Application for Appointment Rate Advisory Committee

Street Number :

Street Name :

Apartment/Suite Number: (Only enter the numbers and/or letters for your Apt, Suite, Trailer, Lot, Unit etc.)

City :

State:

Zip Code :

Mailing Address, if different.

Street Number:

Street Name:

Apartment/Suite Number: (Only enter the numbers and/or letters for your Apt, Suite, Trailer, Lot, Unit etc.)

City:

State:

Zip Code:

Employer :

Occupation :

Are you a City of San Antonio resident?

Yes

If yes, how long?

In which City Council District do you reside? : * = Note that Hispanic includes all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race.

In which San Antonio City Council District, if any, do you work?

If not a City of San Antonio resident, in which suburban city or county unincorporated area do you reside?

If not within Bexar County, in which County do you reside?

Are you a customer of CPS Energy?

Yes

Is the CPS Account in your name?

Yes

If no, what name is the account under and what is the relationship?

Is the CPS Energy account current on payments?

Yes

Customer type :

Residential

Commercial

Both

Customer Account Number: Enter 10 digit CPS Energy Customer Number (numbers only).

If you are a Commercial customer:

In which San Antonio City Council District is your business?

If not in the City, in which suburban city or unincorporated area is your business?

List all CPS Energy programs in which you participate:

List any neighborhood associations to which you belong:

List any associations and/or organizations to which you belong:

List any professional groups to which you belong:

List any economic development, environmental or community activist stakeholder groups to which you belong:

Volunteer Experience/Community Service:

Are you familiar with RAC?

Yes

Are you familiar with the mission statement and vision of the RAC?

Yes

Are there any issues involving rates you feel strongly about?

Yes

If yes, please list the top three

From your perspective, how would you know if the RAC was successful?

What value/perspective do you feel you bring to the RAC?

What expertise do you feel you bring to the RAC?

The RAC committee will require at a minimum 4 hours a month. Do you have the time availability and flexibility to be a RAC member?

Have you ever been employed by CPS Energy?

Yes

If Yes, list your role(s), department(s) and date(s):

Reason for leaving CPS Energy employment:

Please specify appointment/membership/employment on any other governmental Board/Commission/Committee:

Have you ever represented any other private person, group or entity for compensation before the San Antonio City Council, SAWS Board of Trustees, or CPS Energy Board of Trustees or any department, commission, board, or committee of the City of San Antonio, SAWS or CPS Energy within the last three years?

Yes

Do either you, your spouse or your employer have any financial interest, direct or indirect, in any contract with the City of San Antonio, SAWS or CPS Energy, or do either you, your spouse, or your employer have any financial interest, directly or indirectly, in the sale to the City of San Antonio, SAWS or CPS Energy of any land, material, supplies or services?

Yes

Are you a party to any pending litigation involving CPS Energy, the City of San Antonio or any City agency?

Yes

If yes, please describe:

Have you ever been convicted of a felony or a misdemeanor (other than a traffic violation)?

Yes

If yes, please describe:

Please provide a brief narrative outlining your reasons for seeking appointment to the CPS Energy Rate Advisory Committee.

CPS Energy seeks to appoint members of the Rate Advisory Committee in a manner that reflects a balanced representation of the ethnic and gender makeup of the community. Please circle the appropriate codes:

Ethnic Codes : * = Note that Hispanic includes all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race.

Gender Codes :

The foregoing statements are true, accurate and complete; and I agree that any misrepresentation or omission of facts may result in my disqualification for appointment. Note: All information provided herein or pursuant hereto is considered public record upon receipt.

Application to join the Rate Advisory Committee (RAC)

Apply today by completing this application form.

CPS Energy