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1 <br /> DocuSign Envelope ID:C8D9258E-OB18-4FBC-9A51-15AOE32Al2BA <br /> 34 j <br /> CONTRACT NO,:45615VW <br /> VW-TRANSIT BUS PROGRAM <br /> Attachment C <br /> ['ertl.flcsatlnu <br /> The undersigned is an official riuthori2ed to repivwht the upplicant.'rite 1pensoit signing this document <br /> roust have lite ialthority to legally hind the applicant or be the designated fiscal ikon(. <br /> I fvr iff),that all jsi oIN) ed ac livilies will be ear'rkil r aid„t al u/1 rruinE'y!Y}C'£'lved 11111 be I1t11#zed Well,fr r <br /> Melrtr )ot CSV frrr 11-11 1 it fs briendeck t4rd 1 V-01ett the lslirr nhig process trail imlilemenration <br /> tt fll lac:rarcrirrterinc�rl crnrisrrlrrrrl fticl%i ien raid DEQ is har ebjo grc nfed aix s trt insarect project <br /> .►tics Jr A unclerstood that ff'rha,1)r•tr eel A;wlet•Ped ea conlrael with DEQ will he excFc alert. <br /> l f rr-fhev-anew uteri err least 74%Erf t/1c'a"ejrtd,{rtrWJ1i `_S(altar all n still Occur In North Crrrerlirrtr,/in-the liert S <br /> 4'4�irr.5, <br /> Prim Naiw orAuthovizsd Re: ri;-gentative Title <br /> (! � . .. .. 7, larere�trrtScr tsar . <br /> Siestur s orAutli.orized Ri reewntative Date. <br /> d lIritEk <br /> lir+: <br /> Required Attachments <br /> D'leow attach[lie following do-coments with tlta:filvitaines its indicated in tlso parenthesis, It`then filenaines <br /> tire,,oibe:r slum prov'idvd in Aaron livsis„the applivaliun%vill be:rvwmed rot corrections. <br /> 1. All Hpplicants intim dutyitload and complete the application worksheet filled 2019VWl1FPDiese'l,As <br /> and renautto to include your or iani7alkmi noine and prgjc.t title its follows- <br /> (jnrgaiilzat.iotr�rnigtrtiVJ_Jl)rnJcet_title]�'iVlllcs:i~I�npi►t€c�tlon.xls�. <br /> 2. Any ilonpruiil applicants required to obtain a Charitable:Solicitation License from tiro North <br /> C_'arxilinat PCIN1i'lincot ofthc SircrOary of Statc mirm providc ai cop),o the license and nume tit file <br /> With yourorg�anizatlon name and project title as.rollaws. <br /> {lorganizal€an i anael_lproject_titlej_4'1 ffiesel_[anprsal•It_lieeuq ,pdp <br /> 3. Stave[tris tile and rename to include.your urpjnWiflon nomev and project title as follows: <br /> {Jnrgsanixat.€otr nsa[tte�_ g�rn eel i€tit•#_V'�4't)Ic�scl_ntltllcat lomptll). <br /> -1. Optional ottochtrrcnts shotilci be named to include your orgonirntio n nnaw,prgJ"t title,gvncral <br /> description as fislleiss•4:florgatnization nantelJproject title] Y1i`©Iescl support.lido. <br /> 5. For projects requesI ft! I'miding I`or Charging intirastruc:ture kvill)an till-electric replacement or <br /> t l'oOwcr,please include an itemized budgeL(One charger allowed for each vehicle re(rlacemem or <br /> rclvwcr tcqucstc(l )irfame This attaclimcm to includc your orgimizalion nanic rand project titl4 x5tallows:(Jorgatil:uilion 1i1tmeJ_JproJLv1 title] ti1WDksel eharging_htidget,lit](), <br /> All tiles raid unty atdelitiortal Ski purtiriK a 3ocunientattion must be cinaiW to: <br /> ave.N`C:4� `fi�lsfilicaitirtri(ci tic bor.gov elle later than 5t40 pan.EtstCrit Time nit Svptentlwr 30,2019. <br /> Ni:DEQ internal Use Only <br /> Receipt Ditto and Time: <br /> Application ID: <br /> Assigned to: <br /> - � <br /> I7.lurinitiittufi=nvinvan3enl.xl Qaality.rJiv6snc,af,'1irCJeuliey Aug•usi 2,2U19 6 <br /> Page 19 of 26 <br /> f <br /> i <br /> 1 <br />