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28 Weil, Gotshal & Manges LLP 767 Fifth Avenue New York, NY 10153-0119

EXHIBIT 1-T

EO MPP Org Standup Support Services

Case: 19-30088 Doc# 4602-21 Filed: 11/07/19 Entered: 11/07/19 19:32:50 Page 1

of 14
Contract Work Authorization

62-4229 CWA (09-26-18) Sourcing

Contract Work Authorization (CWA)

This Contract Work Authorization (“CWA”) No. C17884 is issued under and pursuant to the Blanket Agreement or Master 

Service Agreement No. (C74) 4400011341 dated January 17, 2017 (the “MSA”) between the below-named Contractor 

(“Contractor”), a Delaware limited liability partnership, and Pacific Gas and Electric Company (“PG&E”), a California 

corporation with its headquarters located at 77 Beale Street, San Francisco, California 94105. Contractor shall perform

all Work under this CWA pursuant to and in accordance with the terms and conditions of the MSA.

Contractor’s

Legal Name: 

PRICEWATERHOUSECOOPERS LLP Total Number of Pages: 13

Contractor’s

Address: 

300 Madison Avenue

New York, NY 10017

Project Name: EO MPP Org Standup Support

Job Location: Various

WORK: Contractor shall, at its own risk and expense, perform the Work described in this Contract Work Authorization and 

furnish all labor, equipment, and materials necessary to complete the Work as summarized below and as more fully described 

in the Attachments and in accordance with the guidelines and standards of the MSA. 

Contractor shall provide Major Projects and Programs (MPP) organization stand-up support including aligning on 2020 

workplan execution, establishing execution governance and controls, and benchmarking leading practices within utility and 

other capital-intensive industries. All Work to be performed in accordance with the Attachment 1 Statement of Work and the 

terms and conditions of the MSA. 

ATTACHMENTS: Each of the following documents are attached to this CWA and are incorporated herein by this reference: 

Attachment 1 Statement of Work, Pages 3 through 12

Attachment 2 Exhibit 1A, Page 13

CWA TERM: This CWA is effective upon signature by both parties and expires on 01/31/2020. Time is of the essence.

CWA 

COMPLETION: 

Contractor shall commence performance hereof when directed to do so by PG&E and Work shall be 

completed by the completion date of 12/31/2019. 

CONSIDERATION: As full consideration for satisfactory performance of the Work under this CWA by Contractor, PG&E’s total 

obligation to Contractor shall not exceed the following amount. This amount is inclusive of all taxes incurred in the 

performance of the Work. Any change to this amount shall only be authorized in writing by a PG&E CWA Change Order, fully 

executed by both PG&E and Contractor.

TOTAL: $1,050,000.00 Not-to-exceed as set forth in Attachment 1 Statement of Work

PG&E Corporation (“PG&E Corp.”) and Pacific Gas and Electric Company (the “Utility,” and, together with PG&E Corp., the “Debtors”), are 

debtors-in-possession in a proceeding pending under chapter 11 of title 11 of the United States Code (the “Bankruptcy Code”), in the United 

States Bankruptcy Court for the Northern District of California. Nothing herein shall be deemed to constitute an assumption of the Contract 

and/or any CWA or a waiver or modification of the Debtors’ rights to assume, assume and assign, or reject the Contract and/or any CWA 

pursuant to section 365 of the Bankruptcy Code. The Debtors hereby reserve all rights available to them under such proceedings. Any 

amounts paid by the Debtors hereunder must be applied to goods and/or services provided to the Debtors on or after January 29, 2019 (the 

“Petition Date”) and shall not be applied to satisfy Claims (as defined in the Bankruptcy Code) arising prior to the Petition Date.

THE PARTIES, BY SIGNATURE OF THEIR AUTHORIZED REPRESENTATIVES, HEREBY AGREE TO THE TERMS OF 

THIS CONTRACT WORK AUTHORIZATION.

