Approved Agreements and Contracts 2024-01-09 Arena Solar Interconnect Agreement

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DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


                                 GENERATOR INTERCONNECTION AND OPERATING
                                    AGREEMENT FOR PROJECTS UP TO 550 kW




    This Generator Interconnection and Operating Agreement (“Agreement”) is entered into on 1/24/2024 | 9:28 AM EST
    by Consumers Energy Company (the “Utility”), City of Muskegon (the “Interconnection Customer”), and (if
    applicable under Section 5)        (the “Property Owner”). Utility and Interconnection Customer are sometimes
    also referred to in this Agreement collectively as “Parties” or individually as “Party.” Interconnection Customer
    shall be the “Applicant” as used in and for purposes of the applicable Consumers Energy Company Generator
    Interconnection Procedures (“Interconnection Procedures”).

                                                             I. RECITALS

    A. Interconnection Customer is an electric service customer of Utility in good standing and has submitted a
       Generator Interconnection Application (“Application”) to Utility.

    B. Interconnection Customer desires to interconnect an electric generating facility with a maximum capacity
       of 550 kilowatts (“kW”) or less (the “Customer Facility”) with Utility’s electric distribution system and operate
       the Customer Facility in parallel with Utility’s distribution system, under Consumers Energy Company’s
       Interconnection Procedures for Level 1, 2, and 3 projects, as defined in the Michigan Public Service
       Commission’s (“Commission”) Interconnection and Distributed Generation Standards (the “Standards”), as
       applicable.

    C. For purposes of this Agreement, “interconnect” means establishing a connection between a non-utility
       generating resource (in this case, the Customer Facility) and Utility’s distribution system. “Operate in parallel”
       means generating electricity from a non-utility resource (in this case, the Customer Facility) that is connected
       to Utility’s system. In all cases, terms shall have the meaning as defined in the Standards or in the
       Interconnection Procedures.

    D. Interconnection of the Customer Facility with Utility’s distribution system is subject to this Agreement, the
       Application, the Interconnection Procedures, the Standards and utility tariffs approved by the MPSC, as
       applicable.

    E. This Agreement does not address any purchase or sale of electricity between Utility and Interconnection
       Customer nor does it create any agency, partnership, joint venture or other business arrangement between
       or among Utility, Interconnection Customer and/or Property Owner.




      Form 1216 8-2023                                                                                       Page 1 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


                                                        II. AGREEMENT

    NOW THEREFORE, in consideration of the above recitals, the mutual covenants contained herein and for good
    and valuable consideration, the Parties agree as follows:

     1. Description of Customer Facility
         1.1   The Customer Facility must be built as described in Exhibit 1, which shall not be changed without thirty
               (30) days advance written notice to Utility according to the notice requirements herein and as depicted
               in Exhibit 2 – Interconnection Diagram.


     2. Interconnection Facilities
         If it is necessary for Utility to install certain interconnection facilities (“Interconnection Facilities”) and make
         certain system modifications in order to establish an interconnection between the Customer Facility and
         Utility’s distribution system, the Interconnection Facilities and modifications shall be described to the
         Interconnection Customer in Exhibit 3 – Interconnection Facilities Scope of Construction.

     3. Design Requirements, Testing and Maintenance of Customer Facility
         3.1   Interconnection Customer shall be responsible for the design and installation of the Customer Facility
               and obtaining and maintaining any required governmental authorizations and/or permits, which may
               include, but shall not be limited to, easements to clear trees, and necessary rights-of-way for installation
               and maintenance of the Utility Interconnection Facilities.

         3.2   Interconnection Customer shall, at its sole expense, install and properly maintain protective equipment
               and devices to protect its equipment and service, and the equipment and system of Utility, from
               damage, injury or interruptions, and will assume any loss, liability or damage to the Customer Facility
               caused by lack of or failure of such protection. Such protective equipment specifications and design
               shall be consistent with the applicable Interconnection Procedures. Prior to the Customer Facility
               operating in parallel with Utility distribution system, Interconnection Customer shall provide satisfactory
               evidence to Utility that it has met the Interconnection Procedures, including but not limited to the
               receipt of approval from the local building/electrical code inspector. The Utility’s approval, or failure
               to approve, under this section shall in no way act as a waiver or otherwise relieve the Interconnection
               Customer of its obligations under this section.

         3.3   At its own expense, Interconnection Customer shall perform operational testing at least five (5) days
               prior to the installation of any Interconnection Facilities by Utility. Utility may but is not required to send
               qualified personnel to the Customer Facility to inspect the facility and observe the testing. Upon
               completion of such testing and inspection, and prior to interconnection, Interconnection Customer
               shall provide Utility with a written report explaining all test results, including a copy of the generator
               commissioning test report.

               As required by Utility, Interconnection Customer shall test protective equipment in accordance with
               manufacturer’s specifications, unless no testing interval is provided, in which case testing shall occur
               every four years (unless an extension is agreed to by Utility) to verify the calibration indicated on the
               latest setting document issued by Utility. The results of such tests shall be provided to Utility in writing for
               review and approval. Utility may, at any time and at its sole expense, inspect and test the Customer
               Facility to verify that the required protective equipment is in service, properly maintained, and
               calibrated to provide the intended protection. This inspection may also include a review of
               Interconnection Customer's pertinent records. Inspection, testing and/or approval by Utility or the
               omission of any inspection, testing and/or approval by Utility pursuant to this Agreement shall not relieve
               the Interconnection Customer of any obligations or responsibility assumed under this Agreement.

         3.4   Interconnection Customer shall operate and maintain the Customer Facility in a safe and prudent
               manner and in conformance with all applicable laws and regulations. Interconnection Customer shall
               obtain or maintain any governmental authorizations and permits required for construction and
               operation of the Customer Facility.

      Form 1216 8-2023                                                                                             Page 2 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


           3.5   Interconnection Customer shall cooperate with Utility to regulate the voltage level at the Point of
                 Delivery by controlling its generators in accordance with Utility's instructions. Such instructions shall
                 include, but not be limited to, (a) maintaining voltage or (b) delivering real and reactive power to the
                 Point of Delivery at levels specified by Utility. Interconnection Customer shall cooperate with Utility to
                 regulate the frequency by controlling its generators in accordance with Utility's instructions. Such
                 instructions shall include, but not be limited to, frequency-droop curves. The instructions given by Utility
                 shall be consistent with the normal practices adhered to by Utility with respect to its own generators
                 located on its system.

           3.6   Installation, inspection, and calibration of protective equipment to trip generation for under- or over-
                 voltage and frequency operation shall be coordinated with Utility, pursuant to Subsection 2.4.2, so as
                 not to degrade the security of Utility's distribution system. Operating practices developed by
                 Interconnection Customer which call for manual tripping of generation for under-or over-voltage and
                 frequency operation shall likewise be coordinated and be consistent with the voltage and frequency
                 ride through provisions listed in the Consumer Energy Company Generator Interconnection Procedures
                 during abnormal system voltage and frequency events, and any successor and/or supplemental
                 documents, which are incorporated herein by reference.

     4. Disconnection
           Utility shall be entitled to disconnect the Customer Facility from Utility’s distribution system, or otherwise refuse
           to connect the Customer Facility, if: (a) Interconnection Customer has not complied with any one of the
           technical requirements contained in the applicable Interconnection Procedures, (b) the electrical
           characteristics of the Customer Facility are not compatible with the electrical characteristics of Utility’s
           distribution system, (c) an emergency condition exists on Utility’s distribution system, (d) Interconnection
           Customer's protective equipment fails, (e) Utility determines that the Customer Facility is disrupting service to
           any Utility customer, (f) disconnection is required to allow for construction, installation, maintenance, repair,
           replacement, removal, investigation, inspection or testing of any part of Utility’s facilities, (g) if a required
           installation (e.g., communication circuit) fails or becomes incapacitated and is not repaired in a timely
           manner, as determined by Utility, or (h) Interconnection Customer commits a material breach of this
           Agreement. When reasonable and appropriate, the Utility will attempt to notify Interconnection Customer
           and coordinate its actions under this Section 4 with Interconnection Customer. This section applies only to
           Utility actions with respect to Customer Facility. Utility shall promptly reconnect the Customer Facility to the
           Utility’s distribution system as soon as the reason for disconnection has been remedied.

