Clean Air Funds Program - Clean Vehicle Technology Application

Clean Vehicle Technology Application

For the Clean Air Funds Program
Applicant Information

Please complete the following information for the person or operation applying for this grant. Please ensure the applicant name and mailing address match the information listed on the applying person or organization's Form W-9.
Applicant Name:*
Organization, Company, or Proprietor's Name as it appears on Form W-9
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact Information

District staff will email the Primary Contact listed below with all updates and requests related to this project.
Full Name:*

First NameLast Name
Title:*
Email:*
example@example.com
Phone Number:*
Contract Signing Authority Information

The Signing Authority listed below will be required to sign this application and any other documents related to this project. District staff will not contact the Signing Authority, unless the Primary Contact cannot be reached.
Full Name:*

First NameLast Name
Title:*
Email:*
example@example.com
Phone Number:*

Project Information

Please describe the details of your project below.
Address where vehicle is permanently domiciled:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Annual Operation:*
In miles or hours
% Use Within District:*
% Use Within CA:*
Existing Vehicle Information

Please describe your existing vehicle below. If you don't know any of the required information, please type in "Unknown" or enter your best guess.
Vehicle Type:*
Please describe:*
Vehicle Make:*
Vehicle Model:*
Vehicle Model Year:*
GVWR*
In lbs
License Plate:*
Vehicle Identification Number:*
Engine Make:*
Engine Model:*
Engine Model Year:*
Fuel Type:*
Engine Serial Number:*
Horsepower*
Odometer Reading*
Engine Family Name:*
New Vehicle Information

Please describe the new vehicle you would like to purchase below. If you don't know any of the required information, please type in "Unknown" or enter your best guess.
Vehicle Make:*
Vehicle Model:*
Model Year:*
Engine Make:*
Engine Model:*
Engine Model Year:*
Horsepower:*
Engine Family Name:*
Provided by your dealer
Fuel Type:*
GVWR*
In lbs
Method of Purchase:*

Budget and Project Funding Information
Please right-click the Budget PDF below and download it to your device.*
After completing the Budget PDF, please download a completed copy to your drive and upload it below:*

Cancelof
Upload New Vehicle Quote:*

Cancelof
Total Project Cost:*
Must match budget
Grant Funding Request:*
Must match budget

Minimum Funding Information
If reduced funding was available, would your project be able to proceed?*

YesNo
Minimum Funding Level:*
Would your project change at the minimum funding level?*

YesNo
Please describe how your project would change at the minimum funding level:*

Terms and Conditions
Are you the signing authority listed in the Applicant Information section above?*

YesNo
Please right-click the Terms and Conditions PDF below and download it to your device. Please then route it to the signing authority for signature:*
Please upload the signed terms and conditions page below:*

Must be signed by signing authority
Cancelof
Terms and Conditions

This application must be signed by the signing authority listed in the Applicant Information section of this form. By signing this document, you are declaring that:
- All information contained in this document and in any attachment is true, accurate and complete to the best of your knowledge.
- The responsible official has the authority to apply for the grant funds on behalf of the applicant named.
- The applicant agrees to the terms and conditions of the agreement (included in the program information).
- Approved projects cannot be altered in any way without prior approval from the District (see draft agreement).
Signing Authority Name:*

First NameLast Name
Signing Authority Title:*
Signature:*

Clear
Date:*

MonthDayYear
Date
Schedule a time to meet with District staff to discuss your application in further detail!*
Should be Empty:

Clean Vehicle Technology Application