January
5, 2018.) Late applications will be declined. Check
www.hatsmart.ca for details specific to each initiative.
Rebates are processed on a first come, first served basis.
Applications will no longer be accepted once Program funding
has been exhausted.
Applicants agree the eligible products will be installed in the
specified dwelling either by themselves or through a service
provider and that purchases and installations are for noncommercial use only.
This program is for existing homes; that is, any home built more
than six months before installations, replacements, and/or
upgrades.
The Applicant is responsible for meeting all Program
requirements and complying with any laws, regulations, or bylaws regarding permits, codes, restrictions, and/or inspections in
relation to products or equipment installed. The Applicant shall
be responsible for any direct or indirect taxes, duties, levies,
fees, or like charges incurred by Applicant as a result of
participation in the Program and hereby indemnifies HAT Smart
for the same.
The Applicant agrees that it is solely responsible for, and liable
for, the selection, purchase, installation, and ownership /
maintenance of the products included in the submitted rebate
application and that HAT Smart is not affiliated in any way with
the manufacturer, distributor, dealer, and/or installer of the
product. The Applicant acknowledges and agrees that HAT
Smart makes no representation or warranty, whether expressed,
implied, direct or indirect, with respect to the products, services
or other measures that the Applicant has purchased and which is
the subject matter of the rebate application. The Applicant further
acknowledges and agrees that HAT Smart is not responsible for
the design, verification, and/or operation of the product, and
accepts no liability nor makes any representations with respect
to estimated or possible energy and/or water savings that will be
incurred in the function of the products, services or measures,
and/or the installation, performance, reliability, safety, use or
fitness of the products for the Applicant’s particular purpose.
Complementary municipal/provincial/corporate rebates
administered by HAT Smart may have different eligibility criteria
including, but not limited to, unique start and end dates. Visit
www.hatsmart.ca for a complete listing of available rebates and
eligibility criteria. Applicants are responsible for researching and
ensuring they qualify under applicable eligibility criteria and
Applicants hereby indemnify HAT Smart against any liability for
the same.
Any other rebate(s), discount(s) and/or incentive(s) offered
and/or provided by any government agency, institution,
manufacturer, distributor, dealer and/or installer are separate
and distinct from the Program and HAT Smart shall not be
responsible for the administration or payment of the same nor be
responsible for the erroneous submission of other rebate(s),
discount(s) and/or incentive(s) to HAT Smart.
Submit Application
Form and Required
Documentation to:
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
A copy of the purchase receipt or other information relevant
to the rebate being applied for is required. Omission of such
required information will result in an incomplete application. HAT
Smart accepts no responsibility for incomplete applications which
will neither be processed nor held by HAT Smart. HAT Smart is
not responsible for incomplete, lost, late or misdirected mail or
illegible submissions.
The following information must be clearly indicated on the
purchase receipt:
a) Purchase date;
b) Verification of qualifying criteria as listed at
www.hatsmart.ca;
c) Detailed invoice indicating the work performed and total
amount has been paid in full; and
d) Business address from which product was purchased.
The Goods and Services Tax (GST) is not considered a part of
the total project costs; therefore, HAT Smart rebates will be
based on pre-tax amounts and will not exceed the amount of
total project costs (less GST), regardless of the maximum listed
rebate amount.
In submitting this application, the Applicant consents to the
collection and use, disclosure and retention of the personal
information herein provided for five years following which such
information will be destroyed or made anonymous.
In submitting this application, the Applicant confirms ownership
of any attribute of an environmental or similar nature that is
created or otherwise arises from the generation of electricity from
solar powered energy. The Applicant further attests that said
attributes have not been claimed, sold, or otherwise transferred
to another party.
In submitting this application, the Applicant consents that the City
of Medicine Hat shall be the aggregator of the solar generator
with ownership of any attribute of an environmental or similar
nature that is created or otherwise arises from the generation of
electricity from solar powered energy. As such, the Applicant
consents that the City of Medicine Hat shall be allowed access
and shall take all steps necessary to provide the City of Medicine
Hat access to appropriate tracking data until a time in which
operation of the solar generator is permanently suspended.
The Applicant consents to the disclosure of information to HAT
Smart and its contractors, employees and partners. HAT Smart
undertakes that the information provided in this application will
not be sold or distributed for commercial or promotional
purposes or financial gain.
HAT Smart reserves the right to change or terminate the
Program at any time without notice or explanation. HAT Smart
will use reasonable efforts to administer a completed eligible
application received prior to such a change or termination of the
Program in accordance with the Program as it existed effective
as of the date of the completed eligible application.
Applicant should retain a copy of its application as Applicant’s
original application and purchase receipt will not be returned by
HAT Smart.
Applicant should allow at least 8 (eight) weeks to process the
application. If approved, Applicant has the option of a credit to its
City of Medicine Hat utility account (Applicant must live at the
installation address) or request the issuance of a cheque for the
amount of the rebate. All rebate cheques issued must be cashed
within 180 days from the cheques’ issuance date and will not be
re-issued after this time.
Customer Service Desk
HAT Smart
City Hall
580 1st Street S.E.
Medicine Hat, AB T1A 8E6
Gas Utility Building
364 Kipling Street S.E.
Medicine Hat, AB T1A 1Y4
By Fax:
By Email:
403.502.8059
[email protected]
For assistance with this Application Form, phone 403.502.8799