United States
Environmental Protection
Agency
OMB Control Number 2060-0578
Partnership Agreement Elf
oEPA
jGREEN
V POWER
' PARTNERSHIP
T
he EPA Green Power Partnership encourages the voluntary use of green power to reduce the
risk of climate change. Partners benefit from the use of green power, while supporting the
development of new, renewable energy in the United States.
By joining EPA's Green Power Partnership,
Partners commit to:
• Use green power that meets or exceeds Partnership
requirements.
• Report on green power use annually.
• Use the Green Power Partner mark in a manner that is consis-
tent with Partner mark use guidelines, available at www.epa.
qov/qreenpower/documents/qpp quidedoc mark.pdf.
In return, EPA commits to:
• Provide public recognition.
• Provide procurement and communications assistance, as re-
quested by Partner.
• Provide a brief description of the Partner's green power commit-
ment on the Green Power Partnership Web site.
General Terms:
• Either party can terminate this agreement at any time without
prior notification or penalties and with no further obligation. EPA
will not comment publicly regarding the withdrawal of Partners.
• Partner agrees that the activities it undertakes connected with
this voluntary agreement are not intended to provide services
to the federal government and that the Partner will not seek
compensation from a federal agency.
• Partner agrees that it will not claim or imply that its participa-
tion in the Green Power Partnership constitutes EPA approval or
endorsement of anything other than its participation in the pro-
gram and will not make statements or imply that EPA endorses
the purchase or sale of the Partner's products and services or
the views of the Partner organization.
• EPA may post information about the Partner's green power use
publicly.
• EPA may periodically revise program benchmark levels or other
eligibility requirements.
Key Green Power Partnership Requirements
Your Organization's Baseload
If your annual electricity use is...
> 100,000,001 kWh
10,000,001 -100,000,000 kWh
1,000,001 -10,000,000 kWh
< 1,000,000 kWh
Green Power Partner
Requirements
You must, at a minimum, use this much
green power
3% of your use
5% of your use
10% of your use
20% of your use
Green Power Leadership Club
Requirements
You must, at a minimum, use this much
green power for your entire organization
30% of your use
50% of your use
100% of your use
Not Applicable
Eligible green power includes electricity generated from solar, wind,
geothermal, biogas, and certain forms of biomass and hydropower.
Green power must be sourced from eligible U.S.-based generation
facilities.
Requirement can be met with any combination of green power
products (i.e., utility product, RECs, or on-site generation).
Partner purchases must be voluntary and incremental to the
renewable electricity included in the standard electricity service.
Requirements must be entirely met with power from "new"
renewable facilities (i.e., installed within the last 15 years).
Partners may join organization-wide (U.S. operations only), at
the facility-level, or a logical aggregation of facilities less than
organization-wide.
More details are available in the Partnership Requirements Document, http://www.epa.gov/qreenpower/documents/qpp partnership reqs.pdf
PLEASE FAX PAGE 2 OF PARTNERSHIP AGREEMENT TO (617) 371-3979 (contractor in support of EPA)
OR E-MAIL TO critchfield.james@epa.gov (must be signed and scanned).
-------
Authorizing Official:
On behalf of F
, the undersigned understands and agrees to the terms of the Partnership.
(Name of organization or entity)
Signature:.
Print Name:
Title:
Date:
Primary Contact:
Public Relations Contact (optional):
Name:
Title: f
Name:
Title: f
Address: |
City:r
State:
Zip:[
Address: [
City:F
State:! Zip:
Phone:
E-mail (required):
Phone:
E-mail:
Electricity and Green Power Information
Reporting Period: The electricity and green power information listed below covers the following 12-month period.
Reporting Period Start Date \^_ Reporting Period End Date \_
Annual electricity use of participating entity: ]J kWh / year
Purchased Green Power
Green power purchase: ]] kWh /year
Contract details
Start date: End date (if applicable):
Green power resource mix
_|% biogas % biomass % geothermal
| | % small hydro J% solar J%wind
Product certification (third party):
Q Green-e Q Not certified Q Other
If other, by whom?
Name of green power providers):
Green power product name(s):
On-site Use of Green Power
Green power generation: f" kWh /year*
Resource type: Q biogas Q biomass Q geothermal
Q small hydro Q solar Q wind
Was the on-site unit installed in the last 15 years? Q Yes Q No
Installed capacity: kW
Location of on-site generation (ZIP code):|_
Installation ownership: Q self Q other
If other, by whom?
* EPA will only count as green power kWh generated from on-site instal-
lations for which the participating entity owns the rights to the renew-
able energy credits (RECs).
Motivating factors behind your green power use (optional) (check an that apply)
Q Brand or product differentiation Q EPA recognition Q Reduce carbon footprint
Q Cost stability or savings Q LEED certification Q Support economic development & job creation
Q Demonstrate environmental leadership Q Meet sustainability goals Q Support renewable energy development
Q Other Q
The government estimates the average time needed to fill out this form is 1.96 hours and welcomes suggestions for reducing this level of effort. Send comments
(referencing OMB control number) to the Director, Collection Strategies Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.
PLEASE FAX PAGE 2 OF PARTNERSHIP AGREEMENT TO (617) 371-3979 (contractor in support of EPA) OR
E-MAIL TO critchfield.james@epa.gov (must be signed and scanned).
United States
Environmental Protection
Agency
EPA-430-K-05-013
www.epa.gov/qreenpower
February 2014
------- |