You may print this form to preview the questions before you complete your online application: Online Application
 
APPLICATION DIRECTIONS:

To apply for a program, please review the Program Descriptions which are online at Program Descriptions if you believe you are eligible for a program and would like to apply for it, you should:

  1. Complete the application online.
  2. Gather the required attachments listed at the end of the application, obtain the required signatures and upload them online.
 
These Programs are developed for incremental economic development assistance to Upstate New York and are not intended to offset the operating costs for existing programs.

Application Information
Your Name:
Your Title:
Company Head(President or CEO):
Company Head Title:
Organization:
Business Address:
City:
County:
State:
Zip:
Telephone:
Fax:
E-mail:
Federal Tax ID Number:
Date:
Organization Type:
What is the applicants relationship to the project for which the funding is being requested?: (Check all that apply)


 
Please tell us how you heard about this program.
(Please identify individual)




Step One: Please check the program for which you want to be considered. If you plan to apply for more than one program, you must submit a separate application for each program.









 
Step Two:  Please complete Applicant, Project, and Financial Information - the person who has the authority to undertake this project and receive funds for it should complete this step.  In all circumstances, funding should be viewed by applicant as a reimbursement for work completed following grant approval.

Project Information

* Denotes Required Fields



Street Address:

City:

Zip:

County:
Kings, Nassau, Queens, Richmond or Suffolk






No


If No, who has primary responsibility of the bills for the project?
 
Will this investment improve energy efficiency?
(year)
 
Will this project stop a facility from closing or relocating outside of the National Grid service territory?

(If Yes, please include explanation in project description)


*Estimated project start date (mm/dd/yyyy)?


Financial Information:



Complete the following Project Budget with as much detail as is currently available below.

Attach commitment letters or letters of intent from each source of financing indicated (other than National Grid).

  Sources  
Use of Funds $ Total Applicant NG Other
Commitments

Either provide as an attachment to your application a detailed budget breakdown by major item or fill out the form below.
   
Please make sure the detail you provide identifies each component and cost for the project.
   
Construction Related (including gas infrastructure):
   
Use (e.g. demolition) Budget $
   
$
$
$
$
$
Research or Productivity Related (identify contractor major study components costs):
   
Use Budget $
   
$
$
$
$
$
   
Marketing (identify specific activities, materials costs associated with the project):
   
Use Budget $
   
$
$
$
$
$
   

Other (be specific):
   
Use Budget $
   
$
$
$
$
$

Project Description:Please input a detailed description about your project into the Text box below (Attach description if necessary)

Project Description:












STEP THREE
Marketing Programs: This section should be completed by only those applicants who are applying for:

Cooperative Business Recruitment

* Denotes Required Fields



How will you deliver your marketing plan? (Check all that apply)
Web based marketing  Public Relations


Does your project require research in order to focus on the appropriate target industries and geographical areas?


If yes, does the research duplicate previous studies on your topic for your geographic area?


(year)

Is your project targeted to decision-makers who can influence the attraction of new jobs and investment to the National Grid service territory?


Does your effort complement sales and/or marketing efforts that impact your regional geographic area?









(#)
(#)
(#)
(#)
  *Jobs   (#)




If funding from National Grid is awarded and proposed project is implemented a final report detailing the measurable results will be required before funds are dispersed.

Natural Gas Capital Investment, Sustainable Gas and Economic Development Programs: This section should be completed by only those applicants who are applying for:
Industrial Building Redevelopment
Cinderella Program
CleanTech Incubation

Brownfield Redevelopment
Natural Gas Capital Investment Incentive
Sustainable Gas and Economic Development

* Denotes Required Fields

What is the project facility's National Grid Gas Service Classification? (This information is included on the facility's National Grid bill.)

Long Island:

New York:






  When will this occur?


Are you currently Served under, or expected to be served under, one of the following Natural Gas Service Classifications. If so, please select which one.; (This information is included on the facility's National Grid bill.)

Long Island:

New York:




Is the existing natural gas infrastructure a barrier to completing your project?





What will the measurable results of your project be?

*What total amount of capital investment will be created by this project? $

*Estimated project start date (MM/DD/YYYY)   *Estimated project completion date (MM/DD/YYYY)   

*How many jobs will be created because of this project?   By end of year 1

Year 3  Year 5

How many jobs will be retained because of this project? (#)   N/A

Do you have a cost estimate for the infrastructure enhancement?



