SJVAPCD

VOUCHER APPLICATION

Please fill out this form completely. All fields are required unless otherwise indicated.

 Program Application Requirements

Please complete a seperate application for each site location as distinguished by an address or intersection. Applicants may apply for more than one charger at a site, and may apply for multiple sites. However, a seperate application must be submitted for each site.

BEFORE YOU BEGIN:

  • IMPORTANT: Please do not purchase or install any chargers until you have received an approved voucher for your project.
  •  Be sure to review the  program guidelines.
  •  Have Electric Vehicle (EV) charger make & model information available. You'll need this to complete the application.
  •  Have the required supporting documents ready for immediate upload (pdf or image files only). You won't be able to submit the application without the documents, and cannot save your progress on an unsubmitted application. Here's what you'll need:
    •  A completed  IRS Form W-9
    •  Governing body resolution to execute the project application (Public Agencies only)
    •  Documented permission from the owner to install the chargers at the site (only if the applicant does not own the site)
    •  Supporting Documentation for  additional funding  for your project (if applicable)
    •  OPTIONAL: Other documentation (maps, etc) that may help to identify the intended location of the EV Chargers
 Applicant Information

Primary Contact Person

 (opt)
 (opt)
 (opt)
 (opt)

Contract Signing Authority

 (opt)
 Site Information
   

Please provide a description of where the Electric Vehicle (EV) charger(s) will be located on the site (for example, location within the parking lot or structure).

 Which of the following applies to your project at this site? Please select one.

NOTE: Level 3 EV chargers must be available to the public 24 hours a day to be eligible for Charge Up! funding

 EV Charger Information

Please list the chargers which you intend to install at the project site. Place each distinct charger model on a row of this table.
Click the "Add charger model" button to add additional models. All fields are required.

MAKE MODEL LEVEL PORT TYPE QUANTITY

Add charger model

 Disclosures

Charge Up! is part of California Climate Investments, a statewide initiative that puts billions of Cap-and-Trade dollars to work reducing greenhouse gas emissions, strengthening the economy and improving public health and the environment — particularly in disadvantaged communities.

Before submitting, be sure to double check your email address. We'll send you a confirmation of receipt as well as a copy of your application.