Section Simplified Application Energy Efficiency Technical Worksheet

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					Section 9006, Simplified Application Energy Efficiency Technical Worksheet
(Total Eligible Project Costs of $200,000 or less) Document Checklist Attach the following documentation: 1. Energy Assessment (if total project cost < $50K*) Middle Initial: including a baseline history of energy use (measured in kWh, BTUs or Therms) and expected energy savings Last Name: resulting from installation of the energy efficiency measure(s) (in kWhs, BTUs or Therms). A good way Company/Organization (if applicable): to provide baseline energy use is to include copies of one to three years of past utility bills. Provide Project Name: references such as manufacturer’s specification sheets that show anticipated energy savings………………… Applicant Information First Name: *Note: Projects with total project costs of $50,000 or less receive extra points for completing an energy audit. 2. Energy Audit required if total project cost >$50K by an independent, qualified entity that documents current energy usage based on utility bills or manufacturers specifications, recommended improvements, their costs and expected energy savings………………….. For more information, please see the attached guidance on energy assessments and energy audits. Section a: Qualifications of key service providers. Company/Organization Name: First Name: Last Name: Title: Daytime Phone (include area code): Web Site: Mailing Address: City: State: Zip: Function: Last manufacturer workshop attended: Credentials and years of related experience: Number and type of similar systems installed: Company/Organization Name: First Name: Last Name: Daytime Phone (include area code): Mailing Address: City: State: Zip: Function: Last manufacturer workshop attended: Credentials and years of related experience: Number and type of similar systems installed: Company/Organization Name: First Name: Last Name: Daytime Phone (include area code): Mailing Address: City: State: Zip: Function: Last manufacturer workshop attended: Credentials and years of related experience: Number and type of similar systems installed:

Title: Web Site:

Title: Web Site:

Disclaimer: This technical requirements worksheet is applicable only for projects eligible under the Section 9006 Simplified Application Process (total eligible project costs $200,000 or less). This worksheet is provided by the National Renewable Energy Laboratory (NREL) to assist applicants in meeting technical requirements contained in Appendix A of 7 CFR Part 4280. This worksheet is meant for guidance purposes only, and is not considered a requirement of the program. The above rule is the final authority for application requirements.

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Section b: Agreements, permits, and certifications. (1) Identify all required building agreements and permits. Building have permit attached initiated needs to be sent none required Electrical have permit attached initiated needs to be sent none required Zoning have permit attached initiated needs to be sent none required Other have permit attached initiated needs to be sent none required (2) Environmental Are there any additional environmental concerns that are not previously identified on Form RD 1940-20? Yes No If yes, describe:

Section c: Energy assessment. Briefly describe current building/facility/process to be modified:

Briefly describe the recent performance history (energy or other) of current building/facility/process to be modified:

Briefly list and describe the proposed energy efficiency improvement(s) and indicate the type of energy to be saved (electricity, gas) and quantity of energy to be saved in kWh, BTUs or Therms for each measure proposed.

Estimated Average Annual Energy Savings of EE Measures:

kWh

Therms

BTUs

Section d: Design and engineering. Do the Energy Efficiency Measures proposed in this project reflect the recommended priorities of the Energy Assessment/Audit…………………………………………………………………………………………... Yes No If No, please explain: Identify suppliers and providers of major pieces of equipment Type of Equipment Supplier Model Number

Function

Section e: Project development schedule. Check boxes to indicate activity: Month 1 Week
Equipment is ordered Equipment arrives Construction Startup and Shakedown

2 4 5 6 7 8 9 10

3 11 12

1

2

3

Disclaimer: This technical requirements worksheet is applicable only for projects eligible under the Section 9006 Simplified Application Process (total eligible project costs $200,000 or less). This worksheet is provided by the National Renewable Energy Laboratory (NREL) to assist applicants in meeting technical requirements contained in Appendix A of 7 CFR Part 4280. This worksheet is meant for guidance purposes only, and is not considered a requirement of the program. The above rule is the final authority for application requirements.

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Section f: Project economic assessment. Costs of project components: Provide a list of eligible project components and cost. $ $ $ $ $ $ $ $ $

Total eligible project cost: Simple payback calculation:
Simple Payback Period (in years) = Total Eligible Project Cost ($) -----------------------------------------------------Annual Savings ($/year)

Where: Annual Savings ($/year) = Estimated Annual Energy Savings (Units of Energy/year) x Local Cost of Unit of Energy ($/Unit of Energy)

Provide calculation here or attach a separate sheet :

Describe any other incentives or savings not included in the simple payback calculation. This may include savings such as those resulting from reduced processing time or reduced maintenance costs.

Section g: Equipment procurement. Certify that "open and free" competition will be used in the procurement of components in a manner consistent with the requirements of 7 CFR part 3015 of this title. See the Technical Requirements Certifications form. Section h: Equipment installation. Is there a plan for “Startup and Shakedown” or Commissioning of the equipment? Yes No If yes, briefly describe:

The equipment must be installed in accordance with all applicable safety and work rules. See the Technical Requirements Certifications form. Section i: Operations and maintenance. Design life of system: Indicate length (years) of warranty for equipment and other warranty elements: Has a responsible party been designated to provide Operations and Management Support……… If yes, list the responsible party: Does the project have unique operation issues? Yes No If yes, please explain:

Yes

No

Section j: Dismantling and disposal of project. Is there a plan for dismantling and disposal? Yes Please describe:

No

Disclaimer: This technical requirements worksheet is applicable only for projects eligible under the Section 9006 Simplified Application Process (total eligible project costs $200,000 or less). This worksheet is provided by the National Renewable Energy Laboratory (NREL) to assist applicants in meeting technical requirements contained in Appendix A of 7 CFR Part 4280. This worksheet is meant for guidance purposes only, and is not considered a requirement of the program. The above rule is the final authority for application requirements.

