DOE HQ F 413.2 SEP 50001 Energy Performance Improvement Report

Superior Energy Performance 50001™ – Energy Performance Improvement Report: 2019
	DOE HQ F 413.2								OMB Control #: 1910-5177
	(10/2018)								Exp. Date: 10/31/2021
	Identifying information:								Guidance
`	1	Company Name							Name of company that owns facility
	2	Unique Facility Name per SEP 50001 Certificate							Name of facility. For facilities located on site with multiple facilities, please provide the unique name that distinguishes this facility
	3	Facility zip code							Zip code where facility is located
	4	Facility boundaries							Please identify the boundary(ies), or how the "facility" was defined for this certification. Example responses include entire facility, subset of production lines, subset of energy consuming systems. See SEP 50001 Program Certification Protocol: 2019 (https://betterbuildingssolutioncenter.energy.gov/resources/sep-50001-certification-protocol)
	5	Facility square footage (ft2)							Please provide an estimate of the square footage for the facility boundaries identified in the previous question
	6	Date SEP 50001 (2019) Program Stage 2 audit started (month/day/year)							Date SEP 50001 (2019) Program Stage 2 audit began
	7	Date Energy Performance Improvement Report completed (month/day/year)							Date this form (Energy Performance Improvement Report) was completed
	Facility contact:								Guidance
	8	First Name							First name of principal contact on facility energy management team
	9	Last Name							Last name of principal contact on facility energy management team
	10	Email							Email of principal contact on facility energy management team
	11	Phone							Phone number of principal contact on facility energy management team
	Verification Body contacts:
	Lead Auditor for SEP 50001								Guidance
	12	First Name							First name of Lead Auditor for SEP 50001
	13	Last Name							Last name of Lead Auditor for SEP 50001
	14	Email							Email of Lead Auditor for SEP 50001
	15	Phone							Phone number of Lead Auditor for SEP 50001
	16	Organization							SEP 50001 Verification Body to which the Lead Auditor for SEP 50001 is affiliated
	SEP Performance Verifier								Guidance
	17	First Name							First name of SEP Performance Verifier
	18	Last Name							Last name of SEP Performance Verifier
	19	Email							Email of SEP Performance Verifier
	20	Phone							Phone number of SEP Performance Verifier
	21	Organization							SEP 50001 Verification Body to which the SEP Performance Verifier is affiliated
	Certification information:
			Start Month/yr	End Month/yr					Guidance
	22	Verified Baseline Period							Start and end month/yr of baseline period.
	23	Verified Reporting Period							Start and end month/yr of reporting period.
	24	Verified SEP 50001 Achievement Period							Start and end month/yr for the SEP 50001 achievement period.
									Guidance
	25	Certification date (month/day/yr)							Month, day, and year SEP 50001 certificate was issued by SEP 50001 Verification Body
	26	Verified Top-down Reporting Period Energy Performance Improvement % (From EnPI Tool)							The Reporting Period Energy Peformance Improvement is the reconciliation between the top down energy performance improvement (calculated as 1 minus SEnPI where SEnPI is the Superior Performance Energy Performance 50001 Indicator) for the facility over the reporting period, and the Bottom-Up Comparison as determined using the Register of Implemented Energy Performance Improvement Action. See Section 8 of the SEP 50001 Program Measurement and Verification (M&V) Protocol: 2019 for further details and using the Reconciliation Factor. In addition, the Reporting Period Energy Performance Improvement must meet all other requirements specified in the M&V Protocol. Source: SEP 50001 Program Measurement and Verification Protocol: 2019 https://betterbuildingssolutioncenter.energy.gov/resources/sep-50001-measurement-and-verification-protocol
	26a	Bottom-up Reconciliation Factor							Reconciliation Factor (RF) is the ratio of bottom up estimated energy savings to energy savings estimated from the top down adjustment method used to calculate the SEnPI. Copy cell L60 from the Register of Implemented Energy Performance Improvement Actions.