    5.     Access to Property
           5.1 At its own expense, Interconnection Customer shall make the Customer Facility site available to Utility.
               The site shall be free from hazards and shall be adequate for the operation and construction of the
               Interconnection Facilities. Utility, its agents and employees, shall have full right and authority of ingress
               and egress at all reasonable times on and across the property at which the Customer’s Facility is
               located, for the purpose of installing, operating, maintaining, inspecting, replacing, repairing, and
               removing the Interconnection Facilities. The right of ingress and egress shall not unreasonably interfere
               with Interconnection Customer's or (if different) Property Owner’s use of the property and does not
               include the right to enter applicant’s residence or other enclosed structure on the property where the
               Customer Facility is located with the residence or other enclosed structure.

           5.2   Utility may enter the property on which the Customer Facility is located to inspect, at reasonable hours,
                 Interconnection Customer’s protective devices and read or test meters. Utility will use reasonable
                 efforts to provide Interconnection Customer or Property Owner, if applicable, at least 24 hours’ notice
                 prior to entering said property, in order to afford Interconnection Customer or Property Owner the
                 opportunity to remove any locks or other encumbrances to entry; provided, however, that Utility may
                 enter the property without notice (removing, at Interconnection Customer’s expense, any lock or other
                 encumbrance to entry) and disconnect the Interconnection Facilities if Utility believes that
                 disconnection is necessary to address a hazardous condition and/or to protect persons, Utility’s
                 facilities, or the property of others from damage or interference caused by Customer Facility.

           5.3   By executing this Agreement, Property Owner consents to and agrees to provide access to its property,
                 including ingress and egress, on which the Customer Facility is located to Utility as described in this

         Form 1216 8-2023                                                                                           Page 3 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


               section, but does not assume or guarantee other performance obligations of the Interconnection
               Customer under this Agreement.

     6. Liability and Indemnity

         6.1   To the extent permitted by law, Interconnection Customer covenants and agrees that it shall hold Utility,
               and all of its agents, employees, officers and affiliates harmless for any claim, loss, damage, cost,
               charge, expense, lien, settlement or judgment, including interest thereon, whether to any person or
               property or both, arising directly or indirectly out of, or in connection with this Agreement, the Project,
               or any of Interconnection Customer’s facilities and associated appurtenances, to which Utility or any
               of its agents, employees, officers or affiliates may be subject or put by reason of any act, action, neglect
               or omission on the part of Utility or the Interconnection Customer or any of its contractors or
               subcontractors or any of their respective officers, agents, employees, and affiliates (excluding claims
               based on Utility’s reckless or intentional misconduct). If this Agreement is one subject to the provisions
               of Michigan Act No. 165, PA 1966, as amended, then Interconnection Customer will not be liable under
               this section for damages arising out of injury or damage to persons or property directly caused or
               resulting from the sole negligence of Utility, or any of its officers, agents or employees.
         .

         6.2   The provisions of this Section 6 shall not be construed to relieve any insurer of its obligations to pay any
               insurance claims in accordance with the provisions of any valid insurance policy.

         6.3   Notwithstanding anything in this Section, or any other provision of this Agreement to the contrary, any
               liability of a Party to the other Party shall be limited to direct actual damages, and all other damages
               at law or in equity are hereby waived. Under no circumstances shall a Party be liable to the other Party,
               whether in tort, contract or other basis in law or equity for any special, indirect, punitive, exemplary or
               consequential damages, including lost profits.

         6.4   The obligations and limits on liability in this Section 6 shall continue in full force and effect
               notwithstanding the expiration or termination of this Agreement, with respect to any event or condition
               giving rise to an indemnification obligation that occurred prior to such expiration or termination.

         6.5   Nothing in this Section 6 waives or limits, or shall be construed to waive or limit, the governmental
               immunity of a Party.

