Step Two:  Please complete Applicant, Project, and Financial Information - the person who has the authority to undertake this project and receive funds for it should complete this step.  In all circumstances, funding should be viewed by applicant as a reimbursement for work completed following grant approval. Project Information * Denotes Required Fields *Project Name: Project Address/Location (the location which will receive the benefits of this program): County: AlbanyAlleganyBroomeCattaraugusCayugaChautauquaChemungChenangoClintonColumbiaCortlandDelawareDutchessErieEssexFranklinFultonGeneseeGreeneHamiltonHerkimerJeffersonLewisLivingstonMadisonMonroeMontgomeryNassauNiagaraOneidaOnondagaOntarioOrangeOrleansOswegoOtsegoPutnamRensselaerRocklandSaratogaSchenectadySchoharieSchuylerSenecaSt LawrenceSteubenSuffolkSullivanTiogaTompkinsUlsterWarrenWashingtonWayneWestchesterWyomingYates Are you planning to redevelop, improve, or market: a site a building, or a site and building a commercial corridor other(specify): Does National Grid service the project's location? electric natural gas both No (Only projects located in the National Grid Electric and/or Gas Service Territory are eligible.)  National Grid account number (if any): N/A Does applicant have primary responsibility for paying the natural gas and electricity bills for project? Yes No If No, who has primary responsibility of the bills for the project?   Will this investment improve energy efficiency? Yes No     If so, when? (year)   Will this project stop a facility from closing or relocating outside of the National Grid service territory? Yes No (If Yes, please include explanation in project description) *Estimated project start date (mm/dd/yyyy)? *Estimated project completion date (mm/dd/yyyy)? Financial Information: What is the total cost of this project? $ * What is the amount of funding you are requesting from this (NG) program? $ > Complete the following Project Budget with as much detail as is currently available below. Attach commitment letters or letters of intent from each source of financing indicated (other than NG).   Sources   Use of Funds $ Total Applicant NG Other Commitments Yes Pending Yes Pending Yes Pending Yes Pending Yes Pending Yes Pending Either provide as an attachment to your application a detailed budget breakdown by major item or fill out the form below.     Please make sure the detail you provide identifies each component and cost for the project.     Construction Related (including electric & gas infrastructure):     Use (e.g. demolition) Budget $     $ $ $ $ $ Research or Productivity Related (identify contractor & major study components & costs):     Use Budget $     $ $ $ $ $     Marketing (identify specific activities, materials & costs associated with the project):     Use Budget $     $ $ $ $ $     Other (be specific):     Use Budget $     $ $ $ $ $ Project Description: Please input a detailed description about your project into the Text box below. Applicants for the Marketing Programs (Section A) must help us to understand how this project will enhance the competitiveness of your community and geographic region.  Please include details about the nature of the project, how the project complements other regional marketing efforts, the target markets you wish to reach, any research needed to accomplish the goals and why the research is needed and the results that you expect to achieve. Applicants for the Capital Investment, Site Development & Revitalization & Urban Development Programs (Section B) should provide a clear description of the project. The description should include: the project goals and how they will be achieved, the project budget, jobs created and/or retained, capital investment and/or improved productivity, and explanation and how they will be achieved, and any other unusual characteristics that will help us evaluate the project. For Building Ready include all information bout the "building", site, real estate market and targeted industry. Applicants for Energy Efficiency & Productivity Programs (Section C) should provide a clear description of the project including specific installations or upgrades and/or modifications. Applicants for Pricing Programs (Section D) should describe the competitive situation of your facility and current energy price arrangements with National Grid. Please include any immediate growth opportunity or retention challenge that you are facing. Project Description: (Attach description if necessary) SECTION A, Marketing Programs: This section should be completed by only those applicants who are applying for: Strategic Economic Development Outreach Cooperative Business Recruitment   * Denotes Required Fields If your project is a marketing or sales initiative what targets have you identified and how? How will you deliver your marketing plan? (Check all that apply) Direct Mail Trade Shows Sales Calls Advertising Web based marketing  Public Relations Other Does your project require research in order to focus on the appropriate target industries and geographical areas? Yes No If yes, does the research duplicate previous studies on your topic for your geographic area? Yes No When were the studies completed? (year) Is your project targeted to decision-makers who can influence the attraction of new jobs and investment to the National Grid service territory? Yes No  (If Yes specify) Does your effort complement sales and/or marketing efforts that impact your regional geographic area? Yes No If so, how does it complement those other efforts? What will the measurable results of your project be? *What total amount of capital investment will be created by this project? $ *Estimated Project start date (MM/DD/YYYY)? *Estimated Project completion Date (MM/DD/YYYY)? (Provide measurable results and briefly explain below)   Responses   (#)   Leads   (#)   Prospect visits/meeting    (#)   Closed deals   (#)   *Jobs   (#) Explain If funding from National Grid is awarded and proposed project is implemented a final report