Weatherization Assistance Program Application: Program Services

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* 1. Company Name

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* 2. Contact Information

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 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

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* 4. What types of services does your company perform?

Energy Audits

NEAT & MHEA Modeling

Quality Control Inspections

Training/Mentoring

Other (please specify)

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* 5. How many years have you been in business?

0–2

3–5

6–10

10+

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* 6. How many individuals does your firm employ?

0–5

6–10

11–25

25+

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* 7. Describe your firm's experience in managing utility weatherization or energy efficiency programs.

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* 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

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* 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.

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* 10. Reference 1

Name

Phone Number

Email Address

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* 11. Reference 2

Name

Phone Number

Email Address

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* 12. Reference 3

Name

Phone Number

Email Address

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* 13. Please describe your proposed approach to completing weatherization work, including timelines, staffing plans, quality assurance measures and safety practices.

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* 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.

Weatherization Assistance Program Application: Program Services

Question Title

* 1. Company Name

Question Title

* 2. Contact Information

Question Title

* 3. Please select the counties for your service territory.

Question Title

* 4. What types of services does your company perform?

Question Title

* 5. How many years have you been in business?

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* 6. How many individuals does your firm employ?

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* 7. Describe your firm's experience in managing utility weatherization or energy efficiency programs.

Question Title

* 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?

Question Title

* 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.).

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* 10. Reference 1

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* 11. Reference 2

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* 12. Reference 3

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* 13. Please describe your proposed approach to completing weatherization work, including timelines, staffing plans, quality assurance measures and safety practices.

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* 14. Please upload proof of insurance, licensing and relevant certifications.

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* 16. Is there any other information you would like to submit for consideration?