Regional Green Building Case Study Project

Regional Green Building Case Study Project - Year 2

Owner Authorization and Designated Project Contact Form

Please complete form for each project participating in the U.S. Green Building Council - Chicago Chapter Regional Green Building Case Study Project.

Questions: casestudy@cntenergy.org or contact Kathryn Eggers @ Center for Neighborhood Technology - (773) 269-4001.

Name of LEED Project: *

Address: *

City: *

State: *

Zip Code: *

The following five boxes must ALL be checked for projects to be included in the Regional Green Building Case Study Project.

* I have Owner's authority to provide the U.S. Green Building Council - Chicago Chapter with data for inclusion in the Regional Green Building Case Study Project.

* I understand that the data collected will be published individually and in aggregate by building type both online and in a printed report and that any sensitive or confidential information will be excluded from publication at the owner's request. I further understand that any project that wishes to be anonymous may do so at the owner's request. The project team may also solicit my permission to include my project as a detailed case study and that additional information may be required should the project be included as a case study.

* Construction is complete. The space is occupied and has been operating for at least 12 months.

* This project can provide at least 12 consecutive months of energy utility data.

* Project will supply their energy utilities' meter and account numbers to the project team, and authorizes access to their utility data by the project team.

Choose only one. This project is: *

I authorize USGBC to grant the research team access to the project LEED checklist and LEED Online site (if applicable) *

I designate the following person to provide data to the USGBC Chicago Chapter researchers on owner's behalf and this person will serve as point of contact for this project. She/he has authorization to provide the researchers with data requested.

Person designated Case Study contact & data provider

First Name: *

Last Name: *

Title: *

Company: *

Mailing Address: *

City: *

State: *

Zip Code: *

Phone Number: *

E-mail: *

Relationship to Owner: *

Other relationship:

This form was submitted by:

First Name: *

Last Name: *

Title: *

Date *

Phone: *

Company: *

E-mail: *

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