Post Installation Certification.pdf
PDF 253 KB Posted
- Attached to
- Z1DA--632-15-101 REPLACE PRIMARY ELECTRICAL DISTRO, PH 1 Federal contract opportunity
- Solicitation number
- 36C24225R0044
About this file
This document is a Project Completion Certification Form for a Combined Heat and Power (CHP) system installed at the Northport VA Medical Center under the 2017 Commercial Efficiency Program. The project involves a CHP system with an annual engine gas/fuel consumption of 225,436 MMBtu, annual electricity generation of 15,696,271 kWh, and a system efficiency of 86.4%. The installation was completed on 1/20/2024, with a total project cost of $11,491,729 and a pre-approved rebate amount of $720,000.
The certification form includes verification statements from both the customer (Northport VA Medical Center) and the project developer/contractor (Charles E. Puckhaber Jr.), confirming compliance with local, state, and national codes, and agreeing to provide system generation data for up to 24 months after final commissioning. The project is noted as being financed, and the system is confirmed as fully operational with interconnection approval received. The form documents the technical specifications, installation details, and contractual agreements associated with the CHP system implementation.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24225R0044 0001 - Amendment No.1 - RFI and Questions.pdf | ||
| ATI NPVA - Certificate.pdf | ||
| Site Walkthrough Sign In Sheet.pdf | ||
| UPDATED Bid - Specifications.pdf | ||
| Protection and Controls Test Plan 9-14-22.pdf | ||
| Certified Relay Test Report.pdf | ||
| OI - 34610 - Northport VA - 020823.pdf | ||
| NVMA Center-CESIR Report.pdf | ||
| Attachment VI.- Wage Rate for Suffolk County__New York.pdf | ||
| Attachment II.- Bid - Specifications for Replace Primary Electrical Distribution.pdf | ||
| Attachment V.- Past Performance Questionnaire - PPQ.pdf | ||
| Attachment IV.- FAR 52.225-2 Buy American Certification.pdf | ||
| Attachment III.- VAAR 852.219-75 VA Notice of Limitations on Subcontracting.docx | DOCX document | |
| Attachment I.- Bid - Drawings for Replace Primary Electrical Distribution.pdf | ||
| 013200 Construction Documentation.docx | DOCX document | |
| 36C24225R0044_1.docx | DOCX document |
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Text version
2017 Commercial Efficiency Program
225435 MMBtu 15696271 kWh
86.4 % 1977 kW
Project Cost (as reflected on invoice ) :
Customer Payment:
Date:
Customer Information
Account No: 618-99-2750-1 Phone Number:
Project Completion Certification Form - Combined Heat and Power (CHP), Version 2.0
Installation Information
Alternate Phone:
Account Name: Northport VA Medical Center
Facility Address: 79 Middleville Rd., Northport, NY 11768 Application ID :
1/20/2024Installation Completion Date :
Application Type:
(Check all that apply)
System Owner Information
Email: otto.stroh@va.gov Phone Number:
Company Name:
Address:
Northport VA Medical Center
Installed System was Pre-approved:
Installed System Configuration:
Annual Engine Gas/Fuel consumption:
System Efficiency:
Annual Electricity Generation:
Net Full Load Capacity:
Rebate
Final Pre-approved Rebate Amount $720,000.00
$11,491,729
Project is financed.
I, the customer, certify that the equipment listed on the rebate application and identified in the PSEGLI issued pre-approval letter has been purchased and installed at the address indicated on the application. I understand that PSEGLI reserves the right to verify any equipment purchases and installations which may include a site visit. I further understand that
PSEGLI may adjust the incentive amount before issuing the rebate based upon the verification and documentation provided by me or my contractors responsible for the installation of the equipment. PSEGLI may request proof of payment, such as copies of cancelled checks and Customer agrees, by signing below, to furnish such documentation.
Customer Name:
(Print)
Customer Signature:
Customer Verification Statement:
Installed CHP system is in compliance with all local, state and national codes pertaining to the installation, operation, and environmental impact of CHP systems
The customer agrees to provide PSEG Long Island CHP system generation data for up to 24 months after approved final commissioning of the CHP plant
CHP System is Fully Operational:
Interconnection Approval Received:
631-261-4400 ext. 7090
631-933-7305
PAM-2016-34610
79 Middeville Rd. Northport, NY 11768
631-933-7305
New Construction CHP Existing Building CHP
Yes No
Yes No
Yes No
2017v2.0_07132017
2017 Commercial Efficiency Program
Project Completion Certification Form - Combined Heat and Power (CHP), Version 2.0
I, the contractor, certify that the equipment listed on the rebate application and identified in the PSEGLI issued pre-approval letter has been purchased and installed at the address indicated on the application. I understand that PSEGLI reserves the right to verify any equipment purchases or installations which may include a site visit. I further understand that
PSEGLI may adjust the incentive amount before issuing the rebate based upon the verification and documentation provided by me or my contractors responsible for the installation of the equipment.
Project Developer Name:
(Print) Charles E. Puckhaber Jr.
Contractor Verification Statement:
The project developer has provided a 5 year service contract / warranty for the CHP system installed at the facility listed above. Such warranty must extend to the installed equipment.
Project Developer Signature: 2/28/2024
PSEGLI USE
ONLY
Project Number:
PSEGLI USE ONLY
Appl. Version:
The project developer has provided a 5 year service contract / warranty for the CHP system installed at the facility listed above. Such warranty must extend to the installed equipment.
Installed CHP system is in compliance with all local, state and national codes pertaining to the installation, operation, and environmental impact of CHP systems
Project Developer Verification Statement:
I, the project developer, certify that the equipment listed on the rebate application and identified in the PSEGLI issued pre-approval letter has been purchased and installed at the address indicated on the application. I understand that PSEGLI reserves the right to verify any equipment purchases or installations which may include a site visit. I further understand that PSEGLI may adjust the incentive amount before issuing the rebate based upon the verification and documentation provided by me or my contractors responsible for the installation of the equipment.
Installed CHP system is in compliance with all local, state and national codes pertaining to the installation, operation, and environmental impact of CHP systems
Contractor Name:
(Print) Charles E. Puckhaber Jr.
Contractor Signature: 2/28/2024
PCC
| 2024-02-28T16:17:01-0500 | |
| Charles E. Puckhaber Jr. |
| 2024-02-28T16:17:42-0500 | |
| Charles E. Puckhaber Jr. |
File details come from the government source that posted it. Updated .