Attestation to the California Public Utilities Commission of Eligibility for CA Industry Assistance

Only facilities that do not report to ARB under the MRR need to complete the attestation process to receive CA Industry Assistance. Facilities are eligible to receive CA Industry Assistance if they primarily operate in an industrial sector that qualifies for Industry Assistance in ARB’s Cap-and-Trade Regulation.

Authorized Representative Information

Company Name (Enter your customer name as indicated on your bill.)

Representative's Name

Title

Email

Phone (numbers only)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Facility Information

Facility Name

Service Address

Primary NAICS Code

Report the NAICS code that most accurately describes the facility’s primary product/activity/service. The primary product/activity/service is the principal source of revenue for the facility as defined in North American Industrial Classification System Manual 2007.

Description of Primary Facility Operations

Account Information

Your 12-digit SDG&E account number can be found at the top of a recent SDG&E bill or by logging into sdge.com/myaccount.

If your account number has two or three leading zeros, please include the zeros.

Primary Utility Account Number

Additional Utility Account Number

Enter each Electric Service Agreement Number (for PG&E), Service Account Number (for SCE, SDG&E, and Pacific Power), or Account Number and Location Number (for Liberty Utilities) for the facility.

Account Number for Bill Credit

Preferred utility account number to which the CA Industry Assistance bill credit should be applied, if applicable.

Acknowledgement

Acknowledgement of Audit

I understand my eligibility for Industry Attestation is auditable, and that as a result of submitting this attestation, I may be selected for an audit. If I am selected for an audit, I agree to comply with all requests for documents to support any information provided in this Attestation. I also agree to allow a Commission designee or utility designee to inspect my facility to verify the activities I am claiming in my Attestation. I further understand that if I am selected to be audited and I do not respond or do not allow the audit to take place, or if the audit determines that I am ineligible, my eligibility for Industry Assistance will be voided and I will not receive future credits.*

Facility representative must sign the statement to confirm that they understand they may be selected for an audit.

Certification

I certify under penalty of perjury under the laws of the State of California that I have personal knowledge of the facts stated in this Attestation and I have the authority to make this Attestation on behalf of the Company. I further certify, to the best of my knowledge, all of the statements and representations made in this Attestation are true and correct. I understand that any false statements or misrepresentations could subject me, personally, and the company that I represent to penalty, including those penalties specified in Public Utilities Code Sections 2111 and 2112.

I understand that I am responsible for notifying the utility and/or the California Public Utilities Commission of any changes to the information reported in this form. I am required to provide updates in writing within 60 days of a change in facility operations. I understand that changes to facility operations, and/or any changes to the information attested to herein, may affect or delay my Industry Assistance credit.*

Facility representative must sign the statements to confirm that all information in the form is true, and they are responsible for notifying the utility and/or the California Public Utilities Commission of any changes.