BRVP - Installation Form

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This website allows recipients of Bike Rack Voucher Program (BRVP) funding to submit the required Installation Form online. The online form can be used instead of the paper version and provides the Bay Area Air Quality Management District (Air District) information about your newly installed bicycle rack equipment. The BRVP is funded by the Transportation Fund for Clean Air.

This website allows you to submit the required Installation Form for one BRVP voucher at a time. If you received equipment from more than one vendor, you will need to complete a separate Installation Form for each voucher received.

Please complete all four (4) sections below. If you need assistance, please contact the TFCA Grants Team at grants@baaqmd.gov.

Thank you for your commitment to clean air projects!

* indicates required field.

Bike Rack Voucher Number

Name of Agency

1) Installation Information

For each location where BRVP equipment was installed, please provide the following information

	Location No.†	Model Number	Qty .	Installation Date	Air District logo on equipment?

Alternatively, you may submit an Excel file with the information indicated above. Please contact the TFCA Grants Team to request an Excel template.

	Upload Excel File

†The Installation Location numeric identifiers can be found on the BRVP Vouchers.

2) Vendor Invoice

Please attach a copy of the invoice from the BRVP vendor.

	Invoice or Delivery Slip (PDF File)	Invoice Number	Date of Invoice	Delivery Date

What was the final total project cost?

Did BRVP funds cover the full cost of your project?

If not, what amount of matching funds did your agency provide?

3) Photos

For each Installation Location, attach a photo(s) of the installed bicycle rack(s) showing the Air District's logo. For convenience, please bundle photo(s) into one PDF file for upload.

Please label each photo with it's corresponding Installation Location numeric identifier and a narrative description of location (e.g. #4 - Civic Center Bart Station).

	Photos (PDF File, limit 5MB)

4) Certification

I certify under penalty of perjury, under the laws of the State of California that the information provided is accurate and that the bicycle rack installations comply with the requirements of the BRVP.

Name of Agency Contact

Email Address

Phone Number

Date

Comments Please provide feedback regarding this installation form and/or the BRVP program to the TFCA Grants Team.

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