Commercial Custom Design Program – Retrofit
Thermal Energy Services Provider Declaration
This declaration form must be filled out in its entirety by organizations or individuals wishing to participate in FortisBC Energy Inc.’s (“FortisBC’s”)
Commercial Custom Design Program – Retrofit (the “Program”). The information provided below should pertain to the building that is the subject of an
Application to the Program. Applications to the Program cannot be accepted if this form is not completed in its entirety and submitted to FortisBC.
Participant name
Building name (if applicable)
Building address
City/town
Postal code
Question 1
Will this site be provided with thermal energy delivered via a thermal energy system owned by a Thermal Energy Services Provider 1 (“TESP”)?
Question 2
If the answer to Question 1 is yes, identify the TESP
Participant declaration
I, the Participant, declare that where a TESP will own the systems providing thermal energy to the site identified above:

I understand that a third party agent will review and/or administer all aspects of my participation in the Program on FortisBC’s behalf, including,
without limitation, my application, Energy Study Proposal, Energy Study, completion documentation and final site audit. This shall include
reviewing, and approving or declining, my eligibility for the Program generally and for any incentives under the Program.

I hereby grant consent to allow FortisBC to share all information and supporting documentation pertaining to my participation in the Program,
along with my natural gas consumption history and bill payment data, with the third party agent, for the purpose of administering my participation
in the Program.

I understand that fees will be incurred for the work performed by the third party agent in reviewing my application to the Program, and if
applicable, administering my participation in the Program (the “Fees”), and that I, the Participant, am solely responsible for payment of the Fees. I
understand that Fees are incurred on an hourly basis and the magnitude of the Fees cannot be known at the outset.

I understand that the Fees will be deducted as they are incurred from any incentives that may be payable to me pursuant to the Program, namely
Energy Study Funding, Capital Incentive Funding and/or Implementation Bonus Funding2. If the value of the Fees exceeds the value of the
incentive(s), I understand that I, the Participant, will be invoiced separately for any such amounts. If it is determined that I am not eligible for any
incentives, I understand that I will be invoiced for all Fees that have been incurred in the evaluation of my participation in the Program. I will pay
all invoices within 30 days of receipt.
I, the Participant, further declare that:

I understand that if my response to Question 1 changes at any time during the course of my participation in the Program I must inform FortisBC
immediately. Fees will be applicable as described above should this site be provided with thermal energy delivered via a thermal energy system
owned by a TESP.

I understand that falsification of information submitted to FortisBC as a part of this declaration or failure to comply, as determined by FortisBC in
its sole discretion, with any of the Terms and Conditions of the Program, means that I will need to repay FortisBC any incentive amount paid to
me under this Program, and will terminate any obligation on the part of FortisBC to pay any subsequent incentives pursuant to the Program.

I have fully read, understand and agree to abide by the terms and conditions contained in this declaration form in addition to the Terms and
Conditions of the Program.

The undersigned is an authorized representative of the Participant and has the authority to bind the Participant.
Participant name (please print)
Participant or authorized representative
signature
Date (Yr/Mth/Day)
Authorized representative name
(if applicable – please print)
Send declaration form to: [email protected]
1
Title
Questions? Contact your Key Account Manager or email
[email protected]
A TESP is defined as an individual other than the Participant, who will/does own thermal energy generating assets for the purpose of selling the thermal energy generated
therefrom to the Participant.
2
These incentives are defined in the Energy Study Approval or Declined Letter and the Capital Incentive Approval or Declined Letter.
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