SECTION 8 SAMPLE DOCUMENTS

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1 SECTION 8 SAMPLE DOCUMENTS

2 Table of Contents Section 8 contains sample documents and material related to the operation of an electric utility system in North Carolina. SAMPLE DOCUMENTS Page # Section 1 Rights and Responsibilities: Sample Ordinance for Adoption of New Electric Utility Customer Policy & Procedures Residential Service Application/Contract Service Application Letter to Student Third Party Notification Industrial/Commercial Agreement Section 2 Establishing and Billing for Services: Sample for Certificate of Deposit Used As A Utility Deposit Acknowledgement and Notice of Assignment Release of Assignment Guaranty Agreement Closed Postcard Bill Envelope Bill Customer Letter Regarding Payment of Bill Billing Error Letter Incorrect Billing Letter Drop Box for Paying After Hours Payment Extension Payment Arrangements Letter Section 3 Service Options: Service Request Equal Payment "Levelized" Bill Letter Bank Draft Credit Card Draft Medical Alert Confirmation Letter Revised February 2009 i

3 Section 4 Discontinuing Service: Sample Documents Table of Contents Final Notice Disconnection After-Hours Agreements Debt Setoff Collection Notification Section 5 Electrical Equipment: Door Hanger for Outage Notification Outage Report Card Customer Outage Letter Section 6 Fee Schedule: Qualified Generation Policy Electric Rate Rider Load Management Rider, R Section 7 Construction and Metering Guidelines: Metering Letter Meter Reading Sample Utility Easement Deed Between Married Individuals and a Municipality Revised February 2009 ii

4 Sample Ordinance for Adoption of New Electric Utility Customer Policies and Procedures AN ORDINANCE OF THE OF THE OF NORTH CAROLINA, DETERMINING THAT IT IS IN THE BEST INTERESTS OF THE OF TO ADOPT CUSTOMER POLICIES AND PROCEDURES FOR UTILITY SERVICE TO CUSTOMERS OF THE MUNICIPALITY. WHEREAS, the of (herein "the Municipality ") owns and operates a utility distribution system for the purpose of furnishing electric power, energy, and other utilities to customers in the service area of the Municipality; and WHEREAS, the of the Municipality (herein "the Governing Board ") has taken into consideration the benefit of adopting customer policies and procedures for the operation of its utility service; and WHEREAS, the Governing Board hereby finds that the establishment of customer policies and procedures for provision of utility services are in the best interests of the Municipality and its citizens NOW, THEREFORE, BE IT ORDAINED, by the of the of : Section 1. The policies and procedures attached hereto (herein the Utility Customer Services Policies and Procedures ) shall be, and hereby are, the customer policies and procedures of the Municipality for the provision of its utility service until such time as the Governing Board shall modify or revoke the same. As set forth in the Utility Policies and Procedures, the [Utility Director or City Manager] shall have the discretion to modify portions of the Utility Customer Services Policies and Procedures from time to time. Section 2. The Utility Customer Services Policies and Procedures shall supersede and take the place of all existing customer policies and procedures of this Municipality regarding its utility services, all of which are hereby revoked and of no further force and effect for utility services provided by the Municipality from and after date of adoption of this Ordinance. This Ordinance adopted this day of, 20 (SEAL) ATTEST: Mayor Clerk Revised February

5 Welcome to Municipality RESIDENTIAL SERVICE APPLICATION/AGREEMENT Date: Service Representative: Customer's Name: Co-applicant s Name: Service Address: Mailing Address: City: State Zip Code Home Telephone Number: ( ) Work Telephone Number: ( ) Cell Telephone Number: ( ) Fax Telephone Number: ( ) address: Emergency Contact Number and Person: Would you like to receive updates from the Municipality? [ ] yes [ ] no ( ) In the event of service interruption should we contact this person? Previous Service Address: Employer's Name: Co-applicant s Employer's Name: Services Requested: [ ] Electricity [ ] Load Management for Water Heater [ ] Water [ ] Load Management for Air Conditioner [ ] Garbage Pick-up [ ] Area Light [ ] Sewer [ ] Other Date and Time Requested: [ ] Before Noon [ ] After 2 p.m. I am interested in the following services: [ ] Direct Draft [ ] Green Power [ ] Credit/Debit Card [ ] Utility Donation Program Revised February

6 Payment [ ] Online Services [ ] Gatekeeper [ ] Budget Billing [ ] Gatekeeper [ ] Due Date [ ] Other Extension Deposit: Do you [ ] own or [ ] rent your residence? Landlord's Name: Have you ever had service with the municipality before? [ ] Letter of Credit History on File/Date Received: [ ] yes or [ ] no Deposit Received: [ ] Cash [ ] Check Amount of Deposit: $ (SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS) Revised February

