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14-025 PG&E service agreement for 22221 McClellan Rd, McClellan Ranch CUSTOMER'S COPY ( KEEP FOR YOUR RECORDS) March 6, 2014 David Brandt City of Cupertino, A GOVERNMENT AGENCY 10300 Torre Avenue CUPERTINO CA 95014 RE: Contract ID: 1166992: MRE Dear David Brandt Enclosed are gas and/or electric agreements for your project located at: 22221 MCCLELLAN.RD, CUPERTINO, 95014 This letter summarizes the agreements for this project. Non-Refundable Refundable 50% Discount Payment Option* Option* Electric"Distribution arid`8erii69,Extension $5 275.25 , $6',393.27 ° $3;')96.64 Less credit(Engineering Advance,etc_.) $2,500.001 : $0:001 $0.0,01 TOTAL** $2,775.25 $6,393.27 $3,196.64 TOTAL PAYMENT DUE $9,168.52 OR $5,971.88 *Only applies to Rule 15 Refundable Amounts. Amount shown is less credit for associated Applicant work. **The Income Tax Component of Contribution(ITCC)is included in the above charges when applicable. Please sign both copies of the agreement and return one copy of the agreement to the address below along with your payment and retain one copy for your records. If the agreement is not returned to PG&E within 90 days of the date of this letter, the proposed agreement is canceled and PG&E may need to re-estimate the job. Changes to the agreement, either to any of the terms or to the amount owing, are not permitted, and any change or interlineations voids the agreement. The payment of any amount less than the full amount shown will be deposited by PG&E, but PG&E will not begin any work on this contract until the amount is paid in full. The contract shall be deemed effective the date a fully executed copy is received by PG&E. Please allow 45 days from PG&E's receipt of the Agreement for construction to commence. PG&E is committed to providing timely and efficient service and we look forward to continuing to work with you on this and future projects. Should you have any questions regarding these contracts, please contact your project manager Serina Oliver at 408- 725-2146 or SRPD @pge.com. Please send the executed Agreements and payment to: PG&E CFM/PPC DEPARTMENT PO BOX 997340 Sacramento, CA 95899-7340 Sincerely, Er\r E.Straub Erin E. Straub Service Planning Supervisor Ref:Contract ID: 1166992:22221 MCCLELLAN RD,CUPERTINO,95014 1106959660E! Dear David Brandt, In response to your application for service, enclosed is the new CPUC-required form, "Statement of Applicant's Contract Anticipated Costs," (SACAC) which identifies PG&I='s cost for the refundable work that is PG&E's responsibility to install as part your job. However, this is work that you can elect to provide under the competitive bidding provisions of Gas/Electric Rules 15 and 16. You can perform this work yourself, hire a contractor, or hire PG&E to do this work. Regardless of whom you choose to do the work, you must complete and return this form. e If you elect to perform this work or have a contractor do it, please enter your costs in the section of the form entitled "Applicant Costs." If you elect to perform this work yourself or have a contractor do it and choose not to provide your costs, please so indicate in the section entitled "Applicant's Election Not To Provide Costs," date, sign and return the form. If you want PG&E to perform the work, check the section "Applicant's Election Not To Provide Costs," date, sign and return the form. PG&E's costs are valid for 90 days from 03/06/2014 PG&E cannot proceed with any work on your application until you sign and return the SACAC form. Please return this document with any other contract documents regarding this job to: PG&E CFM/PPC DEPARTMENT PO BOX 997340 Sacramento, CA 95899-7340 If you have any questions regarding this form please contact your project manager. 106959660E o STATEMENT OF APPLICANT'.5 CONTRACT ANTICIPATED COS1FS.* 6 Project Name: MRE Project Location: 22221 MCCLELLAN RD, CUPERTINO, 95014 Notification Number: 106959660 PM Number(s): (Gas) (Electric) 31021270 APPLICANT COSTS The following statement must only include the contracted anticipated installed costs of facilities installed by the Applicant that are refundable and that are PG&E's responsibility under its tariffs. The costs provided by the Applicant must be taken from the Applicant's contract with its contractor. If the Applicant will be performing the work: itself, the Applicant must also complete and sign this form. The Applicant's statement of costs will be compared with PG&E's estimated installed costs of the same facilities, the lower of which will be used to determine the amount subject to allowances and refunds in accordance with the provisions of PG&E's Gas and Electric Rules 15 and 16. If the Applicant chooses not to provide its costs, it must complete the last section of this form. Until the Applicant either provides the refundable; cost from its contract with its contractor(or its own cost, if applicable), or returns this form indicating that it will not do so, PG&E will not proceed with any work on the Applicant's project. GAS ELECTRIC Residential Service Facilities: Residential Service Facilities: Applicant: $ Applicant: $ PG&E: $0.00 PG&E: $0.00 Number of gas service: 0 Stubs: 0 Number of Electric service: 0 • Applicant's statement of costs include: overhead or underground service conductors, poles, service transformers, connection fittings, service pipe, valves, service connections, and other PG&E-owned service equipment, as detailed in Gas and Electric Rule 16. • Applicant's statement of costs DOES NOT include: inspection fees, nonresidential service costs, regulators, or PG&E-owned metering equipment. Form 79-1003 Tariffs and Compliance Page 1 of 2 Advice 2458-G-C123794 .106959660E Decision 03-03-032 * Automated document, Preliminary Statement, Part A Effective: July 1, 2004 GAS ELECTRIC Gas Distribution Facilities Electric Distribution Facilities and Non-Residential Service Services: and Non-Residential Service Services: Applicant: $ Applicant: $ PG&E: $0.00 PG&E: $6,167.52 GAS DISTRIBUTION TRENCH Applicant: $ PG&E: $0.00 • Applicant's statement of costs include: cables, switches, transformers, distribution main, valves, regulators, nonresidential service costs, and other distribution facilities required to complete the distribution line extension; as detailed in Gas and Electric Rule 15 as PG&E's responsibility. • Applicant's statement of costs DOES NOT include- inspection fees, tie-in of system by PG&E, distribution substructures, electric trench, conduits, feeder conduits, or protective structures, as detailed in Gas and Electric Rule 15. 1 declare under penalty of perjury that the foregoing is true and correct. APPLICANT'S ELECTION NOT TO PROVIDE COSTS: (if this option selected, box must be checked) I choose not to provide to the utility my refundable costs for this project as taken from my contract with my contractor, or as performed by myself, and acknowledge that PG&E will use its estimate of the refundable costs for this project in the contract between it and me. Executed on - ( ! // M/- at CUPERTINO, CA (Date) - (city) By: Print Applicant Na e: avid Brandt Signed: C �� Title: �' n Form 79-1003 Tariffs