Cycle 2 (FYE 2016) Charge! Program Application Form

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Application packages must be submitted to the Air District BOTH electronically (online) and as a hard copy (one copy). Grant applications will be accepted on a first-come, first-serve basis through Friday, January 15, 2016 (by 4 PM), unless funds are exhausted sooner. Only complete applications will be evaluated. Please refer to the Charge! Program website for complete program eligibility requirements and instructions. 


This application works best using Google Chrome or Mozilla Firefox browsers. Please do not use the backward/forward button of the browser to navigate through the application; this will cause data to be lost. Instead, click on the page numbers on the upper right of the page or use the buttons on the bottom to go to the desired page.


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PART 1. APPLICANT INFORMATION

May be modified by the Air District.
APPLICANT'S ADDRESS






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





CONTACT INFORMATION

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






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











For additional information contact us by email at grants@baaqmd.gov (subject "RE: Charge! Program") or by phone at 415-749-4994. For a complete listing of Program Requirements, click here.

PART 2. PROJECT INFORMATION

If the project includes more than one charging facility, then Section II. must be completed for each distinct facility. To add another charging facility, click on "Add Another Facility" on the bottom of the section.  


I. Project Schedule 

Please provide the proposed Project schedule. For the Project Start Date, indicate when work will commence (e.g., apply for permits, initiate CEQA, place order for equipment). For Project Open Date, indicate when all of the installation work for this project will be complete and all of the facilities that are part of this project will be open and available for use.

II. Facility Information
A. FACILITY LOCATION




Upgrades are defined as projects that propose to increase the number of charging ports on existing charging stations.
i.e. site is owned by applicant, applicant has signed agreement with owner, applicant has a memorandum of understanding
Destination
This category is for destinations that may attract people to travel “medium-to-long” distances from their home and where the vehicle would tend to be parked for more than one hour. Examples of this category include shopping and retail/commercial centers, recreational areas, restaurants, theaters, stadiums, amusement parks, museums, and airports.



Workplace
This category may provide an alternative to residential charging for plug-in electric vehicle (PEV) drivers that may not have access to residential charging. 



Multi-Dwelling Unit (MDU)
This category includes a broad range of building complexes, from condominiums to high-rise apartments. MDUs may have parking associated with each unit, or parking only available through commercial lots in close proximity to the complex.





Transportation Corridor

This category refers to charging at a location along a freeway or highway between the origin and destination of a trip with a distance longer than the typical electric vehicle driving range. Transportation Corridor charging gives existing and prospective electric vehicle owners the assurance that they can charge when driving long distances along a freeway or highway. These chargers may also be able to support the needs of local electric vehicle drivers.  




Provide the following total number of existing charge ports at the proposed facility:



Bonus for Solar or Wind



B. CHARGER INFORMATION

Total Eligible Cost
Provide a budget below for this facility broken out by charger type. The Air District will determine your match requirement (%) based on cost information provided in this application.
Charger Type  Charger Quantity # of ports/charger                 Request/Charger ($)  Solar/Wind Bonus Request/Charger ($)  Dual Port Bonus Request/Charger ($)  Total Request/ Charger ($)  Total Request ($) Total Eligible Cost ($) 
For Transportation Corridor Sites: Level 2 Chargers may only be installed in conjunction with DC Fast Chargers.
Refer to Program Requirements for limits.
Refer to Program Requirements for limits.
Refer to Program Requirements for limits.
charger + solar + dual port
Refer to Program Requirements for instructions on how to determine what costs are eligible and what costs are ineligible.
Discounts, Credits, & Non-Air District Grants/Rebates
Provide a list of ALL discounts, credits, and non-Air District grants/rebates by source and by charger type. If these funds are derived from more than a single source, specify each funding source and the amount on a separate line. Air District will subtract these funds from your Eligible Cost to determine award amount. Refer to the FAQ for more information about how award amount is determined. 
Source Amount ($) Funding Status Charger Type
$
$


C. IMPACTED COMMUNITIES & PRIORITY AREAS

As part of the evaluation criteria, projects in PDA or CARE areas will receive high priority.
Using this map or this online map, please use the map to identify which CARE Area the project will operate in. BAAQMD staff may request that the grant applicant provide documentation to verify the information provided below. 
Code
CARE Area

Using the map, please indicate in the table below the Priority Development Area. Use the “zoom in” tool to enlarge the map to best identify boundaries and PDA codes. 

Code PDA Type
PDA

For additional information contact us by email at grants@baaqmd.gov (subject "RE: Charge! Program") or by phone at 415-749-4994. For a complete listing of Program Requirements, click here.
$
$

PART 3. SUPPLEMENTAL DOCUMENTS

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 signed letter of commitment or resolution must address the following:
  • Authorize the submittal of the application.
  • Confirm that the entity has secured matching funds from a non-Air District source(s) that would fund the costs to purchase/install and maintain the vehicle charging station in excess of the award amount.
  • Acknowledge that the entity will operate and maintain the station for its intended purpose for a minimum of three years.
A copy of the estimate to construct the charging station with contractor license number. As part of the estimate, include specification sheet of charging equipment. Submit a cost estimate for each facility.
Map showing the location in detail for each proposed location. Map must show 1) proximity to nearest roadway, 2) proximity to buildings, and 3) proximity to existing charging stations. If proposed locations are in multiple non-congruent areas, it is ideal to upload multiple maps as one PDF file. 
A copy of the memorandum of understanding (MOU), contract with charging station site host/owner, or other documentation.
Proof of insurance as described in Appendix A of the Guidance.
Additional information to help us evaluate your project. Note: If you are requesting a case-by-case evaluation, please provide additional information.

For additional information contact us by email at grants@baaqmd.gov (subject "RE: Charge! Program") or by phone at 415-749-4994. For a complete listing of Program Requirements, click here.

PART 4. CERTIFICATION & SURVEY

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. Also, I understand that any misstatements or omissions of material facts may disqualify this application and any monies awarded based on it.

I agree to the above statements by signing below.






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By pressing the Preview button, you will be able to (1) review a draft version of your application, (2) print a copy of your application to be submitted to the Air District, and (3) submit your online application. Please review your application thoroughly and make any necessary corrections, before printing and submitting.

Reminder: Application packages must be submitted to the Air District BOTH electronically (online) and as a hard copy (one copy). Mail the printed and signed copy of the online application AND the required supplemental documents to the Air District at the address below; please refer to Charge! Program Website document for complete instructions:

Chengfeng Wang
Bay Area Air Quality Management District
939 Ellis Street
San Francisco, CA 94109

For additional information contact us by email at grants@baaqmd.gov (subject "RE: Charge! Program") or by phone at 415-749-4994. For a complete listing of Program Requirements, click here.