This form relates to the installation of new electricity connections, increases in load and major headworks. It applies to all Dampier, Wickham, Tom Price, Paraburdoo and Pannawonica sites. In addition to this form, you must also complete an application form to establish an account for residential or commercial electricity consumption and return to Rio Tinto Utilities Customer Services. We recommend seeking assistance from an electrical contractor when completing this form. Assistance is required for loads greater than 63 amps. All relevant sections of the Western Australian electrical requirements will be met. Please note: Expenditure should not be incurred until you receive a quote in response to this application. Design and quote costs may apply. All amounts must be paid by the customer prior to the commencement of any work. *Details of normal supply Residential 415/240 Volts, 3 Phase, 50Hz 63 Amps, Commercial 415 Volts 3 Phase 50Hz 100 Amps Section Item Description A. Applicant s details All applicants to complete B. Electricity connections 1 2 Connection, load increase or major headworks Load details (greater than 63 amps) 3 Multiple units 4 Attachments and information C. Applicant s signature All applicants to complete This completed application form (pages 1-4) must be returned to: Customer Services Post: GPO Box A42 Perth WA 6837 Email: Piics.utilities@riotinto.com Website: http://www.infrastructurecentral.riotinto.com For assistance please call our service desk on 1800 992 777. A. Applicant s details Applicant s details Applicant name Company name (if applicable) ABN Business address Contact number Home Mobile Postal address Email address I am the (please tick one) Owner Lessee Purchaser Prospective purchaser If the applicant is not the owner, please provide the owner's details: FDMS # RTIO-AM-0099942 Page 1 of 8
Owner's name Business address Contact number Home Mobile Postal address Site for connection details Lot number Street number Street Town Common name location Postcode Purpose of connection (please tick) Residential Commercial Hotel/motel Industrial Multi-residential Other (please specify) B. Electricity connection 1. Type of connection Please indicate the connection/s required: Alterations to current supply New connection Temporary supply (maximum 1 year) Yes No Yes No Yes No Major headworks* required? If yes, fill out Section B4. Yes No *Major headworks will incur an application fee and further charges due to the extended nature of work required. See clause 2 of Schedule A and Terms and Conditions below. 2. Load details for supplies greater than 63 amps (complete where relevant) Load (if applicable) Current load if existing Maximum demand amps/phase or kva Current consumption kwh/day New load: Estimated total maximum demand Initial total loading amps/phase or kva by date Final total loading amps/phase or kva by date Estimated total consumption Initial kwh/day Final kwh/day How was load estimated? Load pattern Operating hours Weekly operating pattern Annual operating pattern (if seasonal) FDMS # RTIO-AM-0099942 Page 2 of 8
Connection Voltage Low voltage supply (please tick) 240V 480 V 415 V OR High voltage supply If HV, complete HV submission form CT metering (loads over 100 amps) Are CT meter/s required: Yes No Type (circle): S T W Motors and equipment Is any of the electrical equipment to be used in the installation categorised within any of the following motor or disturbing equipment categories: Motors Arcing devices Magnetic core equipment Power converting equipment Power correction mitigating equipment Motor A B C New or existing? Motor Size (kw) Starting device Other specifications Equipment A B C Type New or existing? Power rating Other specifications Disturbing device details Disturbing equipment Power converting equipment Arcing devices Magnetic core equipment Power factor correction/harmonic mitigating equipment Number of disturbances Device size (kw) Other relevant information: 3. Multiple units (complete where relevant) Total number of units: Total number of CT meters necessary: Number of S type CT meters Number of T type CT meters Number of W type CT meters FDMS # RTIO-AM-0099942 Page 3 of 8
4. Major headworks (complete where relevant) See additional Terms & Conditions regarding the approval process. Briefly describe additional work required and attach relevant documents to application. 5. Attachments and additional information Applicant has attached: Note: these are optional attachments but will assist your application. Copy of site layout of installation, showing position of all electrical distribution switchboards, existing/proposed points of supply etc Diagram of access roads Diagram of distance to site from two boundaries Diagram of existing buildings Diagram of proposed buildings Electrical single line diagram of installation Equipment technical information data sheet for equipment in Part A2 Earthing sheets Load profiles C. Applicant's signature Applicant s signature Date If the applicant is a company, please enter the signatory s position OFFICE USE ONLY Customer Services superintendent approval signature Date Compliance superintendent approval signature Date FDMS # RTIO-AM-0099942 Page 4 of 8
