Attachment A Worksheets CPT14~2.docx

Green Communities Competitive Grant Application Worksheets Please use the following worksheets to assist you in gathering and preparing information required for your Green Communities Competitive Grants application. These worksheets are intended as a guide only. For complete application instructions, including eligibility, required documentation, award limits, and a list of qualified projects, please refer to the program opportunity notice (PON) for the Green Communities Competitive Grant Program, PON-ENE-2026-001. In the event of any inconsistency or conflict between the Worksheets and the PON, the PON will serve as the final source.

These worksheets do not replace the Grant Table. The Grant Table must be completed and uploaded as a separate document with your application.

If you have questions about filling out these worksheets, please reach out to your Regional Coordinator. For questions about the application process or submitting an application, please contact Green.Communities@mass.gov.

Step 1: Complete the Applicant Information (pg. 3)

· Enter the name of the community in the first box

· Check all boxes that apply to the community

· Fill in the contact information for the applicant. If you need to add more contacts, click the blue box that appears in the bottom right corner of the table to add more rows. Click anywhere inside the table for the blue box to appear.

· Based on the worksheets you've completed in this document, fill out the Total Grant Request table. The totals here should be identical to those in the Grant Table spreadsheet completed separately.

Step 2: Choose the worksheet(s) that corresponds to the project(s) you're applying for, as detailed in the PON

· Please be sure to refer to the PON for all required information and documentation

· Supplemental supporting documentation should be uploaded separately with the application.

· DOER reserves the right to deny incomplete applications Step 3: Complete the application

· The Applicant Information page and relevant worksheet(s) should be saved as one document. Unused worksheets should be deleted.

· Refer to Attachment D – Submitting an Application in the PON for information on how to submit the application.

Contents

Applicant Information (required) Enter the name of the Green Community in the box

Please check all that apply:

Grant Contacts

Traditional ECMs

Building Decarbonization

Special Funding

Administrative Funding[footnoteRef:2] [2: Administrative funding cannot exceed ten percent (10%) of the grant amount or ten thousand dollars ($10,000), whichever is greater.]

Total Grant Request

Prescriptive Projects (PON, pg. 8-13) A. Variable Frequency Drives (VFDs) - Installation of VFDs for 3 phase 10hp or less motors (PON, pg. 8) Funding details

· Two thousand four hundred dollars ($2,400) for up to 1HP and then an additional $200/HP above 1HP up to 10HP

· Maximum of four thousand four hundred dollars ($4,400) for 10HP or not to exceed total project cost, including incentives

3. Municipal Personnel Responsible for Project Oversight

4. VFDs Summary Table

5. Short Project Narrative (describe current building conditions, timeline, procurement, future plans for building) Click or tap here to enter text.

6. Cost/Budget

Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Are there any permits required for this project? (Yes/No, please describe)

8. Attachments:

☐ Energy audit or study recommending project.

☐ Specification sheets

B. Walk-in Refrigerator Controls - Walk-in refrigerator and freezer controls including, evaporator fan electronically commutated (EC) motor, and fan/compressor controls.

Funding details

· One thousand six hundred and fifty dollars ($1,650) per evaporator fan motor

· Not to exceed nine thousand nine hundred dollars ($9,900) per walk-in unit, or not to exceed total project cost, including incentives

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

2. Municipal Personnel Responsible for Project Oversight

3. Walk-in Refrigerator Controls Summary Table

4. Short Narrative (describe current building conditions, timeline, procurement, future plans for building)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

6. Are there any permits required for this project? (Yes/No, please describe)

7. Attachments:

Door and Window Weather-Stripping

· Up to twenty-four dollars ($24) per linear feet

· Not to exceed twenty-four thousand dollars ($24,000) per facility (1,000 linear feet).

· Not to exceed total project cost, including incentives

· Excludes attic and wall insulation projects

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Weather Stripping Summary Table

4. Short Narrative (describe current building conditions, timeline, procurement, future plans for building)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

Window Replacements Funding details:

· Support is limited to seventy-fifty dollars ($75) per square foot of the total window area being replaced; or one hundred dollars ($100) per square foot of the total window area being replaced in municipal facilities that benefit EJ Communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses

· Not to exceed fifty thousand dollars ($50,000) per application; or seventy-five thousand ($75,000) per application in municipal facilities that benefit EJ Communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses

· Not to exceed total project cost, including incentives.

