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HomeMy WebLinkAboutPacific Gas and Electric Company Pacific Gas and LOCAL AGENCY AND DISTRICT Electric Company` CUSTOMERS ON-BILL FINANCING LOAN AGREEMENT The undersigned Local Agency or District' Customer ("Customer") has contracted for the provision of energy efficiency/demand response equipment and services (the "Work") which qualify for one or more of PG&E's applicable rebate or incentive programs. Subject to the conditions (including the process for Adjustment and preconditions to funding)set forth below, Pacific Gas and Electric Company("PG&E") shall extend a loan (the "Loan") to Customer in the amount of the loan balance (the "Loan Balance") pursuant to the terms of this On-Bill Financing Loan Agreement("Loan Agreement")and PG&E's rate schedules E-OBF and/or G-OBF, as applicable(the"Schedule"). To request the Loan,Customer has submitted a completed On-Bill Financing Application and associated documentation as required by PG&E (the"Application"). Collectivelythe Application and this Loan Agreement(including any Adjustment hereunder) comprise the "Agreement". 1. Customer shall arrange for its Contractor, as identified at the end of this Agreement("Contractor"),to provide the Work as described in the Application. 2. The estimated Loan Balance is set forth below. The total cost of the Work as installed, rebate/incentivefor qualifying energy efficiency measures, Loan Balance, monthly payment, and loan term specified in this Loan Agreement may be adjusted, if necessary, after the Work and the post-installation inspection described in the Application and/or herein are completed (the "Adjustment"). The Adjustment will be calculated using the actual total cost of the Work, as installed, and the estimated energy savings(as described in the Application)of such Work. In no eventwill the Loan Balance be increased without Customer's written consent, even if Customer is eligible for such increased Loan Balance. Moreover, in no eventwill the Loan Balance exceed the maximum loan amount stipulated in the Application. Customer understands that in orderto be eligible for the Loan,the initial Loan Balance for Work may not fall below the minimum loan amount, nor may the payback period exceed the maximum payback period.Accordingly, if after the Adjustment, the Loan Balance falls below the minimum loan amount or if the simple payback period exceeds the program maximum payback period, each as described in the Application, PG&E shall have no obligation to extend the Loan, as the Work would not meet program requirements. The Adjustment described in this paragraphwill be communicated to the Customer in writing and will automatically become part of this Loan Agreement, except that any proposed increase in the Loan Balance will only become part of this Loan Agreement upon Customer's written consent to such increase. 3. PG&E shall have no liability in connection with, and makes no warranties, expressed or implied, regarding the Work. The Parties acknowledge and agree that PG&E is only providing the Local Agency or District cited here with financing.The Customer has independently hired contractors ("Local Agency or District Contractors")to perform the work on behalf of the Customer to qualify for financing. The Customer acknowledges and agrees that the Local Agency or District Contractors are not third party beneficiaries to this agreement between the Customer and PG&E. To the extent authorized by law and subject to appropriation of the Legislature,the Customer agrees that it will look only to Local Agency or District Contractors for any claims related to the installed equipment or its performance and that PG&E shall have no responsibility or liability, except for the payment of the loan proceeds, and the Customer shall indemnify PG&E for any claims made by the Local Agency or District Contractors against PG&E. 4. Customer represents and warrants that (a) Customer is receiving this Loan solely for Work obtained in connection with Customer's business, and not for personal, family or household purposes; (b) Customer, if not an individual or a government agency, is duly organized,validly existing and in good standing under the laws of its state of formation,and has full power and authority to enter into this Agreement and to carry out the provisions of this Agreement.Customer is duly qualified and in good standing to do business in all jurisdictions where such qualification is required; (c)this Loan Agreement has been duly authorized by all necessary proceedings, has been duly executed and delivered by Customer and is a valid and legally binding agreement of Customer duly enforceable in accordance with its terms; (d) no