	27	Final Reporting Period Energy Performance Improvement %							If the Reconciliation Factor (RF) in row 26a is ≥ 0.8 use the Top Down SEnPI in row 26. If RF is < 0.8 multiply row 26 by RF. This should be a formula in cell K49 (Row 27)
	28	Did the model as verified meet the requirements of the SEP 50001 Program Measurement & Verification (M&V) Protocol: 2019? (y/n)							The model requirements can be found in the M&V Protocol. Please indicate if the model met the appropriate requirements.
	29	Which adjustment model method (forecast, backcast, chaining, standard conditions, other) was used as described in the M&V Protocol?							The adjustment model method used to determine SEnPI. Source: SEP 50001 Program Measurement and Verification Protocol: 2019
	30	If "Other" was chosen, did the model require and attain prior approval by the SEP 50001 Program Administrator (y/n)?							All models used for determining energy performance improvements must be approved by the SEP 50001 Program Administrator. For model methods not outlined in the M&V Protocol, please indicate if approval by the Administrator was sought and granted.
	31	If Yes to Question 30, did the model as verified meet the M&V requirements set forth in the prior approval by the SEP 50001 Program Administrator (y/n)?							If approval to use an alternate model method was granted by the SEP 50001 Program Administrator, please indicate if the model used for verification met the M&V requirements outlined by the Administrator
	List the versions of the SEP 50001 normative references used in this verification:								Guidance
		Title of Normative Reference	Version Used in the Verification (revision date)						Revision dates can be found on the cover of the normative reference
	32	Superior Energy Performance 50001 Program Measurement & Verification Protocol
	33	Superior Energy Performance 50001 Program Certification Protocol
	Actual and modeled energy consumption information:								Guidance
	Baseline period primary (source) energy consumption (MMBtu)		Actual	Modeled (if chaining, standard conditions, or backcasting)	Specify fuel				For each energy source listed below, please provide the actual energy consumption in the baseline period. If the adjustment model method is backcasting, chaining, or standard conditions, please provide the modeled baseline period consumption as well. For more information, please see the SEP 50001 Program Measurement and Verification Protocol: 2019.
	34	Total
	35	Grid Purchased Electricity
	36	On-site Renewable Electricity (e.g., solar, wind)
	37	Purchased Natural gas
	38	Distillate or Light Fuel Oil (#1, 2, & 4)
	39	Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C)
	40	Coal
	41	On-site Renewable Fuel and/or Recovered Energy (e.g., bio-gas, municipal solid waste, waste fuels, waste gases)
	42	Other Energy Source (please specify)							Please specify the "other energy source" by name
	43	Other Energy Source (please specify)							Please specify the "other energy source" by name
	44	Other Energy Source (please specify)							Please specify the "other energy source" by name
									Guidance
	Reporting period primary (source) energy consumption (MMBtu)		Actual	Modeled (if chaining, standard conditions, or forecasting)	Specify fuel				For each energy source listed below, please provide the actual energy consumption in the reporting period. If the adjustment model method is backcasting, chaining, or standard conditions, please provide the modeled reporting period consumption as well. For more information, please see the SEP 50001 Program Measurement and Verification Protocol: 2019.
