LADWP - R1 (02-2009)

Residential
Non-Taxable Non-Residential
RESERVATION REQUEST FORM
RR SOLAR INCENTIVE PROGRAM
Taxable Non-Residential
Affordable Housing
New Construction REC
Please submit only by mail or courier to:
For details on this program, please see the Program Solar Incentive Program
Guidelines for the Solar Photovoltaic Incentive Program LADWP
at: www.ladwp.com/solar or by calling (213) 367-4122 111 N. Hope St., Room 940
Los Angeles, CA 90012
1. Purchaser
____________________________________ ___________________________________________ ___________________________________
Name/Company Physical Address of System Mailing Address

________________________ _______________________ __________________________ ___________________________________

Telephone Fax Email Federal Tax ID Number (for comm. systems)
or Social Security Number (for res. systems)
Primary contact for questions/correspondence: Current Electric Rate*:
Purchaser Seller Installer Residential Residential TOU A-1 Small Comm. A-2Med. Comm. A-3 Lg. Comm.
* If you need assistance determining your electric rate, call (213) 367-4122
2. Seller (seller of solar photovoltaic equipment)

_________________________________ __________________________________________ ___________________________________

Company Address Mailing Address

________________________ _______________________ __________________________ ___________________________________

Phone Fax Email Federal Tax ID Number
3. Installer
Hired Contractor; License Class and # ______________________ Expires: _______________ Self or Other
____________________________________ ___________________________________________ ___________________________________
Company Address Mailing Address

________________________ _______________________ __________________________ ___________________________________

Phone Fax Email Federal Tax ID Number
4. Solar Photovoltaic System Equipment
Inverter Manufacturer Model Quantity Rating (W) Efficiency (%)
Annual kWh Output:
____________________ ____________________ _______ ________ ___________
PV Module Manufacturer Model Quantity Rating (STC) Rating (PTC) _______________ kWh/year*
____________________ ____________________ _______ __________ ___________ *Attach Copies of PV Watts’ DC to
Performance kWh Meter Manuf. Model Quantity AC Derate Factor & PV Watts AC
Energy & Cost Savings Documents

Annual kWh Output Warranted (Yrs) System Rebate Level Requested $ Battery Back-Up System
Life of Modules Degradation
*All battery back-up systems must submit
________________ X _____20_____ _ X ____.9______ X ____________ = $_______________ a single line diagram with this form

5. Declaration Under Penalty of Perjury 6. Incentive Requested

The undersigned declare under penalty of perjury that: 1) the information provided in
this form is true and correct to the best of my knowledge; 2) that the above-described System Cost (before incentive) $_______________
solar PV generating system will be solely owned or leased by the Customer and is
Other Incentives: $_______________
intended to offset part or all of the Customer’s electrical needs at the site of the
Source:
installation; 3) that the Customer has received a copy of this completed form; 4) that
the Customer understands their electric rate may change; 5) the Customer agrees to
Rated Output (Watts STC) _____________
allow LADWP to account for renewable energy generated by the PV system for
reporting purposes.; 6) the Customer has read and understands the Solar Incentive
Program Guidelines; 7) the Customer agrees to comply with all provisions of the Net Total Request $______________
Energy Metering Ordinance and Interconnection Agreement; and 8) acceptance of
this incentive offer will not exceed LADWP’s annual program customer limits as
defined in Section 2.5 of the Solar Incentive Guidelines, including any previously Pay Incentive to: Purchaser Seller
received funds for corporate or government parents, holding companies or other
business entities.
Purchaser Installer
Print Name: ____________________________ Print Name: ___________________________
Signature: ____________________________ Signature: ___________________________
Date: ____________________________ Date: ___________________________

