Produce 5 Year Pre Tax Pro Forma - DOC by rgr17271

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									[SPECIFY RENEWABLE ENERGY OR ENERGY EFFICIENCY]



   APPLICATION FOR FEDERAL ASSISTANCE

   UNITED STATES DEPARTMENT OF AGRICULTURE

              RURAL DEVELOPMENT

RENEWABLE ENERGY SYSTEMS AND ENERGY EFFICIENCY
            IMPROVEMENTS PROGRAM




                 SUBMITTED BY:

                     NAME

                BUSINESS NAME

                   ADDRESS

                CITY, STATE, ZIP

                  TELEPHONE



                     DATE




                       1
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Table of Contents
Note: This Table of Contents is automatically generated from the document headings.
To re-generate it, right click within the Table of Contents and choose “Update Field” and
select “update page numbers only”. Be sure to do this before final printing!

(1) Forms, Certifications and Agreements ................................................... 3
(2) Project Summary ................................................................................... 4
(3) Financial Information ............................................................................. 5
(4) Matching Funds Information .................................................................. 6
(5) Self-Evaluation Scoring Worksheet ....................................................... 7
(6) Energy Assessment or Energy Audit (Energy Efficiency Only) .............. 8
(7) Technical Report ................................................................................... 9
(8) Business Feasibility Study ..................................................................... 9




                                                    2
(1) Forms, Certifications and Agreements

Attach the federal forms listed on this site and other certifications in the sequence
below:
                           Link to all forms listed below (click)

   SF-424
   SF-424C
   SF-424D
   DUN’S Number and Federal Tax ID Number
       Note: To get a DUNS number, see www.dunandbradstreet.com/US/duns_update/index.html or
       call 800.234.3867

   Request for Environmental Information, Form RD 1940-20
   AD-1049
   AD-1048
   Exhibit A-1, 1940-Q (for grants over $100,000)
   SF-LLL
   AD-1047
   RD 400-1
   RD 400-4
   Statement regarding any relationship with a USDA employee.
   Applicant Certification Regarding Demonstrated Financial Need
   Organizational Documents. Submit a copy of legal organizational documents, unless
    applying as a sole proprietorship.




                                              3
(2) Project Summary
This application is for a renewable energy system / energy efficiency
improvements. <delete one>
Applicant is an agricultural producer/rural small business <delete one>
Project Title:
Applicant Eligibility:
___ Project will be more than 51% owned by U.S. citizens
___Applicant has no outstanding Federal fines or judgments
___Applicant has not previously received a Section 9006 grant or loan guarantee or
received a grant in ____ and is making progress towards project completion as
evidenced by _______________________.


___Applicant is an Agricultural Producer. Provide evidence that 50% or more of gross income
comes from agricultural activity. Calculate from federal tax returns using Schedule F, Line 11 divided by
the sum of Form 1040, Line 22 + Schedule F, Line 35 + Schedule C, Lines 28 and 30). Attach forms as
documentation.
OR
___Applicant is a Rural Small Business. Provide evidence and documentation that your business
meets the definition of small business as defined by the Small Business Administration
(www.sba.gov/size/index.html) and rural as defined by USDA (www.ers.usda.gov/data/LoanLookup/)
NAICS Code: _____ Type of Business: ______________________________


Project Eligibility: Provide brief description of proposed project, explaining whether it is for
renewable energy or energy efficiency system and why it is eligible for funding under the program
guidelines. Include evidence that project is for commercial or pre-commercial technology and that project
is located in a rural area based on USDA definitions.




Operation Description: Describe your total farm/ranch/small business operation and the
relationship of this project to the operation (for example,” this project will be sited on my farmland and will
be used to produce income through the sale of wind-generated electricity”). Also, provide breakdown of
ownership interests in the operation and/or proposed project. Describe ownership, including a list of
individuals and/or entities with ownership interest, names of any corporate parents, affiliates, and
subsidiaries, as well as a description of the relationship, between these entities.




                                                      4
Financial Information and Size Determination: Provide statement and documentation for
verifying the size (gross receipts) of your operation. For Agricultural Producers, this would be Page 1 and
Schedule F of your previous year’s tax return. For businesses, provide sufficient information from your tax returns
or, for manufacturing businesses, verification of employee numbers.