7 Customer's Social Security Number: Co-applicant s Social Security Number: Customer's Driver's License Number: Co-applicant s Driver's License Number: Back of Service Application Account Number: The applicant understands that the Municipality must take actions and expend funds to comply with this request for service. By signing this application, the applicant signifies that he has the authority to request electric service, both permanent and temporary to the premises identified in this application. By signing this Application, the applicant requests permanent electric service, to be preceded by temporary service if needed, for the location identified. Utility service will be subject to any and all rates, rules, regulations, policies, procedures, terms and conditions applicable to the service, and as revised by the Municipality with the authority given it by North Carolina General Statute Chapter 160A, Article 16 and all other applicable statutes. The rights and responsibilities of the Municipality and the customer regarding electric service include those set out in the Municipality s Policies and Procedures Manual (a copy of which is available upon request.) Those policies in effect for the date of this application may be updated or changed from time-to-time by the Municipality, and the terms and provisions of the Manual, as they might change, are incorporated in this Application by this reference. The Municipality will use it s good faith efforts to provide continuous and uninterrupted electric service, but cannot be liable for loss or damage (direct, indirect, incidental, consequential, punitive, special or otherwise) caused by any failure to supply electricity or by an interruption, if it is due to any cause beyond the reasonable control of the Municipality. This Application and the documents referred to in this Application, specifically including the Municipality's Policies and Procedures Manual as it may change from time to time, constitute the entire agreement between the Customer and the Municipality with respect to the provision of utility service by the Municipality. Neither party shall be responsible to the other except as specifically set out in this Application and in those agreements or documents referred to in this Application. Upon acceptance of this application by the Municipality, a valid contract is formed by the Municipality and the applicant. Your social security number(s) is being requested for verification of your identity and to perform a credit check. There is no statutory or other authority requiring you to give your social security number(s), but if you elect not to disclose it/ then you will need to provide an alternative method of identification satisfactory to the Municipality. This account will be deemed an at risk account and will be charged the maximum deposit allowable. Revised February

8 The applicant certifies that there is no outstanding debt for utility services, fees or penalties due the Municipality, either under an agreement signed by the applicant or by another person who is now or has been a member of my household or who resides at the above addresses. Each applicant is jointly and severally liable for all amounts coming due in connection with utility service provided pursuant to this application. Although the Municipality and its customers may not always exercise the rights specified in these policies or available to them by law, that does not prevent the Municipality or the customer from exercising those rights at a later time. PLEASE NOTE THAT THIS IS A CONTRACT FOR ELECTRIC SERVICES BASED ON THE MUNICIPALITY'S POLICIES AND PROCEDURES. AS THEY MAY CHANGE FROM TIME TO TIME, YOU HAVE THE RIGHT TO REVIEW THE POLICY MANUAL OR ASK QUESTIONS IN OUR MUNICIPAL OFFICE. Municipality Type or print (Customer Name) By Municipality Representative Customer Signature Revised February

9 Service Application Letter to Student DATE INSIDE ADDRESS Dear College Student: Welcome to (Name of Municipality). We're happy you have chosen to live off-campus in a home or apartment served with electricity from (Name of Municipality). Our new member orientation booklet will detail most of the information you'll need about electric service and payments. As a municipality, we must require timely payments by all of our customers. Your credit record here may be your first step in establishing a lifetime credit record If you have any problem paying your bill this year, we can be most helpful if you call before the power is disconnected. If you are disconnected, we will require a deposit to turn your power back on. Again, welcome to (Name of Municipality). We hope you become one of our best customers. Sincerely, Municipal Manager Cc: Guarantor Revised February

10 Third Party Notification To reduce the chance of disconnection of utility services, the Municipality gives you the opportunity to have a duplicate of the final cutoff notice sent to a person of your choosing. This person might be a neighbor, a family member or organization who would be willing to assist you when you're on vacation or for some other reason unable to pay your utility bill. The person you select will not be responsible for paying your utility bill. They will simply be notified of your outstanding account. If your bill is not paid by the cutoff date on this notice, your utilities will be disconnected. Customer's Name: Service Address: City: State Zip Code (Signature) Name of Party to be Notified: Address: City: State Zip Code (Signature) While we will make a good faith effort to send a copy of a final notice to the person designated, the Municipality is not liable for failure of the third party to receive the notice, nor will the failure to receive the notice affect the termination of your service. Municipality Account Number: Revised February

11 Industrial/Commercial Agreement Date: Service Representative: Company Name: Company Representative's Name Company Address: City: State: Zip Code: Telephone Number: ( ) Alternate Numbers: ( ) Company's Tax ID Number: Previous Service Address: Is this a [ ] sole proprietorship [ ] LLC [ ] partnership [ ] corporation Please attach Articles of Incorporation or Articles of Organization, business license, and a list of company officers with social security number, address and phone number. Service Requested: [ ] Connection [ ] Disconnection [ ] Electricity [ ] Garbage Pick-Up [ ] Water [ ] Sewer Date and Time Requested: [ ] Before Noon [ ] After 2 p.m. Secondary Voltages Requested: Total Connected Load: Cycling Load Expected: Motor Starting Load: Future Load Expectations: Easement and Right-of-Way Guaranteed: [ ] Yes Amount of Contribution in Aid of Construction: $ Deposit: (check applicable box): [ ] Letter of Credit History on File/Date Received: Deposit Received [ ] Cash [ ] Check Amount of Deposit: $ Amount of Contribution in Aid of Construction: $ The applicant understands that the Municipality must take actions and expend funds to comply with this request for service. By signing this application, the applicant signifies that the customer has the authority to request electric service, both permanent and temporary, to the premises identified in this application. By signing this application, the applicant requests permanent electric service, to be preceded by temporary service if needed, for the location identified. Upon acceptance of this application by the Municipality, a valid contract is formed by the Municipality Revised February

