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**QUALIFIED PRODUCT INFORMATION FORM**

**FOR COMMERCIAL ICE MACHINES**

ENERGY STAR^®^ Qualified Product Information (QPI) Form for use by
ENERGY STAR Commercial Ice Machine Partners (Companies who have joined
ENERGY STAR for Ice Machines by signing the Partnership Agreement).
Information from this form will be added to the list of ENERGY STAR
Qualified Commercial Ice Machines 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                        **Model Number**
                          Name**                         

                                                         

  **Equipment Type\***    **Type of     **Ice Making     **Date Available on
                          Ice\*\***     Technology\^**   Market**

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

\* Indicate IMH (ice making head), RCU (remote condensing unit, please
indicate with/without condensing unit), or SCU (self contained unit).

\*\*Indicate cubed, flake, or nugget. **Note:** **Only cubed machines
can qualify for ENERGY STAR.**

\^ Indicate air-cooled or water-cooled. **Note: Only air-cooled machines
can qualify for ENERGY STAR.**

III. **Energy and Water Efficiency Performance\^\^**

+--------------------+--------------------------+----------------------+
| **Harvest Rate**   | **Energy Use**           | **Potable Water Use  |
|                    |                          | (gal/100 lbs ice)**  |
| **(lbs ice/day)**  | **(kWh/100 lbs ice)**    |                      |
+--------------------+--------------------------+----------------------+
|                    |                          |                      |
+--------------------+--------------------------+----------------------+

\^\^As determined by Air-Conditioning and Refrigeration Institute (ARI)
Standard 810-2006, *Performance Rating of Automatic Commercial
Ice-Makers*. **Note: Energy use must be rounded and reported to three
significant figures for ENERGY STAR qualification. This data will then
be rounded to the first decimal place for posting to the Web site,
consistent with the ARI Directory.**

IV. **Testing Requirements**

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

Date Tested:

#  {#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 Ice Machines. These requirements
include:

\_\_\_\_ On Top/Front of Product \_\_\_\_ In Product Literature \_\_\_\_
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:** <icemachines@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