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 Contingent Approval to Interconnect the Generating Facility (For Utility use only) 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 Certificate of Completion for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW 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: Electrician 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: Inspection: 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: Approval to Energize the Generating Facility (For Utility use only) 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: Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW

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 Contingent Approval to Interconnect the Generating Facility (For Utility use only) 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 Certificate of Completion for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County: Telephone (Day): Fax: (Evening): Location of the Generating Facility (if different from above) Address City: County: Electrician State: Zip: Telephone (Day): FaxName: (Evening): Company: E-Mail Address: Electrician 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: Inspection: 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: Approval to Energize the Generating Facility (For Utility use only) 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: Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 20 kW

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 Contingent Approval to Interconnect the Small Generating Facility (For Utility 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 Small Generating Facility Certificate of Completion for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW 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: Electrician Electrician: 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: Inspection: 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: Approval to Energize the Small Generating Facility (For Utility 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: Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW10kW

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 designPreliminary Approval of Applicable Building Inspection Authority Inspector 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 Contingent Approval to Interconnect the Generating Facility (For Utility use only) 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 Greenville Utilities Commission Certificate of Completion for Interconnecting a Certified Inverter-Based Based, Single-Phase Generating Facility No Larger than 10 20 kW 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: Electrician 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: Inspection: 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) Customer Signature: 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: Approval to Energize the Generating Facility (For Utility use only) 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: Greenville Utilities Commission Terms and Conditions for Interconnecting a Certified Inverter-Based Based, Single-Phase Generating Facility No Larger than 10 20 kW

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 Contingent Approval to Interconnect the Small Generating Facility (For Utility 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 Small Generating Facility Certificate of Completion for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW 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: Electrician Electrician: 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: Inspection: 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 Utility 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 Terms and Conditions for Interconnecting a Certified an Inverter-Based Small Generating Facility No Larger than 10 kW10kW

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 Contingent Approval to Interconnect the Generating Facility (For Utility use only) 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 Certificate of Completion for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW 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: Electrician 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: Inspection: 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: Approval to Energize the Generating Facility (For Utility use only) 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: Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW