DOE F 415.1 DOE Qualified List of ESCOs Application and Annual Recer

DOE F 415.1 (12/2023)

U.S. DEPARTMENT OF ENERGY

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

Part A: Application

(ELIGIBILITY FOR POTENTIAL ENERGY SAVINGS PERFORMANCE CONTRACT AWARD UNDER 10 C.F.R. § 436.32)

Submit the completed application, resumes, and client questionnaires to the U.S. Department of Energy, Federal
Energy Management Program (FEMP), via the eProject Builder System: https://eprojectbuilder.lbl.gov/login.
The FEMP website, DOE Qualified Energy Service Companies | Department of Energy, provides requirements,
instructions, and guidance for properly completing this application.

PLEASE COMPLETE ALL ITEMS ON THIS FORM. Insert N/A in items that are not applicable. See page 7 for
instructions and definitions.
The average estimated time to complete this form is 23 hours.
1. Date:
2. Applicant Information
a. Firm Name:

b. Street Address:

c. City, State, and Zip Code:
d. Email:

e. Firm Website:

3. Type of Organization (check one)
Corporation, incorporated under the laws of the of the state of:
Non-Profit Organization
Other (Explain):
Joint Venture
4. Names of Officers, Owners, or Partners
a. President:
b: Vice President:
c: Secretary:

Partnership
Individual

d: Treasurer:

e. Owners or Partners:

5. Affiliates of Applicant
Name

DOE F 415.1 (12/2023)

Location

Nature of Affiliation

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DOE F 415.1 (12/2023)

U.S. DEPARTMENT OF ENERGY

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

6. Submittal Applicability
a. This submittal applies to:
Parent Company
Joint Venture

Division

Subsidiary

Branch Office

Other

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b. List the names of any of the above marked entities which are to be included in the qualification process, and describe
their functions, responsibilities, and interrelationships:

7. Federal Employer Identification Number:

8. SAM.gov Unique Entity ID:

9. Year Firm was established:

10: Indicate the number of years in business as an Energy Management Contractor:
Indicate all other names for your organization and the length of time your organization had that name:

11. Business Size
a. Size of business:
Small Business (If checked, complete items 11b and 11c)

Other than Small Business

b. Average number of employees (including affiliates) for four (4) preceding calendar quarters:
c. Average annual sales or receipts for preceding three (3) fiscal years:
12. Type of Ownership (See Definitions) (Only applicable for small businesses)

Yes

No

8(a) Small Disadvantaged Business
Minority Business Enterprise
HUBZone
Women-Owned Small Business
Service-Disabled Veteran-Owned Small Business
13. Net Worth
a. Date:

DOE F 415.1 (12/2023)

b. Amount:

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U.S. DEPARTMENT OF ENERGY

DOE F 415.1 (12/2023)

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

14. Project Experience
a. List and describe, on separate pages, two projects completed by your firm that have been operating and saving energy
or reducing utility costs as proven by appropriate measurement and verification (M&V) methodologies. A description
of the M&V methodology must be included. The performance period must be sufficient to validate actual annual
energy savings or utility demand reduction.
Your firm must have performed as the financially responsible prime contractor for both the design and implementation
(i.e., installation or construction) phases of the project. These projects should demonstrate your range of experience
relative to energy performance contracting and energy management expertise (i.e., the type of technologies
implemented). Provide a complete and thorough description of the Technology Categories and Energy Conservation
Measures (ECMs) implemented through each project, including the size and scope of each ECM. For each project
provide information on the following items:
1. Project title and location.
2. Project description and summary that demonstrates the firm’s ability to successfully design and
implement projects, emphasizing the energy and water ECMs and the post-installation measurement and
verification methodology.
3. Client to contact regarding the project, their position, address, telephone number, and email address.
4. Identify whether the project was for public or private sector.
5. Briefly describe the facility including function, number of buildings, and size in square feet.
6. Total contract amount and total implementation price or investment value.
7. Type of financing arranged by your firm.
8. Type and term of contract.
9. Installation (construction) starting and ending dates.
10. State whether the project was completed on schedule. If not, explain.
11. Post-installation performance period starting and ending dates.
12. Projected annual energy savings and/or demand reduction, in energy units and U.S. Dollars ($).
13. Identify performance guarantees if performance-based energy service contract.
14. Actual annual energy savings and/or demand reduction achieved for each project, in energy units and U.S.
Dollars ($) based on appropriate measurement and verification methodologies.
15. eProject Builder non-calculating project data template 3.0.
Note: The Project Data Templates are available at https://eprojectbuilder.lbl.gov/help.
16. Firm notes, explanations, or any other information relating to the project, such as Statue or utility rebates.
Add Attachments

