Appendix B to Subpart T of Part 431 - Certification Report for Certain Commercial Equipment

All information reported in this Certification Report(s) is true, accurate, and complete. The company is aware of the penalties associated with violations of the Act, the regulations hereunder, and is also aware of the provisions contained in 18 U.S.C. 1001, which prohibits knowingly making false statements to the Federal Government.

Name of Company Official or Third-Party Representative: Signature of Company Official or Third-Party Representative: Title: Date: Equipment Type: Manufacturer: Private Labeler (if applicable): Name of Person to Contact for Further Information: Address: Telephone Number: Facsimile Number: For Existing, New, or Modified Models: 1 For Discontinued Models: 2

Submit by Certified Mail to: U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy, Building Technologies Program, Mailstop EE-2J, Forrestal Building, 1000 Independence Avenue, SW., Washington, DC 20585-0121.

Submit by E-mail to: [e-mail].