<p>STATE FINANCIAL MARKETPLACE COMPLIANCE CERTIFICATION FORM (E) Page 1 of 2 STATE FINANCIAL MARKETPLACE COMPLIANCE CERTIFICATION FORM FOR ENERGY CONTRACTS</p><p>______Department Name Lead Contract Person and Phone Number</p><p>______Project Title Contract/Purchase Order Number and/or Projected Issue Date</p><p>______Approximate Contract Dollar Amount Current Interest Rate* Approximate Finance or Lease Charges* I hereby certify the following: A. I am the Department Director or designee and have a full understanding that once these assets or this project is financed, there is no termination for convenience of this financing contract; B. This is an energy Contract for the Department of General Services (“DGS”);  This is an Energy Contract for California Department of Corrections and Rehabilitation (“CDCR”);  Other (please specify) ______The above mentioned department has independent statutory authority pursuant to (code sections) ______. C. The contract described herein is either  an energy savings service agreement pursuant to Public Utilities Code Section 388  an energy service contract pursuant to Government Code Section 4217 D. This procurement used the model contract terms and conditions for the above referenced energy contract vehicle, and the standard Energy $Mart Terms and conditions. Any variations must be previously approved by DGS. Supporting documentation, which identifies any changes to the standard language and DGS approval, is attached; E. The procurement of energy services is in compliance with Budget Letter 06-27, dated September 8, 2006, and the State Administrative Manual, Section 3400. F. Results of the life cycle cost model analysis indicate an actual financed payback of ______years for these energy services and equipment. G. This purchase order and/or agreement has been duly authorized, executed and delivered by the State acting through its duly qualified elected or appointed officers or agents in accordance with it’s contract type; and H. The foregoing statements are true to the best of my knowledge and belief.</p><p>Certified by: ______Date: ______Department Director</p><p>08-09-2007 STATE FINANCIAL MARKETPLACE COMPLIANCE CERTIFICATION FORM (E) Page 2 of 2</p><p>I understand and certify that this is a _____ year financing arrangement and that approximately $______per fiscal year will be required to be set aside out of this department’s budget over the next ____ fiscal years to complete this financing obligation.</p><p>Fund Source ______Budget Line Item: ______</p><p>Certified by: ______Date: ______Department Budget Officer</p><p>Financing transactions less than $500,000 will be approved by the State Financial Marketplace Manger, between $500,000 and $999,999 will be approved by the Deputy Director of the Procurement Division, and all financing transactions over $1,000,000 must be approved by the Director of the Department of General Services.</p><p>Department of General Services Approved/Recommended Denied/Not Recommended</p><p>______Patrick Mullen, State Financial Marketplace Manger, Procurement Division, Department of General Services Date</p><p>Department of General Services Approved/Recommended Denied/Not Recommended</p><p>______Jim Butler, Chief Procurement Officer, Department of General Services Date</p><p>Director, Department of General Services Approved Denied</p><p>______Will Bush, Director, Department of General Services Date</p><p>08-09-2007</p>