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Community Partnership Cenkrft nt <br />Grant Application pp Energy <br />Aoalicant c) <br />City Hall address Z)Pcode <br />Requestorname Title <br />Phone fax <br />Email address <br />What equipment or special project are you asking us to help fund? <br />Equipment/speeial project description (brief) <br />Total equipmentJspecial project cost $ <br />Amount of funding request $ (Maximum is $x500. funding request cannot exceed 50 percent of total equipme 0roject cost) <br />How will your request benefit the community? <br />If awarded, could a check be presented at a city council meeting? ❑ Yes ❑ No <br />Signature (required) <br />Administrator, manager or clerk (print name) Signature <br />Title Date <br />Mail or fax application to: Questions? <br />CenterPoint Energy Contact: Jean Krause <br />Attn: Jean Krause 612-321-4609 <br />P.O. Box 59038 Jean.Krause@CenterPointEnergy.com <br />Minneapolis, MN 55459-0038 <br />Fax: 612-321-4812 <br />CNP 13041420171 Page 2 of 2 <br />17 <br />