DOE F 415.1 (12/2023)

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U.S. DEPARTMENT OF ENERGY

DOE F 415.1 (12/2023)

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

b. Please indicate the total number and total investment value of your firm’s energy efficiency and renewable energy
projects for the past two (2) years in the market sectors in the table below. Select the most appropriate market sector,
and do not list projects in more than one market sector.

Market Sectors

Number of
Projects

Investment Value of
Projects (USD)

Value of Work SubContracted to Minority
Business Enterprises
(MBEs)* in USD

Federal
State (including University/College)
Local (including K-12)
Private University/College
Industrial
Retail
Commercial
Healthcare
Hotel/Hospitality
Residential (including Public Housing)
Other
Total
*Note: Minority Business Enterprises (MBEs), as identified by federal, state, local government programs, the National Minority
Supplier Development Council, or other applicable publicly-recognized organizations.

c. For each of the past five (5) years, identify the total number of projects and total project investment for an Energy
Savings Performance Contracting (ESPC) or other energy efficiency or renewable energy project (e.g., UESC, PPA,
fee for service, etc.) for which your firm had financial responsibility.
Year

DOE F 415.1 (12/2023)

Number of Projects

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Total Investment Value of Projects (USD)

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U.S. DEPARTMENT OF ENERGY

DOE F 415.1 (12/2023)

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

15. Technical Capability
List the technologies which your firm may propose to implement as an energy conservation measure or a water
conservation measure under an energy savings performance contract. Check all that apply:
Energy Efficiency Technologies
Boiler Plant Improvements

Distributed Generation

Chiller Plant Improvements
Building Automation Systems (BAS)/Energy
Management Control Systems (EMCS)
Heating, Ventilating, and Air Conditioning (HVAC,
not including boilers, chillers, and BAS/EMCS)
Lighting Improvements

Energy/Utility Distribution Systems
Water and Sewer Conservation Systems
Electrical Peak Shaving/Load Shifting
Energy Cost Reduction through Rate
Adjustments
Energy (or Water) Related Process
Improvements
Commissioning

Building Envelope Modifications
Chilled Water, Hot Water, and Steam Distribution
Systems
Electric Motors and Drives

Advanced Metering Systems

Refrigeration

Appliance/Plug-load reductions

Other (please specify):
Renewable Energy Technologies
Photovoltaic System Installation

Landfill Gas, Wastewater Treatment Plant Digester Gas, and
Coalbed Methane Power Plant Installation

Solar Hot Water System Installation

Biomass System Installation, using wood waste and other
organic waste streams for heating or power plant installation

Solar Ventilation Preheating System Installation

Replacement of air conditioning and heating units with groundcoupled heat pump systems (or geothermal heat pumps)

Passive Solar Heating Installation

Renewable Energy Distribution

Wind Energy System Installation

Other (please specify):

16. Available Staff
a. Indicate the experience in energy management and energy conservation services of the personnel in your firm that
you are intending to use on projects. These personnel qualifications should be in the form of résumés and submitted in
one file.
Add Attachments

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U.S. DEPARTMENT OF ENERGY

DOE F 415.1 (12/2023)

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

b. List all professional and skilled trades which your firm customarily performs with your own employees.

17. Additional Relevant Information (Optional)
You may provide any additional relevant information regarding your firm's technical, engineering, and management
capabilities, including but not limited to, project lists, project case studies, journal articles, and awards.

