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Application form for feasibility case studies MS Word

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Note: The Feasibility and Case Study Stream of the Building Innovation Fund does not support general energy audits or detailed facility studies that simply

    COMMERCIAL-IN-CONFIDENCE

    Building Innovation Fund: Feasibility/Case

    Study Stream

    Application Form B

    January 2010

NOTE: Please read the Building Innovation Fund Guidelines for Applicants before

    completing this form.

SUBMISSION OF APPLICATIONS

    Applications close at 5 pm on 12 March 2010. Incomplete or late applications will

    not be accepted.

    Please submit a fully completed and signed hard copy of the application form to the

    address below. Please also submit an electronic copy of the application on CD/DVD

    or via email to vitkovskaya.olessya@dpc.sa.gov.au. Both copies must be submitted

    before the closing date and time.

    Applications should be submitted to:

    Olessya Vitkovskaya

    Project Officer

    Sustainability and Climate Change Division

    Department of the Premier and Cabinet

    GPO Box 2343

    ADELAIDE SA 5001

Or couriered to:

    Ms Olessya Vitkovskaya

    Project Officer

    Sustainability and Climate Change Division

    Department of the Premier and Cabinet

    Level 6, 91-97 Grenfell Street

    ADELAIDE SA 5000

    Building Innovation Fund Feasibility/Case Study Stream Application v4.0 - 1 -

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    PART A APPLICANT’S DETAILS A1. Entity name and registration details

    Registered Business Name Trading names (if different from the above) Australian Company Number (ACN) Date of Incorporation Country of Incorporation Australian Business Number (ABN) ABN branch number (if applicable) Is the applicant registered for GST? The entity is (select as appropriate)

    Owner of the building where the

    project will occur

    Part-owner of the building where

    the project will occur

    An agent of the owner acting on

    the owners' behalf

    The entity is (select as appropriate)

    Corporation

    Partnership

    Trust

A2. Partnership details

    If the applicant is a nominated partner applying on behalf of all other partners, please

    provide details below.

    Partnership’s Registered Business Name Partnership’s Australian Business Number (ABN)

    Type of partnership I therefore declare that I am duly authorised to submit the application and

    sign a grant agreement for and on behalf

    all other partners

A3. Non-incorporated trustee details

    If the applicant is a non-incorporated trustee applying on behalf of a trust, please

    provide details below.

    Name of trust Australian Business Number (ABN) of the

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    trustee Type of trust A4. Incorporated trustee details I therefore declare that I am empowered to

    submit the application and sign a grant If the applicant is an incorporated trustee applying on behalf of a trust, please provide agreement as trustee for the trust details below.

    Name of trust Australian Business Number (ABN) of the trustee

    Australian Company Number (ACN) Type of trust I therefore declare that I am empowered to submit the application and sign a grant

    agreement as trustee for the trust

A5. Street address of registered business

    Provide the registered business street address of the applicant’s head office

    Address line 1 Address line 2 Address line 3 Suburb / Town State/ Territory Postcode Country

A6. Postal address of registered business

    Please provide the postal address, if it is different from the above.

    Address line 1 Address line 2 Address line 3 Suburb / Town State/ Territory Postcode Country

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    A7. Primary Contact

    Please note: this person will be a primary contact for this application.

    Name

    Title

    Given name

    Other name(s)

    Family name

    Job title

    Organisation

    ABN Number (if different from A1

    or A2)

    Contact details

    Office telephone number

    Mobile telephone number

    Office fax number

    E-mail address

    Postal address

    Address line 1

    Address line 2

    Address line 3

    Suburb / Town

    State / Territory

    Postcode

    Country

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    PART B FEASIBILITY STUDY DETAILS

    B1. Study Title

    Provide below the full study title, which should be 10 words or less in length. If the

    application is successful, this title may be used by the State Government and the

    Property Council of Australia (South Australian Division) in published material.

B2. Study Summary and Aspiration(s)

    In the space provided below, provide a summary of the study, including its

    aspirations (no more than 300 words). If the application is successful, this summary

    may be used by the State Government and the Property Council of Australia (South

    Australian division) in published material.

Is the feasibility study directed towards retrofitting a commercial office building

    located in South Australia, or retrofitting office building stock more generally in

    South Australia taking into account South Australian climatic conditions and

    existing South Australian office building stock? If ‘NO’, do not proceed

    Note: The Feasibility and Case Study Stream of the Building Innovation Fund does not

    support general energy audits or detailed facility studies that simply seek to identify energy

    saving opportunities in a particular office building.

B3. Study Methodology

    In the space provided below, outline concisely the study methodology (no more than

    1 page). If the application is successful, this information may be used by the State

    Government and the Property Council of Australia (South Australian Division) in

    published material.

B4. Building details

    In the table below provide details of the building the study will apply to.

    If there is more than one building, please attach details of all buildings as a separate

    attachment.

