EXHIBIT A 

Case: 19-30088 Doc# 3177-1 Filed: 07/24/19 Entered: 07/24/19 16:50:47 Page 1

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Pacific Gas and Electric Company

Community Pipeline Safety Initiative

6111 Bollinger Canyon Rd., 3rd Floor

San Ramon, CA 94583

July 9, 2019

«OWNER_NAME»

c/o [Representative Name]

«MAIL_ADDRESS»

«MAIL_CITY», «MAIL_STATE» «MAIL_ZIPCODE»

Re: «SITE_ADDRESS», «PROPERTY_CITY» (Property County Rural) (_______ CDP)

«PROPERTY_STATE», «PROPERTY_ZIPCODE»

Updated Action Plan for Safety Work Near Gas Pipeline

RW-C/VC-xxxx-xx, «Vegetation_P6» 

Thank you for meeting with our representatives to discuss items located on your property that could prevent critical 

access to the Pacific Gas and Electric Company (PG&E) pipeline for first responders and utility crews in the event of an 

emergency or for important maintenance work. These items left unaddressed could also potentially damage the pipeline. 

As a result, we need to work with you to remove and/or modify these items. Please note this Action Plan is revised and 

updated from the previous Action Plan you signed on XX/XX/XX.

The following items will require removal and/or modification:

1. ________________________________________________

2. ________________________________________________

3. ________________________________________________

4. ________________________________________________

5. ________________________________________________

6. ________________________________________________

7. ________________________________________________

PG&E or its authorized representatives or contractors will perform the following work, at no cost to you:

1. ________________________________________________

2. ________________________________________________

3. ________________________________________________

4. ________________________________________________

5. ________________________________________________

6. ________________________________________________

7. ________________________________________________

Owner Self-Perform: 

You have indicated you prefer to perform the following work yourself, which will be completed by ___/___/_____:

1. ________________________________________________

2. ________________________________________________

3. ________________________________________________

4. ________________________________________________

5. ________________________________________________

6. ________________________________________________

7. ________________________________________________

PG&E will perform the indicated work in a professional manner and in accordance with all applicable laws, ordinances and 

regulations. PG&E will obtain any permits or approvals that may be legally required associated with the activities 

Commented [SL1]: Use only if a representative is acting on 

behalf of Owner. If not, remove this line.

Commented [SL2]: Only if applicable

Commented [SL3]: Remove if this is not a revised Action Plan.

Commented [HM4]: Remove if not a revised action plan.

Commented [HM5]: Remove if no modification required.

Case: 19-30088 Doc# 3177-1 Filed: 07/24/19 Entered: 07/24/19 16:50:47 Page 2

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described in this Action Plan. We will keep the work area safe and remove any debris related to our activities from the 

property. 

In connection with PG&E’s agreement to perform the foregoing work, you agree to do the following:

A. Provide access to your property to PG&E and/or their representatives, contractors and sub-contractors during

normal business hours, and if necessary, on Saturdays in order to accomplish necessary work.

B. Remove the contents of any structure to be demolished or relocated, and remove any other personal property that

may be necessary to complete activities described in this Action Plan. You will be responsible for the proper

disposal of any personal property that you no longer wish to store on your property, including any equipment,

appliances, paints, pesticides and similar materials.

C. Keep clear of the work area, and keep any children and pets away from the work area so as not to pose any 

safety risks or hazards while construction is taking place.

D. Cooperate in the execution of any documents that may be required to perform the work, such as permit

applications and related documents that may be required to complete the activities described in this Action Plan.

After we have completed this safety work, we will meet with you to review the improvements and confirm in writing that the 

tasks identified in this Action Plan have been completed. After this review, you will be responsible for the care and 

maintenance of any replacement vegetation that has been provided, including any special care that may be required.

This Action Plan helps to ensure the continued safe operation of the gas pipeline and that first responders and PG&E 

crews can safely and quickly access the gas pipeline in the event of an emergency or for important maintenance work. 

After this gas safety work is completed, kindly keep the area around the pipe safe and clear of any obstructions that could 

prevent safe access to the pipeline.

For the tree(s) that we have determined can remain in place, PG&E safety professionals will conduct regular monitoring 

through a mix of aerial and ground inspections on at least a quarterly basis. Should any of these trees develop into an 

emergency access or safety concern in the future, PG&E will work with you to address the concern at that time. 

If the foregoing is acceptable to you, we ask that you sign this Action Plan in the space provided below and return it in the 

enclosed envelope. After we receive your concurrence, we will schedule the work and access your property at a mutually 

agreed upon date and time. We will not move forward with any work on your property until we have received your written 

agreement.

We appreciate your support as we maintain the safety of the gas system in your local community.

Sincerely,

[NAME]

Land Agent / Land Consultant, Community Pipeline Safety Initiative

[PHONE NUMBER]

ACKNOWLEDGED AND AGREED:

Print Name: _____________________________ Date: ___________________________

Signature: ______________________________ 

Print Name: _____________________________ Date: ___________________________

Signature: ______________________________

PG&E: _________________________________ Date:___________________________

Bob L. Jones / Stephen Hughes

Manager, Land Rights / Supervisor, Land Management

Pacific Gas and Electric Company

Commented [SL6]: Delete if only a Vegetation project

Commented [SL7]: Delete if owner does not want replacement 

vegetation

Commented [SL8]: Remove if signing in person

Commented [SL9]: Select appropriate title

Commented [HM10]: Select appropriate approver.

Case: 19-30088 Doc# 3177-1 Filed: 07/24/19 Entered: 07/24/19 16:50:47 Page 3

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