____________________________________________________________________________________
FOR CITY CLERK ONLY
Council Meeting:
Disposition:
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Public Works
Prepared by: Grey Melgard, Senior Civil Engineer
April Miller, Public Works Director
City Manager Approval: ___
TOPIC: PACIFIC GAS AND ELECTRIC COMPANY PROJECT CONTRACTS SUBJECT: RESOLUTION AUTHORIZING THE CITY MANAGER TO ENTER INTO CONTRACTS
WITH PACIFIC GAS AND ELECTRIC COMPANY FOR THE SECOND STREET UTILITY UNDERGROUNDING (PHASE 2) PROJECT IN AN AMOUNT NOT TO EXCEED $255,351 AND THE FOURTH STREET AND WEST CRESCENT DRIVE
INTERSECTION IMPROVEMENTS PROJECT IN AN AMOUNT NOT TO EXCEED $34,224 AND APPROVING SUPPLEMENTAL BUDGET APPROPRIATIONS; CEQA DETERMINATION: EXEMPT PURSUANT TO CEQA GUIDELINES SECTION 15378(b)(5)
RECOMMENDATION:
Staff recommends that the City Council adopt a resolution:
1. Authorizing the City Manager to enter into contracts with Pacific Gas and Electric Company (PG&E) for the subject projects and provide payment to PG&E to complete the required scope of work; and
2. Authorizing supplemental budget appropriations totaling $34,224 to cover the portion of PG&E’s scope related to the Fourth Street and West Crescent Drive Intersection Improvements Project from the unencumbered Gas Tax Fund (206) balance.
BACKGROUND:
Second Street Utility Undergrounding (Phase 2) Project:
Following the utility undergrounding work performed with the Third Street Rehabilitation project, this project will underground the remaining three utility poles located on the south side of Second Street between Marquard Avenue and West Street.
Fourth Street and West Crescent Drive Intersection Improvements Project:
Fourth Street, also known as the “Miracle Mile,” connects San Rafael to San Anselmo and all points west in Marin County. The route serves nearly 20,000 vehicles per day, and smooth traffic flow is essential to ensure people can get to and from their destinations easily. The existing intersection of Fourth Street and West Crescent features a 3-legged tee-configuration, including a left turn pocket on the east-bound Fourth Street movement. The intersection is uncontrolled along Fourth Street, but has a stop sign controlling West Crescent entering the intersection. There is a pedestrian movement across West Crescent that is currently uncontrolled. The project would include accessibility improvements for the Agenda Item No: 4.g
Meeting Date: August 18, 2025
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
pedestrian crossing and the signalization of the intersection for all movements.
ANALYSIS:
Second Street Utility Undergrounding (Phase 2) Project:
City staff and PG&E have met and developed engineering drawings to support the undergrounding of existing overhead lines and the relocation of existing facilities. Prior to PG&E finalizing a work schedule and beginning construction, the City of San Rafael must enter into an Agreement with PG&E to request PG&E perform the described work and provide payment to PG&E for said work.
Fourth Street and West Crescent Drive Intersection Improvements Project:
City staff and PG&E have met and developed engineering drawings to support the installation of a new power drop and supply that will be utilized for the proposed traffic signal at the intersection. Prior to PG&E finalizing a work schedule and beginning construction, the City of San Rafael must enter into an Agreement with PG&E to request PG&E perform the described work and provide payment to PG&E for said work.
ENVIRONMENTAL DETERMINATION:
This action is exempt from the requirements of the California Environmental Quality Act (CEQA) in accordance with CEQA Guidelines Section 15378(b)(5) in that the action does not meet CEQA's definition of a “project” because the action does not have the potential for resulting in either a direct physical change in the environment or a reasonably foreseeable indirect physical change in the environment. The required environmental review and clearance will be conducted as part of the preliminary engineering and environmental planning phase of design.
FISCAL IMPACT:
Adopting this resolution allows the City Manager to enter into contracts with PG&E. These contracts include a financial commitment from the City to PG&E under the terms of the agreements.
Second Street Utility Undergrounding (Phase 2) Project:
The current estimate to finalize the design, obtain relevant construction permits, and underground the existing overhead lines is $260,350. The City has already paid an engineering advance to PG&E in the amount of $5,000, bringing the outstanding cost to $255,350. Appropriations for the construction phase of the Second Street Utility Undergrounding (Phase 2) Project in the amount of $300,000 were included in the fiscal year (FY) 2025-26 Budget approved by the City Council on June 2, 2025, as part of the Capital Improvement Program budget.
Fourth Street and West Crescent Drive Intersection Improvements Project:
The current estimate to finalize the design, obtain relevant construction permits, and install the new equipment is $36,724. The City has already paid an engineering advance to PG&E in the amount of $2,500, bringing the outstanding cost to $34,224. Funding for the construction phase of the Fourth Street and West Crescent Drive Intersection Improvements Project was projected to be included in the FY 2026- 27 Budget as part of the Capital Improvement Program budget. The City has adequate funds in the unincumbered Gas Tax (206) fund balance to cover the contract cost for the construction of the PG&E scope of work for the Project. Additional supplemental budget appropriations are requested to support PG&E’s scope of work, to be funded through available fund balance within the Gas Tax Fund (206).