12 and the applicant. Utility service will be subject to any and all rates, rules, regulations, policies, procedures, terms and conditions applicable to the service, and as revised by the Municipality with the authority given it by North Carolina General Statute Chapter 160A, Article 16. The rights and responsibilities of the Municipality and the customer regarding electric service include those set out in the Municipality's Policies and Procedures Manual (a copy of which is available upon request), as they may change from time to time. Those policies in effect for the date of this application may be updated or changed from time-to-time by the Municipality, and the terms and provisions of the Manual, as they might change, are incorporated in this Application by this reference. Revised February

13 Industrial/Commercial Agreement (cont'd) By: Signature of Company Representative By: Signature of Municipal Representative Title of Representative (Type or print representative name) Municipality Account Number: PLEASE NOTE THAT THIS IS A CONTRACT FOR ELECTRIC SERVICES BASED ON THE MUNICIPALITY S POLICIES AND PROCEDURES AS THEY MAY CHANGE FROM TIME TO TIME. YOU HAVE THE RIGHT TO REVIEW THE POLICY MANUAL OR ASK QUESTIONS IN OUR MUNICIPAL OFFICE. Revised February

14 SAMPLE FOR CERTIFICATE OF DEPOSIT USED AS UTILITY DEPOSIT For value received, the undersigned (the Customer ), jointly and severally, assign(s) and transfer(s) the Certificate of Deposit described below, together with all modifications, renewals, substitutions thereof, and all rights, options, privileges, and interest therein and therein including, without limitation, all interest and other proceeds earned thereon, and proceeds thereon (the Certificate of Deposit ), To (Name and Address of Municipality) (the Municipality ), and its successors and assigns. (Amount) (Issuing Bank) (Certificate No.) (the Bank ) This Assignment is given as security for the payment by the Customer of all charges for utility services provided to (Description of Facility) located at (Address/Location of Facility) by the Customer. This Assignment shall be a continuing one and shall remain effective for all utility bills incurred by the Customer in connection with the location described above. The Customer warrant(s) and represent(s) that the Certificate of Deposit is owned solely by the Customer and is free and clear of all liens and encumbrances, that the Customer has full power, right and authority to execute and deliver this Assignment, and that it will keep the Certificate of Deposit, or a renewal, modification or substitution thereof, outstanding subject to this Assignment until all amounts secured by this Assignment are paid in full. The Certificate of Deposit shall be titled in the following manner: (Name of Municipality) under Assignment by (Name of Customer). If the Certificate of Deposit is represented by a passbook, certificate or other document evidencing ownership, such paper writing(s) have been delivered and are herewith assigned and pledged to the Municipality by the Customer in connection with this assignment and pledge. Until notified by the Municipality, all interest earned by the Certificate of Deposit shall be paid directly to the Customer. Upon written notice from the Municipality, the Bank shall thereafter pay all interest earned on the Certificate of Deposit directly to the Municipality. Revised February

15 The Customer agrees that should the customer s utility account become delinquent, for any reason, the Municipality is irrevocably authorized and empowered, in its own name or in the name of the Customer, to demand, apply for withdrawal and receive any and all monies or claims for money hereby assigned, and to exercise any and all rights and privileges and receive all benefits (including, without limitation, interest earned thereon) accorded to the Certificate of Deposit, and to execute any and all instruments required therefore, and the Bank is hereby specifically authorized and directed on demand of the Municipality, to pay all monies due under the Certificate of Deposit directly to the Municipality. Failure of the Municipality to exercise any of its rights under this Assignment shall not constitute a waiver thereof, and any and all rights under this Assignment shall be in addition to and not in lieu of any and all rights available to the Municipality. Upon default under this Assignment or the obligations secured by this Assignment, the Customer shall pay all costs and expenses of the Municipality, including reasonable attorney s fees and litigation costs, incurred in the collection of any amounts secured by this Assignment or in enforcing its rights under this Assignment. The payment of these amounts shall also be secured under this Assignment by the Certificate of Deposit. The Municipality shall have no duty or obligation to the Customer with regard to the Certificate of Deposit or in connection with this Assignment, other than to hold and dispose of the Certificate of Deposit, or its proceeds, as provided in this Assignment. At anytime the Municipality may, at its option, return the Certificate of Deposit to the Customer, and in all events upon full payment of all amounts secured by the Assignment, the Municipality shall return the Certificate of Deposit to the Customer. Upon such return, the Municipality shall be released and discharged from any and all liability or obligation related to the Certificate of Deposit or this Agreement. (Customer) By: (Name of Officer/Partner/Member) (Title) By: (Name of Officer/Partner/Member) (Title) (Date) Revised February

