Interconnection Member Signature Sample Clauses

Interconnection Member 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: Contingent Approval to Interconnect the Generating Facility (For Cooperative 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. Cooperative Representative Signature: Title: Date: Interconnection Request ID number: Cooperative 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 Member Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): (Evening): Telephone (Cell): Fax: E-Mail Address: Electrician Name: Address: City: State: Zip: Telephone (Day): (Evening): Telephone (Cell) Fax: E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Cooperative: Interconnection Request ID Number: