ࡱ> bea  bjbj88 .JRR4 P P 8es,sTZ(   ZZZZZZZ$y\+_8ZO"  O"O"8ZMZw%w%w%O"FYw%O"Zw%w%*RpVzb"FUL~YcZ0ZU_"B_V_V vTw%D8   8Z8Z$Z   ZS~!O"_         P p: FORM OF GAS TRANSPORTATION SERVICE REQUEST Date of Request: _____________________________________________ Complete Legal Name of Shipper: ________________________________ Mailing Address: Street Address: __________________________ _____________________ __________________________ _____________________ __________________________ _____________________ Type of Legal Entity and State of Incorporation: __________________________________________________________ 5. Type of Company: (check as appropriate) _____ Local Distribution Company _____ Marketer _____ Intrastate Pipeline _____ End-user _____ Interstate Pipeline _____ Other 6. Name of person completing request, address, email address, and telephone numbers to be used in corresponding: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ Name, email address, and telephone numbers of 24-hour contact person for gas flow and other communications: ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ 8. Are additional or new facilities required to receive or deliver gas for the transportation service requested herein? Yes _____ No ______ 9. Name, email address, fax & telephone numbers and full title of Officer (or General Partner) of Shipper who will execute the written transportation agreement with Transporter. _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Type of service requested: _____Firm Maximum Daily Quantity (MDQ): ___________ Dth _____Interruptible Maximum Daily Quantity (MDQ): ___________ Dth Receipt Point(s): (Attach additional sheet if necessary.) Name Quantity _____________________________________________________ _____________________________________________________ Total: _______ Dth/d Delivery Point(s): (Attach additional sheet if necessary.) Name Quantity _____________________________________________________ _____________________________________________________ Total: ________ Dth/d Rate: Negotiated $_______ Maximum $________ Other (please specify)______ Term: Date service is to commence: _______________________________ Date service is to terminate: ________________________________ 15. Is Shipper an affiliate of Transporter? Yes _____ No ______ 16. Shipper shall provide certification that Shipper has title to or the legal right to cause gas to be tendered to Transporter. 17. Transporter reserves the right to require a cash deposit to guarantee payment of current bills in accordance with the Commissions Rules and Regulations. SHIPPERS PLEASE NOTE: (1) Shipper understands that this request form, complete and unrevised as to format, must be received by Transporter before the transportation request will be accepted and processed. (2) Transporter will commence Firm gas transportation service as soon as is practicable after it determines that it has such capacity, subject to the terms and conditions of Transporters Operating Statement on file with the FERC. Shipper shall submit to Transporter a revised Request for Gas Transportation Service any time Shipper desires to change its Maximum Daily Contact Quantity. The Request for Service will either be approved or denied, by Transporter within sixty (60) days of the receipt thereof. If denied, written notification will be provided to Shipper detailing the reasons for denial, as well as an explanation of what changes would be necessary to enable Transporter to provide the requested service, as well as any additional charges therefore. (3) Shipper, by its signature represents to Transporter that the information above is correct and accurate, and that all necessary transportation arrangements with the upstream and downstream transporters have been or will be secured prior to the commencement of the requested transportation service. (4) Information included in any transportation request form may be subject to review by the FERC or the Colorado PUC. Submit signed completed form to: Public Service Company of Colorado Natural Gas Services 1800 Larimer St., Suite 500 Denver, CO 80202 Acceptance of a service request is contingent upon a satisfactory credit appraisal by Transporter. Shipper must provide evidence of creditworthiness as outlined in Section 19 of this Operating Statement of Operating Conditions. By submitting this request, Shipper certifies further that it will execute, if tendered by Transporter, a Gas Transportation Service Agreement for the level of service requested herein. THIS SERVICE REQUEST IS HEREBY SUBMITTED THIS ___ DAY OF ______________, _____. By _________________________________________________ Title ________________________________________________ Telephone number (____) _______________________________ Shipper ______________________________________________ (For Public Service Company of Colorado use only) Date Received: ________________ Approved: ____________________ Denied: ______________________ By: __________________________ (Transporter Name) Title: _________________________ Date: _________________________     Page  PAGE 4 of  NUMPAGES 4 +,kl  / 0 > ? 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