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SAN MATEO COUNTY <br />San Mateo County Energy Watch Customer Testimonial/Information Release Form <br />Permission to Use Customer Energy Retrofit Information and/or Testimonial <br />In an effort to recognize the energy -savings accomplishments of its participants and promote the wider adoption of energy efficiency, <br />the San Mateo County Energy Watch Program requests that satisfied customers provide permission to use information from their <br />projects for marketing and educational purposes. Your confidential information will never be sold to third party marketing firms. <br />Please initial below the extent to which you authorize promotional use of information related to your energy -efficiency project, <br />Promotional materials may be published and distributed in printed form, on the Internet and/or other formats, via text, pictures and/or <br />video formats. <br />Customer: <br />Please initial each item as appropriate. <br />You may publish my energy savings information, measures installed, type of business, and the community in <br />which my business is located. <br />You may identify my business by name and address. <br />You may identify me by name and publish a statement attributable to me. <br />I DO NOT authorize the promotional uses of my information described above. <br />Authorized Signature. <br />City of Redwood City Print Name: <br />1301 Maple St <br />REDWOOD CITY,CA 94063 Title: <br />Date: <br />Page 13 Contractor Change Order 6/18/2018 <br />