By agreeing or not agreeing to the terms and conditions as set forth below by Dominion Energy Utah Tariff Section 9.05 and 9.06, or submission of requested information will be taken into consideration of your application. Please mark N/A if not applicable to your company.

**Please note, that if you are applying to be a contracted “Zone Bid” Qualified Installer you may have to wait until the next zone bid that is scheduled to go out in 2023 to start work in 2024, you must have your application and Operator Qualifications registered to begin, on or before June 1, 2023. If you are applying to be a Qualified Installer on a singular project currently or about to take place in the 2022 calendar year, indicate on the application below. This form or inquiry does not apply to any and all service line or main line installation contracts outside of the approved scope of work or project awarded. An application and Operator Qualifications will be required to be obtained and submitted for each project thereafter, unless deemed a Zone Bid Qualified Installer.

Information will be considered confidential and treated accordingly. Any information obtained prior to approval to becoming a Dominion Energy Qualified Installer, will not be shared or transferred by any means of communication to any person, or to another agency, except pursuant to a written request by, or with the prior written consent of, the individual to whom the record pertains, to 3rd party agencies. If approved to become a Qualified Installer all information provided will be shared to any or all of Dominion Energy’s contractors, agents, employees, as well as any Federal, State, or local municipalities and their agents upon request.

UTAH TARIFF SECTION 9.05

Main Extensions – Service Lines – Installed by Builder/Developer

APPLICABILITY

Pursuant to Utah Code for Qualifying Installer Requirements Definitions 58-55-308.1 and the terms and conditions set forth in Sections 9.05 and 9.06, of the Utah Tariff effective March 1, 2020, a customer, developer or builder (Builder/Developer) may contract with a Qualifying Installer to install new “Natural Gas Facilities,” “Natural Gas Main”, and Natural Gas Service Lines (Service Line). Main Extensions and Service Lines constructed pursuant to this Section 9.05 and 9.06 collectively will be referred to herein as “Facilities”, and Dominion Energy will be referred to herein as “Company.”

DEFINITIONS

For Sections 9.05 and 9.06 only, “Natural Gas Facilities,” “Natural Gas Main,” “Natural Gas Service Line,” “Minimum System,” and “Qualifying Installer” shall have the meanings set forth in Utah Code Ann. 58-55-308.1.

CONTRACT BETWEEN THE COMPANY AND THE BUILDER/DEVELOPER

A Builder/Developer who desires to construct Facilities pursuant to this Section 9.05 will enter into a written contract with the Company that sets forth the terms and conditions under which such Facilities will be constructed, and under which the Company will accept conveyance of such Facilities and provide natural gas service utilizing such Facilities. The contract with the Builder/Developer shall contain terms and conditions similar to those the Company requires of its own contractors who construct similar natural gas facilities. The Builder/Developer shall be, and shall require the Qualifying Installer to be, subject to warranty, indemnification, and insurance requirements substantially similar to those required of the Company’s own contractors who construct Natural Gas Facilities for the Company. The contract must be fully executed and effective prior to the construction of any Facilities hereunder.

LIABILITY

The Builder/Developer and the Qualifying Installer assume all risks and liabilities arising from the construction of Facilities.

DESIGN AND ENGINEERING

The Company will be responsible for planning, designing, and engineering the Facilities in accordance with the Company’s standards for materials, design, and construction. The Company will bear costs associated with its design and engineering of the Facilities. The Builder/Developer and the Qualifying Installer will cooperate with the Company and provide the Company with any and all information required, in the Company’s reasonable discretion, to enable the Company to plan, design and engineer the Facilities. Under no circumstance will the Company be responsible to pay a Builder/Developer or Qualifying Installer for costs the Builder/Developer or Qualifying Installer incurs in providing information, and/or providing aid to the Company in order that the Company may complete the planning, designing, and/or engineering of Facilities.

INSTALLATION BY QUALIFYING INSTALLER

The Company shall be under no obligation to accept, own or provide natural gas service through any Facility constructed by any entity that is not a Qualifying Installer. The Builder/Developer and Qualifying Installer are prohibited from connecting to, modifying, or repairing the Company’s existing natural gas facilities unless directed to do so by the Company. The Builder/Developer and Qualifying Installer shall bear all costs for repair, connection to, and/or modification of Company natural gas facilities or other third-party-owned facilities necessitated by the construction or installation of Facilities. The Company shall be under no obligation to accept completed Facilities, or to provide natural gas service utilizing such Facilities, until all such costs have been paid in full.

MATERIALS

Any facility constructed hereunder will only be constructed utilizing Company-approved materials that meet Company specifications as well as those requirements set forth in applicable incorporated herein by reference as they may change from time to time.

