**Section 9006: Renewable Energy & Energy Efficiency Program
Application**

**Fiscal Year 2007**

**Deadline:**

**Grant Funding: May 18, 2007**

**All applications must be mailed hard-copy to the USDA Rural
Development State Office at:**

**USDA Rural Development**

**ATTN: Rural Energy Coordinator**

**P.O. Box 11005**

**Casper, WY 82602-5006**

**For Application Assistance Please Contact:**

**Milt Geiger, Rural Energy Coordinator**

**(307) 672-5820, x 4**

[**milt.geiger@wy.usda.gov**](mailto:milt.geiger@wy.usda.gov)

**For website information go to:**

[**www.rurdev.usda.gov/rbs/farmbill/**](http://www.rurdev.usda.gov/rbs/farmbill/)

**or**

[**www.farmenergy.org**](http://www.farmenergy.org/)

**Applications must be Submitted in the Original plus one
[copy]{.underline}.**

**Please note that all grey, shaded areas require text.**

**Name:\_\_[     ]{.underline}\_\_**

**(use exact legal name of person or entity applying)**

**Renewable Energy \_\_[\_\_]{.mark}\_ OR Energy Efficiency
Improvement\_\_[\_\_]{.mark}\_**

**Dun and Bradstreet Universal Numbering System, (DUNS number)**

**If you are applying as a sole proprietor and operating under your
social security number, you will need to use your social security number
as the Duns Number. Otherwise, you must call 866-705-5711 to obtain a
Duns Number.**

**Duns Number \_\_[     ]{.underline}\_\_**

**Simplified Grant Application (For projects less than \$200,000 and
utilizing commercially available technology)**

**YES \_\_[\_\_]{.mark}\_ NO \_\_[\_\_]{.mark}\_**

**Table of Contents**

**Include this or a comparable Table of Contents in your application.
Include page numbers for each component of the application in the table
of contents. Begin pagination immediately following the Table of
Contents.**

> **Page numbers:**

**Cover Page**

**Table of Contents**

**Forms, certifications and agreements      **

Form SF-424, "Application for Federal Assistance"      

Form SF-424-C, "Budget Information"      

Form SF 424-D, "Assurances"      

Form AD-1049, "Certification Regarding Drug-Free Workplace"      

Form AD 1048, "Certification Regarding Debarment"      

Exhibit A-1, "Certification for Contracts, Grants and Loans)

of RD Instruction 1940-Q (for grants exceeding \$100,000      

Form SF-LLL, "Disclosure of Lobbying Activities"      

Form AD-1047, "Certification Regarding Debarment"      

Form RD 400-1, "Equal Opportunity Agreement"      

Form RD 400-4, "Assurance Agreement"      

Certification of any known relationship or association with an

Agency employee      

Form RD 1940-20, "Request for Environmental Information"      

with short form attachment

"Certification of Financial Need"      

"Certification re Qualifications for Simplified Application      

**Organizational Documents      **

**Project Summary      **

**Applicant Eligibility      **

**Project Eligibility      **

**Operation Description      **

**Financial Information for Size Determination      **

**Table of Contents -- continued page numbers:**

**Financial Information (only for projects exceeding \$200,000)      **

**(historical, current, & pro-forma financials)**

**Matching Funds Documentation      **

**Self Evaluation Score      **

**Energy Audit (energy efficiency projects only)      **

**Technical Requirements report for ALL Projects      **

**Feasibility study for renewal energy systems      **

**(for renewable energy projects ONLY)**

**Forms, certifications, and agreements**

Each application submitted must contain, as applicable, the following
forms/documentation. They are attached herewith: ("Fillable" forms are
available at
[www.farmenergy.org/applicationforms.htm](http://www.farmenergy.org/applicationforms.htm))

(1)Form SF-424, **\`\`Application for Federal Assistance"**

> (write in the your duns number on the top of this form)

\(2\) Form SF-424C, \`\`Budget Information\--Construction Programs" Each
cost classification category listed on the form must be filled out
**if** it applies to your project. Any cost category item not listed on
the form that applies to your project can be put under the miscellaneous
category. Attach a separate sheet if you are using the miscellaneous
category and list each miscellaneous cost by not allowable and allowable
costs in the same format as on SF 424C. All project costs must be
categorized as either allowable or not allowable.

\(3\) Form SF-424D, \`\`Assurances\--Construction Programs"

\(4\) AD-1049, \`\`Certification Regarding Drug-Free Workplace
Requirements.\'\'

\(5\) AD-1048, \`\`Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion\--Lower Tiered Covered
Transactions.\'\'

\(6\) Exhibit A-1, (Certification for Contracts, **Grants** and Loans)
of RD Instruction 1940-Q **IF** the grant exceeds \$100,000

\(7\) Form SF-LLL, "Disclosure of Lobbying Activities" - **IF** the
applicant has made or agreed to make payment using funds other than
Federal appropriated funds to influence or attempt to influence a
decision in connection with the application, this form is required.

\(8\) AD-1047, \`\`Certification Regarding Debarment, Suspension, and
Other Responsibility Matters, Primary

\(9\) Form RD 400-1, \`\`Equal Opportunity Agreement.\'\'

\(10\) Form RD 400-4, \`\`Assurance Agreement.\'\'

\(11\) Applicants and borrowers must provide a certification indicating
whether or not there is a known relationship or association with an
Agency employee.

\(12\) Environmental review. All applicants must complete Form RD
1940-20, "Request for Environmental Information" with short form
attachment.

(13)Certification of Financial Need

(14)Certification RE Qualifications for Simplified Application(only for
projects of less than \$200,000)

**This Page Left Blank Intentionally**

![](media/image1.png){width="8.002777777777778in" height="10.50625in"}

## INSTRUCTIONS FOR THE SF-424

Public reporting burden for this collection of information is estimated
to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project (0348-0043), Washington, DC 20503.

**PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.**

> > This is a standard form used by applicants as a required face sheet
> > for pre-applications and applications submitted for Federal
> > assistance. It will be used by Federal agencies to obtain applicant
> > certification that States which have established a review and
> > comment procedure in response to Executive Order 12372 and have
> > selected the program to be included in their process, have been
> > given an opportunity to review the applicant's submission.

