W38-241083ChargePoint Network Communication Board

Module Installation Instructions And Regulatory Approval Conditions 802.11b/g/n and 802.15.4 Module Model No: 241083Z and 241083 FCC ID: W38-241083Z and W38-241083 IC: 8854A-241083Z and 8854A-241083 Date: 11-19-2012 Revision: 1 FCC Compliance Statement This device complies with part 15 of the FCC Rules. Operation is subjected to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. FCC Warning: Any changes or modifications to this device not expressly approved by the party responsible for compliance could void the user’s authority to operate this equipment. Industry Canada This device complies with Industry Canada license-exempt RSS standard(s). Operation is subject to the following two conditions: (1) this device may not cause interference, and (2) this device must accept any interference, including interference that may cause undesired operation of the device.” Le présent appareil est conforme aux CNR d'Industrie Canada applicables aux appareils radio exempts de licence. L'exploitation est autorisée aux deux conditions suivantes : (1) l'appareil ne doit pas produire de brouillage, et (2) l'utilisateur de l'appareil doit accepter tout brouillage radioélectrique subi, même si le brouillage est susceptible d'en compromettre le fonctionnement." Regulatory Approval Conditions for using 241083Z/241083 Module: 1. Antennas must have a greater distance than 20 cm separation from the transmitting antenna to the user body during normal operation condition. This device can be used with Prestta WLAN Embedded Antenna. The specification of the antenna including antenna gain is shown below. 2. If a different antenna than the original certificated antenna is being use for the final product, the host will need to consult with Coulomb Technologies Inc. to verify the condition of approval applicability. 3. A permissive change from Coulomb Technologies Inc. is required as part of final system FCC/IC submission. 4. If the host has other transmitters beside from the module, simultaneous transmitting is not permitted unless a permissive change from the module manufacture is received. 5. For FCC, the label on the final system must include a statement: “Contains FCC ID: W38- 241083Z” or “Contains FCC ID: W38-241083” depend on the model that being used. For IC, “Contains IC: 8854A-241083Z” or “Contains IC: 8854A-241083” depend on the model that is being used. 6. Labeling requirement for FCC, “This device complies with part 15 of the FCC Rules. Operation is subjected to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation”. For IC, “This device complies with Industry Canada license-exempt RSS standard(s). Operation is subject to the following two conditions: (1) this device may not cause interference, and (2) this device must accept any interference, including interference that may cause undesired operation of the device.” “Le présent appareil est conforme aux CNR d'Industrie Canada applicables aux appareils radio exempts de licence. L'exploitation est autorisée aux deux conditions suivantes : (1) l'appareil ne doit pas produire de brouillage, et (2) l'utilisateur de l'appareil doit accepter tout brouillage radioélectrique subi, même si le brouillage est susceptible d'en compromettre le fonctionnement." A user’s manual or instruction manual must be included with customer product. Note: Model: 241083Z is under FCC ID: W38-241083Z and IC: 8854A-241083Z Model: 241083 is under FCC ID: W38-241083 and IC: 8854A-241083

SCS-F26 Modular Approval Letter Page 3 of 3 Rev 7.0 LMA Declaration Letter We, Chargepoint, Inc., declare that we will retain control over the final installation of the device, (FCC ID:W38-241083, IC:8854A-241083) such that compliance of the end product is assured. In such cases, an operating condition on the LMA for the module must be only approved for use when installed in devices produced by a specific manufacturer. Gary Eldridge, P.E. Regulatory Compliance Manager Phone: 408-841-4536 [email protected] Chargepoint, Inc. 1692 Dell Ave. Campbell CA 95008-6901

775 Montague Expressway Milpitas, CA 95035 Tel: 408-526-1188 Fax: 408-526-1088 Email: [email protected] Project and Product Certification Representative Authorization Letter Reason for Amendment (current / obsolete) Revision History Approved Date From To Initial Release (obsolete) 1.0 1.0 Nov-14-2006 Revised wording (obsolete) 1.0 2.0 Sept–25-2007 Updated company template (current) 2.0 3.0 Jan-31-2012 SCS-F18: Project and Product Certification Representative Authorization Letter Page 2 of 2 Rev 3.0 November 19, 2012 To: SIEMIC, INC. 775 Montague Expressway, Milpitas, CA 95035 USA Dear Sir/Madam, Re: Project and Product Certification Representative Authorization Letter We, Chargepoint, Inc., hereby authorize SIEMIC, INC. to act as a Certification Body for certifying for the following project(s): Network Communication PCB, Model: 241083 We affirm that between SIEMIC and C hargepoint, Inc., any difference in understanding, including test plan, measurement methods, applicable standards and relevant procedures and processes have been resolved prior to commencement of testing activities. Sincerely, Gary Eldridge, P.E. Regulatory Compliance Manager Phone: 408-841-4536 [email protected] Chargepoint, Inc. 1692 Dell Ave. Campbell CA 95008-6901

