/ COMMUNITY ENERGY LEADERSHIP PROGRAM
CELP 2016/17 APPLICATION FORM

Community Energy Leadership Program

CELP – 2016/2017

Application Form

Steps:

  1. Read the Community Energy Leadership (CELP) 2016/17 Program Guide
  2. Complete the Application Form
  3. Gather all supporting documents
  4. Submit your CELP Application Package:

by5:00pm, Pacific Daylight Time, Tuesday December 15th,2015

Submit by Email to:

Leah Davies, Coordinator, Community Energy Programs
Communities and Transportation Branch
Ministry of Energy and Mines
Note - Electronic submissions in PDF format are preferred

In order to be eligible to apply for the 2016/17CELP funding, your local government or First Nation must first meet all mandatory criterianoted in the CELP 2016/17Program Guide (Section 3.2 of the Guide).

**To avoid unnecessary effort for both the applicant and the selection committee, please contact if there are any doubts around eligibility**

PLEASE READ THE CELP 2016/17PROGRAM GUIDE(Guide) before starting to complete this Application Form. It is particularly important for applicants to cross-reference the relevant components of the Form below with Guide Table 2(p.7)pertaining to CELP evaluation criteria and supporting documentation.
The Application Form must be completed in full and submitted with supporting documentation. Applicants should be aware that information collected is subject to the Freedom of Information and Protection of Privacy Act
If you require further assistance, please contact:
Leah Davies
Email: / For Administrative Use Only
  1. General Applicant Information

Legal Name of Applicant: (Local Government or First Nation only)
Primary Staff Contact Name:
Primary Council/Board Contact Name: / Title of Primary Staff Contact:
Title of Council/Board Contact:
Phone Number: / Email Address:
  1. Initial Screening – Mandatory Criteria

Please check to confirm that your application will meet all of the Mandatory Criteria below:
Only one application per community will be considered.
The completed project Application Form and supporting documentation are submitted by email to by 5:00pm, Pacific Daylight Time, Tuesday December 15th, 2015.
The proponent, the project and proposed costs are all eligible as defined in this Guide (see Section 2: Eligibility).
The proposed project must be explicitly linked to a community-wide or corporate energy, or capital budget plan.
The application confirms that the proponent community itself is covering a minimum of 5% of thetotal project costs, that no more than 33% of total project costsare being requested from the Program, and that the CELP portion will be applied 100% to the portion owned by theproponent.
The application clearly stipulates that all project fees and expenses must be incurred, and the project complete by March 31, 2017. Large predetermined projects may propose a phase that will be completed by March 31, 2017 as a project under CELP.
If approved by the Ministry, the project will be duly authorized by a Resolution of the appropriate Municipal Council, Regional District Board or First Nations Council, or it is clearly stated in the Application that this will take place before the execution of a Contribution Agreement.
The proposed project must not already have received funding through the Innovative Clean Energy Fund.
For local governments only: Local Government applicants are a signatory to the Climate Action Charter.

When completing the remainder of this application, please be sure to include information from any supporting documents by page references/sections. Failure to reference details by sections/page numbers may result in the reference material not being reviewed and may result in a reduced score.

