Electric Bus Funding Request Form

UPGRADE TO ELECTRIC WITHOUT THE UPCHARGE Imagine your future with cleaner, quieter and more comfortable buses. If you operate a transit or school bus fleet in our service territory, your future is here. For a limited time, we’re helping fleet operators replace existing buses with electric at no additional cost. We’ll cover the price difference between an electric bus and your conventional replacement bus, up to $250,000 per bus. * We’ll also help cover the cost of charging equipment and installation, up to $4,175 each for school buses and up to $60,600 each for transit buses. *Incremental bus cost will be provided to the dealer on your behalf following the receipt of replacement bus invoices. **Charging equipment and installation cost will be provided directly to the program applicant following project completion and receipt of invoices.

Applicant Contact Information

Organization Name*

Street Number*

Street Name*

City*

State*

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Zip Code*

Contact Name*

The individual responsible for purposing the bus and its corresponding equipment.

Contact Email*

Please ensure email address entered is accurate as this will be the primary contact method throughout the application process.

Contact Phone #*

xxx-xxx-xxxx

Bus Request Information

Bus Type*

Transit

School

Number of Buses Requested*

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Total Miles Driven Per Year - Buses Requested*

Sum of all bus miles per year for the buses requested in this application. Please exclude letters or special characters.

Incremental Cost of Electric Bus(es)*

Incremental cost of all buses requested in this application. Per bus incremental cost cannot exceed 250,000. Please exclude letters or special characters.

Anticipated Purchase Date*

Anticipated Delivery Date*

If different from previous

Acknowledgement & Authorization

Completely read and understand the following requirements, acknowledgements, and authorizations for your affirmation:

Existing Transit Bus Acknowledgement*

Does the existing transit bus that will be replaced meet all of the following eligibility criteria? a. The transit authority must be located in Indiana, Kentucky, North Carolina, Ohio, Pennsylvania, Virginia or West Virginia, must own the existing bus, and the bus must be operated within these states. b. The bus must primarily be used for public transportation by the transit bus system; c. The bus must be rated Class 3-8, as defined by the Department of Transportation’s vehicle service classifications; d. The bus must have a GVWR of at least 10,001 pounds; e. The bus must have accumulated at least 10,000 miles transporting people within the area served by the transit authority in at least one of the last three calendar years; f. The bus must have a diesel-powered engine with a model year of 1996-2009 or older; and g. The bus must be able to start, move in all directions, and have all operational parts.

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Replacement Transit Bus Acknowledgement*

Does the replacement bus meet all of the following eligibility criteria? a. It will operate in the same manner and over similar routes as the existing bus that it replaces; b. It is model year 2019 or later; c. It meets all applicable engine standards, certifications, and/or verifications and shall be retained and operated for its useful life by the new owner; d. It meets all Federal safety standards and has all required warranties.

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School Bus Ownership*

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State Authorization*

If the bus is state-owned or third-party owned, the school district must receive an authorized letter from the state agency that owns the bus allowing the district to acquire the new school bus and scrap the existing bus. If you have received this authorization select "Yes" in the field below and upload this authorization to the field below.

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Third Party Authorization

a. provide an authorized letter to the school district allowing the existing bus to be scrapped and agreeing to purchase an eligible replacement bus; b. supply written certifications of eligibility for the new and replacement buses; and c. be serving the school district under a long-term contract for transportation services and the remaining lease or contract term equals three years or more.

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Existing School Bus Acknowledgment*

Does the existing school bus that will be replaced meet all of the following eligibility criteria? a. The school district must be located in Indiana, Kentucky, North Carolina, Ohio, Pennsylvania, Virginia or West Virginia, and the bus must be operated within these states. b. It is and has been for the past twenty-four (24) months used primarily to transport ten (10) or more students to a public pre-primary, primary, or secondary school; c. It is rated Class 3-8, as defined by the Department of Transportation’s vehicle service classifications; d. It has a Gross Vehicle Weight Rating (GVWR) of at least 10,001 pounds; e. It has accumulated at least 10,000 miles transporting students, or has been used at least three days each week transporting students during at least one of the last three school years; f. It has a diesel-powered engine with a model year of 1996-2009 or older; g. It is able to start, move in all directions, and has all operational parts.

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Replacement School Bus Acknowledgement*

Does the replacement bus meet all of the following eligibility criteria? a. It will operate in the same manner and over similar routes as the existing bus that it replaces; b. It is model year 2019 or later; c. It meets all applicable engine standards, certifications, and/or verifications and shall be retained for its useful life by the new owner; d. It meets all Federal safety standards and has all required warranties.

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Existing Bus Scrap/Disable Certification*

Do you confirm that you will provide a signed certification that each diesel bus that is replaced through this program is scrapped or rendered permanently disabled within ninety (90) days of being replaced through: a. Cutting a three-inch by three-inch (3” x 3”) hole in the engine block (the part of the engine containing the cylinders); b. Disabling the chassis by cutting through the frame/rails on each side at a point located between the front and rear axles; c. Submitting a signed certificate of destruction and digital photos of the engine tag (so that the serial number, engine family number, and engine model year are visible) and additional photos showing the method of destruction (destroyed engine block, and cut frame/rails); and d. Equipment and vehicle components that are not part of the engine or chassis may be salvaged from the existing bus (e.g., plow blades, shovels, seats, tires, etc.) and sold or reused.

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Estimated cost of charging infrastructure and associated installation (Optional)

Please provide the estimated cost of infrastructure installation for all buses requested in this application. Please exclude letters or special characters.

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Quote & Authorization Upload*

For each bus requested in this application, provide a quote for combustion and electric bus replacement cost. If applicable provide authorization letters from state or third-party ownership agencies.

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Dealership Information

Dealership Name*

Dealership Street Number*

Dealership Street Name*

Dealership City*

Dealership State*

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Dealership Zip Code*

Dealership Contact Name*

Dealership Email Address*

Dealership Phone Number*

xxx-xxx-xxxx

Sales Reference Number (Optional)

Such as invoice number, purchase number etc.

Application Acknowledgement

Type your full name below to confirm that all of the information above is accurate and complete to the best of your knowledge.*

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