2023 EPA Clean School Bus Rebate Forms: Payment Request Form User Guide

EPA CLEAN

SCHOOL BUS

2023 EPA Clean School Bus Rebate Forms:

Payment Request Form User Guide

July 2024

United States
Environmental Protection
* W -i	Agency

EPA-420-B-24-036

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Table of Contents



Before You Begin	4

1.	Sign In/Register	4

2.	Create/Edit a New Payment Request Form	5

2.1	Start a New Payment Request Form	5

2.2	Welcome Screen	6

2.3	Information Icons	6

2.4	Applicant Information	7

2.5	School District Information	8

2.6	Organizations	10

2.7	Add Organizations	11

2.8	Complete Organizations	12

2.9	Documents	13

2.10	Add Documents	14

2.11	Complete Order Documents	15

2.12	New Bus Information	16

2.13	Add New Bus Information—Existing Bus Information	17

2.14	Add New Bus Information—New Bus Information	19

2.15	Exclude a Bus	23

2.16	Swap a Bus	24

2.17	Complete Bus Information	25

2.18	Infrastructure Information	26

2.19	Add Infrastructure - Level 2 / DC Fast Chargers	27

2.20	Add Infrastructure—Other Eligible Infrastructure Costs	30

2.21	Complete Infrastructure	32

2.22	Funding	33

2.23	Build America, Buy America Compliance	37

2.24	Signature	39

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3. Change Request Process	40

3.1	Withdrawal Request	41

3.2	Edit Request	42

3.3	Extension Request	43

Appendix A: Glossary	44

41

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Before You Begin

This guide will walk you through the steps needed to create, edit, submit, and view an online payment request
form for a Clean School Bus rebate application when you have been chosen for an award. The guide also
includes detailed definitions of key fields in the online form and a printable list of all fields required in the form.
Plan to spend about an hour completing the payment request form, depending on the number of buses and
purchase orders you need to enter.

Follow these steps to prepare:

1. Review the glossary of terms used in the rebate application ( ).

2. Compile all required data.

3. Confirm the point of contact. Confirm the email of the person completing the payment request form
is registered as a designated Primary or Alternate Government point of contact, or Primary or Alternate
Electronic point of contact, in your entity's SAM.gov account by logging on to SAM.gov. Otherwise, the
person will not be able to log into the payment request form from the applicant login webpage.

4. Check your browser version. Before filling out the payment request form, make sure your web
browser version meets or exceeds the following:

— Chrome 38

— Safari 7.1

— Internet Explorer 11

— Firefox13

Note: The sections in this guide follow the order in which you will work through screens to complete the
payment request form.

1. Sign In/Register

Use your existing SAM.gov credentials to sign in to your applicant dashboard. If you cannot sign in, consult
the "Sign In/Register" section of the ~ebate application user guide.

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Il

2. Create/Edit a New Payment Request Form

Note: Your connection to the payment request form system will time out unless you interact with the screen
at least once every 15 minutes. " Interacting" can mean entering or deleting information, or even moving your
cursor on the screen. If your connection times out, you risk losing data entered since the last save.

2.1 Start a New Payment Request Form

After signing in using your Login.gov account, you will see the Clean School Bus Rebate Forms screen.

Clean School Bus Rebate Forms

Clean School Bus Rebate Program
Online Rebate Application Information

eben.bathalon@erg.com I

Rebate Year: 2023

O New Application

Your Rebate Forms

Select a button below to Edit or View an existing rebate form.

• For the 2023 rebate year, you may request edits, an extension, or a withdrawal by selecting Change Request, Change.

• For the 2022 rebate year, you may request edits, a withdrawal, or a Close Out Form extension (see Close Out Form webpage) by emailing cleanschoolbus@epa.gov.

O Form Type O UEI © Applicant O Updated By

O Rebate ID O Form Status O EFT Indicator O School District O Date Updated O Change Request

Application
© Selected

123456000110
1234

EBEN BATHALON INC
Boston

eben.bathalon@erg.com
4/18/2024

O New Payment Request

Application
O Selected

123456000110
1234

EBEN BATHALON INC.
Anchorage School District

eben.bathalon@erg.com
4/18/2024

Payment Request
••• Draft

eben.bathalon@erg.cc
6/12/2024

Application
— Draft

123456000110
1234

EBEN BATHALON INC.
Anchorage School District

eben.bathalon@erg.com
5/30/2024

Application
O Selected

123456000110
1234

EBEN BATHALON INC.
Salem School District

eben.bathalon@erg.com
1/23/2024

Click the "New Payment Request" button to begin.

Note: You can submit a Change Request for any form that has been been created; however, the options you
have for the request depend on whether you have submitted the form or not. The Change Request form allows
you to edit, extend, or withdraw a form. See Section 3 for more information.

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2.2 Welcome Screen

Review the text that provides a list of what's needed to complete the form on the "Welcome" screen and
select "Next" to proceed.

Mote: You will lose work if you use your browser's back, forward, or refresh buttons while in the rebate form.
Instead, navigate using the "Next," "Previous," and "Save" buttons on the screen.

Clean School Bus Rebate Forms

•	Clean School Bus Rebate Program

•	Online Rebate Application information

;n.bathalon@e rg.com

Edit Your Payment Request

I of 10 Welcome

Payment Request Form - Basic Information

As a rebate application award selectee, you must submit an online Payment Request Form that includes an attached scan of the order docunienL(s) foi the new school buses and eligible
charging infrastructure by November 29,2024 at 4:00 p.m. ET.

The following information will help you complete this Payment Request Torm accurately and efficiently.

•	In-form hp|p text is provided helnw the data entry fields and in the "?" next tn the field names.

•	For additional assistance, please refer to the Program Guide and supporting documents at Clean School Bus Program Rebates, or contact the help desk at cleanschoolbusigeoa.gov
(include the Applicant Name, the Rebate ID, Unique Entity Identifier (UEI), Electronic Funds Transfer (EFT) Indicator, and the School District Name).

•	Review your submitted application (access it from the Applicant Dashboard) to confirm what buses are associated with order documents you will add to this form.

•	Name, title, and business email, address and phone number for: existing bus owner, new bus owner, any private fleets, new bus dealer, infrastructure owner and supplier, and other
infrastructure organizations

•	Order Document(s) files (pdf, png, jpeg, and jpg format) including name or number and who the associated purchaser and vendors are for each document

•	If swapping an existing bus that was included in your application: the reason for the swap and all the same documentation that was required in the application form including the bus
title.

•	New bus i nformation including:

o	Gross Vehicle Weight Rating (GVWR),

o	Estimated delivery date,

o	Whether the bus will be equipped with an ADA-Compliant wheelchair lift and its cost,

o	EPA vehicle family,

o	Whether bus is equipped with an auxiliary heater and the type

o	Whether bus is capable of bidirectional charging and whetherthereisa plan to use the bus for bidirectional charging

o Bus shipping cost (if eligible foi EPA rebdte),

•	Electric bus charging infrastructure information (if applicable), including:
o Number of Level 2 and DC Fast chargers and their unit costs,

o Whether the charger costs include installation

o The EVSE output power, manufacturer, model, manufacturer date, number of plugs, Energy Star Compliance (Level 2 chargers), capability for bidirectional charging, and whether it is

Buy America compliant,
o The installation/construction address including county

•	How you plan to allocate your rebate for each bus and for infrastructure costs

•	Whether the infrastructure chargers and materials are Buy America Build America Act (BABA) Compliant and whether you applied for a general waiver (which one(s)) or a project specific
waiver from BABA compliance

To save your work on the form, you must select the "Save" or "Next" button. You will be able to return later to finish your Payment Request Form without losing information.

To submit your Payment Request Form to EPA, complete all pages and then sign and submit Lite form. Make suie to provide a complete signature and check llie "I confirm I have piovided my
signature above" box before selecting the "Submit l-orm" button. Your Payment Request l-orm status will then be displayed on the dashboard as "Submitted".

Note: only Government Business (and alternate) and Electronic Business (and alternate) Points of Contact from SAM.gov can access the dashboard. The Government Business (and alternate)

luthorized representatives may contact selectees to clarify any information provided in the Payment Request Form. If, upon review, the Payment Request Form is accurate and
red information, EPA will issue the rebate payment to the bank account associated with the SAM.gov Unique Entity Identifier (UEI) and Electronic Funds Transfer (EFT)

2.3 Information Icons

Hover your mouse over the information icons, found throughout the payment request form screens, for more
information on specific fields.

Applicant Organization Name
EBEN BATHALON INC.

Unique Entity Identifier (UEI) ©

123456000110

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2.4 Applicant Information

Editable information on this page includes the organization county, and the primary and alternate contact fields
that will prepopulate with information from the associated application. Double-check that the information is
correct; you can edit it if not. Click "Next" to continue.

Clean School Bus Rebate Forms

• Clean School Bus Rebate Program

eben.bathalon@erg.com

Edit Your Payment Request

^ Rebate ID: 023468

^^oflO Applicant Info

' denotes required field

Applicant Info

The information below is automatically filled based on the applicant organization's SAM.gov entity registration and the information submitted in your Clean School Bus
rebate application. Applicant organization address information (except the County) can only be updated at the SAM.gov website. Primary and alternate applicant contacts
may be edited as needed.

Applicant Organization Name
EBEN BATHALON INC.

Unique Entity Identifier (UEI) ©
123456000110

Electronic Funds Transfer (EFT) Indicator©
1234

Physical Street Address 1
309 MAIN ST REAR

City

WATERTOWN

Physical Street Address 2

State or Territory

Organization County© *

Zip Code
02472

Applicant Primary Contact

Primary Contact First Name ©"

Mike

Primary Contact Last Name © '

Johnson

Primary Contact Title © *

Primary Contact Business Phone Number ©'

(123) 908-4392

Primary Contact Business Email ©'

primary@email.com

Applicant Alternate Contact

Alternate Contact First Name ©

John

Alternate Contact Last Name C

Alternate Contact Title ©

Asst. to the Regional Manager

Alternate Contact Business Phone Number©

Alternate Contact Business Email ©

alternate@email.com

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

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2.5 School District Information

School District information is prepopulated from what was submitted in your application. Double-check that
your school district contact information is correct; you can edit it if not. Click "Next" to continue.

Clean School Bus Rebate Forms

eben.bathalon@erg.c<

Edit Your Payment Request

^ Rebate ID: 018167

o

of 8 School District Info

This is the school district that the new replacement buses will serve for at least five years. The School District General Information and School District Priorization Information is
based on the NCES District ID you entered on your application form and is not editable, tf needed, you may update the School District Contact Information.

" denotes required field

School District General Information

National Center for Education Statistics (NCES) District ID
0200180

School District Name
Anchorage School District

Physical Address Line 1
5530 E Northern Lights Blvd

City

Anchorage

State or Territory

Physical Address Line 2

Zip Code
99504

School District Prioritization Information

Prioritized ©

Yes

Priority Reason

Q High Need Q Tribal Q Rural

Are you self-certifying as prioritized?

Yes, a large school district with 80% or rn

e of schools receiving Title I funding

School District Contact Information

First Name©'

Business Email© *

Andy



district@email.com

Last Name © *

Business Phone Number©'

Polk



(239) 343-0393

Regional Manager

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

Ek

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Saving and Editing Your Information

You can save your work while filling out the payment request form and return to it later to finish and
submit. Data entered on each screen will be saved automatically when the "Next" button is selected.

O NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

In addition, you can use the "Save" buttons to save information before proceeding to the next page.

Note: You will lose work if you use your browser's back, forward, or refresh buttons while in the
payment request form. Instead, navigate using the "Next" and "Previous" buttons on the screen.

After saving and exiting the payment request form, you can return to the "Clean School Bus Rebate
Forms" screen later, open the draft form by clicking the "Edit" button, and proceed by navigating to
where you left off. Selecting forms with a "Submitted," "Funding Approved," or "Selected" status will
allow you to view, but not edit, your entries.

Additionally, you can submit a Change Request for any form that has been created. The Change
Request form allows you to edit, extend, or withdraw a form depending on the form status. See
Section 3 for more information on the Change Request form.

Your Rebate Forms

Select a button below to Edit or View an existing rebate form.

• For the 2023 rebate year, you may request edits, an extension, or a withdrawal by selecting Change Request, Change.

• For the 2022 rebate year, you may request edits, a withdrawal, or a Close Out Form extension (see Close Out Form webpage) by emailing cleanschoolbus@epa.gov.

O Form Type O UEI O Applicant O Updated By

O Rebate ID O Form Status O EFT Indicator O School District O Date Updated O Change Request

Application
© Selected

123456000110
1234

EBEN BATHALON INC.
Boston

eben.bathalon@erg.a
4/18/2024

O New Payment Request

Application
O Selected

Payment Request
••• Draft

123456000110
1234

EBEN BATHALON INC.
Anchorage School District

eben.bathalon@erg.a
4/18/2024

eben.bathalon@erg.com
6/12/2024

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2.6 Organizations

The "Organizations" part of the form will prepopulate with information that you entered in your application.
You can edit that information by clicking the "Edit" button. If you need to add missing information on existing
bus owners, new bus owners, private fleets (if the private fleet is not the applicant), new bus dealers,
infrastructure owners (for electric bus charging only), infrastructure suppliers (for charging equipment only), or
any other infrastructure organizations, click the "+ Add Organization" button at the bottom of the screen.

