The Maryland Energy Administration
1623 Forest Drive, Suite 300
Annapolis, Maryland 21403

Attn: David Cronin

* * * * *

This application package is for use in applying to the Maryland Energy Administration for financial assistance under the Jane E. Lawton Conservation Loan Program (JELLP). JELLP is a revolving loan fund designed to assist local government and nonprofit organizations with funds for energy conservation improvements. The Program structures loans for repayment from energy savings achieved by the funded project.

The application package includes:

  1. Application Checklist
  2. Application Instructions
  3. Loan Application and Building Information
  4. Feasibility Study Outline
  5. Project Budget Form
  6. Project Timetable Worksheet
  7. Certification Form
  8. Good Standing Instructions

Applications may be submitted as they are completed. All applications are reviewed on a first-come, first-served basis. You will be notified of additional information that may be required for a complete analysis of your loan application. The application review process can be lengthy, but you are welcome to call for progress reports during this review.

Eligible Applicants:

  1. Non-profit organizations, including private schools and hospitals.
  2. Local governments, including local boards of education and community colleges.

Organizations primarily involved in religious or fraternal activities are not eligible.

Eligible Projects:

  1. Must be in buildings owned/leased by the applicant.

  2. Must be located within Maryland.

  3. Must have a simple payback of no less than one and no greater than seven (7) years.

The "JELLP Application Code" at the top of each form is for MEA use only and does not require a response from Applicant.

Jane E. Lawton Conservation Loan Program

FY 2008 Application, Checklist

 

JELLP Application Code: ______________

Have you completed?:

ITEM

YES

NO
The JELLP Application Form    
Feasibility Study    
Project Budget    
Certification    
Project Timetable    
Application Fee    

Have you attached a copy of: (These items are required. If you are unable to provide any item, please provide a written explanation as to why the item was not submitted with the application and when the item will be submitted.)

Item

Yes

No
Organization By-laws    
Articles of Incorporation    
IRS Letter of Tax Exempt Status    
Latest IRS Reporting Form    
Proof of Ownership for Project, Building or    
Copy of Lease    
Three Years of Financial Statements    
MD Certificate of Good Standing    

(Please note: The Certificate of Good Standing is issued for three (3) months. An additional, current certificate may be required at the time of closing.)

What other information is attached to support your JELLP application?

(Desirable items include: Board of Directors list, descriptive brochures, programs/services information, numbers of customers/clients served, jobs created/lost with/without JELLP project, etc.)

Jane E. Lawton Conservation Loan Program

Application Instructions for General Information

 

These instructions follow the order of requested information on your Jane E. Lawton Conservation Loan Program (JELLP) Application, and are intended to clarify the response required for a complete application. After reading the application and these instructions, should you still have questions, please call: The Maryland Energy Administration, JELLP Manager at 1-800-72-ENERGY.

A. General Information

Note: Enter your total dollar request on the first line (labeled JELLP Loan Request.)

  1. Enter the name of the non-profit organization, including school or hospital, or local government, including public school systems and community colleges, applying for JELLP funds.

  2. Provide the address for the applicant organization listed in #1, above.

  3. Enter federal tax identification number of the applicant organization. (This should be a number that begins with "52 - ").
  4. Place a check mark in the appropriate blanks. For "other," provide a very brief description of the type of organization making application. If you are a Board of Education or Community College, you must apply through your county government.
  5. Enter the name and title of the employee who will be responsible for the JELLP Project oversight, if this application is funded.
  6. This address should be for the employee named in #5 above. If this address is the same as the applicant address listed in #2, write SAME.
  7. Enter the telephone number where the proposed Project Manager may be reached during normal business hours.
  8. If the preparer of this application is other than the proposed Project Manager, enter the preparer's name here. The person named in #8 should be available and prepared to answer questions about the application if necessary during the application review process. If the Contact Person and the proposed Project Manager are the same, please enter PROJECT MANAGER in this blank.
  9. Provide the telephone number for the individual named in #8.

