Horizon Pipeline Company, L.L.C.

Original Volume No. 1

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Effective Date: 09/01/2009, Docket: RP09-856-000, Status: Effective

Original Sheet No. 304 Original Sheet No. 304

EXHIBIT C

DATED ............

EFFECTIVE ...................

Shipper: ...................

Contract No.: ...................

Negotiated Rate Agreement

(If Applicable)

.........................................................

Or

Discount Agreement

(If Applicable)

.........................................................