Alaska Commercial Energy Audit Program Application

Learn more about the Alaska Commercial Energy Audit Program.
What you will need before starting:
- Square footage of buiding.
- Past 12 month energy cost.
- Completed and signed IRS Form W9 (in PDF format)

Building Information

Building Owner Building Owner should be the business or individual that owns the building and must match the name on the attached W-9. The reimbursement will be made to this name.

Building Name Building Name: the building name or its functional name. The street address can be used if no building name is used.

Primary Building Use Category

Building Use Notes: Briefly describe building use (e.g. mixed office + retail)

Physical Address

City

Year Built

Square Footage Please ensure accuracy by matching architectual drawings and/or tax records. Must not exceed 175,000sf to qualify!

Average Number of Employees Number of Employees: If employee numbers fluctuate, please list the average.

Operating Hours/Week

Building HVAC Features

Air Conditioned?
Mechanical Ventilation System?

Annual Energy Cost

Annual Energy Cost: Enter the total cost of electricity and heating fuel for a recent 12-month period.

Contact Information

Please enter the contact information for the primary contact (and optional secondary contact) for the energy audit program. This could be the building owner, a facility manager, a representative from the building management firm, or other contact designated by the building owner. Communications about this program (with the exception of the reimbursement check, which is mailed to the building owner), will be made to the individuals listed here.

Contact Name

Relationship to Owner

Company

Phone

Mailing Address

City, State, Zip Code

Secondary Contact (Optional)

Contact Name

Relationship to Owner

Phone

Commitments

Please note that the first four commitments are mandatory elements and must be selected to qualify. If any of these commitments are not followed, the applicant will be responsible for refunding half the reimbursement to AEA.

Required Commitments

1. This is a privately owned commercial building in Alaska (this includes ownership by nonprofit organizations.)
2. We will commit staff time to support the energy auditor during site visits, and to gather any required information such as utility bills.
3. We will implement the energy auditor's recommended measures to a total cost of at least half the reimbursement value.
4. We will provide a follow-up report within one year of the audit report indicating which measures have been implemented, the date of implementation and updating our utility use history.

Voluntary Elements: Questions 5 through 10 are voluntary elements which will be scored to determine which buildings are selected for the energy audit program, should demand exceed available funding.

Preferred Commitments (Voluntary)

5. Level of Investment (Select A or B)
- A. We anticipate implementing energy efficiency measures in the next year that pay for themselves within:
- B. We commit to investing money to implement recommended energy efficiency measures totaling at least the following percentage of our current annual energy bill (as reported above) within the next year:

6. We will initiate an energy conservation program in the building.
+1 point
7. We will initiate--or have already created (attach)--a building energy policy that supports energy efficiency actions.
+1 point
8. We will allow the use of the building name and location for the purpose of sharing success stories, energy usage data, energy savings summaries, and similar information.
+3 points
9. We will rate our energy auditor on AEA's web site prior to reimbursement.
+1 point

10. Utilites Information (Select A or B)

A. I give permission to AEA and/or our selected energy auditor to obtain my energy usage records from January 2009 to December 2014. If multiple accounts, list all and seperate with commas.
+2 points

Electric Utility

Account #

Heat Fuel Utility

Account #

Other

Account #
B. I will provide at least two years of historic utility bill information to the energy auditor, and will provide updated utility bill information to AEA in the final report.
+0 points

Annual energy cost: $0 +0 Points
Total points earned: 0

Attachments

Please attach only PDF files that do not exceed 4MB in size.

IRS Form W-9 - Mandatory
or Fax to: Attn: Efficiency Audits (907) 771-3044
Building Energy Policy
Optional, see question 7 above.
Notes/Comments
Optional.

Agreement

Name of person submitting form:
I have read and understand the 2012 Commercial Energy Audit Program Guidelines. I certify that I am the building owner or authorized representative for the building listed above and that the information supplied on this form is true and accurate to the greatest extent of my knowledge.