Miami-Cass REMC Application for Operation of Customer -Owned Generation

This application should be completed and returned to the Cooperative Customer Service representative in order to begin processing the request.

INFORMATION: This application is used by the Cooperative to determine the required equipment configuration for the Customer interface. Every effort should be made to supply as much information as possible. ______PART 1 OWNER/APPLICANT INFORMATION Owner/Customer Name:______Mailing Address:______City:______County:______State:______Zip Code:______Phone Number:______Representative:______E-mail Address:______Fax Number:______*************************************************************************** PROJECT DESIGN/ENGINEERING (ARCHITECT) (as applicable)

Company:______Mailing Address:______City:______County:______State:______Zip Code:______Phone Number:______Representative:______E-mail Address:______Fax Number:______*************************************************************************** ELECTRICAL CONTRACTOR (as applicable)

Company:______Mailing Address:______City:______County:______State:______Zip Code:______Phone Number:______Representative:______E-mail Address:______FaxNumber:______

*************************************************************************** TYPE OF GENERATOR (as applicable) Photovoltaic:______Wind:______Microturbine:______Diesel Engine:______Gas Engine:______Combustion Turbine:______Other:______

1 JANUARY 1, 2010 *************************************************************************** ESTIMATED LOAD, GENERATOR RATING AND MODE OF OPERATION INFORMATION The following information is necessary to help properly design the Cooperative customer interconnection This information is not intended as a commitment or contract for billing purposes.

Total Site Load ______(kW) Residential ______Commercial ______Industrial ______Generator Rating ______(kW) Annual Estimated Generation ______(kWh) Mode of Operation: Isolated ______Paralleling ______Power Export ______*************************************************************************** DESCRIPTION OF PROPOSED INSTALLATION AND OPERATION

Give a general description of the proposed installation, including a detailed description of its planned location, the date you plan to operate the generator, the frequency with which you plan to operate it and whether you plan to operate it during on or off-peak hours. ______PART 2 (Complete all applicable items. Copy this page as required for additional generators)

SYNCHRONOUS GENERATOR DATA Unit Number: ______Total number of units with listed specifications on site: ______Manufacturer:______Type: ______Date of Manufacturer: ______Serial Number (each): ______Phases: Single Three R.P.M.: ______Frequency: ______Rated Output (for one unit): ______Kilowatt: ______Kilovolt- Ampere Rated Power Factor (%): ______Rated Voltage (Volts): ______Rated Amperes: ______Field Volts: ______Field Amperes: ______Monitoring power (kW): ______Synchronous Reactance (X’d): ______% on ______KVA base Transient Reactance (X’d): ______% on ______KVA base Subtransient Reactance (X’d): ______% on ______KVA base Negative Sequence Reactance (X’d): ______% on ______KVA base Zero Sequence Reactance (Xo): ______% on ______KVA base

2 JANUARY 1, 2010 Neutral Grounding Resistor (if applicable): ______2 I2 t or K (heating time constant): ______Additional Information: ______********************************************************************************** INDUCTION GENERATOR DATA Rotor Resistance (Rr): ______ohms Stator Resistance (Rs): ______ohms Rotor Reactance (Xr): ______ohms Stator Reactance (Xs): ______ohms Magnetizing Reactance (Xm): ______Short Circuit Reactance (Xd”): ______Design letter: ______Frame Size: ______Exciting Current: ______Temp Rise deg C”): ______Reactive Power Required: ______Vars (no load), ______Vars (full load)) Additional Information: ______********************************************************************************** PRIME MOVE (Complete all applicable items) Unit Number: ______Type: ______Manufacturer: ______Serial Number: ______Date of Manufacture: ______H.P. Rated: ______H.P. Max.: ______Inertia Constant: ______lb.-ft. Energy Source (hydro, steam, wind, etc.) ______********************************************************************************** GENERATOR TRANSFORMER (Complete all applicable items): TRANSFORMER (between generator and utility system) Generator unit number: ______Date of manufacture: ______Manufacturer: ______Serial Number: ______High Voltage: ______KV, Connection: delta wye, Neutral solidly grounded? ______Low Voltage: ______KV, Connection: delta wye, Neutral solidly grounded? ______Transformer Impedance (Z): ______% on______KVA base. Transformer Resistance (R): ______% on ______KVA base. Transformer Reactance (X): ______% on ______KVA base. Neutral Grounding Resistor (if applicable): ______********************************************************************************** INVERTER DATA (If applicable) Manufacturer: ______Model: ______Rate Power Factor (%): ______Rated Voltage (Volts):______Rated Amperes:______Inverter Type (ferroresonant, step, pulse-width modulation, etc.): ______Type communication: forced line Harmonic Distortion: Maximum Single Harmonic (%) ______Maximum Total Harmonic (%) ______Note: Attach all available calculations, test reports, and oscillographic prints showing inverter output voltage and current waveforms. ********************************************************************************** POWER CIRCUIT BREAKER (if applicable) Manufacturer: ______Model: ______Rated Voltage (kilovolts): ______Rated ampacity (Amperes): ______Interrupting rating (Amperes): ______BIL Rating: ______Interrupting medium / insulating medium ( ex. Vacuum, gas, oil ): ______/ ______

3 JANUARY 1, 2010 Control Voltage (Closing): ______(Volts) AC DC Control Voltage (Tripping): ______(Volts) AC DC Battery Close energy: Spring Motor Hydraulic Pneumatic Other: ______Trip energy: Spring Motor Hydraulic Pneumatic Other: ______Bushing Current Transformers: ______(Max. ratio) Relay Accuracy Class: ______Multi ratio? No Yes: (Available taps) ______

******************************************************************************************************************* ADDITIONAL INFORMATION

In addition to the items listed above, please attach a detailed one-line diagram of the proposed facility, all applicable elementary diagrams, major equipment, (generators, transformers, inverters, circuit breakers, protective relays, etc.) specifications, test reports, etc., and any other applicable drawings or documents necessary for the proper design of the interconnection. Also describe the project's planned operating mode (e.g., combined heat and power, peak shaving, etc.), and its address or grid coordinates.

END OF PART 2 *******************************************************************************************************************

SIGN OFF AREA

The customer agrees to provide the Cooperative with any additional information required to complete the interconnection. The customer shall operate his equipment within the guidelines set forth by the cooperative.

______Applicant Date

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ELECTRIC COOPERATIVE CONTACT FOR APPLICATION SUBMISSION AND FOR MORE INFORMATION:

Cooperative contact: ______

Title: ______

Address: ______

______

______

Phone: ______

Fax: ______e-mail: ______

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4 JANUARY 1, 2010