(3) Financial Information
        Attach the following information and delete what does not apply:

        (A) Historical financial statements using                    Generally Accepted             Accounting
            Principles (GAAP) for past three years.

        (B) Current balance sheet and income statement

        (C) Pro forma financial statements reflecting capital costs, start up and
        operations of business financed by the grant for the first three years

        (D) Agricultural Producers Only: Financial information required for commercial
        agricultural lenders can be substituted for complete financial statements

        (E) Demonstration of Financial Need: Attach letter from lender stating that
        applicant cannot complete the project without a Section 9006 grant.




                                                        5
(4) Matching Funds Information
Attach spreadsheet showing all sources of capital for completing the project. See attached Excel template. This
template can be edited by clicking on it and working in it directly.

Matching Funds Worksheet
Section 9006 Grant Application
Project Applicant

Source of Funding:                      Amount ($)        Contact Information for Lenders

Total Project Cost                            $500,000

Applicant                                       $60,000
Other Equity Investors
 Investor A                                     $40,000 Bob Smith, 507-222-2222
 Investor B
 Investor C

Total Equity                                  $100,000

 Lender A                                     $250,000
 Lender B

Total Debt                                    $250,000

In-Kind Contributions                           $50,000

USDA Grant                                    $100,000
 As Percentage of Project Cost                    20%

Also attach letter from lender documenting loan commitment, if available.




                                                          6
(5) Self-Evaluation Scoring Worksheet
Use the attached worksheet to self-score your project. USDA and the National Renewable
Energy Laboratory will make final determinations of project scoring. See the following link for
scoring criteria: Energy Scoring Criteria

Scoring Criteria                      Total           Points        Explanation/Justification and
                                      Points          Assigned to   Application Page Reference
                                      Available       Project

Quantity         of         Energy        15
Replaced/Produced/Saved     (delete
what doesn’t apply)

Environmental Benefits                    10

Commercial Availability                   10

Technical Merit                           35              N/A       To be scored by NREL based on
                                                                    technical report content

Commitments of Matching Funds             15

Small Ag Producer/Very Small              10
Rural Business

Use of Simplified Application              5

Not a previous grantee or borrower         5

Return on Investment                      10

Total Project Score (sum of above)




                                                  7
(6) Energy Assessment or Energy Audit (Energy Efficiency Only)
Attach report from energy assessor or energy auditor regarding energy savings potential of proposed project. Note:
An energy audit from a certified energy auditor is required only for projects with total costs greater than $50,000.




                                                         8
(7) Technical Report
Attach technical report here. Technical reports for specific technologies should follow the format and answer
questions for the applicable technology as listed in Appendix B of final program rules published on July 18, 2005.

    (A) Project Team Qualifications
        Describe the qualifications (and attach resumes or other documentation) of project managers, key
        consultants and sub-contractors. Note: All renewable energy projects greater than $400,000 and energy
        efficiency projects greater than $200,000 must utilize the services of a licensed professional engineer.



    (B) Agreements and Permits
        Identify all agreements and permits required to construct the project and their current status

    (C) Energy or Resource Assessment
        Describe the resources being used (quality and quantity) to produce the renewable energy or expected
        energy savings through energy efficiency

    (D) Design and Engineering
        Describe the design, engineering, testing and monitoring required for the project.

    (E) Project Development Schedule
        Provide detailed project timeline with key milestones

    (F) Project Economic Assessment
        Describe financial performance of the project. Attach or refer to project financial statements attached
        above.

    (G) Equipment Procurement Plan
        Describe source and availability of the required equipment for the project.

    (H) Equipment Installation Plan
        Describe the plan for site preparation and equipment installation .

    (I) Operations and Maintenance Plan
        Describe operations and maintenance requirements, major rebuild requirements and major component
        warranties.

    (J) Project Decommissioning Plan
         Describe plans for dismantling project at end of the project’s economically useful life.




(8) Business Feasibility Study
For renewable energy projects, attach business-level feasibility study prepared by a
qualified independent consultant. Study should include market assessment for
renewable energy to be produced and technical, financial and management feasibility.


                                                          9

								
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