Attachment IV Attestation Forms.pdf

ATTESTATION FROM REC PROVIDER

I, (print name and title)______________________________________________, declare under penalty of perjury, on behalf of (name of REC provider) , that

1) all the RECs associated with this invoice were generated by eligible renewable energy generators as defined in RFP# __________;

2) all the renewable attributes, including any emissions reduction credits or emissions allowances, represented by the REC sales reported in REC Certificate of Transfer were transferred to the (Federal

Agency) _____________________________________ ; and

3) the renewable attributes represented by the REC sales reported in Renewable Energy Certificate of

Transfer were not and will not be sold, marketed or otherwise claimed by a third party

REC Product

Generating Facility MWh From (date) To (date) Fuel Type

Generation

I further declare that the RECs claimed for the REC products LISTED ABOVE and reported in the REC

Certificate of Transfer were sold once and only once, and that the electrical energy that was generated with the RECs reported in the REC Certificate of Transfer was not and will not be sold, marketed or otherwise represented as renewable energy and was not and will not be used to meet any federal, state or local renewable energy requirement, renewable energy procurement, renewable portfolio standard, or other renewable energy mandate. As an authorized agent of the aforementioned Company, I have authority to submit this report on the company’s behalf.

Signature Date

Place of Execution

FAE9152

Typewritten Text

FAE9152

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FAE9152

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FAE9152

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FAE9152

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Attachment IV

RENEWABLE GENERATOR ATTESTATION

Facility Information Name of Facility:

Address of Facility:

Facility ID Number1: EIA, QF, Other (specify) or N/A? (circle one)

Contact Person: Title:

Telephone: Fax:

Fuel Type Capacity*

(MW)

MWh/RECs Sold to Provider

Date Facility First Operational

NOx Emissions (Lbs/MWh)

Period of Delivery (Q#/yy or mm/yy)**

Biomass _____________ (indicate fuel type)

Geothermal

Landfill Gas/ Digester Gas

Wind

Solar electric

* For facilities which have added new renewable capacity, please indicate the amount and operational date of the new capacity and the existing capacity.

** List as separate line items MWh for each month or quarter.

1 Please enter Energy Information Administration (EIA) identification number for the generating facility. If the facility does not have an EIA number, please enter the utility-assigned Qualifying Facility (QF) identification number, other identification number or indicate not applicable (N/A).

RENEWABLE GENERATOR ATTESTATION FORM (CONT’D)

Declaration:

I, (print name and title)________________________________________________________________, declare under the penalty of perjury, that the information provided on this form is true and correct to the best of my knowledge.

Further, I declare that the (indicate) _____ renewable megawatt hours/ _____ renewable attributes listed above were sold exclusively to (name of REC provider) ________________________________________. Further, I declare that 1) all the renewable attributes, including any emissions reduction credits or emissions allowances, represented by the renewable electricity generation listed below were transferred to the REC provider above, 2) to the best of my knowledge, the renewable attributes were not and will not be sold, marketed or otherwise claimed by a third party; 3) the renewable attributes were and will be sold once and only once; 4) the electrical energy that was generated with the attributes was not used on-site for generation;

and 5) the electrical energy that was generated with the attributes was not and will not be separately sold, marketed or otherwise represented as renewable energy and was not and will not be used to meet any federal, state or local renewable energy requirement, renewable energy procurement, renewable portfolio standard, or other renewable energy mandate.

Generating Facility MWh of Generation From (date) To (date) Fuel Type

Further, I declare that the facilities that generated all of the (indicate) ___ renewable kilowatt hours/ ___ renewable attributes sold to (name of REC provider) are listed above by fuel type.

As an authorized agent of (generating company name) _____________________________, I attest that the above statements are true and correct.

Signature: Date:

Place of Execution:

Address of Generating Company:_________________________________________________________

Phone Number: ____________________________________________________________