+---+--------------+-------------+---+--------------------------------+
| > | > Entry:     |             | > | > Entry:                       |
|   |              |             |   |                                |
| I |              |             | I |                                |
| t |              |             | t |                                |
| e |              |             | e |                                |
| m |              |             | m |                                |
| : |              |             | : |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Select     |             | > | > Enter a brief descriptive    |
|   | > Type of    |             |   | > title of the project. If     |
| 1 | >            |             | 1 | > more than one program is     |
| \ |  Submission. |             | 1 | > involved, you should append  |
| . |              |             | \ | > an explanation on a separate |
|   |              |             | . | > sheet. If appropriate (e.g., |
|   |              |             |   | > construction or real         |
|   |              |             |   | > property projects), attach a |
|   |              |             |   | > map showing project          |
|   |              |             |   | > location. For                |
|   |              |             |   | > preapplications, use a       |
|   |              |             |   | > separate sheet to provide a  |
|   |              |             |   | > summary description of this  |
|   |              |             |   | > project.                     |
+---+--------------+-------------+---+--------------------------------+
| > | > Date       |             | > | > List only the largest        |
|   | >            |             |   | > political entities affected  |
| 2 |  application |             | 1 | > (e.g., State, counties,      |
| \ | > submitted  |             | 2 | > cities).                     |
| . | > to Federal |             | \ |                                |
|   | > agency (or |             | . |                                |
|   | > State if   |             |   |                                |
|   | >            |             |   |                                |
|   |  applicable) |             |   |                                |
|   | > and        |             |   |                                |
|   | >            |             |   |                                |
|   |  applicant's |             |   |                                |
|   | > control    |             |   |                                |
|   | > number (if |             |   |                                |
|   | >            |             |   |                                |
|   | applicable). |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > State use  |             | > | > Enter the proposed start     |
|   | > only (if   |             |   | > date and end date of the     |
| 3 | >            |             | 1 | > project.                     |
| \ | applicable). |             | 3 |                                |
| . |              |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Enter Date |             | > | > List the applicant's         |
|   | > Received   |             |   | > Congressional District and   |
| 4 | > by Federal |             | 1 | > any District(s) affected by  |
| \ | > Agency     |             | 4 | > the program or project       |
| . | >            |             | \ |                                |
|   | > Federal    |             | . |                                |
|   | > identifier |             |   |                                |
|   | > number: If |             |   |                                |
|   | > this       |             |   |                                |
|   | >            |             |   |                                |
|   |  application |             |   |                                |
|   | > is a       |             |   |                                |
|   | >            |             |   |                                |
|   | continuation |             |   |                                |
|   | > or         |             |   |                                |
|   | > revision   |             |   |                                |
|   | > to an      |             |   |                                |
|   | > existing   |             |   |                                |
|   | > award,     |             |   |                                |
|   | > enter the  |             |   |                                |
|   | > present    |             |   |                                |
|   | > Federal    |             |   |                                |
|   | > Identifier |             |   |                                |
|   | > number. If |             |   |                                |
|   | > for a new  |             |   |                                |
|   | > project,   |             |   |                                |
|   | > leave      |             |   |                                |
|   | > blank.     |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Enter      |             | > | > Amount requested or to be    |
|   | > legal name |             |   | > contributed during the first |
| 5 | > of         |             | 1 | > funding/budget period by     |
| \ | > applicant, |             | 5 | > each contributor. Value of   |
| . | > name of    |             |   | > in kind contributions should |
|   | > primary    |             |   | > be included on appropriate   |
|   | > or         |             |   | > lines as applicable. If the  |
|   | ganizational |             |   | > action will result in a      |
|   | > unit       |             |   | > dollar change to an existing |
|   | > (including |             |   | > award, indicate only the     |
|   | > division,  |             |   | > amount of the change. For    |
|   | > if         |             |   | > decreases, enclose the       |
|   | >            |             |   | > amounts in parentheses. If   |
|   | applicable), |             |   | > both basic and supplemental  |
|   | > which will |             |   | > amounts are included, show   |
|   | > undertake  |             |   | > breakdown on an attached     |
|   | > the        |             |   | > sheet. For multiple program  |
|   | > assistance |             |   | > funding, use totals and show |
|   | > activity,  |             |   | > breakdown using same         |
|   | > enter the  |             |   | > categories as item 15.       |
|   | > or         |             |   |                                |
|   | ganization's |             |   |                                |
|   | > DUNS       |             |   |                                |
|   | > number     |             |   |                                |
|   | > (received  |             |   |                                |
|   | > from Dun   |             |   |                                |
|   | > and        |             |   |                                |
|   | >            |             |   |                                |
|   | Bradstreet), |             |   |                                |
|   | > enter the  |             |   |                                |
|   | > complete   |             |   |                                |
|   | > address of |             |   |                                |
|   | > the        |             |   |                                |
|   | > applicant  |             |   |                                |
|   | > (including |             |   |                                |
|   | > country),  |             |   |                                |
|   | > and name,  |             |   |                                |
|   | > telephone  |             |   |                                |
|   | > number,    |             |   |                                |
|   | > e-mail and |             |   |                                |
|   | > fax of the |             |   |                                |
|   | > person to  |             |   |                                |
|   | > contact on |             |   |                                |
|   | > matters    |             |   |                                |
|   | > related to |             |   |                                |
|   | > this       |             |   |                                |
|   | >            |             |   |                                |
|   | application. |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Enter      |             | > | > Applicants should contact    |
|   | > Employer   |             |   | > the State Single Point of    |
| 6 | > Id         |             | 1 | > Contact (SPOC) for Federal   |
| \ | entification |             | 6 | > Executive Order 12372 to     |
| . | > Number     |             | \ | > determine whether the        |
|   | > (EIN) as   |             | . | > application is subject to    |
|   | > assigned   |             |   | > the State intergovernmental  |
|   | > by the     |             |   | > review process.              |
|   | > Internal   |             |   |                                |
|   | > Revenue    |             |   |                                |
|   | > Service.   |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Select the | 1.  I.      | > | > This question applies to the |
|   | >            |     State   |   | > applicant organization, not  |
| 7 |  appropriate |             | 1 | > the person who signs as the  |
| \ | > letter in  |  Controlled | 7 | > authorized representative.   |
| . | > the space  |             | \ | > Categories of debt include   |
|   | > provided.  | Institution | . | > delinquent audit             |
|   |              |     of      |   | > disallowances, loans and     |
|   | 1.  A. State |     Higher  |   | > taxes.                       |
|   |              |             |   |                                |
|   |     B.       |    Learning |   |                                |
|   |     County   |             |   |                                |
|   |              |     J.      |   |                                |
|   |     C.       |     Private |   |                                |
|   |              |             |   |                                |
|   |    Municipal |  University |   |                                |
|   |              |             |   |                                |
|   |     D.       |     K.      |   |                                |
|   |     Township |     Indian  |   |                                |
|   |              |     Tribe   |   |                                |
|   |     E.       |             |   |                                |
|   |              |     L.      |   |                                |
|   |   Interstate |             |   |                                |
|   |              |  Individual |   |                                |
|   |     F.       |             |   |                                |
|   |     In       |     M.      |   |                                |
|   | termunicipal |     Profit  |   |                                |
|   |              |     O       |   |                                |
|   |     G.       | rganization |   |                                |
|   |     Special  |             |   |                                |
|   |     District |     N.      |   |                                |
|   |              |     Other   |   |                                |
|   |     H.       |             |   |                                |
|   |              |   (Specify) |   |                                |
|   |  Independent |             |   |                                |
|   |     School   |     O. Not  |   |                                |
|   |     District |     for     |   |                                |
|   |              |     Profit  |   |                                |
|   |              |     O       |   |                                |
|   |              | rganization |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Select the |             | > | > To be signed by the          |
|   | > type from  |             |   | > authorized representative of |
| 8 | > the        |             | 1 | > the applicant. A copy of the |
| \ | > following  |             | 8 | > governing body's             |
| . | > list:      |             |   | > authorization for you to     |
|   |              |             |   | > sign this application as     |
|   | 1.  •        |             |   | > official representative must |
|   |     \"New\"  |             |   | > be on file in the            |
|   |     means a  |             |   | > applicant's office. (Certain |
|   |     new      |             |   | > Federal agencies may require |
|   |              |             |   | > that this authorization be   |
|   |   assistance |             |   | > submitted as part of the     |
|   |     award.   |             |   | > application.)                |
|   |              |             |   |                                |
|   |     •        |             |   |                                |
|   |     "C       |             |   |                                |
|   | ontinuation" |             |   |                                |
|   |     means an |             |   |                                |
|   |              |             |   |                                |
|   |    extension |             |   |                                |
|   |     for an   |             |   |                                |
|   |              |             |   |                                |
|   |   additional |             |   |                                |
|   |     fu       |             |   |                                |
|   | nding/budget |             |   |                                |
|   |     period   |             |   |                                |
|   |     for a    |             |   |                                |
|   |     project  |             |   |                                |
|   |     with a   |             |   |                                |
|   |              |             |   |                                |
|   |    projected |             |   |                                |
|   |              |             |   |                                |
|   |   completion |             |   |                                |
|   |     date.    |             |   |                                |
|   |              |             |   |                                |
|   |     •        |             |   |                                |
|   |              |             |   |                                |
|   |   "Revision" |             |   |                                |
|   |     means    |             |   |                                |
|   |     any      |             |   |                                |
|   |     change   |             |   |                                |
|   |     in the   |             |   |                                |
|   |     Federal  |             |   |                                |
|   |              |             |   |                                |
|   | Government's |             |   |                                |
|   |              |             |   |                                |
|   |    financial |             |   |                                |
|   |              |             |   |                                |
|   |   obligation |             |   |                                |
|   |     or       |             |   |                                |
|   |              |             |   |                                |
|   |   contingent |             |   |                                |
|   |              |             |   |                                |
|   |    liability |             |   |                                |
|   |     from an  |             |   |                                |
|   |     existing |             |   |                                |
|   |              |             |   |                                |
|   |  obligation. |             |   |                                |
|   |     If a     |             |   |                                |
|   |     revision |             |   |                                |
|   |     enter    |             |   |                                |
|   |     the      |             |   |                                |
|   |              |             |   |                                |
|   |  appropriate |             |   |                                |
|   |     letter:  |             |   |                                |
|   |              |             |   |                                |
|   |     A.       |             |   |                                |
|   |     Increase |             |   |                                |
|   |     Award B. |             |   |                                |
|   |     Decrease |             |   |                                |
|   |     Award    |             |   |                                |
|   |              |             |   |                                |
|   | > C.         |             |   |                                |
|   | > Increase   |             |   |                                |
|   | > Duration   |             |   |                                |
|   | > D.         |             |   |                                |
|   | > Decrease   |             |   |                                |
|   | > Duration   |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Name of    |             |   |                                |
|   | > Federal    |             |   |                                |
| 9 | > agency     |             |   |                                |
| \ | > from which |             |   |                                |
| . | > assistance |             |   |                                |
|   | > is being   |             |   |                                |
|   | > requested  |             |   |                                |
|   | > with this  |             |   |                                |
|   | >            |             |   |                                |
|   | application. |             |   |                                |
+---+--------------+-------------+---+--------------------------------+
| > | > Use the    |             |   |                                |
|   | > Catalog of |             |   |                                |
| 1 | > Federal    |             |   |                                |
| 0 | > Domestic   |             |   |                                |
| \ | > Assistance |             |   |                                |
| . | > number and |             |   |                                |
|   | > title of   |             |   |                                |
|   | > the        |             |   |                                |
|   | > program    |             |   |                                |
|   | > under      |             |   |                                |
|   | > which      |             |   |                                |
|   | > assistance |             |   |                                |
|   | > is         |             |   |                                |
|   | > requested. |             |   |                                |
+---+--------------+-------------+---+--------------------------------+

> **This page is left blank intentionally.**

  ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- ----- -------- --------------- ------------------ ----------- ----- ------------
  **Budget                                                                                                                                                                                                                                                                                                                                                                             OMB               
  Information---Construction                                                                                                                                                                                                                                                                                                                                                           Approval          
  Programs**                                                                                                                                                                                                                                                                                                                                                                           No.               
                                                                                                                                                                                                                                                                                                                                                                                       0348-0041         

  **Note: Certain Federal                                                                                                                                                                                                                                                                                                                                                                                
  assistance programs require                                                                                                                                                                                                                                                                                                                                                                            
  additional computations to                                                                                                                                                                                                                                                                                                                                                                             
  arrive at the Federal share                                                                                                                                                                                                                                                                                                                                                                            
  of project costs eligible                                                                                                                                                                                                                                                                                                                                                                              
  for participation. If such                                                                                                                                                                                                                                                                                                                                                                             
  is the case you will be                                                                                                                                                                                                                                                                                                                                                                                
  notified.**                                                                                                                                                                                                                                                                                                                                                                                            

  Cost Classification                                                                                                                                                                                                                                                                                                                a\.   Total    b\. Costs Not                                  c\.   Total
                                                                                                                                                                                                                                                                                                                                           Cost     Allowable for                                        Allowable
                                                                                                                                                                                                                                                                                                                                                    Participation                                        Costs
                                                                                                                                                                                                                                                                                                                                                                                                         (Column a-b)

  1\.                          Administrative and legal expenses                                                                                                                                                                                                                                                                     \$             \$                                             \$    

  2\.                          Land, structures, rights-of-way, appraisals, etc.                                                                                                                                                                                                                                                     \$             \$                                             \$    

  3\.                          Relocation expenses and payments                                                                                                                                                                                                                                                                      \$             \$                                             \$    

  4\.                          Architectural and engineering fees                                                                                                                                                                                                                                                                    \$             \$                                             \$    

  5\.                          Other architectural and engineering fees                                                                                                                                                                                                                                                              \$             \$                                             \$    

  6\.                          Project inspection fees                                                                                                                                                                                                                                                                               \$             \$                                             \$    

  7\.                          Site work                                                                                                                                                                                                                                                                                             \$             \$                                             \$    

  8\.                          Demolition and removal                                                                                                                                                                                                                                                                                \$             \$                                             \$    

  9\.                          Construction                                                                                                                                                                                                                                                                                          \$             \$                                             \$    

  10\.                         Equipment                                                                                                                                                                                                                                                                                             \$             \$                                             \$    

  11\.                         Miscellaneous                                                                                                                                                                                                                                                                                         \$             \$                                             \$    

  12\.                         **Subtotal**                                                                                                                                                                                                                                                                                          \$             \$                                             \$    

  13\.                         Contingencies (sum of lines 1-11)                                                                                                                                                                                                                                                                     \$             \$                                             \$    

  14\.                         **Subtotal**                                                                                                                                                                                                                                                                                          \$             \$                                             \$    

  15\.                         Project (program) income                                                                                                                                                                                                                                                                              \$             \$                                             \$    

  16\.                         **Total Project Costs**(subtract #15 from #14)                                                                                                                                                                                                                                                        \$             \$                                             \$    

  **Federal Funding**                                                                                                                                                                                                                                                                                                                                                                                    

  17\.                         Federal assistance requested, calculate as follows: Enter eligible costs from line 16c \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Multiply x \_\_\_\_\_\_\_\_\_\_\_\_ % (Consult Federal agency for Federal percentage share). Enter the resulting Federal share.                                                                                       \$    
                               \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....                                                                                        

  Previous Edition Usable                                                                                                                                                                                                                                                                                           Page 1 of 2                                     **SF-424C**(Rev.                     
                                                                                                                                                                                                                                                                                                                    **Authorized for                                4/92) Prescribed                     
                                                                                                                                                                                                                                                                                                                    Local                                           by OMB Circular                      
                                                                                                                                                                                                                                                                                                                    Reproduction**                                  A-102                                
  ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- ----- -------- --------------- ------------------ ----------- ----- ------------

> ![](media/image2.png){width="10.389583333333333in"
> height="7.979861111111111in"}
>
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Certifications/ General Information

> **Relationships to RD Employees**- To assure the high standards of
> honesty, integrity and impartiality maintained by Rural Development
> employees, we need to identify any Rural Development assistance to be
> provided to employees, their relatives, or their Business or close
> personal associates. This includes insured or guaranteed, loans or
> grant to individuals or organizations. If you know of any relationship
> or association you (the applicant) may have with a Rural Development
> employee, please provide this information, or advise if there is none.
> Your response will allow us to make special provisions for processing
> but will not affect your application status.
>
> Immediate family, other relatives or close associates who are USDA
> Rural Development employees, if any as listed here
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If none, indicate here
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> Signature
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> ![](media/image16.png){width="8.125in" height="10.625in"}

**REQUEST FOR ENVIRONMENTAL INFORMATION**

**ATTACH TO 1940-20**

•**[DESCRIPTION OF PROJECT]{.underline}:** Provide a brief description
of how the proposed loan funds and funds from other sources (including
your own) will be used by your business. Describe how this project
affects any boxes checked "Yes" in Item #3.

If construction, exterior, or interior renovations are involved, please
describe.

If loan is for purchase of office equipment, safety equipment, or motor
vehicles, please describe.

Indicate any evidence of the community's awareness of the project
(newspaper articles, public notices, public hearings, etc.) and any
objections.

•**[LOCATION OF PROJECT]{.underline}:** Please provide a location map
which identifies the location of your business. The map should be
specific enough for use in identifying the site on a floodplain map.

•**[PERMITS REQUIRED]{.underline}:** List any local, state or federal
permits, which your project will require, and the status of each permit
process.

•**[HAZARDOUS WASTES/MATERIALS]{.underline}:** Describe any regulated
hazardous materials or wastes, which your business uses or creates.
Include a description of how hazardous wastes/materials are stored,
handled and disposed of and what, if any, federal, state and local
regulations you are required to comply with.

**[•]{.underline}** ANSWER THE FOLLOWING QUESTIONS TO THE BEST OF YOUR
ABILITY.

  --------------------------------------------- --------- -------- -----------------
                                                **Yes**   **No**   

  Is your business located out of a 100-year                       How was this
  floodplain?                                                      verified?

  Is your business located within a historic                       Describe
  district or in an area, which could be                           district.
  considered eligible for designation as a                         
  historic district?                                               

  If you own your building, and are                                Year building was
  renovating/remodeling or demolishing, is the                     constructed
  building in excess of 50 years old?                              

  Does your community have zoning?                                 Describe zoning

  Does your property contain an underground                        Describe type,
  storage tank?                                                    size, age

  Does the property contain any areas where                        Describe release
  regulated hazardous substances or petroleum                      
  products appear to have been released?                           

  Does your business wastewater go to a septic                     Permit No.
  tank?                                                            

  Does your business have a private well for                       Permit No.
  potable water?                                                   
  --------------------------------------------- --------- -------- -----------------

For all questions answered "Yes" above, please discuss further here.

     

For Projects involving agricultural land, please provide:

-   Aerial photo from the Farm Service Agency (FSA) or Natural Resource
    Conservation Service (NRCS)

-   Or an aerial photo from another resource

For Projects involving structures over 50 years old, please provide
several interior and exterior pictures of the building,

**Certification of Demonstrated Financial Need**

**Demonstrated Financial Need is defined as demonstration or
documentation by an applicant that the applicant is unable to finance
the project from its own and commercially available resources without
grant assistance, or that the project proposed by the applicant cannot
achieve the income and cash flows to sustain it financially over the
long term without grant assistance.**

**Attach sufficient information to document the financial need for the
requested grant. A letter from the primary lender specifically
documenting the need for this grant assistance is strongly
recommended.**

**Additional financial information and project financials may be
provided or the agency may request additional information to make this
determination.**

**This is to certify the financial need for the requested grant
assistance**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant**

**Supporting lender letter and/ financial information is attached**

> **Certification Regarding Qualification**
>
> **For Simplified Grant Applications**

WHEREAS,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Herein called the "Grantee," intends to obtain assistance from the
United States of America, acting through the U.S. Department of
Agriculture, herein called the "Government," acting under the provisions
of the Renewable Energy Systems and Energy Efficiency Improvements Grant
Program 4280-B regulations.

NOW THEREFORE, the Grantee hereby certifies the following simplified
application criteria have been or will be met:

(1) The grantee (applicant) is eligible in accordance with 4280.107
    (Guide 5)

(2) The project is eligible in accordance with 4208.108

(3) Total eligible project costs are \$200,000 or less. The total
    eligible project cost of my project is \_\_\_\_\_\_\_\_\_\_\_.

(4) The proposed project will use commercially available renewable
    energy systems or energy efficiency improvements.

(5) Construction planning and performing development will be performed
    in compliance with 4280.115. The grantee or the grantee's prime
    contractor will assume all risks and responsibilities of project
    development.

(6) The grantee or the grantee's prime contractor is responsible for all
    interim financing

(7) The proposed project is scheduled to be completed within [24
    months]{.underline} after entering into a grant agreement. The
    agency may extend this period if the Agency determines, at its sole
    discretion, that the applicant is unable to complete the project for
    reasons beyond the applicant's control.

(8) The grantee agrees not to request reimbursement from funds obligated
    under this program until after project completion, including all
    operations testing and certifications acceptable to the Agency.

IN ADDITION, the Grantee hereby certifies the following application
processing and administration requirements have been met and/or are
agreed to:

(1) Applications documents have been submitted in accordance with
    4280.111, or if applying for a combined grant and loan, also in
    accordance with 4280.193 ©.

(2) The grantee has certified that it meets the definition of
    demonstrated financial need, as defined in 4280.103. The Agency
    reserves the right to request additional information.

(3) The grantee certifies that project development will follow 4280.115,
    except as follows:

\_\_\_\_\_\_ (i) The grantee will participate in project development
without direct compensation subject to approval in writing by the prime
contractor. All applicable construction practices, manufacturer
instructions, and all safety codes and standards will be followed during
construction and testing, and the work product must meet all applicable.
The prime contractor will be responsible for the overall successful
completion of the project including any work done by the grantee,
[or]{.underline}

\_\_\_\_\_\_\_\_ (ii) The grantee can demonstrate to the Agency that the
grantee has the necessary experience and other resources to successfully
complete the project and may serve as the prime contractor/installer.
Projects where the grantee serves as the prime contractor will secure
the services of an independent, professionally responsible, qualified
consultant to certify testing specifications, procedures, and testing
results.