and Compliance -- Page 2 of 2 Advice 2458-G-CI2379-E -106959660E Decision 03-03-032 Automated document, Preliminary Statement, Part A Effective: July 1, 2004 DISTRIBUTION: REFERENCES: PACific` gas and Applicant(copy) Notification# 106959660 Division (copy) Contract# 1166992 ldctf c Company'' CFM (Original) t T&CS E-PM# 31021270 G-PM# DISTRIBUTION SERVICE AND EXTENSION_ AGREEMEN"f Prior MLX E IG 1974 DECLARATIONS 1 Customer # 1040905 Submitted to App\\cartby•. SER\N A O\_\V ER Date of issuance'. January 2, 2014 1. City of Cupertino (Applicant), has requested PACIFIC GAS & ELECTRIC COMPANY, a California corporation (PG&E), to deliver Electric energy to the property situated at:22221 MCCLELLAN RD, CUPERTINO, 95014 and shown on the attached drawings. 2. Applicable Documents. The cost summary for the facilities to b0 installed is attached hereto as Exhibit A. These facilities shall be installed in accordance with the applicablO rules on file with the California Public Utilities Commission (which may include Gas and Electric Rules 2, 13, 15; 16, and 20), as well as the requirements set forth in the Provisions and the General Terms and Conditions for Gas and Electric Service by Applicant. 3. Construction Options. The responsibility for providing line extension work is divided between PG&E and the Applicant. However, Applicant may choose to have a qualified contractor perform some of the work that is PG&E's responsibility, and may choose to have PG&E perform some or all of the work that is the Applicant's responsibility. PG&E will reimburse or collect money based on its estimate of the costs, subject to the applicable rules. Based on Applicant's request, the contract costs are based on the following construction options: To Be Performed By PG&E Responsibility PG&E Applicant Main Trench 0 0 Gas Main Pipe Installation 0 Service Pipe.Installation 0 0 Distribution Wire and Electric Equipment Installation 0 Service Wire Installation 0 2 To Be Performed By Applicant Responsibility PG&E Applicant Gas Service Trench 0 Distribution Trench 0 0 Electric Service Trench Distribution Substructure Installation Service Substructure Installation 0 0 1.PG&E's responsibilities per Rule 15.b.1.b and Rule 16.D.2 2.Applicant's responsibilities per Rule 15.b.1:a and Rule 16.D:1 Page 1 of 2 Form 62-0980 106959660E Advice No. 2687-G12754-E 1 Automated document, Preliminary Statement, Part ARevised December 2005 4. N/A Refund/Discount Option Selection Applicant, in accordance with PG&E's extension rules, must select one of the following options for each commodity you are requesting service (gas and/or electric). Once the sE!lection has been made, it cannot be changed. Gas Electric 10-Year Subject to Refund Option 10-Year Subject to Refund Option -or -or 0 Non-Refundable 50% Discount Option Non-Refundable 50% Discount Option ACCEPTED: APPLICANT; City of Cupertino By: / (Authorized Signature) David Brandt /� (Type or Print Name) TITLE: C y, , DATE: •�L MAILING ADDRESS: 10300 Torre Avenue CUPERTINO, CA 95014 PACIFIC GAS AND ELECTRIC COMPANY: By: Erlr\E.S�raub (Authorized-Signature) Erin E. Straub (Type or Print Name) TITLE: Service Planning Supervisor DIVISION: De Anza DATE: Page 2 of 2 Form 62-0980 106959660E Advice No. 2687-GI2754-E Revised December 2005 " Pacific Gas and Electric Company ��lDISTRIBUTION AND SERVICE EXTENSION AGREEMENT EXHIBIT A-COST SUMMARY REFERENCES: Notification# 106959660 Contract# 1166992 E-PM# 31021270 G-PM# Applicant: City of Cupertino Project Location/Name: 22221 MCCLELLAN RD, CUPERTINO, 95014 SUMMARY OF: PAYMENTS The total cash payment you