Document ID: EPA-HQ-OAR-2006-0407-0018
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2010-01-05T05:00Z

Service and Product Provider (SPP) Partnership

  Application Data Form

PLEASE SUBMIT THIS APPLICATION DATA FORM AND ATTACHMENTS REQUESTED IN
QUESTIONS 5, 6, and 7 TO   HYPERLINK "mailto:SPP@ENERGYSTAR.GOV" 
SPP@ENERGYSTAR.GOV , ALONG WITH YOUR COMPLETED PARNERSHIP APPLICATION
PACKET.

Date:	 

Company Name (Web Display):  

	Web Address:

	

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

Identify your company type: (Check all that apply)

	Architecture or A/E

Engineering

	Distributor

Equipment Manufacturer 

	Energy Consultant / Energy Management Services 

Financial Services

	Energy Improvement Contractor 

On-site Energy Production Services

	Energy Information Services

 

Unregulated Energy Retailer and Marketer

	Energy Service Company (ESCO)

Please 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, Convenience Stores, 

Department Stores, Discount Stores-Warehouse Clubs, Drug Stores,
Restaurants, Supermarkets)

	Higher Education

Small Business

	Hospitality and Entertainment (Hotels, Resorts, Stadiums, Theaters,
Museums, Convention Centers)

State Government

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.

Complete this question ONLY if 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.

To help us understand your business, please provide brief descriptions
for a minimum of two energy efficiency projects completed for your
clients.

Name of Project/Client	Date(s) of project completion	Project Scope
and/or Energy Efficiency 

Measures Implemented/Recommended

List 10 customer commercial buildings which you have benchmarked using
Portfolio Manager in the last 12 months. To meet the SPP requirement,
you must benchmark at least 10 customer buildings – and receive energy
performance ratings (EPR) and/or energy use intensity (EUI) scores –
in the past 12 months. 

Please provide an email attachment of a Statement of Energy Performance
(SEP) for each facility listed. SEPs can be generated in   HYPERLINK
"https://www.energystar.gov/istar/pmpam/"  Portfolio Manager  for all
buildings with at least 11 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.)

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

Please list at least one customer building which your organization has
helped to earn the ENERGY STAR label 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.)

Name of Building Receiving Label	Customer Organization Name	Label Year

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   HYPERLINK
"http://www.energystar.gov/index.cfm?c=new_bldg_design.bus_target_finder
"  Target Finder , an online tool for commercial building 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.

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

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
projects. 

List at least one energy 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 additional guidelines on
creating   HYPERLINK
"http://www.energystar.gov/index.cfm?c=industry.bus_industry_spps" 
Teaming Profiles  on the ENERGY STAR Web site.

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

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 methods for minimizing respondent burden,
including through the use of automated collection techniques to the
Director, Collection Strategies Division, U.S. Environmental Protection
Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. 
Include the OMB control number in any correspondence.  Do not send the
completed form to this address.

OMB Control No. 2060-0347

EPA Form 5900-195	Page   PAGE  3  of   NUMPAGES  3 		 Version: 11/10/09