B Altimore Energy Initiative Loan Program Initial Financing Request

b altimore energy initiative loan program initial financing request form page 2 baltimore energy initiative loan program initial

B altimore Energy Initiative Loan Program Initial Financing
Request Form Page 2

Baltimore Energy Initiative Loan Program
Initial Financing Request Form
Date Form Submitted:  / / 
1. Contact Information for Person Completing this Application
Name:  
Title:  
Telephone:  - -  x 
Cell Phone:  - - 
Email:  
2. Information about the Applicant
Legal Name of Business/Organization:  
Year Established:  
Address: Street:  
City:  
State:  
Zip:  - 
Purpose, Work or Services of Business/Organization:  
Legal Structure (check one): Non-Profit Corp. For Profit Corp. Limited
Partnership General Partnership
Limited Liability Company Sole Proprietorship Other:  
Non-profit Organizations: Are at least 50% of your services provided
to low-income persons whose annual family-income is 80% or less of
median family income for the Baltimore metropolitan area? Yes No .
N.A.
For-Profit Businesses: Does your business have a tangible net worth
less than $15 million and an average net income less than $5 million
after taxes for the preceding two years (the U.S. SBA definition of
small business)? Yes No N.A.
3. Information about the Proposed Energy Project to Achieve Energy
Savings
Project Name:  
Project Address: Street:  
City: Baltimore
State: MD
Zip:  - 
Is this address: in a New Market Tax Credit census tract? Yes No
…in a Baltimore Main Streets District? Yes No
Year Building Built:  
Building Gross Sq Ft:  
Number of Floors:  
Number of Liens on Property:  
Total Outstanding Value of Debt being Secured by Liens on Property: $
 
Project Type(s): (check all that apply)
Limited Energy Retrofit or Equipment Replacement in Existing Building
Gut Rehab of Existing Building
Extensive Building Energy Retrofit in Existing Building New
Construction
Brief Project Description:
 
Project Dates: Estimated Project Start Date:  
Estimated Project Completion Date:  
For Retrofits of Existing Buildings: Has an energy audit or other
analysis been performed to quantify the project’s energy savings?
Yes No In process N.A.
For Gut Rehab or New Construction: Has a building energy simulation
model been completed to predict the building’s energy consumption?
Yes No In process N.A.
4. Project Budget
Cost Category
Budget
Degree of Certainty about Cost
Project Soft Costs / Pre-development Costs
$  
 
Project Hard Costs – Energy Measures
$  
 
Project Hard Costs – Non-energy Measures
$  
 
Other:  
$  
 
Total:
$  
 
Important Comments about the Project Budget:
 
5. Energy Loan Request and Other Project Financing
Baltimore Energy Initiative Loan Program Request:
$  
Other Potential Project Financing:
Amount:
Source
Status
Other Loan
$  
 
 
Other Loan
$  
 
 
Public Grants
$  
 
 
BGE Energy Solutions rebate (required)
$  
Baltimore Gas & Electric
 
Other:  
$  
 
 
Applicant Equity
$  
 
 
Project Total (including this loan request)
$  
Important Comments about the Project Financing:
 
NOTE: Before completing and submitting this Initial Financing Request
Form, please review the Baltimore Energy Initiative Loan Program
Guidelines and Instructions document available at
www.EnergyLoansBEI.org.
This form is not the full loan application form, but rather an
abbreviated form to begin the discussion about the energy project and
its possible financing through the Baltimore Energy Initiative Loan
Program.
The completed Initial Financing Request Form should be saved as a Word
document with a unique file name and the file emailed to:
[email protected]
Baltimore Energy Initiative Loan Program staff at The Reinvestment
Fund and Healthy Neighborhoods Inc. (the loan fund managers) will
review the submitted form and contact its author to discuss the
project and its possible financing and will advise when a full
building energy loan application should be completed and submitted.
06/30/15