Jane E. Lawton Conservation Loan Program

FY 2008 Application

JELLP Application Code: ____________

A. General Information

JELLP Loan Request $ ____________________

1. Name of Applicant: ____________________________________________

2.Address:_____________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

3. Federal Tax Identification No.____________________________________

4. Type of Applicant:

___Nonprofit - profit School

___Nonprofit - profit Hospital

___ Non-profit Other

___ County Government (Includes Board of Education and Community College

___ Municipal Government

___Nonprofit - profit other __________________________________________

5. Name and Title of Proposed Project Manager __________________________

_______________________________________________________________

6. Address ______________________________________________________

_______________________________________________________________

7. Telephone Number ______________________________________________

8. Contact Person _______________________________________

9.Telephone Number _______________________________________________

Jane E. Lawton Conservation Loan Program

Application Instructions for Building Information

 

B. Building Information

  1. Enter the name of the building or complex of buildings for which the Project is proposed.
  2. If the Project is proposed for a complex, enter the total number of buildings in the complex, whether or not the project improvements will occur in all buildings.

  3. Provide the address for the building/complex listed in #10, above.

  4. Enter the State Legislative District number for the location of the PROJECT BUILDING.
  5. Check the appropriate response as owner or lessee of the project building. If the building is leased, the existing lease must be in effect for five (5) years beyond the simple payback of the proposed JELLP project.
  6. In a very brief paragraph, describe the existing conditions in the project building that prompted Applicant to seek JELLP funds. Your description should touch upon the most significant problems and their impact, but is not intended to replace the thorough description to be provided in the feasibility study attached to this application.
  7. Provide the utility name and your account number for all utilities in the Project Building. This information will only be used for determining and monitoring energy consumption.

Jane E. Lawton Conservation Loan Program

 

FY 2008 Application

JELLP Application Code: _____________

B. Building Information

10. Name of Building or Complex _________________________________________

11. If a Complex, Total Number of Buildings _________________________________

12. Address _________________________________________________________

___________________________________________________________________

13. State Legislative District _____________________________________________

14. Is the applicant the legal owner of the Building/Complex? Yes ____ No ____
If no, does the applicant lease the Building/Complex? Yes ____ No ____
What is the length of the lease? _______years

15. Briefly describe current Building/Complex conditions that evidence a need for JELLP funds: _______________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

16. Provide the name and account number for all utilities to the Project Building:

a. _________________________________________________________________

b. _________________________________________________________________

c. _________________________________________________________________

(Use additional sheets if necessary.)

Jane E. Lawton Conservation Loan Program

Application Instructions for Feasibility Study Outline

 

C. Feasibility Study Outline

  1. A detailed Feasibility Study must be completed and included with this application. The Feasibility Study may be completed by an individual or firm of your choice. See Appendix A for an outline of the Feasibility Study minimum requirements.

  2. Enter the projected savings to be derived from the Project in dollars, BTU'S, and units of fuel. Be sure to be consistent in time period for each response; annual savings estimates are preferred.

  3. Calculate the Simple Payback for the proposed project. To do this, divide the total project cost by the estimated annual savings. The result is the project simple payback in years.
  4. If the author of your Feasibility Study was the same person named in the application as either Project Manager or Contact Person, enter SAME.

  5. Provide the address as appropriate if your response to #21 is other than SAME.

  6. Provide the telephone number of the person listed in #21, above.

  7. A timetable must be developed to show the approximate duration for each step of the project from start to finish. The project start should be shown from the time of award of financial assistance (commitment letter) to completion of project (complete installation of improvements). The timetable should show all significant steps in the project, such as loan closing, advertising for bids, bid award, equipment installation, etc. Dates of occurrence should be entered where known or anticipated and, for all entries, an expected duration is required. See Appendix B for timetable format.

Jane E. Lawton Conservation Loan Program

 

FY 2008 Application

JELLP Application Code: ________________

C. Feasibility Study Outline

18. Attach the completed, original feasibility study to your application package.

19. Projected Savings in: (Enter savings for each applicable category.)

Dollars:___________________

BTU'S:___________________

Unit of fuel:________________

20. What is the estimated Simple Payback for the Project?______________

21. Name of Preparer of Project Feasibility Study____________________

22. Address:________________________________________________

__________________________________________________________

__________________________________________________________

23. Telephone Number ________________________________________

24. Attach the proposed timetable for the Project from start to finish, based on an approved JELLP application. Use the form provided in Appendix B.

Jane E. Lawson Conservation Loan Program

Application Instructions for Project Budget

 

D. Project Budget

  1. A budget must be developed for the proposed project and submitted with this application. The budget must show all associated project costs and expenditures. Also outlined should be anticipated contributions of money, equipment, and in-kind services, including applicable utility rebates. Remember that the applicant needs to contribute to the project, and that the contribution should approximate 10% of the JELLP request, but does not have to be cash. See Appendix C for Project Budget format.

  2. In narrative form, describe the financial aspects of your proposed project. Include in this description why JELLP funds are essential to your project.

  3. Use this area to identify resources outside your organization that are anticipated to ensure completion of your approved JELLP project. These resources may include local government contributions and applicable utility rebates.

  4. If the JELLP request and anticipated additional resources are insufficient to complete your proposed project, use this area to describe why the project will not be completed with approval of this application. This section will only apply to projects planned for completion in stages, perhaps over a period of years, or new construction.

  5. If you have bid your project, and selected a contractor, provide the name, address, telephone number, and a contact person for the selected contractor. If the bid process is to be completed after submission of the application, enter TO BE BID.

Jane E. Lawson Conservation Loan Program

FY 2008 Application

JELLP Application Code:

D. Project Budget

26. Attach the completed project budget to your application. Use the form labeled Appendix C.

26. Budget Narrative: (use additional sheets if necessary)________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

27. Are there additional resources committed to assure project completion? (Please outline other resources by dollar amount and contributor for all confirmed and anticipated resources).

28. Does your request represent the minimum amount needed to complete the project?

YES ____ NO ____ (Why Not? - Use additional sheets if necessary)

29. Proposed Project contractor.

Firm Name ________________________________________________________

Address___________________________________________________________

__________________________________________________________________

Telephone Number___________________________________________________

Contact Person _____________________________________________________

(use additional sheets if necessary)

Jane E. Lawson Conservation Loan Program

Application Instructions for Certification

 

E. Certification

30. The Certification must be signed by the applicant's authorized representative and submitted with the application. Authorized representatives eligible to sign the Certification include the following:

a). If Applicant is a local jurisdiction, the Certification must be signed by the Chief Elected Officer or if none, by the governing body of the local jurisdiction.

b). If Applicant is a public school, the application shall be approved by the Board of Education of the County in which the project is located, and the certification must be signed by the superintendent of public schools for the same County. The approval authority for each county is different, so you may also need the signature of the Chief elected official or governing body in your county.

c). If Applicant is a community college, the certification must be signed by the President of the community college, and the Chief Elected Official for the applicable local jurisdiction.

d) If the Applicant is a non-profit organization, the certification must be signed by the organization's director and the application shall be approved by the governing board of the organization, if any.

Other information concerning your JELLP application:

31A. The application fee is 1% of your request, up to a maximum of $250 and must be submitted with the application. The application fee is nonrefundable.

B. The closing fee is 1% of the loan award, up to a maximum of $1,000, less any application fee paid. Closing fee is payable at closing.

C. All checks for fees should be made payable to the Maryland Energy Administration.

32. The JELLP Application Code at the top of each form is for MEA use only and does not require a response from Applicant.

Jane E. Lawson Conservation Loan Program

 

FY 2008 Application

JELLP Application Code: ____________

E. Certification

I certify that the submission of this application for funds from the Jane E. Lawson Conservation Loan Program (JELLP) is authorized under local law and that the applicant possesses legal authority to carry out the JELLP activities in accordance with applicable law and regulations of the Maryland Energy Administration and the State of Maryland.

