Nevada Conservation Credit System – Debit project review FormPage 1
Nevada Conservation Credit System
DEbit Project reviewForm
This Debit Project Review Form is completed throughout the consultation process for projects located within the Sage-Grouse Management Area by the Project Proponent, Verifier, and SETT. The entity responsible for completing each section of this form is identified within thebold text at the beginning of each section.The initial step is to complete Section I prior to beginning Fieldwork, and submit the form to the SETT within the Pre-Fieldwork Submittal Packet.
I.Project INformation And Documentation
This section should be completed by the Project Proponent or Authorized Agent. This section captures basic project information necessary to inform the Administrator about the proposed project. Attach the relevant Permit or Lease Application and provide the file name below.
Project Information SUMMARY (SETT USE ONLY)Project ID / Date Received / WAFWA Zone / PMU / BSU
PROJECT INFORMATION
Project Name / Specify unique name of the debit project. Include relevant permit identification numbers, if applicable.
Credit Buyer Information / Enter the name of the Project Proponent (company or corporation name).
Contact Information / Enter the name(s) and contact information – including telephone, email and mailing address – of the individual to be contacted with all questions regarding this form.
Project Location / Specify the county, parcel number(s), NDOW PMU, and WAFWA Management Zone. If helpful, include geographical or political boundaries (e.g. the border of a city or county, rivers, mountain ranges or other geographic features), and provide file name and specific page numbers of attachment containing relevant maps.
Project Duration / Specify the permit duration of the proposed project.
Project Description / Provide a brief project description. Provide file name and specific page numbers of attachment containing relevant maps. Provide shapefiles depicting the project and boundaries of the proposed disturbance and describe here, if available.
Attachments / Please attached the Avoidance and Minimization Documentation completed with the appropriate Land Management Agency.
NEVADA CONSERVATION CREDIT SYSTEM
Request to Be Listed on Registry
I hereby request the Sagebrush Ecosystem Program (SEP) include information on my projects and credit development/requirements in the registry maintained on the Sagebrush Ecosystem Program website(s) (e.g. sagebrusheco.nv.gov; enviroaccounting.com/NVCreditSystem/Program/Home).
I agree to have video, audio, photographic, digital electronic, or any other medium that depict
______a) the likeness of myself, employees, contractors, and family members
______b) my property/projects, especially emphasizing the portion generating/requiring credits.
I also agree to have my name and biographical material used in connection with such recordings; and the SEP may use, reproduce, exhibit, and/or distribute my name, biographical material, and such recordings in any medium (e.g. print publications, video, internet, etc.) for promotional, advertising, educational, and/or other lawful purposes.
I request that
______a) my contact information be listed on the aforementioned registry for the use of credit sellers/buyers
______b) my contact information be password protected and distributed to only eligible interested parties as determined by the SEP
______c) my contact information is not released at all
Information I would like released, in conjunction with my name:
Phone Number: H/C______
Email Address: ______
Mailing Address: ______
______
I hereby authorize the SEP to disclose, in good faith, the approved information for necessary promotional, advertising, educational, and/or other lawful purposes that have to do with my project that may be used as part of presentations to inform the public about the Sagebrush Ecosystem Program. I will hold the SEP free of liability for the exchange of this information and any other reasonable and necessary information incident to the requirements of the Program, including advertisement for or exchange of credits.
Name of Owner (Print): ______Date: ______
Name of Authorized Agent (Print): ______Date: ______
Signature: ______Project: ______
II.DEBIT DisclosureSummary
This section should be completed by the Verifier, and sent to theSETT within the Verifier Project Assessment Submission Packet post-fieldwork.This section summarizes the amount of debits projected to be generated by the residual impacts of the debit project.Debits occur when anthropogenic disturbances are proven unavoidable and minimization does not provide for complete direct or indirect impact avoidance. Debits areestimated by a verifier using the Conservation Credit SystemUser’s Guide and reviewed by the SETT. Debits are incurred for permanent and temporary impacts.
Fill in the total area of direct and indirect impacts, and permanent and term debit disclosure summary tables below, or cut and paste theDebit Disclosure Summary table(s) from the debit calculator spreadsheet for permanent and eachduration of debits generated by the disturbance. Add additional rows to these tables if necessary for projects with multiple term debit lengths.
