Microsoft Word - EV Charger Rebate Manual

Last Updated: May 5, 2022

Electric Vehicle Charger Rebate Manual

Contents

Contents ........................................................................................................................................................ 1

Electric Vehicle Charger Rebate Eligibility .................................................................................................... 2

Charging Safety ......................................................................................................................................... 2

Home Charger Requirements ................................................................................................................... 3

Licensed Contractors................................................................................................................................. 3

Home Charger Estimate Approval Process ............................................................................................... 4

Home Charger Installation ........................................................................................................................ 5

Home Charger Reimbursement ................................................................................................................ 5

Portable Charger Requirements ............................................................................................................... 6

Portable Charger Estimate Approval Process ........................................................................................... 6

Portable Charger Installation and Reimbursement .................................................................................. 7

Frequently Asked Questions ......................................................................................................................... 8

Attachment A: Home Charger Installation Estimate Summary Form ................................................... A:1-2

Attachment B: Home Charger Reimbursement Request Form ................................................................. B:1

Attachment C: Home Charger Invoice Summary Form ........................................................................... C:1-2

Attachment D: Portable Charger Estimate Summary Form ……………………………………………………………….D:1-2

Attachment E: Portable Charger Reimbursement Request Form………………………………………………………….E:1

Electric Vehicle Charger Rebate Eligibility

The Clean Cars for All (CCFA) program offers up to $2,000 in additional Electric Vehicle Charger Rebate

to grantees, or Participants, who have purchased or leased a new or used plug-in hybrid electric vehicle

(PHEV) or battery electric vehicle (BEV). The EVSE rebate is only available to CCFA Participants on a

reimbursement basis who have purchased a PHEV or BEV through the program and have completed

their post-inspection and dismantled their old vehicle. EVSE must be installed at the home address listed

on the original electric vehicle application and Participant intends to operate the charger for the

remaining operational period of the CCFA replacement vehicle.

Participants can choose one of the following EVSE options:

1) Level 2 home charger installation (up to $2,000)

• Participant reimbursed for one level 2 charger and necessary installation costs. The charger

requires a dedicated 208/240-volt supply circuit and may either be hardwired directly to an

electrical service panel or plugged into a newly installed or pre-existing NEMA receptacle.

2) Level 2 portable charger (up to $600)

• Participant reimbursed for one level 2 portable charger and must have a pre-existing

208/240-volt receptacle with a dedicated supply circuit at their residence to plug the

charger into.

Eligible costs include a level 2 electric vehicle (EV) charger, labor, permits, and materials necessary for a

Participant to safely charge their vehicle at a residence. The following items are reimbursable costs:

• Level 2 EV charger

• Labor costs related to site preparation, permit submission, charger installation, and time

spent at final inspection

• Permitting costs

• Panel and sub-panel upgrades

Material costs including, but not limited to receptacles, conduit, wire, breakers,

miscellaneous fittings and connectors

• NEMA adapters for portable chargers that are designed to safely work with a specific

charger brand

Participant must submit their charger estimate request to cleancars@gridalternatives.org

within 60

days of purchasing their replacement vehicle. Funding is reserved during this 60-day timeframe and

requests received after this deadline are subject to case-by-case approval and funding availability.

Charging Safety

Charging an electric vehicle is safe and easy when done with proper, independently certified equipment.

Underwriter’s Laboratory (UL), is a nationally recognized testing laboratory that performs extensive

laboratory safety testing that products must pass before they can be safety certified and made available

to the public for sale. It is recommended that all Participants purchase a UL-listed charger that meets

strict safety standards and has undergone rigorous testing. Work with your contractor to determine

what equipment and electrical configuration will work best for your vehicle type and residence.

Participants should follow all manufacturer suggested guidelines when operating the charger for safe

usage.

Home Charger Requirements

• The level 2 charger must be new, supplied by a dedicated 208/240-volt supply circuit, and

deliver a minimum of 16 amps. The charger may either be hardwired directly to an electrical

service panel or plugged into a pre-existing or newly installed NEMA receptacle.

• Level 2 home chargers do not have a price cap and may be purchased by the Participant or

contractor. The average cost for a level 2 home charger is between $500-$700. Level 2 portable

chargers may also be purchased under this option.