· While the maximum U-values of replacement windows are .25 for fixed windows and .30 for operable windows, DOER will prioritize funding the installation of Energy Star ® Most Efficient certified windows for the northern climate zone.

· DOER will prioritize applications for window replacements in buildings that are fully electrified.

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Window Replacements Summary Table

4. Short Narrative (describe current building conditions, timeline, procurement, future plans for building, and EJ Communities and Other Vulnerable Populations enhanced funding request if applicable)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Attachments:

☐ Energy audit or study recommending project.

☐ Photographs of the existing windows ☐ Basic floor plans identifying the specific areas where the windows will be replaced.

☐ Specification sheets, including U-Values

C. Workforce Development - Education and training for existing municipal and/or workers looking to enhance their skills in energy-related technologies.

· Funding is limited to the cost of the training – staff time will not be reimbursed by this grant

· Maximum of three thousand dollars ($3,000) per employee

· Limited to three (3) staff in building or vehicle operations/maintenance departments

· Training examples may include advanced HVAC systems and heat pump maintenance and repair building controls training, Building Operator Certification, electric vehicle maintenance and repair, and electric vehicle station installation and maintenance

· DOER will not fund training for proprietary equipment

· If requesting training for three (3) personnel, at least one must be in school facilities

1. Municipal/School Personnel Responsible for Coordinating Training

2. Municipal/School Personnel Requesting Training

3. Short Narrative (describe how the training will enhance and facilitate existing and proposed new energy conservation measures)

4. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

D. Light-duty Hybrid (HEVs) or Plug-in Hybrid Vehicles (PHEVs) - Purchase or lease of new light-duty (<8,500 lbs. GVWR) HEVs or PHEVs. HEVs must replace an “exempt” gas or diesel vehicle in the municipal fleet. PHEVs must replace a gas or diesel vehicle in the municipal fleet.

· Maximum of five thousand dollars ($5,000) towards the purchase OR three thousand dollars ($3,000) towards the lease

· Not to exceed vehicle purchase/lease cost. All vehicles purchased must remain in the municipal fleet for five (5) years. Leases are for a minimum of three (3) years

· The award limit for this measure is double the standard funding amount for Climate Leader Communities, Specially Eligible, or for projects located at municipal facilities that serve EJ communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses. These increases are not cumulative or stackable for communities meeting multiple special applicant statuses.

· See VEH 110 for the state vehicle contract

1. Municipal Personnel Responsible for Project Oversight

2. Vehicle(s) to be replaced

3. New Light-duty HEV(s) or PHEV(s)

4. Short Narrative (describe project and EJ Communities and Other Vulnerable Populations enhanced funding request if applicable)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

6. Attachments:

☐ AFDC Cost Calculator Printout (https://afdc.energy.gov/calc/)

E. Light-duty Battery Electric Vehicles (BEVs) - Purchase or lease of new light-duty (<8,500 lbs. GVWR) BEVs. BEVs must replace a gas or diesel-powered vehicle in the municipal fleet.

· Maximum of seven thousand five hundred dollars ($7,500) towards the purchase OR five thousand dollars ($5,000) towards the lease

· Not to exceed vehicle purchase/lease cost. All vehicles purchased must remain in the municipal fleet for five (5) years. Leases are for a minimum of three (3) years

· The award limit for this measure is double the standard funding amount for Climate Leader Communities, Specially Eligible, or for projects located at municipal facilities that serve EJ communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses. These increases are not cumulative or stackable for communities meeting multiple special applicant statuses.

· Please note that funding from MassEVIP cannot be combined with funding from Green Communities for vehicles

· See VEH 110 for the state vehicle contract

1. Municipal Personnel Responsible for Project Oversight

3. New Light-duty BEV(s)

4. Short Narrative (describe project and EJ Communities and Other Vulnerable Populations enhanced funding request if applicable)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

F. Medium- or Heavy-duty BEVs - Purchase or lease of new medium- or heavy-duty (>8,500 lbs. GVWR) BEVs. BEVs must replace a gas or diesel-powered vehicle in the municipal fleet.

