SMALL BUSINESS ADVANTAGE GRANT APPLICATION INSTRUCTIONS

Transcription

1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION SMALL BUSINESS OMBUDSMAN OFFICE SMALL BUSINESS ADVANTAGE GRANT APPLICATION INSTRUCTIONS Each application will be reviewed as submitted. If an application is missing any required information it will be deemed deficient and the application will be routed through the Deficiency Process identified in the Step-By-Step Guide to Applying. Prior years application forms will be returned without review. All application fields must contain a response. If a portion of the application does not apply to a project, the abbreviation NA should be written in the information field. Utilize the fields on the form, if more space is needed attach additional sheets as required. Write the owner s name and the application section number at the top of all extra pages. Staple all the sheets together. Type or print legibly all items except the owner s signature in Section 10. Printed applications must be in black or blue ink. SECTION 1 - OWNER INFORMATION Commonwealth of Pennsylvania Vendor ID#: An accurate Commonwealth of Pennsylvania vendor ID is required. The vendor ID number can be obtained by visiting click on Non-Procurement Vendor Site then Non-Procurement Registration Form or by calling , Monday through Friday. Please note that the process to obtain a vendor ID number takes several days. Federal Employee Identification Number (EIN): This information must be identical to that on file with the PA Vendor Data Management Unit. Owner Name Name of the owner, president or CEO of the applying business. Company Legal Name Must be legal name of the applying business. If operating under a fictitious name, include the legal name and fictitious name. Example: Jane Smith DBA Jane s Flower Shop. This information must be identical to that on file with the PA Vendor Data Management Unit. Enter the number of employees for the entire company worldwide. To count part-time employees, applicant should include its full-time equivalent employees. Must have 100 or fewer full-time equivalent employees. Type of Entity Check the applicable box. Address This information must be identical to that on file with the PA Vendor Data Management Unit. Type of Business Dentist, Hair Salon, Restaurant, Dry Cleaner, etc. Telephone Number Business telephone number. Contact Name Designated contact person for the company. All correspondence will be sent to this person. Phone Number Phone number of the designated contact person. Address address of the designated contact person

2 Permitted Facilities: You must check Not Applicable or identify the permitted processes in the spaces provided. Examples include, but are not limited to, the following: wastewater treatment systems, air purification systems or water treatment systems. DEP permit type Permit number Date issued Compliance status: Check Yes or No accordingly for any permitted processes or equipment at the company SECTION 2 - PROJECT INFORMATION Project Title Identify the title of the project; for example Installation of high efficiency boiler. Type of Project Check appropriate box. Technology Type Check all boxes that apply to the project. SECTION 3 - PROJECT COSTS AND TIMEFRAME The grant request may be up to a maximum of $9,500. The Amount of Grant Request cannot be more than 50 percent of the Total Eligible Cost of Project. Total Project Cost Total amount of the project. Amount of Rebate/Incentive Amount of rebate/incentive received for any equipment submitted as part of this application. Example: Act 129 rebate from utility company Total Eligible Cost of Project Total cost of project minus amount of rebate/incentive. Amount of Grant Request The amount of funding you are requesting. Estimated Project Start Date Estimated date that the project is to start. MUST BE ON OR AFTER JULY 27, Estimated Project Completion Date Estimated date that the project will be complete. MUST BE ON OR BEFORE JUNE 30, SECTION 4 - PROJECT LOCATION Identify location where project investment is to be made. Do not use PO Box numbers. SECTION 5 - PROJECT SUBCONTRACTOR/VENDOR Identify all subcontractors providing equipment and services. Identify contact person s name, title, phone number, and . Identify company name, address, and EIN number

3 SECTION 6 - PROJECT SCOPE/BENEFITS SUMMARY In this section, you will provide a detailed description of the project, including but not limited to the following: What and how this funding will impact the business. Describe what the project will accomplish and a timetable for the project tasks. Explain how this project will reduce pollution or energy consumption and include an explanation of the economic and environmental advantages offered by this project over the current process or technology. Include any process audit recommendations resulting from a site assessment of the process or service impacted. Provide a statement quantifying any energy or resource reduction along with any pollution or emission prevention; for example, kwh saved or pounds of waste prevented, etc. Provide the unit cost for each item, waste/emission or energy/resource in Section 8 ($/gal, $/kwh, $/Mcf, $/ton, $/month, etc.) of the application. SECTION 7 - EQUIPMENT/CONTRACTED SERVICES Equipment and labor must be identified separately. Provide an accurate, clear, detailed and itemized list of the following: Equipment Attach brochures, equipment specifications, or other information from the manufacturer or vendor. Type of equipment, manufacturer, and model number Cost of the equipment Is the equipment ENERGY STAR rated Yes/No Contracted Service/Labor (Labor costs of the applicant s own employees, even if such costs are incurred in the acquisition and installation of the project, are not eligible). Describe contracted service i.e., installation of LED lighting, HVAC, etc. Cost of service SECTION 8 - POLLUTION PREVENTION (P2) AND ENERGY EFFICIENCY (E2) QUANTIFICATION This section displays the type(s) of pollution being reduced, resource(s) usage being offset and the energy reduction described in SECTION 6 PROJECT SCOPE/BENEFITS SUMMARY. Total Cost Savings are also identified in this section. Complete Section 8.A. only if the project is pollution prevention. Complete Section 8.B. only if the project is energy consumption. Applicants submitting applications for Anti-Idling technology should complete Section 8.B. only. Note about new construction: For assistance calculating savings for projects not involving the replacement of existing equipment or materials, it may be helpful to refer to the EPA ENERGY STAR, Business Improvements website at

