Energy Star Qualified Product Information Form

OMB No. 2060-0528 ® ENERGY STAR QUALIFIED INDOOR PRODUCT INFORMATION FORM FOR INDOOR RESIDENTIAL LIGHT FIXTURES

ENERGY STAR product information form for use by ENERGY STAR qualified residential light fixture partners (Companies who have joined ENERGY STAR for residential light fixtures by signing a Partnership Agreement) You may use this form to report those products that are sold under your company’s brand name. If your firm sells models (fixtures) under a brand name different from your company name, you must list the brand name and the associated retailer/organization. Please copy this form and return one for each lamp/ballast combination to the address below.

MANUFACTURER (ENERGY STAR Partner): _____Sea Gull Lighting Products, Inc.______

SECTION I -- LAMP & BALLAST INFORMATION:

Number of Number of Individual Lamp Lamp Lamp (e.g., lightbulb) Ballast Lamps/ Ballasts/ Listed Lamp 1 2 Fixture Fixture Wattage Type Size Manufacturer & Model Number Manufacturer & Model Number 2 1 32 L T8 Keystone AXL/F32T8/32W/830 Robertson ISS232T8MVW

ENERGY STAR should review this submittal as a (circle one): Lamp &/or Ballast Platform3 Complete Fixture Both 1. Lamp Type: For example, CFL = Compact Fluorescent, CR = Circular, L = Linear 2. Lamp Size: For example, T4, T5, or T8. 3. A lamp and ballast platform does not receive the ENERGY STAR mark and cannot be promoted as an ENERGY STAR qualified product. Rather, you may promote the “qualified” lamp, ballast, or lamp/ballast platform as a component that meets applicable ENERGY STAR Program Requirements when used in ENERGY STAR qualified residential light fixtures.

SECTION II -- TEST RESULTS: Enter results from test report (complete using average of tested samples) or manufacturer data as specified in the ENERGY STAR Program Requirements for Residential Light Fixtures Version 4.0 and attach required documentation to this form. Performance Characteristic Test Result Required Documentation (please attach to this form) Combined Lamp & Ballast Requirements

System Efficacy _4664_(2332)______Total Lumen Output Test report from a lab accredited by NVLAP or one of its MRA signatories, an EPA __59______Input Power (watts) approved Platform Letter of Qualification, or EPA-approved documentation from an ___79.05______Lumens Per Watt industry association. Lamp Requirements Test report from a lab accredited by NVLAP Lamp Life __10,000______Average Rated Hours or one of its MRA signatories, an EPA approved Platform Letter of Qualification, % of initial lumens EPA-approved documentation from an Lumen Maintenance __80______at 40% rated lamp life industry association, or a test report from an (4,000 hour minimum) ISO 9000 registered facility. Test report from a lab accredited by NVLAP or one of its MRA signatories, an EPA Lamp Color Rendering Index __82______CRI approved Platform Letter of Qualification, or EPA-approved documentation from an industry association. 2700K 3000K 3500K Target CCT (circle one) Test report from a lab accredited by NVLAP 4100K 5000K 6500K or one of its MRA signatories, an EPA approved Platform Letter of Qualification, Lamp Correlated Color Temperature (CCT) Samples falling within 7-step Mac EPA-approved documentation from an _>90______% Adam ellipse industry association, or a test from an ISO 9000 registered facility. List ANSI-IEC Designated No documentation required at time of __G13_____ Lamp Base Type submittal. Lamp/Lampholder Compatibility ANSI-IEC Standardized Lamp? Yes OR No For fixtures that do not use an ANSI-IEC standardized lamp from ANSI C78.901 & If “Yes”, list ANSI-IEC Lamp C78.81 or IEC 60901 & 60081, supply a lamp _1005-1___ OR N/A Standard Data Sheet Number manufacturer specification sheet. Check box if lamp labeling A copy of the actual language that will be Lamp Labeling Requirement x requirement has been met: included on the lamp base or glass.

Revised – January 2005 Version 4.0 OMB No. 2060-0528

Electromagnetic and Radio Frequency Check box if the ballast meets FCC No documentation required at time of x Interference requirements for consumer use: submittal.

Test report from a lab accredited by NVLAP Ballast Frequency __24______kHz or one of its MRA signatories, an EPA approved Platform Letter of Qualification, Check box if ballast meets transient EPA-approved documentation from an Transient Protection x protection requirements: industry association, or a test report from the ballast or fixture manufacturer. For T4 and T5 lamps, test report from a lab Testing requirements met? Yes OR N/A accredited by NVLAP or one of its MRA signatories, an EPA approved Platform Letter End of Life Protection (Only required for of Qualification, EPA-approved ballasts with lamps sized T5 & smaller) documentation from an industry association, Maximum number of lamps shut down or a test report from the ballast or fixture _____ OR N/A when lamp end of life event occurs: manufacturer. For T3 lamps and smaller, a circuit diagram and engineering description. Dimming-Capable Ballast? Yes OR No No documentation required at time of Dimming Check one box if ballast is dimming- 3-Way Switching submittal, except when torchiere fixtures are capable: submitted. Continuous Dimming Safety – Ballasts and “Non Edison base Cover page of a safety test report or a general Listed for Safety? Yes OR N/A Fluorescent Adapters” coverage statement. Fixture Requirements (Only required for fixture submittals. Leave blank for lamp/ballast platform submittals.) Provide two-year fixture manufacturer written Check box if fixture warranty is included Fixture Warranty x warranty language that is included with with fixture packaging: product packaging. No documentation required at time of Noise <24 ______dBA submittal. A copy of the language that includes guidance on ballast replacement and states that the Check box if the submitted fixtures meet the Replaceable Ballast x ballast is replaceable with the use of a replaceable ballast requirement: “qualified electrician” without the cutting of wires.

Revised – January 2005 Version 4.0 OMB No. 2060-0528

SECTION II -- TEST RESULTS (continued): Enter results from test report (complete using average of tested samples) or manufacturer data as specified in the ENERGY STAR Program Requirements for Residential Light Fixtures Version 4.0 and attach required documentation to this form. Cover page of a safety test report or a general Safety – Portable Fixtures Listed for Safety? Yes OR N/A coverage statement. Cover page of a safety test report or a general Safety – Hardwired Fixtures Listed for Safety? Yes OR N/A coverage statement. Manufacturer documentation including total wattage consumed by all LEDs, manufacturer Do any of the submitted fixtures use Decorative LEDs Yes OR No warranty, and spec. sheet showing wattage, decorative LEDs? efficacy, LED life, color, and lumen depreciation. Do any of the submitted fixtures use a factory-installed device to permanently No documentation required at time of Permanent Conversions Yes OR No convert an Edison lamp base to a pin-base submittal. for fluorescents? Line Voltage Socket (LVS) Do any of the submitted fixtures use the No documentation required at time of Yes OR No Standard Design twist-and-lock LVS standard design? submittal. Do any of the submitted fixtures ship with Line Voltage Socket (LVS) self-ballasted pin-based lamps (i.e., No documentation required at time of Standard Design with Self-Ballasted Pin- Yes OR No integrated lamp and ballast) that use the submittal. Based Lamp twist-and-lock LVS standard design? For fixtures that are not shipped with lamps: Does the packaging include a NEMA or ANSI generic lamp description, including a Yes N/A color designation? Does the packaging suggest that the consumer select a lamp with a rated lamp Yes N/A life of 10,000 hours or more? For fixtures that are shipped with lamps: Does the packaging clearly describe the Yes N/A target CCT designation in Kelvin? Written copy or PDF graphic of the language Product Packaging for Consumer For recessed downlight fixtures that are IC-Rated: that will be displayed on product packaging Awareness Requirements Does the packaging clearly state this Yes N/A and within the packaging, as required. rating? For recessed downlight fixtures that are Air-Tight (AT) rated: Does the packaging include an “air-tight” or similar designation to clearly show that the fixture produces less air leakage than Yes N/A 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283? Is the fixture itself labeled “air tight,” or Yes N/A similar designation? Are installation instructions included? Yes N/A

ADDITIONAL TEST RESULTS FOR INDOOR RECESSED DOWNLIGHT RETROFIT KITS ONLY: When qualifying a recessed downlight retrofit kit for ENERGY STAR, the following documentation must be provided in addition to the information required above.

Reflector Type ______No supplemental documentation required

Aperture Size ______Inches No supplemental documentation required

Check box if submitted fixtures meet air Air Tight For Restricted Air Movement Manufacturer or laboratory data tight requirement:

Check box if submitted fixtures have an Manufacturer engineering description and/or Electrical Connections Edison lamp socket with wire “pigtail” to diagram describing electrical connection the ballast:

Check box if submitted fixtures meet safety Cover page of a safety test report or a general Safety – Fixture Conversions, Retrofits requirements for conversions & retrofits: coverage statement included

Fixture Compatibility List? Yes N/A Written copy or PDF graphic of the language Product Packaging for Consumer ASTM E283 Compliance Language? Yes N/A that will be displayed on product packaging as Awareness Requirements well as installation instructions Installation Instructions? Yes N/A

Revised – January 2005 Version 4.0 OMB No. 2060-0528 SECTION III -- FIXTURE MODELS WITH SAME LAMP/BALLAST COMBINATION: Does the lamp Typed Fixture Manufacturer Model Number Brand Name Fixture Type2 ship with Description Intended Use (circle all that apply) /Retail SKU1 fixture? Attached3 49012LE-15 Sea Gull Lighting Y N Living Room Kitchen Utility Room Garage, WM Y N Products, Inc. (for all) Laundry Room, Bathroom Hallway Bedroom Living Room Kitchen Utility Room Garage, 49015LE-05 Y N Y N WM Laundry Room, Bathroom Hallway Bedroom N Living Room Kitchen Utility Room Garage, 4903LE-09 Y N Y WM Laundry Room, Bathroom Hallway Bedroom Living Room Kitchen Utility Room Garage, 49056LE-02 Y N Y N WM Laundry Room, Bathroom Hallway Bedroom Living Room Kitchen Utility Room Garage, 49056LE-05 Y N Y N WM Laundry Room, Bathroom Hallway Bedroom Living Room Kitchen Utility Room Garage, 4916LE-61 Y N Y N WM Laundry Room, Bathroom Hallway Bedroom Living Room Kitchen Utility Room Garage, 4987LE-15 Y N Y N WM Laundry Room, Bathroom Hallway Bedroom Living Room Kitchen Utility Room Garage, 4989LE-68 WM Y N Y N Laundry Room, Bathroom Hallway Bedroom 59034LE-15 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 5914LE-15 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 5934LE-15 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 5934LE-34 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 5962LE-98 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 9511LE-15 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 9512LE-15 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom 9522LE-15 CM Y N Living Room Kitchen Utility Room Y N Garage, Laundry Room, Bathroom Hallway Bedroom Y N Y N Living Room Kitchen Utility Room Garage, Laundry Room, Bathroom Hallway Bedroom Y N Y N Living Room Kitchen Utility Room Garage, Laundry Room, Bathroom Hallway Bedroom 1. List all fixture models (and Retail SKU Number when applicable) that will use this lamp/ballast combination. Only one set of test results is required per lamp/ballast combination. 2. Fixture Type: CM = Ceiling Mounted, WM = Wall Mounted, RC = Recessed Canister, RCIC = IC-Rated Recessed Canister, RCAT = Air-Tight Recessed Canister, RCICAT = IC-Rated & Air-Tight Recessed Canister, RT = Recessed Troffer, SU = Suspended, PT = Portable, TO = Torchiere, UC = Under Cabinet, FC = Furniture/Cabinet Integrated, AR = Architectural, RDRK – Recessed Downlight Retrofit Kit, O = Other. NOTE: Although you may indicate more than one fixture type, only your first selection will appear on the ENERGY STAR Web site. 3. E.g. “This close-to-ceiling mount fixture features an antique brass finish coupled with a glass dome that has a subtle swirl pattern throughout the glass.” This is a marketing tool; all electronic photos that are submitted will be included in the ENERGY STAR Visual Catalog, which is sent to interested utilities and used by ENERGY STAR in its presentations. SECTION IV -- MARKETING REQUIREMENTS:

Upon approval of this product, the Partner will take steps to ensure that the ENERGY STAR mark will appear (check all that apply): _x__ On product packaging (required) _x__ In product literature (required) __x_ On Internet site (required)

Following ENERGY STAR acceptance of a product, partner has 90 days to fulfill the labeling requirements. ENERGY STAR reserves the right to remove a non-compliant product from the Web site after 90 days. Explain briefly in writing how you plan to implement the above listed labeling requirements within the timeline (use additional pages if necessary): _Sea Gull Lighting is committed to the Energy Star program and acknowledges the value in labeling and co-branding. All Sea Gull Lighting packaging will reflect the Energy Star rating when appropriate. The company strongly co-brands its collateral materials, as evidenced throughout its 74 page energy efficient lighting catalog, as well as by dedicating a website in support of Energy Star products. (www.energystarlights.com)

Revised – January 2005 Version 4.0 OMB No. 2060-0528 SECTION V -- SUBMITTAL PROCEDURE: 1. Fill out entire ENERGY STAR for Residential Light 6. Keep a copy of this form and attached Fixture Qualified Product Information Form. documentation for your records. 2. Fill out one form for each lamp/ballast combination. 7. Mail this form and attached documentation to: 3. For multiple fixture models using same lamp/ballast ICF Consulting combination list those fixture models in Section III. C/O Brooke Taylor 4. Attach ALL required testing and verification documentation. 1725 Eye Street NW, Suite 1000 5. Sign and date Section VI below. Washington DC 20006 SECTION VI -- VERIFICATION: (To be signed by senior representative of the fixture manufacturer)

I declare that the above information is accurate and true to the best of my knowledge. I understand that if any of the above information is found to be inaccurate by ENERGY STAR or any of ENERGY STAR’s contractors that the above products will be removed from the ENERGY STAR qualified product list, and that EPA may terminate the ENERGY STAR agreement between EPA and the responsible manufacturer.

Printed Name: ___Rebecca Gilmore______Manufacturer Signature: ______Date: ___9-20-05______Contact Email Address: [email protected]

Revised – January 2005 Version 4.0