PACIFIC GAS AND ELECTRIC COMPANY CONTRACTOR: PRICEWATERHOUSECOOPERS LLP

Signature Signature

Name Richard Cordova Name Daryl Walcroft 

Title Manager, Sourcing Title Principal 

Date Date 18 October 2019

Case: 19-30088 Doc# 4602-21 Filed: 11/07/19 Entered: 11/07/19 19:32:50 Page 2

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Contract Work Authorization

CWA No. C17884

Page 2 of 13

62-4229 CWA (09-26-18) Sourcing

ADMINISTRATION

PG&E 

Negotiator

Lyn Blowe Contractor 

Representative

Daryl Walcroft 

Phone 925.459.8016 Phone 415.216.8359 

Email C6b7@pge.com Email daryl.walcroft@pwc.com

Accounting Reference ED 8166320 / ET 8190423 

PR 423391 

PG&E Work 

Supervisors:

Roger Jackson (RHJC) 

Jonathan Seager (J7Se) 

Phone: 916.472.2332 

415.973.6410 

INVOICE 

INSTRUCTIONS: 

As described in more 

detail in the invoicing 

section of the Terms and 

Conditions, Contractor 

shall send invoices for 

each payment when due, 

showing the Purchase 

Order Number (starts with 

“27” or “35”) and the Line 

Item number, if 

applicable.

The default submission system for invoices to PACIFIC GAS AND ELECTRIC COMPANY should be through 

the Taulia electronic invoicing portal, which also provides real-time invoice payment status. 

In rare cases that it is infeasible for a supplier to use this system, please send paper invoices to the address 

below. Invoice payment status for paper invoices can be accessed through the automated PG&E Paid Help 

Line at (800) 756-PAID (7243) or by emailing APPaidline@pge.com

Send ORIGINAL Invoice to: PG&E Accounts Payable* 

PO Box 7760 

San Francisco, CA 94120-7760 

Send COPY of Invoice to: E-MAIL TO:

Roger Jackson RHJC@pge.com

Andre Bell ARBU@pge.com

INTERNAL PG&E USE ONLY

Distribution Date

Distribution of Copies:

 ARIBA Contracts (“CXXXX” Series): Buyer 

uploads an executed copy in Ariba. 

 Contractor 

(Signed Original Copy) 

 Work Supervisors:

Roger Jackson (RHJC) 

Jonathan Seager (J7Se) 

 Job Owners:

Roger Jackson (RHJC) 

Jonathan Seager (J7Se) 

 Invoice Approvers:

Roger Jackson (RHJC) 

Jonathan Seager (J7Se) 

 Supervisor 

V.P. Sourcing/ Purchasing 

 Director Law 

Case: 19-30088 Doc# 4602-21 Filed: 11/07/19 Entered: 11/07/19 19:32:50 Page 3

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CWA PwC C17884

Attachment 1 Statement of Work

Page 3 of 13

3 

STATEMENT OF WORK

Pursuant to

MASTER SERVICES AGREEMENT

This Statement of Work (SOW) outlines the engagement between Pacific Gas and Electric Company (“PG&E” or 

“Client”) and PricewaterhouseCoopers LLP (“PwC” or “Consultant”) to perform the services described below. The 

term "Client" in the Agreement shall include the entity signing this Statement of Work. Any terms used in this SOW 

and not otherwise defined will have the same meaning as in the Agreement. If there is a conflict between the 

Agreement and the SOW, this SOW shall prevail.

I. PURPOSE AND SCOPE

This SOW covers services as outlined in Section 2.1. This SOW confirms the understanding of the

objectives, Deliverables, timing, staffing, and fees for this project.

As a part of PG&E’s Electric Operations (EO) reorganization, Major Projects and Programs (MPP) was

created to serve as the accountable entity for executing large, highly complex programs. This entity will

focus on getting large-scale programs ready to construct and ready to operate.

PG&E is seeking assistance from PwC in helping stand-up the MPP organization as the team places

new leadership and matures its governance, processes, and capabilities. This effort will include

immediate support to address near-term challenges in the 2020 workplan development, while also laying

out a capability roadmap in a 90-day plan. PwC will support leadership interviews, preparing materials

for, and facilitating, workshops, and providing industry perspectives on leading practices of other entities

that execute major projects.

II. PARTIES' RESPONSIBILITIES

2.0 PG&E Responsibilities

PG&E will maintain ownership and accountability of all Deliverables related to the design,

documentation, and execution of the work plan. These include but are not limited to:

Employee and contractor safety controls and performance metrics

Organizational charts including leadership placement

Job descriptions and job levelling decisions

Process ownership documentation and role assignments

Work transition ownership and work plan definitions and agreements

Governance structure, charters, and decision roles and responsibilities

Implementation plans including change and engagement management

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CWA PwC C17884

Attachment 1 Statement of Work

Page 4 of 13

4 

2.1 Services to be provided by PwC:

PwC shall provide the following services (the “Services”): 

Stabilize – 30-day workplan to address near-term opportunities

Goals 1. Align on strategic objectives for MPP organization and inform

based on benchmarking to Utility and non-Utility peers

2. Inventory 2020 workplans with Asset Risk Mgmt. stakeholders

3. Define major project and determine delineation of work between

MPP, DO, and TO

4. Conduct working sessions and agree on 2020 workplan based on

execution constraints, etc.

5. Determine work planning stage-gate agreements between EO

organizations (e.g., MPP and ARM/CWSP)

6. Finalize work transition plan for 2019 and beyond

7. Finalize Execution Strategy for Portfolio Mgmt.

8. Assess work readiness including drivers for delays, critical path

analysis, throughput calculations, and performance tracking

Metrics 1. Conduct working sessions with PG&E and PwC SMEs to discuss

leading industry practices including leading and lagging indicators

2. Agree on critical metrics for MPP overall and select execution

organizations (e.g., Project Delivery)

3. Identify data gaps in gathering information needed for reporting

Scorecard 1. Refine MPP dashboard to reflect critical metrics

2. Support template and guidance for scorecard creation

3. Determine ownership for populating scorecard

Cadence 1. Conduct leadership working sessions to highlight pain points and

develop an MPP governance structure recommendation

2. Assess and align MPP governance with overall EO plan

3. Define cadence of updates, decision reporting forums, and

communication protocols for organization

Organize – 90-day workplan to assess current state and define future state

Current State 

Assessment

1. Determine select processes and/or capabilities for assessment

2. Support working sessions with SMEs to assess current state

maturity and pain points

3. Refine frameworks for process, capability, culture, and governance

in order to highlight opportunities

Future State Definition 1. Support leadership discussions in identifying future state objectives

2. Provide industry leading practices and analogs to facilitate

discussions and working sessions

3. Map out progression from current state to future state (e.g., multistep journey vs. step-change)

Gap Identification and 

Recommendations

1. Conduct gap analysis from current state to future state

2. Support development of opportunities / recommendations

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CWA PwC C17884

Attachment 1 Statement of Work

Page 5 of 13

5

3. Highlight identified pain points and how these are addressed by 

potential recommendations

4. Support development of prioritization criteria based on SME and 

leadership input on which recommendations are near vs. long term 

and which recommendations drive greatest impact

Strategic Action Plan 1. Assist roadmap creation based on prioritization criteria

2. Identify impacted stakeholders and potential mitigation plans

3. Support development of workplan and checklist to transition 

support back to PG&E

4. Conduct hand-off working sessions (as needed) with MPP owners

Executive Reporting and 

Leadership Support

1. Facilitate bi-weekly leadership status updates

2. Compile updates for broader EO leadership (as needed)

3. Prepare Senior Team discussion materials (as needed)

4. Support team in other corporate-wide guidance (as needed)

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CWA PwC C17884

Attachment 1 Statement of Work

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6 

2.2 Deliverables:

PwC shall provide Deliverables in accordance with the scope of work identified in section 2.1. 

The Deliverables assume support at the proposed team structure and will be evaluated on an 

ongoing basis to determine if additional support is needed. Any changes to the Deliverables or 

scope of support will be mutually agreed upon by the PG&E and PwC teams via a change order. 

Completion of Deliverables will be reliant on appropriate and timely access to data and PG&E 

SMEs. If such items are not provided PwC will escalate to the PG&E Work Supervisor and note in 

writing which Deliverables may be at risk for timely delivery and/or completion.

This SOW will include the following Deliverables: 

Stabilize – 30-day workplan to address near-term opportunities

Goals 1. Summary of MPP Goal Definitions

2. Benchmarking of Leading Practices by Utility and non-Utility peers

3. 2020 Workplan Inventory and Finalized Workplan

4. 2020 Workplan Stakeholder Workshops

5. Proposed Work Plan Stage-gate / Hand-off Process (between

Asset Risk Mgmt. and MPP and/or DO, TO)

6. Interaction Model between Program Mgmt., Contract Mgmt., and

Construction Mgmt.

7. Portfolio Mgmt. Execution Strategy Summary

Metrics 1. Benchmarking of metrics used by Utility and non-Utility peers

2. Finalized MPP Metrics (including Work Readiness) and protocol for

updating metrics

3. Summary of Data Gaps for Metric Reporting

Scorecard 1. Finalized MPP Performance Dashboard / Scorecard

2. Scorecard Templates and User Guidance

Cadence 1. Draft MPP Governance Structure

2. Alignment of MPP Governance and EO Governance Forums

3. Summary of Pain Points / Action items

4. Communications Plan and Timeline (e.g., Goals, Metrics,

Scorecard, and Cadence)

Organize – 90-day workplan to assess current state and define future state

Current State 

Assessment

1. Current state maturity baseline of:

– Processes (e.g., Portfolio Mgmt., Contract Mgmt., Construction

Mgmt. incl. Work Readiness and Performance, Work & Resource

Mgmt.); Note: to-be down-selected prior to assessment

– Capabilities (e.g., skillsets, staffing)

– Culture (e.g., Incentives, Behaviors)

– Governance (e.g., Metrics, Controls)

Future State Definition 1. MPP and other LOB Stakeholder Workshops

2. Future State Definition and Objectives (aligned to maturity

assessment)

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CWA PwC C17884

Attachment 1 Statement of Work

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7 

Gap Identification and 

Recommendations

1. Gaps and issue identification (e.g., Processes, Capabilities,

Culture)

2. Opportunity List

3. Recommendation Prioritization Criteria

Strategic Action Plan 1. Recommendation Plan and Roadmap

2. Preliminary Stakeholder Identification and Assessment Framework

3. Transition Workplan to Hand-off to PG&E

Executive Reporting and 

Leadership Support

1. EO Leadership Team updates (as needed)

2. Senior Team and Enterprise updates (as needed)

3. Communications and employee engagement support (as needed)

PwC will provide a bi-weekly leadership check-in to monitor progress and approve milestone 

Deliverables. Note, that Deliverable timing may change based on access to data, availability of 

stakeholder / leadership for working sessions, and/or other externalities (e.g., PSPS event). To 

drive sustainability of the MPP organization stand-up, each deliverable will be transferred to a 

respective MPP owner once complete. The proposed owner list is shown below:

Deliverables Transfer to PG&E Owner

Stabilize – 30-day workplan to address near-term opportunities PG&E Owner

Goals 1. Summary of MPP Goal Definitions

2. Benchmarking of Leading Practices by Utility

and non-Utility peers

3. 2020 Workplan Inventory and Finalized

Workplan

4. 2020 Workplan Stakeholder Workshops

5. Proposed Work Plan Stage-gate / Hand-off

Process (between Asset Risk Mgmt. and MPP

and/or DO, TO)

6. Interaction Model between Program Mgmt.,

Contract Mgmt., and Construction Mgmt.

7. Portfolio Mgmt. Execution Strategy Summary

Jonathan Seager

(Major Programs/

Project Delivery)

Shawn Adderly

(Chief of Staff)

Metrics 1. Benchmarking of metrics used by Utility and

non-Utility peers

2. Finalized MPP Metrics (including Work

Readiness) and protocol for updating metrics

3. Summary of Data Gaps for Metric Reporting

Shawn Adderly

(Chief of Staff)

Scorecard 1. Finalized MPP Performance Dashboard /

Scorecard

2. Scorecard Templates and User Guidance

Shawn Adderly

(Chief of Staff)

Cadence 1. Draft MPP Governance Structure

2. Alignment of MPP Governance and EO

Governance Forums

3. Summary of Pain Points / Action items

Jonathan Seager

(Major Programs/

Project Delivery)

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CWA PwC C17884

Attachment 1 Statement of Work

Page 8 of 13

8 

4. Communications Plan and Timeline (e.g., Goals,

Metrics, Scorecard, and Cadence)

Shawn Adderly

(Chief of Staff)

Organize – 90-day workplan to assess current state and define 

future state

Current State 

Assessment

1. Current state maturity baseline of:

– Processes (e.g., Portfolio Mgmt., Contract

Mgmt., Construction Mgmt. incl. Work

Readiness and Performance, Work &

Resource Mgmt.); Note: to-be down-selected

prior to assessment

– Capabilities (e.g., skillsets, staffing)

– Culture (e.g., Incentives, Behaviors)

– Governance (e.g., Metrics, Controls)

Shawn Adderly

(Chief of Staff)

Brian Meagher

(Electric Process

Improvement)

Future State 

Definition

1. MPP and other LOB Stakeholder Workshops

2. Future State Definition and Objectives (aligned

to maturity assessment)

Shawn Adderly

(Chief of Staff)

Brian Meagher

(Electric Process

Improvement)

Gap 

Identification 

and 

Recommendations

1. Gaps and issue identification (e.g., Processes,

Capabilities, Culture)

2. Opportunity List

3. Recommendation Prioritization Criteria

Shawn Adderly

(Chief of Staff)

Brian Meagher

(Electric Process

Improvement)

Strategic 

Action Plan

1. Recommendation Plan and Roadmap

2. Preliminary Stakeholder Identification and

Assessment Framework

3. Transition Workplan to Hand-off to PG&E

Shawn Adderly

(Chief of Staff)

Brian Meagher

(Electric Process

Improvement)

Executive 

Reporting and 

Leadership 

Support

1. EO Leadership Team updates (as needed)

2. Senior Team and Enterprise updates (as

needed)

3. Communications and employee engagement

support (as needed)

Shawn Adderly

(Chief of Staff)

Deliverables will be prepared at the direction of PG&E and are intended to be treated solely as 

PG&E-owned, and will not be represented as having been prepared by PwC. In addition to 

Deliverables, PwC may develop software or electronic materials (including spreadsheets, 

documents, databases and other tools) to assist with the engagement. If these are made available 

to PG&E they are provided "as-is." 

The exhibits below summarize at a high-level the path forward for standing-up the MPP 

organization. PwC’s scope of support will only be for the 30-day and 90-day workplan, with the 

intent of transitioning the work back to PG&E once the organization has stabilized and leadership 

teams are in-place.

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CWA PwC C17884

Attachment 1 Statement of Work

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9 

Workplan Summary

Key Assumptions

For estimates and data pertaining to data associated with the scope of work, PwC shall

rely on information provided by PG&E

PG&E will provide timely access to the Electric Operations and other LOB leadership and

stakeholders on an as-needed basis

Any scope changes to Deliverables shall be discussed and prioritized with the designated

PG&E Work Supervisor lead as needed. PwC shall not be obligated to add to, modify, or

otherwise change this Statement of Work unless such Scope Changes are mutually

agreed to between PwC, PG&E and impacted project parties

In the event that PG&E proposes a Scope Change, PwC and PG&E, in good faith, shall

discuss and document the recommended changes at their earliest opportunity. If such