• Installation must be completed by a licensed contractor and at least one electrician on each

crew must hold an Electric Vehicle Infrastructure Training Program (EVITP) certification.

• Electrical permits are required and may be obtained from the city or county's building division’s

permitting office by the contractor or Participant/property owner. The permit must be finalized

before the installation begins and a final inspection should be performed by the permitting

office after the installation is completed.

• Participant must either be the property owner of the residence where the charger is installed or

they are required to receive permission from the property owner (e.g. landlord, homeowners

association, etc.).

Keep in mind that level 2 chargers that have a continuous amperage supply below 40 amps require a

significantly higher amount of time to charge your electric vehicle. Charging times vary depending on

your electrical system capacity, charging rate, vehicle battery size, and state of charge (empty vs. full

battery).

Licensed Contractors

A home charger must be installed by a contractor with a valid Contractors State License Board (CSLB) C-

10 or C-46 License and at least one electrician on each crew, at any given time, must hold an

Electric

Vehicle Infrastructure Training Program (EVITP) certification as required by Public Utilities Code 740.20.

One member of each crew may be both the contractor and an EVITP certified electrician. The EVITP

certification requirement does not apply to single-family home residential electric vehicle chargers that

can use an existing 208/240-volt receptacle.

Work done, costs incurred, and equipment purchased/ ordered for installations that are performed by

non-licensed contractors and contractors without an EVITP certified electrician are not eligible for

reimbursement. Participant and household members may not perform any installations, even if they are

a licensed contractor or EVITP certified electrician. Participant should verify their contractor has a valid

and active license on the CSLB website:

https://www.cslb.ca.gov/onlineservices/checklicenseII/checklicense.aspx

. EVITP certification for

electricians can be verified by certification number or last name on the EVITP website:

https://db.evitp.org/

Participant will pay the licensed contractor directly for the invoice balance after the installation is

completed. The Air District will not reimburse contractors and will directly reimburse Participant for

eligible costs after a reimbursement request with all required documentation is submitted.

The Air District does not have an authorized contractor list. Participants may utilize the following

resources to find qualified installers in their area. Please note, these are not exhaustive lists and

contractors may sign up to be included in these databases on a voluntary basis.

• CALeVIP’s Installers and Electricians search tool: https://calevip.org/find-an-evsp

. Search for

contractors by county and utilize the filter for EVITP status.

• EVITP’s “Find a Contractor” tool: https://evitp.org/california

Participants may use any contractor they choose that meet the requirements stated above. Participants

may also reach out to GRID Alternatives (the case managers for the Clean Cars for All Program), who

have a licensed contractor and EVITP certified electrician. If you would like to inquire about an estimate

from GRID Alternatives, you may contact them via email at evs@gridalternatives.org

Home Charger Estimate Approval Process

Participant must receive written estimate approval for their project from Clean Cars for All staff before

proceeding with purchasing any equipment and installing the charger. Work done, costs incurred, and

equipment purchased/ ordered prior to the approval of the estimate will not be eligible for

reimbursement.

Submit the following estimate documents to [email protected]

1) Home Charger Installation Estimate Summary Form (Attachment A)

o Form must be completely filled out and signed by Participant

2) Contractor’s Estimate

o Official estimate from a licensed contractor that includes the following information:

 Contractor’s business name and contact information

 Participant’s full name and installation address (do not include a family member

or property owner’s name)

 Estimate date

 Scope of work

 Itemized costs for labor, materials, and permits

 Charger make and model

3) Charger Equipment Specification Sheets

o Provide a URL web address to product page or technical specifications document

(screenshot of product page can be provided in addition)

Estimates may take up to 4 weeks for Air District staff to review. Incomplete submissions are subject to

additional delays or rejection.

After receiving written estimate approval from CCFA staff, Participant may proceed with the licensed

contractor that provided the estimate to complete the installation, and purchase the charger if the

contractor will not be providing it.

If Participant decides to change contractors after receiving an estimate approval, a new request must be

submitted. Minimal changes to estimate costs and scope of work after an estimate approval do not

require resubmission, but must be clearly reflected on the Home Charger Installation Invoice Summary

Form (Attachment C) and on supporting documents with the final reimbursement request.

Home Charger Installation

Participant must complete the charger installation within 60 days of receiving estimate approval.

Reimbursement requests must be submitted within 14 days of the project completion date or final

payment of the invoice. Requests submitted after the deadline will be evaluated on a case-by-case

basis.

Electrical permits must be secured before the installation begins and may be acquired by the contractor

or the Participant/property owner. All electrical work must be coordinated with utility companies and

permitting agencies and must meet all applicable state and local laws. A copy of the final electrical

permit and associated costs must be submitted in order to receive reimbursement.

Once the installation is completed, Participant receives itemized invoice and pays the contractor for the

amount in full. Participant should not pay the contractor for the entire invoiced amount until they verify

the work has been completed, copies of permits and final inspections are obtained, and the Home

Charger Invoice Summary Form (Attachment C) has been signed by the contractor to ensure proper

documentation is obtained in a timely manner.

Home Charger Reimbursement

Once a level 2 home charger is installed, the project has passed the final inspection, and the contractor

has been paid in full, Participant must submit the following:

1) Home Charger Installation Reimbursement Request Form (Attachment B)

2) Home Charger Installation Invoice Summary Form (Attachment C) signed by the grantee and

licensed contractor

3) Invoices

o Itemized invoice from contractor for level 2 charger installation, which includes:

 Line-item costs for charger, labor, materials, and permit*

 Participant’s full name and address of installation site

 Contractor’s name, business address, and phone number or email address

4) Proof of Payment

o Proof of payment for invoiced amounts through one or a combination of the following:

 Receipt

 Check copy (cancelled)

 Bank account/credit card statement

 Paid invoice from contractor with $0 balance and method of payment (e.g.

credit card, check, cash)

5) Permit

o Copy of the final permit that shows the permit number, issue date, site address,

requestor, permit type, and description of work

6) Photos

o Photo(s) of installed charger plugged into the CCFA vehicle

*If Participant chooses to purchase the charger and/or obtain the permit themselves, separate

invoices and/or proof of payment must be provided.

Reimbursements shall not exceed the final amount invoiced for the complete installation of a level 2

home charger or $2,000, whichever is less. Reimbursement amounts will be rounded down to the

nearest whole dollar amount.

Reimbursement checks will be mailed by the Air District to the address listed on the Form W9 submitted

with the original CCFA application within 90 days of receiving a complete and correctly filled out

reimbursement request (invoices, proof of payment, permit, photos, EVSE Reimbursement Request Form

[Attachment B], and Home Charger Invoice Summary Form [Attachment C]). Incomplete requests are

subject to additional delays.

Portable Charger Requirements

• Participant may purchase one new level 2 portable charger that delivers a minimum of 16 amps.

• Portable chargers must clearly state the charger is portable in the product description. Chargers

that are required to be mounted or do not state portable in their product description are not

eligible portable chargers.

• Participant must have an existing NEMA receptacle, supplied by a dedicated 208/240-volt supply

circuit, to plug the charger into. The receptacle must be able to safely support the charger

amperage and be compatible with the selected charger.

o If the selected charger plug is not compatible with the existing receptacle, a NEMA

adapter may be selected from the same charger manufacturer and must be used

according to the manufacturer’s guidelines for safe operation. Only necessary NEMA

adapters are eligible and may not be purchased as a back-up or if you do not have an

existing compatible receptacle.

• Level 2 portable chargers are eligible for reimbursement up to $600, including taxes and

shipping costs. The average cost for a level 2 portable charger is between $200-$500.

Portable Charger Estimate Approval Process

Participant must receive written estimate approval for their project from Clean Cars for All staff before

proceeding with purchasing the level 2 portable charger. Work done, costs incurred, and equipment

purchased/ ordered prior to the approval of the estimate will not be eligible for reimbursement.

