Energize Denver: Buildings 5,000 - 24,999 sq. ft. Letter of Attestation for LED Lighting Compliance Form

This form serves as the Letter of Attestation for Lighting Compliance. It will need to be completed by the Lighting Professional Service provider that verified the specified building's compliance with the 5,000 - 24,999 sq. ft. lighting requirement.

Once submitted, a PDF of the form and the relevant lighting certification will be emailed to the submitter (lighting professional) and the Building Owner. This documentation will need to be uploaded to the Lighting Compliance Form as the "Signed Attestation from a Lighting Specialist" and the "Lighting Professional Certification" attachments.

To learn more about the performance requirements for buildings 5,000 - 24,999 sq. ft. visit: https://www.denvergov.org/energizedenver.

I. Lighting Service Provider Information

First Name *

Last Name *

Phone Number *

Email Address *

Company Name *

II. Building Information

Denver Building ID * 🛈

Building City *

Building Address *

Building Address 2

Building State *

Building Zip *

- The Denver Building ID is a unique 5-digit number assigned to each individual building required to comply with the Energize Denver Small Building requirements.

Building Owner First Name *

Building Owner Last Name *

Building Owner Email Address *

III. Lighting Audit Information

Date of Lighting Audit * +

IV. Letter of Attestation for LED Lighting Compliance

This note is to confirm that [pipe:216] [pipe:37] completed the lighting audit on [pipe:227] for the following building:

Building ID: [pipe:180]

Building Address: [pipe:162], [pipe:181], [pipe:182] [pipe:183]

I confirm that the above-referenced building (please select the appropriate option): *

Utilizes LED lighting for greater than or equal to 90% of the total lighting load

Utilizes LED lighting for less than 90% of the total lighting load

Lighting audit/ verification was not conducted on the entire building

Please contact the Energize Denver Help Desk for more information regarding obtaining partial compliance for your building.

Phone: 844-536-4528

Email: energizesmallbuildings@denvergov.org

Schedule a Phone Appointment: https://energyreporting.as.me/EnergizeDenver5000to24999

The lighting specialist completing this letter: *

Completed the lighting audit and completed lighting upgrades to the building

Completed the lighting audit and/or verification only (i.e. lighting work was completed by another service provider)

[pipe:216] [pipe:37]

I declare that the above statements are true and accurate to the best of my knowledge, information and belief.

Sincerely, *

clear

V. Lighting Specialist Certification

Certification held by Lighting Specialist completing this letter: *

Certified Lighting Consultant through the American Lighting Association

Lighting Certification from the National Council on Qualifications for the Lighting Professions

National Association of Innovative Lighting Distributors (NAILD) Lighting Specialist II (LSII) designation

Certified Lighting Efficiency Professional (CLEP)

Licensed Electrical Contractor Registered with the State of Colorado (Lighting Audit Only)

Master Electrician licensed in the State of Colorado

Certified Energy Manager (CEM)

Service Providers for Xcel Energy’s Multi-Family Building Efficiency Program and any Business Energy Assessment Programs (implementing a BEA of Multifamily Efficiency program on behalf of Xcel Energy)

Please upload a copy of your relevant lighting certification *

Once submitted, a PDF of the form and the relevant lighting certification will be emailed to the submitter (lighting professional) and the Building Owner. This documentation will need to be uploaded to the Lighting Compliance Form as the "Signed Attestation from a Lighting Specialist" and the "Lighting Professional Certification" attachments.