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Railbelt Reliability Council (RRC)

Qualified Representative Appointment Form

RRC Directors should complete this form any time they wish to convey or modify the appointment of a Qualified Representative (QR) to a Technical Advisory Committee (TAC) Working Group. Directors should also use this form to communicate their option to decline the opportunity to appoint a QR to a particular TAC working group.

Directors should review and understand the Qualified Representative Policy when using this form.

When sharing a QR with other Voting Directors, only the Designated Contact should complete this form.

By submitting this form, you are affirming that the QR meets applicable qualifications to serve in the role to which they are appointed. Additional documentation may be required upon request.

Director Information

Director Information

Name

Please enter your name.

Please enter your email address.

Please enter the name of your affiliated organization (Ex. CEA, AIPPA, AKPIRG, REAP)

Please select your RRC Board Seat.

TAC Working Group Appointment

TAC Working Group Appointment

TAC Working Groups 

Please select the TAC Working Group(s) this appointment form pertains to.

Please enter the name of the 'Other' TAC Working Group.

Will you be appointing a QR to the above selected working group? 

To the extent known, please list out the Working Group meeting dates for which this QR will be attending.

Please list any additional information you wish to provide regarding this QR appointment.

Qualified Representative Information

Qualified Representative Information

QR Name

Please enter the full name of the QR you intend to appoint to a TAC Working Group.

Please enter the QR's email.

Please enter the QR's phone number

Shared Qualified Representative

Shared Qualified Representative

Are you sharing this QR with another Director? 
Other Voting Director(s) Board Seat(s)  

Please select the Board Seat(s) letter(s) of the other Voting Director(s) you are sharing this QR with (if unknown, please refer to the RRC website: https://www.akrrc.org/team). You do not need to select your own Board Seat.

Qualified Representative Fee

Qualified Representative Fee

Are you requesting to receive meeting fees for this QR? 

Please enter the hourly rate the QR is to receive for attendance at TAC working group meetings (not-to-exceed $150/hr. per the Board Member Fees and Reimbursement of Expenses Policy)

To whom should the QR fee payment be remitted to? 

Please enter the name of the individual/entity the QR fee payment should be remitted to.

Does the RRC have a completed Form W-9 for the entity/individual where the QR fee payment is to be routed? 

If unsure, please verify with RRC staff.

QR Fee Payment Information

Qualified Representative Fee Payment Information

Does the RRC already have payment information for this QR? 

If unsure, please verify with RRC staff.

How should the QR fee payment be remitted?

The following information is required to ensure the QR is paid properly. Should you not readily have any of the following information available or would rather provide this information via a different method, please email the below requested information to accounting@akrrc.org with RRC staff copied.

Please provide the name of the financial institution.

Please provide the mailing address where the check should be sent.

Please provide the ABA routing number.

Please provide the account number.