5900-xxx Reporting Form

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Overview

Contact & Organizational Info
Green Power Information
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 Mollie Lemon at your earliest convenience. Mollie Lemon's email address is lemon.mollie@epa.gov.
All fields are required unless noted otherwise.
Contact Information
	Primary Contact	Public Relations Contact (Optional)
Salutation
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 (select from picklist)
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)
Motivating Factors (Optional): Check the motivating factors behind you green power use (check all that apply)
(If other, please specify):
Reporting Period: 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

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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 within the last 15 years.

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.

Only Complete if 3rd Party Owned System

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

3rd Party Owner Optional

Power Purchase Agreement Start Date (mm/dd/yy)

Power Purchase Agreement End Date (mm/dd/yy)

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: Profile

Partner Profile (Optional)
All Green Power Partners have the opportunity to have a Partner Profile on the Web site. The Partner Profile is a short paragraph (200 word limit) that describes briefly a Partner’s organization, its decision to use green power, and its experience to date with green power. If you would like to create a Partner Profile, please draft a paragraph in the space provided below. EPA will then review the Profile and offer you a chance to approve it prior to posting on the Green Power Partnership Web site. Note, EPA cannot endorse your green power provider on the Web site, so please make sure the profile does not include reference to the entity from which you are procuring your green power. In writing your Partner Profile, provide a brief description of your organization and try to address these questions: - How much green power is your organization using? - What was the driver behind your organization's switch to green power? - Any lessons learned during your green power commitment process you would like to share with others? - What are the biggest benefits that have accrued to your organization since it switched to green power? If you’d like to provide a quote about the benefits of green power for your organization, please include the name and title of the person the quote is attributed to.
Current Profile for Your Organization:
You can find existing GPP profiles at:	http://www.epa.gov/greenpower/partners/index.htm
	Note: The "Save & Exit" button above will only work if you've enabled macros. If you have not enabled macros, simply save the file as you would any other Excel file.