HomeMy WebLinkAboutContracts & Agreements_33-2002SELF -GENERATION INCENTIVE PROGRAM CONTRACT
BETWEEN PROGRAM ADMINISTRATOR, HOST CUSTOMER, AND APPLICANT
This Contract is made by and between [insert Applicant's name] City of Redlands
organized and existing under Califomia law (Applicant), [insert Host Customer's name]
City of Redlands (Host Customer), organized and existing under Califomia law,
and Southem California Edison, a California corporation (Program Administrator).
1.0 PROGRAM OVERVIEW AND PROJECT DESCRIPTION - The Self -Generation incentive
Program (Program), authorized by the Califomia Public Utilities Commission (CPUC) in
Decision 01-03-073, encourages the installation of several types of self -generation
technologies, both renewable and non-renewable, at customer sites in Califomia. The Program
offers differential incentives for self -generation technologies (SG Unit(s)) differentiated by their
fuel type, air emissions characteristics, and system costs. The Program, to be funded by
California investor -owned utility customers, is administered by Program Administrator for
customers within its service territory, under the auspices of the CPUC. Customers who
participate in the Program must be current electric or gas distribution customers of Program
Administrator who pay the Public Goods Charge (PGC) or gas Demand Side Management
(DSM) surcharge. Customers can participate either by hiring a separate entity to act as
Applicant, or by submitting their own Application. Applicants acting on behalf of customers must
include the Host Customer's signature on the Reservation Request Form, Appendix A.
1.1 The Program provides three levels of incentive payments, subject to the availability of
Program funds. The different levels of payments and other details are set forth in detail in D.
01-03-073 and in Appendix C. Installation and operation of the SG Unit(s) must be verified
before incentive payments can be made. Applicant and Host Customer, as defined in the
Appendix C, Self -Generation Incentive Handbook, Section 6, must also agree to permit the
Program's Measurement and Evaluation (M&E) consultant to measure and verify the amount of
energy production in accordance with the M&E consultant's approved M&E Plan, as described
in the Program Handbook, Appendix C, Section 5.3. Finally, Applicant must also agree to
provide any additional cost information requested by Program Administrator in order to
substantiate total qualifying project cost.
1.2 The Program requires that the SG Unit(s) be covered by warranties of three, or in some
cases five, years depending on the type of SG Unit(s) involved.
1.3 This Contract is limited to Application No. SGIP01-031 RR attached to this Contract as
Appendix A. If all Contract terms and conditions are complied with, Program Administrator will
pay Applicant incentives based on the incentive guidelines set in forth D.01-03-073 and in
Appendix C. Program Administrator reserves the right to modify or cancel the incentive offer if
Applicant 's actual installation of SG Unit(s) differs from the proposed installation described in
Appendix A. SG Unit(s) must also be installed by the date shown on the Reservation
Confirmation and Incentive Claim Form, Appendix B, issued by Program Administrator.
2.0 DOCUMENTS INCORPORATED BY REFERENCE - The following documents set forth
additional terms, conditions and requirements of this Contract:
Appendix A — Self -Generation Incentive Program Reservation Request Form
Appendix B — Self -Generation Incentive Program Reservation Confirmation and Incentive Claim
Form
July 2.2001 Rev. 0
Appendix C — Self -Generation Incentive Program Handbook, dated July 2, 2001, or as amended
Appendix D — Insurance Requirements
Appendix E — (Pacific Gas and Electric Company [PG&E1 Only) Reservation of Rights
Applicant, and Host Customer if different, acknowledges having received, read, and agreed to
be bound by Appendices A, B, C, and D, and, where PG&E is the Program Administrator,
Appendix E, copies of which were previously provided to it, and the terms of which are
incorporated herein by reference as though set forth in full. Should a conflict exist between this
Contract and these Appendices, this Contract shall control.
3.0 SUBMITTAL REQUIREMENTS FOR PAYMENT - As a condition of payment, the
Applicant shall submit to Program Administrator, within the deadlines established by Program
Administrator, the documents listed below and described in detail in Appendix C, Section 4.0.
Each document requires review and Program Administrator's written approval before Applicant
may move to the next stage of the application process.
3.1 The Self -Generation Incentive Program Reservation Request Form (Appendix A)
describes the Project, lists the SG Unit(s) that will be installed in the Project, and estimates its
size (in projected kW which it will produce) and its costs (including interconnection fees and in
some cases warranty costs). Program Administrator will review the Reservation Request Form
and, if the Project appears to meet eligibility requirements, Program Administrator will make a
conditional reservation of funds for the Project and will send Applicant a Conditional
Reservation Notice Letter, the description of which is in Appendix C, Section 4.3.
3.2 Proof of Project Advancement. Within 90 calendar days of the date on the Conditional
Reservation Notice Letter, Applicants must submit the following information to demonstrate to
Program Administrator that the Project is progressing and that there is an increased
commitment to complete the Project.
• Air Pollution Permitting —Applicants must submit copies of any required air pollution
permitting applications, such as a Permit to Construct. This must include proof of
payment for any associated application or permit fees.
• Electrical Interconnection Application — Applicants must submit a complete
Application To Interconnect A Generating Facility to the local electric utility. For more
information on the utility interconnection process, see Appendix C, Section 5.1.
• Purchase Order — Applicants must submit purchase orders for the SG Unit(s) as soon
as they are issued, and in no event later than 90 calendar days from the date of the
conditional Reservation Notice Letter. If any purchase orders are revised, copies of the
revised purchase orders must be submitted as soon as they are issued. .
• Revised Sizing or Efficiency Calculations — If anything has changed since the initial
submittal of these calculations, they should be revised and resubmitted at this time.
• Self -Generation Incentive Program Contract, including proof of insurance in
accordance with Section 10.0 below.
3.1 After Program Administrator reviews the Proof of Project Advancement items and
determines that the Project has met all the necessary criteria, Program Administrator will send
Applicant the Reservation Confirmation and Incentive Claim Form. This form will list the
specific reservation amount and the reservation expiration date (nine months later).
3.4 Upon Project completion, and prior to the reservation expiration date, Applicants will have
to complete and submit the Reservation Confirmation and Incentive Claim Formto request
Ju1v 2.2001 Rev. 0
an incentive payment. In addition to the completed Reservation Confirmation and Claim Form,
Applicants must submit the following attachments when requesting incentive payment:
• Proof of System Interconnection — Applicants must submit a copy of the signed letter
from their utility granting the distributed energy system owner permission to operate in
parallel with the electric utility transmission and distribution system. For questions on
the interconnection process, see Appendix C, Section 5.1.1.
• Final Building Inspection Report —Applicants must submit a copy of their final building
inspection report demonstrating that the Project meets all codes and standards of the
permitting jurisdiction. Contact your local permitting jurisdiction to leam about permitting
requirements.
• Final Air Permitting Documentation — For those technologies that require an air
permit, Applicants must submit a copy of the final documentation indicating compliance
with all applicable air pollution regulations.
• Final Equipment and Installation Invoice —Applicant must submit a copy of invoices
demonstrating final eligible Project costs. For a list of eligible Project costs, see
Appendix C, Section 3.4.1.
• Proof of Warranty —Applicants must submit proof of warranty for the distributed energy
technology used in their Project. This could include a manufacturers warranty statement
or extended maintenance and service contract terms and conditions.
3.5 The Field Verification Visit by the Program Administrators or their contractors will verify
that the SG Unit(s) have been installed and are operating in accordance with the claim
information. No incentive payment can be made until the Field Verification Visit has been
satisfactorily completed. The terms and conditions for the Field Verification Visit are set forth in
paragraph 4.1 below.
