Green Power Partnership - Local and State Government

OMB Control Number 2060-0578

Partnership Agreement

T

he EPA Green Power Partnership encourages the voluntary use of green power to reduce the
risk of climate change. Partners benefit from the use of green power, while supporting the
development of new, renewable energy in the United States.

By joining EPA’s Green Power Partnership,
Partners commit to:

General Terms:
• Either party can terminate this agreement at any time without
prior notification or penalties and with no further obligation. EPA
will not comment publicly regarding the withdrawal of Partners.
• 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.
• Partner agrees that it will not claim or imply that its participation in the Green Power Partnership constitutes EPA approval or
endorsement of anything other than its participation in the program and will not make statements or imply that EPA endorses
the purchase or sale of the Partner’s products and services or
the views of the Partner organization.
• EPA may post information about the Partner’s green power use
publicly.
• EPA may periodically revise program benchmark levels or other
eligibility requirements.

• Use green power that meets or exceeds Partnership
requirements.
• Report on green power use annually.
• Use the Green Power Partner mark in a manner that is consistent with Partner mark use guidelines, available at www.epa.
gov/greenpower/documents/gpp_guidedoc_mark.pdf.

In return, EPA commits to:
• Provide public recognition.
• Provide procurement and communications assistance, as requested by Partner.
• Provide a brief description of the Partner’s green power commitment on the Green Power Partnership Web site.

Key Green Power Partnership Requirements
Your Organization’s Baseload

Green Power Partner
Requirements

Green Power Leadership Club
Requirements

You must, at a minimum, use this much
green power

You must, at a minimum, use this much
green power for your entire organization

≥ 100,000,001 kWh

3% of your use

30% of your use

10,000,001 - 100,000,000 kWh

5% of your use

50% of your use

1,000,001 - 10,000,000 kWh

10% of your use

100% of your use

≤ 1,000,000 kWh

20% of your use

Not Applicable

If your annual electricity use is...

• Eligible green power includes electricity generated from solar, wind,
geothermal, biogas, and certain forms of biomass and hydropower.
• Green power must be sourced from eligible U.S.-based generation
facilities.
• Requirement can be met with any combination of green power
products (i.e., utility product, RECs, or on-site generation).

• Partner purchases must be voluntary and incremental to the
renewable electricity included in the standard electricity service.
• Requirements must be entirely met with power from “new”
renewable facilities (i.e., installed within the last 15 years).
• Partners may join organization-wide (U.S. operations only), at
the facility-level, or a logical aggregation of facilities less than
organization-wide.

More details are available in the Partnership Requirements Document, http://www.epa.gov/greenpower/documents/gpp_partnership_reqs.pdf
PLEASE FAX PAGE 2 OF PARTNERSHIP AGREEMENT TO (617) 371-3979 (contractor in support of EPA)
OR E-MAIL TO [email protected] (must be signed and scanned).

Authorizing Official:
On behalf of

, the undersigned understands and agrees to the terms of the Partnership.
(Name of organization or entity)

Signature: _________________________________________________

Title:

Print Name:

Date:

Primary Contact:

Public Relations Contact (optional):

Name:

Name:

Title:

Title:

Address:

Address:

City:

State:

Zip:

City:

Phone:

Phone:

E-mail (required):

E-mail:

State:

Zip:

Electricity and Green Power Information
Reporting Period: The electricity and green power information listed below covers the following 12-month period.
Reporting Period Start Date

Reporting Period End Date

Annual electricity use of participating entity:

kWh / year

Purchased Green Power

On-site Use of Green Power

Green power purchase:

kWh /year

Resource type: o
 biogas

Contract details
Start date:

% biogas

% small hydro

kWh /year*
o biomass

o geothermal

o small hydro o solar o wind

End date (if applicable):

Was the on-site unit installed in the last 15 years? o Yes o No

Green power resource mix
% biomass
% solar

% geothermal
% wind

o Not certified

Installed capacity:

kW

Location of on-site generation (ZIP code):
Installation ownership:

Product certification (third party):
o Green-e

Green power generation:

o self

o other

If other, by whom?

o Other

* EPA will only count as green power kWh generated from on-site installations for which the participating entity owns the rights to the renewable energy credits (RECs).

If other, by whom?
Name of green power provider(s):
Green power product name(s):

Motivating factors behind your green power use (optional)

(check all that apply)

o Brand or product differentiation

o EPA recognition

o Reduce carbon footprint

o Cost stability or savings

o LEED certification

o Support economic development & job creation

o Demonstrate environmental leadership

o Meet sustainability goals

o Support renewable energy development

o Other
The government estimates the average time needed to fill out this form is 1.96 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.
PLEASE FAX PAGE 2 OF PARTNERSHIP AGREEMENT TO (617) 371-3979 (contractor in support of EPA) OR
E-MAIL TO [email protected] (must be signed and scanned).

EPA-430-K-05-013
www.epa.gov/greenpower
February 2014