THE NAME ON THE INVOICE(S) AND PROOF OF
PAYMENT(S) PROVIDED WITH THE CLAIM FOR
PAYMENT MUST EXACTLY MATCH THE
RECIPIENT NAME ON THE VOUCHER AND IRS
FORM W-9
New Online Web Portal
For faster service, please submit your Claim for Payment packet online at:
https://ww2.valleyair.org/grants/ag‐burn‐alternatives‐grant‐program/
For new users, you can submit your Claim for Payment and stay informed on the status of your application by creating a new account and connecting your application.
Access Code: WLCXUYgH
For assistance, contact District staff at
[email protected]
or 559‐230‐5800
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org
City of Visalia
7579 Avenue 288
Visalia, CA 93277
126.0Walnuts Land Application
AG BURN ALTERNATIVES GRANT PROGRAM
Voucher Number: Maximum Voucher Amount:
Recipient:
Address:
City, State, Zip:
Crop Location:
City, State, Zip:
You have been approved for funding to chip/shred the following orchard removal crop(s) to be used on-site or at an approved off-site location, as indicated below, as an alternative to the open burning of these materials:
Crop Type: _______________ Crop Acres: ______________ Project Type: ___________________
This voucher is redeemable in the amount up to a maximum of _________________based on the final disposition of the agricultural material (project type) and number of acres indicated above. Incentive amount may be reduced if the final project is different from what is listed above or if the final eligible cost is less than the maximum voucher amount. Co- funding is allowed, however, the total combined funding may not exceed 100% of the total eligible project costs.
The maximum incentive is $600 per acre for chipping with soil incorporation, $300 per acre for chipping without soil incorporation, and $600 per acre for off-site beneficial re-use. An additional $400 per acre is provided for each incentive category to agricultural operations with 100 total acres or less within the San Joaquin Valley.
Terms of Voucher
Project life for this voucher is twelve (12) months from the date of issuance, during which I agree to:
1) Chip/shred the number of acres of the crop identified above. 2) Use the chipped/shredded agricultural material under the same disposition method as indicated above as applied for. 3) Certify that I will continue to use the acres identified for continued agricultural use. 4) Certify that I am currently in compliance with all federal, State, and local air quality rules and regulations and I am not aware of any outstanding or pending enforcement actions. 5) Adhere to all terms & conditions of the Ag Burn Alternatives Grant Program and Guidelines. 6) Submit a completed and signed Voucher, Claim for Payment Form, Breakdown of Services and Costs Form, Disclosure of Co-Funding Form, invoice(s) for services conducted, including a breakdown of services and documentation of any additional incurred costs, and proof of payment. The name on the invoice(s) and proof of payment(s) must match the recipient name on the voucher and IRS Form W-9. Any discrepancy will delay processing of the reimbursement payment.
7) Allow the completion of the post-inspection of the completed project by District staff.
This voucher is valid up to twelve (12) months from the issued date and is to be returned once the project is complete
Recipient: By signing below, you are confirming the information listed above and accepting the terms of this Voucher and the corresponding Claim for Payment Form.
Recipient Signature: Date:
Nick Bartsch, Signing Authority
By signing, I validate the issuance of this Voucher in accordance with the Ag Burn Alternatives Grant Program
Signature: Issued:
Todd DeYoung, Director
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org Page 1 of 6 G-243820 $37,800.00
City of Visalia
7579 Avenue 288 Ave 288 & Rd 68, NE
Visalia, CA 93277 Visalia, CA 93277
$37,800.00
01/06/2025
AG BURN ALTERNATIVES GRANT PROGRAM
INDEMNIFICATION
Recipient agrees to indemnify, save, hold harmless, and at District’s request, defend District, its boards, committees, representatives, officers, agents, and employees from and against any and all costs and expenses (including reasonable attorneys’ fees and litigation costs), damages, liabilities, claims, and losses (whether in agreement, tort, or strict liability, including, but not limited to, personal injury, death, and property damage) occurring or resulting to District which arises from any negligent or wrongful acts or omissions of Recipient, its officers, agents, subcontractors, or employees in their performance of this Voucher.
NON-DISCRIMINATION CLAUSE
During the performance of this Voucher, the Recipient shall not unlawfully discriminate, harass, or allow harassment against any employee or applicant for employment because of sex, race, color, ancestry, religious creed, national origin, physical disability (including HIV and AIDS), mental disability, medical condition (e.g., cancer), age (over 40), marital status, denial of family care leave and denial of pregnancy leave. Recipients shall ensure that the evaluation and treatment of their employees and applicants for employment are free from such discrimination and harassment.
Recipients shall comply with the provisions of the Fair Employment and Housing Act (Gov. Code 12990 (a-f) et seq.) and the applicable regulations promulgated thereunder (California Code of Regulations, Title 2, Section 7285 et seq.) The applicable regulations of the Fair Employment and Housing Commission implementing Government Code Section 12990 (a-f), set forth in Chapter 5 of Division 4 of Title 2 of the California Code of Regulations, are incorporated into this Voucher by reference and made a part hereof as if set forth in full. Recipients shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other agreement.
CONTINUED AGRICULTURAL USE CERTIFICATION
Recipient agrees to continue to use the acres identified on the Voucher for continued agricultural use. The property undergoing an orchard removal, will remain a commercial agricultural operation, consistent with District Rule 4103 – Open Burning, and Section 80100 of Title 17, Code of California Regulations, which provides for the open burning of agricultural materials produced wholly from agricultural operations in the growing and harvesting of crops or the raising of fowl or animals for the primary purpose of making a profit, providing a livelihood, or conducting agricultural research or instruction by an educational institution. Land conversions intended for non-agricultural purposes are not eligible for funding. The orchard or vineyard materials to be removed at the above-described location are from a commercial agricultural operation.
