Contract - Guaranteed Energy Savings Proj No 124-015 - Veregy

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48 ATTACHMENT I: FORM ALLOCATION OF SECTION 179D DEDUCTION ADDRESS OF GOVERNMENT-OWNED BUILDING: Project Name: Project Street: Project City, State & Zip Code: AUTHORIZED REPRESENTATIVE OF THE OWNER OF THE GOVERNMENT-OWNED BUILDING: Owner Name: Representative Name: Representative Title: Representative Street Address: Representative City, State & Zip: Representative Phone Number: AUTHORIZED REPRESENTATIVE OF DESIGNER RECEIVING THE ALLOCATION OF THE SECTION 179D DEDUCTION: Designer Name: Representative Name: Representative Title: Representative Street Address: Representative City, State & Zip: Representative Phone Number: PROJECT COST: DATE PROJECT PLACED IN SERVICE: AMOUNT OF SECTION 179D DEDUCTION ALLOCATED TO THE DESIGNER: Building Envelope: Lighting System: HVAC System: TOTAL: Under penalties of perjury, I declare that I have examined this allocation, including accompanying documents, and to the best of my knowledge and belief, the facts presented in support of this allocation are true, correct and complete. AUTHORIZED REPRESENTATIVE OF AUTHORIZED REPRESENTATIVE OF OWNER OF GOVERNMENT-OWNED BUILDING: DESIGNER: ___________________________________________ _________________________________________ By: By: Dated: Dated: