BATTERY HOST SITE INTAKE FORM / /

Your property atEnter Name/Address -AND- Borough of Host Sitehas been identified as a potential host site for a battery energy storage system under a Con Edison demonstration project through Governor Cuomo’s Reforming the Energy Vision (REV) program.

GI Energy Contact
Name / Enter First & Last Name /
Title / Enter Title /
Office Phone / Enter Office (###) ###-#### /
Cell Phone / Enter Cell (###) ###-#### /
Email / Enter /
Address / Enter # Street, Suite #
City, State & ZIP /

If selected, you would be compensated through a regularlease payment. GI Energy is serving as project developer[1] and will be your primary point of contact.A GI Energy project representativemay have already reached out to you to review this form and certain project FAQs.Please complete and signthis form to have your property assessed as a potential host site, and to authorize GI Energy to receive required energy information about the property from Con Edison.

Host Site Contact Information
Primary Contact / Additional Contact(please provide in event primary is unavailable)
Name / Enter First & Last Name / Name / Enter First & Last Name /
Company / Enter Company / Company / Enter Company /
Title / Enter Title / Title / Enter Title /
Office Phone / Enter Office Phone (###) ###-#### / Office Phone / Enter Office Phone (###) ###-#### /
Cell Phone / Enter Cell Phone (###) ###-#### / Cell Phone / Enter Cell Phone (###) ###-#### /
Email / Enter Work Email Address / Email / Enter Work Email Address /
Mailing Address / Enter # Street, Suite/Apt. #
Town/City, State & ZIP / Mailing Address / Enter # Street, Suite/Apt. #
Town/City, State & ZIP /
Host Site Property Information
Address Information / For your Block and Lot, please see the NYC Borough-Block-Lot (BBL) Lookup tool.
Street Number / Enter Street Number Used by US Postal Service / Block / Enter Block # From NYC BBL Lookup Tool /
Street Name / Enter Street Name Used by US Postal Service / Lot / Enter Lot # From NYC BBL Lookup Tool /
Neighborhood / Enter Neighborhood (e.g. Greenpoint, Flushing, etc.) / For your Zoning Designation, please see the NYC Zoning and Land Use Application (ZOLA) tool.
Borough / Enter Borough / Zoning Designation / Enter Zoning Designation From NYC ZOLA Tool /
State / Enter Two-Letter State Abbreviation (e.g. NY) / For your Property Tax Class, please see latest property tax bill using the NYC Dept. of Finance NYCProperty tool.
Zip Code / Enter Zip Code / Property Tax Class / Enter Property Tax Class From Latest Tax Bill /
Host Site Electric Account Information
Please refer to latest Con Edisonelectric bill(s). Host Siteswith more than four (4) accounts must fill in a 2nd form. / For your Building Identification Number (BIN), please see the NYC DOB Buildings Information tool.
15-Digit Con Edison Electric Acct. # / Name on Account Bills / “Service Delivered To” Address on Account Bills / 7-Digit NYC DOB BIN
Enter Acct. # (##-####-####-####-#) / Name on Account at Left / Enter “Service Delivered To” Address From Bill / Enter BIN (#######) /
Enter Acct. # (##-####-####-####-#) / Name on Account at Left / Enter “Service Delivered To” Address From Bill / Enter BIN (#######) /
Enter Acct. # (##-####-####-####-#) / Name on Account at Left / Enter “Service Delivered To” Address From Bill / Enter BIN (#######) /
Enter Acct. # (##-####-####-####-#) / Name on Account at Left / Enter “Service Delivered To” Address From Bill / Enter BIN (#######) /
Host Site Leasing Information
Do you have at least 1,200 s.f. (L 40’ x W 30’ x H 15’) of ground-level outdoor space available for lease? (Yes/No) / Enter YES or NO
Add Brief Description As Needed /
Asking lease rate for ground-level outdoor space ($/s.f./y)? / Enter Your Most Competitive$/s.f./y (NOTE: This Is A Major Selection Criterion) /
Eligible for at least 66-monthlease term? (Yes/No) / Enter YES or NO /
If not 66-month term, what is preferable term? / Enter Preferable Term (in Months) or “No Preference” /
What are lease renewal options at end of term? (e.g. 12-month renewed annually, 60-month renewal, etc.?) / Enter Lease Renewal Options
Add Brief Description As Needed /
Host Site Permitting/Environmental/Legal Dispute Information
Does the site contain any known contamination or environmental hazards limiting land uses such as new construction or redevelopment? / Enter YES or NO
Add Brief Description As Needed
Details Can Be Addressed By Phone or During Site Visit
Has the site been subject to any NYC DEP, NYS DEC, US EPA or other environmental or health investigations, violations or cleanup efforts? / Enter YES or NO
Add Brief Description As Needed
Details Can Be Addressed By Phone or During Site Visit
Has the site been subject to any other legal disputes or code violations? / Enter YES or NO
Add Brief Description As Needed
Energy Data Release Authorization
The undersigned certifies thathe or she is an authorized agent of the Host Site listed above, and hereby authorizes GI Energy to receive information on all Con Edison electric accounts listed above, limited to historical interval data, site drawings, access to Customer Care and other like data and documentation, as required to fulfill the obligations of NYS PSC Case 14-M-0101. When submitting this form, please include a PDF copy (ALL PAGES) of the most recent Con Edison electric bills for ALL accounts serving the Host Site.
Signature / / FIRST, HIT SAVE. Then click icon at left to insert signature image (e.g. PNG, JPG, GIF) from local drive or server. Resize to fit. Convert form to PDF for submission. /
Printed Name / Enter First & Last Name (Must Match Signature Above) /
Title / Enter Title /
Organization (Relationship to Host Site) / Enter Organization (Relationship to Host Site in Parens, e.g. Property Owner, Property Manager, etc.) /
Date (MM/DD/YYYY) / Click Here to Select Date From Drop-down Menu /

All information provided here is strictly confidential. It will not be used for any purpose other than host site assessment for the battery demonstration project as described in NYS PSC Case 14-M-0101.Submission of this form does not obligate any party—Con Edison, GI Energy, property owner(s) or property representative(s)—to any further participation or interaction with regard to this battery demonstration project. If your property is selected for further analysis, GI Energy may contact you for follow-up information.Authorized energy data forCon Edison accountslisted above will be accessible by GI Energy unless and until the customer or its successor delivers to Con Edison a signed written letter revoking the authorization granted hereby at the following address: Con Edison Energy Efficiency and Demand Management Department, 4 Irving Place - 10th Floor, New York, NY 10003, Attention: Department Manager.

GI Energy-Con Edison REV Demo Project – Battery Host Site Intake Form Rev. 5/7/17 – FOR DISTRIBUTION TO HOST SITES

[1] As approved by the New York State Public Service Commission (NYS PSC). For details, please see NYS PSC Case 14-M-0101, Matter 14-00581 at