OPTIONS:
The City Council has the following options to consider relating to this item:
1. Adopt the resolution as presented.
2. Do not adopt the resolution.
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3
RECOMMENDED ACTION:
Staff recommends that the City Council adopt a resolution:
1. Authorizing the City Manager to enter into contracts with Pacific Gas and Electric Company (PG&E) for the subject projects and provide payment to PG&E to complete the required scope of work; and
2. Authorizing supplemental budget appropriations totaling $34,224 to cover the portion of PG&E’s scope related to the Fourth Street and West Crescent Drive Intersection Improvements Project from the unencumbered Gas Tax Fund (206) balance.
ATTACHMENTS:
1. Resolution
2. PG&E Contract for Second Street Utility Undergrounding (Phase 2) Project
3. PG&E Contract for Fourth Street and West Crescent Drive Intersection Improvements Project RESOLUTION NO.
RESOLUTION AUTHORIZING THE CITY MANAGER TO ENTER INTO CONTRACTS
WITH PACIFIC GAS AND ELECTRIC COMPANY FOR THE SECOND STREET UTILITY UNDERGROUNDING (PHASE 2) PROJECT IN AN AMOUNT NOT TO EXCEED $255,351
AND THE FOURTH STREET AND WEST CRESCENT DRIVE INTERSECTION IMPROVEMENTS PROJECT IN AN AMOUNT NOT TO EXCEED $34,224, AND APPROVING SUPPLEMENTAL BUDGET APPROPRIATIONS; CEQA DETERMINATION:
EXEMPT PURSUANT TO CEQA GUIDELINES SECTION 15378(b)(5)
WHEREAS, Pacific Gas and Electric Company requires contracts from the City of San Rafael to guarantee available funding for the utility undergrounding and installation of new utilities for the Second Street Utility Undergrounding (Phase 2) Project and the Fourth Street and West Crescent Drive Intersection Improvements Project; and WHEREAS, appropriations for the construction phase of the Second Street Utility Undergrounding (Phase 2) Project were included in the FY 2025-26 Budget approved by the City Council on June 2, 2025, as part of the capital improvement program budget; and WHEREAS, funding for the construction phase of the Fourth Street and West Crescent Drive Intersection Improvements Project was projected to be included in the FY2026-27 Budget as part of the capital improvement program budget; and WHEREAS, the City has adequate funds in the Gas Tax (206) to cover the contract cost for the construction of the Pacific Gas and Electric Company scope of work for the Fourth Street and West Crescent Drive Intersection Improvements Project; and WHEREAS, supplemental budget appropriations are requested to support Pacific Gas and Electric Company’s scope of work for the Fourth Street and West Crescent Drive Intersection Improvements Project to be funded through the available balance within the Gas Tax (206) fund; and
WHEREAS, this action is exempt from the requirements of the California Environmental Quality Act (CEQA) in accordance with CEQA Guidelines Section 15378(b)(5) in that the action does not meet CEQA's definition of a “project” because the action does not have the potential for resulting in either a direct physical change in the environment or a reasonably foreseeable indirect physical change in the environment; and
WHEREAS, the required environmental review and clearance will be conducted as part of the preliminary engineering and environmental planning phase of the projects.
NOW, THEREFORE, BE IT RESOLVED, that the City Council of the City of San Rafael hereby finds the foregoing recitals are true and correct, determines that this action is exempt under CEQA Guideline Sections 15378(b)(5) and authorizes the City Manager to enter into contracts with Pacific Gas and Electric Company for the Second Street Utility Undergrounding (Phase 2) Project in an amount not to exceed $255,351 and the Fourth Street And West Crescent Drive Intersection Improvements Project in an amount not to exceed $34,224 and authorizing supplemental budget appropriations from unencumbered Gas Tax Fund (206) balance.
I, LINDSAY LARA, Clerk of the City of San Rafael, hereby certify that the foregoing Resolution was duly and regularly introduced and adopted at a regular meeting of the City Council of the City of San Rafael, held on Monday, the 18th day of August 2025, by the following vote, to wit:
AYES: Councilmembers:
NOES: Councilmembers:
ABSENT: Councilmembers:
_____________________
Lindsay Lara, City Clerk
130618288
July 28, 2025
Customer Payment
Coupon
References
Notification # 130618288
Contract # 50126821 V1
ERR-PM # 35619952
Customer # 4827926
City of San Rafael
111 Morphew St
SAN RAFAEL, CA 94901
Customer Cost Summary
1879 SECOND STREET, SAN RAFAEL
Amounts Due Total Due
Elec Reloc & Rearrangement Non-Refundable Payment $260,350.05 Minus the following credit
Advance Credit ($5,000.00)
$255,350.05
Important Payment Information
To complete your contract ONLINE
Follow the instructions provided with your electronic contract Submit payment at https://www.pge.com/contractpayments
To complete your contract BY MAIL
Please make check payable to: PG&E or Pacific Gas and Electric Complete, sign and return the enclosed agreement(s), the SACAC form and the customer payment coupon with your payment
Remit payment and SACAC form to:
PG&E CFM/PPC Department
PO BOX 997340
Sacramento, CA 95899-7340
IMPORTANT MESSAGE
Please review the enclosed information
and total due. This document needs
to be returned with the enclosed
agreements.