4.0 INSPECTIONS - As a condition of receiving incentive payments, Applicant and Host
Customer must ensure that Program Administrator and the Program M&E consultant have
access to the Project Site(s) for all Field Verification Visits summarized below and described in
detail in Appendix C, Section 4.4.9. Incentive payments will not be made if the Field Verification
Visit shows that the SG Unit(s) have not been installed or are not operational.
4.1 At the post -installation Field Verification Visit, Program Administrator or its authorized
agent checks installed SG Unit(s) to verify that the SG Unit(s) described in Appendix A have
been installed and are operating. During the Field Verification Visit, Host Customer must
provide access to the SG Unit(s) and must demonstrate the operation of the SG Unit(s). During
the Field Verification Visit, Host Customer must ensure that someone is present who is
knowledgeable about the SG Unit(s) and their operation.
4.2 Applicant and Host Customer must also agree to further Field Verification Visits and
interviews, as necessary for Measurement and Evaluation under the M&E Plan submitted by
the Program's M&E consultant and as discussed in Appendix C, Section 5. The same terms
and conditions specified in paragraph 4.1 will apply to such further Field Verification Visits.
5.0 PAYMENT - The total incentive payment shall not exceed the Total Incentive reserved in
the Reservation Confirmation and Incentive Claim Form. Program Administrator will make the
Incentive Payment to Applicant only after the appropriate documents have been submitted
(within the deadlines established by Program Administrator) and approved, and the first Field
Verification Visit has been satisfactorily completed, in accordance with the Program rules set
Ju1v 2. 2001 Rev. 0
forth in Appendix C. Program Administrator's determination of the incentive amount is final and
Applicant agrees to accept this determination.
5.1 Payment to Third Party: Applicant may designate in writing a third party to whom
Program Administrator shall make approved incentive payments.
6.0 REVIEW AND DISCLAIMER - Program Administrator 's review of the design,
construction, installation, operation or maintenance of the Project or the SG Unit(s) is not a
representation as to their economic or technical feasibility, operational capability, or reliability.
Applicant and Host Customer agree that neither of them will make any such representation to
any third party. Applicant is solely responsible for the economic and technical feasibility,
operational capability, and reliability of the Project and the SG Unit(s).
7.0 TERM AND TERMINATION - The Term of this Contract shall begin on the iast date that a
party signs it, and shall terminate no later than December 31, 2005, unless terminated earlier
pursuant to this contract, or unless extended by order of the CPUC or by written agreement of
the parties.
8.0 ASSIGNMENT- Applicant and Host Customer consent to Program Administrator's
assignment of all of Program Administrator's rights, duties and obligations under this Contract to
the CPUC and/or its designee. Any such assignment shall relieve Program Administrator of all
rights, duties and obligations arising under this Contract. Other than Program Administrator's
assignment to the CPUC or its designee, neither party shall assign its rights or delegate its
duties without the prior written consent of the other party, except in connection with the sale or
merger of a substantial portion of its properties. Any such assignment or delegation without
written consent shall be null and void. Consent to assignment shall not be unreasonably
withheld. Applicant must provide assurance of the success of a Project if assigned by providing
any additional information requested by Program Administrator.
9.0 PERMITS AND LICENSES - Applicant, at its own expense, shall obtain and maintain all
licenses and permits needed to perform its work on the Project.
10. 0 INSURANCE - Applicant and Host Customer shall, at their own expense, maintain the
insurance coverage set forth in Appendix D, or an equivalent amount of self -insured coverage
satisfactory to Program Administrator, and shall submit proof of such insurance to Program
Administrator as part of the Proof of Project Advancement described in Paragraph 3.2 of this
Contract.
11.0 ADVERTISING. MARKETING AND USE OF PROGRAM ADMINISTRATOR'S NAME -
Applicant and Host Customer shall not use Program Administrator's corporate name, trademark,
trade name, logo, identity or any affiliation for any reason, including to solicit customers to
participate in the Project, without prior written consent of Program Administrator. Applicant shall
make no representations to its customers on behalf of Program Administrator.
