Energy Efficiency and Conservation Block Grant Project Application

Energy Efficiency and Conservation Block Grant Project Application

KY Office of Energy Policy requests project submissions from small municipalities throughout the state.
Grantee Information
Local Government Agency:
What Community Does Your Agency Serve:
Agency Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County:
UEI #:
Authorized Applicant's Contact Information:
Name:

First NameLast Name
Title:
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Project Information
OEP is soliciting energy conservation projects in the range of $500,000 to $1,000,000. The types of projects have been restricted to the following categories. Please select the category that your proposed project would fall under (for more detailed description of the categories, please see the attached PDF):

Energy Efficiency and Conservation Programs for Buildings and FacilitiesEnergy Distribution TechnologiesMaterial Conservation ProgramsReplacement of Traffic Signals and Street LightingOn-site Renewable Energy On or In a Government BuildingProjects that reduce, capture, or use methane and other greenhouse gasses generated by landfills
Is your proposed project in an area that was impacted by the December 2021 tornadoes or the 2022 flooding in Eastern Kentucky?

YesNo
The federal government recognizes census tracts that are overburdened and underserved as Disadvantaged Communites (DAC). See the Climate and Economic Justice Screening Tool map for more information and to see if your project's location falls into one of these areas.
Is your proposed project located in a Disadvantaged Community (DAC), as defined by the Climate and Economic Justice Screening Tool?

YesNo
Project Title:
Amount Requested:
Total Project Cost:
Start Date:

MonthDayYear
Date
End Date:

MonthDayYear
Date
Scope of Work
Provide a description of your proposed project, including proposed project activities, needs addressed, community benefits, and a brief justification for funding.
What is the estimated timeline to complete your project? Include milestones.
Metrics
Estimated annual energy savings from proposed project (kWh):
Estimated annual energy savings ($):
Estimated Renewable Energy Generated (kWh):
Estimated cost savings from renewable generation ($):
Detailed Project Budget
Provide a detailed cost breakdown of the entire project. Download our budget sheet here.

For best results, open the file in Excel for web. If you have issues with this form, contact energy@Ky.gov to have the file sent to you via email.
Budget File Upload:

Cancelof
Signature
Name of Authorized Applicant:

First NameLast Name
I hereby represent and certify that the attached information, to the best of my knowledge, is true and complete and accurately describes the proposed project for which we are seeking financial assistance.*

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Energy Efficiency and Conservation Block Grant Project Application

Grantee Information

Authorized Applicant's Contact Information:

Project Information

Scope of Work

Metrics

Detailed Project Budget

Signature