Gas Budget Support Form

GAS BUDGET SUPPORT FORM

RECITALS

WHEREAS, Funding Agency Name: (the "Provider") has established funds and programs to support eligible gas budget needs; and

WHEREAS, Applicant Name: (the "Applicant") seeks financial support for gas-related budget items identified in this form; and

WHEREAS, the parties desire to set forth the scope, payment terms, reporting obligations and legal terms governing the provision of such support.

APPLICANT INFORMATION

SCOPE OF WORK

The Provider agrees to provide budget support to the Applicant for gas-related expenses described below. The Applicant shall expend funds solely for the purposes described and in accordance with this form and any attachments.

BUDGET SUMMARY

Provide an itemized budget for gas support. Amounts payable are subject to verification and documentation requirements described in this form.

PAYMENT TERMS

Provider will disburse funds to Applicant according to the schedule and conditions set forth below. All amounts are payable in lawful currency and subject to verification of expenditures and satisfactory supporting documentation.

Late Payment Fee: If any undisputed payment due to Applicant by Provider is not paid within days after the due date, a late fee of per month (or the maximum permitted by law, if lower) will accrue on the overdue balance.

TERM AND TERMINATION

This support commences on and terminates on unless earlier terminated in accordance with this section.

Either party may terminate this agreement for convenience upon written notice to the other party not less than days prior to the effective termination date. Termination for material breach may be immediate upon written notice if the breaching party fails to cure within any cure period expressly stated in this form.

REPORTING AND RECORDS

Applicant shall maintain complete and accurate records substantiating expenditures and program activities funded by Provider. Applicant shall submit interim and final reports in the form and frequency set by the Payment Schedule and shall permit Provider, or its designee, reasonable access to records for audit and review for a period of not less than three (3) years following final payment.

CONFIDENTIALITY

The parties acknowledge that confidential information disclosed in connection with this support shall be used only for the purposes of performing obligations hereunder. Each party agrees to protect Confidential Information of the other using at least the same degree of care it uses to protect its own confidential information, but no less than a reasonable standard. Confidential Information does not include information that: (a) is or becomes publicly known through no breach of this form; (b) is rightfully received from a third party without duty of confidentiality; or (c) is independently developed without use of the other party's Confidential Information.

GOVERNING LAW; DISPUTE RESOLUTION

This form and any dispute arising out of or relating to it shall be governed by the laws of the state of without regard to conflict-of-law principles. The parties shall attempt to resolve disputes in good faith, including informal negotiations between executive representatives, before initiating litigation.

REPRESENTATIONS; WARRANTIES; INDEMNITY

Each party represents that it has authority to enter into this form and that the information provided is true, complete and accurate. Applicant agrees to indemnify and hold harmless Provider from and against any claims, liabilities or losses arising from Applicant's misuse of funds, negligence or breach of this form, except to the extent such claims result from Provider's gross negligence or willful misconduct.

ENTIRE AGREEMENT

This form, together with any attachments, exhibits and written amendments signed by both parties, constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior and contemporaneous communications, proposals and understandings, whether oral or written.

ADDITIONAL INFORMATION

ENTITY TYPE

Identify Applicant entity type (select all that apply):

Nonprofit    Municipality    Private Company    Other (specify below)

CERTIFICATION

By signing below, the Applicant certifies that the information contained in this form and attachments is true and accurate, that funds will be used for the purposes described, and that Applicant will comply with the terms, reporting requirements and records retention provisions set forth herein. Applicant further acknowledges that any material misrepresentation may result in recovery of funds and other remedies available to Provider.

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