5900-195 Service and Product Provider (SPP) Partnership Applicati

OMB Control No. 2060-0347

Service and Product Provider (SPP) Partnership

Application Data Form

PLEASE SUBMIT THIS APPLICATION DATA FORM AND ATTACHMENTS REQUESTED IN QUESTIONS 5, 6, and 7 TO SPP@ENERGYSTAR.GOV, ALONG WITH YOUR COMPLETED PARNERSHIP APPLICATION PACKET.

Date:

Company Name (Web Display):
Web Address:

1. An unbiased 3-5 sentence description of your company, its services, and products. Description should address service and/or product offerings provided to improve energy efficiency of customer buildings.

2. Identify your company type: (Check all that apply)

	Architecture or A/E		Engineering
	Distributor		Equipment Manufacturer
	Energy Consultant / Energy Management Services		Financial Services
	Energy Improvement Contractor		On-site Energy Production Services
	Energy Information Services		Unregulated Energy Retailer and Marketer
	Energy Service Company (ESCO)

3. Please identify the market sector(s) that your company actively serves: (Check all that apply)
   
   

	Commercial Real Estate		Industry
	Corporate Real Estate (Banks, Financial, Consulting, Telecommunications)		K-12 Education
	Federal Government		Local Government
	Healthcare (Hospital, Medical Office Building)		Retail (Apparel, Big Box, Convenience Stores, Department Stores, Discount Stores-Warehouse Clubs, Drug Stores, Restaurants, Supermarkets)
	Higher Education		Small Business
	Hospitality and Entertainment (Hotels, Resorts, Stadiums, Theaters, Museums, Convention Centers)		State Government

4. To which SPP partnership category would you like to apply? (SELECT ONE)

Please determine which partnership category reflects the primary area of your business and is the best fit for you based on the SPP Partnership Requirements. Please select only one area below.

	Existing Commercial Buildings SPP If selecting this area, answer question 5 only.		Commercial New Construction SPP (i.e. Architecture Firms) If selecting this area, answer question 6 only.
	Industrial SPP If selecting this area, answer question 7 only.

5. Complete this question ONLY if you selected the “Existing Commercial Buildings SPP” partnership category in Question 4. SPPs in this partnership category conduct business primarily with existing commercial buildings clients. Please complete Question 5a and 5b and/or 5c to allow us to verify that you meet requirements for partnership.

   1. To help us understand your business, please provide brief descriptions for a minimum of two energy efficiency projects completed for your clients.

Name of Project/Client	Date(s) of project completion	Project Scope and/or Energy Efficiency Measures Implemented/Recommended

2. List 10 customer commercial buildings which you have benchmarked using Portfolio Manager in the last 12 months. To meet the SPP requirement, you must benchmark at least 10 customer buildings – and receive energy performance ratings (EPR) and/or energy use intensity (EUI) scores – in the past 12 months.

Please provide an email attachment of a Statement of Energy Performance (SEP) for each facility listed. SEPs can be generated in Portfolio Manager for all buildings with at least 11 consecutive months of data entered. (Note: For SPP partnership application, SEPs are requested as evidence of SPP benchmarking and DO NOT need to be reviewed and/or stamped by a Professional Engineer. Information provided will remain confidential, and will be used only to verify eligibility in terms of partnership requirements.)

Portfolio Manager Building ID#	Customer Organization Name	Building Received an EPR Rating?	Building Received an EUI Score?

3. Please list at least one customer building which your organization has helped to earn the ENERGY STAR label in the last 12 months. (Note: In order to receive credit for helping a customer building to earn the ENERGY STAR, your organization must be indicated as the primary SPP for the building in Portfolio Manager.)

Name of Building Receiving Label	Customer Organization Name	Label Year

6. Complete this question ONLY if you selected the “Commercial New Construction SPP” partnership category in Question 4. SPPs in this partnership category are comprised of architecture and A/E firms specializing in commercial building design.

Determine if design projects are eligible for Designed to Earn the ENERGY STAR by using EPA’s Target Finder, an online tool for commercial building designs. List at least one project you plan to submit for the Partnership Application requirement. EPA will review and approve eligible projects and applications to activate this Partnership Agreement.

Name of Design Project	Space/Building Type (office, K–12, etc.)	Design Completion Date

7. Complete this question ONLY if you selected the “Industrial SPP” partnership category in Question 4. SPPs in this partnership category work with ENERGY STAR Industrial partners to implement energy efficiency projects.

List at least one energy efficiency project that you completed for an ENERGY STAR Industrial partner in the last 2 years. Please attach a completed “Teaming Profile” outlining the project scope and resulting savings for that project. Review additional guidelines on creating Teaming Profiles on the ENERGY STAR Web site.

ENERGY STAR Industrial Partner Organization Name	Brief Project Description	Year Project Completed

The public reporting burden for this collection of information is estimated to average 30 minutes per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

EPA Form 5900-195 Page 3 of 3 Version: 11/10/09