ORGANIZATIONAL INFORMATION
Organization Name:
Mailing Address: City: State: CO Zip: County:
Project Site Address (if different): City: State: CO 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:
Please indicate your organizational status: Private 501(c)3 non-profit Governmental Private for-profit Other
2008-2009 GRANT REQUEST
Project Amount:
Solar Rebate:
Rebate Provider:
Solar Renewable Energy Credits:
Federal Investment Tax Credit:
Final Amount Requested:
Describe briefly how you arrived at this amount (100 words or less):
To be eligible for this grant, applicants must conduct an energy audit BEFORE applying for the grant. Certificates can be submitted in lieu of an audit. Please indicate certificates:
Energy Star
HERS
LEED
Other
Energy Audit by certified rater (Please include a copy of report with hard copy attachments)
PROJECT DESCRIPTION
What is the project type:
Photovoltaic Panel Installation
Total system size: kW (DC nameplate rated capacity)
Mount: Roof Ground
Azimuth:
Tilt Angle:
PV Watts estimated annual production: kWh/year
Estimated percentage of optimum orientation production based on actual installation tilt and azimuth: %
Is the array completely free of shade between the hours of 9am and 3pm? Yes No
Equipment information:
Panel brand, model, power rating, quantity:
Inverter brand, model, power rating, quantity:
INSTALLER INFORMATION
Company Name:
Company Website:
Company Address:
Project Contact Name:
Contact Email:
Installation warranty term offered:
Client Service Agreement offered: Yes No
Payback Analysis performed: Yes Please include a copy of report with hard copy attachments.
Installer Qualifications/Certifications held:
EXPECTED OUTCOMES
Please describe the intended beneficiaries of this project and how they will directly benefit (100 words or less):
What do you expect to accomplish in the first 6 months of the project (100 words or less)?
Will you own the final structure:
If no, please explain (100 words or less):
ADDITIONAL ORGANIZATIONAL INFORMATION
Please indicate the counties that you serve:
Please list your current Board Members:
Name
Please list staff positions involved with the project and the years of service with the organization:
Title
General description of Housing Projects Completed in the Last Five Years:
Year
Funded in full or part by EOC? ===
Does your agency have a non-discrimination policy that includes race, ethnicity, gender, sexual orientation and religion? Yes No Does your organization have an established accounting system and conduct an annual audit? Yes No If yes, please identify the CPA firm that conducted your most recent audit: And the year of your most recent audit:
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 Star, HERS, LEED or other certificate OR copy of Energy Auditor's report and invoice • Solar Energy Audit including payable analysis report and copy of audit receipts • Signed Certification Form Mailing Address: Energy Outreach Colorado Attn: Energy Solutions Grants 225 E 16th Ave Ste 200 Denver, CO 80203