consent, approval,authorization,order, registration or qualification of or with any court or regulatory authority or other governmental body having jurisdiction over Customer is required for, and the absence of which would adversely affect,the legal and valid execution and delivery of this Loan Agreement,and the performanceof the transactions contemplated by this Loan Agreement;(e)the execution and delivery of this Loan Agreement by Customer hereunderand the compliance by Customer with all provisions of this Loan Agreement: (i)will not conflict with or violate any Applicable Law; and (ii)will not conflict with or result in a breach of or default under any of the terms or provisions of any loan agreement or other contract or agreement under which Customer is an obligor or by which its property is bound; and (f)all factual information furnished by Customer to PG&E in the Application and pursuant to this Agreement is true and accurate. 5. The Application must include the Federal Tax Identification Number or Social Security Number of the party who will be the recipient of the checks for the rebate/incentive or any Loan proceeds. Checks may be issued directly to the Customer or its designated Contractor or both, for the benefit of the Customer,as specified below. Customer acknowledges that PG&E will not be responsible for any tax liability imposed on the Customer or its contractor in connection with the transactions contemplated under the Agreement, whether by virtue of the Loan contemplated under the Agreement, or otherwise, and Customer shall indemnify PG&E for any tax liability imposed upon PG&E as a result of the transactions contemplated underthe Agreement. ' Local Agency or District as defined in California Government Code§50001 and§58004. 1 Form 79-1194 Advice 3926-G/5214-E Automated Document—Preliminary Statement Part A January 2018 6. Upon completion of the Work, Customer shall send a written confirmation of completion to PG&E's On-Bill Financing Program Administrator at the address listed in Section 15. Within 60 days after receiving the confirmation, PG&E (a) will conduct a post installation inspection and project verification,including review of invoices, receipts and other documents as required by PG&E to verify the correctness of any amounts claimed by Customer; and (b)will adjust, if necessary, the total cost, incentive,Loan Balance, monthly payment, and loan term as stated above. Customer shall give PG&E reasonable access to its premises and the Work. If the Work conforms to all requirements of the Agreement and all amounts claimed by Customer as Work costs are substantiated to PG&E's reasonable satisfaction, PG&E will issue a check ("Check") to Customer or Contractor(as designated by Customer in Section 15) for all amounts PG&E approves for payment in accordance with the Agreement. The date of such issuance is the "Issuance Date". If the Check is issued to Customer, Customer shall be responsible for paying any outstanding fees due to Contractor for the Work. Ifthe Check is less than the amountduefrom Customerto Contractor,Customershall be responsible for the excess due to the Contractor. 7. Customer shall repay the Loan Balance to PG&E as provided in this Loan Agreement irrespective of whether or when the Work is completed, or whether the Work is in any way defective or deficient, and whether or not the Work delivers energy efficiency savings to Customer. 8. The monthly payments will be included by PG&E on the Account's regular energy service bills, or by separate bill, in PG&E's discretion. Regardless whether the monthly payments are included in the regular utility bill or a separate loan installment bill, the following repayment terms will apply: a. The Customer agrees to repay to PG&E the Loan Balance in the number of payments listed below and in equal installments (with the final installment adjusted to account for rounding),by the due date set forth in each PG&E utility bill or loan installment bill renderedin connection with Customer's account(identified by the numberset forth below)("Account"),commencing with the bill which has a due date falling at least 30 days after the Issuance Date. b. If separate energy service bills and loan installment bills are provided, amounts due underthis Loan Agreement as shown in the loan'installment bill shall be deemed to be amounts due under each energy services bill to the Account, and a default under this Loan Agreement shall be treated as a default under the Account. c. If the Customer is unable to make a full utility bill payment in a given month, payment arrangements may be made at PG&E's discretion. d. Any partial bill payments received for a month will be applied in equal proportion to the energy charges and the loan obligation for that month, and the Customer may be considered in default of both the energy bill and the loan installment bill. e. Further payment details are set forth below. 