Plant: Click or tap here to enter text. Date: Click or tap here to enter text. PE:   Click or tap here to enter text.     OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review                                                                                Review location: Corporate Office ☐	Site Visit☐	Other ☐           If other is checked, please describe how the PE confirmed that the plant met the eligibility requirements for certification and the authenticity and completion of the data used in the EPI.           Click or tap here to enter text

    Plant Physical Characteristics and Eligibility     oo        The plant has established a formal certification file.  Yes☐  No☐     oo        Where? Click or tap here to enter text.     oo        The plant's activities conform to the eligibility description in the EPI Instructions.  Yes☐  No☐     oo        These plant activities are described in the certification file.  Yes☐  No☐     oo        Relevant calculations of plant activities (e.g., space requirements) meet specified minimums in the EPI Instructions.  Yes☐  No☐     oo        These plant calculations supporting eligibility are documented in the certification file.  Yes☐  No☐

    Plant Operating Characteristics  oo     All data are confirmed to belong to the plant named in the EPI and plant certification documents.                                      Yes☐  No☐  oo     All data are confirmed to match the same 12-month time period specified on the Statement of Energy Performance.                                      Yes☐  No☐  oo     The plant's data is current (defined as within one year of the Period Ending Date on the Statement of Energy Performance).                                      Yes☐  No☐  oo     All original source data (e.g., production records) has been reviewed to assure all data were correctly transcribed into a spreadsheet, database, etc.                                      Yes☐  No☐        o           If original source data are not available for review: Internal verification procedures           have been verified by PE and are applied to any company databases used for applicable data.                                      Yes☐  No☐ NA ☐  oo     All calculations made using the original source data have been reviewed to assure     accuracy, correct conversion of units, and use of generally accepted and uniformly applied conversion factors.                                      Yes☐  No☐ NA☐  oo     Annual totals resulting from all calculations match the values entered into the EPI.                                      Yes☐  No☐  oo     Annual totals resulting from all calculations match the units specified in the EPI.                                      Yes☐  No☐  oo     Inputs or calculations for other required plant physical characteristics (e.g., square footage, kilns) are consistent with source documents provided in the certification file.                                      Yes☐  No☐  oo     All source data, calculations, and assumptions have been documented in the formal certification file. Note that referral to a company database is not adequate; the file includes     a static record of data drawn from the database on the date of EPI completion (i.e., the date the EPI score and Statement of Energy Performance were produced).                                      Yes☐  No☐  oo     All production metrics (e.g., quantities, capacities, labor hours) follow the procedure specified in the EPI instructions.                                      Yes☐  No☐  oo     Source data, calculations, and documentation for all other data types (e.g. HDD/CDD) have been reviewed and documented in the formal certification file.                                      Yes☐  No☐ NA☐  oo     For cement plants, all energy data was entered using High Heating Value.                                      Yes☐  No☐ NA☐  oo     For cement plants, no slag/flyash/pozzolanic blends are produced at this plant.                                      Yes☐  No☐ NA☐     Energy Data  oo     All data confirmed to belong to the plant are named in the EPI and plant certification  Yes☐  No☐

    documents.

 oo     All data confirmed to match the same 12-month time period are specified on the Statement of Energy Performance.  Yes☐  No☐  oo     The plant's data are current (defined as within 6 months of the Period Ending Date on the Statement of Energy Performance.  Yes☐  No☐        o           If not, why?	Click or tap here to enter text.  oo     All original source data (e.g., utility invoices) have been reviewed to assure all data were correctly transcribed into a spreadsheet, database, etc.  Yes☐  No☐        o           If original source data are not available for review: Internal verification procedures           have been verified by PE and are applied to any company databases used for applicable data.

 Yes☐  No☐ NA☐  oo     All calculations made using the original source data have been reviewed to assure accuracy, correct conversion of units, and use of generally accepted and uniformly applied conversion factors.

 Yes☐  No☐  oo     Annual totals resulting from all calculations match the values entered into the EPI.  Yes☐  No☐  oo     All source data, calculations, and assumptions have been documented in the formal certification file. Note that referral to a company database is not adequate; the file must include a static record of data drawn from the database on the date of EPI completion (i.e., the date the EPI score and Statement of Energy Performance were produced).

 Yes☐  No☐  oo     Annual totals resulting from all calculations match the units specified in the EPI.  Yes☐  No☐  oo     All energy sources used at the plant are included in the EPI.  Yes☐  No☐  oo     All energy sources follow the energy accounting procedure specified in the EPI instructions.  Yes☐  No☐  oo     Calculations for energy transfers (purchased steam, compressed air) have been reviewed for accuracy.  Yes☐  No☐ NA☐

    ENERGY STAR Energy Performance Score

 oo     All the required data have been entered into the EPI.  Yes☐  No☐  oo     The data have been properly entered into the EPI.  Yes☐  No☐  oo     The plant's EPI score is 75 or higher.  Yes☐  No☐

    PE Verification  oo     The PE review of the plant has been documented (e.g., site visit vs. corporate office, date, personnel met with, findings/corrections/recommendations from the review).  Yes☐  No☐  oo     The PE completed the Verification Checklist for submission to EPA, and added the original document to the formal certification file.  Yes☐  No☐  oo     The PE signed, stamped  -  indicating if embossed, and provided the required license information on the Statement of Energy Performance for submission to EPA, and added the original document to the formal certification file.

 Yes☐  No☐

    Please note any company personnel involved in review:

    Please comment on any answers marked no and note any findings, corrections, or recommendations from the review:

    PE Signature:

    This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 20 minutes 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.

                                                        MB Control No. 2060-034 OMB Control No. 2060-0347

         The public reporting burden for this collection of information is estimated to average 30 minutes 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, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 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 5900-19

                                                                             Date Generated: February 22, 2019 Primary Property Type: K-12 School Gross Floor Area (ft²): 100,000 Estimated Date of Certification of Occupancy:                                       N/A                                  ENERGY STAR(R)                                  Design Score2                ENERGY STAR(R) Statement of Energy Design Intent (SEDI)1                TEST OMB Control No.2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review       1.         This form is required when applying for Designed to Earn the ENERGY STAR recognition. It was generated from ENERGY STAR Portfolio Manager.       2.         The ENERGY STAR 1  -  100 Score is based on total annual Source Energy. To be eligible for Designed to Earn the ENERGY STAR recognition you must score at least 75.

 Property & Contact Information for Design Project  Property Address       Project Architect      Owner Contact  TEST

       123TEST       ,      ,  TEST, Maryland 20855       (	)	-	      (	)	-

 Property ID: 6709012              Architect Of Record            Property Owner

           ,

      	, 	      (	)	-

      (	)	-

Estimated Design Energy         No estimated energy information provided.

           K-12 School Estimated Design Use Details   This Use Detail is used to calculate the 1-100 ENERGY STAR Score. Number of Workers on Main Shift	50                                        Percent That Can Be Cooled	All of it - 100% Number of Computers	175	default value

          Gymnasium Floor Area 0 Sq. Ft. default value Number of Walk-in Refrigeration/Freezer Units  1	default value

          Student Seating Capacity 1,000	default value Weekend Operation No   Cooking Facilities	Yes School District         Percent That Can Be Heated All of it - 100%   High School	No

          Gross Floor Area	100,000 Sq. Ft.           Months in Use

        Design Energy and Emission Results	 Metric                                    Design Project                                  Median Property                                Estimated Savings ENERGY STAR Score (1-100)                                          N/A                                        50                                       N/A Energy Reduction (from Median)(%)                                          N/A                                        0                                       N/A Source Energy Use Intensity (kBtu/ft²/yr)                                          0                                        103                                       103 Site Energy Use Intensity (kBtu/ft²/yr)                                          0                                        45                                        45 Source Energy Use (kBtu/yr)                                          0                                    10,306,168                                    10,306,168 Site Energy Use (kBtu/yr)                                          0                                     4,569,702                                    4,569,702 Energy Costs ($)                                          0                                      111,649                                     111,649 Total GHG Emissions (Metric Tons CO2e)                                          0                                        394                                       394

        This section is only required if you are using this document to apply for Designed to Earn the ENERGY STAR. All design projects that achieve an EPA energy performance score of 75 or higher are eligible for this certification.   1) Does your property type match the function or use of a property that's eligibility to receive an ENERGY STAR design score?     If you are not sure your project is eligible for an ENERGY STAR design score, please describe the property's major functions or use: Yes No/Not Sure 2) Is the design project at least 95% complete with construction documents?     If no, please explain: Yes No 3) Is the property currently unoccupied and not yet generating energy bills? Yes No   4) Do energy calculations account for the whole building intended operations and all energy sources? Yes No 5) Is the Architect of Record (AOR) applying for ENERGY STAR partnership? Yes No 6) Was the design record created in the owner's Portfolio Manager account? Yes No 7) Are you seeking other qualifications for this design project?     If so, please select all that apply: Yes No AIA 2030 Commitment Architecture 2030 Challenge Federal, State or Local Disclosure Ordinance Green Globes LEED Other, please indicate: 	 Designed to Earn the ENERGY STAR: Application Checklist	         Professional Verification         I 	(Name) verify that the above information is true and correct to the best of my knowledge.

        Signature: 	Date:

        Verifying Professional

        ,         (	)	-

        Note: When applying for the ENERGY STAR Designed to Earn, the signature of the Verifying Professional must match the stamp.      Verifying Professional Stamp (if applicable)

        I agree to adhere to the ENERGY STAR Identity Guidelines when using the Designed to Earn the ENERGY STAR recognition graphic in association with this project.

        Architect of Record Acknowledgement         As the Architect of Record representative, I confirm that the information on this SEDI is true and accurate to the best of my knowledge. It is our best estimate for all energy use of specified systems and processes but does not guarantee the operational performance of this building. Instead, this project has been specified to achieve Designed to Earn the ENERGY STAR recognition in an effort to assist the Owner/Developer in meeting their operational performance goal for the building to earn ENERGY STAR certification.

