New Construction Electric Service Agreement Instructions for Electric Service Applicants This form is for service that requires construction of a powerline to a location. Scroll down to fill out this form. For service to an existing service location, click here. Complete this form, read and sign the Electric Service Agreement at the bottom, then submit the form by clicking the "Submit Form" button at bottom. You will need to provide a copy of the recorded landowner's deed and pay a non-refundable $100 engineering fee before the application can be processed. You will receive an email with instructions once you submit your application. Member Information *Member/Legal Business Name: *Primary Phone: *Is the primary a mobile phone?: Yes No Secondary Phone: Is the secondary a mobile phone?: Yes No Please note that by providing your cell phone number, you are giving the cooperative permission to text you about important, account-related information (outages, balance due, etc.) and in emergency situations. *Email: *Preferred Method of Communication: Phone Email Text Service Location *Physical Address: *City: *Zip Code: *Location inside the city limits?: Yes No *County: Atascosa Brooks Dimmit Duval Edwards Frio Jim Hogg Kinney LaSalle McMullen Medina Real Starr Uvalde Webb Zapata Zavala If located in Dimmit, Kinney, LaSalle, Starr, Webb, or Zavala counties: A Certificate of Compliance must be on file before your application can be processed. You can obtain your Certificate by contacting the appropriate county planning department. If the location is in the city limits for any of the above counties, city permits may also be required. Subdivision: Lot: Gate Code: GPS Coordinates: Billing Address The Billing Address is the same as the Service Address. *Billing Address: *Billing City: *Billing State: Billing Zip Code: Membership Information *Are you an existing member of Medina EC?: Yes No If you are an existing member, provide your current Member Number: Member Number: If you are not a current Member, there will be a $5.00 Membership Fee required. Entity Type Select appropriate type to determine eligibility and type of membership in the Cooperative. *Select Appropriate Entity Type: Individual/Sole Proprietor/Single Member LLC Multiple-member LLC C Corporation S Corporation Partnership Trust Unincorporated Association Joint Venture Governmental Agency Other If Other is selected above, please explain: *Complete Applicable Information: Your social security number will be used to verify your identity and to determine your deposit requirements. If you choose not to provide your SSN, a government-issued photo ID must be presented in person. Social Security Number: Driver's License Number: Driver's License State: Federal Tax ID Number is required if member is a business. Federal Tax ID Number: Joint Membership Individuals joined in a legally recognized partnership are eligible for joint membership. Relationships may include husband and wife, parent and child, and siblings who are joint owners. See Section 2.6 of Bylaws for further direction of Joint Membership.If you would like a joint membership then provide information about the second member below. Joint Member Name: Joint Member Social Security Number: Joint Member Driver's License Number: Joint Member Driver's License State: Deposit Requirements A deposit may be required. Your utility credit check may be used to determine deposit requirements. This will not affect your existing credit score. All accounts with an unsatisfactory credit check will require a deposit, and staff will let you know what your options are once they process your application. A non-refundable $100 engineering fee is due before a site visit can be set up to stake your job. You will receive an email or call with information on how to pay that fee. Additional Information *Enroll in Operation Round Up?: Yes No *Select your Preferred Billing Cycle: 1 (Due 21st) 2 (Due 28th) 3 (Due 7th) 4 (Due 14th) 5 (Prepaid Electricity) Predominant Use of Electricity *Select Predominant Use of Electricity: Residential Farm or Ranch Business Commercial or Industrial Other For Residential, Complete this Section. Residential Type: Primary Residence Occupied Full Time Weekend/Vacation Home Other Personal Residential Use For Other Personal Residential Use, indicate use. Example: residential water well, personal shed, personal hunting cabin, gate, etc. Other Residential Use: A $1,800 construction credit is available for a permanent residence. To qualify for the credit, prior to the site visit the location must have: adequate water supply, a connection to wastewater facilities, and the home must be constructed or placed on a permanent foundation. If it is a mobile home, all wheels, axles and hitch must be removed. For Farm or Ranch Business, Complete this Section. Type of Farm or Ranch Use: Irrigation Pivot Stock Water Well Farm Building Other Farm Use If Irrigation, Pivot or Water Well then indicate HP: If Farm Building, indicate use: If Other Farm Use, indicate use: For Commercial