SCHEDULE A Rio Tinto Utilities fixed fees and charges 1 Guidance to electrical services charges all connections Where our electricity is available to your property and has enough capacity, the following charges apply: Description Rio Tinto charges (inclusive of GST) Domestic underground mains connection $ 300.00 Pole to pillar (cost for up to three dwellings per lot more than three dwelling per lot is considered a subdivision development at full cost) Upgrade of underground service from single phase to three phase Disconnection/reconnection of overhead/underground service Supply disconnect/reconnect (at the customer s request) $ 750.00 per dwelling $ 257.00 $ 257.00 $ 257.00 Temporary supply (single phase or three phase) $ 721.00 Three phase meter fee (upgrade from single phase or new three phase meter) $ 276.00 Subsidiary meter (additional three phase meter fee) $ 148.50 Project cancellation or amendment $ 345.00 plus costs incurred 2 Additional charges - major headworks Where the electrical works are identified as major headworks (by the applicant and/or Rio Tinto), the following charges apply: Description Application fee Project forecast fee Implementation of works Rio Tinto charges $345 (incl. GST). This fee will be deducted from the final invoice amount unless the applicant revises or cancels the project. 10% of the forecasted cost of the project As quoted FDMS # RTIO-AM-0099942 Page 5 of 8
TERMS AND CONDITIONS 1. DEFINITION OF TYPES OF CONNECTION Alterations to current supply New connection Temporary supply (maximum 1 year) Major Headworks An increase or decrease in supply requirements. Permanent energisation of existing temporary supply and attachment to dwelling. Electricity required for temporary supply via a builder s pole. A connection that is beyond the standard new connection and requires further investigation by Rio Tinto. This may include (but is not limited to): - Relocation of Rio Tinto assets - Extension of network 2. GENERAL CONDITIONS 2.1 This application is not binding on Pilbara Iron Company Services Pty Ltd until the quote issued in response to this application is accepted and the quoted invoice paid along with all relevant fees. Further terms and conditions issued with any quote will apply. 2.2 The Supply Authority is not responsible or liable for any injury loss or damage which may occur to the customer s premises fittings fixtures furniture and personal belongings including those of his licensees or invitees no matter how so every such injury loss or damage may occur. This includes but is not limited to: a. Injury loss or damage caused by increases or decreases in the voltage or other change in the energy supplied; and/or b. Failure of any apparatus instrument meter or appliance owned or supplied or failure of any apparatus instrument meter or appliance owned or supplied by the Supply Authority. 2.3 The customer will indemnify and keep indemnified the Supply Authority against all claims demands suits actions cost and damages arising from loss or damage to any property and caused directly or indirectly by the supply of energy to the consumer s premises. 2.4 The charge in Schedule A clause 1 is for STANDARD services when a suitable low voltage mains supply exists in the street in front of the site address. For loads above the STANDARD supply, the network may need to be upgraded. If so, a separate quote will be issued for the upgrade. 2.5 Details of normal supply 415/240 Volts, 3 Phase, 50Hz,Commercial 415 Volts, 3 Phase, 50Hz 100 Amps. 2.6 If works are required to extend the network, major headworks charges will apply and a separate quote will be issues for the extension (see clause 3 - Major Headworks). 2.7 If it is necessary to relocate Rio Tinto assets, major headworks charges will apply (see clause 3 Major Headworks). 2.8 Rio Tinto will not energise a connection or reconnection until we have received a Completion Notice from the applicant s electrical contractor. This is a regulatory requirement. FDMS # RTIO-AM-0099942 Page 6 of 8