Further, I certify that I understand a person may not make or cause to be made any false statement or report in any document required to be furnished to the Maryland Energy Administration for use in any agreement relating to financial assistance.

And, a person applying for or benefiting from financial assistance under the JELLP may not knowingly make or cause to be made any false statement or report for the purpose of influencing the action of the Administration on an application or for the purpose of influencing the action of the Administration affecting financial assistance already provided.

I also understand that any person who violates these rules shall be subject to the following penalties: 1). immediate cancellation of the loan and acceleration of the terms of financial assistance provided by the JELLP; and 2). subject to charges and upon conviction, subject to a fine not exceeding $50,000 or imprisonment not exceeding 1 year, or both.

I hereby certify that I have read and understand the above regulations.

I authorize the Maryland Energy Administration to contact the utilities designated by me through this JELLP application, to obtain whatever energy use information may be necessary to approve and/or monitor any loan award based on said JELLP application.

In witness whereof, the applicant has caused this document to be duly executed on this ____ day of ____________.


______________________________________________________
Signature of Authorized Representative


_______________________________________________________
Typed Name of Authorized Representative


________________________________________________________
Representative's Title

Appendix A

CELP FEASIBILITY STUDY MINIMUM REQUIREMENTS

 

It is recommended that you complete a comprehensive energy audit of your structure(s). From this audit, a detailed description of the project for which you are requesting JELLP funds can be developed. A complete energy audit will also provide the additional information requested by these minimum requirements, and can be used as the basis for future JELLP project requests.

1. IDENTIFY PROJECT

2. BILLING/FUEL USE

3. BUILDING SUMMARY

4. CALCULATIONS

Appendix B

JELLP Application Code: ___________

JELLP PROJECT BUDGET

1. JELLP Loan Request: (Itemize equipment and installation expenses for which you are requesting JELLP funds):

a.______________________________________________$ _______________

b. _____________________________________________ $ _______________

c. _____________________________________________ $ _______________

Total JELLP funds requested (This number must agree with amount entered on page 1):

$ ________________(X)

 

2. Applicant contribution: (this must be at least 10 % of Item X)

a. Cash (include loan fees) $ __________________________________________

b. In-kind (total in-kind) $ ____________________________________________

_________________________________________________________________

_________________________________________________________________

c. Equipment (total equipment) $ _______________________________________

_________________________________________________________________

_________________________________________________________________

Total applicant contribution $ __________________________________________ (Y)

 

3. Other Contributions to JELLP project (itemize and include utility rebates)

a. ____________________________________________$ ________________

b. ____________________________________________$ ________________

Total other contributions .......................................................$ ________________

 

4. Total cost of JELLP Project (X+Y+Z) .........$ _______________________

(Attach an explanation if you are claiming hardship.)

New Construction Only:

What is the total construction project cost? $ _________________

Fill in the following information for all sources other than the JELLP loan. Attach a copy of the commitment letter, if available.

Source Amount Rate Term/Years

Special Conditions
         
         
         
         

Appendix C

JELLP Application Code: __________

THE MARYLAND CERTIFICATE OF GOOD STANDING

INSTRUCTIONS

There are two (2) methods for obtaining this certificate:

1). Regular - send a check for $6.00 along with a letter requesting the certificate. Include in this brief letter the Company name and the State I.D. number. You should receive a response within 5-10 working days.

2). Expedited - send a check for $15.00 along with the information outlined in #1. Be sure to write "EXPEDITE" on the outside of your envelope. Expedited requests are guaranteed to be returned within 48 hours of receipt.

In all cases, your request should be mailed to:

Department of Assessments and Taxation
301 W. Preston Street
Baltimore, MD 21201

ATTN: Charter Department

If you have additional questions, please call the Department of Assessments and Taxation directly at (410) 767-1340.