(a) A complete account certificate of representation for a CO₂ authorized account representative or an CO₂ authorized alternate account representative shall include the following elements in a format prescribed by the department or its agent:

1. (1) identification of the CO₂ budget source and each CO₂ budget unit at the source for which the account certificate of representation is submitted;
2. (2) the name, address, e-mail address, and telephone number of the CO₂ authorized account representative and any CO₂ authorized alternate account representative;
3. (3) a list of the owners and operators of the CO₂ budget source and of each CO₂ budget unit at the source;
4. (4) the following certification statement by the CO₂ authorized account representative and any CO₂ authorized alternate account representative: "I certify that I was selected as the CO₂ authorized account representative or CO₂ authorized alternate account representative, as applicable, by an agreement binding on the owners and operators of the CO₂ budget source and each CO₂ budget unit at the source. I certify that I have all the necessary authority to carry out my duties and responsibilities under the CO₂ Budget Trading Program on behalf of the owners and operators of the CO₂ budget source and of each CO₂ budget unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions and by any decision or order issued to me by the department or a court regarding the source or unit."; and
5. (5) the signature of the CO₂ authorized account representative and any CO₂ authorized alternate account representative and the dates signed.