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 Molly Kiick at HeatRecovery@nyserda.ny.gov or call (518) 862-1090, ext. 3232.
* Required field
Who is the Applicant? Program funds will be distributed to the Applicant
Select the category you are applying for:
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
Annual Electricity Cost ($)
Annual Natural Gas Costs ($)
Annual Fuel Costs ($)
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.
I certify that:
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 participant, agree and authorize the sharing of the participant-customer’s information and/or projectlevel 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