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4. APPLICANT'S CONTRACT ANTICIPATED COST INFORMATION (to be completed only if installation is performed by a Qualified Contractor/Subcontractor as selected in Section 3 above) Applicant and/or Appplicant's Qualified Contractor/Subcontractor understands that for the portion of the Electrical Distribution and/or Service Extension that SCE would normally install, in accordance with SCE's Rule's 15 and/or 16 and the Terms and Conditions Agreement for Installation of Distribution. Line Extension by Applicant, the Applicant, prior to performing any work associated with the installation of these electrical facilities, and for the purpose of utility billing and accounting, shall elect one of the following options, and return this form to SCE prior to SCE proceeding with any further work on the Applicant's project. Option 1 Applicant elects to provide SCE with the Applicants Contract Anticipated Costs, which are subject to refund, that are associated with that portion of the new Distribution Line and/or Service Extension normally installed by SCE, and understands that the lower of SCE's estimated refundable cost or the Applicant's Contract Anticipated Costs, which are subject to refund, as submitted below, shall apply to any applicable SCE refunds and allowances provided in accordance with Rule 15 and 16, 1 or Option 2 Applicant elects not to provide SCE with the Applicants Contract Anticipated Costs, which are subject to refund. The Applicant understands that by selecting this option, the Applicant is directing SCE to use SCE's estimated refundable cost for all billing and accounting. Applicant understands the Applicants Cost Information, as described above, and hereby elects the following by initialing the appropriate selection below: Option 1 - Applicants Contract Anticipated Costs $ Option 2 - SCE's Estimated Refundable Costs 5. ITCC SCE shall value all trenching, conduit, backfill, street repair, substructures, and encasement, based on SCE's estimate of such items, for the purpose of collecting the applicable governmental taxes (ITCC) on contributions to SCE. 6. UTILITY Upon receipt of this completed and signed form, SCE shall begin the process of producing theapplicable contracts and forms based on the selection made by the Applicant. SIGNATURE I declare under penalty ofp that th foregoing is true d corre Applicant's signature: 0 7 Applicant's printed name: CYA17-#I A S A -&97-,Z 11 N T 6 R I M L IT y M AN h.G c P, Date : i Excludes the estimated costs of work the Applicant cannot perforin, such as, work on or in proximity to, energized equipment. Foran 14-754, New 7/04