"Energy Service Company (Esco) Retail Access Application Form" - New York

Energy Service Company (Esco) Retail Access Application Form is a legal document that was released by the New York State Department of Public Service - a government authority operating within New York.

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Download "Energy Service Company (Esco) Retail Access Application Form" - New York

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ENERGY SERVICE COMPANY (ESCO)
RETAIL ACCESS APPLICATION FORM
1. Business Information
Business Name: _______________________________________
Address: _____________________________________________
City: ________________________ State: _______Zip: _______
Telephone: ___________________ Fax: ___________________
If you intend to market your services under a DBA list name(s) here:
(Copy of your certificate of assumed name is required)
___________________________________________________________
Do you currently have any energy affiliates (including subsidiaries) located or
operating within New York State?
Yes ______
No ______
If yes, provide the contact information for any entity with an ownership interest of 10
percent or more in the company listed above:
Business Name: ____________________________________________
Contact Name: _____________________________________________
Address: __________________________________________________
City: _____________________________ State: _____ Zip:_________
Telephone: ________________________ Fax: ___________________
Email Address: ______________________________________________
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ENERGY SERVICE COMPANY (ESCO)
RETAIL ACCESS APPLICATION FORM
1. Business Information
Business Name: _______________________________________
Address: _____________________________________________
City: ________________________ State: _______Zip: _______
Telephone: ___________________ Fax: ___________________
If you intend to market your services under a DBA list name(s) here:
(Copy of your certificate of assumed name is required)
___________________________________________________________
Do you currently have any energy affiliates (including subsidiaries) located or
operating within New York State?
Yes ______
No ______
If yes, provide the contact information for any entity with an ownership interest of 10
percent or more in the company listed above:
Business Name: ____________________________________________
Contact Name: _____________________________________________
Address: __________________________________________________
City: _____________________________ State: _____ Zip:_________
Telephone: ________________________ Fax: ___________________
Email Address: ______________________________________________
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During the previous 36 months, have any criminal or regulatory sanctions been
imposed for any senior officer of the ESCO applicant, its subsidiaries or its energy
affiliates listed above?
Yes _____
No _____
If yes, provide the following information:
Name: __________________________________________________
Title: ___________________________________________________
Name: __________________________________________________
Title: ___________________________________________________
2. Contact Information
Executive Contact
Name and Title: ___________________________________________
Address: _________________________________________________
City: ___________________________State: _____Zip: ___________
Telephone: ___________________ Fax: _______________________
Email Address: _____________________________________________
Regulatory Contact
Name and Title: ____________________________________________
Address: __________________________________________________
City: _________________________ State: _____ Zip: _____________
Telephone: ______________________Fax: _____________________
Email Address: _____________________________________________
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Marketing Contact
Name and Title: ________________________________________
Address: ______________________________________________
City: ___________________________State: _____Zip: ________
Telephone: _____________________Fax: ___________________
Email Address: __________________________________________
Power to Choose Website Information
Website Address: ________________________________________
Customer Service Email Address: ____________________________
Toll Free Number: _________________________________________
Vendor Contact (e.g. EDI Vendor)
Vendor Name: ____________________________________________
Address: _________________________________________________
City: ________________________State: _____ Zip: _____________
Contact Name: ____________________________________________
Telephone: _________________Fax: __________________________
Email Address: _____________________________________________
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Additional Requirements
3.
(Required for New ESCO Applications and Triennial Filings)
• Copy and proof of acceptance of your registration with the NYS Dept of State
and a copy of your certificate of assumed name (if applicable);
• Comprehensive copy of your standard sales agreement(s), including
presentation of the customer disclosure statement;
• Marketing representative ID badge;
• Marketing standards quality assurance plan;
• Third party verification (TPV) script;
• Sample forms of notices for assignment, discontinuance and transfer of 5000 or
more customers to other providers;
• Sample(s) of your billing format(s);
• Procedures you will use to obtain customer’s authorization for historic usage and
credit information;
• Copies of information and promotional materials used for mass marketing
purposes;
• HEFPA documents, if providing energy supply to residential customers;
• Internal procedures for the prevention of slamming or cramming;
• A list of entities, including contractors and sub-contractors, that will market on
behalf of your ESCO;
• Attestation that you will comply with the requirements of the New York State’s
Environmental Disclosure Program, if you intend to serve electric customers;
• NYS DPS Office of Consumer Services Service Provider Form.
• Letter from a utility that you have successfully completed EDI Phase I Testing.
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4. Identify the Types and Locations of Markets
For Eligible ESCOs that have completed Phase III Testing, place an “√” in the applicable
cells of the table below to 1) designate the individual utility retail access programs in which
you participate, and the customer market(s) in each program you serve; 2) indicate the
commodities you offer in each service territory, and 3) indicate the billing options you offer
in each territory. If you are a new ESCO applying for eligibility, please leave this
section blank. If you are an ESCO that has eligibility but are not serving, leave this
section blank.
Utility
Customer
Commodity
Billing Options
Markets
Res
Non
Nat
Electric Utility Rate
Utility Bill
*Single
Dual
Res
Gas
Ready
Ready
Retailer
Bill
n/a
n/a
n/a
Central Hudson
n/a
n/a
n/a
Con Edison
n/a
n/a
n/a
n/a
n/a
Corning Natural Gas
n/a
n/a
n/a
n/a
n/a
LIPA
National Grid
n/a
n/a
n/a
n/a
(KEDNY, KEDLI)
National Grid
n/a
n/a
n/a
(Upstate)
n/a
n/a
National Fuel Gas
n/a
n/a
n/a
NYSEG
n/a
n/a
Orange & Rockland
Rochester Gas &
n/a
n/a
n/a
Electric
n/a
n/a
n/a
n/a
n/a
St. Lawrence
The designation “N/A” indicates that either a commodity or billing option is not available in a specific
service territory.
*Single Retailer is also known as “ESCO Consolidated Billing”
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