KYTC_RFP 4_Attachment 03a_Administrative Proposal Form_v10_20260428.pdf

Attachment 3a – Administrative Proposal Form

Attachment 3a - Administrative Proposal Form This PDF is the Administrative Proposal Form. Please fill out all sections of this PDF form and return it as a searchable PDF document. Only one Administrative Proposal Form should be submitted for each unique Proposer team even if that Proposer team is submitting proposals for more than one zone. This form is one of four parts of the complete Administrative Proposal. Use the file naming convention provided in the RFP for all submitted files.

1 PROPOSER INFORMATION

1.1 Zones this Administrative Proposal Applies to (list all zones for which proposals are being submitted):

1.2 Proposer Business Name:

1.3 Federal Tax ID Number:

1.4 Proposer KY Business License

Number:

1.5 Unique Entity Identifier (UEI):

1.6 Mailing Address:

1.7 City, State:

1.8 Contact Person Name (Authorized agent for all Proposal and communication purposes):

1.9 Contact Title:

1.10 Contact Telephone Number:

1.11 Contact Email Address:

1.12 Project Manager Name (Primary Point of Contact during Project Implementation):

1.13 Project Manager Telephone Number:

1.14 Project Manager Email Address:

2 PROPOSER BACKGROUND, EXPERIENCE, AND TEAM ORGANIZATION

2.1

Proposer Team Organization: Provide an organizational chart that clearly identifies the following team members/roles: Electric Vehicle Supply Equipment (EVSE) Station Operator and Owner, Hardware Supplier, Network Operator, Project Manager for Construction, Project Manager for Operations and Maintenance (O&M), General Contractor, Electrical Design Firm, Civil Design Firm.

Attach the organization chart to this file in pdf format.

2.2

Has the Proposer had experience constructing and operating NEVI-funded projects?

☐ Yes ☐ No If yes, provide the specific program and project details by completing the table below (required):

Proposer Name Project Location (Full Address) Date of Start of

Operations

Note: Maximum 5 projects

Note: Maximum 5 projects

2.3 PRIOR EXPERIENCE

Complete the following table with prior experience of the Proposer of constructing and operating EV charging sites that have 100kW or higher ports.

Proposer/Operator Name Street Address, City, State, ZIP

EVSE

Operational Start Date

(MM/YYYY)

Power Level Per Port (kW)

3 APPROACH TO EVSE OPERATIONS AND MAINTENANCE

3.1

Who is responsible for preventative maintenance?

For preventative maintenance, what is your site inspection frequency?

For preventative maintenance, what is your site preventative maintenance frequency?

Do you monitor EVSE remotely 24/7?

☐ Yes ☐ No

3.2

Who is responsible for corrective maintenance?

For corrective maintenance, what is your planned response time?

For corrective maintenance, what is your time to complete resolution?

3.3 Do you plan to continue to operate the site after the required 5 years of O&M?

☐ Yes ☐ No

3.4

Confirm all proposed payment options (check all that apply):

☐ Free, no payment required ☐ Contactless credit/debit ☐ EVM chip credit/debit ☐ Automated toll-free phone number with live operator ☐ Automated toll-free phone number with Interactive Voice Response (IVR) touch-tone system ☐ SMS link to secure payment portal ☐ Phone app ☐ Cash ☐ Other:

Which proposed payment options are accessible to persons with disabilities? (check all that apply):

☐ Free, no payment required ☐ Contactless credit/debit ☐ EVM chip credit/debit ☐ Automated toll-free phone number with live operator ☐ Automated toll-free phone number with Interactive Voice Response (IVR) touch-tone system ☐ SMS link to secure payment portal ☐ Phone app ☐ Cash ☐ Other:

Which proposed payment options are accessible to persons with limited English proficiency?

(check all that apply):

☐ Free, no payment required ☐ Contactless credit/debit ☐ EVM chip credit/debit ☐ Automated toll-free phone number with live operator ☐ Automated toll-free phone number with Interactive Voice Response (IVR) touch-tone system ☐ SMS link to secure payment portal ☐ Phone app ☐ Cash ☐ Other:

3.5

Confirm all proposed customer service options (check all that apply):

☐ On-site staff ☐ Toll-free phone number ☐ SMS number ☐ Website ☐ App (must support live chat) ☐ Email

Which proposed customer service options will be accessible to persons with disabilities? (check all that apply):

☐ On-site staff ☐ Toll-free phone number ☐ SMS number ☐ Website ☐ App (must support live chat) ☐ Email

Which proposed customer service options will be accessible to persons with limited English proficiency? (check all that apply):

☐ On-site staff ☐ Toll-free phone number ☐ SMS number ☐ Website ☐ App (must support live chat) ☐ Email

Who is responsible for answering and supporting each customer service option (if different, list for each proposed customer service option)?

What languages do your customer service mechanisms support?

3.6 Describe how EV charging prices will be established, considering NEVI requirements:

4 APPROACH TO CYBERSECURITY AND DATA MANAGEMENT

4.1

Has the station operator already obtained a third-party certification or authorization, such as Federal Risk and Authorization Management Program (FedRAMP) Certification, Government Risk and Authorization management Program (GovRAMP) certification, SOC 2 Type 2, or ISO 27001?

☐ Yes ☐ No If yes, provide proof of which certification or authorization is held. Attach proof to this file in pdf format.

If no, does the station operator plan to obtain a third-party certification or authorization?

Has the network provider (EVSP) already obtained a third-party certification or authorization, such as FedRAMP Certification, GovRAMP certification, SOC 2 Type 2, or ISO 27001?

☐ Yes ☐ No If yes, provide proof of which certification or authorization is held. Attach proof to this file in pdf format.

If no, does the EVSP plan to obtain a third-party certification or authorization?

4.2

Which of these items are included in your approach to cybersecurity? (Include frequency, as appropriate, for each checked item. Check all that apply.)

☐ Third-party audits – Frequency:

☐ Risk assessments – Frequency:

☐ Penetration testing – Frequency:

☐ Vulnerability scanning – Frequency:

☐ Software updates – Frequency:

☐ Network segmentation:

☐ Multifactor authentication:

☐ Employee training – Frequency:

☐ Physical security:

4.3

Who is responsible for responding to cybersecurity events, as defined in Attachment 1 – Technical Requirements?

What is your response time to cybersecurity events?

Who do you notify of a cybersecurity event, as defined in Attachment 1 – Technical Requirements?

What is the time frame of notification of a cybersecurity event?

Certification

I certify that if awarded, all proposed activities will be carried out, all money received will be utilized solely for the purposes for which it is intended, records documenting the planning process and implementation will be maintained and submitted when requested, and KYTC is hereby granted access to inspect project sites and/or records.

I acknowledge I have thoroughly examined the Request for Proposals and, to the best of my knowledge and belief, all information included in this Proposal is true and accurate, including the commitment of all physical and financial resources. This Proposal has been duly authorized by the applying organization.

I understand that intentionally providing false information in this Proposal may result in criminal prosecution and may be a reason to reject my Proposal.

If funding is awarded for the project described in this Proposal, I understand that an executed Project Agreement between the Proposer and KYTC is required before the project can be started, costs can be incurred, or such funding can be authorized for use in implementing the project.

I certify under penalty of perjury and pursuant to the laws of the Commonwealth of Kentucky that the preceding is true and correct.

Proposer (Legally Responsible Entity):

Authorized Signature: ___________________________________

Print Name/ Title: ________________________________________

Date: _____________________________________________________

Attachment 3a - Administrative Proposal Form