BETTERMENT COSTS

The Builder/Developer shall bear all costs associated with construction of the Minimum System as determined by the Company. In the event that the Company requires the Builder/Developer and/or a Qualifying Installer to install a Main Extension that is greater than the Minimum System, the difference in cost shall be calculated based upon the Company’s costs for installation of similar facilities in the Company’s same construction zone.

INSPECTION

The Company will be solely responsible for inspecting and mapping the Facilities and for the collection and development of as-built notes. The Company will bear all costs associated with the inspection and mapping of Facilities. The Builder/Developer and the Qualifying Installer will coordinate with the Company to provide Company inspectors access to the site during the entirety of construction. The Builder/Developer’s trench cannot be backfilled and compacted by the Qualifying Installer until all required Company inspection and mapping has been completed. The Builder/Developer and Qualifying Installer will provide the Company with no less than ten business days’ advance notice of commencement of construction. The Company shall schedule all jobs efficiently, and will employ reasonable efforts to schedule each job in the order in which it was received. The Builder/Developer and Qualifying Installer shall make the worksite available for inspection by federal and state authorities at any and all times.

TESTING

The Qualifying Installer shall conduct all required testing of the Facilities under the direction of Dominion Energy Utah and at no cost or expense to Dominion Energy Utah.

DOCUMENTS

The Builder/Developer and Qualifying Installer shall provide Dominion Energy Utah with all the documentation reasonably required by the Company relating to the Facilities, including but not limited to documentation relating to materials utilized in constructing the Facilities and the construction and testing of the Facilities.

INTERCONNECTION

The Qualifying Installer may only connect the Facilities to Company’s existing natural gas facilities at the Company’s direction and under the Company’s supervision. The Company shall install all meters. The Builder/Developer and Qualifying Installer shall bear all costs associated with contractors, materials, and associated facilities involved with connecting a Main Extension or Service Line to other Company-owned natural gas facilities, except for the cost of a standard residential meter, bracket, and applicable taxes.

COMPLIANCE WITH APPLICABLE LAW AND COMPANY STANDARDS

The Builder/Developer and the Qualifying Installer shall comply with all applicable federal, state, and local statutes, codes, rules, regulations, ordinances, orders, Tariff provisions, Company Standard Practices, Company Contractor Safety Manual, Company Policies, and Company Procedures, all of which are incorporated herein by reference as they may change from time to time, including but not limited to laws, rules, and regulations governing pipeline safety, materials, records, construction, licensing, health, safety, environmental conditions, and labor (collectively, Requirements). The Company will not accept conveyance of or provide natural gas service utilizing any Facility that it reasonably believes fails to comply with the Requirements.

RIGHTS-OF-WAY, FEE PROPERTY AND PERMITS

The Builder/Developer shall comply with all right-of-way requirements set forth in Section 7.05 of the Tariff. The Builder/Developer shall provide the Company with any and all rights-of-way, fee property, and/or permits that the Company deems, in its sole discretion, to be necessary for the ownership and operation of the Facilities. The Company shall not bear any costs associated with such rights-of-way, fee property, and/or permitting. Such rights-of-way and/or fee property shall be conveyed to the Company in the form utilized by the Company to procure its own rights-of-way and/or fee property, or in some other form that is acceptable to the Company, in its sole discretion. Such rights-of-way and/or fee property shall be conveyed free of hazardous materials (as defined by federal, state or local laws and Section 7.05 of this Tariff), contaminants or environmental conditions on, upon, or into the surface or subsurface of soil, water, or watercourses within or adjacent to the right-of-way or fee property. The Company shall be under no obligation to accept completed Facilities, or to provide natural gas service utilizing such Facilities, until all such rights-of-way, fee property and/or permits have been conveyed to the Company.

CONVEYANCE

The Builder/Developer shall cause the Facilities to be conveyed to the Company, together with any rights-of-way and/or fee property reasonably required by the Company to provide natural gas service, free of hazardous materials (as defined by federal, state or local laws and Section 7.05 of the Tariff), contaminants, or environmental conditions on, upon, or into the surface or subsurface of soil, water, or watercourses within or adjacent to the right-of-way or fee property. Conveyance shall be at no cost to the Company. All Facilities and property conveyed hereunder must be conveyed free and clear of all liens, claims, security interests, and any other encumbrances whatsoever, see Section 7.05 of the Tariff. The Company shall be under no obligation to accept completed Facilities, or to provide natural gas service utilizing such Facilities, until all costs referenced in this Section 9.05 have been paid in full. The Company need not accept conveyance of or provide natural gas service utilizing any Facility that fails to comply with all Requirements set forth herein.

The Company’s failure to discover or reject a defective Facility or a Facility not constructed in accordance with the Requirements is not deemed to be a waiver of the Company’s rights set forth herein. The Builder/Developer shall be responsible to pay for repair or replacement of any Facility not constructed in accordance with the Requirements.