18. Disclose whether your firm (or predecessors, if any) or any principal of the firm has been insolvent or
declared to be in bankruptcy with in the past five (5) years. Responses of not applicable (N/A) will be considered
incomplete.
No
If yes, please provide an explanation.
Yes

19. Indicate whether your firm or any principal of the firm has been debarred by the Federal Government.
Responses of not applicable (N/A) will be considered incomplete.
If yes, please provide an explanation.
Yes
No

20. Signature
The information herein (including all pages attached) is correct and neither the applicant nor any person (or
concern) in any connection with the applicant as a principle or officer, so far as is known, is now debarred, or
otherwise declared ineligible by any agency of the Federal Government from making offers for furnishing materials,
supplies, or services to the Government or any agency thereof.
a. Name of Person Authorized to Sign:

c. Signature:

d. Date Signed:

b. Title of Person Authorized to Sign:

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DOE F 415.1 (12/2023)

U.S. DEPARTMENT OF ENERGY

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

Instructions
Firms applying to the U.S. Department of Energy’s (DOE) Qualified List of Energy Service Companies (ESCOs) should upload this
properly completed DOE Qualified List of ESCOs Application, including employee résumés and Client Questionnaires to eProject
Builder https://eprojectbuilder.lbl.gov/home/login. Firms will need to request an eProject Builder account by completing an eProject
Builder Account Registration Form. Additional requirements, instructions, and guidance are provided on the DOE website
https://www.energy.gov/eere/femp/doe-qualified-energy-service-companies.
The eProject Builder Qualified List of ESCOs Application Guide is provided at https://eprojectbuilder.lbl.gov/help in the Training
Documentation section of the webpage. The New Application section of the Application Guide provides detailed instructions for
uploading your firm’s application files (required and optional).

Definitions
SIZE OF SMALL BUSINESS
(See Item 11a.)
a. Affiliates - Business concerns are affiliates of each other
when either directly or indirectly (i) one concern controls or
has the power to control the other or (iii) a third-party controls
or has the power to control both. In determining whether
concerns are independently owned or operated and whether or
not affiliation exists, consideration is given to all appropriate or
not affiliation exists, consideration is given to all appropriate
factors including common ownership, common management,
and contractual relationship. (See items 5 and 6a.)
b. Small business concern - A small business concern for the
purpose of Government procurement is a concern, including its
affiliates, which is independently owned and operated, is not
dominant in the field of operation in which it is competing for
Government contracts, and can further qualify under the
criteria concerning number of employees, average annual
receipts, or the other criteria, as prescribed by the Small
Business Administration. (See Code of Federal Regulations,
Title 13, Part 121, as amended which contains industry
definitions and related procedures)
c. Number of employees - (Item 11b) In connection with the
determination of small business status, "number of employees"
means the average employment of any concern, including the
employees of its domestic and foreign, affiliates, based on the
number of persons employed on a full-time, temporary, or other
basis during each of the pay periods of the preceding 12
months. If a concern has not been in existence for 12 months,
"number of employees" means the average employments of
such concern and its affiliates during the periods that such
concern has been in existence based on the number of persons
employed during each of the pay periods of the period that such
concern has been in business.

DOE F 415.1 (12/2023)

TYPE OF OWNERSHIP
(See Item 12.)
a. Disadvantaged business concern - any business concern
which is at least 51 percent owned by one or more socially and
economically disadvantaged individuals; or, in the case of any
publicly owned business, at least 51 percent of the stock of
which is one by one or more socially and economically
disadvantaged individuals; and whose management and daily
business operations are controlled by one or more of such
individuals.
b. Minority Business Enterprises (MBEs) - a business that is at
least 51 percent minority owned, operated and controlled, as
identified by federal, state, local government programs, the
National Minority Supplier Development Council, or other
applicable publicly recognized organizations.
c. Women-owned business - a business that is at least 51
percent owned by a woman or women who are U.S. citizens
and who also control and operate the business.
d. HUBZone business - a small business that is at least 51
percent owned and controlled by U.S. citizens, a Community
Development Corporation, an agricultural cooperative, a Native
Hawaiian organization, or an Indian tribe, have its principal
office in a HUBZone, and have at least 35 percent of its
employees live in a HUBZone.
e. Service-Disabled Veteran-Owned Small Business
(SDVOSB) - a business that is at least 51 percent owned by one
or more service-disabled veterans or in the case of any publicly
owned small business, not less than 51 percent of the stock of
which is owned by one or more service-disabled veterans; and
the management and daily business operations of which are
controlled by one or more service-disabled veterans or in the
case of a veteran with permanent and severe disability, the
spouse or permanent caregiver of such veteran. The Service
Disabled Veteran (SDV) must have a service-connected
disability that has been determined by the Department of
Veterans Affairs or Department of Defense. The SDV must
hold the highest officer position in the SDVOSBC.

