Fillable COVER-PRO APPLICATION ENERGY CONSULTANT SUPPLEMENT 1. Full name (Philadelphia Insurance Companies)

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COVER-PRO APPLICATION ENERGY CONSULTANT SUPPLEMENT 1. Full name (Philadelphia Insurance Companies)

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COVER-PRO
SM
APPLICATION
ENERGY CONSULTANT SUPPLEMENT
1. Full name of the Applican
t Firm:
2. Does the Applicant hold any professio
nal certifications such as a
Certified Environmental Auditor (CEA) or a
Certified Energy Plans Examiner (CEPE)? If yes, please list all certifications.
3. What percentage of the Applicant’s g
r
oss ann
ual re
venue comes from the following types of clients?
Residential: %
Professional / Commercial: %
Industrial / Institutional: %
Other: (specify) %
Other: (specify) %
Other: (specify) %
TOTAL MUS
T EQUAL
100 %
4. Does the Applicant have an ownership interest in any c
lients? If yes,
please describe:
ADDITIONAL INFORMATION
This section may be used to provide additional information to
any question on this ap
plication. Please
identify the question number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or O
fficer)
__________________________________________
Signature Date
PI-PLSP-ECSUPP 08/10
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COVER-PRO APPLICATION ENERGY CONSULTANT SUPPLEMENT 1. Full name (Philadelphia Insurance Companies)

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Completed 7 November 2020

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