ESBD_369598_1721930693846_582-24-86400-VW TxVEMP Marine Vessel App-FINAL-acc.pdf

Repower Project Application Form Ferry and Tug Marine Vessels and Related Charging

Infrastructure Projects

Ferry, Tug, and Switcher Grant Program

Texas Commission on Environmental Quality (TCEQ) Texas Volkswagen Environmental Mitigation Program (TxVEMP)

Solicitation No. 582-24-86400-VW

Esta es la aplicación de subvención para el Programa de Mitigación Ambiental de Texas Volkswagen (TxVEMP por sus siglas en inglés). Debe llenar y enviar esta aplicación para solicitar una subvención. Comuníquese al 833-215-TXVW (8989) para obtener ayuda con esta solicitud.

Eligible Activities This project application form should be completed only by applicants seeking to repower a ferry or tug under the TxVEMP.

Applicants may request additional funding for on-site charging infrastructure to fuel one or more of the qualifying marine vessels by filling out optional Section 7.

Applicants will be subject to application submission limitations as defined in Section 11.1 of the RFGA. For the purposes of these limitations, an applicant includes an individual or business and all of their associated legal affiliates. Applicants may not submit more than one vessel in a single application. TCEQ reserves the right to limit the award of more than $10 million in grant funds to a single applicant.

Application Completeness TCEQ will review applications for completeness. If an application is found to be incomplete, TCEQ will notify the applicant in writing and provide details about what is missing from the application. Applicants will be provided a deadline to submit the missing information to TCEQ.

Submission Instructions Submit a completed and signed application form and the required attachments by uploading to TCEQ’s File Transfer Protocol Secure (FTPS) site or by submitting the application and associated documents by mail. All applications must be received by TCEQ no later than 5:00 p.m. Central Time on the application submission deadline listed in the table below. Refer to Section 11.0 of the RFGA for detailed instructions on submitting an application.

Learn how to create an account and submit your application via FTPS in this (Step-by-Step Video Guide).

Important Dates Date

Program Opening Date July 25, 2024

Application Submission Deadline Oct 29, 2024

TCEQ-21000-a (Rev. July 2024) Page 1 of 21 https://ftps.tceq.texas.gov/ https://ftps.tceq.texas.gov/ https://www.youtube.com/watch?v=GW4eEe_uUwc

Section 1: Ferry and Tug Marine Project Criteria and Description Ferry and Tug Marine Project Criteria

Applicants seeking to repower a ferry or tug must meet the conditions found in Section 5 of this application for program requirements and eligibility criteria. Additional marine project criteria are in Sections 5.1.1 and 5.2 of the RFGA.

1. Marine Project Type: Repower

Applicants may submit more than one application under this solicitation. Applicants may not include activities for more than one vessel in a single application. Repower projects involve replacing the existing engine(s) on an eligible marine vessel.

2. Project and Business Description

In the space below, please provide a detailed description of the proposed repower project. Include a description of your business and how the equipment is used in your routine operations. Any grant-funded equipment must be intended for the same or a similar purpose as the equipment being repowered.

TCEQ-21000-a (Rev. July 2024) Page 2 of 21

Section 2: Applicant Information

1. Legal Name of the Individual or Entity Applying for the Grant If selected for a grant, the legal name of the applicant will be used for contracting purposes.

Applicant/Entity Legal Name (Must Match W-9 Form)

2. Entity Information Entities required to register with the Secretary of State must have an active registration by July 25, 2024, 5:00 p.m. CT and must maintain an active registration throughout the contract period.

Ownership / Business Type

Employer Identification Number (EIN)

3. Authorized Official (AO) The applicant or an officer or employee who has legal authority to sign for and speak on behalf of the applicant.

AO First Name

AO Middle Initial

AO Last Name

AO Suffix (If applicable)

AO Title

AO Primary Phone Number

AO Secondary Phone Number

AO Email Address

AO Mailing Address (Street or PO Box)

AO City, State, and Zip Code

4. Designated Project Representative (DPR) The applicant or an employee who will serve as the point of contact for this application.

Is the DPR the same person as the AO?

(If yes, select Yes and continue to Section 3.

If no, select No and enter DPR information.)

DPR First Name

DPR Middle Initial

DPR Last Name

DPR Suffix (If applicable)

DPR Title

DPR Primary Phone Number

DPR Secondary Phone Number

DPR Email Address

DPR Mailing Address (Street or PO Box)

DPR City, State, and Zip Code

TCEQ-21000-a (Rev. July 2024) Page 3 of 21 https://www.irs.gov/pub/irs-pdf/fw9.pdf

Section 3: Third-Party Preparer Signature Page

1. Third-Party Preparer A third-party preparer is someone other than the applicant or an employee of the applicant. If a third-party preparer was not used in the preparation of this application, select “No” from the drop-down list and proceed to Section 4.

Was this application prepared by a third-party?

2. Third-Party Preparer Certification I hereby certify to the best of my knowledge and belief that all information provided in this application, including any attachments, is true and correct, as represented to me by the applicant. I understand that failure to sign the application will make this application ineligible. I understand that making a false statement may cause the submitted application to be ineligible, may make any resulting contracts voidable, and may subject me to criminal and civil penalties.

Third-Party Preparer Printed Name (First Last)

Title

Company Name

Mailing Address (Street or PO Box)

City

State

Zip Code

Primary Phone Number

Secondary Phone Number

Email Address

Third-Party Preparer Signature*

Third-Party Signature Date

*If using an electronic signature instead of a typed signature, please complete the entire application before signing electronically. The ability to edit, add, or remove information will not be available after the application is electronically signed.

TCEQ-21000-a (Rev. July 2024) Page 4 of 21

Section 4: Certification of Eligibility to Receive a State-Funded Grant All applicants must complete this section to certify eligibility to receive a grant under this program, even if child support obligations do not apply to the applicant. Failure to complete this section may result in rejection of the application.

Certification Regarding Child Support Obligations Under Texas Family Code, Section 231.006, a child support obligor who is more than 30 days delinquent in paying child support and a business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25%, is not eligible to receive a state-funded grant or loan. All applicants must include in the application the name and social security number of the individual or sole proprietor and each partner, shareholder, or owner with an ownership interest of 25% or more of the business entity submitting the application.

Federal Privacy Act Notice: This notice is given pursuant to the Federal Privacy Act. Disclosure of your Social Security Number (SSN) is required under Texas Family Code, Section 231.006(c) and Section 231.302(c)(3). The SSN will be used to identify persons who may owe child support. The SSN will be kept confidential to the fullest extent allowed under Texas Family Code, Section 231.302(e).

Please Check One of the Following Applicant Options.

1. Individual or Sole Proprietor

2. One or more individuals own 25% or more of the business entity

3. No individual owns 25% or more of the business entity

4. Governmental Entity

If Option 1 or 2 is checked above, list the applicable name(s) and social security number(s) below.

Name Social Security Number

Name Social Security Number

Name Social Security Number

Name Social Security Number

Applicant Certification By signing this application in Section 10, under Texas Family Code, Section 231.006, the applicant certifies that the individual or business entity named in this application is not ineligible to receive the specified grant and acknowledges that any contract may be terminated, and any payments may be withheld if this certification is inaccurate.

TCEQ-21000-a (Rev. July 2024) Page 5 of 21 https://statutes.capitol.texas.gov/Docs/FA/htm/FA.231.htm#231.006 https://www.justice.gov/opcl/privacy-act-1974 https://statutes.capitol.texas.gov/Docs/FA/htm/FA.231.htm#231.006 https://statutes.capitol.texas.gov/Docs/FA/htm/FA.231.htm#231.302 https://statutes.capitol.texas.gov/Docs/FA/htm/FA.231.htm#231.302 https://statutes.capitol.texas.gov/Docs/FA/htm/FA.231.htm#231.006

Section 5: Program Certifications This section includes specific requirements and statements for funding under the TxVEMP Grants Program. These terms apply to any contract awarded by TCEQ from this application. The TxVEMP Grants Program RFGA and draft contract, located on the TxVEMP webpage, contain additional terms and conditions that the applicant should review before submitting an application.

By signing this application, you understand and certify compliance with all the statements below, as well as with any state statutes, regulations, policies, guidelines, and requirements as they relate to the application, acceptance, and use of funds for this project. A waiver may be requested for the ownership and use requirements under Appendix C in the RFGA.

If any of these certifications change after submittal of the application, you will provide prompt notification to TCEQ within three business days of becoming aware of the change. Failure to notify TCEQ and/or any changes to your certifications may make the application ineligible and may make any resulting contracts voidable.

Equipment and Activity Certifications

1. Ownership. The equipment the applicant proposes to repower has been continuously owned by the applicant for the two years immediately preceding the application signature date.

2. Operation and Registration. The equipment has been continuously located and used in Texas for the two years immediately preceding the application signature date. In addition, the equipment has been registered for operation in Texas.

3. Condition. The equipment is in good operating condition and capable of performing its primary function in the routine operations of the applicant at the time of application signature. To the best of the applicant’s knowledge, the equipment is capable of continuing to perform its primary function for at least five years from the application signature date, taking into account normal maintenance, repairs, and upkeep.

4. Continued Operation and Use. If the grant funds were not available, the applicant expects to otherwise continue to operate the equipment in Texas for at least five years from the application signature date, and the applicant otherwise would not have planned to replace the equipment.

5. Disposition. The applicant has the legal authority to complete the approved method of disposition of the equipment or engine being replaced. If selected for a grant, the grantee is responsible for completing the disposition of the old equipment and engines being replaced before the reimbursement payment will be issued by TCEQ.

6. Not Otherwise Required. To the best of the applicant’s knowledge, the proposed activities are not required by any state or federal law, rule or regulation, memorandum of agreement, or other legally binding contract.

7. No Emissions Reductions Credits. Activities funded under this program are not eligible to generate marketable credits under state or federal emissions reduction credit averaging, banking, or trading programs.

If the project is funded, the applicant waives, for all time, its right to claim or apply for any emissions reduction credits from the use of the equipment or low-emission technology funded under the TxVEMP Grants Program.

8. Not to Exceed 100% of Equipment Cost. The amount of the TxVEMP grant award plus any other public financial assistance, tax credits or deductions, or other grants may not exceed the total eligible costs of the equipment.

9. Duty to Use, Maintain, and Repair Equipment. If awarded a grant, the applicant agrees to replace or repower the old equipment and purchase new equipment as described in this application. The applicant agrees to use any grant-funded equipment as described in this application. The applicant will maintain and repair any grant-funded equipment to ensure it remains in good operating condition during the Activity Life.

10. Requirement to Monitor. The applicant will monitor and log the use of the grant-funded equipment over the designated Activity Life. The applicant agrees to provide all required information on the use of the equipment upon request of TCEQ.

11. Insurance Coverage. The applicant will maintain, for the term of the Activity Life, property loss insurance in an amount equal or greater than the grant award and any other types of insurance required under a TxVEMP contract, or self-insurance coverage (for government entities) on any equipment acquired, leased, repowered, or constructed using these funds.

TCEQ-21000-a (Rev. July 2024) Page 6 of 21 https://www.tceq.texas.gov/agency/trust/

Section 5: Program Certifications Continued

Administrative and State Contracting Certifications

12. Legal Authority. The applicant has legal authority in the State of Texas to apply for the grant. The applicant's governing body has authorized the filing of the application, understands these requirements and certifications, and has authorized the individual identified as the Authorized Official to act in connection with the application and to provide such additional information as may be required.

13. Conflict of Interest. The applicant has not given, offered to give, nor intends to give any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted application. All purchase decisions must be based on sound business decisions and arm’s length bargaining.

14. Nondiscrimination. The applicant will comply with all state and federal statutes relating to nondiscrimination. If the applicant is an employer under the Texas Labor Code, it must not discriminate on the basis of race, color, disability, religion, sex, national origin, age, or genetic information in its employment decisions.

15. Risk Review. The applicant’s prior performance under other TCEQ contracts; its overall compliance history;

and any federal, state, or local enforcement action for violation of environmental laws or permit conditions may be considered in determining eligibility. If the application is prepared by an individual who has previously submitted inaccurate or fraudulent information to the agency, the application will be considered “high risk” and reduce the likelihood of an award.

16. Texas Public Information Act. Information, documentation, and other material in connection with this solicitation or any resulting contract or grant may be subject to public disclosure pursuant to Texas Government Code, Chapter 552. In accordance with Texas Government Code, Section 2252.907, the applicant is required to make any information created or exchanged with the State pursuant to the contract and grant, and not otherwise excepted from disclosure under the Texas Public Information Act, available in a format that is accessible by the public at no additional charge to the State.

17. Debt to the State. The applicant is not indebted to the State nor has an outstanding tax delinquency. The applicant must comply with all state and federal tax laws and fee requirements and is solely responsible for filing all state and federal tax and fee forms.

18. Contract. The applicant understands that a PDF of the draft contract may be viewed and downloaded from the TxVEMP webpage. The draft contract is for reference only and contains terms and conditions which are standard provisions for grants awarded under this program. Any requested changes to the draft contract must be received by TCEQ no later than the date of the submission of this application. However, the applicant further understands that TCEQ will not normally change the contract language in response to individual requests from grant recipients and is under no obligation to do so. TCEQ reserves the right to modify the draft contract terms as necessary due to statutory, rule, or policy changes. Modifications will be posted to the TxVEMP webpage and the Electronic State Business Daily.

