low-nosupplementalformfy2017.pdf
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- Opportunity number
- FTA-2017-003-TPM-LOWNO
- Issued by
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Department of Transportation
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FTA Supplemental Form
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v1.0 Applicant and Proposal Profile Form - Low or No Emission Bus Program (5339(c)) Page of Low or No Emission Bus Program (5339(c)) Applicant and Proposal Profile Is this a resubmission due to an invalid/error message from FTA?
Section I. Applicant Information Applicant Eligibility:
Population Served:
Section II. Project Information/Evaluation Criteria (This section repeats per project) About the Project (Descriptive title of this project) Project Type:
Technology:
Is this application a partnership between an eligible applicant and one or more private section partners?
***Address each of the evaluation criteria as described in the Notice of Funding Opportunity.*** Demonstration of Need Demonstration of Benefits Planning and Local/Regional Prioritization Local Financial Commitment Project Implementation Strategy If selected, can this project be obligated within 12 months from the time of award?
Technical, Legal, and Financial Capacity Project Budget Description
QTY
Federal Amount Local Match Total Cost Total:
Project Scalability Is Project scope scalable?
Matching Funds Information Project Timeline Timeline Item Description Timeline Item Date Congressional Districts (Place of Performance) Congressional District Congressional Representative 9.0.0.2.20120627.2.874785
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| Grants.gov Tracking Number (13 characters): |
| Organization Legal Name (200 characters): |
| FTA Recipient ID Number (30 characters): |
| Applicant Eligibility - Direct or designated recipient: |
| Applicant Eligibility - State: |
| Applicant Eligibility - Local: |
| Applicant Eligibility - Tribe: |
| Population Served - Urbanized Area: |
| Population Served - Rural: |
| Description of services provided and areas served (4000 characters): |
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| Project Title (200 characters): |
| Project Executive Summary (500 characters): |
| Project Type - Vehicle: 0 |
| Project Type - Facilities: 0 |
| Project Type - Other: 0 |
| Applicant Type - If Other, Specify (200 characters): |
| Technology - Battery electric: 0 |
| Technology - Diesel-electric hybrid: 0 |
| Technology - CNG: 0 |
| Technology - Hydrogen fuel cell: 0 |
| Project Type - Other: 0 |
| Applicant Type - If Other, Specify (200 characters): |
| If yes, please list the partners and describe the qualifications of each (4000 characters): |
| Demonstration of Need (4000 characters): |
| Demonstration of Benefits (4000 characters): |
| Planning and Local/Regional Prioritization (4000 characters): |
| Local Financial Commitment (4000 characters): |
| Project Implementation Strategy (4000 characters): |
| Technical, Legal, and Financial Capacity (4000 characters): |
| Item Description (100 characters): |
| Quantity: |
| Federal Amount: |
| Local Match: |
| Total Cost: |
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| Grand Total - Federal Amount: |
| Grand Total - Local Match: |
| Grand Total - Total Cost: |
| If Yes, specify minimum Federal Funds necessary: |
| Provide explanation of scalability with specific references to the budget line items above (4000 characters): |
| Matching Funds Amount: |
| Source of Matching Funds (4000 characters): |
| Supporting Documentation of Local Match (4000 characters): |
| Timeline Item Description (100 characters): |
| Timeline Item Date (format MM/dd/YYYY): |
| Insert Project Timeline Item: |
| Congressional District: |
| Congressional Representative: |
| Insert Congressional District Item: |
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