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* 1. Company Name

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* 2. Contact Information

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

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

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* 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.

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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?

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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

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

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