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2020-2021 Green Jobs Green New York Loan Fund

Residential Financing Contractor Participation Agreement

Before starting and completing this form, please review the full program details and eligibility of the Green Jobs Green New York Loan Fund Residential Financing Program.

Note: You will not able to save uncompleted forms. Be sure to have all the required information in hand before beginning this form.

To complete this Agreement, you will need to upload the following documents:

• Detail of company and staff experience in the residential energy efficiency sector:
Employee roster of both certified and non-certified employees providing work experience, previous firms worked at and training.  The contractor must provide sufficient information for NYSERDA staff to make a determination on the qualifications of a contractor to perform work.

• Doing Business As (DBA) Certificate (if applicable):
Organizations that conduct business under a name other than their legal name need a Certificate of Assumed Name. This certificate is also called the "doing business as” (DBA) certificate. 

• Completed IRS Form W-9:
Your Employer Identification Number (EIN) is not your Social Security Number. Do not upload an IRS Form W-9 with a Social Security Number to this Agreement. 
- If your Taxpayer Identification Number is a Social Security Number, complete all other information on this form and leave the W-9 Form blank. You will then need to submit a printed and signed copy of IRS Form W-9 to NYSERDA Finance via mail. Be sure to include your auto-generated Tracking ID Number (displayed on-screen after you submit this Agreement) on any forms submitted by mail to NYSERDA. 
- View and print the IRS Form W-9  
- Review the IRS Form W-9 instructions 
Certified Staff Template
Identify all staff that will be working on projects through the program, their certifications (BPI, SPFA, NATE, NORA), and their manufacturer installation certifications. You may upload additional multiples if necessary.

Please note: NYSERDA may request a copies of certificates or ID cards for certifications other than BPI. 

 • Proof(s) of Insurance:
Provide in accordance with Section 2.06 of the Participation Agreement copies of insurance policies, each of which shall: (1) reference this Agreement; name or be endorsed to cover the Participating Contractor as the insured, and NYSERDA and the State of New York as additional insured; and reference all work to be performed under the Program; (2) provide that such policy may not be cancelled or modified until at least 30 days after receipt by NYSERDA of written notice thereof; and be reasonably satisfactory to NYSERDA in all other respects.
• Workers’ Compensation Form CE-200 (if applicable):
If you are a Sole Proprietor complete and upload form CE-200.  
After you submit the Agreement you will receive an auto-generated Tracking ID Number. You should print or save this tracking number and refer to it when checking on the status of your application.

For full program details and eligibility, visit  If you have any questions, feel free to contact or call 518-862-1090 ext. 3253.

*required field

Company Information

My company is

Company Mailing Address

Is the mailing address the same as the physical address?

Company Physical Address

Authorized Company Contact

Authorized Contact Name

Is the Authorized Contact same as the owner?

Owner Name

Service Area

The information below will be used on NYSERDA’s Home Energy Efficiency Financing website to allow homeowners to find contractors servicing their county.  It is the contractor's responsibility to obtain all required licenses and permits in the counties in which they provide services per the terms outlined in the Participation Agreement.

Select all that apply:

Capital Region

Central NY Region

Finger Lakes Region

Long Island Region

Mid-Hudson Region

Mohawk Valley Region

New York City Boroughs Region

North Country Region

Southern Tier Region

Western Region

Affiliations with other NYSERDA programs

Indicate the other NYSERDA Programs that you participate in (check all that apply)

Supporting Documentation / Attachments

Click here to downlad the Certified Staff Template.

Certified Staff

Insurance Certificate

Doing Business As Certificate (if applicable)

Details of company and staff experience in the Energy Efficiency Sector

Employee work experience, previous firms and training


By signing below, I attest that I have legal signatory rights to enter into a contractual agreement on behalf of my company.

I have read, understand, and agree to comply with all participation commitments in NYSERDA's 2020-2021 Green Jobs Green New York Loan Fund Residential Financing Contractor Participation Agreement, including all Participation Statuses and all supporting policies described or referenced therein. I understand that my participation in the Program is not approved until NYSERDA has reviewed and approved this Agreement.

I understand the provisions of this Agreement are effective from the date of approval by NYSERDA. NYSERDA reserves the right to modify the provisions of this Agreement at any time. I certify under the penalties of law that the statements made in the Agreement and in supporting documentation provided along with the Agreement, have been examined by me and are true and complete. I understand that by signing this Agreement, I consent to any other inquiry to verify or confirm the information I have given. I hereby authorize any reference identified or provided to NYSERDA by Contractor to release to NYSERDA any information pertaining to past or present relevant work. I hereby release from all liability or damage, NYSERDA and those persons, agencies or organizations who may furnish such information.

I understand that by submitting this application, I authorize NYSERDA and entities doing business on NYSERDA’s behalf to add me to the mailing lists and to share my information with other New York State government entities. My information will not be shared outside of New York State government, and I reserve the right to unsubscribe at any time. 

Authorized Signature

Choose how to sign

Tracking Number

You will be provided with a Tracking Number upon submission.