FOR
GRANT CALL
Energy Management Information Systems (EMIS) Demonstration
For Internal Use
Application Ref. No / :
File Ref. No / :
Officer-in-charge / :
Date Received / :
NOTES
We recommend that you thoroughly assess the capabilities of the EMIS Consultant that you are selecting to ensure that it matches your needs and requirements well.
This form can act as a checklist for filling in the application form. You will need the following information to fill in the form:
Business particulars.
EMIS consultant’s particulars.
Project information.
You must submit the following documents, in addition to the application form:
A copy of the ACRA Business Profile.
A copy of contract (ongoing projects) with EMIS Consultant.
A copy of CVs of key project team members
To assist us in evaluating your application, the requested information must be provided as completely as possible. If the space provided is insufficient, a separate sheet may be used. Information that is not yet available or not applicable must be indicated accordingly.
Submit one hard copy of this application (printed double-sided), bound and submitted in sealed envelope in person by 6 October 2015 (extended deadline), 12 noon, to:
EMIS Grant Call Coordinator
c/o Dir (Energy Efficiency and Conservation Department)
National Environment Agency
40 Scotts Road #19-00
Singapore 228231
By submitting this application, the applicant agrees that:
a. NEA is under no obligation to accept any application. NEA shall normally not enter into correspondence with any applicant regarding the reasons for non-acceptance of a proposal;
b. Applicant shall abide by the decisions of the NEA; and
c. Applicant shall not take legal action against the NEA in relation to their role in evaluating and deliberating on the project application
Up to two projects may be selected to receive the grant. Successful applicants will be notified in writing within 2 months of the grant call closing date.
PART I – COMPANY (APPLICANT) DATA
(Supply information on separate sheets if necessary)
1.
GENERAL
(a) Registered Name of Company:
(b) Mailing Address :
Tel : / Fax :
(c) ACRA Reg. No : / Date of Registration :
(Accounting and Corporate Regulatory Authority, Singapore) (DD/MM/YYYY)
Attach a copy of the ACRA Business Profile
PART II – EMIS CONSULTANT DATA
(Supply information on separate sheets if necessary)
1.
(a) Registered Name of EMIS Consultant:
(b) Address :
Tel: / Fax :
(a) Project Team – EMIS Consultant Project Manager and key members
Name / Email / Designation
Attach the Curriculum Vitae of the key EMIS Consultant Project Team members. Each CV shall be limited to one page.
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3.LIST OF PREVIOUS PROJECTS OF SIMILAR SCOPE AND SCALE COMPLETED BY EMIS CONSULTANT/ PROJECT TEAM LEADER & MEMBERS
Project / Brief Project Description
(incl. year, scope, scale & work done etc.) / Local / Overseas
(Pls specify country.) / Industry Type (Semiconductor, Petrochemicals, etc. Pls specify.) / Investment Cost (USD/SGD) / Outcomes/ Results / Team member
involved & roles performed
(a)
(b)
(c)
Applicant may attach any supporting documents (where applicable).
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PART III – PROJECT INFORMATION(Supply information on separate sheets if necessary)
For this section, applicants may attach any relevant technical information in separate sheets. Examples may be sample dashboards, meter & software/hardware specifications, energy/process flow diagrams, proposed setup configuration, data flow diagram etc.
1.
FACILITY LOCATION
(b) Address :
Tel : / Fax :
2.
SCOPE OF EMIS
(a) Scope of EMIS : / Full facility level/ Partial facility level
· The EMIS should be implemented on a full facility level. For very large facilities, partial facility level implementation covering key energy consuming processes or systems may be allowed.
Provide a brief description of the facility and the systems and processes within the facility. Describe the energy-consuming systems that will be covered by the EMIS and the key operating parameters to be monitored. For partial facility implementation, highlight the systems which will be excluded, the reasons for exclusion and the energy consumed by these systems which will be excluded
3.
PAST ENERGY CONSUMPTION
Past year’s total energy consumption* (12-month total) / Quantity (MWh/ mmBTU/ etc.) / S$
Electricity
Natural Gas
Diesel
Others (specify)
* For partial- facility implementation of EMIS, provide a breakdown of the energy consumption according to the scope.
4.ENERGY USE PERFORMANCE INDICATORS TO BE MONITORED BY EMIS
Specify any energy metrics intended for use in the EMIS. Also, list any targets and describe how these will be established.
5.
CAPABILITIES AND FEATURES OF EMIS
List the capabilities & features of the EMIS here.
6.
PROJECT DELIVERABLES
List the project deliverables here.
7.
PROJECT SCHEDULE
State the estimated project duration (up to post-implementation review of EMIS implementation) in terms of calendar months.
Insert or attach a detailed project schedule (e.g. project time-line, Gantt chart) of project activities and milestones. The detailed project schedule should include a planned post-implementation review.
8.
PROJECTED ENERGY SAVINGS
Areas for Improvement (specify the systems & any potential action items & type of energy saved e.g. electricity, natural gas, fuel oil etc) / Estimated Annual Cost Savings (S$) / Estimated Annual Energy Savings (MWh/ mmBTU/ etc.)
The project should target to achieve a minimum of 2% energy use reduction, attributable to the use of EMIS
9.
ESTIMATED PROJECT COST
Description / Amount, S$ (excl. GST)
EMIS consultancy cost
- For consultancy services provided during the design, implementation & post-implementation phases
State costs excluding GST. Note that GST-registered companies will be paid GST on the reimbursable amount.
10.
OTHER RELEVANT INFORMATION
For ongoing projects, attach a copy of the signed contract with EMIS Consultant.
Specify any other important information that is not covered in the above sections.
NEA may request for further information, as necessary.
PART IV – DECLARATION BY APPLICANT
1. I declare that the Company has been granted the following incentives** for this project:
2. I declare that the Company has applied/is applying for the following incentives** for this project:
3. I declare that the Company is free from any litigation pertaining to the project in Singapore or overseas.
4. I declare that the Company is commited to carry out the project to the utmost of its ability and is commited to share with NEA any relevant information pertaining to the implementation, performance and outcomes of the project during and after its execution.
I declare that the facts stated in this application and the accompanying information are true and correct to the best of my knowledge and that I have not withheld / distorted any material facts. I understand that if I obtain the grant by false or misleading statements, I may be prosecuted under the Penal Code and, in addition, NEA may, at its discretion, withdraw the grant and recover immediately from my company any amount of the grant that may have been disbursed.
Signature of CEO / MD # / Signature of CFO
Name:
Email: / Name:
Email:
Company Stamp / Date (DD/MM/YYYY)
# Delete accordingly
1. Contact Person
/ 2. Claims Certifying Authority (CFO or Accountant)
Name:
Designation:
Contact No.:
Email: / Name:
Designation:
Contact No.:
Email:
Signature of Contact Person / Signature of Claims Certifying Authority
** Indicate incentives/loans etc. administered by any government agencies, participating financial institutions and any other private entities. Indicate N/A when appropriate.
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