        Signature: 		 Date:

        Building Owner/Developer Acknowledgement         As the Building Owner/Developer representative, I concur that this project be nominated for Designed to Earn the ENERGY STAR recognition. Our organization understands the importance of measuring actual energy use in Portfolio Manager after receiving         the Certificate of Occupancy to verify that this property is performing as intended. We understand that once the building earns an ENERGY STAR score of 75 or higher, it may be eligible for ENERGY STAR certification.

        Signature: 		 Date:

        This document was generated from Target Finder, an EPA tool located on the ENERGY STAR Web site, www.energystar.gov.         This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 3.75 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.

                                     STATEMENT OF ENERGY PERFORMANCE

                                Enter Name   OMB No. Control 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

                                For 12-month period ending:      Enter Month/Day/ Year

                 Facility Address Enter Name Street Address      Owner's Address Owner's Name Street Address        Corporate Energy Manager Contact Contact        Name Email Address Phone

                 Address 2	Address 2                  Durham, NC	City, State                  27705	ZIP

                 Automobile Engine Plant Energy Performance Indicator                  Version 1.1, Release 10/26/2018                        Professional Engineer Stamp

   Based on the conditions observed at the time of my visit to this facility, I certify that the information used in this tool to generate the energy    performance score

Energy      Number

                 Performance	##                  Score:                  ## GHG Savings (Kg CO2e)                 ## ## Source Energy Savings (MMBtu) Site Energy Savings (MMBtu)                  Professional Verification Professional Engineer Name Address Address 2                  City, State ZIP Phone Number: Email Address: License Number:

                 Licensing State:

                 EPI Verification - choose "Yes" for one option:

   represented on this statement is accurate.

                                       No  EPI attached for EPA review.

                                       No  EPI contains proprietary information and has been sent to the designated reviewer.

      NOTE:     1.       Applications for certification of plant energy performance to the US EPA must be made within 12 months of Period Ending date. Plants that apply for recertification must use the subsequent 12-month period of continuous data if the plant was certified the previous year, unless an exception has been discussed with and granted by the US EPA. Award of the ENERGY STAR is not final until approved by the US EPA.

    2.       All energy performance scores and supporting data must first be verified by the US EPA or a US EPA-designated EPI reviewer if supporting data is considered to be proprietary before submitting applications for the ENERGY STAR.

    3.       An energy performance score of 75 is the minimum required score to be considered eligible for the ENERGY STAR.

    4.       Estimates of energy and CO2 emissions savings are provided to illustrate the difference between the benchmarked plant's energy use and estimated CO2 emissions as compared to "an average plant" that is defined as having an energy performance score at the 50th percentile.

      The fuel mix used to estimate emissions data for the average plant is the same as for the benchmarked plant. These estimates are provided to assist plants with communicating their energy and environmental achievements.       For US EPA Use Only:

            This collection of information is approved by OMB under the Paperwork Reduction Act, 44       U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 range up to 15 minutes 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 5900-89

                                                92                                           ENERGY STAR(R)                                            Score'     SOP Example

    Registry Name: SOP Example Registry Name Property Type: Office     Gross Floor Area (ft'): 100,300 Built: 2000

    For Year Ending: Jan 31, 2018[2]     Date Application Becomes Ineligible: May 31, 2018

              1.                TheENERGY STAR Soote is basedon IOlal5°'.r0e energy.A scoceof75istheITWlflUTIto be eligiblefortheENERGY STAR.               2.                Applications m..rstbe sutW'ritted within120daysof theYeYEndng Date. The awardis not fnalLrti1approval is received fromEPAor NRCan.

                      Please use the Licensed Professional's Guide to the ENERGY STAR(R) for Commercial Buildings for reference in completing this checklist                       (http://www.energystar.gov/lpguide).

               Property & Contact Information

               Property Address                SOP Example Registry Name 100 Healthy Highway                Chicago, Illinois 60827

               Property ID: 6084115       Property Owner DMWOfficeco.       1234 Data Center Way Silver Spring, MD 20910 (_)_-          Primary Contact Danielle Wilmot 9300 Lee Hwy          Fairfax, VA 22031 <PHONE_NUMBER> <EMAIL_ADDRESS>

              1.                 Review of Whole Property Characteristics

               Basic Property Information

                1)                   Propeny Name for Registry: SOP Example Registry Name                    Is this the official name to be displayed in the Registry of ENERGY STAR Certified Buildings and Plants?

                   If "No", please specify:

                2)                   Propeny Type: Office                    Is this an accurate description of the primary use of this property?

                3)                   Location:

    □Yes	□No

    □Yes	□No     □Yes	□No

                   Notes: 100 Healthy Highway                   Chicago, Illinois 60827

                   Is this correct and complete?

                4)                   Gross Floor Area: 100,300 tt::                    Is value an accurate account of the gross floor area for the property?

                5)                   Average Occupancy(%): 80                    Is this occupancy percentage accurate for the entire 12 month period being assessed?

                6)                   Number of Buildings: 1                    Does this number accurately represent all structures?

                7)                   Whole Propeny Verification:                    Does this application represent the entire property? II any space or energy use has been exduded from this property, please describe ij in the notes section below.  □Yes	□No  □Yes	□No  □Yes	□No  □Yes	□No

               Indoor Environmental Quality 1)   Outdoor Air Ventilation    Does this property meet the minimum ventilation rates according to ANSVASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality?

2)   Thermal Environmental Conditions    Does this property meet the acceptable them1al environmental conditions according ANSI/ ASHRAE Standard 55, Thermal Environmental Conditions for Human Occupancy?

3)   Illumination    Does this property meet the minimum illumination levels as recommended by the Illuminating Engineering Society of North America (IESNA) Lighting Handbook? □Yes □Yes □Yes □No □No □No Notes:

              1.                 Review of Property Use Details

               Office: Office Use - Vacant

                1)                   Gross Floor Area: 15,000 tt::                    Is this the total size, as measured between the outside surface of the exterior walls of the building(s)? This includes all areas inside the building(s) such as: occupied                    tenant areas, common areas, meeting areas, break rooms, restrooms, elevator shafts, mechanical equipment areas, and storage rooms. Gross Floor Area should not include interstitial plenum space between floors, which may house pipes and ventilation. Gross Floor Area is not the same as rentable, but rather includes all area inside the building(s). Leasable space would be a sub-set of Gross Floor Area. In the case where there is an atrium, you should count the Gross Floor Area at the base level only. Do not increase the size to accommodate open atrium space at higher levels. The Gross Floor Area should not include any exterior spaces such as balconiesor exterior loading docks and driveways.

 □Yes	□No

                2)                   Weekly Operating Hours: O	□Yes	□No                    Is this the total numberof hours per week that the property is occupied by the majority of the employees? It doesnot include hours when the HVAC systemis startingupor shutting down, orwhen property is occupied only by maintenance, security, cleaning staff, orother support personnel. For properties with a schedule that varies during the year, use the schedule most often followed.                 3)                   Number of Workers on Main Shift: O	□Yes	□No                    Is this the total numberof wor1<ers present during the primary shift? This isnot a total count of workers, but rather a count of workers who are present at the same time. For example, ii there are two daily eight hour shifts ol 100 workers each, the Number of Wor1<ers on Main Shilt value is 100. Number of Wor1<ers on Main Shift may include employees of the property, sub-contractors who are ons e regularly, and volunteers who perform regular ons e tasks. Number of Wor1<ers should not include visitors to the buildings such asclients, customers, or patients.                 4)                   Number of Computers: O	□Yes	□No                    Is this the total numberof computers, laptops, and data servers at the property? This number should not include tablet computers, such as iPads, or any other types of office equipment.                 5)                   Percent That Can Be Heated: 100	□Yes	□No                    Is this the total percentage of the property that can be heated by mechanicalequipment?                 6)                   Percent That Can Be Cooled: 100	□Yes	□No                    Is this the total percentage of the property that can be cooled by mechanical equipment? This includes all types of cooling from central air to individual window un s.

                Notes:

               Office: Building Use

                1)                   Gross Floor Area: 85,300 tt::                    Is this the total size, as measured between the outside surface of the exterior walls of the building(s)? This includes all areas inside the building(s) such as: occupied                   tenant areas, common areas, meeting areas, break rooms, restrooms, elevator shafts, mechanical equipment areas, and storage rooms. Gross Floor Area should not include interstitial plenum space between floors, which may house pipes and ventilation. Gross Floor Area is not the same as rentable, but rather includes all area inside the building(s). Leasable space would be a sub-set of Gross Floor Area. In the case where there is an atrium, you should count the Gross Floor Area at the base level only. Do not increase the size to accommodate open atrium space at higher levels. The Gross Floor Area should not include any exterior spaces such as balconiesor exterior loading docks and driveways.

 □Yes	□No

                2)                   Weekly Operating Hours: 60	□Yes	□No                    Is this the total numberof hours per week that the property is occupied by the majority of the employees? It doesnot include hours when the HVAC systemis starting upor shutting down, orwhen property is occupied only by maintenance, security, cleaning staff, orother support personnel. For properties with a schedule that varies during the year, use the schedule most often followed.                 3)                   Number of Workers on Main Shift: 250	□Yes	□No                    Is this the total numberof wor1<ers present during the primary shift? This isnot a total count of workers, but rather a count of workers who are present at the same time. For example, ii there are two daily eight hour shifts ol 100 workers each, the Number of Wor1<ers on Main Shift value is 100. Number of Wor1<ers on Main Shift may include employees of the property, sub-contractors who are onsije regularly, and volunteers who perform regular onsije tasks. Number of Wor1<ers should not include visitors to the buildings such asclients, customers, or patients.                 4)                   Number of Computers: 400	□Yes	□No                    Is this the total numberof computers, laptops, and data servers at the property? This number should not include tablet computers, such as iPads, or any other types of office equipment.                 5)                   Percent That Can Be Heated: 33	□Yes	□No                    Is this the total percentage of the property that can be heated by mechanicalequipment?                 6)                    Percent That Can Be Cooled: 100	□Yes	□No Is this the total percentage of the property that can be cooled by mechanical equipment?                    This includes all types of cooling from central air to individual window unijs.

                Notes:

                Parking: Parking Use

                1)                   Open Parl<ing Lot Size: 50,000 ft::                    Is this the total area that is lit and used for par1<ing vehicles? Open Parking Lot Size refers specifically to open area, which may include small shading covers but does not include any full structures with roofs. Parl<ing lot size may include the area of par1<ing spots, lanes, and driveways.

