ORGANIZATIONAL INFORMATION

PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS:

• Indicate your organizational status: Private, non-profit – 501(c)3 Government Private, for profit Other Please select
  If Other, please explain:
   
• Provide your ten-digit Xcel Energy account number located on your energy bill. This will help us evaluate your energy use and to assess where energy saving opportunities exist at your facility.
   
• What is your annual utility cost (broken out by fuel type)?

  Electric: $	Do not know	Electric Provider:
  Natural Gas: $	Do not know	Natural Gas Provider:

• Who is responsible for paying utilities? Organization Please select Both Residents
   
• Does your organization have at least two years of utility consumption data (i.e., energy bills) available?
  Yes No Please select
  
  If yes, please provide that information to Energy Outreach Colorado with your hard-copy attachments.
  If no, please contact Xcel Energy and obtain that information. You may contact us with questions about this process.
   
• Your organization: Owns the facility Short-term/rents the facility Please select Has a long-term lease for the facility
   
• How old is your facility?
   
• What is the total square footage of your facility (including the basement):
   
• How many housing units does your facility have (if applicable)?
   
• Total number of floors in facility (including the basement):
   
• Is your facility (check all that apply):
  Multi-family construction
  Single-family construction
  Commercial/Industrial construction
   
• Please briefly describe what services your organization provides:
  
   
• Briefly describe, on average, how many hours of service your organization provides per week (general hours of operation) and indicate if your hours of operation are consistent throughout the year, or if your services are seasonal:
  
   
• Your organization provides the following services: (check all that apply):
  Laundry
  Showers
  Kitchen/Cooking
  Refrigeration
  Exterior Lighting
  Office Space (computers, copiers, etc.)
  Other that impact energy consumption – please explain:
   
• Briefly explain the population that your organization serves:
  
   
• Has your facility received any significant energy efficiency work on it in the last ten years? Yes No Please select
  
  If yes, please briefly explain the type of energy efficiency work that has been conducted on your facility:
  
   
• Is your facility registered as a “historical” structure that might limit the NEEP team’s ability to change things, such as windows?
  Yes No Please select
   
• How long does your organization intend to remain at the location?
   
• Has your organization conducted an energy audit on your facility in the last 5 years?
  Yes No Please select
  
  If yes, please provide that information to Energy Outreach Colorado with your hard-copy attachments.
   
• Will the NEEP team have access to your entire building to conduct an energy audit if/when necessary?
  Yes No Please select
   
• Does your organization have a facilities manager, or someone knowledgeable about the building’s operations, who will be available as needed for the NEEP team regarding your facility?
  Yes No Please select
   

  Facility Contact First Name:
  Facility Contact Last Name:
  Title:
  E-mail:		Phone Number:

• If chosen as a NEEP facility, will you comply with the needs of the contractors to do the install and upgrades?
  Yes No Please select
   
• Please describe what impact has rising energy costs had on your operations?
  
   
• Please describe in detail any ‘symptoms’ that your facility has that it is in need of energy efficiency work including but not limited to:
  • Comfort level of facility, including noise pollution, air quality, hot and cold rooms (indicators may include windows open in the winter, the need for space heaters, clients wearing coats indoors, etc.) When discussing problems with specific rooms please include what the rooms are used for and who uses them
  • Overall health of residents/staff members
  • Other issues that may be related to efficiency of building (food freezing in refrigerator or melting in freezer, mold/mildew, vermin, etc)
  • Typical complaints received from clients or staff