Note: Information for each organization only needs to be entered once, even if the organization applies to
multiple buses or pieces infrastructure or belongs to multiple organization types.

Note: It is strongly recommended that you add all the organizations that were associated with this rebate at
this time to avoid returning to this page later.

Clean School Bus Rebate Forms

• Online Rebate Application Information

E

eben.bathalon@erg.com

Edit Your Payment Request

Rebate ID: 023468

^^oflO Organizations

This page is for adding organization information for existing buses, new buses, private fleets and infrastructure. Organizations that you entered in your application are already
included on this page, so you can update existing organizations or enter new organizations below. For each organization that you add by selecting the "+Add Organization"
blue box, you'll need to first select the organization type(s) and then enter the name, contact and address information for the organization. Information for each organization
only needs to be entered once, even if the organization applies to multiple buses or infrastructure, or multiple organization types. It is strongly recommended that you add
all the organizations that are associated with this rebate at this time to avoid having to return to this page later. The following organization types need to be entered on
this screen:

•	Existing Bus Owner: Alt existing bus owners. If the existing bus owner is the applicant, the school district that the new buses will serve, or a private fleet entered in your
application, then you do not have to enter existing bus owner information as it's already included within this form.

•	New Bus Owner: All the planned new bus owners (e.g. district, nonprofit, private fleet, tribes). If the new bus owner will be the applicant, the school district that the new
buses will serve, or the private fleet entered in your application, then you do not have to enter new bus owner information as it's already included within this form.

•	Private Fleet (existing or new buses): Any private fleet for existing or planned new buses that is not the applicant needs to be entered here unless you already entered
the private fleet(s) in your application. Applicants may list multiple private fleets here or in the application.

•	New Bus Dealer: The vendor or dealer that the planned new bus owner will purchase the bus from needs to be identified.

•	Infrastructure Owner (electric bus charging): All infrastructure owners (e.g. school district, private fleet) of the electric bus charging equipment needs to be identified. If
the infrastructure owner is the applicant, the school district that the new buses will serve, or a private fleet entered in your application, then you do not have to enter new
bus owner information as it's already included within this form.

•	Infrastructure Supplier (charging equipment only): All infrastructure suppliers from which charging equipment was purchased (includes the installer of the
infrastructure charging equipment when they are also the charging equipment supplier).

•	Other Infrastructure Organization: All other eligible Infrastructure organizations (e.g., performing trenching and wiring, project management, but excluding charger
installer when the charger is installed by the infrastructure charging equipment supplier).

On the bus and infrastructure (if applicable) pages you will be selecting organizations you entered here or in your application for each bus and infrastructure owner, supplier,
or organization.

' denotes required field

Organizations

Organization

1

Org. Name: Fleets 'R' Us

Type: Private Fleet

Contact Name: Paul Wethers

Address: 324 South St, Boston Massachusetts

Organization

2

Org. Name: Bus Owners Inc.

Type: Existing Bus Owner, New Bus Owner

Contact Name: Kevin Smith

Address: 1324 Main St., Boston Massachusetts

Return to Bus Information Page

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

Previous

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2.7 Add Organizations

To add an organization, click on the "+ Add Organization" button. Check the boxes for all applicable
organization types and enter the organization name. Once you enter all contact and address information, click
the Complete" button Note that this button does not save your form: you must click "Save" or "Next"
to save your information.

Add another organization by selecting "+ Add Organization" at the bottom of the Organizations section on
this screen. You may add as many organizations as needed and delete or edit them at any time. Deleting an
organization is permanent, so do not do so unless you are sure it's necessary. You must click the "Complete"
button before moving on.

Organizations

Org. Name: Fleets 'R' Us

Type: Private Fleet

Contact Name: Paul Wethers

Address: 324 South St., Boston Massachusetts

General Information

Organization Type' ©

Existing Bus Owner
Q New Bus Owner
I | Private Fleet {existing or new buses)

~ New Bus Dealer

I | Infrastructure Owner (electric bus charging)
| | Infrastructure Supplier (charging equipment only)
I | Other Infrastructure Organization

Organization Name©'

Bus Owners Inc.

Contact Information

Organization Contact First Name © '
| Kevin

Organization Contact Last Name ©'
| Smith

Organization Contact Title ©'

Organization Contact Business Email© '

owners@email.com

Organization Contact Business Phone Number©'

Regional Manager

Address

Organization Address 1 ©'

1324 Main St.

Organization Address 2 C

Organization County ©'

+ Add Organization

Organization City©'

Organization State or Territory © *

Organization Zip ©"

Return to Bus Information Page

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

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2.8 Complete Organizations

Once you have added all your organizations, click "Next" to continue.

If you are returning to this page from the "Bus Information" page, click the "Return to Bus Information Page"
button to continue your application. If not, click "Next" to continue.

Clean School Bus Rebate Forms

• Clean School Bus Rebate Program

= Dashboard I Helpdesk

eben.bathalon@erg.ci

Edit Your Payment Request

^ Rebate ID:023468

^^oflO Organizations

This page is for adding organization information for existing buses, new buses, private fleets and infrastructure. Organizations that you entered in your application are already
included on this page, so you can update existing organizations or enter new organizations below. For each organization that you add by selecting the "+Add Organization"
blue box, you'll need to first select the organization type(s) and then enter the name, contact and address information for the organization. Information for each organization
only needs to be entered once, even if the organization applies to multiple buses or infrastructure, or multiple organization types. It is strongly recommended that you add
all the organizations that are associated with this rebate at this time to avoid having to return to this page later. The following organization types need to be entered on
this screen:

•	Existing Bus Owner: All existing bus owners. If the existing bus owner is the applicant, the school district that the new buses will serve, or a private fleet entered in your
application, then you do not have to enter existing bus owner information as it's already included within this form.

•	New Bus Owner: All the planned new bus owners (e.g. district, nonprofit, private fleet, tribes). If the new bus owner will be the applicant, the school district that the new
buses will serve, or the private fleet entered in your application, then you do not have to enter new bus owner information as it's already included within this form.

•	Private Fleet (existing or new buses): Any private fleet for existing or planned new buses that is not the applicant needs to be entered here unless you already entered
the private fleet(s) in your application. Applicants may list multiple private fleets here or in the application.

•	New Bus Dealer: The vendor or dealer that the planned new bus owner will purchase the bus from needs to be identified.

•	Infrastructure Owner (electric bus charging): All infrastructure owners (e.g. school district, private fleet) of the electric bus charging equipment needs to be identified. If
the infrastructure owner is the applicant, the school district that the new buses will serve, or a private fleet entered in your application, then you do not have to enter new
bus owner information as it's already included within this form.

•	Infrastructure Supplier (charging equipment only): All infrastructure suppliers from which charging equipment was purchased (includes the installer of the
infrastructure charging equipment when they are also the charging equipment supplier).

•	Other Infrastructure Organization: All other eligible Infrastructure organizations (e.g., performing trenching and wiring, project management, but excluding charger
installer when the charger is installed by the infrastructure charging equipment supplier).

On the bus and infrastructure (if applicable) pages you will be selecting organizations you entered here or in your application for each bus and infrastructure owner, supplier,
or organization.

' denotes required field

Organizations

Org. Name: Fleets 'R' Us

Type: Private Fleet

Contact Name: Paul Wethers

Address: 324 South St., Boston Massachusetts

Organization

Org. Name: Bus Owners Inc.

Type: Existing Bus Owner, New Bus Owner

Contact Name: Kevin Smith

Address: 1324 Main St., Boston Massachusetts

+ Add Organization

Return to Bus Information Page

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

EEk

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2.9 Documents

The "Order Documents" part of the form is where you will enter a description of and upload Order Documents
(purchase orders, sales orders, and/or quotes). Click the "+ Add Document" button to add an order document.
If you need to add missing information on order documents that you already entered, click the "Edit" button.

Edit Your Payment Request

% Rebate ID: 023468

^^oflO Documents

On this page you will need to enter a description of and upload Order Documents that could include purchase orders, sales orders or quotes. Refer to the 2023 Clean School Bus Rebates
Program Guide, and the Questions and Answers: 2023 Clean School Bus (CSB'l Rebate Program documents for more information on requirements for Order Documents.

' denotes required field

Order Documents

Document Name: Bus Order Doc

1 Note: Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cras dignissim

a sapien sit amet iaculis.

Type: Order Document
Purpose: New Bus

Document

Name: Infrastructure Order Doc

Note: Vivamus ut risus dignissim, eleifend ligula sit amet, aliquam metus.
Nam fringilla suscipit risus, ultrices egestas dui. In interdum libero scelerisque
nunc vehicula imperdiet.

Type: Order Document

Purpose: Electric Bus Charging Equipment, Other Infrastructure Installation
Costs

HhAdd Document

Return to Organizations Page

Return to Bus Information Page

Return to Infrastructure Page

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

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2.10 Add Documents

To add Order Documents, click the "+ Add Document" button. Order Documents could include purchase
orders, sales orders, or quotes; they contain the information and specifications for bus and/or electric bus
charging infrastructure procured from a single vendor. Multiple Order Documents can be added on this
screen for additional vendors, for additional buses, or for electric bus charging infrastructure. Enter the
Order Document name and check the boxes for all applicable document purposes. If you would like, add a
description of the Order Document to keep track of which documents have been added. You must also select
the associated purchaser and vendor from the dropdown menus. The dropdown menus are filled with the
organizations that you added previously. If you do not see the purchaser or vendor organization you need to
select in the dropdown, click the "Return to Organizations Page" link at the bottom of this screen to enter the
missing organization. Lastly, upload a PDF or image of your Order Documents. The file size must be between 1
KB and 5 MB. Accepted file types include .pdf, .png, .jpeg, and .jpg. When ail fields have been entered, click
the "Complete" button for the purchase order. Note that this button does not save your form: you must
click "Save" or "Next" to save your information.

Add additional Order Documents by selecting "+ Add a Document" at the bottom of the screen. You may add
as many Order Documents as you need and delete or edit them at any time. Deleting an Order Document is
permanent, so please do not do so unless you are sure it's necessary. You must click the "Complete" button at
the bottom of the order document before moving on.

You can use the "Cancel" button to revert back to the previously saved order document if changes were made
(and the "Complete" button was not clicked), or to review what you entered for a saved order document.

Order Document Information

Order Document Name©'

Order Document Description ©

| New Bus OD

Document Purpose (Choose all that apply)' ©

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do
eiusmod tempor incididunt ut labore et dolore magna aliqua.

Qj New Bus

( ) Electric Bus Charging Equipment

I | Other Infrastructure Installation Costs

Associated Purchaser"

| Org. Name: Existing Bus Owner Group Inc. | Org. Type: undefined | Contact Name: Shawn Price x ~

Associated Vendor'

| Org. Name: Other Infra Org. | Org. Type: undefined Contact Name: Darryl Paulson * ~

Document Upload ©'

File Name Size

X CSB-Pass.pdf 24.57 kB

Allowed frletypes: '.pdf, ".png, '.jpeg, ".jpg
Minimum file size: 1KB
Maximum file size: 5MB

Name: Charger OD

Note: Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do
eiusmod tempor incididunt ut labore et dolore magna aliqua.

Type: Order Document
Purpose: Electric Bus Charging Equipment

Name: Other Infra OD

Note: Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do
eiusmod tempor incididunt ut labore et dolore magna aliqua.

Type: Order Document

Purpose: Other Infrastructure Installation Costs

-------
2.11 Complete Order Documents

Once you have added all your documents, click "Next" to continue.

If you are returning to this page from the "Bus Information" page, click the "Return to Bus Information Page"
button to continue your application. If not, click "Next" to continue.

Clean School Bus Rebate Forms

> Online Rebate Application Information

eben.bathalon@erg.com

Edit Your Payment Request

^ Rebate ID: 023468

JjyoflO Documents

On this page you will need to enter a description of and upload Order Documents that could include purchase orders, sales orders or quotes. Refer to the 2023 Clean School Bus Rebates
Program Guide, and the Questions and Answers: 2023 Clean School Bus (CSB1 Rebate Program documents for more information on requirements for Order Documents.

' denotes required field

Order Documents

Name: Bus Order Doc

Note: Lorem ipsum dolor sit amet, consecteturadipiscingelit. Crasdignissim
a sapien sit amet iaculis.

Type: Order Document
Purpose: New Bus

Name: Infrastructure Order Doc

Note: Vivamus ut risus dignissim, eleifend ligula sit amet, aliquam metus.
Nam fringilla suscipit risus, ultrices egestas dui. In interdum libera scelerisque
nunc vehicula imperdiet.

Type: Order Document

Purpose: Electric Bus Charging Equipment, Other Infrastructure Installation
Costs

Return to Organizations Page

Return to Bus Information Page

Return to Infrastructure Page

Q NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

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2.12 New Bus Information

Click "Edit" to complete the required bus information for each bus from your application. If there is a red box
with a circle icon that says "Bus Information Incomplete" next to a bus, you must click on the "Edit" button
and complete all of the required fields. If there is a yellow box with a triangle icon that says "Bus Excluded"
next to a bus, this indicates that you checked the "Exclude Bus" box. If you did not intend to exclude that bus,
you must click on the "Edit" button and uncheck the "Exclude Bus" box.

Edit Your Payment Request

^ Rebate ID: 023468

^JoflO Buses

On this page you'll see information you entered in your application form for existing and new buses. You'll need to enter additional new bus information on this page. The existing bus
information from the application form is not editable; however, if you need to swap another existing bus for one already entered, you can do that here. You may also exclude a bus that you
included in your application form; however, do not exclude a bus if you want to replace it with a different existing bus; chose "Swap Existing Bus" instead.

You will need the following information to complete the new bus fields on this page:

•	New bus Owner

•	Which Order Document corresponds to the new bus

•	New Bus Fuel Type (if your swapping an existing bus for another existing bus)

•	New Bus GVWR from Order Document

•	Whether Replacement Bus will be Equipped With an ADA-Compliant Wheelchair Lift

•	New bus Estimated Delivery Date

•	New Bus Manufacturer

•	New Bus Model

•	New Bus Model Year

•	New Bus EPA Vehicle Family

•	Information on whether bus is Capable of Bidirectional Charging

•	Whether the bus is Equipped With an Auxiliary Heater

•	The Auxiliary Heater Fuel Type (if bus will be equipped)

•	New Bus Purchase Price

•	The Americans with Disabilities Act (ADA) Compliance Costs

•	The bus Shipping Costs (if applicable)

If you swap another existing bus for one already entered, you'll need the following information:

•	The reason for the swap

•	All the same documentation that was required in the application form including the bus title.

' denotes required field

Bus Information

Existing Bus VIN: 12345678912346578	Q ,„formatjon lntomplete

Existing Bus Fuel Type: Diesel	I click the "Edit" button far this rc

New Bus Fuel Type: Propane	I complete all required fields.

Existing Bus VIN: 12345679898765435
Existing Bus Fuel Type: Propane
New Bus Fuel Type: Electric

A Bus Excluded

This bus has been selected to be
excluded from the rebate.

Existing Bus VIN: 32165498754621321
Existing Bus Fuel Type: CNG
New Bus Fuel Type: Electric

New Bus GVWR: 30,000 lbs

New Bus Rebate Amount: $345,000

New Bus Purchase Price: S450.000.01

Return to Organization Entry

Return to Document Entry

Bus Costs and Rebate Summary

Number of Buses Requested from
Application

Number of Buses Ordered from Payment
Request

Total Replacement Bus and Infrastructure Rebate Amount Requested 0
$375,000.00

Total Shipping Rebate Requested
$40,000.00

Total ADA Rebate Requested
$20,000.00

Total Eligible Rebate for Shipping Costs
$35,784.25

Total Eligible Rebate for ADA Costs
$17,852.05

Total Shipping Cost Responsibility
$5,421.02

Total ADA Cost Responsibility
$0.00

EEk

-------
2.13 Add New Bus Information —Existing Bus Information

The data fields associated with old buses are shown in the list below, with required fields marked with
asterisks. Enter the required information, then click "Complete."

Existing Bus Information

Existing Bus Owner©

~ Swap Existing Bus © Q Exclude Bus ©

Org Name: Bus Fleet Org. | Contact Name: Paul Gagne

Existing Bus VIN ©
12345678903333333

Existing Bus Fuel Type ©

Diesel

Existing Bus GVWR ©
34,250

o
o

Existing Bus Odometer©
350,000

Existing Bus Model ©
Standard

Existing Bus Model Year ©
lbs 2012

Existing Bus NCES District ID ©
0200180

Existing Bus Manufacturer©

Lion Electric Company

Existing Bus Manufacturer (Other) ©

1. See information on excluding a bus in Section 2.15. If a bus is to be excluded, entering the remaining
bus information fields for this bus is not needed.

2. See information on swapping another existing bus for one you entered in your application in
Section 2.16.

3. The Existing Bus Owner field is prepopulated from the information in the application and is not
editable. If swapping existing buses, you will be able to select the existing bus owner from the
dropdown. If dropdown does not list the existing bus owner, go back to the "Organizations" screen to
enter the existing bus owner's organization.

4. The Existing Bus VIN is prepopulated from the information in the application and is not editable. If
swapping existing buses, enter the 17-digit Vehicle Identification Number (VIN) of the existing bus to be
replaced.

5. Existing Bus FuelType is prepopulated from the information in the application and is not editable. If
swapping existing buses, select the fuel type of the existing bus to be replaced.

6. Existing Bus GVWR is prepopulated from the information in the application and is not editable. If
swapping existing buses, enter the estimated gross vehicle weight rating (GVWR) for the existing bus
to be replaced.

7. Existing Bus Odometer is prepopulated from the information in the application and is not editable. If
swapping existing buses, enter the odometer reading of the existing bus to be replaced. If the exact
reading is unknown, provide an estimate.

8. Existing Bus Model is prepopulated from the information in the application and is not editable. If
swapping existing buses, enter the model name of the existing bus to be replaced.

9. Existing Bus ModelYear is prepopulated from the information in the application and is not editable. If
swapping existing buses, enter the model year of the existing bus to be replaced.

-------
Existing Bus GVWR © Existing Bus Model Year O IM Existing Bus Manufacturer (Other)©

34,250 lbs 2012

Existing Bus VIN 0 Existing Bus Odometer 0 © Existing Bus NCES District ID 0

12345678903333333 35Q 0Q0 mj 0200180

Existing Bus Fuel Type© Existing Bus Model© Existing Bus Manufacturer©

Diesel Standard '~'on ^'ectr'c Company

0 Existing Bus Average Annual Fuel Consumption 0 0

6,815 gal

Existing Bus Average Annual Mileage 0 0

Existing Bus Annual Idling Hours 0

32,000 mi 2,154

10. Existing Bus NCES District ID is prepopulated from the information in the application and is not
editable. If swapping existing buses, enter the seven-character MCES District IC for the school district
the existing bus primarily served during the 2022-2023 school year. EPA strongly encourages third-
party applicants to replace existing buses that provided service to the public school district listed on
the application, or another school district eligible for priority consideration, as listed in the Prioritized
School Districts list found on the ?023 CSB Rebates webpaae. if the school district listed on the
application was eligible for priority consideration.

11. Existing Bus Manufacturer is prepopulated from the information in the application and is not editable.
If swapping existing buses, select the manufacturer's name of the existing bus to be replaced.

12. Existing Bus Manufacturer (Other) is prepopulated from the information in the application and is
not editable. If swapping existing buses, and the Existing Bus Manufacturer is "Other," enter the
manufacturer name of the existing bus that will be replaced if it doesn't appear in the selection.

13. Existing Bus Average Annual Fuel Consumption is prepopulated from the information in the
application and is not editable. If swapping existing buses, enter the estimated average annual fuel
consumption of the existing bus to be replaced.

14. Existing Bus Average Annual Mileage is prepopulated from the information in the application and is
not editable. If swapping existing buses, enter the estimated remaining mileage of the existing bus to
be replaced.

15. Estimated Remaining Life is prepopulated from the information in the application and is not editable.
If swapping existing buses, enter the estimated average annual service life (in years) for the existing
bus to be replaced.

16. Existing Bus Annual Idling Hours is prepopulated from the information in the application and is not
editable. If swapping existing buses, enter the estimated annual idling hours for the existing bus to be
replaced.

-------
2.14 Add New Bus Information —New Bus Information

The data fields associated with new buses are shown in the list below, with required data fields marked with
asterisks. Enter the required information then click "Complete."

New Bus Information

New Bus Owner© HvS Bus and Infrastructure Rebate Amount

Requested 0

Org Name: EBEN BATHALON No ETFi (2). | Contact Name: Mike Smith

$265,000.00

This field is mandatory to complete the Payment Request Form but is not
required to complete and save the bus information. New Bus Purchase Price © '

$234,324.00

Order Document Listing New Bus ©

Doc Name: sdfsd | Doc Description: sdfsd

This field is mandatory to complete the Payment Request Form but is not
required to complete and save the bus information.

New Bus Dealer©

EBEN BATHALON INC.

1. New Bus Owner is the name of the Organization that will own the new bus listed in the New Bus
fields below. If the organization does not appear in the dropdown, complete the listed steps in the help
text for New Bus Owner to add the Organization.

2. Order Document Listing New Bus is the order document for the new bus listed in the fields in this
section. If the document does not appear in the dropdown, complete the listed steps in the help text
for Order Document Listing New Bus to add the Document.

3. Bus and Infrastructure Rebate Amount Requested is automatically filled based on New Bus Fuel
Type, New Bus GVWR, and prioritization status of school district per the 2023 Clean School Bus
Rebates Program Guide. If this is a propane or CNG replacement bus, this value is only for a bus
rebate, as a rebate is not offered for infrastructure costs for CNG and propane buses.

Note: If you are swapping out an existing bus from what you entered in your application, the amount
of the rebate requested for this bus cannot exceed (but can be less than) what was in your application
form.

4. New Bus Purchase Price* is the purchase price of the ordered replacement school bus, including tax
and any eligible training/consulting/warranty line-item expenses associated with the individual bus in
the order document. Do not include charging infrastructure costs here.

5. New Bus Dealer is populated from the information provided on the "Documents" page. If it's
incorrect, you will need to go back to the "Documents" page and edit the Order Document listed
in the "Order Document Listing New Bus" field. Follow the steps in the help text for the "Order
Document Listing New Bus" field to avoid losing information you have already entered.

-------
o
o

New Bus Fuel Type ©

Electric

New Bus GVWR0 A

The GVWR you entered is for
a Class 3 thru 6 replacement
bus. Class 7+ replacement
buses receive a higher rebate
than eligible Class 3 thru 6
buses. If you entered a Class
3 thru 6 bus in error, update
your GVWR.

0
©
0

New Bus Manufacturer©"

New Bus Manufacturer (Other) 0 "

New Bus Model© *

| Replacement Bus Equipped with ADA-
Compliant Wheelchair Lift ©

Other

New Bus Model Year ©*

2024

New Bus EPA Vehicle Family© '

23423423433

Capable of Bidirectional Charging? © *

New Bus Delivery Date © "

05/01/2024

Yes

Planning to Use Bidirectional Charging
for This Bus?

Shipping Cost Rebate Requested ©
$20,000.00

Bus Shipping Costs © '

$5,423.00

Eligible Bus Shipping Rebate ©
$5,423.00

Shipping Cost Responsibility ©

$0.00

ADA-Compliance Rebate Requested ©
$20,000.00

ADA-Compliance Costs © *

$23,423.00

Eligible ADA-Compliance Rebate ©
$20,000.00

6. New Bus Fuel Type is prepopulated from the information in the application and is not editable unless
you are swapping an existing bus to be replaced for a different one. If swapping a bus, fuel types that
can be chosen for new replacement buses may be limited based on the vehicle model year and fuel
type entered for the existing bus to be replaced. See Section 3 of the 2023 Clean School Bus
Rebates Program Guide for bus eligibility requirements.

7. New Bus GVWR* is for the bus gross vehicle weight rating in pounds and is editable but prepopulated
from your application. The form will provide a notice if a value entered warrants a lower rebate value.
This could happen if the rebate application had a GVWR over 26,000 pounds for this bus, but the bus's
GVWR is actually 26,000 pounds or less.

8. New Bus Delivery Date* is the date on which the bus is expected to be delivered. It is entered in the
format MM/DD/YYYY

9. New Bus Manufacturer* provides a list of bus manufacturers to choose from. If the manufacturer of
your new bus is not shown, choose the "Other" option and an additional field will appear allowing you
to enter the manufacturer of your new bus.

10. The New Bus Manufacturer (Other)* field will only appear if you choose "Other" in the New Bus
Manufacturer field. Enter the name of the manufacturer for your new bus.

11. New Bus Model* is the model name (not the bus type) of the new bus.

12. New Bus Model Year* is the manufacturing year of the new bus, which must be 2022 or later.

13. New Bus EPA Vehicle Family* is the 12-character alphanumeric EPA Vehicle Family, or 10- to
12-character CARB Executive Order ID. The EPA Vehicle Family can be found on the Vehicle Emission
Control Information (VECI) label, which is usually on or near a door pillar or on the engine compartment
sheet metal. If the bus is not an EPA-certified vehicle, enter the CARB Executive Order ID. If the
vehicle does not have EPA or CARB certification, contact the CSB helpdesk (cleanschoolbus@epa.aov).

-------
The GVWR you entered is for
a Class 3 thru 6 replacement
bus. Class 7+ replacement
buses receive a higher rebate
than eligible Class 3 thru 6
buses. If you entered a Class
3 thru 6 bus in error, update
your GVWR.

| Replacement Bus Equipped with ADA-
Compliant Wheelchair Lift 0

New Bus Model©'

New Bus Model Year © '

New Bus EPA Vehicle Family© '

23423423433

New Bus Delivery Date © *

05/01/2024

Capable of Bidirectional Charging? © *

^ Planning to Use Bidirectional Charging
for This Bus?