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U.S. DEPARTMENT OF ENERGY

DOE F 415.1 (12/2023)

Contractor Name:

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

DOE Qualified List of ESCOs
CLIENT QUESTIONNAIRE

Project Title:
1. Was the applicant firm the prime contractor for the design and construction of the complete project?

2. Was the project completed on schedule?

3. Did the contract involve energy savings performance guarantees? If so, describe performance guarantees (e.g.,
annual energy or cost savings).

4. Did the installed project achieve energy savings and/or demand reduction projected or guaranteed by the
contractor?

5. Was the method(s) used by the contractor to determine annual energy savings and/or demand reduction
acceptable for the type of energy conservation measures installed?

6. Did the contractor provide satisfactory operations, maintenance, and repair services, if any?

7. Were rebates from the utility in your area available to you? If yes, did the contractor arrange satisfactory utility
supplier rebates or other financial incentives?

DOE F 415.1 (12/2023)

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U.S. DEPARTMENT OF ENERGY

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

DOE F 415.1 (12/2023)

OMB Control No.
Expires: MM/YYYY

8. Did the contractor provide or arrange satisfactory project financing?

9. What was the capital investment in the energy project?

10. Provide an overall rating of the quality and timing of services provided by the contractor. If your answers to
questions 1-8 were all “yes,” please briefly explain your reasons for giving a “Fair” or “Poor” rating, as
applicable.
Excellent Exceeded expectations. Highly recommend contractor.
Good

Met all requirements. Recommend contractor.

Fair

Achieved project objective, room for improved quality and performance. Recommend
contractor.

Poor

Significant shortfall in performance and quality. Would not recommend contractor.

Remarks:

Client Name:

Title:

Organization:

Address:

Telephone:

Email:

Client Signature:

DOE F 415.1 (12/2023)

Title:

Date:

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U.S. DEPARTMENT OF ENERGY

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

DOE F 415.1 (12/2023)

OMB Control No.
Expires: MM/YYYY

PART B: Annual Recertification Statement Instructions
Each firm included on the DOE Qualified List of Energy Service Companies (ESCOs) must submit an annual
recertification letter to remain on the DOE Qualified List. Two certification statements are provided below. Select and
submit the certification statement appropriate for your firm on your firm’s letterhead stationery.
Statement 1: Certification of Existing Information
“I certify that [insert firm name] is presently on DOE’s Qualified List of Energy Service Companies
and that the information furnished in the original submission has not materially changed and request
that my firm remain on DOE’s [insert year] Qualified List.”
Date:

Signed: ___________________________
[Print Name and Title]

Statement 2: Certification with Changes
“I certify that [insert firm name] is presently on DOE’s Qualified List of Energy Service Companies
and request that my firm remains on DOE’s [insert year] Qualified List. Please update the information
for my firm with the following changes:
[1. Review your firm’s contact information in the DOE Qualified List of ESCOs. Update the contact
information as needed. 2. List any other changes.]
Point of Contact:
Title:
Address:
Phone/Fax:

Email:

Website:
I certify that these changes do not affect my firm’s qualifications and the basis for which the firm was
originally qualified.”
Date:

Signed: ___________________________
[Print Name and Title]

Your recertification letter must also include whether your firm is currently certified in any of the following
socio-economic categories (see definitions on page 7 or 11).
8(a) Small Disadvantaged Business (NAICS Code

Yes

No

Minority Business Enterprise

Yes

No

HUBZone

Yes

No

Women-Owned Small Business

Yes

No

Service-Disabled Veteran-Owned Small Business

Yes

No

541330)

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DOE F 415.1 (12/2023)

