Energy Solutions Grants Application

EOC Energy Solutions Grants Application

ORGANIZATIONAL INFORMATION

Organization Name:

Mailing Address:

City: State: Zip: County:

Project Site Address (if different):

City: State: Zip: County:

Gas Utility Provider for Project Site:

Who pays the gas utility bill?:

Electric Utility Provider for Project Site:

Who pays the electric utility bill?:

Contact Name: Title:

Phone Number: Email Address:

Alternate
Contact Name: Title:

Phone Number: Email Address:

Please indicate your organizational status:

2008-2009 GRANT REQUEST

Project Amount Requested:	$
Energy Audit Cost:	$ No more than 20% of project amount
Administration Amount Requested:	$ No more than 5% of overall budget
Total Amount Requested:	$

Describe briefly how you arrived at this amount (100 words or less):

PROJECT DESCRIPTION

What is the project type:
What is the scope of the work:
Project status (please select all that apply):
Under consideration
Partially funded
Work underway
Other - please describe (100 words or less):

Please describe the intended beneficiaries of this project and how they will directly
benefit (100 words or less):

EXPECTED OUTCOMES

What do you expect to accomplish in the first 6 months of the project (100 words or less)?

CONSERVATION INVESTMENTS AND TOTAL ANTICIPATED COST OF PROJECT

Will you own the final structure:
If no, please explain (100 words or less):


Energy audit data will be submitted (please select all that apply):
with application	with mid-year report
with final report

Please list the measures that will be installed for this grant. Ask your energy rater to provide the estimated cost and estimated annual savings:
Measure With Details (Values)	# of Dwellings	Estimated Cost Per Measure	Total Estimated Cost	Energy Outreach Share of Cost	Est. Annual Energy Savings
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ADDITIONAL ORGANIZATIONAL INFORMATION

Please indicate the counties that you serve:

Adams Alamosa Arapahoe Archuleta Baca

Bent Boulder Broomfield Chaffee Cheyenne

Clear Creek Conjeos Costilla Crowley Custer

Delta Denver Dolores Douglas Eagle

El Paso Elbert Fremont Garfield Gilpin

Grand Gunnison Hinsdale Huerfano Jackson

Jefferson Kiowa Kit Carson La Plata Lake

Larimer Las Animas Lincoln Logan Mesa

Mineral Moffat Montezuma Montrose Morgan

Otero Ouray Park Phillips Pitkin

Prowers Pueblo Rio Blanco Rio Grande Routt

Saguache San Juan San Miguel Sedgwick Summit

Teller Washington Weld Yuma Statewide

Please list your current Board Members:

Name	Occupation

Please list staff positions involved with the project and the years of service with the organization:

Title	# of Years with Organization

General description of Housing Projects Completed in the Last Five Years:

Does your agency have a non-discrimination policy that includes race, ethnicity, gender, sexual orientation and religion?

Does your organization have an established accounting system and conduct an annual audit?

If yes, please identify the CPA firm that conducted your most recent audit:
And the year of your most recent audit:

If no, please explain (100 words or less):

How do you plan to recognize Energy Outreach Colorado?

Please submit a hard copy of the following attachment by mail:

• Current housing project budget with sources of revenue listed including:
- Conditions upon funding sources (grant vs. loan, population to be served)
- Status of each funding source (committed; pending)
• Latest annual report
• A complete copy your audited financial documents including profit & loss, income statement, balance sheet and management letter, if applicable.
• Letter of support from property owner, if necessary
• Copy of Energy Auditor's report and invoice, if available
• Signed Certification Form

Mailing Address:
Energy Outreach Colorado
Attn: Energy Solutions Grants
225 E 16th Ave Ste 200
Denver, CO 80203