Eastern Iowa Light & Power Cooperative - Application for Operation of Customer-Owned Generation

This application for AEP-3 should be completed as soon as possible and returned to the Cooperative's Member Services department along with the application fee in order to begin processing the request. Please see the chart below to determine appropriate amount.

INFORMATION: This application is used by the Cooperative to determine the required equipment configuration for the Customer Interface. Every effort should be made to supply as much information as possible.

PART 1

Owner/Applicant Information

Company/Member Name

Mailing Address

City

County

State

Zip Code

Phone Number

Representative

(If applying as a Company)

Email Address

Project Design/Engineering (Architect)

Company

Mailing Address

City

County

State

Zip Code

Phone Number

Representative

Electrical Contractor

Check if Project Design/Engineering (Architect) and Electrical Contractor are the same:

Company

Mailing Address

City

County

State

Zip Code

Phone Number

Representative

Description of Proposed Installation and Operation

Give a general description of the proposed installation, including a detailed description of its planned location and when you plan to operate the generator

Ex: Ground array with trench over to disconnect near meter. POC is load side of pole top disconnect. 7.19 kW AC/10 kW DC.

Connector Information

PART 2

Inverter Information

Complete all applicable items

Manufacturer

Model Number

Rated Power Factor (%)

Rated Voltage (Volts)

Rated Amperes

Number of Inverters

Inverter Type

ferroresonant, step, pulse-width modulation, etc.

Type Commutation

Additional Notes (if needed):

Solar Panel Information

Complete all applicable items

Manufacturer

Model/Type

Unit Number

Serial Number

Manufacture Date

H.P. Rated

H.P. Max

Inertia Constant (lb-ft2)

Additional Notes (if needed):

Additional Information

In addition to the items listed above, please attach a detailed one-line diagram of the proposed facility, all applicable elementary diagrams, major equipment, (generators, transformers, inverters, circuit breakers, protective relays, etc.) specifications, test reports, etc., and any other applicable drawings or documents necessary for the proper design of the interconnection. Also describe the project's planned operating mode (e.g., combined heat and power, peak shaving, etc.), and its address or grid coordinates.

One-Line Diagram

Proof of Liability Insurance

Site Plan

Misc Spec Info (panels, inverters, etc.)

Optional Agreement For Electric Service (AEP-3)

Optional Agreement For Electric Service (AEP-3)_page 3

Optional Agreement For Electric Service (AEP-3)_page 4

Optional Agreement For Electric Service (AEP-3)_page 5

Optional Agreement For Electric Service (AEP-3)_page 6

Optional Agreement For Electric Service (AEP-3)_page 7

Eastern Iowa Light & Power Cooperative Electric Tariff (17.5.17 - Co-Generation, Small Power and Alternate Energy Producer Buy Back Rate [AEP-3])

SIGN OFF AREA

The customer agrees to provide the Cooperative with any additional information required to complete the interconnection. The customer shall operate their equipment within the guidelines set forth by the cooperative.

If you agree to the statement above, please check the box:

Date of Sign Off

ELECTRIC COOPERATIVE CONTACT FOR APPLICATION SUBMISSION AND FOR MORE INFORMATION:

Cooperative contact: Aaron Healy

Title: Member Services Supervisor

Address: PO Box 3003

Wilton, IA 52778-3003

Phone: 855-938-3616

Fax: 563-732-3224

E-mail: aaron.healy@easterniowa.com

Residential	Commercial
Industrial	Hog Confinement
Agriculture	Other

Photovoltaic	Wind
Microturbine	Diesel Engine
Gas Engine	Turbine
Other