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NEW YORK STATE ELECTRIC & GAS CORPORATION aia Streetlight Request Form Service Class 3 Project: Notes Other Information * This form must be submitted to your NYSEG representative along with written authorization from the Municipality to Install or remove the equipment indicated. }* Please Include a sketch/layout if new poles are being installed. initial term plus any balance due on service rendered to the time of termination. @ Non-LED streetlights are no longer available as of 12/1/2020. '@ All failures of existing Streetlights Lights will be replaced with an LED Streetlights Light of comparable size. @ It is the Customer's responsibility to select the Luminaire, Lamp, Wattage, and Bracket, The Company does not provide lighting design service. @ Additional information regarding NYSEG Streetlight service can be found in NYSEG's Streetlight Tariff. Signatures