Attachment JA1 Coal Attestation Form.pdf
PDF 403 KB Posted
- Solicitation number
- SP060426R0409
- Issued by
-
Defense Logistics Agency Energy
About this file
This document is a CFPF (Coal-Fired Power Facility) Attestation Form template for federal contract SPE604-26-R-0409 under Executive Order 14386 Nationwide Coal. The document provides instructions and two required attestation forms that contractors must submit to document coal-based power supply compliance.
Form A is submitted by the Retail Energy Supplier to the Government and requires attestation that: (1) all coal-based power was generated by CFPF generators as defined in the contract; (2) all coal-based power was obtained through direct contractual agreements with CFPF facilities; and (3) all data on Form B is accurate and properly sourced. The form requires the supplier to report total kilowatt-hour generation and the compliance period dates, signed by an authorized agent under penalty of perjury.
Form B is completed by each coal-fired production facility that supplied power during the compliance period and must be returned to the Contractor for submission to the Government. The form requires facility information including name, address, eGRID subregion, and facility ID number (EIA or Qualifying Facility identification). The facility must report fuel type capacity in megawatts, total kilowatt-hours sold to the supplier during the compliance period, the date the facility became operational, and the period of delivery. The form includes a declaration signed under penalty of perjury by an authorized agent of the generating company, confirming the accuracy of information and that kilowatt-hours were sold exclusively to the named Retail Energy Supplier, along with generating company contact information.
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Attachment JA1- CFPF Attestation Forms
SPE604-26-R-0409
EO 14386 Nationwide Coal
CFPF Attestation Form Directions:
The Contractor must submit both Form A and Form B for electricity from coal-based power supplies.
Form A, provided to the Government, details the total amount of coal-based power delivered during the Annual Compliance Period. This form includes the total electricity supplied under the contract and a breakdown of each CLIN's consumption.
The Contractor is responsible for providing Form B to every coal-fired production facility that it has a contractual agreement with that fulfilled the government's requirements during the contract compliance period. These facilities must then complete the form and return the completed and signed document to the Contractor for submission to the Government.
SPE604-26-R-0409
EO 14386 Nationwide Coal
FORM A: COAL BASED POWER SUPPLY ATTESTATION FROM RETAIL ENERGY SUPPLIER
I, (print name and title) , declare under penalty of perjury, on behalf of (name of Retail Energy Supplier) , that
1) all coal based power supply associated with this Annual Compliance Report and delivered to the Government were generated by CFPF generators as defined in the subject Contract.
2) all coal-based power supply was obtained by the Retail Energy Supplier through a direct contractual agreement with a CFPF(s); and
3) all data on Form B is accurate and sourced from the specific CFPF(s).
Total CFPF Product Supplied
Total kWh Generation
From (date) To (date)
As an authorized agent of the aforementioned Company, I have authority to submit this report on the company’s behalf.
Signature and Title Date
SPE604-26-R-0409
EO 14386 Nationwide Coal
FORM B: COAL BASED POWER SUPPLY ATTESTATION FROM CFPF GENERATOR
Facility Information
Name of Facility:
Address of Facility:
eGRID Subregion of Facility:
Facility ID Number1:
Fuel Type Capacity
(MW)
Total kWh Sold to
Supplier During
Compliance Period
Date Facility First Operational
Period of Delivery (mm/yy)
Coal
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).
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) kilowatt hours listed above were sold exclusively to (name of the Retail Energy Supplier) .
As an authorized agent of (generating company name) , I attest that the above statements are true and correct.
Signature: Date:
Address of Generating Company:
Phone Number:
Contact Person: Title:
Telephone: Email:
| CFPF Attestation Form Directions: |
| Total CFPF Product Supplied |
| FORM B: COAL BASED POWER SUPPLY ATTESTATION FROM CFPF GENERATOR |
File details come from the government source that posted it. Updated .