4 A. Pollution Prevention (P2) (Pollution, waste or emissions being reduced) EXISTING EQUIPMENT Use one line for each type of pollution, waste and/or emission. Identify the type of pollution, waste, or emission. Column A - Provide the Waste/Emission unit price and unit of measure. Column C - Calculate the Annual Cost by multiplying the Waste/Emission Unit Price by the Annual Volume. If you have multiple items, complete the equation above for each item and then total your Annual Cost (Column C) at the bottom of the EXISTING EQUIPMENT section. REPLACEMENT EQUIPMENT Use one line for each type of pollution, waste and/or emission. Identify the type of pollution, waste, or emission. Column A - Provide the Waste/Emission unit price and unit of measure. Column C - Calculate the Estimated Annual Cost by multiplying the Waste/Emission Unit Price by the Annual Volume. If you have multiple items, complete the equation above for each item and then total your Estimated Annual Cost (Column C) at the bottom of the REPLACEMENT EQUIPMENT section. POLLUTION PREVENTION (P2) QUANTIFICATION RESULTS Total Estimated Cost Savings (P2) Existing Equipment Total Current Annual Cost minus Replacement Equipment Total Estimated Annual Cost. (Existing Equipment Total in Column Replacement Equipment Estimated Total in Column C = Total Estimated Cost Savings) Estimated Savings in Percentage (P2) Total Estimated Cost Savings divided by Existing Equipment Total Current Annual Cost, multiplied by 100 = Estimated Savings in Percentage. B. Energy Efficiency (E2) (Water, raw materials, energy being conserved etc.) EXISTING EQUIPMENT Use one line for each type of energy and/or resource. Identify the type of energy/resource. Column A - Provide the Energy/Resource unit price and unit of measure

5 Column C - Calculate the Annual Cost by multiplying the Energy/Resource Unit Price by the Annual Volume. If you have multiple items, complete the equation above for each item and then total your Annual Cost (Column C) at the bottom of the EXISTING EQUIPMENT section. REPLACEMENT EQUIPMENT Use one line for each type of energy and/or resource. Identify the type of energy/resource. Column A - Provide the Energy/Resource unit price and unit of measure. Column C - Calculate the Estimated Annual Cost by multiplying the Energy/Resource Unit Price by the Annual Volume. If you have multiple items, complete the equation above for each item and then total your Annual Cost (Column C) at the bottom of the REPLACEMENT EQUIPMENT section. ENERGY EFFICIENCY (E2) CONSERVATION QUANTIFICATION RESULTS Total Estimated Cost Savings (E2) - Existing Equipment Total Current Annual Cost minus Replacement Equipment Total Estimated Annual Cost. (Existing Equipment Total in Column C Replacement Equipment Estimated Total in Column C = Total Estimated Cost Savings) Estimated Savings in Percentage (E2) Total Estimated Cost Savings divided by Existing Equipment Total Annual Cost, multiplied by 100 = Estimated Savings in Percentage. SECTION 9 - RESULTS SUMMARY OF SAVINGS In this section you will record your results for Pollution Prevention (P2) and Energy Efficiency (E2) from section 8.A. and/or 8.B. Provide the Total Eligible Cost of this Project Total Project Costs minus applicable rebate/incentive. Must match Total Eligible Cost of Project in Section 3. Provide the Pollution Prevention (P2) Total Estimated Cost Savings from 8.A. Provide the Pollution Prevention (P2) Estimated Savings in Percentage from 8.A. Provide the Energy Efficiency (E2) Total Estimated Cost Savings from 8.B. Provide the Energy Efficiency (E2) Estimated Savings in Percentage from 8.B. In order to meet eligibility requirements, your equations must show that your project will save a minimum of $500 and at least 25% annually in energy consumption/pollution output

6 If the project resulted in both pollution and energy savings, the applicant can combine the Pollution Prevention (P2) Total Estimated Cost Savings from 8.A. with the Energy Efficiency (E2) Total Estimated Cost Savings from 8.B. in order to meet the minimum eligibility requirements of $500 and 25%. Complete the tables in Part 2. Provide the Pollution Prevention (P2) Total Estimated Cost Savings from P2 in Part 1. Provide the Energy Efficiency (E2) Total Estimated Cost Savings from E2 in Part 1. Total Estimated Cost Savings: P2 + E2 = Total Estimated Cost Savings. Provide the Pollution Prevention (P2) Total Annual Cost for EXISTING equipment from 8.A. Provide the Energy Efficiency Annual Cost for EXISTING equipment from 8.B. Total Current Annual Cost: P2 + E2 = Total Current Annual Cost. Total Estimated Cost Savings: Total Estimated Cost Savings from Part 2 divided by Total Current Annual Cost x 100 = %. SECTION 10 - COMPANY COMMITMENT Identify Company Name Must match Company Legal Name identified in Section 1. Identify Name and Title of the owner, president, or CEO of the applying business. Signature Signature of owner, president, or CEO. Original signature is required. Date Date signed by owner, president, or CEO. address of owner, president, or CEO. Phone number of owner, president, or CEO