2.9 If these services are required as part of a Pole to Pillar installation, the price of the disconnection/reconnection is included in the price of that installation. 2.10 The installation of a three phase meter will incur additional charges. 2.11 Demolition is not to start until an applicant s account is closed and Rio Tinto has informed all parties. 2.12 Additional charges may apply for services carried out outside normal business hours. 2.13 The applicant must additionally complete the account application form to establish an account for residential or commercial electricity consumption billing and return this to Rio Tinto Utilities Customer Services. 2.14 Cancellation or revision of works will result in an administration fee of $345 inclusive of GST. 3. MAJOR HEADWORKS 3.1 Applicants are required to make an up-front contribution towards the overall cost of the capital works required to provide supply. Applicants may also be asked to pay towards the cost of the existing supply facilities. 3.2 The capital contribution must be paid before work is scheduled. Lead up time, from date of payment to completion of our work, will vary depending on the circumstances at the time; however, it normally takes up to 12 weeks. 3.3 An application fee of $345.00 (GST inclusive) is required to initiate a formal quote. This application fee is deductible from the final invoice amount. 3.4 Your application will not be processed if the application fee has not been paid. 3.5 Payment can be made by cheque to Rio Tinto at the time of submitting your application. An invoice will be issued for this fee on receipt of your application if payment is not included with your application. 3.6 Where the application proceeds to the development of a formal quotation, further terms and conditions will apply. 3.7 A formal quote is valid for a period of 90 days. If the quote lapses, the application charge will be forfeited and a new application will have to be made. If alterations to the original proposal are requested, there will also be a $345.00 (GST inclusive) administration fee. 3.8 Where possible, supply extensions/connections are made from the nearest point of Rio Tinto s network. 3.9 If a new power line needs to be built or an existing one upgraded, Rio Tinto will carry out a design that provides the least cost option taking into account terrain, access, environmental requirements and vegetation. Any preliminary quote supplied will not include the cost of vegetation cleaning and/or FDMS # RTIO-AM-0099942 Page 7 of 8
environmental clearances. Should environmental considerations indicate that a referral to the Environment Protection Authority for assessment be required, Rio Tinto will discuss available options with you. 3.10 An application for a supply will grant Rio Tinto a right of entry to access the property to survey, construct and maintain the power line at all times. 3.11 If the new electricity connection is required for primary production, verification of business status as a primary producer must be provided by the Applicant when requested by Rio Tinto. 3.12 If the electricity connection is required for a new or existing residence, a copy of the local shire building approvals must be provided by the applicant. 3.13 Major headworks must comply with Rio Tinto standards (as well as relevant regulatory and legislative frameworks). Contact Customer Services for further information (details above). 4. IMPORTANT NOTICE TO APPLICANT(S) FOR CREDIT (SECTION 18(E)(1) PRIVACY ACT 1988) Pilbara Iron Company Services Pty Ltd reserves the right to vary its fees and charges without notice. Notice of disclosure of your credit information to a credit reporting agency. (Privacy Act 1988) Pilbara Iron Company Services Pty Ltd may give information about you to a credit reporting agency, for the following purposes: o To obtain a consumer credit report about you, and/or o To allow the credit reporting agency to create or maintain a credit information file containing information about you. o The information is limited to: o Identity particulars your name, sex, address (and the previous two addresses), date of birth, name of employer, and driver s license number. o Your application for credit or commercial credit the fact that you have applied for credit and the amount. o The fact that Pilbara Iron Company Services Pty Ltd is a current credit provider to you. o Loan/Account repayments/payments which are overdue by more than 60 days and for which debt collection action has started. o Advice that your loan/account payments/repayments are no longer overdue in respect of any default that has been listed. o Information in that the opinion of Pilbara Iron Company Services Pty Ltd you have committed a serious credit infringement (that is, fraudulently or shown an intention not to comply with your credit obligations). o Dishonoured cheques cheques drawn by you for $100- or more that have been dishonoured more than once. o That credit provided to you by Hamersley Iron has been paid or otherwise discharged. FDMS # RTIO-AM-0099942 Page 8 of 8