Electric Vehicle Charger Program – Application Form - Éco-Ouest

Instructions:

The following application form outlines the details required to participate in Eco-West Canada’s rebate program for the installation of electric vehicle charging stations in public places, on-street, multi-unit residential buildings, workplace, strategic infrastructure projects for urban delivery, and light-duty fleet applications.

Please complete each portion of this form for all electric vehicle charging stations included in your proposed project. Applications must be submitted to zev@eco-ouest.com along with all required attachments as indicated below. We encourage you to provide as many details as possible. This application form allows for up to ten charging connectors. Additional entries can be submitted through an additional application form if needed.

Please note, retroactive funding is not available through the program. Applicants must not initiate work, sign any contracts, or begin construction until their applications have been approved in writing, and funding agreements have been duly signed.

If you have any questions or concerns, please email zev@eco-ouest.com

General and primary contact information (5 points):

Organization Name(Required)

Organization Type:(Required)

Primary contact Name(Required)

Primary Contact Title(Required)

Primary Contact Phone(Required)

Primary Contact Email(Required)

Organization – brief description (150 words max) (10 points):

Organization name and description(Required)

– Tell us about your organization & its ability to complete the project.
– Where will the project location be located? (Public Spaces, On-street, MURB, Workplace, Light-duty vehicle fleets)

Organization website

Organization Address:(Required)

Street Address Address Line 2 City Province Postal Code

How did you hear about the program (select all that apply)

Internet Search

Peers

Social Media

Newsletter

Presentation

Media

Service providers

Other (Please specify)

Does your community and/or organization already have an EV charger?

Yes

Please describe your project, including the following:

Motivation for pursuing the project and how the project will support the community or other stakeholder
Description of benefits and reasoning for the planned installation of the locations throughout the community.
Approach to ensure stations are visible, have appropriate lighting, and are accessible 24/7, 365 days per year (all if available to the public)
Confirmation that the install site will not be impacted by, or is free of subsurface utilities such as water, gas, irrigation, or communication lines, if trenching is required.
Confirmation that each connector includes a dedicated EV-only parking spot with appropriate signage
Confirmation that the municipality/organization understands and accepts expenses, including but not limited to networking fees, electrical demand, electricity, and maintenance.

Project description (100-300 words) (20 points)(Required)

Project Details (35 points)(Required)

You can enter up to 10 rows.

Location Name

Location address

GPS Coordinates

Charger brand/model & # connectors

Charger plug type

Charging voltage

Power output

Intended use

Pay for use

Electric Vehicle Charging Station Cost Details (25 points)(Required)

Charging station and equipment quote ($)

Install and construction quote ($)

Engineering and design quote($)

Permitting and Inspection quote ($)

Signage costs ($)

Total cost per EV charging station ($)

Expected project start date(Required)

Expected project completion date (5 points)(Required)

Any deviations from this application form should be immediately notified to EWC. A duly executed amendment to the Letter of Engagement could be required depending on the degree of change to the project scope, completion date, or other project aspects.

Please include the following documentation as attachments

Total Points: 100 points

Copy of all itemized quotes for costs included in table 3, including quotes for the EV charging station equipment and installation. A detailed scope of work description is required for engineering and design costs.

Copy of all specification sheets (or brochure with technical information) for all EV charging station equipment.

Proof of Land ownership for the charging station installation sites.

All organizations not registered as a municipality will need to provide Articles of Incorporation

A council resolution or company/business commitment letter stating a commitment to the project pending funding.

Upload Files

Drop files here or

Max. file size: 100 MB.

Attestations(Required)

By submitting this proposal, the Project Applicant attests that:

It is acting on behalf of all partners and collaborators and has received written permission from them to do so.
All funding (cash and in-kind) identified by the Applicant and its partners and collaborators in the proposal is expected to be available for commitment at the time of the signing of the Contribution Agreement by duly authorized representatives of the Project Applicant and its partners and collaborators.
Any proprietary or confidential information provided as part of the submission, by any party, is provided with the approval of that party. Federal reviewers are bound by the requirements of the Access to Information Act and the Privacy Act regarding the treatment of confidential information.
It understands and acknowledges that should the Project be accepted for co-funding from the Program no liability and no commitment or obligation exists on the part of NRCan to make a financial contribution to the Project until a written Contribution Agreement is signed by both parties, and, furthermore, that any costs or expenses incurred or paid by the Applicant prior to the execution of a written Contribution Agreement by both parties are the sole responsibility of the Applicant, and no liability exists on the part of NRCan.
It understands and acknowledges that NRCan officials will not entertain any request by Project proponents to review or revisit NRCan’s Project approval decisions.
It understands and acknowledges that NRCan reserves the right to alter or cancel the currently envisaged process at its sole discretion.
It understands and acknowledges that no Member of the House of Commons shall be admitted to any share or part of the Contribution Agreements, or any resulting benefit.

Name(Required)

First Last

Title(Required)

Municipality/Organization(Required)

Name

This field is for validation purposes and should be left unchanged.

Services

EWC provides a full range of project management services that target areas of activity and implement green projects that aim to reduce GHG emissions and the overall carbon footprint of municipalities:

Activity Sectors

Eco-West Canada works with small to medium size municipalities and other clients to plan and implement sustainability projects in the following sectors of activity:

Municipal Waste Management

Organics Diversion / Waste to Value-Added

Transportation / Electric Vehicles

Energy Efficiency

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