need to make depends upon your selection of the 10 Year Refundable Advance Option or the Non-Refundable Discount Option for your gas and/or electric extension under Rule 15. Since you may elect one option for the gas extension and a different option for the electric extension, several different cash payments are available. Each payment option is summarized below. These payments include all billing under this Agreement including payments subject to refund, and non-refundable payments. To determine what is refundable or non-refundable, or to see full detailed billing information, please see the attached cost summaries. Even if you have no payment due for your gas and/or electric extension (Rule 15), you must still elect the 10 Year Refundable or Non-Refundable Discount Option for each extension on the second page of the Declarations. 10 Year Refundable Advance Option -Gas & Electric(1) $11,668.52 (2) --OR Non-Refundable Discount Option -Gas & Electric (1) $8,471.88 3 --OR 10 Year Refundable Advance Option -Gas/ (1) (2) Non-Refundable Discount Option -Electric $8,471.88 --OR 10 Year Refundable Advance Option -Electric/ (1) (2) Non-Refundable Discount Option -Gas $11,668.52 (1) Amounts shown do not include reimbursements for facilities that are normally the responsibility of PG&E per our tariffs. See the Reimbursement Summary for a total of all Reimbursements to be paid upon acceptance of facilities. (2) The payment amount shown on this line includes both refundable payments under Rule 15 for the gas and/or electric extension,plus other non-refundable payments. The total payment is not subject to refund. Please see the attached detailed Cost Summaries to determine the portion of this payment that may be subject to refund. (3) The payment amount shown on this line includes only non-refundable payments under Rule 15 for the gas and/or electric extension,plus other non-refundable payments. None of the payment shown is subject to refund. Page 1 of 1 62-4527 (Rev 1/91) Service Planning 9069596BQE Advice No. 1633-G/1342-E Automated document, Preliminary Statement, Part A Effective 4/02/91 Pacific Gas and Electric Company REFERENCES: DISTRIBUTION AND SERVICE EXTENSION AGREEMENT Notification# EXHIBIT A -COST SUMMARY* 106959660 I, . Contract# 1166992 PM# 31021270 MLX # ApplicantCity of Cupertino Project LocationlNama2221 MCCLELLAN RD, CUPERTINO 95014 ELECTRIC DISTRIBUTION LINE AND SERVICE EXTENSION COST SUMMARY Cost of Ownership charges as described in the rules and in the Unsupported Extension Cost section of the Provisions Agreemer Apply Total number of residential lots/units for this project: Total number of non-residential lots/units for this project: 1 Ca\cu\aC�ons io determ\ne be app\\ed to 6\str\buC1on\\ne cefundab\e amount on a pev \otlun\t bass. Cost of Services:(5) Engineering &Administrative Costs $0.00 Value of Applicant Design Work N $0.00 Service Tie-In Cost(Energized) by PG&E N $0.00 Electric Metering N $0.00- Others (N/A) N $0.00 Inspection Fees N $0.00(4) Service Cost- PG&E installed #Services 0 N $0.00 Service Cost-Applicant installed #Services 0 N $0.00(5) Total Estimated Cost of Service Subject to Allowance (_) $0.00 Cost of Service Within Allowance: less Total Residential Service Allowance $1,918.00 x 0 = (-) $0.000) Excess Service Cost N $0.00 Estimated Service Cost Within Allowance (Total less Excess) (_) $0.00 Average Cost per Lot or Unit Within Allowance $0.00 / 0 = $0.00 Excess Service Allowance Applied to Distribution Line Extension Refundable Amount per Lot or Unit` $1,918.00 - $0.00 = $0.00** Allowance Ave.Cost/Unit