or Industrial Use, Complete this Section. Indicate type of Commercial Use. Example: office, pump jack, manufacturing plant, etc. Commercial Use: For Other Use, complete this section. Indicate Other Use. For example church, school, cemetery, etc. Other Use: For Residential Accounts only, please indicate your Ethnic Code (for federal reporting purposes). Ethnic Code: American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Two or More Races Does your account need to be placed on the Life Support Registry? Account on Life Support Registry?: Yes No Physician's note required. Information and form are located here. It is the applicant's responsibility to obtain and submit the appropriate documentation. Without all forms, your account will not be placed on the registry. New Construction Information Metering requirements vary based on type of service. You should provide a suitable and easily accessible location including: (1) sufficient and proper space for installation of meters and other apparatus of the Cooperative, (2) meter loop, (3) safety service switches when required and (4) an adequate anchor for service drops. We recommend you use a licensed electrician for the installation of the meter loop. Wiring specifications may be found here. Construction Details *Type of Construction: New Construction Relocate *Main Disconnect (Amps) New: Main Disconnect (Amps) Existing: If primary meter, enter PME. New Meter Location: Meter Pole Main Residence or Building If available, provide New Meter GPS Coordinates. GPS Coordinates: Please indicate if you need temporary power during construction. Need temporary power: Yes No If you need temporary power, describe needs and location: For your convenience, Medina EC sells 200 amp meter loops for $680-780* plus applicable taxes. If you would like more information about purchasing your meter loop from the cooperative, indicate here or discuss it with the line designer during the site visit to your location. *Pricing is determined by the size of meter pole and is subject to change without notice. Do you want info on a meter loop?: Yes No Do you want info on a security light?: Yes No Service Voltage and Main Disconnect Size Primary: Overhead Underground Secondary: Overhead Underground Secondary Voltage: 120/240 1 Phase 3 Wire 240/480 1 Phase 3 Wire 120/208 3 Phase 4 Wire Wye 277/480 3 Phase 4 Wire Wye Note:120/208 3 Phase 4 Wire Wye - Service is limited to 100kVA transformer on the pole.277/480 3 Phase 4 Wire Wye - Service is limited to three (3) 100kVA transformers on the pole. Electrician Information Electrician/Engineer Name: Phone Number: Email Address: License Number: Residential Facility Information Select a Facility and provide, below, the information indicated in parenthesis for the facility chosen. For example, if House is selected then provide the number of square feet and the number of rooms. Facility: House (square feet, number of rooms) Mobile Home (square feet) Travel Trailer (length) Hunting Cabin (square feet) Residential Water Well Other Personal Residential Use (description) Facility Details: Are other facilities connected to the meter? (ie. pool, barn, outside lighting, etc.) If so, then describe in the text box below. Residential - Other Facilities: For Irrigation Accounts In the Irrigation Motor text box below, provide information about electric motors. For each type of motor used, indicate 1 or 3 phase, horsepower and quantity. For example: 1 phase 2.5 HP Qty 5 3 phase 5.0 HP Qty 3 Irrigation Motor Information: For Commercial Business Hours of Operation per Day: Building Size (sq. ft.): Information on Structure and/or Connected Load: For Oil & Gas In the Oil and Gas Load text box below, provide detailed load breakdown. For example: Pump Jack -3- 50HP each, OR Pump Jack -3- 37.3kVa each. Oil & Gas Load Information: Upload Documents A recorded landowner's deed is required. You can provide it with your application here, or you can provide it later. The application cannot be scheduled for construction until the deed is provided, so we recommend that you provide it as soon as possible. Recorded landowner's deed: A Certificate of Compliance is required for Dimmit, Kinney, LaSalle, Starr, Webb and Zavala counties. You can obtain your Certificate by contacting the appropriate county planning department. If the location is within the city limits for any of the above listed counties, city permits may also be required. Certificate of Compliance: THIS AGREEMENT ("Agreement") is between Medina Electric Cooperative, Inc. ("Seller"), a Texas electric cooperative corporation, and the undersigned ("Member"). Seller and Member are collectively referred to as the "Parties" and each individually as a "Party." Capitalized words are defined terms. If not found in the document below, their definitions can be found in the cooperative's Tariff or Bylaws. In consideration of compensation to be paid by Member to Seller hereunder, and the mutual covenants, agreements and obligations of the parties hereinafter set forth, the undersigned