Laserfiche WebLink
C�Mrw <br /> ILLINOIS Non-Residential Gas Services Agreement for Natural Gas Customers <br /> *Mandatory Fields <br /> Date: 2-1-2011 Requested Effective Date: Au ust 1,2011 <br /> *Customer: lCity of Decatur *Contact Person: Ron Neufeld <br /> *Account No: See Attached *Contact Phone: 217-424-2702 Contact Fax: 217-424-2717 <br /> *Contact Email Address: Irneufeld0decaturnetorg <br /> Mark the applicable Ameren Illinois Gas Service the customer receives: <br /> 0 Zone I Zone II (E) Zone III <br /> Mark the applicable rider: ® Rider S Rider T <br /> Enter the applicable rate: GDS 2 ® GDS 3 ® GDS 4 ® GDS 6 <br /> MDCQ: <br /> MDCQ is the maximum number of Therms of gas Ameren Illinois shall be obligated to deliver to the Customer on any day. Usage on any <br /> day in excess of the MDCQ shall be subject to MDCQ Overrun Charges, if applicable. <br /> Customer's Requested Maximum Daily Contract Quantity(MDCQ): (Therms) <br /> Tax Information: <br /> Gas use Tax: <br /> Customer is exempt from Gas Use Tax? © Yes(D No If yes, submit Form RG-61 and one of the following must be checked: <br /> O By a business located in an enterprise zone certified by the Department of Commerce and Economic Opportunity. Provide the name <br /> of the enterprise zone in which you are located: <br /> O By a government body or entity organized and operated exclusively or charitable, re i sous or erlurntional purposes. Provide your <br /> exemption identification number: E- <br /> © In the production of electric energy. This does not include gas used in general maintenance or heating of an electric energy <br /> production facility or other structure. <br /> ® In a petroleum refinery operation. <br /> ® In a liquefaction and fractionation processes that produce value-added natural gas by-products for resale. <br /> ® In the production of anhydrous ammonia and downstream nitrogen fertilizer products for resale. <br /> Gas Revenue Tax: <br /> Customer is Exempt from Gas Revenue Tax? ® Yes ID No If yes, one of the following must be checked: <br /> 0 Receipts from interstate commerce <br /> ® Receipts from re-billable service(sale for resale) <br /> © Federal Government <br /> © Certified Enterprise Zone—Submit the certificate from DCEO and a letter from the IL-Dept of Revenue <br /> NOTE: If you purchase gas from an Illinois broker or marketer and pay tax on the purchase,you must provide a completed Form RG-12 <br /> to your delivering supplier to prevent your delivering supplier from charging you Gas Use Tax. <br /> Ameren Illinois <br /> Customer Q Zone I ® Zone II Q Zone III <br /> By: BY: <br /> (Authorized Customer Representative) (Al Representative) <br /> Date Accepted: Date Accepted: <br /> Please return this form via fax or email to Ameren Illinois Business Center. <br /> Fax: 877.263.7369 or email:gasagreements0ameren.com <br /> Save as Print <br />