Please complete the Application, and include a Scope of Work and Budget in the Uploads section below.
Please note: Partially completed information cannot be saved, be sure to have all details with you before beginning the form. Upon submission, you will receive a confirmation and a tracking number on your screen to print or save. Refer to this tracking number to check on the status of your request. For the best form completion experience, use the Google Chrome browser.
For full program details, eligibility, and templates for the Budget and Scope of Work visit https://portal.nyserda.ny.gov/CORE_Solicitation_Detail_Page?SolicitationId=a0r8z000000EJUm. If you have any questions, contact Lauren De La Fuente at HeatRecovery@nyserda.ny.gov or call (518) 862-1090, ext. 3588.
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Select the category you are applying for:
To be eligible for Category 4, the Applicant must be a qualified solution provider through RFQL 5217 – Heat Recovery Solutions.
Who is the Applicant? Program funds will be distributed to the Applicant
Check all that apply
Do not submit a Social Security Number to NYSERDA on this form. If, in accordance with the rules on IRS “Form W-9,” your Taxpayer Identification Number is a Social Security Number, please complete all other information on this form except for Employer Identification Number (EIN). Leave this field blank. Please submit a printed and signed copy of IRS Form W-9 to NYSERDA via mail, attention to Norma Johnston, Finance. Please include your auto-generated Application ID Number on the email and copies of any other submitted forms. The IRS Form W-9 can be found and printed here: https://www.irs.gov/pub/irs-pdf/fw9.pdf
Primary Contact
Accounts Receivable Contact Full Name
Please confirm the Project Total Budget, as included in the Attachment B Budget ($)
Please confirm the total requested NYSERDA Cost-Share, as included in the Attachment B Budget ($)
Select the facility's sector:
To be eligible for more than 75% cost-share, you must submit documentation to verify your multifamily building(s) as affordable housing using the Multifamily Affordability Verification Application. The form has an attestation that must be completed by the building owner. Please complete and submit this form once you submit your Heat Recovery application.
Are you requesting greater than 75% cost-share?
Facility Owner Full Name
Scope of Work
Budget
Heat Recovery Opportunity Documentation : Please upload documentation validating the opportunity for Heat Recovery at the site (e.g. completed FlexTech reports or feasibility studies, etc) as available.
The Applicant certifies that the information provided is true to the best of their knowledge. The Applicant understands that this application may not be approved if the requirements of the Program are not met. The Applicant understands that services through the Program are contingent on compliance with the Terms and Conditions in Attachment A of PON 5547.
I, the Applicant, authorize NYSERDA to add me to the mailing lists and to share my information with New York State government and other entities doing business on NYSERDA’s behalf. I reserve the right to unsubscribe at any time.
I certify that:
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
I am a U.S. citizen or other U.S. person (defined at the IRS webpage provided below).
For the full instructions, please see the IRS Instructions for the Requestor of Form W-9, found here: https://www.irs.gov/instructions/iw9/ar02.html
I understand that by signing below I, the Applicant, am certifying that:
I am authorized to commit my organization to the terms of this Application; and
I have read, understand, and agree to the Terms and Conditions in Attachment A – Sample Agreement
I, the building owner, authorize the New York State Energy Research and Development Authority (NYSERDA), and its designated representatives, to access energy billing and consumption data for the participating site(s). This authorization automatically terminates at the end of eight years following the execution date of the Purchase Order associated with this Application. I authorize NYSERDA, and its designated representatives, to access and utilize any and all energy consumption information and data. I understand that this information will be used to evaluate energy use patterns for the purpose of measuring energy performance and determining the potential and actual energy savings resulting from evaluated or implemented energy projects. Owners of participating site(s) agree to cooperate with activities designed to evaluate program effectiveness, such as responding to questionnaires and allowing on-site inspection and measurement of installed measures.
I, the customer, agree and authorize their utility’s sharing of the participant-customer’s information and/or project-level information with New York State Department of Public Service Staff and NYSERDA, including its agents or authorized representatives, consistent with NYSERDA’s New York State Public Service Commission and statutorily authorized responsibilities, including, but not limited to supporting market development initiatives, and other evaluation and measurement activities. (For clarity, the term project level includes the information based on the scope of the project, including, but not limited to, aggregated and anonymized whole building, building or subsets of the project.)
I, the participant, agree and authorize the sharing of the participant-customer’s information and/or project-level information with New York State Department of Public Service Staff and appropriate local utility, including its agents or authorized representatives, in carrying out its responsibilities under New York State Public Service Commission orders. (For clarity, the term project level includes the information based on the scope of the project, including, but not limited to, whole building, building or subsets of the project.) I understand that NYSERDA is subject to the NYS Freedom of Information Law, Public Officers law, Article 6, and that NYSERDA cannot guarantee confidentiality of any information submitted.
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Tracking Number