9. Any notice from PG&E to Customer regarding the Program or the transactions contemplated under the Loan Agreement may be provided within a PG&E utility bill or loan installment bill, and any such notices may also be provided to Customer at the address below or to the Customer's billing address of record in PG&E's customer billing system from time to time, and in each case shall be effective five(5)days after they have been mailed. 10. The Loan Balance shall not bear interest. 11. Customer may, without prepayment penalty, pay the entire outstanding loan balance in one lump sum payment provided the customer first notifies PG&E by telephoning the toll free phone number(1-800-468-4743),and by sending written notice to PG&E On- Bill Financing Program Administrator at the address listed below, in advance of making the lump sum payment. Accelerated payments that are received from Customer without PG&E's prior approval may, at PG&E's sole discretion, be applied proportionally to subsequent energy charges and Loan repayments and PG&E shall have no obligation to apply accelerated payments exclusively to reduction of the outstanding Loan. 12. The entire outstanding Loan Balance will become immediately due and payable, and shall be paid by Customer within 30 days if: (i) the Account is closed or terminated for any reason; (ii) Customer defaults under the Agreement; (iii) Customer sells the equipment forming part of the Work to any third party; or (iv)Customer becomes Insolvent. Customer becomes "Insolvent" if: (i) Customer is unable to pay its debts as they become due or otherwise becomes insolvent, makes a general assignment for the benefit of its creditors, or suffers or permits the appointment of a receiver for its business or assets or otherwise ceases to conduct business in the normal course; or (ii) any proceeding is commenced by or against Customer under any bankruptcy or insolvency law that is not dismissed or stayed within 45 days. 13. Customer understandsthat without limiting any other remedy availableto PG&E against Contractor or Customer,failure to repay the Loan Balance in accordance with the terms of the Agreement could result in shut-off of utility energy service, adverse credit reporting,and collection procedures,including,without limitation, legal action. 14. If there is any conflict among the documents comprising the Agreement, the following order of priority shall apply: 1. this Loan Agreement;2. the Application; 3. any documents attached to the Application. 2 Form 79-1194 Advice 3926-G/5214-E Automated Document—Preliminary Statement Part A January 2018 15. LOCAL AGENCY OR DISTRICT REQUIREMENT a. All Payment Obligations Subject to Appropriation The Customer acknowledges that the cost incurred pursuant to this Loan Agreement will be part of the monthly bill for electric use. All payment obligations and the Work replacement obligations of the Customer under this Loan Agreement or any related agreement or application is subject to appropriation by the Legislative body belonging to Local Agency or District cited in this loan agreement. b. No Lien or Encumbrance; Subordination: (1) Notwithstanding any other provision in this Loan Agreement— , PG&E acknowledges that nothing in this Loan Agreement shall constitute a mortgage,charge, assignment, transfer,pledge, lien or encumbrance upon either the Work or any part of the buildings, structures or related facilities in which the Work is constructed, installed or situated (collectively, the "Related Facilities"). Accordingly, PG&E agrees it will not record or file any instrument that would indicate or imply it has a security interest in the Related Facilities, including but not limited to a UCC-1. (2) In addition to the preceding paragraph(a), if this Loan Agreement were ever construed or deemed to create any such encumbrance,then: (i)this Loan Agreement shall be junior and subordinate and subject in all respects to the terms and conditions of any and all leases, and indentures related to lease revenue bonds issued by the Local Agency or District cited here or any other issuer of bonds on behalf of the Local Agency or District concerning the Related Facilities entered into in the past, the present or the future(the "Senior Security Documents"); and (ii)any term or condition of this Loan Agreement relating to any right, title or interest in the Related Facilities or other benefits derived there from shall be in all respects junior and subordinate to, and subject to the terms of, the Senior Security Documents. 3 Form 79-1194 Advice 3926-G/5214-E Automated Document—Preliminary Statement Part A January 2018 15. Loan Particulars. This table is to he com leted by PG&E Total Cost Incentive Customer Loan Balance' Monthly Payment Term z Number of Buy-Down (months) Payments (if applicable) $1,706,177.00 $- $- $1,706,177.00 $21,874.06 78 78 Check Made Payable to Customer❑ or Contractor❑ customer to select payment method. Note that only one check can be issued 16. This agreement at all times shall be subject to such modifications as the California Public Utilities Commission may direct from time to time in the exercise of its jurisdiction. Federal Tax ID or Social Security#,Customer Federal Tax ID or Social Security#,Contractor 94-6000338 94-0742640 PG&E Account#/Service Agreement# 0941013473/0941013004 Account Name,Customer Name,Contractor Primary Customer Name: CITY OF FRESNO-1 of 6 Pacific Gas and Electric Company Streetlights Primary MDSS Application Number: TIFID: 008483 Customer Address(For OBF Check Delivery) Contractor Address(For OBF Check Delivery) 245 Market St, Mail Code N10D San Francisco ICA 194105 Name and : .. ___:thorized Representative of Name and Title of Authorized Representative of I.Customer Contractor �1�07I M.zi4W DPW 2>fl'4-_C+r Pacific Gas and Electric Company Signature of Authorized Representative of Customi9, Date 8- P ACCEPTED:Pacific Gas and Electric Company By Date PG&E On-Bill Financing Authorized Representative Address: On-Bill Financing Program APPROVED TO FORM Mail Code N6G N OFF E Pacific Gas and Electric Company BY: PO Box 770000 CITY ATTORNEY San Francisco, CA 94177-0001 -31'al►c(on PA- &N((rt, 4(pa ty' The Loan Balance shall not exceed one-hundred thousand dolars ($100,000) for commerc4al Customers and shall not exceed two-hundred Fifty thousand dollars ($250,000)for government agency and multi-family customers, excepting leans to government agency and multi-family customers where, in PG&E's sole opinion,the opportunity for uniquely large energy savings exist, in which case the Loan Balance may exceed two-hundred fifty thousand dollars($250,000) but shall not exceed two million dollars($2,000,000). 2 The loan term in months will be established by PG&E at the time of the OBF Loan Agreement initiation.The maximum loan term shall be sixty (60)months excepting:1)loans to Government agency Customers or Multi- Family Customers will have a maximum loan term of one hundred and twenty(120)months or the expected useful life (EUL)of the installed energy efficiency measures, which everis less; and 2)loans to customers where,in PG&E's sole opinion,credit and risk factors support a loan term longerthan sixty (60)months, ATTEST: 4 FormYVONNE SPENCE,CMC Advice 396-G 26-G/52119E 521E-E Automated Document—Preliminary Statement Part A VIP) K January 2018 CL M H % ® £■ ° I = = - - ƒ ) Bk) [ og § qk t LL § 3 § )0 & ° J ) § £ � « § a %U) � " n ■ 2 E 93 ui § 2 § { 0 ( E� 2m k , § CD \� § cc � ° I § 2 k Goo - - @ � K 00 � � § LU 2 2 S � -j °° ° -JG - \k k 00 § Ka A § 2 §i Cq mm LU _ _ _ 2 � 2 _ 2 | q ƒ | o z £ £ o � - o1 tw < \ } = o _ o � « _ U) 0 � � � \ � ( k � § § § \ § ®7 I / • • 2 O E ƒ 0w Em a L � b k § z � 2 < k $ � � « ° 0 k of 0 � � 8 E � $ O 6 =2 7 c o � § § § § = � _ _ E § � A M = � k a k § 8 § ( ] ( z g o2 w . £ �_ 2 a E 0 m L) 0 U 2 R . e � � § � � § < r- a e ' ¥ a » (Az kCL L) � v IL ElectricPacific Gas and • .. On-Bill Financing Program FinancingSupplement to the On-Bill ProgramFinancing pp • The On-Bill Financing Program (the"Program") is funded by California Loan Features:The loans offered under the Program are interest- utility customers and administered by Pacific Gas and Electric Company free(0%)and free of any fees, late payment penalties or other (PG&E)under the auspices of the California Public Utilities Commission charges.The loan terms and conditions are calculated by dividing the (CPUC).The Program provides qualified PG&E customers with a means loan amount(eligible project cost less Qualified Program Incentives) to finance energy-efficient(EE)retrofit projects implemented under by the estimated monthly energy savings resulting from the Retrofit select PG&E EE Programs(the"Qualified Program").The loans issued Project.The ensuing number of monthly payments must not exceed under the Program are interest-free, unsecured loans to fully or partially the Maximum Loan Term set forth in chart below("Loan Amount and reimburse qualified PG&E customers for the costs they incur in Term Limitations"). connection with a qualified retrofit project(the"Retrofit Project"),which Eligibility:Prior to purchasing and installing any energy-efficient term shall mean the energy efficiency retrofit project described in measures or equipment under the Qualified Program, Customer Customer's relevant Energy Efficiency Program Application. must satisfy the eligibility requirements of both the Program and Conditions for Eligibility:Participation in the Program is limited to Qualified Program. Because energy efficiency projects in progress PG&E customers that meet the following conditions and satisfy are ineligible under the.Program,Customer must receive the signed these conditions throughout the duration of the Retrofit Project up to loan agreement from PG&E before commencing any work or and including the date of Final Verification(defined below in Section purchasing any equipment for the Retrofit Project. 