Opt-In Form for Electric Vehicle Charging Rate

Please fill out this form if you are interested in enrolling in the Electric Vehicle Charging Rate (EVC Rate). The EVC Rate reduces the Retail Transmission Service Rates (RTSRs) for participating electric vehicle (EV) charging stations. The EVC Rate is intended for large charging stations with at least one Direct Current Fast Charger (DCFC), also referred to as a Level 3 charger. Personal chargers (e.g., attached to the side of a house) are not eligible.

Once we receive the completed form, and unless we have any questions about it, we will begin applying the EVC Rate on your next billing period or as soon as possible after that. You will remain enrolled for as long as the account continues to meet the eligibility requirements listed below. You may opt out of the EVC Rate at any time.

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Customer Account Information

You will need your electricity bill on hand to enter the following information. Enter it exactly as it appears on your electricity bill. If your information is not entered as it appears on your electricity bill, we may not be able to process your form.
Service Address:*

Customer Contact Information


Charging Station Information:


Customer Certification

1. On behalf of the account holder, I would like to enrol the account in the EVC Rate
2. I confirm that the EV charging station associated with the account meets each of the following eligibility criteria:
  1. The charging station contains at least one DCFC stall (also referred to as a Level 3 charger).
  2. At least 90% of the account’s total monthly peak demand relates to EV charging (i.e., the DCFC and any lower level, non-DCFC chargers); auxiliary loads (e.g. for vending machines, tire inflation or restrooms) do not exceed 10% of the total monthly peak demand.
  3. The account has a monthly peak demand that is equal to or greater than 50 kW but less than 5,000 kW.
  4. The account has or is expected to have a 12-month average load factor equal to or less than 20%, calculated according to the following formula:
    Formula
  5. The charging station does not primarily serve commercial and/or public sector fleets.
  6. The total DER nameplate capacity of any DER connected behind the account’s meter does not exceed the total annual peak demand of the charging station.

3. I certify that the information provided on this form is true and accurate, and that in the event Elexicon Energy has any questions about it, I will provide true and accurate responses.
4. I acknowledge that I am required to notify Elexicon Energy within 30 days of ceasing to meet the eligibility requirements, upon which the account will be removed from the EVC Rate.
5. I acknowledge that if Elexicon Energy determines that I deliberately or recklessly provided false information on this form or in response to any of its questions about it, or that I deliberately or recklessly failed to notify Elexicon Energy within 30 days of ceasing to meet the eligibility requirements, Elexicon Energy will rebill the account for the difference between the EVC Rate that was charged and the RTSR that should have been charged, plus interest.
6. I have authority to sign this form on behalf of the account holder.
Certification*
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Name of Individual Signing on Behalf of the Account Holder:*