a. Emission Reductions. If awarded a grant, the applicant certifies that it will provide written notification to TCEQ within 30 calendar days of any termination of use, change in use, sale, transfer, or accidental or intentional destruction of grant-funded equipment during the activity life. The applicant further agrees that TCEQ may be entitled to the return of all or a prorated share of the grant funds for any loss of emissions reductions compared with the emissions reductions projected in awarding the grant.

b. Texas Grant Management Standards. In accordance with Texas Government Code, Chapter 783, if the applicant is a local government, federal or state entity, or political subdivision, it will comply fully with the Texas Grant Management Standards (TxGMS). This includes compliance with relevant sections of TxGMS when procuring goods and services under a resulting contract. For all other applicants, the selected items of cost of TxGMS apply to any resulting contract.

c. Procurement of Goods and Services. If this application results in a contract, all procurement transactions made with (or to be reimbursed by) grant funds must be conducted in a manner providing full and open competition. All purchase decisions must be based on sound business decisions and arm’s length bargaining, and purchases must be made without any real or apparent personal or organizational conflicts of interest as described in TxGMS.

d. Grant Administration. The applicant will maintain an appropriate grant administration system to ensure that all terms, conditions, and specifications of the grant, including these certifications, are met.

TCEQ-21000-a (Rev. July 2024) Page 7 of 21 https://statutes.capitol.texas.gov/Docs/GV/htm/GV.552.htm https://statutes.capitol.texas.gov/Docs/GV/htm/GV.552.htm https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2252.htm#2252.907 https://www.tceq.texas.gov/agency/trust/all-electric https://statutes.capitol.texas.gov/Docs/GV/htm/GV.783.htm https://comptroller.texas.gov/purchasing/docs/grant-management-reader.pdf

Section 5: Program Certifications Continued

Administrative and State Contracting Certifications Continued

e. Audit. Acceptance of funds under this program acts as acceptance of the authority of TCEQ, the State

Auditor’s Office (SAO), or any successor agency, to conduct an audit or investigation in connection with those funds. The applicant or other entity that may receive funds directly or indirectly from TCEQ must provide the SAO with access to any information the SAO considers relevant to the investigation or audit.

The applicant will include this clause concerning the authority to audit funds received indirectly and the requirement to cooperate in any subcontract it awards.

19. Contracting with an Executive of a State Agency. Under Texas Government Code, Section 669.003, relating to contracting with an executive head of a state agency, the applicant represents that no person who, in the past four years, served as an executive of TCEQ or any other state agency, was involved with or has any interest in this application. If the applicant employs or has used the services of a former executive head of TCEQ or other state agency, then the applicant shall provide the following information: name of former executive, name of state agency, date of separation from state agency, position with applicant, and date of employment with applicant.

20. Debarment and Excluded Parties. The applicant certifies that the applying entity and its principals are eligible to participate in this transaction and have not been subjected to suspension, debarment, or similar ineligibility determined by any federal, state, or local governmental entity. The applicant also certifies that it and its principals are not listed in the State of Texas Debarred Vendor List maintained by the Texas Comptroller of Public Accounts, or the System for Award Management (SAM.gov) maintained by the General Services Administration as authorized by Executive Order No. 13224, “Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism,” published by the U.S.

Department of Treasury, Office of Foreign Assets Control.

21. Abortion Funding Limitation. The applicant represents and warrants it is not an abortion provider or an affiliate of an abortion provider under Texas Government Code, Chapter 2273, Prohibited Transactions.

22. COVID-19 Vaccine Passport Prohibition. Under Texas Health and Safety Code, Section 161.0085, the applicant certifies that it is not ineligible to receive funds.

23. Disclosure Protections for Certain Charitable Organizations. If the applicant is a governmental entity, it represents and warrants that it will comply with Texas Government Code, Section 2252.906 relating to disclosure protections for certain charitable organizations, charitable trusts, and private foundations.

24. Public Camping Ban. If the applicant is a local entity, it certifies and affirms that it has not received a final judicial determination finding it intentionally adopted or enforced a policy that prohibited or discouraged the enforcement of a public camping ban in an action brought by the Attorney General under Local Government Code Section 364.003. If the applicant is currently being sued under this provision, it must disclose the lawsuit and its current posture to TCEQ.

TCEQ-21000-a (Rev. July 2024) Page 8 of 21 https://statutes.capitol.texas.gov/Docs/GV/htm/GV.669.htm#669.003 https://comptroller.texas.gov/purchasing/programs/vendor-performance-tracking/debarred-vendors.php https://sam.gov/ https://www.govinfo.gov/content/pkg/FR-2001-09-25/pdf/01-24205.pdf https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2273.htm https://statutes.capitol.texas.gov/Docs/HS/htm/HS.161.htm#161.0085 https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2252.htm#2252.906 https://statutes.capitol.texas.gov/Docs/LG/htm/LG.364.htm#364.003 https://statutes.capitol.texas.gov/Docs/LG/htm/LG.364.htm#364.003

Section 5: P rogram Certifications Continued

Marine Project Certifications For the repower of a marine vessel, the following certifications apply. By signing this application, you are certifying the applicable eligibility requirements listed herein.

Repower of a Marine Vessel:

a. The applicant must currently and have continuously owned the marine vessel for a minimum of two years immediately preceding the application signature date. Ownership by an affiliate or subsidiary of the applicant does not meet these requirements. The applicant will provide proof of ownership, which may include a copy of the bill of sale, maintenance records, or in some cases a title.

b. The marine vessel must currently be used in its primary function in the routine operations of the applicant and have been used in its primary function in the routine operations of the applicant in Texas for the two years immediately preceding the application signature date.

c. The marine vessel must be in operating condition with at least five years of useful life remaining.

d. Where required under Texas boating regulations, the vessel must currently be registered in the applicant’s name for operation in Texas. Any United States Coast Guard documentation of the vessel must also be in the applicant’s name.

A waiver may be requested for the ownership and use requirements pursuant to Appendix C in the RFGA.

TCEQ-21000-a (Rev. July 2024) Page 9 of 21

Section 6: Ferry and Tug Marine Vessel Information Activity Number ___ An activity represents the individual repower of a single propulsion or auxiliary engine.

Click here for additional pages ___ Applicants may include up to 10 activities on a single application.

Eligible ferries and/or tugs include unregulated, Tier 1, or Tier 2 marine engines. Applicants may not include activities for more than one vessel in a single application.

Refer to Sections 9.0 and 10.0 of the RFGA for more information on eligible costs and determining grant amounts.

1. Old Vessel and Engine Information

Vessel Type

Vessel Name & USCG Registration Number List the vessel name and number as found on the US Coast Guard records

Vessel Make

Vessel Model

Vessel Model Year

Engine Make

Engine Model

Engine Identification Number

Engine Model Year

Engine Horsepower Rating (bhp/hr)

Fuel Type Select the fuel type of the old equipment from the drop-down list

Engine Family Code 12-digit emissions code required for engines 2003 and newer

Federal NOX Emissions Standard (g/bhp-hr)

2. New Equipment to be Purchased with Grant Funds for Repower Engine Manufacture Year

Must be no more than 1 year older than the calendar year purchased Engine Horsepower Rating

(bhp/hr) Fuel Type

Choose the new equipment fuel type from the drop-down list Federal NOX Emissions

(g/bhp-hr)

3. Annual Usage Usage Type Standard or Non-Standard (only one usage type per application)

Activity Annual Usage Rate

Usage Unit Select from drop-down list

4. Requested Grant Amount

Requested Grant Amount

Cost Per Ton of NOX Reduced Use the grant estimator to determine CPT

TCEQ-21000-a (Rev. July 2024) Page 10 of 21

Section 6.1: Ferry and Tug Marine Propulsion and Auxiliary Engines

Activities 01-05 The activities below represent individual repower of a single propulsion or auxiliary engine. Applicants may not include activities for more than one vessel in a single application. Fill in a column for each additional propulsion or auxiliary engine being repowered. If you have more than 5 activities, provide the engine information for activities 06–10 starting on page 12 of this application.

Color photographs of the right and left side of each engine, including a close-up of the engine data plate, must be provided with the application. Each photograph must be labeled with the associated activity number.

1. Marine Engines Being Repowered Complete the following fields for each marine engine being repowered. Refer to Sections 5.1 and 5.2 of the RFGA for additional project criteria.

Activity 01 02 03 04 05

Total number of cylinders

Total displacement of the engine in liters (L)

Total engine horsepower

Engine displacement per cylinder in liters/cylinder

(L/Cyl) Engine power density in horsepower/liter (hp/L)

Tier 1 or Tier 2 engines – maximum revolutions per minute of engine (RPM) Engine Category*

(Cat 1, Cat 2, Cat 3, Auxiliary)

*Engine category may be determined by referencing Table 1 – Engine Displacement Categories from the Marine Technical Supplement.

2. Additional Engine or Project Information Use the space below to provide any additional information if needed.

TCEQ-21000-a (Rev. July 2024) Page 11 of 21

Section 6.1: Ferry and Tug Marine Propulsion and Auxiliary Engines Continued

Activities 06-10

1. Marine Engines Being Repowered Complete the following fields for each marine engine being repowered. Refer to Sections 5.1 and 5.2 of the RFGA for additional project criteria.

