C OMMERCIAL B UILDING R ETROFIT
P ROGRAM (W ITH F AÇADE I MPROVEMENT )
2012 APPLICATION
(REVISED 8.22.2012)
RETURN APPLICATION TO:
DEADLINE: October 5, 2012
City of Charlotte
Neighborhood & Business Services
600 East Trade Street Suite 311
Charlotte, NC 28202
Nicole Storey, AICP
nrstorey@charlottenc.gov
704-336-2929
704-336-3959 (fax)
Please Read The Important Information Below About Completing And Submitting The
COMMERCIAL BUILDING RETROFIT PROGRAM 2012 (With Façade Improvement) Application
Grant guidelines are available at http://www.charmeck.org/Departments/NBS/Home.htm or 704-336-5615.
Attendance at a pre-application workshop is highly encouraged. All meetings are held at Old City Hall in
the Wilmore Room, 600 E. Trade Street. Workshops are scheduled for:
August 28th 9:00 – 10:00 am
September 11th 3:30pm – 4:30pm
September 19th 5:30pm – 6:30pm
September 25th 10:00am – 11:00 am
Deadline for project submittal is 5:00 p.m. on Friday October 5, 2012. (NOTE: Old City Hall will have
limited accessibility September 3-7, 2012, visit http://charlottein2012.com for details)
Applications will be returned as incomplete if all items on the application are not answered and all required
attachments are not included. Incomplete applications will not be considered.
Grant applications are reviewed by a team comprised of City staff. Applicants will receive notification of
the review team's decision within 30 days of the application submission date. Eligibility of proposed
improvements for participation in the grant program is at the sole discretion of the City.
The City does not reimburse for any work started or completed prior to application approval and contract
signing. City payment for eligible work is also contingent upon completion of the project as proposed by
the applicant and approved by the review team, payment of all related taxes, satisfactory final inspections,
and satisfaction of all requirements set forth in the grant agreement.
I am applying for a Façade Improvement Grant (optional) in addition to CBRetro Grant.
Please check if you’d like to be contacted about these other N&BS grant opportunities:
Security Grants
Brownfield Assessment & Cleanup Grants
Big Box Demolition
For more information about these grant opportunities please visit: http://charmeck.org/city/charlotte/nbs/Pages/default.aspx
I have read and understand the grant information contained herein as well as those outlined in the
Commercial Building Retrofit Program 2012 Guidelines.
Signature
Date
PLEASE NOTE, THIS APPLICATION WILL BE CONSIDERED INCOMPLETE AND RETURNED IF ALL ITEMS ARE
NOT ANSWERED AND ALL REQUIRED ATTACHMENTS INCLUDED.
SECTION 1: BUSINESS INFORMATION (ALL ITEMS MUST BE ADDRESSED—Use Additional Sheets If Needed)
Every grant or loan applicant that is not a natural person must provide to the City the name, date of birth, address, and telephone
number of every person or other entity that holds 10% or more of the beneficial ownership of the applicant, as member, partner,
shareholder, or otherwise. Upon the City’s request, the applicant must provide supporting documentation pursuant to this paragraph.
1. Legal Name of Applicant/
Business Entity:
2. Project Address:
3. Mailing Address (if
different from above):
4. Tax ID No.:
5. If applicant is a Company,
indicate the type (Corp,
LLC, etc.)
6. Contact Person’s Name:
7. Yrs/Mos in operation:
8. Title:
9. Email:
10. Phone :
11. Cell:
12. Are all of the local, state and federal taxes for the business paid up-to-date
(including real property and business privilege taxes)?
Yes
No (if no, provide explanation)
13. Have you or your company ever applied for or received any financial assistance from any City business assistance program?
Yes
No
If yes, what program?
SECTION 2: PERSONAL BACKGROUND INFORMATION (ALL ITEMS MUST BE ADDRESSED)
The City conducts a criminal background check on all program applicants and/or all principals of the company. For this reason, it is
important that the questions in this section be answered completely and truthfully. An arrest or conviction record will not necessarily
disqualify you. An untruthful answer, however, will cause your application to be denied. Attach additional sheets as necessary.
14. Provide the full name, birth date (DOB), address, years at address, and % of ownership in company for each company principal.
Name
DOB
Address
Yrs There Ownership
%
%
%
%
%
15. Each principal must provide a list of all of his/her prior addresses for the past five years, including street address, city and state.
(This must be provided for each principal in the business and attached to this application form).
16. Have you ever been charged with or arrested for any criminal offense other than a minor vehicle
Yes
No
violation? (This question must be answered for each principal in the business. All arrests and
charges must be explained, including the outcome of each, on an attached sheet.)
