Provide comprehensive baseline information about the facility to establish accurate measurement and verification protocols for the proposed energy efficiency upgrade.
Property Name/Asset ID
Complete Facility Address
Primary Building Type
Office Building
Retail Center
Industrial Warehouse
Healthcare Facility
Educational Institution
Multi-Family Residential
Mixed-Use Development
Hotel/Hospitality
Data Center
Other
Building Age (years)
Total Gross Floor Area (square meters)
Net Occupiable Area (square meters)
Current Occupancy Rate (%)
Primary Facility Operating Hours
Does this facility operate 24/7 in any areas?
Specify 24/7 operational zones and critical systems:
Current Energy Systems Baseline - Provide details about existing equipment to be replaced or modified
Existing Lighting Systems (select all that apply)
Fluorescent T8/T12
Metal Halide
High-Pressure Sodium
Incandescent
Halogen
Early Generation LED (pre-2015)
Smart Lighting Controls
Daylight Harvesting
Occupancy Sensors
None - No Existing System
Existing HVAC Systems (select all that apply)
Central Chiller Plant
Packaged Rooftop Units
Split Systems
Variable Air Volume (VAV)
Constant Air Volume (CAV)
Boiler System
Heat Pump
Direct Digital Controls (DDC)
Pneumatic Controls
None - No Existing System
Existing Renewable Energy Systems
Solar PV Array
Solar Thermal
Wind Turbine
Geothermal Heat Pump
None
Historical Energy Consumption & Cost Baseline (Last 24 Months)
Billing Period End Date | Electricity Consumption (kWh) | Electricity Cost | Natural Gas Consumption (kWh equivalent) | Natural Gas Cost | Total Energy Cost | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | 1/31/2024 | 85000 | $12,750.00 | 25000 | $1,250.00 | $14,000.00 | |
2 | 2/29/2024 | 78000 | $11,700.00 | 28000 | $1,400.00 | $13,100.00 | |
3 | $0.00 | ||||||
4 | $0.00 | ||||||
5 | $0.00 | ||||||
6 | $0.00 | ||||||
7 | $0.00 | ||||||
8 | $0.00 | ||||||
9 | $0.00 | ||||||
10 | $0.00 |
Primary Utility Provider Contact Information & Rate Structure Details
Upload Facility Floor Plans & Single-Line Electrical Diagrams
Upload Photographs of Existing Equipment to be Replaced (minimum 5 images)
Detail the complete technical scope of the proposed energy efficiency upgrade, including equipment specifications, installation requirements, and integration with existing building systems.
Proposed Retrofit Type (select all that apply)
LED Lighting Retrofit
Smart HVAC Controls Upgrade
High-Efficiency HVAC Equipment
Building Management System (BMS) Implementation
Solar PV Installation
Energy Storage System
Building Envelope Improvements
Water Heating System Upgrade
Other
Total Number of LED Fixtures to be Installed
Describe Smart Controls Platform & Integration Protocol
Specify New HVAC Equipment Models & Efficiency Ratings
Proposed Solar PV System Capacity (kWp)
Detailed Equipment Specification & Cost Schedule
Equipment Description | Manufacturer & Model | Quantity | Unit Cost | Total Equipment Cost | Expected Lifespan (years) | Warranty Period (years) | ||
|---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | ||
1 | LED Panel 2x4ft | Acme Lighting AL-2000 | 200 | $85.00 | $17,000.00 | 15 | 7 | |
2 | Smart Thermostat | TechControls TC-5000 | 50 | $250.00 | $12,500.00 | 10 | 5 | |
3 | $0.00 | |||||||
4 | $0.00 | |||||||
5 | $0.00 | |||||||
6 | $0.00 | |||||||
7 | $0.00 | |||||||
8 | $0.00 | |||||||
9 | $0.00 | |||||||
10 | $0.00 |
Detailed Scope of Work & Installation Methodology
Will this project require building automation system integration?
Describe BAS Integration Requirements, Protocols, and Cybersecurity Measures
Primary Equipment Vendor/Contractor Company Name
Vendor Experience Rating (1-5 scale, where 5 is extensive relevant experience)
Upload Equipment Cut Sheets & Technical Specifications (PDF format)
Upload Vendor Quotes & Proposals (consolidated PDF)
Upload Proposed Equipment Layout & Installation Diagrams
Are there any known site constraints or accessibility challenges?
Describe constraints: roof load limits, ceiling height restrictions, electrical panel capacity, structural limitations, etc.
Provide comprehensive financial analysis demonstrating project viability through energy savings, cost reductions, and return on investment metrics. Include detailed calculations and conservative estimates.
Total Project Cost (Equipment + Installation + Soft Costs)
Detailed Cost Breakdown & Financial Analysis
Cost Category | Amount | Funding Source | Annual Savings Generated | Payback Period (years) | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Equipment Purchase | $250,000.00 | Capital Budget | $0.00 | 0 | |
2 | Installation Labor | $120,000.00 | Capital Budget | $0.00 | 0 | |
3 | Engineering & Design | $30,000.00 | Operational Budget | $0.00 | 0 | |
4 | Commissioning | $15,000.00 | Operational Budget | $0.00 | 0 | |
5 | Contingency (10%) | $35,000.00 | Capital Budget | $0.00 | 0 | |
6 | $0.00 | 0 | ||||
7 | $0.00 | 0 | ||||
8 | $0.00 | 0 | ||||
9 | $0.00 | 0 | ||||
10 | $0.00 | 0 |
Projected Annual Electricity Savings (kWh)
Projected Annual Cost Savings
Simple Payback Period (years)
Internal Rate of Return (IRR) %
Net Present Value (NPV) - 10 Year Horizon
Have you conducted a measurement & verification (M&V) plan compliant with IPMVP?
Upload M&V Plan Document
Describe your proposed M&V approach and methodology
Projected Annual CO2 Emissions Reduction (metric tonnes)
Sensitivity Analysis - Rate impact of variable changes on project viability
Very High Risk | High Risk | Moderate Risk | Low Risk | Very Low Risk | |
|---|---|---|---|---|---|
Energy Price Escalation Rate (+2%) | |||||
Equipment Performance Degradation | |||||
Extended Installation Timeline | |||||
Reduced Occupancy Rates |
Are utility rebates or incentive programs applicable?
Utility Incentive Schedule
Incentive Program Name | Expected Rebate Amount | Application Deadline | Rebate Status | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | LED Lighting Rebate | $25,000.00 | 6/30/2024 | Applied | |
2 | |||||
3 | |||||
4 | |||||
5 | |||||
6 | |||||
7 | |||||
8 | |||||
9 | |||||
10 |
Describe any alternative scenarios or options considered (e.g., smaller system, phased approach)
Outline comprehensive project execution timeline, installation phases, and strategies to minimize operational disruption to facility occupants and critical business functions.
Preferred Project Start Date
Expected Project Completion Date
Total Project Duration (working days)
Detailed Project Phasing & Milestone Schedule
Phase Name | Start Date | End Date | Key Activities & Deliverables | Requires After-Hours Work? | Affected Building Zones | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Pre-Construction & Mobilization | 7/1/2024 | 7/5/2024 | Site setup, safety planning, material delivery | Loading dock, storage areas | ||
2 | Zone 1 LED Installation | 7/8/2024 | 7/19/2024 | Fixture replacement, wiring, testing | Yes | Floors 1-5 office areas | |
3 | |||||||
4 | |||||||
5 | |||||||
6 | |||||||
7 | |||||||
8 | |||||||
9 | |||||||
10 |
Operational Disruption Impact Assessment (Rate severity 1-5, where 5 is maximum disruption)
Noise & Vibration | |
Dust & Air Quality | |
Access Restrictions | |
Power Interruptions | |
Network/IT Disruption | |
Parking Availability |
Will any areas require temporary shutdown or evacuation?
Specify shutdown duration, affected areas, and temporary relocation plan
Does the project require after-hours or weekend work?
Detail after-hours schedule, premium labor cost impact, and security arrangements
Safety & Risk Mitigation Measures (select all applicable)
Temporary barriers & signage
HVAC isolation for dust control
Fire watch during hot work
Elevator lockout procedures
Emergency egress maintenance
Background checks for contractors
Daily safety briefings
Real-time noise monitoring
Air quality monitoring
None of the above
Communication Plan for Building Occupants & Stakeholders
Are there any seasonal constraints or blackout periods?
Specify restricted periods and rationale (e.g., peak season, exams, holidays)
Contingency Plan for Unexpected Issues or Delays
Upload Construction Schedule Gantt Chart (PDF or image)
Complete all required approvals, risk assessments, and compliance verifications necessary for ESG Committee and Asset Manager authorization to proceed with project execution.
Has a preliminary risk assessment been completed?
Upload Risk Assessment Matrix & Mitigation Plan
Explain why risk assessment is pending and propose timeline
ESG Alignment & Strategic Fit Assessment
Poor | Fair | Good | Very Good | Excellent | |
|---|---|---|---|---|---|
Carbon Reduction Contribution | |||||
Alignment with Corporate Sustainability Goals | |||||
Stakeholder Value Creation | |||||
Regulatory Compliance Enhancement | |||||
Resilience & Adaptation Benefits |
Does this project comply with all relevant building codes and safety standards?
Identify specific compliance gaps and remediation plan
I confirm that all equipment specifications meet or exceed minimum efficiency standards
I verify that utility incentive applications have been submitted or will be submitted prior to procurement
I acknowledge that this project aligns with the facility's 5-year capital improvement plan
Facility Manager Name
Facility Manager Approval Date
Facility Manager Digital Signature
Asset Manager Name
Asset Manager Approval Date
Asset Manager Digital Signature
Does this project require ESG Committee review?
ESG Committee Chair Name
Has ESG Committee approval been granted?
ESG Committee Approval Date
Specify ESG Committee concerns and required actions
Final Approval Comments & Conditions
To configure an element, select it on the form.