NJCAT VERIFICATION PROGRAM

LIMITED PRELIMINARY APPLICATION

 

Instructions:  Applicants interested in obtaining NJCAT technical assessment of their technology should complete this application along with the confidentiality agreement in triplicate and return them to NJCAT at the above address.  Applications must include a check in the amount of $1000.00 for the technical assessment fee.

1.  ORGANIZATION INFORMATION

Organization Type:        

      Corporation            Partnership            LLC            Sole Proprietorship         Other              

Organization Name:                                                                                     

Mailing Address:                                                                                          

Contact:                                                              Title:                                                      

Phone Number:                                                            Fax Number:                                         

E-Mail Address:                                            

Name and Address of Key Personnel (Officers, Directors, Partners):

                                                                                                                                                                 

                                                                                                                                                                 

Please identify any staff of NJCAT, including Member organizations, with whom you have discussed the preparation of this application.

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

 

Signature:                                                 Title:                                                      

 

Name (please print or type):                                                      Date:                                                     

 2.  MANDATORY CRITERIA FOR ELIGIBILITY

In order for your environmental/energy technology, product, process, or equipment-based service to be eligible to apply to the NJCAT Verification Program, it must meet the following requirements.

 

1.                  Is your technology either:

 

                        (a)        an environmental/energy technology product or process that offers an environmental benefit or addresses an environmental problem, or

 

                        (b)        an equipment-based environmental/energy service that can make claims based solely on measurable performance of the equipment?

 

2.                  Is your technology currently commercially available or commercially ready for full-scale application?  (A technology is considered commercially available when a full-scale unit is available, and sufficient information about the technology is available, or can be readily obtained, to assess full-scale capabilities.)

 

         Yes                                          No

 

If you answered “No” to Question 2 but have a pilot-scale unit or prototype unit ready for demonstration, you are encouraged to contact the NJCAT Verification Program for advice regarding testing procedures to generate relevant data for subsequent claim(s) verification.

 

3.  GENERAL DESCRIPTION OF THE TECHNOLOGY

 

a) Briefly describe your technology.  

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

    (If necessary, continue on attached page)

 

Attach any information which may help to explain your technology, such as sketches, photographs, drawings, flow sheets, performance data or graphs.  Describe clearly the problems which are solved by the subject technology and any limitations of the subject technology.  Describe also how these problems are currently approached, or were approached prior to the development of your technology.  Is your technology patented?  If so, identify by US patent number(s).  What are the advantages and disadvantages of your technology?  Is your technology currently applied commercially?  Has your technology been licensed for development by any other party?

 

2)                  Please list the third party studies that will be submitted in support of your performance claims.

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

 

3)                  Are the QA?AC procedures for the supporting studies documented?

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

 

4)                  Briefly describe the potential market for your product.

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

 

5)                  By what authority do you submit the technology for evaluation by NJCAT?  Specify whether you own full rights to the technology or are a licensee of the technology or by what other means you hold rights to the subject technology.

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

 

6)                  If you are a licensee, or otherwise hold less than full rights to the subject technology, has the owner of the technology consented in writing to this evaluation?  

         Yes                                          No

If yes, please attach a copy of such written consent.

 

7)                  Describe the target technology performance claim(s) that you want verified. (Note that documentation must be available to support these claims)

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     


 

8)                  Check all that describe your technology:

            Pollution prevention (waste avoidance, recover, “clean” technology)

            Pollution control (waste management, add-on treatment, end-of-pipe treatment)

            Site remediation/charaterization (groundwater, soil)

            Measurement/ monitoring,

            Conservation technology (energy, water)

            Habitat restoration (constructed wetlands)

            Energy Efficieciency

            Renewable Energy

            Alternative Energy Services

            Other (describe):                                                                                                     

 

9)                  Check all that describe the media to which your technology applies:

Environmental Technology                                                                                                                    Soil/solid wastes

            Water/liquid wastes

            Mixed wastes

            Air

            Multi-media

            Other (describe):                                                                                                    

            Energy Technology

                        Fossile Fuel Technology

                        Nuclear Technology

                        Renewable Technology

                        Alternative Fuels

                        Soalr/PV

                        Fuel Cells

                        Wind

                        Transportation

            Other (describe): ):                                                                                         

 

4.  POTENTIAL CONFLICT OF INTEREST

 

In order to ensure that verification activities are objective and unbiased, any potential conflict of interest with NJCAT (including its employees and agents) must be specified by the applicant.  If a conflict of interest is perceived to exist, it will be resolved prior to receipt of the Application for Acceptance into the NJCAT Verification Program.

 

Please specify any potential conflict of interest with NJCAT (indicate if “None”).

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

                                                                                                                                                     

 

5.  PARTICIPATION IN NJCAT PROGRAMS IS STRICTLY VOLUNTARY.

NJCAT determinations as to eligibility and verification will be based on criteria available to the participant.  Participants will be free to terminate participation at any time.

 

6.  NJCAT DOES NOT GUARANTEE THAT ALL TECHNOLOGY SUBMITTED FOR VERIFICATION WILL BE FOUND TO BE VERIFIABLE.  

Participant, by taking part in NJCAT programs, understands and accepts this risk.  Before technology is accepted by NJCAT for the Technology Verification Program, the participant will be asked to sign a formal release acknowledging this risk and releasing NJCAT, its officers, directors, trustees, employees, members and subcontractors from any and all liability arising out of participant’s participation in the NJCAT program.