If you complete your contract ONLINE,
a copy will be saved to your Customer
Connections Online (CCO) account at
pge.com/cco.
To learn more about PG&E's gas and
electric safety initiatives and resources
please visit pge.com/safety.
Have Questions?
Please Call 1-800-422-0436
* Automated document, Preliminary Statement, Part A
130618288
62-4527 (Rev 1/91)
Service Planning
Advice No. 1633-G/1342-E
Effective 4/02/91
Pacific Gas and Electric Company
Agreement to Perform
Tariff Schedule Related Work
DISTRIBUTION:
Applicant (Original)
Division (Original)
ACCTG. SVCS.
REFERENCES:
Notification # 130618288
Contract # 50126821 V1
RR-PM # 35619952
July 28, 2025
City of San Rafael, A GOVERNMENT AGENCY (Applicant) has requested PACIFIC GAS AND ELECTRIC COMPANY, a California corporation (PG&E), to perform the tariff schedule related work as located and described in paragragh 3 herein. PG&E agrees to perform the requested work and furnish all necessary labor, equipment, materials and related facilities required therefore, subject to the following conditions:
1. Whenever part or all of the requested work is to be furnished or performed upon property other than that of Applicant, Applicant shall first procure from such owners all necessary rights-of-way and/or permits in a form satisfactory to PG&E and without cost to it.
2. Applicant shall indemnify and hold harmless PG&E, its officers, agents and employees, against all loss, damage, expense and liability resulting from injury to or death of any person, including but not limited to, employees of PG&E, Applicant or any third party, or for the loss, destruction or damage to property, including, but not limited to property of PG&E, Applicant or any third party, arising out of or in any way connected with the performance of this agreement, however caused, except to the extent caused by the active negligence or willful misconduct of PG&E, its officers, agents and employees. Applicant will, on PG&E's request, defend any suit asserting a claim covered by this indemnity. Applicant will pay all costs that may be incurred by PG&E in enforcing this indemnity, including reasonable attorneys' fees.
3. The location and requested work are described as follows: (Describe in detail the materials and facilities to be furnished and/or work to be performed by PG&E. If more space is required, use other side and attach any necessary drawings as Exhibits A, B, C, etc):
LOCATION: 1879 SECOND STREET, SAN RAFAEL
DESCRIPTION OF WORK ELECTRIC: Underground overhead lines and relocate facilities.
DESCRIPTION OF WORK GAS:
Electric Gas
Engineering and Administrative Costs (+) $50,612.87 $0.00 Including Applicant Design Value of $0.00 $0.00
Re-engineering/Comp Prep/Add'l AD Plan Checks (+) $0.00 $0.00 Facilities (Cable, Transformers / Gas Pipe) (+) $0.00 $0.00 Trench, Conduits & Substructures (+) $66,748.30 $0.00
Tie-In / Meters (+) $88,974.69 $0.00
Trench Permits & Land Rights (+) $3,623.86 $0.00
Inspection Fees (+) $0.00 $0.00
Subtotal (=) $209,959.72 $0.00
Including Net Joint Pole Credit Value of $0.00 $0.00
plus ITCC @ 24% Electric 0% Gas (+) $50,390.33 $0.00
plus Non Taxable Work (+) $0.00 $0.00
D.0405055 Line Extension Costs - Residential (+) $0.00 $0.00 D.0405055 Line Extension Costs - Non-Residential (+) $0.00 $0.00 less Value of Relocation Applicant Design Work (-) $0.00 $0.00 less Work Provided by Applicant (-) $0.00 $0.00
less Salvage (-) $0.00 $0.00
Total Payment (=) $260,350.05 $0.00
#Form 62-4527#
* Automated document, Preliminary Statement, Part A
130618288
62-4527 (Rev 1/91)
Service Planning
Advice No. 1633-G/1342-E
Effective 4/02/91
4. Applicant shall pay to PG&E, promptly upon demand by PG&E, as the complete contract price hereunder, the sum of Two hundred sixty thousand three hundred fifty dollars and five cents $260,350.05 Upon completion of requested work, ownership shall vest in: PG&E Applicant Executed this #signDayWPA# day of #signMonWPA# #signYrWPA# City of San Rafael, A
GOVERNMENT AGENCY
Applicant
PACIFIC GAS & ELECTRIC COMPANY
By: #sigWPA# By: Korinna Outwater
April Miller
Print/Type/Name
Title: Director Title: Service Planning Supervisor
Mailing Address: 111 Morphew St
SAN RAFAEL, CA 94901
130632924
May 14, 2025
Customer Payment
Coupon
References
Notification # 130632924
Contract # 50122234 V1
E15-PM # 35621491
E16-PM # 35621491
Customer # 4827939
City Of San Rafael
111 Morphew St c/o Dept of Public Works
SAN RAFAEL, CA 94901
Customer Payment Summary
2202 4TH STREET, SAN RAFAEL
Please pay the Total Due based upon the payment option(s) you selected on page two of the enclosed Gas and Electric Extension Agreement.
