ESBD_376987_1726675119224_582-25~4.PDF

Project Application Form Texas Natural Gas Vehicle Grant Program (TNGVGP)

Texas Commission on Environmental Quality (T CEQ) Texas Emissions Reduction Plan (TERP)

Solicitation No. 582-25-70000-NV

If you have questions on how to fill out this project application, please contact us at 512-239- 4950 or TERP@tceq.texas.gov.

Esta es la aplicación para el Programa de Subvenciones de Gas Natural para Vehículos de Texas (TNGVGP por sus siglas en Inglés). Debe llenar y enviar esta aplicación para solicitar una subvención. Comuníquese al 800-919-TERP (8377) para obtener ayuda con esta aplicación.

TCEQ invites individuals and entities that have on-road heavy-duty or medium-duty vehicles powered by diesel or gasoline to complete this TNGVGP application to repower their vehicles with natural gas engines or replace their vehicles with natural gas vehicles.

Multiple Activities and Project Areas

Applicants may include up to 10 vehicles on a single application. Multiple activities included on a single application must be operated in the same primary area and be classified as the same project type (replacement or repower). Applicants may submit more than one application during this grant round.

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 submitting the application and associated documents by mail. All applications must be received by TCEQ no later than 5:00 p.m. Central Time (CT), on the application submission deadline listed in the table below. Use TCEQ’s FTPS server to submit your application securely (FTPS: A Step-by-Step Video Guide).

Please see Section 12 of this application for application submission instructions.

Important Dates Date

Program Opening Date September 18, 2024

Application Submission Deadline March 4, 2025

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. Please review the FY25 TNGVGP Request for Grant Applications (RFGA) located on the TNGVGP webpage for eligibility and other requirements.

TCEQ-20625 (Revised September 2024) Page 1 of 21 mailto:TERP@tceq.texas.gov https://ftps.tceq.texas.gov/ https://ftps.tceq.texas.gov/ https://www.youtube.com/watch?v=GW4eEe_uUwc https://www.tceq.texas.gov/airquality/terp/tngvgp.html

Section 1: Applicant Information

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

Applicant Legal Name (Must Match W-9 Form):

2. Business Information Entities required to register with the Secretary of State must have an active registration by September 18, 2024, 5:00 p.m. CT and 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 of the applicant who has the legal authority to sign for and speak on behalf of the entity.

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, Zip Code:

4. Designated Project Representative (DPR) The applicant or an employee of the applicant 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 2.

If no, 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, Zip Code:

TCEQ-20625 (Revised September 2024) Page 2 of 21 https://www.irs.gov/pub/irs-pdf/fw9.pdf

Section 2: Third-Party Preparer Signature Page

1. Third-Party Preparer (TPP) A third-party preparer is someone other than the applicant or an employee of the applicant who assisted in preparing this application.

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 and 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 make the submitted application ineligible, may make any resulting contracts voidable, and may subject me to criminal and civil penalties. I also understand that if I have previously submitted inaccurate or fraudulent information to the agency, it will result in this application being considered “high risk,” and reduce the likelihood of an award.

TPP Printed Name (First and Last):

TPP Title:

TPP Company Name:

TPP Mailing Address (Street or PO Box):

TPP City, State, Zip Code:

TPP Primary Phone Number:

TPP Secondary Phone Number:

TPP Email Address:

TPP Signature*:

TPP Signature Date:

* If using an electronic 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-20625 (Revised September 2024) Page 3 of 21

Section 3: Certification of Eligibility to Receive a State-Funded Grant All applicants must complete this section of the form to certify their eligibility to receive a grant under this program, even if child support obligations do not apply to the applicant. Failure to submit this form may result in the rejection of this 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)(2). SSNs will be used to identify persons that may owe child support. The SSNs 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 (Check only one).

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 name(s) and SSN(s) below.

Name Social Security Number

Name Social Security Number

Name Social Security Number

Name Social Security Number

By signing Section 10 of this application, 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 a grant and acknowledges that any contract may be terminated, and any payments withheld if this certification is inaccurate.

TCEQ-20625 (Revised September 2024) Page 4 of 21

Section 4: Certifications This section includes specific requirements and statements for funding under TNGVGP. These terms apply to any contract awarded by TCEQ from this application. The TNGVGP RFGA and the draft contract, located on the TNGVGP 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 that relate to the application, acceptance, and use of funds for this project.

If any of these certifications materially change after the submittal of the application, you must notify TCEQ in writing within three business days of becoming aware of the change. Failure to notify TCEQ of any changes to your certifications may make the application ineligible and may make any resulting contracts voidable.

1. Legal Authority. The applicant has the 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 person identified as the Authorized Official to act in connection with the application and to provide such additional information as may be required.

2. Emissions Reductions. If awarded a grant, the applicant certifies that they 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 vehicles 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.

3. Texas Grant Management Standards. In accordance with Texas Government Code, Chapter 783, if the applicant is a local government, state entity, or political subdivision, it will comply fully with the Texas Grant Management Standards (TxGMS). This includes compliance with the relevant sections of TxGMS when procuring goods and services under a resulting contract. For all other applicants, the Cost Principles and Selected Items of Cost under TxGMS apply to any resulting contract. These documents are available at: https://www.comptroller.texas.gov/purchasing/grant-management/.

4. 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.

5. 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.

6. 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.

7. Grant Administration. The applicant will maintain an appropriate grant administration system to ensure that they meet all terms, conditions, and specifications of the grant, including these certifications and assurances.

8. Audit. Acceptance of funds under this program acts as acceptance of the authority of the State Auditor’s Office, 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 state auditor with access to any information the state auditor considers relevant to the investigation or audit. Applicant will include this clause concerning the authority to audit funds received indirectly and the requirement to cooperate in any subcontract it awards.

9. 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.

10. Contract. The applicant understands that a PDF of the draft contract may be viewed and downloaded from the TNGVGP webpage. The draft contract is for reference only and contains terms and conditions

TCEQ-20625 (Revised September 2024) Page 5 of 21 https://www.tceq.texas.gov/airquality/terp/tngvgp.html https://www.comptroller.texas.gov/purchasing/grant-management/ 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 TNGVGP webpage and the Electronic State Business Daily.

11. 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 applicant employs or has used the services of a former executive head of TCEQ or other state agency, the applicant shall provide the following information: name of the former executive, name of the state agency they worked at, the date of their separation from the state agency, their position with the applicant, and the date of their employment with the applicant.

12. Debarment. 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 on the State of Texas Debarred Vendor List maintained by the Texas Comptroller of Public Accounts, or the System for Award Management (SAM) 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.

13. 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.

14. 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.

15. 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.

16. 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-20625 (Revised September 2024) Page 6 of 21 https://www.tceq.texas.gov/airquality/terp/tngvgp.html https://www.txsmartbuy.com/esbd https://comptroller.texas.gov/purchasing/programs/vendor-performance-tracking/debarred-vendors.php https://sam.gov/content/home https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2252.htm#2252.906

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

By signing this application, the applicant understands and certifies compliance with all the statements below, as well as with any state statutes, regulations, policies, guidelines, and requirements as they relate to this application, acceptance, and the use of funds for this project. If any of these certifications materially change after submittal of the application, you will provide prompt written notification to TCEQ within three business days of becoming aware of the change. Failure to notify TCEQ of any changes to your certifications may make this application ineligible and may make any resulting contracts voidable.

A waiver may be requested for the ownership and use requirements under Appendix B in the RFGA.

1. Ownership. Unless a waiver is granted by TCEQ on a finding of good cause, each vehicle being replaced or repowered must have been owned, leased, or otherwise commercially financed by the applicant in Texas for at least the two years immediately preceding the application signature date.

2. Registration & Operation. Unless a waiver is granted by TCEQ on a finding of good cause, each vehicle being replaced or repowered has been registered and operated in Texas for at least 75% (or for fleet vehicles, registered and operated in the Clean Transportation Zone at least 75%) of the vehicle’s total annual miles for the two years immediately preceding the application signature date.

3. Condition. Each vehicle being replaced or repowered is in good operating condition with at least two years of useful life remaining.

4. Destruction. If selected for a grant, the vehicle and engine being replaced must be destroyed and rendered permanently inoperable (referred to as disposition) for replacement and repower projects. The contract will specify requirements for the destruction of the vehicle and the engine, and for submitting disposition verification to TCEQ. Failure to comply with these requirements, including providing TCEQ with disposition verification within 90 days of the reimbursement payment being issued by TCEQ, may invoke the contract’s remedies, including termination of the contract and the return of grant funds.