8): (a)the PG&E customer must be a business("Commercial Inspection:PG&E may assist Customers in understanding the Customer")or a federal,state,county or local government agency energy efficiency measures available under the Qualified Program ("Government Customer").'Commercial Customers and Govemment Customers are collectively referred to as"Customer;" and will answertheir questions concerning this Program.After (b)Customer currently receives service from PG&E at the location of Customer has decided upon the measures that comprise the Retrofit the Retrofit Project(the"Location"); (c)Customer has continually Project, PG&E may request an engineering review,perform an maintained an active PG&E account for the previous 24 months and inspection of the Location,calculate the projected energy savings, has a minimum of 12 months of historical metered energy usage at calculate the Loan Terms and prepare the Loan Documents, Customer's current Location;(d)at the time the Customer's Thereafter,PG&E will provide Customer with a copy of the:Loan Program Application is Approved and Customer's Loan Agreement is Agreement,the Application,the applicable On-Bill Financing (OBF) executed, and at the time the loan is to be funded following Gas and/or Electric Rate Schedule and Loan Calculation Summary completion of the Retrofit Project and satisfaction of all other Sheet(collectively,the"Loan Documents"). requirements of the Loan Agreement, Customer must be in good Loan Documents: If the terms of the loan are acceptable,Customer credit standing,as determined by PG&E through credit review which shall execute the Loan Documents and return them to PG&E prior to may include a commercial credit check and will include a bill the commencement of the Retrofit Project.Incomplete or incorrect payment history review, which may be based upon the following and applications cannot be processed and may result in the delay of other criteria: PG&E's approval and possible disqualification from the Program. a. No 24-hour disconnection notices in the last 12 months; Customer may withdraw its Application for any reason without b. No returned payments within the last 12 months; penalty by sending written notice to PG&E. c. No more than 1 payment arrangement in the last 12 months; Customer's Responsibilities for Contractor and Vendor:Upon d. No payment arrangements not satisfied by customer within PG&E's notification to Customer that the Retrofit Project is eligible the last 12 months; for the Program,Customer may begin the Retrofit Project. PG&E does not endorse or recommend any particular contractor or vendor C. No security deposit assessed within the last 12 months; and nor does PG&E review any contractor or vendor proposals. Rather, f. The Retrofit Project qualifies and Customer is eligible for Customer shall be solely responsible for reviewing the feasibility of an incentive under the Qualified Program. the contractor's and vendor's proposal(s)and verifying their respective qualifications,pricing, energy savings,warranties and the Loan Amount and Term Limitations terms and conditions of the contractor's and/or vendor's contract with Customer. Interest 0%,with no additional fees or charges Minimum Loan Amount $5,000 Maximum Loan Amount Commercial Customer: $100,000/premises Government Customer: $250,000/ meter Maximum Loan Term,not Commercial Customer:60 months to exceed the Expected Government Customer: 120 months Useful Life(EUL)of the measures "Residential customers are ineligible. Page l of 2 1'(Af Ih,,:lfunl f;;CUSTOMER'S DESIGN OF THE RETROFIT Agreement with PG&E.which may include new contract terms PROJECT AND SELECTION AND USE OF ENERGY EFFICIENCY reflecting the changes in the Retrofit Project.