Solar Ground Lease Agreement

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					                                         Solar Thermal Incentive Program




            SOLAR THERMAL INCENTIVE



            APPLICATION FORM

              Program Opportunity # CCEF-ST-001
                         Version 1




               FOR   RESIDENTIAL PROJECTS




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                     APPLICATION FORMS
                                                            Solar Thermal Incentive Program

   Questions or clarifications about this document should be directed to:

            Connecticut Clean Energy Fund
            200 Corporate Place, 3rd Floor
            Rocky Hill, CT 06067
            Telephone: 860.563.0015
            FAX:         860.563.4877
            E-mail:      solarthermal@ctcleanenergy.com


   This document is available on the following Web site:

            Connecticut Clean Energy Fund
            http://www.ctcleanenergy.com/solarthermal




            Applicants should review the Application Instructions, located on CCEF’s
                  Web site, carefully before completing the Application Forms.




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                                  APPLICATION FORMS
Incentive Application                                             Solar Thermal Incentive Program


   General Instructions
   This Solar Thermal Incentive Application Form is the legal agreement between the Connecticut Clean
   Energy Fund (CCEF) and the incentive recipient (Contractor) governing CCEF’s funding of this
   project. A copy of the contractor’s proposal or agreement with the Project Owner must accompany
   this application. Please carefully read all of the following information. Fully complete all sections of
   the Solar Thermal Incentive Application Form. Supporting documents must be delivered to CCEF as
   one package or email message – partial applications and piecemeal submittals will not be accepted.
   PROJECTS THAT ARE UNDER CONSTRUCTION, COMPLETED CONSTRUCTION OR HAVE
   BEEN PLACED IN-SERVICE BEFORE RECEIVING CCEF’S WRITTEN APPROVAL ARE
   NOT ELIGIBLE FOR FUNDING UNDER THIS PROGRAM.

      1. Review the Solar Thermal Incentive Program Description document for information about how
         to participate in this incentive program.
      2. Complete all sections of Solar Thermal Incentive Application Form. All information is
         necessary for processing the application. Illegible or incomplete forms will be discarded and
         the Project Owner will be notified.
      3. Fill out the application on-line at www.ctcleanenergy.com/solarthermal. As an alternative, you
         may download the application document and mail or email the completed original of the Solar
         Thermal Incentive Application Form and appropriate documents to:
                   Project Assistant – Solar Thermal
                   Connecticut Clean Energy Fund
                   200 Corporate Place, 3rd Floor
                   Rocky Hill, CT 06067
                   solarthermal@ctcleanenergy.com

            Note: Applications and supporting documents will not be accepted via facsimile.
      4. Contractors will be notified by email within thirty (30) days if their applications have been
         approved, denied, or if more information is required. The approval notice will include the
         incentive amount and an Incentive Reservation Confirmation Number from CCEF.
      5. Upon receiving an Incentive Reservation Number from CCEF, Contractors will have six (6)
         months to complete the system installation.
      6. Contractors will bill the Project Owners the total price of the system minus the CCEF incentive,
         and Project Owners will make payments to the contractors according to the terms of their
         contract.
      7. CCEF will remit the incentive payment to Contractors within fifteen (15) business days
         following receipt of notice of project completion, successful completion of the system
         commissioning process and receipt of copies of all required municipal and utility approvals.
      8. For all inquiries regarding the Solar Thermal Incentive Program, contact Program Manager,
         Bill Colonis, by email at bill.colonis@ctcleanenergy.com or by phone at (860) 257-2888.
      9. Applications for solar water heating systems received after the program start date (target:
         October 16, 2009) on residences in Connecticut are eligible for an incentive under this
         program, provided the primary purpose of the system is to supplement domestic water heating,
         the system is installed by an eligible installer that meets all terms and conditions of the
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                                     APPLICATION FORMS
Incentive Application                                              Solar Thermal Incentive Program

            “Request for Qualifications for Eligible and Provisional Contractors,” and the system meets all
            minimum requirements of the Solar Thermal Incentive Program.
      10. Systems that include space heating as well as domestic hot water (DHW) heating and/or
          process water heating may be accepted under this program, but the incentive will be based only
          on the portion of the system attributable to the DHW (and process hot water, for commercial
          sites) needs of the site.
      11. Systems are subject to random inspection at completion. The agreement between Contractor
          and Project Owner must include Project Owner’s agreement to an inspection by a CCEF
          representative or designated subcontractor.
      12. Incentive funds will NOT be distributed until project is complete and meets final inspection
          requirements.
      13. The CCEF will not make any payments without proof that all required permits and approvals
          have been obtained.
      14. CCEF reserves the right to refuse any incentive application for cause at its discretion; withhold
          payment until any identified problems with the solar domestic hot water system are resolved;
          terminate this reward in whole or in part due to the Contractor’s failure to fulfill the terms and
          conditions in this document; make the final determination on whether items meet the standards
          set forth in the program; and inspect the system to ensure that it is consistent with program
          guidelines.
      15. By accepting the benefits of the incentive, Project Owner agrees to participate for one time, if
          requested by CCEF or by Solar CT, as a site on the Connecticut Solar Tour coordinated by
          Solar CT in conjunction with the American Solar Energy Society’s National Solar Tour (see the
          ASES website at:
          http://www.ases.org/index.php?option=com_content&view=article&id=158&Itemid=16 ).
          In addition, Project Owner’s name, photographs of the building where the solar system is
          installed, and information about the system may be used in various communications to the
          media and in educational publications.
      16. Project Owner agrees to collaborate with the CCEF if Project Owner prepares any press release
          or plans any news conference related to the system.
      17. Acceptance of this incentive does not constitute the approval, acceptance, warranty, guarantee
          or endorsement of CCEF.
      18. Request for Qualifications for Eligible and Provisional Contractors, CCEF-ST-09-001 (ST
          RFQ), including Attachment E, Special Terms and Conditions Applicable to Receipt of
          Recovery Act Funds, is incorporated herein by this reference and Contractor shall comply with
          all terms and conditions therein. In the event that any provisions herein conflicts with those in
          ST RFQ, the provisions herein shall apply.