5. Not Otherwise Required. The proposed activities are not required by any state or federal law, rule or regulation, memorandum of agreement, or other legally binding contract.

6. 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. In addition, emissions reductions achieved by a TNGVGP grant may not be combined with, or be assigned for use by, other incentive programs.

7. Qualifying Vehicles (Natural Gas Vehicles). Qualifying vehicles must be:

a) A new medium-duty or heavy-duty natural gas vehicle, not previously subject to a first sale or lease; or a used medium-duty or heavy-duty natural gas vehicle that is of model year 2017 or later, provided that the model year may not be more than six years older than the current model year at the time of the submission of the grant application.

b) Of the same weight classification and use as the vehicle being replaced.

c) A natural gas vehicle fueled by compressed natural gas (CNG), liquefied natural gas (LNG), or liquefied petroleum gas (LPG), or a combination of diesel fuel and natural gas that is capable of achieving at least 60% displacement of diesel fuel by natural gas. Vehicles capable of operating independently on either natural gas or another fuel will not be eligible under this program.

d) Certified to the current federal emissions standards applicable to that vehicle and/or engine or a lower Family Emission Limit (FEL).

e) Certified by the EPA to emit at least 25% less nitrogen oxides (NOX) than the vehicle and/or engine being replaced. Replacement vehicle/engine certified NOx emission standards can be found in the TNGVGP Grant Amount Tables.

8. Qualifying Engines and Conversion Systems (Natural Gas Repower Projects).

a) A replacement natural gas engine must be certified by the U.S. Environmental Protection Agency

(EPA) to the current federal emissions standards or a lower Family Emission Limit (FEL).

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b) A replacement natural gas engine must be certified by the EPA to emit at least 25% less NOX than the engine being replaced.

c) A natural gas conversion system must be certified or approved by the EPA for installation on the engine being converted.

d) A natural gas conversion system must be certified by the EPA to the current federal emissions standards or a lower FEL, or otherwise accepted by TCEQ as meeting the emissions criteria (see RFGA Section 2.3).

e) A natural gas conversion system must be certified by the EPA to a NOX emissions standard or FEL, or otherwise accepted by the TCEQ as meeting an emissions standard, that is at least 25% less than the emissions standard or FEL of the original engine.

f) The replacement or converted natural gas engine must receive not less than 60% of its power from CNG, LNG, or LPG. Vehicles capable of operating independently on either natural gas or another fuel will not be eligible under this program.

9. Other Financial Incentives. A qualifying vehicle is not eligible if it or the natural gas engine powering it:

a) has been awarded a grant under TNGVGP for a previous reporting period; or

b) has received a similar grant or tax credit in another jurisdiction if that grant or tax credit program is relied on for credit in the state implementation plan.

10. Activity Life Requirements. The activity life begins on the date TCEQ approves the disposition for an activity. An activity ends on the earlier of either the fourth anniversary of the date of disposition approval for the activity, or the date the vehicle reaches 400,000 miles after the date of disposition approval. For the duration of the activity life, a grantee must:

a) Own or lease to purchase, the grant-funded vehicles.

b) Register and operate the grant-funded vehicles in Texas (at least 75% of the vehicles’ total annual usage must occur in Clean Transportation Zone).

c) Maintain mileage and location records for the grant-funded vehicles.

d) Maintain the grant-funded vehicles in proper operating condition.

e) Obtain sufficient commercial insurance for each grant-funded vehicle to protect against loss, damage, or liability (proof of self-insurance will be sufficient for governmental entities).

f) 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 vehicles. Any sale of the grant-funded vehicle during the contract period will be subject to preapproval and consent to assignment by TCEQ in accordance with the contract terms.

11. Annual Usage Reporting. During the activity life, TCEQ will provide grantees with annual usage reports to complete and return via email by the specified deadlines. The usage reports are used to ensure compliance with the annual usage requirements identified in the contract’s Scope of Work. Failure to submit the required annual usage reports demonstrating the grantee achieved the required NOX reductions may result in termination of the contract and return of grant funds.

TCEQ-20625 (Revised September 2024) Page 8 of 21

Section 6.1: Old Vehicle Information Old Vehicle Activity Number 001 002 003 004 005

Vehicle Category:

Vehicle Type:

Last 4 Digits of the Vehicle ID:

(VIN)

Vehicle Make:

Vehicle Model:

Vehicle Model Year:

Gross Vehicle Weight Rating:

(GVWR)

Engine Make:

Engine Model:

Engine Identification Number:

Engine Model Year:

Fuel Type:

Engine Family Code:

(12-digit emissions code required for engines 2003 and newer) Federal NOX Emissions (g/mi or g/bhp-hr):

(Refer to Section 2.3 of the RFGA to determine the correct unit of measure) Emission Standard Category Bin for chassis-certified heavy-duty vehicles, and chassis-certified heavy-duty vehicles classified as medium-duty passenger vehicles:

(Refer to Section 2.3 of the RFGA to determine the correct Bin)

TCEQ-20625 (Revised September 2024) Page 9 of 21

6.2: New Vehicle Information New Vehicle Activity Number 001 002 003 004 005

Vehicle Type:

(The new vehicle type must be the same as the old vehicle type listed under the same activity number)

Vehicle Year:

Engine Year:

Fuel Type:

(CNG, LNG, LPG, CNG/Diesel, or LNG/Diesel) Federal NOX Emissions (g/mi or g/bhp-hr):

(Refer to Section 2.3 of the RFGA to determine the correct unit of measure)

Fueling Facilities: Please list the primary fueling facilities where the grant-funded vehicle will refuel.

Facility Name Physical Address City Zip Code

TCEQ-20625 (Revised September 2024) Page 10 of 21

Section 6.1 (cont.): Old Vehicle Information Old Vehicle Activity Number 006 007 008 009 010

Vehicle Category:

Vehicle Type:

Last 4 Digits of the Vehicle ID:

(VIN)

Vehicle Make:

Vehicle Model:

Vehicle Model Year:

Gross Vehicle Weight Rating:

(GVWR)

Engine Make:

Engine Model:

Engine Identification Number:

Engine Model Year:

Fuel Type:

Engine Family Code:

(12-digit emissions code required for engines 2003 and newer) Federal NOX Emissions (g/mi or g/bhp-hr):

(Refer to Section 2.3 of the RFGA to determine the correct unit of measure) Emission Standard Category Bin for chassis-certified heavy-duty vehicles, and chassis-certified heavy-duty vehicles classified as medium-duty passenger vehicles:

(Refer to Section 2.3 of the RFGA to determine the correct Bin)

TCEQ-20625 (Revised September 2024) Page 11 of 21

Section 6.2 (cont.): New Vehicle Information New Vehicle Activity Number 006 007 008 009 010

Vehicle Type:

(The new vehicle type must be the same as the old vehicle type listed under the same activity number)

Vehicle Year:

Engine Year:

Fuel Type:

(CNG, LNG, LPG, CNG/Diesel, or LNG/Diesel) Federal NOX Emissions (g/mi or g/bhp-hr):

(Refer to Section 2.3 of the RFGA to determine the correct unit of measure)

Fueling Facilities: Please list the primary fueling facilities where the grant-funded vehicle will refuel.

Facility Name Physical Address City Zip Code

TCEQ-20625 (Revised September 2024) Page 12 of 21

Section 7: Activity Cost and Grant Amount Are the activity cost calculations the same for all activities? ________ If the activity cost calculations are the same for all activities in this application, enter only under Activity 001.

Activity Cost Calculations Activity costs paid prior to the application submission period are not eligible.

Activity 001 002 003 004 005

(A) Total Eligible Costs of the Qualifying Vehicle, Engine, or Conversion System:

Invoice costs of the qualifying vehicle, engine, or conversion system, including taxes and government fees, delivery and shipping fees, factory and extended warranties, service contracts, mechanic and safety inspections, cooperative fees, and dealer processing fees not related to financing.

(Refer to Sections 3.2 and 3.3 of the RFGA.)

(B) Scrap Value:

($1,000 for replacement projects, $250 for repower projects).

(C) Other Financial Incentives and Tax Credits:

(D) Subtotal – Incremental Cost:

(D) = (A) - (B) - (C)

(E) Maximum Eligible Grant Amount:

An applicant may qualify for up to 90% of the incremental cost associated with the purchase of the grant-funded vehicle or the repower of the existing vehicle.

(E) = (D) × 0.9

(F) Maximum Grant Table Amount:

Enter the Grant Table Amount from the appropriate Maximum Grant Amount Table on the TNGVGP webpage.

