KYTC_RFP 4_Attachment 11_Utility Data Request Form_v10_20260428.pdf

Attachment 11 – Utility Data Request Form

Attachment 11 — Utility Data Request Form

This Utility Data Request Form provides a tool for Proposers to request the required utility-related information for potential EV charging stations. The Proposer can use the information in this form to inform applications and cost proposals. This form will not be scored but will be a part of the administrative responsiveness check. The Proposer is to complete its portion of the form and send it to the utility requested to serve the facility so that the utility can provide preliminary information about the potential costs, ability to serve the requested load at the Proposer location, and other information it deems useful for evaluating the utility services and costs at a specific site.

Proposers are to provide a site plan to the utility with this form to help inform the utility’s responses.

More information about the KYTC NEVI Formula Program can be found at KYTC’s NEVI website.

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https://www.kyevcharging.com/

To be Completed by Proposer

Proposer Information Company Name Contact Name Contact Address Contact Email Contact Phone Site Host Information (if different than Proposer) Company Name Site Address Street City ZIP plus 4 Electrician/Engineer Information (if different than Proposer) Company Name Contact Name Contact Email Contact Phone EVSE location on site (lat/long) Do you have a detailed site plan or preliminary design developed? If so, please submit a drawing or rendering with this document.

If project receives funding, developer intends to break ground on this date:

Electrical Load Information Proposed number of chargers and charger size (kW) Proposed connected load (kW) Note: 600kW typical for NEVI-compliant station Requested service voltage Note: 480 V / 3 PH typical for NEVI-compliant station Is overhead or underground service currently available at the site?

Proposer (continue completion of this page)

Expected load profile (if known) At what hour of the day is peak load anticipated to occur?

How is load expected to vary across the day?

Projected monthly energy use (kWh)

ASTRITECKY

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Is the Proposer planning to install a battery energy storage or solar system at the site? If so, please describe the size, capacity, and basic system information.

Will the EVSE load be added to an existing meter/account, or will a new account be requested?

If EVSE load will be added to an existing account, provide account number.

If you have any additional documents related to the proposed charging site, expected load profile, etc., please attach them here.

Please indicate when the desirable in-service date is for the station. Please understand that it can take one year or more for the utility to obtain transformers and other equipment.

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To be Completed by Utility Utility Ability to Serve (to be completed by utility) Note to utility regarding the equipment provided under the National Electric Vehicle Infrastructure (NEVI) Formula Program: All utility upgrades for NEVI sites must meet Build America, Buy America Act compliance (Federal Register: Build America, Buy America Compliance Guidance for Grants and Agreements). There are waivers for Iron and Steel de Minimis Costs, and Construction Materials de Minimis Costs that can be utilized to achieve compliance with BABA.

Additional information can be attached to this data request sheet. For instance, a map of system capacity for a given area or a letter/memo from the utility describing available service for a given exit so as to avoid answering multiple individual requests.

Three-phase power available at EVSE location? Y or N If power is not available, where is the nearest service (i.e. lat/long, address, distance, direction)?

Can requested connected load be served? Y or N Utility will provide power if site/application is selected? Y or N Utility service application process next steps

Preliminary cost estimates/range of all potential costs. Please include line item costs, a total cost, and if applicable, identify what costs will be invoiced to the customer.

Other information worth noting (i.e., rates, supply lead times, etc.);

Summary of scope of work and equipment to provide service.

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https://www.federalregister.gov/documents/2023/08/23/2023-17724/guidance-for-grants-and-agreements#:%7E:text=BABA%20required%20that%20by%20May,materials%20used%20in%20the%20project https://www.federalregister.gov/documents/2023/08/23/2023-17724/guidance-for-grants-and-agreements#:%7E:text=BABA%20required%20that%20by%20May,materials%20used%20in%20the%20project

Contact information to further discuss rates, connection, etc.

Contact Name

Contact Email

Contact Phone

Disclaimer: It is understood that the information provided by the utility is non-binding until a formal service application is received by the utility from the selected Proposer. The information above is provided as a preliminary step for NEVI station Proposer’s due diligence in determining potential site viability and implementation costs.

Utility Representative Name

Signature

Date

Additional Information:

Attachment 11 — Utility Data Request Form