Parties agree as follows: 1. SERVICE. Seller shall use reasonable diligence to provide electric energy service to the Member's Service Location at the particular point where electric energy first leaves the line or equipment owned by the Seller and enters the Member's service entrance conductors. When electric energy becomes available, the Member will purchase all electric energy required to be used at the Service Location from Seller and use such electric energy exclusively for the operation of Member's equipment. Seller may limit the amount of electric energy to be furnished, as indicated in the Service Rules and Regulations of the Seller. Member understands that the voltage and frequency of electric energy provided may vary within the standards set forth in the Seller's Service Rules and Regulations. Nothing contained herein shall prohibit the Member from safely using electric energy generated by Member owned energy resources (e.g. solar). 2. RATES. Member shall pay for electric service in accordance with the Seller's standard tariff schedules in effect for like conditions of service to the class of service furnished hereunder. If Member's service is misclassified, whether because of misrepresentation of the facts or otherwise, Seller reserves the right to apply the correct rate schedule and adjust prior and future billings accordingly, and to take other action which may include requiring the Member to make a cash contribution in aid of construction for facilities. If any tariff or rate is changed by the Seller, or by order or consent of any regulatory authority having a jurisdiction thereof whether or not at the request of the Seller, such changed tariff, rate or redefined class of service shall be applicable to service provided hereunder from and after the effective date of such change. Member shall pay a minimum charge each month for having service available irrespective of whether or not any energy is actually used. Irrigation account yearly minimums will be billed and paid in equal monthly installments. 3. BILLING AND PAYMENT. Periodically, Seller will render to the Member a statement for services rendered. The Member shall pay the total amount shown on such statement within sixteen (16) days from its date. Payment may be made to Seller in person, electronically or by mail at the offices of the Seller. The initial monthly billing period shall start when power is made available to the customer. 4. BREACH. A Party breaches this Agreement by failing or refusing to perform a material obligation. 4.1 Discontinuance of Service. Seller may discontinue service if the Member has breached any portion of this Agreement by failure to make timely payment or failure or refusal to perform any of Member's obligations, and the Seller has given the Member notice, if required, in accordance with the service rules and regulations of the Seller regarding Discontinuance of Service, as they are now or may hereafter be amended. Member hereby waives any and all damages which result as a consequence of such discontinuance of service. Seller shall not be liable for any damages of any kind or character resulting from discontinuance or disconnection made pursuant to Seller's rules governing discontinuance of service. 4.2 Other Legal Remedies. At Seller's option, if Member becomes delinquent in the payment of his or her account, Seller may declare the remaining minimum amount for the remaining term of this Agreement due and may exercise legal action in a court of competent jurisdiction to obtain judgment or other legal or equitable relief. If Seller hires an attorney for collection of Member's account, Member agrees to pay all reasonable attorney's fees and collection expenses incurred in such matter. 5. MEMBERSHIP AND MEMBER'S INSTALLATION. Member shall pay the membership fee, take any action that may be required to qualify as a member, comply with and be bound by the provisions of the Seller's Articles of Incorporation and by-laws as well as Seller's rules and regulations as may from time to time be adopted by the Seller. The electric service contracted for herein is to be provided and taken in accordance with the provisions of this Agreement, and the Seller's service rules, regulations and tariffs, including any and all amendments that may hereafter be approved or ordered. SAID SERVICE RULES, REGULATIONS AND TARIFFS ARE A PART OF THIS AGREEMENT TO THE SAME EXTENT AS IF FULLY SET OUT HEREIN AND ARE ON FILE AND AVAILABLE AT THE SELLER'S OFFICE IN HONDO, TEXAS. Member warrants that his or her installation at the Service Location (including all conductors, switches, equipment, wiring and protective devices of any kind or character) is constructed in accordance with the National Electrical Safety Code of the American Standards Association, as well as, applicable laws, ordinances, and Seller's wiring specifications. Member also warrants that Member's installation will be maintained in such a manner as to conform to such standards. 