6 Miss. Code. R. 3-5.33 - Description of Company

All questions must be addressed by the ESP in order for this application form to be properly completed. Failure to answer any question, or comply with any directive contained in this form may be used by the Division as grounds to find the ESP ineligible. If a question or directive does not pertain to your firm in any way, please indicate that fact with the symbol N/A.

A. Firm's name, business address

B. Names and Titles of Two Contact People

C. Submittal is for: Parent Company, Division, Subsidiary or Branch Office.

D. Date prepared.

E. Type of Firm

F. Federal Employer Identification Number

G. Year Firm was established

H. Name and Address of Parent Company, if applicable.

I. Former Firm Name(s), if applicable

J. Five-year summary of contract values for energy service contracts, guaranteed energy savings performance contracts or shared savings contracts in which your firm or team members played a significant role. (Indicate the type of contract by labeling energy service contracts as ESCs, guaranteed energy savings performance contracts as GESPCs, and shared savings contracts as SSCs.)

K. Corporate Background/Historical Data

Notes

6 Miss. Code. R. 3-5.33

Miss. Code Ann. § 31-7-14 (Supp. 2017).

Adopted 4/15/2018