(G) Requested Grant Amount:

Requested grant amount must be the lesser of:

the Maximum Eligible Grant Amount (E), or the Maximum Grant Table Amount (F).

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Section 7 (cont.): Activity Cost and Grant Amount Activity Cost Calculations Activity costs paid prior to the application submission period are not eligible.

Activity 006 007 008 009 010

(A) Total Eligible Costs of the Qualifying Vehicle, Engine, or Conversion System:

Invoice costs of the qualifying vehicle, engine, or conversion system, including taxes and government fees, delivery and shipping fees, factory and extended warranties, service contracts, mechanic and safety inspections, cooperative fees, and dealer processing fees not related to financing.

(Refer to Sections 3.2 and 3.3 of the RFGA.)

(B) Scrap Value:

($1,000 for replacement projects, $250 for repower projects).

(C) Other Financial Incentives and Tax Credits:

(D) Subtotal – Incremental Cost:

(D) = (A) - (B) - (C)

(E) Maximum Eligible Grant Amount:

An applicant may qualify for up to 90% of the incremental cost associated with the purchase of the grant-funded vehicle or the repower of the existing vehicle.

(E) = (D) × 0.9

(F) Maximum Grant Table Amount:

Enter the Grant Table Amount from the appropriate Maximum Grant Amount Table on the TNGVGP webpage.

(G) Requested Grant Amount:

Requested grant amount must be the lesser of:

the Maximum Eligible Grant Amount (E), or the Maximum Grant Table Amount (F).

TCEQ-20625 (Revised September 2024) Page 14 of 21 https://www.tceq.texas.gov/downloads/air-quality/terp/tngvgp/tngvgp-22-grant-amount-tables.pdf

Section 8: Percent Annual Usage Is the percent of annual usage the same for all activities? ____ If the percent of annual usage is the same for all activities in this application, enter only under Activity 001 In the table below, identify the counties where the grant-funded vehicle will operate and provide the percent of annual usage in the space provided. Each qualifying vehicle must be operated at least 75% of its total annual mileage in the eligible counties of the Clean Transportation Zone (CTZ).

Does the activity involve the transport of raw agricultural products? ____ Projects involving the transport of raw agricultural products may be exempt from the requirements that grant-funded vehicles operate at least 75% of annual mileage in the eligible counties of the CTZ. Refer to Appendix D of the RFGA.

Activity 001 002 003 004 005

Counties by Area in the CTZ Annual % Annual % Annual % Annual % Annual %

Austin Area:

Bastrop, Caldwell, Hays, Travis, and Williamson Counties Beaumont-Port Arthur Area:

Hardin, Jefferson, and Orange Counties Corpus Christi Area:

Nueces and San Patricio Counties Dallas-Fort Worth Area:

Collin, Dallas, Denton, Ellis, Henderson, Hood, Hunt, Johnson, Kaufman, Parker, Rockwall, Tarrant, and Wise Counties El Paso Area:

El Paso County Houston-Galveston-Brazoria Area:

Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller Counties San Antonio Area:

Bexar, Comal, Guadalupe, and Wilson Counties Tyler-Longview Area:

Gregg, Harrison, Rusk, Smith, and Upshur Counties Other Eligible Counties:

Anderson, Aransas, Atascosa, Austin, Bee, Bell, Brazos, Burleson, Calhoun, Colorado,DeWitt, Duval, Falls, Fayette, Freestone, Frio, Goliad, Gonzales, Grimes, Hill, Howard, Hutchinson, Jackson, Jim Wells, Karnes, La Salle, Lavaca, Lee, Leon, Limestone, Live Oak, Madison, Matagorda, McLennan, McMullen, Medina, Milam, Navarro, Panola, Refugio, Robertson, Titus, Victoria, Walker, Washington, Webb, and Wharton Counties

Total % Annual Usage:

The total amount cannot be more than 100%

TCEQ-20625 (Revised September 2024) Page 15 of 21

Section 8 (cont.): Percent Annual Usage In the table below, identify the counties where the grant-funded vehicle will operate and provide the percent of annual usage in the space provided. Each qualifying vehicle must be operated at least 75% of its total annual mileage in the eligible counties of the Clean Transportation Zone (CTZ).