775 Montague Expressway Milpitas, CA 95035 Tel: 408-526-1188 Fax: 408-526-1088 Email: [email protected] Confidentiality Request Letter Reason for Amendment (current / obsolete) Revision History Approved Date From To Initial Release (obsolete) 1.0 1.0 Nov-14-2006 Adding CFR 2.459 (obsolete) 1.0 2.0 August – 11 - 2008 Updated company template & Added text box (current) 2.0 3.0 Jan-31-2012 November 19, 2012 To: Federal Communications Commission Authorization and Evaluation Division 7435 Oakland Mills Road Columbia, MD Subject: Permanent Confidentiality Request for FCC ID: W38-241083 We hereby request confidential treatment of information accompanying this application as outlined below: - Block Diagram - Schematics - Operational Description The above materials contain trade secrets and proprietary information not customarily released to the public. The public disclosure of these materials may be harmful to the applicant and provide unjustified benefits to its competitors. The applicant understands that pursuant to Section 0.457 & 0.459 of the Rules, disclosure of this application and all accompanying documentation will not be made before the date of the Grant for this application. Sincerely, Gary Eldridge, P.E. Regulatory Compliance Manager Phone: 408-841-4536 [email protected] Chargepoint, Inc. 1692 Dell Ave. Campbell CA 95008-6901

SCS-F26 Modular Approval Letter Page 1 of 3 Rev 7.0 775 Montague Expressway Milpitas, CA 95035 Tel: 408-526-1188 Fax: 408-526-1088 Email: [email protected] Modular Approval Declaration Letter Reason for Amendment (current / obsolete) Revision History Approved Date From To Initial Release (Obsolete) 1.0 1.0 Dec-04-2006 Added IC Modular Letter (Obsolete) 1.0 2.0 Feb 16 2009 Add LMA and MA option (Obsolete) 2.0 3.0 April 14 2010 Revised per RSS Gen issue 3.0 (Obsolete) 3.0 4.0 Jan 12 2011 Removed Foot(2) (obsolete) 4.0 5.0 July 19 2011 Adding New note per KDB996369 D01 V01R03 (obsolete) 5.0 6.0 August 29 2011 Updated company template & Added text box (current) 6.0 7.0 Jan-31-2012 SCS-F26 Modular Approval Letter Page 2 of 3 Rev 7.0 11/19/2012 (Product name) FCC ID : W38-241083 , is seeking FCC Authorization as a Single Modular transmitter / Single Limited Modular Approval (Please check one). The EUT meets the requirements for Single Modular approval / Single Limited Modular Approval (please check one) as detailed in FCC public Notice DA00-1407. Compliance to each of the requirements is described below: Questions are: * Please provide a detailed explanation if the answer is “No.” 1. “The modular transmitter must have its own RF shielding.” Yes / No 2. “The modular transmitter must have buffered modulation/data inputs.” Yes / No 3. “The modular transmitter must have its own power supply regulation.” Yes / No 4. “The modular transmitter must comply with the antenna requirements of section 15.203 and 15.204(c).” Yes / No 5. “The modular transmitter must be tested in a stand-alone configuration.” Yes / No 6. “The modular transmitter must be labeled with its own FCC ID number.” Yes / No 7. “The modular transmitter must comply with any specific rule or operating requirements applicable to the transmitter and the manufacture must provide adequate instruction along with the module to explain any such requirements.” Yes / No 8. “The modular transmitter must comply with any applicable RF exposure requirements.” Yes / No Note: (1) LMA may be granted when one or more of the requirements in the table above cannot be demonstrated. LMA will also be issued in those instances where applicants can demonstrate that they will retain control over the final installation of the device, such that compliance of the end product is assured. In such cases, an operating condition on the LMA for the module must state that the module is only approved for use when installed in devices produced by a specific manufacturer. When LMA is sought, the application for equipment certification must specifically state how control of the end product into which the module will be installed, and will be maintained, such that full compliance of the end product is always ensured. (2) Please provide Clear and specific instructions describing the conditions, limitations and procedures for third-parties to use and/or integrate the module into a host device. (3) For non-Software Defined Radio transmitter modules where software is used to ensure compliance of the device, technical description of how such control is implemented to ensure prevention of third party modification must be provided (see KDB 594280). Note 1: Compliance of a module in its final configuration is the responsibility of the applicant. A host device will not be considered certified if the instructions regarding antenna configuration provided in the original description, of one or more separately certified modules it contains, were not followed. Example: A separately certified low-power transceiver module using Bluetooth technology which is housed in a desktop computer, laptop or peripheral does not require the overall system to be recertified, if the desktop computer, laptop or peripheral, as a stand-alone unit, complies with all applicable technical standards. Gary Eldridge, P.E. Regulatory Compliance Manager Phone: 408-841-4536 [email protected] Chargepoint, Inc. 1692 Dell Ave. Campbell CA 95008-6901