Equipped with Auxiliary Heater? © "

Yes

Auxiliary Heater Fuel Type © *

Other

Auxiliary Heater Fuel Type (Other) © *

Wood

Eligible Bus Shipping Rebate ©
$5,423.00

Shipping Cost Responsibility ©

$0.00

ADA-Compliance Rebate Requested ©
$20,000.00

ADA-Compliance Costs©'

$23,423.00

Eligible ADA-Compliance Rebate ©
$20,000.00

ADA Cost Responsibility ©
$3,423.00

Total Rebate Amount Requested ©
$290,423.00

14. Capable of Bidirectional Charging?* Indicate if the bus has the bidirectional charging feature. Choose
"Yes" if the bus is capable of two-way energy flow (e.g., grid-to-vehicle when the bus EV battery is
charged by the electrical grid, vehicle-to-grid when the bus EV battery can also supply energy to the
electrical grid). Choose "No" if the bus can only receive energy and be charged by the electrical grid
(grid-to-vehicle).

15. Planning to Use Bidirectional Charging for This Bus? if the bus is bidirectional charging capable, and
you are planning to use that feature, check this box.

16. Equipped with Auxiliary Heater?* Indicate if an auxiliary heater has been equipped on this bus.

17. In the Auxiliary Heater Fuel Type* field, choose the auxiliary heater fuel type from the dropdown
menu. If the auxiliary heater fuel type is not listed, choose "Other" and enter the type in the "Auxiliary
Heater Fuel Type (Other)" field.

18. In the Auxiliary Heater Fuel Type (Other)* field, enter the auxiliary heater fuel type.

19. Shipping Cost Rebate Requested is automatically populated with a value of $20,000 if the school
district that the buses will serve for the next five years is in an area where the Clean School Bus
Program offers a rebate for shipping costs of this new bus.

20. In the Bus Shipping Costs* field, enter the actual anticipated shipping costs for this bus based on the
order document associated with this bus.

£3

| Replacement Bus Equipped with ADA-
Compliant Wheelchair Lift 0

New Bus Delivery Date 0 '

05/01/2024

New Bus Model O'

New Bus Model Year 0 *

2024

New Bus EPA Vehicle Family O "
23423423433

Capable of Bidirectional Charging? 0 '

Q Planning to Use Bidirectional Charg!
for This Bus?

Equipped with Auxiliary Heater? 0 '

Yes

Auxiliary Heater Fuel Type 0 *

Other

Eligible Bus Shipping Rebate 0
$5,423.00

Shipping Cost Responsibility 0
$0.00

ADA-Compliance Rebate Requested 0
$20,000.00

ADA-Compliance Costs O'
| $23,423.00

Eligible ADA-Compliance Rebate 0
$20,000.00

ADA Cost Responsibility 0
$3,423.00

Total Rebate Amount Requested 0
$290,423.00

Auxiliary Heater Fuel Type (Other) 0 *

Wood

21. The Eligible Bus Shipping Rebate field is read-only and displays the bus shipping rebate this bus is
eligible for based on the bus shipping costs entered. If these costs are more than the shipping cost
rebate requested, then the bus is eligible for the shipping cost rebate requested amount of $20,000.
If the bus shipping costs are less than the shipping cost rebate requested, the bus is eligible for the
amount entered in the "Bus Shipping Costs" field.

22 The Shipping Cost Responsibility field is read-only and is calculated based on the cost of this bus.
This is the amount that exceeds the rebate, i.e. the amount the applicant will be responsible to pay for.

23 The ADA-Compliance Rebate Requested field is automatically populated with a value of $20,000
when the box is checked in the "Replacement Bus Equipped with ADA-Compliant Wheelchair
Lift" field. This is the maximum rebate you can receive for a bus equipped with an ADA-compliant
wheelchair lift.

24. In the ADA-Compliance Costs* field, enter the purchase price listed in the order document for
equipping this bus with an ADA-compliant wheelchair lift.

25 The Eligible ADA-Compliance Rebate field is the ADA-compliant rebate this bus is eligible for
based on the ADA-compliance costs entered. If the ADA-compliance costs are more than the ADA-
compliance rebate requested, the bus is eligible for the ADA-compliance rebate requested amount of
$20,000. If the ADA-compliance costs are less than the ADA-compliance rebate requested, the bus is
eligible for the amount entered in the "ADA-Compliance Costs" field.

26. The ADA Cost Responsibility field is read-only, calculated based on the cost of the ADA-Compliant
Wheelchair Lift that exceeds $20,000 (the maximum available for the wheelchair lift). It is the amount
the applicant will be responsible for paying for that exceeds the rebate.

27. Total Rebate Amount Requested is the sum of the replacement bus and infrastructure rebate amount
requested, the eligible bus shipping rebate (if applicable), and the eligible ADA-compliance rebate (if
applicable).

-------
2.15 Exclude a Bus

If a bus that was previously entered in the rebate application will not be included in your payment request
form, you can check the "Exclude Bus" box at the upper right of the Existing Bus Information screen. No
further information will be required for this bus, and the costs and awards for this bus and any associated
electric charging infrastructure will not be included in totals presented elsewhere on the form.

Note: If you select the "Exclude Bus" checkbox by mistake, simply uncheck it to restore information you
submitted in the application for existing and new buses. Unchecking the box also restores the option to swap
this existing bus rather than excluding it.

Bus#©

Existing Bus Information

Q Exclude Bus ©

Existing Bus VINO
12345679898765435

Existing Bus Fuel Type ©

Propane

Existing Bus GVWR ©
35,000

Existing Bus Odometer ©
250,000

Existing Bus Model ©
Yellow

Existing Bus Model Year ©
lbs	2000

Existing Bus NCES District ID ©
7898654

Existing Bus Manufacturer©

Blue Bird Corporation

Existing Bus Manufacturer (Other) ©

Complete

O Bus Excluded From Rebate

This bus will be excluded from rebate, and is listed for historical informational purposes only.

-------
2.16 Swap a Bus

If you choose to swap out an existing bus for a different existing bus, you will need to choose the existing bus
owner from the dropdown list. If you don't see the owner, click "Return to Organization Entry" to add them;
you will then need to choose a reason for swapping the existing bus from the dropdown menu. If you select
"Other," you will need to provide a reason for swapping out the existing bus. Then you will need to complete
all of the fields relevant to the existing bus information. Lastly, you will need to complete the new bus
information as described in Section 2.14.

Note: At this stage, the rebate amount allocated for this new bus cannot be increased beyond the initial rebate
allocation from the selected application. The rebate amount can still decrease if the new bus fuel type or
GVWR changes would be eligible for a smaller rebate.

Note: If you select the "Swap Existing Bus" checkbox by mistake, simply uncheck it to restore information
you submitted in the application for existing and new buses. Unchecking the box also restores the option to
exclude this existing bus rather than swapping it.

Existing Bus Information

Q Swap Existing Bus ©

Reason for Swapping Old Bus ' Reason for Swapping Old Bus (Other) © '

Other

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WVWMW I/WWWWVW VVVWW VWV WWWVW WN^/VV WVW4W WWWWWV r

primis in faucibusorci luctus et ultrices posuere cubilia curae; Proin at rutrum ipsum.

WWVW VWVWAAAWWWWWW VWVWW VSAAA/WW UVWWVk WWW'WWW WWWW 1

72 characters remaining.

Existing Bus Owner ©

Org Name: Fleets 'R' Us | Contact Name: Paul Wethers

This field is mandatory to complete the Payment Request Form but is not required to complete and save the bus information.

Existing Bus VIN © *

12343252643456233

0 characters remaining.
Existing Bus Fuel Type © "

Diesel

Existing Bus GVWR © '
30,000

Existing Bus Odometer © '

300,000

Existing Bus Model © '

Existing Bus Model Year© '

Existing Bus NCES District ID © "

Existing Bus Manufacturer © "

Lion Electric Company

Existing Bus Average Annual Fuel Consumption © *

Estimated Remaining Life©"

Existing Bus Average Annual Mileage © '

Existing Bus Annual Idling Hours © *

20,000

Existing Bus Title© '

File Name

X CSB-Pass.pdf 24.57 kB

Allowed file types: *.pdf, *.png, *.jpeg, \jpg
Minimum file size: 1KB
Maximum file size: 5MB

-------
2.17 Complete Bus Information

Once the information has been entered completely for the buses, the fields at the bottom of the page will
calculate totals based on this information. This information includes the total number of buses from the
application and the number ordered, in case any buses are excluded. The total rebate requested amount for all
buses, shipping, or ADA-compliant wheelchair lift, and the total eligible rebate and applicant cost responsibility
for shipping and ADA-compliant wheelchair lifts are also presented. Please review the prepopulated bus cost
total fields listed below before clicking "Next" to continue.

Bus Costs and Rebate Summary

Number of Buses Requested from
Application

Number of Buses Ordered from Payment
Request

Total Replacement Bus and Infrastructure Rebate Amount Requested G
$375,000.00

O
©

Total Shipping Rebate Requested
$40,000.00

Total Eligible Rebate for Shipping Co:
$35,784.25

Total Shipping Cost Responsibility
$5,421.02

o
o

Total ADA Rebate Requested
$20,000.00

Total Eligible Rebate for ADA Costs
$17,852.05

Total ADA Cost Responsibility
$0.00

1. The Number of Buses Requested from Application field is prepopulated from the information in your
rebate application.

2. The Number of Buses Ordered field is prepopulated from the information in your payment request
form.

3. The Total Replacement Bus and Infrastructure Rebate Amount Requested field is the sum of all

requested replacement buses. This includes the replacement bus and infrastructure rebate amount
requested, but not any shipping or ADA-compliant rebate.

4. The Total Shipping Rebate Requested field is read-only and displays the sum of the shipping rebate
requested for all buses.

5. The Total Eligible Rebate for Shipping Costs field is read-only and displays the sum of all eligible
rebates for shipping costs for all buses.

6. The Total Shipping Cost Responsibility field is read-only and displays the sum of all shipping cost
responsibility for all buses.

7. The Total ADA Rebate Requested field is read-only and displays the sum of all ADA-compliant rebates
requested for all buses.

8. The Total Eligible Rebate for ADA Costs field is read-only and displays the sum of all eligible rebates
for ADA-compliant costs for all buses.

9. The Total ADA Cost Responsibility field is read-only and displays the sum of ADA-compliant cost
responsibility for all buses.

-------
2.18 Infrastructure Information

Read the introductory information on this screen to make sure you have all the information needed to
complete this screen. Click "+ Add Infrastructure" to add information for EVSE (electric vehicle supply
equipment) or other eligible infrastructure costs purchased.

Clean School Bus Rebate Forms

•	Clean School Bus Rebate Program

•	Online Rebate Application Information

eben.bathalon@erg.com I

Edit Your Payment Request

% Rebate ID: 023468

Oof

10 Infrastructure

Since you are planning to replace an existing bus(es) with an electric bus(es), enter information about the chargers and other eligible rebate infrastructure costs on this page. The acronym
EVSE appears on this page, and it stands for electric vehicle supply equipment (charger).

You will need the following information to complete the fields on the page:

•	Type and number of charger(s) to be installed (Level 2 or DC Fast Charger)

•	Other costs that are eligible for infrastructure rebate funds

•	EVSE output power, manufacturer, model, date of manufacture, number of plugs, capability for bidirectional charging, Energy Star compliance (Level 2 chargers), and Buy America
compliance

•	Infrastructure type for other infrastructure that doesn't include the charger(s)

•	Description of work for other eligible infrastructure besides the charger(s)

•	Cost per charger and whether the charger cost includes installation

•	Order Document associated with each charger and other eligible infrastructure costs

•	Infrastructure Owner for each charger, materials installed, or work performed

•	Installation/Construction address including street, city, state, zip and county

' denotes required field

Infrastructure Information

Enter information for each type of EVSE that was purchased. Enter the cost of installation and any necessary electrical/construction work separately. If you don't have a breakdown of
installation and EVSE cost, enter the full amount in the EVSE cost field.

+ Add Infrastructure

Return to Organization Entry

Return to Document Entry

Infrastructure Totals

Level 2 Charger Costs ©

DC Fast Charger Costs 0

Other Infrastructure Costs © $0.00

Total of All Eligible Charging Infrastructure Costs© $0.00

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

-------
2.19 Add Infrastructure - Level 2 / DC Fast Chargers

Note: You only have to complete the "Infrastructure Information" section for electric buses. Choose the
infrastructure type by using the dropdown menu. The data fields associated with Level 2 and DC fast chargers
are described below, with required fields marked with asterisks.

Infrastructure Information

Infrastructure Type G'

Level 2 Charger

x ~

EVSE Maximum Output Power (kW) © '

EVSE Manufacturer© *

Blink

x ~

EVSE Model©*

XLT34

EVSE Date of Manufacture *

05/23/2024

Number of Plugs on EVSE © '

Q EVSE Capable of Bidirectional Charging? ©

Infrastructure Quantity©'

Infrastructure Cost per Charger© '

$3,242.00

Infrastructure Subtotal
$16,210.00

Q Cost Includes Installation ©

Order Document Listing Infrastructure ©

Doc Name: Order document | Doc Description: Lorem i...