Payment Options Subtotal Total Due
10-Year Refundable Advance Option Gas and Electric $36,723.71 $34,223.71 Non-Refundable 50 percent Discount Option for Gas and
Electric
$28,924.47 $26,424.47
10-Year Refundable Advance Option for Gas and
Non-Refundable 50 percent Discount Option for Electric
$28,924.47 $26,424.47
Non-Refundable 50 percent Discount Option for Gas and
10-Year Refundable Advance Option for Electric
$36,723.71 $34,223.71
The Total Due for each payment option above includes:
Advance Credit ($2,500.00)
Important Payment Information
To complete your contract ONLINE
Follow the instructions provided with your electronic contract Submit payment at https://www.pge.com/contractpayments
To complete your contract BY MAIL
Please make check payable to: PG&E or Pacific Gas and Electric Complete, sign and return the enclosed agreement(s), the SACAC form and the customer payment coupon with your payment
Remit payment and SACAC form to:
PG&E CFM/PPC Department
PO BOX 997340
Sacramento, CA 95899-7340
IMPORTANT MESSAGE
Please review the enclosed information
and total due. This document needs
to be returned with the enclosed
agreements.
If you complete your contract ONLINE,
a copy will be saved to your Customer
Connections Online (CCO) account at
pge.com/cco.
To learn more about PG&E's gas and
electric safety initiatives and resources
please visit pge.com/safety.
Have Questions?
Please Call 1-800-422-0436
Gas and Electric
Extension Agreement*
* Automated document,
Preliminary Statement, Part A
"PG&E" refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation. ©2015 Pacific Gas and Electric Company. All rights reserved.
Form 79-1169
Advice 4862-G/7158-E
130632924
For Internal Use
Notification # 130632924
Contract # 50122234
E-PM # 35621491
G-PM #
E-Prior MLX/PM#
G-Prior MLX/PM#
Customer # 4827939
V1
May 14, 2025
City Of San Rafael
111 Morphew St c/o Dept of Public Works
SAN RAFAEL, CA, 94901 Re: 2202 4TH STREET, SAN RAFAEL
DearApril Miller
We are writing to let you know Pacific Gas and Electric Company (PG&E) will extend its facilities to provide the requested gas and electric service to the project address listed above. PG&E's costs have been developed based on the choices and information provided in your application and may change if you make changes. This letter, including PG&E's tariffs, which are incorporated by reference below, will serve as our contract. As required by the California Public Utilities Commission (CPUC), special facilities will be handled in a separate contract. Per Decision 22-09-026, Residential and Non-residential Customers submitting an application for new gas service on or after July 1, 2023, do not qualify for Allowances, Refunds or Discount Option.
Per Decision 23-12-037, Mixed-Fuel New Constructions project applications received after July 1, 2024, will not qualify for Allowances, Refunds, or Discount Option. For new applications for Gas Service Extension(s) on or after July 1, 2023, and Mixed Fuel New Construction projects after July 1, 2024, Applicants must pay PG&E its total estimated installed cost upon contract execution, in advance of PG&E commencing its work. Upon completion of the work and determination of actual costs, PG&E will provide Applicant with a final invoice or refund to account for a true-up to actual costs. An Applicant's failure to pay a final invoice in a timely manner is a violation of PG&E's Gas Rules 15/16 and may result in discontinuance of service. Non-Residential Customers submitting an application for new gas service on or after July 1, 2023 may qualify for Allowances, Refunds or Discount Option if approved by the CPUC. Please complete the following four steps to execute this contract.
1 Review the following work responsibilities and cost information.
Work To Be
Done By
GAS MAIN GAS SERVICE ELECTRIC DISTRIBUTION ELECTRIC SERVICE Trench Pipe Trench Pipe Trench Substr. Facilities Trench Substr. Facilities
PG&E X X X X
Customer
GAS ELECTRIC
Total non-refundable project costs $0.00 $21,125.23
Refundable extension costs $0.00 $16,311.22
Allowances (credit) - $0.00 - $712.74
Net refundable amount = $0.00 = $15,598.47
10 YEAR REFUNDABLE OPTION
Net refundable amount $0.00 $15,598.47
Credit for value of design and/or
facilities provided by applicant - $0.00 - $0.00
Total non-refundable project costs + $0.00 + $21,125.23 Total (if you select this option) = $0.00 = $36,723.70
NON-REFUNDABLE 50% DISCOUNT OPTION
Net refundable amount $0.00 $15,598.47
Discount: 50% of Net refundable amount - $0.00 - $7,799.23 Credit for value of design and/or
facilities provided by applicant - $0.00 - $0.00
Total non-refundable project costs + $0.00 + $21,125.23 Total (if you select this option) = $0.00 = $28,924.47
Potential refund per residential lot/unit $0.00 $0.00
Potential reimbursement per service completion
Pressurized or energized system $0.00 $0.00
Not pressurized or energized system $0.00 $0.00
Reimbursement for other work
performed $0.00 $0.00
All amounts include the Income Tax Component of Contribution (ITCC) PG&E is required to charge customers, where applicable.
