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CM Marin Energy Watch PartnershipPG&E ENERGY WATCH Marin Energy Watch Partnership AUTHORIZATION TO RECEIVE CUSTOMER INFORMATION OR ACT ON A CUSTOMER'S BEHALF SUBMITTED TO THE FOLLOWING Please check all that apply: PG&E _X__ SCE SoCalGas SDG&E THIS IS A LEGALLY BINDING CONTRACT READ IT CAREFULLY (Please Print or Type) I, _______ __,J'"'"im'"'-'-'S=--c=h-'-'u""'tz=------------------C-=-=-=ity-'--'-'M=a=n=a=gi.::e..:..r _______ _ NAME TITLE (IF APPLICABLE)] of __ __,C"'"itya.,......ao=f--'S=-=a=n..:..R'""a=f=a=e..:..I ________________________ (Customer) have the following NAME OF CUSTOMER OF RECORD 1400 Fifth Avenue San Rafael CA MAILING ADDRESS CITY STATE and do hereby appoint Dana Armanino, Marin Co. Community Development Agency NAME OF THIRD PARTY 94901 ZIP of __ C_o_u_n"""ty~o..:..f"""M~a"""'ri"""'n .... 1 ..:..35..:..0'-1"""C""'--'-'iv--ic_C __ e ___ n ..... te~r ..... D_r ____ • ._, S""'"a=n"'""""R""'"a"'"fa=ec..al---C __ A .......... 9 __ 4""'"90""'"3"--_______________ _ MAILING ADDRESS CITY STATE ZIP to act as my agent and consultant (Agent) for the listed account(s) and in the categories indicated below: ACCOUNTS INCLUDED IN THIS AUTHORIZATION: 1. To be submitted electronically SERVICE ADDRESS CITY SERVICE ACCOUNT NUMBER 2 . ----------------------------SERVICE ADDRESS CITY SERVICE ACCOUNT NUMBER 3. --------------------------------SERVICE ADDRESS CITY SERVICE ACCOUNT NUMBER (For more than three accounts, please list additional accounts on a separate sheet and attach ii to this form) INFORMATION, ACTS AND FUNCTIONS AUTHORIZED: This authorization provides authority to the Agent. The Agent must thereafter provide specific written instructions/requests (e-mail is acceptable) about the particular account(s) before any information is released or action is taken. In certain instances, the requested act or function may result in cost to you, ·the customer. Requests for information may be limited to the most recent 12 month period. I (Customer) authorize my Agent to act on my behalf to perform the following specific acts and functions (initial all applicable boxes): X X 1. Request and receive billing records, billing history and all meter usage data used for bill calculation for all of my account(s), as specified herein, regarding utility services furnished by the Utility1 . 2. Request and receive copies of correspondence in connection with my account(s) concerning (initial all that apply): X a. Verification of rate, date of rate change , and related information; ___ b. Contrasts and Seivice Agreements; ___ c. Previo us or proposed issuance of adjustmentslcredits; or ___ d. Other previously issued or unresolved/disputed billing adjustments. 3. Request im•estigation of my utility bill(s). -"""X~-4. Request special metering, and the right to access interval usage and other metering data on my account(s). --"-X'---_ 5 . Request rate analysis . 6. Request rate changes. 7. Request and receive verification of balances on my account(s) and discontinuance notices . 1 The Utility will provide standard customer information without charge up to two times in a 12-month period per service account. After two requests in a year, I understand I may be responsible for charges that may be incurred to process this request. 4-3-735 PG&E ENERGY WATCH AUTHORIZATION TO RECEIVE CUSTOMER INFORMATION OR ACT ON A CUSTOMER'S BEHALF I (CUSTOMER} AUTHORIZE THE RELEASE OF MY ACCOUNT INFORMATION AND AUTHORIZE MY AGENT TO ACT ON MY BEHALF ON THE FOLLOWING BASIS 2 (initial one box only}: 2If no time period is specified, authorization will be limited to a one-time authorization One time authorization only (limited to a one time request for information and/or the acts and functions specified above at the time of receipt of this Authorization). One yea r a utho ri;wtion Request s fo r information and/or for the acts and fun ctions specified above will be accepted and processed each time requested with in the twelve month pe ri od from tho date of ex ec ut ion of t his Authoriz ati on. X Authorization is given for the period commencing with the date of execution until 07/05/2021 (Limited in duration to three years from the date of execution.} Requests for information and/or for the acts and functions specified above will be accepted and processed each time requested within the authorization period specified herein. RELEASE OF ACCOUNT INFORMATION: The Utility will provide the information requested above, to the extent available, via any one of the following. My (Agent} preferred format is (check all that apply}: Hard copy via US Mail (if applicable). Facsimile at this telephone number: _______ _ X Electronic format via electronic mail (if applicable) to this e-mail address: umsjohn@comcast.net or darmanino@marincounty.org I (Customer), Jim Schutz (print name of authorized signatory), declare under penalty of perjury under the laws of the State of California that I am authorized to execute this document on behalf of the Customer of Record listed at the top of this form and that I have authority to financially bind the Customer of Record. I further certify that my Agent has authority to act on my behalf and request the release of information