(4) The project is complete when the grantee has provided a written
    final project development, testing, and performance report
    acceptable to the Agency. Upon notification of receipt of an
    acceptable project completion report, the grantee may request grant
    reimbursement. The Agency reserves the right to observe the testing.

(5) National flood insurance is required, if applicable. Business
    interruption insurance is [not]{.underline} required.

IN WITNESS WHEREOF, I have executed this certification on this
\_\_\_\_\_ day of \_\_\_\_\_\_\_\_, 20\_\_\_.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature

**Organizational Documents**

Except for sole proprietorships, each applicant must attach copies of
legal organizational documents including:

1\. Articles of Incorporation

2\. Bylaws

**Attach above items as appropriate here:**

**[PLEASE NOTE!]{.mark}**

[The following page beginning with the **[project summary]{.underline}**
includes **[examples]{.underline}** highlighted in yellow to assist you
in completing your application.]{.mark}

[]{.mark}

[Please utilize these examples as you write your application but
**[delete]{.underline}** these highlighted sections before printing the
final copy that will be submitted to our office.]{.mark}

**Project Summary**

(A summary of the project proposal, [not to exceed one
page]{.underline}, must include the following: Title of the project, a
detailed description of the project including its purpose and need,
goals and tasks to be accomplished, names of the individuals responsible
for conducting and completing the tasks, and the expected timeframes for
completing all tasks, including an operational date.

**[Title of Project:]{.underline}      **

*[(Examples: Producers -- Converting Gravity Irrigation to Center Pivot;
Businesses -- Replacing old HVAC System)]{.mark}*

**[Description of project including its purpose and need:]{.underline}
     **

*[(Examples: Producers -- The project will consist of replacing the old,
inefficient gravity irrigation system with a new, more efficient center
pivot. The purpose of the project is to become more energy efficient and
to save on water usage. By replacing the old system, less energy use
will be required by lowering the pumping needs; Businesses -- The
project will consist of replacing the old, inefficient HVAC system with
a new, higher-efficiency HVAC unit. The purpose of the project is to use
less energy and allow the business to become more energy efficient
throughout.)]{.mark}*

**[Goals and tasks to be accomplished:]{.underline}      **

[]{.mark}

*[(Example: Producers -- The goal of the project is to become more
energy efficient and to save on water usage. The tasks include
installing the underground pipe and new center pivot; Businesses -- The
goal of the project is to upgrade the HVAC system to become more energy
efficient and to save on electric bills. The tasks include installation
of the new HVAC system.)]{.mark}*

**[Names of the individuals responsible for conducting and completing
the tasks:]{.underline}      **

*[(List the business owner/individual applicants, any contractor/vendor
doing work with the project and the energy auditor, along with their
corresponding project task.)]{.mark}*

**[Expected timeframes for completing all tasks, including an
operational date:]{.underline}      **

*[(Example: Producer -- The underground and new pivot will be installed
by March of 2007. The pivot will take approximately 3 days to install
and the underground will take approximately 2 days, weather permitting;
Businesses -- The new HVAC system will be operational by March of 2007.
The new unit and duct work will take approximately 4 days to
install.)]{.mark}*

**Applicant Eligibility**

The applicant or borrower must be an agricultural producer or rural
small business.

Definition of an Agricultural Producer:

*An agricultural producer is an individual or entity directly engaged in
the production of agricultural products, including crops (including
farming), livestock (including ranching), forestry products,
hydroponics, nursery stock, or aquaculture, whereby 50% or greater of
their gross income is derived from the operations.*

Definition of a Rural Small Business:

*An entity is considered a small business in accordance with the Small
Business Administration (SBA) small business size standards by NAICS
found in Title 13 CFR part 121. A private entity including a sole
proprietorship, partnership, corporation, cooperative, including a
cooperative qualified under section 501©(12) of the internal revenue
code), and an electric utility including a Tribal or governmental
electric utility that provides service to rural consumers on a cost of
service basis without support from public funds or subsidy from the
government authority establishing the district, provided such utilities
meet SBA's definition of small business. These entities must operate
independent of direct Government control. With the exception of the
entities described above, all other non-profit entities are excluded.*

Individuals must be citizens of the United States (U.S.) or reside in
the U.S. after being legally admitted for permanent residence. Entities
must be at least 51 percent owned, directly or indirectly, by
individuals who are either citizens of the U.S. or reside in the U.S.
after being legally admitted for permanent residence.

If the applicant or borrower, or an owner has an outstanding judgment
obtained by the United States in a Federal Court (other than in the
United States Tax Court), is delinquent in the payment of Federal income
taxes, or is delinquent on a Federal debt, the applicant or borrower is
not eligible to receive a grant, until the judgment is

paid in full or otherwise satisfied or the delinquency is resolved.

If an applicant has been debarred from receiving Federal assistance, the
applicant is not eligible to receive a grant, direct loan, or guaranteed
loan under this program.

As previously noted the applicant must have demonstrated financial need.

An applicant that has received one of more grants and/or loans under
this program must make satisfactory progress, as determined by the
Agency, toward completion of any previously funded projects before it
will be considered for subsequent funding.

**[Briefly notate how you meet the above eligibility requirements and
certify your eligibility:]{.underline}**      

*[(Example: I am an eligible producer as more than 50% of my gross
income is derived from ag operations. I am an individual of the United
States. I do not have any outstanding judgments, nor am I debarred from
receiving Federal assistance. I have demonstrated financial need. I have
never received a grant through this program.]{.mark}*

I meet the above described eligibility requirements

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Applicant t 6

**Project Eligibility**

The proposed project must be for renewable energy or energy efficiency
purposes. This is identified in the project description and further
confirmed in the technical report portion of this application.

The project must be for commercially or pre-commercially available and
replicable technology. Additionally, the project must have technical
merit. Documentation of the commercial or pre-commercial availability
and the technical merit of the technology is also described in the
technical report portion of this application.

The applicant must be the owner of the project and control the revenues
and expenses of the operation, including operation and maintenance of
the proposed project. A qualified third-party under contract to the
owner may be used to control revenues and expenses and manage the
operation and/or maintenance of the proposed project.

**[Describe/notate how you meet the above eligibility
requirements]{.underline}:      **

*[(Example: I as the applicant will own the project and control the
revenues and expenses of the operation, including the operation and
maintenance of the proposed project.)]{.mark}*

Sites must be owned or controlled by the applicant for a reasonable term
consistent with the economic life of the project and as a minimum the
financing term of any associated Federal loans or loan guarantees.

**[Describe here your ownership/control of sites being improved with
requested funds:]{.underline}** *     *

*[(Example: The site is owned and controlled by myself as the applicant.
The site will be owned for at least the economic life of the
project.)]{.mark}*

The requested project must be located in a rural area. *Rural is defined
as any area other than a city or town that has a population of greater
than 50,000 inhabitants and the urbanized area contiguous and adjacent
to such a city or town according to the latest decennial census of the
United States.*

**[Identify the location of your project to verify that the project
meets the above location requirement (include address and legal
description):]{.underline}** *     *

*[(Provide here either the legal description of the entire project (as
listed on your tax statement) or the physical address of the
business)]{.mark}*

Satisfactory sources of revenue in an amount sufficient to provide for
the operation, management, maintenance, and debt service of the project
must be available for the life of the project. This documentation is
provided in the financial and/or technical report portions of this
application.