6. EASEMENTS AND RIGHT OF ACCESS. Member shall grant or secure for the Seller, at the Member's expense, any rights of way on property owned or controlled by the Member and to provide suitable space on such premises for installation of facilities where such rights of way and space are necessary to provide electric service to the Member. The Seller's representatives, employees and assigns are hereby granted rights of ingress and egress to the Member's premises at all reasonable times for the purpose of inspection of facilities, providing service, and in order to carry out the provisions thereof, together with the right of ingress and egress over Member's adjacent lands to or from said right of way for the purpose of constructing, improving, reconstructing, repairing, inspecting, patrolling, maintaining, and removing said power line and appurtenances; the right to relocate said line in the same relative position to any adjacent road if and as widened in the future; the right to trim or cut down trees or shrubbery to the extent necessary to prevent possible interference within the operation of said line or to remove possible hazard thereto, and the right to remove, or to prevent the construction of, for a distance of twenty (20) feet on each side of the actual center of said line, any or all buildings, structures or other obstructions which may endanger or interfere with the efficiency, safety or convenient operation of said line and its appurtenances. If such buildings, structures or other obstructions are constructed by the Member within the forty (40) foot space described above without prior written consent of the Seller, then the Seller shall have the right to remove same from such space and Member agrees to pay the Seller the reasonable cost of such removal, and this Agreement, together with other provisions of this grant, shall constitute a covenant running with the land for the benefit of the Seller, its successors and assigns. Failure to provide unrestricted access for the above purposes shall be cause for discontinuance of service. 7. CONTINUITY OF SERVICE. Seller shall use reasonable diligence to provide constant and uninterrupted electric power, however, if electric power or service should fail or be interrupted, or become defective, or be reduced through an act of God, governmental authority, action of the elements, public enemy, terrorism, accident, strikes or labor trouble, maintenance, repair or upgrading work, or any cause beyond the reasonable control of the Seller, the Seller shall not be liable under the provisions of this Agreement. 8. LATE PAYMENT CHARGE. In the event Member fails to pay Seller's monthly billing when due, said bill will become delinquent and a 5% late payment fee will apply. 9. TERM OF AGREEMENT. Upon acceptance by the Seller, this document shall constitute an agreement between the Member and the Seller. The initial term shall be one year from the date service is made available if Member is given a line extension credit, or one month if no line extension credit is given. After the initial term, this Agreement shall remain in effect until terminated by either Party in accordance with the Seller's service rules and regulations. Termination shall not relieve Member of any obligation to Seller arising before termination. 10. NOTICES. All notices required to be given under the terms and provisions of this Agreement may be given by mailing such notice to the other Party by United States mail addressed to the Party at the Party's last known mailing address. The notice shall bear the dates of its mailing, and shall be effective on and after such date. 11. EFFECTIVE DATE. Not-withstanding anything contained herein, this Agreement shall not become effective and is not binding until executed by the Seller and the Member. 12. WAIVER. No waiver, expressed or implied, to any breach of any one of the covenants or agreements hereof shall be deemed to be a waiver of any subsequent breach. Failure of Seller to discontinue service shall not constitute a waiver of Seller's right to discontinue service. Each day Member fails to pay Seller's invoice after payment is due shall constitute a separate breach of this Agreement. 13. ASSIGNMENT. This Agreement shall not be assigned by the Member, except in accordance with the Articles, Bylaws, and rules and regulations of the Seller. This Agreement shall inure the benefit of the Seller's successors and assigns. 14. METER TAMPERING. In the event the Seller reasonably determines that its meter or equipment has been tampered with or bypassed, Seller may disconnect service and/or estimate electric energy consumed. The Member agrees to pay any statement or statements reflecting the highest estimated usage of electricity by the Member for the longest period of time such tampering or bypassing may have continued plus all labor, material and equipment necessary to repair or replace damaged facilities. A minimum charge for meter tampering is established in the Seller's tariffs and will be assessed. 