The Partner Agrees to:

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

2. Help EPA determine greenhouse gas emissions prevented by annually providing data on existing CHP projects and

new project development, as well on other CHP-related activities.

3. Assess the potential for CHP development at their facilities.

4. Support development of new CHP projects.

5. Publicize the energy, environmental, and economic benefits of their projects.

6. Government partners also agree to promote the benefits of CHP and support the development of projects within

their respective jurisdictions.

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.

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.

Partner’s Letter of Intent

With this letter ____________________________________________________________ (company/institution, or federal, state, local or tribal agency) 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: ______________________

Page 1

Please e-mail or fax the completed Letter of Intent (2 pages) to chp@epa.gov 

or 617/371-3979 (contractor in support of EPA)

OMB Control No. 2060-0578

Approval Expires 07/31/2015
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.

Your Organization’s website address: _________________________________________________________________

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

________________________________________________________________________________________________

May we provide a link to your CHP-related webpage? £ Yes £ No

Does your Organization have any videos that you’d like to be linked from your Partner Profile page on the CHP 

Partnership Web site? If so, list the titles and URLs here (see Guidelines for Partner Videos at: http://epa.gov/chp/partnership/videoguidelines.html): 

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

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 use on separate pages, along with your signed 

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.

Page 2

EPA-430-F-05-034

www.epa.gov/chp

October 2005

Office of Air and Radiation 

(6202J)

PLEASE E-MAIL OR FAX THE COMPLETED LETTER OF INTENT TO CHP@EPA.GOV 

or 617/371-3979 (contractor in support of EPA) 

£	CHP Project Developer

£	Construction

£	Consultant/Engineering

£	ESCO

	 £	End-user

£	Equipment Manufacturer

£	Financier

£	Non-governmental Organization (NGO)

£	Utility

£	Government (Federal/State/Local/Tribal 

Agency)