DEFINITIONS AND EXPLANATION OF TERMS
(For more detail see rules 15 and 16):
Total non-refundable project costs include costs for
work such as electric trench and excavation, conduits,
inspections, streetlights, conversion from overhead to
underground and contract processing.
Refundable extension costs include costs for facilities such as electric conductor, transformers and poles; gas pipe, gas share of distribution trench and regulators;
and meters.
Allowances are a credit against refundable extension
costs. They are based upon the number of residential
units expected to be connected within the first six
months and the expected annual non-residential net
(distribution) revenue from your project.
Allowances granted under either option are subject to
deficiency billing if the number of residential units
connected or the annual non-residential net revenue
falls below the forecast used to calculate the
allowances.
Net refundable amount is the portion of overall costs
eligible for refund to you based upon additional
residential meters being set or upon increases in nonresidential annual net (distribution) revenue. A cost-ofownership charge is assessed against the Net refundable amount (except for individual residential
applicants) per Rule 15.
Potential refund per residential lot/unit is for those
lots/units for which you did not already receive an
allowance (i.e., units not expected to be connected in
the first six months). Any refunds may be decreased or
eliminated by cost-of-ownership charges assessed
under the provisions of Rule 15.
Potential reimbursement per service completion is
the amount to which a customer may be entitled for
performing certain service connection work PG&E
would otherwise perform when installing service
extensions and are not to be confused with refunds.
Reimbursement for other work performed is
the amount to which a customer may be entitled
for performing certain work (other than service
completions) that normally is PG&E's responsibility.
Gas and Electric
Extension Agreement*
* Automated document,
Preliminary Statement, Part A
"PG&E" refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation. ©2015 Pacific Gas and Electric Company. All rights reserved.
Form 79-1169
Advice 4862-G/7158-E
130632924
2 Select one of the following payment options.
#opt1#
10-Year Refundable Option for Gas and Electric
#opt2#
Non-Refundable 50 Percent Discount Option for Gas
and Electric
#opt3#
10-Year Refundable Option for Gas and NonRefundable 50 Percent Discount Option for Electric #opt4#
Non-Refundable 50 Percent Discount Option for
Gas and 10-Year Refundable Option for Electric
Gas
$0.00
$0.00
$0.00
$0.00
+
+
+
+
Electric
$36,723.71
$28,924.47
$28,924.47
$36,723.71
-
-
-
-
Advance
SEE PMT CPN
SEE PMT CPN
SEE PMT CPN
SEE PMT CPN
=
=
=
=
Total Due
$36,723.71
$28,924.47
$28,924.47
$36,723.71
3 Review these important terms and conditions.
This Gas and Electric Extension Agreement is controlled by, and incorporates by reference, PG&E's tariffs, including Gas and Electric rules 2, 15, and 16; the Distribution and Service Extension Agreement-Provisions (Form 62-0982) and the General Terms & Conditions for Gas and Electric Extension & Service Construction by Applicant (Form 79-716), all as approved and authorized by the CPUC. This agreement at all times shall be subject to such modifications as the CPUC may direct from time to time in the exercise of its jurisdiction.
You can view PG&E's tariffs online at pge.com/tariffs or contact the PG&E representative listed below. Additional details underlying the amounts shown in this agreement, as well as the calculation of allowances, refunds or deficiency bills can also be provided by your local PG&E representative. 4 After completing steps 1, 2 and 3 and having checked one, but only one, of the four payment options above, please complete and return the following items to PG&E.
Sign and return this contract as indicated below.
Submit the Payment Coupon with Total Due based on your option selected.
Sign and return the enclosed Statement of Applicant's Contract Anticipated Costs (SACAC) [Form 79-1003] (explanation in box to the right).
Please provide your payment and required forms within 90 days from May 14, 2025. PG&E is not bound by the costs set forth above if payment and the signed forms are not received by PG&E within 90 days.
If you have any questions, please contact Veronica Molinar at 877-743-7782 or by email at [email protected].
ADDITIONAL INFORMATION
What is the SACAC form
Under PG&E's rules 15 and 16 you have a choice:you can
perform the work yourself, hire a qualified contractor to perform the work or hire PG&E to do the work. We are
required by the CPUC to provide you with PG&E's costs.
This form identifies our cost for the refundable service that is PG&E's responsibility to install. PG&E's costs were
developed based on your choices within the application and may change if you change that choice.
How do I fill out the SACAC?
If you want to do this work yourself or have a qualified contractor do this work, please enter your estimated costs in the section of the SACAC form entitled "Applicant Costs" or check the box in the section entitled "Applicant's Election Not To Provide Costs," sign and return to PG&E. PG&E will send you a revised agreement by return mail only if you choose to provide your estimated costs.
If you want PG&E to do this work, please check the section "Applicant's Election Not to Provide Costs," sign and return the SACAC form along with a check for the Total Due
based on the option you selected above.
You must return the completed SACAC form to PG&E
regardless of who you choose to do the work.
Please follow payment instructions
found on your Payment Coupon.
I,__________________________________ (Applicant), hereby attest and certify that this project does not meet the definition of MixedFuel New Construction as described in PG&E Gas and Electric Rules 1 and 15, provided below:
MIXED-FUEL NEW CONSTRUCTION: A new end-use load or consistent with the definition of New Construction in the CEC 2022 Building Energy Efficiency Standards, a building that has never been used or occupied for any purpose, or any renovation where 50 percent or more of the exterior weight bearing walls are removed, that uses gas and/or propane in addition to electricity.
Pacific Gas and Electric Company
This contract has been reviewed and approved by:
Korinna Outwater
Service Planning Supervisor
Customer
Agreed and accepted by:
City Of San Rafael, A GOVERNMENT AGENCY
Authorized Signatory April Miller
Title Director
Signature #sigMLX#
Date #sigDateMLX#
#titleMLX#
#Form 79-1169#
130632924
STATEMENT OF APPLICANT'S CONTRACT
ANTICIPATED COSTS.*
Project Name: W Crescent and 4th Street Elec.
Project Location: 2202 4TH STREET, SAN RAFAEL
Notification Number: 130632924
PM Number(s): (Gas) (Electric) 35621491
APPLICANT COSTS
The following statement must only include the contracted anticipated installed costs of facilities installed by the Applicant that are refundable and that are PG&E's responsibility under its tariffs.
The costs provided by the Applicant must be taken from the Applicant's contract with its contractor. If the Applicant will be performing the work itself, the Applicant must also complete and sign this form.
The Applicant's statement of costs will be compared with PG&E's estimated installed costs of the same facilities, the lower of which will be used to determine the amount subject to allowances and refunds in accordance with the provisions of PG&E's Gas and Electric Rules 15 and 16.
If the Applicant chooses not to provide its costs, it must complete the last section of this form. Until the Applicant either provides the refundable cost from its contract with its contractor (or its own cost, if applicable), or returns this form indicating that it will not do so, PG&E will not proceed with any work on the Applicant's project. · Applicant's statement of costs include: overhead or underground service conductors,poles, service transformers, connection fittings, service pipe, valves, service connections,and other PG&E-owned service equipment, as detailed in Gas and Electric Rule 16.
· Applicant's statement of costs DOES NOT include: inspection fees, nonresidential service costs, regulators, or PG&E-owned metering equipment.
Form 79-1003
Advice 4350-G/6050-E
February 2021
†Information collected on this form is used in accordance with PG&E's privacy policy. The privacy policy is available at pge.com/privacy Automated document, Preliminary Statement, Part A
GAS ELECTRIC
Residential Service Facilities: Residential Service Facilities:
Applicant: $ #applicantCostGas# Applicant: $ #applicantCostElec# PG&E: $0.00 PG&E: $0.00
Number of gas service: 0 Stubs:0 Number of Electric service: 0 #Form 79-1003#
May 14, 2025
* This form at all times shall be subject to such modifications as the California Public Utilities Commission May direct form time to time in the exercise of its jurisdiction.
130632924
GAS ELECTRIC
Gas Distribution Facilities
and Non-Residential Service Services:
Electric Distribution Facilities
and Non-Residential Service Services:
Applicant: $ #gasDistFacilities# Applicant: $ #elecDistFacilities# PG&E: $0.00 PG&E: $1,580.88
GAS DISTRIBUTION TRENCH
Applicant: $ #gasDistTrench#
PG&E: $0.00
· Applicant's statement of costs include: overhead or underground service conductors,poles, service transformers, connection fittings, service pipe, valves, service connections,and other PG&E-owned service equipment, as detailed in Gas and Electric Rule 16.
· Applicant's statement of costs DOES NOT include: inspection fees, nonresidential service costs, regulators, or PG&E-owned metering equipment.
I declare under penalty of perjury that the foregoing is true and correct.
APPLICANT'S ELECTION NOT TO PROVIDE COSTS: (if this option selected, box must be checked) I choose not to provide to the utility my refundable costs for this project as taken from my contract with my contractor, or as performed by myself, and acknowledge that PG&E will use its estimate of the refundable costs for this project in the contract between it and me.