12.0 INDEPENDENT CONTRACTOR - In assuming and performing the obligations of this
Contract, Applicant is an independent contractor and shall not be eligible for any benefits which
Program Administrator may provide its employees. All persons, if any, hired by Applicant shall
be its employees, subcontractors, or independent contractors and shall not be considered
employees or agents of Program Administrator.
Julv 2.2001 Rev. 0
13.0 RIGHT TO AUDIT AND REPORT INFORMATION - Program Administrator can
periodically audit Applicant 's records related to the work done under this Contract, and can
report the results of its audit to the CPUC or its designee. Applicant must provide all requested
Project documents to Program Administrator upon written request, and must, for 5 years
following Contract termination, maintain copies of all Project documents, including, but not
limited to, Contracts, invoices, purchase orders, reports, and all back-up documents, for
Program Administrator's review.
14.0 INDEMNIFICATION
14.1 Applicant shall indemnify, defend and hold harmless Program Administrator, its affiliates,
subsidiaries, current and future parent company, officers, directors, agents and employees, from
and against all claims, demands, losses, damages, costs, expenses, and liability (legal,
contractual, or otherwise), which arise from or are in any way connected with any: (i) injury to or
death of persons, including but not limited to employees of Program Administrator, Host
Customer, or Applicant; (ii) injury to property or other interests of Program Administrator, Host
Customer, Applicant, or any third party; (iii) violation of local, state or federal common law,
statute, or regulation, including but not limited to environmental laws or regulations; or (iv) strict
liability imposed by any law or regulation; so long as such injury, violation, or strict liability (as
set forth in (i) - (iv) above) arises from or is in any way connected with this Contract or
Applicant's performance of, or failure to perform, this Contract, however caused, regardless of
any strict liability or negligence of Program Administrator whether active or passive, excepting
only such loss, damage, cost, expense, liability, strict liability, or violation of law or regulation
that is caused by the negligence or willful misconduct of Program Administrator, its officers,
managers, or employees.
14.2 Applicant acknowledges that any claims, demands, losses, damages, costs, expenses,
and legal liability that arise out of, result from, or are in any way connected with the release or
spill of any legally designated hazardous material or waste as a result of the work performed
under this Contract are expressly within the scope of this indemnity, and that the costs,
expenses, and legal liability for environmental investigations, monitoring, containment,
abatement, removal, repair, cleanup, restoration, remedial work, penalties, and fines arising
from strict liability, or violation of any local, state, or federal law or regulation, attomey's fees,
disbursements, and other response costs incurred as a result of such releases or spills are
expressly within the scope of this indemnity.
14.3 Applicant shall, on Program Administrator's request, defend any action, claim or suit
asserting a claim which might be covered by this indemnity. Applicant shall pay all costs and
expenses that may be incurred by Program Administrator in enforcing this indemnity, including
reasonable attorney's fees.
15.0 LIMITATION OF LIABILITY - Program Administrator shall not be liable for any incidental
or consequential damages, including, without limitation, loss of profits or commitments to
Subcontractors, and any special, incidental, indirect or consequential damages incurred by
Applicant or by Host Customer.
16.0 VENUE - This Contract shall be interpreted and enforced according to the laws of the
State of Califomia. Sole jurisdiction and venue shall be with the courts in Los Angeles County,
California.
Ju1v 2.2001 Rev. 0
17.0 DISPUTE RESOLUTION - The parties to this Contract shall attempt in good faith to
resolve any dispute arising out of or relating to this Contract promptly by negotiations between a
vice president of Program Administrator or his or her designated representative and an
executive of similar authority from Applicant and/or Host Customer. Either party must give the
other party or parties written notice of any dispute. Within twenty (20) calendar days after
delivery of the notice, the executives shall meet at a mutually acceptable time and place, and
shall attempt to resolve the dispute. If the matter has not been resolved within thirty (30)
calendar days of the first meeting, any party may pursue other remedies, including mediation.
