LDNPA Form under 25K - Lake District Foundation

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Low Carbon Lake District Grants Programme Application Form UNDER £25k (Round 3)

PRIVATE AND CONFIDENTIAL
DATA 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 under £25,000 ex VAT only. If your project is valued at or above £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 INFORMATION
Business / Organisation Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code
Name*
First Last
Position in Organisation:*
Phone*
Email*
2. PRE-QUALIFICATION QUESTIONS
If 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
- No
2. Will the project complete delivery within the programme timescales (by March 2023)?*
- Yes
- No
3. Can you provide before and after utility bill data or other such evidence of energy or carbon saving?*
- Yes
- No
4. 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
- No
5. 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
- No
Please upload your organisational carbon footprint.*
Drop files here or
Max. file size: 64 MB.
3. PROJECT INFORMATION
Location 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 Lakeland
Will the proposed project take place inside the Lake District National Park*
- Yes
- No
Will the proposed project take place on a Listed Building*
- Yes
- No
Brief 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 year
Please 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 year
Please 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.
Is the project match funding confirmed?*
- All confirmed
- More than 50% confirmed
- Identified but not confirmed
- Not identified or confirmed
Commencement anticipated*
- Less than 3 months
- Less than 6 months
- More than 6 months
Completion anticipated*
- Less than 6 months
- Less than 12 months
- More than 12 months
Payback 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 Years
Project Implementation Plan*
Please detail how the project will be managed and what support is required.
4. PROJECT COSTS
You must endeavour to provide at least three quotes for the work.
Quote 1
Quote 1 Supplier Name*
Quote 1 Value(£) ex VAT*
Quote 1 Value(£) incVAT*
Quote 1 File*
Please upload a copy of the quote. Please note that the maximum size allowed for each file is 64MB.
Drop files here or
Max. file size: 64 MB.
Quote 2
Quote 2 Supplier Name
Quote 2 Value(£) ex VAT
Quote 2 Value(£) inc VAT
Quote 2 File
Please upload a copy of the quote. Please note that the maximum size allowed for each file is 64MB.
Drop files here or
Max. file size: 64 MB.
Quote 3
Quote 3 Supplier Name
Quote 3 Value(£) ex VAT
Quote 3 Value(£) inc VAT
Quote 3 File
Please upload a copy of the quote. Please note that the maximum size allowed for each file is 64MB.
Drop files here or
Max. file size: 64 MB.
Procurement Process*
Please tell us how you acquired these quotes (where did you advertise, or who did you invite, and who responded).
Please name your preferred supplier*
Value of grant requested*
This can be up to 60% of the cost of the project
5. PERMISSIONS
Permissions 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 financial management accounts for the last two years*
(Such as those you would submit to companies house or the charity commission)
Drop files here or
Max. file size: 64 MB.
6. CLIENT DECLARATION
Client 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.
Phone
This field is for validation purposes and should be left unchanged.

The Lake District Foundation

The Lake District Foundation a charity registered in England and Wales with the charity number 1174201, and is registered with the Fundraising Regulator.