Form 79-1004 Tariffs and Compliance Advice 2552-G-B/2517-E-B 106959660E Page 1 of 4 Decision 04-05-055 * Automated document, Preliminary Statement, Part A Effective: July 26, 2004 Allowances Residential: $1,918.00 x 0 (_) $0.00 Allowance Lots/Units plus ITCC @ 34% Residential Allowances (+) $0.00 SUB TOTAL Residential Allowance $0.00 Non-Residential: $1,359.00 / 0.1680 (_) $8,089.29 Net Annual Revenue Cost-of-Service-Factor plus ITCC @ 34% Non-Residential Allowances N $2,750.36 SUB TOTAL Non-Residential Allowances (_) $10,839.64 less Residential Service Allowance: ( 0 x $0.00 )+ _34% _ $0.00 Lots/Units Ave.Cost/Unit ITCC Total Distribution Line Extension Allowance $10,839.64 Amount Subject to Refund Engineering &Administrative Costs $3,988.51 Value of Applicant Design Work (+) $0.00 Tie-In of Distribution Line Extension by PG&E (+) $1,264.96 Electric Metering (Non-Residential Projects) (+) $1,439.39 Other Taxable Charges: N/A (+) $0.00 PG&E installed - Cost of Distribution Line and Non-Res Svcs. (+) $6,167.52 Applicant installed - Cost of Distribution Line and Non-Res Svcs. (+) $0.00(1) Value of Distribution Substructures (+) $0.00 Inspection Fees (+) $0.00(') SUB TOTAL (_) $12,860.39 plus ITCC @ 34% (+) $4,372.53 Total Refundable Amount (_) $17,232.92 Less Total Allowances (not to exceed Total Refundable Amount) (-) $10,839.64 Balancer Net Refundable Amount (_) $6,393.27 10 Year Refundable Advance Option Balance: Net Refundable Amount $6,393.27 Less Credit for Value of Applicant Design Work (-) $0.00 Less Cost of Dist. Line Ext. and Non-Res Svcs. installed by Applicant (-) $0.00 Less Distribution Substructures by Applicant (-) $0.00 Net 10 Year Refundable Advance Option Payment $6,393.27(2) f=) Non-Refundable Discount Option Balance: Net Refundable Amount $6,393.27 less Discount $6,393.27 x 0.50 = (-) $3,196.64 Balance Discount Rate Less Credit for Value of Applicant Design Work (-) $0.00 Less Cost of Dist. Line Ext. and Non-Res Svcs. installed by Applicant (-) $0.00(5) Less Distribution Substructures by Applicant (-) $0.00 Net Non-Refundable Discount Option Payment $3,196.64(2) Form 79-1004 Tariffs and Compliance 1069596BOE Page 2 of 4 Advice 2552-G-B/2517-E-B Decision 04-05-055 * Automated document, Preliminary Statement, Part A Effective: July 26, 2004 'Non-Refundable Payments Rule 16 Non-Refundable Payments Excess Service Costs $0.00 Service Costs Beyond Preferred Service Location N $0.00 Service Riser N $1,728.22 Value of Rule 16 Land Rights Costs N $0.00 Value of Service Trench, Conduits & Substructures in the N $6,131.47 Franchise Area or on 3rd Party Property Inspection Fees N $540.84 Rule 16 Trench Permits Obtained by PG&E N $0.00 Other Taxable Charges: N/A N $0.00 Cost of Additional Rule 16 Applicant Design Plan Checks N $0.00 SUB TOTAL (_) $8,400.54 Plus ITCC @ 34% + O $2,856.18 Other Non-taxable Charges: N/A N $0.00 D.04-05-055 Line Extension Costs- Residential N $0.00 D.04-05-055 Line Extension Costs- Non-Residential N $150.00 Inspection Fees (not subject to ITCC) N $0.00 Plus Service Trench, Conduits, & Substructures installed by N $0.00 PG&E on Private Property Less Excess Service Facilities Installed by Applicant (-) $0.00 Less Service Costs Beyond Preferred Location by Applicant (-) $0.00 Less Service Riser Installed by Applicant (-) $0.00 Less Service Trench, Conduits, & Substructures in the (-) $6,131.47 Franchise Area &3rd Party Property installed by Applicant Less Rule 16 Applicant Design Work Associated with Excess (-) $0.00 Total Rule 16 Non-Refundable Payment N $5,275.25 Rule 15 Non-Refundable Payments Inspection