Does the activity involve the transport of raw agricultural products? ____ Projects involving the transport of raw agricultural products may be exempt from the requirements that grant-funded vehicles operate at least 75% of annual mileage in the eligible counties of the CTZ. Refer to Appendix D of the RFGA.

Activity 006 007 008 009 010

Counties by Area in the CTZ Annual % Annual % Annual % Annual % Annual %

Austin Area:

Bastrop, Caldwell, Hays, Travis, and Williamson Counties Beaumont-Port Arthur Area:

Hardin, Jefferson, and Orange Counties Corpus Christi Area:

Nueces and San Patricio Counties Dallas-Fort Worth Area:

Collin, Dallas, Denton, Ellis, Henderson, Hood, Hunt, Johnson, Kaufman, Parker, Rockwall, Tarrant, and Wise Counties El Paso Area:

El Paso County Houston-Galveston-Brazoria Area:

Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller Counties San Antonio Area:

Bexar, Comal, Guadalupe, and Wilson Counties Tyler-Longview Area:

Gregg, Harrison, Rusk, Smith, and Upshur Counties Other Eligible Counties:

Anderson, Aransas, Atascosa, Austin, Bee, Bell, Brazos, Burleson, Calhoun, Colorado,DeWitt, Duval, Falls, Fayette, Freestone, Frio, Goliad, Gonzales, Grimes, Hill, Howard, Hutchinson, Jackson, Jim Wells, Karnes, La Salle, Lavaca, Lee, Leon, Limestone, Live Oak, Madison, Matagorda, McLennan, McMullen, Medina, Milam, Navarro, Panola, Refugio, Robertson, Titus, Victoria, Walker, Washington, Webb, and Wharton Counties

Total % Annual Usage:

The total amount cannot be more than 100%

TCEQ-20625 (Revised September 2024) Page 16 of 21

Section 9: Disposition of Old Vehicle/Engine Being Replaced Unless otherwise approved by TCEQ, a grant applicant must agree to dispose of vehicles and engines replaced under this program by the methods outlined in Section 2.4 of the RFGA.

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

Standard Destruction: Standard disposition requires making a 3-inch or larger hole in the engine block and cutting both frame rails or other main structural components of the equipment, or by completely crushing the equipment, including the engine.

If the proposed method of disposition is “standard destruction,” check the box to the right and continue to Section 10.

Alternative Destruction: TCEQ will consider alternative methods of rendering the vehicle permanently inoperable in lieu of the standard method of destruction. If the proposed method of disposition is “alternative destruction,” check the box to the right and complete questions

9.2 and 9.4.

Permanent Removal from Texas: TCEQ will consider proposals for the permanent removal of vehicles from Texas in lieu of destruction. If the proposed method of disposition is Permanent Removal from Texas, check the box to the right and complete Sections 9.3 and 9.4 below.

2. Alternative Destruction. If the applicant is proposing an alternative method of destruction in lieu of the standard method of destruction outlined in Section 2.4 of the RFGA, explain the alternative method of destruction in the space provided below.

3. Permanent Removal from Texas. Proposals for the permanent removal of vehicles and engines from Texas in lieu of destruction will only be accepted for vehicles and engines exported to a destination outside of the United States, Canada, and the United Mexican States. If awarded a grant, the grantee must submit to TCEQ documentation of the export and transfer of ownership of the vehicles and engines prior to reimbursement. In the space provided below, please give a detailed plan for the export and transfer of ownership.

4. Activities Included in the Alternative Destruction or Permanent Removal from Texas

Alternative Destruction: Does the method of alternative destruction apply to all vehicles and engines listed in this application?

If no, list the activity numbers to which the proposal applies:

Permanent Removal from Texas: Does the proposal to export and transfer ownership of the vehicles and engines apply to all activities listed in this application?

If no, list the activity numbers to which the proposal applies:

TCEQ-20625 (Revised September 2024) Page 17 of 21

Section 10: Project Summary Page

1. Applicant Information

Applicant Legal Name:

Applicant Type:

Applicant Mailing Address:

(Street or PO Box)

Applicant City, State, and Zip Code:

How did you hear about this grant program?

