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**QUALIFIED PRODUCT INFORMATION FORM**

**FOR COMMERCIAL DISHWASHERS**

ENERGY STAR^®^ Qualified Product Information (QPI) Form for use by
ENERGY STAR Commercial Dishwashers Partners (Companies who have joined
ENERGY STAR for Commercial Dishwashers by signing the Partnership
Agreement). Information from this form will be added to the list of
ENERGY STAR Qualified Commercial Dishwashers on the ENERGY STAR Web site
at [www.energystar.gov](http://www.energystar.gov/).

**Note:** Partners may use this QPI form to report only those products
that are sold under the company's brand name. If your company sells its
equipment to another company that uses its own brand name, that company
must join ENERGY STAR and report its own models. Please copy this form
and return one for each qualifying model to the address or fax number
provided in Section VI, below.

I.  **Contact Information**

  ---------------------------- --------------------- ---------------------
  **Company Name: (as listed   **Name of Person      
  in the PA)**                 Submitting            
                               Information:**        

                               **Tel:**              **Fax:**

                               **E-mail:**           
  ---------------------------- --------------------- ---------------------

II. **Qualifying Model Information**

+------------------------+-----------------------+---------------------+
| **Brand**              | **Model Name**        | **Model Number**    |
+------------------------+-----------------------+---------------------+
|                        |                       |                     |
+------------------------+-----------------------+---------------------+
| **Machine Type\***     | **Sanitation Method** | **Date Available on |
|                        |                       | Market**            |
|                        | **(high or low        |                     |
|                        | temp)\*\***           |                     |
+------------------------+-----------------------+---------------------+
|                        |                       |                     |
+------------------------+-----------------------+---------------------+

\* Indicate undercounter, single-tank door-type, single tank conveyor,
or multiple tank conveyor. Single tank door-type category includes pot,
pan, and utensil machines.

\*\* For machines that are convertible between high and low temperature
operation manufacturer should indicate as "high and low" and can provide
both sets of performance results in Section III, below. These machines
must meet both high and low temperature performance requirements to earn
the ENERGY STAR.

III. **Energy and Water Efficiency Performance**

  ----------------------- --------------- ----------- -----------------------
  **Idle Energy Rate      **Volume of                 **Water Consumption
  (kW)\***                Tank(s)\*\***               (GPR)\*\*\***

                          **Wash**        **Rinse**   

                                                      
  ----------------------- --------------- ----------- -----------------------

\* Results should represent **tank heater** idle energy rate (door
closed) rounded to 2 significant digits.

\*\* Manufacturers submitting multiple tank conveyors must provide wash
and rinse tank data.

\*\*\*To determine gallons per rack (GPR), manufacturers must use the
calculations provided in Section 3 of the ENERGY STAR specification. GPR
results should be rounded to 3 significant digits.

**NOTE:** Dishwashers that include a manual rinse after the final
sanitizing rinse are not eligible for ENERGY STAR.

IV. **Testing Requirements**

**[Water Consumption]{.underline}**

Tested by: (Name of Independent Testing Firm)

Date Tested:

**NSF Certification**

Certification to NSF/ANSI 3 (circle): Yes (*note: ENERGY STAR requires
certification to NSF/ANSI 3*)

Listed in NSF database (yes/no):

If not listed with NSF, please provide the following additional
information (as applicable to each machine type):

**Undercounter and Door-Type Machines:**

  --------------- -------------- -------------- ------------- ------------
  **Gallons per   **Wash Time**  **Rinse Time** **Dwell       **Load
  Hour**                                        Time**        Time**

                                                              
  --------------- -------------- -------------- ------------- ------------

**Conveyor Machines:**

  ------------------------ ----------------------- -----------------------
  **Gallons per Hour**     **Rack Length**         **Conveyor Speed**

                                                   
  ------------------------ ----------------------- -----------------------

**[Idle Energy Rate]{.underline}**

Tested by: (Name of Independent Testing Firm or Self-Tested)

Date Tested:

**[Test Procedures]{.underline}**

Testing must be done in accordance the following test standards:

**Water Consumption:**

-   NSF/ANSI 3-2007 Standard, *Commercial Warewashing Equipment.*

**Energy Consumption:**

-   ASTM Standard F1696, *Standard Test Method for Energy Performance of
    Single-Rack Hot Water Sanitizing, Door-Type Commercial Dishwashing
    Machines*

-   ASTM Standard F1920, *Standard Test Method for Energy Performance of
    Rack Conveyor, Hot Water Sanitizing, Commercial Dishwashing
    Machines*

#  {#section .unnumbered}

# Labeling Requirements

By checking the items below, you are confirming that you have reviewed
and will meet the labeling requirements outlined in the ENERGY STAR
Program Requirements for Commercial Dishwashers. These requirements
include:

\_\_\_\_ On Top/Front of Product \_\_\_\_ In Product Literature
\_\_\_\_On Product Packaging \_\_\_\_ On Internet Site

If answer to any of the above is no, explain why:­­­­­­

Please check one or more of the following international markets where
these products are sold (if applicable):

\_\_\_ Australia/New Zealand \_\_\_ Canada \_\_\_ EU \_\_\_ Japan \_\_\_
Mexico \_\_\_ Taiwan

V.  **Contact Information**

Please submit your completed QPI Forms in one of the following ways:

**E-mail:** <commercialdishwashers@icfi.com>

**Fax:** (202) 862-1144 c/o Rebecca Duff, ICF International

**US Mail/Overnight Express:** Rebecca Duff, ICF International, 1725 Eye
Street NW, Suite 1000, Washington, DC 20006