Power Of Attorney printable pdf download

POWER OF ATTORNEY

General Purpose – This Power of Attorney “POA” is intended to enable the party listed herein to

execute an electric supply agreement between a designated, licensed third party electric supplier

chosen through a competitive bidding process conducted by Affinity Energy Management, LLC on

behalf of the members of the Delmarva Poultry Industry, Inc. “DPI”. It is the intent of the

aggregation initiative and competitive bidding process to procure a competitive electric supply

agreement for members of DPI that is below Delmarva Power’s current standard offer supply price.

I, __________________________, of _________________________________________________,

(Name)

(Address)

City of ______________________, State of ____, do hereby appoint Edward C. Jackson, Principal

of Affinity Energy Management, LLC of 220 Cherry Blossom Place, Hockessin, Delaware, 19707

my attorney in fact to act in my name, place and stead in any way which I myself could do, if I were

personally present, with respect to the execution of an electric supply agreement for the properties

served by Delmarva Power under my legal control listed below:

Delmarva Power Account No.

Service Address as Shown on Delmarva Power Bill

_________________________ ___________________________________________________

To induce any third party to rely upon this power of attorney, I agree that any third party receiving a

signed copy or facsimile of this power of attorney may rely upon such copy, and that revocation or

termination of this power of attorney shall be ineffective as to such third party until actual notice or

knowledge of such revocation or termination shall have been received by such third party. I, for

myself and for my heirs, executors, legal representatives and assigns, agree to indemnify and hold

harmless any such third party from any and all claims that may arise against such third party by

reason of such third party having relief on the provisions of this POA.

Optional Special Instructions: _____________________________________________________

This power of attorney may be revoked by me at any time and expires 27 months from the date it is

fully executed and witnessed.

____________________

Date

Signature of Grantor (Person Appointing Attorney-In-Fact)

____________________________________

Witness Name

Signature of Witness

I accept my appointment as Attorney-In-Fact.

Edward C. Jackson, Principal

Signature of Attorney-In-Fact

Name of Attorney-In-Fact

Completed POA form should be sent to Delmarva Poultry Industry, Inc. by December 1, 2012.

Fax to 1-302-856-9799, mail to 16686 County Seat Highway, Georgetown, DE 19947, or scan the

signed POA form and e-mail to .

Power Of Attorney