Industrial Symbiosis Grant 2024 Application.docx

Industrial Symbiosis Program Grant Application Administered by the Washington State Department of Commerce, Office of Economic Development and Competitiveness

Applications DUE: November 1, 2024 at 5:00 PM PST

Summary Data

Applicant Name (in box below)

Company Name

Company Address

State & Zip Code

City & County

Company Website

Please provide three (3) business-related references

Contact Name/Company:

Phone/Email:

Business Relationship:

Contact Name/Company:

Phone/Email:

Business Relationship:

Contact Name/Company:

Phone/Email:

Business Relationship:

Project Summary

Project Location (type in box below)

Proposed Project Type

☐ Expansion of existing process and efforts ☐ Implementation of a new project ☐ Research and development into new areas and technologies ☐ Other

Briefly summarize the proposed project and how it will advance the reduction, reuse, or elimination of industrial waste to benefit Washington’s circular economy.

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[word limit: 100]

Which of the following categories apply to the proposed project:

☐ Waste heat reuse ☐ Agriculture ☐ Bioenergy ☐ Forestry ☐ Utilities ☐ Built environment waste ☐ Food waste ☐ Waste plastics ☐ Waste glass ☐ Facilitation and assessments ☐ Other [explain]_________________________________________

What type and quantity of direct full-time equivalent (FTE) jobs are anticipated to be created?

Professional: __ Technical/Skilled: __ Semi-skilled: __ Unskilled: __ Total new FTEs: __

Qualifications

Status of primary Applicant’s business entity

☐ Private business ☐ Non-profit organization ☐ Tribal Nations ☐ Public/Government agency ☐ Other: Click or tap here to enter text.

Uniform Business Identifier (UBI) number, if applicable: Click or tap here to enter text.

Statewide Vendor Number (SWV), if applicable: Click or tap here to enter text.

Applicant’s business entity type (e.g. corporation, government agency, sole proprietor, LLC, non-profit)

Year of legal establishment of business entity

Funding Timeline

If selected, does Applicant agree to the timeline to receive a funding award on or around November 22, 2024? Project expenses may not be incurred prior to full execution of the contract.

☐ Yes ☐ No

If selected, does Applicant agree to utilize funds and complete performance on described project’s scope of work by June 30, 2025?

☐ Yes ☐ No

Funding Request

Total amount of grant funding requested within this application (type in box below)

$ Click or tap here to enter text.

Commerce intends to issue multiple grant awards within a range of $150,000.00 to $500,000.00 per applicant. Proposals in excess of this amount will be considered non-responsive and will not be evaluated. In the event additional funding becomes available during the period of performance, any contract awarded may be amended to provide for additional related services. Additional funding is not guaranteed.

Has Applicant previously applied for funding through Commerce?

☐ Yes

What is the primary purpose/intended use for the funds being requested? (type in box below)

Equipment is not an allowable expense within this program.

Project General Budget (attach a separate table for expanded space, as needed)

Describe any additional funding sources related to this project (private investment, incentives, matching funds, etc.)

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Technical Proposal

Scoring of all applications will be based on criteria outlined in the Program Guidelines

Project Approach/Methodology:

Provide a complete description of the proposed business approach and methodology for the project. Attach separate page for expanded space, as needed.

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[Word limit: 500]

Work Plan:

Provide all project requirements and proposed tasks, services, activities, subcontractor needs, etc. necessary to accomplish the scope of the project described in this application. Attach separate page for expanded space, as needed.

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Project Schedule:

Include a schedule indicating the timeline for project milestones and deliverables. Attach separate page for expanded space, as needed.

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Outcomes and Performance Measurement:

Describe the anticipated impact and outcomes from this project and how these will be monitored, measured, and reported to Commerce. Highlight how the outcomes will advance broader Industrial Symbiosis Program goals in Washington. Attach separate page for expanded space, as needed.

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Risks:

Identify and list potential risks considered significant to the success of the project, and include how Applicant will effectively mitigate, monitor and manage these risks. Attach separate page for expanded space, as needed.

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Deliverables:

Provide details of the project deliverables resulting from the proposed scope of work as it relates to grant funding expenditures. Attach separate page for expanded space, as needed.

