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APR 0 9 2020 <br /> Signature: <br /> The undersigned Energy Provider hereby agrees and warrants to the State of North Carolina and the <br /> County Department,that the undersigned will comply with the terms and conditions outlined in this <br /> Agreement to receive monies under the Low-Income Home Energy Assistance Program. <br /> I hereby declare that I have read and understand the above and agree to comply and abide with the <br /> terms and conditions specified while participating In the program. <br /> Central Electric Membership Corp An 9 et t k a 1\J) C) t <br /> (Print Company Name) Print County Director Name) <br /> '//,R <br /> a./..‘ <br /> (Signatur/.f Company Representative) (Signature of County Director) <br /> 04/09/2020 S71 2/020. <br /> (Date) (Date) <br /> 4/08/2020 C' csu 1 r) .Q Ln <br /> (Print Mailing Address) (Print Mailing Address) <br /> PO BOX 1107 - r -c-ny-C1 -L 2._>33/ <br /> (Print City,State,Zip Code) Print City,State,Zip Code) <br /> n <br /> SANFORD NC 27331 `l (a -� <br /> (Telephone Number) t (T-Iephone Number) <br /> 919-774-4900 Cl ii - C rk A . GO <br /> (Provider Federal ID Number(FEIN)or SSN) (Primary E-mail Address) <br /> 56-0478157 <br /> (Primary E-mail Address) AM-1 A, 'Ia1f\J 4 v p <br /> Chi‘v LeeCoon4c kc o�C me it io(,6S <br /> DSS-8163 (06/18) Page 3 of 3 <br /> Economic and Family Services <br />