   □Yes	□No

                2)                   Partially Enclosed Parking Garage Size: Oft::	□Yes	□No                    Is this the total area of parl<ing structures that are partially enclosed? This includes par1<ing garages where each level is covered at the top, but the walls are partially or fully open.                 3)                   Completely Enclosed Parl<ing Garage Size: 80,000 ft::	□Yes	□No                    Is this the total area of parl<ing structures that are completely enclosed on all four sides and have a roof? This includes underground parking or fully enclosed par1<ing on the first few stories of a building.                 4)                   Supplemental Heating: No	□Yes	□No                    Is this the correct answer to whether your par1<ing garage has Supplemental Heating, which is a heating system to pre-heat ventilation air and/or maintain a minimum temperature during winter months?

                Notes:

              2.                 Total Energy (kBtu) 5,394,118.2 % Dill from National Median Source EUI -42.1% Energy Intensity Site (kBtu/ft')	53.8 Source (kBtu/ft')	155.1 Emissions (based on site energy use) Greenhouse Gas Emissions (Metric TonsC02e) 910.2                                  Power Generation Plant or Distribution Utility: Commonwealth Edison Co

Note: Al values are annual :zed to a 12 th period. SourceEnergy includes energy usedin generation and tr.lOSITlission to enable an equitable .lSsessment. Review of Energy Consumption Data Overview

Site Energy Use Summary

   National Median Comparison

Natural Gas (kBtu)                                                                 661,333.3 (12%)    National Median Site EUI (kBtu/ft')    92.8 Electric - Grid (kBtu)                                                               4,732,784.9 (88%)    National Median Source EUI (kBtu/ft')   267.7

               Summary of All Associated Energy Meters

              Notes: The following meters are associated with the property, mearing that they are added together to get the total energy use for the property. Please see additional tables in this checklist for the exact meter consumption values. Note: please review all meter entries, making note of any unusual entries, and, if they are correct, provide a manual note to explain.                Meter Name Natural Gas Electric Grid Meter

              Total Energy Use   Fuel Type Natural Gas Electric - Grid       Stan Date      01/01/2000      01/01/2017        End Date        In Use In use         Associated With: SOP Example SOP Example     □Yes	□No

                 Do the meters shown above account for the total energy use of this property during the reporting period of this application?

              Additional Fuels

                 Do the meters above include all fuel types at the property? That is, no addrtional fuels such as district steam, generator fuel oil have been excluded.

              On-Site Solar and Wind Energy

                 Are all on-site solar and wind installations reported in this list (if present)? All on-srte systems must be reported.

□Yes	□No

□Yes	□No

               Natural Gas Meter: Natural Gas (therms)

                         Associated With: SOP Example                                    Stan Date

         End Date

         Usage                                   12/31/2016         03/31/2017          1,200                                   03/31/2017         06/30/2017           800                                   06/30/2017         07/31/2017           100                                   07/31/2017         08/31/2017                                            90                                   08/31/2017         09/30/2017           350                                   09/30/2017         10/30/2017           800                                   10/30/2017         11/30/2017          1,000

 Start Date                                          End Date        Usage  11/30/2017                                         12/30/2017        1,200 12/30/2017                                         01/31/2018        1,500

     Total Consumption (therms):                                                                           7,040                                                                                Total Consumption (kBtu (thousand Btu)):

               Total Energy Consumption for this Meter

                  Do the fuel consumption totals shown above include consumption of all energy tracked through this meter that affect energy calculations for the reporting period of this application (i.e., do the entries match the utility bills received by the property)?

                Notes:       704,000  □Yes	□No

               Electric - Grid Meter: Electric Grid Meter (kWh (thousand Watt-hours))

               Associated With: SOP Example  Start Date       End Date                                         Usage                                     Green Power? 01/01/2017      02/01/2017                                        125,000                                          No 02/01/2017      03/01/2017                                        13,000                                          No 03/01/2017      04/01/2017                                        122,000                                          No 04/01/2017      05/01/2017                                        119,500                                          No 05/01/2017      06/01/2017                                        145,000                                          No 06/01/2017      07/01/2017                                        15,000                                          No 07/01/2017      08/01/2017                                        180,000                                          No 08/01/2017      09/01/2017                                        175,600                                          No 09/01/2017      10/01/2017                                        160,000                                          No  10/01/2017      11/01/2017                                        124,000                                          No 11/01/2017      12/01/2017                                        99,000                                          No  12/01/2017      01/01/2018                                        121,000                                          No 01/01/2018      02/01/2018                                        113,000                                          No                                                                                Total Consumption (kWh (thousand Watt-hours)):                                        Total Consumption (kBtu (thousand Btu)):

               Total Energy Consumption for this Meter          1,512,100

         5,159,285.2

     □Yes	□No

              4. Signature & Stamp of Verifying Licensed Professional

	(Name) visited this site on 	(Date). Based on the conditions obseived at the time of the Visit to this property, I verify that the information contained within this application is accurate and in accordance with the Licensed Professional Guide. Signature 	 Date 		_ Licensed Professional License: U.S. License 554534534 in AK Jane The LP 1010 school street Poolesville, MD 20837 7032252264 <EMAIL_ADDRESS>NOTE: When applying for the ENERGY STAR, the signature of the Verifying Professional must match the stamp.

    Professional Engineering Stamp    Do the fuel consumption totals shown above include consumption of all energy tracked through this meter that affect energy calculations for the reporting period of this application (i.e., do the entries match the utility bills received by the property)?

 Notes:

               5. Signatory Agreement               I hereby nominate the above described property for award of the ENERGY STAR. I have provided a copy of the Licensed Professionals Guide to the ENERGY STAR for Commercial Buildings to our Licensed Professional (LP) for reference. As documented by the above Checl<list, this property meets the conditions necessal)' to qualify as                ENERGY STAR. I am submitting this application within four months of the Year Ending Date (Janual)' 31, 2018} used

               to generate the application. I will assist EPA/NRCan, if requested, in verifying any data inducted in this application. Furthennore, I agree to associate the ENERGY STAR logo only with this property and to adhere to the ENERGY STAR Identity Guidelines.

               Signature (must be a direct employee of the building owner/manager): 	_

               Date: 		_

               Signatory Name: Danielle Wilmot Property OWner: DMW Office co.

               The government estimates the average time needed to fillout this formis 6 hours (includes thetime for entefing energy data, Licensed ProfessJonal facility inspection, andnotarizing the SEP) and welcomes suggestions for reducingthis level of effort Send comments (referencing 0MB control number) to tile Oirector, Colection Strategies Division, U.S.,EPA (2822T), 1200 Pennsylvania Ave.,NW, Washington, D.C. 20460

                        STATEMENT OF ENERGY IMPROVEMENT

                        Site Name         OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

                         For Baseline Period	2018                          beginning the 1[st] of: January	2018

         Site Address	Company/Owner Address (if different)          Contact Name	Name		                                   Street Address	Street Address		                                   Address 2	Address 2		                                   City, State	City, State		                                   ZIP	ZIP

          Baseline	 1[st] Year	2[nd] Year	3[rd] Year	4[th] Year December December December December December 2018	2019	 2020	2021		2022                               Final December 2023

                                       0.00                                        0.00                                        0.00                                        0.00                                        0.00                                        0.00

                                        --                                         --                                         --                                         --                                         --                                         --

                                        --                                         --                                         --                                         --                                         --

                                        --                                         --                                         --                                         --                                         --

Energy Improvement                                         Period Ending: Site Electricity (MMBtu)                    Site Thermal Energy (MMBtu) Source Electricity (MMBtu) Source Thermal Energy (MMBtu) Total Source Energy (MMBtu) Production Unit or Sq. Ft                              Energy Intensity (MMBtu/Production Unit or Sq. Ft)                % Energy Intensity Reduction from Baseline Annual Source Energy Avoided (MMBtu) Annual CO2e Avoided (metric tons)

             Yes	No A customized energy intensity metric, normalized for multiple factors, has been entered directly into row 30.              Absolute	Intensity The basis for calculating annual avoided CO2e emissions is:                  Professional Certifier Stamp/Seal

Based on my review, I certify that the information used in this tool to generate the energy intensity reduction represented on this statement is accurate.

Professional Verification         Certifier Name Certifier Title Address Address 2 City, State ZIP Phone Number

         Certifier Signature

         For U.S. EPA Use Only:

       This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average up to 15 minutes 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 5900-198

                                                                      OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

              Company Name*               Enter the company name exactly as it should appear in recognition materials.

              Your answer

Site Name*               Enter the sitename exactly as it should appear in recognition materials.

              Your answer

Site Mailing Address*               Enter the site's full mailing address (including street address, city, district/state/province, and zip code/postal code} exactly as it should appear in recognition materials.

              Your answer

Site Country *

              Your answer

              Site Contact

              Note: The Site Contact must be located within the U.S.

Site Contact Name*               Please enter the site contact's full name.

              Your answer

              Note: TheSite Contact must be located within the U.S.

              Site Contact Name*               Pleaseenter the site contact's full name.

              Your answer

              Title*

              Your answer

              Email*

              Your answer

              Phone*

              Your answer

              Site Contact Mailing Address               Complete this question only if the site contact's mailing address is different from the site mailing address.

              Your answer

              Is the Corporate Energy Director the same person as the Site Contact?*               0 Yes               Q No

              Corporate Energy Director Name*

              Your answer

              Title*

              Your answer

              Email*

              Your answer

              Phone*

              Your answer

              Corporate Energy Director Mailing Address*               Your answer

              CEO Name*

              Your answer

              Title*

              Your answer

              Email*

              Your answer

              Phone*

              Your answer

              CEO Mailing Address*               Your answer

              If you wish to have a thirdperson, such as theplant manager at aninternational plant, named inthe congratulatory letter, please identify that personhere.

