Low Carbon Lake District Grants Monitoring FormPRIVATE AND CONFIDENTIALIn order to access support please complete this monitoring form. Upon receipt of a complete and satisfactory monitoring form, your grant will be paid to you via Bank Transfer into the bank account previously supplied.DATA PROTECTION AND FREEDOM OF INFORMATION ACT STATEMENTWe 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 the LDF to hold and share your information.* I acknowledge and agree for the LDF to hold and share information provided.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.1. ORGANISATION DETAILSBusiness / Organisation Name*Address* Street Address Address Line 2 City ZIP / Postal Code 2. CONTACT DETAILSName* First Last Contact Position in Organisation:*Phone*Email* 3. PROJECT SPECIFICATIONProject Name*Project Reference NumberProject Specification*Please describe the development that was undertaken including specificationsPermissionsPlease upload evidence that all relevant permissions e.g planning permission have been granted Drop files here or Select filesMax. file size: 64 MB.Insurance*Please upload the latest copy of your public liability insurance documents Drop files here or Select filesMax. file size: 64 MB.Date Project was Completed* DD slash MM slash YYYY 4. PROJECT COSTSTotal Project Cost inc VAT*Total Project Cost exc VAT*Receipts*Please upload all receipts relating to expenditure on this project. If the receipt includes work not covered by this grant, please either submit a partial receipt or highlight the eligible expenditure. Drop files here or Select filesMax. file size: 64 MB.5. BRANDING AND PUBLICITYYour Project*Please upload three photos of your project. By uploading these images, you agree to them being used by the Lake District Foundation and the wider project partners for use in publicising the scheme. Drop files here or Select filesMax. file size: 64 MB.On Site Publicity*Please upload at least one photo of the publicity poster or plaque in place. By uploading these images, you agree to them being used by the Lake District Foundation and the wider project partners for use in publicising the scheme. Drop files here or Select filesMax. file size: 64 MB.Additional Publicity*Please upload other evidence of branding and publicity e.g screenshots of the ERDF logo on your webpage, newsletters or social media posts relating to your project Drop files here or Select filesMax. file size: 64 MB.5. CARBON SAVINGSBaseline carbon consumption data*Please upload utility statements relating to the prior year (one or more years before project competition date) e.g. if you have installed an air source heat pump to replace a gas boiler and radiators for space heating, please upload gas consumption data. If you have installed solar PV panels to replace electricity use for lighting and appliances, please upload electricity consumption data from the grid. Drop files here or Select filesMax. file size: 64 MB.Post-Project carbon consumption dataIf you have post-project carbon consumption / generation data please upload it now. Alternatively we will be in touch at a future date to gather this information. Drop files here or Select filesMax. file size: 64 MB.6. GRANT SCHEME FEEDBACKIn order to support the Lake District Foundation to continually improve this programme and to inform future low carbon initiatives in Cumbria please answer the following:Did you experience any problems at any stage during this project, and if so how did you solve those problems?*Did this grant have any benefits /disbenefits you weren’t expecting?*Do you have any future plans for reducing the carbon footprint of your organisation?*What more would you do if additional grants or support became available?*7. STATE AID NOTICEThe assistance was funded under the State Aid rules by applying the de minimis exemption (in accordance with COMMISSION REGULATION (EU) No 1407/2013 of 18 December 2013).In order to comply with the State Aid rules you will need to keep a record of this information and will also be required to declare the value of this assistance if you are offered or receive any further support under GBER and/or de minimis. As a recipient of public funding it is your responsibility to ensure that this information is made available to any delegated authorities (such as auditors or monitoring officers) that have been appointed to verify the activity of the work undertaken by the project. Any state aid granted in error may be subject to repayment with interest.Please seek legal advice if you are unsure about your state aid obligations.8. BANK DETAILSAccount Holder Name*Account NumberSort Code9. CLIENT DECLARATIONBy entering your name and date here, and submitting this registration form:I confirm that I am authorised to sign this form on behalf of the business.I confirm that I have read and understood the data protection statement and consent to my data being used as described.I confirm that the business / organisation named on the state aid declaration has been awarded the state aid (if applicable). I confirm that I understand the obligations with regard to state aid and acknowledge that in the event of this declaration being made incorrectly, the business / organisation may become liable to repay the full cost of the support received.I confirm that the business satisfies the criteria for an SME: has fewer than 250 full time equivalent employees; has either an annual turnover of less than €50m or a balance sheet of less than €43m, when linked or partner organisations are taken into account (i.e. when more than 25% of the capital or the voting rights of the Company is owned by another enterprise, or you own more than 25% of the capital or voting rights of another enterprise).I agree to provide updated information in the future to enable the full impact of the support received to be evaluated. This may include financial information, information about jobs safeguarded/created or information about carbon and energy savings.I understand the need to retain audit evidence and state aid information in relation to this support.Name*Position*Date*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.
