Form 810ppn - Preferred Partners Network Request For Insurance Form
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1Form 810PPN
Preferred Partners Network Request for Insurance Form
®
EnergyRight
Solutions for Business/Industry
Request for Certificate of Insurance
To qualify as a Preferred Partners Network (PPN) member you must provide proof of current insurance coverage as
outlined below. Proof of insurance shall be provided to the Tennessee Valley Authority (TVA) along with your membership
application. Once approved, the PPN member is responsible for providing current insurance information, on an annual
basis and when changes occur, with notice to TVA.
Trade Ally Instructions:
Complete this form and send it to your insurance agent to request a Certificate of Insurance as required by TVA to
®
become a member of the EnergyRight
Solutions for Business/Industry Preferred Partners Network. All contractors and
installers must provide general liability, workers’ compensation and auto liability insurance. All other trade allies
must provide proof of at least general liability insurance.
Company Information
Company Name___________________________
Contact Name_________________________________
Address__________________________________
City_________________
State____
Zip_______
E-Mail___________________________________
Phone_______________
Fax__________________
Insurance Agent Instructions:
TVA implements energy efficiency programs across multiple states. The company
listed above has applied to become a PPN contractor for TVA’s EnergyRight Solutions for Business/Industry Program. For
more information about TVA and its programs, please see Through contracts with its PPN
members, TVA requires all approved PPNs to maintain specified insurance coverage as well as other obligations.
Requested Certificate of Insurance Information:
The insurance carried by the Company named above must
cover the work it will perform as a PPN Member and cannot have any exclusion for the type(s) of damage that it may
cause as a result of said work.
The required Certificate(s) of Insurance should specifically name TVA as an Additional Insured* and include proof of
insurance for the following:
•
Occurrence based Commercial General Liability Insurance (including products and completed operations
coverage)**
With combined single limits, per accident, should be $1,000,000 for bodily injury, including death
o
and property damage; and
TVA must be specifically named as an Additional Insured
o
•
State-required workers’ compensation insurance should be $500,000.
•
Comprehensive Auto Liability insurance for bodily injury and property damage should be $1,000,000 per
accident.
* TVA is not liable or responsible for any problems that may arise with the company listed above.
**If the company is not a contractor/installer they only have to provide proof of general liability insurance as outlined above.
Please note in your records that TVA is a Certificate Holder and Additional Insured and should be notified of renewals,
cancellations or changes in coverage.
Please e-mail or mail the insurance certificate directly to:
EnergyRight Solutions for Business/Industry Program
424 Church Street, Suite 1320
Nashville, TN 37219
Fax: 1.866.248.0244
Email:
PPN@tva.gov
Insurance Certificate Request Form v2 140930
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