Which of the following manufacturing or commercial purposes as classified by the North American Industry Classification System describes this project? (You may determine your NAICS classification by checking: http://www.census.gov/epcd/www/naics.html)








What size is the project? (How many acres is the site; how many square feet is the building)?

Is the site, building or project area currently vacant or underutilized?

 



Is the site, building or project area (please check all that apply):




located in

Does the site or building have: Water Telecom?

Has your project been through the SEQRA Process? 

Has it received a negative declaration? 




Will the project be fully occupied when completed?


If no, do you plan to market your completed project to potential out-of-state tenants or owners?


Do you have a written marketing plan?




How will you deliver your marketing plan? (Please check all that apply.)

Cinderella Revitalization Program applicants only

What Type of project (click all that apply)?







Natural Gas Manufacturing Productivity


What is your National Grid Gas service classification? (This information is included on the facility's National Grid bill.)

Long Island:

New York:






Is the existing natural gas infrastructure a barrier to completing your project?





What size is the project? (How many acres is the site; how many square feet is the building?)

Is the site or building (please check all that apply):

a NYS designated RebuildNY Site?

in


Does the site or building have: Water Telecom?

What will be the measurable results of your project be:

What total amount of capital investment will be created by this project?

How many jobs will be created because of this project? or How many new jobs result from this project?

Total_________     By end of Year 1______     Year 3_______    Year 5______

How many jobs will be retained because of this project?   NA

Therms savings Estimated $ savings annually

Please Explain

What is the applicant's primary NACIS code?  __________

What is the applicant's secondary NACIS code?  _________

Grant amount (check all that apply)

  Up to $15,000 or 40% (whichever is less) of the costs of a "lean manufacturing" or manufacturing assistance projects

    Up to $15,000 or 50% (whichever is less) of the costs incurred by eligible applicants whose top management commits the time and resources to growth-targeted activities that will result in greater utilization of manufacturing capacity.

   up to $40,000 or 60% (whichever is less) of the costs incurred by eligible applicants whose top management commits the time and resources to projects that combine and coordinate the productivity and growth activities described above.

Expected estimated measurable results (check all that apply):

From lean manufacturing project (or comparable):

Cost savings of  $________ per year

New annual revenue $____________

 Retained annual revenue $____________

Jobs retained   _______

 Jobs created _______

Capital investment $____________

From growth activities:

 Increase in sales _______%

 New annual revenue $____________

Retained annual revenue $____________

New product development (describe)_____________________________________________________________

___________________________________________________________________________________________

New Customers (describe)_____________________________________________________________________

___________________________________________________________________________________________

FINAL SECTION ALL PROGRAMS: Signatures, Attestments and Disclaimers: Please read the disclaimers carefully and sign the application.

Disclaimers

1) National Grid has the sole responsibility for selecting grant recipients.

2) National Grid retains the right to conduct pre-installation and post-installation site visits.

3) National Grid makes no warranty, guarantee, or representation, express or implied, with regard to any economic benefits, energy savings, or improved energy quality resulting from use of Program grants. While the Programs are intended to provide benefits to recipients, the recipient understands and agrees that National Grid is not liable for any losses resulting from the recipient's participation in the Programs or from the Programs' failures to result in benefits to recipients.

4) In the event the grant recipient utilizes a contractor to accomplish the project goals, National Grid makes no warranty, guarantee, or representation, express or implied, with regard to any materials or workmanship provided by any contractors engaged by the recipients or the reasonableness of the prices charged by them. The recipient understands and agrees that the contractor alone is responsible for the work, and not National Grid. National Grid assumes no liability or responsibility for any damages or claims resulting from your use of any contractor.

5) The information contained in this application, the required attachments and any site visit made by an authorized National Grid employee will be used to evaluate your project. An incomplete application will be disqualified.

6) Funds granted through this program may only be used by the applicant for the use stated and approved. National Grid reserves the right to withhold funding if the substance of the project changes or the requirements of the program are not met.

7) All Economic Development Programs will be administered in accordance with the applicable tariffs as specified in PSC No. 207, Rule 34 and Service Classification No. 12.

