WA State Transit Association 4/18/2023

ECY 070-714 December 2022 Clean Fuel Standard Aggregator Designation Form Instructions: This form is used by the Washington State Department of Ecology (Ecology) to approve the designation of a third-party aggregator by another party that is eligible to participate in the Clean Fuels Standard as a credit generator or regulated party. Ecology must approve the designation of an aggregator in order for the aggregator to report and generate credits or deficits on behalf of the company designating them. The information submitted is subject to Ecology verification. Both the designating organization and the aggregating organization must submit the signed and completed form to CFS@ecy.wa.gov. The aggregating organization must also upload the signed and completed form to WFRS-CBTS by visiting their Organization Profile and clicking “Add Designator(s)”. Section 1. Designating Organization Company Name: ______________________________________________________________________________ Physical Address: _____________________________________________________________________________ City: ________________ State/Province: ________________ Country: _______________ Zip: _______________ ☐ Check here if mailing address is the same as above Mailing Address: ______________________________________________________________________________ City: ________________ State/Province: ________________ Country: _______________ Zip: _______________ Legal Contact If the designating organization does not have legal counsel, please list a person from the organization with authority to accept legal responsibility for the organization. ☐ By checking this box and signing below, I acknowledge my role as the legal contact for the designating organization. Name: _______________________________ Title: _______________________________ Telephone: ________________________ Email: ________________________ Fax: ________________________ Signature: _______________________________ Date: ____________ 3.21.23