Clean Energy Future Fund – Application form

For detailed information, please refer toClean Energy Future Fund - Applicant guidelines

If you have remaining questions, please contact ceff@dwer.wa.gov.au

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Clean Energy Future Fund – Application form

APPLICANT DETAILS

Name of organisation

Postal address Street Suburb

Postcode State

Website

Organisation’s ABN

Registered for GST YES NO

Brief description of the organisation

CONTACT PERSON

Title First name Last name

Position

Email Phone/Mobile

ALTERNATIVE CONTACT PERSON

Title First name Last name

Position

Email Phone/Mobile

The contact person and alternative contact person provided above may be contacted by the Assessment Panel for more information during the application process

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MANAGEMENT TEAM MEMBERSIncluding Declaration of Fit and Proper Persons – Please complete for all members of the executive/management team and add more rows if required

Title First name Last name

Position Include a short description of role and responsibilities in relation to the project

Relevant experience Include a short description of financial and project management roles/responsibilities for similar projects

Title First name Last name

Position Include a short description of role and responsibilities in relation to the project

Relevant experience Include a short description of financial and project management roles/responsibilities for similar projects

Title First name Last namePosition Include a short description of role and responsibilities in relation to the project

Relevant experience

Include a short description of financial and project management roles/responsibilities for similar projects

Clean Energy Future Fund – Application form

Have any of the executive/management team:

any current convictions for any offences from any court, or are you currently the subject of any charge pending before any court, or court proceedings?

YES NO

If yes to above, please provide details of the charge or conviction(s)

ever been declared bankrupt, either voluntarily or through a creditor’s petition? YES NO

If yes to above, please provide details

been in a position of responsibility (management, financial, executive or otherwise) for a company that has experienced insolvency?

YES NO

If yes to above, please provide details

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APPLICATION SUMMARY This summary may be used to promote your project on the department’s website and in media releases

Project title

Key objectives and brief description

Will the project take place primarily in Western Australia? YES NO

Project location Please provide further detail as necessary, including description of project elements that do not take place with Western Australia (e.g. GPS Coordinates)

Proposed project timeframe (assuming funding is announced in or around September 2020)

Start date

End date

Total amount requested of the Clean Energy Future Fund for this application • The minimum grant that will be made per project is $250,000 and the maximum is $2,000,000• State Government funding (including the Clean Energy Future Fund) may comprise a maximum of 25 per cent of total project costs

$

% of total project cost

Does the applicant consent to the general conditions of the Funding Agreement? YES NO

If no, please indicate which conditions you object to and why

Clean Energy Future Fund – Application form

PROJECT SUMMARY AND OBJECTIVES (IMPORTANT: Refer to section 1.2 of the Applicant guidelines for more information)

The objective of the Clean Energy Future Fund is to provide a source of funding to support the implementation of innovative clean energy projects in Western Australia that offer high public value by contributing to one or more of the outcomes listed below

Please outline how the project contributes to one or more of the following outcomes:

Significant, cost-effective reduction in greenhouse gas emissions below projected (or baseline) emissions as a direct result of the clean energy project

Design, deployment, testing or demonstration of innovative clean energy projects likely to deliver community benefits or lead to broad adoption and significant reductions in greenhouse gas emissions

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Clean Energy Future Fund – Application form

MINISTERIAL STATEMENT OF PRIORITIES(IMPORTANT: Refer to section 3.5 of the Applicant guidelines for more information)

Ministerial priorities require that preference is given to innovative clean energy projects at significant facilities in regional and remote Western Australia Please outline how your project aligns with the current Ministerial Priorities

Is your project proposed to be undertaken at a significant facility?

Significant facilities are those that meet, or are expected to meet, facility level reporting thresholds under the National Greenhouse and Energy Reporting Act 2007

YES

NO

Please provide further detail as necessary – e.g. already or planning to commence NGERs reporting; energy consumption or production data, or greenhouse gas emissions data

Is your project in regional or remote Western Australia?

Regional and remote Western Australia means facilities that are at the fringe of, or are not connected to, the South West Interconnected System or the North West Interconnected System

YES

NO

Please provide further detail as necessary (e.g. GPS coordinates)

ASSESSMENT OF ELIGIBILITY CRITERIA (IMPORTANT: Refer to section 3.3 of the Applicant guidelines for more information)

Applicant eligibility

At the time of entering a Funding Agreement, the applicant must be an Australian entity incorporated under the Corporations Act 2001 (Commonwealth)

Please confirm applicant is incorporated and provide supporting evidence

(e.g. copy of certificate of incorporation)

YES NO

Are the members of the management team fit and proper persons? (see Management Team Members section above)

Applicants must declare in the Application Form if any of the management team have any current convictions, are subject to any pending court charges or proceedings, or have ever been declared bankrupt or in a position of responsibility for a company in insolvency

YES NO

Project eligibility

1.

a. Is the amount of funding requested between $250,000 and $2,000,000?

