D0312015 Final Decision on Opinion Regarding AB 117's Expanded Registration of Electric Serv Providers and Reetnry fee
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0462-800

ELECTRIC SERVICE PROVIDER REGISTRATION APPLICATION FORM

***PLEASE PRINT OR TYPE***

1. Exact Legal Name of Registrant:

2. Current Address:

3. Current Telephone Number: ______________________________________________________________________

4. Type of Ownership:

_ Individual _ Partnership _ Corporation _ Limited Liability Company

_ Government Entity _ Other

INCOMPLETE APPLICATIONS

CANNOT BE PROCESSED

5. If a non-California corporation, limited liability company, or limited partnership, attach a copy of the certificate from the California Secretary of State permitting the entity to transact business in California. (See Corporations Code Sections 2105, 15692, 17451.)

6. a. If registrant is a corporation, the state in which the registrant is incorporated and

date of incorporation:____________________________(State of Incorporation) _______________(Date)

b. List names and titles of corporate officers. (Attach additional page if necessary):

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

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7. If a partnership list all general partners. (Attach additional page if necessary.)

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

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8. If a limited liability company list all managers and/or officers and their titles.
(Attach additional page if necessary.)

_____________________________________________________________________________________________________

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9. If registrant has listed type of ownership as "government entity" provide a brief description of the government entity, and list the names and titles of the personnel responsible for managing the sale of electricity to residential and small commercial customers. (Attach additional page if necessary.)

_____________________________________________________________________________________________________

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10. If registrant has listed type of ownership as "other" describe the type of ownership, list the names and titles of all managers or officers, and attach a copy of the document establishing the entity as well and the bylaws or similar governing document of the entity. (Attach additional page if necessary.)

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12. List all of the names and addresses of all the corporate registrant's affiliates in which the registrant owns, controls or hold five percent or more of the affiliate. If this information is contained in any report required by the Securities and Exchange Commission, that report may be submitted in lieu of the information. See the "NOTICE" section for the definition of an "affiliate."

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

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13. The street address and telephone number of the registrant's principal place of business, if
different
from current address and telephone number listed in line numbers 2 and 3:

____________________________________________________________________________________________________

Street Address

____________________________________________________________________________________________________

City State Zip Code

____________________________________________

Telephone Number

14. a. Please provide a brief description of the electrical services you plan to offer.

____________________________________________________________________________________________________

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____________________________________________________________________________________________________

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communication regarding customer complaints or inquiries are to be addressed.

____________________________________________________________________________________________________

Name Title

____________________________________________________________________________________________________
Address

____________________________________________________________________________________________________
City State Zip Code

____________________________ _____________________________ ______________________________________
Telephone Number FAX Number E-Mail Address
(If available) (If available)


Name:_____________________________________________________________________________________________

Street Address:____________________________________________________________________________________

City and State:_________________________________________________________ Zip Code:_________________

20. Disclosures

_ No _ Yes If yes, please explain on additional page.

b. Within the last ten years, have any of these persons had any civil, criminal, or regulatory sanctions imposed against them pursuant to any state or federal consumer protection law or regulation?

_ No _ Yes If yes, please explain on additional page.

21. Provide a full set of fingerprints of: (1) if a sole proprietorship, the registrant; (2) if a partnership, all general partners; (3) if a corporation, all corporate officers; and (4) if a limited liability company, all of the members, managers and officers. If your company does not offer electric service to residential or small commercial customers, this fingerprinting requirement may be limited to a designated corporate officer(s) approved by the Energy Division. Use the fingerprint cards included with this application. Additional fingerprint cards may be obtained from the Commission. The fingerprints shall be performed by a law enforcement agency, or other person which is qualified to provide fingerprint services. The ESP registrant shall also provide the name and address of the entity or person which provided the fingerprint services, and the date on which the service was provided.

NOTICE

Each ESP registered with the California Public Utilities Commission (CPUC) should be familiar with all the laws and decisions pertaining to the offering of electrical services to customers in California. This notice mentions some of the provisions that the ESP must abide by.

To be issued an ESP Registration number, your you are required to provide the CPUC with a cash (cashier's check) security deposit in the minimum amount of $25,000 or post a financial guarantee bond in favor of the CPUC in that amount. This deposit must be received by the CPUC before your ESP registration will be considered complete. The deposit or financial guarantee bond shall be delivered to the Energy Division address listed on the first page of this form. In the alternative, the ESP may elect to open a customer trust account in a format approved by the CPUC's General Counsel. Pending such an approval, the ESP must post the cash deposit or the financial guarantee bond. This deposit requirement is subject to change.

Unless you are an ESP who has been authorized by the California Independent System Operator to act as a scheduling coordinator, each registered ESP is required to submit to the Energy Division a copy of all of its scheduling coordinator agreements. The agreements are to be submitted on or before the date when the ESP signs up its first customer.

Prior to signing up and initiating a direct access service request on behalf of any residential or small commercial customer, all registered ESPs serving such customers are required to provide the potential customer with a written notice which describes the price, terms, and conditions of service. The notice shall include all of the elements required by Public Utilities Code § 394.5, and the requirements set forth in the CPUC's consumer protection decision, D.98-03-072, as modified by
D.99-05-034.

Public Utilities Code § 394.7 prohibits all ESPs from soliciting those residential and small commercial consumers whose names appear on the list that is maintained pursuant to that code section.

In order to change the electricity provider of a residential or small commercial customer, all ESPs must follow the verification procedures set forth in Public Utilities Code § 366.5.

Each registered ESP serving residential or small commercial customers is required to submit annual filings containing information regarding its standard service plans. This information is to be submitted on the form adopted by the CPUC. (Public Utilities Code § 392.1(a); D.98-03-072.)

Each ESP who offers to sell electricity to end-use customers is required to disclose its electricity sources to those customers in accordance with Public Utilities Code § 398.4 and as directed by the California Energy Commission.

In addition to the $100 registration fee, you are required to pay the annual fee required by Public Utilities Code § 394.3(b). This fee is assessed on each registered ESP on September 1st of each year.

For the purposes of this form, the following definition of an "affiliate" applies:

"Affiliate" means any legal entity in which five percent or more of the outstanding shares are owned, controlled, or held with power to vote, directly or indirectly either by the ESP or any of its subsidiaries; or by the ESP's controlling entity or any of its subsidiaries; or by any company in which the ESP, its controlling entity, or any of the ESP's affiliates, exert substantial control over the operation of the company or indirectly have substantial financial interests in the company which is exercised through means other than ownership. For purpose of this definition, "substantial control" include, but is not limited to, the possession, directly or indirectly and whether acting alone or in conjunction with others, of the authority to direct or cause the direction of the management or policies of the company. A direct or indirect voting interest of five percent or more by the ESP in an entity's company creates a rebuttable presumption of control.

Any material change in the information required by this form shall be provided to the CPUC within 60 days, except for any change in the ESP's telephone number or address, which shall be reported within five days of such a change. (Public Utilities Code § 394.1(d).)

Submit the original signed form together with all required documents, and three additional copies.

DECLARATION

If this registration form is verified outside of California, the verification must be made by an affidavit sworn or affirmed before a notary public.)

I, (print name and title) ___________________________________________________________ hereby certify that I am empowered to act on behalf of _______________________________________________ (registrant's name) and to make this application on its behalf. I declare under the penalty of perjury under the laws of the State of California that I have read the above notice, that the above statements and information submitted in connection with this application are true and correct, and that any documents furnished in connection with this application are true and correct copies.

Dated this ___________________________________________, at _____________________________________________

(date) (place of execution)

Signature:__________________________________________________________

(END OF ATTACHMENT A)

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