for the accounts listed on this form and perform the specific acts and functions listed above. I understand the Utility reserves the right to verify any authorization request submitted before releasing information or taking any action on my behalf. I authorize the Utility to release the requested information on my account or facilities to the above Agent who is acting on my behalf regarding the matters listed above. I hereby release, hold harmless, and indemnify the Utility from any liability, claims, demands, causes of action, damages, or expenses resulting from: 1) any release of information to my Agent pursuant to this Authorization; 2) the unauthorized use of this information by my Agent; and 3) from any actions taken by my Agent pursuant to this Authorization, including rate changes. I understand that I may cancel this authorization at any time by submitting a written request. [This form must be signed by someone who has authority to financially bind the customer (for example, CFO of a company or City Manager of a municipality}.] r~t J1 AUTHORlzkecrs"TOMERSIGNATlJRE ,r (415) 485-3070 TELEPHONE NUMBER Executed this Q £3 day of 63 2018 ~ San Rafael, CA MONTH YEAR CITY AND STATE WHERE EXECUTED I (Agent), hereby release, hold harmless, and indemnify the Utility from any liability, claims, demand, causes of action, damages, or expenses resulting from the use of customer information obtained pursuant to this authorization and from the taking of any action pursuant to this authorization, including rate changes. AGENT SIGNATURE Marin County Community Development Agency COMPANY Executed this _____ day of ________ _ MONTH YEAR (415) 473-3292 TELEPHONE NUMBER Authorization to Receive Customer Information or Act on a Customer's Behalf This is a legally binding contract, please read carefully. 1,Jim Schutz, City Manager NAME & TITLE (IF APPLICABLE) of City of San Rafael MCE CUSTOMER NAME (ON ACCOUNT) 1400 Fifth Avenue San Rafael MAILING ADDRESS CITY have the following mailing address CA 94901 STATE ZIP and do hereby appoint the County of Marin and all of its authorized energy contractors NAME OF THIRD PARTY 3501 Civic Center Dr., Rm 308 San Rafael CA 94903 MAILING ADDRESS CITY STATE ZIP to act as my agent and consultant (Agent) for the listed account(s) and in the categories listed below: Accounts Included in this Authorization: SERVICE ADDRESS AND CITY SERVICE ACCOUNT NUMBER See attached List See attached list SERVICE ADDRESS AND CITY SERVICE ACCOUNT NUMBER SERVICE ADDRESS AND CITY SERVICE ACCOUNT NUMBER (For more than three accounts, please list additional accou nts on a separate sheet and attach it to this form) INFORMATION, ACTS AND FUNCTIONS AUTHORIZED -This authorization provides authority to the Agent. The Agent must thereafter provide specific written instructions/requests (e-mail is acceptable) about the particular account(s) before any information is released or action is taken. In certain instances, the requested act or function may result in a cost to you, the customer. Requests for information may be limited to the most recent 12 month period. ...... --~--.....:--,.... /';.~.,.. ~ .:., , ... tr \-· {( hl '-1MCE Clean Energy M y comnrnnity. My choice. Authorization to Receive Customer Information or Act on a Customer's Behalf The Authorization to Receive Customer Information or Act on a Customer's Behalf form permits account holders to specifically delegate certain rights to third parties concerning MCE account(s). The MCE customer may permit a third party to receive information or transaction business on his or her behalf. The customer must specify what information the third party is entitled to receive, what if any act(s) the third party may transact on his/her behalf, and whether the authorization is being provided on a one time basis or on a longer term basis (not to exceed three years). Please return the completed application to MCE. Electronic copy preferred. Mailing Address MCE 1125 Tamalpais Avenue San Rafael, CA 94901 Fax (415) 459-6010 Visit mceCleanEnergy.com for more information about MCE. Email info@mceCleanEnergy.com Please keep a copy of the completed authorization form for your records. Release of Account Information: MCE will provide the information requested above, to the extent available, via any one of the following. My (Agent) preferred format is (check all that apply): • Hard copy via US Mail (if applicable). • Facsimile at this telephone number: ________________ _ ~ Electronic format via electronic mail (if applicable) to this e-mail address: darmanino@marincounty.org (Customer), .Jim Schutz, City Manager (print name of authorized signatory), declare under penalty of perjury under the laws of the State of California that I am authorized to execute this document on behalf of the Customer of MCE listed at the top of this form and that I have authority to financially bind the Customer of MCE. I further certify that my Agent has authority to act on my behalf and request the release of information for the accounts listed on this form and perform the specific acts and functions listed above. I understand the MCE reserves the right to verify any authorization request submitted before releasing information or taking any action on my