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Electric Vehicle ChargePoint® Home Charger for Residential Customers 2020

Install a ChargePoint Home or Home Flex charger, connect it to our ChargePoint Utility Home Charging Program, and drive away with a $500 rebate!

A completed application and all supporting documents must be received within 90 days of installation. Incomplete applications will cause delays in payment or denial of the application. Rebates for ChargePoint Home and Home Flex chargers installed prior to 2020 are allowed if you now connect your charger to our ChargePoint Utility Home Charging Program.

Email the application and all supporting documentation to: rebate@brightenergysolutions.com, or mail or fax the application and all supporting documentation to your local utility (listed on back).

Customer Information (Please Print)

Name of Homeowner Phone Installation Date

Installation Address City State ZIP Code

Mailing Address City State ZIP Code

Email Address (By providing your email address, you are granting The Utility permission to send emails regarding this project or updates on our incentive programs.)

Municipality Utility Name & Account Number

Plug-In Hybrid or All-Electric Vehicle (Resident must own or lease electric vehicle to qualify for charger rebate.) Manufacturer / Make Model Model Year

Dealership Name Dealership City Dealership State

Copy of Proof of Purchase Attached (Check Box): (Proof of Purchase can include vehicle registration, title, lease, or final purchasing agreement. Transaction must be completed, and customer must be in possession of the vehicle to be eligible for rebate.)

ChargePoint Home Charging Station

Model: CHARGEPOINT Home 32 Amp Serial #

Model: CHARGEPOINT Home Flex Serial #

The charger has been activated and connected to ChargePoint, and has been connected to my local municipal utility through theChargePoint Utility Home Charging Program. See page 4 for instructions. (Check Box):

This incentive only applies to the purchase of a ChargePoint Home or ChargePoint Home Flex Wi-Fi-enabled electric vehicle charger. A full-time resident of this household must own or lease a plug-in hybrid or all-electric vehicle.

Rebate $500.00

Please visit www.brightenergysolutions.com for more information about the Bright Energy Solutions programs, or contact your local municipal utility.

mailto:rebate@brightenergysolutions.comhttp://www.brightenergysolutions.com/

Electric Vehicle ChargePoint Home Charger for Residential Customers 2020

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Certifications and Signature

I hereby certify that: 1. The information contained in this application is accurate and complete. 2. A full-time resident of this household owns or leases a plug-in hybrid or all-electric vehicle (EV.) Limited to one rebate per EV 3. A ChargePoint Home or Home Flex Level 2 charger has been installed at the address identified in this application. 4. The Level 2 charger has been activated and connected to ChargePoint, and has been connected to my local municipal utility

through the ChargePoint Utility Home Charging Program. 5. I agree to maintain connection to the ChargePoint Utility Home Charging Program through a Wi-Fi connection for a minimum of 36

months from the date of incentive payment. 6. I agree to participate in Bright Energy Solutions surveys and interviews to benefit electric vehicle adoption. 7. I have read and understand the terms and conditions applicable to this incentive program as set forth in this application, including

those set forth on the last page of this application form. I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I am not allowed to receive more than one incentive from this program on any piece of equipment. I agree to indemnify, defend, hold harmless and release The Utility from any claims, damages, liabilities, costs and expenses (including reasonable attorneys’ fees) arising from or relating to the removal, disposal, installation or operation of any equipment or related materials in connection with the programs described in this application, including any incidental, special or consequential damages. Homeowner Signature Print Name

Date

Member Utility Use Only

Date Received Pre-Inspected? Yes No

Date Pre-Inspected: Initials:

Post-Inspected? Yes No

Date Post-Inspected Initials:

Incentive Approved Yes No Amount: $ Date Approved:

Utility or Program Representative

Electric Vehicle ChargePoint Home Charger for Residential Customers 2020

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ACTIVATE AND CONNECT YOUR CHARGER

4. Open the ChargePoint mobile app, follow these steps:

Select Account

Select Connections

Select Browse Connections

Under Service Providers, find your local municipal utility

Select your local municipal utility and enter the requested information

Select and agree to the Terms and Conditions

Click Submit to finish your request

5. Your enrollment is now “Pending”. Once approved by Bright Energy Solutions, an approved email will be sent and the status will change from “Pending” to “Active”.

6. Once your charger is “Active”, the associated Home station is now linked to the Utility program.

Activate charger using the ChargePoint mobile app

1. Download the ChargePoint mobile app

2. Create a ChargePoint account or Log In to an existing account

3. Activate your home charger by following the steps as prompted.

Once your charger has been activated, you are ready to connect

to the Utility Home Charging Program.