Submit the following estimate documents to [email protected]

1) Portable Charger Estimate Summary Form (Attachment D)

o Supporting documentation that shows where the charger will be purchased and

confirms the make, model, and amperage. Examples include:

 Hyperlink or URL web address (screenshot of product page can be provided in

addition)

 Quote (in-store or online)

o Form must be completely filled out and signed by Participant

2) Photo of pre-existing NEMA receptacle

3) Level 2 portable charger equipment specification sheet or URL web address

Estimates may take up to 4 weeks for Air District staff to review. Incomplete submissions are subject to

additional delays or rejection. After receiving written estimate approval from CCFA staff, Participant

may proceed with purchasing the portable charger.

If Participant chooses to purchase a different portable charger after receiving estimate approval, a new

request must be submitted.

Portable Charger Installation and Reimbursement

After a level 2 portable charger is purchased and received, plug the charger into the existing 208/240-

volt receptacle and plug the charger connector into the vehicle to verify the charger works.

Participant must submit the following to c[email protected]

1) Portable Charger Reimbursement Request Form (Attachment E)

2) Proof of Payment

o Proof of payment for portable charger and any adapter that includes the make, model,

cost, and method of payment. This information can be provided through one or

ombination of the following documents:

o Receipt

o Check copy

o Bank account/credit card statement

o Paid invoice with $0 balance

3) Photos

o Photo of portable charger plugged into the 208/240-volt receptacle

 Any adapter purchased must also be plugged into the charger and receptacle

o Photo of charger plugged into the CCFA vehicle

Reimbursements shall not exceed the final amount invoiced for the complete installation of a level 2

portable charger, or $600, whichever is smaller. Reimbursement amounts may be rounded down to the

nearest whole dollar amount.

Reimbursement checks will be mailed out by the Air District within 90 days of receiving a correctly filled

out reimbursement packet, which includes the Portable Charger Reimbursement Request Form

(Attachment E), proof of payment, and photos.

8

FrequentlyAskedQuestions

WhodoIcontactifIhavequestions?

EmailaCCFAcasemanagerat[email protected]orcall855‐256‐3656.

CanIpurchaseandinstallausedcharger?

No,allequipmentmustbenewandpurchasedfromareputablebusiness.

CanIinstallaLevel1orDCFastcharger?

No,onlylevel2chargersareeligiblefortheprogram.

WhatifIhaveanexistingreceptacle,butdonotwanttopurchaseapo

rtablechargerandinsteadbuy

achargerthatneedstobewall‐mounted?

Alicensedcontractorwillstillneedtobeinvolvedtoperformasiteassessment,performelectricalload

calculations,andmountthecharger.AnEVITPcertifiedelectricianisnotrequiredwhenthechargercan

useanex

isting208/240‐

voltreceptacle.Inthesecases,permitsareusuallystillrequired dependingon

thetypeofworkperformed.Consultwithyourcontractorandlocalbuildingpermitdepartmentfor

moreinformation.

CanIinstallmyownchargerandgetreimbursedformytime? 

No,evenifaParticipantisalicensedcontractororEVITPcer

tifiedelectrician,Participantsarenot

permittedtoinstalltheirownhomecharger.

CanIobtainanestimatefromacontractorbeforeI’vepurchasedareplacementvehicleordismantled

myoldvehicle?

Yes,Participantsmaypursueanestima tefromalicensedcontractor,butcannotenterintoany

agreementswiththecon

ractorforthework,beginwork,orpurchasethechargerbeforetheyreceive

writtenestimateapproval.

DoIneedapermit?

Forthehomechargerinstallations,anyelectricalworkperformedrequiresapermitandthefinalper mit

mustbeobtainedbeforeanyworkontheinstallationbegins.Thepermitmay

beobtainedfromthecity

orcounty’sbuildingdivision’spermittingofficebythecontractorortheParticipant/propertyowner.If

thecontractorobtainsthepermit,acopyofthefinalpermitshouldbeprovidedtotheParticipantand

associatedcostsmustappearonthefinalinvoice.IftheParticipantobtainsth

epermit,theywillnee

dto

provideacopyofthefinalpermitandproofofpaymentforthepermittingcosts.Aftertheinstallationis

completed,Participantshouldcoordinatewiththecontractoronthefinalinspection.Installations

performedwithoutapermitwillnotbeeligibleforreimbursement.

CanIgetreimbursedfo

rinstallingachargeratadifferentlocationthantheaddressIusedtoapplyto

CleanCarsforAll?

No,aParticipantmaynotinstallachargeratadifferentaddressotherthanthehomeaddresslistedon

theiroriginalCCFAapplication.However,iftheParticipanthasmovedandthenewaddressislocatedin

aneligi

lezipcode,aninstallationmaybepermittedwithpre‐approvalfromCCFAprogramstaff.Email

9

[email protected]withthereques

tandincludeanewFormW‐9andproofofresidency

thatisdatedwithinthelast90days(e.g.utilitybill,cellphonebill,paystub,propertytax,oraUSPS

changeofaddressconfirmation).

Howdoesthereimbursementprocesswork?

Participantsmustpayforallcostsinfullandhaveproofofpaymentbeforesubmittingareimbursement

request.Afteracompletereimburse

mentrequestisreceived,AirDistrictstaff willmailareimbursement

checktotheaddresslistedontheFormW‐9within90days.TheAirDistrictdoesnothaveanauthorized

contractorlistandwillnotreimbursecontractorsdirectly. 

DoIneedtopaytaxesontherebateamount?

TheAirDistrictwillissueaForm1099‐G(CertainGo

ernmentPayments)toallParticipantswhoreceive

$600ormoreinfundingtopaytaxeson. TheForm1099‐Gismailedinlate‐January/earlyFebruaryof

thefollowingcalendaryearforthereimbursementcostsforthetaxyearyour

eceivetherei

mbursement

check.Forexample,ifthecheckisreceivedinFebruary2022,aForm1099‐Gwillbeissuedfortaxyear

2022andsentinJanuary/February2023.YoumayreceiveuptotwoForm1099sifyourvehicle

purchaseandchargerreimbursementcheckoccurindifferentcalendaryears.

Isth

e$500publicchargecardavaila

ble?

Thisoptioniscurrentlyunderdeve lopment.Participantswhodonotoptforthehomecharger

installationorportablechargerandareinterestedinthepublicchargecardmaysignuptobenotified

whenthereisanupdatebyemailing[email protected].Ifthepublicchargecardbeco

mes

availableinthefuture,itmayonlybeofferedtoprojectsthatareawardedafterthisoptionis

established.

Attachment A

Home Charger Installation Estimate Summary Form

This form is filled out by the Participant and summarizes the cost estimates for your level 2 home charger

installation project. Estimate approval is required before purchasing any equipment and installing the charger.

Participant Information

Participant Name:

Electric Vehicle Project Number:

Home Address (on electric vehicle application):

Vehicle Purchase Date:

Installation Address (

if installation address is different from home address, a Form W-9 and Proof of Residency is required for submission):

Contractor and Electrician Information

Business Name:

Business Address:

Phone Number:

E-mail Address:

Contractor’s Name:

C-10 License Number:

Electrician’s Name:

EVITP Certification Number:

Charger Type and Costs

Charging Station Cost:

Manufacturer:

Sales Tax

Shipping and Handling:

Model

Total Charger Cost:

Amperage:

Charger will be purchased by: Contractor Participant

If charger is purchased by Participant, include a website URL link, screenshot, or quote from store where charger will be purchased:

Installation Costs

Labor Cost:

Permit Cost

Materials Cost:

Permit will be obtained by: Contractor Participant

Panel/Subpanel Upgrade Cost:

Taxes:

Total Installation Cost:

Charger Installation Type: Hardwired NEMA Outlet

Total Project Costs (charger costs + installation costs):

A-1

AttachmentA

HowtoSubmitYourEstimateRequest

Submityourestimaterequestwithin60daysofpurchasingyourplug‐inhybridorbatteryelectricvehicleto

cleancars@gridalternatives.orgforapprovalbeforepurchasinganyequipmentandbeginningyour

installation.Estimateapprovalsmaytakeupto4weeks.

RequiredDocuments

1) HomeChargerInstallationEstimateSummaryForm(AttachmentA)

2) Officialestimatefromlicensedcontractor

3) Level2chargerequipmentspecificationsheetorURLwebaddresstoproductpagewithtechnical

specifications

ProjectInstallationRequirementsChecklist

ParticipantSignatureREQUIRED:

Confirmthefollowing:



CCFAreplacementvehicleisaplug‐inhybridorbatteryelectricvehicle.



Previousvehiclehasbeenbroughttoanauthorizeddismantlerforapost‐inspectionandfinaldismantling.



EVSEisanewLevel2chargerwithaminimumof16amps.



EVSEwillhaveadedicated208/240‐voltsupplycircuitandeitherbehardwireddirectlytoanelectrical

servicepanelorpluggedintoanewlyinstalledorpre‐existingNEMAreceptacle.



IfthecontinuousamperagesuppliedtotheEVSEisbelow40amps,Iunderstandtheuseof

loweramperageEVSEmaysignificantlyincreasethetimerequiredtofullychargemyvehicle.



Anelectricalpermitwillberequestedbythecontractorormyselfandfinalizedbeforethe

projectinstallationbegins.



Iunderstandthatworkdone,costsincurred,andequipmentpurchased/orderedpriortothe

approvaloftheestimatewillnotbeeligibleforreimbursement.



IhaveconfirmedtheaboverequirementswiththelicensedcontractorandprocuredanEVSEinstallation

costestimatethatincludesthefollowingitems:

o Participant’sfullname,installationlocation,loadcalculations(demonstratingthatthesupplycircuit

andelectricalservicepanelsaresizedforcontinuousEVSEload),itemizedcostsforlabor,materials,

andpermitsnecessaryforLevel2charg

erinstallation.

o IfEVSEisnotpurchasedbycontractor,Ihaveprovidedaseparatecostestimateforthecharger.



IintendtooperatethechargerfortheremainingoperationalperiodoftheCCFAreplacement

vehicle.



ParticipantSignature: Date:

Comments:

A-2

Attachment B

Home Charger Installation Reimbursement Request Form

After your Clean Cars for All (CCFA) home charger project is completed, submit this form and the

required supplemental documents to cleancars@gridalternatives.org

Participant Name:

Installation Address:

Home Address Listed on original CCFA application:

Date Installation Completed:

Total Eligible Project Costs (charger, installation, permit costs): $

Total Amount Requested for Reimbursement (max $2,000): $

Please check the boxes below:

 I have purchased a Plug‐in Hybrid or Battery Electric Vehicle through the CCFA Program.

 I took my old car to an Authorized Dismantler prior to the installation of my home charger.

 I have attached the following required documents:

Required Documents

1) Home Charger Installation Reimbursement Request Form (Attachment B)

2) Home Charger Installation Invoice Summary Form (Attachment C)

3) Invoices

‐ Itemiz

ed invoice from contractor for level 2 charger installation, which includes:

a. Line‐item costs for charger, labor, materials, and permit

b. Participant’s full name and address of installation site

c. Contractor’s name, business address, and phone number or email address

4) Proof of Payment

‐ Proof of payment for invoiced amounts through one or a combination of the following:

a. Receipt

b. Check copy

c. Bank account/credit card statement

d. Paid invoice from contractor with $0 balance and method of payment (e.g. credit card,

check, cash)

5) Copy of final permit

6) Photo(s) of installed charger plugged into the CCFA vehicle

B-1

Attachment C

*Participants are required to receive written estimate approval from CCFA staff before purchasing any equipment and installing

their charger. Participants have 60 days to complete the installation and 14 days to submit the reimbursement request.

Submissions received after this date will be considered on a case-by-case basis and may be denied.

Home Charger Installation Invoice Summary Form

This form summarizes the final costs for the Participant’s level 2 home charger installation project. The form is

filled out by the Participant (contractor may assist if information is not available on the contractor invoice) and

signed by both the Participant and licensed contractor.

