RfA_Annex_2A_Application_Form_Surface_Studies-02 · Web view2018. 10. 8. · (Fifth Edition)...

AFRICAN UNION UNION AFRICAINE

UNIÃO AFRICANA

Department of Infrastructure and Energy

GEOTHERMAL RISK MITIGATION FACILITYFOR EASTERN AFRICA (GRMF)

Request for Application for Surface Studies and Drilling Projects

Annex 2A Application Form for Surface Studies (Fifth Edition)

Application-ID: 05-SS-xx-xxName of applicant: xxxxxxxxxxxxxxxxxxxxxxxxName of project: xxxxxxxxxxxxxxxxxxxxxxxxCountry of project: xxxxxxxxxxxxxxxxxxxxxxxx

Project funded by:

TECHNICAL CONSULTANT

Geothermal Risk Mitigation Facility (GMRF)

Appl.-ID: 05-SS-XX-YY Request for Application (FifthEdition)Annex 2A Application Form for Surface Studies /60

Contact

African Union CommissionRoosevelt Street, W21K19;P.O. Box 3243Addis Ababa, Ethiopia

Rashid Ali ABDALLAHGRMF Project ManagerInfrastructure & Energy DepartmentPhone: +251 11 518 2414E-mail: [email protected] E-mail: [email protected] Website: www.grmf-eastafrica.org

http://www.grmf-eastafrica.org/

mailto:[email protected]

mailto:[email protected]


Appl.-ID: 05-SS-XX-YY Request for Application (Fifth Edition)Annex 2A Application Form for Surface Studies /60

ABBREVIATION LIST CHP Combined Heat and Power

DEM Digital Elevation Model

EIA Environmental Impact Assessment

km² Square kilometre

LFY Last Fiscal Year

LCOE Levelised Cost of Energy/Electricity

LiDAR Light Detection and Ranging

MT Magnetotelluric

MWe Megawatt electric

N/A Not applicable

TDEM Time-Domain Electromagnetic

WBS Work Breakdown Structure

Style coding

White cells are input cells intended for the Applicant

Grey cells are fixed and should not be changed

Yellow highlighted text indicates that the text should be replaced by the Applicant

Italic text indicates that the text is there for guidance

Copyright © GRMF 2016



FORM 00: CONTENT LIST

Form reference

Name Usage

If any attachments relate to this form, the Applicant should indicate this by entering the reference of the attachment below.

Required information submitted

Application Form

00 Content listThis form is summarising all required forms and attachments

Not applicable

A0Information table about entity

A1-S Project data sheetProvides information on proposed project for website publication

A2Application Summary

Provides general information on the Applicant and project

A3 Resource DataProvides detailed information on the geothermal resource

B1-S Project description

B1-S_aGeneric surface survey

Provides details on the planned surface survey method(s) (One for each surface survey method used in the project)

B1-S_bList of contractors / Procurement plan

C1Concession agreement details

C2 Exploration licence

C3Environmental permits

D1 Market viability

E1 Project personnel A template for the staffing plan is provided




Form reference

Name Usage



in a separate Word version.

E2 Personnel CV Format E2 is provided separately as Word version.

E3Project developer´s experience

E4Statement on capabilities

E5-SPlans for subsequent drilling

F1 Financing plan

F2-S Cost estimate

Cost estimate for entire proposed project. Excel version available. Filled in Excel version has to be additionally included in the electronic copy.

F3Project financing plan

Detailed financing plan of project. Excel version available. Filled in Excel version has to be additionally included in the electronic copy.

F4 N/A

F5-S Key financials

Declarations and Guarantees to be attached

G1Declaration Procurement standards

Word version available Not applicable

G2

Declaration non-existence of grounds for rejection

Word version available Not applicable




Form reference

Name Usage



G3Audited financial statements

Formless Not applicable

Further Attachments (Shall be added and denominated by the Applicant)

FormReference#-X1

Name of attachment 1 to Form #

Supplement to FORM #

FormReference#-X2



FormReference#-X3



FormReference##-X1

Name of attachment 1 to Form ##

Supplement to FORM ##

FormReference##-X2

Name of attachment 2 to Form ##

Supplement to FORM ##

To be continued

(Place) _________________, (Date) _______________

Name and PositionSignature

___________________________________ ____________________________




FORM A0: INFORMATION ABOUT THE ELIGIBLE ENTITY

Explanation

Name of the eligible entity

Type of the eligible entity Public Private PPP

Address of the eligible entity

Name of eligible entity’s contact person in regard to the Expression of Interest

Telephone number of the contact person

Fax number of the contact person

Email address of the contact person

Name(s) of consortium members (if applicable)1

Application includes eligible infrastructure activities(Infrastructure only in combination with surface study) Yes No

Country in which proposed project is located

Name of the activity/program/project

Remarks:(If application has been made for sites that could be considered connected, make clear justification on why the sites are considered separate / not connected. Briefly state reasons and give more detail in B1-S – Project description)

1 For the GRMF a “Consortium” is any kind of cooperation with the objective of a joint development of a geothermal project. For this cooperation, there could be either:

a) A Special Purpose Vehicle (SPV) especially established for the particular project, with shareholders from participating partners,

b) A Joint Venture agreement between cooperating parties,In case of a) the SPV will be the applicant and finally also the beneficiary. The declarations and the grant contract will have to be signed by the representative(s) of this corporation.In case of b) the joint venture agreement has to be submitted to AUC with the application. The declarations and grant contract have to be signed by every cooperating party.




FORM A1-S: PROJECT DATA SHEET SURFACE STUDY

General information

Project Name Country

Resource

Estimated size of resource (MWe)2

Type of resource (e.g. low-temperature non-magmatic fault hosted deep circulation system)

Surface Study

Type of major survey(s) plannedSize (km²) / % of concession to be covered

Latitude/Longitude WGS 84 of midpoint: decimal degrees [°] with 5 positions after decimal point

Project Developer (Applicant)

Name Legal Status Location of Head Office

Published information sources (references)

Author(s) Year Title Journal/ConferencePages/Paper no.

2 Use same value as calculated with assumptions documented in section “Preliminary resource capacity evaluation” of Form A3.




FORM A2: APPLICATION SUMMARY

Project Summary

Project name Country:

Name of project areaConcession area size (km2)

Applicant general information

Name of company

Current no of employees

Headquarter address

Name of local entity

Current number of employees

AddressLFY3 turnover (USD)

Applicant contact personnel

Role TitleFirst name

Family name

E-mail Phone Address

Project managerDeputy project manager

3 Last Fiscal Year




Personnel Man-months (full time equivalent)

Local personnel (originally based in country)

External personnel (personnel working from outside the country or expatriated to the country during the project)

Direct employees

Sub-consultants4

Changes from the Applicant’s Expression of Interest

Has any part of the proposed project changed in comparison to the information and / or specifications given in the Applicant’s Expression of Interest?If yes, please specify the details below.

Yes

No

4 Regarding the eligibility of costs resulting from the assignment of sub-consultants, please refer to the „Conditions for Early Contracting“.




FORM A3 RESOURCE DATA

Independent geothermal field

Provide reasoning that the geothermal field is not a part of a field which has already been developed or received a GRMF grant. The reasoning can include, but is not limited to:

Evidence of a separate/independent heat source

Distance(s) between adjacent geothermal field(s) (should be supported by an overview map showing the proposed field and the surrounding field(s))

Orientation of fractures and faults / changes in fracture intensities

Resistivity map outlining the geothermal resource and indicating if the geothermal resource, at the surface, exists as a single field, or is divided into more than one sub-unit

(maximum 500 words).




Topography

Scanned topographic maps (digital topographic maps) should be provided and if additionally available Digital Elevation Models (DEMs) as well as aerial photographs and/or satellite imagery. The Applicant should not provide raw data (xyz format) but raster images [tiff or png or jpeg format] with coordinate grid. Images of free or cheap data (topographic maps or freely available DEMs) should be provided for the entire area (i.e. also in the surrounding of the concession area) and more costly data might only cover a part of the concession area focussing on most important features. Figure captions should be given in the explanatory text to all provided images so that they can easily be identified on the attached CD/DVD/USB and projection and reference datum need to be clearly specified. All images and figures have to be provided in adequate resolution which is high enough to recognise described features in sufficient detail. A printout of the images/figures should be attached to the hardcopy of the Application. (maximum 500 words)

Geology

Raster images with coordinate grid of scanned geologic maps [tiff or png or jpeg format] or originally acquired digital geologic maps. Figure captions should be given in the explanatory text to all provided images so that they can easily be identified on the attached CD/DVD/USB and projection and reference datum need to be clearly specified. All images have to be provided in adequate resolution which is high enough to recognise described features in sufficient detail. A printout of the images/figures should be attached to the hardcopy of the Application. (maximum 500 words)

Surface manifestations

Selected Digital Elevation Model (DEM) with locations of surface manifestations including alteration zones as well as travertine and silica sinter deposits, lineaments (local fault pattern), Late Quaternary volcanic




centres, earthquake epicentres, geophysics other than resistivity as far as available (e.g. isolines around gravity highs and lows, magnetic highs and lows), line around surface study area to show areal interconnection of those features. The Applicant should provide raster images with coordinate grid [tiff or png or jpeg format]. The explanatory text should contain a summary of field features and characteristics as well as available geophysics. An additional Excel table should include a list of surface manifestations with coordinates (incl. projection and reference datum identical to that used in the raster images), elevation, date of sampling, measured temperature (in case of fluids), pH (field measurement in case of fluids), electrical conductivity (field measurement in case of fluids), short description (incl. type and flow rate; the latter, if applicable), photograph (the latter, if available). A printout of the images/figures and Excel table should be attached to the hardcopy of the Application. (maximum 500 words)

Heat source

Narrative on volcanic activity phases of the volcano related to the geothermal system including an Excel table with dating results (e.g. caldera forming event, pre- and post-caldera activity). The table should contain not only the activity phase, age incl. “error bar”, but also the dating method and the dated material (e.g. total rock, sanidine), if given in similar detail in the publication used as data source. Type of eruption style (explosive, effusive) and type of volcanic rock (alkali basalt, trachyte, phonolite etc.) should also be given.

Especially in case of non-volcanic low-temperature resources, give description of evidences on reservoir temperature other than geothermometers, if any (e.g. from geothermal gradient wells or adjacent exploration wells which allow conclusion on the prospect of the project proposed for funding) A printout of images/figures and Excel table should be attached to the hardcopy of the Application. (maximum 500 words)

Reservoir

Narrative description on type of permeability (in case of fracture permeability refer to figure with lineament




mapping).

For reservoir characterisation provide tables with chemical (and if available isotopic) composition of fluids and gases including geothermometric results, if applicable. The Excel tables should include the year of sampling (or if taken from old reports lacking this information instead the year of this report) from the fluid and gas samples used for reservoir characterisation and geothermometry.