  1. Project Relevance & Feasibility (40 points total)

Project Name:
AClean or Renewable Energy (generation) project , or
an Innovative Energy Efficiency project
1.1.Community Leadership – See Guide Table 2, Section 4.1.1 (pg. 7) for information to include in this section. In addition, please reference keys ‘excerpts’ (pages and sections) of your community’s most relevant energy-related plan (attach the relevant plan).
1.2.Project Management, PlanSchedule – See Guide Table 2, Section 4.1.2 (pg. 7) for information to include in this section.
Identify your community’s management team, and any external resources that you will be using to complete the project:
Use key excerpts (referring to any page and/or section) from your project plan to describe the project (purpose, goals, deliverables, schedule, etc.)Attach project plan and schedule.
Construction Start Date: Construction End Date:
Who will own the completed project?
What assurance can you provide the Province that sufficient staffing or other resources will be in place to reliably operate and maintain the facility/equipment over its lifetime?
1.3TechnicalFeasibility & Preparedness – See Guide Table 2, Section 4.1.3 (pg.8) for information to include in this section. Use excerpts of relevant documentation to demonstrate feasibility and preparedness (attach feasibility study/business plan).
Summarize project viability and readiness to construct
Detail all licenses, approvals, permits and their status
Provide details on theproject team (including the management team, technical team, subcontractors, etc.) and track record
1.4Budget & Financial Feasibility - See Guide Table 2, Section 4.1.4 (pg. 8)for information to include in this section. Provide an attached project budget. The attached project budget must include:
a)The total project cost
b)An itemized cost estimate of the project components
c)Quarterly costs until completion
d)Annual revenue or energy cost savings upon completion
e)The funding amount requested from CELP
f)A list of other funders / contributors / financers, with their amounts itemized and the status of their funding (e.g. confirmed, tentative, etc.). Include in this list the community’s own contribution.
Total estimated cost of the project? $
Total of your own budget contribution (at least 5%)? $
Provide the legal name of all funding partners, how much funding, and their role in the project:
a) Legal name: $ Role:
b) Legal name: $ Role:
c) Legal name: $ Role:
Requested funding from CELP?* ($10,000 to $150,000; maximum 33% of total project costs)
$ (Note, a maximum of two larger-scale projects (i.e. $120,000 to $150,000 will be selected)
If a funding shortfall exists, demonstrate the capacity to access necessary funds
1.5Risks - See Guide Table 2, Section 4.1.5 (pg. 8)for information to include in this section. Outline any project risks to completion and describe risk mitigation measures to ensure project success.
  1. Energy and Greenhouse Gas Savings (15 points total)

See Guide Table 2, Section 4.2.0 (pg. 9)for information to include in this section.
Use the Energy& GHG Calculator provided. Attach your completed Energy & GHG Calculator to your final application, and attach a document summarizing your assumptions used when completing the Energy & GHG Calculator.
Compared to business-as-usualover the life of the completed project, what is the:
annual projected energy saved (if energy efficiency ) or produced (if renewable) (kWh or gigajoules);
annual projected greenhouse gas emissions reduced: (tonnes of CO2e); and
Cost per tonne of GHG emissions based on CELP funding:
  1. Employment and Economic Benefits (15 points total)

See Guide Table 2, Section 4.3.0 (pg. 9) for information to include in this section.
Describe the types of employment and number of jobs, and training (if relevant).
Detail the Employment hours that the project will create during the two phases:
during the construction phase - ; and
during the operations and maintenance phase
Describe any broader local economic benefits to the community.
  1. Other Benefits to the Community (5 points total)

Describe other anticipated benefits to the community See Guide Table 2, Section 4.4.0 (pg. 9)for information to include in this section:
  1. Innovation and Replicability (15 points total)

Describe projectinnovation and replicabilitySee Guide Table 2, Section 4.5.0 (pg. 9)for information to include in this section.
  1. Funding Need and Leveraging (10 points total)

Describe the project funding needandleveraged funding.See Guide Table 2, Section 4.6.0 (pg. 10)for information to include in this section.
Describe and demonstrate how this project cannot proceed as described in this application without the assistance of CELP funding
Describe to what extent this funding has been able to confirm or leverage funding from other sources (itemized amounts by funding source)
(Note, the total project budget will be used to determine the value of leveraged funding).
Thank you for completing your Application.

Please print this Form and sign below as the Council/Board representative for the project, attesting to the accuracy of the information in the Application form above, and use the checkboxes below to confirm that:

On behalf of my community, I have read the CELP 2016/17 Program Guide and meet all of the mandatory criteria in order to apply for this year’s program funding (Section3.2.1 of guide).

Attached, or forthcoming, is a Resolution from our Council/Board authorizing the project to proceed prior to the execution of a Contribution Agreement with the Province.

Once signed, please scan the document and convert to a PDF before submitting to .

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Signature______

Date

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Print Full Name

Please go back to ‘page 1’ for next steps.

Community Energy Leadership Program Application Form, Oct 2015Page 1 of 5