detailing the measurable results will be required before funds are dispersed. SECTION B - Electric Capital Investment, Natural Gas Capital Investment, Site Development, Revitalizationn & Urban Development and Sustainable Gas and Economic Development Programs: This section should be completed by only those applicants who are applying for: Industrial Building Redevelopment ShovelReady Incentive Urban Center/Commercial CleanTech Incubation  Brownfield Redevelopment Electric Capital Investment Incentive 3-Phase Power Natural Gas Capital Investment Incentive Main Street Revitalization Building Ready Urban Center/Commercial Sustainable Gas and Economic Development * Denotes Required Fields If existing, what is the project facility's National Grid Electric Service Classification? (This information is included on the facility's National Grid bill.) SC2 SC3 SC3A SC12 or Other Natural Gas Service (if applicable) What will the project's average monthly electric demand (kW) ? What will it be after the project(kW)?   When will this occur? Are you currently Served under – or expected by National Grid to be served under – one of the following Natural Gas Service Classifications. If so, please select which one.; (This information is included on the facility's National Grid bill.) SC3 SC5 SC6 SC7 SC8 SC9 or Other Is the existing natural gas or electric infrastructure a barrier to completing your project? Yes No Please explain What will the measurable results of your project be? *What total amount of capital investment will be created by this project? $ *Estimated project start date (MM/DD/YYYY)   *Estimated project completion date (MM/DD/YYYY)    *How many jobs will be created because of this project?   By end of year 1 Year 3  Year 5 How many jobs will be retained because of this project? (#)   N/A Do you have a cost estimate for the infrastructure enhancement? Yes No Which of the following manufacturing or commercial purposes as classified by the North American Industry Classification System describes this project? (You may determine your NAICS classification by checking: http://www.census.gov/epcd/www/naics.html) Manufacturing (NAICS Codes 31, 32, or 33) Wholesale Trade (NAICS Code 42) Regional Warehousing or storage (NAICS Code 493) Agri-Business (NAICS Codes 111, 112, 113) Professional, Scientific or Technical Services (NAICS Code 541) Administrative or Support Services (NAICS 561) Other (please identify) What size is the project? (How many acres is the site; how many square feet is the building)? Is the site, building or project area currently vacant or underutilized? Yes No if underutilized, what portion of the project is occupied and by whom?   Is the site, building or project area (please check all that apply): a government designated Brownfield? a NYS designated RebuildNY Site? a NYS designated BuildNowNY site? in a NYS designated Empire Zone? a NYS designated ShovelReady site? in a federal designated Empowerment or Enterprise Zone? located in a HD designated Entitlement Community? Does the site or building have: Natural gas Electric Water Sewer Telecom? Has your project been through the SEQRA Process?  Yes No Has it received a negative declaration?  Yes No  If no, describe where you are in the process. Will the project be fully occupied when completed? Yes No If no, do you plan to market your completed project to potential out-of-state tenants or owners? Yes No Do you have a written marketing plan? Yes No What is your primary target market? How will you deliver your marketing plan? (Please check all that apply.) Direct Mail Trade Shows Sales Calls Advertising Web based Marketing Public Relations or Other Mainstreet Revitalization Program applicants only What Type of project? Development of a second story or mixed use planning strategy. Research, marketing, architectural, engineering work that advances a construction project. Site preparation and construction of commercial and industrial re-use projects Renovation and rehabilitation of commercial, industrial or mixed-use buildings under       100,000  square feet. SECTION C, Renewable Energy, Energy Efficiency Productivity Programs: This section should be completed by only those applicants who are applying for: Energy Efficiency in the Empire Zones Agribusiness Productivity Renewable Energy and Economic Development Manufacturing Productivity Power Quality Enhancement    What is the customer's National Grid electric service classification? (This information is included on the facility's National Grid bill.) SC2 SC3 SC3A SC12 Other   If you are a SC12 Business Expansion Customer, when does your contract expire? What is the project's average monthly electric demand (kW)? Is the existing natural gas or electric infrastructure a barrier to completing your project? Yes No Please Explain What size is the project? (How many acres is the site; how many square feet is the building?) Is the site or building (please check all that apply): a government designated Brownfield? a NYS designated BuildNowNY site? a NYS designated RebuildNY Site? a NYS designated ShovelReady site? in a NYS designated Empire Zone? in a federal designated Empowerment or Enterprise Zone? Does the site or building have: Natural gas Electric Water Sewer Telecom? What will be the measurable results of your project be: What total amount of capital investment will be created by this project? How many jobs will be created because of this project?  or How many new jobs result from this project? Total_________     By end of Year 1______     Year 3_______    Year 5______ How many jobs will be retained because of this project?   NA kWH savings    kW savings   Estimated $ savings annually Please Explain For Manufacturing Productivity Program applicants: What is the applicant's primary NACIS code?  __________ What is the applicant's secondary NACIS code?  _________ Grant amount (check all that apply)   Up to $15,000 or 40% (whichever is less) of the costs of a "lean manufacturing" or manufacturing assistance projects     Up to $15,000 or 50% (whichever is less) of the costs incurred by eligible applicants whose top management commits the time and resources to growth-targeted activities that will result in greater utilization of manufacturing capacity.    up to $40,000 or 60% (whichever is less) of the costs incurred by eligible applicants whose top management commits the time and resources to projects that combine and coordinate the productivity and growth activities described above. Expected estimated measurable results (check all that apply): From lean manufacturing project (or comparable): Cost savings of  $________ per year New annual revenue $____________  Retained annual revenue $____________ Jobs retained   _______  Jobs created _______ Capital investment $____________ From growth activities:  Increase in sales _______%  New annual revenue $____________ Retained annual revenue $____________ New product development (describe)_____________________________________________________________ ___________________________________________________________________________________________ New Customers (describe)_____________________________________________________________________ ___________________________________________________________________________________________ Renewable Energy and Economic Development Program applicants only Applicant and collaborators must answer all questions below and supply all information requested below Regional economic development organization, Municipality, 501(c)3, 501(c)6, or 501(c)4 Corporation (if different from the applicant): Name:__________________________________________________________________________________________________ Address:_______________________________________________________________________________________________ Contact Person:________________________________________________________________________________________ Title:_________________________________________________________________________________________________ Telephone:_____________________________________________________________________________________________ Email Address:_________________________________________________________________________________________ Describe how the proposed project accomplishes the following: - Creates an asset that will enhance regional business attraction efforts; - Serves as a learning center for renewable energy research, development and technology transfer; and - Helps to address long-term workforce development goals and issues in the "green" energy sector. _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Attach description if the above space is not adequate. Generation developer (if different from the applicant): Name:__________________________________________________________________________________________________ Address:_______________________________________________________________________________________________ Contact Person:________________________________________________________________________________________ Title:_________________________________________________________________________________________________ Telephone:_____________________________________________________________________________________________ Email Address:_________________________________________________________________________________________ Generation Location (if different from above) ________________________________________________________ Type of renewable generation technology proposed (check all that apply): Solar Photovoltaic Geothermal Biomass Anaerobic digestion Other (describe) ________________________ Estimated date that proposed generation will be connected to the grid: ________________________ Has funding, equal to, or greater than four times the National Grid grant been secured? Yes No Attach commitments for matching funds secured to meet eligibility requirements. Regional research institution or university/college (if different from the applicant): Name:__________________________________________________________________________________________________ Address:_______________________________________________________________________________________________ Contact Person:________________________________________________________________________________________ Title:_________________________________________________________________________________________________ Telephone:_____________________________________________________________________________________________ Email Address:_________________________________________________________________________________________ Describe involvement of regional research institution or university/college in the proposed project: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Attach description if the above space is not adequate. Is there a Memorandum of Understanding (MOU) between the regional research institution or university/college, the project developer and the 501(c)3, 501(c)6, or 501(c)4 corporation, municipality or regional economic development organization that describes the collaboration on the project and relationship between the entities involved? Yes No Attach memorandum of understanding. SECTION D, Pricing Programs: This section should be completed by only those applicants who are applying for: Small Business Growth (Demand Charge Reduction) Targeted Financial Assistance   * Denotes Required Fields What is the customer National Grid service classification? (This information is included on the facility's National Grid bill.) SC2    SC3    SC3A    SC12     Other (please identify):   If you are a SC12 Business Expansion Customer, when does your contract expire (mm/dd/yyyy)?        What is the project's average monthly electric demand (kW)? Is the existing natural gas or electric infrastructure a barrier to completing your project? Yes No Please Explain Which of the following manufacturing or commercial purposes as classified by the North American Industry Classification system describes this project?  (you may location a NAICS classification by checking: http://www.census.gov.epcd/www/naics.html: Manufacturing (NAICS Codes 31, 32, or 33) Wholesale Trade (NAICS Code 42) Regional Warehousing or storage (NAICS Code 493) Professional, Scientific or Technical Services (NAICS Code 541) Administrative or Support Services (NAICS 561) Other (please identify) What size is the project? (How many acres is the site; how many square feet is the building?): Does the site or building have: Natural gas Electric Water Sewer Telecom What will be the measurable results of your project? *What total amount of capital investment will be created by this project? $ *How many jobs will be created because of this project?   By end of year 1 Year 3  Year 5 How many jobs will be retained because of this project?   NA Please Explain STEP FIVE: Signatures, Attestments and Disclaimers: Please read the disclaimers carefully and sign the application. Disclaimers 1) National Grid has the sole responsibility for selecting grant recipients. 2) National Grid retains the right to conduct pre-installation and post-installation site visits. 3) National Grid makes no warranty, guarantee, or representation, express or implied, with regard to any economic benefits, energy savings, or improved energy quality resulting from use of Program grants. While the Programs are intended to provide benefits to recipients, the recipient understands and agrees that National Grid is not liable for any losses resulting from the recipient's participation in the Programs or from the Programs' failures to result in benefits to recipients. 4) In the event the grant recipient utilizes a contractor to accomplish the project goals, National Grid makes no warranty, guarantee, or representation, express or implied, with regard to any materials or workmanship provided by any contractors engaged by the recipients or the reasonableness of the prices charged by them. The recipient understands and agrees that the contractor alone is responsible for the work, and not National Grid. National Grid assumes no liability or responsibility for any damages or claims resulting from your use of any contractor. 5) The information contained in this application, the required attachments and any site visit made by an authorized National Grid employee will be used to evaluate your project. An incomplete application will be disqualified. 6) Funds granted through this program may only be used by the applicant for the use stated and approved. National Grid reserves the right to withhold funding if the substance of the project changes or the requirements of the program are not met. 7) All Economic Development Programs will be administered in accordance with the applicable tariffs as specified in PSC No. 207, Rule 34 and Service Classification No. 12. 8) All materials become the property of National Grid and will not be returned. National Grid reserves the right to use any submitted material for marketing the Economic Development Program. 9) Program assistance is only available to customers who are current in payments with National Grid or have executed a deferred payment agreement. Attestments and Signatures APPLICANT: I certify that all statements made in this application, including all attachments, are correct to the best of my knowledge and that I have reviewed and agree to the terms stated on this form, including those provisions regarding warranties and liabilities. Signed by Applicant: ______________________________________________________________________________________ Signature Printed Name_____________________________________________________________________________________ Title: ______________________________________________, Date: ______________________________________________ For Manufacturing Productivity Program only: Signed by Co-Applicant (RTDC): _____________________________________________________________________________ Signature Printed Name_____________________________________________________________________________________ Title: ______________________________________________, Date: ______________________________________________   THE FOLLOWING DOCUMENTATION IS REQUIRED DEPENDING ON WHICH PROGRAM YOU ARE APPLYING FOR SECTION A, Marketing Programs: Strategic Economic Development Outreach Completed and Signed Application Completed, signed and dated W-9 Form Marketing Plan Project Budget Commitment letters or documentation of secured funding Final or draft collateral material Cooperative Business Recruitment Completed and Signed Application Completed, signed and dated W-9 Form Marketing Plan Project Budget Commitment letters or documentation of secured funding (including applicants) Final or draft collateral material   SECTION B, Electric Capital Investment, Natural Gas Capital Investment, CleanTech Incubation, Site Development, Revitalization & Urban Development and Sustainable Gas and Economic Development Programs: Industrial Building Redevelopment Completed and Signed Application including IDA sponsorship signature Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Marketing Plan, if you have one ShovelReady Incentive Completed and Signed Application Completed, signed and dated W-9 Form Shovel-Ready site application questionnaire and designation letter issued by the New York State BuildNowNY program or certification from NYS as a "shovelready" site Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Marketing Plan Electric Capital Investment Incentive Completed and Signed Application Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Documentation from the NYS Empire State Development Corporation or a local development agency indicating your efforts to obtain state and local Economic Development incentives for the project and their disposition of your request Letter of endorsement from industrial development agency or other public development agency Natural Gas Capital Investment Incentive Completed and Signed Application Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Documentation from the NYS Empire State Development