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                                      APPLICATION FORMS
Incentive Application                                               Solar Thermal Incentive Program

   Application Certification
   The undersigned applicant is a duly authorized representative of the Contractor listed below with the
   authority to bind the Contractor to this Application’s terms and conditions for the proposed project. In
   addition, Contractor has read, understands, and agrees to be bound by the terms and conditions of the
   Solar Thermal Incentive Program, as found at www.ctcleanenergy.com/solarthermal

   The information contained in this Application or any part thereof, including its Exhibits, Schedules,
   and other documents and instruments delivered or to be delivered to CCEF, is true, accurate, and
   complete. This Application includes all information necessary to ensure that the statements herein do
   not in whole or in part mislead CCEF as to any material fact.

   Contractor shall comply with the foregoing and all additional Federal and State requirements
   that are or may be incorporated herein.

   I certify:
           That the statements made in this Application, including all attachments, forms, and exhibits, are
            true and correct to the best of my knowledge, and are in all respects fair and without collusion
            or fraud.
           That the Contractor did not participate in the solicitation development process outside of
            CCEF’s requested public comment period.
           That the Contractor has not been convicted of bribery or attempting to bribe a public official or
            employee of the state, has not been disqualified for contract awards by any agency of the state,
            and is not in default under any contract with an agency of the state.
           That the Contractor does not have an affiliation or relationship, financial or otherwise, with any
            other Contractor under this program.


   Legal name of Contractor:

   I hereby approve of this Solar Thermal Incentive Application. I am the authorized representative of the
   owner of the solar thermal system for which this incentive application is being submitted.

   Signature of authorized
   representative of Contractor
   Name of authorized
   representative:

   Title:

   Date signed:




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                                       APPLICATION FORMS
Incentive Application                                                 Solar Thermal Incentive Program

   General Information

   Contractor (company selling and installing the system):
   ________________________________________________
   Phone: _________________________ Fax: _________________________
   Email Address: _________________________________________________


   Installation Site Address:
   _______________________________________________________________
   City: ____________________________ State: ________ Zip: ____________
   Contact Person at Site: ________________________________________________________
   Phone: _________________________ Fax: _________________________
   Email Address: _________________________________________________
   Installation site: Residence: Yes       # of families _____ # of bedrooms _____



   Project Owner
   Name of Owner: _____________________________________________________________
   Mailing Address:
   ______________________________________________________________________
   City: ____________________________ State: ________ Zip: ____________
   Phone: _________________________ Fax: _________________________
   Email Address: _________________________________________________

   If owner is a not-for-profit organization, please provide documentation of tax-exempt status.




   Project Site Information

   1. Proposed solar hot water project (check all that apply):
            Domestic water heating:      Space Heating:       _ Process water heating:
            Other (describe): _______________________________________________________
   2. Present Hot Water System:       Electric   Gas    Oil     Other ____________________________
   3. Proposed Back-up Hot Water System:         Electric       Gas      Oil     Other (describe):
      _____________________________________________________________________________
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                                       APPLICATION FORMS
Incentive Application                                              Solar Thermal Incentive Program
   3. Electrical Distribution Company: _________________________________
   4. Gas Distribution Company: ______________________________________
   5. Solar Collector Location: Rooftop       Pole Mount or Ground Mount          Other (describe):
      _____________________________________________________________________________ n
   6. Solar Collector Orientation: __________ degrees (e.g., 180 degrees magnetic South)
   7. Solar Collector Tilt: __________ degrees (e.g., flat mount = 0 degrees; vertical mount = 90 degrees)
   8. What percent (%) of the total annual DHW load is the Solar Thermal system designed to offset?
   ______%
   9. To determine shading issues, installer must use a Solar Pathfinder or substitute approved by CCEF
   and submit a Solar Site Analysis Report with the application, including a digital photo of the shading
   chart. Describe any shading and percent (%):
   __________________________________________________________________________________
   __________________________________________________________________________________
   10. A one-page Site Sketch must accompany this application. The sketch must indicate the location of
   the solar collector(s) and location of storage tank. The installation address and the installer’s name and
   telephone number must also be included on the Site Sketch. Please use the form on the following
   page.




