Pvpartners Less100app5

PV Partners Application
for Systems < 100kW CITY OF PALO ALTO

UTILITIES
PV App. #__________
1. Project Site Address: _________________________________________________________________ Palo Alto, CA 9430__

-
Electric Account No.: _____________________________ Electric Rate Code: E-_____
2. Host Customer Check if Applicant

Company Name: ______________________________________________________________________________________
Contact Name: ______________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
If not same as above
Phone: ________________________________ Email: ______________________________________________
Retrofit New Construction
Residential Below Mkt. Residential Commercial Non-Profit Government Industrial Mixed-Use
3. Seller Check if Applicant

Company Name: ______________________________________________________________________________________
Contact Name: ______________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
Phone: ________________________________ Email: ______________________________________________
License No.: _______________ Class: __________ Exp. Date: __________________ Provide 10-Year Warranty? o
4. Installer (if different from seller) Check if Applicant

Company Name: ______________________________________________________________________________________
Contact Name: ______________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
Phone: ________________________________ Email: ______________________________________________
License No.: _______________ Class: __________ Exp. Date: __________________ Provide 10-Year Warranty? o
5. System Owner (if not Host Customer) Check if Applicant

Company Name: ______________________________________________________________________________________
Contact Name: ______________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
Phone: ________________________________ Email: ______________________________________________
7. System Equipment
PV Modules
Array No. PV Manufacturer Model No. PTC watts / module Quantity
1
2
3
4
Inverters
Array No. Inverter Manufacturer Model No. Efficiency Quantity
1
2
3
4
2/1/08 Page 1 of 2
PV Partners Application
for Systems < 100kW CITY OF PALO ALTO
UTILITIES
PV App. #__________
Performance Meter
Meter Manufacturer: ________________________________ Model No.: __________________________________________
8. Generation Output
Array No. Power (CEC Watts AC) Tilt (degrees) Azimuth (degrees) Annual Shading %
1
2
3
4
TOTAL System Watts AC : 0.00
9. System Cost 10. Estimated Annual Energy (kWh):

(use EPBB calculator)
Modules: ____________________
Inverters: ____________________ 11. Rebate Calculation
Other (fees, construction): ____________________ Rebate Level ($ / Watts)*: ___________________
Labor (design & install): ____________________ 0.00
Total System Watts AC: ___________________
TOTAL COST: $0.00 TOTAL REBATE: $0.00
*Rebate Level depends on the electric rate, customer type, and the available funds in the current rebate step. Please verify correct level
at 650-329-2241.
Rebate Payment goes to: m Host Customer m System Owner m Seller m Installer
12. Attachments
o CPAU Utility Bill
o Purchase order / contract for PV System equipment and installation
o Printout of EPBB estimate of Annual Energy Production
o Shading Analysis (if not minimally shaded)
o Residential Water & Energy Efficiency Checklist (residential only)
o Documentation tax-exempt status of a Non-Profit / Public Entity
13. Terms and Conditions

Eligible participants must be current electric distribution customers of City of Palo Alto Utilities (CPAU). The parties agree to comply
with all terms and conditions established in the PV Partners Guidebook. CPAU reserves the right to cancel or modify the incentive if
the actual installation differs from the installation described on the PV Partners Program Application, if the system fails inspection,
and/or is not installed by the date listed on the Claim Form. CPAU reserves the right to verify project costs were incurred as submitted
in the Program Application.
14. Signatures
Each of the undersigned declares under penalty of perjury that:
HOST CUSTOMER SYSTEM OWNER (if different from Host Customer)

Signature: _____________________________________ Signature: _________________________________________
Print Name: _____________________________________ Print Name: _________________________________________
Date: ____________________ Date: ____________________
SELLER / INSTALLER CITY OF PALO ALTO UTILITIES

Signature: _____________________________________ Signature: _________________________________________
Print Name: _____________________________________ Print Name: _________________________________________
Date: ____________________ Date Approved: ____________________
Return with ORIGINAL signatures to:

PV PARTNERS PROGRAM
2/1/08 CPAU | P.O. Box 10250 | Palo Alto, CA 94303 Page 2 of 2

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PV Partners Application

for Systems < 100kW CITY OF PALO ALTO

1. Project Site Address: _______________________________________________________________ Palo Alto, CA 9430

2. Host Customer Check if Applicant

3. Seller Check if Applicant

4. Installer (if different from seller) Check if Applicant

5. System Owner (if not Host Customer) Check if Applicant

9. System Cost 10. Estimated Annual Energy (kWh):

13. Terms and Conditions

HOST CUSTOMER SYSTEM OWNER (if different from Host Customer)

SELLER / INSTALLER CITY OF PALO ALTO UTILITIES

Return with ORIGINAL signatures to:

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