FYE 2017 Charge! Program Application Form v.2

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Charge! is a grant program that helps to offset a portion of the cost of purchasing, installing, and operating new publicly available charging stations at qualifying facilities within the Bay Area Air Quality Management District's (Air District) jurisdiction and is funded by the Air District's Transportation Fund for Clean Air (TFCA) Program.  Applications may be submitted after an applicant has attended at least one pre-application on-line webinar, and after reviewing the Charge! Program Guidance. 


Applications will be accepted electronically (online) on a first-come, first-served basis through May 22, 2017 (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. Do not use the backward/forward button of the browser to navigate through the application; this will cause data to be lost. Instead, if you want to go to a different page, click on the page numbers on the upper right area of each page or use the navigation buttons on the bottom of each page to go to the desired page.


* Indicates required field.


PART 1. APPLICANT INFORMATION

Enter a title describing the project (e.g., "Install 6 Level 2 charging stations at a workplace in Santa Clara"). The Air District may modify the Proposed Project Title to make sure all applicants have a unique project title.
Attending the pre-application workshop is mandatory prior to submitting an application for the Charge! Program. Please see the schedule of pre-application workshops on the Charge! Program website at www.baaqmd.gov/charge.
APPLICANT INFORMATION






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





PROJECT CONTACT INFORMATION

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






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










Project Budget
Provide an estimate of the total cost of the project (sum of all eligible costs)
Matching Funds: Enter in the amount of matching funds that will be applied to eligible project costs by each funding source. Note that the sum of all matching funds must total at least 25% of the Estimated Total Eligible Project Cost. To add additional sources of funding, click "Add line item" below. Note that eligible matching funds do not include other Air District-dervided funds, such as TFCA County Program Manager Funds.
Source Source Type Amount ($) Status
Item

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


I. Project Schedule 

The proposed Project schedule should cover all facilities that are part of the proposed project. For the Expected Project Start Date, indicate when work will commence (e.g., apply for permits, initiate CEQA, place order for equipment). For Proposed Project Completion 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. Note: To be eligible for funding, all stations must be installed and operating within 9 months from the date the Funding Agreement is executed.

II. Facility 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. A maximum of five facilities may be included in this application--if you have more than five facilities, please contact us.
A. FACILITY LOCATION





Destination
Destination Facilities provides access to charging for customers and visitors, and are located at or within close proximity to and directly serve one or more activity centers, such as a library, park, or shopping center.


Workplace
Workplace Facilities Provides access to charging for fleets, employees, and visitors and are located at, or within close proximity, to an employment center.

Multi-Dwelling Unit (MDU)
Multi-Dwelling Unit Facilities Provides access to charging for MDU residents and their guests, and are located at, or within close proximity to, an MDU consisting of at least 5 or more residential units.  Note: Single-occupancy residences and MDUs with less than five residential units are NOT eligible. 

Transportation Corridor
Transportation Corridor Facilities provides access to fast charging to help extend the range of PEV drivers making long trips, and are located in close proximity to freeways and highways, e.g., a rest area.

Transit Parking
Transit Parking Facilities provides access to charging for users of other forms of transit, e.g., a transit hub, airport long term parking, or a park-and-ride location.


B. IMPACTED COMMUNITIES & PRIORITY AREAS

As part of the evaluation criteria, projects in PDA or CARE areas may 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. 

Name           PDA Type
PDA
C. Charging Station Information
Enter information for your proposed charging stations. If this facility has more than one charging station type, click "Add another charging station type" to add another line
Quantity: Type Ports per Station     Make & Model Base Award
$
$
D. Plus-up Funding
If this facility is co-locating charging stations with a new solar installation, enter in the rating (in watts) of the new solar system. Leave blank if not applicable
$
$
$
$
$
$

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

1. Evidence of Authority to Apply
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.
2. Property ownership
Proof of property ownership or written permission from property owner to install and operate PEV Charging Stations. Include for each facility--Click "Add another attachment" below to upload more than one file. (max 5)
3. Cost Quote
A line item cost quote to purchase and install the charging stations from a licensed contractor, include the contractor license number. Include for each facility--Click "Add another attachment" below to upload more than one file. (max 5)
4. Map
Map showing the location in detail for each proposed charging station. Map must show 1) proximity to nearest roadway, 2) proximity to buildings, and 3) proximity to existing charging stations. Click "Add another attachment" below to upload more than one file. (max 5)
5. Proposed Charging Station Spec Sheet
Please upload the specification sheet for the proposed charging stations, Click "Add another attachment" below to upload more than one file. (max 5)
6. W-9
A W-9, available from www.irs.gov. DO NOT UPLOAD THIS DOCUMENT. Mail to the following address:

Bay Area Air Quality Management District
ATTN: Finance/Grants Charge! Program
375 Beale Street, Suite 600
San Francisco, CA  94105
7. Additional or clarifying information (optional)
If there's any additional or clarifying information you would like to include with your application, please enter it below (optional). You may also include attachments, click "Add another attachment" below to upload more than one file. (max 3)


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.


The applicant entity I represent has read, understood, and agrees to comply with the requirements listed in the Charge! Program Guidance.


This application is for evaluation purposes only and does not guarantee project funding.


The applicant entity I represent agrees to operate and maintain all charging stations until the usage requirements have been met and for a minimum of 3 years from the date that the equipment is placed into service.


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 that requires the project applicant to implement any portion of the project that would be funded by the Air District.


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.


The applicant entity I represent agrees to submit Semi-annual Progress Reports until the station is put into service and Annual Monitoring Reports on an annual basis for the duration of the project to report, at a minimum, electricity dispensed, proof of insurance, and cost to use the station(s). 


The applicant entity I represent will allow Air District staff or its designee to inspect all charging station(s) and to audit program records.


Should the project sponsor fail to meet any of the Program requirements, the award may be cancelled and forfeited; this potentially would require reimbursement of a pro-rated amount of the award.


I have the legal authority to apply for funding on behalf of the applicant entity and that I am authorized to sign this application on behalf of applicant.




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

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.
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