20231251 Ver 1_Agent Authorization_20230914

CYPR ESS CR EEK
RENEWA.BLES
AGENT AUTHORIZATION
This form authorizes state employees, federal employees, and all entities under contract with Cypress Creek
Renewables (CCR) to perform site assessments, site verifications, and permitting exercises on the purchase or lease
site. Cypress Creek Renewables is not responsible for damages resulting from assessment, verification, and permitting
activities. This form must be completed in full.
A list of CCR's third party contractors is available upon request.
Property Address:
Parcel Tax ID Number(s): 00
Owner Name(s): 1
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Address:
Telephone Number:
E-mail
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Fax (optional) 0
4Ownenatur Dak Signed
Spouse's Signature Date Signed
3402 PICO BLVD., SANTA MONICA, CA 90405 CCRENEW.COM