All negotiations and any mediation conducted pursuant to this clause are confidential and shall
be treated as compromise and settlement negotiations, to which Section 1152.5 of the California
Evidence Code shall apply, and Section 1152.5 is incorporated herein by reference.
Notwithstanding the foregoing provisions, a party may seek a preliminary injunction or other
provisional judicial remedy if in its judgment such action is necessary to avoid irreparable
damage or to preserve the status quo. Each party is required to continue to perform its
obligations under this Contract pending final resolution of any dispute arising out of or relating to
this Contract.
18.0 INTEGRATION AND MODIFICATION - This Contract constitutes the entire Contract and
understanding between the Parties as to its subject matter. It supersedes all prior or
contemporaneous contracts, commitments, representations, writings, and discussions between
Applicant, Host Customer, and Program Administrator, whether oral or written, and has been
induced by no representations, statements or Contracts other than those expressed herein.
NO AMENDMENT, MODIFICATION OR CHANGE TO THIS CONTRACT SHALL BE BINDING
OR EFFECTIVE UNLESS EXPRESSLY SET FORTH IN WRITING AND SIGNED BY
PROGRAM ADMINISTRATOR'S REPRESENTATIVE AUTHORIZED TO SIGN THE
CONTRACT.
This Contract is subject to such changes or modifications by the CPUC as it may, from time to
time, direct in the exercise of its jurisdiction Program Administrator.
By execution of this Contract, Applicant certifies the Project meets all Program eligibility
requirements, and that the information supplied in Appendix A is true and correct. Applicant and
Host Customer further certify that Applicant and Host Customer have read and understand the
Self -Generation Incentive Program documents described in Appendix C and agree to abide by
the rules and requirements set forth in this Contract and in Appendices B, C & D.
The undersigned declare under penalty of perjury under the laws of the State of California that
1) the information provided in the attached Self Generation Incentive Program Reservation
Request Form is true and correct to the best of my/our knowledge, 2) the above SG Unit(s)
described in the Self Generation Incentive Program Reservation Request Form are new and
intended to offset part or all of the Host Customer's electrical needs at the site of installation, 3)
the site of installation is located within the Program Administrator's service territory, 4) the SG
Unit(s) are not intended to be used as a backup generator, and 5) the Host Customer has
received a copy of this Contract and the completed Reservation Request Form.
July 2.2001 Rev_ 0
In witness whereof, the parties have executed this Contract as of the latest date below.
PR
By
Title.
Name
Printed:
Date:
ADMIN
Gene E . Rodri
3/19/02
CITY OF REDLANDS
(APPLICAN
By: ��!
Title: Mayor
Name
Printed: Karl N. (Kasey) Haws
Date:
Attest:
h 3, 20
Lorr e Poyzr ity Clerk
All communications under this Contract shall be rwarded y to:
Program Administrator
Self -Generation Incentive Program
Southern California Edison
2131 Walnut Grove Avenue
3rd Floor, B 10
Rosemead, CA 91770
CITY OF REDLANDS
JHOST CUSTOMER]
-2
Title: Mayor
Name
Printed: Karl N. (Kasey) Haws
Date: March 5, 2002
July 2. 2001 Rev. 0
•UUI HI- R\ Cal DQRNLt
EDISON
APPENDIX A
An f.F r.1,4: tiSP_`11a7T? S.cf •� i . l :,n±
SELF -GENERATION INCENTIVE PROGRAM
Reservation Request Form
Application Number.
(leave blank)
Program Administrator
Self -Generation Incentive Program
Southem California Edison
2131 Walnut Grove Avenue
3rd floor, B 10
Rosemead, Ca. 91770
Phone 1-800-736-4777
626-302-8436
Fax: 626-302-6253
1.. Applicant
Company Name:
Tax Payer ID:
Contact Name:
Address:
Phone
E-mail
2. Host Customer
Company Name:
Tax Payer ID:
Contact Name:
Address:
Facility Address
(if different)
Phone:
E-mail:
Electric Utility Account Number
Please attach a copy of a recent electric billing statement Host
Customer must be the customer of record whose name appears
on the electric bill.
3. Program Information
Have you previously applied for funding rebates from a buy down
program or other source for this project? t1 Yes G No
If yes, reservation # andlor source:
4. Host Customer Load
Host Customer Site Annual Peak Demand: kW
Existing Demand Reduction Obligation: kW
(from other intenuptibletcurtailableldemand reduction programs or utility tariffs)
Demand Reduction Program/Tariff:
Net Host Customer Annual Peak Demand kW
5. Generating System Information
M. Fuel Cell (Renewable Fuel) C PV f Wind
El Fuel Cell (Non -Renewable Fuel) C Small/Micro-turbine
El IC Engine Generators I Hybrid*
Manufacturer:
Model Number.
Power Rating*: kW/Unit
Number of Units:
Total System Output kW
(Number of Units x Power Rating*)
'Please check the Hybrid box if more than one type of generator technology is proposed
and include a separate reservation request form for each generation technology.
"Power Rating for PV = PTC x Inverter Efficiency; for Fuel Cells, Miao turbines, IC
Engines =At ISO Condltions for Wind = Max. Point on Manufacturers Power Curve <30
MPH.
6. System Cost
Total Eligible Project Cost $
7. Total lncentive
ELIGIBLE
INCENTIVE PAYMENT: $
Based on lesser of.
$/Watt
Maximum % of Project Cost
Less Other Incentives: $
Source:
SELF -GENERATION
INCENTIVE REQUESTED: $
Payment should be made to: f Applicant fl Host Customer
Note: See instructions in the Self -Generation Incentive Program Handbook for completing this form.
Page 1 of 2
Rev July 24, 2001
SU{j!HI-R\ CAI IHjRNIA
EDISON
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SELF -GENERATION INCENTIVE PROGRAM
Reservation Request Form
Program Administrator
Self -Generation Incentive Program
Southem California Edison
2131 Walnut Grove Avenue
3rd floor, B 10
Rosemead, Ca. 91770
Phone 1-800-736-4777
626-302-8436
Fax: 626-302-6253
APPLICANT & HOST CUSTOMER AGREEMENTS
The undersigned agree that -
A. Applicant and Host Customer agree to release the Program Administrator, its affiliates, subsidiaries, current and future parent company, officers,
managers, directors, agents, and employees from all claims, demands, losses, damages, costs, expenses, and liability (legal, contractual, or otherwise),
which arise from or are in any way connected with any. (1) injury to or death of persons, including but not limited to employees of the Program
Administrator, Host Customer, or Applicant (2) injury to property or other interests of the Program Administrator, Host Customer, Applicant or any third
party, (3) violation of local, state, or federal common law, statute, or regulation, including but not limited to environmental laws or regulations, natural
resources; (4) generation system performance shortfall; so long as such injury, violation, or shortfall (as set forth in (1) - (4) above) arises from or is in
any way connected with the Project, including Applicants performance of or failure to perform the Project, however caused, regardless of any strict
liability or negligence of the Program Administrator, its officers, managers, or employees.
B. Host Customer understands that the Program Administrator has made no warranty or representation regarding the qualifications of the Applicant and
that the Host Customer is solely responsible for the selection of the Applicant to implement the Project Host Customer understands that the Applicant
may be an independent contractor and is not authorized to make any representations on behalf of the Program Administrator.
C. The Host Customer agrees that the Program Administrator will have no role in resolving any disputes between it and the Applicant.
