Authorization for Design and Construction Payment Account ‘Tris Authorization for Design and Construction Payment Account form (“the “Authorization Form”) is used to set up your BC Hydro payment account (the “Account” for design and construction work (the “Work"). Plesse complete and submit this {orm to your focal BC Hydro local Distribution Design office representative In order for invoicing and payment to commence. Invoices and payment receipts will be sent to the email eddress you provide below. Note: If an email address isnot provided, this ‘may result In delays in delivery of invoices, racolpts and other correspondence due to imitations with Canada Post delivery times. ‘We recommend you save an electronic version of this form when completed. You can reference your saved copy to help you complete @ new Authorization Form to set up @ BC Hydro payment account for any future design and construction work you may have with BC Hyd. "Note: Folds marked with an indicate requited infor matian A-—Identification of Account Holder 11am opening this Design and Construction Payment Account as the (please check only one box)": roperty Owner [Developer C]Consuttant [General Contractor CJ other os B—Identification of Property “This Account in elation tothe following Project Site (service address or civic adress: street (6419 Brembet ROT TT TTT TT TT TTT 1 TTT lei fwdtidmis tak TT TTT TTT) brovince/state(B | PostavZP code: VECHMG] [| IF there are changes tothe location ofthe Project site listed above during the Wort, isthe customers responsibilty t inform 1 Hydro. isthe responsiblity ofthe Account Holder to inform the BC Hydro Distribution Designer i there has been a change in ownership et the property whare tho Wark s boing parformed ori there has been a change to whom invoicing and payment is to be conducted with. A new Authorization Form must be completed by the new Account Holder. BC Hydro will not be responsible for correction after involees are lesued (the “Involees"). Tole Please enter the Design Number you were provided with for work at this Project Si Please enter the name of your BC Hydro Distribution Designer: C—Address and Contact Information Name’: Richard Jelley _ Sg eveaeeaeaeeeec Ura aero 1 Business or company name: British Columbia Business ID (Registration Number Email address* (For ivotces and rece. Muipte mal addresses not stowod.): Fjelley@shawcable, com Phone’: 250-302-4818 Ext ‘Mobile: 250-392-0133 Mating edorese': Bldg. No: ‘Street: 74 broadway ave north Unit No. city: Wiliams lake Province: BC Postal Code: V2G1C1 I you have an existing BC Hydro electrical consumption Account, please provide the Account number: 7249 8505 941 @BCHydro sora Power smartD—Terms and Conditions [As the Account Holder, you agree to the following payment terms in relation to the Account: 4. BC Hydro Distribution will determine the amount of the deposit required from the Account Holder, and the Account Holder ‘ill pay the deposit before any Work is commenced. 2. The Account Holder is responsible for any interim and final payments due and owing on any Invoices provided by BC Hyeiro in relation te any and ail Work. 3. The Account Holder will pay each Invoice within ninety (90) days of receipt, 4. if Account Holder disputes an invoice or portion of an Invoice, the Account Holder will provide notice to their design representative of the dispute and wil pay such undisputed portion within ninety (90) days of receipt thereof. 5. Ifrequested, the Account Helder will provide valid documentation demonstrating the Account Holder's ablity to act on ‘behalf ofthe property owner where the Work is being performed. 6. Any refund owing will be ‘ested to the Account Holder. 7. Telus Costs: There may be poles involved with your project that are jointly owned by BC Hydre and TELUS. You may also incur costs from TELUS for werk requiring the relocation, replacement or removal of jointly owned poles. ‘We will share project details and your contact information with TELUS so they may contact you with any TELUS related costs associated with your project. Your contact information includes your name, address, email adkiress, and phone number. Plesse contact TELUS directly at engineering.8C@telus.com to arrange payment for any TELUS portion of your project costs ‘and to coordinate any work to be performed by TELUS. E—Privacy {8 Hydro catlects your personal infrmation for he purpose of fuling your electrical connection request and processing payment for he Work, We may need to diclose your information tothe developer, your sacral contractors, goneral contractor and project managers. required, we may also share your details with the local muncipal goverment, Technical Safety BC, and other tiesto coordinate sevice. If you ae acting as an agenton behalf ofthe customer, you warrant you have their permission to provda thar personal information. 8C Hydro collects thisnformaton under the suthorty of section 26(<) ofthe Freedom of nfermation and Protection of Privacy {ctf you have questions about the collection of your persona information as described inthis form, please contact us t 41800 BCHYDRO (1 800 224 9376). F—Declaration for Design and Construction By submitting this eppliation, ! am confirming | am the Account Holder or an Authorized Signatory for the Account Holder. Me ae a ena ens ene aie Understand: eset gee to comply with the Terms and Conditions set out above, see BL orn 005/10 fe BC Hydro oes. Power smart