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                                      APPLICATION FORMS
Incentive Application                       Solar Thermal Incentive Program




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                        APPLICATION FORMS
Incentive Application                                            Solar Thermal Incentive Program


   Project Equipment Information
   1. Solar system manufacturer (if OG300 rated): _________________________________________
   2. SRCC # (if OG300 rated): ___________________________________
   3. Solar Collector Manufacturer: ________________________ Collector Model #: ______________
   4. SRCC # (if OG 100 Rated): _________________________________
   5. Clear Day / C rating: _______________________kBtu/day
   6. If not SRCC rated, provide certification information, including independent testing reference and
      rating conditions. Panel rating for Connecticut conditions: __________________ kBtu/day
   7. Number of Collectors: ___________ Size of each Collector (sq. ft.) ___________
   8. Total Rated Output: _____________ kBtu/day (Number of Collectors x Collector OG-100 Rating)
   9. Type of System: Drainback with water         Drainback with antifreeze
      Pressurized closed loop antifreeze         Other ___________________________________
   10. Storage Tank Manufacturer: _________________________ Model #: _________________
   11. Storage Tank Type: _________________ Capacity: _____ Insulation R-Value: _____
   12. Pump Manufacturer: _________________________ Model #: _______________
   13. Pump Type: _________________________            PV Driven?: Yes    No

   Warranties (must be declared in customer contract):
   Installer’s warranty on system: Parts: ________ years     Labor __________ years
   Manufacturers’ warranties (must be passed on to Project Owner):
   1. Collectors: _____ years     2. Storage Tank: _____ years   3. Pumps: _____ years
   4. Installation: _____ years   5. Heat Exchanger: _____ years


   System Output and Incentive
   Calculation of the system output must be corrected for shading of the collectors. Use of the Solar
   Pathfinder™ Assistant Version 4.1 (or equivalent) is recommended. The incentive is based on the
   estimated output of the system during the winter months.
   1. Solar thermal energy system calculated output for months of October - March:
   __________ MMBtu x (                         owner is not for profit) = $_____________
   2. Percent Shading: __________ %
   3. Requested Incentive Amount: $_____________




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                                       APPLICATION FORMS
Incentive Application                                            Solar Thermal Incentive Program


   Land Use, Ownership, and Permitting
   What is the Project Owner’s control over the intended host site?
         Owner                         Lease agreement                       Purchase option
               Other (describe):
   If the host site is not owned by the Project Owner, provide written proof of rights to install the
   proposed equipment at the site.

   What (if any) land use permits will be required to install the proposed equipment at the site (such as
   conditional use, special use, or other similar permits and approvals)?

   Is the current local zoning appropriate for such an installation?            Yes      No
   If you responded No to the above, describe any re-zoning plans and issues.


   Identify all, if any, permits that will be required.
   Permit                                                         Application filed        Permit secured




   Project Budget and Schedule

    Project Schedule                                              Date (expressed in #
                                                                  of months after
                                                                  contract signing)
    Execution of project contract
    Site design complete
    Site permitting complete
    Commencement of construction
    Start of operation (system commissioning)


    Total Project Budget                                          Projected Cost - $

    Total labor hours estimated for project
    Collectors
    All other equipment (tank, pump, controller, piping)
    Site engineering, design, and permitting
    Labor – construction and installation
                                                       Total: $ 0.00



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                                       APPLICATION FORMS
 Incentive Application                                                 Solar Thermal Incentive Program


Additional Documentation
    All applicants must provide the following additional documentation as an attachment to their
    application forms.

    Utility Bills
    Provide copies of:
        Utility or fuel bills covering the most recent twelve (12) months for the hot water heating
           system, if metered separately from the space heating system.
        Utility or fuel bills covering the most recent twelve (12) months for the combined heat/hot
           water system, if Domestic Hot Water and/or Process Hot Water is included.
        Bills covering the most recent twelve (12) months of water usage, or documentation of water
           consumption.

    System Schematic
    Please provide a system schematic showing all major equipment items and their connections. Please
    identify all major components by brand and model, and include specification sheets.

    Energy Audit
    For this program, an energy audit and implementation of energy efficiency measures is not required,
    but is strongly recommended if no efficiency upgrades have been completed within the past five (5)
    years. With the assistance of the federal tax incentives and conservation/energy efficiency incentive
    programs run by the utilities, economic payback is usually very short. Please check
    http://www.ctenergyinfo.org/energy-programs.htm for program information.

    Project Agreements
    Provide any existing relevant documentation as outlined below that demonstrates the ability of the
    Contractor to successfully develop and operate the proposed project.

            For third-party ownership projects, where the project Owner plans to sell the project’s energy
             to the host site, a copy of the Power Purchase Agreement between the Owner and Host;
            Any contract or letter of intent to negotiate (a) a lease, or option to lease, the site for a term
             necessary to assure financing of the project, or (b) a purchase, or option to purchase, the site;
            Any letters of intent to negotiate necessary easements;


Checklist
               /fuel bills




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                                        APPLICATION FORMS

				
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