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Anaheim Public Utilities (APU) is offering rebates to Customers (both residential and business) who install Level 2 (240- Volt) plug-in Electric Vehicle (EV) Chargers (Charger) at their residences or businesses for private use only. Customers will be reimbursed for out-of-pocket expenses. Please select all applicable rebates you are applying for below: Up to $1,000 per any Level 2 EV Charger including related electric panel and service upgrade for Customers not participating in any available time-based rate, as applicable Up to $1,500 per Networked Charger including related electric panel and service upgrade, and the Customer must also sign up for any available time-based rate, as applicable • Fill out an application for each EV Charger and attach all of the following required documents: A photo of the installed EV charging station A copy of your Anaheim Public Utilities bill A copy of your Building Department Permit Card showing final sign off A photo of the serial number on your EV Charger All charging station purchase and installation receipts (Date on Receipts must be within one year of purchase) • Submit the documents to: Anaheim Public Utilities – Private Use Electric Vehicle Charger Rebate Program 201 S Anaheim Blvd., Suite #801, Anaheim, CA 92805 or [EMAIL REDACTED] • If you have any questions, please contact the Program Manager at [PHONE REDACTED] or [EMAIL REDACTED] CUSTOMER INFORMATION Name of Customer: Daytime Phone Number: Account Number (Found on the top right corner of your bill): Total Dollar Amount of Receipts: Amount Being Requested for Rebate: Mailing Address: CHARGING STATION INFORMATION Charging Station Make and Model: Charging Station Serial Number: Charging Station Installation Address: Vehicle to be charged VIN: Property Type Where Charger Is Installed (Ex: single family residence, condominium complex, apartment complex, business, etc.): CUSTOMER SIGNATURE I certify that the information on this application is true and correct and that I understand and agree to the Program guidelines. For Customers requesting rebates for Networked EV Chargers who are enrolling in a Time-of-Use Rate, I certify that I am enrolled into a Time-of-Use Rate and agree to remain on it for a minimum of 12 months as defined by APU’s Electric Utility Rates Schedules. Customer Signature Date Maximum of one EV Charger rebate per Customer, not to exceed $1,000 per Customer. Maximum of one Networked EV Charger rebate per Customer, not to exceed $1,500. For more information about required City of Anaheim permits please contact the Building Division at [PHONE REDACTED] or Anaheim.net/Building December 2023 Private Use Electric Vehicle Charger Rebate Application SIGN ---PAGE BREAK--- PRIVATE USE ELECTRIC VEHICLE CHARGER REBATE PROGRAM GUIDELINES • Anaheim Public Utilities does not warrant, endorse or assume liability for the quality, performance or safety of the Customer selected contractor and/or retailer or wholesaler. Performance of any product and acceptance of materials used is solely the Customer’s responsibility. • Applicant agrees that any incentive may be credited towards any delinquent (as currently defined in the City of Anaheim Rates, Rules and Regulations) utility bill(s) for which the Customer is responsible for, whether the account(s) is open or closed. • Applicant is responsible for obtaining all required permits from the City of Anaheim. • Applicant must receive electric service from Anaheim Public Utilities. • Applicant must submit all required documents listed to be eligible for a rebate. • Applicant understands and agrees that Anaheim Public Utilities may inspect the installed EV Charger before the incentive is paid. • Maximum of 1 EV Charger rebate per Customer. • Prior to installation, the applicant is responsible for meeting all Program requirements and for checking with state, county or city governments and homeowner’s associations (if any) regarding: o Codes o Conditions o Ordinances o Restrictions o Rules and regulations • The EV Charger must be installed within Anaheim Public Utilities service area.