5900-xxx Reporting Form

EPA's Green Power Partnership and Combined Heat and Power Partnership (Renewal)

gpp_yr2014.xls

Green Power Partnership - Local and State Government

OMB: 2060-0578

Document [xlsx]
Download: xlsx | pdf

Overview

Contact & Organizational Info
Green Power Information
Profile


Sheet 1: Contact & Organizational Info


Green Power Partnership Yearly Reporting Form
This Yearly Report form should be used to update the EPA on your organization's green power usage. Please complete the report, save the file, and return to your account manager or Mollie Lemon at your earliest convenience. Mollie Lemon's email address is [email protected].
All fields are required unless noted otherwise.
Contact Information

Primary Contact Public Relations Contact (Optional)
Salutation


Contact Name


Title


Street Address


City/State/Zip


Email Address


Phone Number




Organizational Information
Partner Name

Website Link

Green Power Related Web Page
(e.g. environmental or sustainability page)
Optional


Industry (select from picklist)



Organizational Electricity Use
Annual Electricity Use (kWh/yr)

Scope of Reported Electricity Use (select from picklist)

Please Identify Reporting Facility or Group of Facilities (only if "Single Facility or Subset" is selected above)



Motivating Factors (Optional): Check the motivating factors behind you green power use (check all that apply)






(If other, please specify):





Reporting Period: The electricity and green power information contained in this report covers the following 12-month period. Partners may choose to report most recent calendar year, fiscal year, other 12-month period, or forward-looking data.
Reporting Period Start Date

Reporting Period End Date









Sheet 2: Green Power Information

Green Power Information
Select the appropriate check box(es) below:








yes

We are purchasing green power or renewable energy certificates (RECs) from a provider.


no

We are producing green power onsite.





Please update the information below with your current green power product purchase information. If you are purchasing more than one green power product or REC product, list each purchase on a separate row.



Product's Resource Mix (should total 100%)




Green Power Provider(s)
One provider per row
Product Name
Optional
Green Power Purchase (kWh/year) Bio-
gas
(%)
Bio-mass (%) Geo-
thermal (%)
Hydro (%) Solar (%) Wind (%) Unknown (%) Total (%) 3rd Party Certified? % New Renew-ables* Contract Begin Date (mm/dd/yy) Contract End Date (mm/dd/yy) Is this provider also supplying your electricity?










0














0














0





Total: 0




* % of product from facilities placed in service within the last 15 years.






















Please update the information below with your current onsite green power production information. If you use more than one onsite generation type, list each onsite resource type on a separate row.











Only Complete if 3rd Party Owned System


Onsite Generation Technology
One onsite resource type per row
Green Power Production (kWh/year) Rated Capacity (kW) Optional Year Installed Optional Location
(ZIP Code)
Optional
3rd Party Ownership? Optional 3rd Party Owner Optional Power Purchase Agreement Start Date (mm/dd/yy) Power Purchase Agreement End Date (mm/dd/yy)






































Total: 0 * EPA will only count as green power the kWh output from on-site installations for which the Green Power Partner owns the rights to the renewable energy certificates (RECs).




























Total Green Power 0








Percent Green Power 0.00%

























































Sheet 3: Profile

Partner Profile (Optional)
All Green Power Partners have the opportunity to have a Partner Profile on the Web site. The Partner Profile is a short paragraph (200 word limit) that describes briefly a Partner’s organization, its decision to use green power, and its experience to date with green power.

If you would like to create a Partner Profile, please draft a paragraph in the space provided below. EPA will then review the Profile and offer you a chance to approve it prior to posting on the Green Power Partnership Web site. Note, EPA cannot endorse your green power provider on the Web site, so please make sure the profile does not include reference to the entity from which you are procuring your green power. In writing your Partner Profile, provide a brief description of your organization and try to address these questions:

- How much green power is your organization using?
- What was the driver behind your organization's switch to green power?
- Any lessons learned during your green power commitment process you would like to share with others?
- What are the biggest benefits that have accrued to your organization since it switched to green power?

If you’d like to provide a quote about the benefits of green power for your organization, please include the name and title of the person the quote is attributed to.
Current Profile for Your Organization:

You can find existing GPP profiles at: http://www.epa.gov/greenpower/partners/index.htm




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