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Seminole Service Agreement

SERVICE AGREEMENT

 

THIS AGREEMENT BETWEEN SEMINOLE NATION OF OKLAHOMA FAMILY SERVICES LIHEAP
AND_______________________________________________
                                                                   
ENERGY SUPPLIER

1.     ALLOW FOR A RATE DISCOUNT OF_________ON COST OF SERVICE
        TO RECIPIENTS OF LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR;

2.     AND/OR, WEATHERIZATION DISCOUNT OF___________ON COST OF
        SERVICE TO RECIPIENTS OF LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR;

3.     AND/OR, ARREARAGE FORGIVENESS ON COST OF SERVICE TO
        RECIPIENTS OF LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR;
        ______YES ______NO

4.     AND/OR, FEE WAIVER ON COST OF SERVICE TO RECIPIENTS OF
        LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR
           
        ______YES ______NO

THIS AGREEMENT IS EFFECTIVE AS OF______________________________.
                                                                       
Month          Date          Year

________________________________        
__________________________________

SEMINOLE NATION OF OKLAHOMA      AUTHORIZED VENDOR
REPRESENTATIVE
FAMILY SERVICES LIHEAP
COORDINATOR
LIHEAP FY 1997