KYTC_RFP 4_Attachment 04a_Technical Proposal Form_v10_20260428.pdf

Attachment 4a – Technical Proposal Form

Attachment 4a - Technical Proposal Form

This PDF is the Technical Proposal Form. Please fill out all sections of this PDF form and return it as a searchable PDF document. One Technical Proposal Form should be submitted for each site. While Proposers may submit on multiple sites, only one site may be submitted for each zone in the RFP. This form is one part of the complete Technical Proposal and all parts must be completed (RFP Section 5.5).

Use the file naming convention provided in the RFP for all submitted files.

1 Proposed Site Location Details

1.1 Zone:

1.2 Latitude:

1.3 Longitude:

Note: The coordinates above shall indicate the location of the driving point of entry (curb cut) to the charging station, as defined in 23 CFR 680.104

1.4 Provide the parcel number for the

charging station:

1.5 Site Name:

1.6 Physical Address:

1.7 City:

1.8 County:

1.9 Zip Code:

1.10 Site host (Entity) legal name and d/b/a:

1.11 Will the proposed project site and proposed EVSE charging station be owned and operated by Proposer?

☐ Yes ☐ No

1.12 Site Utility Provider:

2 EVSE Technical Requirements

2.1

Provide specification cut sheets for both direct current fast charging (DCFC) and Level 2 electric vehicle supply equipment (EVSE), if incorporated, that clearly identifies the following information per port: power, output current, output voltage, ambient operating temperature, and enclosure environmental rating.

2.2

Provide a diagram of the proposed EV charging equipment and electrical connections, including equipment power and/or energy ratings, as applicable. Include the utility transformer, charging cabinet(s), dispensers, connectors, batteries, solar panel(s), and any other proposed electrical equipment in the diagram, as applicable. The diagram should clearly indicate any power sharing arrangement between ports so that the power available per port can be determined based on the number of ports in use. The definition of charger, charging port, and connector shall be as defined in 23 CFR 680.104.

2.3

DCFC Vendor (Entity) Name:

DCFC Make and Model:

Level 2 Vendor (Entity) Name (if applicable):

Level 2 Make and Model (if applicable):

Confirm all proposed EVSE is Build America, Buy America compliant, per requirements:

☐ Yes ☐ No

2.4

Confirm each 150 kW or higher direct current fast charging (DCFC) EVSE is capable of simultaneously providing at least 150kW per port, per requirements:

☐ Yes ☐ No

Confirm each DCFC has both a NACS connectors and a CCS1 connector, per requirements:

https://www.federalregister.gov/documents/2023/02/21/2023-03498/waiver-of-buy-america-requirements-for-electric-vehicle-chargers

2.5

Are you providing a Battery Energy Storage System?

☐ Yes ☐ No

If Yes:

Is the battery shared among all ports?

☐ Yes ☐ No

What is the size of the battery per port in kWh?

What is the overall size of the battery in kWh?

What is the overall power input rating of the battery in kW?

What is the overall power output rating of the battery in kW?

Does the above comply with Technical Requirement 2.8, as detailed in Attachment 1 – Technical Requirements?

☐ Yes ☐ No

2.6 What is the planned grid capacity in kW or the planned size of the utility transformer in kVA?

2.7 Expected utility upgrades required:

3 General Project Approach and Understanding

3.1 Complete Attachment 4b, Proposed Project Schedule, per the instructions provided in the attachment.

4 EVSE and Utility Information

4.1

Number of 150kW or greater DCFC ports:

Number of 6kW or greater Level 2 ports:

4.2

Maximum DCFC power in kW per port:

Enter the maximum kW available for each vehicle operating concurrently in the scenarios below:

Vehicle 1 Power Vehicle 2 Power Vehicle 3 Power Vehicle 4 Power

1 Vehicle Charging 2 Vehicles Charging 3 Vehicles Charging 4 Vehicles Charging

Note: If the site contains more than four ports, explain the power sharing configuration, per the above. If the site contains less than four DCFC ports, include the Level 2 ports in the above table.

5 Approach to Site Requirements

5.1

Who is responsible for general site maintenance (trash removal, lighting, general site upkeep, etc.)?

What is the proposed frequency for general site maintenance (trash removal, lighting, general site upkeep, etc.)?

Who is responsible for general snow and ice removal?

What is your response time for snow and ice removal?