Fees $0.00 Re-engineering/Composite Fees N $0.00 Cost of Additional Applicant Design Plan Checks N $0.00 Value of Distribution Conduits N $0.00 Distribution Risers Installed by PG&E N $0.00 Value of Distribution Trench N $0.00 PG&E Land Rights Costs N $0.00 Rule 15 Trench Permits Obtained by PG&E N $0.00 N/A N $0.00 SUB TOTAL (_) $0.00 Plus ITCC @ 34% N $0.00 Less Distribution Conduits Installed by Applicant (-) $0.00 Less Distribution Trench Provided by Applicant (-) $0.00 Total Non-Refundable Electric Rule 15 Payment (_) $0.00 Relocation/Rearrangement of PG&E Facilities Value of Relocation/Rearrangement Facilities $0.00 Value of Relocation/Rearrangement Conduits & Substructures N $0.00 Value of Relocation/Rearrangement Trench & Excavation N $0.00 Engineering &Administrative Costs N $0.00 Form 79-1004 Tariffs and Compliance Advice 2552-G-B/2517-E-B 106959660E Page 3 of 4 Decision 04-05-055 * Automated document, Preliminary Statement, Part A Effective: July 26, 2004 Value of Relocation Applicant Design Work (+) $0.00 Cost of Additional Applicant Design Plan Checks (+) $0.00 Tie-In of Relocation/Rearrangement by PG&E (+) $0.00 Relocation/Rearrangement Trench Permits Obtained by PG&E: (+) $0.00 Relocation/Rearrangement Land Rights (+) $0.00 Relocation/Rearrangement Inspection Fees (+) $0.00 SUB TOTAL (_) $0.00 Plus ITCC @ 34% + O $0.00 Plus Relocation/Rearrangement- Non Taxable (+) $0.00 Less Relocation/Rearrangement Facilities Installed by Applicant (-) $0.00 Less Conduits & Substructures Installed by Applicant (-) $0.00 Less Trench & Excavation Provided by Applicant H $0.00 Less Value of Relocation Applicant Design Work (-) $0.00 Less Relocation/Rearrangement Salvage (-) $0.00 Total Relocation/Rearrangement of PG&E Facilities Payment (_) $0.00 Total Payment for Electric Distribution Line and Service Extension Cash Payment- 10-Year Refundable Advance Option Rule 15 Refundable Advance Payment $6!393.27(3) Rule 16 Non-Refundable Payment (+) $5,275.25 Rule 15 Non-Refundable Payment (+) $0.00 Relocation/Rearrangement of PG&E Facilities Payment (+) $0.00 Total (_) $11,668.52 --OR-- Cash Payment-Non-Refundable Discount Option Rule 15 Non-Refundable Discount Option Payment $3,196.64(3) Rule 16 Non-Refundable Payment(Not Subject to Discount) (+) $5,275.25 Rule 15 Non-Refundable Payment(Not Subject to Discount) (+) $0.00 Relocation/Rearrangement of PG&E Facilities Payment (+) $0.00 Total (_) $8,471.88 Value of Electric Facility Reinforcements by PG&E: $0.00 based upon Applicant's estimated demand of 0.00 kVa (Reference: Payment Adjustments. Excess Facilities section of the Provisions) (1)Total Service Allowance not to exceed the Cost of Service (2)10 Year Refundable and Discount Option credit amounts will be paid upon acceptance of facilities. Credit amounts are subject to future deficiency billing in accordance with the tariff. (3)10 Year Refundable and Discount Option credit amounts do not offset Other Non-Refundable or Relocation Fees. See Reimbursement Summary for a total of Reimbursements and Credits to be paid upon acceptance of facilities. (4)Inspection Fees(Only Refundable if Applicant's Actual Cost is Used. Applicant's Actual Cost+Inspection Cannot Exceed PG&E's Estimate) (5)The lower of PG&E's estimated costs or the Applicant's Contract Anticipated Costs(as documented on Form 79-1003 "Statement of Contract Anticipated Costs")will be used to establish the cost of Service and Distribution Line Extension subject to Allowance ** PG&E USE ONLY Excess service allowance applied to distribution refundable amount per lot/unit $0.00 + $0.00 (_) $0.00 Allowance 34% ITCC Refund per Residential Lot/Unit Form 79-1004 Tariffs and Compliance Advice 2552-G-B/2517-E-B 106959660E Page 4 of 4 Decision 04-05-055 * Automated document, Preliminary Statement, Part A Effective: July 26, 2004 REFERENCES: Pacific Gas and Electric Company Notification# 106959660 DISTRIBUTION AND SERVICE EXTENSION AGREEMENT Contract# 1166992 j EXHIBIT A -COST SUMMARY E15-PM# 31021270 E16R-PM# 31021270 E2013-PM# E20C-PM# G15-PM# G16R-PM# Applicant: City of Cupertino Project Location/Name: 22221 MCCLELLAN RD, CUPERTINO 95014 REIMBURSEMENT SUMMARY Reimbursements are provided for facilities that are installed by the Applicant which are normally the responsibility of PG&E per our tariffs. Reimbursements will be made after the facilities are accepted by PG&E, operational and ready to supply service. Reimbursable payments made for services will bet reimbursed at the average rate shown as each service is connected. All reimbursements will be based upon PG&E's estimated costs. t� Electric Rule 15 10 Year Refundable AdvancCredit Amount - or - Non-Refundable Discount Option Credit Amount -$0 ,1) .00 Joint Pole Credits (+) $0.00 PG&E Betterments - - SUB TOTAL: w/ 10 Year Refundable Advance Credit Amount (_) $0.00 -or- w/Non-Refundable Discount Credit Amount (_) $0.00 Electric Rule 16 Joint Pole Credits $0.00 Applicant Design Work within the Allowance (+) $0.00 SUB TOTAL: ------ _-=__=— - (_) $0.00 Reimbursements per Service Completion -Electric Energized System $0.00 /service (2) Non-energized System $0.00 /service (z) Electric Rule 20B Joint Pole Credits $0.00 Rule 20B Payment Credit (+) $0.00 SUB TOTAL: (_) $0.00 Electric Rule 20C Joint Pole Credits $0.00 Rule 20C Payment Credit (+) $0.00 SUB TOTAL: (_) $0.00 r Page 1 of 2 Form 79-1004 106959660E Compliance Advice 2458 G C/23 9 C Decision 03-03-032 * Automated document, Preliminary Statement, Part A Effective: July 1, 2004 Streetlights LS-1 Standard Luminaries $0.00 Standard Poles &Arms N $0.00 Protective Tubes M $0.00 Internal Wiring N $0.00 Overhead Conductor N $0.00 Underground Conductor N $0.00 Connections N $0.00 LS-2 Connections H $0.00 SUB TOTAL: (_) $0.00 Gas Rule 15 10 Year Refundable Advance Credit Amount $0.00(1) - or - Non-Refundable Discount Option Credit Amount $0.00 PG&E Betterments N $0.00 SUB TOTAL: w/ 10 Year Refundable Advance Credit Amount (_) $0.00 -or- w/Non-Refundable Discount Credit Amount (_) $0.00 Gas Rule 16 Stub Services $0.00 Applicant Design Work within the Allowance (+) $0.00 SUB TOTAL: (_) $0.00 Reimbursements per Service Completion -Gas Pressurized System $0.00 /service(2) Non-Pressurized System $0.00 /service(2) Total Reimbursement 10 Year Refundable Advance Option -Gas &Electric $0.0013) --OR Non-Refundable Discount Option -Gas & Electric $0.00(3) --OR 10 Year Refundable Advance Option -Gas/ Non-Refundable Discount Option - Electric $0.003) --OR 10 Year Refundable Advance Option - Electric/Non-Refundable Discount Option -Gas $0.003) (1) 10 Year Refundable and Discount Option credit amounts will be paid upon acceptance of facilities. Credit amounts are subject to future deficiency billing in accordance with the tariff. (2) This Reimbursement will be paid on a per service basis as each service is completed. (3) Excludes service completion reimbursements made under Rule 16. Service completion reimbursements will be made as each service is connected,on a per service basis. PagE, 2 of 2 Form 79-1004 Tariffs and Compliance 906959660E Advice 2DeciGon 03-03-032 * Automated document., Preliminary Statement, Part A Effective: July 1, 2004