16 Acknowledgment And Notice Of Assignment The undersigned (the "Bank") acknowledges receipt of notice and a copy of an Assignment of Certificate of Deposit/Time Deposit as Utility Deposit granted by (the customer) for the Certificate of Deposit described below ("Certificate of Deposit") issued by the Bank to (Municipality) (the "Municipality") as collateral for obligations due to the Municipality. (Amount) (Certificate No) Bank hereby certifies that the Certificate of Deposit is valid and does evidence our obligations to Customer. Our records do not disclose any liens, claims or encumbrances against the Certificate of Deposit except (if none, so state). We have compared the signatures appearing on the foregoing Assignment filed by the Customer with us with the signature cards on our records, and the same compare correctly therewith and are sufficient to authorize withdrawal of funds from said account and for all purposes with respect to said accounts. We will be guided by the foregoing Assignment until receipt of further contrary written notice or instructions from the Municipality and hereby waive and release for the term of the foregoing Assignment any right to set off against any obligation of the Customer, to the Bank which may not exist or hereinafter arise. (Bank) By: (Name) (Title) Revised February

17 Release Of Assignment The undersigned Customer acknowledges receipt and return of the Certificate of Deposit described below and the undersigned Municipality releases and terminates all of its claims, rights, title and interest in the Certificate of Deposit described below, all as of the day of 20 (Amount) (Certificate No.) (Issuing Bank) (Municipality) By: (Name) (Title) (Customer) Revised February

18 Guaranty Agreement SAMPLE GUARANTY AGREEMENT FOR INDIVIDUAL GUARANTOR AND APPLICANT GUARANTY AGREEMENT Date: Service Representative: Applicant s Name: ( Applicant ) Service Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Address: Account Number Guarantor s Name: ( Guarantor ) Mailing Address: City: State: Zip Code: Street Address: City: State: Zip Code: Address: Guarantor s Account Number The Guarantor unconditionally and absolutely guarantees to the Of (the Municipality ) and its successors and assigns the prompt and full payment of all amounts due under the Applicant s utility bills from the Municipality for service from and after the date set forth above and, unless a maximum amount is set forth below by the Guarantor initialing Option 1, 2 or 3 the Guarantor's liability for those and other amounts due hereunder shall be unlimited: Option 1 - up to the amount of the Municipality s standard deposit. Option 2 - up to $XXX Option 3 total amount of bill Revised February

19 The Guarantor may have the following options available: Option 1 will payment arrangements or extensions be allowed on this account? (If yes, there will be a maximum of 2 payment arrangements or extensions in one year.) Option 2 would the guarantor like to receive a copy of the bill? Option 3 would the guarantor like notification of delinquent actions? The Guarantor understands and agrees that this is an unconditional guaranty of payment of bills incurred. This Guaranty Agreement shall cover all future indebtedness of the Applicant for his utility bills to the Municipality until termination of this Guaranty Agreement as herein provided. The Municipality may after one year terminate the Guaranty Agreement and establish credit or a deposit with the account holder. The Guarantor may terminate this Guaranty Agreement by delivery to the Municipality at Revised February

20 of notice of termination, and such termination shall be effective only as to utility services provided to Applicant after thirty (30) days from the Municipality s receipt of the notice of termination. Any notice given pursuant to this paragraph shall be in writing, and shall be delivered personally to, or received by certified United States Mail by, the Municipality at the address set forth above. Such written notice of termination shall be the sole and exclusive method for terminating this Guaranty Agreement as to future obligations of the Applicant and such termination shall not affect this Guaranty Agreement as to amount due from the Applicant for utility services provided to the Applicant up to the date thirty (30) days after notice is received by the Municipality as set forth above. Time is of the essence hereof. [Note - Policies and procedures will need to be coordinated with this termination of Guaranty Agreement.] The Guarantor acknowledges that the Applicant will be receiving utility services from the Municipality based upon this Guaranty Agreement and acknowledges the direct and indirect benefit to the customer and the Guarantor and that such consideration is sufficient for the purposes of this Guaranty Agreement. The Guarantor waives notice of acceptance of this Guaranty Agreement and waives diligence on the part of the Municipality in collection of the indebtedness. Except as specifically set forth above, the Guarantor also waives notice of non-payment, presentment demands for payment, protest, notice of dishonor and default, with respect to amounts guaranteed under this Guaranty Agreement. This Guaranty Agreement is in addition to such other security as the Municipality may now or hereafter require for utility services to the Applicant. It shall not be necessary for the Municipality to enforce payment by the Guarantor, to first institute suit, or to pursue or exhaust remedies against the Applicant, or against any other security that the Municipality may have. Without limiting the generality of the foregoing, the Guarantor expressly waives any rights the customer otherwise might have under the provisions of G S.N.C. 26-7, et seq. Guarantor agrees that in this Guaranty Agreement is placed in the hands of an attorney for enforcement, the Guarantor will reimburse the Municipality for all reasonable costs and expenses incurred, including, without limitation, reasonable attorney s fees. The Guarantor hereby consents and agrees that the Municipality may at any time, and from time to time, in its sole discretion: (i) modify, renew, extend or otherwise change the time of payment and/or the manner, place or terms of payment of any and all amounts guaranteed hereunder; (ii) grant indulgences generally to the Applicant; (iii) exchange, release and/or surrender all or any of the collateral secured, which is or may be held by it now or hereafter as security for payment of all amounts guaranteed hereunder; (iv) settle or compromise with the Applicant any or all amounts guaranteed hereunder; (v) change its utility policies and procedures; and (vi) change its rates, all in such manner and on such terms as the Municipality may deem proper and/or desirable, and without notice to or further assent from the Guarantor. Revised February

21 This Guaranty Agreement shall be deemed to have been made under and construed and governed in accordance with the laws of the State of North Carolina, notwithstanding its principles of conflicts of law. No waiver by the Municipality of any default or other matter under this Guaranty Agreement shall operate as a waiver of the same on a future occasion. The Guarantor agrees that this Guaranty Agreement shall continue in full force and effect notwithstanding the death of the Guarantor. Should any one or more provisions of this Guaranty Agreement (or portions hereof) be determined to be illegal or unenforceable by a court of competence jurisdiction, the other provisions (and portions hereof) shall remain in full force and effect. The Guarantor agrees that this Guaranty Agreement shall inure to the benefit of and may be enforced by the Municipality and its successors and assigns, and shall be binding and enforceable against the Guarantor and the Guarantor s legal representatives, successors and assigns. Throughout this Guaranty Agreement, unless the context clearly indicates otherwise, the masculine, feminine and neuter genders shall be interchangeable, the singular shall be deemed to include the plural, and vice versa. IN WITNESS WHEREOF, this Guaranty Agreement has been signed and sealed by the individual set forth below, with such individual adopting the word SEAL appearing next to the Guarantor s signature as the Guarantor s seal, all to be effective the day and year first above written. (Signature of Guarantor) (SEAL) (Guarantor's Account Number) (Type or Print Name of Guarantor) Revised February

22 Closed Postcard Bill Make Checks Payable to: Municipality Address City, N.C. Zip Code Meter Readings Description Current Previous Multiplier Usage Charges Electric XXXX XXXX XX XXX $XX.XX Water XXXX XXXX XX XXX $X.XX Sewer XXXX XXXX XX XXX $X.XX TOTAL Please return top copy with payment. Bill is past due on DATE. $XX.XX [Add desired information and notices.] NOTE: To insure customer privacy, bills sent in postcard format should be closed in some way. Office supply vendors can help you with a discreet bill format. Revised February

23 Envelope Bill $XX.XX Amount Due Current Bill Past Due After: Please Pay to: Municipality Address City, N.C. Zip Code (Area Code) Phone Number Customer Record Meter Readings kwh Used Rate Present Previous Present Previous Schedule Amount XXXX XXXX XXX XXX Residential $XX.XX Messages: Conservation Discount % NC Sales Tax Amount Now Due $ X.XXCR $ X.XX $XX.XX $XX.XX payment posted last month. Thank you. Retain this portion for your records. If the budget billing plan was chosen, pay $XX.XX [Add desired information and notices] Customer Record Meter Readings kwh Used Rate Present Previous Present Previous Schedule Amount XXXX XXXX XXX XXX Residential $XX.XX Conservation Discount % NC Sales Tax Amount Now Due $ X.XXCR $ X.XX $XX.XX Past Due After: or DO NOT PAY THIS AMOUNT PAID BY BANK DRAFT ON DATE. Revised February

24 Customer Letter Regarding Payment of Bill Date Customer Name Customer Address Account Number Dear : Please forgive our use of a form letter; however, we needed to communicate with you as quickly as possible. Please notice the following request(s): We received your copy of the money order sent for payment. Please send us the original to assure proper credit. The enclosed check is made payable to another business. The enclosed check has not been signed. The payment did not reference the correct account number. The correct account is. To list an account in a business name, we need to have a copy of the documents evidencing the organization of your business entity. Your amount of payment did not match the amount due. Please call me to be sure I credit the proper account(s). We received your bill stub, but there was no payment enclosed. To begin equal payment billing, you must have a zero balance on the account. We will begin equal payment at that time. Please sign and return the enclosed right-of-way easement. Please sign and return the enclosed application for service. Revised February

25 Other If you need to respond, please use the envelope I have enclosed for you. Thanks for your time and consideration. Sincerely, Consumer Service Representative Revised February

26 Billing Error Letter DATE INSIDE ADDRESS Dear Customer: We need to apologize for a mistake made by (Name of Municipality). Due to an incorrect location listed in our computer, (Name of Municipality) has been billing you for electricity used at another map location. After finding and correcting the mistake, the correct billing gives you $XXX which is detailed on the enclosed bill If your bill has a balance, we will be glad to work out any kind of payment arrangement necessary to accommodate you. If there is a credit, you may elect to use that credit against your next bill or have a check written to you. Please let us know. Thanks for your understanding, and thank you for giving us the opportunity to serve you better. Sincerely, Finance Director Revised February

27 Incorrect Billing Letter DATE INSIDE ADDRESS Dear Customer: We need to apologize for a mistake made by (Name of Municipality). Due to an incorrect location listed in our computer, (Name of Municipality) has been billing you for electricity at the incorrect rate. After finding and correcting the mistake, we have changed the account to the correct rate. Please note this on your next bill. [Add desired language for recovering undercharges.] (refer to Section 2 under Billing Adjustments for language). Thanks for your understanding, and thank you for giving us the opportunity to serve you better. Sincerely, Finance Director Revised February

