Dominion Virginia Power

Dominion Virginia Power
Competitive Bid Supply Service Pilot

Request for Qualifications

Qualification Package - Certification Form

The potential bidder whose name and authorized signature appear below hereby submits this Qualification Package in response to Dominion Virginia Power’s Request for Qualifications issued on October 21, 2004 (“RFQ”) for the Competitive Bid Supply Service Pilot (“CBS Pilot”). The undersigned potential bidder hereby certifies that:

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  It has a valid license to operate as a Competitive Service Provider (“CSP”) per 20 VAC 5-312-40 of the Rules Governing Retail Access to Competitive Energy Service (20 VAC 5-312-10 et seq.) (“Rules”) and that a copy of such license or other proof of license (such as a copy of approval order) is provided herewith (ATTACH COPY OF PROOF OF LICENSE) or proof of a waiver from the State Corporation Commission (“Commission”) of this requirement due to an application for a license pending before the Commission;
  

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  Registration with Dominion Virginia Power is in process in compliance with 20 VAC 5-312-50 of the Rules, or already has been completed;
  

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  EDI testing with Dominion Virginia Power is underway in accordance with VAEDT EDI test plan found in 20 VAC 5-312-20.L of the Rules, or already has been completed;
  

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  As a bidder, it agrees to conform to 20 VAC 5-312-70 of the Rules in communications with and handling of customers;
  

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  Dominion Virginia Power’s creditworthiness review is in process for the scale of service to be provided by the bidder prior to submission of any bid proposals; and
  

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  If selected to serve customers in the Competitive Bid Supply Service Pilot that, bidder will provide monthly billing amounts netting non-tariff items, such as rebates and credits, and excluding additional items, such as late payment charges for each randomly selected customer as notified by Dominion Virginia Power.
  

In submitting this Qualification Package, the potential bidder acknowledges and accepts all of the terms and conditions of the RFQ.

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Legal Name of Applicant
Signature of Authorized Representative
Name (Please Print)
Title
Date

Contact information of the individual signing this form:

Mailing Address:


Telephone:
Fax: ___________________________________
E-Mail:

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