The Project meets all above described project eligibility requirements.

Signed \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Applicant

**Operation Description**

\(A\) Description of the applicant's total farm/ranch/business operation
and the relationship of the proposed project to the applicant's total
farm/ranch/business operation:

**[Describe here or attach:]{.underline}**      

*[(Example: Ag Producers -- I own and/or operate approximately 1500
acres, of which are all irrigated. I produce primarily corn, soybeans
and wheat; The project will affect 160 acres of my row crop production.
Businesses -- My primary business operation is a full service auto
repair shop. Currently I own one location of where all of the business
activity is completed. This location is the proposed project
site.)]{.mark}*

\(B\) Description of the ownership, including a list of individuals
and/or entities with ownership interest, names of any corporate parents,
affiliates, and subsidiaries, as well as a description of the
relationship, including products, between these entities:

**[Describe here or attach here:]{.underline}      **

*[(Example: Sole Proprietors -- I am a sole proprietor and own 100% of
the business. Partnership -- Jane Doe and John Doe own 100% of the
business (50/50). Jane and John are brother and sister. Corporation --
List the names and titles of all owners, and the percent of their
ownership interest.)]{.mark}*

> **Financial Information for Size Determination**
>
> Provide financial information to allow the Agency to determine the
> applicant's size. All information submitted under this paragraph must
> be substantiated by authoritative records.

**(A) Rural small businesses** must provide sufficient information to
determine total annual receipts for **and** number of employees of the
business **and** any parent, subsidiary, or affiliates at other
locations. Voluntarily providing tax returns is one means of satisfying
this requirement. The information provided must be sufficient for the
Agency to make a determination of business size as defined by SBA.

**State total income or gross income and reference attached appropriate
IRS or other financial documentation, including a statement and
verification of number of employees:**      

(B) **Agricultural producers**: Provide the gross market value of your
    agricultural products, gross agricultural income, and gross non-farm
    income of the applicant for the calendar year preceding the year in
    which you submit your application. **(Provide a complete copy of
    your previous year tax return)**

> **State income and attach appropriate IRS or other sufficient
> documentation:**

**Financial Information**

**([For projects exceeding \$200,000]{.underline})**

Financial information is required for all projects exceeding \$200,000
on the **total** operation of the agricultural producer, rural small
business **and** its parent, subsidiary, or affiliates at other
locations. All information submitted under this paragraph must be
substantiated by authoritative records.

**Historical, current, and pro-forma** financial information is
requested.

Businesses shall provide financial information prepared in accordance
with GAAP. Agricultural producers may submit information in accordance
with GAAP or in the format that is generally required by commercial
agriculture lenders.

**Attach the following:**

**Historical: 1. Attach previous 3 years income statements:**

**2. Attach previous 3 years balance statements:**

**Current: 3. Attach Current Balance Sheet:**

**4. Attach Current Income Statement:**

**Pro-forma: 5. Attach pro forma balance sheet\* at startup:**

**6. Attach pro forma balance sheet\*\* for 3 years**

**projected.**

> **7. Attach pro forma cash flow and income statements\*\*\***
>
> **for 3 years projected.**
>
> **\* pro forma start up balance sheet should reflect use of grant/loan
> proceeds.**
>
> **\*\*pro forma balance statements should reflect necessary startup
> capital, operating capital, and short-term credit.**
>
> **\*\*\* cash flow and income statements should list any assumptions
> showing the basis for the projections.**

**Matching Funds Documentation**

Submit or complete the following spreadsheet identifying sources of
matching funds, amounts and status of matching funds. The spreadsheet
will also include a directory of matching funds source contact
information. Attach any applications, correspondence, or other written
communication between applicant and matching fund source.

**It is very important to attach a firm commitment letter from the
lender or funding source providing the matching funds. If available cash
or savings is intended to be used as match, an account statement showing
sufficient available funds must be attached.**

Match fund source amount Contact

[*     *]{.mark}

*[Example:]{.mark}*

*[Bank of Example \$75,000 John Doe]{.mark}*

Without specific statutory authority, other Federal grant awards and
applicant in-kind contributions cannot be used to meet the matching fund
requirement. Third-party, in-kind contributions are limited to 10% of
the matching fund requirement of the grant. The Agency will advise if
the third-party, in-kind contributions are acceptable in accordance with
7 CFR part 3015.

Passive third party equity contributions are acceptable for renewable
energy system projects, including those that are eligible for Federal
production tax credits, provided the applicant meets the requirements of
Section 4280.107 (applicant eligibility).

**Self Evaluation Score**

Complete the following evaluation. To justify the score, submit the
total score along with appropriate calculations and attached
documentation, or cross-references to information elsewhere in the
application.

**Evaluation Criteria Scoring Guideline**

**Name of
Applicant:\_     \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Type of
Technology:\_     \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Final Total Score (Points)**

**(1) Quantity of Energy Replaced, Produced, or Saved.**

Points may only be awarded for one category (A, B, or C).

\(A\) Energy replacement

If the proposed renewable energy system is [intended primarily for self
use]{.underline} by the agricultural producer

or rural small business, and will provide energy replacement of:

+--------------------------------------------------------------+-------+
| Greater than 0 but equal to or less than 25%, **award 5      | P     |
| points.**                                                    | oints |
|                                                              |       |
|                                                              |       |
+--------------------------------------------------------------+-------+
| Greater than 25%, but equal to or less than 50%, **award 10  |       |
| points.**                                                    |       |
+--------------------------------------------------------------+-------+
| Greater than 50%, **award 15 points.**                       |       |
+--------------------------------------------------------------+-------+
| Determine energy replacement by dividing the estimated       |       |
| quantity of renewable energy to be generated over a 12 month |       |
| period by the estimated quantity of energy consumed over the |       |
| same 12 month period during the previous year by the         |       |
| applicable energy application. The estimated quantities of   |       |
| energy must be converted to British thermal units (BTU's),   |       |
| Watts, or similar energy equivalents to facilitate scoring.  |       |
| If the estimated energy produced equals more than 150% of    |       |
| the energy requirements of the applicable process(es), score |       |
| the project as an energy generation project.                 |       |
+--------------------------------------------------------------+-------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_     \_\_\_\_\_.*

***OR***

\(B\) Energy Savings (include additional 5 points if applicable)

\(1\) If the estimated energy expected to be saved by the installation
of the energy efficiency

improvements will be from:

+--------------------------------------------------------------+-------+
| 20% up to but not including 30%, **award 5 points.**         | P     |
|                                                              | oints |
|                                                              |       |
|                                                              |       |
+--------------------------------------------------------------+-------+
| 30% up to but not including 35%, **award 10 points.**        |       |
+--------------------------------------------------------------+-------+
| 35% or greater, **award 15 points.**                         |       |
+--------------------------------------------------------------+-------+
| Energy savings will be determined by the projections in an   |       |
| energy assessment or audit.                                  |       |
+--------------------------------------------------------------+-------+

\(2\) Additional points.

