Combined Heat and Power Parternship - Private Sector

OMB Control No. 2060-0578
Approval Expires 04/30/2009

Partner’s Letter of Intent
for Companies and Institutions
Please fax the completed Letter of Intent (2 pages) to 617/482-1320

(contractor in support of EPA)

With this letter ____________________________________________________________ (company/institution)
joins EPA's Combined Heat and Power (CHP) Partnership and agrees to work with EPA to promote the benefits
of CHP and support development of new CHP projects.
Sincerely, __________________________________________________________________________________
Authorized Company Representative Signature
Name: _____________________________________________________________________________________
Title: ___________________________________________________________ Date: ______________________

The Partner Agrees to:
1. Designate a liaison for EPA's CHP Partnership.
2. Provide data on existing CHP projects and new project development to help EPA determine climate benefits.
3. Provide input to EPA-developed CHP Partnership tools and services.
4. Employ CHP Partnership tools and services, as appropriate, to recognize and promote CHP development.

EPA Will:
1. Promote understanding and recognition of the environmental, energy, and economic benefits of CHP.
2. Support the Partner with tools and services intended to accelerate the development of CHP projects, including
recognition of Partner's CHP accomplishments and associated benefits.
3. Designate a Program Manager as Partner liaison.

General Terms:
1. This agreement can be terminated by either party, at any time, without prior notification, penalties, or
further obligation.
2. EPA will honor requests to keep reported data or activities confidential.
3. The Partner agrees that the activities it undertakes connected with this voluntary agreement are not intended to
provide services to the federal government and that the Partner will not seek compensation from a federal
agency.
4. The Partner agrees that it will not claim or imply that its participation in the Partnership constitutes EPA approval
or endorsement of anything other than its commitment to the Partnership.

Please complete the information on page 2.

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Partner's Liaison:
Name: __________________________________________________________________________________________
Title: ____________________________________________________________________________________________
Address: _________________________________________________________________________________________
City: _________________________________________________________ State:_______ Zip: __________________
Telephone: __________________________________________ Fax: ________________________________________
E-mail: __________________________________________________________________________________________

Additional Partner Information:
Please check the box below that best describes your company’s CHP-related service or activity.

CHP Project Developer
Construction
Consultant/Engineering
ESCO
End-user
Equipment Manufacturer
Financier
Non-governmental Organization (NGO)
Utility

Your organization’s Web site address: _________________________________________________________________
Does your organization have a CHP-related Web page? If so, please list here:
________________________________________________________________________________________________
May we provide a link to your CHP-related Web page?

… Yes

… No

Please provide a brief profile of your organization’s involvement with CHP and what services you provide, if appropriate.
(If the space below is not adequate, please mail or fax this information to us on separate pages, along with your signed
Letter of Intent.):
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
The government estimates the average time needed to fill out this form is 4.9 hours and welcomes suggestions for reducing this level of effort. Send comments
(referencing OMB control number) to the Director, Collection Strategies Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.

PLEASE FAX THE COMPLETED LETTER OF INTENT TO 617/482-1320 (contractor in support of EPA)
Office of Air and Radiation
(6202J)

EPA-430-F-05-034
www.epa.gov/chp
October 2005

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