This field is mandatory to complete the Payment
Request Form but is not required to complete and
save the infrastructure information.

1. The Infrastructure Type* field requires you to choose the charging infrastructure type from the
dropdown menu. You must add all charging infrastructure that has been purchased with rebate funds.
"Level 2 Charger" and "DC Fast Charger" refer to the actual chargers and pedestals. Other eligible
infrastructure costs include construction, electrical work, site preparation, design and engineering,
labor and permitting, etc.

Note: If the cost of the chargers and pedestals includes installation, then include those costs along
with the charger information.

2. The EVSE Maximum Output Power (kW)* field requires you to enter the rated maximum output
power of the charger (in kilowatts). The kilowatts for a Level 2 charger should not be higher than 20. For
a DC fast charger, the kilowatts should not be less than 20.

3. Choose the EVSE Manufacturer* from the dropdown list. If the manufacturer is not listed, Choose
"Other" and enter the manufacturer in the EVSE Manufacturer (Other) field below.

4. The EVSE Model* field is for the model name of the charger. If it is a Level 2 charger, enter the model
name listed on the Energy Star certification.

5. Enter the EVSE Date of Manufacture* listed on the charger or order documents.

6. The Number of Plugs on EVSE* field is for the number of plugs on each charger.

7. EVSE Capable of Bidirectional Charging? Check this box if the charger is capable of bidirectional
charging (i.e., the EVSE can both receive energy and provide energy to an external load—as in the case
of vehicle-to-grid charging, which supplies energy back to the electrical grid).

-------
EVSE Maximum Output Power (kW) 0 "

EVSE Manufacturer© *

Blink

EVSE Model 0 '

EVSE Date of Manufacture *

05/23/2024

Number of Plugs on EVSE 0 *

O
d
©

Q EVSE Capable of Bidirectional Charging? 0
~ Planning to Use Bidirectional Charging?
Q This Charger Is Energy Star Compliant 0 *

| This Charger or Infrastructure Materials Is Buy America
Compliant© *

Infrastructure Quantity ©"

Infrastructure Cost per Charger © *

$3,242.00

Infrastructure Subtotal
$16,210.00

Q Cost Includes Installation ©

Order Document Listing Infrastructure ©

Doc Name: Order document | Doc Description: Lorem i...

This field is mandatory to complete the Payment
Request Form but is not required to complete and
save the infrastructure information.

Infrastructure Vendor

EBEN BATHALON INC.

8. Planning to Use Bidirectional Charging? Check this box if you intend to use the bidirectional
charging feature.

9. This Charger Is Energy Star Compliant* is only applicable to Level 2 chargers and should be checked
as all Level 2 chargers are required to be Energy Star compliant. If the charger you are planning to use
is not Energy Star compliant, then it is not eligible for a rebate under the Clean School Bus Rebate
Program.

10. This Charger or Infrastructure Materials Is Buy America Compliant* See 2023 Clean School

Bus Rebates Program Guide's terms and conditions for information on Build America, Buy America
requirements. If you plan to utilize a general waiver or project specific waiver to avoid compliance with
Build America, Buy America requirements, then you can leave this unchecked; however, it must be
justified on the Build America, Buy America screen of this form.

11. The Infrastructure Quantity* field requires you to enter the number of chargers purchased at the
same price. If multiple types of chargers were purchased, each type must be entered individually.
Additionally, if multiple chargers of the same type were purchased at different costs, the chargers need
to be entered as separate infrastructure items.

12. Enter the unit cost in the Infrastructure Cost per Charger* field.

13 The Infrastructure Subtotal field is read-only and displays the subtotal for each infrastructure line
item.

14. Check the Cost Includes Installation box if the cost listed in the "Infrastructure Cost per Charger"
field includes installation.

15. Select the Order Document Listing Infrastructure from the purchase order, sales order, or approved
quote that has been entered on the Order Document page and lists this infrastructure to be purchased.
If the order document for this infrastructure is not listed in the dropdown, complete the remainder of
the fields for this infrastructure item and click the "Return to Document Entry" button.

-------
| | Planning to Use Bidirectional Charging? Infrastructure Vendor

Q This Charger Is Energy Star Compliant © *

3 This Charger or Infrastructure Materials Is Buy America
Compliant© *

Infrastructure Owner ©

EBEN BATHALON INC.

Org Name: EBEN BATHALON INC. | Contact Name: Mike Smith

This field is mandatory to complete the Payment Request Form but is not required to complete and save the infrastructure
information.

Installation/Construction Address

Street Address©

23 North St.

City©

Anchorage

County©'

State or Territory ©"

Rockland

Alaska

Zip©'

16. The Infrastructure Vendor is prepopulated based on the document selected. If you need to change the
infrastructure vendor, select "Return to Document Entry" and update the Order Document information,

17. Select the Infrastructure Owner from the dropdown menu. If you don't see the owner, complete the
"Installation/Construction Address" fields, click the "Complete" and "Save" buttons, and then click
"Back to Organization Entry" to add them.

18. The Street Address field is for the street address where the charger(s) or other eligible infrastructure
will be installed. Once the first infrastructure line item has been added, this field will be pre-filied to
match, but still editable.

19. The City field is the city where the infrastructure (charger and other eligible infrastructure) will be
installed or performed. Once the first infrastructure line item has been added, this field will be pre-fi I led
to match, but still editable.

20. The State or Territory* field is the state or territory from the dropdown list. Once the first
infrastructure line item has been added, this field will be pre-fi I led to match, but still editable.

21. The County* field is the county where the infrastructure (charger and other eligible infrastructure) will
be installed or performed. Once the first infrastructure line item has been added, this field will be pre-
filled to match, but still editable.

22. I he Zip* field is the five-digit zip code or the nine-digit zip plus 4 (e.g., NNNNN-NNNN). Once the first
infrastructure line item has been added, this field will be pre-fi I led to match, but still editable.

-------
2.20 Add Infrastructure—Other Eligible Infrastructure Costs

Note: You only have to complete the "Infrastructure Information" section for infrastructure costs related to
installing chargers for electric buses. Choose "Other Eligible Infrastructure Costs" using the dropdown menu.
The data fields associated with "Other Eligible Infrastructure Costs" are shown below, with the required
fields marked with asterisks. Other Eligible Infrastructure Costs include construction, electrical work, site
preparation, design and engineering, labor and permitting, etc.

Infrastructure Information

Infrastructure Type 0 4

Other Eligible Infrastructure Costs

Other Eligible Infrastructure Cost© *

Order Document Listing Infrastructure 0

This field is mandatory to complete the Payment
Request Form but is not required to complete and
save the infrastructure information.

Infrastructure Vendor

1. The Infrastructure Type* field requires you to select the charging infrastructure type from the
dropdown menu. You must add all charging infrastructure that has been purchased with rebate funds.
"Level 2 Charger" and "DC Fast Charger" refer to the actual chargers and pedestals. Other eligible
infrastructure costs include construction, electrical work, site preparation, design and engineering,
labor and permitting, etc.

2. The Infrastructure Type (Other)* field requires you to select the type of other eligible infrastructure
costs from the dropdown.

3. In the Description ofWork* field, provide a detailed description of the infrastructure-related work
entered in the "InfrastructureType (Other)" field.

4. The Other Eligible Infrastructure Cost* field is for the total of other eligible infrastructure costs for
this infrastructure type. The costs for this infrastructure type (for example, wiring, design, and panels)
are reflected on an approved quote, sales, or purchase order that you received for this work.

5. Select the Order Document Listing Infrastructure from the purchase order, sales order, or approved
quote that has been entered on the Order Document page and lists this infrastructure to be purchased.
If the order document for this infrastructure is not listed in the dropdown, complete the remainder of
the fields for this infrastructure item and click the "Return to Document Entry" button. If you add or
correct Order Documents, click the "Return to Infrastructure Page" button found on the Document
page.

6. The Infrastructure Vendor field is prepopulated based on the document selected. If you need to
change the infrastructure vendor, select "Return to Document Entry" and update the Order Document
information.

-------
Infrastructure Owner ©

This field is mandatory to complete the Payment Request Form but is not required to complete and save the
infrastructure information.

Installation/Construction Address

O
O

Street Address©

State or Territory © '

City©

County© *

Zip©'

7. Select the Infrastructure Owner from the dropdown menu. If you don't see the owner, complete the
"Installation/Construction Address" fields, click the "Complete" and "Save" buttons, and then click
"Back to Organization Entry" to add them. If you add an infrastructure owner, click the "Return to
Infrastructure Page" button found on the Organizations page once you have added the owner.

8. The Street Address field is for the street address where the charger(s) or other eligible infrastructure
will be installed or performed. Once the first infrastructure line item has been added, this field will be
pre-filied to match, but still editable.

9. The City field is the city where the infrastructure (charger and other eligible infrastructure) will be
installed or performed. Once the first infrastructure line item has been added, this field will be pre-fi lied
to match, but still editable.

10. The State orTerritory* field is the state or territory from the dropdown list. Once the first
infrastructure line item has been added, this field will be pre-fi I led to match, but still editable.

11. The County* field is the county where the infrastructure (charger and other eligible infrastructure) will
be installed or performed. Once the first infrastructure line item has been added, this field will be pre-
filied to match, but still editable.

12. The Zip* field is the five-digit zip code or the nine-digit zip plus 4 (e.g., NNNNN-NNNN). Once the first
infrastructure line item has been added, this field will be pre-fi I led to match, but still editable.

£J

-------
2.21 Complete Infrastructure

Once you have added all your infrastructure items, check the Infrastructure Totals section to see totals for all
infrastructure entered including Level 2 Charger, DC Fast Charger, and Other Infrastructure Costs as well as
the total infrastructure charging costs that are eligible for rebate. The actual eligible rebate for infrastructure will
be determined when you allocate funding on the Funding page.

Once you have reviewed your infrastructure totals, select "Next" to continue.

Edit Your Payment Request

^ Rebate ID:023468

of 10 Infrastructure

Since you are planning to replace an existing bus{es) with an electric bus(es), enter information about the chargers and other eligible rebate infrastructure costs on this page. The acronym
EVSE appears on this page, and it stands for electric vehicle supply equipment (charger).

You will need the following information to complete the fields on the page:

• Type and number of charger(s) to be installed (Level 2 or DC Fast Charger)

• Other costs that are eligible for infrastructure rebate funds

• EVSE output power, manufacturer, model, date of manufacture, number of plugs, capability for bidirectional charging, Energy Star compliance (Level 2 chargers), and Buy America
compliance

• Infrastructure type for other infrastructure that doesn't include the charger(s)

• Description of work for other eligible infrastructure besides the charger(s)

• Cost per charger and whether the charger cost includes installation

• Order Document associated with each charger and other eligible infrastructure costs

• Infrastructure Owner for each charger, materials installed, or work performed

• Installation/Construction address including street, city, state, zip and county

" denotes required field

Infrastructure Information

Enter information for each type of EVSE that was purchased. Enter the cost of installation and any necessary electrical/construction work separately. If you don't have a breakdown of
installation and EVSE cost, enter the full amount in the EVSE cost field.

Infra.

Infra. Type: Level 2 Charger
Manufacturer: InCharge
Model: 23

Quantity: 2

Cost (per item): $2,324
Subtotal: $4,648.00

Infra. Type: Infrastructure Materials Only
(e.g. wiring, panels, conduit)

Description: Lorem ipsum...

Cost: $35,112.01

infra.

Infra. Type: DC Fast Charger
Manufacturer: InCharge
Model: XLT

Quantity: 3

Cost (per item): $3,251
Subtotal: $9,753.00

+Add Infrastructure

Return to Organization Entry Return to Document Entry

Infrastructure Totals

Level 2 Charger Costs 0 $4,648.00

DC Fast Charger Costs 0 $9,753.00

Other Infrastructure Costs © $35,112.01

Total of All Eligible Charging Infrastructure Costs 0 $49,513.01

NOTE: Use of the browser back, forward, or refresh buttons will result in loss of work. Please navigate using the buttons at the
bottom of the form.

-------
2.22 Funding

This page is prepopulated with information from the bus information page and the infrastructure page. Every
time a change is made to either of those pages, it will be reflected here. Click "Edit" for each bus to indicate
how much funding you will allocate to the bus. The maximum amount of funding you can allocate for each bus
may not exceed the full cost of the bus or the rebate amount, whichever is less. As you add funding to each
bus, the "Total Remaining Rebate Amount for All Buses" number will change. After you allocate funding for
each bus, indicate the amount of funding you will use for infrastructure costs in the "Funding Allocation for All
Eligible Infrastructure Costs" field.The amount of funding you allocate for infrastructure costs may not exceed
the lesser of the "Unallocated Bus Rebate Eligible for Infrastructure" and the "Total Eligible Infrastructure
Costs." Assure that you have allocated all funding you are eligible for. If you have unallocated eligible rebate
funding, as noted by the value in the "Total Unallocated Requested Rebate Amount," you will lose that funding.