              Contact Name

              Your answer

              Title

              Your answer

              Email

              Your answer

              Phone

              Your answer

              Contact Mailing Address

              Your answer

               Who is the point of contact for this application?*                0 Site Contact                0 Corporate Energy Director                0 Other Contact

               Which people should be acknowledge in the congratulatory letter?               0	Site Contact               0	Corporate Energy Director               0	Other (Add name and title in the comment box below)

               Who should receive the certificate of recognition that EPA will mail upon completion of review of this application?*                EPA will mail a congratulatory letter to all contacts listed (who are located in the US). One certificate will be prepared and mailed to the individual selected below. The individual selected must have a US-based address.                0  Site Contact                0 Corporate Energy Director                0 Chief Executive Officer                0 Other Contact

                     This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 10 minutes 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.

                                                                    OMB Control Number 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

     ENERGY STAR(R) Challenge for Industry Registration Form      Please complete this form to take the ENERGY STAR Challenge for Industry by pledging to improve the energy efficiency of your manufacturing site by 10 percent within 5 years from your baseline year. For information on requirements, supporting tools, and recognition, please visit www.energystar.gov/industrychallenge.

     * Required      Site Information	      Company Name *

     Your answer      Site Name *

     Your answer      Site Address *

     Your answer      Site City *

     Your answer      Site State (and/or District, Province, etc.) *

     Your answer

     Site ZIP Code or Postal Code *

     Your answer      Site Country *

     Your answer      Industry Description *      Please provide a short description of your business. Example: Our company manufactures widgets.      Your answer

     Products Produced at This Site *

     Your answer      Contact Information	      Contact Name *

     Your answer

     Your answer

     Contact Phone *

     Your answer      Contact Email *

     Your answer      Baseline, Tracking, and Goals	      Energy Intensity Metric *      Identify the metric used to track energy intensity. Example: Btu per pound of product.

     Your answer      Explanation of Energy Intensity Metric Selection *      Please include a brief explanation of why the selected metric is appropriate. Example: "Our site produces a variety of widget types which we track by weight."      Your answer

     Your answer

     Baseline Year *      Please select the ending month of your 12-month baseline period. The baseline must begin in the year prior to signing up for the Challenge. The baseline can be based on the immediate past year (e.g., a site signing up in April 2014 could set their baseline as January 1, 2013 - December 31, 2013), or another consecutive 12-month period such as the most recent 12 months (e.g., a site signing up in April 2014 could set their baseline as April 1, 2013 - March 31, 2014), or the site's most recent fiscal year.

     Your answer

     Baseline Energy Intensity *      Please enter this site's source energy intensity (including all electricity, fuels, steam, etc.) for the Baseline Year using the Energy Intensity Metric units identified above. For information on source energy, please refer to the ENERGY STAR Challenge for Industry Participant Handbook, Appendix 3: http://1.usa.gov/1t9EpqQ

     Your answer      10% Energy Intensity Reduction Target *      Please enter this site's source energy intensity target (i.e., energy intensity that is 10% lower than the Baseline Energy Intensity entered above).

     Your answer      Formal Site File *      We have established the required formal site file. Note: a formal site file must be established at the start of participation in the ENERGY STAR Challenge for Industry, and must be verified by a Professional Engineer as a step in the recognition application process.      Yes No

     Additional Information

     Is your company an ENERGY STAR Industrial Partner? * Yes

 Is this the first time this site has signed up for the Challenge for Industry? If no, please indicate how many times this site has signed up in the "Other" text box below. *  Yes  No Other:

 How did you learn of the ENERGY STAR Challenge for Industry? (Optional)  If you are participating as part of program promoting the Challenge please name that organization (e.g., industry association, utility) below.

 Your answer

 This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 10 minutes 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 Number 5900-263

 BEFORE YOU CLICK SUBMIT: Using your browser's Print function, please print this completed form to a PDF or paper and retain for your Formal Site File. Then click Submit.

 Never submit passwords through Google Forms                                                          SUBMIT

                                                                      OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

        [DATE]

        ENERGY STAR for Industry         U.S. Environmental Protection Agency 1200 Pennsylvania Avenue, NW         Mail Code 6202A Washington, DC 20460

        Dear ENERGY STAR for Industry:         As the corporate energy director for [name of company], I am writing to nominate the following plant(s) for award of the [Year] ENERGY STAR:

        [Plant name]         [Plant street address] [Plant city, state, zip code]         [Repeat for additional plants]

        As documented by the attached Statement of Energy Performance, I affirm that the aforementioned plant meets the conditions necessary to qualify for the ENERGY STAR, including an Energy Performance Score in the top quartile of the most current version of the ENERGY STAR Energy Performance Indicator for this type of plant, or for petroleum refineries, scoring within the top quartile of the Solomon-EII(TM) scoring system.         I have personally examined and am familiar with the information contained in this Application. The information is based on reasonable inquiry and is, to the best of my knowledge, true, accurate, and complete. I have no reason to believe the plant would not meet all EPA program requirements for receiving the ENERGY STAR.         I am submitting this application within one year of the period ending date on the enclosed Statement of Energy Performance. I understand EPA reserves the right to request and review any records which support the data used to produce the Energy Performance Score for this plant. I also certify that I am maintaining a formal certification file on this plant in accordance with EPA's formal certification file requirements. Furthermore, I agree to associate the ENERGY STAR name and logo only with the aforementioned plant and to adhere to ENERGY STAR's Identity Guidelines.

        Sincerely,

        Signature	         Signatory Name (Corporate Energy Manager for [Company name]):

        Attachments: Statement of Energy Performance, EPI Printout, Award Specification Sheet, PE Verification Checklist

        This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060- 0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 range up to 10 minutes 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 5900-264

                                                                      OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

      The data on this form is used for generating certification materials, which includes a certificate for each plant and a letter to the Corporate Energy Manager (CEM) and Chief Executive Officer (CEO). Complete this form with company and plant names and contact information as it should be referenced on certification materials. The letters to the CEO will reference the plants that received certification and will acknowledge the CEM for helping reduce energy use. If any other staff should be acknowledged, please write their names and titles at the end of the form. For multiple plants that fall under the same CEO and CEM input additional plants on page 2. For multiple plants with a different CEO or CEM use a separate form.

 Corporate Energy Manager  Organization's Chief Executive Officer  Name

 Title

 Company

 Address 1

 Address 2

 City

 State

 Zip code

 Email

 Phone

 Plant Owner (complete if different from CEO contact information)  Company

 Address

 City, State, Zip

 Email

 Plant 1  Plant name

 Company name

 Address 1

 Address 2

 City

 State

 Zip code

 Decal type (see below)  Cyan and white☐	Etched☐

 ENERGY STAR Decals  NOTE: Unless specified otherwise, all recognition materials will be addressed and sent to the Corporate Energy Manager at the location specified above. The congratulatory letter for the CEO will be sent directly to the address provided for the CEO. Please specify any other information/requests for distribution of recognition materials in the space below.  Cyan and White

 Etched

      EPA Form 5900-265

 Plant 2  Plant name

 Company name

 Address 1

 Address 2

 City

 State

 Zip code

 Decal type  Cyan and white☐	Etched☐

 Plant 3  Plant name

 Company name

 Address 1

 Address 2

 City

 State

 Zip code

 Decal type  Cyan and white☐	Etched☐

 Plant 4  Plant name

 Company name

 Address 1

 Address 2

 City

 State

 Zip code

 Decal type  Cyan and white☐	Etched☐

 Plant 5  Plant name

 Company name

 Address 1

 Address 2

 City

 State

 Zip code

                        .       This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 range up to 15 minutes 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.

 Decal type  Cyan and white☐	Etched☐

                        .       This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 range up to 15 minutes 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.

        ENERGY STAR(R) Certification Audit: Instructions       OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

           To help ensure the integrity of the ENERGY STAR brand, EPA is performing audits on certification applications to ensure that all energy use is accounted for accurately, the building characteristics have been properly reported, and indoor environmental quality has not been compromised in pursuit of energy conservation. Your application has been randomly selected for an audit and will be processed alongside the information you provide in this audit document. The status of your application is contingent on the approval of all entries in your application and audit.

           As part of the audit process, EPA is requesting that you provide detailed explanations and/or documentation for each of the following application sections:

         oo             Property Information - provide a description of your property along with details from your site visit          oo            Indoor Environmental Quality - provide a completed version of the Indoor Environmental Quality Measurement Form. You may have already completed this form as part of your site visit. If not, a copy has been included in the same email as this audit form. Refer to the Guide for Licensed Professionals for more information: www.energystar.gov/lpguide.          oo            Total Building Energy Use - explain what fuel types are being used at the property and provide the 12 months of utility bills that were included in the application for each meter.          oo            Property Use Details - provide an explanation of how values were determined for all property use details, along with supporting documentation as appropriate and available.

           When reviewing this audit documentation, EPA is looking for both an explanation of how all values were confirmed during the site visit as well as proof that the applicant and LP understand Portfolio Manager definitions and policies.  Please complete this audit document by XX/XX/XXXX in order to avoid delays in the processing of this application. If you have any questions while completing the form, please send them to<EMAIL_ADDRESS>            Attachments: Please list the supporting documents that you have included as part of this audit in the space below. 12 months of utility bills for each meter used at the property are required. Optional attachments may include photographs, as-built building drawings or any other materials that will help EPA verify the values submitted as part of the application.            Click here to enter text.

        EPA Form No. 5900-382

 Property Information

    Property Name: Click here to enter text. Street Address: Click here to enter text.

    City, State, Zip: Click here to enter text. Application Tracking Number:      Portfolio Manager Property ID: Click here to enter text.      Primary Property Type: Click here to enter text.

           Property Description               Please describe the main uses and occupants/tenants at the property, major energy using systems, property features, and any other pertinent information. Please also confirm that the Primary Property Type listed above matches EPA's definition for that property type. For example, in order for a property to be correctly classified as Retail, its Gross Floor Area must be greater than 5,000 sq. ft. and it must have at least one exterior entrance to the public.               Click here to enter text.

              Link to property website (if available): Click here to enter text.               Link to property image on a satellite map (if available): Click here to enter text.

              Does this application represent the entire property? If any spaces or structures have been excluded, please explain here:               Click here to enter text.