YES NO

b. Is the grant amount requested of the Clean Energy Future Fund equal to or less than 25% of the total eligible costs? YES NO

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Clean Energy Future Fund – Application form

2. Can the applicant demonstrate that the project will take place primarily in Western Australia? YES NO

3. Provide evidence that demonstrates the applicant has, or will have prior to funds being released:   

a. ownership or the right to access the land on which the project is proposed to take place

YES NO

b. ownership of, access to, or the beneficial use of, any intellectual property necessary to carry out the project YES NO

c. secured or is able to secure the required regulatory approvals to carry out the project YES NO

d. adequate insurance to cover potential liability that may result from conducting activities to carry out the project YES NO

Provide details of planning, environmental and/or other approvals that are required for the project:

Mark N/A if not required

If required approvals have not yet been granted, what strategies are in place to obtain approval and when is approval anticipated?

Mark N/A if not required

4. Is the project an activity that is a requirement under Commonwealth or state law? YES NO

5. Will the project commence prior to a Funding Agreement being executed? YES NO

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Clean Energy Future Fund – Application form

ASSESSMENT OF MERIT CRITERIA (IMPORTANT: Refer to section 3.4 of the Applicant guidelines for more information)

Note: Value for money is a key underlying principle in the expenditure of public fundsThis means gaining the best possible outcome, for every dollar spent, by assessing the overall costs and benefits to Western AustraliaThe Assessment Panel will consider cost and non-cost factors (as identified below), to make a value judgment about the best outcome

1. Reducing emissions (40%)

Provide evidence of:a. the quantifiable direct and indirect greenhouse gas emissions reductions expected to be achieved

by the project b. how the project aligns with the Western Australian State Government’s aspiration to achieve net

zero greenhouse gas emissions across the Western Australian economy by 2050

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Clean Energy Future Fund – Application form

2. Business case (20%)

Please attach a business case which identifies in sufficient detail the financial and technical viability of the project, which should clearly indicate: a. justification for the need for Government assistance by presenting the:

i. costs and benefits of both the project and the ‘normal’ business-as-usual solution ii. likelihood that the project would proceed without the funding requested

b. the project’s technical feasibility and likelihood of successc. the ongoing viability of the project once the period of Government funding comes to an endd. the amount of funding sought for the project, as a proportion of the total project cost (see row

below)e. proportion of total funds contributed by the applicant (do not include other grants)f. other expected sources of funding and evidence that funding has been, or has a reasonable

chance of being securedg. demonstrated financial capacity of the applicant to fund its contribution to the costs of the project,

including ongoing operation and maintenance costs

Please attach Business Case as a DocX or PDF file together with a completed Application FormPlease clearly indicate which sections of your document(s) relate to the relevant sections of criteria a-g above

Confirm the total amount of funding sought for the project from the Clean Energy Future Fund $

Confirm the amount of funding sought for the project from the Clean Energy Future Fund as a proportion of the total project cost %

Confirm total amount to be sourced from any Commonwealth funding sources and provide detail as necessary $

Confirm amount to be sourced from Commonwealth funding sources as a proportion of the total project cost %

Please confirm that the Clean Energy Future Fund is the only State Government Funding sought for the project YES NO

If no, provide details of funding source, amount and proportion of total project costs

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Clean Energy Future Fund – Application form

3. Organisational capacity and risk management (20%)Provide evidence of the applicant’s capacity and capability to implement the project and readiness to commence project delivery, including: 

a. technical and management capability and expertise of the applicantb. track record of the applicant in undertaking similar projects, including delivering projects on time

and on budgetc. time frame for project commencement and deliveryd. roles of project partners and the status of any relevant agreements between project partners e. governance structure for delivery of the projectf. comprehensiveness and quality of planning for the project, including: 

i. costings, budgets and procurement planningii. performance criteriaiii. project implementation planiv. a proposed milestone schedule with timeframes and deliverablesv. other relevant planning activities 

g. a clear and detailed funding strategy demonstrating a clear path to achieving financial close and commencing project delivery upon execution of a Funding Agreement

h. a risk management plan outlining details of the risks associated with the project, how they will be managed and how risks will be monitored during the life of the project to ensure that any change in their impact or likelihood will be reported to the department (Such risks include but are not limited to compliance, Health Safety Environment and Quality considerations, conflicts of interest,  technical, planning, delivery, counter-party and financial)

Please attach supporting information as DocX or PDF and/or clearly indicate which sections of the Business Case refer to criteria a-h above

Additional benefits (20% total)

4. Not common practice

Detail the degree of innovation and/or the extension of the project beyond ‘common practice’ in Western Australia for the relevant sector or subsector

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Clean Energy Future Fund – Application form

5. Potential for wider adoption

Detail the likelihood that the project will result in similar projects being implemented by the applicant or by others, multiplying the emissions reduction potential - this could include the potential for cost reductions for future applications by demonstration of new technology

6. Public good: Detail how the project will contribute to: a) Knowledge sharing

Outline the quality and extent of the knowledge sharing information about, and resulting from, the project that the applicant proposes to make publicly available to build capacity amongst others, support learning-by-doing and/or demonstrate the feasibility of new technologies or processes

b) Economic development: Detail how the project is anticipated to deliver economic benefits to the state

For example, outline the number of jobs expected to be created by the project and/or the extent to which the project represents a new industry or business practice in the state (Please include any identified economic, environmental and/or social benefit, such as greenhouse gas emissions reduction, estimated jobs created (part-time, full-time, volunteer positions) and flow-on benefits to the WA community)

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Clean Energy Future Fund – Application form

7. Ongoing commitment

Detail the applicant’s ongoing commitment to and investment in the project and the role it would play in the applicant’s strategy and objectives for reducing greenhouse gas emissions and improving energy management

PROJECT MILESTONE SUMMARY

Detailed project milestones to be completed on the following page Proposed due date

1. Start of project

2. Mid-project update

3. Acquittal, including final project evaluation and financial report

Milestone due dates and payment schedule may be modified in consultation with successful applicants prior to the execution of a Funding AgreementRefer to sections 4-7 of the Applicant guidelines for further information

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DETAILED PROJECT MILESTONES Please outline the proposed milestones and reporting schedule for your project in the table below

Key deliverables  Start and completion dates  Expected expenditure to complete milestone (including contribution from Clean Energy Future Fund) 

Funding requested at completion of milestone 

PROJECT EVALUATION

Outline the key performance indicators for the project

How will the project be measured against achievement of its objectives? How will its success be measured? What type of data/information will be collected to evaluate the project?

PROJECT PARTNERS List details of partnering organisations and their contribution/s if relevant

Partner Contribution

PROJECT STAKEHOLDERS (if applicable)List details of key stakeholders directly involved or impacted by the project and describe their role

Stakeholder Role

Clean Energy Future Fund – Application form

PROJECT BUDGET – INCOME AND EXPENDITUREUse the table below to list the items to be funded through this Clean Energy Future Fund funding application

Do NOT include GST in the costings

GRANT AMOUNT REQUESTED (excl GST): $A minimum ($250,0000) and maximum ($2,000,000) grant limit applies per project

Item (please provide description)Estimated expenditure ($, excluding GST)

Clean Energy Future Fund contribution

Co-contribution Other funds (if applicable)

Subtotal

Total project budget (excl GST)

Refer to the Applicant guidelines for further guidance on eligible costs

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Clean Energy Future Fund – Application form

 

INSURANCES

It is a condition of your grant that you have adequate insurance to cover potential liability in conducting activities in relation to the project, including those funded by the Clean Energy Future Fund Provide details of insurance held (type of insurance/s, provider, value insured and expiry date) and attach relevant documents as relevant(Relevant insurances may include: Workers’ compensation; director’s and officer’s liability, public liability; personal accident insurance for volunteers; contents/mobile plant & equipment)

CONFLICT OF INTEREST (if not relevant for your project – please mark as N/A)

Declare any actual, potential or perceived conflict of interest that you may be aware of in relation to this project or this application process

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Clean Energy Future Fund – Application form

DECLARATION

I, (name) (position) of (organisation)

declare

that the information given in this Clean Energy Future Fund application and all attached documents is complete

and correct to the best of my knowledge, information and belief.

Authorised officer

Signature

Name/Position

Date

Witnessed by

Signature

Name/Position

Date

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Clean Energy Future Fund – Application form

Clean Energy Future FundAPPLICATIONS CLOSE – 7am AWST, Monday July 13 2020

Late applications will not be accepted

Applications must be electronic and lodged via email to ceff_applications@dwer.wa.gov.au

Applicants will be notified that their applications have been received by automated email

APPLICATION CHECKLIST

Before you send your application – please ensure you have completed all the information and attached relevant supporting documentation, including:

I have read and understand the Applicant guidelines

Application includes all details of project funding

Completed all relevant fields of the form

Confirmed budget details are correct and all amounts are GST exclusive

Application has been signed by the authorised officer

All supporting documents are ready to be attached to the submission as applicable (e.g. certificate of incorporation, business case, financial statement, certificates of insurance, project approvals support/partnership letters etc)

Applications that are incomplete or inadequate may not be assessed

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