OFFICIALUSEONLY

Indicate the payment receipt number

andthecorrespondingamount.
ReceiptNo.______________________
Amount:$______________________

OperationalReport
ElectricPowerCompanies
NewReport

ReportUpdate

Instructions:
Whenfillingoutthisform,examinetheprovisionsofSection2.02ofRegulationNo.8618andbesuretoprovide
alltherequiredinformation.
IndicateN/Awheretheinformationisnotapplicable.
UseComplementarySheet(CEPRZ01)ifadditionalspaceisrequired.
IncludetherequireddocumentsaccordingtotheRegulationNo.8618,enumeratedintheAnnexessection.
PresentacopyofthepaymentevidencewhensubmittingthisForm.
A. ElectricPowerCompanyGeneralInformation
1. CompanyName:

2. FiscalYearStartDate:

3. FiscalYearEndDate:

B. OperationalReportGeneralInformation
ThisreporthasbeenreferredtotheCommonwealthEnergyPublicPolicyOfficeforreviewandcommentspriortoitsfilingbeforetheEnergy
Commission.
ThisreporthasnotbeenreferredtotheCommonwealthEnergyPublicPolicyOfficeforreviewandcommentspriortoitsfilingbeforetheEnergy
Commission.(ExplainthereasonsfornotreferringthereporttotheCEPPO)

CEPRB03(Rev.August2015)OperationalReportofElectricPowerCompanies
Reference:RegulationonCertification,AnnualFees,andOperationalPlansforElectricPowerCompaniesinPuertoRico,RegulationNo.8618.

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Annexes:(MarkthedocumentsincludedwiththeOperationalReportForm)
OperationalPlan(Section2.02(A)(1)).
OperationalBudgetforcurrentfiscalyear(Section2.02(A)(3)).
MostrecentfinancialstatementcertifiedbyaCertifiedPublicAccountant(Section2.02(A)(4)).
Reportsaboutthechangesthecompanyforesees,plansfor,orenvisagesinitsoperationalbudgetsforthefollowingfive(5)years
(Section2.02(A)(5)).
Coststudiesandreportsfortheelectricservicesthecompanyprovides(Section2.02(A)(6)).
Reportsandstudiesoftheaveragefrequency(hertz)oftheelectricpowersystemduringthethree(3)fiscalyearspriortothesubmissionofthe
Report(Section2.02(A)(7)).
Operationandmaintenancereportsforthethree(3)fiscalyearspriortothesubmissionoftheReport(Section2.02(A)(8)).
Reportsofelectricpoweroutagesthathaveoccurredduringthethree(3)fiscalyearspriortothesubmissionoftheReport(Section2.02(A)(9)).
Reportsregardingrequestsforenergytransmissionorwheeling(Section2.02(A)(10)).
CopiesofinformationsubmittedtoanypublicentityofanystateorlocaljurisdictionregardingtheprovisionofelectricserviceinPuertoRico
(Section2.02(A)(11)).
ComplementarySheet(CEPRZ01).
Other:

Formcompletedby:

Name

Position

Signature

Date

OATH
I, (Name) _____________________________, (Position) ________________________ of the electric company
_________________________________, certify, under oath and subject to the penalties provided for the crime of
perjury,thattheinformationprovidedinthisformandinalltheannexesiscompleteandcertain,andthatIhavelegal
capacitytobindthecompany.
In___________________________,PuertoRico,on______of__________________of________.

AFFIDAVITNo._________________________
Sworn and subscribed before me by ____________________________________________________ identified
accordingtothemeansprovidedbylaw,specificallyby__________________________.
In___________________________,PuertoRico,on______of__________________of________.

CEPRB03(Rev.August2015)OperationalReportofElectricPowerCompanies
Reference:RegulationonCertification,AnnualFees,andOperationalPlansforElectricPowerCompaniesinPuertoRico,RegulationNo.8618.

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_______________________________
Notary

CEPRB03(Rev.August2015)OperationalReportofElectricPowerCompanies
Reference:RegulationonCertification,AnnualFees,andOperationalPlansforElectricPowerCompaniesinPuertoRico,RegulationNo.8618.

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