       2	Audit form for Application Tracking Number XXXX EPA Form No. 5900-382

          [Optional] How much time was spent at the property during the site visit?

      oo         Less than 2 hours       oo         2-4 hours       oo         4-8 hours       oo         More than 8 hours

Did any edits need to be made to the application following the site visit (Yes/No)? Click here to enter text. If yes, please explain the edits that were made: Click here to enter text. If a representative of the Licensed Professional visited the property, please provide a detailed summary of the instructions given by the Licensed Professional to the person(s) performing the site visit and verifying the application contents: Click here to enter text. Date(s) of the site visit: Click here to enter text. Who conducted the site visit (name, organization, title): Click here to enter text.  Site Visit  Please provide a completed copy of the Indoor Environmental Quality Measurement Form. You may have already completed this form as part of your site visit. If not, a copy has been included in the same email as this audit form.

 Please ensure that the form has been signed by the Licensed Professional. Refer to the Guide for Licensed Professionals for more information on how the required indoor environmental standards should be verified at www.energystar.gov/lpguide.  Indoor Environmental Quality

 Energy Consumption Data

       3	Audit form for Application Tracking Number XXXX EPA Form No. 5900-382

            Please submit copies of twelve months of the utility bills reported in your ENERGY STAR application. You may use the checklist below to confirm that all meters have been included in the audit documentation.

   Meter Name    Fuel Type  12 months of Bills  Provided (Yes/No)    Click here to enter text.    Click here to enter text.      Yes/No    Click here to enter text.    Click here to enter text.      Yes/No    Click here to enter text.    Click here to enter text.      Yes/No    Click here to enter text.    Click here to enter text.      Yes/No    Click here to enter text.    Click here to enter text.      Yes/No    Click here to enter text.    Click here to enter text.      Yes/No

   IT Meter Name    Location                            12 months of Meter Readings                                       (Yes/No)    Click here to enter text.    Click here to enter text.      Yes/No    Click here to enter text.    Click here to enter text.      Yes/No

     How was it verified that all meters have been included in the application? Click here to enter text.

     If this application was for a property with multiple tenants and you do not have access to utility bills, please explain how the total energy usage of the property was determined and provide master meter readings or a calculated aggregate of all tenant meters.      Click here to enter text.           This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 45 minutes to 1 hour and 45 minutes per response. Send comments        4	Audit form for Application Tracking Number XXXX EPA Form No. 5900-382

          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.

       5	Audit form for Application Tracking Number XXXX EPA Form No. 5900-382

                                                                  OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review

                        LEARN MORE AT                         energystar.gov            Challenge for Industry Professional Engineer Verification Checklist

 oo    All information supporting the energy consumption used to calculate the site's energy intensity metric is treated consistently across the baseline and tracking periods, especially    for energy sources that may be invoiced at irregular (non-monthly) intervals.                                      Yes□  No□  oo    If site exports electricity or steam, these exports have been subtracted from the site's total    enernv use.                                      Yes□  No□NA□  oo    All forms of energy purchased and used on site were properly converted to BTUs, summed    and reported on the Statement of Enerqy Improvement as site enerqy_                                      Yes□  No□  oo    All energy was properly converted from "site" to "source" energy, summed and reported on    the Statement of Energy Improvement as source energy.                                      Yes□  No□  oo    All data used reflects the whole facility and not a single process or individual part of the    site.                                      Yes□  No□

             Site Energy Intensity Improvement  oo    The baseline data entered into the Statement of Energy Improvement matches the baseline approved by U.S. EPA when the site registered to participate in the ENERGY    STAR Challenqe for Industry.                                      Yes□  No□                                                                               0  If no, an explanation for the difference must be noted in this checklist (below), accompanied by any necessary supporting documentation.                                      Yes□  No□  oo    The site reduced its energy intensity by at least 10 percent within 5 years of the conclusion of the baseline period, and all data was accurately recorded in the Statement of Energy    Improvement.                                      Yes□  No□  oo    The period during which the energy intensity reduction was achieved ends no earlier than    12 months, nor later than 60 months, from the conclusion of the baseline period. The 10    percent energy intensity reduction is calculated against the baseline period for the final 12    months of the trackinq period.                                      Yes□  No□  oo    The tracking period begins immediately following the end of the baseline period and    continues through the end of the period for which the 10 percent reduction is achieved.                                      Yes□  No□

             PE Verification  oo    The PE review of the plant has been documented (e.g., site visit vs. corporate office, date,    personnel met with, findings/corrections/recommendations from the review).  Yes□ No□  oo    The PE completed the Verification Checklist for submission to EPA, and added the original    document to the formal certification file.  Yes□ No□  oo    The PE signed, stamped - indicating if embossed, and provided the required license information on the Statement of Energy Performance for submission to EPA, and added    the original document to the formal certification file.  Yes□ No□

             Site Annual Carbon Dioxide Emissions Avoided (Optional)  oo    If site has reported the avoided carbon dioxide equivalent (CO2e), the emission estimates    that are linked with the energy intensity reduction were calculated correctly using proper emission factors.  Yes□ No□

             Com letion of Formal Site File

              oo                 All documentation/calculations supporting all the statements above are located in the formal site file.      Yes□ No□

             PE Verification

             Updated March 16, 2017

                  This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060- 0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 25 minutes 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 No. 5900-387

                                                                 OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review               Appendix A: Indoor Environmental Quality Measurement form for ENERGY STAR Building Verification Site Visit

    Instructions: The LP (or his/her representative) must use this form to record measurements taken during the ENERGY STAR building verification site visit. Forms should be kept on file for two years. Should an ENERGY STAR application be selected for an audit, you will be required to submit this form as supporting documentation. Please attach additional notes pages if necessary.

          Property Name: 		  Property Address: 		  LP Name: 	 Site visit date: 	 Information on person conducting the site visit:

          Name: 	   Title: 	  Organization:

    Outdoor Air Ventilation     The LP must verify that the property meets the minimum ventilation rates according to ANSI/ASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality.

      Select the method used (check all that apply)                For mechanically ventilated buildings, the LP must confirm minimum outdoor ventilation rates by any of the following; direct airflow measurements per ANSI/ASHRAE Standard 62.1, Section 6.2, the Ventilation Rate Procedure, or CO2 concentration measurements per ASHRAE 62.1 Appendix C, and ASTM D6245 Standard Guide for Using Indoor CO2 Concentrations to Evaluate Indoor Air Quality and Ventilation, or                detailed airflow calculations derived from as-built equipment specifications, and physical inspection of system operation and control          For naturally ventilated buildings, the LP must follow ASHRAE 62.1, Section 6.4, Natural Ventilation Procedure to confirm the minimum outdoor air opening and space configuration requirements.          Dwelling units in multifamily housing shall use ASHRAE 62.2, Ventilation and Acceptable Indoor Air Quality in Residential Buildings. Hospitals and Senior Care Communities may use ASHRAE Standard 62.1, or ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities - 2013.          For building occupancy types not covered by these standards, buildings with physical constraints that make it infeasible to provide these minimum outdoor air rates, as well as spaces that are inaccessible to the LP (e.g. individual apartments) the LP must use their professional judgement to confirm that outdoor air ventilation has not been compromised in pursuit of energy conservation.  Description of verification method and documentation of measurement results:

    Thermal Environmental Conditions     The LP must verify that the property meets the acceptable thermal environmental conditions according ANSI/ ASHRAE Standard 55, Thermal Environmental Conditions for Human Occupancy. Temperature measurements are not required for Data Centers.

  Location   Space Function   Date and Time    Specific    Location  Dry bulb Temp.   (°F)                              Relative Humidity (%)                          Air Speed (ft/min) (optional)     Notes and Observations

    Indoor Lighting Conditions     The LP must verify that the property meets the acceptable minimum illumination levels as recommended by the Illuminating Engineering Society of North America (IESNA) Lighting Handbook. Horizontal and/or vertical illumination measurements must be taken. Both measurements are not required.

   Location   Space Function    Date and   Time   Specific Location                             Horizontal Illumination                                        (fc)                                     Vertical                                Illumination (fc)     Notes and Observations

    I verify that the measurements on this form are accurate and taken in accordance with the requirements described in the ENERGY STAR Licensed Professional's Guide.

    LP Signature: 		Date:

  September 2018	Page 3 of 4

    Notes Section (optional     Please use this section to document your notes about the site visit.

 September 2018	Page 4 of 4

      This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 15 minutes 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.

 September 2018

                                                                      OMB Control No. 2060-0347 Expiration Date: XX/XX/XXXX Approved while under OMB review                                       Energy Treasure Hunt Sheet

          Instructions: The Energy Treasure Hunt is a dynamic, effective process for identifying savings opportunities in a facility. Documenting these opportunities supports implementation of stronger energy management practices consistent with the EPA's ENERGY STAR Guidelines for Energy Management (www.energystar.gov/guidelines). Please provide information on your building(s) and summarize project opportunities as requested below.

          I.              Building Information

           1.               Company name:                                                                          2.               Company point of contact:            3.               Site name(s) and address(es):                                                                          4.               Type of building/plant in which treasure hunt has taken place:            5.               Square footage of building(s):                                                                          6.               ENERGY STAR score/Energy Use Intensity (EUI) (for buildings only):            7.               Date of hunt, to confirm within eligible period:

          II.              Opportunity Summary

           Treasure Hunt Opportunities      Report Dollar Savings       Report Energy Savings  1. Total energy savings predicted from a hunt  $                                                                             Btu  2. Top three projects identified    Project 1  $                                                                             Btu    Project 2  $                                                                             Btu    Project 3  $                                                                             Btu  3. Savings as a percent of energy use                                                                               %                                                                               %

          This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 range up to 1 hour and 25 minutes 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 5900-437

     2020 ENERGY STAR[(R)] Awards      PART 2: Excellence Award Application                                                       OMB Control No. 2060-0347                                                     Expiration Date: XX/XX/XXXX                                                        Approved while under OMB

                                       The simple choice for energy efficiency.                                                                                Eligibility:	This award is open to ENERGY STAR energy efficiency program sponsors, service and product providers, state and local governments, and/or other partner organizations that have demonstrated innovation in increasing access to the data required by EPA's ENERGY STAR Portfolio Manager tool, and/or expanding the use of the data and building performance metrics available from it.               Multiple partner organizations may apply for this award together, as appropriate, when efforts were collaborative in nature. Please remember to review and complete PART 1: General Instructions & Executive Summary before completing this part of your application.