17. Are all personal local, state, and federal taxes of each principal in the business paid up-to-date?
18. Please list all property owned by each principal in Mecklenburg County. Attach on separate sheet.
Yes
No
SECTION 3: BUILDING/PROJECT INFORMATION
Please complete as applicable:
19. Square footage of building:_______________ Number of stories: ________________________
20. Year Built: ____________________________More than 50 years old?
Yes
No
21. Number of residential units (if applicable): _________________________________________________________
22. Number of employees (full and part time):__________________________________________________________
23. Is the property in a Local, State, or National Historic District: __________________________________________
24. Is the project within the City’s Business Corridor Revitalization Geography? _________________
(see corridor map at http://charmeck.org/city/charlotte/nbs/ed/financialprograms/Documents/ProgramGeographyMap2008.pdf )
SECTION 3: BUILDING/PROJECT INFORMATION (Continued)
25.
What is your legal interest in the building?
Property Owner
Tenant (If tenant, property owner must complete an Owner
Consent form)
26. Provide a list of ALL businesses operating from the project address – attach a separate sheet if necessary:
Business Name
Type of Business
Owner’s Name
____________________________
_____________________________
___________________________
____________________________
_____________________________
___________________________
____________________________
_____________________________
___________________________
____________________________
_____________________________
___________________________
____________________________
_____________________________
___________________________
____________________________
_____________________________
___________________________
SECTION 4: PROJECT OVERVIEW
Please complete as applicable, include supporting information and attach additional sheets as necessary:
27.
Total project cost (total value including energy efficiency and other improvements)?______________________________
28.
Total funds contributed by owner(s) and/or financed? ______________________________________________________
29.
Are grant funds contributed by others (ex. Duke, PNG, other grants)? If so, what amount? _________________________
30.
Expiration date of other leveraged funds (if applicable)? ____________________________________________________
31.
Are there adequate funds currently available to complete this project? _________________________________________
32.
If awarded, are you able to execute a contract with the City of Charlotte within 10 days of receipt? __________________
33.
What is the expected date of completion for the grant funded improvements? ____________________________________
34.
Are there any known obstacles or challenges that may delay adherence to this deadline (if so, please explain)? _________
__________________________________________________________________________________________________
35.
Are there any known code violations at the site?
Yes
No If yes, explain. _______________________________
__________________________________________________________________________________________________
36.
How many jobs will be created or retained as a result of these improvements? ___________________________________
37.
If selected, are you able to begin the project within 30 days of contract signing? ________________________________
SECTION 5: DOCUMENATION & REPORTING (READ CAREFULLY – ALL ITEMS ARE REQUIRED )
IMPORTANT!! When submitting attachments please provide as much detail as possible regarding the proposed
improvements and anticipated energy savings (i.e. include types of materials, quantities, specs, brands, etc.) Applications that
do not include sufficient project details will not be considered.
Personal Background Exhibits, if applicable (see Section 2).
N/A
Organizational Documentation (corporate, partnership, LLC, proprietorship documentation) (see question 5)
N/A
Owner Consent Form (provided)—Required if you are not the owner of the project real estate
N/A
Char-Meck Business Privilege License- Current Copy
N/A
Project Scope & Budget – Use the CBRetro2012 Project Summary form to provide a summary of the scope and budget for the
proposed improvements. Include energy efficiency improvements as well as façade and/or other improvements as applicable.
Provide specific details regarding the improvements, including items to be changed or replaced, type/brand of new materials to be
used and location of the improvements. Include the name of the contractor/company selected to complete the work.
In addition, attach any and all documents/specs/information and written estimates from suppliers, contractors, auditors or
installers. Include “before” pictures where applicable.
Two (2) cost estimates are required for each improvement. The City will only make payments for project costs based on
invoices for completed work, not speculative budget estimates.
Communication Strategy – Submit a brief description of how the proposed energy efficiency improvements will contribute to
an overall sustainability initiative for the company/community. List any other actions, existing or planned, that will contribute to
this initiative and how the initiative will be communicated to residents or employees.
Energy Audit Report – Provide ASHRAE Level 2 – Energy Survey and Analysis Energy Audit or equivalent professionally
prepared estimate of energy savings. Audit reports prepared within two (2) years of contract execution may be acceptable to fulfill
this requirement upon staff’s approval provided that the report(s) provide an assessment of current energy usage and quantifiable,
site specific recommendations for energy efficiency improvements. Audits completed prior to contract execution are not eligible
for reimbursement.
The following shall be required if your project is selected:
X
Energy Usage Reporting – participants must provide energy bills for the 12 month period preceding installation of the
improvements and a signed permission and waiver form authorizing Duke Energy to release energy usage data to the City of
Charlotte for a period of up to 24 months following project completion.
