Area Light Service Contract - Service Form

Fill out the form below online or click here to download the form

** If you choose to download the form, please fill out, scan and send to engineeringservices@missionvalleypower.org

Service Loc.

Meter No.(Required)

Stop No.

Account No.

Location No.

Work Order No.

The undersigned, The undersigned,

whose mailing address

and telephone number are(Required)

, and whose Social Security Number or Business ID Number is

hereby agrees to enter into a contract with Mission Valley Power (“MVP”) on the following terms and conditions.

1. Applicant certifies that he/she is the ______(Owner/Lessee/Renter, Etc.)_____ of property located at

(physical address)

2. Security Deposit:

Deposit Transferred from Location Number

Credit Reference History:

3. General Connect/Transfer Fee or Reconnect Fee: $10.00, to be billed on first month’s bill.

4. Rate Schedule.

(a) Existing Area/Security Light

LED (with) (w/o) pole

Monthly Rate
$10.05

Total Monthly Charge

(b) New Area/Security Light Installed with new Pole
Customer is responsible for actual cost of new pole.
Customer agrees to pay for area/security lighting service for a minimum period of three (3) years at the monthly rate specified above.

Special Terms and Conditions

Where more than 150 feet of extension and/or one pole per unit are required, the customer will make a non-refundable contribution for the coverage at actual cost to Mission Valley Power. Ownership of all facilities remains with MVP.
The original term of contract shall be not less than three years. Should termination be requested by the customer within the contract minimum period, he/she shall be liable for the in and out costs, or the balance of the contract charges, whichever is the lesser.

5. Aid-to-Construction*:

Total

UG Area Light Installation Fee

Other

Total

*Special Note: MVP does not offer any aid-to-construction for a new pole for an Area/Security light. Customer is responsible for actual cost of new pole.

The Applicant consents to be bound by all of the terms, conditions, fees and charges set forth above, by all provisions contained in MVP’s Operations Manual and federal regulations found at 25 C.F.R. Part 175 (including any revisions to the manual or regulations), and by applicable rate and fee schedules (that may change from time to time) available for review at MVP’s Pablo office.

Applicant’s Name:

Applicant’s Signature

Date

Applicant’s Signature

Date

Name of Business:

By: (Officer of Business)

Date

Signature of Business Officer (Authorized to Contract on Behalf of Business)

The Confederated Salish and Kootenai Tribes operate and manage the Bureau of Indian Affairs’ Flathead Agency Power division under the name “Mission Valley Power” pursuant to a contract authorized under the Indian Education and Self-Determination Act (25 U.S.C. 450f). MVP maintains its system records consistent with the federal Privacy Act (43 CFR Part 2, Subpart D). This information is being collected to determine the consumers’ electrical needs and will be used to determine consumption costs. Response to this request is required to obtain a benefit in accordance with 25 CFR 175. Failure to provide all or part of this information may preclude MVP from providing requested service(s).

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Area Light Service Contract - Service Form

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