Bus Funding Allocations

This section is prepopulated with information from the bus information page. Every time a change is made
to either of those pages, it will be reflected here. Click "Edit" for each bus to indicate how much funding
you will allocate to the bus. If one of the read-only fields needs to be corrected, you can do so on the "Bus
Information" page.

Bus Funding Allocations

Bus

Existing Bus VIN: 12312312112321212
Existing Bus Fuel Type: CNG
New Bus Fuel Type: Electric

A Bus Excluded

This bus has been selected to be
excluded from the rebate.

Bus#©

Existing Bus VIN 0
12312312312123111

Shipping Rebate Used
$5,423.00

ADA Rebate Used
$20,000.00

| Existing Bus Fuel Type©

Gasoline

New Bus Purchase Price ©

$234,324.00

Bus and Infrastructure Rebate Amount

Requested ©

$345,000.00

New Bus Fuel Type ©

Electric

Funding Allocation for This Bus © '

Remaining Rebate Amount for This Bus
$34,324.00

Remaining Rebate Amount for
Infrastructure

Complete

A Bus Allocation Less Than Purchase Price

You entered a funding allocation for this bus that is less than New Bus Purchase Price. You may allocate funding up to the New
Bus Purchase Price, or use this unallocated funding (for new electric buses only) for infrastructure funding allocation.

% Bus# is a read-only field, prepopulated with information from the "Bus Information" page.

2. Existing Bus VIN is a read-only field, prepopulated with information from the "Bus Information" page.

3. Existing Bus Fuel Type is a read-only field, prepopulated with information from the "Bus Information"
page.

4. New Bus Fuel Type is a read-only field, prepopulated with information from the "Bus Information"
page.

-------
Bus Funding Allocations

Bus

Existing Bus VIN: 12312312112321212
Existing Bus Fuel Type: CNG
New Bus Fuel Type: Electric

A Bus Excluded

This bus has been selected to be
excluded from the rebate.

Bus#©

Existing Bus VIN ©
12312312312123111

Shipping Rebate Used
$5,423.00

ADA Rebate Used
$20,000.00

Existing Bus Fuel Type ©
Gasoline

New Bus Purchase Price ©
$234,324.00

New Bus Fuel Type ©
Electric

Bus and Infrastructure Rebate Amount
Requested ©

$345,000.00

Funding Allocation for This Bus © *

$200,000.00

Remaining Rebate Amount for This Bus
$34,324.00

O Remaining Rebate Amount for
Infrastructure
$145,000.00

A Bus Allocation Less Than Purchase Price

You entered a funding allocation for this bus that is less than New Bus Purchase Price. You may allocate funding up to the New
Bus Purchase Price, or use this unallocated funding {for new electric buses only) for infrastructure funding allocation.

Complete

Cancel

5. Shipping Rebate Used is a read-only field, prepopulated with information from the "Bus Information"
page. Funding allocations for bus and infrastructure on this screen will not change the amount of the
shipping rebate you have used.

6. ADA Rebate Used is a read-only field, prepopulated with information from the "Bus Information"
page. Funding allocations for bus and infrastructure on this screen will not change the amount of the
ADA rebate you have used.

7. Mew Bus Purchase Price is a read-only field, prepopulated with information from the "Bus
Information" page.

8. Bus and Infrastructure Rebate Amount Requested is a read-only field, prepopulated with information
from the "Bus Information" page.

9. The Funding Allocation forThis Bus field requires that you enter the amount that you want to
allocate in rebate funding for this bus. The amount entered cannot be more than the lower of the new
bus purchase price and the bus and infrastructure rebate amount requested. For electric buses, any
remaining unallocated rebate amount for this bus will be available for eligible infrastructure costs.

10. Remaining Rebate Amount forThis Bus is a read-only field, calculated based on the input for the
funding allocation of this bus.

11. Remaining Rebate Amount for Infrastructure is a read-only field, listing the amount of rebate funding
that is available to apply toward eligible infrastructure costs. This field is calculated based on the
remaining unallocated rebate amount requested for this bus. Note that for CNG and propane buses,
any unallocated bus rebate is not available for infrastructure, so your rebate will be reduced if you do
not allocate all the rebate amount requested.

-------
^ Total Rebate Amount Requested fiRI

$425,000.00

0 Total Bus Costs ©

Rebate Amount Allocated to All Buses
$425,000.00 """""" $235,000.00

Total Remaining Rebate Amount for All Buses
$784,069.00 $34,324.00

12. Total Rebate Amount Requested is a read-only field listing the sum of all "Bus and Infrastructure
Rebate Amount Requested" fields for the buses listed above.

13. Total Bus Costs is a read-only field listing the sum of all "New Bus Purchase Price" fields for the buses
listed above.

14. Rebate Amount Allocated to All Buses is a read-only field listing the sum of all "Funding Allocation
forThis Bus" fields for the buses listed above.

15. Total Remaining Rebate Amount for All Buses is a read-only field listing the amount of rebate
funding that is eligible to be applied to buses, but has not been allocated. Any unallocated rebate
funding from electric buses is eligible to be considered for infrastructure rebate allocation.

Infrastructure Award Allocations

Infra. Infra. Type: Level 2 Charger Quantity: 5

1 Manufacturer: Blink Cost (per item): $3,242

Model: XLT34 Subtotal: $16,210.00

Unallocated Bus Rebate Eligible for Infrastructure Q
$145,000.00

O Total Eligible Infrastructure Costs Q
$16,210.00

Funding Allocation for All Eligible Infrastructure Costs 0 '
$15,000.00

A Infrastructure Allocation Less Than Available
Rebate

You entered a funding allocation for infrastructure that is less than
the available rebate.

Infrastructure Award Allocations

1. Unallocated Bus Rebate Eligible for Infrastructure is the amount of unallocated bus rebate that
could be used for eligible infrastructure costs. It does not include unallocated CNG or propane bus
rebate funding (if applicable).

2. Total Eligible Infrastructure Costs field is the total of all eligible charging infrastructure costs found on
the "Infrastructure" page.

3. In the Funding Allocation for All Eligible Infrastructure Costs* field, enter the rebate amount you
would like to allocate for eligible infrastructure costs. You cannot allocate more than the lesser amount
of the "Unallocated Bus Rebate Eligible for Infrastructure" and "Total Eligible Infrastructure Costs"
fields. Any unallocated amount will reduce the amount of your rebate.

-------
Total Funding Allocations

O

o
o

Total Costs for Buses and Infrastructure

Total Eligible Replacement Bus and Infrastructure Rebate Requested ©
$425,000.00

Total Applicant Cost Responsibility
$550,279.00

$800,279.00

o
o

Total Unallocated Requested Rebate Amount©
$175,000.00

Total Allocated Rebate Amount©
$250,000.00

Total Funding Allocations

1.	Total Eligible Replacement Bus and Infrastructure Rebate Requested is a read-only field, listing the
sum of all "Total Bus and Infrastructure Rebate Amount Requested" fields for the buses listed above.

2.	Total Costs for Buses and Infrastructure is a read-only field that sums the costs for all buses above,
as well as infrastructure (if applicable).

3.	Total Applicant Cost Responsibility is a read-only field listing a total for the applicant cost
responsibility, given the above funding allocations, for all buses and Infrastructure (if applicable).

4.	Total Allocated Rebate Amount is a read-only field listing a total for the allocations toward each bus
listed above, as well as infrastructure (if applicable).

5.	Total Unallocated Requested Rebate Amount is a read-only field that provides the amount of
unallocated rebate, based on the allocation amounts above. Any unallocated requested rebate amount
will reduce your rebate.

-------
2.23 Build America, Buy America Compliance

All infrastructure costs must be Build America, Buy America compliant. Select "Yes" or "No" in the dropdown
menu to indicate if the infrastructure you entered is Build America, Buy America compliant. Next select,
"Yes" or "No" for the second question to indicate if you applied for waivers for any of the chargers or other
infrastructure eligible materials listed on the infrastructure screen. Then select the waivers that apply. If you
select "Project Specific Waiver," you will be prompted to upload a file. The file size must be between 1 KB and
5 MB. Accepted file types include .pdf, .png, .jpeg, and .jpg. Click "Next" to continue.

BABA Compliance

Yes

Choose All Waivers That Apply '
Q General BABA Approved Waiver(s)

Q Project Specific Waiver O
Review General Waivers

Did You Apply for Waivers for Any of the Federally Funded Infrastructure? *

Choose All General Waivers That Apply *

| | Amended Public Interest Waiver of Section 70914(a)

Q EPA Electronic Vehicle Chargers Product Waiver of Section 70914(a)

[ | Pacific Island Territories Public Interest General Applicability Waiver
| | EPA De Minimis General Applicability Waiver of Section 70914
| | EPA Small Project General Applicability Waiver of Section 70914(a)

Adjustment Period Waiver of Section 70914(a)

| | WIFIA Program Waiver of Section 70914(a)

Q Minor (Ferrous) Components of Iron and Steel Products Public Interest General
Applicability Waiver of Section 70914(a)

| | Project Specific Nonavailability Waiver to North Unit Irrigation District in Oregon

| | Public Interest General Applicability Waiver of Section 70914(a) for Awards Under
the Clean Ports Program

Q Other

Other General Waiver(s)

Lorem ipsum...

Project Specific Waiver Upload Q '

File Name

Size

CSB-Pass.pdf

24.57 kB

Allowed file types: *.pdf, \png, ".jpeg, *.jpg
Minimum file size: 1KB
Maximum file size: 5MB

1. Is Infrastructure Entered on Infrastructure Page BABA Compliant?* is a yes/no selection
applying to any chargers and infrastructure materials (e.g., wiring, panels, conduit) entered on the
"Infrastructure" page.

2. Did You Apply for Waivers for Any of the Federally Funded Infrastructure?* is a yes/no selection to
indicate if waivers are applicable.

3. Choose All Waivers That Apply*

a. Checking General BABA Approved Waiver(s) will provide a list of known general waivers to
select or enter.

b. Checking Project-Specific Waiver will allow the user to upload the project-specific waiver in a
file upload field below it.

-------
BABA Compliance

Is Infrastructure Entered on Infrastructure Page BABA Compliant? © '

Choose All Waivers That Apply *
Q General BABA Approved Waiver(s)

Qj Project Specific Waiver Q
Review General Wavers

Did You Apply for Waivers for Any of the Federally Funded Infrastructure? *

Choose All General Waivers That Apply "

~	Amended Public Interest Waiver of Section 70914(a)

Q EPA Electronic Vehicle Chargers Product Waiver of Section 70914(a)

I | Pacific Island Territories Public Interest General Applicability Waiver
| | EPA De Minimis General Applicability Waiver of Section 70914
I | EPA Small Project General Applicability Waiver of Section 70914(a)

Adjustment Period Waiver of Section 70914(a)

I | WIFIA Program Waiver of Section 70914(a)

Q Minor (Ferrous) Components of Iron and Steel Products Public Interest General
Applicability Waiver of Section 70914(a)

I 1 Project Specific Nonavailability Waiver to North Unit Irrigation District in Oregon

~	Public Interest General Applicability Waiver of Section 70914(a) for Awards Under
the Clean Ports Program

Q Other

Other General Waiver(s)

Project Specific Waiver Upload O *



File Name

Size

X

CSB-Pass.pdf

24.57 kB

Allowed file types: *.pdf, \png, '.jpeg, *.jpg
Minimum file size: 1KB
Maximum file size: 5MB

4.	Choose All General Waivers That Apply* will only show if "General BABA Approved Waiver(s)" has
been checked.

a.	Amended Public Interest Waiver of Section 70914(a)

b.	EPA Electronic Vehicle Chargers Product Waiver of Section 70914(a)

c.	Pacific Island Territories Public Interest General Applicability Waiver

d.	EPA De Minimis General Applicability Waiver of Section 70914

e.	EPA Small Project General Applicability Waiver of Section 70914(a)

f.	Adjustment Period Waiver of Section 70914(a)

g.	WIFIA Program Waiver of Section 70914(a)

h.	Minor (Ferrous) Components of Iron and Steel Products Public Interest General Applicability
Waiver of Section 70914(a)

i.	Project Specific Nonavailability Waiver to North Unit Irrigation District in Oregon

j. Public Interest General Applicability Waiver of Section 70914(a) for Awards Under the Clean Ports
Program

k. Other

5.	Other General Waiver(s) will only be available if "Other" is selected from the General Waivers list. You
may enter any applicable general waivers in this field.

6.	Project Specific Waiver Upload will only be available if "Project Specific Waiver" has been checked
above. Upload the applicable waiver in this field. The file must be between 1 KB and 5 MB in size, and
must be one of the accepted file types: .pdf, .png, .jpeg, and .jpg.

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2.24 Signature

Please review the summary cost information provided at the top of the screen before you sign the payment
request form. All are read-only fields:

o
o

Total Rebate Allocated to Buses
$275,000.00

Total Shipping Rebate
$45,423.00

Total Rebate Allocated to Infrastructure

$15,000.00

Total Combined Rebate to be Paid

$377,767.00

Total ADA Rebate
$42,344.00

Total Bus Costs
$784,069.00

Total Infrastructure Costs
$16,210.00

Total Shipping and ADA Costs
$102,579.00

Total Combined Costs
$902,858.00

Total Applicant Responsibility
$525,091.00

1. Total Rebate Allocated to Buses provides a total allocation to all buses.

2. Total Shipping Rebate provides a total of shipping rebates for all buses (if applicable). If not
applicable, this field will not show.

