Qualified Partner Application Form EFFICIENCY MAINE BUSINESS PROGRAM Step 1 of the application process Please complete the application form in full, after reading the terms and conditions. Qualified Partner Contact Information Company Name* Name* First Last Title/Role* Admin SupportApplication IntakeInside SalesInstallerOutside SalesOwnerPresidentProgram Manager/CoordinatorVice President Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What county is your business in?* AndroscogginAroostookCumberlandFranklinHancockKennebecKnoxLincolnOxfordPenobscotPiscataquisSagadahocSomersetWaldoWashingtonYorkN/A Is your mailing address same as physical address?* YesNo Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office Phone* Cell Phone Website Email* Tax Status* Corporation Individual/Sole Proprietor Partnership Tax Exempt/Government Please enter your 9 Digit Federal Tax ID number. If doing business as a sole proprietor, please enter your Social Security Number.* This number is a: Tax ID Number Social Security Number Business Type and Services Provided (Check All that Apply) Business Type* Installer Supplier Architect/Engineering Firm ESCO/Auditor/Consultant Services Lighting Solutions Heating & Cooling Solutions -- Electric Heating Solutions -- Natural Gas Heating Solutions -- Oil, Propane and Compressed Natural Gas Compressed Air Solutions Water Heating Solutions Refrigeration Agricultural Solutions Please provide license information for all of the following that apply: EPA 608 License Number EPA 608 License Expiration Date Master Electrician License Number Master Electrician License Expiration Date Natural Gas Technician License Number Natural Gas Technician License Expiration Date Master Plumber License Number Master Plumber License Expiration Date Oil and Solid Fuel License Number Oil and Solid Fuel License Expiration Date Professional Engineer License Number Professional Engineer License Expiration Date Other Attach copies of current professional licenses (e.g. electrical, plumbing, propane/gas) as may be relevant to the services applicant intends to provide. Attach a copy of a current certificate of insurance evidencing commercial general liability coverage. Attach License Files Drop files here or Please provide a company bio to be used in the Qualified Partner Locator on the Efficiency Maine website.* Efficiency Maine Partner Expectations Please read the Efficiency Maine Partner Expectations by clicking below. Partner Expectations Efficiency Maine Partner Expectations In order to receive and maintain status as a Partner in Efficiency Maine’s business program, all applicants must comply with the following: Complete a one time mandatory new Qualified Partner online training Participate in an annual Business Program Recertification webinar held in May and June Participate in a minimum of 5 projects per program year to remain an active Partner Execute an agreement with Efficiency Maine in which the applicant(s) affirm that they will represent Efficiency Maine to their customers, according to Efficiency Maine policies and procedures, and will be subject to any quality-control inspections that may be required by Efficiency Maine or its contractor Agree to indemnify and hold harmless Efficiency Maine from any legal liability Provide proof of $1 million insurance coverage to cover any potential liability on the part of the Partner to third persons Partner will cooperate with inspections and verifications of Partner projects Meet certain minimum performance standards, as required by the Business Program and measured by quality assurance surveys submitted by Efficiency Maine Business Program participants Maintain an email address Agrees to conduct business in an honest and ethical manner in the following areas: 1. Avoid conflicts of interest with all parties. 2. Comply with applicable laws, ordinances, regulations, and codes. 3. Fulfill contractual obligations. Represent Efficiency Maine in a manner that does not adversely affect Efficiency Maine’s business, operations, reputation, or goodwill. This includes: 1. Respectful treatment of the customer’s facility and property, including communication with the customer and Program Implementer and/or Program Administrator when damage to the facility or property has occurred as a result of project implementation. 2. Truthfulness in all aspects of engagement with Efficiency Maine. This includes accuracy on the completion and customer eligibility of submitted applications and reports, as well as the attributed savings resulting from retrofits and installation. Efficiency Maine Terms and Conditions Please read the Efficiency Maine Terms and Conditions by clicking below. Terms and Conditions TERMS AND CONDITIONS 1. Applicant approval will be effective as of the date of an Application Approval Notice and Applicant will be subject to these Terms and Conditions and all program-specific Terms and Conditions for participation. Efficiency Maine Partner approval will continue for a term of one year from the date of the program’s Application Approval Notice, and will automatically renew each year on the anniversary of such Application Approval Notice for additional one year periods, unless otherwise suspended or terminated in accordance with these terms and conditions. 2. Once approved as an Efficiency Maine Partner, Applicant may be listed on Efficiency Maine’s website as a participating Partner of Efficiency Maine. 3. Efficiency Maine will provide Applicant with informational training materials, and additional training as required by each Efficiency Maine Program for which Applicant has been approved. 4. Applicant will indemnify, reimburse, hold harmless and defend Efficiency Maine, from any claims of any kind, including but not limited, to all fees and charges of engineers, architects, attorneys and other professionals and all court or arbitration or other disputed resolution costs arising out of or connected in any way with any act or omission of Applicant, its employees, agents or subcontractors of any tier or any other entity or person for whom Applicant is liable, in the performance or nonperformance of services as an Efficiency Maine Partner. 5. Applicant understands that there will be inspections and verifications of Partner’s work in accordance with policies and procedures of the Efficiency Maine program. Applicant must cooperate with these inspections and verifications, and continue to perform at an acceptable standard. 6. Once approved as an Efficiency Maine Partner, Applicant is authorized to use the Efficiency Maine Partner logo consistent with Efficiency Maine logo usage guidelines, provided that Applicant submits the proposed materials for review and approval by Efficiency Maine. 7. In being recognized as a Partner by Efficiency Maine, nothing shall create any agency relationship between Efficiency Maine and Applicant. Applicant shall, at all times, be considered, and render services as, an independent contractor. 8. Applicant understands that Efficiency Maine is not endorsing its business, or warranting or endorsing any equipment that may be sold by Applicant. Under no circumstances shall Efficiency Maine be liable to Applicant for any direct or indirect losses, costs or damages arising from or related to, any representations, equipment or installations made by the Applicant. 9. Partner status may not be assigned. Applicant may discontinue participating as a Partner by notifying Efficiency Maine in writing. Efficiency Maine may suspend or terminate a person’s “Partner” status if, in its sole discretion, it determines that a Partner has failed to provide services in accordance with, or has failed to abide by, the policies and procedures of the Efficiency Maine Business Program or has otherwise acted in a manner that is materially adverse to Efficiency Maine’s Business Program. Written notification of suspension or cancellation of a Partner’s status shall be sent to a Partner’s last known address and will be effective upon mailing. 10. Efficiency Maine and its representatives shall have no responsibility for the discovery, presence, handling, removal, or disposal of hazardous materials of any kind, including without limitation asbestos, asbestos products, PCBs, or other toxic substances; or exposure of Partner or any other persons to such materials, in connection with Partner’s participation in any Efficiency Maine program. By clicking the “Submit” button below, I represent and warrant that (i) I am duly authorized to submit this Application on behalf of the Applicant; (ii) the information provided in this Application and any other related documents delivered to Efficiency Maine, is true, accurate and complete; (iii) I have read this Application in its entirety; and (iv) I understand and accept the terms and conditions contained in this Application. I further understand and accept that the approval or rejection of the Application is in the sole discretion of Efficiency Maine and that only upon receipt of any program-specific Application Approval Notice will Applicant be a Partner of Efficiency Maine. Signature CAPTCHA Thank you for completing the form. You'll receive a email verifying that your application has been received. Step 2 of the application process After review and acceptance of your completed application, you will receive by email the links to your requested training webinars as well as copies of the presentations, Proof of Completion and Certificate of Insurance Request forms. Provide the Certificate of Insurance Request form to your insurance provider. Review the required training webinars, complete and sign the Proof of Completion form, and return to Efficiency Maine. Step 3 of the application process After final review and acceptance of all your completed application materials and your completed online training sessions, you will receive written notice by email approving your application and the user access information needed for project submissions.