15. DISCLAIMER OF WARRANTIES. SELLER MAKES NO WARRANTIES WHATSOEVER WITH REGARD TO THE PROVISION OF ELECTRIC DISTRIBUTION SERVICE AND DISCLAIMS ANY AND ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, NOTWITHSTANDING ANY COURSE OF PERFORMANCE OR USAGE OR TRADE, OR LACK THEREOF, THAT MAY BE INCONSISTENT WITH THIS SECTION. 16. MEMBER INDEMNITY - INTERFERENCE WITH CONTRACT. Member warrants that the negotiation, execution or performance of the Agreement does not breach any of Member's other contracts and is not prohibited by any of Member's other contracts, and that there is not any other supplier of Member with a contractual right to supply electrical distribution service to the Service Location at the time this Agreement is executed. 17. ENTIRE AGREEMENT, MODIFICATION, SEVERABILITY, INTERSTATE OPERATIONS, LAW GOVERNING: 17.1 Entire Agreement. This Agreement constitutes the entire agreement and understanding between the parties respecting construction of electric utility facilities and distribution (wires) service to the Member's Premises. There are no prior agreements or understandings between the parties respecting the electric service described herein. Seller, its agents and employees have made no representations, promises, or made any inducements, written or verbal, which are not contained herein. The Parties are not bound by or liable for any statement, representation, promise, inducement, understanding, or undertaking of any kind or nature (whether written or oral) with regard to the subject matter hereof not set forth or provided for herein. Member agrees that it is not relying on any statement not herein contained. This Agreement replaces allprior agreements and undertakings, oral or written, between the Parties with regard to the subject matter hereof. It is expressly acknowledged that the Parties may have other agreements covering other services not expressly provided for herein, which agreements are unaffected by this Agreement. 17.2 Modification in Writing. This Agreement may be amended only upon mutual agreement of the Parties, which amendment will not be effective until reduced to writing and executed by the Parties. 17.3 Severability. If any provision of this Agreement is determined to be void, unenforceable, or in violation of law, such provision shall be severed from this Agreement and the remaining provisions of this Agreement shall continue to be binding on the parties. 17.4 Intrastate Operations. Member will not take any action that would cause the Seller,which is not a "public utility" under the Federal Power Act, to become a "public utility" under the Federal Power Act or become subject to the plenary jurisdiction of the Federal Energy Regulatory Commission. It is understood and agreed that taking such an action shall give the Seller the right to immediately disconnect from Member's Facilities and discontinue provision of service. 17.5 Texas Law. This Agreement was executed in the State of Texas and shall be governed by, interpreted, construed, and enforced in accordance with the laws thereof, without regard to conflict of law principles. The provisions and obligations of this Agreement are performable in Medina County, Texas such that exclusive venue for any action arising out of this agreement shall be in Medina County, Texas. This Agreement is subject to all valid, applicable federal, state, and local laws, ordinances and rules and regulations of duly constituted regulatory authorities having jurisdiction. 18. VENUE. It is further understood and agreed between Seller and Member that venue of any and all litigation arising out of any breaches of the provisions of this Agreement shall be in Medina County, Texas. 19. DEPOSIT. Member may be required to make a deposit to secure payment for electric service. Amount will depend on credit check and type of service. 20. CONTRIBUTION IN AID OF CONSTRUCTION. Member will pay to Seller a non-refundable contribution in aid of construction, if applicable. This amount will be the basis for determining a reimbursement for a Qualifying Facility, per the Seller's tariff. For Qualifying Facilities, Member will pay a reimbursement for extension of service in accordance with the Seller's tariff. 21. AUTHORITY. Member represents and warrants that each representative of Member executing this Agreement is duly authorized to do so. By executing below, the natural person(s) who executes this Agreement on behalf of Member represents and warrants that he or she has the authority to bind said entity. Click here to draw your signature. Member Signature With your mouse, draw your signature. Then click Finish. Click here to draw your signature. Joint Member Signature With your mouse, draw your signature. Then click Finish. Date: (MM/DD/YYYY) Click here to draw your signature. Commercial / Corporate Signature Authority With your mouse, draw your signature. Then click Finish. Name of Person Signing: Commercial/Corporate Title: Date: (MM/DD/YYYY)If Commercial / Corporate signature is other than President, Vice President, Partner, or Owner, proof of signature authority may be required.