· Maximum of fifteen thousand dollars ($15,000) towards the purchase OR ten thousand dollars ($10,000) towards the lease

· Not to exceed vehicle purchase/lease cost. All vehicles purchased must remain in the municipal fleet for five (5) years. Leases are for a minimum of three (3) years

· The award limit for this measure is double the standard funding amount for Climate Leader Communities, Specially Eligible, or for projects located at municipal facilities that serve EJ communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses. These increases are not cumulative or stackable for communities meeting multiple special applicant statuses.

· Please note that funding from MassEVIP cannot be combined with funding from Green Communities for a single EV charging station

· See VEH 111 for the state vehicle contract

1. Municipal Personnel Responsible for Project Oversight

3. New Medium- or Heavy-duty BEV(s)

4. Short Narrative (describe project and EJ Communities and Other Vulnerable Populations enhanced funding request if applicable)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

G. Electric Vehicle Charging Stations - Installation of new publicly accessible and/or fleet EV charging stations on municipally owned property.

· Maximum of seven thousand five hundred dollars ($7,500) per charging station. Not to exceed implementation cost less any incentives.

· See VEH 102 for the state contract with EV charging stations

· Equipment must meet MA appliance efficiency standards – visit the State Appliance Standards Database - Homepage

· Please note that funding from MassEVIP cannot be combined with funding from Green Communities for a single EV charging station

1. Municipal Personnel Responsible for Project Oversight

2. Location of Station

3. Short Narrative (describe project)

4. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

5. Attachments:

☐ Confirmation the equipment meets the Massachusetts appliance efficiency standard

H. Battery-powered Lawn Care & Landscaping Equipment - Purchase of new battery-powered lawn equipment for maintaining municipal or school properties.

· Must replace existing fossil-fuel-powered lawn equipment

· Award not to exceed the equipment purchase cost less any incentives

· Retail-Grade Battery-Powered Product Categories

· Lawnmower: up to seventy-five dollars ($75) (battery capacity < 500-watt hours), Leaf blower: up to thirty dollars ($30), String Trimmer: up to thirty dollars ($30), Chainsaw: up to thirty dollars ($30)

· Professional-Grade Product Categories

· Lawnmower or Electric Utility Vehicle: up to three thousand five hundred dollars ($3,500) (battery capacity > 7000-watt hours), Leaf blower: up to one hundred dollars ($100) (battery capacity > 500-watt hours), String Trimmer: up to one hundred dollars ($100) (battery capacity > 500-watt hours), Chainsaw: up to one hundred dollars ($100) (battery capacity > 500-watt hours)

· Must apply for MassSave or other utility incentives if available

· The award limit for this measure is double the standard funding amount for Climate Leader Communities, Specially Eligible, or for projects located at municipal facilities that serve EJ communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses. These increases are not cumulative or stackable for communities meeting multiple special applicant statuses.

1. Municipal Personnel Responsible for Project Oversight

2. Equipment to be replaced

3. New Medium- or Heavy-duty BEV(s)

4. Short Narrative (describe project and EJ Communities and Other Vulnerable Populations enhanced funding request if applicable)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

LED Lighting Funding details:

· Funding for lighting retrofits and replacement projects is limited to $1.00 per kilowatt-hour (kWh) of the electricity savings estimated for the first 12 months. This limit increases to $1.20/kWh for projects in municipal facilities that benefit EJ Communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses.

· LED retrofit/replacement must include controls (e.g. dimmers, timers, motion/daylight sensors, etc.) or already have controls in place.

· LED retrofit/replacements must be either:

1. whole fixture replacements of existing lamps and ballasts.

2. retrofit kits with internal drivers for non-linear and specialty lighting fixtures; or

3. Type C TLED lamp replacements with compatible external LED drivers.

· Daylighting – for existing, high-efficiency interior lighting

· Not to exceed total project cost, including incentives.

1. Municipal Personnel Responsible for Project Oversight

2. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Lighting Replacements Summary Table

Annual kWh

4. Short Narrative (describe project, proposed, or already installed, lighting control equipment and EJ Communities and Other Vulnerable Populations enhanced funding request if applicable)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

☐ The audit recommending the proposed measure(s) including the estimated costs, savings, and hours of operation.

