Rate Schedule 5.  Appendix IIIII
Restoration Services Certification Form

[Name of Generator Owner] hereby certifies that the [name/location of generation equipment] successfully unit] performed a Black Start and System Restoration Services testCapability Test on [date] in accordance with the ISO Procedures and [successfully completed/did not complete] this test in accordance with the test protocols set forth in Appendix [I/II] of Rate Schedule 5 of the ISO Services Tariff. 

[Name of Generator Owner] further certifies that it identifies and maintainshas identified a list of critical components in its black start facilities units providing Restoration Services (e.g., batteries, diesel back-up generators, inverters etc.), maintains such critical components, and has performed tests to verify the condition of these critical components in accordance with good industry utility practice.

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Signature of Officer