DOE HQ F 413.28 Partnership Agremeent with Energy Star

DOE HQ F 413.28
(05/2015)

OMB Control No. 2060-0528
Approval expires 02/29/2016

Instructions for Partnering with ENERGY STAR®
As an Energy Efficiency Program Sponsor

Organizations interested in partnering with ENERGY STAR as an Energy Efficiency Program
Sponsor should take the following steps:
1. Review the Energy Efficiency Program Sponsors Program Definitions and Program
Requirements documents.
2. Select the area(s) of interest for a new partnership on the Participation Form. Please
select only the items in the first section under Energy Efficiency Program Sponsor.
3. Review, complete and sign the Partnership Agreement by checking the authorization
box, entering the date of signature, and entering the contact information of the signatory.
4. Save your changes to the completed document and send it to the email address below.
If you are unable to send the document by email, please send a hard copy to the
address listed below.
[email protected]
Or
ENERGY STAR
c/o ICF International
1725 Eye Street, NW, Suite 1000
Washington, DC 20006
A copy of the signed Partnership Agreement will be returned to you for your records.

Change for the Better with ENERGY STAR

EPA Form No. 5900-33

ENERGY STAR Partnership Agreement

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OMB Control No. 2060-0528
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Program Definitions and Eligible Organizations
Section 1. Energy Efficiency Program Sponsors
Eligible organizations: A regulated utility, publicly owned utility, or energy delivery company; a
national, regional, state, or local government entity; an organization involved in coordinating and/or
administering energy efficiency or environmental education programs that promote ENERGY STAR.
See Program Requirements for Energy Efficiency Program Sponsors for the Commercial & Industrial
Sectors and/or the Program Requirements for Energy Efficiency Program Sponsors (residential
sector).
Section 2. Commercial and Industrial Service and Product Providers
Eligible organizations: An organization that offers energy-efficient products and/or services that
agrees to promote and communicate ENERGY STAR to improve the energy performance of
commercial buildings. Eligible organizations include: architects, and A/E firms, banks and
commercial financial lenders, contractors, distributors, energy management service
companies/consultants, energy service companies (ESCOs), engineers, equipment manufacturers,
and unregulated energy retailers and marketers. See the ENERGY STAR Partnership Partner
Requirements for Commercial & Industrial Service and Product Providers.
Section 3. Financing Partners
Eligible organizations for Mortgages for Energy-Efficient Homes: A mortgage lender offering special
financing for ENERGY STAR qualified new homes. See Program Requirements for Lenders,
Mortgages for Energy Efficient Homes.
Section 4. Home Builders/Developers and Home Energy Raters
Eligible organizations: A site-built home builder constructing traditional homes on site; a
manufactured home builder providing factory-built, HUD code-based homes; a home energy rater
verifying the performance of ENERGY STAR qualified new homes. See the ENERGY STAR
Partnership Agreement for Home Builders and Verification Organizations.
Section 5. Retailers/E-tailers and Buying Groups
Eligible organizations for Retailers/E-tailers: A retail organization selling, marketing, and promoting
ENERGY STAR qualified products. Retail organizations can include independent retailers, national
chains, buying groups, and online merchants. See Program Requirements for Retailers/E-tailers.
Eligible organizations for Buying Groups: A retail organization selling ENERGY STAR qualified
products. See Program Requirements for Buying Groups.
Section 6. Business Improvement
Eligible organizations: Any public or private organization can partner to improve its facilities by
committing to continuous improvement of its energy efficiency. For Program Requirements see the
Partnership Letter in the Business Improvement section of www.energystar.gov.
Section 7: Manufacturers
Eligible Organizations: A company that manufactures or private labels any product(s) that meet(s) the
current ENERGY STAR qualification criteria.

EPA Form No. 5900-33

ENERGY STAR Partnership Agreement

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OMB Control No. 2060-0528
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Partnership Agreement between
ENERGY STAR® and
(ENTER PARTNER NAME HERE)

Through this agreement, __________________________________ (“ENERGY STAR Partner")
joins in partnership with the US Environmental Protection Agency (EPA) and the Department of
Energy (DOE) in one or more areas. ENERGY STAR Partner recognizes ENERGY STAR as a
broad partnership designed to promote buildings, products, homes, and industrial facilities that use
less energy while providing the same or better performance than conventional designs. ENERGY
STAR Partner wishes to use the ENERGY STAR name and/or mark in association with qualified
products or homes. ENERGY STAR Partner agrees to use the partnership and the ENERGY STAR
mark to promote energy efficiency as an easy and desirable option for organizations and consumers
to prevent pollution, protect the global environment, and save on energy bills. ENERGY STAR
Partner agrees that it is important to build and maintain the meaning of the ENERGY STAR mark as
a trustworthy symbol that makes it easy to make a change for the better.

