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Weatherization Assistance Program Application: Program Services
1.
Company Name
2.
Contact Information
Address
City/Town
ZIP/Postal Code
Email Address
Phone Number
3.
Please select the counties for your service territory.
Anson
Bladen
Brunswick
Cabarrus
Carteret
Chatham
Columbus
Craven
Cumberland
Duplin
Durham
Edgecombe
Franklin
Granville
Greene
Harnett
Hoke
Johnston
Jones
Lee
Lenoir
Montgomery
Moore
Nash
New Hanover
Onslow
Orange
Pamlico
Pender
Person
Richmond
Robeson
Sampson
Scotland
Stanly
Union
Vance
Wake
Warren
Wayne
Wilson
4.
What types of services does your company perform?
Energy Audits
NEAT & MHEA Modeling
Quality Control Inspections
Training/Mentoring
Other (please specify)
5.
How many years have you been in business?
0–2
3–5
6–10
10+
6.
How many individuals does your firm employ?
0–5
6–10
11–25
25+
7.
Describe your firm's experience in managing utility weatherization or energy efficiency programs.
8.
Does your company have comprehensive general liability insurance in the amounts of $250,000 per person, $250,000 for property damage and $500,000 per incident?
Yes
No
9.
List the relevant licenses and certifications your company or employees currently hold (General Contractor, HVAC, Electrical, Lead-Safe RRP, Energy Auditor, Quality Control Inspector, etc.).
Provide three references from recent projects managing utility weatherization or energy efficiency programs.
10.
Reference 1
Name
Phone Number
Email Address
11.
Reference 2
Name
Phone Number
Email Address
12.
Reference 3
Name
Phone Number
Email Address
13.
Please describe your proposed approach to completing weatherization work, including timelines, staffing plans, quality assurance measures and safety practices.
14.
Please upload proof of insurance, licensing and relevant certifications.
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15.
Please upload a proposal of relevant costs, an itemized budget for services provided, and/or sample invoices for proposed measures or services. Use templates provided for relevant services here:
advancedenergy.org/weatherization-assistance-program
. You may upload additional information as desired.
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No file chosen
16.
Is there any other information you would like to submit for consideration?