3. Total ADA Rebate provides a total of ADA rebates for all buses (if applicable). If not applicable, this
field will not show.

4. Total Rebate Allocated to Infrastructure provides a total allocation to Infrastructure.

5. Total Combined Rebate provides the total rebate allocation for buses, infrastructure, shipping and
ADA (if applicable).

6. Total Bus Costs provides a total of all bus costs.

7. Total Infrastructure Costs provides a total of all infrastructure costs (if applicable).

8. Total Shipping and ADA Costs provides a total of all shipping and/or ADA costs for all buses.

9. Total Combined Costs provides a total of all costs listed above.

10. Total Applicant Responsibility provides the calculated difference between "Total Combined Costs"
and "Total Combined Rebate" to be paid.

To complete your payment request form, you must read and certify the items listed in the "Signature and
Certification" section, sign, confirm signature, and click "Submit Form."

The "Name" and "Title" fields on this page are prepopulated based on who is logged into this form. If you
are the authorized representative, confirm your title in the "Title" field and update it if needed. If you do not
have the authority to sign this payment request form, notify the authorized representative so they can sign
and submit it. If you sign and confirm signature, but then return to a previous screen to make edits, you will
need to repeat the signature and confirmation steps to submit your form. If a different user needs to sign
and submit the form, they must also be a SAM.gov point of contact (Government Business or alternate, or
Electronic Business or alternate) for your organization and will need to use Login.gov to enter the Clean School
Bus Rebate Forms site to complete the payment request form (saved as a draft). In this case, they must edit
the "Name" and "Title" fields on this screen to show their full name and title before signing and submitting.

-------
3. Change Request Process

For 2023 Clean School Bus (CSB) Rebate Program forms, you can request certain actions to be considered
by EPA from the applicant dashboard that can make changes to your forms. The form status determines
what actions you can request. Actions include, reopening a form that has been submitted for edits before
it's reviewed by EPA, requesting an extension to complete a form that's in "draft" status, and requesting a
withdrawal of a form that could lead to withdrawal of the application from the 2023 CSB Rebate Program.
Check "Change" under "Change Request" on your dashboard and then select the option you need from the
available change requests for the form.

Note: For the 2022 CSB Rebate Program, you will need to send an email to cleanschoolbus@epa.gov to
request change actions to your forms.

The image of the applicant dashboard below shows the location of the "Change" form. Additionally, as you
submit "Change Requests" they appear above your forms in the "Your Change Requests" section.

Clean School Bus Rebate Forms

• Clean School Bus Rebate Program

• Online Rebate Application Information

eben.bathalon@erg.com I

Rebate Year: 2023 v |

O New Application

Your Change Requests
O Rebate ID

O Form Type

O Request Type

O Submitted By

Payment Request

Extension Request

eben.bathalon@erg.com

Your Rebate Forms

Select a button below to Edit or View an existing rebate form.

• For the 2023 rebate year, you may request edits, an extension, or a withdrawal by selecting Change Request, Change.

• For the 2022 rebate year, you may request edits, a withdrawal, or a Close Out Form extension (see Close Out Form webpage) by emailing cleanschoolbus@epa.gov.

O Form Type O UEI 0 Applicant 0 Updated By

O Rebate ID O Form Status O EFT Indicator O School District O Date Updated O Change Request

123456000110
1234

EBEN BATHALON INC.
Boston

eben. batholon@erg.com
4/18/2024

O New Payment Request

Application 123456000110 EBEN BATHALON INC. eben.bathalon@erg.com

O Selected 1234 Anchorage School District 4/18/2024

Payment Request

eben.bathalon@erg.com

Change B

••• Draft

6/12/2024

Application
- Draft

123456000110
1234

EBEN BATHALON INC.
Anchorage School District

eben.bathalon@erg.com
5/30/2024

Change G5

¦ © view ¦

023394

Application
O Selected

123456000110
1234

EBEN BATHALON INC.
Salem School District

eben.bathalon@erg.com

1/23/2024

Change B

¦ / Edit ¦

Payment Request
••• Draft

eben.bathalon@erg.com
5/22/2024

Change Q3

Application
— Draft

123456000110
1234

EBEN BATHALON INC.
O

eben.bathalon@erg.com
11/16/2023

Change G3

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3.1 Withdrawal Request

Withdrawal requests can only be made from forms that have a "Submitted',' "Selected" or "Funding Approved"
status. Choose the reason for your request. Select "Withdrawal Request" from the RequestType field
dropdown. Then select the "Reason for Request" from the dropdown of options. If you choose "Other," type
your reason in the box provided. Use the dropdown menu to indicate if this is a new withdrawal request for
this form. Then provide a detailed explanation indicating why you are asking to withdraw the application. Once
you have completed the required fields, click the "Submit" button.

Note: If you do not rescind your withdrawal request within 14 days of submitting the request, the award will
be cancelled.

Submit Your Change Request

Application Form (022699)

RequestType"

Withdrawal Request

Please indicate the reasori(s) for the requesting withdrawal
Reason for Request Q'

Please provide a detailed explanation for why the request is necessary Q"

Reason for Request (Other) *

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Note Award Cancellation

If after 14 days the user has not rescinded their withdrawal request - the award will be canceled.

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3.2 Edit Request

Edit requests can only be made from forms that have a "Submitted," "Selected," or "Funding Approved"
status. Choose the reason for your request. Select "Edit Request" from the RequestType field dropdown.
Then select the "Reason for Request" from the dropdown of options. If you choose "Other;' type your reason
in the box provided. Use the dropdown menu to indicate if this is a new edit request for this form. Then
provide a detailed explanation indicating why you are asking to edit the application. Once you have completed
the required fields, click the "Submit" button.

Submit Your Change Request

Application Form (022699)

RequestType *

Please indicate the reason(s) for the requested edit
Reason for Request 6"

Is this a new request for this Request i ype for this form? O'

Reason for Request (Other) *

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Please provide a detailed explanation for why the request is necessary © *

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3.3 Extension Request

Extension requests can only be made from forms that have a "Draft" status. Choose the reason for your
request. Select "Extension Request" from the "RequestType" field dropdown.Then select the "Reason for
Request" from the dropdown of options. If you choose "Other," type your reason in the box provided. Use the
dropdown menu to indicate if this is a new extension request for this form. Then use the dropdown menu and
boxes provided to fill in the requested extension date. Last, provide a detailed explanation indicating why you
are asking for an extension for submission of this form. Once you have completed the required fields, click the
"Submit" button.

Submit Your Change Request

Payment Request Form (022699)

Request Type'

Extension Request

Is this a new request for this Request Type for this form? 0 "

Please provide the requested extension date
Month' Day *

Reason for Request (Other) *

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Appendix A: Glossary

The following provides definitions of terms and abbreviations used throughout the payment request form and
system screens.

"Your Rebate Forms" Screen: Definitions

¦ Rebate ID: Unique ID assigned by EPA to each rebate request.

¦ Form Type: Application, payment request, or close-out form.

¦ Form Status: Draft, Submitted, or Funding Approved.

¦ UEI: Unique Entity ID from SAM.gov.

¦ EFT Indicator: Electronic funds transfer indicator for the associated bank account from SAM.gov.

¦ Applicant: Legal business name from SAM.gov for this UEI.

¦ School District: School district served by the new buses for the next 5 years.

¦ Updated By: Last person to update the form.

¦ Date Updated: Last date this form was updated.

"Applicant Info" Screens: Definitions

Applicant Organization Name (and address information): Your applicant organization's SAM.gov
name and physical street address are automatically filled in, based on the organization you chose when
starting this application.

Unique Entity Identifier (UEI): This is your applicant organization's SAM.gov UEI, automatically filled
in based on the organization you chose when starting this application.

Electronic FundsTransfer (EFT) Indicator: This is your SAM.gov EFT indicator, automatically filled in
based on the organization you chose when starting this application.

¦ Applicant Primary Contact: Review the primary contact for the applicant. The primary contact may or
may not be someone different from the government business (or alternate), or the electronic business
(or alternate) contact. Edit the primary contact information if there are any errors.

¦ Applicant Alternate Contact: Review the alternate contact for the applicant. The alternate contact
may or may not be someone different from the government business (or alternate), or the electronic
business (or alternate) contact. Edit the alternate contact information if there are any errors.

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School District Info" Screens: Definitions

National Center for Education Statistics (NCES) District ID:The NCES District ID was brought
into this form from your application and is not editable. This is the school district that the new
buses will serve for the next 5 years. If you don't have a NCES District ID, contact the help desk at

cleanschoolbus@epa.aov.

School District Name and Address: The contact information for the school district. This may be
different from the applicant contacts.

¦	Prioritized: Read-only field, filled with "yes" or "no" based on whether the school district meets
prioritization criteria.

¦	Priority Reason: The reason for which your school meets the prioritization criteria.

School District Contact Information: Review the school district contact. The school district contact
may or may not be someone different from the primary (or alternate) applicant contact. Edit the school
district contact information if there are any errors.

Organizations" Screens: Definitions

¦	Organization Type: Check the boxes for all of the types that apply to your organization:

—	Existing Bus Owner: All existing bus owners that are not the applicant, or the public school
district or public charter school that the new buses will serve.

—	New Bus Owner: All new bus owners (e.g., school district, nonprofit, private fleet,Tribe) that
are not the applicant, or the public school district or public charter school that the new buses will
serve.

—	Private Fleet (existing or new buses): Any private fleet that is not owned by the applicant.
School districts that contract out bus service to multiple private fleets may only submit one
application but may list multiple private fleets on the application.

—	New Bus Dealer: The vendor or dealer that the new bus owner will purchase the bus from.

—	Infrastructure Owner (electric bus charging): All infrastructure owners (e.g. school district,
private fleet) of the electric bus charging equipment. If the infrastructure owner is the applicant,
the school district that the new buses will serve, or a private fleet entered in your application,
then you do not have to enter new bus owner information as it's already included within this
form.

—	Infrastructure Supplier (charging equipment only): All infrastructure suppliers from which
charging equipment was purchased (includes the installer of the infrastructure charging
equipment when they are also the charging equipment supplier).

—	Other Infrastructure Organization: All other eligible Infrastructure organizations (e.g.,
performing trenching and wiring, project management, but excluding charger installer in the case
that the charger is installed by the infrastructure charging equipment supplier).

Organization Name: The name of the organization.

¦	Contact Information: The first and last name, title business email, and business phone number of the
organization's contact.

¦	Address: The address of the organization including city, state, county, and zip code.

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"Documents" Screens: Definitions

Order Document Name: The name of the document you are adding. Documents could include
purchase orders, sales orders, or quotes.

Order Document Description: This optional field can be used to enter any additional information about
the document and is limited to 250 characters.

¦ Document Purpose: All document categories that could apply to the order document are selectable in
this field. Multiple sections can be made for an order document.

— New Bus: The replacement bus.

— Electric Bus Charging Equipment: Charging equipment for the replacement bus.

— Other Infrastructure Installation Costs: Other infrastructure costs for the replacement bus
(e.g. wiring, conduit, labor, project management, etc.).

¦ Associated Purchaser: The associated purchaser for this document from the dropdown list.
The associated purchaser can be a new bus owner, private fleet, or infrastructure owner on the
"Organizations" page.

¦ Associated Vendor: The associated vendor for this document. The associated vendor can be a private
fleet, infrastructure supplier, or other infrastructure organization on the "Organizations" page.

¦ Document Upload: Attach a file or scan of the relevant document.

— Allowed file types: *.pdf, *.png, *.jpeg, *.jpg

— Allowed file size: 1 KB-5 MB

"Buses" Screens: Definitions

Existing Bus Information: All information for each of the existing buses that will be replaced. A
description of these fields can be found in the 2023 Clean School Bus Rebate Forms: Application User
Guide.

New Bus Information: All information for each bus that will be replacing the existing buses.

¦ Swap Existing Bus: Select this if an old bus provided in the application will be swapped for a different
old bus.

¦ Exclude Bus: The bus to be swapped in the application will be excluded from the rebate.

¦ New Bus Owner: The name of the Organization that will own the new bus. The owner is listed in the
dropdown for this field.

Order Document Listing New Bus: The order document for the new bus listed in the fields in this
section.

Bus and Infrastructure Rebate Amount Requested: The amount requested for the new bus based
on New Bus Fuel Type, New Bus GVWR, and prioritization status of school district per the 2023 Clean
School Bus Rebates Program Guide.

New Bus Purchase Price: The purchase price of the ordered replacement school bus, including tax
and any eligible training/consulting/warranty line-item expenses associated with the individual bus in
the purchase order.

¦ New Bus Fuel Type: The fuel type used by the new bus.

¦ New Bus GVWR:The bus gross vehicle weight rating in pounds.

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¦ New Bus Delivery Date:The date on which the bus is expected to be delivered.

New Bus Manufacturer: The manufacturer of the new bus.

¦ New Bus Model: The model name (not the bus type) of the new bus.

