Public Facility Energy Efficiency and Water Conservation Act

New Mexico Energy, Minerals and Natural Resources Department (EMNRD)

1220 S. St. Francis Dr., Santa Fe, NM 87505 (505) 476-3310

Energy Service Company Application

The following information must be provided to the EMNRD Energy Conservation and Management Division to certify that an Energy Service Company (ESCO) meets the required criteria for a qualified provider as required by the Public Facility Energy Efficiency and Water Conservation Act (6-23 NMSA 1978). / Application No.
For EMNRD use only
Form version date: 1/5/11

Contact Information

Name of Firm / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
NM Registered
Professional
Engineer / Project Manager

Experience

Years experience as energy efficiency contractor / Number of qualified energy savings contracts undertaken by firm in past three years
Summarize type and size of qualified energy savings projects implemented by ESCO or primary energy management contractor
Project Personnel
Name of Firm / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project Responsibilities
Experience, Licenses, and Certificates
Project Personnel (continued)
Provide additional key personnel who will work on the project. Duplicate this page as necessary.
Name of Firm / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project Responsibilities
Experience, Licenses, and Certificates
Name of Firm / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project Responsibilities
Experience, Licenses, and Certificates
Name of Firm / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project Responsibilities
Experience, Licenses, and Certificates

References

Provide a reference for each qualified energy savings project undertaken by firm in last three years.
Name of Client / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project
Description
Name of Client / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project
Description
Name of Client / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project
Description
References (continued)
Provide a reference for each qualified energy savings project undertaken by firm in last three years. Duplicate this page as necessary.
Name of Client / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project
Description
Name of Client / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project
Description
Name of Client / Principal Contact
MailingAddress
(Address, City, ZipCode)
Telephone
Numbers / Email
Project
Description
Agreement
The ESCO applicant named above and signing this statement through the authorized representative below agrees that all information provided in this application package is true and correct to the best of the authorized representative’s knowledge. The applicant has read 6-23 NMSA 1978. The applicant understands that the purpose of this application is to evaluate ESCO qualifications and maintain a pool of qualified providers that may propose guaranteed utility savings contracts for governmental units under the Public Facilities Energy Efficiency and Water Conservation Act. The applicant is experienced in the design, implementation, and installation of energy conservation measures and meets EMNRD experience qualifications.
Printed Name of Authorized Representative / Title