Electric Power Authorization Form

ELECTRIC POWER AUTHORIZATION FORM

WHEREAS

WHEREAS, Client Name: (the "Client") requires electric power services and authorizations at the Service Premises described below; and

WHEREAS, Service Provider Name: (the "Service Provider") is engaged in the business of providing electric power activation, temporary power installations, meter work, and related services and agrees to perform such services under the terms of this Agreement.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows.

PARTY INFORMATION

Individual Corporation LLC Other:

SERVICE PREMISES & CONTACTS

Account Number:    Meter Number:

Contact Phone:    Contact Email:

AUTHORIZATION

The Client hereby authorizes the Service Provider to perform the following at the Service Address (select all applicable):

Energize / Activate Service De-energize / Disconnect Install Temporary Power Perform Meter/Connection Work

Client certifies that all equipment to be energized is installed in accordance with applicable electrical codes and that the Service Provider may access the meter, service entrance, and electrical room as necessary to complete the authorized work. Client acknowledges that it is responsible for code compliance of the Client-owned electrical distribution beyond the point of attachment and for obtaining any required permits unless otherwise agreed in writing.

SCOPE OF WORK

PAYMENT TERMS

Total Fee: $ .

Late Fee: on unpaid balances. Client agrees to reimburse Service Provider for reasonable collection costs, including attorneys' fees, if payment is not made when due.

TERM AND TERMINATION

Term Start Date: . Term End Date: .

Either party may terminate this Agreement for convenience upon written notice to the other party delivered at least days prior to the proposed termination date. Notwithstanding the foregoing, either party may terminate immediately for material breach if the breaching party fails to cure within a commercially reasonable period following written notice.

CONFIDENTIALITY

Each party shall hold in confidence all non-public information disclosed by the other party that is designated confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure ("Confidential Information"). Confidential Information does not include information that (a) is or becomes publicly available through no fault of the receiving party; (b) is lawfully obtained from a third party without breach of any obligation of confidentiality; or (c) is independently developed without use of the disclosing party's Confidential Information. Receiving party shall use Confidential Information solely to perform its obligations under this Agreement and shall disclose it only to employees and contractors who have a need to know and who are bound by confidentiality obligations at least as protective as those set forth herein.

INSURANCE, INDEMNITY & LIABILITY

Service Provider shall maintain commercial general liability and workers' compensation insurance in amounts sufficient for the work performed. To the fullest extent permitted by law, Client shall indemnify, defend and hold harmless Service Provider and its contractors from and against claims, losses, liabilities and expenses (including reasonable attorneys' fees) arising from Client's negligence, willful misconduct, or breach of this Agreement, except to the extent such claims are caused by Service Provider's gross negligence or willful misconduct.

SAFETY, PERMITS AND COMPLIANCE

Service Provider will comply with applicable safety regulations and industry standards. Client is responsible for obtaining any permits or approvals required at the Service Premises unless otherwise agreed in writing. Client authorizes Service Provider to notify authorities if hazards or unsafe conditions are discovered.

GOVERNING LAW; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict-of-law principles. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals and communications, whether written or oral. Any modification must be in writing and signed by both parties.

GENERAL NOTICES

Notices required or permitted under this Agreement shall be in writing and delivered to the addresses listed above, or to such other address as a party may designate by notice in accordance with this section.

ACKNOWLEDGMENT

By signing below, the undersigned represent and warrant that they are authorized to execute this Agreement on behalf of the party for whom they sign, that they have read and understood all terms and conditions contained herein, and that they accept those terms on behalf of their organization.

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