D. The Host Customer has the authority to contract on behalf of the legal owners of the Project Site, for installation of the generating system, or has
obtained the permission of the legal owner of the Project Site to install the generating system under contract with the Applicant
E. Host Customer understands that the Program requires inspections and measurements of the performance of the proposed generating system. Host
Customer shall permit Program Administrator, its employees, contractors, and agents, during normal business hours, to: (a) install all necessary
performance measurement equipment on the System in order to enable Program Administrator to accomplish performance evaluations; and (b)
demonstrate, inspect, monitor, and photograph the System. These data and field measurement documentation are not for purposes of enforcement and
shall not be released to outside parties, except as may be required by the California Public Utilities Commission (CPUC).
F. Host Customer shall use its best efforts to accommodate the scheduling requirements of Program Administrator and its agents for all field
measurements. Host Customer shall agree to allow all information provided as part of the reservation claim process to be entered into a statewide
database that will permit tracking of application for this and other incentive programs. Access to this database will be limited to Program Administrators
and the CEC.
G. The undersigned declare under penalty of perjury under the laws of the State of Califomia that 1) the information provided in this form is true and correct
to the best of my knowledge, 2) the above described generating system is new and intended to offset part or all of the Host Customer's electrical needs
at the site of installation, 3) the site of installation is located within the utility's service territory, 4) the self generating equipment is not intended to be used
as a backup generator, and 5) the Host Customer has received a copy of this completed form.
Applicant
Print Name
Title
Signature Date
Host Customer (if different than Applicant)
Print Name
Title
Signature Date
There are other submittal requirements; if necessary, add a second form. Attach a copy of the proof of utility service and system sizing
calculation. Reservation will not be processed without the required attachments.
RevJury24, 2001
Page 2 of 2
'iUlttHttt\ Cnt o-QuNL.t
EDISON
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APPENDIX B
SELF -GENERATION INCENTIVE PROGRAM
Reservation Confirmation and Incentive Claim Form
Payment will be made to: ❑ Applicant ❑ Host Customer
Reservation Number:
Program Administrator
Self -Generation Incentive Program
Southern Califomia Edison
2131 Walnut Grove Avenue
3rd Floor, B 10
Rosemead, Ca 91770
Phone: 1-800-736-4777
626-302-8426
Fax: 626-302-6253
APPLICANT
Company Name:
Tax Payer ID:
Contact Name:
Address:
Phone
E-mail
HOST CUSTOMER
Company Name:
Tax Payer ID:
Contact Name:
Address:
Phone
E-mail
CONFIRMATION OF INCENTIVE RESERVATION
Reservation Incentive Amount: $
Self -Generation System Size: kW
Facility Address:
Reservation Expiration Date:
The generating system must be placed in service and a copy of this Claim
Form, including all appropriate documentation, must be retumed to the
Program Administrator. Mailed claim forms must be postmarked by, and
faxed Claim Forms will be accepted no later than, the Reservation
Expiration Date. This reservation is nontransferable and the generating
system must be installed on the Facility Site and sold to the Host Customer
listed above and as submitted on the original Reservation Request Form.
INCENTIVE CLAIM
The undersigned declare under penalty of perjury under the laws of the State of California that 1) the information provided in this form is true
and correct to the best of our knowledge, 2) the above described generating system is new and intended to offset part or all of the Host
Customers electrical needs at the site of installation, 3) the site of installation is located within the Utility's service territory and, the self -
generating equipment is not intended as a back-up generator, 4) the Host Customer has received a copy of this completed form, 5) an
electrical generating system meeting the terms and conditions of Self Generation Incentive Program has been installed and is operating
satisfactorily as of the date stated, 6) the rated electrical output of the generating system and the physical location of the system are as stated
above under Self -Generation Incentive Program Reservation, Confirmation and Incentive Claim Form, and 7) except as noted below, there
were no changes in the information regarding the Host Customer's generating system specifications, installation location or price from that
information provided in the Reservation Request Form originally submitted by the undersigned.
