Simplified Interconnection Application
Certified Inverter-Based Generating Facilities
With a Rated Capacity Up To and Including 10 kW AC
This Application is considered complete when it provides all applicable and correct information required below.
Additional information to evaluate the Application may be required.
PROCESING FEE
A fee of $50 must accompany this Application.
INTERCONNECTION CUSTOMER
Name: _______________________________________________________________________________
Contact Person: _______________________________________________________________________________
Address: _______________________________________________________________________________
City, State, Zip: _______________________________________________________________________________
Telephone (Day): __________________________________ (Evening) ___________________________________
Fax Number: ____________________ E-Mail Address: _____________________________________________
ENGINEERING FIRM (If Applicable)
Contact Person: ________________________________________________________________________________
Address: ________________________________________________________________________________
City, State, Zip: ________________________________________________________________________________
Telephone (Day): _______________________________ Fax Number: ______________________________________
E-Mail Address: _________________________________________________________________________________
CONTACT (if different from Interconnection Customer)
Name: ________________________________________________________________________________
Address: ________________________________________________________________________________
City, State, Zip: ________________________________________________________________________________
Telephone (Day): ___________________________________ (Evening) ____________________________________
Fax Number: _____________________ E-Mail Address: _____________________________________________
Owner(s) of the Facility (include % ownership by any electric utility):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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Generating Facility Information
Location (if different from above): _____________________________________________________________________
Electric Service Company: _____________________________________________________________________
Account Number: _____________________________________________________________________
Generator 10 kW Inverter Process
Inverter Manufacturer: _____________________________________________ Model ___________________________
Nameplate Rating: (kW) (kVA) (AC Volts) ______________________________________________________________
Single Phase ___________ Three Phase ___________
Prime Mover:
System Design Capacity: __________ (kW) __________ (kVA)
Photovoltaic Reciprocating Engine Fuel Cell Turbine Other (describe) ___________
_________________________________________________________________________________________________
Energy Source:
Solar Wind Hydro Diesel Natural Gas Fuel Oil Other (describe) ___________
_________________________________________________________________________________________________
Is the equipment ULl741 Listed? Yes _____ No _____ If Yes, attach manufacturer's cut-sheet showing ULl741 listing
Estimated Installation Date: _________________________ Estimated In-Service Date: __________________________
The 10 kW Inverter Process is available only for inverter-based Generating Facilities no larger than 10 kW that meet the
codes, standards, and certification requirements of Attachment 3 of the Generator Interconnection Procedures (SGIP), or
the QRU has reviewed the design or tested the proposed Generating Facility and is satisfied that it is safe to operate.
List components of the Generating Facility equipment package that are currently certified:
Equipment Type
Certifying Entity
1. _____________________________________________ ______________________________________________
2. _____________________________________________ ______________________________________________
3. _____________________________________________ ______________________________________________
4. _____________________________________________ ______________________________________________
5. _____________________________________________ ______________________________________________
Interconnection Customer Signature
I hereby certify that, to the best of my knowledge, the information provided in this Application is true and correct. I agree
to abide by the Terms and Conditions for Interconnecting an Inverter-Based Generating Facility No Larger than 10kW as
pursuant to the description contained in the New Mexico Interconnection Manual, Exhibit 3A, and further agree to return
the notice of completion when the Generating Facility has been installed.
Signed: __________________________________________________________________
Title: __________________________________________________________________
Date: __________________________________________________________________
Utility Signature
The undersigned Utility agrees to abide by the Terms and Conditions contained in the New Mexico Interconnection
Manual, Exhibit 3A, and that optional paragraph 6.0 indemnification _______ does _______ does not apply.
Signed: _________________________________________________________
Title: _________________________________________________________
Date: _________________________________________________________
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