         6.6   Nothing in this Section 6 shall imply, or be construed to imply indemnification of any Party by the State
               of Michigan, its department, and agencies or other governmental customers that are restricted from
               entering into indemnification provisions by law.

     7   Insurance

         For Level 3 and greater projects, Interconnection Customer shall obtain and continuously maintain
         throughout the term of this Agreement General Liability insurance written on an occurrence form, or other
         form acceptable to the Utility, and covering bodily injury and property damage liability with a per
         occurrence amount of at least:

                                       Interconnection Level               Minimum Limit
                                               1&2                         Not applicable
                                                 3                           $1,000,000

         Such limit may be achieved through any combination of primary and excess or umbrella liability insurance
         policy. When requested in writing by the Utility, said limit shall be increased each year that this Agreement
         is in force to a limit no greater than the amount arrived at by increasing the original limit by the same
         percentage change as the Consumer Price Index - All Urban Workers (CPI-U.S. Cities Average). Such policy
         shall include, but not be limited to, contractual liability for indemnification assumed by Interconnection
         Customer under this Agreement.



      Form 1216 8-2023                                                                                         Page 4 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


         Consumers Energy Company, its Directors, Officers, and Employees are to be included as ADDITIONAL
         INSUREDS and such coverage shall be primary to any insurance maintained by Consumers Energy Company.
         The Utility shall not be responsible for any unpaid premiums under Interconnection Customer’s policy.

         Evidence of insurance coverage on a certificate of insurance shall be provided to the Utility when requested
         by the Utility Interconnection Customer shall immediately provide the Utility written notice if the policy is
         cancelled or substantial changes are made that affect the additional insured. At the Utility’s request,
         Interconnection Customer shall provide a copy of the policy to the Utility.

         All certificates and notices                CONSUMERS ENERGY COMPANY
         shall be sent to:                           Attn: Insurance Risk Management
                                                     One Energy Plaza
                                                     Jackson, MI 49201-2276
                                                     InsuranceCertificates@cmsenergy.com


     8. Subcontractors

         Either party may contract with a subcontractor to perform its obligations under this Agreement and shall
         incorporate the obligations of this Agreement into its respective subcontracts, agreements and purchase
         orders. Each party shall remain liable to the other Party for the performance of such subcontractor under
         this Agreement subject to the provisions of Section 6.

     9. Force Majeure

         Neither party shall be liable for failure to perform and of its obligations hereunder, to the extent due to events
         outside of its control, including, but not limited to events such as fire, flood, storm, other natural disaster,
         national emergency or war, epidemic or pandemic (referred to collectively as “Force Majeure”), and not
         due to labor problems, inability to obtain financing, negligence or other similar condition of such party,
         provided that either party has given the other prompt notice of such occurrence. The party affected shall
         exercise due diligence to remove such Force Majeure with reasonable dispatch, but shall not be required
         to accede or agree to any provision not satisfactory to it in order to settle and terminate a strike or other
         labor disturbance.

     10. Breach and Default

         A breach of this Agreement (“Breach”) shall occur upon the failure of a Party to perform or observe any
         material term or condition of this Agreement. Upon a Breach by one Party, the non-breaching Party shall
         give written notice of such Breach to the breaching Party. The Party in Breach shall have thirty (30) business
         days from the date of the written notice to cure the Breach. If a Breach is not cured within the thirty (30)
         business day period provided for herein, the Party in Breach shall be deemed in default (“Default”). The non-
         defaulting Party shall then have the right to terminate this Agreement by written notice, shall be relieved of
         any further obligations hereunder, and may pursue any and all remedies available to it at law or in equity.

    11. Retirement
         Upon termination or cancellation of this Agreement or at such time after any of the Interconnection Facilities
         described herein are no longer required, the Parties shall mutually agree upon the retirement of the
         Interconnection Facilities, which may include without limitation (i) dismantling, demolition, and removal of
         equipment, facilities, and structures, (ii) security, (iii) maintenance and (iv) disposing of debris. The cost of
         such removal shall be borne by the Interconnection Customer.