.

Connect the charger to the Utility Home Charging Program

Electric Vehicle ChargePoint Home Charger for Residential Customers 2020

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ELIGIBILITY:

• These incentives are offered by Missouri River Energy Services and its participating members. For questions regarding eligibility, contact your local utility. • Residential customers who purchase electricity from The Utility are eligible to participate in the Bright Energy Solutions ChargePoint Utility Home Charging

Program. Eligible equipment must be connected to an electric service billed by The Utility under a residential rate class or serving residential space. Residential customers installing a charger in a multifamily situation billed by the Utility under a commercial rate class may also qualify if approved by Bright Energy Solutions. Someone living at the residence full-time must own or lease one plug-in hybrid or all electric vehicle per charger rebated.

• This program is applicable only to equipment that meets the detailed equipment specifications and requirements described in this application. The Utility will determine, in its discretion, whether such specifications and requirements are satisfied.

• Customers may not receive more than one incentive for each piece of equipment installed under this program or any combination of Bright Energy Solutions

programs.

TERMS AND CONDITIONS: 1. Incentive Offer: Projects, including all required installation, must be completed by December 31 of the year indicated on this application. A signed application,

itemized invoices, and other required documents must be submitted to the participating utility within 90 calendar days of project completion. Projects completed prior to January 1, 2020 may be eligible for a rebate if now activated and connected to the ChargePoint Utility Home Charging Program.

2. Compliance: a) All projects must comply with federal, state, and local safety, building, and environmental codes. b) Equipment must not be used to qualify and receive payment for energy savings from any wholesale electricity market. c) Customers may only receive one incentive per piece of qualifying equipment. d) All terms and conditions of this application must be satisfied by the customer.

3. Payment: Once completed paperwork is submitted, incentive payments are usually made within 4 – 8 weeks. Incomplete applications will either delay payments or be denied. The Utility reserves the right to refuse payment and participation if the customer or the customer’s contractor violates program rules and procedures.

4. Inspection: The Utility may conduct an inspection of the customer’s facility to survey any installed projects. The Utility may inspect customer records relating to incentives sought by the customer.

5. Information Sharing: The Utility reserves the right to publicize your participation in this program, unless you specifically request otherwise in writing. Information contained in this application may be shared with state boards, commissions, departments, and other Bright Energy Solutions participating utilities.

6. Program Discretion: Incentives are available on a first-come, first-served basis. This program and its incentive amounts are subject to change or termination without notice at the discretion of The Utility. Neither pre-approval of a project, nor any other action by The Utility, will entitle a customer to an incentive payment until the application is finally approved by The Utility. The Utility reserves the right to load manage (cycle on or off) customer equipment that qualifies for incentives under this program.

7. Logo Use: Customers or trade allies may not use the name or logo of Bright Energy Solutions, The Utility, or any other participating utility in any marketing, advertising, or promotional material without written permission.

8. Disclaimers: The Utility a) does not endorse any particular manufacturer, product, labor or system design by offering these programs; b) will not be responsible for any tax liability imposed on the customer as a result of the payment of incentives; c) does not expressly or implicitly warrant the installation or performance of installed equipment or any contractor’s quality of work (contact the equipment

manufacturer or contractor for warranties); d) is not responsible for the proper disposal/recycling of any waste generated as a result of this project; e) is not liable for any damage, injury, or loss of life arising from or relating to the removal, installation, or operation of any equipment, or any other action

taken by the customer or The Utility, in connection with a project undertaken by the customer under the programs described in this application; f) does not guarantee that a specific level of energy or cost savings will result from the implementation of energy efficiency measures or the use of products

funded under this program.

INCENTIVE LIMIT:

Eligible customers may purchase and install qualifying equipment and receive a home charger incentive of $500 (limit one charger per household).

Incentives for particular items of equipment and/or systems are limited as set forth in this application.

