2A9X3-CLRC66303HNYEV Charger

Applicant Declaration QSF27-14-04 Rev 1.0 Rev. Feb 6, 2023Page 1 of 2 Original Issue: Jan. 4, 2021 SGS North America Inc. 620 Old Peachtree Road SUITE 100 Suwanee, Georgia 30024 United States Applicant Legal Business Name Siemens Industry Inc. Address 3617 Parkway Lane Norcross, GA 30092 USA Grantee Code 2A9X3 FCC ID 2A9X3-CLRC66303HNY Authorized Contact Name Alex O'Sullivan Contact Email [email protected] Contact Phone 770-576-9657 I, the undersigned, certify that I am an authorized signatory for the Applicant and therefore declare; a) in accordance with 47CFR2.911(d), all of the statements herein and the exhibits attached hereto are true and correct to the best of my knowledge and belief. b) in accepting a Grant of Equipment Authorization issued by a TCB, under the authority of the FCC, as a result of the representations made in this application, the Applicant is responsible for: (1) labeling the equipment with the exact FCC ID as specified in this application, (2) compliance statement labeling pursuant to the applicable rules, (3) compliance of the equipment with the applicable technical rules, c) if the Applicant is not the actual manufacturer of the equipment, appropriate arrangements have been made with the manufacturer to ensure that production units of this equipment will continue to comply with the FCC’s technical requirements. d) in accordance with 47 CFR 2.909 and KDB394321, the Applicant has read, understood and agrees to accept that they are the responsible party and agree to abide by their responsibilities as specified under 47 CFR 2.909 and KDB394321. e) in accordance with ISO 17065, FCC KDB641163, FCC KDB610077, KDB394321 and RSP-100, the Applicant has read, understood, accepts and agrees to abide by the post market surveillance requirements. (1) the Applicant understands, accepts and agrees that a sample may be requested for surveillance testing. (2) the Applicantshall make provisions to always have a production sample available upon request by SGS, FCC and/or ISED. (3) the Applicantshall, upon request by SGS, at the Applicant’s expense, provide a production sample of the requested product to SGS, FCC and/or ISED as instructed. The sample shall include all support devices, cables, software, accessories or other hardware or software required for evaluation, review, certification and audit surveillance of products certified by SGS. f) neither the Applicant nor any party to the application is subject to a denial of Federal benefits, that includes FCC benefits, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. §862 because of a conviction for possession or distribution of a controlled substance. See 47CFR 1.2002(b) for the definition of a “party” for these purposes. g) the Applicant has read, understood, accepts and agrees to abide by the SGS North America, Inc.(TCB) terms and conditions. Link to CFRs:https://www.fcc.gov/wireless/bureau-divisions/technologies-systems-and-innovation-division/rules-regulations-title-47 Link to KDBs:https://apps.fcc.gov/oetcf/kdb/index.cfm Link to RSP-100:https://www.ic.gc.ca/eic/site/smt-gst.nsf/eng/sf01130.html Link to the Covered List:Covered List Siemens Industry Inc. (“the applicant”) certifies that the equipment for which authorization is sought is not “covered” equipment prohibited from receiving an equipment authorization pursuant to section 2.903 of the FCC rules. Siemens Industry Inc. (“the applicant”) certifies that, as of the date of the filing of the application, the applicantis not identified on the Covered list, established pursuant to§1.50002, as an entity producing “covered” equipment. Applicant Declaration QSF27-14-04 Rev 1.0 Rev. Feb 6, 2023Page 2 of 2 Original Issue: Jan. 4, 2021 SGS North America Inc. 620 Old Peachtree Road SUITE 100 Suwanee, Georgia 30024 United States Applicant Signature:Date: Print Name: Alex O'Sullivan Title: UL Hardware Manager AC Applicant Signature:Date: Print Name: Title: AC Global R&D Manager Applicant Signature:Date: Print Name: Title: North America Finance Head *NOTE: This declaration cannot be signed by an Agent, it shall be signed by an authorized person listed in the FCC database