Management Proposal

Scoring will be based on the criteria outlined in the Program Guidelines

Structure and Internal Controls:

Provide overview of the proposed project team structure and internal controls to be used throughout the project. Please detail prime responsibility level and final authority for the work. Attach separate page for expanded space, as needed.

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Skills and Qualifications:

Provide details about the team members’ skills and qualifications to perform the proposed scope of work. Attach separate page for expanded space, as needed.

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Has the Applicant had a contract terminated for default in the last five years?

☐ Yes If so, please explain this situation: Click or tap here to enter text.

Environmental Health Disparities

Scoring will be based on the criteria outlined in the Program Guidelines

Use the Washington Environmental Health Disparities Map to identify the applicant’s project location. Describe how applicant’s project can benefit surrounding communities and will reduce environmental health disparities. For a research and development project, describe how the project will accomplish this goal once the technology is commercialized. (type in box below)

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Authorized Official’s Signature

To the best of my knowledge, I certify all data and information in this application is true, accurate and correct.

Authorized Signatory Name - Title - Date (in box below)

Diverse Business Inclusion Plan Form

Proposers are required to submit a Diverse Business Inclusion Plan with their Proposal describing in good faith their aspirational goals for subcontractor types. In accordance with legislative findings and policies set forth in RCW 39.19, the state of Washington encourages participation in all contracts by firms certified by the Office of Minority and Women’s Business Enterprises (OMWBE), set forth in RCW 43.60A.200 for firms certified by the Washington State Department of Veterans Affairs, and set forth in RCW 39.26.005 for firms that are Washington Small Businesses. No minimum level of minority- or women-owned business, Washington Small Businesses, or Washington State certified Veteran Business participation is required as a condition for receiving an award. Any affirmative action requirements set forth in any federal governmental rules included or referenced in the contract documents will apply.

COMMERCE has the following agency goals:

· 10% participation by Minority Owned Business

· 6% participation by Women Owned Business

· 5% participation by Veteran Owned Business

· 5% participation by Small Businesses

If awarded a contract as a result of this application:

Do you anticipate subcontracting* with State Certified Minority Businesses? ☐ Yes ☐ No Do you anticipate subcontracting with State Certified Women’s Businesses? ☐ Yes ☐ No Do you anticipate subcontracting with State Certified Veteran Businesses? ☐ Yes ☐ No Do you anticipate subcontracting with Washington State Small Businesses? ☐ Yes ☐ No

Proposer’s Goals:

Please list the approximate percentage of work to be accomplished by each subcontractor type:

If you plan to subcontract and answered ‘No’ to all questions above, please explain:

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☐ I/We do not plan to subcontract any of the work described in this RFP.

Please identify the person in your organization who will manage your Diverse Business Inclusion Plan related to this project:

Name: __________________ Title: __________________ Phone: __________________ E-Mail: __________________

* Please note that subcontracting must be done in accordance with contractual terms and conditions which may include specific subcontractor selection requirements. Do not select subcontractors until you have reviewed all applicable requirements.

Certifications and Assurances Form

I/we make the following certifications and assurances as a required element of the Proposal to which it is attached, understanding that the truthfulness of the facts affirmed here and the continuing compliance with these requirements are conditions precedent to the award or continuation of the related contract:

1. I/we declare that all answers and statements made in the Application are true and correct.

2. The prices and/or cost data have been determined independently, without consultation, communication, or agreement with others for the purpose of restricting competition. However, I/we may freely join with other persons or organizations for the purpose of presenting a single application.

3. The attached Proposal is a firm offer for a period of 60 days following receipt, and it may be accepted by COMMERCE without further negotiation (except where obviously required by lack of certainty in key terms) at any time within the 60-day period.

4. In preparing this Application, I/we have not been assisted by any current or former employee of the state of Washington whose duties relate (or did relate) to this RFP or prospective contract, and who was assisting in other than his or her official, public capacity. If there are exceptions to these assurances, I/we have described them in full detail on a separate page attached to this document.

5. I/we understand that COMMERCE will not reimburse me/us for any costs incurred in the preparation of this Proposal. All Applications become the property of COMMERCE, and I/we claim no proprietary right to the ideas, writings, items, or samples, unless so stated in this Application.