behalf. I authorize MCE to release the requested information on my account or facilities to the above Agent who is acting on my behalf regarding the matters listed above. I hereby release, hold harmless, and indemnify MCE from any liability, claims, demands, causes of action, damages, or expenses resulting from: 1) any release of information to my Agent pursuant to this Authorization; 2) the unauthorized use of this information by my Agent; and 3) from any actions taken by my Agent pursuant to this Authorization, including rate changes. I understand that I may cancel this authorization at any time by submitting a written request. [This form must be signed by someone who has authority to financially bind the customer (for example, CFO of a company or City Manager of a municipality).] U ZED CUSTOMER SIGNATURE Jim Schutz, City Manager, City of San Rafael (415) 485-3070 TELEPHONE NUMBER Executed this~ day of ~~C 2018 at San Rafael , CA . DAY MONT YEAR CITY AND ST A TE WHERE EXECUTED I (Agent), hereby release, hold harmless, and indemnify the Marin Energy Authority from any liability, claims, demand, causes of action, damages, or expenses resulting from the use of customer information obtained pursuant to this authorization and from the taking of any action pursuant to this authorization, including rate changes. I (Customer) authorize my Agent to act on my behalf to perform the following specific acts and functions (initial all applicable boxes): ~ Request and receive billing records, billing history and all meter usage data used for bill calculation for all of my account(s), as specified herein, regarding utility services furnished by the Marin Energy Authority1. ~ Request and receive copies of correspondence in connection with my account(s) concerning (initial all that apply): ~ Verification of rate, date of rate change, and related information; ~ Contracts and Service Agreements; • Previous or proposed issuance of adjustments/credits; or • Other previously issued or unresolved/disputed billing adjustments. ~ Request investigation of my utility bill(s). ~ Request special metering, and the right to access interval usage and other metering data on my account(s). ~ Request rate analysis. • Request rate changes. • Request and receive verification of balances on my account(s) and discontinuance notices. 1 MCE will provide standard customer information without charge up to two times in a 12-month period per service account. After two requests in a year, I understand I may be responsible for charges that may be incurred to process this request. I (Customer) authorize the release of my account information and authorize my agent to act on my behalf on the following basis 2 (initial one box only): 2 If no time period is specified, authorization will be limited to a one-time authorization • One time authorization only (limited to a one-time request for information and/or the acts and functions specified above at the time of receipt of this Authorization). • One year authorization -Requests for information and/or for the acts and functions specified above will be accepted and processed each time requested within the twelve month period from the date of execution of this Authorization. ~ Authorization is given for the period commencing with the date of execution until 011os12021 (Limited in duration to three years from the date of execution.) Requests for information and/or for the acts and functions specified above will be accepted and processed each time requested within the authorization period specified herein. AGENT CUSTOMER SIGNATURE 415-4 73-3292 TELEPHONE NUMBER County of Marin COMPANY Executed this_ day of____ at ____________ _ DAY MONTH YEAR CITY AND ST A TE WHERE EXECUTED CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: City Manager Project Manager: Cory Bytof Extension: 3407 Contractor Name: County of Marin Contractor's Contact: Dana Armanino Contact's Email: darmanino@countyofmarin.org D FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION DEPARTMENT 1 Project Manager a. Email PINS Introductory Notice to Contractor b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org 2 City Attorney a. Review, revise, and comment on draft agreement and return to Project Manager b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor 3 Project Manager Forward three (3) originals of final agreement to contractor for their signature 4 Project Manager When necessary, * contractor-signed agreement agendized for Council approval *PSA > $20,000; or Purchase> $35,000; or Public Works Contract> $125,000 Date of Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY s Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 6 City Attorney Review and approve hard copy of signed agreement 7 City Attorney Review and approve insurance in PINS, and bonds (for Public Works Contracts) 8 City Manager/ Mayor Agreement executed by Council authorized official 9 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager COMPLETED DATE NA 7/31/2018 Click here 1 ,,, enter a date. Click here to enter a elate. Click here to enter a date. )l'N/A Or Click here to enter a date. 1; ~l l1 0/;r-- i 3 ~ /1 f\Jr ,, REVIEWER Check/Initial • CB CB I A • ~J~i: • N 'A • • /~ V}A iA rr ~ 4-3-735