Partner Selection forSustainable Energy Measures Delivery in Stafford Borough

Please complete all sections of this document

1. Company Information

1.1 / Registered trading name & address:
1.2 / Address (email) for correspondence relating to this application:
1.3 / Contact name:
Position in company:
Telephone number:
Email address:
1.4 / Company website:
1.5 / Company status (please select)
Sole Trader Partnership Limited Company Public Limited Company Charity Other
If other, please specify:
1.6 / Date of formation or registration:
1.7 / Registration number:
1.8 / VAT Number:
1.9 / Does your company (or any members of the partnership/consortium if applicable) have any association (either directly or indirectly) with any member or employee of Marches Energy Agency?
If yes, please provide details:

2.Financial Information

The financial information completed below and submitted in support of your application must relate solely to your organisation and not to a group, parent or holding company.

Notes

  • Companies that have been operating for less than three years should submit figures for their trading period to date. This information will be considered accordingly.

2.1 / Please provide details of the published figures for the three previous financial years for:
Year ending: / Year ending: / Year ending:
Information required from the Income statement
Turnover / Sales / £ / £ / £
Net Operating Profit (before interest and tax) / £ / £ / £
2.2 / Please confirm that audited accounts (audited if applicable) for the last three financial years (or for the period of your incorporation if trading less than three years) are available on request to support the above information:

3.Health and Safety

3.1 / Does your company comply with the Health & Safety at Work Act 1974?
3.2 / Does your company have a written Health & Safety Policy Statement (developed/revised within last 2 years)?
3.3 / If yes, is the statement available to Marches Energy Agency on request?
3.4 / Please detail safety arrangements applicable to this project:
3.5 / Please identify the person in your company who is responsible for co-ordinating safety matters
Name:
Telephone number:

4.Insurance

Please provide details of all insurance cover currently in force. The required levels are indicated below.

4.1 / Total sum insured: / Insurer / Policy Number / Cover £ / Renewal Date
Public Liability
(minimum £5m cover)
Employer’s Liability
(minimum £10m)
4.2 / Are Insurance certificates available to Marches Energy Agency on request?
4.3 / If your current levels of cover are less than those stated, are you prepared to increase your cover at no cost to Marches Energy Agency?
4.4 / Are there any outstanding claims against you (other than routine employment cases)?
If yes, please list as appropriate

5.Activities and Capacity

5.1 / Please provide a brief description of the applicant’s business structure and main business activities – including a list of the services you provide and what qualifications your surveyors and installers have.
5.2 / Please indicate – if known - if you intend to sub-contract any part of the delivery of the installations, with details of which part and how the process would work:
5.3 / Please provide contact details of any sub-contractors or partner organisations proposed if answered yes to question 5.2:
5.4 / Please give details of how you will look to provide local employment opportunities, either in future or through existing arrangements.
5.5 / Would you be prepared to provide training opportunities, work experience placements and or take part in an apprenticeship scheme to Stafford-based work seekers as part of this scheme? If so, please provide details on how this may work and list any relevant experience of such activities.
5.6 / How do you seek to reduce your organisation’s environmental impact?
5.7 / Please state which geographical area(s) you are able/ willing to operate within; (either by Local Authority Area, or within a radius of your office).
5.8 / Do you have Green Deal Assessor capacity in-house or do you use a third-party to supply assessments?
Are you a Green Deal Advice Organisation?
5.9 / Do all employees carry methods to identify themselves, such as an ID card?
Do they wear a uniform of any kind?
Are employees who may potentially be required to enter peoples’ properties DBS checked (formally CRB checked, excluding Green Deal Assessors who require a CRB check as an element of their training)
6. Details of provision of Sustainable Energy Measures
6.1 / Do you have access to ECO funding through a Green Deal Provider, directly from an Obligated Party or through ECO brokerage? (please state via which mechanism)
6.2 / Please select which strands of ECO you have secured funding for;
HHCRO CERO CSCO
6.3 / If yes (to question 6.1), how many ECO measures have you installed to date?
What is the breakdown of these measures (by ECO strand)?
HHCRO CSCO CERO
6.4 / Are you able to provide associated Green Deal Assessments and EPC’s for ‘pre-assessed leads’?
6.5 / Please complete the sections below in order to signify which ECO measures you are able to deliver, whether this is sub-contracted and the associated referral fee you are willing to offer for the successful completion of each measure. Please also offer an indication of the time taken to install from referral date (in normal circumstances).
6.5.1 / HHCRO Boiler Replacement
Able to deliver through ECO funding arrangements
Delivery – In-house Via sub-contractor
Proposed referral fee per completed installation - £
Expected turnaround time from referral -
6.5.2 / HHCRO or CSCO Loft Insulation
Able to deliver through ECO funding arrangements
Delivery – In-house Via sub-contractor
Proposed referral fee per completed installation - £
Expected turnaround time from referral -
6.5.3 / HHCRO or CSCO Cavity Wall Insulation
Able to deliver through ECO funding arrangements
Delivery – In-house Via sub-contractor
Proposed referral fee per completed installation - £
Expected turnaround time from referral -
6.5.4 / HHCRO Secondary measures
What additional measures (if any) are you able to offer under HHCRO? (i.e. Draught proofing, glazing)
6.5.5 / CERO Hard-to-treat Cavity Wall Insulation
Able to deliver through ECO funding arrangements
Delivery – In-house Via sub-contractor
Proposed referral fee per completed installation - £
Expected turnaround time from referral -
6.5.6 / CERO Solid Wall Insulation
Able to deliver through ECO funding arrangements
Delivery – In-house Via sub-contractor
Proposed referral fee per completed installation - £
Expected turnaround time from referral -
Please provide indicative funding rates for solid wall insulation, based upon the household heating fuel types listed below;
Mains gas heated Electrically heated
Solid fuel heated: Oil heated:
LPG gas heated:
Do you have the capability to install Internal wall insulation?
If yes, is this provision in-house or via a sub-contractor
6.5.7 / Renewable Energy
Which renewable energy technologies (if any) are you able to deliver?
6.5.8 / Renewable Heat
Which renewable heat technologies (if any) are you able to deliver?
6.5.9 / Please list any accreditations that you hold in relation to the installation of renewable energy or renewable heat technologies (e.g. MCS accreditation) and any memberships within the renewable energy industry (e.g. REA)
6.5.10 / Please list details of the type of renewable (energy or heat) measures you have installed in the past year
6.5.11 / Green Deal
Are you a Green Deal registered installer?
Are you a registered Green Deal Provider?
Do you have access to Green Deal Finance, and can you construct Green Deal plans?
Have you finalised any green deal plans to date? (if so how many?)
7. Supporting Statement

Please use the box below to add any further comments or information that may support your submission.

7.1
8. Reference and Experience

Marches Energy Agency may elect to contact any of the referees provided. Your permission to do so will be assumed unless you state otherwise.

8.1 / Reference 1
Customer Name:
Address:
Telephone number:
Brief Description of service provided:
8.2 / Reference 2
Customer Name:
Address:
Telephone number:
Brief Description of service provided :

9. Declaration

I confirm that the information provided above is accurate at the time of completion.

Completed by:

Name:

Position:Date: