Appalachian Power TakeCharge - Trade Ally Application

Program Requirements
The Trade Ally (TA)/ Quality Contractor Network (QCN) must be enrolled and in good standing with Appalachian Power Company, TakeCharge Programs to be eligible to submit applications on behalf of Appalachian Power customers. Please complete all fields and provide all requested documents to complete enrollment. Failure to provide the requested information will result in postponed project processing. Completion of this form does not guarantee acceptance in the TA/QCN Programs. Appalachian Power reserves the right to decline participation requests for any reason, including, but not limited to, prior program misrepresentation, fraud, and customer complaints.

Trade Allies/ Quality Contractor Network are responsible for informing TRC of any changes to the information provided here. Confirmation of TA/QCN enrollment does not imply endorsement, certification, or qualification of the applicant’s company, products, or services. Subsequently, TA's/QCN's may not represent themselves as being endorsed by Appalachian Power. Use of the Appalachian Power name or logo by a TA/QCN is not permitted without prior approval from Appalachian Power.

Submit this form and the required documents to enroll as a TA/QCN.

For any VA questions, email TakeChargeSavings@trccompanies.com or call
1-833-402-2221.

For any WV question, email WestVirginiaTakeCharge@trccompanies.com or call 1-855-242-6645.
Appalachian Power TakeCharge VA: Business Energy Solutions, Custom C&I, Small Business Direct Install and Home Performance Programs and Appalachian Power TakeCharge WV: Small Business Direct Install and Go Electric programs are administered by TRC, a third-party implementation specialist that helps businesses save energy.
Trade Ally/ Quality Contractor Network- Company Information
Company Name (as shown on W-9)*
Company Tax ID Number*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the mailing address the same as the physical address?*

YesNo
Mailing address if not the same as the physical address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number*
Please enter a valid phone number.
Primary Email Address (please provide single contact email for company)*
example@example.com
Website URL
www.example.com
How long have you been in business?*

Less than a year1 to 3 yearsMore than 3 years
Attach a copy of your Form W-9 here. *

Form W-9 (Rev. October 2018) version signed on current year of company receiving the incentive.
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Trade Ally/Quality Contractor Network- Contact Information

Please provide the primary contact information and any other contacts for this location/branch who will participate in the Appalachian Power Company’s C&I or Home Performance Programs administered by TRC.

Primary Contact
Primary Contact Name*
Title/Department*
Phone Number*
Please enter a valid phone number.
Phone Type*
Email Address*
example@example.com
Certifications/Licenses

Secondary Contact
Secondary Contact Name
Title/Department
Phone Number
Please enter a valid phone number.
Phone Type
Email Address
example@example.com
Certifications/Licenses

Additional Contact
Additional Contact Name
Title/Department
Phone Number
Please enter a valid phone number.
Phone Type
Email Address
example@example.com
Certifications/Licenses

Virginia Business Licenses & Certifications

Complete all required fields and attach copies of licenses/certifications.

Department of Professional & Occupational Regulation (DPOR) License
Trade Ally/Quality Contractor Network must provide a copy of their Virginia Business License (appropriate for services offered), certificate of good standing and proof that all taxes are paid from the Virginia Department of Revenue.

Reference: DPOR Home Page
DPOR License Description*
DPOR License Number*
DPOR Expiration Date*

MonthDayYear
Date
Attach a copy of the DPOR License here.*

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Certificate of Insurance (COI)
Trade Ally/Quality Contractor Network shall, before the commencement of any services, furnish Program Implementer with a certificate of insurance (COI) evidencing the required coverages. Trade Ally insurance shall be provided by an insurance carrier licensed in the state of Virginia. TA/QCN shall ensure their subcontractors provide the insurance listed above and verify that such policies are in force. All certificates shall state that the insurance carrier or the Trade Ally will give thirty (30) days prior written notice by email of any cancellation or non-renewal in such policies, addressed to TakeChargeSavings@trccompanies.com
COI Insurance Company Providing Coverage*
COI Issuing State/Municipality*
COI Policy Number*
COI Expiration Date*

MonthDayYear
Date
Attach a copy of the COI here.*

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Tradesman License
A minimum of one (1) Trade Ally/Quality Contractor Network employee or subcontractor must hold the certification or license appropriate for services offered. Trade Ally must provide a copy of their Virginia Tradesman License.

Reference: Virgina Tradesman Program
Tradesman License Number*
Tradesman License Expiration Date*

MonthDayYear
Date
Attach a copy of the Tradesman License here.*

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West Virginia Business Licenses & Certifications

Complete all required fields and attach copies of licenses/certifications.

West Virginia Tax Division Business License
Trade Ally/Quality Contractor Network must provide a copy of their West Virginia Business License (appropriate for services offered), certificate of good standing and proof that all taxes are paid from the West Virginia Tax Division.

Reference: West Virginia Tax Division Website
License Number*
Expiration Date*

MonthDayYear
Date
Attach a copy of the West Virginia Business License here.*

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Certificate of Insurance (COI)
Trade Ally/Quality Contractor Network shall, before the commencement of any services, furnish Program Implementer with a certificate of insurance (COI) evidencing the required coverages. Trade Ally insurance shall be provided by an insurance carrier licensed in the state of West Virginia. TA/QCN shall ensure their subcontractors provide the insurance listed above and verify that such policies are in force. All certificates shall state that the insurance carrier or the Trade Ally will give thirty (30) days prior written notice by email of any cancellation or non-renewal in such policies, addressed to WestVirginiaTakeCharge@trccompanies.com.
COI Insurance Company Providing Coverage*
COI Issuing State/Municipality*
COI Policy Number*
COI Expiration Date*

MonthDayYear
Date
Attach a copy of the COI here.

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Program Requirements

Trade Ally/ Quality Contractor Network- Company Information

Trade Ally/Quality Contractor Network- Contact Information

Service Area and Program Interest

Virginia Business Licenses & Certifications

West Virginia Business Licenses & Certifications

Sign & Submit

Terms & Conditions Acknowledgement