241083 WIFI module WIFI Antenna Gobi Antenna Gobi Antenna

241083 with Gobi3000 Modem

Label Location

241083 WIFI module WIFI Antenna Gobi Antenna Gobi Antenna

MPE CALCULATION (FCC ID: W38-241083) RF Exposure Requirements: 47 CFR §1.1307(b) RF Radiation Exposure Limits: 47 CFR §1.1310 RF Radiation Exposure Guidelines: FCC OST/OET Bulletin Number 65 EUT Frequency Band: 2412 ! 2462 MHz; Limits for General Population/Uncontrolled Exposure in the band of: 300!1500MHz; 1500 ! 100,000 MHz Power Density Limit: 0.549 mW / cm 2 ; 1 mW / cm 2 ; Equation: S = PG / 4πR 2 or R = √PG / 4πS Where, S = Power Density P = Power Input to Antenna G = Antenna Gain R = distance to the center of radiated antenna ______________________________________________________________________________________________________________________ Prediction distance 20cm 1) , When not installing Modular Approved Radio Gobi3000 WLAN(2412!2462MHz): Power = 23.9 dBm , antenna gain = 2.5 dBi , Power density = 0.0869 mW/cm 2 Maximum simultaneous MPE is 0.0869 mW/cm 2 which is less than Limit = 1 mW/ cm 2 2) , When installing Modular approved Radio Gobi3000 (Below conducted RF power is from Gobi Radio FCC grant , FCC ID: QISGOBI3000 , IC ID : 6369A!GOBI3000) WLAN(2412!2462MHz): Power = 23.9 dBm , antenna gain = 2.5 dBi , Power density = 0.0869 mW/cm 2 GSM 850/900: Power = 33.04 dBm,Max duty cycle=25%, antenna gain = 1.4 dBi , Power density = 0.138 mW/cm 2 GSM 1800/1900: Power = 30.79 dBm,Max duty cycle=25%, antenna gain = 1.8 dBi , Power density = 0.090 mW/cm 2 CDMA2000 (all bands): Power = 24.59 dBm , antenna gain = 1.8 dBi , Power density = 0.0867 mW/cm 2 UMTS (all bands): Power = 24.52 dBm , antenna gain = 1.8 dBi , Power density = 0.0853 mW/cm 2 Maximum simultaneous MPE is 0.138 mW/cm2/0.549 + 0.0869 mW/cm2 =0.338 x 100% =33.8% which is less than 100% The Above Result had shown that Device complied with MPE requirement for both cases. Completed By : Jason Zhang Date : Oct 30, 2012