Area of Impact SummaryTotal Area of Direct Impact
(acres) Permanent Debits
Total Area of Indirect Impact
(acres) Permanent Debits
Total Area of Direct Impact
(acres)___ Year Debits
Total Area of Indirect Impact
(acres)___Year Debits
DEBITDISCLOSURE Summary - ___-Year Debit Duration
Current Area-Weighted
Average Habitat Function
(%)
Projected Area-Weighted Average Habitat Function
(%)
Projected Functional Acres below Current
(f-acres)
Projected Area-Weighted Average Multiplier
(multiplier)
Term
Debits Generated*
(debits)
DEBITDISCLOSURE Summary - permanent Debit Duration
Current Area-Weighted
Average Habitat Function
(%)
Permanent Area-Weighted Average Habitat Function
(%)
Permanent Functional Acres
(f-acres)
Permanent Area-Weighted Average Multiplier
(multiplier)
Permanent
Debits Generated*
(debits)
CCS Version / List the Version of the CCS that was used in the Analysis
*The total debits generated may not be equivalent to a debit project’s credit obligation. A debit project’s credit obligation is determined by multiplying total debits by a proximity ratiodetermined by the location of the credit project site or sites used to offset debits generated. Credit sites that are distant from a debit project site have a proximity ratio that is greater than 1;therefore,the total credit obligation may be greater than the total debits generated.The credit obligation is addressed under the Credit Fulfillment Summary.
Signatures
The information included above and all attachments are accurate to the best of my ability.I understand that the number of Debits listed above in the Debit Disclosure Summary have been verified and approved by the SETT, and will be valid for five years from the date of signing this document. The number of Debits may change due to application of proximity ratios.
______
Credit Buyer SignatureDate
______
Credit System Administrator SignatureDate
III.Credit FULFILLMENT Summary
This section is completed by the Project Proponent and reviewed by the SETT upon purchase or transfer of credits.This sectionsummarizes the credits purchased to fulfill the credit obligation associated with thedebit project. The Credit Obligation and Balance Summary table identifies the credit project(s) from which the Project Proponent (Credit Buyer) purchased credits in order to offset the credit obligation for the debit project, taking into account the proximity ratio.
Completion of this section is initiated by a Credit Buyer and submitted for approval to the Sagebrush Ecosystem Technical Team (SETT) after the Credit Buyer has acquired all credits needed to fulfill their credit obligation. Copies of the completed Credit Purchase Agreements associated with all acquired credits must be attached to this form. The Credit Buyerand SETT representative must each sign below to confirm that a credit obligation has been fulfilled by the Credit Buyer.
CREDIT BUYERIcertify that I have purchased credits from the credit projects(s) listed in the Credit Obligation and Balance Summary table to offset the credit obligation by the debit project described herein, and that the contents of the Credit Obligation and Balance Summary table are accurate to my best ability.
______
Credit Buyer Date
ADMINISTRATOR
I certify that the credits from the credit projects(s) listed in the Credit Obligation and Balance Summary table satisfy the Credit Buyer’s requirement to offset the total credit obligation associated with the debit project described herein.
______
Credit System Administrator Signature Date
debit project review Form
Version 1.0
Nevada Conservation Credit System – debit project review FormPage 1
Fill in the term and permanent credit obligation and balance summary tables below for permanent and each duration of debits that credits are acquired to be offset. Attach all Credit Purchase Agreements associated with all purchased credits, and provide electronic file name in credit obligation and balance summary tables. Add additional Credit Obligation and Balance Summary tables if necessary for projects with multiple term debit lengths.
Credit Obligation and Balance Summary - ___-Year Debit DurationName of Credit Project / Credit Purchase Agreement Electronic File Name / Credit Term Length / Number of Permanent Credits Purchased / Proximity
Ratio / Credits Available to Offset Credit Obligation / Term Credit Obligation
Specify the balance of credits to be purchased
State the unique name of the Credit Project from which Credits where purchased / Include the electronic file name of the associated Credit Purchase Agreement attached / State the length of the time the credit will be valid including 1) the total years and 2) the beginning and end of the credits’ term (e.g. 20 years, June 2016 - June 2036) / Specify the number of credits purchased / Specify the Proximity Ratio / Divide the number of credits purchased by the Proximity Ratio to calculate the number of Credits that can be used to offset the credit obligation / Subtract the credits purchased from the remaining debit balance to specify the remaining balance of credit obligation after each credit purchase
Total Permanent Credits
Purchased / Specify the total number of credits purchased / Total Permanent
Debits Offset / Specify the total debits offset
Credit Obligation and Balance Summary - Permanent Debit Duration
Name of Credit Project / Credit Purchase Agreement Electronic File Name / Permanent Credit Beginning Date / Number of Permanent Credits Purchased / Proximity
Ratio / Credits Available to Offset Credit Obligation / Permanent Credit Obligation
Specify the balance of credits to be purchased
State the unique name of the Credit Project from which Credits where purchased / Include the electronic file name of the associated Credit Purchase Agreement attached / State the date that the permanent credit was awarded / Specify the number of credits purchased / Specify the Proximity Ratio / Divide the number of credits purchased by the Proximity Ratio to calculate the number of Credits that can be used to offset the credit obligation / Subtract the credits purchased from the remaining debit balance to specify the remaining balance of credit obligation after each credit purchase
Total Permanent Credits
Purchased / Specify the total number of credits purchased / Total Permanent
Debits Offset / Specify the total debits offset
debit project review Form
Version 1.0