Executed on #signDateSACAC# at
(Date) (City)
By:
Print Applicant Name: City Of San Rafael, A GOVERNMENT AGENCY #sigSACAC# Signed:
Title: Director
#titleSACAC#
Form 79-1003
Advice 4350-G/6050-E
February 2021
†Information collected on this form is used in accordance with PG&E's privacy policy. The privacy policy is available at pge.com/privacy Automated document, Preliminary Statement, Part A
#applicantSACAC#
April Miller
Cost Breakdown
Total number of combined meters: 1
Total number of non-residential lots/units for this project: 1 Total number of residential lots/units for this project: 0 Cost of Services:
Engineering & Administrative Costs $0.00
Inspection Fees (+) $0.00
Others (N/A) (+) $0.00
Electric Metering (+) $0.00
Service Tie-In Cost (Energized) by PG&E (+) $0.00
Including Applicant Design Value of $0.00
Service Cost - Applicant installed # Services 0 (+) $0.00 Service Cost - PG&E installed # Services 0 (+) $0.00
Total Estimated Cost of Service Subject to Allowance (=) $0.00 Cost of Service Within Allowance:
less Total Residential Service Allowance
(not to exceed Total Estimated Cost of Service Subject to Allowance) Excess Service Cost
Estimated Service Cost Within Allowance (Total less Excess) Average Cost per Lot or Unit Within Allowance
Excess Service Allowance Applied to Distribution Line Extension Refundable Amount per Lot or Unit:
Applicant: April Miller
Project Location/Name 2202 4TH STREET, SAN RAFAEL
$0.00 X 0 (-) $0.00 =
$0.00 / 0 = $0.00
(=) $0.00
(=) $0.00
$0.00
Allowance
- $0.00
Ave. Cost / Unit
= $0.00
Service Tie-in Cost by Applicant (+) $0.00
**
Including Net Joint Pole Credit Value of $0.00
000130632924 Page 1 of 4
May 14, 2025
Pacific Gas and Electric Company
Detailed Cost Sheet - Electric Distribution
and Service Extension Costs
References
Notification # 130632924
Contract # 50122234 V1
E15-PM # 35621491
E16-PM # 35621491
Customer # 4827939
000130632924 Page 2 of 4
Allowances
Residential:
Amount Subject to Refund
Engineering & Administrative Costs $8,052.68
Including Applicant Design Value of $0.00
Tie-In of Distribution by PG&E (+) $3,327.94
Electric Metering (Non-Residential Projects) (+) $192.71 Other Taxable charges ( N/A )
PG&E installed - Cost of Distribution Line and Non-Res Svcs.
Applicant installed - Cost of Distribution Line and Non-Res Svcs. (+) $0.00 (=) $13,154.21
Inspection Fees (+) $0.00
SUB TOTAL
Total Refundable Amount (+) $16,311.22
(+) $0.00
(+) $1,580.88
plus ITCC @ 24% (+) $3,157.01
Less Total Allowances (not to exceed Total Refundable Amount) (-) $712.75 Balance: Net Refundable Amount $15,598.47
10 Year Refundable Advance Option
Balance: Net Refundable Amount $15,598.47
Less Credit for Value of Applicant Design Work $0.00
Less Cost of Dist. Line Ext. and Non-Res Svcs. installed by Applicant Less Distribution Substructures by Applicant
Net 10 Year Refundable Advance Option Amount
Non-Refundable Discount Option
Balance: Net Refundable Amount
Less Credit for Value of Applicant Design Work
Less Cost of Dist. Line Ext. and Non-Res Svcs. installed by Applicant Less Distribution Substructures by Applicant
Net Non-Refundable Discount Option Amount
$0.00
$0.00
$0.00
$15,598.47
$15,598.47
$0.00
$0.00
$7,799.23
$0.00
Allowance
X 0
Lots / Units
= $0.00
plus ITCC @ 24% Residential Allowances (+) $0.00
SUB TOTAL Residential Allowances (=) $0.00
Non-Residential: $84.84
Net Annual Revenue
/ 0.1476
Cost-of-Service-Factor
= $574.79
plus ITCC @24% Non-Residential Allowances (+) $137.95
SUB TOTAL Non-Residential Allowances (=) $712.74
less Residential Service Allowance:
( 0
Lots/Units
X $0.00
Ave. Cost / Unit
) + 24%
ITCC
= $0.00
Total Distribution Line Extension Allowance (=) $712.74 less Discount $15,598.47
Balance
X 0.50
Discount Rate
= (-) $7,799.23
Value of Distribution Substructures (+) $0.00
Including Net Joint Pole Credit Value of $0.00
Less Non-Residential Service Costs not Qualified for Refunds (-) $0.00 Less Distribution Extension Costs not Qualified for Refunds (-) $0.00 Non-Refundable Payments
Rule 16 Non-Refundable Payments
(+) $0.00
$0.00
Service Costs Beyond Preferred Service Location
Excess Service Costs
Service Riser (+) $1,340.89
Value of Service Trench, Conduits & Substructures in the Franchise Area or on 3rd Party Property
(+) $2,053.34
Value of Rule 16 Land Rights Costs (+) $0.00
(+) $0.00
Cost of Additional Rule 16 Applicant Design Plan Checks (+) $0.00 Other Taxable Charges: N/A
(+) $460.00
(+) $0.00
Rule 16 Trench Permits Obtained by PG&E
Inspection Fees
(+) $15,493.59 Plus Service Trench, Conduits, & Substructures installed by PG&E on Private Property