U.S. DEPARTMENT OF ENERGY

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

Recertification statements that do not include socioeconomic categories responses are not complete and the firm will
not be recertified.
Using your firm’s eProject Builder account, upload your firm’s signed recertification letter (on your firm’s letterhead
stationery).
The eProject Builder Qualified List of ESCOs Application Guide is provided at https://eprojectbuilder.lbl.gov/help in
the Training Documentation section of the webpage. The Recertification section of the Application Guide provides
detailed instructions for uploading your firm’s recertification letter.
The Recertification section also provides instructions for uploading project data. Although not a requirement for
recertification, eProject Builder enables you to submit information about your projects. Submitting project data is a
requirement for projects implemented under the DOE IDIQ ESPC and the DOE ESPC ENABLE programs, and this
feature is also used by many state and local government energy performance contract projects. You may wish to enter
your ESCO’s projects in eProject Builder if you haven’t previously done so. For eProject Builder questions, please
email epb-support@lbl.gov or call 510-486-7442.
Firms that choose not to complete the [Insert Year] recertification process should inform DOE’s Federal Energy
Management Program (FEMP) via a letter requesting removal from the DOE Qualified List of ESCOs.
Definitions
a. Disadvantaged business concern - any business concern which is at least 51 percent owned by one or more socially
and economically disadvantaged individuals; or, in the case of any publicly owned business, at least 51 percent of the
stock of which is one by one or more socially and economically disadvantaged individuals; and whose management and
daily business operations are controlled by one or more of such individuals.
b. Minority Business Enterprises (MBEs) - a business that is at least 51 percent minority owned, operated and
controlled, as identified by federal, state, local government programs, the National Minority Supplier Development
Council, or other applicable publicly recognized organizations.
c. Women-owned business - a business that is at least 51 percent owned by a woman or women who are U.S. citizens
and who also control and operate the business.
d. HUBZone business - a small business that is at least 51 percent owned and controlled by U.S. citizens, a Community
Development Corporation, an agricultural cooperative, a Native Hawaiian organization, or an Indian tribe, have its
principal office in a HUBZone, and have at least 35 percent of its employees live in a HUBZone.
e. Service-Disabled Veteran-Owned Small Business (SDVOSB) - a business that is at least 51 percent owned by one or
more service-disabled veterans or in the case of any publicly owned small business, not less than 51 percent of the
stock of which is owned by one or more service-disabled veterans; and the management and daily business operations
of which are controlled by one or more service-disabled veterans or in the case of a veteran with permanent and severe
disability, the spouse or permanent caregiver of such veteran. The Service Disabled Veteran (SDV) must have a serviceconnected disability that has been determined by the Department of Veterans Affairs or Department of Defense. The
SDV must hold the highest officer position in the SDVOSBC.

DOE F 415.1 (12/2023)

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U.S. DEPARTMENT OF ENERGY

DOE F 415.1 (12/2023)

DOE QUALIFIED LIST OF
ENERGY SERVICE COMPANIES (ESCOs)
APPLICATION AND ANNUAL RECERTIFICATION FORM

OMB Control No.
Expires: MM/YYYY

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to update the DOE Qualified List of Energy Service Companies (ESCOs) Application and
Annual Recertification Statement. The DOE Qualified List of ESCOs is required by the Energy Policy Act, as
amended, and is the required first step in the Federal procurement process for the energy savings performance
contracting (ESPC) project financing methodology. The application form is for use by new applicant firms, i.e., firms
not already included on the DOE Qualified List of ESCOs. Application information is used by DOE to determine
whether an applicant firm is qualified to bid on Federal ESPC opportunities. The Annual Recertification Statement is
for use by ESCO firms to maintain their inclusion on the DOE Qualified List of ESCOs, i.e., firms that have been
previously approved for inclusion. The Annual Recertification Statement is used by DOE to determine whether an
ESCO firm maintains its qualification to bid on Federal ESPC opportunities. The Energy Policy Act, as implemented
by the United States Code and the Code of Federal Regulations, requires at least an annual update to the DOE
Qualified List of ESCOs.
Public reporting burden for this collection of information is estimated to average 23 hours per response for new
applications, and 2 hours per response for annual recertifications, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise
Policy Development & Implementation Office, IM-22, Information Collection Management Program (1910-XXXX),
U.S. Department of Energy, 1000 Independence Ave., SW, Washington, DC 20585; and to the Office of Management
and Budget (OMB), OIRA, Paperwork Reduction Project (1910-XXXX), Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to
a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction
Act unless that collection of information displays a currently valid OMB control number.
Submission of this data is completely voluntary. It is a business decision made by firms specifically to participate in the
Federal ESPC program. No firm is required to apply.

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