8) All materials become the property of National Grid and will not be returned. National Grid reserves the right to use any submitted material for marketing the Economic Development Program.

9) Program assistance is only available to customers who are current in payments with National Grid or have executed a deferred payment agreement.


Attestments and Signatures

APPLICANT: I certify that all statements made in this application, including all attachments, are correct to the best of my knowledge and that I have reviewed and agree to the terms stated on this form, including those provisions regarding warranties and liabilities.

Signed by Applicant: ______________________________________________________________________________________

Signature Printed Name_____________________________________________________________________________________

Title: ______________________________________________, Date: ______________________________________________

For Manufacturing Productivity Program only:

Signed by Co-Applicant (RTDC): _____________________________________________________________________________

Signature Printed Name_____________________________________________________________________________________

Title: ______________________________________________, Date: ______________________________________________


THE FOLLOWING DOCUMENTATION IS REQUIRED DEPENDING ON WHICH PROGRAM YOU ARE APPLYING FOR


Marketing Program:

Cooperative Business Recruitment Program

  1. Completed and Signed Application
  2. Completed, signed and dated W-9 Form
  3. Marketing Plan
  4. Project Budget
  5. Commitment letters or documentation of secured funding (including applicants)
  6. Final or draft collateral material

 


Capital Investment Programs:

Natural Gas Capital Investment Incentive

  1. Completed and Signed Application
  2. Completed, signed and dated W-9 Form
  3. Project Prospectus / Detailed Project Description
  4. Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements.
  5. Commitment letters or documentation of secured funding (including applicants)
  6. Documentation from the NYS Empire State Development Corporation or a local development agency indicating your efforts to obtain state and local Economic Development incentives for the project and their disposition of your request
  7. Letter of endorsement from industrial development agency or other public development agency


Site Development Programs:

Cindrella Program

  1. Completed and signed application (print the signature page, sign and date it and upload it to your application)
  2. Copy of your W-9 Form (link to blank W-9 Form)
  3. Project Prospectus / Detailed Project Description
  4. Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements.
  5. Commitment letters or documentation of secured funding (including applicants)
  6. Business Attraction/Marketing Plan, if available
  7. Letter of support/endorsement from the industrial development agency, other public development agency, or local community groups/elected officials, if applicable

Industrial Building Redevelopment Program

  1. Completed and Signed Application including IDA sponsorship signature
  2. Completed, signed and dated W-9 Form
  3. Project Prospectus / Detailed Project Description
  4. Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements.
  5. Commitment letters or documentation of secured funding (including applicants)
  6. Marketing Plan, if you have one

    CleanTech Incubation

    1. Completed and signed application (print this signature page, sign and date it and upload it to your application)
    2. Completed, signed and dated W-9 Form
    3. Project Prospectus / Detailed Project Description
    4. Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements.
    5. Commitment letters or documentation of secured funding (including applicants)
    6. Business Attraction/Marketing Plan, if available

    Brownfield Redevelopment Assistance Program

    1. Completed and signed application
    2. Completed, signed and dated W-9 Form
    3. Project Prospectus / Detailed Project Description
    4. Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements.
    5. Commitment letters or documentation of secured funding (including applicants)
    6. Business Attraction/Marketing Plan, if available

    Sustainable Gas and Economic Development

    1. Completed and signed application
    2. Completed, signed and dated W-9 Form
    3. Project Prospectus / Detailed Project Description
    4. Project cost estimates including detailed cost estimates for any specific energy infrastructure improvements.
    5. Commitment letters or documentation of secured funding (including applicants)
    6. Letter of support from the Municipality, IDA or a local development corporation indicating your efforts to obtain state and local Economic Development incentives for the project and their disposition of your request
    7. Business Attraction/Marketing Plan, if available
    8. If owner or developer obtains letter of endorsement from industrial development agency or other public development agency.

    Natural Gas Manufacturing Productivity Programs:

    Natural Gas Manufacturing Productivity Program

         1.  Completed and Signed Application
         2.  Completed, signed and dated W-9 Form
         3.  Detailed project description
         4.  Project cost estimates
         5.  Contract with Regional Technology Development Center (RTDC)
         6.  Commitment letters or documentation of secured funding