28 Drop Box for Paying After-Hours [This message should be posted prominently at the drop box.] For customer convenience, a drop box is located in. A check and billing stub may be deposited in the box mounted on the wall at. For added security, please do not deposit cash in the after-hours depository. Payments put in the drop box after will be posted the next business day. Revised February

29 Payment Extension Date: Customer s Name Service Address: City: State Zip Code Reason for Extension: Arrangements/Explanation: I, the customer, agree to pay the past due amount of $ by. I understand that if any of these arrangements are not paid when due, all delinquent amounts become immediately due and payable and my utility service will be disconnected. (Signature of Customer) (Signature of Utility Representative) Municipality Account Number: Revised February

30 Payment Arrangements Letter DATE INSIDE ADDRESS Dear Customer: Thank you for asking about bill payment arrangements. We are glad to assist whenever we can. Here is the schedule we have agreed to: Signature of Customer: Account Number: Utility Representative: Municipality: I, the customer, agree to pay $ a month on this delinquent account and continue those payments for months until my account has been fully paid. I understand that if any of these payments are not paid when due, all delinquent amounts become immediately due and payable and my utility service will be disconnected. Thanks for allowing us to serve you. Sincerely, Finance Director Revised February

31 Service Request Date: Customer Name: Street Address: City: State: Zip Code: Daytime Telephone Number Request Description Received by:: Referred to Expected Action Date: Municipality Account Number: Revised February

32 Equal Payment Date: Customer Name: Street Address: City: State: Zip Code: By signing up for an equalized payment plan, the customer agrees to pay each month an amount equal to one twelfth of the customer s total yearly payments. Should rate increases occur, the Municipality may increase the amount of payment accordingly. The customer agrees to stay on this plan for one year, unless the customer moves outside the Municipality s service area. At that time all amounts due the Municipality will be due and payable. The customer agrees to pay $ a month for 11 months. The 12th month is used to settle any overpayments or underpaid amounts. If payment schedule is not followed and account falls into arrears, the account becomes subject to all rules of the Municipality regarding disconnection and termination of service and the account may be removed from the equal payment plan. If the customer has any major changes in the customer s household that would effect electric consumption (for example, installation of central air or addition of a family member), please notify the Municipality's Customer Service Department. Should it become necessary to adjust the customer's account for an incorrect billing, the customer's account will be settled on the equal payment plan and then reinstated. (Signature of Customer) (Signature of Municipality Representative) Municipality Account Number: Note: Need to make consistent with termination policies and procedures. Revised February

33 Equal Payment Bill Letter DATE INSIDE ADDRESS Dear Customer: The Municipality s Equal Payment Plan takes the guesswork out of your utility bill. Every month your costs are the same, so you avoid any spikes in your bill, keeping your budget intact. From the dog days of summer to the dead of winter, your utility bill stays the same. Here s how the program works: The Municipality calculates your average annual utility usage Annual usage is divided into 11 equal monthly payments The September bill is used to settle your account If you paid for m ore electricity than you used over the first 11 months, we will credit your account. Then, you may request a check for the extra amount or keep the credit and pay less next year. Likewise, if you used more than you paid for, then we will bill you for that amount. Your payments may be adjusted annually depending on electricity usage and current electric rates. To be eligible to participate in the program: You must have an active account at least six months old You must not have had more than one late payment over the last six months Your equal payment bill can start any month and end any time you choose. Any balance when you end the equal payment bill service is added to your next bill. With the equal payment bill, your bill is computed just like always, The same bill still arrives in the mail to tell you how many kilowatts-hours were used and the total bill amount, and the meter is still read on the same schedule as in the past. By using the equal payment power bill, you will not have to deal with higher payments during the summer air conditioning season or the winter heating season or the holidays. The equal payment bill only works if you pay your bill promptly every month. If you receive two delinquent notices, you will be removed from the equal payment billing service. Thanks for asking. Sincerely, Revised February

34 Note: Need to make consistent with termination policies and procedures. Revised February

35 Bank Draft Date: Customer Name: Street Address: City: State: Zip Code: Customer's Utility Account Number: Customer s Bank and Location: Customer s Bank s Routing Number: Customer s Bank Account Number: Please attach a copy of a voided check or deposit slip for this account. The customer agrees to have the customer s utility bill paid directly from the above checking or savings account each month on the bill s due date. The customer will be notified of the amount withdrawn for payment. This agreement will remain in effect until the customer notifies the Municipality, in writing, to discontinue the service. (Signature of Customer) (Signature of Municipality Representative) Revised February

36 Credit Card Draft Date: Customer Name: Street Address: City: State: Zip Code: Customer's Utility Account Number: Customer s Credit Card Number: Credit Card s CVC code: The customer agrees to have the customer s utility bill paid directly from the above credit card account each month on the bill s due date. The customer will be notified of the amount withdrawn for payment. This agreement will remain in effect until the customer notifies the Municipality, in writing, to discontinue the service. (Signature of Customer) (Signature of Municipality Representative) Revised February

