Preparer Information

First Name

Last Name

E-Mail

Building Information and Location

Building Owned by		Building Name
Street Address
Street Address Line 2
City	State/Province	Country	Zip Code

Contractor Information

Building Mechanical Contractor	Active Mechanical Maintenance Contract? Yes No
Building Controls Contractor	Active Controls Maintenance Contract? Yes No
What kind of control system does the building have (Siemens, JCI, Alerton, etc.)?

Plant Operating Data

Total building area (sq. ft.)	Air conditioned area (sq. ft.)
Operating schedule for chiller plant? (24/7, 06:00 to 18:00 M-F, etc.)
Operating schedule for air-handlers? (24/7, 06:00 to 18:00 M-F, etc.)
Describe building served by central plant: -- Select -- Office Hospital Residential Hotel Data Center Lab 50% Lab/50% Office Other	Does the building utilize "free cooling"(plate & frame HX)? Yes No	Does the chilled water plant serve any data center or process cooling load? Yes No

Equipment Information

Please select the number of chillers in your building: 0 1 2 3 4 5 6 7 8 9 10

What is the most amount of chillers that operate during the hottest days of the summer (all units, only 2 of 3, etc)?

Is there an outside air temperature the chiller plant is off (e.g. when OSA is less than 55F, etc.)?

Primary Chilled Water Pumps

Please select the number of primary pumps in your building: 0 1 2 3 4 5 6 7 8 9 10

Secondary Chilled Water Pumps

Please select the number of secondary pumps in your building: 0 1 2 3 4 5 6 7 8 9 10

Condensor Water Pumps

Please select the number of condensor water pumps in your building: 0 1 2 3 4 5 6 7 8 9 10

Cooling Tower Data

Please select the number of cooling tower cells in your building: 0 1 2 3 4 5 6 7 8 9 10

What is the typical cooling tower water set point (70°F, 75°F, 85°F, etc.)?

Air Handler Information

Type of chilled water valves used on air-handlers? -- Select -- 2-way DDC 2-way Pneumatic Nil 3-Way DDC 3-Way Pneumatic Mix of Valve Types

How many AHUs served by plant?

How many fan coils or CRAC units served by plant?

VAV Air Handlers

Please select the number of air handlers in your building: 0 1 2 3 4 5 6 7 8 9 10

Do the AHUs and VAVs use eletric heat, steam or heating hot water?

What is the average price for electricity? ($0.09/kWh, $0.12/kWh, etc)

Utilities

Name of Provider
Month -- Select -- January February March April May June July August September October November December	Consumption (kWh)	Demand (kW)	Total Cost
Month -- Select -- January February March April May June July August September October November December	Consumption (kWh)	Demand (kW)	Total Cost
Month -- Select -- January February March April May June July August September October November December	Consumption (kWh)	Demand (kW)	Total Cost
Month -- Select -- January February March April May June July August September October November December	Consumption (kWh)	Demand (kW)	Total Cost
Month -- Select -- January February March April May June July August September October November December	Consumption (kWh)	Demand (kW)	Total Cost
Month -- Select -- January February March April May June July August September October November December	Consumption (kWh)	Demand (kW)	Total Cost

Additional Comments