Participant and Project Information

Participant Name:

Electric Vehicle Project Number:

Estimate Approval Date*:

Installation Address:

Contractor and Electrician Information

Business Name:

Business Address:

Phone Number:

E-mail Address:

Contractor’s Name:

C-10 License Number:

Electrician’s Name:

EVITP Certification Number:

Charger Type and Costs

Charging Station Cost:

Manufacturer:

Sales Tax

Shipping and Handling:

Model

Total Charger Cost:

Amperage:

Charger purchased by: Contractor Participant

Installation Costs

Labor Cost:

Total Hours Spent on Installation:

Materials Cost:

Hourly Labor Rate (divide labor costs by total hours):

Permit Cost:

Permit obtained by: Contractor Participant

Panel/Subpanel Upgrade Cost:

Taxes:

Charger Installation Type: Hardwired NEMA Outlet

Total Installation Cost:

Total Project Costs (charger costs + installation costs):

C-1

AttachmentC

C‐2

HowtoSubmitYourReimbursementRequest

Thisformisrequiredtobesubmittedaspartofthereimbursementrequestforyourhomecharger

installationprojectwithin14daysofcompletion.RefertotheHome Charger Installation Reimbursement

RequestForm(AttachmentB)foracompletelistofrequireddocuments.

ProjectInstallationRequirementsChecklist

ParticipantSignatureREQUIRED

Confirmthefollowing:



EVSEisanewLevel2chargerwithaminimumof16amps.



EVSEhasadedicated208/240‐voltsupplycircuitandiseitherhardwireddirectlytoanelectricalservicepanel

orpluggedintoanewlyinstalledorpre‐existingNEMAreceptacle.



IfthecontinuousamperagesuppliedtotheEVSEisbelow40amps,Iunderstandtheuseof

loweramperageEVSEmaysignificantlyincreasethetimerequiredtofullychargemyvehicle.



Afinalizedelectricalpermitwasobtainedfortheprojectinstallation.



Iunderstandthatworkdone,costsincurred,andequipmentpurchased/orderedpriortothe

approvaloftheestimatewillnotbeeligibleforreimbursement.



Ihaveconfirmedtheaboverequirementswiththelicensedcontractorandhavereceivedanitemized

invoicefortheEVSEinstallationthatincludesthefollowingitems:



Participant’sfullname,installationlocation,loadcalculations(demonstratingthatthesupplycircuit

andelectricalservicepanelsaresizedforcontinuousEVSEload),itemizedcostsforlabor,materials,

andpermitsnecessaryforLevel2chargerinstallation.

o IfEVSEand/orpermitisnotpaidforbythecontractor,Ihaveprovidedaseparateinvoiceand

proo

fofpayment.



IintendtooperatethechargerfortheremainingoperationalperiodoftheCCFAreplacement

vehicle.

I,,confirmtheaboverequirementsarecorrectandtrueandthattheHomeCharger

InstallationInvoiceSummaryFormisjustasummaryoftheinvoice(s)andnotacontract.Ialsounderstandthatifthe

continuousamperagesuppliedtotheinstalledEVSEisbelow40amps,theloweramperagemaysignificantlyincrease

thetimerequiredtofullychargemyvehicle.



ParticipantSignature: Date:

ContractorSignatureREQUIRED

I,,confirmtheaboveinstallationrequirementsarecorrectandtrue.Iconfirmthatat

leastoneelectricianwhoholdsanElectricVehicleInfrastructureTrainingProgramcertificationwasontheinstallation

crew.IunderstandthattheHomeChargerInvoiceSummaryFormisjustasummaryoftheinvoice(s)andnota

contract.

ContractorSignature: Date:

Comments:

Attachment D

Portable Charger Estimate Summary Form

This form is filled out by the Participant and summarizes the cost estimates for your level 2 portable

charger project. Estimate approval is required before purchasing the equipment and plugging the charger

into your existing receptacle.

Participant Information

Participant Name:

Electric Vehicle Project Number:

Home Address (on electric vehicle application):

Vehicle Purchase Date:

Installation Address (

if installation address is different from home address, a Form W-9 and Proof of Residency is required for submission):

Pre-existing Receptacle Type (e.g. NEMA 6-20R, 14-50R, etc.):

Charger Type and Costs

Charger Cost:

Charger Manufacturer:

Charger Sales Tax:

Charger Model:

Charger Shipping and Handling:

Charger Amperage:

Total Charger Cost:

Charger Plug Type (e.g. NEMA 6-20P):

Where will the charger be purchased? Include a website URL link or attach a store quote.

Adapter Type and Costs (optional)

Adapter Cost:

Adapter Sales Tax:

Adapter Manufacturer:

Adapter Shipping and Handling:

NEMA Adapter Type (e.g. 6-20, 6-20R to 14-50P):

Where will the adapter be purchased? Include a website URL link or attach a store quote.