+--------------------------------------------------------------+-------+
| If the project has total eligible project costs of [\$50,000 | P     |
| or less]{.underline} AND opts to obtain a professional       | oints |
| energy audit, **award an additional 5 points**.              |       |
|                                                              |       |
+--------------------------------------------------------------+-------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_     \_\_\_\_\_.*

***OR***

\(C\) Energy generation

+--------------------------------------------------------------+-------+
| If the proposed renewable energy system is intended          | P     |
| primarily for production of energy for sale, **award 10      | oints |
| points.**                                                    |       |
|                                                              |       |
+--------------------------------------------------------------+-------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_     \_\_\_\_\_\_.*

**(2) Environmental benefits**

+---------------------------------------------------------------+------+
| If the purpose of the proposed system contributes to the      | Po   |
| environmental goals and objectives of other Federal, State,   | ints |
| or local programs, **award 10 points**.                       |      |
|                                                               |      |
|                                                               |      |
+---------------------------------------------------------------+------+
| Award points only if the applicant provides documentation     |      |
| from an appropriate authority supporting this claim. The      |      |
| Wyoming State Energy Office (307-777-2804) can assist.        |      |
+---------------------------------------------------------------+------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_     \_\_\_.*

**(3) Commercial availability**

+---------------------------------------------------------------+------+
| If the proposed system or improvement is currently            | Po   |
| commercially available and replicable,                        | ints |
|                                                               |      |
| **award 5 points.**                                           |      |
|                                                               |      |
+---------------------------------------------------------------+------+
| If the proposed system or improvement is commercially         |      |
| available and replicable and is also provided with a [5 year  |      |
| or longer warranty]{.underline} providing the purchaser       |      |
| protection against system degradation or breakdown or         |      |
| component breakdown, **award 10 points.**                     |      |
+---------------------------------------------------------------+------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_     \_\_\_.*

**(4) Technical Merit --** [Score each paragraph (A) through (J) within
this category according to the following rules:]{.underline}

*The contents of the Technical report will substantiate the score for
technical merit**. NOTICE TO APPLICANT: NREL will determine final points
awarded.***

  ------------------------------------------------- ---------------------
  **If the description - - - -**                    

  Has no significant weaknesses and exceeds the     **award 100%** of the
  requirements of the paragraph                     total possible score.

  Has one or more significant strengths, and meets  **award 80%** of the
  the requirements of the paragraph                 total possible score.

  Meets the basic requirements of the paragraph but **award 60%** of the
  also has several weaknesses                       total possible score.

  Is lacking in one or more critical aspects, key   **award 40%** of the
  issues have not been addressed, but the           total possible score.
  description demonstrates some merit or strengths  

  Has serious deficiencies, internal                **award 20%** of the
  inconsistencies or is missing information         total possible score.

  Has no merit in this area                         **award 0%** of the
                                                    total possible score.

  **The total possible points for Technical Merit   
  is 35 points.**                                   
  ------------------------------------------------- ---------------------

+-------------------------------------------------+------+------+-----+
| **The 10 subparagraphs which are the basis for  | *    | **%  | *   |
| evaluation.**                                   | *Max | of   | *Sc |
|                                                 | imum | s    | ore |
|                                                 | poss | core | Awa |
|                                                 | ible | a    | rde |
|                                                 | sco  | ward | d** |
|                                                 | re** | ed** |     |
+-------------------------------------------------+------+------+-----+
| \(A\) **Qualifications of the project team**    | 10   |      |     |
| -The applicant has described the project team   |      |      |     |
| service providers, their professional           |      |      |     |
| credentials, and relevant experience. The       |      |      |     |
| description supports that the project team      |      |      |     |
| service, equipment, and installation providers  |      |      |     |
| have the necessary professional credentials,    |      |      |     |
| licenses, certifications, or relevant           |      |      |     |
| experience to develop the proposed project.     |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(B\) **Agreements and Permits** -The applicant | 5    |      |     |
| has described the necessary agreements and      |      |      |     |
| permits required for the project and the        |      |      |     |
| schedule for securing those agreements and      |      |      |     |
| permits.                                        |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(C\) **Energy or Resource Assessment** -The    | 10   |      |     |
| applicant has described the quality and         |      |      |     |
| availability of a suitable renewable resource,  |      |      |     |
| or an assessment of expected energy savings for |      |      |     |
| the proposed system.                            |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(D\) **Design and Engineering** -The applicant | 30   |      |     |
| has described the design, engineering, and      |      |      |     |
| testing needed for the proposed project. The    |      |      |     |
| description supports that the system will be    |      |      |     |
| designed, engineered, tested so as to meet its  |      |      |     |
| intended purpose, ensure public safety, and     |      |      |     |
| comply with applicable laws, regulations,       |      |      |     |
| agreements, permits, codes, and standards.      |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(E\) **Project Development Schedule**-The      | 5    |      |     |
| applicant has described the development method  |      |      |     |
| including the key project development           |      |      |     |
| activities and the proposed schedule for each   |      |      |     |
| activity. The description identifies each       |      |      |     |
| significant task, its beginning and end, and    |      |      |     |
| its relationship to the time needed to initiate |      |      |     |
| and carry the project through to successful     |      |      |     |
| completion. The description addresses grantee   |      |      |     |
| or borrower project development cash flow       |      |      |     |
| requirements.                                   |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(F\) **Project Economic Assessment**-The       | 20   |      |     |
| applicant has described the financial           |      |      |     |
| performance of the proposed project, including  |      |      |     |
| the calculation of simple payback. The          |      |      |     |
| description addresses project costs and         |      |      |     |
| revenues, such as applicable investment and     |      |      |     |
| production incentives and other information to  |      |      |     |
| allow the assessment of the project's cost      |      |      |     |
| effectiveness.                                  |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(G\) **Equipment Procurement** - The applicant | 5    |      |     |
| has described the availability of the equipment |      |      |     |
| required by the system. The description         |      |      |     |
| supports that the required equipment is         |      |      |     |
| available, and can be procured and delivered    |      |      |     |
| within the proposed project development         |      |      |     |
| schedule.                                       |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(H\) **Equipment Installation** -The applicant | 5    |      |     |
| has described the plan for site development and |      |      |     |
| system installation.                            |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(I\) **Operations and Maintenance** -The       | 5    |      |     |
| applicant has described the operations and      |      |      |     |
| maintenance requirements of the system          |      |      |     |
| necessary for the system to operate as designed |      |      |     |
| over the design life.                           |      |      |     |
+-------------------------------------------------+------+------+-----+
| \(J\) **Dismantling and disposal of project     | 5    |      |     |
| components**                                    |      |      |     |
|                                                 |      |      |     |
| The applicant has described the plan for        |      |      |     |
| dismantling and disposing of project components |      |      |     |
| at the end of their useful lives and associated |      |      |     |
| wastes.                                         |      |      |     |
+-------------------------------------------------+------+------+-----+
| Total Possible Score                            | 100  | T    |     |
|                                                 |      | otal |     |
|                                                 |      | S    |     |
|                                                 |      | core |     |
|                                                 |      | Awa  |     |
|                                                 |      | rded |     |
+-------------------------------------------------+------+------+-----+
|                                                 |      |      |     |
+-------------------------------------------------+------+------+-----+
| [Total Score                                    |      | **Po |     |
| Awarded\_\_\_\_\_\_\_\_\_]{.underline}=         |      | ints |     |
| \_\_\_\_\_\_% X 35 total possible points =      |      | a    |     |
|                                                 |      | ward |     |
| Total Possible Score 100                        |      | ed** |     |
+-------------------------------------------------+------+------+-----+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_     \_\_\_.*