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Technical Requirements Certifications Small Energy Efficiency: Total project cost of $200K or less
WHEREAS, __ ______________ herein call the “Grantee”, intends to obtain assistance from the United States of America, acting through the U.S. Department of Agriculture, herein called the “Government”, acting under the provisions of the Renewable Energy Systems and Energy Efficiency Improvements Program, 4280-B regulations.

NOW THEREFORE, the Grantee hereby certifies the following technical requirements have been or will be met:
1. The proposed project will be installed according to applicable federal, state, and

local codes.
2. For this project, “open and free” competition will be used for the procurement of

components in a manner consistent with the requirements of 7 CFR part 3015 of this title.

3. Equipment installation will be made in accordance with all applicable safety and

work rules. Additionally, the Grantee agrees that upon successful system installation and following established operation, the successful applicant must deliver invoices and evidence of payment.

4. Project components will be dismantled or disposed of as appropriate or if

necessary to ensure public safety at the end of their useful lives.

5. Project developer will hold appropriate liability insurance.

6. The project will be completed within two years from date of the approval.

IN WITNESS WHEREOF, I have executed this

day of

, 20

.

________________________________ Grantee ________________________________ Grantee
Disclaimer: This technical requirements worksheet is applicable only for projects eligible under the Section 9006 Simplified Application Process (total eligible project costs $200,000 or less). This worksheet is provided by the National Renewable Energy Laboratory (NREL) to assist applicants in meeting technical requirements contained in Appendix A of 7 CFR Part 4280. This worksheet is meant for guidance purposes only, and is not considered a requirement of the program. The above rule is the final authority for application requirements.

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Additional Information & Guidance Energy Assessments and Energy Audits for the Section 9006 Program
Energy assessments All energy efficiency improvement projects with total eligible project costs of $50,000 or less must provide an energy assessment. The energy assessment must include adequate and appropriate evidence of energy savings expected when the proposed system is operated as designed. This assessment should be conducted by an experienced energy assessor, certified energy manager or professional engineer from an independent firm or the local utility. The energy assessment must cover the following: Situation report Provide an assessment of current energy cost and efficiency by analyzing energy bills and briefly surveying the target building, machinery, or system. Potential improvements Identify and provide a savings and cost analysis of low-cost/no-cost measures. Estimate the overall costs and expected annual energy and cost savings from these improvements. Energy audits An energy audit must be conducted for all energy efficiency improvement projects with total eligible project costs greater than $50,000. An energy audit is a written report by an independent, qualified party that focuses on potential capital-intensive projects and involves detailed gathering of field data and engineering analysis. The audit provides detailed project costs and savings information with a high level of confidence sufficient for major capital investment decisions. Typically, Certified Energy Managers and Professional Engineers qualify as independent qualified parties; however the vendor and the applicant do not qualify. An energy audit may also be performed by the local utility. The methodology of the energy audit must meet professional and industry standards. The energy audit must cover the following: Situation report Provide a narrative description of the facility or process, its energy system(s) and usage, and activity profile. Also include price per unit of energy (electricity, natural gas, propane, fuel oil, renewable energy, etc.,) paid by the customer on the date of the audit. Any energy conversion should be based on use rather than source. Potential improvements List specific information on all potential energy-saving opportunities and their costs.

Disclaimer: This technical requirements worksheet is applicable only for projects eligible under the Section 9006 Simplified Application Process (total eligible project costs $200,000 or less). This worksheet is provided by the National Renewable Energy Laboratory (NREL) to assist applicants in meeting technical requirements contained in Appendix A of 7 CFR Part 4280. This worksheet is meant for guidance purposes only, and is not considered a requirement of the program. The above rule is the final authority for application requirements.

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Technical analysis Discuss the interactions among the potential improvements and other energy systems.  Estimate the annual energy and cost savings expected from each improvement identified in the energy audit.  Calculate all direct and indirect costs of each improvement.  Rank potential improvement measures by cost-effectiveness. Potential improvement description Provide a narrative summary of the potential improvement(s) and its ability to provide needed benefits, including a discussion of nonenergy benefits.  Provide preliminary specifications for critical components.  Provide preliminary drawings of project layout, including any related structural changes.  Document baseline data compared to projected consumption, together with any explanatory notes. When appropriate, show before-and-after data in terms of consumption per unit of production, time or area. Include at least 1 year's bills for those energy sources/fuel types affected by this project. Also submit utility rate schedules, if appropriate.  Identify significant changes in future related operations and maintenance costs.  Describe explicitly how outcomes will be measured.

Disclaimer: This technical requirements worksheet is applicable only for projects eligible under the Section 9006 Simplified Application Process (total eligible project costs $200,000 or less). This worksheet is provided by the National Renewable Energy Laboratory (NREL) to assist applicants in meeting technical requirements contained in Appendix A of 7 CFR Part 4280. This worksheet is meant for guidance purposes only, and is not considered a requirement of the program. The above rule is the final authority for application requirements.

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