6. Unless otherwise required by law, the prices and/or cost data which have been submitted have not been knowingly disclosed by the Applicant and will not be knowingly disclosed by him/her prior to opening, directly or indirectly, to any other Applicant or to any competitor.

7. I/we agree that submission of the attached Application constitutes acceptance of the Application Guidelines contents and the attached example contract and general terms and conditions. If there are any proposed edits to these terms, I/we have described those edits in detail on a page attached to this document.

8. No attempt has been made or will be made by the Applicant to induce any other person or organization to submit or not to submit an Application for the purpose of restricting competition.

9. I/we grant COMMERCE the right to contact references and any others who may have pertinent information regarding the ability of the Applicant and the lead staff person to perform the services contemplated in this Application.

10. If any staff member(s) who will perform work on this contract has retired from the state of Washington under the provisions of the 2008 Early Retirement Factors legislation, his/her name(s) is noted on a separately attached page.

11. I/we are not debarred from doing business with the state of Washington or the United States.

I/We have reviewed the Contract and General Terms and Conditions and I/we: (check one) ☐ are submitting proposed contract edits. If proposed contract edits are being submitted for consideration, I/we have attached them to this form. (See Section 2.14) ☐ are not submitting proposed contract edits. (Default if neither are checked)

Applicant Signature & Date

Printed Name & Title

Contractor Certification Form

EXECUTIVE ORDER 18-03 – WORKERS’ RIGHTS

WASHINGTON STATE GOODS & SERVICES CONTRACTS

Pursuant to the Washington State Governor’s Executive Order 18-03 dated June 12, 2018, the Washington Department of Commerce is seeking to contract with qualified organizations which certify that their employees are not, as a condition of employment, subject to mandatory individual arbitration clauses and class or collective action waivers.

I hereby certify, on behalf of the organization identified below, as follows (check one and sign below):

☐ NO MANDATORY INDIVIDUAL ARBITRATION CLAUSES AND CLASS OR COLLECTIVE ACTION WAIVERS FOR EMPLOYEES. This organization does NOT require its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waivers.

OR

☐ MANDATORY INDIVIDUAL ARBITRATION CLAUSES AND CLASS OR COLLECTIVE ACTION WAIVERS FOR EMPLOYEES. This organization requires its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waivers.

OR

☐ This organization certifies it has no employees.

I hereby certify, under penalty of perjury under the laws of the state of Washington, that the certifications herein are true and correct and that I am authorized to make these certifications on behalf of the organization listed herein.

Name: ___________________________________________________________________________________ Print full legal name of organization

Printed Name Print city and state where signed

Small or Veteran-Owned Business Certification Form

Small Business ☐ By checking this box and signing below I/we hereby certify under penalty of perjury that the business represented in this Proposal is a Washington business including a sole proprietorship, corporation, partnership, or other legal entity, that is:

(a) Owned and operated independently from all other businesses and has either:

(i) Fifty or fewer employees; or

(ii) A gross revenue of less than seven million dollars annually as reported on its federal income tax return or its return filed with the department of revenue over the previous three consecutive years; or

(b) Is certified with the Office of Women and Minority Business Enterprises under chapter 39.19 RCW. I/we are including a copy of the certification.

Veteran-Owned Business ☐ By checking this box and signing below, I/we certify the business represented in this Proposal is certified by the Washington Department of Veteran Affairs. I/we are including a copy of the certification.

Failure to return or sign this Exhibit, or failure to check an applicable box, may result in failure to qualify as a responsive and responsible Small or Veteran-Owned Business.

Failure to include a copy of the relevant certification may result in failure to qualify as a responsive and responsible Small or Veteran-Owned Business.

Additional Representation The following answers (or lack of answers) is not required nor scored and will not impact the outcome of this application. This information helps Commerce monitor our level of success in meeting our diverse contracting goals.

For informational purposes only, the business represented in this Proposal is:

☐ Certified Woman-Owned by the Office of Women and Minority Business Enterprises ☐ Certified Minority-Owned by the Office of Women and Minority Business Enterprises

Applicant Signature & Date

Printed Name & Title

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