(if a Loan f EQUIPMENT, MEASURES AND SELECTION OF CONTRACTORS AND Modification Agreement is required, it shall be deemed part of VENDORS IS AT CUSTOMER'S SOLE DISCRETION AND AT the"Loan Documents.") CUSTOMER'S SOLE RISK TO THE EXTENT PERMITTED BY Is, If the changes to the Retrofit Project are such that it no longer APPLICABLE LAW,PG&E EXPRESSLY AND SPECIFICALLY meets the Program's payback criteria or other conditions,the DISCLAIMS ANY LIABILITY IN RESPECT OF ANY ADVICE, Retrofit Project will be considered ineligible,the Loan Agreement will INFORMATION OR OTHER INSTRUCTION PROVIDED BY OR ON be terminated and no loan proceeds will be disbursed. BEHALF OF PG&E TO CUSTOMER IN CONNECTION WITH THE c' It PG&F DFTFRMINI-S. IN ITS %BS0l,U7F DISCRI11ON'TI AT QUALIFIED PROGRAM, PROGRAM OR RETROFIT PROJECT. PG&E CI ISR)NIFR'S CA DI f I IAS DLTI'NORA l lit)OR flAS()I I IFIOVISI DOES NOT WARRANT OR BEAR ANY RESPONSIBILITY FOR ANY OF PLACED Cl iSYUMFICS RI'MV\IFN I-01- I'I It: L11:1N A f RISK. H IF THE FOLLOWING: LOAN PROCEEDS SIIALI_NOT 1W ISSUfT). LVI AA''TIIOl1Gll I IIL; o. THE WORK PERFORMED BY CUSTOMER'S CONTRACTOR(S)OR RI.:fRUfIT 111MA:C I MAY 11,Wli BEFNI S.\1ISF:u,'I'uRIL1 VENDOR(S),THAT THE RETROFIT PROJECT IS APPROPRIATE FOR CU\IPLLI'ED.V C'11S'f0\Iflt'S I:.\I'I:N'Sl:. THE LOCATION; I Islnlr;rint l)ls Subject to and following PG&E's satisfactory Final b.THE RETROFIT WILL RESULT IN OR YIELD ANY ENERGY Verification,an incentive check and the loan proceeds will be issued EFFICIENCY SAVINGS OR A SPECIFIC AMOUNT OF ENERGY to Customer or,at Customer's written direction,to Customer's EFFICIENCY SAVINGS OR OTHER REDUCTION IN CUSTOMER'S contractor or vendor. PG&E UTILITY BILL_AFTER COMPLETION OF THE RETROFIT PROJECT; �ncrtl!.I'r it t�inn�' THE CUSTOMER IS REPONSIBLE FOR REPAYING THE OBF iI.Applications for loans under the Program will be accepted From LOAN IN ITS ENTIRETY,REGARDLESS OF THE PROJECT qualified Customers on a first-come, first-served basis until the funds allocated by PG&E for the Program are no longer available. PERFOMANCE OF THE ENERGY EFFICIENCY RETROFIT; The Program may be modified or terminated by the CPUC or PG&E d.THE CONTRACTOR'S OR VENDOR'S SERVICES WILL BE TIMELY, at any time and without prior notice.However,termination of the COMPLETE OR ERROR-FREE,OR THAT DEFECTS IN THE RETROFIT Program following execution of a Loan Agreement by Customerwill PROJECT WILL BE CORRECTED BY SUCH INDIVIDUALS; not affect that Loan Agreement,or,if Customer thereafter satisfies ANY ERRORS,OMISSIONS, DEFECTS OR DELAYS IN THE DESIGN all Program conditions,the disbursement. OR CONSTRUCTION OF THE RETROFIT PROJECT OR THE It. The loan proceeds may only be used to pay or reimburse OPERATION OF ANY ENERGY EFFICIENCY MEASURES INSTALLED Customer for implementing or installing energy-efficient measures AT THE LOCATION. or equipment through the Qualified Program. t.,nlicatn Ott;Upon completion of the Retrofit Project,Customer shall ;, If there is any conflict between the terns of any document relating request PG&E's post-completion inspection and final verification that to the Program,the Loan Documents shall control, the Retrofit Project has been completed in conformity with the d For all retrofit projects,including but not limited to streetlight, requirements of the Qualified Program and that customer remains HVAC and lighting retrofits, Customer acknowledges and eligible(the"Final Verification"). understands that Customer is able to use the installation vendor or ;, If there has been any change to the Retrofit Project's scope,cost contractor of their choice. and/or incentives available under the Qualified Program or energy savings,Customer will be required to enter into a Loan Modification I have read,understand and agree to all of the On-Bill Financing Program requirements and terms and conditions set forth in this Program description. I understand that loan calculations will be based on pre-inspection results and on the applicable program documentation, and that my agency/company must meet all eligibility criteria and requirements in order to participate in the Program.Any unapproved changes to project scope,costs or run hours,or to my agency's/company's creditworthiness, between the time the Loan Documents are accepted and signed and the Retrofit Project is completed and the project's and my agency's/company's continued eligibility are verified,could result in loan ineligibility. 0T Y of EIZ--f5SNO _5"c-0 � M o Z-I t ppi N11mc or SInC>: r a, the•lit[alpl nanic on your �M �,tulhon[ed Represcnlanre's Pnnlcd Name Aatlytuhr Rc;fr�•s�rnnuse'sXipnalura Irtic hate Tax identification inturmation(select one): w Federal Tay In Nun ber. _ 9-4 6Uo03.Jl_e u Social Srcufit)Number. FOR ep&F. USE ONLY: PO&FOHF Administrator Printed Name Dale RClrorlt Pfugram Applicalioni Number 01ii:Application Number t 'PCCF' (;­,:d EI-Irs,Conpane. a 5uhsidian el PG IE t'or peraiu:n ^_ol I'a•Ilie Cleo ecd Eleclne Cm-Van)- All—his reserved hest b)•('ahrorma unhh cu slomers and adnnn:st.'ed by 1.G&,E w der lhr Flflif c,Cenumse,on POSE prints ds materials with soy based mks 4en recycled paper Ci Apnl?ul I (711•n71u-(nnu Page 2 of 2