  Description: The goal of this award is to recognize partners who have demonstrated innovation in:               oo                  Increasing the flow of data into Portfolio Manager; and/or               oo                  Using the data and metrics from Portfolio Manager to drive improvements in commercial, industrial, or multifamily building energy performance and other environmental objectives.

              This award is intended to recognize initiatives that demonstrate breakthrough or precedent- setting innovations. As appropriate for their initiatives, applicants should be able to substantiate how their work:

              oo                  Represents a breakthrough or precedent-setting innovation;               oo                  Reaches new or underserved markets; or increases scale in established customer segments;               oo                  Increases the availability of building energy performance data to the public, including key stakeholders;               oo                  Incorporates ENERGY STAR tools, resources and branding; and               oo                  Deploys new technologies or implementation approaches.

              Given the emphasis on innovation, this award will not recognize a partner for the same activity more than once, nor will it recognize well-established, on-going activities, programs, products and services.[1]

              Criteria:	EPA anticipates that a diverse range of activities, programs, products and services will compete for this award. The most competitive applications will be those that clearly address ENERGY STAR program objectives, while reducing or removing key market barriers. Awards for data innovation will be made primarily using the following two criteria:

              Increasing the flow of data into Portfolio Manager

              This criterion pertains to innovative efforts to make it easier to obtain the data required to benchmark in Portfolio Manager or to transfer that data into Portfolio Manager.

              The following are examples of the types of activities, programs, products and services that would compete in this category:

  [1] These types of notable efforts to support benchmarking and the use of energy performance data meet key requirements for ENERGY STAR awards in other categories and should be included in those applications.

              oo                  A utility that simplifying or automating the process of mapping meters to buildings to provide customers with whole-building, aggregate consumption data.               oo                  An energy information services company automating a direct data feed from a building automation system to Portfolio Manager.               oo                  A property management company implementing a simplified process for energy information to flow from tenant to owner to Portfolio Manager.               oo                  An energy information services company creating software that is then adopted by multiple utilities to send customer energy data into Portfolio Manager.

              Expanding use of energy performance metrics from Portfolio Manager

              This criterion pertains to innovative efforts to expand use of the data and/or building performance metrics available from Portfolio Manager to achieve greater energy efficiency and other environmental objectives in the commercial, industrial and multifamily buildings markets.

              The following are examples of the types of activities, programs, products and services that would compete in this category:

              oo                  Local or state governments working to creatively visualize building performance metrics and increase the accessibility of the information resulting from local voluntary initiatives and/or reporting required by benchmarking and transparency laws.               oo                  Utilities using ENERGY STAR energy performance metrics as an integral part of the marketing and delivery of their commercial efficiency programs.               oo                  A service provider using ENERGY STAR metrics to enhance design, analysis, auditing,                  procurement, or financing of energy efficiency, demand reduction, and/or green energy supply programs.

Supporting   Materials:	Each applicant must submit at least one item in PART 3: Supporting Materials. (required).               Applicants are encouraged to submit supplemental materials that demonstrate the development, use, or promotion of their innovation. These materials may include, but are not limited to:

              oo                   Screen shots to convey software functionality (particular emphasis should be placed on capturing the customer's point of view);               oo                   Fact sheets;               oo                   Online guidance materials;               oo                   Participant or customer-facing marketing/promotional materials;               oo                   Conference presentations highlighting the innovation; and/or               oo                   Case studies/examples of the activities, programs, products or services.

Award Evaluation Criteria:   Reviewers will apply this application's criteria, as appropriate to your activity:   	2

Increasing the flow of data into Portfolio Manager

      oo            Developing novel business processes and customer service approaches that reflect industry best practices when creating solutions for providing users with utility data for benchmarking.       oo            Demonstrating active and productive collaboration with stakeholders to overcome key market, policy or regulatory barriers to providing greater access whole-building energy data.       oo            Creating scalable technology platforms for the acquisition of energy data from many sources, and for the distribution of data for many applications and to many users.

Expanding use of performance metrics from Portfolio Manager

      oo           Increasing market awareness and understanding of ENERGY STAR energy performance scores and other benchmarking metrics.       oo          Demonstrating integration of ENERGY STAR performance metrics alongside other data and analytical offerings.       oo          Presenting energy performance metrics specifically for traditionally hard-to-reach market segments, e.g., small and medium businesses; multifamily housing; and economically disadvantaged neighborhoods.       oo          Applying technology to engage building owners and managers in dynamic and motivating ways.       oo          Using benchmarking results to generate interest in other ENERGY STAR resources and initiatives (e.g., ENERGY STAR Certification; development of local benchmarking competitions; use of ENERGY STAR qualified products).

BEGIN APPLICATION

                                           PART 2:                                 Award Accomplishments Document                  (use the following information to create a Word or PDF file)   	3

Accomplishments Narrative:   Your application narrative must be no more than three pages and use a minimum of 11-point black font. Margins should be no less than 1" on all sides. Pages that exceed the limit will not be evaluated. See "Supporting Materials" section below for examples of supporting content that will not count towards the page limit. Please note that any supporting materials should be clearly referenced in the award narrative.

  The accomplishments narrative should include the following:

  oo       Description of Data Innovation. Applicants should provide an overview of their activities, programs, products or services, with particular emphasis on (1) how this solution facilitates benchmarking in Portfolio Manager by commercial building owners/operators; and/or (2) how this solution leverages data and/or performance metrics from Portfolio Manager to drive measurable energy saving or other environmental protection activities. Applicants are expected to describe in specific terms the innovations for which they are seeking recognition and how they address the specific award criteria established above.

  oo       Market Effects/Cumulative Accomplishments. EPA recognizes that in some cases, innovative efforts will involve new or precedent-setting activities that may have only achieved limited market effects at the time of application. Nonetheless, applicants should make every attempt to provide both qualitative and numerical data to support the case that the market has changed or will likely change in a significant and sustained way as a result of your innovative work with data. When such data are not available because the innovation is new, applicants should describe the likely potential impacts of the innovation in detail.

  	4

                Prepare/Gather Remaining Documents for Upload

        PART 3: Supporting Materials (at least one required, as described in the Application Instructions above)         PART 4: Organization's High-Resolution Logo (required)

 ENERGY STAR[(R)] is the simple choice for energy efficiency. For 25 years, EPA's ENERGY STAR program has been America's resource for saving energy and protecting the environment. Join the millions already making a difference at energystar.gov.

 This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0347). Responses to this collection of information are voluntary (Section 103(g) Clean Air Act). 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 average 14 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.                                        5

                                                    2020 ENERGY STAR[(R)] Awards PART 2: Excellence Award Application                                        The simple choice for energy efficiency. OMB Control No.

              Eligibility:	This award is open to ENERGY STAR energy efficiency program sponsors, service and product providers, state and local governments, and/or other partner organizations that have demonstrated innovation in increasing access to the data required by EPA's ENERGY STAR Portfolio Manager tool, and/or expanding the use of the data and building performance metrics available from it.               Multiple partner organizations may apply for this award together, as appropriate, when efforts were collaborative in nature. Please remember to review and complete PART 1: General Instructions & Executive Summary before completing this part of your application.

  Description: The goal of this award is to recognize partners who have demonstrated innovation in:               oo                  Increasing the flow of data into Portfolio Manager; and/or               oo                  Using the data and metrics from Portfolio Manager to drive improvements in commercial, industrial, or multifamily building energy performance and other environmental objectives.

              This award is intended to recognize initiatives that demonstrate breakthrough or precedent- setting innovations. As appropriate for their initiatives, applicants should be able to substantiate how their work:

              oo                  Represents a breakthrough or precedent-setting innovation;               oo                  Reaches new or underserved markets; or increases scale in established customer segments;               oo                  Increases the availability of building energy performance data to the public, including key stakeholders;               oo                  Incorporates ENERGY STAR tools, resources and branding; and               oo                  Deploys new technologies or implementation approaches.

              Given the emphasis on innovation, this award will not recognize a partner for the same activity more than once, nor will it recognize well-established, on-going activities, programs, products and services.[1]

              Criteria:	EPA anticipates that a diverse range of activities, programs, products and services will compete for this award. The most competitive applications will be those that clearly address ENERGY STAR program objectives, while reducing or removing key market barriers. Awards for data innovation will be made primarily using the following two criteria:

              Increasing the flow of data into Portfolio Manager

              This criterion pertains to innovative efforts to make it easier to obtain the data required to benchmark in Portfolio Manager or to transfer that data into Portfolio Manager.

  [1] These types of notable efforts to support benchmarking and the use of energy performance data meet key requirements for ENERGY STAR awards in other categories and should be included in those applications.   	1

              The following are examples of the types of activities, programs, products and services that would compete in this category:

              oo                  A utility that simplifying or automating the process of mapping meters to buildings to provide customers with whole-building, aggregate consumption data.               oo                  An energy information services company automating a direct data feed from a building automation system to Portfolio Manager.               oo                  A property management company implementing a simplified process for energy information to flow from tenant to owner to Portfolio Manager.               oo                  An energy information services company creating software that is then adopted by multiple utilities to send customer energy data into Portfolio Manager.

              Expanding use of energy performance metrics from Portfolio Manager

              This criterion pertains to innovative efforts to expand use of the data and/or building performance metrics available from Portfolio Manager to achieve greater energy efficiency and other environmental objectives in the commercial, industrial and multifamily buildings markets.

              The following are examples of the types of activities, programs, products and services that would compete in this category:

              oo                  Local or state governments working to creatively visualize building performance metrics and increase the accessibility of the information resulting from local voluntary initiatives and/or reporting required by benchmarking and transparency laws.               oo                  Utilities using ENERGY STAR energy performance metrics as an integral part of the marketing and delivery of their commercial efficiency programs.               oo                  A service provider using ENERGY STAR metrics to enhance design, analysis, auditing,                  procurement, or financing of energy efficiency, demand reduction, and/or green energy supply programs.