Corporation or a local development agency indicating your efforts to obtain state and local Economic Development incentives for the project and their disposition of your request Letter of endorsement from industrial development agency or other public development agency CleanTech Incubation Completed and signed application (print this signature page, sign and date it and upload it to your application) Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Business Attraction/Marketing Plan, if available 3-Phase Power Incentive Completed application Completed, signed and dated W-9 Form Brief project description Commitment letters or documentation of secured funding (including applicants) Business Case that demonstrates the economic development value of extending 3-phase power and details your exploration of alternatives to 3-phase power. The value of extending 3-phase may be shown in such indicators as new or retained jobs, increased capital investment, improved product output. Your discussion of the alternatives to 3-phase power you have explored would summarize the other energy options you have considered (such as on-site generation, written-pole motors) AND why you have rejected each Detailed cost estimate for 3-phase power extension If you are implementing an alternative to 3-phase power, please attach your Statement of Work Agreement from NYSERDA Brownfield Redevelopment Completed and signed application Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Business Attraction/Marketing Plan, if available Building Ready Upstate Completed and Signed Application Completed, signed and dated W-9 Form Marketing Plan Project Budget Preliminary or final site-building plan and documentation to show approval from local municipality and/or planning board Letter of support from local IDA or LDC Mainstreet Revitalization Program Completed and signed application Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Business Attraction/Marketing Plan, if available Letter of support/endorsement from the host Municipality Urban Center/Commercial District Revitalization Completed and signed application Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Letter of support from the Municipality, IDA or a local development corporation indicating your efforts to obtain state and local Economic Development incentives for the project and their disposition of your request Business Attraction/Marketing Plan, if available If owner or developer obtains letter of endorsement from industrial development agency or other public development agency. Sustainable Gas and Economic Development Completed and signed application Completed, signed and dated W-9 Form Project Prospectus / Detailed Project Description Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements. Commitment letters or documentation of secured funding (including applicants) Letter of support from the Municipality, IDA or a local development corporation indicating your efforts to obtain state and local Economic Development incentives for the project and their disposition of your request Business Attraction/Marketing Plan, if available If owner or developer obtains letter of endorsement from industrial development agency or other public development agency. SECTION C, Energy Efficiency and Productivity Programs: Manufacturing Productivity Program      1.  Completed and Signed Application      2.  Completed, signed and dated W-9 Form      3.  Detailed project description      4.  Project cost estimates      5.  Contract with Regional Technology Development Center (RTDC)      6.  Commitment letters or documentation of secured funding   Energy Efficiency in the Empire Zones Completed and Signed Application Completed, signed and dated W-9 Form Copy of your New York State Empire Zone Certification Detailed project description Project cost estimates Commitment letters or documentation of secured funding (including applicants)  Power Quality Enhancement      1.  Completed and Signed Application      2.  Copy of applicant's Federal Tax ID Certificate      3.  Detailed project description      4.  Project cost estimates      5.  Commitment letters or documentation of secured funding (including applicants)      Agribusiness Productivity Completed and signed application Completed, signed and dated W-9 Form Energy efficiency incentive commitment from a utility, state or federal agency program, dated after October 31, 2002 Cost estimates for total project, including Sources and Uses of Funding Commitment letters or documentation of secured funding for the project, including applicant's equity      Renewable Energy and Economic Development Completed and signed application Completed, signed and dated W-9 Form Detailed project description Cost estimates for total project including sources & uses of funding and any letters of funding commitments Memorandum of Understanding (MOU) between regional research institution of university/college, the project developer and the 501(c)3, 501(c)6 or 501(c)4 corporation, municipality or regional economic development organization that describes the collaboration on the project and relationship between the entities   SECTION D, Pricing Programs: Small Business Growth (Demand Charge Reduction) Completed and signed application Completed, signed and dated W-9 Form Copy of your prior month's National Grid bill Targeted Financial Assistance Completed and signed application Completed, signed and dated W-9 Form If you are demonstrating imminent facility closure or facility relocation from National Grid's service territory, you must attach your audited balance sheets, income statements and source/uses of funds for the last 3 years. If you are considering a relocation from NG service territory to an area outside of NG service territory, you must identify the relocation sites you are considering Documentation of the number of jobs you will be attracting or retaining Supporting letters from state and/or local development agencies detailing the benefits you are receiving from each