5.2 Do you plan to provide free Wi-Fi at the site?

6 Proposed Site Details, Design, and Layout

• Describe the approach to each item below and clearly identify each item in a preliminary site design and layout attached to this Proposal.

• The preliminary site design and layout shall be clear and legible and include a scale.

• All items must be on-site and controlled by the Proposer team.

6.1

For Corridor Zones Driving distance to corridor (to nearest one-tenth of a mile from the nearest access point to the corridor):

For Urban and Rural Zones:

Straight-line distance to the nearest NEVI-funded station (to nearest one-tenth of a mile):

6.2

Vehicular access points of ingress and egress to the charging station (must be identified on both area map and proposed layout) ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.3

Site improvements required to meet compliance with requirements ((civil site work such as paving, curb cuts, striping, walkways, ramps, etc.)

☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.4

EVSE-designated charging spaces ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.5

ADA-compliant EV charging spaces ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.6

EV charge ports (using the definitons in 23 CFR 680.104) ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.7

Electrical infrastructure (transformer, etc.)

☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

https://www.ecfr.gov/current/title-23/chapter-I/subchapter-G/part-680/section-680.104

6.8

Lighting ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.9

Trash receptacles ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.10

Signage at EVSE charging spaces ☐ Existing ☐ Proposed/Modifications Provide additional detail (required):

6.11

Physical protection (bollards, fencing, curbs, etc.)

☐ Existing ☐ Proposed ☐ N/A Provide additional detail (required):

6.12

Emergency shutoff ☐ Existing ☐ Proposed Provide additional detail (required):

6.13

Proposed site is in a 100-year floodplain, according to the FEMA Flood Map Service Center ☐ Yes ☐ No If Yes, provide details about proposed mitigations at the site to protect the equipment in the case of a flooding event (required):

6.14

Will the proposed site require any tree clearing or trimming?

☐ Yes ☐ No If Yes, provide details about proposed tree clearing or trimming:

6.15 Any additional information about proposed site design and layout, including any additional amenities not already outlined:

https://msc.fema.gov/portal/home

7 Area Map

• Describe the approach to each item below and clearly identify each item in an area map attached to this Proposal.

• The area map shall be clear and legible and include details that show the site location in relation to the nearest state highway or interstate.

• Indicate the distance from the corridor or nearest NEVI-funded station to the site as defined in the

RFP.

• The area map must include a scale.

7.1

Vehicular access points of ingress and egress to the charging station (must be identified on both area map and proposed layout) ☐ Existing ☐ Proposed/Modifications

Provide additional detail (required):

8 Primary Amenities

• If included in the proposal, describe the approach to each item below and clearly identify each item in the preliminary site design and layout attached to this Proposal.

• Amenities must be on-site and controlled by the Proposer team.

8.1

Access to restroom Hours available each day:

☐ Existing ☐ Proposed ☐ N/A Provide additional detail (required if existing or proposed):

8.2

Access to food and drink Hours available each day:

☐ Existing ☐ Proposed ☐ N/A Provide additional detail (required if existing or proposed):

8.3

Retail or shopping on-site Hours available each day:

☐ Existing ☐ Proposed ☐ N/A Provide additional detail (required if existing or proposed):

8.4

Canopy above chargers ☐ Existing ☐ Proposed ☐ N/A Provide additional detail (required if existing or proposed):

8.5

Pull-through charger space(s) to accommodate vehicles pulling trailers ☐ Existing ☐ Proposed ☐ N/A Provide additional detail (required if existing or proposed):

8.6

Security cameras overlooking EVSE ☐ Existing ☐ Proposed ☐ N/A

Provide additional detail (required if existing or proposed):

8.7

On-site staff Hours staff is on-site and available each day:

☐ Existing ☐ Proposed ☐ N/A

Provide additional detail (required if existing or proposed):

8.8

160 kWh or greater Battery Energy Storage System (BESS) ☐ Existing ☐ Proposed ☐ N/A

Provide additional detail (required if existing or proposed):

9 Administrative Responsiveness Check

Requirement Requirement Met (Proposer to Complete)

9.1 Proposal is submitted by the Proposal deadline and in

the format outlined by the RFP. ☐ Yes ☐ No

9.2 Proposal includes a completed letter from the site

owner, as defined. ☐ Yes ☐ No

9.3 Proposal includes an organizational chart, as defined. ☐ Yes ☐ No

9.4 Proposal includes specification cut sheets for all

proposed EV charging equipment. ☐ Yes ☐ No

9.5 Proposal includes a preliminary site design and layout, as defined. ☐ Yes ☐ No

9.6 Proposal includes an area map, as defined. ☐ Yes ☐ No

9.7 Proposal includes signed FHWA Form 1273. ☐ Yes ☐ No

9.8 Proposal includes acknowledgement of all issued

addendums. ☐ Yes ☐ No

9.9 All sections of Attachment 3a - Administrative Proposal Form and Attachment 4a - Technical Proposal Form, are completed.

