Better Buildings C Better Buildings Challenge Financial Ally Website

Website Profile Page Template for Financial Allies

OMB 190-5141

Expiration Date: 8/31/2015

Background: DOE will highlight Better Buildings Challenge Financial Allies with profile pages on the program website. Please complete the information below.

1. Organization Name

How would you like your organization to be referenced?

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2. Background

Provide 2-3 sentences of background information on your organization. Suggested maximum of 100 words.

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3. Financial Commitment

Provide the total dollar value of your financial commitment.

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4. Target Market/Description of Customers:

What are the target markets or the specific customer group(s) that your financial product are designed to serve?

Building Types: (Check applicable boxes)

☐ Commercial Office ☐ Industrial

☐ University ☐ Health Care

☐ Retail ☐ Food Service

Occupancy Type: (Check applicable boxes)

☐ Owner-occupied ☐ Tenant-occupied

Types of Upgrades: (Check applicable boxes)

☐ Comprehensive Building Performance

☐ On-site Boiler Conversions

☐ Combined Heat & Power Conversions

☐ On-site Power Generation

Financing Structures: (Check applicable boxes)

☐ Energy Services Contracts

☐ Non-debt Structures

☐ Performance Insurance

☐ Leases

☐ Payment Determined by Performance

5. 

   1. OMB 1910-5141

   2. Expiration date: 8/31/2015

   Contact:

Provide the name, title, telephone and email information for the person to contact at your organization in order to receive additional information about available products. This information will be published on the U.S. DOE BBC website.

Name:

Title:

Telephone Number:

Email Address:

6. Logo

Provide your organization’s logo as an attachment for placement on your profile page.

File type options: high resolution .eps, ai or .jpg

7. Photo

Provide up to three photos of your owned or leased buildings as attachments for placement on your profile page. Please include captions and attributions, if applicable, below.

File type options: high resolution .jpg or .tiff

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4. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910-5141), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-5141), Washington, DC  20503.

5. In furtherance of the objectives of the Better Buildings Challenge, the Department of Energy (DOE) intends to publicly post information submitted in response to this template on the Better Buildings Challenge website.  Information submitted to DOE will be handled in accordance with all applicable federal laws, rules, or regulations, including but not limited to the Trade Secrets Act, 18 U.S.C. §1905, and the Freedom of Information Act (FOIA), 5 U.S.C. §552, and DOE's implementing regulations at 10 CFR 1004.  Participation in the Better Buildings Challenge is voluntary.  Do not include any personal or confidential commercial and financial information in response to this template. Commercial and financial information is considered to be confidential when its release would be likely either to harm the submitter’s commercial interests or to affect the agency’s ability to obtain information in the future.  This statement serves as your written notice that DOE intends to publicly post this information.  By submitting information in response to this template, you are certifying that this information does not contain confidential commercial or financial information.