Other:

2. Project Information

Primary Project Area:

Emission Source: On-Road

Project Type:

(Select Replacement or Repower)

Total Number of Activities in this Application:

(This number should match the number of Section 6 forms)

Total Eligible Costs of Project:

(Total eligible costs of all activities from Section 7)

Total Requested Grant Amount:

(Total requested grant amount of all activities from Section 7)

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

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 the certifications in Sections 4 and 5 of 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 this application will make it ineligible. I understand that making a false statement may make the submitted application 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*:

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 TERP program staff at TERP@tceq.texas.gov or 800-919-

TERP (8377).

*If using an electronic 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.

TCEQ-20625 (Revised September 2024) Page 18 of 21 mailto:TERP@tceq.texas.gov

Section 11: A pplication 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 attachments

• the applicant’s contact information

• all required signatures

• all information necessary for TCEQ to review the application for selection according to the program requirements listed in the RFGA

Application Section Checklist (All Applications)

Section 1: Applicant Information Please fill out entirely.

Section 2: Third-Party Preparer Signature Page

Please fill out entirely if application was prepared by a third party. Signature Required.

Section 3: Certification of Eligibility Please fill out entirely.

Section 4: Certifications Please read and include with application.

Section 5: Program Certifications Please read and include with application.

Section 6: Vehicle Information Please fill out entirely.

Section 7: Activity Cost and Grant Amount Please fill out entirely.

Section 8: Percent Annual Usage Please fill out entirely.

Section 9: Disposition of Old Vehicle/Engine Please fill out entirely

Section 10: Project Summary Page Please fill out entirely. Signature Required.

Required Attachments Checklist (All Applications)

W-9 Form Please download, fill out entirely, and include with application. Signature Required.

Copy of State or Federal Identification Card

Include only if applying as an Individual or Sole Proprietor.

Copy of Registration Documents for Vehicle Being Replaced or Repowered

Please include registration documents for the 12 months immediately preceding the application signature date.

Copy of Title of Vehicle Being Replaced or Repowered

Please include proof of ownership for the two years immediately preceding the application signature date.

Color Photographs of Vehicle Being Replaced or Repowered

Please attach color photographs of the front, right side, left side, rear, engine, and engine data plate of each vehicle to be replaced or repowered. All photographs of the vehicle should include tires.

Purchase Documentation of Grant- Funded Vehicle, Engine, or Conversion System

Include only if the purchase has been completed.

TCEQ-20625 (Revised September 2024) Page 19 of 21 https://www.irs.gov/pub/irs-pdf/fw9.pdf

Supplemental Forms (if applicable)

Supplemental Form 1: Waivers of Program Requirements and Special Ownership Preapproval

Please fill out entirely (if applicable) and include with application. Signature Required.

Supplemental Form 2: Agricultural Please fill out entirely (if applicable) and include Product Transportation with application.

TCEQ-20625 (Revised September 2024) Page 20 of 21

Section 12: Application Submission Instructions Electronic Application Submissions Applications may be submitted securely by uploading the file to TCEQ's FTPS Server and selecting the share file(s) button. Enter TNGVGP-Apply@tceq.texas.gov as the email address. See detailed directions for using TCEQ’s FTPS site. Please note: Applications uploaded to TCEQ’s FTPS server without completing the share file(s) step will not be considered as submitted. Learn how to create an account and submit your application via the FTPS site in this step-by-step video guide. It is preferable that the application and its attachments be submitted as a single PDF, but it is not required. If the attachments for an application will be submitted as separate files, each attachment must be grouped by activity and clearly labeled with the activity number at the top of each page.

Physical Application Submissions Applications may also be submitted by mailing a physical copy to one of these addresses:

Standard Mail:

Texas Commission on Environmental Quality Air Grants Division, MC-204 (TNGVGP) P.O. Box 13087 Austin, TX 78711-3087

Express Mail:

Texas Commission on Environmental Quality Air Grants Division, MC-204 (TNGVGP) 12100 Park 35 Circle, Building F, 1st Floor, Suite 1301 Austin, TX 78753

TCEQ-20625 (Revised September 2024) Page 21 of 21 https://ftps.tceq.texas.gov/ https://ftps.tceq.texas.gov/help/ https://ftps.tceq.texas.gov/help/ https://www.youtube.com/watch?v=GW4eEe_uUwc https://www.youtube.com/watch?v=GW4eEe_uUwc https://www.youtube.com/watch?v=GW4eEe_uUwc mailto:TNGVGP-Apply@tceq.texas.gov