    Name of the Building (if applicable)

    Address line 1

    Address line 2

    Address line 3

    Suburb / Town

    State South Australia

    Postcode

    Year it was built

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Is this a commercial office building, which complies with the following: Number of storeys

    The building is used for commercial

    purposes, where at least seventy per

    cent of the floor area of the building

    has been occupied by commercial

    offices1.

    Percentage of the building used for commercial purposes

    The building has been occupied by commercial offices within the 12

    months prior to submission of this 2application

    The building will be occupied by commercial offices within 12 months 3after completion of the project

Does the owner solely tenant this building?

B5. Study Project Team

    B5.1. In the table below provide details of the lead organisation, which will be

    undertaking the feasibility study.

    Registered Business Name Trading names (if different from the above) Australian Company Number (ACN) Australian Business Number (ABN) Note: If undertaken by a consultant, is done so by a consultant that is a registered

    Australian Business that complies with

    relevant laws.

B5.2. In the space provided below, provide the names of other organisations

    involved in the study.

B5.3. In the space provided below outline the organisations’ capabilities, skills and

    experience relevant to the study.

     1 The assessment panel may apply minor variations when the project has significant demonstration and innovation potential. 2 Preference will be given to projects for occupied buildings 3 Preference will be given to projects for occupied buildings

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B6. Study Duration

    Note: ?The study should commence not more than 8 months after the application is accepted

    by the Department, and is completed by 31 December 2011.

    Project commencement date (dd/mm/yy)

    Project completion date (dd/mm/yy)

    Note: Project commencement means the date on which the study

    commences.

    Project completion means the date on which the final report and

    other deliverables are submitted to the Department.

B7. Study outcomes/deliverables

    In the space provided below, outline the expected outcomes of the study.

B8. Project innovation and demonstration potential

    B8.1. In the space provided below, please outline the innovation potential of the

    study addressing one or more of the following criteria (no more than a page):

    ? the application of technologies for the first time in Australia

    ? technologies applied for the first time to the commercial office building

    stock

    ? technologies that have been trialled before, but were unsuccessful, or are

    at a demonstration stage, where further trials could create public benefit

B8.2 In the space provided below, please outline the demonstration potential of the

    study, i.e. the extent of the potential for measuring and sharing project

    outcomes and learnings, including potential greenhouse gas emission

    reductions, costs savings and productivity gains and how the

    innovation/technology could be more widely adopted by other building owners.

B9. Greenhouse gas emissions abatement potential

    In the space provided below, please provide relevant information relating to the

    study’s potential to project significant reductions in greenhouse gas emissions from

    commercial office buildings arising from savings in base or total building energy

    consumption (no more than a page).

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    B10. Project financial support

    Please provide the details below concerning costing of the project and funding

    sought from the State Government. All amounts should be GST exclusive.

    An estimate of the upper limit cost of the feasibility study ($) Amount of applicant’s funds ($) Other funding ($) (please specify)

    Funding sought through South Australia’s Building Innovation Fund ($)

    Funding sought through South Australia’s Building Innovation Fund (% of total project costs)

    Note: For Feasibility and Case Study projects, the Building Innovation Fund provides grants of a minimum of $20,000 per

    study.

    Applicants will be eligible for up to 50% of the eligible study costs,

    i.e. a minimum of one-half of study costs should be met by the

    applicant.

    A maximum of 15% of the total Building Innovation Fund will be

    available for feasibility or case studies.

B11. Study project budget

    In this section, please outline a detailed project budget of eligible expenditure.

    Head of Expenditure ($)

Total

    Note: The following items are considered eligible expenditure:

    ? The cost of a study.

    The following items of expenditure are not supported by the Building Innovation Fund:

    ? salaries costs for the time spent by employees on the project

    ? the costs of preparing the original grant application, preparing any project variation

    requests, and preparing any project reports required under the grant agreement

    ? obtaining resources used on the project, including interest on loans, job advertising and

    recruiting, and contract negotiations

    ? administration expenses including communications, accommodation, office computing

    facilities, printing and stationery, postage, legal and accounting fees, and bank charges

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    ? travel expenditure

    ? in-kind or non-cash contributions.

    This list is not exhaustive. Other activities or specific expenditure may be ineligible because the Program Delegate decides it does not directly support the achievement of the planned outcomes of the project or to be contrary to the spirit and intention of the Building Innovation Fund.

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    PART C SUPPORTING DOCUMENTS CHECKLIST

    To assist with processing the application, please provide below a list of the

    documents attached to support the application. Please note that mandatory

    documents must accompany the application form and incomplete applications will not

    be processed.

    To support your application, you may also submit any other pertinent documents up

    to maximum of 10 pages.

    MANDATORY ATTACHMENTS

    Letter from Accountant confirming funds, are Attached available for applicant to provide its share of

    the project cost

ADDITIONAL ATTACHMENTS

    If there is more than one building, which is Attached subject of the study, details of all the

    buildings are provided.

     Attached

     Attached

     Attached

     Attached

    ELECTRONIC VERSION OF THE Attached APPLICATION FORM AND

    ATTACHMENTS

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