    12. Governing Law
         This Agreement shall be interpreted, governed, and construed under the laws of Michigan.




      Form 1216 8-2023                                                                                         Page 5 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


    13. Amendment, Modification or Waiver

         Any amendments or modifications to this Agreement shall be in writing and agreed to by both Parties. The
         failure of any Party at any time to require performance of any provision hereof shall in no manner affect its
         right at a later time to enforce the same. No waiver by any Party of the breach of any term or covenant
         contained in this Agreement, whether by conduct or otherwise, shall be deemed to be construed as a further
         or continuing waiver of any such breach or a waiver of the breach of any other term or covenant unless
         such waiver is in writing.

         In the event future changes in either the (i) design or operation of the Customer Facility, (ii) federal, state or
         local laws, regulations or codes, (iii) Interconnection Customer’s requirements, or (iv) Utility’s requirements,
         necessitate additional facilities or modifications to the then existing Interconnection Facilities herein, the
         Parties shall undertake such additions or modifications as may be necessary. Before undertaking such future
         additions or modifications, the Parties shall consult, develop plans and coordinate schedules of activities to
         minimize disruptions to the Interconnection Facilities. The cost of such future additions or modifications to
         the Interconnection Facilities shall be borne by the Interconnection Customer unless agreed upon otherwise
         at the time, with payment due on a mutually agreed upon schedule. Such future additions or modifications
         shall be part of the Interconnection Facilities from the time they are placed in service. The ownership,
         operation and maintenance responsibilities for any such future additions or modifications shall be made
         consistent with the responsibilities allocated in this Agreement.

    14. Notices

         Any notice required under this Agreement shall be in writing and mailed, personally delivered or
         electronically mailed to the Party at the address below. Written notice is effective within three (3) business
         days of depositing the notice in the United States mail, first class postage prepaid. Personal notice or
         electronic mail notice is effective upon delivery, provided it is received by 5:00 p.m. local time at the
         recipient’s business location on a business day (or otherwise, on the next business day). Written notice of
         any address changes shall be provided. Utility may consider changes of address in other Utility systems of
         record (e.g., Interconnection Customer billing address) as notice of address change under this Agreement.
         All written notices shall refer to the Interconnection Customer’s Utility account number, as provided in Section
         1 of this Agreement. All written notices shall be directed as follows:

         Notice to Utility:
         Manager, Distribution Agreements & Programs
         Consumers Energy Company
         1945 W. Parnall Rd
         Jackson, MI 49201


         Notice to Interconnection Customer:
         Dan VanderHeide
         933 Terrace Street
         Muskegon, MI 49440


         Notice to Property Owner (if different than Interconnection Customer):


    15. Term of Agreement and Termination

         This Agreement shall become effective upon execution by all Parties and, if applicable, the Property Owner,
         and it shall continue in full force and effect until terminated upon thirty (30) days’ prior notice by the
         Interconnection Customer, upon Default of either Party as set forth in Section 10, or upon mutual agreement
         of the Parties. The Utility may terminate the agreement on reasonable notice for reasons consistent with
         existing law, regulations and tariffs. In addition, see Section 18 regarding transfers of ownership in the
         Customer Facility.


      Form 1216 8-2023                                                                                         Page 6 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


    16. Entire Agreement and Amendments

         This Agreement and the Consumers Energy Company Interconnection Procedures shall constitute the entire
         understanding between the Parties with respect to the subject matter hereof, supersede any and all prior
         discussions and agreements between the Parties with respect to the subject matter hereof and bind and
         inure to the benefit of the Parties, their successors, and permitted assigns. No amendments or changes to
         this Agreement shall be binding unless made in writing and duly executed by both Parties.

    17. No Third Party Beneficiary

         The terms and provisions of this Agreement are intended solely for the benefit of each Party, and it is not the
         intention of the Parties to confer third-party beneficiary rights upon any other person or entity.

    18. Assignment and Binding Effect

         This Agreement shall not be assigned by a Party without the prior written consent of the other Party. Any
         attempt to do so will be void. Subject to the preceding, this Agreement is binding upon, inures to the benefit
         of, and is enforceable by the Parties and their respective successors and assigns. Interconnection Customer
         agrees to notify Utility in writing upon the sale or transfer of the Customer Facility. This Agreement shall
         terminate upon such notice (or upon Utility notifying Interconnection Customer that Utility has identified a
         change in ownership of the Customer Facility) unless Utility consents to this Agreement remaining in force
         until an equivalent agreement in a form acceptable to Utility is signed by the new owner of the Customer
         Facility.