Partner Commitments
ENERGY STAR Partner is committed to taking action in the area(s) indicated on the ENERGY
STAR Participation Form. For the designated program area(s), ENERGY STAR Partner agrees to
fulfill all requirements as outlined in the following supporting documents:
 ENERGY STAR Program Requirements, defining requirements for being recognized as a
partner in each program area, such as manufacturing, selling, or promoting ENERGY STAR
qualified products to consumers or organizations. Specific requirements include identifying a
responsible party for each area of participation and updating EPA/DOE on the efforts
undertaken through the partnership. Where applicable, these include ENERGY STAR
eligibility criteria defining the energy and other performance specifications that must be met
for use of the ENERGY STAR mark on and/or in association with buildings, homes, and
products; and
 ENERGY STAR Identity Guidelines, describing how the ENERGY STAR name and mark
may be used. Partner will adhere to these guidelines and ensure that its authorized
representatives, such as advertising agencies, dealers, and distributors, are also in
compliance.
EPA/DOE will undertake a variety of efforts to build awareness of the ENERGY STAR name and
mark, maintain the credibility of the ENERGY STAR name and mark, and promote the benefits of
energy-efficient homes, buildings, products, services, and industrial facilities. EPA/DOE will strive to:
 increase awareness of the ENERGY STAR name and mark across the residential,
commercial, and industrial sectors by distributing key messages on the benefits of ENERGY
STAR qualified buildings, homes, and products;
 make current versions of the ENERGY STAR Identity Guidelines and ENERGY STAR
Program Requirements easily accessible through the Internet and other means;
 maintain a Web site where ENERGY STAR Partner can furnish information on its program
efforts and responsible key contacts as outlined in the ENERGY STAR Program
Requirements; and
 provide ENERGY STAR Partner with public recognition through the Internet and other
mechanisms for its efforts in the ENERGY STAR Partnership and its role in protecting the
environment.

EPA Form No. 5900-33

ENERGY STAR Partnership Agreement

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Disclaimers
Partner will not construe, claim, or imply that its participation in the ENERGY STAR program
constitutes federal government approval, acceptance, or endorsement of anything other than
Partner’s commitment to the program. Partner understands its participation in the ENERGY STAR
program does not constitute federal government endorsement of Partner or its buildings, homes,
products, services, or industrial facilities. Partner understands that the activities it undertakes in
connection with the ENERGY STAR program are voluntary and not intended to provide services to
the federal government. As such, Partner will not submit a claim for compensation to any federal
agency.

Dispute Resolution
Partner and EPA/DOE will assume good faith as a general principle for resolving conflicts under the
ENERGY STAR program. Both parties will endeavor to resolve all matters informally, so as to
preserve maximum public confidence in ENERGY STAR.
In the event informal channels do not produce a mutually agreeable resolution to a matter in dispute,
either party to this agreement shall notify the other in writing as to the nature of the dispute, the
specific corrective action sought, and their intent to terminate the Partnership Agreement, either as a
whole or in part, unless specific corrective actions sought are undertaken:
 within 20 days of receiving formal notification from EPA/DOE indicating intent to terminate
the Partnership Agreement, either as a whole or in part, Partner will reply, agreeing to either
(1) undertake in a timely and effective manner the corrective actions sought by EPA/DOE, or
(2) terminate the Partnership Agreement, either as a whole or in part;
 within 20 days of receiving formal notification from Partner indicating its intent to terminate
the Partnership Agreement, either as a whole or in part, EPA/DOE will reply, either (1)
agreeing to undertake in a timely and effective manner the corrective actions sought by
Partner, or (2) explaining why such corrective actions cannot be undertaken;
 if Partner fails to respond within 20 days of receiving formal notification of EPA/DOE’s intent
to terminate the Partnership Agreement, either as a whole or in part, or if Partner responds
but does not agree to undertake corrective actions sought by EPA/DOE, or if Partner agrees
but does not initiate the corrective actions in a timely manner, then this agreement is
terminated, either as a whole or in part.

Entry into Force and Duration of Agreement
Both parties concur that this agreement and the terms outlined in the supporting documents will
become effective when signed by both parties. This agreement may be updated at any time to add
new areas for which ENERGY STAR Partner wants to be recognized as a partner. Both parties
concur that this agreement is wholly voluntary and may be terminated by either party at any time,
and for any reason, with no penalty. Failure to comply with this Partnership Agreement, applicable
Program Requirements, and Identity Guidelines can result in termination of this agreement and
authorization to use the ENERGY STAR mark. EPA/DOE will actively pursue actions for resolving
issues of noncompliance.
The undersigned hereby execute this Partnership Agreement on behalf of their party. The
signatories of this agreement affirm that they have the authority to execute this agreement on behalf
of ENERGY STAR Partner and EPA/DOE.