IMPORTANT: Attach a signed copy of the purchase agreement(s) and labor contract(s), a copy of your most recent
LADWP electric bill, a copy of the PV Watts calculations, and a copy of the building permit if new construction.
 INSTRUCTIONS FOR THE RESERVATION REQUEST FORM (LADWP FORM RR)
Title Box: Indicate the funding category of the request.
Section 1. Purchaser
Provide the purchaser name, complete installation address, mailing address (if different from the installation address), phone and fax number
and email address. If the physical address of the installation is the retailer’s office or personal property, list the supplier of the PV as the seller.
Check the box indicating whether the purchaser, seller, or installer is to be the primary contact for questions.
Section 2. Seller
Provide the seller company name and a contact person name, complete address, phone and fax number and email address.
Section 3. Installer
Check the appropriate box for whether the system is to be installed by a contractor (include contractors license class, number and expiration
date) or other, such as “owner install.” If installed by a contractor, provide the contractor’s company name and contact person name, complete
address and email address. All contractors must have an active “A”, “B” “C-10” or “C-46” license.
Section 4. System Equipment
Provide the name of the inverter manufacturer, the inverter model, the number of inverters, the power rating in watts, and the efficiency at ¾
load. Eligible inverters and rating information is located on the California Energy Commission’s website at
www.consumerenergycenter.org/erprebate.
Identify the performance (kWh) meter manufacturer, complete model number and the number of meters.
Identify the manufacturer name of the photovoltaic modules and the complete model number as on the CEC list, the quantity of PV modules
and the nameplate rating in kW STC. To adjust the STC rating for California, multiply the PTC rating by 1.12. Note the orientation and degree of
module tilt or if flat. Use this information to calculate a PV Watts Version 2 expected kilowatt hour output for first year of system operation and
submit this printout along with the RR form. The Los Angeles version of PV Watts 2.0 is located on the web at
http://mapserve2.nrel.gov/website/LA_PVWatts/. If the inverter rated output is less than the system output (kW), the inverter rated output will be
used to calculate the incentive. Where more than one type of inverter is used the weighted average inverter efficiency will be used.
If you are installing your system with panels manufactured in the City of Los Angeles, you may include both the base and Los Angeles
Manufacturing Credit (LAMC) for your total incentive level multiplier. If your panels are manufactured outside of the City of Los Angeles, use the
base credit only.
Section 5. Declaration Under Penalty of Perjury
Form must be signed by customer and installer under penalty of perjury or it will be rejected.
Section 6. Incentive Requested
Provide the system-installed cost (before the LADWP Solar Incentive Program incentive). Identify incentives expected or received from other
sources. The “Total Request” should therefore be based on the LADWP incentive level in place at the time the application is received by
LADWP and the system cost after subtracting other incentives.
Check the box indicating whether the incentive is to be paid to the customer or a third party.
Signatures:
The purchaser and the installer must always print and sign his or her name on the form.
Please indicate if whether the rebate payment is to be assigned to a third party. A third party is an entity other than the purchaser. If yes, please
fill in the name and address in the space provided and attach the original of the assignment form (LADWP PA). The assignment form must
contain original signatures. Non-Residential Payees will be reported as the recipient of the payment(s) for tax purposes.
Attachments: Please attach the documentation necessary to provide the following:
1. Evidence of an agreement(s) to purchase and install the system.*
2. Evidence of electrical service from LADWP at the installation location (a copy of your most recent LADWP electric bill) showing the account
number, address, and name on the account.
3. A copy of the building permit if this is new construction
4. Copy of the PV Watts version 2 Calculator for Overall DC to AC De-rate Factor and a copy of the AC Energy annual kilo Watt hours
expected production for the first year.
5. If claiming non-taxable incentive rate, include copy of letter from Internal Revenue Service confirming non-taxable status.
6. If reservation is for 30 kW- AC CEC or larger system, include a check for 0.5% of anticipated incentive amount.
*Evidence of an agreement to purchase and install can consist of a signed copy of the system or equipment purchase agreement(s) and/or a
signed installation contract(s).

*Be aware that that the LADWP Solar Inspection may find variations in the tilt angle, orientation, shading percentage, or equipment used that may
moderately increase or decrease the incentive amount from the original reservation application