5900-68 Qualified Product Information Form for Commercial Refrig

	United States ENVIRONMENTAL PROTECTION AGENCY
	Washington, DC 20460
	Version 2.0 Qualified Product Information Form for Commercial Refrigerators and Freezers Office of Atmospheric Programs
	ENERGY STAR® qualified product information form for use by ENERGY STAR qualified commercial refrigerators and freezers partners (Companies who have joined ENERGY STAR for commercial refrigerators and freezers by signing the Partnership Agreement). This form should be used to qualify solid door, glass door, and mixed door refrigerator and freezer cabinets. You may use this form to report only those products that are sold under your company’s brand name. If your firm sells its models to another company that uses its own brand name, that company must join the program and report its own products. Information from this form will be added to the list of ENERGY STAR qualified Commercial Refrigerators and Freezers products. Please send this form for each qualifying product model to ENERGY STAR for Commercial Refrigerators and Freezers via fax at (202) 862-1144 or email [email protected].
	Company Information
	Company Name
	(as listed in Partnership Agreement):
	Is the company name listed above the
	original equipment manufacturer (OEM)?
	If not, what is the name of the OEM?
	Product Contact Information (For public requesting product information)
	Name:
	Tel:
	Fax:
	E-mail:
	Product Information Submitted By (leave blank if same as Product Contact)
	Name:
	Tel:
	Fax:
	E-mail:
	Product Information
	Please complete all the fields below (see Term Definitions at the end of the document).
	Note: Each tested model number should be reported on a separate QPI form. The data submitted using this form must apply to the as-tested model number listed below, and if applicable, any additional model number variations that represent differences that do not affect the energy performance of the model, such as color or finish. These additional model numbers may be listed in Table 1.
	Brand Name:
	Model Name (if applicable):
	As-Tested Model Number (listed on test report):
	Date Product First Shipped:
	Product Type:
	Product Orientation:
	Product Marketed As:
	If Other, please explain:
	Check to Confirm: Product temperature of equipment as shipped meets temperature referenced in product definitions (Sections 1A-1B of specification).
	Number of Doors:			Solid:		Glass:
	Door Opening:
	Defrost Type:
	Refrigerant Type:
	Total AHAM Volume:				cu. ft.
	If Mixed Solid/Glass Door Cabinet, input volume for each compartment:
		Solid:			cu. ft.
		Glass:			cu. ft.
	As a reminder, for a mixed solid/glass door cabinet, the sum of the volumes for each compartment must be equivalent to the total AHAM volume of the cabinet listed above.
	External Dimensions
	Height:				in.		cm.
	Width:				in.		cm.
	Depth:				in.		cm.
	Type of Illumination Used:
	If Other, please explain:
	Total Illumination Wattage:				Watts
	Check to Confirm: Model was tested in accordance with ANSI/ASHRAE 72-2005 with all standard accessories in the ON position (if manually controlled).
	Integrated Average Product Temperature:				degrees Fahrenheit
	Total Energy Consumption:				kWh/day (rounded to two decimal places)
	Per the requirements in the ENERGY STAR Partnership Agreement, has the label been placed:
	On product packaging?
	In product literature?
	On your Internet site where the product information is displayed?
	On the top/front of the product?
	Safety Requirements
	Check to confirm that model is third-party certified to applicable requirements set forth in the following quality and safety standards:
	ANSI/NSF International Standard for Food Equipment - Commercial Refrigerators and Freezers (ANSI/NSF 7-2007)
	UL Standard for Commercial Refrigerators and Freezers (UL-471)
	Testing Information
	Confirm that the following product specific documents for the model being qualified are attached:
	Product specification sheet
	Test report(s) from an approved Testing Laboratory, as described below
	Name of Testing Laboratory:
	Confirm Testing Laboratory meets ONE of the following two criteria:
	Approved by California Energy Commission Appliance Efficiency Program
	(see http://www.energy.ca.gov/appliances/database/forms_instructions_cert/approved_test_laboratories/)
	Verified by a certification body, which is accredited by the Standards Council of Canada
	(see http://oee.nrcan.gc.ca/regulations/html/EERGuide_Part1.cfm?attr=0)
	Date Tested:
	Table 1. Additional Models Table
	Instructions: In the table below, you may provide the model number variations that represent aesthetic differences that do not affect the performance of the equipment. Aesthetic differences may include external finish, color, or door opening orientation (left-opening versus right-opening). EPA will consider other variations on a case-by-case basis. The number of doors, including half doors, is not considered an aesthetic difference. By including additional model numbers in this table, you are indicating that the data reported in this form applies to them, that they meet all program requirements, and that you understand they will be listed on the ENERGY STAR Qualified Product List.
	Additional Model Number		Description of aesthetic difference (i.e., finish type, color, hinge configuration)
	Qualification
	By checking this box, I declare that the above information is, to the best of my knowledge, accurate and associated with the products included for qualification in this submittal. I understand that the ENERGY STAR Program will associate all data in this submittal with the products listed in this submittal upon receipt. I understand that if any of the above information is found to be inaccurate, the products will be removed from the ENERGY STAR qualified products list. I understand that intentionally submitting false information to the U.S. government is a criminal violation of the False Statements Act, Title 18 U.S.C. section 1001.
	Date:
	TERM DEFINITIONS
	Commercial Food-Grade Refrigerator: A refrigeration cabinet designed for storing food products at temperatures above 32 degrees Fahrenheit (F) but no greater than 40 degrees F and intended for commercial use.
	Commercial Food-Grade Freezer: A refrigeration cabinet designed for storing food products at temperatures of 0 degrees F and intended for commercial use.
	Refrigeration Cabinet: A refrigerator or freezer used for storing food products at specified temperatures, with the condensing unit and compressor built into the cabinet, and designed for use by commercial or institutional facilities, other than laboratory settings. These units may be vertical or chest configurations and may contain a worktop surface.
	Closed Refrigerator: A display or holding refrigerator where product is accessible for removal by opening or moving doors or panels.*
	Solid Door Cabinet: A commercial food-grade refrigerator or freezer in which all outer doors on all sides of the unit are solid doors. These doors may be sliding or hinged.
	Glass Door Cabinet: A commercial food-grade refrigerator or freezer in which all outer doors on at least one side of the unit are glass doors. These doors may be sliding or hinged.
	Mixed Solid/Glass Door Cabinet: A commercial food-grade refrigerator or freezer in which all outer doors on at least one side of the unit are a combination of solid and glass doors. A unit which has all glass doors on one side and a combination of solid and glass doors on another is considered a glass door cabinet.
	Solid Door: Less than 75% of the front surface area is glass.
	Glass Door: Greater than, or equal to, 75% of the front surface area is glass.
	Worktop Surface: A solid working surface. The working surface may be a cutting board, a stainless steel work surface, or a stone slab. This surface may not add to the total energy consumption of the unit.
	Chest Configuration: An enclosed refrigeration cabinet to which access is gained only through a top-opening door.
	AHAM Volume: The interior volume of a refrigerator as calculated by AHAM Standard Household Refrigerators/Household Freezers (ANSI/AHAM HRF-1-2004).*
	Integrated Average Product Temperature: The integrated average of all test package temperatures, recorded at 15-minute intervals, as determined by the test method referenced in Section 4, Test Criteria.
	* Definition from ANSI/ASHRAE Standard 72-2005, Method of Testing Commercial Refrigerators and Freezers, American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc. 2005.
	The public reporting and recordkeeping burden for this collection of information is estimated to average 4.85 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.