WV Energy Efficiency Impact Grant

Name of Applicant:*

Business Legal Name:*

Tax Identification Number:*

Address:*

Email:*

Phone:*

Area CodePhone Number

Business Establishment Date: *

MonthDayYear

Type of Business:*

Sole ProprietorPartnershipLLCCorporation

***Following are not eligible: home-based businesses, churches, non-profit organizations, banks and financial institutions, investment real-estate entities, and government agencies.

Grant Amount Requested:*

***Applicants may request between $1-$3,000 for their project. Please note funds may ONLY be used for installation of insulation, installation of energy efficient lighting, HVAC upgrades (to existing systems), weather sealing, and the purchase and installation of ENERGY STAR appliances (includes but not limited to, furnaces and air conditioners), per U.S. Department of Energy guidelines.

Do you consent to completing a virtual energy audit of your business?

YesNo

Intended use of funds:

***Results from the virtual energy audit will help to best determine the most beneficial energy efficiency upgrades for your business. The audit results are merely suggestions and not required. You may use the funds on any of the eligible activities listed above.

Business Annual Sales/Income based on 2019:*

Business Expenses for 2019:*

Net Income/Loss for 2019: (if negative note that here and fill in next area):*

If negative amount, please fill in here:

Number of Current Employees:*

Requirements:

Business must be licensed, and a copy of that license attached to your submitted application.
Proof that taxes are current for the county in which your business resides.
Businesses must be in a good standing with the State of West Virginia.
JCDA members of the Board of Directors are ineligible.
The selection committee’s decision will be final.
Money must be expended within 12 months of the award.

I am of record, the authorized owner/representative given the authority to sign this document and act on behalf of the entity identified.

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for the benefits.

I agree to cooperate fully with the Jackson County Development Authority and West Virginia Office of Energy, or authorized agents with these organizations, to review expenditures to the use of the funds.

I hereby agree to indemnify and hold harmless the Jackson County Development Authority and West Virginia Office of Energy, it’s Board Members and/or agents from and against any and all claims, demands, or causes of action of any kind or nature in connection herewith.

Upload a File:

Browse Files

Authorized Agent:*

Title:*

Date*

MonthDayYear

Authorized Agent

The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity enforceability and admissibility.