☐ Room-by-room lighting inventory including the number and wattage of the existing lights and hours of operation. Wattage and cost of proposed replacement lights ☐ Specification sheets of proposed lighting products and controls

LED Streetlights Funding details:

· Funding for lighting retrofits and replacement projects is limited to $1.00 per kilowatt-hour (kWh) of the electricity savings estimated for the first 12 months. This limit increases to $1.20/kWh for projects in municipal facilities that benefit EJ Communities and Other Vulnerable Populations per Section 1.B Award Levels, Limits, & Applicant Statuses.

· LED streetlights must be controls-ready (7-pin).

· The municipality must own, or be in the process of purchasing, the streetlights.

· Not to exceed total project cost, including incentives.

1. Municipal Personnel Responsible for Project Oversight

2. Streetlights Replacements Summary Table

Annual kWh

3. Short Narrative (describe project, proposed, or already installed, lighting control equipment and EJ Communities and Other Vulnerable Populations enhanced funding request, if applicable)

4. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

5. Attachments:

☐ The audit recommending the proposed measure(s) including the estimated costs, savings, and hours of operation ☐ Lighting inventory including the number and wattage of the existing lights and hours of operation. Wattage and cost of proposed replacement lights.

☐ Specification sheets of proposed lighting products and controls ☐ Email or letter of support from the utility

I.

Energy Conservation Measure in Existing Buildings (PON pp. 13-17)

1. Building Envelope Improvements Funding details

· Storm windows, window inserts, insulation, and air sealing

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Building Envelope Summary (please list each measure separately, add more rows if necessary) Facility Name and Measure (e.g. Town Hall – Attic Insulation) Existing Condition (e.g. fiberglass batt R-20) Proposed Condition (e.g. blown-in cellulose R-60) Funding Request

4. Narrative (describe current building conditions, timeline, procurement, future plans for building)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Attachments:

☐ An assessment recommending the proposed measure(s) including the estimated costs and savings.

☐ Photographs and descriptions of the existing conditions ☐ Existing and proposed R-values and/or U-values ☐ Calculations listing all assumptions for projected energy savings and costs.

☐ Mass Save weatherization calculation spreadsheet with the application, if applicable ☐ Basic floor plans identifying the specific areas within the building where the building envelope improvements will take place.

☐ Specification sheets, if applicable

1. Heating, Ventilation, and Air Conditioning (HVAC) Equipment -

Heat pumps, energy recovery ventilation, repair and/or replacement of non-heating HVAC equipment and controls, hybrid RTUs and infrared heaters (see PON)

· HVAC projects must meet required building energy improvements (see PON pg. 14)

· Projects that retain fossil-fuel heating systems as a backup source are allowed but must include integrated controls. New backup fossil-fuel heating systems are ineligible for funding, aside from infrared heaters for garages and hybrid RTUs. Projects that fully replace fossil-fuel heating systems are prioritized

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. HVAC Summary (please list each measure separately, add more rows if necessary) Facility Name

Existing Condition (e.g. Oil Boiler) Proposed Condition (e.g. Ground Source Heat Pump) Funding Request

4. Narrative - At a minimum the narrative should include: a) the current condition of the building; b) any improvements that have been or will be made to the building envelope (PON pg. 14); c) a detailed description of the existing HVAC system and the proposed replacement; d) the anticipated project implementation timeline; d) the rationale for selecting the proposed system, referencing any relevant studies or assessments; e) confirmation the existing or planned upgrade of the electrical service is sufficient to support the proposed system; f) the planned procurement process; g) the long-term plans for the building

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Attachments:

☐ The audit recommending the proposed measure(s) including the estimated costs and savings. The audit of the proposed measure must also contain an evaluation from a qualified contractor or electrician assessing that the building’s electrical supply is adequate for the requested equipment.

☐ Documentation that one of the four options for meeting the building envelope improvements is met. Documentation can be an audit, study, or past invoices confirming weatherization work.

☐ For projects that retain fossil-fuel heating systems as a backup source, please include verification of integrated controls and information on the switchover temperature.

