5900-585 Green Power Partnership Reporting Form

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Overview

Partnership Terms
Contact & Organizational Info
Green Power - Retail Options
Green Power - Project-Specific
Profile
Summary
Burden Statement

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Sheet 1: Partnership Terms

	Name of individual agreeing to the terms:
	Date agreement signed:
	I understand and agree to the requirements below to become an EPA Green Power Partner.
By joining EPA's Green Power Partnership, Partners commit to:
•	Use green power that meets or exceeds Partnership requirements.
•	Report on green power use annually.
•	Display the Green Power Partner Mark in a manner that is consistent with Partner Mark Use Guidelines.
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 website.
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 publicly post and/or share information about the Partner’s green power use.
•	EPA may periodically revise program benchmark levels or other eligibility requirements.
For more information on partnership requirements (including minimum green power use and eligible green power sources) go to:
https://www.epa.gov/greenpower/green-power-partnership-requirements

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Sheet 2: Contact & Organizational Info

Green Power Partnership Yearly Reporting Form
This Yearly Report 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 James Critchfield ([email protected]) at your earliest convenience.
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
Street Address of Partnering Entity (e.g. Headquarters)
City/State/Zip of Partnering Entity
Website Link
Green Power Related Web Page (e.g. environmental or sustainability page) Optional
Industry (select from picklist)
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 (mm/dd/yyyy)
Reporting Period End Date (mm/dd/yyyy)
Organizational Electricity Use
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 your green power use (check all that apply)

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Sheet 3: Green Power - Retail Options

	Retail Supply Options
	Please populate the fields below with your green power purchase information corresponding to the reporting period indicated on the “Contact & Organizational Info” tab. If you are making multiple green power purchases, list each purchase on a separate row. Depending on the Supply Option Type you choose, some cells may be shaded, indicating that you should not enter information into those cells.
	For more information on how EPA defines Supply Option Types, click either of the question mark icons or visit:							https://www.epa.gov/greenpower/green-power-supply-options
	Enter each procurement on a separate row.		Total kWh:	0	Product's Resource Mix (should total 100%)
	Supply Option Type	Green Power Provider	Product Name Optional	Green Power Purchase (kWh/year)	Bio- gas (%)	Bio-mass (%)	Geo- thermal (%)	Hydro (%)	Solar (%)	Wind (%)	Unknown (%)	Total (%)	Contracted Delivery Begin Date (mm/dd/yyyy)	Contracted Delivery End Date (mm/dd/yyyy)	REC Generation Date (QX-20XX) Optional		RECs Cover From (mm/dd/yy)	REC Cover To (mm/dd/yy)	3rd Party Certified?	Note Optional
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	Retail Supply Options: These "off the shelf" options are typically standardized products (e.g. resource mix, price, 3rd-party certification status) for sale to consumers from retail suppliers, such as utilities, competitive electricity suppliers, and REC marketers. Retail supply options generally involve short-term commitments by the consumer to purchase a pre-determined volume or a volume tied to their electricity consumption. The renewable energy project(s) used to supply the product may be periodically changed by the supplier during the duration of the contract. These options include: -- Community Choice Aggregation Products -- Competitive Supplier Green Power Products -- Unbundled Renewable Energy Certificates (RECs) -- Utility Green Power Products
	For more information on how each supply option is defined, visit:			https://www.epa.gov/greenpower/green-power-supply-options

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Sheet 4: Green Power - Project-Specific

	Project-Specific Supply Options
	Please populate the fields below with your green power purchase information corresponding to the reporting period indicated on the “Contact & Organizational Info” tab. If you are making multiple green power procurements, list each procurement on a separate row. Depending on the Supply Option Type you choose, some cells may be shaded, indicating that you should not enter information into those cells.
	For more information on how EPA defines Supply Option Types, click either of the question mark icons or visit:					https://www.epa.gov/greenpower/green-power-supply-options
														To determine coordinates use:
	Enter each procurement on a separate row.				Total kWh:	0								MapQuest Latitude / Longitude Finder
	Supply Option Type	Green Power Provider or Project Owner	Product Name Optional	Renewable Resource Type	Renewable Generation Technology	Green Power Use (kWh/year)	Contracted Delivery Begin Date (mm/dd/yyyy)	Contracted Delivery End Date (mm/dd/yyyy)	Rated Capacity (kW) of Project/Offtake	Year Project Installed or Developed	3rd Party Certified?	Project Name	Project Location (Onsite / Offsite)	Latitude of Project	Longitude of Project	Note Optional
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	Project-Specific Supply Options: These options are generally customized products negotiated between the consumer and supplier. Project-specific supply options involve long-term commitments by consumers to purchase a volume tied to the output of a pre-determined generation capacity. The renewable energy project used to supply the product is constant throughout the term of the contract or commitment. These options include: -- Financial Power Purchase Agreements -- Physical Power Purchase Agreements -- Self-Supply -- Shared Renewables -- Utility Green Tariff Products
	For more information on how each supply option is defined, visit:			https://www.epa.gov/greenpower/green-power-supply-options

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Sheet 5: Profile

Partner Profile (Optional)
All Green Power Partners have the opportunity to have a Partner Profile on the Partnership's website. The Partner Profile is a short paragraph (200 word limit) that describes briefly a Partner’s organization, its use of 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 website. Note, EPA cannot endorse your green power provider on the website, 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:	https://www.epa.gov/greenpower/green-power-partner-list

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Sheet 6: Summary

Summary
This page summarizes the information you entered in the previous tabs of the reporting form. Please review the details below and confirm the information is correct. If you see incorrect information, go back to the previous tabs and make the appropriate changes. Once everything is accurate, save the file and email it to James Critchfield ([email protected]) at your earliest convenience. Thank you.
Data Element	Details
Partner Name
Primary Contact
Reporting Period	?? - ??
Electricity Use (kWh/yr)	0
Total Green Power (kWh/year)	0
Required Green Power Percentage	0%
Green Power Percentage	0%

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Sheet 7: Burden Statement

Burden Statement

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0578). Responses to this collection of information are voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be approximantely 3 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 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 # 5900-585