    19. Severability

         If any provision of this Agreement is determined to be partially or wholly invalid, illegal, or unenforceable,
         then such provision shall be deemed to be modified or restricted to the extent necessary to make such
         provision valid, binding, and enforceable; or, if such provision cannot be modified or restricted in a manner
         so as to make such provision valid, binding or enforceable, then such provision shall be deemed to be
         excised from this Agreement and the validity, binding effect, and enforceability of the remaining provisions
         of this Agreement shall not be affected or impaired in any manner.

    20. Effective Date

         This Agreement is effective as of the later (or latest) of the dates set forth below.

    21. Counterparts and Electronic Documents

         This Agreement may be executed and delivered in counterparts, including by a facsimile or an electronic
         transmission thereof, each of which shall be deemed an original. Any document generated by the parties
         with respect to this Agreement, including this Agreement, may be imaged and stored electronically and
         introduced as evidence in any proceeding as if original business records. Neither party will object to the
         admissibility of such images as evidence in any proceeding on account of having been stored electronically.




      Form 1216 8-2023                                                                                       Page 7 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28




    CONSUMERS ENERGY COMPANY                                 CITY OF MUSKEGON
                                                                      (Interconnection Customer)

    By:                                                      By:
                             (Signature)                                           (Signature)

    Tyler Root                                               Dan VanderHeide
                         (Print or Type Name)                                  (Print or Type Name)


    Title: LVDP DER Engineer                                 Title: Director of Public Works
            1/24/2024 | 9:28 AM EST                                  1/24/2024 | 7:40 AM EST
    Date:                                                    Date:




                                                                              (Property Owner, if applicable)
                                                                     By:
                                                                                            (Signature)



                                                                                   (Print or Type Name)


                                                                     Title:

                                                                     Date:




      Form 1216 8-2023                                                                                          Page 8 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


                                                              EXHIBIT 1
                                                 Description of Customer Facility



    The Customer Facility must be built with the following ratings, which shall not be changed without thirty (30) days
    advance written notice to Utility according to the notice requirements herein and as depicted in Exhibit 2 –
    Interconnection Diagram:

         Photovoltaic/Solar (“PV”) Array Rating: 400 (AC) kW
         Photovoltaic/Solar (“PV”) Array Rating: 450 (DC) kW
         Wind Turbine (WT) Rating:          kW


         Battery Max Output Rating:           kW
         Battery Rating:         kWh
         Battery Chemistry (e.g., lead acid, lithium ion):
         Battery Coupling:
         Number of Batteries onsite:
         Storage Capacity:
         Other (specify type and rating):          kW Type:
         Service Type:       Single Phase                    Three Phase
         Voltage Level: 7.2/12.47 kV



         Equipment Specifications:

                             # of                Make:                              Model
                           Inverters
                              4               SolarEdge                    SolarEdge SE100K




         Additional Details:

         Customer Facility Location:
         Trinity Health Arena - 470 W Western Ave, Muskegon, MI 49440

         If Interconnection Customer is not the owner of the property identified above, the Property Owner must sign
         this Agreement for the purposes indicated in Section 5.

         Interconnection Customer Utility service account number (if applicable): 100000379758




      Form 1216 8-2023                                                                                      Page 9 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


                                                             EXHIBIT 2
                                                    INTERCONNECTION DIAGRAM




      Form 1216 8-2023                                                        Page 10 of 11
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28
DocuSign Envelope ID: CDA9EFFD-DCC7-4892-8C3B-E6217D1A3E28


                                                             EXHIBIT 3
                             INTERCONNECTION FACILITIES SCOPE OF CONSTRUCTION (if applicable)



                    Notification Number (s): N/A

                    Estimated cost of work: N/A




                    General description of the scope of construction: N/A




      Form 1216 8-2023                                                                          Page 11 of 11

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