1. Water Heaters - Air-source heat pump water heaters, solar thermal, or tankless electric.

Funding details

· Water heaters using fossil fuels are ineligible

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Water Heater Summary (please list each measure separately) Facility Name

Existing Condition (e.g. Natural Gas, 100-gallon) Proposed Condition (e.g. Heat Pump, 125-gallon) Funding Request

4. Narrative - At a minimum the narrative should: a) a description of the existing water heater system (make/model/year) and the proposed replacement; b) the anticipated project implementation timeline; c) the rationale for selecting the proposed system, referencing any relevant studies or assessments; d) confirmation the existing or planned upgrade of the electrical service is sufficient to support the proposed system; e) the planned procurement process.

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Attachments:

☐ The audit recommending the proposed measure(s) including the estimated costs and savings. The audit of the proposed measure must also contain an evaluation from a qualified contractor or electrician assessing that the building’s electrical supply is adequate for the requested equipment.

☐ A description, including make and manufacturer, of the facility’s existing and proposed water heater.

1. Building Controls Systems

- Building control systems, also known as Building Automation Systems (BAS), Energy Management Systems (EMS), or Building Management Systems (BMS) Funding details:

· The building controls system and communication protocol must be open-source and allow communication with other vendors’ control systems. Technicians, beyond the proposed vendor, should be able to install updates and revisions to the system.

· The building controls system’s remote-control units and transducers must be interchangeable with the main building control units from other vendors.

· Project applications shall include training procedures. Training must cover operations, emergencies, adjustments, troubleshooting, maintenance, and repairs.

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Building Controls Summary (please list each measure separately)

4. Narrative - At a minimum the narrative should: a) a description of the building controls system (manufacturer/model) and the proposed replacement; b) number of data points requested; c) systems and equipment to be monitored and/or controlled; d) the anticipated project implementation timeline; e) the rationale for selecting the proposed system, referencing any relevant studies or assessments; f) the proposed systems communication protocol (e.g., BACnet); g) the planned procurement process; h) the training proposal from the vendor or manufacturer including the municipal and/or school personnel to be trained to operate the building controls.

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Attachments:

· The audit recommending the proposed measure(s) including the estimated costs and savings.

The following materials are recommended to be included in the application, but not required:

☐ Operations and Maintenance manuals ☐ As-built control drawing package ☐ Graphical user interface ☐ As-built control sequences ☐ Maintenance service agreements, state of warranty date, and similar continuing commitments

1. Retro-commissioning

· Square footage (must be a minimum of 20,000 square feet)

· Priority is given to buildings with EUIs between fifty (50) and one hundred and twenty (120)

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Building Controls Summary (please list each measure separately)

4. Narrative - At a minimum the narrative should include: a) a brief description of the building and the HVAC system (central plant as well as distribution systems for both heating and cooling); b) controls system description, including brand, age, and date of last software update; c) a list of major equipment, including number and age of each type; d) a brief history of any facility renovations, retrofits, and equipment replacements; e) the anticipated project implementation timeline; f) a commitment to implement cost-effective retro-commissioning measures identified; g) the rationale for selecting the proposed system, referencing any relevant studies or assessments; h) the planned procurement process

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

☐ The audit recommending the proposed measure(s) including the estimated costs and savings.

1. Pumps, Motors, and Drives

· Installation of VFDs over 10hp

3. Municipal Personnel Responsible for Project Oversight

4. VFDs Summary Table

5. Short Project Narrative (describe current building conditions, timeline, procurement, future plans for building)

6. Cost/Budget

Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

8. Attachments:

1. Battery Energy Storage Systems (BESS)

· BESS technologies that enable municipal facilities to mitigate demand charges and/or regional network service and installed capacity charges.

3. Municipal Personnel Responsible for Project Oversight

4. BESS Summary Table

5. Narrative - At a minimum the narrative should include: a) current building conditions; b) the anticipated project implementation timeline; c) the planned procurement process; d) future plans for the building; e) if the BESS is paired with existing municipally owned solar PV identify system location and size; f) if the BESS is paired with a new solar PV installation provide information on the solar PV system as appropriate; g) if onsite energy generation is available (e.g. solar PV, CHP, etc.), indicate whether the BESS is configured in such a way as to enable those resources to continue to provide power to the facility in the case of an outage

6. Cost/Budget

Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

8. Attachments:

☐ A copy of a recent bill showing demand charges ☐ Interval data for the proposed facility (if exists)

1. Repairs of Existing Renewable Energy Systems

- Awards can be used to maintain or repair behind-the-meter renewable energy systems that are inoperable or malfunctioning. Systems must be owned by the municipality and tracked in MassEnergyInsight.

