LDNPA Form over 25KLow Carbon Lake District Grants Programme Application Form OVER £25k (Round 3)PRIVATE AND CONFIDENTIALDATA PROTECTION AND FREEDOM OF INFORMATION ACT STATEMENT“We need to store your data on our database in order to give you the full assistance under this scheme. All information given will be held for a period of 7 years and only used in line with the Data Protection Act 2018 and the General Data Protection Regulations 2016. As a requirement of our grant funding, we will need to share your information with our funding providers, the Ministry of Housing, Communities and Local Government, the European Court of Auditors, the European Commission Auditors and the National Audit Office (and if required to their auditors). It may be necessary to share your information within the Low Carbon Lake District project partnership which includes your Local Authority, in order to offer the full support service.Whilst we will use our best endeavours to ensure that commercially sensitive information remains confidential, you should be aware that some information relating to this public funded project may be declared to third parties under the Freedom of Information Act 2000.Agreement for us to hold and share your information.* Please note that if you do not agree to us sharing your information, we will be unable to offer you full assistance under the scheme. I acknowledge and agree that the LDF need to hold and share information provided in this form.PLEASE NOTE:This form is for projects valued at OVER £25,000 ex VAT only. If your project is valued at under £25,000 please contact us for a different form.Please complete a separate application form for each project you wish to undertake.1. BUSINESS / ORGANISATION INFORMATIONBusiness / Organisation Name*Address* Street Address Address Line 2 City ZIP / Postal Code Name* First Last Position in Organisation:*Phone*Email* 2. PRE-QUALIFICATION QUESTIONSIf the answer to any of the following is no, you will not be eligible for a grant.1. Does the project create carbon savings* Yes No2. Will the project complete delivery within the programme timescales (by March 2023)?* Yes No3. Can you provide before and after utility bill data or other such evidence of energy or carbon saving?* Yes No4. Can you demonstrate one or more of the following: The project will not happen without this support, the project will go ahead sooner with this support, the project is larger with support, the project will happen within the Lake District rather than elsewhere with support.* Yes No5. Have you calculated your organisational carbon footprint?*If you haven't already calculated your carbon footprint you could try the free Footprint Calculator designed by Cumbria Action for Sustainability: https://cafs.org.uk/business-carbon-calculator-login/ You only need to complete the building, waste and water tabs. Yes NoPlease upload your organisational carbon footprint.* Drop files here or Select filesMax. file size: 64 MB.3. PROJECT INFORMATIONLocation where proposed project will take place* Street Address Address Line 2 City ZIP / Postal Code Please select the District Council where the project will take place* Allerdale Barrow Carlisle Copeland Eden South LakelandWill the proposed project take place inside the Lake District National Park* Yes NoWill the proposed project take place on a Listed Building* Yes NoBrief Description of Proposed Project(s):*Please tell us about the operational area you a trying to address, your current situation and the project you would like to undertake with support from the Low Carbon Lake District grant scheme. For example, you may tell us that you are a hotel that uses electricity for lighting and appliances, currently buying electricity from the grid, and you would like to install a solar PV array in order to generate your own electricity.Current (or counterfactual) energy or carbon consumption per yearPlease tell us how much energy is used per year in kWh or L or tonnes. For example if your proposed project is to switch to LED lights please tell us the current energy in kWh used to power your lights. The counterfacual energy consumption is the theoretical standard, so for example if you wanted to heat a new building, the counterfactual might be standard gas boiler and the proposed project might be an air source heat pump. Projects that address resource efficiency are also eligible, for example projects that save water.Proposed energy or carbon consumption per yearPlease tell us how much energy will be used per year in kWh or L or tonnes. For example if your proposed project is to switch to LED lights, please tell us the estimated energy in kWh that will be used.Anticipated Useful Life of the project (years)*Is the project match funding confirmed?* All confirmed More than 50% confirmed Identified but not confirmed Not identified or confirmedCommencement anticipated* Less than 3 months Less than 6 months More than 6 monthsCompletion anticipated* Less than 6 months Less than 12 months More than 12 monthsPayback period*The payback period is the time until the project will start to pay for itself in terms of the energy saved vs initial cost. More than 4 years Between 2 and 4 years Less than 2 YearsProject Implementation Plan*Please detail how the project will be managed and what support is required.4. PERMISSIONSPermissions Status*Please list all required legal permissions, including planning permissions, and their current status.Proof of Permissions*Please upload proof of permissions, or plans and maps if permissions have not yet been received.Max. file size: 64 MB.Please attach copies of the last two years accounts* Drop files here or Select filesMax. file size: 64 MB.5. CLIENT DECLARATIONClient Declaration* I confirm that I am authorised to sign this form on behalf of the business / organisation. I agree to provide updated information in the future to enable the full impact of support to be evaluated. This may include financial information or information about employees such as jobs that have been created or safeguarded as a result of the support provided. I understand the need to retain audit evidence and state aid information in relation to this support.Name*Position*Date* DD slash MM slash YYYY How long did it take you to complete this form (minutes)Please tell us approximately how long it took to complete this form so that we can continue to improve the application process.CommentsThis field is for validation purposes and should be left unchanged.