Better Buildings, Better Plants Voluntary Pledge Program

OMB Control No. 1910-5141

Exp. Date XX/XX/XXXX

Background: Showcase Project(s) demonstrate that Better Plants Challenge Partners are taking immediate, concrete actions resulting in significant and real savings. The information collected in this form will be used to highlight the development, implementation and results of these projects and the resulting energy, water, and cost reductions. Partners are encouraged to have multiple showcase projects; however the first showcase project should be submitted within 6 months of joining the program. Please submit individual forms for each showcase project.

Savings and Data: Showcase projects are expected to show savings of 10% or more, over either an established baseline period (for retrofits) or relative to similar plants (for new construction). The baseline period should be the 12 months of usage prior to the start of construction, and actual savings are reported as the 12 months following project completion. Showcase projects can be posted with estimated savings figures, and should be updated once actual data is available.

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Showcase Project Type:

Showcase Project Information

1. Showcase Project Name

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2. Location (City/State or Street Address)

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3. Plant Description (400 words or less)
   Please identify the plant, what is made there, and approximate production volumes.

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4. Project square footage
   Please provide the total building square footage impacted in this project.

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5. Expected implementation start date

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6. Expected implementation end date

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7. Project Cost

Costs should include all capital and operational expenses needed to complete the energy efficiency-related aspects of this project only, not the full project cost if non-energy savings measures were taken.

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8. Expected annual savings

(see the paragraph on Savings and Data above for details on the baseline and actual periods). For water (gal or gal/unit of output), energy MMBTU/unit of output), data centers (PUE or percent)

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9. Expected annual cost savings

(see the paragraph on Savings and Data above for details on the baseline and actual periods).

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10. Background
    First paragraph (80 words max): Provide high level content about the facility and the energy-efficiency components of the project (e.g., why it was selected? How does it fit into a broader energy efficiency plan?) Provide any additional background content you would like to convey, while maintaining a focus on the energy efficiency aspects of the project (e.g., what was the process for identifying the opportunity, defining the project, and deciding to proceed?). Links to PDFs or other presentations, or to videos, are welcome.

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11. Solutions

Provide details on each of the energy efficiency measures taken at this facility. If possible, include the savings (estimated or actual) of each mesure, as well as other technical details (such as technologies used, wattage, flow rates, etc.). Links to PDFs or other presentations, or to videos, are welcome.

Savings Measure	Cost	Savings Achieved	Notes

12. Other Benefits

First paragraph (80 words max): Provide a brief summary of the other benefits expected from this project (e.g., ENERGY STAR rating, productivity improvements, maintenance savings, improved safety, etc.) once implementation is complete.

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13. Photo(s)

Provide up to three vertical photo of the project (either completed or in process) as an attachment. Please include short captions below. Additional photos are welcomed and may be used for other promotional purposes. For examples of acceptable photos, please review completed showcase projects here: http://www4.eere.energy.gov/challenge/showcase

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

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This data is being collected to support the Department of Energy Better Buildings Initiative. The data you supply will be used for developing best practices to facilitate reductions in energy intensity by commercial, manufacturing, and community organizations.

Public reporting burden for this collection of information is estimated to average 1 hour 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, Enterprise Policy Development & Implementation Office, IM-22, 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.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

Submission of this data is voluntary.

Learn more at energy.gov/betterbuildingschallenge