Scope Change is agreed to by PwC, the Parties shall generate and execute a mutually

agreed-to SOW Change Order in compliance with PG&E Sourcing policies, forms, and

processes. A SOW Change Order shall outline the specific Scope Changes, including

cost and scheduling impacts due to the Scope Change

2.3 Proposed Team Structure

The PwC team will work under the direction of Jonathan Seager on this engagement. An integrated 

team comprised of PwC consultants will execute the work streams identified. Additional input from 

PG&E leadership will guide the analyses. Further description of team structure and member roles 

are described in the exhibit below:

Case: 19-30088 Doc# 4602-21 Filed: 11/07/19 Entered: 11/07/19 19:32:50 Page

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CWA PwC C17884

Attachment 1 Statement of Work

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10

The proposed team structure will be evaluated on an ongoing basis and any changes to the 

Deliverables or scope of support will be mutually agreed upon by the PG&E and PwC teams.

2.4 Timing

The timing of the Services is as follows:

Proposed Project Start Date: September 30, 2019

Estimated Project Completion Date: December 20, 2019

2.5 Your Responsibilities

During the term of this project, PwC will work in collaboration and at the direction of the designated 

PG&E Work Supervisor. The PwC Team will meet with the designated PG&E Work Supervisor as 

appropriate to discuss status and open issues arising from the Services, PwC’s progress reports 

and/or reports identified as Deliverables in this project, PwC’s resource utilization and staffing mix, 

adherence (or changes) to Deliverables and project plan, as well as any requests for scope 

changes. PG&E shall also provide executive sponsor input and oversight as requested by the 

PG&E Work Supervisor with input from the PwC Team.

PwC's role is advisory only. Client is responsible for all management functions and decisions 

relating to the PwC Services, including evaluating and accepting the adequacy of the scope of the 

PwC Services in addressing your needs. Client also is responsible for the results achieved from 

using the PwC Services or any related Deliverables. 

III FEES, EXPENSES AND PAYMENT

Professional Fees, Expenses and Payment Terms:

– PwC’s labor fees for this project are based agreed upon MSA terms with PG&E and estimated

on the time required by professionals to complete the engagement. Individual hourly rates

vary according to the experience and skill required

– Estimated professional fees requested for the scope of work described above amounts to

approximately $950,000

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CWA PwC C17884

Attachment 1 Statement of Work

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11

– PwC will also bill PG&E for reasonable out-of-pocket expenses not to exceed ten percent

(10%) of labor fees estimated

– Total estimated fees and expenses for the scope of work described above amounts to a total

not to exceed of $1,050,000

– Our project plan contemplates regular dialog with senior leadership to align on key points and

timely consideration of new issues or opportunities as they arise

– Any additional work outside of the scope outlined within this SOW will be agreed separately

and performed at mutually agreed upon rates, via the standard Change Order Process which

shall not be authorized without the prior written approval of PG&E and PwC

Other Terms: 

– PG&E will be solely responsible for any and all communications required with PG&E’s federal

and state regulators and/or independent monitor(s) relating to these Services and

Deliverables. Contractor is not being engaged to interact or meet with third parties, including

but not limited to PG&E’s regulators and/or independent monitor(s)

– If Contractor is requested or authorized by PG&E or required by government regulation,

regulatory agency, subpoena, or other legal process to produce Contractor’s Deliverables,

working papers or personnel for testimony or interview with respect to Services Contractor

performed for PG&E, PG&E will reimburse Contractor for Contractor’s and its counsels’

expenses and professional time incurred in responding to such a request

PG&E and Consultant Work Supervisor Name, Number, and Email Address

PG&E Work Supervisor:

Jonathan Seager, Senior Director Major Programs / Project Delivery

Phone: 415.533.8983

Email: J7SE@pge.com

PG&E Team Lead:

Shawn Adderly, Chief of Staff EO MPP

Phone: 925.448.7992

Email: S3A8@pge.com

Consultant Work Supervisor:

Daryl Walcroft, Principal

Phone: 415.216.8359

Email: daryl.walcroft@pwc.com

Consultant Team Lead(s):

Billy Raley, Director

Phone: 407.562.8162

Email: billy.r.raley@pwc.com

Hugh Le, Director

Phone: 720.284.2854

Email: hugh.le@pwc.com

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CWA PwC C17884

Attachment 1 Statement of Work

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12

Work Location(s)

This project will be conducted primarily out of PG&E’s Corporate Headquarters in San Francisco, 

CA. Work will be coordinated through the PG&E work supervisor or designees. 

Other Items

This agreement shall be governed by Master Services Agreement 4400011341 between PwC 

and PG&E. PwC is owned by professionals who hold CPA licenses as well as by professionals 

who are not licensed CPAs. Depending on the nature of the services we provide, non-CPA owners 

may be involved in providing services to you now or in the future.

At the onset of this project, PwC will prepare a project schedule and work breakdown. This 

schedule will include all PwC project management activities, Deliverables, and key 

interdependencies. The schedule and Deliverables will be subject to the specification and approval 

of the PG&E Work Supervisor.

PwC is not providing legal advice or legal opinions in this engagement. 

Each of the parties has caused this Agreement to be executed on its behalf by its duly authorized 

representative as of the date first above written.

PricewaterhouseCoopers LLP

By: 

______________________

Name/Title:

Daryl Walcroft / Principal

Date: 

______________________

Pacific Gas & Electric Company

By: 

_____________________________

Name/Title: 

_____________________________

Date: 

_____________________________ 18 October 2019

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Sourcing 

October 2018

Page 1 of 1

Subcontractor and Supplier Utilization Plan EXHIBIT 1A

Prime Contractor/Supplier Name: PG&E Contract # (if any): Contract Duration From: To:

Employer Identification # (EIN): Total Bid/Contract Value: Total Amount to be Self Performed:

PG&E Project/Product: Is Prime Contractor/Supplier CPUC Clearinghouse Certified? Yes No VON #: 

Name of Preparer: Is Prime Contractor/Supplier a Registered Small Business Certified? Yes No Small Business #: 

Preparer E-Mail: Estimated Amount to be Paid to all Subcontractors (Subs) and Suppliers ($): (for the duration of the contract)

Preparer Contact Phone: Subs and Suppliers: Small Businesses: CPUC Certified Businesses:

(1) 

Tier 

Level 

(2) 

Name of Subcontractors (s) 

and Supplier (s)

(3)

Emergency Point of Contact / 

Phone #

(4)

Contractor’s License # / Motor Carrier Permit 

(5)

Description of Work to be 

Performed or Major Materials to 

be Supplied 

(6)

Is 

Excavation 

to be 

Performed

(7) 

Gold 

Shovel 

Status

(8) 

Risk 

Level 

(9) 

ISN ID# 

and/or PG&E 

Qualified 

Vendor #

(10) 

Union 

Signatory

License/Permit 

Type

License/Permit 

# 

Expiration 

Date

Special 

Permit 

Required

The information provided on this form may form the basis of a Statement of Record, against which PG&E may conduct an audit or review to ensure compliance. 

Indicate All Subcontractor(s) and Supplier(s) of any tier prior to performing Work on designated project. Submit Exhibit 1A to best demonstrate your plan for the indicated services.

In the event of a change in planned Subcontractor(s) or Supplier(s) of any tier, submit a revised Exhibit 1A prior to performing the Work via the method outlined in the contract or work authorization.

Refer to Exhibit 1 for additional instructions on completing this form.

Please include additional sheets as needed.

(11) Signature Date Rev. #:

I hereby certify that the information listed is true to the best of my knowledge.

CWA PwC C17884 

Attachment 2 Exhibit 1A 

Page 13 of 13

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