Activity 06 07 08 09 10

Total number of cylinders

Total displacement of the engine in liters (L)

Total engine horsepower

Engine displacement per cylinder in liters/cylinder

(L/Cyl) Engine power density in horsepower/liter (hp/L)

Tier 1 or Tier 2 engines – maximum revolutions per minute of engine (RPM) Engine Category*

(Cat 1, Cat 2, Cat 3, Auxiliary)

*Engine category may be determined by referencing Table 1 – Engine Displacement Categories from the Marine Technical Supplement.

2. Additional Engine or Project Information Use the space below to provide any additional information if needed.

TCEQ-21000-a (Rev. July 2024) Page 12 of 21

Section 7: Charging Infrastructure (Optional)

Charging Infrastructure Project Certifications Skip to Section 8 if not applicable.

This Section must be completed only by applicants requesting grant funds for on-site electric charging infrastructure.

Site Ownership

Is the Applicant the Property Owner?

Applicants are required to be the owner of the site where the charging infrastructure equipment will be installed unless the applicant establishes permission to install, operate, and maintain the grant-funded charging infrastructure equipment at the site during the Activity Life.

The information below must be completed by the property owner if the applicant does not own the site where the equipment will be installed.

Property Owner Name

Authorized Representative (AR) of Property Owner

AR Title

AR Phone Number

AR Email Address

AR Mailing Address (Street or PO Box)

AR City, State, and Zip Code

I, the undersigned owner or authorized representative of the real property located at the address identified in the Infrastructure Project Location field below, consent to the installation of the charging infrastructure on this property. I understand and agree that the applicant is obligated, unless otherwise approved by TCEQ, to keep the charging infrastructure in operation and in service for the duration of the Activity Life.

Property Owner or Authorized Representative Signature*

Date

*If using an electronic signature instead of a typed signature, please complete the entire application before signing electronically. The ability to edit, add, or remove information will not be available after the application is electronically signed.

Infrastructure Equipment Ownership

By signing this application, the applicant certifies that it will purchase and own the grant-funded equipment during the contract period and throughout the Activity Life subject to the following:

• Any sale of the grant-funded equipment during the Activity Life will be subject to approval and consent to assignment by TCEQ in accordance with the contract terms.

• An entity that purchases the equipment and leases it to another entity may establish eligibility provided that the applicant maintains ownership of the grant-funded equipment during the Activity Life.

TCEQ-21000-a (Rev. July 2024) Page 13 of 21

Section 7: Charging Infrastructure (Optional) Continued

Charging Infrastructure Equipment Information This section must be completed by applicants who are requesting grant funds to purchase and install charging infrastructure for qualifying alternatively fueled equipment detailed in Section 6 of this application. At least one qualifying piece of equipment must operate on the fuel type selected in Part 1 of this Section. All grant-funded charging infrastructure must be owned and operated by the applicant. Leased equipment is not eligible.

1. Fuel Type and Information Select the fuel type from the drop-down box below:

Fuel Type Electricity

Please provide the charge rate (kW) of the charging infrastructure.

Charge Rate (kW)

Please list the number of dispensing units and the number of connectors.

Number of dispensing units

Number of connectors or charging nozzles

2. Infrastructure Project Location Please list the location of the proposed charging infrastructure project.

Physical Address

City

State

Zip Code

County

3. Infrastructure Project Details Please briefly describe the proposed charging infrastructure project below. Be sure to describe how this charging infrastructure will support, at the very least, the qualifying equipment detailed in this application. If this project will expand existing charging infrastructure, please indicate this as well.

TCEQ-21000-a (Rev. July 2024) Page 14 of 21

Section 7: Charging Infrastructure (Optional) Continued

4. Required Documentation Applicants with projects that include charging infrastructure must provide documentation that includes:

a. a site plan with the application (including a scaled map which could be a photograph, satellite map, drawing, or similar graphic of the proposed site) that shows the planning and design of the proposed facility. The site plan must:

i. demonstrate how the equipment may access the proposed facility; and

ii. provide the location of the facility within the property and include any easements, set-back requirements, and property boundaries.

b. a demonstration of the applicant’s ability to install, operate and maintain the charging infrastructure at the proposed site by providing documentation, such as property ownership records, lease agreements or other legal agreements, that can show the following:

i. the ability to complete any required construction on the proposed site; and

ii. the ability to operate on the proposed property for the duration of the contract if awarded a grant.

5. Infrastructure Grant Amount Please indicate the projected costs and requested grant amount in the space provided below. Governmental entities may receive up to 100% of the incremental cost of the charging infrastructure associated with this project. Non-governmental entities will be reimbursed up to 75% of the eligible cost of the charging infrastructure.