Siemens Industry Inc. Prepared by: Alex O’Sullivan Smart Infrastructure; Management: Imrich Kocai 3617 Parkway Lane Norcross, GA 30092 USA Tel.: +1 770-576-9657 www.siemens.com Page 1 of 1 _ Siemens Industry Inc., SI E PR R&D AC, 3617 Parkway Lane Norcross, GA 30092 NameAlex O’Sullivan DepartmentSI E PR R&D AC Siemens eMobility Federal Communication Commission Equipment Authorization Branch 7435 Oakland Mills Road Columbia, MD 21046 Telephone+1 770-576-9657 [email protected] Your letter ofN/A Our referenceN/A DateFeburary21, 2023 Siemens business letter – External USA – SI E PR R&D AC Regarding: 2A9X3-CLRC66303HNY To whom it may concern: We, the undersigned, hereby authorize SGS North America to act on our behalf in all manners relating to application for equipment authorization with respect to the FCC ID above, including signing of all documents relating to these matters. Any and all acts carried out by the agent on our behalf shall have the same effect as acts of our own. We, the undersigned, hereby certify that we are not subject to a denial of federal benefits, that includes FCC benefits, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. 853(a). Where our agent signs the application for certification on our behalf, I acknowledge that all responsibility for complying with the terms and conditions for Certification, as specified by SGS North America, Inc., still resides with Siemens Industry Inc. With kind regards,Enclosures Siemens Industry Incorporated Signature(s) Siemens eMobility Alex O’Sullivan UL Hardware Manager AC 770-576-9657 [email protected] Imrich Kocai AC Global R&D Manager 678-576-0736 [email protected] Tom Kussner North America Finance Head 678-231-9726 [email protected]

Siemens Industry Inc. Prepared by: Alex O’Sullivan Smart Infrastructure; Management: Imrich Kocai 3617 Parkway Lane Norcross, GA 30092 USA Tel.: +1 770-576-9657 www.siemens.com Page 1 of 2 _ Siemens Industry Inc., SI E PR R&D AC, 3617 Parkway Lane Norcross, GA 30092 NameAlex O’Sullivan DepartmentSI E PR R&D AC Siemens eMobility Federal Communication Commission Equipment Authorization Branch 7435 Oakland Mills Road Columbia, MD 21046 Telephone+1 770-576-9657 [email protected] Your letter ofN/A Our referenceN/A DateFeburary21, 2023 Siemens business letter – External USA – SI E PR R&D AC Regarding: 2A9X3-CLRC66303HNY Confidentiality Request regarding application for FCC ID To whom it may concern: LONG TERM CONFIDENTIALITY Pursuant to 47 CFR Section 0.459 and 0.457 of the commission’s rules, the applicant hereby request confidential treatment of the documents listed below, associated with the certification application referenced above. Schematic(s) Block Diagrams Operational Descriptions The documents above contain proprietary information not released to the public. Public disclosure of this information may prove harmful to the business of the applicant. SHORT TERM CONFIDENTIALITY Additionally, the applicant requests the following documents be held confidential until the device is marketed or 180 days from the grant date, whichever is less. If the device is marketed within 180 days of the Grant Date, the applicant will notify the TCB per FCC KDB 726920 D01 Confidentiality Request Procedures. External Photos Internal Photos Test Setup Photos User manual(s) Letter of to Federal Communication Commission Error! Reference source not found. Page 2 of 2 _ With kind regards,Enclosures Siemens Industry Incorporated Signature(s) Siemens eMobility Alex O’Sullivan UL Hardware Manager AC 770-576-9657 [email protected] Imrich Kocai AC Global R&D Manager 678-576-0736 [email protected] Tom Kussner North America Finance Head 678-231-9726 [email protected]

Justification statement for Antenna To: Federal Communication Commission Equipment Authorization Branch 7435 Oakland Mills Road Columbia, MID 21046 Regarding: FCC ID: 2A9X3-CLRC66303HNY Dear Sir/Madam, Only radiated measurements are used for EUT with FCC ID: 2A9X3-CLRC66303HNY to show compliance with FCC limits for fundamental and spurious emissions. All measurements were performed radiated and therefore additional antenna gain documentation is not required. The detailed information for antenna as below shows: Design Specifications Typical Antenna Type FPC Working Frequency 13.56 MHz

EXTERNAL PHOTOS FCC ID: 2A9X3-CLRC66303HNY IC: 29968-CLRC66303HN 2 © SGS SA 2016 ALL RIGHTS RESERVED FRONT 3 © SGS SA 2016 ALL RIGHTS RESERVED BACK 4 © SGS SA 2016 ALL RIGHTS RESERVED LEFT SIDE 5 © SGS SA 2016 ALL RIGHTS RESERVED RIGHT SIDE 6 © SGS SA 2016 ALL RIGHTS RESERVED ACCESS COVERS 7 © SGS SA 2016 ALL RIGHTS RESERVED AC PLUGS WWW.SGS.COM

WiFi radio only Wifi & LTE radios WiFi & RFID radios All 3 radios

INTERNAL PHOTOS FCC ID: 2A9X3-CLRC66303HNY IC: 29968-CLRC66303HN 2 © SGS SA 2016 ALL RIGHTS RESERVED REAR COVER REMOVED 3 © SGS SA 2016 ALL RIGHTS RESERVED PCBTOP VIEW 4 © SGS SA 2016 ALL RIGHTS RESERVED PCB BOTTOM VIEW 5 © SGS SA 2016 ALL RIGHTS RESERVED RFID RADIO 6 © SGS SA 2016 ALL RIGHTS RESERVED RFID ANTENNA WWW.SGS.COM

Test Report Number: 4691635EMC03 Rev: 0 Siemens Industry / GEN 3 EVSE Page: 1 of 4 Remarks: This report details the results of the testing carried out on one sample; the results contained in this test report do not relate to other samples of the same product. The manufacturer should ensure that all products in series production are in conformity with the product sample detailed in this report. This document is issued by the Company under its General Conditions of Service accessible at http://www.sgs.com/en/Terms-and- Conditions.aspx. Attention is drawn to the limitation of liability, indemnification and jurisdiction issues defined therein. Any holder of this document is advised that information contained hereon reflects the Company’s findings at the time of its intervention only and within the limits of Client’s instructions, if any. The Company’s sole responsibility is to its Client and this document does not exonerate parties to a transaction from exercising all their rights and obligations under the transaction documents. Any unauthorized alteration, forgery or falsification of the content or appearance of this document is unlawful, and offenders may be prosecuted to the fullest extent of the law. RF Exposure Report Project Number: 4691635 Report Number: 4691635EMC03 Revision Level: 0 Client: Siemens Industry Equipment Under Test: Electric Vehicle Charger Model: GEN3 EVSE Contains FCC IDs: Z64-WL18DBMOD XMR201606EC21A Applicable Standards: 47 C.F.R. §§ 2.1091; FCC KDB 447498 FCC OET Bulletin 65 Supplement Tested by: Jeremy Pickens, RF Lab Manager Reviewed by: David Schramm, Operations Manager Test Report Number: 4691635EMC03 Rev: 0 Siemens Industry / GEN 3 EVSE Page: 2 of 4 SGS North America Inc. Consumer and Retail 620 Old Peachtree Road NW, Suite 100, Suwanee, GA 30024 t (770) 570-1800 www.sgs.com Member of the SGS Group (SGS SA) TABLE OF CONTENTS 1 GENERAL INFORMATION ............................................................................................................................................. 3 1.1 CLIENT INFORMATION ................................................................................................................................................... 3 1.2 TEST LABORATORY ....................................................................................................................................................... 3 1.3 GENERAL INFORMATION OF EUT .................................................................................................................................. 3 1.4 OPERATING MODES AND CONDITIONS .......................................................................................................................... 3 2 RF EXPOSURE ................................................................................................................................................................... 4 2.1 TEST RESULT ................................................................................................................................................................. 4 2.2 TEST METHOD ............................................................................................................................................................... 4 2.3 SINGLE TRANSMISSION RF EXPOSURE LEVELS .............................................................................................................. 4 2.4 SIMULTANEOUS TRANSMISSION RF EXPOSURE LEVELS ................................................................................................ 4 Test Report Number: 4691635EMC03 Rev: 0 Siemens Industry / GEN 3 EVSE Page: 3 of 4 SGS North America Inc. Consumer and Retail 620 Old Peachtree Road NW, Suite 100, Suwanee, GA 30024 t (770) 570-1800 www.sgs.com Member of the SGS Group (SGS SA) 1 General Information 1.1 Client Information Name: Siemens Industry Address: 5400 Triangle Parkway City, State, Zip, Country: Norcross, GA 30092-2450, USA 1.2 Test Laboratory Name: SGS North America, Inc. Address: 620 Old Peachtree Road NW, Suite 100 City, State, Zip, Country: Suwanee, GA 30024, USA Accrediting Body: A2LA Type of lab: Testing Laboratory Certificate Number: 3212.01 1.3 General Information of EUT Type of Product: Electric Vehicle Charger Model Number: GEN3 EVSE Serial Number: TBD Frequency Range (2.4G WLAN): 2412-2462MHz Frequency Range (LTE): 1850-1910MHz (Band 2) 1710-1755MHz (Band 4) 698-716MHz (Band 12) Antenna (WLAN): Chip Antenna (Pulse, P/N: W3006) Peak Gain: 2.2dBi Antenna (LTE): 2x2 MIMO LTE + GNSS FPC Antenna (Pulse, P/N: W6113XXXXX) Peak Gain: 3.4dBi (Bands 2 and 4) 2.9dBi (Band 12) Rated Voltage: 220 Vac 60Hz Test Voltage: 220 Vac 60Hz Sample Received Date: 28 September 2020 Dates of testing: NA – Calculations Only 1.4 Operating Modes and Conditions For this assessment, the EUT’s maximum conducted power and ERP/EIRP were considered. Data was pulled from the existing modules’ certifications. Test Report Number: 4691635EMC03 Rev: 0 Siemens Industry / GEN 3 EVSE Page: 4 of 4 SGS North America Inc. Consumer and Retail 620 Old Peachtree Road NW, Suite 100, Suwanee, GA 30024 t (770) 570-1800 www.sgs.com Member of the SGS Group (SGS SA) 2 RF Exposure 2.1 Test Result Test Description Specification Test Result RF Exposure FCC Part 1.1310 Compliant 2.2 Test Method Using the maximum conducted power including tune up tolerances and ERP/EIRP with provided antenna gains, the power density was calculated. 2.3 Single transmission RF Exposure Levels 2.4 Simultaneous transmission RF Exposure Levels Expressed as a percentage of the limit. Color is only used to identify worst-case. Conducted Power w/tolerance Antenna Gain Cable LossDistance (R) Power Density EIRP Avg /(4πR 2 )FCC% of LimitVerdict TypeMHzdBmColumn1Column2dBm3mWcmmW/cm 2 mW/cm22Column5Column6 LTE Band 21850-191024.03.40.027.4550200.1091.0011%Pass LTE Band 41710-175524.03.40.027.4550200.1091.0011%Pass LTE Band 12698-71624.02.90.026.9490200.0970.5917%Pass WLAN2400-2483.517.53.20.020.7…

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Test Report Number: 4717427EMC01 Rev: 1 Siemens Industry Inc. / GEN3 EVSE Page: 1 of 27 Remarks: This document is issued by the Company subject to its General Conditions of Service printed overleaf, available on request or accessible at http://www.sgs.com//en/Terms-and-Conditions.aspx. And for electronic format documents, subject to Terms and Conditions for Electronic Documents at http://www.sgs.com/en/Terms-and-Conditions/terms-e-document.aspx. Attention is drawn to the limitation of liability, indemnification and jurisdiction issues defined therein. Any holder of this document is advised that information contained hereon reflects the Company’s findings at the time of its intervention only and within the limits of Client’s instructions, if any. The Company’s sole responsibility is to its Client and this document does not exonerate parties to a transaction from exercising all their rights and obligations under the transaction documents. This document cannot be reproduced except in full, without prior written approval of the Company. Any unauthorized alteration, forgery or falsification of the content or appearance of this document is unlawful and offenders may be prosecuted to the fullest extent of the law. Unless otherwise stated the results shown in this test report refer only to the sample(s) tested and such sample(s) are retained for a maximum of 30 days only. EMC Test Report Project Number: 4717427 Proposal: 11789 SUW-202209003463 Report Number: 4717427EMC01 Revision Level: 1 Client: Siemens Industry Inc. Equipment Under Test: Wireless Vehicle Charging Transfer Switch Model: GEN3 EVSE FCC ID: 2A9X3-CLRC66303HNY IC: 29968-CLRC66303HN Applicable Standards: FCC Part 15 Subpart C, §15.225 RSS-210, Issue 10, December 2019 ANSI C63.10: 2013 RSS-GEN, Issue 5, March 2019 Report issued on: 03 March 2023 Test Result: Compliant FOR THE SCOPE OF ACCREDITATION UNDER CERTIFICATE NUMBER: 3212.01 Report must not be used by the client to claim product certification, approval, or endorsement by A2LA, NIST, or any agency of the Federal Government. Prepared by: Brandon Osborn, EMC/RF Project Engineer Reviewed by: David Schramm, Operations Manager Test Report Number: 4717427EMC01 Rev: 1 Siemens Industry Inc. / GEN3 EVSE Page: 2 of 27 SGS North America Inc. Connectivity & Products 620 Old Peachtree Road NW, Suite 100, Suwanee, GA 30024 t (770) 570-1800 www.sgs.com Member of the SGS Group (SGS SA) TABLE OF CONTENTS 1 SUMMARY OF TEST RESULTS ..................................................................................................................................... 3 1.1 MODIFICATIONS REQUIRED TO COMPLIANCE ................................................................................................................ 3 2 GENERAL INFORMATION ............................................................................................................................................. 4 2.1 CLIENT INFORMATION ................................................................................................................................................... 4 2.2 TEST LABORATORY ....................................................................................................................................................... 4 2.3 GENERAL INFORMATION OF EUT .................................................................................................................................. 4 2.4 OPERATING MODES AND CONDITIONS .......................................................................................................................... 4 2.5 EUT CONNECTION BLOCK DIAGRAM – RADIATED MEASUREMENTS ............................................................................ 5 2.6 SYSTEM CONFIGURATIONS ............................................................................................................................................ 5 3 OCCUPIED BANDWIDTH ............................................................................................................................................... 6 3.1 TEST RESULT ................................................................................................................................................................. 6 3.2 TEST METHOD ............................................................................................................................................................... 6 3.3 TEST SITE ...................................................................................................................................................................... 6 3.4 TEST EQUIPMENT .......................................................................................................................................................... 6 3.5 TEST DATA .................................................................................................................................................................... 7 4 FIELD STRENGTH OF THE FUNDAMENTAL ........................................................................................................... 8 4.1 TEST RESULT ................................................................................................................................................................. 8 4.2 TEST METHOD ............................................................................................................................................................... 8 4.3 TEST SITE ...................................................................................................................................................................... 9 4.4 TEST EQUIPMENT .......................................................................................................................................................... 9 4.5 TEST DATA .............................................................................................................................................................…

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TEST SETUP PHOTOS FCC ID: 2A9X3-CLRC66303HNY IC: 29968-CLRC66303HN 2 © SGS SA 2016 ALL RIGHTS RESERVED RSE –9KHZ TO 30MHZ –FRONT VIEW 3 © SGS SA 2016 ALL RIGHTS RESERVED RSE –9KHZ TO 30MHZ –REAR VIEW 4 © SGS SA 2016 ALL RIGHTS RESERVED RSE –30MHZ TO 1GHZ –FRONT VIEW 5 © SGS SA 2016 ALL RIGHTS RESERVED RSE –30MHZ TO 1GHZ –REAR VIEW 6 © SGS SA 2016 ALL RIGHTS RESERVED AC POWERLINE CONDUCTED EMISSIONS 7 © SGS SA 2016 ALL RIGHTS RESERVED AC POWERLINE CONDUCTED EMISSIONS WWW.SGS.COM