Funding details

· Repairs or replacement of the system’s critical components that restore equipment to its original production levels (e.g. inverter repair or replacement, production tracking system repair or replacement, replacing damaged PV panels, repairing wiring or mounting systems, etc.)

3. Municipal Personnel Responsible for Project Oversight

4. Renewable Repairs Summary Table

5. Narrative - At a minimum the narrative should include: a) current building conditions; b) the anticipated project implementation timeline; c) the planned procurement process; d) future plans for the building; e) description of the original renewable energy system; f) the current malfunctioning situation and its impact on energy production; g) the specific repairs or replacements needed for the renewable energy system to function properly.

6. Cost/Budget

Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

8. Attachments:

☐ Cost estimates and a quote for the repairs/replacements.

☐ Specification sheets, if applicable.

1. Commercial Refrigeration

Energy Star-rated Commercial Refrigeration – (see prescriptive measures listed in Section 2 for walk-in refrigerator and freezer controls). This category can include case motor replacement, cooler night covers, door heater controls, electronic defrost controls, or novelty cooler shutoff.

1. Facility Name(s) (from MassEnergyInsight) and Address(es)

3. Commercial Refrigeration Summary Table

4. Short Narrative (describe current building conditions, timeline, procurement, future plans for building)

5. Cost/Budget Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

7. Attachments:

Building Decarbonization Project Please refer to the PON for full details on Building Decarbonization projects.

1. Before proceeding with the application, please confirm your understanding or confirmation of the following:

☐ The project being proposed can be completed within three years of the grant contract execution.

☐ Communities applying for a building decarbonization grant cannot apply for other projects in this PON.

☐ Communities receiving decarbonization grant awardees under this PON will be ineligible to apply for competitive grants for two years after the award.

2. Application will benefit EJ Communities and Other Vulnerable Populations (see PON for more details) ☐ Yes ☐ No

3. Facility Name(s) (from MassEnergyInsight) and Address(es)

4. Municipal Personnel Responsible for Project Oversight

5. Building Decarbonization Summary (please list measures separately) Facility Name

Existing Conditions

Proposed Conditions (e.g. HVAC, insulation, air sealing) Funding Request

6. Detailed Narrative - At a minimum the narrative should include: a) a description of the current condition of the building (Age of building, size of conditioned space, EUI, operating hours, building envelope description); b) any improvements that have been or will be made to the building envelope; c) a detailed description of the existing HVAC system and the proposed replacement: d) a description of the proposed controls system; e) the anticipated project implementation timeline: f) the rationale for selecting the proposed system, referencing any relevant studies or assessments; g) confirmation the existing or planned upgrade of the electrical service is sufficient to support the proposed system; h) the planned procurement process; i) the long-term plans for the building; j) how project will benefit EJ Communities and/or Other Vulnerable Populations (if applicable)

7. Cost/Budget Grant Request

Utility Incentive

Municipal Funds (25%, or 10% EJ/vulnerable populations based on the total project cost minus utility incentives and other grants)

Other (describe in narrative)

Total Project Cost

8. Are there any permits required for this project? (Yes/No, please describe)

9. Attachments:

☐ Utility rebate ☐ A letter from the municipality’s CEO committing a minimum of twenty-five percent (25%) or ten percent (10%) of local matching funds toward the project ☐ Specification sheets ☐ The audit recommending the proposed measure(s) including the estimated costs and savings. The audit of the proposed measure must also contain an evaluation from a qualified contractor or electrician assessing that the building’s electrical supply is adequate for the requested equipment.

☐ Engineering plans and drawings ☐ Existing and proposed building carbon (GHG) emissions intensity, (CO2e per square foot) ☐ Proportion of building thermal load being addressed.

☐ Commissioning plans for the requested equipment.

☐ Detailed project cost estimates.

Special Funding Project (For Specially eligible and Climate Leader Communities ONLY) Please refer to the PON for full details on Special Funding projects.

1. Projects at facilities not in the applicant’s Green Community baseline Energy efficiency projects, which are included in the list of qualified projects, at a facility not included in the municipality’s baseline but in a district associated with the municipality, such as a regional school district, a water district, or a wastewater district.