**(5) Readiness (Grants only)**

If the applicant has written commitments, prior to the Agency receiving
the complete application,

from the source(s) confirming commitment of:

+------------------------------------------------------------+---------+
| 50% up to but not including 75% of the matching funds,     | Points  |
| **award 5 points**.                                        |         |
|                                                            |         |
+------------------------------------------------------------+---------+
| 75% up to but not including 100% of the matching funds,    |         |
| **award 10 points.**                                       |         |
+------------------------------------------------------------+---------+
| 100% of the matching funds, **award 15 points**.           |         |
+------------------------------------------------------------+---------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_\_\_\_\_\_.*

**(6) Small Agricultural Producer/Very Small Rural Business**

If the applicant is an agricultural producer producing agricultural
products with a gross market value of:

+------------------------------------------------------------+---------+
| less than \$600,000 in the preceding year, **award 5       | Points  |
| points**.                                                  |         |
|                                                            |         |
+------------------------------------------------------------+---------+
| less than \$200,000 in the preceding year,                 |         |
|                                                            |         |
| **OR**                                                     |         |
|                                                            |         |
| is a Very Small Rural Business as defined in 4280.103 (a   |         |
| business with less than 15 employees and less than \$1     |         |
| million in annual receipts), **award 10 points.**          |         |
+------------------------------------------------------------+---------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_\_\_\_\_\_.*

**(7) Simplified application**

+------------------------------------------------------------+---------+
| If an applicant is eligible for and uses the simplified    | Points  |
| application process **or** if the project has total        |         |
| eligible project costs of \$200,000 or less, **award 5     |         |
| points.**                                                  |         |
+------------------------------------------------------------+---------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_\_\_\_\_\_.*

**(8) Previous grantees and borrowers**

+------------------------------------------------------------+---------+
| If the applicant has not been awarded a grant or loan      | Points  |
| under this program within the 2 previous Federal fiscal    |         |
| years, **award 5 points.**                                 |         |
+------------------------------------------------------------+---------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_\_\_\_\_\_.*

**(9) Return on investment (NREL will make the final determination for
these points.)**

If the proposed project will return the cost of investment in

  ------------------------------------------------------------- ---------
  Less than 4 years, **award 10 points**.                       Points

  4 years up to but not including 8 years, **award 4 points.**  

  8 years up to 11 years, **award 2 points.**                   
  ------------------------------------------------------------- ---------

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_\_\_\_\_\_.*

**(10) Loan Rate (Guaranteed Loans only; 4280.129 (e)):**

+------------------------------------------------------------+---------+
| If the rate of the loan is below the Prime Rate (as        | Points  |
| published in the Wall Street Journal) plus 1.5 percent,    |         |
| **award 5 points**. **OR**                                 |         |
+------------------------------------------------------------+---------+
| If the rate of the loan below the Prime Rate (as published |         |
| in the Wall Street Journal) plus 1 percent, **award 10     |         |
| points**.                                                  |         |
+------------------------------------------------------------+---------+

*Attach the documentation to substantiate this score for this category.*

*You have identified this documentation via tab #\_\_\_\_\_\_\_.*

**Energy Audit**

**([For Energy Efficiency Projects Only]{.underline})**

Either an energy assessment or an energy audit is required for energy
efficiency improvement projects. For energy efficiency improvement
projects with [total eligible]{.underline} project costs
[greater]{.underline} than \$50,000, **an energy audit must be conducted
by or reviewed and certified by an energy auditor.**

For energy efficiency improvement projects with total eligible project
costs of [\$50,000 or less]{.underline}, an energy assessment or an
energy audit may be conducted by either an energy assessor or an energy
auditor**. Note: It is strongly recommended that you obtain the Energy
Audit!**

Definitions:

**[Energy assessment]{.underline}** -- a report conducted by an
experienced energy assessor, certified energy manager or professional
engineer assessing energy cost and efficiency by analyzing energy bills
and briefly surveying the target building, machinery or system. The
report identifies and provides a savings and cost analysis of
low-cost/no-cost measures. The report will estimate the overall costs
and expected energy savings from these improvements, and dollars saved
per year. The report will estimate weighted-average payback period in
years. See the Technical Report guide for a complete description.

[**Energy audit**]{.underline} -- A report conducted by a Certified
Energy Manager or Professional Engineer that focuses on potential
capital-intensive projects and involves detailed gathering of field data
and engineering analysis. The report will provide detailed project cost
and savings information with a high level of confidence sufficient for
major capital investment decisions. It will estimate costs, expected
energy savings from the subject improvements, and dollars saved per
year. The report will estimate weighted-average payback period in years.
See the Technical Report guide for a complete description.

**Attach Energy Audit:**

**Technical Requirements reports for ALL Projects**

Technical requirement reports are required for each project. Technical
requirements reports are of course different based on the technology
being used. There are ten (10) different technical requirement reports
guides available for the various technologies as follows:

1.  Biomass/bioenergy

```{=html}
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```
1.  Anaerobic digester projects

2.  Geothermal, electric generation

3.  Geothermal, direct use

4.  Hydrogen

5.  Solar, small (10 KW or smaller)

6.  Solar, large (larger than 10KW)

7.  Wind, small (100 KW or smaller & 120' or less in height)

8.  Wind, large (larger than 100 KW)

9.  All energy efficiency improvement projects

Applicants should identify the appropriate technical report guide from
the above list that is applicable for their project and request that
guide from USDA Rural Development.

**It is critical that you obtain the appropriate technical requirements
report guide, complete a strong report by addressing each of the items
(a) through (j) in the guide, and attach the report to your application.
Supporting information including charts, drawings, design information,
vendor information etc. may be included with the report. The strength of
this report will be the basis for technical merit score and project
eligibility determinations.**

The services of a professional engineer (P.E.) or a team of licensed
PE's are required:

-   on renewable projects with total eligible projects costs exceeding
    \$400,000

-   on energy efficiency projects with total eligible project costs
    exceeding \$200,000

These services include a design review, installation monitoring, testing
prior to commercial operation, and project completion certification.

On projects exceeding total eligible costs of \$1,200,000, the technical
report must be reviewed and include an opinion and recommendation by an
independent qualified consultant.

**Attach your technical report :**

**Feasibility study for renewable** **energy systems**

**([For renewable projects with a total cost greater than \$200,000
ONLY]{.underline})**

For each application for a renewable energy system project, with total
eligible project costs greater than \$200,000, a business level
feasibility study by an independent, qualified consultant will be
required by the Agency for start-up or existing businesses. The
feasibility study must include an analysis of the **market, financial,
economic, technical, and management feasibility** of the proposed
project.

The feasibility study should include an opinion and a recommendation by
the independent consultant.

**Attach feasibility study here.**