Station Isolation Request Form

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Notice of Collection

Personal information is collected on this form by GrandBridge Energy under the authority of the Electricity Act, S.O. 1998, Chapter 15, Schedule A. The principal purpose of the information we collect is to accurately deliver our services and billing to you and ensure that we deal only with you or individuals you have authorized. Personal information will be used only for the purpose set out in our Privacy Policy. If you have any questions about this collection, how GrandBridge Energy may use your personal information or would like further information about its privacy policies, please contact GrandBridge Energy’s Chief Privacy Officer, 39 Glebe Street, Cambridge, ON, by phone at 1-877-871-2215, or by email at: [email protected]

Complete all fields and submit this form for any primary/substation isolation outage requests for maintenance. Completion of this form does not guarantee an appointment. A GrandBridge Energy Customer Service representative will contact you to confirm the date and time of your appointment. A minimum of two (2) weeks of lead time for isolation requests is required. Please note that we require a minimum of two business days' notice when cancelling an isolation.

Customer Information

Company Name(Required)

Company Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Customer Phone Number(Required)

Company Email(Required)

GrandBridge Energy Account Number

Contractor Information

Name of Company Performing the Work(Required)

Full Name of Contractor Requesting the Isolation(Required)

Primary Phone Number for Contractor on Site(Required)

Email Address(Required)

Project / Isolation Details

Isolation Service Address(Required)

Street Address Address Line 2 City Province Postal Code

Date of Isolation Request(Required)

Requested Start Time(Required)

Estimated Restoration Time(Required)

Reason for Isolation(Required)

ESA Permit Number(Required)

ESA Permit Number is required to complete this form. Please ensure you've pulled a permit with ESA before attempting to submit this request.

Billable Information

Purchase Order Number(Required)

Billable Costs for Isolation Go To(Required)

Contractor completing the work

Customer/Company requesting the work

Name of Person or Department to Address Invoice(Required)

Billable Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Important Notice

GrandBridge Energy cannot operate customer equipment due to liability issues; therefore, the customer must have their contractor operate customer equipment. GrandBridge Energy will refuse to operate customer-owned equipment if requested, and your isolation may be cancelled. The customer is required to apply their working grounds. Please ensure you have the necessary operators on site to avoid work delays or appointment cancellations. As Controlling Authority, GrandBridge Energy locks are on all customer-owned high-voltage equipment.

Name of Signatory

First Last

Signature(Required)

Date(Required)

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