** For specially eligible Green Communities applying for projects at facilities that are not included in your Green Community baseline, please refer to the specific worksheet for that project type. Within the narrative section of this worksheet, clearly state that the project is at facilities not in your Green Community baseline.

1. Other innovative clean energy projects Applicants may apply for other innovative energy and emission-saving projects, provided they meet all competitive grant eligibility requirements. Applicants must contact their Green Communities Regional Coordinator to discuss potential proposals.

** For specially eligible Green Communities applying “other innovative clean energy projects”, please contact your Green Communities Regional Coordinator early in the grant application process.

1. Community outreach programs

- Community outreach programs to promote existing residential and/or commercial energy efficiency programs, such as MassSave, including supplemental grant programs; and/or to promote other clean energy initiatives such as community-shared solar, Solarize, or HeatSmart.

Funding details:

· Awards are capped at twenty-five thousand dollars ($25,000) for municipalities with populations under thirty-five thousand and fifty thousand dollars ($50,000) for municipalities with populations over thirty-five thousand.

1. Municipal Personnel Responsible for Project Oversight

2. Community Project Partner(s)

3. Project Partner(s) – if applicable

4. Detailed Narrative -- At a minimum the narrative should include: a) a brief summary of project including outcomes; b) what specifically will grant funds be used for; c) what population in your municipality will benefit from project and how will they benefit; d) the rationale for selecting the population noted in (c) above; e) proposed tasks and implementation timelines; f) outreach/education methods and materials; g) proposed budget; h) measurement and verification methodology of clean energy results

5. Simple Cost/Budget (please include an itemized budget as an attachment) Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

☐ Itemized budget ☐ Qualifications of person(s) completing the work – please attach resume(s) ☐ Memorandum(s) of Agreement with partners ☐ Letters of support

1. Solar PV for facilities already electrified

- Onsite solar PV systems providing electricity to a municipal facility heated with cold-climate heat pumps. Grants may not be used for project elements that are not directly associated with the solar project (e.g., roof replacement). Grant funds, regardless of system ownership, can only be used for costs associated with the deployment of new solar PV.

Funding details:

· Eligible costs include but may not be limited to:

· Solar panels and related equipment procurement, including balance of system materials such as inverters, controllers, and wiring.

· Related structural systems procurement, including steel.

· Interconnection and permitting costs.

· Commencement of construction (site prep) or installation.

· Award not to exceed project costs less any incentives.

· See PON for funding limits

1. Municipal Personnel Responsible for Project Oversight

2. Renewable Repairs Summary Table

3. Detailed Narrative – At a minimum the narrative should include: a) a description of current building conditions (Age of building, size of conditioned space, EUI, operating hours, building envelope description); b) confirmation building is electrified; c) implementation timeline; d) procurement process; e) future plans for the building; f) description of the proposed PV system; g) description of roof age and confirmation of its structural integrity to support solar equipment

4. Simple Cost/Budget (please include an itemized budget as an attachment) Grant Request

Utility Incentive

Community Funds

Other (describe in narrative)

Total Project Cost

5. The application must include:

☐ Documentation that illustrates a clear plan for moving the project forward including a detailed project proposal and utility interconnection application, or a proposed project schedule.

☐ Site assessment (Google Earth maps or NREL's PV Watts can provide assessment information) ☐ The site’s suitability score as defined by DOER’s Technical Potential for Solar Study ☐ Include documentation confirming structural integrity to support solar equipment.

☐ Visuals that demonstrate solar access. Images should clearly show any HVAC equipment, trees, structures that cause shading.

☐ Bid documentation.

If applicable:

☐ Signed memorandum of understanding or a letter of intent between the applicant and the solar developer demonstrating intent to proceed with the project (power purchase agreements).

☐ Proof of submission to the SMART program ☐ Preliminary SMART statement of qualification (SOQ)

Administrative Funding Funding Details Justification for any funds to be used for administrative costs; this MUST be provided. In no case shall more than 10 percent of the grant award (or $10,000, whichever is higher) be used to fund administrative costs.

1. Administrative Personnel Information

2. Funding Request $$

3. Justification Statement (identify the specific roles and responsibilities of each of administrative personnel and why administrative funding is needed for this project)

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