HomeMy WebLinkAboutNative Village of Minto- Signature PagesRenewable Energy Fund Round IX
Grant Application - Standard Form
WEED
=WD ENERGY AUTHORITY
SECTION 9 -APPLICANT INFORMATION
Please specify the legal grantee that will own, operate, and maintain the project upon complefion.
Name (Name of utility, IPP, local govemment, or other govemment entity)
Native village of Minto
Type of En ti
Fiscal Year End:
Government
12015
i ax I U ;;92-6002702
Tax Status: ❑ For -profit ❑ Non-profit x Government (check one)
Date of last financial statement audit:
MailiqR Address:
Physical Address:
PO Box 58026
101 Lakeview Street
Minto, Alaska
Minto, Alaska
99758
99758
Telephone:
Fax: Email:
907-798-7112
907-798-7627 mintovillagecouncil@hotmail.com
pplicant Point of Contact / Grants Manager
Name: Next Energy Solution Inc. - Foley Quinn Title: Owner/ Operator
Brianna Gennaro Grant Writer/ Grant Manager
Mailing Address:
Next Energy Solution Inc.
231 Walnut Street
Spooner, Wisconsin 54801
Telephone:
Fax:
Email:
(631) 942- 66891(715) 416- 3022
N/A
admin(a-D-nextenergysolution.com
foleye-nexteneEgysolution.com
APPLICANT SIGNATORY AUTHORITY CONTACT INFORMATION
Name: Title:
Carla Dick Chief
Mailing Address:
PO Box 58026
Minto, Alaska 997558
Telephone:
Fax:
Email:
907-798-7112 19D7-798-7627
Carla smith$5 hotmaii.com
1.1.2 Applicant Alternate Points of Contact
Name Telephone:
Fax:
Email:
AEA 15003 Page 3 of 24
7/8/f4
Renewable Energy Fund Round IX
Grant Application - Standard Form MWCi ENERGY ALFHORIT'
III�IIII wry
SECTION 13 AUTHORIZED SIGNERS FORM
Community/Grantee Name: Native Village of Minto
Regular Election is held: February Date: February 10, 2015
Authorized Grant 5igner(s):
Printed Name
Title
Term
Signature
Carla Dick
Chief
2 yr
I authorize the above person(s) to sign Grant Documents:
Must be authorized by the highest ranking or anization/communi !municipal official
Printed Name
Title
Term
Signature
Carla Dick
Chief
2 year
Grantee Contact Information:
Mailing Address:
PO Box 58026
Phone Number:
907-798-7112
i Fax Number:
907-798-7527
E-mail Address:
Carla_smith85@hotmaii_com
Federal Tax ID #:
92-6002702
Please subunit an updated .form whenever there is a change to the above information.
AEA 15003 Page 23 of 24 7/8i14
Renewable Energy Fund Round IX
Grant Application - Standard Form
ENERGY AUTHORITY
,�,�v f ��+�•� �� —: r�uu�=�::rVl!�14L E.�V�.:U��N'��LTI<gN .AND CERTIFI��kT#C)P1.
UI3lV1ET Tl~iE tPLLt3fVl146 DOGDIEITS WITH 1f0Uft ApPLtATiN,
A. Contact information and resumes of Applicant's Project Manager, Project
Accountant(s), key staff, partners, consultants, and suppliers per application form
Section 3.1, 3,4 and 3.6.
Applicants are asked to provide resumes submitted with applications in separate electronic
documents if the individuals do not want their resumes posted to the project web site.
B. Letters or resolutions demonstrating local support per application form Section 9.
C. For projects involving heat: Most recent invoice demonstrating the cost of heating
fuel for the building(s) impacted by the project.
D. Governing Body Resolution or other formal action taken by the applicant's governing
body or management per RFA Section 1.4 that:
- Commits the organization to provide the matching resources for project at the
match amounts indicated in the application.
Authorizes the individual who signs the application has the authority to commit
the organization to the obligations under the grant.
Provides as point of contact to represent the applicant for purposes of this
application.
- Certifies the applicant is in compliance with applicable federal, state, and local,
laws including existing credit and federal tax obligations.
E. An electronic version of the entire application on CD or other electronic media, per
RFA Section 1.7.
F. CERTIFICATION
The undersigned certifies that this application for a renewable energy grant is truthful
and correct, and that the applicant is in compliance with, and will continue to comply
with, all federal and state laws including existing credit and federal tax obligations and
that they can indeed commit the entity to these obligations,
Print Name
Carla Dick
Signature
Title
Chief
Date
September 15, 2015
AEA 15003 Page 24 of24 71$f14