☐ Yes ☐ No

9.10 All sections of Attachment 4b, Proposed Project

Schedule, are completed. ☐ Yes ☐ No

9.11 All inputs required in Attachment 5, Cost Proposal

Form, are provided. ☐ Yes ☐ No

9.12 Proposal includes Attachment 11, Utility Data Request

Form. ☐ Yes ☐ No

9.13 Proposer does not appear on any list of suspended or debarred individuals or entities, as defined by the state of Kentucky and has completed Attachment 3b – Affidavit for Bidders and Offerors.

☐ Yes ☐ No

9.14 Proposer is not barred or suspended from consideration for work with the federal government and does not appear on the Federal Excluded Parties List.

9.15 Proposer is registered to do business in the state of Kentucky and has provided Proposer Federal Tax ID Number in the Proposal.

☐ Yes ☐ No

9.16 Proposer has provided unique entity identifier in the

Proposal. ☐ Yes ☐ No

9.17 At least 20 percent non-federal match is provided by

other sources. ☐ Yes ☐ No

9.18 Proposal includes transmittal letter as outlined in

Attachment 12. ☐ Yes ☐ No

10 Technical Responsiveness Check

Requirement Requirement Met (Proposer to Complete)

Site Requirements

10.1 Site includes at least one ADA-compliant parking

space with access to the EV charging infrastructure. ☐ Yes ☐ No

10.2 Charging is publicly available 24 hours a day, 365 days

a year. ☐ Yes ☐ No

EV Charger Requirements

10.3

Site includes at least four ports, at least two of which are DCFC ports. All DCFC ports support at least 150kW per port simultaneously, and all Level 2 ports support at least 6kW per port simultaneously. (The definitions of ports shall be the same as 23 CFR 680.104.)

☐ Yes ☐ No

10.4 EVSE has a minimum of four ports. (The definition of

ports shall be the same as 23 CFR 680.104.) ☐ Yes ☐ No

10.5 DCFC has the capacity to deliver direct current (DC) output up to at least 350 amps, (ADC) and Level 2 has the capacity to deliver alternating current (AC) output of at least 30 amps.

☐ Yes ☐ No

10.6 EVSE is capable of operating at an ambient temperature range of minus 22 degrees to 122 degrees Fahrenheit.

☐ Yes ☐ No

10.7 EVSE enclosures have a minimum rating of IP54 or

equivalent. ☐ Yes ☐ No

10.8 DCFC has the ability to provide DC output voltages

somewhere within the range of 250 to 920 volts (VDC). ☐ Yes ☐ No

10.9

All DCFC includes combined charging system (CCS1) connectors capable of simultaneously DC fast charging all ports continuously, and all Level 2 have J1772 connectors capable of simultaneously charging all ports continuously.

☐ Yes ☐ No

10.10 Proposal includes North American Charging Standard (NACS) connectors for DCFC, per Attachment 1 - Technical Requirements.

☐ Yes ☐ No

10.11

EVSE has been certified by an OSHA Nationally Recognized Testing Laboratory (NRTL) to the appropriate Underwriters Laboratories (UL) standards.

DCFC is certified to UL 2202. Level 2 is certified to UL 2594. All EVSE is certified to UL 2231-1 and UL 2231- 2.

☐ Yes ☐ No

10.12 EVSE meets the minimum power supply and Battery Energy Storage System requirements per Attachment 1.

☐ Yes ☐ No

Miscellaneous Requirements

10.13 EVSE site meets all requirements of the RFP and 23

CFR 680 as detailed in RFP. ☐ Yes ☐ No

CERTIFICATION

Before certifying the accuracy of this Proposal, please review the entire RFP and attachments, as well as all required documentation and narrative information below. In addition, all Proposers must include acknowledgement of all issued addendums, per the instructions detailed in the addedum. Ensure all required documents have been completed, all files have been uploaded, and you have submitted all required files prior to 11 a.m.. Eastern Standard Time.

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: _____________________________________________________