Common use of Interconnection Customer Signature Clause in Contracts

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Facility’s intended design: Sell All Net Meter If Net Metering, do you intend to keep your current retail rate schedule? Yes No Length of contract term and option under the Cogeneration & Small Power Producer Tariff: Term (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Utility: Interconnection Request ID Number: The Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach signed electrical inspection): Print Name: Date: As a condition of interconnection, you are required to send/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility information below): Name: Company: Address: City: Fax: State: Zip: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW. Utility Signature: Title: Date:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Facility’s intended design: Sell All Net Meter If Net Metering, do you intend to keep your current retail rate schedule? Yes No Length of contract term and option under the Cogeneration & Small Power Producer Tariff: Term (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): Fax: (Evening): Location of the Generating Facility (if different from above) Address City: County: State: Zip: Name: Company: E-Mail Address: License NumberAddress: Date Approval to Install Generating Facility granted by the UtilityCity: Interconnection Request ID NumberState: Zip: Telephone (Day): Fax: (Evening): The Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach signed electrical inspection): Signature: Print Name: Date: As a condition of interconnection, you are required to send/email/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility information below): Utility Name: CompanyAttention: E-Mail Address: Address: City: Fax: State: Zip: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW. Utility Signature: Title: Date:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW 10kW and return the Certificate of Completion when the Small Generating Facility has been installed. Signed: Title: Date: Facility’s intended design: Sell All Net Meter If Net Metering, do you intend to keep your current retail rate schedule? Yes No Length of contract term and option under the Cogeneration & Small Power Producer Tariff: Term (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B For Company use only) Interconnection of the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified an Small Generator 10 kW Inverter Process 4 Inverter-Based Small Generating Facility No Larger than 10 kW 10kW and return of the Certificate of Completion. Utility Company Signature: Title: Date: Interconnection Request Application ID number: Utility Date: Company waives inspection/witness test? Yes No Small Generator 10 kW Inverter Process 5 Is the Small Generating Facility owner-installed? Yes No Interconnection Customer NameCustomer: Contact Person: Address: Location of the Small Generating Facility (if different from above) City: ): City State: Zip: Telephone (Day): Fax: Telephone (Evening): E-Mail Address: Name: Address: City: City State: Zip: Telephone (Day): Fax: Telephone (Evening): E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the UtilityCompany: Interconnection Request Application ID Numbernumber: The Small Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach signed electrical inspection): Print Name: Date: Small Generator 10 kW Inverter Process 6 As a condition of interconnection, you are required to send/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility Company information below): Name: Company: Address: City, State ZIP: Fax: State: Zip: Approval to Energize the Small Generating Facility (For Company use only) Energizing the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW. Utility 10kW Company Signature: Title: Date:: Small Generator 10 kW Inverter Process 7

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Facility’s intended designInspector Signature: Sell All Net Meter If Net Metering, do you intend to keep your current retail rate schedule? Yes No Length of contract term and option under the Cogeneration & Small Power Producer TariffPermit # (if required): Date: Term (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer (must be utility billing customer) Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Utility: Interconnection Request ID Number: The Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach Attach signed electrical inspection): Print Name: Date: inspection and a signed electrical permit. As a condition of interconnection, you are required to send/fax a copy of this form along with a copy of the signed electrical permit to: Greenville Utilities Commission Electric Engineering Office 000 Xxxxxxx Xxxx P.O. Box 1847 Greenville, North Carolina 00000 000-000-0000 (fax) I hereby certify that, to (insert Utility information below): Namethe best of my knowledge, the Generating Facility listed above has been installed in accordance with the Greenville Utilities Commission Interconnection Procedures for Certified Inverter-Based, Single-Phase Generators No Larger than 20 kW and the Greenville Utilities Commission Terms and Conditions for Interconnecting a Certified Inverter-Based, Single-Phase Generating Facility No Larger than 20 kW. Signature: Company: Address: City: Fax: State: ZipDate: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW. Utility Signature: Title: Date:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Facility’s intended design: Sell All Net Meter If Net Metering, do you intend to keep your current retail rate schedule? Yes No Length of contract term and option under the Cogeneration & Small Power Producer Tariff: Term (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Utility: Interconnection Request ID Number: The Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach signed electrical inspection): Print Name: Date: As a condition of interconnection, you are required to send/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility information below): Name: Company: Address: City: Fax: State: Zip: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW. Utility Signature: Title: Date:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW 10kW and return the Certificate of Completion when the Small Generating Facility has been installed. Signed: Title: Date: Facility’s intended design: Sell All Net Meter If Net Metering, do you intend Contingent Approval to keep your current retail rate schedule? Yes No Length of contract term and option under Interconnect the Cogeneration & Small Power Producer Tariff: Term Generating Facility (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B For Company use only) Interconnection of the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW 10kW and return of the Certificate of Completion. Utility Company Signature: Title: Date: Interconnection Request Application ID number: Utility Company waives inspection/witness test? Yes No Is the Small Generating Facility owner-installed? Yes No Interconnection Customer NameCustomer: Contact Person: Address: Location of the Small Generating Facility (if different from above) ): City: State: ZipZip Code: Telephone (Day): Fax: (Evening): Fax: E-Mail Address: Name: Address: City: State: ZipZip Code: Telephone (Day): Fax: (Evening): Fax: E-Mail Address: License Numbernumber: Date Approval to Install Generating Facility granted by the UtilityCompany: Interconnection Request Application ID Numbernumber: The Small Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach signed electrical inspection): Print Name: Date: As a condition of interconnection, you are required to send/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility Company information below): Name: Company: Address: City, State ZIP: Fax: State: Zip: Energizing the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW. Utility 10kW Company Signature: Title: Date: