Gpp Yr2012

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Overview

Contact & Organizational Info
Green Power Information
Partner Profile

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Sheet 1: Contact & Organizational Info

Green Power Partnership Yearly Reporting Form

This Yearly Report form should be used to update the EPA on your organization's green power usage. Please complete the report, save the file, and return to your account manager or Blaine Collison at your earliest convenience. Blaine Collison's email address is collison.blaine@epa.gov.

All fields are required unless noted otherwise

Contact Information

Primary Contact

Public Relations Contact

Contact Name

Title

Street Address

City/State/Zip

Email Address

Phone Number

Organizational Information

Partner Name

Website Link

Green Power Related Web Page (e.g. environmental or sustainability page) Optional

Industry

Organizational Electricity Use

Annual Electricity Use (kWh/yr)

Scope of Reported Electricity Use (select from picklist)

Please Identify Reporting Facility or Group of Facilities (only if "Single Facility or Subset" is selected above)

Reporting Period (Optional): The electricity and green power information contained in this report covers the following 12-month period. Partners may choose to report most recent calendar year, fiscal year, other 12-month period, or forward-looking data.

Reporting Period Start Date

Reporting Period End Date

Note: If the "Next Page" button does not work, please navigate through the other worksheets by clicking on the "Green Power Information" and "Partner Profile" tabs at the bottom of the screen.

Chemical

Clothing & Textile

Constr. & Eng. Srvcs.

Consulting Srvcs.

Consumer Products

Education (Higher)

Education (K-12)

Educational (Other)

Energy Services

Food & Beverage

Govt. (Federal)

Govt. (Local, Municipal)

Govt. (State)

Green Power Community

Health Care

Hotels & Lodging

Industrial Goods & Srvcs.

Insurance

IT & Telecom

Legal Services

Marketing, Advtg. & PR

Media & Publishing

Museums, Parks & Zoos

Non-profit (NGO)

Other

Printing & Packaging

Real Estate

Recreation

Religious

Restaurants & Cafes

Retail

Shipping

Sports Teams & Venues

Transportation

Tribal Nations

Wineries & Breweries

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Sheet 2: Green Power Information

Green Power Information

Select the appropriate check box(es) below:

yes

We are purchasing green power or renewable energy certificates (RECs) from a provider.

no

We are producing green power onsite.

Please update the information below with your current green power product purchase information. If you are purchasing more than one green power product or REC product, list each purchase on a separate row.

Product's Resource Mix (should total 100%)

Green Power Provider(s) One provider per row

Product Name Optional

Green Power Purchase (kWh/year)

Bio- gas (%)

Bio-mass (%)

Geo- thermal (%)

Hydro (%)

Solar (%)

Wind (%)

Unknown (%)

Total (%)

3rd Party Certified?

% New Renew-ables*

Contract Begin Date (mm/dd/yy)

Contract End Date (mm/dd/yy)

Is this provider also supplying your electricity?

0

0

0

Total:

0

* % of product from facilities placed in service after January 1, 1997.

Please update the information below with your current onsite green power production information. If you use more than one onsite generation type, list each onsite resource type on a separate row.

Onsite Generation Technology One onsite resource type per row

Green Power Production (kWh/year)

Rated Capacity (kW) Optional

Year Installed Optional

Location (ZIP Code) Optional

3rd Party Ownership? Optional

Total:

0

* EPA will only count as green power the kWh output from on-site installations for which the Green Power Partner owns the rights to the renewable energy certificates (RECs).

Total Green Power

0

Percent Green Power

0.00%

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Sheet 3: Partner Profile

Partner Profile (Optional)

All Green Power Partners have the opportunity to have a Partner Profile on the Partnership's Web site. The Partner Profile is a short paragraph (200 word limit) that briefly describes a Partner’s organization, its decision to purchase green power, its experience to date with green power, and may include a quote about the benefits of green power to the organization. (Please be sure to include the name and title of the person the quote is attributed to.) You may revise your existing Partner Profile below.

Current Profile for Your Organization:

You can find your current Partner Profile Page at:

http://www.epa.gov/greenpower/partners/index.htm