FYE 2016 Bicycle Rack Voucher Program (BRVP)

PART 1. APPLICANT INFORMATION

GRANT APPLICATION

BICYCLE RACK VOUCHER PROGRAM (BRVP) FOR PUBLIC AGENCIES

FYE 2016

NOTE: This application will work best using Google Chrome or Mozilla Firefox browsers.

DIRECTIONS: Before you start the application, please review the Program Requirements . Note that only public agencies located in the Bay Area Air Quality Management District's jurisdiction are eligible for funding. Applications for funding will be accepted until 4:00 PM, Wednesday, June 22, 2016, unless funding is exhausted sooner.

Public Agency Name

APPLICANT'S ADDRESS

Legal Address

Street Address Line 2

City

State

Zip

Do you have a mailing address different from above?

YesNoAll official documents regarding this grant will be sent to the legal address unless a mailing address is provided.

Mailing Address

Mailing Address Line 2

City

State

Zip

CONTACT INFORMATION

Project Contact

This person serves as the point of contact for day-to-day communications.

Name of Project Contact

Project Contact Position/Title

Project Contact Email Address

Project Contact Phone Number

Is the person authorized to sign documents the same as Project Contact

YesNo

Authorized Signatory

This person is authorized to sign the application and execute grant funding agreements.

Authorized Signatory Name

Authorized Signatory Position/Title

Authorized Signatory Email Address

Authorized Signatory Phone Number

Is the person completing the application the same as Project Contact?

YesNo

Person Completing Application

Person Completing Application Name

Person Completing Application Position/Title

Person Completing Application Email Address

Person Completing Application Phone Number

For additional information contact us by email at grants@baaqmd.gov (subject "RE: BRVP") or by phone at 415-749-4994. Please review Program Requirements.

PART 2. PROJECT SITING

DIRECTIONS: Indicate proposed location(s) where bicycle rack(s) will be installed and the nearest activity center(s) for each proposed location. To be eligible for funding, bicycle racks must be installed within one-tenth (1/10) mile of at least one major activity center. For the purpose of the BRVP, "major activity centers" are locations that attract significant vehicle travel for utilitarian purposes. Examples of such destinations include, but are not limited to:

Transit stations
Employment Centers
Educational institutions
Shopping centers (e.g., a mall or other shopping complex)
Recreational facilities*

*NOTE: Although BRVP equipment may be installed at the entrance or exit of recreational facilities, BRVP-funded equipment may not be installed within a recreational park.

Complete the following information for each proposed distinct location:

	Street Address	City	Activity Center(s)	Does the applicant own the site property?
Location

For additional information contact us by email at grants@baaqmd.gov (subject "RE: BRVP") or by phone at 415-749-4994. Please review Program Requirements.

PART 3. VENDOR SELECTION

DIRECTIONS: You will need to complete a separate application for each vendor if you would like to order from more than one vendor. To view pricing for the approved vendor, please visit the BRVP website.

Which of the approved Vendors listed below are you requesting bicycle racks vouchers? (choose one)

For additional information contact us by email at grants@baaqmd.gov (subject "RE: BRVP") or by phone at 415-749-4994. Please review Program Requirements.

PART 4. VOUCHER AWARD

What is your sales tax rate? (e.g., if your sales tax rate is 9%, please enter 0.09)

To find out what your sales tax rate is, please visit the California State Board of Equalization Board's webpage.

DIRECTIONS: Please indicate the type and number of bicycle racks you are requesting from the approved Vendors below.¹

Dero

Order

Model #

Bike Capacity/Unit

Quantity

Total ($)

Peak Racks Inc.

Order

Model #

Bike Capacity/Unit

Quantity

Total ($)

Saris Cycling Group

Order

Model #

Bike Capacity/Unit

Quantity

Total ($)

Sportworks Northwest Inc.

Order

Model #

Bike Capacity/Unit

Quantity

Total ($)

Urban Bicycle Parking Systems Inc.

Order

Model #

Bike Capacity/Unit

Quantity

Total ($)

Total Quantity

Estimated Tax ($)

Estimated Total Cost ($)2

Estimated Maximum Voucher Award ($)3

¹ The calculator above is a tool to assist BRVP applicants in their estimating of project costs and possible voucher awards. BRVP applicants are strongly encouraged to contact the pre-approved BRVP Vendor to obtain estimates for purchase and delivery of bicycle rack equipment.

² Estimated Total Cost includes tax, but does NOT include applicable shipping costs.

³ Estimated Maximum Voucher Award indicated on this form is for only evaluation purposes and does not guarantee the award of a Voucher. Maximum Voucher Award is up to the full cost of the bicycles rack(s), not to exceed $60 per bicycle parking space created. Total Maximum Voucher Award is limited to $15,000 per applicant.

For additional information contact us by email at grants@baaqmd.gov (subject "RE: BRVP") or by phone at 415-749-4994. Please review Program Requirements.

PART 5. DOCUMENTS TO UPLOAD

DIRECTIONS: Upload the documents listed below. If the submitted application is incomplete or any documentation is missing or unclear, the application will be rejected.

A signed letter of commitment from an individual with authority to enter into a financial commitment and carry out the Project (e.g., Chief Executive or Financial Officer, Executive Director, City Manager);

OR

A signed resolution from the governing board (e.g., City Council, Board of Supervisors, Board of Directors).

The document must address the following:

Authorize the submittal of the application and identify the individual authorized to submit the application and carry out the Project.
Confirm that the Agency has secured matching funds from a non-Air District source(s) that would fund the costs to purchase, install and maintain equipment in excess of the Voucher amount.
Acknowledge that the Agency will install the equipment within four months of the Vendor’s delivery of the equipment and will maintain the equipment for its intended purpose for a minimum of 3 years after installation.

Note: A sample letter of commitment is available online .

A map of proposed location(s) where equipment will be installed; also indicate the distance to the nearest major activity center(s) for each proposed location.
Proof of insurance:

Liability Insurance with a limit of not less than $1 million per occurrence, of the type usual and customary to the business of the Project Sponsor, that also covers bike rack equipment;
Property Insurance in an amount of not less than the insurable value of the bike rack equipment funded under the Voucher, and covering all risks of loss, damage or destruction equipment; and
Workers Compensation Insurance as required by California law and employers liability insurance with a limit not less than $1 million.

UPLOAD:

Note: If you are uploading more than one file for each item, you must put the files in a zip folder in order to upload.

Letter of Commitment or Resolution

If you are uploading more than one file for each item, you must put the files in a zip folder in order to upload.

Map

If you are uploading more than one file for each item, you must put the files in a zip folder in order to upload.

Proof of Insurance

For additional information contact us by email at grants@baaqmd.gov (subject "RE: BRVP") or by phone at 415-749-4994. Please review Program Requirements.

PART 6. CERTIFICATION

By submitting this application online, I agree to the below statements and certify that to the best of my knowledge, the information contained in this application and in any documentation accompanying this application or submitted in furtherance of this application is true and accurate and I understand that any misstatements or omissions of material facts may disqualify this application and any monies awarded based on it.

I certify that:

	Agree
The applicant entity I represent has read and understood the requirements of the BRVP.
This application is for evaluation purposes only and does not guarantee the award of a Voucher.
The proposed Project and the emissions reductions that would be realized from it are not required by any federal, state or local regulation, judicial order, agreement, memorandum of understanding, contract, mitigation requirement, or other binding obligation.
This application is for equipment that has not already been funded by and is not currently under consideration for funding by any public agency.
The applicant entity I represent is in compliance and will remain in compliance with all applicable federal, state, and local air quality rules and regulations related to this project.
If this application is approved for an award of funding, that all bicycle racks will be installed within four (4) months of delivery from the Vendor.
For 3 years from the date of installation of the bicycle rack(s), the bicycle rack(s) will be operated and maintained, and will not be removed from service or relocated without prior approval from the Air District.
The applicant entity I represent will allow Air District staff or its representatives to inspect installation locations and to audit the Agency's Project records.
The amount of the Voucher for the bicycle racks will be forfeited at a pro-rated amount to the Air District, if the applicant entity I represent does not meet any of the aforementioned requirements.
I have the legal authority to apply for funding on behalf of the applicant entity and I am authorized to sign this application on behalf of applicant entity.

Print Name

Title

Date

_____________________________

Sign Your Name

SURVEY

Please help us improve our grant application process and outreach by answering a few survey questions!

How did you hear about this grant opportunity?

Did you or anyone associated with this application attend an Application Workshop, a meeting, or other event where information was presented about BAAQMD grant programs?

YesNo

Was this application easy to follow?

YesNo

Please share your suggestions for improving the application process:

Do you know of an agency that can benefit from this TFCA Grant Opportunity? If so, who should we contact?

In order to be considered complete, applications must be submitted BOTH online and as a hard-copy by the submittal deadline. Please submit:

Hard-copy; Print the completed online application form and mail the signed hardcopy along with the required attachments to the Air District at 375 Beale Street, Suite 600, San Francisco, CA 94015 (Attn: SID: BRVP),
Online applications; complete this online form, upload the required attachments, and click the submit button.

After clicking the SUBMIT below, you will be able to (1) review a draft version of your application, (2) print a hard-copy of your application, and (3) submit your online application to the Air District.

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For additional information contact us by email at grants@baaqmd.gov (subject "RE: BRVP") or by phone at 415-749-4994. Please review Program Requirements.