Indicate if the resource temperature is likely to be:

less than 120 °C (low temperature)

between 120 and 170 °C (medium temperature)

higher than 170 °C (high temperature).

Indicate the depth range of the resource. In the case the depth range is not known, please give an estimate of it. Give details of your methodology and basis of estimate.

Also present lines of evidence for the type of reservoir rock(s).

Reference data from surrounding boreholes including geophysical logs and/or an evaluation of the possible interaction with adjacent geothermal fields should be given for low- and high-temperature prospects, if applicable.

Additionally, even if not explicitly requested for, the Applicant should provide any further information mentioned in its Expression of Interest => e.g. if marked “yes” in row “Does the geochemical study include trace element analyses [e.g. REE]?” the Applicant should provide those.

A printout of the images/figures and Excel table should be attached to the hardcopy of the Application.

The explanatory text (without diagrams and tables) should not exceed 1200 words.

Recharge

Provide a narrative description on the recharge area. A printout of optional images/figures should be attached to the hardcopy of the Application. (maximum 500 words)




Cap rock

Provide any evidence for cap rock/seal (if present) in case of geothermal high-temperature reservoirs.

In case of a low-temperature reservoir in a sedimentary basin give lithology and thickness of expected aquitard on top of thermal water aquifer as e.g. deduced from surrounding wells and/or seismic lines.

Give rock units of hanging wall and foot wall in case of fault-hosted geothermal circulation system.

A printout of the images/figures should be attached to the hardcopy of the Application. (maximum 500 words)

Conceptual model

Provide figure(s) with schematic geological cross section showing all components of the expected geothermal system. A printout of the images/figures should be attached to the hardcopy of the Application.

(narrative description maximum 1500 words)




Preliminary resource capacity evaluation

Give method(s) and formula(e) of resource capacity calculation in MWe (Excel file of calculation e.g. by volumetric method) and assumptions made. Sustaining or substantiating studies and reviews should be provided under section “Data sources and method references”. Provide an estimation on convective heat loss and if data of shallow gradient drilling are available, give also results of conductive heat loss including a map with contours of temperature e.g. in 1m depth and temperature gradient (tiff or png or jpeg format) with coordinate grid including projection and reference datum). If the resource capacity estimate is done in terms of a recognised standard (e.g. the Australian Code for Geothermal Resource and Reserve Reporting 2008, or the Canadian equivalent) this should be clearly stated and a Competent Person statement under the Code included. All Applicants should select the value with highest probability for the project data sheet (Form A1) A printout of the images/figures and Excel table should be attached to the hardcopy of the Application. (maximum 500 words)

Data sources and method references

Unpublished reports etc. and published papers, conference contributions etc. used as data sources and as method references should be inserted as citation list. The reference style is not important as long as author(s), publication or report date, title, journal/report, volume/report number and pages are included (in contrast to the selected publications in the project data sheet used for publishing on the GRMF webpage in uniform reference style). Be aware that in a case-by-case decision some references can be asked for in the evaluation phase (e.g. in case the presented conceptual model is not coherent) and the Applicant should be able to send the requested reports/publications immediately in pdf format.

Required attachments

Attached Item Reference




Topographic map and/or DEM (tiff or png or jpeg)

Geologic map (tiff or png or jpeg)

Selected DEM (tiff or png or jpeg) with locations of surface manifestations, lineaments and survey area

Excel table with list of surface manifestations

Photographs of prominent surface manifestations

Excel table with dating results of volcanic rocks (if any)Excel table with chemical fluid and gas composition, isotopic composition of fluids and gases and geothermometric resultsGeophysical logs from surrounding boreholes, if availableHigh and low temperature surface studies: Geological cross section(s) of geothermal system (jpeg or png or tiff)

Map with contours of temperature in e.g. 1m depth and temperature gradient (jpeg or png or tiff), if applicable

Excel file with resource capacity calculation

Remarks (please provide remarks if any of the required attachments are not provided).




FORM B1-S: PROJECT DESCRIPTION

Proposed Surface Study plan summary

The main objective of a surface exploration programme is to optimise the siting, targeting and design of exploration wells. The Applicant should provide a narrative technical description of the surface study plan specifying the overall concept and strategy behind it, the activities to be carried out, the technical specifications to be followed, all underlying assumptions and the expected results.

The work programme must be in continuity with any previous studies and with objectives well defined. Objectives must be reached in a sequential way with intermediate reviews and go/no go decisions if several survey phases are planned.

The overall timeline for all planned surface study measures should be provided as attachment (see attachment list below).

The coherence of the plan and risk mitigation strategies (e.g. in form of a decision tree) are important criteria especially if several surveys of different disciplines are planned. The plan should also consider administrative, legal, customs and other local conditions or regulations which might affect the project planning and execution as well as the availability of key contractors (consultation methodology and selection process).

If applicable, give details (country-specific regulations) on custom clearance requirements for any necessary temporarily imported equipment.

Specify envisaged geophysical method(s). Give short description on planned method, instrument(s), principle and measured parameter(s), range of application (e.g. investigation depth), type of modelling and interpretation.

Please specify, whether the technical equipment (e.g. geophysical signal sources, geophysical sensors, recorders, receiver stations, GPS equipment) is rented or provided and specify the proposed providers for equipment. Specify the proposed contractors of the specialist service for geophysical and supplementary surveys and post-survey data processing/modelling, in case the services will be contracted.

Please specify also details on any planned supplementary geological, hydrogeological and/or geochemical surveys if necessary for siting reservoir confirmation wells as well as details on any necessary purchase of already existing data as the basis for the proposed study.

Please make sure that all activities are eligible for support from the GRMF facility and that the survey is not a reconnaissance study. Eligible activities are addressed in the Developer Manual.

Summaries of the Environmental and Social Inception Report and of the Draft Stakeholder Engagement Plan have to accompany the Surface Study Plan Summary.

(maximum 2000 words)




Supplementary Mapping, if applicable

Describe details on methodology, technique and equipment for mapping of surface manifestations (incl. travertine, alteration zones) and lineaments e.g. with remote sensing methods like IR-camera surveys for detecting so far undiscovered manifestations or LiDAR surveys for constraining the local fault pattern or for geo-hazard mapping of unstable slopes. Give also details on any other planned mapping method like soil temperature or soil gas measurements. Please note that for LiDAR, a detailed surface survey form (B1-S_a) has to be filled out additionally to the short description. The expected timeline in relation to other survey(s) should be given as attachment. (maximum 500 words)

Supplementary Geology, if applicable

Describe details on methodology, technique and equipment for e.g. reservoir rock characterisation, structural interpretation, mineralogical composition of alteration zones etc. The timeline in relation to other survey(s) should be given as attachment. (maximum 500 words)




Supplementary Geochemistry, if applicable

Describe details on methodology, technique and equipment e.g. for additional sampling of fluids and gases for isotope investigations etc. The timeline in relation to other survey(s) should be given as attachment. (maximum 500 words)

Geophysics summary

Give short summary on all planned geophysical methods: type of surveys and inversions as well as joint inversions of data from different methods and refer to individual surface survey forms for further detail. The timeline in relation to other survey(s) should be given as attachment. (maximum 500 words)






Summarising timeline of all planned surface study methods in parallel with milestones and go/no go decisions (Gantt chart or Excel bar chart)

Proposed Project Work Breakdown Structure (WBS) structure

Signed “contract” or “Heads of Agreement” for service contractors with substantial* scope other than predefined ones e.g. in case of a planned InSAR survey which is not listed as predefined method

Remarks (please provide remarks if any of the required attachments are not provided)

* Substantial means in the same order of magnitude as the major survey types predefined in Form B1-S_a below and not e.g. the laboratory contractor for analysing a small number of supplementary gas samples




FORM B1-S_A: GENERIC SURFACE SURVEY

Generic surface survey

Attach one B1-S_a form for each type of survey planned to be carried out. Use the generic survey form and modify accordingly. Examples of the common major survey types are given below for guidance in necessary modifications. Please modify the generic survey form by own initiative in case the Applicant’s proposed other substantial survey is not listed below.

Attachment Name: Form B1-S_a

Major survey type

Magnetotelluric (MT)

Time-Domain Electromagnetic (TDEM)

ESIA Process: Scoping Study and Stakeholder Engagement

Aeromagnetic

Gravity

Seismic (active)

Micro-seismicity (passive)

LiDAR

TG Well(s)

Other substantial survey:

Justification and expected outcome

Give a detailed justification of the suggested survey and its expected outcome. Avoid reproducing of textbook sections. (maximum 500 words)




Survey Coverage

Describe planned coverage and measurement density/spacing. Give size of total survey area / %-age of total concession area covered and total number of soundings/stations/seismometers/line-kilometres etc. Provide as attachment an elevation map (e.g. DEM or scanned topographic map with visible contour lines including coordinate grid with projection and reference datum) showing the locations of the planned stations/seismometers/flight lines etc. [tiff or png or jpeg]. (maximum 500 words)

Survey details/specifications

Describe planned field or air-borne technique and data collection strategy including personnel skills (number and qualification of technical personnel doing the measurements, if applicable) or experience of contractor as well as equipment.

Additionally an equipment list and the signed “contract” or “Heads of Agreement” for service contractors with substantial scope (if any) should be provided as attachment. (maximum 1000 words)




Modelling and Interpretation strategy

Including but not limited to planned modelling tools; grid dimensions and modelling/analysis process; timeline. The latter should be included in the attached timeline for this individual method. (maximum 500 words)

Equipment list

Equipment type/model, ownership (e.g. leased/rented); quantity (e.g. number of instruments); Consumables directly related to the survey, age of equipment, maintenance etc. as comment.

Equipment Ownership Quantity Comment




Logistics and support

Provide details on the field logistics (on-site accommodation and transport with expected total number of kilometres for all vehicles roughly estimated with distance between accommodation site and airstrip/airport or mean distance between accommodation site and measurement sites in the field) and support including the effort you will put into safety and security measures (both for personnel and equipment) etc. (maximum 500 words)




Timeline of major individual surface survey

Provide details on the timeline including mobilisation/demobilisation of field or air-borne survey, data processing and interpretation, reporting etc. and Gantt chart or Excel bar chart as attachment. The timeline needs to include project milestones and any seasonal weather constraints. (maximum 500 words)

Project management issues

Provide details on general methodologies of quality assurance (QA) followed to reach the best possible result, project management (including procurement procedures, tendering, bonds, contracts etc.) including specifications and specification on any duties (e.g. import duty), taxes (e.g. Value Added Tax), exemptions from taxes, customs clearance fees, levies etc. applicable to the project, and details on mandatory insurances as per Grant contract Article 11and RfA Chapter 7 (maximum 1500 words). In case of more than one major surface survey, refer to the detailed description of this section provided with the first major surface survey to avoid possible duplications.