Inspection Fees (not subject to ITCC) (+) $0.00
Non-Residential Per Meter Charge 1 unit(s) (+) $282.00
Residential Per Meter Charge = 0 unit(s) (+) $0.00
Other Non-taxable Charges: (+) $0.00
Plus ITCC @ 24% (+) $925.01
Total Rule 16 Non-Refundable Amount (=) $20,554.84
Less Service Trench in the Franchise Area or
on & 3rd Party Property installed by Applicant
Less Rule 16 Applicant Design Work Associated with Excess (-) $0.00 SUB TOTAL (=) $3,854.23
000130632924
Inspection Fees (+) $0.00
Re-estimating/Composite Preparation (+) $0.00
Cost of Additional Applicant Design Plan Checks (+) $0.00 Value of Distribution Conduits (+) $0.00
Distribution Risers Installed by PG&E (+) $0.00
Value of Distribution Trench (+) $0.00
PG&E Land Rights Costs (+) $0.00
Rule 15 Trench Permits Obtained by PG&E (+) $460.00
Other (+) $0.00
SUB TOTAL (=) $460.00
Plus ITCC @ 24% (+) $110.40
Other Non-taxable Charges (+) $0.00
SUB TOTAL (=) $570.40
Less Cost of Distribution Line Extension Installed by Applicant (-) $0.00 Less Distribution Substructures by Applicant (-) $0.00
Less Rule 15 Applicant Design Work (-) $0.00
Less Distribution Conduits Installed by Applicant (-) $0.00 Less Distribution Trench Provided by Applicant (-) $0.00 Total Non-Refundable Electric Rule 15 Amount (=) $570.40 (-) $0.00
Less Service Costs Beyond Preferred Location by Applicant (-) $0.00 Less Excess Service Facilities Installed by Applicant (-) $0.00 SUB TOTAL (=) $20,554.84
Non-Residential Service Costs not Qualified for Refunds (+) $0.00 Distribution Extension Costs not Qualified for Refunds $0.00 Rule 15 Non-Refundable Payments
Relocation/Rearrangement Inspection Fees
Relocation/Rearrangement Trench Permits Obtained by PG&E Value of Relocation Applicant Design Work
Tie-in/Meter of Relocation/Rearrangement by PG&E
Relocation/Rearrangement Land Rights
D.0405055 Line Extension Costs - Non-Residential (PMC Charge) Plus Relocation/Rearrangement - Non Taxable
D.0405055 Line Extension Costs - Residential (PMC Charge)
SUB TOTAL
Relocation / Rearrangement of PG&E Facilities
Actual Cost Billing Forecast(6)
(+) $0.00
(+) $0.00
(+) $0.00
(+) $0.00
(+) $0.00
(+) $0.00
(+) $0.00
Plus ITCC @ 0% (+) $0.00
(=) $0.00
(+) $0.00
000130632924
Re-engineering/Comp Prep/Add'l AD Plan Checks (+) $0.00 Value of Relocation/Rearrangement Facilities $0.00
Value of Relocation/Rearrangement Conduits & Substructures (+) $0.00 Value of Relocation/Rearrangement Trench & Excavation (+) $0.00 Engineering & Administrative Costs (+) $0.00
Total Relocation / Rearrangement of PG&E Facilities Amount (=) $0.00 Less Relocation/Rearrangement Salvage (-) $0.00
Including Net Joint Pole Credit Value of $0.00
Less Value of Relocation Applicant Design Work (-) $0.00 Less Trench & Excavation Provided by Applicant (-) $0.00 Less Conduits & Substructures Installed by Applicant (-) $0.00 SUB TOTAL (=) $0.00
Less Relocation/Rearrangement Facilities Installed by Applicant (-) $0.00 Value of Electric Facility Reinforcements by based upon Applicant's estimated demand of: kVa
(Reference: Payment Adjustments. Excess Facilities section of provisions) PG&E: $0.00
0.00 (1) Total Service Allowance not to exceed the Cost of Service (2) 10 Year Refundable and Discount Option credit amounts will be paid upon acceptance of facilities. Credit amounts are subject to future deficiency billing in accordance with the tariff. (3) 10 Year Refundable and Discount Option credit amounts do not offset Other Non-Refundable or Relocation Fees. See Reimbursement Summary for a total of Reimbursements and Credits to be paid upon acceptance of facilities. (4) Inspection Fees (Only Refundable if Applicant's Actual Cost is Used. Applicant's Actual Cost + Inspection Cannot Exceed PG&E's Estimate)
(5) The lower of PG&E's estimated costs or the Applicant's Contract Anticipated Costs (as documented on Form 79-1003 "Statement of Contract Anticipated Costs") will be used to establish the cost of Service and Distribution Line Extension subject to Allowance (6) Per CPUC Decision 23-12-037, Actual Cost Billing Forecast is to cover any cost increases due to unforeseen circumstances.
Total Non-Refundable Electric Rule 16 Amount (+) $20,554.83 Total Non-Refundable Electric Rule 15 Amount (+) $570.39 Total Non-Refundable Relocation / Rearrangement Amount (+) $0.00 Total Non-Refundable Costs (+) $21,125.23
Actual Cost Billing Forecast Fee (+) $0.00
Total Non-Refundable Payment (=) $21,125.23
Note: This supplemental detailed cost sheet is for reference only and is not intended for use in place of the actual contract for the project listed.