Equipment Total

Supplies and Materials Total

Construction Total

Contract Services Total

Total Eligible Project Costs

Charging Infrastructure Grant Amount

TCEQ-21000-a (Rev. July 2024) Page 15 of 21

Section 8: New Equipment Usage Area

Activities 01-05

Check here if percent annual usage is the same for all activities and enter under Activity 01.

At least 51% of the grant-funded equipment’s annual operation must occur in one of the priority areas or within the coastal county lines of eligible counties for the duration of the Activity Life.

In the table below, identify the areas where the TxVEMP grant-funded equipment will operate, and provide the percent of annual operation for Activities 01–05 in the space provided. For applications with more than 5 activities, please also fill out page 17. Applicants may elect to increase their total annual commitment up to a maximum of 95%. Refer to Section 5.5 of the RFGA for usage requirements. A map of the priority areas and counties can be found in Appendix B of the RFGA.

Activity

Priority Areas 01 02 03 04 05

% of Annual Usage in Austin Area Bastrop, Caldwell, Hays, Travis, and Williamson Counties

% of Annual Usage in Beaumont-Port Arthur Area Hardin, Jefferson, and Orange Counties

% of Annual Usage in Dallas-Fort Worth Area Collin, Dallas, Denton, Ellis, Hood, Johnson, Kaufman, Parker, Rockwall, Tarrant, and Wise Counties % of Annual Usage in El Paso Area

El Paso County* % of Annual Usage in Houston-Galveston-Brazoria Area

Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller Counties

% of Annual Usage in San Antonio Area Bexar, Comal, Guadalupe, and Wilson Counties % of Annual Usage in Other Counties

Bell County Total Annual Usage

The total % of annual operation must be at least 51%, but not more than 95%. Enter the combined percentage of the eligible areas for each activity.

*These counties use a different formulation of diesel fuel that we will consider in our NOX reduction calculations.

Refer to the applicable technical supplement for more information.

Project Activity Life

Activity Life 5 years

TCEQ-21000-a (Rev. July 2024) Page 16 of 21

Section 8: New Equipment Usage Area Continued

Activities 06-10 At least 51% of the grant-funded equipment’s annual operation must occur in one of the priority areas for the duration of the activity life.

In the table below, identify the areas where the TxVEMP grant-funded equipment will operate, and provide the percent of annual operation in the space provided. Applicants may elect to increase their total annual commitment up to a maximum of 95%. Refer to Section 5.5 of the RFGA for usage requirements. A map of the eligible areas and counties can be found in Appendix B of the RFGA.

Activity

Priority Areas 06 07 08 09 10

% of Annual Usage in Austin Area Bastrop, Caldwell, Hays, Travis, and Williamson Counties

% of Annual Usage in Beaumont-Port Arthur Area Hardin, Jefferson, and Orange Counties

% of Annual Usage in Dallas-Fort Worth Area Collin, Dallas, Denton, Ellis, Hood, Johnson, Kaufman, Parker, Rockwall, Tarrant, and Wise Counties % of Annual Usage in El Paso Area

El Paso County* % of Annual Usage in Houston-Galveston-Brazoria Area

Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller Counties

% of Annual Usage in San Antonio Area Bexar, Comal, Guadalupe, and Wilson Counties % of Annual Usage in Other Counties

Bell County Total Annual Usage

The total % of annual operation must be at least 51%, but not more than 95%. Enter the combined percentage of the eligible areas for each activity.

*These counties use a different formulation of diesel fuel that we will consider in our NOX reduction calculations.

Refer to the applicable technical supplement for more information.

TCEQ-21000-a (Rev. July 2024) Page 17 of 21

Section 9: Disposition of Old Equipment Being Replaced Disposition requires that the old equipment and engine be destroyed and rendered permanently inoperable and non-repairable. Unless otherwise approved by TCEQ, a grant applicant must agree to dispose of the equipment repowered under this program by Standard Disposition. Anything other than standard disposition must be pre-approved by TCEQ and included in the contract as a Special Condition.

If selected for a TxVEMP grant, the grant recipient is responsible for completing the disposition and providing disposition verification to TCEQ before the reimbursement payment will be issued by TCEQ.

1. Method of Disposition Mark the proposed method of disposition below.

Standard Disposition: Complete destruction or otherwise rendering permanently inoperable by crushing the engine or by making a 3-inch or larger hole in the engine block. If you are proposing to use the Standard Method of Disposition, continue to Section 10.

Alternative Disposition: TCEQ will consider alternative methods of rendering the equipment permanently inoperable in lieu of the standard method of disposition. If you are proposing to use an Alternative Method of Disposition, continue to Item 2 below.

2. Alternative Disposition If the applicant is proposing an Alternative Method of Disposition in lieu of the standard method of disposition, provide a detailed explanation in the space provided below. See Section 11.11 of the RFGA for additional information regarding prior approval by TCEQ.

TCEQ-21000-a (Rev. July 2024) Page 18 of 21

Section 10: P roject Summary Page

1. Applicant Information

Applicant/Entity Legal Name (Must match Section 2)

Applicant Type

Applicant Mailing Address (Street or PO Box)

Applicant City, State, and Zip Code

2. Project Information

Primary Project Area

Emission Source Marine

Project Type Repower

Total Number of Activities in this Application (This number must match the number from Section 6)

Total Requested Grant Amount (Total requested grant amount of all activities and infrastructure)

3. Authorized Official The applicant or an officer or employee of the applicant who has the legal authority to sign on behalf of the applicant.

I hereby certify to the best of my knowledge and belief that all information provided in this application and any attachments is true and correct, including any representations made by a third-party preparer. My signature also constitutes acceptance of all certifications in this application, the terms of the RFGA, and any other changes posted through addenda on the Electronic State Business Daily. I understand that failure to sign the application will make it ineligible. I understand that any false statement may cause the submitted application to be ineligible, may make any resulting contracts voidable, and may subject me to criminal or civil penalties.

Printed Name of Authorized Official

Authorized Official Title

Signature of Authorized Official*

Date of Signature

*If using an electronic signature instead of a typed signature, please complete the entire application before signing electronically. The ability to add, edit, or remove information will not be available after the application is electronically signed.

The application, signed by the Authorized Official, must be received by the application deadline or the application will not be accepted.

Upon submission, all proposals become the property of the State of Texas and as such become subject to the Texas Public Information Act, Texas Government Code, Chapter 552.

Personal Information Policy: Individuals are entitled to request and review their personal information that the agency gathers on its forms. Individuals may request to have their provided personal information updated. To review such information, contact TxVEMP program staff at VWSettle@tceq.texas.gov or 833-215-TXVW (8989).

TCEQ-21000-a (Rev. July 2024) Page 19 of 21 https://statutes.capitol.texas.gov/Docs/GV/htm/GV.552.htm mailto:VWSettle@tceq.texas.gov

Section 11: Application Checklist All applications for funding must be submitted within the application submission period listed on the cover page of the RFGA. A complete application must include:

• all pages of the application • all required signatures

• all required attachments • any additional supporting documentation

• applicant’s contact information

Application Section Checklist All sections of the application must be completed entirely.

Mark each box below to certify that you have fully completed the indicated section and that you have signed all sections requiring a signature.

Section 1: Ferry and Tug Marine Project Criteria and Description

Section 2: Applicant Information

Section 3: Third-Party Preparer Signature Page Signature Required only if prepared by third-party.

Section 4: Certification of Eligibility to Receive a State-Funded Grant

Section 5: Program Certifications Read and include with the application.

Section 6: Ferry and Tug Marine Vessel Equipment Information

Section 6.1: Ferry and Tug Marine Propulsion and Auxiliary Engines

Section 7: Charging Infrastructure (Optional) Signature Required only if requesting infrastructure and not the property owner.

Section 8: New Equipment Usage Area

Section 9: Disposition of Old Equipment Being Replaced

Section 10: Project Summary Page Signature Required.

Section 11: Application Checklist Read and include with application.

Required Attachments Checklist

IRS Form W-9 Download, fill out entirely, and include with the application. Signature Required.

Copy of State or Federal Identification Card Include only if applying as an Individual or Sole Proprietor.

Color Photographs of Marine Vessel and Engines Being Replaced Attach color photographs of the front, right side, left side, and rear of vessel; left and right side of engine, including a close-up photo of the engine data plate. Label each photo with the associated activity number.

United States Coast Guard “Certificate of Documentation”

Ownership Documentation May include a copy of the bill of sale, maintenance records, or in some cases a title.

TCEQ-21000-a (Rev. July 2024) Page 20 of 21 https://www.irs.gov/pub/irs-pdf/fw9.pdf

Section 11: Application Checklist Continued

Required Charging Infrastructure Attachments Checklist (Applications with Charging Infrastructure)

Site Plan Include with the application.

Site Property Rights or Ownership Documentation Include with the application.

Supplemental Forms (if applicable)

Supplemental Form 1: Waiver Request Include with the application. Signature Required.

Supplemental Form 2: Non-Standard Usage

TCEQ-21000-a (Rev. July 2024) Page 21 of 21