The Partner Agrees to: 

1. Designate a liaison for EPA's CHP Partnership. 

2. Provide data on existing CHP projects and new project development to help EPA determine climate benefits. 

3. Provide input to EPA-developed CHP Partnership tools and services. 

4. Employ CHP Partnership tools and services, as appropriate, to recognize and promote CHP development. 

EPA Will: 

1. Promote understanding and recognition of the environmental, energy, and economic benefits of CHP. 

2. Support the Partner with tools and services intended to accelerate the development of CHP projects, including 

recognition of Partner's CHP accomplishments and associated benefits. 

3. Designate a Program Manager as Partner liaison. 

Partner’s Letter of Intent 

for Companies and Institutions 

With this letter ____________________________________________________________ (company/institution) 

joins EPA's Combined Heat and Power (CHP) Partnership and agrees to work with EPA to promote the benefits 

of CHP and support development of new CHP projects. 

Sincerely, __________________________________________________________________________________ 

Authorized Company Representative Signature 

Name: _____________________________________________________________________________________ 

Title: ___________________________________________________________ Date: ______________________ 

Please fax the completed Letter of Intent (2 pages) to 617/482-1320 (contractor in support of EPA) 

OMB Control No. 2060-0578 

Approval Expires 04/30/2009 

General Terms: 

1.	 This agreement can be terminated by either party, at any time, without prior notification, penalties, or 

further obligation. 

2.	 EPA will honor requests to keep reported data or activities confidential. 

3.	 The Partner agrees that the activities it undertakes connected with this voluntary agreement are not intended to 

provide services to the federal government and that the Partner will not seek compensation from a federal 

agency. 

4.	 The Partner agrees that it will not claim or imply that its participation in the Partnership constitutes EPA approval 

or endorsement of anything other than its commitment to the Partnership. 

Please complete the information on page 2. Page 1 
________________________________________________________________________________________________ 

Please provide a brief profile of your organization’s involvement with CHP and what services you provide, if appropriate. 

(If the space below is not adequate, please mail or fax this information to us on separate pages, along with your signed 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

________________________________________________________________________________________________ 

Partner's Liaison: 

Name: __________________________________________________________________________________________ 

Title: ____________________________________________________________________________________________ 

Address: _________________________________________________________________________________________ 

City: _________________________________________________________ State:_______ Zip: __________________ 

Telephone: __________________________________________ Fax: ________________________________________ 

E-mail: __________________________________________________________________________________________ 

Additional Partner Information: 

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

 CHP Project Developer 

 Construction 

 Consultant/Engineering 

 ESCO 

 End-user 

 Equipment Manufacturer 

 Financier 

 Non-governmental Organization (NGO) 

 Utility 

Your organization’s Web site address: _________________________________________________________________ 

Does your organization have a CHP-related Web page? If so, please list here: 

May we provide a link to your CHP-related Web page?  Yes  No 

Letter of Intent.): 

The government estimates the average time needed to fill out this form is 4.9 hours and welcomes suggestions for reducing this level of effort. Send comments 

(referencing OMB control number) to the Director, Collection Strategies Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. 

PLEASE FAX THE COMPLETED LETTER OF INTENT TO 617/482-1320 (contractor in support of EPA) 

Office of Air and Radiation EPA-430-F-05-034 

(6202J) www.epa.gov/chp

October 2005 

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