OMB Control No. 2060 - 0347

EPA Form 5900 - 195 Page 1 of 3 Version: 11 / 1 0/09



# Serv ice and Product Provider (SPP) Partnership Application Data Form
P LEASE SUBMIT THIS APPLICATION DATA FORM AND ATTACHMENTS REQUESTED IN QUESTION S 5 , 6, and 7 TO SPP@ENERGYSTAR.GOV , ALONG WI TH YOUR COMP LETED PARNERSHIP APPLICATION PACKET
. Date: Company

Name (Web Display

) : We b Address: 

### 1) An unbiased 3 -5 sentence description of your company, its services , and products . D escription should address service and/or product offerings provided to improve energy efficiency of customer buildings.



### 2) Identify your company type : (Check all that apply)

Architecture or A/E Engineering Distributor Equipm ent Manufacturer Energy Consultant / Energy

Management Services Financial Services Energy Imp rovement Contractor On - site Energy Production Services Energy Information Services Unregulated Energy Retailer and Marketer Energy S ervice Co m pany

(ESCO) 

### 3) P lease identify the market sector(s) that your company actively serves : (Check all that apply)

Commercial Real Estate Industry Corporate Real Estate (Banks, Financial, Consulting, Telecommunications) K- 12 Education Federal Government Local Government Healthcare (Hospital, Medical Office Building) Retail (Apparel, Big Box, Convenien ce Stores, Department Stores, Discount Stores -Wa rehouse Clubs, Drug Stores, Restaurants, Sup ermarkets ) Higher Education Small Business Hospitality and Entertainment (Hotels, Resorts, Stadiums, Theaters, Museums , Convention Centers) State GovernmentOMB Control No. 2060 - 0347

EPA Form 5900 - 195 Page 2 of 3 Version: 11 / 1 0/09 

### 4) To which SPP partnership category would you like to apply? (SELECT ONE) Please determine which partnership category reflects the primary area of your business and is the best fit for you based on the SPP Partnership Requirements. Please select only one area below. Existing Commercial Buildings SPP If selecting this area, answer question 5 only
. Commercial New Construction SPP (i.e. Architecture Firms) If selecting this area, answer question 6 only
. Industrial SPP If selecting this area, answer question 7 only
. 

### 5) Complete this question ONLY i f you selected the “ Existing Commercial Buildings SPP ” partnership category in Question 4 . SPPs in this partnership category conduct business primarily with existing commercial buildings clients. Please complete Question 5a and 5b and/or 5c to allow us to verify that you meet requirements for partnership. a) To help us understand your business, p lease provide brief descriptions for a minimum of two energy efficiency projects completed for your clients.

b) L ist 10 customer commercial buildings which you have benchmarked using Portfolio Manager in the l ast 12 months. T o meet the SPP requi rement , you must benchmark at least 10 customer buildings – and receive energy performance rating s (EPR) and/or energy use intensity

(EUI) score s – in the past 12 months. Please provide an em ail attach me nt of a Statem ent of Energy Performan ce (SEP) for ea ch facility listed
. SEPs can be generated in Portfolio Manager for all buildings with at least 1 1 consecutive months of data entered. (Note: For SPP partnership application, SEPs are requested as evidence of SPP benchmarking and DO NOT need to be reviewed and/or stamped by a Professional Engineer. Information provided will remain confidential, and will be used only to verify eligibility in terms of partnership requirements.) Name of Proje ct/Client Date(s) of project completion Project Scope and/or Energy Efficiency Me asures Implemented/Recommended

Portfolio Manager Building ID# Customer Organization Name Building Received an EPR Rating? Building

Received an EUI Score?OMB Control No. 2060 - 0347

EPA Form 5900 - 195 Page 3 of 3 Version: 11 / 1 0/09 c) Please list at least one customer building which your organization has helped to earn the ENERGY STAR labe l in the last 12 months . (Note: In order to receive credit for helping a customer building to earn the ENERGY STAR, your organization must be indicated as the primary SPP for the building in Portfolio Manager .)



### 6) Complete this question ONLY if you selected the “ Commercial New Construction SPP ” partnership category in Question 4 . SPPs in this partnership category are comprised of architecture and A/E firms specializing in commercial building design. Determine if design projects are eligible for Designed to Earn the ENERGY STAR by using EPA’s Target Finder , an online tool for commercial buildin g designs. List at least one project you plan to submit for the Partnership Application requirement. EPA will review and approve eligible projects and applications to activate this Partnership Agreement.



### 7) Complete this question ONLY if you selected the “ Industrial SPP ” partnership category in Question 4 . SPPs in this partnership category work with ENERGY STAR Industrial partners to implement energy efficiency pr ojects. List at least one e n ergy efficiency project that you completed for an ENERGY STAR Industrial partner in the last 2 years . Please attach a completed “Teaming Profile” outlining the project scope and resulting savings for that project. Review additi onal guidelines on creating Teaming Profiles on the ENERGY STAR W eb site
.

The public reporting burden for this collection of information is estimated to average 30 minutes per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested method s for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Age ncy (2822T), 1200 Pennsylvania Ave., NW , W ashington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. Name of Building Receiving Label Customer Org anization Name Label Year

Name of Design Project Space/Building Type (office, K– 12, etc.) Design Completion Date

ENERGY STAR Industrial Partner Organization Name Brief Project Description Year Project Completed