Application Form

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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
Project: Energy efficiency in Municipal Associations - EeMA
General information
Within the regional project “Energy efficiency in Municipal Association EeMA”, support will be provided to LGA’s in
strengthening their role towards its members in the field of energy efficiency and energy saving. One of the
packages of this project is related to the implementation of (at least) one energy efficiency pilot project per LGA.
The project idea is part of a broader initiative to promote capacity building in implementing energy efficiency
measures based on a cost-optimum model and in compliance with the country legal requirements and National
Energy Efficiency Action Plans. This pilot project intends to bring innovation and new approaches towards the
implementation of energy efficiency projects at local level.
The expectation of implementing such pilot should be tangible and realistic, with clear focus in decreasing energy
consumption and reducing CO2 emission, while keeping the same level of the comfort or service delivery towards
citizens, or improving it.
The scope of the project proposal
The project proposal has to promote innovative ideas: policy regulation, EE strategic planning or innovative
technical project, like: (but not limited to!)
 in building sector
 in public lighting sector
 in sustainable transport sector e.g. bike paths, bike renting scheme, etc.,
 more rational use of energy which can be focused but not limited only to:
o building sector: building envelope improvements such as external thermal insulation of building,
replacement of external windows and external doors, waterproof roof insulation, etc.,
o heating systems, electrical and lighting systems, air conditioning and ventilation and control systems,
o introduction of renewable energy sources-such as solar panels for hot water preparation, solarassisted space heating systems, utilization of geothermal pumps etc.,
o integration of EE measures with RES, etc1.
Selection criteria for pilot project proposal(see annex 1)
Energy saving domain (utilization of RES technologies can be included)
Countable or calculated reduction of CO2 emissions.
Reasonable payback period(project idea with shortest payback period will have an advantage)
Fully in line with national policies, norms and standards.
The ORF EE in close cooperation with the Technical team2 will select one pilot project per LGA to be financed within
the WP 3 of the project, up to max 40.000,00 € (gross) including supervision and commissioning costs.
Any additional cost above the limit has to be borne by beneficiary/municipality. The commitment and the readiness
to take any additional cost above specified limit for fully implementation of the project in due time has to be
specified during application phase by applicant, or to list other funds available. (See 1b)
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In case of infrastructure investment project, the construction permit (if it is needed) should be obtained until May 1st, 2015.
If the detail design is not developed, the detail design will be required ONLY after the project is selected and funding sources are determined. If
co-financing is declared letter of commitment will be required on later stage.
2
Technical team will be composed by one LGA member (project coordinator), independent engineer contracted for supervision by GIZ and one
member from GIZ ORF EE Team.
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
Application Form
To be filled by LGA project coordinator
Application No.:Click here to enter text.
Place:Click here to enter text.
Date:Click here to enter text.
To be submitted to:
Name of the LGA:Click here to enter text.
Address:Click here to enter text.
For: EeMA Pilot project – WP 3
Please check the box ☐ and/or fill in necessary information
1. Applicant details and type of required funding
a. Applicant
Name of Municipality
Number of Inhabitants
Budget for 2013
Budget for 2014
b. Total amount required for financing (please mark X in one of the options)
☐
Total amount to be financed within WP 3 of EeMA
Project
€
€
☐
Total amount to be cofinanced from municipal funds
and/or other available funding
€
(if other funding please specify the name of the
donor/financial institution): Click here to enter text.
(Please see above for max financing within EeMA)
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
2. The title and the aim of the project:
Project title:
Click here to enter text.
Project goal:
Click here to enter text.
3. Type of the pilot project
a. ☐ Local policy paper
b. ☐ Municipal regulation, feasibility study, SEAP, MEEP, etc.
c. ☐ Training and technical support
d. ☐ Investment project
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
4. Short project description
a. Please describe the pilot project idea with the justification for being innovative project (why it's new for your
municipality, did you have any project similar to this in the past? etc. (max. ½ page)
Click here to enter text.
*(please include in your description the energy efficiency component)
b. Specify the type of EE measures / document / feasibility
study, etc....to be financed within EeMA funding
c. Any other measures that will be financed by
other financial sources (under 1b, if any?)
Click here to enter text.
Click here to enter text.
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
5. Description of pilot project being innovative, replicable, possibility for dissemination?
max. ½ page
Click here to enter text.
6. Strategic planning
a. Does the municipality have any strategic development plan in place?
☐ Local development action plan
☐ Municipal strategic development plan
☐ Municipal plan for EE or municipal EE action plan
☐ SEAP
☐ Other Click here to enter text.
b. Does the pilot project you are applying with, is included in any strategic planning document?
☐ Local development action plan
☐ Municipal strategic development plan
☐ SEAP
☐ Municipal plan for EE or municipal EE action plan
☐ Other Click here to enter text.
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
7. Project design documentation
a. Does the municipality have prepared any energy audit/or EE feasibility study report for proposed pilot
project? (applicable only for point 3d)
b. Does the municipality have already detailed design ready for proposed pilot project? (applicable only for
point 3d)
*if YES – please include/attach the above mentioned documentation with your application (if the project is not selected the
documentation will be returned to the applicant)
8. Construction permits (based on your national regulations, do you need to obtain construction permit for
the project you are applying?)