EPA Form No. 5900-33

ENERGY STAR Partnership Agreement

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OMB Control No. 2060-0528
Approval expires 02/29/2016

Partnership Agreement Signatory for ENERGY STAR:

Signature:

EPA Use Only

Name:

Elizabeth Craig, Director
Climate Protection Partnerships Division,
U.S. Environmental Protection Agency

Title:

Date:

Partnership Agreement Signatory for ______________________________________
By checking this box I affirm that I have read and understand the terms of this Partnership
Agreement and am authorized to bind this organization to the terms of the Partnership Agreement.
____________________________
(Date)

Name:
Title:
Address:
City:
State:
Zip
Country:
Phone:
Fax:
E-mail:
Web site:
The public reporting and recordkeeping burden for this collection of information is estimated to average 4.2 hours 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.

EPA Form No. 5900-33

ENERGY STAR Partnership Agreement

5

OMB Control No.
Approval expires

ENERGY STAR® Participation Form:
Partner Name:
Date:
Partner will participate in the program(s) checked below.
Promote ENERGY STAR as an Energy Efficiency
Program Sponsor* in the:
o Consumer Product Market
o Residential New Construction Market
o Existing Commercial Buildings Market
o New Commercial Buildings Market
o Industrial Market
* Such as states, utilities, or regional program coordinators
Help Clients Improve Their Energy Performance
Commercial and Industrial Service and Product Providers,
supporting the:
o Existing Commercial Buildings Market
o New Commercial Buildings Market
o Industrial Market
Offer Consumer Financing*
o Mortgages for Energy-efficient Homes
*Please refer to the ENERGY STAR Partnership
Agreement for Lenders.

Home Performance with ENERGY STAR
o Sponsor Home Performance with ENERGY STAR Program
Promote ENERGY STAR Certified Products
o Retailers/E-tailers
o Buying Groups

Other Products
o Battery Charging Systems
o Commercial Water Heaters
o Computer Servers
o New Refrigerated Beverage
Vending Machines
o Pool Pumps
o Rebuilt Refrigerated Beverage
Vending Machines
o Residential Dehumidifiers
o Residential Water Heaters—Solar
o Residential Water Heaters—Non-solar
o Room Air Cleaners
o Storage
o Uninterruptible Power Supplies
o Water Cooler

Label and Promote ENERGY STAR Certified Products
Residential Appliances
o Clothes Washers
o Dishwashers
o Refrigerators and/or Freezers
o Room Air Conditioners
Commercial Food Service Equipment
o Commercial Dishwashers
o Commercial Fryers
o Commercial Griddles
o Commercial Hot Food Holding Cabinets
o Commercial Ice Machines
o Commercial Ovens
o Commercial Refrigerators and Freezers
o Commercial Steamers

EPA Form No.

Lighting Products
o Decorative Light Strings
o Integral LED Lamps
o Lamps
o Luminaires
o Screw Based Compact Fluorescent
Lamps (CFLs)
Office Equipment
o Computers
o Imaging Equipment
o Displays

Deploy ENERGY STAR Qualified Set-top Boxes
o Cable, Satellite, and Telecom Service Providers

Through our partnership with ENERGY
the
performance of our own

Heating, Ventilation, and AC Products
o Boilers
o Central ACs and Air-source Heat Pumps
o Furnaces
o Geothermal Heat Pumps
o Light Commercial HVAC
o Residential Ceiling Fans
o Residential Ventilating Fans
Home and Building Envelope Products
o Residential Insulation Products
o Roof Products
o Windows, Doors and Skylights
o Window Components

Label and Promote ENERGY STAR Qualified Homes*
o Home Builders/Developers
o Home Energy Raters
*Please refer to the ENERGY STAR Partnership Agreement for
Home Builders and Verification Organizations.

o

Home Electronics
o Audio/Video Equipment
o Set-top Boxes
o Small Network Equipment
o Telephony
o Televisions

we also commit to improve

ENERGY STAR Participation

OMB Control No.
Approval expires

Partner Name:
Date:

If your organization has different contacts for multiple products or program areas (for example: appliances and
home electronics, or manufacturing and retail sales), please fill out a separate Participation Form for each set of
contacts. The stand-alone Participation Form can be found at: www.energystar.gov/join
ENERGY STAR Program Area

Responsible Agent of Company

Primary Contact (if different)

Additional Contact
  (Marketing, etc.)

Additional Contact
  (if appropriate)

Contact Name
Title
Company
Address
City
State
Zip
Country
Phone
Fax
Email

Contact Name
Title
Company
Address
City
State
Zip
Country
Phone
Fax
Email

Return Completed Participation Form to:

[email protected]
Or
ENERGY STAR
c/o ICF International
1725 Eye Street, NW, Suite 1000
Washington, DC 20006

EPA Form No.

ENERGY STAR Participation