Organization: Project Coordinator: Address: City: County: Zip: Telephone: fax: Email: Alternate Contact Person/Telephone/Email: Project location
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- Navigate this page:
- Alternate Contact Person/Telephone/Email: Project location
- AFV Conversions and Up Fits
- _____________________________________________________________________ Refueling / Recharging Infrastructure
- Other Emission Reduction Efforts
- Project Summary: Task 1: Acquisition and Installation of Equipment or Infrastructure. tASK 1 DELIVERABLES Deliverable 1.1
- Deliverable 1.2
- Task 3: Public Awareness and Education. tASK 3 DELIVERABLES
- Task 4: Reporting. tASK 4 DELIVERABLES
- Timeline Project Dates: December 15, 2014 – September 15, 2015 1 st Quarter: *Dec 15, 2015 – March 31, 2015
- 3 rd Quarter: July 01, 2015 – *September 15, 2015
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Overview
Project Coordinator: Address: City: County: Zip: Telephone: FAX: Email: Alternate Contact Person/Telephone/Email: Project location (if different than applicant location) Address: City: County: Zip: A  pplicant type (check one): Public Private
Total Project Cost: $ Amount Requested: $ Matching Funds: $ (minimum 20% of total project cost) Project type/specifics:
Vehicle type (make, model, year): Type of fuel used: Dedicated Bi-fuel B Number of vehicles: B Estimated % miles using alternative fuel (bi-fuel or PHEV applications): Estimated per-vehicle annual mileage: Alternative fuel station(s) where vehicle(s) will refuel or recharge (address):
Vehicle type (make, model, year) to be converted/ up-fitted: Type of fuel to be converted to: Number of conversions or up fits to be installed: Dedicated Bi-fuel B Estimated % miles using alternative fuel (bi-fuel applications) Estimated per vehicle annual mileage: Alternative fuel station(s) where vehicle(s) will refuel or recharge (address):
Alternative fuel type: Estimated annual gallons / kWh to be dispensed: Open to the public: Yes No
Technology: Number to be purchased: Annual per vehicle hours of use: Annual per vehicle gallons to be saved:
Technology: Number to be purchased: Annual average per vehicle miles: Annual per vehicle fuel use (gal):
Technology: Number to be purchased: Annual average vehicle mileage Current average miles per gallon Parameters to be monitored: Estimated annual per vehicle fuel savings: Other Emission Reduction Efforts: How does this project fit with current or future emission reduction efforts? Emission Reductions: total project annual grams per mile. Check if attaching own data Leave below blank if NCSC is calculating. CO: NOx: VOCs: PM: “Buy America” Compliance Applicant hereby certifies compliance with “Buy America” requirements; OR Applicant hereby certifies “Buy America” is inapplicable to this project. (For AFV purchases) Applicant hereby certifies that vehicle final assembly occurs in the U.S. Project Description Statement of Work Project Summary: Task #1: Acquisition and Installation of Equipment or Infrastructure. tASK 1 DELIVERABLES Deliverable 1.1: Copies of paid invoices for all costs associated with project will be provided. If submitting more than one invoice for reimbursement, final invoice will be marked as such. If only submitting one invoice, this will be marked as final. Cost share letter will be submitted with final invoice [ refer to deliverable 4.1]. Deliverable 1.2: Brief description of what was accomplished will be provided. Task #2: Usage tracking of project technology/fuel. tASK 2 DELIVERABLES Deliverable 2.1: If possible 6 months of recorded usage will be provided in acceptable form. Deliverable 2.2: An estimate of gallons usage or saved for additional twenty-four (24) months will be provided. Task #3: Public Awareness and Education. tASK 3 DELIVERABLES Deliverable 3.1: Documentation of all Public Awareness and Education activities will be provided via quarterly report template provided by the NC Clean Energy Technology Center. Deliverable 3.2: Copies of all press releases and promotional material used to showcase project to the public will accompany quarterly reports. All press releases will acknowledge support through the NC Clean Energy Technology Center at NC State University with federal Congestion Mitigation Air Quality funding provided from the NC Department of Transportation. Deliverable 3.3: Photo of project signage and /or photo of vehicle decals will be provided. Deliverable3.4: Documentation of participation in NC Smart Fleet initiative (if applicable) Task #4: Reporting. tASK 4 DELIVERABLES Deliverable 4.1: Cost share documentation on letterhead will accompany final invoice. Deliverable 4.2: Completion of quarterly progress reports Deliverable 4.3 Copies of paid invoices for grant funded project [see Deliverable 1.1] will accompany all requests for reimbursement. Deliverable 4.4: One (1) final report summarizing project deliverables. Timeline Project Dates: December 15, 2014 – September 15, 2015 1st Quarter: *Dec 15, 2015 – March 31, 2015 Quarterly report due: January 15, 2015 2nd Quarter: April 01, 2015 – June 30, 2015 Quarterly report due: July 15, 2015 3rd Quarter: July 01, 2015 – *September 15, 2015 Quarterly and Final report due: September 30, 2015 *Indicates elongated or shortened quarters due to overall project period Budget
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