LEED for Homes Project Application Form

Please complete the following information for your project. Provide as much information as possible. A special field is provided at the end of the form for any special project description or comments. Upon submission, Green Dinosaur's project intake administrator will review and process your application. We will contact you if there are any questions.

APPLICANT INFORMATION

Please provide your contact information for processing and administration of this application.

Applicant Representative*

Applicant Phone*

Applicant E-Mail*

PROJECT IDENTIFICATION

Please provide the following project identification information. This information will be used to identify your project in all future correspondence.

Project Name*

Enter the name of your project (i.e. Someone Residence, Somewhere Villas, etc.)

Project ID

Enter the LEED Project ID number

Street Number and Name*

Enter the house/building number and street name (i.e. 555 Somewhere St.)

City/County*

Enter the city or county where your project is located

State*

Enter the state where your project is located

Zip Code*

Enter the zip code where your project is located

PROJECT STATUS

Please help us understand the timing of your project. This information will be used to assure timely response to you throughout the project.

Project Status Description*

Describe the current status of your project. Provide information regarding any special funding criteria (tax credits, fundraising, etc.), special approvals (planning, coastal commission, etc.), or construction mitigation work that may have impact on the progress of your project.

Project has started design

Project has been funded

Permits have been issued for construction

Construction has started at the project site

Estimated Breakground Date*

Estimated Completion Date*

PROJECT DETAILS

Please help us understand the specifics of your project. This information will help us better understand your project, so that we can provide the best possible support.

Description of Home(s) Proposed for Participation*

Describe the residence(s) that are proposed for participation. Include information concerning the number of bedrooms, bathrooms, amenities and other relevant information.

Description of Mixed-Uses/Secondary Buildings

Describe any mixed-uses or secondary buildings located within the project site boundary. Include any retail/commercial spaces, out-buildings, and/or related structures.

Total No. of Homes/Units*

Enter the total number of homes/units on the site

Total No. of Floors/Stories*

Enter the total number of residential floors

Total No. of Buildings*

Enter the total number of residential buildings

Project Types (Select all that apply)

Custom Single-Family Home

Production Single-Family Home(s)

Multi-Family Housing (up to 3 Stories)

Mid-Rise (>3 Stories)

Gut-Rehab

Attached Homes (townhouse, duplexes)

Detached Homes (tract housing)

Affordable Housing (government subsidized)

Stacked Flats (Multi-Family/Mid-Rise)

Mixed Configurations (Multi-Family/Mid-Rise)

CERTIFICATION DETAILS

Please help us understand the certification approach and details for the project. This information will help us better understand the project goals and approach to be taken to the certification process.

Certification Program*

Select the appropriate certification program for the project. Please note for v2008/2010, an active project registration with LEED Online is required.

Select

Total No. of Checklists*

Enter the total number of project checklists to be submitted. Please select the appropriate checklists types to be used.

Checklist Single-Family

Checklist Multi-Family

Checklist Mid-Rise

Will Sampling be used by the Green Rater to verify this project

(Select)

What Sampling Rate will be used?

Select or enter value

Sampling Rate Justification

Describe why you have selected the chosen sampling rate listed above (NA if not applicable)

PROJECT TEAM INFORMATION

Please introduce us to your project team. This information will help us better communicate with your team and assist you in completing your project.

Real Estate Developer

Enter the contact information for the Real Estate Developer who is responsible for planning and financing of the project.

Contact Name

Company Name

Address

Phone No.

E-Mail Address

Is the developer a non-profit organization?

Builder (Contractor)

Enter the contact information for the Builder/Contractor who is primarily responsible for constructing the project.

Contact Name

Company Name

Address

Phone No.

E-Mail Address

Does this builder specialize in multi-family construction?

Does this builder specialize in affordable housing?

Architect (Designer)

Enter the contact information for the Architect/Designer who is primarily responsible for the design of the project.

Contact Name

Company Name

Address

Phone No.

E-Mail Address

Green Rater

Enter the contact information for the Green Rater who will verify the project measures in construction

Contact Name*

Company Name

Address*

Phone No.*

E-Mail Address*

Energy Modeler

Enter the contact information for the Energy Modeler who is responsible for the whole building energy simulations.

Contact Name

Company Name

Address

Phone No.

E-Mail Address

HERS Rater

Enter the contact information for the HERS Rater who is responsible for diagnostic testing and verification of the project.

Contact Name

Company Name

Address

Phone No.

E-Mail Address

Description of Special Project Conditions (if any)

PROVIDER PROJECT FEES - v2008/2010

The following fee schedule applies to projects that are registered and will certify under LEED for Homes/LEED for Homes Mid-Rise v2008/2010. Please note that an active registration under v2008/2010 with GBCI is required. Single Family (Custom) = $1,100.00 Single Family (Production) = $1,100.00 (1st Certification Packet) Single Family (Production) = $572.00 (each additional Certification Packet) Multi-Family/Mid-Rise = $1,950.00 (1st Certification Packet) Multi-Family/Mid-Rise = $572.00 (each additional Certification Packet)

PROVIDER PROJECT FEES - v4

The following fee schedule applies to projects that are registered and will certify under LEED for Homes/LEED for Homes Mid-Rise v4. Please note that v4 is required for all newly registered projects. Single Family (Custom) = $1,950.00 Single Family (Production) = $1,950.00 (1st Certification Packet) Single Family (Production) = $600.00 (each additional Certification Packet) Multi-Family/Mid-Rise = $2,950.00 (1st Certification Packet) Multi-Family/Mid-Rise = $900.00 (each additional Certification Packet)

Payment Policy

Green Dinosaur, Inc. requires all Provider Project Fees to be paid in full at the time of application. Payment is required via ACH or Credit Card and is authorized by your completion and upload of the One-Time Payment Authorization Form below. You will not be allowed to "submit" this application until your form has been uploaded. Final certification may be withheld until all fees are received. Fees do not include fees owed and paid directly to USGBC/GBCI for registration and certification of the project or optional LEED Interpretation fees. The services provided by Green Dinosaur, Inc. and its affiliates and/or subcontractors relate only to LEED for Homes Provider services associated with rating the project according to the LEED for Homes Rating System and in accordance with the LEED for Homes Provider roles and responsibilities defined within the LEED for Homes Green Rater Agreement. Green Dinosaur, Inc. and its affiliates and/or subcontractors does not guarantee or warrant that the project will achieve certification at any level of the LEED for Homes Program. Green Dinosaur, Inc.'s liability shall be expressly limited to the fees received and shall not be refundable in the event of project suspension, abandonment, cancellation, or failure to certify under the LEED for Homes Program. Any dispute arising out of the work associated with this application will be governed by the procedural and substantive law of the State of California.

Signed Payment Authorization Form*

Download a blank payment form at this link: https://drive.google.com/file/d/0B62tTr9vmfrqQVhnTDBxVHJpRVk/view?usp=sharing. Upload your signed One-Time Payment Authorization Form. Please refer to the Project Provider Fees above to calculate your project fee.

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Accepted and Agreed By:*

Acceptance Date:*

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