Total Project Costs (charger costs + optional adapter):

D-1

AttachmentD

HowtoSubmitYourEstimateRequest

Submityourestimaterequestwithin60daysofpurchasingyourplug‐inhybridorbatteryelectricvehicleto

cleancars@gridalternatives.orgforapprovalbeforepurchasinganyequipment.Estimateapprovalsmay

takeupto4weeks.

RequiredDocuments

1) PortableChargerEstimateSummaryForm(AttachmentD)

2) Photoofpre‐existingNEMAreceptacle

3) Level2portablechargerequipmentspecificationsheetorURLwebaddresstoproductpagewith

technicalspecifications

ProjectRequirementsChecklist

ParticipantSignatureREQUIRED:

Confirmthefollowing:



CCFAreplacementvehicleisaplug‐inhybridorbatteryelectricvehicle.



Previousvehiclehasbeenbroughttoanauthorizeddismantlerforapost‐inspectionandfinaldismantling.



EVSEisanewLevel2portablechargerwithaminimumof16amps.



Ihaveapre‐existingNEMAreceptaclewithadedicated208/240‐voltsupplycircuittoplugthechargerinto.



IfthecontinuousamperagesuppliedtotheEVSEisbelow40amps,Iunderstandtheuseof

loweramperageEVSEmaysignificantlyincreasethetimerequiredtofullychargemyvehicle.



Iunderstandthatworkdone,costsincurred,andequipmentpurchased/orderedpriortothe

approvaloftheestimatewillnotbeeligibleforreimbursement.



IintendtooperatethechargerfortheremainingoperationalperiodoftheCCFAreplacement

vehicle.



ParticipantSignature: Date:

Comments:

D-2

AttachmentE

PortableChargerReimbursementRequestForm

AfteryourCleanCarsforAll(CCFA)portablechargerisreceivedandpluggedintoyourpre‐existingreceptacle,

submitthisformandtherequiredsupplementaldocumentsto[email protected].

Pleaseconf

irmthefollowingandsignbelow:



IhavepurchasedaPlug‐inHybridorBatteryElectricVehiclethroughtheCCFAProgram.



ItookmyoldcartoanAuthorizedDismantlerpriortotheinstallationofmyportablecharger.



IunderstandthatifthecontinuousamperagesuppliedtotheinstalledEVSEisbelow40a

mps,theloweramperage

maysignificantlyincreasethetimerequiredtofullychargemyvehicle.



Iunderstandthatworkdone,costsincurred,andequipmentpurchased/orderedpriortotheapprovalofthe estimate

willnotbeeligibleforreimbursement.



IintendtooperatethechargerfortheremainingoperationalperiodoftheCCFAreplacementvehicle.



Ihaveattachedthefollowingrequireddocuments:

1) PortableChargerReimbursementRequestForm(AttachmentE)

2) Invoice/ProofofPayment

‐ Invoice/proofofpaymentforlevel2portablechargerandanyadapterthatincludesthemanufacturer

make&model,amperage,andcosts

‐ Proofofpaymentmustshowmethodofpaymentan

dincludesoneoracombinationofthefollowing:

receipt,checkcopy,bankaccount/creditcardstatement,paidinvoicewith$0balance.

3) Photo(s)ofportablechargerandanyadapterpluggedintopre‐existingoutletandchargerpluggedinto

CCFAvehicle

Iconfirmthattheaboverequirementsprovidedinthisrequestarecorrectandtrue.

ParticipantSignature:  Date:

ParticipantInformation

ParticipantName:

ElectricVehicleProjectNumber:



EstimateApprovalDate*:

InstallationCompletionDate:

InstallationAddress:

Pre‐existingReceptacleType(e.g.NEMA6‐20R,14‐50R,etc.):

ProjectEquipmentandCosts:

ChargerManufacturerandModel:

ChargerAmperage:

TotalChargerCost(charger,taxes,shipping&handling): TotalAdapterCosts(adapter,taxes,shipping&handling):

TotalProjectCosts(chargercosts+optionaladapter):

Amountrequestedforreimbursement(max$600):

E-1