37 MEDICAL ALERT CERTIFICATION Name on Customer Account: Customer/Location Number: Service Address: Mailing Address: Telephone Number: Patient Name: Emergency Number: Relationship: Medical Condition: Type of Life Support: The customer agrees that it is their responsibility to provide the letter of certification from a doctor or hospital advising of their medical condition. The certification will be reviewed and brought up to date each year. By signing this agreement, the customer agrees to pay his/her account by the due date, so that service will not be interrupted of failure to pay. The Municipality will make a good faith effort to make contact with the customer before service is terminated. The Municipality will make good faith efforts to keep power flowing to all life support patients. However, due to conditions beyond the control of the Municipality, electric power cannot be guaranteed 100 percent of the time. It is understood that the customer should have a backup plan for movement of the patient if the Municipality is unable to restore power. Signature of Customer: Date: Physician Information: The above information is true concerning the above referenced patient's medical condition: Signature of Physician: Address: Date: Telephone Number: FOR OFFICE USE ONLY: Revised February

38 Representative Signature: Date: Medical Alert Confirmation ADDRESS DATE Dear Customer: The Municipality of (name of Municipality) is dedicated to serving its customers. In the interest of protecting the health and well being of our citizens, we need some further information about your account. Our records indicate a life-support machine at your account. Please verify that a machine is in use at the above location by sending us a letter from your doctor. This information will assist us in record keeping and ensure that the greatest possible care is taken regarding your account. Thanks for your time and consideration Sincerely, Customer Service Supervisor Revised February

39 Final Notice of Disconnection Final Notice of Disconnection Municipality Date of Termination of Service: Customer's Name Service Address Your utility bill is past due and should be paid by The amount you owe, including late payment penalties, is In order to continue services at this account, payment in the amount of $ must be received by. If you question the accuracy of this bill, you can request a hearing to present your concerns. If you would like a hearing or think the Municipality may have made an error in calculating your bill, please call the Customer Service Department with the Municipality at (xxx) xxx-xxxx or visit the Customer Service Office during business hours. You are still responsible for paying the undisputed portions of your bill. If your service is disconnected a reconnection fee of must be paid. If you have paid this bill since the date of this notice, please disregard this reminder and accept our thanks. Municipality Account Number: Date of Notice: Note: If your second notice form is a postcard, it must be a closed postcard, so as to avoid publicizing the debt of your customer. For the same reason, any door hanger used to remind customers of impending cutoff should be closed and discreet. If you use bright red door hangers only for cutoffs, everyone in your municipality knows what is hanging on the door. Office supply vendors can help you get closed postcards and door hangers. Revised February

40 After-Hours Agreements Date: Time Complete: [ ] a.m. [ ] p.m. Customer's Name: Service Address: Service Requested for: [ ] Electric [ ] Water [ ] Sewer After-Hours Customer Service Call Problem: Action Taken: Responsibility: [ ] Customer AMOUNT OF CHARGE: $ [ ] City The amount charged to customer will be be included in the next utility bill. Signature of Service Person Signature of Customer After-Hours Request for Reconnection I request that my utility service be reconnected outside regular working hours. For this service I agree to pay, along with my delinquent bill and other nonpayment fees, an additional fee of $. I will pay my total charges during regular working hours on the next day City Hall is open. If I do not honor this agreement, I will be subject to additional charges and immediate disconnection of my utility service, as well as the loss of after-hours reconnect service for the next three months. Municipality Account Number Revised February

41 Debt Setoff Collection Notification Date: INSIDE ADDRESS RE: Debt Setoff Collection Notification Dear : As authorized by North Carolina General Statues, Chapter 105A, The Debt Setoff Collection Act, intends to submit the debt(s) summarized below to the North Carolina Department of Revenue for collection by applying the debt(s) against any income tax refund of $50.00 or more that you may be entitled to receive. Additionally, as authorized by North Carolina General Statue 18C-134, if applicable, the local agency intends to submit the above debt against certain lottery prizes to which you may become entitled. Your indebtedness to the Municipality is as follows: Total Debts: $ If you have any questions regarding this action, please contact me at (XXX) XXX-XXXX Sincerely, Finance Manager Please take notice that the Municipality intends to submit the debt you owe for electric service to the State of North Carolina to be an offset against any State Tax Refund you are owed. You have the right to contest this matter by filing a written request for a hearing with the Municipality within thirty (30) days after the date the Municipality mailed you this notice. You may mail your request to the Customer Service Representative of the Municipality at or deliver it to the Billing Payment Office during regular business hours. Failure to request a hearing within the required time will result in setoff of your electric utility bill against your State Tax Refund. A collection assistance fee of $15.00 will be added to your utility bill debt if it is submitted for setoff from your State Tax Refund Municipality Account Number: Date of Notice: Revised February

