For administration use / Application number / Date received

The Resource Efficient Scotland

Convenience Store Resource Efficiency Grant

(5RE003-000)

Resource Efficient Scotland

A programme managed on behalf of the Scottish Government by:

Zero Waste Scotland

Ground Floor, Moray House, Forthside Way, Stirling, FK8 1QZ

In partnership with The Scottish Grocers Federation

1.Contact Information

Contact name:
Name of business requesting funding:
Statusof business/organisation (partnership, limited company, social enterprise etc.):
Please tick here to confirm that you are a food and drink retail store with a sales area under 3,000 sq. foot (or 280 sq. metres)
No. of Employees:
Annual Turnover (£)
Address of convenience store (including postcode):
Telephone number:
Email address:
Company Registered Address (if different from above):
Company Registration Number:
VAT Registration Number:
No. of Years Trading:

2.Project Timeframe

Please set out the key stages of project delivery in the table below and indicate when you require financial support from Resource Efficient Scotland. Please note that installations need to be complete by the 1stMarch 2016 in order to comply for phase 1 funding. Phase 2 funding may become available in the new financial year, subject to review.

Proposed Start Date
Proposed End Date
Any additional details if required

3.Project Details

Project Description
Please provide detail of the project you wish to undertake, listing the eligible technologies that you intend to install. Please note that refrigeration equipment needs to appear on the Energy Technology List and LED bulbs should be certified under the CE and RoHS mark.

4.Environmental Impact

Using your free Resource Efficiency Audit (which is a pre-requisite to receiving this grant support), please provide a breakdown of the energy savings that will be achieved via your intended project.[1]

Technology (LED lighting, heat recovery unit etc.) / Cost saving per annum (£) / CO2 saving per annum (tonnes) / Energy saving per annum (kWh)
1.
2.
3.
4.
5.
Summary of existing resource efficiency commitments made by the company
Please provide a brief summary of the efforts your organisation has already made to improve its resource efficiency (for example, roof insulation, staff awareness training, double glazed windows etc.)

5.Project Costs

Please use this section to outline project costs, the amount of funding required from the Resource Efficient Scotland programme, and the amount of funding being provided by other sources. Please note that Zero Waste Scotland will NOT pay the VAT element of any costs, this should be claimed back from HMRC with your standard return.

Summary of Project Costs
Please outline the funding you require from the Resource Efficient Scotland programme and itemise what it will be used for. Please note that installations should be complete by the 1st March 2016. Please remember to attach a copy of the quote for the intended works as an appendix to this application. Please show the net, VAT and total amounts as ZWS will not pay for the VAT.
Summary of Co-funds
Please state how you are going to co-fund the balance of the project costs, for example by a loan, internal reserves, etc. Please note that you cannot co-fund your project by utilising any financial mechanisms that would put your de minimis limit above the ceiling of 200,000 euros over the current and previous two fiscal years.

6.State Aid

State Aid De Minimis Declaration

You are being considered for support under the De Minimis Regulation (Commission Regulation 1407/2013). This may allow single undertaking[2] to receive up to €200,000 (cash grant equivalent) of state aid over a 3-yearfiscal period. The sterling equivalent is calculated using theCommission exchange rate applicable on the written date ofoffer of the de minimis funding.

To establish whether you are eligible to receive de minimis aid you must declare the full amount of de minimis aid which you have already been granted during the previous two fiscal years of your organisation and the current fiscal year. Potentially any assistance you may have received from a public body might be a de minimis aid. This could be from central, regional, devolved governments or agencies or a local council.