Supporting   Materials:	Each applicant must submit at least one item in PART 3: Supporting Materials. (required).               Applicants are encouraged to submit supplemental materials that demonstrate the development, use, or promotion of their innovation. These materials may include, but are not limited to:

              oo                   Screen shots to convey software functionality (particular emphasis should be placed on capturing the customer's point of view);               oo                   Fact sheets;               oo                   Online guidance materials;               oo                   Participant or customer-facing marketing/promotional materials;               oo                   Conference presentations highlighting the innovation; and/or               oo                   Case studies/examples of the activities, programs, products or services.   	2

3 Award Evaluation Criteria:   Reviewers will apply this application's criteria, as appropriate to your activity:

Increasing the flow of data into Portfolio Manager

      oo            Developing novel business processes and customer service approaches that reflect industry best practices when creating solutions for providing users with utility data for benchmarking.       oo            Demonstrating active and productive collaboration with stakeholders to overcome key market, policy or regulatory barriers to providing greater access whole-building energy data.       oo            Creating scalable technology platforms for the acquisition of energy data from many sources, and for the distribution of data for many applications and to many users.

Expanding use of performance metrics from Portfolio Manager

      oo           Increasing market awareness and understanding of ENERGY STAR energy performance scores and other benchmarking metrics.       oo          Demonstrating integration of ENERGY STAR performance metrics alongside other data and analytical offerings.       oo          Presenting energy performance metrics specifically for traditionally hard-to-reach market segments, e.g., small and medium businesses; multifamily housing; and economically disadvantaged neighborhoods.       oo          Applying technology to engage building owners and managers in dynamic and motivating ways.       oo          Using benchmarking results to generate interest in other ENERGY STAR resources and initiatives (e.g., ENERGY STAR Certification; development of local benchmarking competitions; use of ENERGY STAR qualified products).

BEGIN APPLICATION

                                           PART 2:                                 Award Accomplishments Document                  (use the following information to create a Word or PDF file)

Accomplishments Narrative:   Your application narrative must be no more than three pages and use a minimum of 11-point black font. Margins should be no less than 1" on all sides. Pages that exceed the limit will not be evaluated. See "Supporting Materials" section below for examples of supporting content that will not count towards the page limit. Please note that any supporting materials should be clearly referenced in the award narrative.

  The accomplishments narrative should include the following:

  oo       Description of Data Innovation. Applicants should provide an overview of their activities, programs, products or services, with particular emphasis on (1) how this solution facilitates benchmarking in Portfolio Manager by commercial building owners/operators; and/or (2) how this solution leverages data and/or performance metrics from Portfolio Manager to drive measurable energy saving or other environmental protection activities. Applicants are expected to describe in specific terms the innovations for which they are seeking recognition and how they address the specific award criteria established above.

  oo       Market Effects/Cumulative Accomplishments. EPA recognizes that in some cases, innovative efforts will involve new or precedent-setting activities that may have only achieved limited market effects at the time of application. Nonetheless, applicants should make every attempt to provide both qualitative and numerical data to support the case that the market has changed or will likely change in a significant and sustained way as a result of your innovative work with data. When such data are not available because the innovation is new, applicants should describe the likely potential impacts of the innovation in detail.

  	4

                Prepare/Gather Remaining Documents for Upload

        PART 3: Supporting Materials (at least one required, as described in the Application Instructions above)         PART 4: Organization's High-Resolution Logo (required)

 ENERGY STAR[(R)] is the simple choice for energy efficiency. For 25 years, EPA's ENERGY STAR program has been America's resource for saving energy and protecting the environment. Join the millions already making a difference at energystar.gov.

     The public reporting and recordkeeping burden for this collection of information is estimated to average 14 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, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 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.   	5

                                                   2020  ENERGY STAR[(R)] Awards PART 2: Partner of the Year Award                                        The simple choice for energy efficiency. Application Service & Product Provider OMB Control No.

   About the Award

   Eligibility: ENERGY STAR service and product provider (SPP) partners are eligible to apply[1].    Submission Instructions: Please review and complete PART 1: General Instructions & Executive Summary before completing this part of your application.    Description: This award recognizes service and product provider partners who demonstrate outstanding success in using ENERGY STAR tools and resources to help clients improve the energy performance of their existing buildings and/or building design (commercial new construction) projects.    Criteria: The 2019 ENERGY STAR Awards are based on work completed and accomplishments achieved during the 2019 calendar year, except when specifically noted. Accomplishments outside this timeframe should be excluded to the extent possible. They should only be mentioned to provide context for this year's accomplishments and to demonstrate continuous improvement that continued through the2019 calendar year. Applicants should be aware that EPA will refer to application material in its promotion of winners' achievements.    Please do not include confidential data. Applications citing or including confidential business information will NOT be evaluated.    Accomplishments Narrative: The narrative consists of four sections -           1.              Quantifying ENERGY STAR Benchmarking & Certification Success           2.              Integrating ENERGY STAR into Client Services           3.              Integrating ENERGY STAR into Marketing & Communications           4.              Collaborating with EPA to Advance ENERGY STAR    All Service and Product Provider Partners must address the criteria in Section 1A or 1B as well as Sections 2, 3, and 4. SPPs that work primarily with existing buildings should complete Section 1A. SPPs that work primarily with building designs should complete Section 1B.    Your narrative response should be provided directly in this application within the provided text boxes; do not attempt to expand the size of the boxes or decrease font size. Do not provide a separate narrative document; additional or separate narrative pages will not be evaluated.    Supporting Files: (minimum of 1 required) Applicants are encouraged to submit electronic copies of supporting materials that support the application. Make sure to clearly reference any supporting materials within the narrative of the application. Supporting materials must be directly relevant to energy performance and/or ENERGY STAR. Examples of supporting materials are program descriptions, brochures, energy policy statements, etc.

How Applications Are Scored    The application is scored on a 100-point scale, and the weight of each section is provided in the application. Note that you should provide a    detailed description of your 2019 accomplishments demonstrating how the required application criteria have been met. Winning

   [1] Information on service and product provider partnership requirements is available here on the ENERGY STAR web site.

 2020  ENERGY STAR[(R)] Awards PART 2: Partner of the Year Award                                        The simple choice for energy efficiency. Application Service & Product Provider    applications will clearly show the organization's commitment to improving facility energy performance or design energy efficiency for their clients through services, programs, and outreach efforts that leverage ENERGY STAR.

                               BEGIN APPLICATION

 RT 2:	Partner of the Year Award	efficiency.   lication Service & Product Provider 2020 PA App ENERGY  STAR[(R)] Awards                                                    The simple choice for energy                                     PART 2:                         Award Accomplishments Document

Company Information:  Company Web Site:  Enter company's Web site URL here  URL(s) for company web page(s) highlighting ENERGY STAR:  Enter URL for company web page(s) highlighting ENERGY STAR

   Please indicate your ENERGY STAR Service Provider category (select only one):           oo              Existing Buildings           oo              Commercial New Construction/Building Design (Architecture / Engineering)

   Accomplishments Narrative:

Section 1  -  Quantifying ENERGY STAR Benchmarking & Certification Success (35 points)    Section 1A: If you serve the existing buildings market:    ENERGY STAR Benchmarking (20 points)

   Please provide the following for activity in the last 12 months only:              oo                 Number of buildings (scored and unscored) your organization has benchmarked in Portfolio Manager[2]                    o                       Enter total: 	              oo                 Number of buildings your organization has benchmarked in Portfolio Manager for each of the following resource types                    o                       Energy: 	                    o                       Water: 	                    o                       Waste: 	              oo                 The percentage of your customers' total buildings benchmarked in Portfolio Manager                    o                       Enter percentage: 	%

          [2] Scored properties of types that are eligible to receive an ENERGY STAR score. Unscored properties are properties of types that are not eligible to receive a score.

          oo              If the percentage is less than 100%, please provide an explanation below:

                                      Click or tap here to enter text.

   ENERGY STAR Certification (15 points)    Please provide the following for activity in the last 12 months only:              oo                 Number of buildings your organization has helped to obtain initial ENERGY STAR certification                    o                       Enter total: 	              oo                 Number of buildings your organization has helped to obtain ENERGY STAR re-certification                    o                       Enter total: 	              oo                 Number of buildings for which your organization has provided cost-free verification                    o                       Enter total: 	    Section 1B: If your organization serve the commercial new construction market (Architecture/Engineering Firms)    Use of ENERGY STAR Design Tools (25 points)    Over the past 24 months, enter information for activities completed by your firm and for your projects:              oo                 Number of design projects where an energy use target was established using ENERGY STAR Target Finder or Portfolio Manager                    o                       Enter total: 	              oo                 Number of design projects that received Designed to Earn the ENERGY STAR recognition                    o                       Enter total: 	              oo                 Enter average percent energy reduction (compared to median EUI) of all projects that received Designed to Earn the ENERGY STAR recognition                    o                       Enter average energy percent reduction: 	%    ENERGY STAR Benchmarking (10 points)              oo                 Number of projects that received Designed to Earn the ENERGY STAR recognition and currently have benchmarked energy use in Portfolio Manager                    o                       Enter total: 	              oo                 Number of projects that received Designed to Earn the ENERGY STAR recognition and earned ENERGY STAR certification (for the actual energy performance)                    o                       Enter total:

                             All applicants must complete Sections 2-6. Section 2 - Integrating ENERGY STAR into Client Services (25 points)    Please describe how your organization has used your ENERGY STAR partnership and EPA's tools to help your customers set targets for their buildings or design projects, create and implement energy management plans, implement efficiency improvements, and evaluate progress. Please provide specific examples of ENERGY STAR tools and resources you have used that were helpful to your customers.

                                        Click or tap here to enter text.

   Discuss how your organization used ENERGY STAR to help clients gain recognition for achieving energy efficiency and enhanced performance in design projects and/or existing buildings. Include specific examples such as ENERGY STAR Design profiles, results from franchise energy efficiency competitions, success stories, or case studies your organization or EPA created for your customers.

                                        Click or tap here to enter text.

   Discuss specific value propositions your organization used to encourage your customers to pursue ENERGY STAR recognition over the past year.

                                        Click or tap here to enter text.