42 Outdoor Lighting Date: Customer s Name: Street Address: City: State: Zip Code: Address of Light Installation: Description of Light: [ ] High Pressure Sodium [ ] Other Kind [ ] 100 W HPS [ ] 200 W HPS [ ] 175 W Mercury Vapor Quantity Rate/Month Installation Date: Term of Contract: By agreeing to install outdoor lighting at the above address, the customer agrees to let the Municipality's utility department employees install, maintain and repair the outdoor light. Other Installation Charges may apply. (Signature of Customer) (Signature of Municipality's Representative) Municipality Account Number: Revised February

43 Door Hanger for Outage Notification Customer's Mailing Label Your area will experience a brief electricity outage from to The Municipality's electrical crews will be in the area during this time working to make your service better. Sometimes it is necessary to interrupt electric service to perform maintenance work or make improvements. The Municipality apologizes for any temporary inconvenience this outage may cause you and assure you your service will be restored as soon as possible. Revised February

44 Outage Report Card Power Outage Grid Address Name Time of Call: [ ] a.m. [ ] p.m. Telephone No. Time Power Off: [ ] a.m. [ ] p.m. Date: Time Power On: [ ] a.m. [ ] p.m. Date: Trans. Service Primary Sec. Tree Remarks: Operator Trk No. Time Assigned [ ]a.m. [ ] p.m. Date Customer Call Back Time: a.m. p.m./date: Revised February

45 Customer Outage Letter DATE INSIDE ADDRESS Dear Customer: Please accept our sincere apologies for any inconvenience caused by the power outage on [DATE]. Our records indicate your power was interrupted from xx:xx (a.m./p.m.) to xx:xx (a.m./p.m.). We are sorry that the nature of the trouble which caused the breaker to cut off prevented us from giving you any quality information about when power would be restored. With the situation, we recognized you were forced into a quick decision on closing the store and consideration of its reopening. Because we could not give any guarantee of when power was to be restored, we understand that you had to make a decision to close the store for the evening. We commend your quick response and ongoing situation analysis and trust that our help in troubleshooting your local problem was also helpful. Thanks for your consideration and understanding. Sincerely, Utility Director Revised February

46 Municipality of Qualified Generation Policy Availability Qualified generation as set forth in this policy may be used in conjunction with the Municipality s (insert applicable rate schedule) as an option to reduce peak load to achieve those benefits, if any, afforded, under such rate schedules or riders, if such generation meets the criteria under this policy. The amount of generation for each customer shall be available on a first come, first served 1 basis and shall be limited in an aggregate amount of all customers to the Municipality s allocation of qualified generation under (Power Agency) policy. Eligibility Requirements and Restrictions Each request to participate in qualified generation shall be subject to review and approval by the Municipality under the terms set forth by Power Agency, and each customer shall not install or operate such generation until approved by the Municipality. Information on the nameplate kw rating, load served, installation, protective relays, and operation of generator(s) shall be included with the request to determine eligibility as outlined in this policy. Customers shall provide the following notice requirements based on nameplate capacity rating of the individual generator: Those generators in existence and operation prior to December 1, 1993; Customer shall be required to submit an application on a form supplied by the Municipality, without a notice period Less than 95 kw; Customer shall be required to submit an application on a form supplied by the Municipality, prior to the operation of such generation, without a notice period. Greater than or equal to 95 kw, but less than or equal to 2,500 kw; Customer shall be required to submit a seven 1 Method of allocation and availability given as an example. The Municipality may choose its own non-discriminatory method of allocation. Revised February

47 month notice to the Municipality prior to the scheduled operation date of such generation. Greater than 2,500 kw; Customer shall be required to submit a thirteen month notice to the Municipality prior to the scheduled operation date of such generation. Customers with individual general units greater than 2,500 kw shall be charged for reserve capacity at the per kw rate set forth, from time to time, in the Power Agency policy. Operating Standards Generators shall meet the safety and operating standards of the Municipality. No backfeed shall be allowed into the Municipality s system, and parallel operation shall be allowed only with the appropriate protective devices. Protective device information shall be provided upon request. In the event of an emergency on the combined system, each generating unit may be called on by, as stated in Power Agency policy, under its General Load Reduction Plan. Revised February

48 Municipality of Sample Electric Rate Rider Load Management Rider, R-1 Recommend using the actual rate schedule. Availability This Rider is available in conjunction with service under the Municipality s General Service Schedule. The availability of credits under this Rider is contingent upon the Customer s load reduction in a corresponding reduction in the Municipality s billing demand from Power Agency. Method of Demand Reduction Credits are available under this Rider for demand reduction during the monthly system peak. If the customer should elect to use qualified generation, as defined by Power Agency policy, as an option to reduce that demand, it must meet the requirements as set forth in the Municipality s Qualified Generation Policy. Monthly Credit The Customer will receive a monthly credit of per kw for the reduction in demand during the 60-minute interval of current billing month used by Power Agency for wholesale billing purposes which is coincidental with Monthly System Peak Demand as defined in the Power Coordination Agreement between and dated. Determination of Demand for Credit The following method will be used for the determination of kw demand reduction: The reduction of kw demand will be determined solely and exclusively by the Municipality from the Customer s average kw demand during the two 60-minute intervals preceding and the two 60-minute intervals following the Municipality s Load Management Period, minus, the Customer s demand during the 60-minute interval of system peak. Revised February