Mail the completed application and sales receipt to your utility. Or email the documents to: rebate@brightenergysolutions.com

2018-1118

IOWA Alton Municipal Electric PO Box 910 Alton, IA 51003-0910 Phone: (712) 756-4314 Fax: (712) 756-8999 Atlantic Municipal Utilities PO Box 517 Atlantic, IA 50022 Phone: 712-243-1395 Fax: 712-243-2028 Denison Municipal Utilities PO Box 518 Denison, IA 51442-0518 Phone: (712) 263-4154 Fax: (712) 263-8767 Hartley Municipal Utilities 11 S. Central Ave. Hartley, IA 51346-1400 Phone: (712) 928-2240 Fax: (712) 928-2878 City of Hawarden Utilities 1150 Central Ave. Hawarden, IA 51023-1815 Phone: (712) 551-2565 Fax: (712) 551-1117

Kimballton Municipal Utilities PO Box 79 Kimballton, IA 51543-0092 Phone: (712) 773-3451 Fax: (712) 773-3452 Lake Park Municipal Utilities PO Box 536 Lake Park, IA 51347-0536 Phone: (712) 832-3667 Fax: (712) 832-3669 Manilla Municipal Utilities PO Box 398 Manilla, IA 51454-0398 Phone: (712) 654-3952 Fax: (712) 654-3955 Orange City Municipal Utilities PO Box 406 Orange City, IA 51041-0406 Phone: (712) 707-4885 Fax: (712) 707-4351 Paullina Municipal Utilities PO Box 239 Paullina, IA 51046-0239 Phone: (712) 949-3428 Fax: (712) 949-3499 City of Pella PO Box 88 Pella, IA 50219 Phone: (641) 628-2581 Fax: (641) 628-1642 Primghar Municipal Utilities 160 S. Hayes Ave. PO Box 39 Primghar, IA 51245-7723 Phone: (712) 957-2435 Fax: (712) 957-5300

Remsen Municipal Utilities 008 W. Second St. PO Box 510 Remsen, IA 51050-7712 Phone (712) 786-2136 Fax: (712) 786-2091 Rock Rapids Municipal Utilities 310 S. Third Ave. Rock Rapids, IA 51246-1610 Phone: (712) 472-2511 Fax: (712) 472-2512

Sanborn Municipal Utilities PO Box 548 Sanborn, IA 51248-0548 Phone: (712) 930-3842 Fax: (712) 930-3060 Shelby Municipal Utilities PO Box 186 Shelby, IA 51570-0816 Phone: (712) 544-2404 Fax: (712) 544-2703

Sioux Center Municipal Utilities 335 First Ave. NW Sioux Center, IA 51250-1814 Phone: (712) 722-0761 Fax: (712) 722-0760 Woodbine Light & Power 517 Walker St. Woodbine, IA 51579-1262 Phone: (712) 647-2340 Fax: (712) 647-2341 MINNESOTA Adrian Public Utilities PO Box 190 Adrian, MN 56110-0190 Phone: (507) 483-2849 Fax: (507) 483-2005 ALP Utilities PO Box 609 Alexandria, MN 56308-0609 Phone: (320) 763-6501 Fax: (320) 762-1411 Barnesville Municipal Utilities PO Box 550 Barnesville, MN 56514-0550 Phone: (218) 354-2292 Fax: (218) 354-2472 Benson Municipal Utilities 1410 Kansas Ave. Benson, MN 56215-1718 Phone: (320) 843-3707 Fax: (320) 842-7151 Breckenridge Public Utilities 420 Nebraska Ave. Breckenridge, MN 56520-1419 Phone: (218) 643-4681 Fax: (218) 643-1173 Detroit Lakes Public Utilities PO Box 647 Detroit Lakes, MN 56502-0647 Phone: (218) 847-7609 Fax: (218) 847-8969

Elbow Lake Municipal Electric PO Box 1079 Elbow Lake, MN 56531-1079 Phone: (218) 685-4135 Fax: (218) 685-4948 Henning Municipal Utilities PO Box 55 Henning, MN 56551-0055 Phone: (218) 583-2402 Fax: (218) 583-2637 Hutchinson Utilities Commission 225 Michigan St. SE Hutchinson, MN 55350 Phone: (320) 587-4746 Fax: (320) 587-4721 Jackson Municipal Utilities 80 W. Ashley St. Jackson, MN 56143-1669 Phone: (507) 847-4410 Fax: (507) 847-5586 Lake Park Public Utilities PO Box 239 Lake Park, MN 56554-0239 Phone: (218) 238-5532 Fax: (218) 238-6344 Lakefield Public Utilities PO Box 1023 Lakefield, MN 56150-1023 Phone: (507) 662-6363 Fax: (507) 662-5990 Luverne Municipal Utilities PO Box 659 Luverne, MN 56156-0659 Phone: (507) 449-2388 Fax: (507) 449-5034 Madison Municipal Utilities 404 Sixth Ave. Madison, MN 56256-1265 Phone: (320) 598-7373 Fax: (320) 598-7376 Melrose Public Utilities 225 First St. N.E. Melrose, MN 56352-1153 Phone: (320) 256-4278 Fax: (320) 256-7766 Moorhead Public Service 500 Center Ave., 2nd Floor PO Box 779 Moorhead, MN 56561-0779 Phone: (218) 477-8000 Fax: (218) 477-8020 Ortonville Municipal Utilities 315 Madison Ave. Ortonville, MN 56278 Phone: (320) 839-3428 Fax: (320) 839-2319