COULOMB TECHNOLOGIES CORP. Charge station main board with 802.11b/g/n Model: 241083 Oct 26th, 2012 Report No.: SL12082403-CPC-001_241083(WLAN) (This report supersedes None ) Modifications made to the product : None This Test Report is Issued Under the Authority of: Jason Zhang Test Engineer David Zhang Engineering Reviewer This test report may be reproduced in full only. Test result presented in this test report is applicable to the representative sample only. Title: RF Test Report Coulomb Technologies Corp. Model : 241083 To FCC 15.247:2011,RSS#210 Issue 8:2010 Serial# SL12082403#CPC#001_241083(WLAN) Issue Date Oct 26th, 2012 Page 2 of 85 www.siemic.com Laboratory Introduction ATION SIEMIC, headquartered in the heart of Silicon Valley, with superior facilities in US and Asia, is one of the leading independent testing and certification facilities providing customers with one#stop shop services for Compliance Testing and Global Certifications. In addition to testing and certification, SIEMIC provides initial design reviews and compliance management through out a project. Our extensive experience with China, Asia Pacific, North America, European, and international compliance requirements, assures the fastest, most cost effective way to attain regulatory compliance for the global markets. Accreditations for Conformity Assessment Country/Region Accreditation Body Scope USA FCC, A2LA EMC , RF/Wireless , Telecom Canada IC, A2LA, NIST EMC, RF/Wireless , Telecom Taiwan BSMI , NCC , NIST EMC, RF, Telecom , Safety Hong Kong OFTA , NIST RF/Wireless ,Telecom Australia NATA, NIST EMC, RF, Telecom , Safety Korea KCC/RRA, NIST EMI, EMS, RF , Telecom, Safety Japan VCCI, JATE, TELEC, RFT EMI, RF/Wireless, Telecom Mexico NOM, COFETEL, Caniety Safety, EMC , RF/Wireless, Telecom Europe A2LA, NIST EMC, RF, Telecom , Safety Accreditations for Product Certifications Country Accreditation Body Scope USA FCC TCB, NIST EMC , RF , Telecom Canada IC FCB , NIST EMC , RF , Telecom Singapore Ida, NIST EMC , RF , Telecom EU NB EMC & R&TTE Directive Japan MIC (RCB 208) RF , Telecom HongKong OFTA (US002) RF , Telecom Title: RF Test Report Coulomb Technologies Corp. Model : 241083 To FCC 15.247:2011,RSS#210 Issue 8:2010 Serial# SL12082403#CPC#001_241083(WLAN) Issue Date Oct 26th, 2012 Page 3 of 85 www.siemic.com This page has been left blank intentionally. Title: RF Test Report Coulomb Technologies Corp. Model : 241083 To FCC 15.247:2011,RSS#210 Issue 8:2010 Serial# SL12082403#CPC#001_241083(WLAN) Issue Date Oct 26th, 2012 Page 4 of 85 www.siemic.com CONTENTS 1 EXECUTIVE SUMMARY & EUT INFORMATION ............................................................................................................. 6 2 TECHNICAL DETAILS .................................................................................................................................................. 7 3 REPORT REVISION HISTORY ....................................................................................................................................... 9 4 TEST SUMMARY ........................................................................................................................................................ 10 5 MEASUREMENTS, EXAMINATION AND DERIVED RESULTS ...................................................................................... 12 ANNEX A. TEST INSTRUMENT & METHOD......................................................................................................................... 29 ANNEX B EUT PHOTOGRAPHS ........................................................................................................................................ 34 ANNEX C. TEST SETUP AND SUPPORTING EQUIPMENT ................................................................................................... 34 ANNEX C. TEST SETUP AND SUPPORTING EQUIPMENT ................................................................................................... 34 ANNEX D USER MANUAL, BLOCK & CIRCUIT DIAGRAM ................................................................................................... 38 ANNEX E USER MANUAL, BLOCK & CIRCUIT DIAGRAM ................................................................................................... 39 ANNEX E SIEMIC ACCREDITATION ................................................................................................................................... 58 Title: RF Test Report Coulomb Technologies Corp. Model : 241083 To FCC 15.247:2011,RSS#210 Issue 8:2010 Serial# SL12082403#CPC#001_241083(WLAN) Issue Date Oct 26th, 2012 Page 5 of 85 www.siemic.com This page has been left blank intentionally. Title: RF Test Report Coulomb Technologies Corp. Model : 241083 To FCC 15.247:2011,RSS#210 Issue 8:2010 Serial# SL12082403#CPC#001_241083(WLAN) Issue Date Oct 26th, 2012 Page 6 of 85 www.siemic.com 1 Executive Summary & EUT information The purpose of this test programme was to demonstrate compliance of the Coulomb Technologies Corp., Charge station main board with 802.11b/g/n, and Model: 241083 against the current Stipulated Standards. The Charge station main board with 802.11b/g/n have demonstrated compliance with the FCC 15.247:2011 & IC RSS210 Issue 8: 2010. Applicant & EUT Information Applicant Information Applicant / Client Coulomb Technologies Corp. 1692 Dell Ave. Campbell, CA 95008 UNITED STATES Manufacturer1 Coulomb Technologies Corp. 1692 Dell Ave. Campbell, CA 95008 UNITED STATES EUT Information EUT Description : Main board Model Name : 241083 Serial No : N/A Input Power : 5VDC Frequency : WLAN (2412MHZ#2462MHz) Radiated power : WIFI:0.245W (23.9 dBm) Modulation : DSSS/OFDM Classification Per Stipulated Test Standard : Spread Spectrum System / Device Title: RF Test Report Coulomb Technologies Corp. Model : 241083 To FCC 15.247:2011,RSS#210 Issue 8:2010 Serial# SL12082403#CPC#001_241083(WLAN) Issue Date Oct 26th, 2012 Page 7 of 85 www.siemic.com 2 TECHNICAL DETAILS Laboratory performing…

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Radiated Emission Radiated Emission Test Setup (30MHz – 1GHz) - Front View Radiated Emission Test Setup (30MHz – 1GHz) – Rear View Radiated Emission Test Setup (Above 1GHz) - Front View Radiated Emission Test Setup (above 1GHz) – Rear View Conducted Emission Conducted Emission Test Setup – Front View Conducted Emission Test Setup – Rear View