### • • • Use the Green Power Mark in a manner that is consistent w ith Partner mark use guidelines.

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## Name of individual agreeing to the terms: **I understand and agree to the above requirements to become an EPA Green Power Partner. General Terms:**  Either party can terminate this agreement at any time w ithout prior notification or penalties and w ith no further obligation. EPA w ill not comment publicly regarding the w ithdrawal of Partners. Partner agrees that the activities it undertakes connected w ith this voluntary agreement are not intended to provide services to the federal government and that the Partner w ill not seek compensation from a federal agency. Partner agrees that it w ill not claim or imply that its participation in the Green Pow er Partnership constitutes EPA approval or endorsement of anything other than its participation in the program and w ill not make statements or imply that EPA endorses the purchase or sale of the Partner’s products and services or the views of the Partner organization. EPA may post information about the Partner’s green pow er use publicly. EPA may periodically revise program benchmark levels or other eligibility requirements. 

### For more information on partnership requirements (including minimum green power use and eligible green power sources) go to: http://epa.gov/greenpower/join/purchase.htm. Provide procurement and communications assistance, as requested by Partner. Provide a brief description of the Partner's green pow er commitment on the Green Power Partnership W eb site. 

### In return, EPA commits to: Provide public recognition. Report on green power use annually. 

### The U.S. EPA's Green Power Partnership encourages the voluntary use of green power to reduce the risk of climate **change. Partners benefit from the use of green power, while supporting the development of new, renewable energy in the United States.**  **By joining EPA's Green Power Partnership, Partners commit to:** Use green power that meets or exceeds Partnership requirements.

1 of 1 EPA-HQ-OAR-2004-0501-DRAFT-0024**Primary Contact Public Relations Contact**  (Optional) **Salutation Contact Name**  **Title Street Address**  **City/State/Zip Email Address**  **Phone Number**
**Partner Name Website Link**  **Green Power Related Web Page** (e.g. environmental or sustainability page) Optional **Industry** (select from picklist) **Annual Electricity Use (kWh/yr) Scope of Reported Electricity Use**  (select from picklist) **Please Identify Reporting Facility or Group of Facilities**  (only if "Single Facility or Subset" is selected above)

**(If other, please specify):**

**Reporting Period Start Date Reporting Period End Date**  

### Organizational Electricity Use **Contact Information** 

# Green Pow **er Partnership Yearly Reporting Form**  **This Yearly Report form should be used to update the EPA on your organization's green power usage. Please complete the report, save the file, and return to your account manager or James Critchfield at your earliest convenience. James Critchfield's email address is critchfield.james@epa.gov.** 



### Organizational Information **All fields are required unless noted otherwise.**



### Reporting Period (Optional): The electricity and green pow er information contained in this report covers the follow ing 12-month period. Partners may choose to report most recent calendar year, fiscal year, other 12-month period, or forw ard-looking data. **Motivating Factors** (Optional): Check the motivating factors behind you green pow er use (check all that apply) Cost stability or savings Demonstrate environmental leadership LEED certification Meet sustainability goals Support economic development & job creation Support renewable energy development Other Brand or product differentiation EPA recognition Reduce carbon footprint

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**Green Power Provider(s)** One provider per row **Product Name** Optional **Green Power Purchase**  (kW h/year) **Bio**

**gas** (%) **Bio-mass**

(%) **Geo**

**thermal** (%) **Hydro**

(%) **Solar**

(%) **Wind** (%) **Unknown**

(%) **Total**

(%) **3rd Party**

**Certified? % New Renew** 

**ables*** **Contract**

**Begin Date** (mm/dd/yy) **Contract End**

**Date** (mm/dd/yy) **Is this provider also**

**supplying your electricity?**  0 0 0 Total: 0 * % of product from facilities placed in service within the last 15 years.

**Onsite Generation Technology** One onsite installation per row **Green Power Production**  (kW h/year) **Rated Capacity (kW)**  Optional **Power Purchase**  **Ag reement**  **Start Date** (mm/dd/yy) **Power**

**Purchase Ag**  **reement End Date**  (mm/dd/yy)

Total: 0 * EPA will only count as green power the kW h output from onsite installations for which the Green Power Partner owns the rights to the renewable energy certificates (RECs). **Total Green Power 0**  **Percent Green Power 0.00%**  **Select the appropriate check box(es) below :** 

**Year Installed** Optional **We are purchasing green pow er or renew**  **able energy certificates (RECs) from a provider. We are using green pow**  **er onsite.**

**Location (ZIP Code)**  Optional **Product's Resource Mix (should total 100%)**

**3rd Party Ownership?**  Optional **Please update the information below with your current green pow**  **er product purchase information. If you are purchasing more than one green pow er product or REC product, list each purchase on a separate row**  **.**

**Please update the fields below with your current onsite green pow**  **er use information. If you have more than one onsite system, list each installation on a separate row .**  **Only Complete if 3rd Party Owned System 3rd Party Owner**  Optional **Green Pow er Information** 

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## You can find existing GPP profiles at: 

## Partner Profile (Optional)

**Current Profile for Your Organization: Al**  **l Green Power Partners have the opportunity to have a Partner Profile on the Web site. The Partner Profile is a short paragraph (200 word limit) that describes briefly a Partner’s organization, its decision to use green power, and its experience to date with green power.**  **If you would like to create a Partner Profile, please draft a paragraph in the space provided below. EPA will then review the Profile and offer you a chance to**  **approve it prior to posting on the Green Power Partnership Web site. Note, EPA cannot endorse your green power provider on the Web site, so please make**  **sure the profile does not include reference to the entity from which you are procuring your green power. In writing your Partner Profile, provide a brief description of your organization and try to address these questions:**  **- How much green power is your organization using? - What was the driver behind your organization's switch to green power?**  **- A ny lessons learned during your green power commitment process you would like to share with others?**  **- What are the biggest benefits that have accrued to your organization since it switched to green power? If you’d like to provide a quote about the benefits of green power for your organization, please include the name and title of the person the quote is attributed**  **to.**

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