Information on infrastructure (eligible for infrastructure grant)

Infrastructure

Details on infrastructure requirements and information and justifications for infrastructure plan: in land logistics, road access construction and maintenance, reliable water supply infrastructure, if applicable: transport and crew accommodation. Please note that the suggested infrastructure should be in direct relation to the planned surface study and not in anticipation of any subsequent drilling project. (maximum 1000 words)

Attachment reference of related material: [type reference here]

Existing survey(s)

Comments

Has there been similar survey(s) carried out in the area before?

Yes

NoWho has done this/these survey(s)?

Does the Applicant have access to this data or is it possible to gain access to the data?

Yes

NoCost of gaining access to data (in USD)

Have the survey data been reviewed prior to this Application?

Yes

No




Required Attachments


DEM or scanned topographic map with location of soundings/stations/flight-lines etc. for each planned major survey (tiff or png or jpeg)Detailed timeline for each planned major survey (Gantt chart or Excel bar chart) (tiff or png or jpeg). Also the timespan for mob/demob including custom clearance, modelling and interpretation etc. should be specified in adequate detail

Equipment list (see template above)

Signed “contract” or “Heads of Agreements” for service contractors with substantial scope


Specific surveys

Please use the following examples as guidance for filling out the generic survey forms after being adapted to the specific survey by the Applicant

Magnetotelluric Survey (MT)

1. Survey justification, planned coverage and sounding spacing/density, and expected outcomes.

2. Survey details, including personnel skills, equipment, field methods, data collection methods including strategies to maximise sounding density over most prospective areas, frequency range, etc.

3. Expected timeline for the survey in relation to other scientific surveys (incl. mobilisation/demobilisation).

4. Number of MT soundings.

5. Field logistics and support.

6. Field operation report, provision of data etc.




Specific surveys

7. Modelling strategy, including modelling process, grid dimensions and timeline.

8. Final interpretation report incl. joint inversions, if applicable.

Time-Domain Electromagnetic (TDEM) survey

1. Survey justification, planned coverage and sounding locations, and expected outcomes.

2. Survey details including personnel skills, equipment used, field methods, etc.

3. Expected timeline for the survey (incl. mobilisation/demobilisation).

4. Number of TDEM soundings.



ESIA Process

1. Prior to Surface Studies: Inception Report and Draft Stakeholder Engagement Plan.

2. Work Plan as part of the Inception Report with methodologies, expected timeline and duration of scoping studies, including stakeholder engagement (corresponding to technical studies).

3. Scoping Report with ToR for ESIA, updated Stakeholder Engagement Plan.

4. Personnel Skills and field methods, field logistics and support

Aeromagnetic Survey

1. Survey justification, planned coverage (line spacing, flight elevation etc.), and expected outcomes.

2. Survey specifications – personnel skills, equipment details, positioning system, etc.

3. Expected timeline for the survey in relation to other surveys (incl. mobilisation/demobilisation).

4. Number of line-km to be flown.




Specific surveys




Gravity Survey

1. Survey justification, planned coverage (station spacing), and expected outcomes.

2. Survey specifications – personnel skills, equipment details, positioning system, terrain corrections, etc.

3. Expected timeline for the survey (incl. mobilisation/demobilisation).

4. Number of stations to be occupied.



7. Final interpretation report.

Active Seismic Survey

1. Survey justification, planned coverage (line and station spacing), and expected outcomes.

2. Survey specifications – contractor experience, equipment details, positioning system, etc.

3. Expected timeline for the survey incl. mobilisation/demobilisation.

4. Number of line-km to be surveyed.



7. Data processing and interpretation details, including final interpretation report.




Specific surveys

Passive Seismic Survey (micro-seismology or micro-seismicity)

1. Survey justification, planned coverage and expected outcomes.

2. Survey specifications – seismometer details, installation (e.g. surface or borehole), data timing and collection, expected event sensitivity.

3. Expected timeline and duration of survey with mobilisation/demobilisation (including seismometer installation and removal).

4. Number of seismometers to be installed.

5. Interpretation strategy, including analysis process, grid dimensions and timeline.

6. Data processing and interpretation details, including final interpretation report.

LiDAR Survey

1. Survey justification, planned coverage and expected outcomes.

2. Survey specifications – contractor experience, equipment, scan angle, swath overlap, positioning system, vertical and horizontal accuracy, natural colour imagery.

3. Expected timeline of survey incl. mobilisation/demobilisation.

4. Number of line-km to be flown (total area surveyed).

5. Data reporting and presentation, interpretation strategy and timeline.


Temperature Gradient Well(s)

1. Survey justification, planned coverage and expected outcome.

2. Survey specification – number of wells, well(s) location, equipment, expected depth, well specification, geothermal gradient determination.

3. Expected timeline and survey duration.


5. Interpretation, data reporting and presentation.




Specific surveys





FORM B1-S_B: LIST OF SUB-CONTRACTORS / PROCUREMENT PLAN

List of contractors

Applies only to those that are part of the team at the time of proposal submittal (contracts signed after submission deadline of EoI under the precondition that the “Conditions for Early Contracting” have been observed).Provide list of main contractors who are foreseen to be involved in the Surface Study (please amend or modify where applicable) .If use of the entity’s own personnel is intended for any of the work/role/responsibilities listed, the entity’s name should be inserted in the “Name of contractor or sub-contractor” box for the respective work/role/responsibilities.

Name of contractor

Name of major surface survey

Has provided similar services in year(s)

Has provided similar services in (Eastern) Africa in [country / year(s)]

Has the contractor already worked for the Applicant before?

Name:Major geophysical survey:

Yes

No

Name:Major geophysical survey:

Yes

No

Name:Major remote sensing survey:

Yes

No

Name:(any other major surveys):

Yes

No

A template for the Procurement Plant is provided separately. The template needs to be filled with final values in case of early contracting as well as with anticipated values for scheduled tenders/contracts.




FORM C1: CONCESSION AGREEMENT DETAILS

Concession agreement

Applicants should provide information on the status (e.g. in place or under negotiation, meaning application already submitted to respective authority) as well as timing of authorisation to carry out exploration activities (e.g. concession agreements, exploration or prospecting licences).

A geo-referenced map showing the area of the authorisation shall be included (if in place) or needs to be provided before signing of the Grant Agreement (if under negotiation). This is also necessary in case no concession agreement is required (public entity).

If the authorisation is in place, a copy needs to be provided as evidence. A letter from the authority granting the authorisation is also requested, stating that all conditions and timelines of the authorisation have been met.

If no authorisation is yet in place, Applicants need to provide a Letter of Support from the government of the target country of their project.

Applications without authorisation and without a Letter of Support will be excluded from the Application Round.

Applicants shall also provide details on any required environmental, drilling and social permits, water rights and the permission to access the land at the geothermal prospect as well as on any other relevant authorisations. Applicants shall provide evidence of all respective permits or specifications on the plans and timelines to get them.

If existing (i.e.: nationally required to get the concession), a copy of the project development Description Report (covering at an early stage of the project phases, environmental impacts, social impacts and mitigation measures) shall be provided as attachment to this form.

Concession agreement granted?

Yes

No, but application submitted and under evaluation by relevant Agency

No, and not applied for

Not required

If “Yes”, please fill in this information:

Granted by (Agency)

Date granted

Concession agreement reference




Right to extend concession period

Yes

No

N/A (Not applicable)

Size and location of concession Area

Concession period

FROM: [YYYY-MM-DD]

To: [YYYY-MM-DD]

Possible extension ( No. of Years )

If “No, but application under evaluation by relevant Agency”, please fill in this information:

Date of submission of application:[YYYY-MM-DD]

Responsible authority

In any case (also in case of “not required”), fill in the requested information below:

General description of Concession Agreement

Provide a narrative description of the granted concession agreement. If the concession has not yet been issued, please provide additional details on timing. If the concession is not required, specify why not (e.g. governmental project with government as owner of the land) and give reasons for exclusive right to undertake exploration (maximum 1000 words).






Geo-referenced map showing the concession area (tiff or png or jpeg)Copy of the concession agreement or concession applicationLetter of Support from the Government, if concession is not yet grantedLetter from granting agency that work commitments etc. have been met satisfactorily

Project development Description Report (if existing)





FORM C2: EXPLORATION LICENCE

Exploration licence

Exploration licence granted?

Yes



Not required

If “Yes”, please fill in this information:

Granted by (Agency)

Date granted

Exploration licence reference

Right to extend exploration licence period

Yes

No

N/A (Not applicable)

Licence period

FROM: [YYYY-MM-DD]To: [YYYY-MM-DD]

Possible extension ( No. of Years )







In any case (also in case of “not required”), fill in the requested information below:

General description of exploration licence (max 1000 words)

Provide a narrative description of the granted licence, coverage, timing and licence area. If the licence has not yet been issued, please provide additional details on when the application was submitted – including relevant confirmation by the issuing authority.

Provide a clear outline and understanding of the applicable laws and regulations a project developer must comply to when undertaking surface exploration activities. Provide a clear chronology of how the project developer has filed and obtained the necessary authorizations and permits. Provide a summary table of what is required- compared to what has already been obtained at the time of the filing of the application and what is still pending with indication of most likely deadline(s) to get the remainder (if any).






Copy of the exploration licence, or licence application in case licence is not granted prior to the GRMF grant ApplicationTable of items/issues since filing of the licence





FORM C3: ENVIRONMENTAL PERMITS

Environmental/Social permits

Applications need to include evidence that the required environmental and social permits, agreements and assessments have been obtained or are in the process of being obtained. At a minimum, Applications need to demonstrate that they will comply with relevant local and national environmental and social legislation and that they will follow the Applicable Environmental and Social Standards as listed in the Developer Manual, section 11 Demonstration of compliance will be undertaken, but not be limited to, the submission of an Environmental and Social Inception Report and a Draft Stakeholder Engagement Plan as described in the Developer Manual.

Applications not demonstrating that they will comply with relevant local and national environmental- and social legislation will be excluded from the Application Round.

If environmental and social permits are not required, Applicants must provide evidence that they were notified so by the relevant authority.

In all cases (permits already obtained, in progress or not required), Applicants shall provide a copy of their draft Environmental Impact Assessment (EIA) (ESIA or EIS or any other as required) for subsequent drilling activities as attachment to this form.

Has the main environmental/social permit been granted?

Yes



Not required

Granted by (Agency)

Date granted

Environmental permit reference

Next to the permit referred to above, are any other environmental/social permits or studies required before start of the activities?

Yes

No

If “yes”, please specify







If “Not required”, please fill in why not

General description of status of environmental/social permits (max 1000 words)

Provide a narrative description of the status regarding environmental/social permits. Please further elaborate of status of any Environmental and Social Studies as required for Surface Studies by the respective national legislation, explain work plan for environmental and social scoping studies during the surface study phase



Copy of required environmental/social permits

Copy of draft EIA (ESIA or others – as required) for subsequent drilling activitiesInception report and Stakeholder Engagement plan as per standards described in developer manual (submission is mandatory).





FORM D1: MARKET VIABILITY

Information on project market viability

Applicants should provide a convincing plan to successfully and efficiently bring the proposed project at the concession area into sustainable power production. Such a plan shall include but not be limited to: A description of the anticipated construction cost of completing the well field and gathering system, power plant, power transmission infrastructure description and cost, information on feed-in tariffs, compared analysis (Levelised Cost of Energy/Electricity, LCOE) with other available energy options in the country, anticipated power sales prices, information on potential electricity customers and information on potential direct applications.

If available, a recent report from a reputable international organization/Bank/Consultant on existing energy prices (LCOE , Feed in Tariffs, current selling prices to industry and particulars) for existing fuels/energies used in the country or energy imported from neighbouring countries should also be provided. Report(s) can be added as attachment to Form D1.

Additionally please indicate who bears the costs for the interconnection to the national grid and the extent of grid infrastructure required for this interconnection.

The Applicant should also provide information about any signed or on-going discussions related to off-take agreements. (maximum 1000 words)

Attachment reference of related material [type reference here]



Signed off-take agreement (if any) or MoU (if any)

Map of National Power Grid and image showing distance to closest interconnection point (jpeg, png, tiff)

External report on energy prices (if available)





FORM E1: PROJECT PERSONNEL / STAFFING PLAN

CV summaries

Provide a brief summary of each member in the project team including contractors and sub-consultants. Include qualification and relevant experience. The forms should include the resumes of the Project Manager and Chief Geologist with emphasis on geothermal field exploration with African focus.

Memorandum of Understanding or equivalent between the Applicant and any designated consultants, service companies or contractors shall be included only if those consultants are part of the team at the time of proposal submittal.5

A staffing plan needs to be provided as an attachment, including the Applicants own personnel and the contractors. The staffing plan should outline the staffing requirements during the project and should consider for what time period each staff member is needed.

1) Name:Position: Project Manager

Employed by Lead Project developer

Employed by Consortium partner, JV partner, or Sub-contractor

Area for short description of key personnel max 200 words per individual.

2) Name:Position:Chief Geologist

Employed by Lead Project developer

Employed by Consortium partner, JV partner, or Sub-contractor

Area for short description of key personnel max 200 words per individual.

5 Regarding the eligibility of costs resulting from the assignment of external staff, please refer to the „Conditions for Early Contracting“.






Staffing plan (own personnel & contractors)





FORM E2: PERSONNEL CV

CVs of key personnel

The Applicant (including private sector partners, contractors and sub-consultants6) needs to demonstrate exploration experience and expertise by providing CVs of the Applicant’s key personnel designated to work on the proposed project. Experience and expertise should be specifically related to geothermal surface studies preferably in the region.

The signed CVs for all personnel (team lead/key experts) shall be provided. It is advisable to provide all CVs indicated in the outlined project structure – including their roles and rank in the project.

In case the same person is the assigned project manager and the lead geoscientist, the CV should have clearly separated sections for easy assessable skills in project management and geoscience, respectively.

Form E2 is provided separately

Attached CV (to be duly filled in by the Applicant):

Attached Item

CV of Forename Surname

CV of Forename Surname

To be continued

6 Regarding the eligibility of costs resulting from the assignment of external staff, please refer to the „Conditions for Early Contracting“.




FORM E3: PROJECT DEVELOPER’S EXPERIENCE

Project Developer’s experience

The Applicant (including private sector partners, contractors and sub-consultants7) needs to demonstrate exploration experience and expertise by providing relevant references. Experience and expertise should be specifically related to surface studies and will be demonstrated by project references.

References should at least contain information on the project’s name, year of execution, client and location of the project, the scope of work, project’s budget and the budget of the work delivered by the Applicant. The explanatory text should include also a short description with outcome and lessons learnt as well as of lead contractor and sub-consultants. Only project references from the last 7 years shall be included of similar exploration programmes, i.e. where mainly the same investigation methods, experts and team leaders/partners have been used.


General overview:

Former geothermal surface studies

No. Country Location of field area Type of study/survey Year

1

2

3

4

5

6

7

8

9

10

7 Regarding the eligibility of costs in assigning contractors/sub-consultants, please refer to the „Conditions for Early Contracting“.




Detailed description:8

Ref … Project title …

Name of legal entity

Name of client

Overall project value (in USD)

Proportion carried out by legal entity (%)

Number of permanent staff provided

Origin of funding

Year of execution

Name of external partners if any

… … … … … …

Description of projectPlease include information regarding outcome, location, lessons learned.…

8 Please duplicate template, max. 15 references per applicant (including consortium member and sub-contractors)




FORM E4: STATEMENTS ON CAPABILITIES

Statements on Financial, Management and Organisational Capability

The Applicant needs to provide documented proof that the company is financially and organisationally capable of conducting surface studies and that it has the resources and the management capabilities to mitigate any eventual difficulties (designated person, alternative option) and to cover any eventual cost increases (refer to company’s references with similar successfully implemented work).

The required information consists of the following: information on the company, its legal entity, its core business, including an attached group organisational chart (containing key positions and names), statements on its capital capacity, audited annual financial statements of the last three accounting years, a declaration of no objection from the tax authorities and an external credit rating assessment, if available.

Applicants shall provide evidence that they exist as legal entities. Evidence of partners/contractors management and coordination skills as well as evidence where similar organisation has already been successfully implemented should also be demonstrated.

In addition, the following information needs to be submitted to allow for a KYC assessment:1. Name of shareholder entity (e.g. copy of company's registry)2. Beneficiary of shareholders (entities respectively person behind with a share or voting rights of >

25%)3. List of acting persons in the Management4. Place of registry of company5. Full names birthday and nationality for natural persons

(maximum 1000 words)







Certificate of registration of legal entity verified by the registering authority

Yes

N/A

Letter of intent from all consortium participants and/or joint venture participants and/or (sub-) contractors

Group organisational chart

Audited annual financial statements of the last three accounting yearsDeclaration of no objection from the tax authorities

External credit rating assessment (if any)





FORM E5-S: PLANS FOR SUBSEQUENT DRILLING

Plans for subsequent exploration drilling

Applicants need to provide information on plans for subsequent reservoir confirmation drilling and testing if the surface studies provide good evidence for a promising geothermal resource. Details should be given on plans for obtaining expertise (e.g. identified team and partners), finance (i.e. identified (e.g. pre-committed) funds to cover the Applicant’s portion of the financing) and equipment (type and availability of rig) for subsequent reservoir confirmation drilling at the prospect. Also accessibility of terrain for heavy trucks could be mentioned. Evidence of past experience where similar industry connections needed for the project exist already and has shown success, will be beneficial. Any well thought and structured exploration drilling plan with identification of potential contractors/sub-consultants and financiers will be considered. (maximum 1000 words)



FORM F1: FINANCING PLAN

Financing Plan

The Applicant needs to present a plan for financing the remaining portion of the surface studies budget which is not proposed for funding by the Facility. The remaining portion includes the own share of the eligible costs, all non-eligible costs, as well as potential cost overruns.

The financing plan shall include information on all financing sources and streams in place including any other public funding schemes and disbursements scheduled (earliest/latest). If some financing is pending approval, clear evidence of commitment should be shown and if some financing is unsure, a clear outline of alternatives should be considered. Also a risk analyses on so far unavailable (planned) funds should be given.

In addition a clear outline of the funds allocated to the project by financing source shall be included in Form F3: Project Financing Plan.

Joint funding by GRMF and other public bilateral and multilateral funding schemes or facilities (e.g. NEPAD-IPPF, ARGeo, Development Banks etc.) is allowed. Applicants (Private or Public Private Partnerships: “PPP”) need to clearly specify which other public funding schemes are applied for, which amounts are applied for and whether or not the requested funds have already been granted. Applicants need to provide evidence that at least 20 % of the eligible costs are borne by the Applicant. Public bodies are excluded from this rule. (maximum 1500 words)

Attachment reference of related material: [type reference here]

FORM F2-S: COST ESTIMATE

Format F2-S is provided separately as an Excel file. The filled file has to be attached to the application as printout, Excel, as well as legible PDF version.


Instructions:

All values- apart from the local currency column, are to be stated in USD.

It is important that each cost item is itemized in as much details as possible. No lump sums should be in this form for costs that can be broken down and explained in more details. Explanatory information regarding the costs can be added to the comments column in the Excel sheet.

Please thoroughly cross check the list of eligible activities, as provided in the developer manual.


FORM F3: PROJECT FINANCING PLAN

Format F3 is provided separately as Excel file. The filled file has to be attached to the application as printout, Excel, as well as legible PDF version.

Instructions:

Please provide the following information:

- total costs of proposed programme- total eligible costs and amount applied for (drilling programme and infrastructure upgrade provided

separately)- equity share of the eligible entity (indicate readiness for disbursement and support by financial

statements/ audit reports)- funds by further donors and complete financing structure (%-shares of each donor / entity / subsidy

programme, commercial bank)

Additionally, please indicate who bears the costs for the interconnection to the national grid and the extent of grid infrastructure required for this interconnection.

FORM F4: N/A

FORM F5-S: KEY FINANCIAL

COST SummaryUSD (values from FORM F2A-D – Columns W/Y & rows 379 to 381)

% of GRMF eligible costs

Total estimated cost to complete the proposed surface study (including infrastructure)

$ NA

Total GRMF eligible costs – of which:

$ 100%

a) eligible costs for infrastructure activities

$ NA

b) eligible costs for surface study activities

$ NA

Total project grant value applied for – of which:

$ %9

a) grant value for infrastructure activities

$ %10

b) grant value for surface study activities

$ %11

Exchange rates Currency name Abbreviation Exchange rate to USD12

Local currency:

Other currency:

9 Overall percentage in relation to Total GRMF eligible costs10 Percentage indicating eligible infrastructure activities versus applied grant value for infrastructure activities (maximum 20%)11 Percentage indicating eligible costs for surface study activities versus applied grant value for surface study activities (maximum 80%) 12 Exchange rates to be used in this Application shall be according to ITA Clause 12.1 (a).

FORM G1: DECLARATION OF ACCEPTANCE AND ADHERENCE TO PROCUREMENT STANDARDS

Format G1 provided separately

No of Pages: XX [excluding this page]

FORM G2: DECLARATION OF NON-EXISTENCE OF REJECTION GROUNDS

Format G2 provided separately


FORM G3: AUDITED ANNUAL FINANCIAL STATEMENTS OF THE LAST THREE ACCOUNTING YEARS


FORM [ENTER FORM REFERNCE NUMBER]-X[ENTER ATTACHMENT NUMBER]: [ENTER ATTACHMENT NAME]


Related to FORM XX

This is a cover page for all attachments or appendixes that are to be handed in with the Application to the GRMF and shall be deleted if no further attachments are included in this Application Form.

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