¦ New Bus ModelYear: The manufacturing year of the new bus, which must be 2022 or later.

New Bus EPA Vehicle Family: The 12-character alphanumeric EPA Vehicle Family, or 10- to
12-character CARB Executive Order ID. The EPA Vehicle Family can be found on the Vehicle Emission
Control Information (VECI) label, which is usually on or near a door pillar or on the engine compartment
sheet metal. If the bus is not an EPA-certified vehicle, enter the CARB Executive Order ID. If the
vehicle does not have EPA or CARB certification, contact the CSB helpdesk ( ).

Capable of Bidirectional Charging?: If the bus is capable of two-way energy flow, the bus has the
bidirectional charging feature (e.g., grid-to-vehicle when the bus EV battery is charged by the electrical
grid, vehicle-to-grid when the bus EV battery can also supply energy to the electrical grid). If not, the
bus can only receive energy and be charged by the electrical grid (grid to vehicle).

Auxiliary Heater Fuel Type: The fuel type used to run the auxiliary heater on the bus.

Auxiliary Heater Fuel Type (Other): The auxiliary heater fuel type if not listed in the dropdown
selection for the Auxiliary Heater Fuel Type.

¦ Shipping Cost Rebate Requested: If the school district that the buses will serve for the next five
years is in an area where the Clean School Bus Program offers a rebate for shipping costs of this new
bus, this number will be $20,000.

¦ Bus Shipping Costs: The actual anticipated shipping costs for the bus based on the order document
associated with the bus.

Eligible Bus Shipping Rebate: The bus shipping rebate this bus is eligible for based on the bus
shipping costs entered. If these costs are more than the shipping cost rebate requested, then the
bus is eligible for the shipping cost rebate requested amount of $20,000. If the bus shipping costs are
less than the shipping cost rebate requested, the bus is eligible for the amount entered in the "Bus
Shipping Costs" field.

¦ Shipping Cost Responsibility: The amount of money that exceeds the rebate, i.e. the amount the
applicant will be responsible to pay for.

ADA-Compliance Rebate Requested: If the box is checked in the "Replacement Bus Equipped with
ADA-Compliant Wheelchair Lift" field, this number will be $20,000. This is the maximum rebate you
can receive for a bus equipped with an ADA-compliant wheelchair lift.

¦ ADA-Compliance Costs: The purchase price for equipping this bus with an ADA-compliant wheelchair
lift.

Eligible ADA-Compliance Rebate: The ADA-compliant rebate this bus is eligible for based on the ADA-
compliance costs entered. If the ADA-compliance costs are more than the ADA-compliance rebate
requested, the bus is eligible for the ADA-compliance rebate requested amount of $20,000. If the
ADA-compliance costs are less than the ADA-compliance rebate requested, the bus is eligible for the
amount entered in the "ADA-Compliance Costs" field.

¦ ADA Cost Responsibility: The amount the applicant will be responsible for paying for that exceeds the
rebate.

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Total Rebate Amount Requested: The sum of the Replacement Bus and Infrastructure Rebate
Amount Requested, and if applicable. Eligible Bus Shipping Rebate, and the Eligible ADA-Compliance
Rebate for this bus.

Number of Buses Requested from Application: The number of replacement buses that were
requested in the application.

Number of Buses Ordered from Payment Request: The number of replacement buses listed above
in the "Number of Buses Requested for Application" minus any excluded buses.

Total Replacement Bus and Infrastructure Rebate Amount Requested: The sum of all requested
replacement bus rebates that includes the Replacement Bus and Infrastructure Rebate Amount
Requested for each bus.

Total ADA Rebate Requested: The sum of ADA requested rebates for all applicable replacement
buses with ADA-compliant wheelchair lifts.

Total Eligible Rebate for ADA Costs: The sum of all eligible rebates for ADA costs for all replacement
buses.

Total ADA Cost Responsibility: The sum of ADA applicant cost responsibility for all replacement
buses.

Total Shipping Rebate Requested: The sum of shipping rebates for all applicable replacement buses.

Total Eligible Rebate for Shipping Costs: The sum of all eligible rebate for shipping costs for all
replacement buses.

Total Shipping Cost Responsibility: The sum of shipping cost responsibility for all replacement
buses.

Bus Information Incomplete: There are fields that need to be completed for the bus selected.

"Infrastructure" Screens: Definitions

Infrastructure Information: All required information for each piece of EVSE that will be used by the
new buses.

¦ Infrastructure Type: The charging infrastructure to be purchased for all electric buses. "Level
2 Charger" and "DC Fast Charger" refer to the actual chargers and pedestals. Other eligible
infrastructure costs include construction, electrical work, site preparation, design and engineering,
labor and permitting, etc.

¦ Infrastructure Type (Other): The type of other eligible infrastructure costs found in the dropdown.
Other Eligible Infrastructure Costs include construction, electrical work, site preparation, design and
engineering, labor and permitting etc.

¦ Description of Work: A detailed description of the infrastructure-related work entered in the
"InfrastructureType (Other)" field.

EVSE Maximum Output Power (kW): The rated maximum output power of the charger (in kilowatts).
The kilowatts for a Level 2 charger should not be higher than 20. For a DC fast charger, the kilowatts
should not be less than 20.

EVSE Manufacturer: The manufacturer of the charger.

¦ EVSE Model: The model name of the charger. If it is a Level 2 charger, the model name is listed on the
Energy Star certification.

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EVSE Date of Manufacture: The date that the EVSE was manufactured, listed on the charger.

Number of Plugs on EVSE: The number of plugs on each charger.

This Charger Is Energy Star Compliant: This field is only required for Level 2 chargers and should be
checked if all Level 2 chargers are required to be Energy Star compliant.

This Charger is Buy America Compliant: See 2023 Clean School Bus Rebates Program Guide's terms
and conditions for information on Build America, Buy America requirements.

Infrastructure Quantity:The number of chargers purchased at the same price. If multiple types of
chargers were purchased, each type must be entered individually. Additionally, if multiple chargers
of the same type were purchased at different costs, the chargers need to be entered as separate
infrastructure items.

¦ Infrastructure Cost per Charger: The cost of each charger for that specific infrastructure line item.
Infrastructure Subtotal: The subtotal for each infrastructure line item.

Cost Includes Installation: The cost listed in the "Infrastructure Cost per Charger" field includes
installation.

Other Eligible Infrastructure Cost: The total of other eligible infrastructure costs for this infrastructure
type. The costs for this infrastructure type (for example, wiring, design, and panels) are reflected on an
approved quote, sales, or purchase order that you received for this work.

Order Document Listing Infrastructure: A document from the purchase order, sales order, or
approved quote that has been entered on the Order Document page and lists this infrastructure to be
purchased.

¦ Infrastructure Vendor: The vendor that supplied, installed, or provided other services that apply to the
specific infrastructure line item.

¦ Installation/Construction Address: The location, including the street address, city, state or territory,
zip code, and county, where the EVSE will be installed. Once the first infrastructure line item has been
added, this field will be pre-filied to match, but still editable.

¦ Street Address: The street address where the charger(s) or other eligible infrastructure will be
installed.

¦ City: The city where the infrastructure (charger and other eligible infrastructure) will be installed or
performed.

¦ State orTerritory: The state or territory from the dropdown list.

¦ County: The county where the infrastructure (charger and other eligible infrastructure) will be installed
or performed.

¦ Zip: The five-digit zip code or the nine-digit zip plus 4 (e.g., NNNNN-NNNN).

¦ Level 2 Charger Costs: The sum of all Level 2 charger costs entered on this form.

¦ DC Fast Charger Costs: The sum of all DC fast charger costs entered on this form.

¦ Other Infrastructure Costs: The sum of all other eligible infrastructure costs entered on this form.

Total of All Eligible Charging Infrastructure Costs: The total of the costs for Level 2 and DC fast
chargers, as well as any other eligible infrastructure costs entered in fields on the Infrastructure page.

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"Funding" Screens: Definitions

Bus Funding Allocations Section: Where funding is allocated for each new bus being requested.

¦ Bus #: The number assigned to the bus line item by the form, as indicated on the Bus Information
page.

Existing Bus VIN: VIN for the Existing Bus, as indicated on the Bus Information page.

Existing Bus Fuel Type: The fuel type for the existing bus, as indicated on the Bus Information page.

¦ New Bus Fuel Type: The fuel type for the new bus, as indicated on the Bus Information page.
Shipping Rebate Used:The shipping rebate used, as indicated on the Bus Information page.

¦ ADA Rebate Used: The ADA rebate used, as indicated on the Bus Information page.

New Bus Purchase Price: From the Bus Information page, the purchase price of the ordered
replacement school bus, including tax and any eligible training/consulting/warranty expenses
associated with this bus.

Bus and Infrastructure Rebate Amount Requested: From the Bus Information page, the amount
requested for the new bus based on New Bus Fuel Type, New Bus GVWR, and prioritization status of
the school district.

Funding Allocation forThis Bus: The amount allocated in rebate funding for this bus. The amount
entered cannot be more than the lower of the new bus purchase price and the bus and infrastructure
rebate amount requested. For electric buses, any remaining unallocated rebate amount for this bus will
be available for eligible infrastructure costs.

Remaining Rebate Amount forThis Bus: The remaining award amount after indicating the Bus
Allocation.

Remaining Rebate Amount for Infrastructure: The amount of rebate funding that is available to apply
toward eligible infrastructure costs. This field is calculated based on the remaining unallocated rebate
amount requested for this bus. Note that for CNG and propane buses, any unallocated bus rebate
is not available for infrastructure, so your rebate will be reduced if you do not allocate all the rebate
amount requested.

Total Rebate Amount Requested:The sum of all "Total Bus and Infrastructure Rebate Amount
Requested" fields for the buses listed above.

¦ Total Bus Costs: The sum of all "New Bus Purchase Price" fields for the buses listed above.

Rebate Amount Allocated to All Buses: The sum of all "Funding Allocation forThis Bus" fields for the
buses listed above.

Total Remaining Rebate Amount for All Buses: The amount of rebate funding that is eligible to be
applied to buses, but has not been allocated. Any unallocated rebate funding from electric buses is
eligible to be considered for infrastructure rebate allocation.

Infrastructure Award Allocations Section: The place where funding is allocated to all eligible
infrastructure.

Unallocated Bus Rebate Eligible for Infrastructure: The amount of unallocated bus rebate that could
be used for eligible infrastructure costs. It does not include unallocated CNG or propane bus rebate
funding (if applicable).

Total Eligible Infrastructure Costs: The total of all eligible charging infrastructure costs found on the
"Infrastructure" page.

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Funding Allocation for All Eligible Infrastructure Costs: The rebate amount you would like to allocate
for eligible infrastructure costs. You cannot allocate more than the lesser amount of the "Unallocated
Bus Rebate Eligible for Infrastructure" and "Total Eligible Infrastructure Costs" fields. Any unallocated
amount will reduce the amount of your rebate.

Total Funding Allocations: The total eligible rebate funding for all buses and infrastructure, the total
costs for buses and infrastructure indicated on this form, and the total allocated funding for buses and
infrastructure costs.

Total Eligible Replacement Bus and Infrastructure Rebate Requested: The sum of all "Total Bus and
Infrastructure Rebate Amount Requested" fields for the buses listed above.

Total Costs for Buses and Infrastructure: The costs for all buses above, as well as infrastructure (if
applicable).

Total Applicant Cost Responsibility: The applicant cost responsibility, given the above funding
allocations, for all buses and infrastructure (if applicable).

¦ Total Allocated Rebate Amount: The total for the allocations toward each bus listed above, as well as
infrastructure (if applicable).

Total Unallocated Requested Rebate Amount: The amount of unallocated rebate, based on the
allocation amounts above, and the total requested rebate amount.

Build America, Buy America (BABA) Page: Definitions

Is Infrastructure Entered on Infrastructure Page BABA Compliant?: Confirmation that any chargers
and infrastructure materials (e.g., wiring, panels, conduit) entered on the "Infrastructure" page are
BABA compliant.

Did You Apply for Waivers for Any of the Federally Funded Infrastructure?: Confirmation whether
you applied for any waviers such as a general BABA approved wavier(s) or a project specific wavier(s)
to avoid being BABA compliant with the Federally Funded Infrastructure to be purchased.

Signature Page: Definitions

Total Rebate Allocated to Buses: The total allocation to all buses.

Total Shipping Rebate: The total of shipping rebates for all buses (if applicable). If not applicable, this
field will not show.

¦ Total ADA Rebate: The total of ADA rebates for all buses (if applicable). If not applicable, this field will
not show.

Total Rebate Allocated to Infrastructure: The total allocation to infrastructure.

Total Combined Rebate: The total rebate allocation for buses, infrastructure, shipping and ADA (if
applicable).

¦ Total Bus Costs: The total of all bus costs.

¦ Total Infrastructure Costs: The total of all infrastructure costs (if applicable).

Total Shipping and ADA Costs: The total of all shipping and/or ADA costs for all buses.

¦ Total Combined Costs: The total of all costs listed above.

Total Applicant Responsibility: The calculated difference between "Total Combined Costs" and "Total
Combined Rebate" to be paid.

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