Charge! - Interim Status Report

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This Interim Status Report (Expenditure Report) is to be submitted in order to notify the Air District that all of the Project Charging Stations have been installed and comply with the Program Requirements.  


Due Date: Within 60 calendar days from the date the last Project charging stations has been installed and placed into service.


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† Any projects that have started prior to the contract execution date will be ineligible for reimbursement.

PART 1. FACILITY INFORMATION

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

Refer to Attachment B of your contract for the Facility ID.


 Indicate when all the charging stations, as part of this facility, were open and available for use by the public.







Station installation completed as follows: 



Solar/wind installation completed as follows (if applicable):

For additional information contact us by email at climatetech@baaqmd.gov (subject "RE: Charge Program Project ##EV###") or by phone at 415-749-4994.
PART 2. ACKNOWLEDGEMENT OF AIR DISTRICT FUNDING
Provide documentation that the Project Sponsor has acknowledged the Air District as a project funding source pursuant to Section II.11 of the contract:
For each facility, attach a photo(s) of the installed charging station(s) showing the Air District's logo.  Take zoomed-in and zoomed-out (showing the parking space) photos. For convenience, please bundle photo(s) into one PDF file for upload. 

Please label each photo with its corresponding Facility, and a narrative description of location (e.g. Facility #1 - Ashby Bart Station Parking Lot). If you have multiple facilities, please include pictures of each facility. 

If you would like to email us additional pictures, please send them to grants@baaqmd.gov with your project number as the subject. 
PART 3. INVOICES
A copy of the General Invoice Form can be downloaded here:  https://app.box.com/s/2zbrv1jriodubxa1lemt08gp60qyrbpq 

Please download the general invoice form and submit the completed form, along with all invoices and proof of payments using the form below or email to mtang@baaqmd.gov.

PART 4. SITE NOTIFICATION

Per funding agreement (see Attachment A, Paragraph 8), Project Sponsor shall notify the US Department of Energy-Alternative Fuel Data Center of the address where the charging stations are installed within 60 days from the date the charging stations are placed into service. 

 

You can enter the information for the charging stations here:  http://www.afdc.energy.gov/locator/stations/places/new

PART 5. CERTIFICATION
By submitting this report, I certify under penalty of perjury, under the laws of the State of California that the information provided is accurate and that the charging station(s) installation comply with the requirements of the Charge! Program.




For additional information contact us by email at grants@baaqmd.gov (subject "RE: Charge Program Project ##EV###") or by phone at 415-749-4994.