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CM Customer Infromation Authorization (missing Agent signature)Pacific Gas and AUTHORIZATION TO RECEIVE CUSTOMER Electric Company INFORMATION OR ACT UPON A CUSTOMER'S BEHALF THIS IS A LEGALLY BINDING CONTRACT, PLEASE READ CAREFULLY (Please Print or Type) ILi of City of San Rafael (Customer) have the following mailing address NAME OF CUSTOMER OF RECORD 1400 5th Avenue San Rafael CA 94901 , and do hereby appoint MAILING ADDRESS CITY STATE ZIP American Energy Partners of 2 Harris Ct Ste B-1 NAME OF THIRD PARTY MAILING ADDRESS Monterey CA 93940 CITY STATE Z.P 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. 50 Canal Street, San Rafael 2003975593-7 SERVICE ADDRESS CITY SERVICE ACCOUNT NUMBER 2. 40 Canal Street, San Rafael 3983370550 SERVICE ADDRESS CITY SERVICE ACCOUNT NUMBER 3. 111 Morphew Street, San Rafael 9087543148 SERVICE ADDRESS CITY SERVICE ACCOUNT NUMBER (For mon: than three accounts, please list additional accounts 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 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): 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 Utility. 2. Request and receive copies of correspondence in connection with my account(s) concerning (initial all that apply): a. Verification of rate, date of rate change, and related information; 0 b. Contracts and Service Agreements; 0 c. Previous or proposed issuance of adjustments/credits; or 0 d. Other previously issued or unresolved/disputed billing adjustments. 3. Request investigation of my utility bill(s). 4. Request special metering, and the right to access interval usage and other metering data on my account(s). 0 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./ understand I may be responsible for charges that may be incurred to process this request. wtomated Document, Preliminary Statement A Page 1 of 2 Form 79-1095 Advice 4002 -G/5349 -E August 2018 1." Pacific Gas and Electric Company AUTHORIZATION TO RECEIVE CUSTOMER INFORMATION OR ACT UPON 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 BASISZ ktg one box only): 2 If no time period is specified, authorization will be limited to a one-time authorization 0 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). 0 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. 0 Authorization is given for the period commencing with the date of execution until (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: ❑ Electronic format via electronic mail (if applicable) to this e-mail address: rlegaspi@amenergypartnerS.Cog I (Customer), (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. I understand that this agreement at all times shall be subject to such modifications as the California Public Utilities Commission may direct from time to time in the exercise of its jurisdiction. [This form must be signed by someone who has authority to financially bind the customer (for AUTHORY-E- 'CUSTOMER SIGNATURE Executed this day of 3 21 MONTH YEAR -36 /TELEPHONE NUMBER at Q/t to CITY AND STATE WHERE E ELUTED 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 COMPANY Executed this day of MONTH YEAR Automated Document, Preliminary Statement A TELEPHONE NUMBER Page 2 of 2 Form 79-1095 Advice 4002 -G/5349 -E August 2018 RAFq�! 2 z �o ,lY WITH P 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: American Energy Partners Contractor's Contact: Chris Chase Contact's Email: cchase@amenergypartners.com ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor Click here to ❑ enter a date. b. Email contract (in Word) and attachments to City 3/24/2021 CB Attorney c/o Laraine.Gittens@cityofsanrafael.org 2 City Attorney a. Review, revise, and comment on draft agreement Click here to and return to Project Manager enter a date. ❑ b. Confirm insurance requirements, create Job on Click here to PINS, send PINS insurance notice to contractor enter a date. ❑ 3 Department Director Approval of final agreement form to send to Click or tap ❑ contractor to enter a date. 4 Project Manager Forward three (3) originals of final agreement to Click here to ❑ contractor for their signature When necessary, contractor -signed agreement enter a date. ❑ N/A 5 Project Manager agendized for City Council approval * *City Council approval required for Professional Services ❑ Agreements and purchases of goods and services that exceed Or $75,000; and for Public Works Contracts that exceed $175,000 Click here to Date of City Council approval enter a datE PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 7 City Attorney Review and approve hard copy of signed 3/25/21 LG agreement 8 City Attorney Review and approve insurance in PINS, and bonds 3/25/21 LG (N/A) (for Public Works Contracts) 9 City Manager/ Mayor Agreement executed by City Council authorized City Clerk official 10 Attest signatures, retains original agreement and J forwards copies to Project Manager