Self -Generation System Size:
Total Eligible Project Costs: $
Requested Incentive Amount $
Facility Address (if changed):
kW
Provide a description and reason for any changes, exceptions or
modifications to the information provided in the above Confirmation
of Incentive Reservation or Self -Generation Incentive Program
Reservation Request Form on a separate sheet of paper.
Applicant
Print Name
Tile
Signature Date
Host Customer (if different than Applicant)
Print Name
Tile
Signature Date
Pau .;h!iv ^ i ni
APPENDIX C
SOUTHERN CALIFORNIA
EDISON
An EDISON INTERNAIIONAP°4 Company
SeIfGemeratiori Ir.ce;r.l.LiVe
Program Ha.
ok
COVER SHEET
(FULL DOCUMENT IS AVAILABLE IN
MUNICIPAL UTILITIES)
July 2, 2001
July 2. 2001 Rev 0
APPENDIX D—INSURANCE COVERAGE REQUIREMENTS
Workers' Compensation and Employers' Liability: Worker's Compensation insurance or self-
insurance indicating compliance with any applicable labor codes, acts, laws or statutes, state or
federal, where Applicant performs work. Employers' Liability insurance shall not be Tess than
$1,000,000 for injury or death each accident.
Commercial General Liability: Coverage shall be at least as broad as the Insurance Services
Office (ISO) Commercial General Liability Coverage "occurrence" form, with no coverage
deletions. The limit shall not be less than $1,000,000 each occurrence for bodily injury, property
damage and personal injury. If coverage is subject to a general aggregate limit, this aggregate
limit shall be twice the occurrence limit. Coverage shall:
a) By "Additional Insured" endorsement add as insureds Program Administrator, its
affiliates, subsidiaries, and parent company, and Program Administrator's directors, officers,
agents and employees with respect to liability arising out of or connected with the work
performed by or for the Applicant (ISO Form CG2010 or equivalent is preferred). In the event
the Commercial General Liability policy includes a "blanket endorsement by contract," the
following language added to the certificate of insurance will satisfy this requirement: "Program
Administrator, its affiliates, subsidiaries, and parent company, and Program Administrator 's
directors, officers, agents and employees with respect to liability arising out of the work
performed by or for the Applicant are additional insureds under a blanket endorsement;" and
b) Be endorsed to specify that the Applicant's insurance is primary and that any
insurance or self-insurance maintained by Program Administrator shall not contribute with it.
Business Auto: Coverage shall be at least as broad as the Insurance Services Office (ISO)
Business Auto Coverage form covering Automobile Liability, code 1 "any auto." The limit shall
not be Tess than $1,000,000 each accident for bodily injury and property damage.
Professional Liability Insurance: Errors and Omissions Liability insurance appropriate to the
Applicant 's profession. Coverage shall be for a professional error, act or omission arising out of
the scope of services shown in the Contract. The Limit shall not be less than $1,000,000 for
each claim. If coverage is subject to an aggregate, this aggregate limit shall be twice the claim
limit.
Additional Insurance Provisions: As part of proof of project advancement documentation,
Applicant shall fumish Program Administrator with certificates of insurance and endorsements of
all required insurance for Applicant. The documentation shall state that coverage shall not be
canceled except after thirty (30) days prior written notice has been given to Program
Administrator. The documentation must be signed by a person authorized by that insurer to
bind coverage on its behalf and shall be submitted to this address:
PROGRAM ADMINISTRATOR'S INSURANCE DEPARTMENT
A copy of all such insurance documents shall be sent to Program Administrator's
Contract negotiator and Project Administrator. Program Administrator may inspect the original
policies or require complete certified copies at any time. Upon request, Applicant shall furnish
Program Administrator the same evidence of insurance for its Subcontractors, as Program
Administrator requires of Applicant.
July 2.2001 Rev. 0