	45	Total
	46	Grid Purchased Electricity
	47	On-site Renewable Electricity (e.g., solar, wind)
	48	Purchased Natural gas
	49	Distillate or Light Fuel Oil (#1, 2, & 4)
	50	Residual or Heavy Fuel Oil (# 5, 6, Navy Special & Bunker C)
	51	Coal
	52	On-site Renewable Fuel and/or Recovered Energy (e.g., bio-gas, municipal solid waste, waste fuels, waste gases)
	53	Other Energy Source (please specify)							Please specify the "other energy source" by name
	54	Other Energy Source (please specify)							Please specify the "other energy source" by name
	55	Other Energy Source (please specify)							Please specify the "other energy source" by name
	56. Model validity and relevant Variables
		Energy source (choose from list)	If "other" please specify	R^2 for model of energy source	p-value from F test for overall model fit	Relevant variables in model for the energy source (e.g., production, HDD, CDD, etc.)	p-value for relevant variable in model for this energy source		Guidance
									For each modeled energy source, please provide the parameters to test model validity: R^2 value for the model for the energy source, the p-value from the F-tes of the overall model, the relevant variables included in the model for the energy source, and the p-vaue for each of the relevant variables. NOTE: Each modeled energy source will have one R^2 value, one overall model p-value, multiple relevant variables and a p-value for each relevant variable. The energy source, specification of "other", the R^2, and the overall model p-value, only needs to be completed for the first relevant variable entry, and does not need to be completed for successive relevant variable entries for the same model
			First ISO 50001 and SEP 50001 program certification	ISO 50001 recertification and first SEP 50001 program certification OR upgrade to SEP 50001 mid-ISO 50001 certification	ISO 50001 and SEP 50001 recertification				Guidance
	57	Certification status for this facility (check one box, and follow instructions for next steps per your selection)							Please indicate this facility's ISO 50001 and SEP 50001 program certification history. Your answer to this question will determine which SEP 50001 Voluntary Cost/Benefit Form that the Administrator may request the facility to complete next. All facilities are requested, but not required, to fill out one SEP 50001 Voluntary Cost/Benefit Form (1, 2, or 3) as well as the SEP 50001 Voluntary Cost/Benefit Form 4.
		Instructions for next steps	Please complete SEP 50001 Voluntary Cost/Benefit Form 1	Please complete SEP 50001 Voluntary Cost/Benefit Form 2	Please complete SEP 50001 Voluntary Cost/Benefit Form 3
		This data is being collected to facilitate delivery of technical assistance and other program services. The data you supply will be used to evaluate the effectiveness of investments in energy management systems and to improve the usefulness of Federal technical assistance and recognition programs. 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 OMB control number 1910-5177, 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 OMB control number 1910-5177, 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. The US DOE, as the Superior Energy Performance 50001 (SEP 50001) Program Administrator within the United States, maintains the confidentiality of proprietary energy and production related data as proprietary that is submitted to the SEP 50001 program by SEP 50001-certified facilities, to the fullest extent of US federal law. Data included within the SEP 50001 Application, SEP 50001 Energy Performance Improvement Report, SEP 50001 Voluntary Cost/Benefit Form, and any other forms or data shared with the US DOE will not be released publicly. The US DOE will make public the following information about each SEP 50001-certified facility: 1. Facility name 2. Facility location (city, state) 3. Verified achievement period energy performance improvement a. The SEP 50001-certified facility can elect if energy performance improvement is reported, or not. If the energy performance improvement is reported, the facility has the option to report as an absolute value of energy savings (BTU), a percentage value as compared to the energy baseline (SEnPI), or both. 4. Verified achievement period length 5. Certification date (month/year) US DOE will, from time-to-time, publicly share aggregate, program-wide metrics, such as number of SEP 50001-certified facilities, and annual and cumulative SEP 50001 program energy savings without revealing data or analysis that could lead to the identification of specific facilities. US DOE may use data to study the effectiveness and impact of the SEP 50001 program. Results from such analysis will be made public only if participating organization anonymity can be ensured. The participating organization may be asked if they wish to voluntarily participate in the formation of case studies and other activities regarding the SEP 50001 program. All data provided to US DOE is subject to the Freedom of Information Act (FOIA), however, US DOE will notify the SEP 50001-certified facility if a FOIA request has been submitted for which their data might be responsive. US DOE will consult with the SEP 50001-certified facility and ensure the facility has an opportunity to inform US DOE what data they view is proprietary. US DOE will review the SEP 50001-certified facility’s suggestions and will not release to the public any data US DOE deems proprietary.