Zip Code:
APPROVED
Print Name
Signature of Authorized Lead Applicant (Awardee)
NOT APPROVED
CMO Program Manager Approval
DateSignature
Date
Authorized Lead Applicant (Awardee) Name/Title/Organization Must check box below:
I agree that the eligible additional funding will be used directly towards the awarded project's eligible activities only in support of the project scope outlined in the Awardee's Voucher Agreement and the total voucher award does not exceed $1,500,000 in the Awardee's amended Voucher Agreement.
I certify to the best of my knowledge and belief that this MPV Window 1 Awardees Additional Funding Request is accurate and complete and all outlays and obligations are for the purposes set forth in the Voucher Agreement:
D. Lead Awardee Attestation and Signature
There is a set-aside fund specifically for current MPV funded projects. Window 1 MPV Awardees are eligible for up to $500,000 in additional funding for their current funded project without submitting a new voucher application¹. The additional funds for Window 1 MPV Awardees may be applied to a variety of eligible activities related to insurance compliance, capital acquisition, planning and operations, administration, outreach and marketing, participation in the Clean Mobility Equity Alliance (CMEA) meetings and other pro
gram activities only in support of the project scope outlined in their voucher agreement. Awardees must submit an updated financial sustainability plan, an updated project milestone schedule and a revised budget that justifies the need and use of additional funds based on the current approved milestone schedule and budget to the Program Administrator for review and approval within 90 business days of receipt of their notification email. Program Administrator will work with each awardee to process their voucher agreement amendment.
Additional set-aside funds can go directly to the Awardee's original project scope and can include for costs such as:
• Insurance compliance
• Projects going back to their original scope of work/budget worksheet and maintain the number of vehicles they had to decrease because of increase of other costs. • Changing infrastructure type or vehicle model due to supply and demand if corresponds with your original project scope and needs assessment results. • Capital acquisition (including vehicles, micromobility devices, and infrastructure equipment) if corresponds with your original project scope and needs assessment results. • Planning and operations activities if corresponds with your original project scope and needs assessment results and during the project's Voucher Funding Term. • Administration activities associated with payment request submissions, insurance compliance, data reporting, printing, record retention, and mailing. • Outreach and marketing activities associated with conducting community outreach, educational forums, collecting community input, and promoting the service. • Participation in the CMEA meetings and CMO-related program trainings and networking opportunities including the Fall 2023 Clean Mobility Equity Forum in Los Angeles. •
Ot
her program activities only in support of the project scope outlined in your voucher agreement are subject for approval by the Program Administrator and CARB. ¹ Window 1 MPV awardees who have less than $1M in voucher funding in their current voucher agreement may apply for more than $500k to reach up to $1.5M total in their amended voucher agreement. However, approval is upon availability of funds and CARB’s discretion.
INSTRUCTIONS:
To request addition funding of up to $500,000, the Awardee shall submit this Mobility Project Voucher Window 1 Awardees Additional Funding Request within 90 business days of receipt of their notification email. The Additional Funding Request must be submitted via email to [email protected] or by mail and include the supporting documents:
1. Updated Financial Sustainability Plan
2. Revised Mobility Project Voucher Budget Worksheet
3. Updated Project Milestone Schedule
A. General Information
B. Reas
on for Additional Funding
Window 1 Mobility Project Voucher (MPV) Awardees
Additional Funding Request
CMO Mobility Project
Voucher Agreement #:
Mailing Address:
City:
Phone Number:
Lead Applicant (Awardee)
Organization Name:
State:
Email Address:
Total Voucher Amount Not-to-Exceed $1,500,000Requested Additional Funding Amount Provide reason for additional funding request and how the set-aside funds will go towards your orginal project scope:
C. Total Voucher Amount Requested
Indicate the executed voucher funding amount, the requested additional funding amount, and the total requested amount in voucher funding:
Executed Voucher Funding Amount
Cesar Hernandez 4/16/24
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