CARBON PROJECT by HC12070400387


									                                                                                        CARBON PROJECT

                                                                               VALIDATION, VERIFICATION,


Company Legal Name:                                                               dba*:
                      Date:                                                       Jurisdiction of
   Type of Legal Entity:
       Primary Contact:                                                           Title:
       Mailing Address:
                       City:                                          State/                        Country:
                  Email(s):                                                                    Post. Code:
Tel:                                  Fax:                                      Website:
       * ”doing business as” – for contracting purposes please ensure that your company’s full legal name is listed above.

Project Title:
Nearest City:                                                                  State:
Project Proponent:
Organization Type:

Project Type(s):               Afforestation:                                      Reforestation:
                               Improved Forest Management                          REDD / Avoided Conversion
                               Agricultural Land Management                        Other:
Total Project Area:                      Hectares           Acres              Number of Sites:
Land Tenure:                   Private Company                                     Public Agency
                               Group or Co-operative                               Community / Indigenous Land
Project Start Date:                                                            Project Length:
Estimated total emissions reductions / sequestration:                                   tonnes CO2e per year

       Rainforest Alliance Carbon Application 01May12 (C-10)                                                      Page 1 of 4
                                                                                    tonnes CO2e over project life
 Brief Description of Project:

VCS = Verified Carbon Standard, CCBA = Climate, Community, Biodiversity Alliance, ACR = American Carbon Registry, CAR =
Climate Action Reserve

     VCS Validation
 Name of methodology used:
 Is Methodology VCS approved:                         Yes                          No                         Submitted for VCS
 PDD Status:                                          Not started                  In progress                 Complete
 Risk assessment and buffer                           Not started                  In progress                 Complete
 determination status:
 Market leakage assessment (REDD or                   Not started                  In progress                 Complete
 IFM projects only)

     VCS Methodology Approval Process
                                                        st                                                         nd
 Assessment requested:                                1                                                        2
     nd             st
 If 2 , state the 1 assessor:

     VCS Verification
 Name of methodology used:
 Monitoring Report Status:                            Not started                  In progress                 Complete

     CCBA Validation
 PDD Status:                                          Not started                  In progress                 Complete

     CCBA Verification
 Monitoring Report Status:                            Not started                  In progress                 Complete

     CAR Verification
 Date project was submitted to the Reserve:
 Initial site verification                            Yes                                             No
 Verification type:                                   Desk review                                     Site visit

     CarbonFix Certification
 Project status:                                       Not yet submitted           Submitted for pre-         Pre-validation
                                                   for pre-validation          validation                   complete

     Plan Vivo Verification
 Project status:                                      Validation                   Project                     Validation

          Rainforest Alliance Carbon Application 01May12 (C-10)                                              Page 2 of 4
                                                requested                    undergoing validation       complete
Please detail the service requested:

   ACR Verification
Project status:                                    Not yet submitted for eligibility              Eligibility screening
                                                screening                                       completed
GHG Project Plan Status                             Not started                  In progress                 Compete
GHG Assertion Status                                Not started                  In progress                 Compete
Please detail the service requested:

   Other carbon evaluation type
Please detail the service requested:

       When would you be ready for evaluation?



       It is the policy of the Rainforest Alliance to ensure that there is clear transparency and
       independence in our carbon validation and verification program and decision-making
       processes and to identify and address any actual or potential conflicts of interests
       involving Rainforest Alliance and any party with whom we enter into an agreement. To
       assist us in complying with this policy, please Identify any potential conflict of interest
       regarding the requested services within this application . If no known conflict of interest
       is identified please indicate “No known conflict of interest”.

       Potential or Real Conflict of Interest:

           No known conflict of interest

         Examples of potential conflict of interest would be any situation that would compromise Rainforest
       Alliance’s ability to perform a wholly independent validation or verification of the requested service identified
       in this application.

       Rainforest Alliance Carbon Application 01May12 (C-10)                                               Page 3 of 4
- Application Contact Page -

Please use the following Rainforest Alliance Regional Office contact matrix for submitting your
application. Please use the location of your project site to select a regional office. Applications for
methodology reviews or multi-regional projects should be sent to the global address.

                                                                          Rainforest Alliance Regional Office /
         Region                        Contact Details
                                                                                 Partner Organization
Global                                            Headquarters
                                            Jared Nunery
                                    Carbon Technical Specialist
                                         Rainforest Alliance
                                       65 Millet St., Suite 201
                                     Richmond, VT 05477 USA
                                      Tel: +1 802 - 434 - 8732
                                      Fax: +1 802 - 434 - 3116
Africa                                      Africa Regional Office
Asia, Australia, New                   Asia-Pacific Regional Office
Zealand                      Pertokoan Griya Alamanda, Blok No. 17
                         Jl. Kapten Cokorde Agung Tresna, Lingkungan
                       Jayagiri, Kelurahan Dangin Puri Kelod, Kecamatan
                                          Denpasar Timur
                                Denpasar – Bali INDONESIA 80234
                                       Tel (+62) 361/256-689
                                       Fax (+62) 361/256-634
Brazil                                    Contact, Imaflora               Imaflora
                            Rua Chico Mendes 185, Caixa Postal 411
                            Piracicaba, Sao Paolo, BRASIL 13400-390
                                    Tel/Fax (+55) 19/3414-4015
Canada                                      Canada Regional Office
                                      3-929 Beach Blvd
                                   Hamilton, ON L8H 6Z6
                                    Phone: 647-899-7214
                                      Fax: 866-438-1971
Central America,                       Mesoamerica Regional Office
CARICOM/Caribbean                8ª. Avenida 15-62, Zona 10
                                Guatemala City, GUATEMALA
                                    Tel (+502) 2383 5757
                                    Fax (+502) 2383 5788
Europe and Russia                      Contact NEPCon                     NEPCon

Mexico                                    Mesoamerica Regional Office – Mexico
                              Margarita Maza de Juárez 422, Col.
                                    Centro Oaxaca, Oaxaca,
                                      MÉXICO CP 68000
                       Tel/Fax +52 (951) 502-6473 / 502-6532 / 132-8567
South America                         South America Regional Office
(except Brazil)               Calle Manual Ignacio Salvatierra 359
                                             (2˚ Piso)
                                      Santa Cruz, BOLIVIA
                                      Tel +591 3 332-5042
                                     Fax +591 3 332-7451
United States of                                US Regional Office
America                         801 Highway 3 North, Suite 200
                                      Northfield, MN 55057
                                       Tel (507) 663-1115
                                      Fax (507) 663-7771

Rainforest Alliance Carbon Application 01May12 (C-10)                                              Page 4 of 4

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