Section 3  -  Integrating ENERGY STAR into Marketing & Communications (20 points)    Please describe any ENERGY STAR-related marketing and sales strategies your organization used for your customers in the past year. This may include activities designed to increase consumer awareness or demand for ENERGY STAR benchmarking, certification, and/or energy-efficient design recognition from EPA. Please provide specific examples of how your organization promotes the ENERGY STAR brand and logo through your marketing materials.

                                        Click or tap here to enter text.    If applicable, please quantify the results of your engagement:

             oo                 Indicate the number of views of ENERGY STAR-related webpages or blog posts:                    o                       Enter total: 	              oo                 How many times has your organization shared ENERGY STAR-related content on social media?                    o                       Enter total: 	              oo                 Provide readership and click statistics on newsletters with ENERGY STAR content:

                                        Click or tap here to enter text.

             oo                 Other: (include examples of outreach activities not discussed in sections above).

                                        Click or tap here to enter text.

Section 4  -  Collaborating with EPA to Advance ENERGY STAR (20 points)    Please describe how your organization has provided feedback or collaborated with EPA this year. Include instances in which your organization has given input on the design and functionality of ENERGY STAR tools and resources, reviewed or co-authored industry

   publications with EPA, or assisted EPA in communicating initiatives and campaigns by connecting with clients, using EPA communication tools, or participating in conferences or webinars highlighting ENERGY STAR.

                                        Click or tap here to enter text.

         Prepare/Gather Remaining Documents for Upload

          PART 3: Supporting Materials (at least one required, as described in the Application Instructions above)           PART 4: Organization's High-Resolution Logo (required)

 ENERGY STAR[(R)] is the simple choice for energy efficiency. For 25 years, EPA's ENERGY STAR program has been America's resource for saving energy and protecting the environment. Join the millions already making a difference at energystar.gov.

 The public reporting and recordkeeping burden for this collection of information is estimated to average 14 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, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 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.

                         Award Accomplishments Document          (use the following information to create a Word or PDF file)                                        The simple choice for energy efficiency.

    About the Award                 Eligibility:	ENERGY STAR partners awarded Sustained Excellence in 2018 and/or 2019. Please remember to review and complete PART 1: General Instructions & Executive Summary before completing this part of your application.

                Description: This award recognizes businesses and organizations that demonstrate sustained excellence in energy management in partnership with ENERGY STAR.

                Criteria:	The 2019 ENERGY STAR Awards are based on work completed and energy savings demonstrated during the 2019 calendar year. Selected accomplishments outside of this time may be mentioned for reference in your application and to demonstrate continuous improvement but will not be considered as evidence of meeting award requirements in 2019. Applications will be evaluated on:                 oo                    Demonstration of leadership, including active engagement and promotion of the ENERGY STAR partnership, actions that improved and strengthened the energy program, and quality, quantity, and impact of communication efforts.                 oo                    Sustained or improved energy performance.

                All sections of the applications are weighted and evaluated on an equal basis.                 Materials:	Be aware that EPA will refer to material in applications in its promotion of winners' achievements. Please do not include confidential data. Applications citing or including confidential business information will NOT be evaluated.

BEGIN APPLICATION

    	1

    A)        Participation in the ENERGY STAR partnership     Describe your participation in the ENERGY STAR partnership, including use of resources, recognition activities, and support of ENERGY STAR initiatives, such as:        oo           ENERGY STAR Certification of eligible buildings and plants on an annual basis        oo           Engaging tenants, occupants, employees, and customers about ENERGY STAR achievements        oo           Achieving Designed to Earn the ENERGY STAR for commercial new construction or multifamily design projects        oo           Participation in and achievement of the ENERGY STAR Challenge for Industry for manufacturing sites        oo           Hosting a competition using ENERGY STAR resources        oo           Helping to develop and use new ENERGY STAR tools and resources        oo           Holding ENERGY STAR Industrial Showcases at plants        oo           Supporting ENERGY STAR Industrial Focuses        oo           Participating in ENERGY STAR meetings and events        oo           Promoting the ENERGY STAR partnership to customers, industry peers, and other organizations

    B)        Communication strategies that leverage ENERGY STAR and results     Describe how you used communications to support and promote your energy management program and enhance your partnership with ENERGY STAR. Discuss your organization's communication strategies for promoting energy efficiency with ENERGY STAR to internal and external stakeholders, how you implemented your strategy, and the 2019 results. Please address the following within your response:        oo           Goals of the outreach: What were the goals for your outreach efforts to audiences?        oo           Target audiences: Which audiences did you target and why?        oo           Metrics: What metrics did you identify to track to measure your success?        oo           Tactics and materials: What tactics and supporting materials did you use to implement your strategy and reach your target internal audiences?        oo           2019 accomplishments, including measured results: What did your communications achieve in 2019? How many people did you reach?

    Please briefly share the stories that accompany your communications. Provide samples of your work, such as advertisements, news stories, posters, articles, press releases, photos of the ENERGY STAR decal/ flag/ banner in prominent locations, and other creative materials. In particular, highlight any shareable online content, such as videos, social media activity, dedicated web pages, energy-saving guidance promoted online, etc.

    C)        Actions to grow and sustain energy and related sustainability practices     Describe actions taken in 2019 to sustain and grow your leadership in energy management and related sustainability areas, such as:        oo              Implementing new strategies and initiatives        oo              Deploying of new best practices

    	2

       oo              Adopting of innovative technologies        oo              Investing and piloting new projects        oo              Integrating of energy management into new business processes        oo              Benchmarking water, wastes, or other resources        oo              Operating supply chain, customer, or tenant initiatives        oo              Achieving of major milestones and goals

    Discuss any challenges that your energy program faced and how you overcame them.     NOTE: Supporting materials submitted should reflect a sampling of an organization's strongest examples of external and internal communications related to promoting their partnership and achievements with ENERGY STAR. These materials should be submitted electronically with the application and must include proper use of the ENERGY STAR logo in accord with the ENERGY STAR Brand Book.

    EPA is not looking for entire PowerPoint presentations, but, rather, excerpts of slide sets where ENERGY STAR was highlighted. This helps reduce the length of attachments and allows the strongest examples to be demonstrated. To limit the size of attachments, some applicants have found it helpful to prepare a slide set with multiple examples of outreach included on just a few slides.

    Section 2  -  Demonstration of Energy Savings     This section of the application focuses on actual energy performance improvements achieved by your organization during the past year. Your application will be judged on the magnitude of your 2019 improvements as well as your current energy performance relative to your peers.

    While 2019 savings are the focus of this section, you are encouraged to report and illustrate the cumulative accomplishments of your efforts (e.g., dollars saved since program began, total energy saved since "x date in the past," etc.) When highlighting cumulative accomplishments, include a timeframe for the longer-term accomplishments (e.g., saved $3 million in 2019 and more than $10 million since 2001).

    Please note that commercial and institutional building partners will respond to section A only, and industrial partners will respond to section B only.     A.        Commercial and Institutional Building Partners     All Commercial and Institutional Building Partners must summarize and provide a POY Report from Portfolio Manager showing organization-wide improvements. This POY Report must be generated for the period ending August 2019 or later. Additional supplemental guidance for generating this report can be found at www.energystar.gov/awards.

    In your summary, please provide one or more equivalency statements for your energy savings by equating them to a metric related to your business or industry, or other financial or environmental metrics. Examples include:           oo              Number of first-year teachers that could be hired           oo              Number of MRI machines that could be purchased

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          oo              Number of hotel rooms that could be rented

    Additionally, to illustrate your energy program's long-term accomplishments, please provide cumulative energy reductions (kBtu, or %), cost savings ($ or %), and carbon dioxide savings (total or %) for the years your program was awarded Partner of Year and Sustained Excellence or for a longer period during which your organization has been an ENERGY STAR partner.

    B.        Industrial Partners (NAICS 21, 31-33)     The entire table must be included in your narrative. Please provide a summary of your organization-wide energy performance, and copy the completed table into your narrative. If your company's energy program is global, you may choose to include all operations worldwide or only operations in the U.S. Please identify whether the information you share is U.S. only or global. Please be sure to use the proper units and intensities as stated in the table.

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    (Note: Cut and paste this table into your Accomplishments document for editing

 1. Number of facilities tracked and benchmarked by plant type *

 2. Total number of facilities operated by plant type

 3. Total output, in units, which apply to the business of your company and correlate with energy usage, e.g. ft[2], tons of a  specific product, etc. for 2019

 4. Aggregate energy intensity for 2019** in MMBtu/total output

 5. Aggregate energy intensity for the corresponding period in 2018 in MMBtu/total output

 6. Change in energy intensity (#4-#5)

 7. Aggregate energy intensity for the corresponding period in an earlier year*** in MMBtu/total output

 8. Change in energy intensity (#4 - #7)

    *Plant type refers to the primary process used or product produced by the plant, e.g. auto assembly, metal casting; cement; etc.     **Calculate using 12 months of continuous data. Due to the deadline for this application, it is acceptable to complete the 12-month period using data from the final two months in 2018, e.g. the data period could be from November 2018 through October 2019.     ***Selection of the specific year is at your discretion. If 2019 represents the first year for which energy was tracked, please enter "not available" in rows 7 and 8.

    Lines 7 and 8 in the table are requested to enable a view of your energy program's long-term energy savings. To further illustrate these long-term savings, you may provide equivalent dollars saved along with carbon dioxide emissions prevented for the equivalent period.

    You may provide a summary report from your corporate tracking system that includes this information. In addition to the information above, if ENERGY STAR has provided your industry with a plant Energy     Performance Indicator (EPI), please provide ratings for each plant you have scored in the past year. If scores have improved over time for a plant, show that information as well. Additionally, provide results and accomplishments of plants taking the ENERGY STAR Challenge for Industry.

    It is helpful to EPA to understand changes in business activity that may have impacted energy use in the past 12-month period. Provide an explanation when appropriate. In addition, describe any efforts to normalize data, such as accounting for weather, climate differences, or other business effects.

    In your summary, please provide one or more equivalency statements for your energy savings by equating them to a metric related to your business or industry, or other financial or environmental metrics. Examples include:        oo           Number of socks that would have to be sold to equal the value of energy saved        oo           Number of cars that would have to be sold to equal the value of energy saved

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