Sauk Centre Public Utilities Commission PO Box 128 Sauk Centre, MN 56378-0128 Phone: (320) 352-6538 Fax: (320) 352-2833

St. James Public Utility PO Box 70 St. James, MN 56081-0070 Phone: (507) 375-1226 Fax: (507) 375-3061 Staples Water & Light 122 6th St. NE Staples, MN 56479-0000 Phone: (218) 894-2550 Fax: (218) 894-2552 Wadena Utilities Department PO Box 30 Wadena, MN 56482-0030 Phone: (218) 631-7712 Fax: (218) 631-7713 Westbrook Public Utilities PO Box 308 Westbrook, MN 56183-0308 Phone: (507) 274-6712 Fax: (507) 274-5569 Willmar Municipal Utilities PO Box 937 Willmar, MN 56201-3111 Phone: (320) 235-4422 Fax: (320) 235-3980 Worthington Public Utilities PO Box 458 Worthington, MN 56187-0458 Phone: (507) 372-8680 Fax: (507) 372-8688 NORTH DAKOTA Cavalier Municipal Utilities PO Box 750 Cavalier, ND 58220-0750 Phone: (701) 265-8800 Fax: (701) 265-8720

Hillsboro Municipal Utilities PO Box 400 Hillsboro, ND 58045-0400 Phone: (701) 636-4620 Fax: (701) 636-4621 Lakota Municipal Light Plant PO Box 505 Lakota, ND 58344-0505 Phone: (701) 247-2561 Fax: (701) 247-2552

Northwood Municipal Utilities PO Box 397 Northwood, ND 58267-0397 Phone: (701) 587-5370 Fax: (701) 587-5829 Valley City Public Works PO Box 240 Valley City, ND 58072-0240 Phone: (701) 845-0380 Fax: (701) 845-4588 SOUTH DAKOTA Big Stone City Municipal Utilities PO Box 246 Big Stone City, SD 57216-0246 Phone: (605) 862-8121 Fax: (605) 862-8109 Brookings Municipal Utilities PO Box 588 Brookings, SD 57006-0588 Phone: (605) 692-6325 Fax: (605) 697-8470

Burke Municipal Utilities PO Box 250 Burke, SD 57523 Phone: (605) 775-2913 Fax: (605) 775-3014

Faith Municipal Utilities PO Box 368 Faith, SD 57626 Phone: (605) 967-2261 Fax: (605) 967-2266 Flandreau Municipal Utilities 1005 W. Elm Ave. Flandreau, SD 57028 Phone: (605) 997-2492 Fax: (605) 997-2915 Fort Pierre Municipal Utilities PO Box 700 Fort Pierre, SD 57532-0700 Phone: (605) 223-7690 Fax: (605) 223-7693 Town of Pickstown PO Box 107 Pickstown, SD 57367-0107 Phone: (605) 487-7553 Fax: (605) 487-7553 Pierre Municipal Utilities PO Box 1253 Pierre, SD 57501-1253 Phone: (605) 773-7341 Fax: (605) 773-7406 City of Vermillion 25 Center St. Vermillion, SD 57069-2101 Phone: (605) 677-7050 Fax: (605) 677-5461

Watertown Municipal Utilities 901 Fourth Ave. SW Watertown, SD 57201-4106 Phone: (605) 882-6233 Fax: (605) 882-6238

Winner Municipal Utilities PO Box 691 Winner, SD 57580-0691 Phone: (605) 842-2621 Fax (605) 842-1653

Text1: Check Box5: OffName of Homeowner: Phone: Installation Date: Installation Address: City: State: ZIP Code: Mailing Address: City_2: State_2: ZIP Code_2: Email Address By providing your email address you are granting The Utility permission to send emails regarding this project or updates on our incentive programs: Municipality Utility Name Account Number: Manufacturer Make: Model: Model Year: Dealership Name: Dealership City: Dealership State: Serial: Serial_2: Check Box2: OffCheck Box3: OffHomeowner Signature: Print Name: Date: Date Received: Date PostInspected: Amount: Date Approved: Utility or Program Representative: Text4: Text5: Text6: Check Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffActivate charger using the ChargePoint mobile app: 6: