Regional General Contractor Application

RGC Submission ID

Legal Business Name(Required)

Company name must match the Employer Identification Number (EIN)

D/B/A (Doing Business As) Name

If using a d/b/a, a certificate must be provided as supporting documentation.

Employer Identification Number (EIN)(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Street Address is different from mailing address

Street Address

Street Address Address Line 2 City State ZIP Code

Are you registered to work on Federal funding projects via SAM.gov?(Required)

Yes

SAM Registration

If so, please provide your company's unique entity identifier

Are you registered as a business in the State of Indiana?(Required)

Yes

My company is registered or qualifies in Indiana as a:

Minority-owned business enterprise (MBE)

Women-Owned Business Enterprise (WBE)

Indiana Veteran-Owned Small Business Enterprises (IVOSBE)

Please rank your regional preference for a region to oversee in the IESP program. If you only want to work in one or two regions, rank just those regions.

If any regions are given the same rank, their rankings will be randomly assigned.

First Choice

Second Choice

Third Choice

My company provides the following services (check all that apply):(Required)

For each service indicated, you will need to upload an IESP Recently Completed Project Experience Form to document your project experience.

General Contractor

Carpenter/General Labor

Insulation and Air Sealing Installer

HVAC Installer

Heat Pump Installer

Electrical Installer

Plumbing Installer

Appliance Installer

Other

If other, describe:

While the information below was previously submitted when you applied to be in the Qualified Contractor network, please answer the following State and Federal compliance requirement questions.

Has any principal or officer of your company been convicted of a felony within the past 5 years?(Required)

Yes

Has any principal or officer of your company been under disciplinary action (probation, suspension, and termination) within a federal or state program?(Required)

Yes

Has any principal or officer of your company been debarred by any government agency?(Required)

Yes

Has any governmental entity made a finding of non-responsibility regarding the individual or entity seeking to apply in the last 5 years?(Required)

Yes

Has any governmental entity or other governmental agency terminated or withheld a procurement contract with the above-named individual or entity due to intentional provision of false or incomplete information?(Required)

Yes

IESP Contractor Participation Agreement(Required)

I certify that I have read and agree to the terms in the RGC Program Documents associated with the Indiana Energy Saver Program applied for under this Application.

Certification Statement(Required)

I attest that I have authority on behalf of the Applicant to submit this Application to participate in the Program. I certify that all information and representation contained in this Application are true and correct to the best of my knowledge. I agree on behalf of the Applicant to provide any additional materials the Program may ask for during the review process. I acknowledge and agree on behalf of the Applicant that if the Applicant is selected to be a Regional General Contractor of a region, that the Applicant agrees to be bound by all terms contained in the RGC Program Documents and all Work is subject to the provisions of the RGC Program Documents.

Applications missing any of the required documentation will not be approved.

Only PDF files can be uploaded.

Recently Completed Projects(Required)

Documentation shall be provided for each of the services previously indicated. Please upload a completed IESP Recently Completed Project Experience Form to document your project experience.

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 1.

Employee roster(Required)

https://indianaenergysaver.com/wp-content/uploads/2025/01/iesp_contractor_employee_list_form.pdf https://indianaenergysaver.com/wp-content/uploads/2025/01/iesp_recently_completed_project_form.pdf Please upload a single PDF document containing 1) your completed IESP Employee Roster Form and 2) any supporting documentation to verify employee certifications.

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 1.

D/B/A certificate(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 1.

Indiana Diversity Supplier disadvantaged business enterprise certification(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 1.

Upon satisfactory review and acceptance of all required documents, you will be asked to provide a copy of your current insurance certificate (general liability, workers compensation, automobile and errors and omissions if applicable) with the Indiana Office of Energy Development and the State of Indiana listed as additional insured.

Upon final approval, you will be issued an IESP Qualified Contractor Certificate for proof of certification and enrollment in the Indiana Energy Saver Program Qualified Contractor Network. Indiana Energy Saver Program badges will be generated for the approved employee roster and mailed directly to the address on file.

If the information provided on your Contractor Application Form and any attachment changes (including supporting documents), it must be reported to OED, in writing or via email to contractors@indianaenergysaver.com

To ensure delivery to your inbox, please add contractors@indianaenergysaver.com to your safe senders list.

Unique ID

Comments

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