ENERGY MASTERPLAN (EMP) FundingApplication Form

1.1 ApplicantDetails

SEC Title
Lead Applicant Company Name
Principal Business Activity
Company No.
Are you able to claim back VAT? If so please provide your VAT no.
Tax Clearance Advisory No. (TCAN)
Contact Details / Title / First Name / Surname
Address
Telephone / Mobile
Email / Website
Is the Lead Applicant the Primary
Contact for SEAI communication? / Yes / No If “No”, please include contact info for the Primary Contact below:
Financial Controller/ Treasurer / Email

1.2 BankAccount Details (for purposes of receipt of grant payment from SEAI)

Account Holder Name (Print)
Account Name (Print)
Bank Name (Print)
Bank Branch / Address (Print)
IBAN (max 34 characters) / International Bank Account Number (IBAN)
Bank Identifier BIC / Swift Code
(11 characters) /

1.3 Request for Funding –Energy Master Plan (EMP) development

The applicant should request support for the level of professional support services which reflects the complexity of the data collection necessary for their EMP and Register of Opportunities. Havingconsidered the requested support,and with SEAI approval, an offer will be provided up to a ceiling value for each SEC level.This funding is in addition to the mentor days that will be assigned to the SEC on signing of the 3-year Partnership Agreement.
Funding requested for Stage One
Indicate requested grant from the maximum threshold amounts set out below:
Note: Guidance on definition of SEC Levels 1-4 is provided in the EMP FundingApplication Guidelines / Grant requested
(tick box)
Level 1 SEC €10,000 / 
Level 2 SEC €15,000 / 
Level 3 SEC €20,000 / 
Level 4 SEC €25,000 / 
Basis for level of requested funding
Please provide a list of the planned and/or anticipated professional services that will be required for the development of your EMP and Register of Opportunities, which should be relevant to the scale and reach of your SEC. It is not expected or required that projects have detailed costing at this point HOWEVER, it is expected that sufficient information is provided which is in line with the value of grant requested. This will be a factor in the assessment of the grant funding offer.
If you are eligible to claim for VAT, please detail costs excluding VAT only. If you are not eligible, please fill in both columns and provide a letter from Revenue confirming this.
Professional service requirements
(Insert additional lines as necessary) / Scope of work / Costs (€)
Excluding VAT / Costs (€)
Including VAT
Total

1.4 Grant Milestone Payments

Please identify any interim milestone payments required within year one. There are a maximum of four milestones allowed for the Energy Masterplan and the final milestone must be no later than 12 months after the start date i.e. the EMP and Register of Opportunities must be completed within a 12 month period.
Project Payment Milestones / Month (e.g. Month 1, Month 2, Month 3) / Amount of Grant Requested (€)
1
2
3
4

1.5 SEC Summary

Please provide a high level outline of your SEC;the bullet pointsbelow are prompts to aid applicants but it is not essential to have all of the answers at this stage.
Describe theprojectlocations and scale:
  • Geographical spread?
  • How many households?
  • How many businesses?
  • Any other stakeholders are within your SEC?
  • Do you have an estimate of the amount of money currently spent on energy within your SEC?

Describe the current state of your SEC activity:
  • Has a Steering Committee been formed?
  • What level of community engagement has there been so far?
  • Are there any energy efficiency projects underway or completed?
Any other relevant high-level project information:

1.6 SEC Inputs

Please provide ageneral summary of what inputs your SEC will bring to the Partnershipusing the following headings.
Local knowledge
  • What existing community organisations or relationships are in place?
  • Are there any previous energy surveys or feasibility studies?

Time – a sample format is included in Appendix C of the Application Guide to assist you here:
  • Identify the SEC inputs involved in work done to date
  • Outline your estimate of the SEC inputs for the proposed EMP
People - an outline of the stakeholders already engaged in your SEC :
  • Describe your SEC structure and team members
  • What is the level of local participation (or how you envisage that the partnership will be developed)?

1.7 Additional Documentation needed to complete your Partnership Application

Please tick to indicate that you haveattached a copy of the following documents with your EMP funding application
Signed Community Charter
Completed SEC Competency Evaluation

APPENDIX A

Please provide the following on Company Letterhead

DECLARATIONOF FINANCIAL RESOURCESFOR THE PROJECT

I, ______, in my capacity as Managing Director/Treasurer / (or equivalent) of ______(hereinafter called the “Organisation”) confirm to the Sustainable Energy Authority of Ireland that the Organisation has access to an amount of ______in place to meet the Milestone 1 costs of the project outlined in the Organisation’s grant application to the Sustainable Energy Communities Partnership Agreement.

Managing Director/Treasurer (or equivalent): (Print)______

Signature:______

Date: ______

APPENDIX B

DE MINIMIS AID DECLARATION - EC REGULATION 1407/2013

EC Regulation 1407/2013 deals with 'de minimis' aid and sets a limit on how much assistance can be given to organisations without the prior approval of the EU Commission. The current limit for a company, or group, irrespective of size or location, is €200,000 over a three year period.

De minimis aid is small amounts of State Aid given to companies. It can come from any State body, agency or Government department.

This Sustainable Energy Communities Programme is being operated under the de minimis regulation. SEAI must ensure that any grant approved for a company, when added to other aid, will not bring them above the allowed limit. As an applicant you are also obliged to ensure you stay within the limits. Therefore you must make a full declaration of all other de minimis aid received in the last three years.

When completing the declaration below you should consider that aid includes assistance such as free or subsidised consultancy services as well as direct grant support.

If you are in any doubt whether support you received is de minimis aid then please include it.

DECLARATION STATEMENT OF DE MINIMIS AID

(Delete which ever not applicable)

I confirm that I have/have not received any de minimis aid during the previous 3 fiscal years (i.e. current fiscal year and the previous two fiscal years):

If you have then please complete the following table outlining the de minimis aid received during the previous 3 fiscal years (i.e. current fiscal year and the previous two fiscal years):

Body providing the assistance / aid / Value of assistance (calculating the Gross Grant Equivalent) / Date of assistance

Declaration

Company
Client Name
Signature
Date

SEC Energy Master Plan fundingapplication form_Rev01

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