UTAH TARIFF SECTION 9.06

QUALIFYING INSTALLER REQUIREMENTS

DEFINITIONS

For Sections 9.05 and 9.06 only, “Natural Gas Facilities,” “Natural Gas Main,” “Natural Gas Service Line,” and “Qualifying Installer” shall have the meaning set forth in Utah Code Ann. 58-55-308.1.

APPLICABILITY

Pursuant to Utah Code Ann. 58-55-308.1 and the terms and conditions set forth in this Section 9.06 a Builder/Developer (defined in Section 9.05 above) may contract with a Qualifying Installer to install new Natural Gas Main (Main Extension) or Natural Gas Service Line (Service Line) to serve a new facility, structure, or development. Main Extensions and Service Lines constructed pursuant to this Section 9.06 will be referred to herein, collectively, as “Facilities.” The installation of Facilities shall be referred to herein as “Work.” An individual or entity desiring to become a Qualifying Installer must comply with the requirements set forth in this Section.

QUALIFICATIONS

A Qualifying Installer must comply with the provisions of Utah Code Ann. 58-55-308.1. Additionally, prior to becoming a Qualifying Installer, each individual or entity must obtain all qualifications and meet all standards required by all applicable federal, state, and local statutes, codes, rules, regulations, ordinances, orders, Tariff provisions, Company Standard Practices, Company Contractor Safety Manual, Company Policies, and Company Procedures, all of which are incorporated herein by reference as they may change from time to time, including, but not limited to, welder qualifications pursuant to American Petroleum Institute RP1104 and Department of Transportation Operator Qualification requirements, ASME B31Q, Department of Transportation drug and alcohol plan requirements, and any other requirements that Company also requires of its own contractors who install Facilities for the Company (collectively, Installer Requirements).

The Company is under no obligation to accept or approve anyone who has a documented history of unsafe work practices or violation of Utah Code Ann. 54-8a-1 et seq., and/or any applicable Installer Requirements incorporated herein as they may change from time to time. The Company may determine, in its sole discretion, whether any violation or history disqualifies an individual or entity unqualified from becoming a Qualifying Installer. Any Qualifying Installer who ceases to meet all Installer Requirements and other requirements set forth herein, or who breaches any agreement with Dominion Energy Utah, shall immediately cease to be a Qualifying Installer.

CONSTRUCTION AND INSPECTION

In addition to complying with the provisions of Section 9.05 above, each Qualifying Installer must perform all Work under this Section with the best industry practices and in compliance with applicable standards, requirements, policies, and procedures including, but not limited to, the Installer Requirements and any drawings, supplemental specifications, standards, permits, or other documents provided or made available to the Qualifying Installer. A Qualifying Installer may not perform any Work pursuant to this Section without either the presence of a Company Inspector on the site, or approval from the Company to proceed in the Inspector’s absence. Each Qualifying Installer performing Work under this Section must permit and facilitate inspection of such Work by Dominion Energy Utah, the Division of Public Utilities, or any other regulatory body with jurisdiction.

MATERIALS

Facilities will only be constructed utilizing Company-approved materials that meet the same Company specifications applicable to work conducted by Company-retained contractors.

DENIAL OR TERMINATION OF QUALIFYING INSTALLER STATUS

The Company may deny or terminate Qualifying Installer status, when an Applicant or Qualifying Installer fails to comply with or violates any term or condition set forth in Utah Code Ann. 58-55-308.1, Sections 9.05 and 9.06 of the Tariff, or any term or condition set forth in a contract with the Company.

Thank you for taking the time to apply to become a Qualified Installer, by marking no we cannot accept your application at this time. If you have additional questions or concerns, please send an email to QualifyingInstaller@dominionenergy.com

Applicant/Contact Information

Contractor License and/or Business License

(emailed copy required)

Key Employees

Identify key employees that with gas industry experience and number of years’ of experience they have.

Insurance Coverage

Dominion Energy requires the following minimum limits of project insurance coverage from each contractor and all subcontractors:

MINIMUM LIMITS

1. Workers Compensation - Statutory
2. Employers Liability - $2,000,000 per occurrence
3. Commercial General Liability - $2,000,000 per occurrence
4. Automobile Liability - $2,000,000 per occurrence

DOT Operator Qualification and Drug & Alcohol Compliance

(Emailed or Mailed Copy Required)

Anyone performing Dominion Energy operator-defined "Covered Tasks" must be qualified in accordance with DOT Pipeline Safety Regulations (49 CFR 192.801 - .809). Additionally, all contractors performing safety sensitive work must administer a DOT-PHMSA compliant Drug and Alcohol Testing program (49CFR Part 199 and Part 40).

References

Please list 3 previous projects your company has been apart of. Be sure to list; business name, mailing address, approximate project location, project contact name, number, and email address, and estimated value of project.