ETP Questionnaire

Thank you for your submission to Nicor Gas Emerging Technology Program! We are searching for emerging technologies and products that have the potential for natural gas savings, and are economically competitive, commercially available, and ready for the Nicor Gas market. Based on the completed form you provided, we are requesting additional information about your technology/product so it can advance to the next stage of consideration.

General Information
One-line product description, including what it does.		Your input is required for this field.
What customer need(s) and problem(s) does the product address?		Your input is required for this field.
What year did your product become commercially available in North America?		Your input is required for this field.
Describe the origin of the product – who developed it, has it undergone significant changes, etc.		Your input is required for this field.
Estimated service life (years)		Your input is required for this field.

Costs
Current system cost ($)		Your input is required for this field.
If the cost varies, please provide a reasonable representative cost for a typical installation scenario. Scenario details can be included in the following description of what is included in the system cost.		Your input is required for this field.
Estimated system cost in 18 months ($)		Your input is required for this field.
What do you expect to drive the cost down in the next 18 months?		Your input is required for this field.
Installation cost ($)		Your input is required for this field.
Annual maintenance cost ($)		Your input is required for this field.

Energy Savings Potential
Annual natural gas consumption of this product (therms/year/unit) If the product is not gas-fired, please insert 0.	therms/year/unit	Your input is required for this field.
If your product is not gas-fired, but displaces gas use elsewhere, how much gas does it save annually? (therms/year/unit) If not applicable, please state N/A.	therms/year/unit	Your input is required for this field.
Estimated annual electricity savings (kWh/year/unit). If electricity use increases, enter as a negative number.	kWh/year/unit	Your input is required for this field.

Non-Energy Benefits
What improvements does your technology offer over the primary competing product in the market?		Your input is required for this field.
Does your technology/practice save water? If yes, please state how many gallons per year?		Your input is required for this field.
Does your technology/practice have wastewater/sewer savings? If yes, please state how many gallons per year?		Your input is required for this field.
Does your technology/practice save on install costs? If yes, please state how much your technology/service saves than primary competing product.		Your input is required for this field.
Does your technology/practice require fewer hours of annual maintenance than primary competitor? If yes, please state on average how many hours of maintenance labor it saves.		Your input is required for this field.
Are there other non-energy benefits that your technology/product offers?		Your input is required for this field.

Support and Distribution in Nicor Gas Territory
How many units of your product were installed in Illinois from January 1 to December 31 of last year?		Your input is required for this field.
How many total units of your product are projected to be installed in Illinois by December 31 of this year?		Your input is required for this field.
Are there distributors, builders, or other trade allies that are already using your product? If yes, please list 2-5 examples.		Your input is required for this field.

Commercialization
Has your product been used in any field demonstrations to date? If so, please list and describe.		Your input is required for this field.
Has your product been used in other utility energy efficiency programs? If yes, please describe. State no or unknown, if applicable.		Your input is required for this field.
Describe the obstacles your product/technology has faced in achieving wide commercialization.		Your input is required for this field.
What are the commercial production levels for this product/technology for the current year? State in number of units produced per year.		Your input is required for this field.
What are the commercial production levels for this product/technology in five years? State in number of units produced per year.		Your input is required for this field.
Summarize the competitive strategy used to gain market share for this product.		Your input is required for this field.
Under what conditions do you recommend not installing your product in Nicor Gas territory?		Your input is required for this field.

Competing Products
What is the primary competing product to your technology?		Your input is required for this field.
Initial cost for competing product ($)		Your input is required for this field.
Estimated initial cost in 18 months ($)		Your input is required for this field.
Installation cost ($)		Your input is required for this field.
Annual maintenance cost ($)		Your input is required for this field.
Estimated effective service life (years)		Your input is required for this field.
Annual natural gas consumption of this product (therms/year/unit)	therms/year/unit	Your input is required for this field.

Potential Pilot Assessment Information

If your product were to be part of a pilot assessment, do you have a potential site willing to participate? If yes, complete below questions. If no, skip remaining questions.

Potential site location (address)

Line 1:
Line 2:
City:

State/Province:

Zip/Postal Code:

Potential site type

Name of contact at potential site

Phone number of contact

Email of contact

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Terms and Conditions

Questions		Yes	No
1	Does this technology/product reduce a customer’s consumption of natural gas while delivering the same or superior service as compared to the system it replaces?			Response required for this question.
2	Will your technology result in electricity savings for consumers?			Response required for this question.
3a	Is your technology commercially available in the U.S.? If yes, proceed to question 4.			Response required for this question.
3b	Will your technology be commercially available in the U.S. in the next 6 months?			Response required for this question.
4	Is this technology/product currently receiving incentives (rebates) from one or more North American energy utilities? If unknown, answer “no”.			Response required for this question.
5	In addition to natural gas savings, are there other performance benefits to your technology? Examples include: quieter performance, simplified installation, reduced maintenance requirements, increased indoor air quality, water savings, etc.			Response required for this question.
6	Can your technology be retrofitted to existing equipment?			Response required for this question.
7	Has this technology/product been evaluated by recognized professionals (engineers, architects, contractors) to confirm its compatibility with existing building practices and systems and its ease of installation?			Response required for this question.
8a	Has this technology/product been installed at multiple sites in North America? If no, skip to Question 9a.			Response required for this question.
8b	To the best of your knowledge, is this technology/product currently in operation at all sites where installed?			Response required for this question.
9a	Is there an available service network to support your product in the Nicor Gas territory? If yes, proceed to question 10.			Response required for this question.
9b	Do you have the capacity to build/establish a service support network in the Nicor Gas territory?			Response required for this question.
10	Does your product/technology require mitigation measures for noise, vibration, emissions, or other safety issues?			Response required for this question.
11	Does the installation of your technology require upgrading of ancillary equipment?			Response required for this question.
12	Based on the price that this technology/product will sell for 18 months from now, will it save enough energy to pay for itself in 5 years or less?			Response required for this question.

Alternate Contact Information
Name		Please enter a company name.
Title		Please enter the product name.
Company		Please enter the primary use/function.
Office Phone Number		Please enter the primary use/function.
Mobile Phone Number		Please enter the primary use/function.
E-mail Address		Please enter the primary use/function.
Company Website (if available)		Please enter the primary use/function.