☐ YES, construction permit is obligatory and it is obtained for the project
☐ YES, construction permit is obligatory, and will be obtained in the near future for the project implementation
☐ NO, construction permit is not obligatory
If yes, please describe how long it takes to obtain construction permit, and are you albe to do so
Click here to enter text.
9. Tendering procedures and bidder selection for construction works/supply/service
What is the duration of an usual tendering procedure according to your national regulation?
days / or
month
10.
Project management and implementation planning
Please describe the timeline for the project implementation cycle
2015
Date / Month to Date / Month
Project idea/design development, from:
Project revision, from:
Project tendering and selection of bidder, from:
Project implementation, from:
Commissioning:
*(note: the deadlines described above will be considered as realistic for project implementation, if the project is awarded)
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11.
Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
Information on regard to energy consumption for the projects proposal (applicable only for investment projects)
Operation
Period
[YEAR]
List the type of fuel in use/annualy in
last 3 years, (electricity, firewood,
coal, lignite, LPG, natural gas, diesel,
etc.)
Total amount
Measuring unit
[m3], [ton],
[liters], [kWh],
etc.
Converted to
[kWh]
(not obiligatory)
Please estimate the energy
savings potential in %, after the
measure you propose is
implemented?
2011
2012
2013
Total energy savings estimation – compare to average energy consumption in last three years (indicator for project selection, see annex 1 – point 4)
Saved (KWh/year)
Saved (EUR/year)
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
12.
Beneficiary
Please describe who will be the final beneficiary of the project
Click here to enter text.
13.
Estimated project cost including design preparation and revision
Please list all costs related to the project preparation and implementation (drafting
detailed design, revision and all other costs related to obtain the construction permit –
if applicable)
EUR
EUR
EUR
EUR
EUR
EUR
EUR
The project will cover the costs for implementation („up to“), while supervision and commissioning
engineer from the project side will be contracted directly by GIZ.
*Technical personnel from beneficiary municipality with Engineering background for project
supervision will be evaluated with 3 points in the project selection phase, annex 1-7 (please send
the CV)
Total estimated project costs
EUR
*submission Cost estimation on BoQ format will be considered as an advantage!
14.
Sources of municipal co-funding (if available)
Municipal sources for financing the project, in case of co-financing:
☐ Municipal budget
☐ Voluntary contribution ☐ Grants from national
of citizens
level
EUR
EUR
15.
EUR
The deadline for project implementation is October 2015


Planned date for the beginning of the project:
Date of the completion of the project:
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☐ Other
EUR
Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
16.
Have you applied with this pilot project to any other institution/fund/donor? (ifyes,
please provide more information)
Click here to enter text.
17.
Contact details
Name, Surname
Municipality
Position
Telephone
E-Mail
Click here to enter
text.
Click here to enter
text.
Click here to enter
text.
Click here to enter
text.
Click here to enter
text.
18. General Conditions;
* The applicant declare that the project proposal submitted did not start and will not start to be implemented
before a decision for financing is made, signing respective contracts and all procurement procedures are fulfilled.
* The applicant declares and agrees that all procedures and activities necessary for project implementation would
be in line with country national regulations for public procurement and construction work implementation.
* The applicant declares that is informed that all statistical data given in this project proposal can be archived and
electronically processed for statistical purposes and documentation by EeMA project.
* The applicant declares that is informed and accept that financing of the project will be done through LGA.
* Regular payment of membership fee to Association is basic precondition for application
(Signature of Mayer and stamp)
Delivered to LGA on date:
Received by:
(signature)
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Open Regional Funds for South East Europe
Modernisation of Municipal Services (ORF MMS) and Energy Efficiency (ORF EE)
Annex 1. Evaluation Criteria
No
Description of evaluation criteria
1.
The policy paper, strategy document (like SEAP, MEEP etc.) is contributing towards
fulfilling local, national, regional (if exist), EU targets/agenda.
The investment/technical pilot project is included in any local strategic planning
documents, SEAP, EE Plans, MEEP, Sustainable local development plan etc. ( see table
5.b)
Detail design ready ( see table 7.b) – only for investment/technical projects
Innovation and replicability, possible impact of the project
Readiness for co-financing ( see table 1.b)
Payback period and/or Energy audit report
2.
3.
4.
5.
6.
7.
Technical personnel with engineering background for supervision available
enclose CV to this application)
(please
Points (max
30)
1-10 points
1-5 points
5 points
1-7 points
1-5 points
1-5 points
3 points
Important note;
Project announcement and tendering procedure will be organized by the beneficiary municipality according to
national legislation.
GIZ (on behalf of BMZ and SDC) will finance the project on “up to” level and if the project costs are above the
maximal amount, the beneficiary municipality has to bear remaining cost.
Technical team3 will be included in the offer evaluation(s) connected to pilot projects, together with the
Evaluation team from beneficiary municipality.
For three short listed projects the site-visits will be organized (together with Technical team) in order to select
the most attractive EE project for implementation.
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Technical team will be composed by one LGA member (project coordinator), supervising engineer contracted for supervision
by GIZ and one member from GIZ ORF EE Team.
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