X
Federal Reporting & Compliance – to be in compliance with all federal reporting guidelines the following documentation must
submitted at the indicated frequency:
Davis-Bacon Act: requires that all contractors and subcontractors performing work stemming from ARRA funds to pay laborers
and mechanics not less than the prevailing wages and fringe benefits as determined by the Secretary of Labor. This information is
required to be collected from applicable contractors on a weekly basis and submitted to the City at the time of reimbursement
request submittal. Reference http://www1.eere.energy.gov/wip/davis-bacon_act.html for more details regarding Davis Bacon.
Buy American Act: requires that parts, materials and construction equipment be American made unless meeting requirements for
exception. Buy American documentation should be submitted as part of the reimbursement request process. Reference
http://www1.eere.energy.gov/recovery/buy_american_provision.html for more information regarding the Buy American Act.
State Historic Preservation Office: All projects located within a designated historic district OR built more than 50 years prior to
the date of this application must be approved or deemed exempt by the State Historic Preservation Office prior to construction.
Any projects that begin construction before gaining approval by SHPO (State Historic Preservation Office) will be ineligible for
reimbursement. Reference http://www1.eere.energy.gov/wip/pdfs/state_historic_preservation_programmatic_agreement_nc.pdf
for more information.
Waste Stream Management: Waste Stream management plans and reporting is required for projects that produce significant
waste. Reference http://www.dmme.virginia.gov/DE/ARRA-Public/WasteStream.pdf for more information.
SECTION 6: FAÇADE IMPROVEMENT GRANT DOCUMENTATION & REPORTING
PARTICIPATION IN THIS GRANT IS OPTIONAL. IF APPLYING, ALL ITEMS ARE REQUIRED & MUST BE
ATTACHED
Please complete as applicable, include supporting information and attach additional sheets as necessary:
Do you have site plans for your project?
Yes
No If yes, please submit a copy with your application.
Have building permits been applied for?
Yes
No If yes, provide a copy of the permit
Statement of Project Description – A written narrative of what the façade project will involve. Provide as much detail as possible,
including what you are changing or replacing, type of materials to be used, color, location, on façade, etc.
Photograph(s) of Existing Façade – Submit several photos of your building’s current condition. If applicable, also take photos of
buildings in the area to demonstrate that your proposed improvements will maintain the character of the area. Be sure to label each
photo and indicate what improvements you are proposing to make in each. Photos can be submitted electronically in JPEG format.
Drawings of Proposed Façade Improvements – Include a concept of what the site will look like after work is completed. For
larger projects involving a major scope of work this will include copies of your renovation plan containing elevations and site plans. For
small projects, a simple sketch may be appropriate at the City’s sole discretion. In addition to a conceptual drawing, include product
sample sheets of design elements such as windows, doors, lighting, canopies, etc. showing color, size, type of material, etc.
Copy of Site Plan – If your project requires site plans to be submitted for permitting purposes, a copy of the project site plans as
submitted, must be included with the grant application.
Detailed Cost Estimates/Bids for Proposed Improvements – Submit minimum of two (2) cost estimates from qualified
contractors. Estimates should include details regarding the proposed scope of work. Use the form provided for project budget & scope.
If Applicant is requesting a 60% reimbursement for use of certified SBE firms, list of all certified SBE firms that will be used
together with a description of the work each firm will be performing, attach cost estimates from each firm. Visit
http://smallbiz.charmeck.org for a list of certified SBE firms.
IMPORTANT!! When submitting attachments please provide as much detail as possible. Applications that do not
include sufficient project details will not be considered.
SECTION 7: APPLICANT SIGNATURE
By signing below, the Applicant acknowledges that he/she has received and read the program guidelines for the Commercial Building
Retrofit Program 2012 (With Façade Improvement). Also, the Applicant acknowledges that he/she is duly authorized to act on behalf of
the Company and/or each principal of the company and that the Company is properly organized and licensed to conduct business in the
state of North Carolina.
The Applicant assures that the above information is true and correct and agrees to comply with all City of Charlotte guidelines
applicable to this program. The applicant also agrees that in the event of his/her/their breach of any condition or provision, or whenever
deemed to be in the interest of the City of Charlotte, the City’s N&BS Department or any representative thereof has the right to
terminate the program agreement.
The Applicant authorizes the City of Charlotte to request criminal record information about each principal of the Company for the
purpose of determining eligibility for this grant. The Applicant understands that the City will conduct a review of local property taxes
and Business Privilege taxes on the Company and each principal of the Company for the purpose of determining eligibility for this
grant.
Applicant further understands that he/she must submit detailed federal compliance and reporting documentation to satisfy Davis-Bacon
Act, Buy American Act, State Historic Preservation Office and Waste Stream Management procedures in addition to applicable receipts
and proof of payment in advance of project deadlines to be eligible for grant reimbursement.
The Applicant authorizes the City to use his/her/its name, likeness, photos and/or information about the project participating in the
Program for promotional purposes.
Date Signed
Signature