The following is not a comprehensive list of all possible forms of aid. However, it should give you an indication of common forms of aid

Forms of possible aid:

• State grants;

• interest rate relief;

• tax relief;

• tax credits;

• State guarantees or holdings;

• State provision of goods or services on preferential terms;

• direct subsidies;

• tax exemptions;

• preferential interest rates;

• guarantees of loans on especially favourable terms;

• acquisition of land or buildings either gratuitously or on favourable terms;

• provision of goods and services on preferential terms;

• indemnities against operating losses;

• reimbursement of costs in the event of success;

• State guarantees, whether direct or indirect, to credit operations preferential re-discount rates;

• dividend guarantees;

• preferential public ordering;

• reduction of, or exemption from, charges or taxes, including accelerated depreciation and the reduction of social contributions;

• deferred collection of fiscal or social contributions;

• assistance financed by special levies;

Please note, there are current restrictions for de minimis support for following sectors/activities which are subject to special procedures and require permission of the relevant department of the Scottish Government:

-Fisheries

-Transport Sector

-Import/Exporting activities.

-Agriculture, other than marketing of processed products

You should have received a letter informing you if you were given assistance under the de minimis regulation. If you are not sure whether or not any public assistance you have received is de minimis aid, please contact the body which granted the assistance to clarify this and then provide information about all forms of public assistance you have received in the in the last three fiscal years (or pending) within the table below, and read and sign the de minimis declaration. Please attach a separate sheet if necessary. If you have not received de minimis aid previously please state £0.

Source of public funding / De minimis? (Yes / No) / Date received
(or applied for if pending) / Amount received/pending (£)
Total

Declaration

I understand that my application for support from Zero Waste Scotland is governed by the European Community rules on State Aid, and is being considered under De Minimis Aid and that, therefore, my application must satisfy the conditions of the De Minimis rule. I further understand that aid that exceeds the De Minimis rule is illegal aid, which I may be required to repay. I confirm that I have detailed above the total amount of all forms of aid received by us in the past 3 fiscal years, or currently pending, and I acknowledge that Zero Waste Scotland may use this information to make its own determination as to whether or not my application meets the conditions of the De Minimis rule.

Please sign the de minimis declaration (for and on behalf of your organisation). If you have not received the any previous De Minimis funding please still sign below to declare this. The signatory must be an officer of the company with the authority to bind the organisation in legal agreements.

______

I declare that the information in this application is complete and accurate:

Organisation: ………………………………………………………………………………………

Signature of Responsible Person: ……………………………………………………………………

Name:…………………………………………………………………………………….

Date: ……………………………………………………………………………………

7.Application checklist

Please use the checklist below to ensure you have completed all necessary documentation and to list any additional documents you are submitting in support of your application.

Documents / y/n
1 / Completed and signed application form
2 / Copy of Resource Efficiency Audit
3 / Copy of quote for the intended works
4 / Statement of any material litigation either pending or threatened, or any other legal proceedings against the Company

8.Application declaration

By submitting this document you are:

  • Applying for funding from the Resource Efficient ScotlandSmall Grocers Energy Efficiency Grant.
  • Confirming that to the best of your knowledge all information given in this form and associated documents is correct and accurate at the time of submission.
  • Confirming that the De Minimis Declaration in Section 6 is correct.

Signed (applicant) / Print Name
Date / Position

Please note that you must insert the signature of an authorised member of your organisation or your applicant will be deemed non-compliant.

This form and the accompanying documents should be submitted by email to Lynda Stephens, . Note that installations should be installed before the 1stMarch 2016 in order to comply with phase 1 funding deadlines. It is recommended that applications are submitted at least 6 weeks prior to this deadline, to allow sufficient time for the installation of measures. Phase 2 funding may become available in the new financial year, subject to review, but there is no guarantee of availability.

[1] To receive a free resource efficiency audit, phone 0808 808 2268 or visit

[2] "Single undertaking" includes, for the purposes of the Regulation, all enterprises having at least one of the following relationships with each other:

a) one enterprise has a majority of the shareholders' or members' voting rights in another enterprise;

b) one enterprise has the right to appoint or remove a majority of the members of the administrative, management or supervisory body of another enterprise;

c) one enterprise has the right to exercise a dominant influence on another enterprise pursuant to a contract entered into with that enterprise or to a provision in its memorandum or articles of association;

d) one enterprise which is a shareholder in or member of another enterprise, controls alone, pursuant to an agreement with other shareholders in or members of that enterprise, a majority of shareholders' or members' voting rights in that enterprise.