The removal of this orchard or vineyard is not for the purpose of preparing the land for a commercial, residential, or other non-agricultural use.
TAX IMPLICATIONS
Approximately one year after incentive funds have been issued, the Recipient may receive an Internal Revenue Service (IRS) Form 1099. For information about the tax implications related to receiving incentive funds, please consult your tax advisor, as the District does not provide tax advice.
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org Page 2 of 6
AG BURN ALTERNATIVES GRANT PROGRAM
BREAKDOWN OF COSTS AND SERVICES FORM
Please submit this form with your Claim for Payment Packet. Include a breakdown of the costs for the applicable services Identify who conducted the service and costs for each applicable service o If the service was conducted by the grower, be sure to identify the costs on this form and include an itemized statement of cost incurred (e.g. tree rope removal, fuel, labor, maintenance costs, etc.) Note in the comments section if any of the individual services listed were combined and performed as a single process. Also include costs for any steps not identified in the table. Include the cost of the services and explanation of the process.
Note in the comments section if disposition of the agricultural material was for any off-site beneficial re- use and identify which practice was used (mulch, co mposting, land application near roadways for dust suppression, or other District appr oved use of the agricu ltural material) and any costs or revenue associated with the practice.
Please note: Disposition of the agricultural material must not be for any combustion practice such as biomass power generation, pyrolysis, or air curtain burners.
Orchard Removal
SERVICES PROVIDED PERFORMED BY: COST
Equipment Move-In Fees Grower Contractor $
Pushing/Piling Grower Contractor $
Chipping Grower Contractor $
Spreading Grower Contractor $
Soil Incorporation Ripping Number of Passes: _________ Grower Contractor $ Soil Incorporation Discing Number of: Passes:________ Grower Contractor $ Additional Costs: _______________________________ Grower Contractor $ Total Cost $
Comments:
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org Page 3 of 6
AG BURN ALTERNATIVES GRANT PROGRAM
CLAIM FOR PAYMENT FORM
Recipient Name: _______________________________ Voucher Number: _____________ Recipient Reimbursement
Address: Tax ID: ________ ______________________________ City, State, Zip: Phone Number:
Location of Removal of Agricultural Material
Name:
Address:
City, State, Zip:
Final Disposition of Agricultural Material
Name:
Address:
City, State, Zip:
Itemization of Invoice(s) and Costs Incurred
Date of Invoice Description Amount Paid
Total Amount Paid
Grant Amount:
Claim Packet Checklist
Signed Voucher (must match the Application Signing Authority) Completed Breakdown of Services and Costs Form and Completed Disclosure of Co-Funding Form Invoice(s) from contractor services (must show an itemization of services conducted and the name on the invoice(s) must match the recipient name on the voucher and IRS Form W-9 exactly) Documentation of any additional incurred costs by the participating grower, if additional costs are beyond those on the invoice(s) for contracted services. Additional costs must be itemized and applicable payment date(s) identified Proof of payment (copies of cancelled checks, receipts or finance documents and the name on the proof of payment must match the recipient name on the voucher and IRS Form W-9 exactly)
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org Page 4 of 6 City of Visalia G-243820
$37,800.00
Disclosure of Co-Funding Form
Project Number: G-243820
To be eligible to receive incentive funding from the San Joaquin Valley Air Pollution Control District (District), you must indicate below if you have applied for or received funding from any other sources for this project. You must also indicate if you intend to ap ply for additional funding from other sources in the future for this project. In addition, you are required to disclose the value of an y current financial incentive that directly reduces the project cost includ ing tax credits or deductions or other public financial assist ance.
Additional funding sources include, but are not limited to, federal, state, and third-party private sources.
For any additional funding that you will receive or have received for this project, please attach copies of letter(s) of financial commitment, copy of agreement(s) or grant award letter(s) that are specific to the proposed project.
Information provided on this form may be shared as required by federal, state, and local laws. Any owner, designee, or other third party who is found to have submitted multiple applications or signed multiple contracts for this same specific project without proper disclosure shall be disqualified from funding for that project from all sources within the control of the District.
NOTE: Applying for or receiving funding from other sources for this project does not necessarily preclude you from applying for or receiving funding from the District.
SECTION 1: Applicant certifies (please check one):
Yes, I HAVE applied and/or WILL APPLY for funding from other sources for this project. Please list the name of the source and funding amount received or requested. If available, please attach grant award letters for the proposed project from all additional funding sources listed below.
Source: Funding Amount:
1. $
2. $
3. $
No, I HAVE NOT applied and WILL NOT apply for funding from other sources for this project.
SECTION 2: If applicable, please list here any other financial incentives you have received and/or will receive from third-party sources which directly reduce the project cost. Please attach all letters of financial commitment from the third-party sources with the amount identified.
Source: Financial Incentive Amount:
1. $
2. $
3. $
Nick Bartsch
Signing Authority (Print Name)
Signing Authority Signature Date
(Date required on this document)
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org Page 5 of 6
AG BURN ALTERNATIVES GRANT PROGRAM
This document is to provide instructions and guidance for the successful completion of a Claim for Payment Packet for the Ag Burn Alternatives Grant Program. For assistance, contact District staff by email at [email protected] or phone at (559) 230-5800.
STEPS FOR REIMBURSEMENT
1. Complete the project as described on the Voucher.
Funding shall only be allowed toward reimbursement for services described on the Voucher up to the maximum amount listed on the Voucher and payment is for reimbursement only.
2. Obtain itemized invoice(s) and proof of payment.
3. Submit complete Claim for Payment Packet by the expiration date of your Voucher.
Claim for Payment Packet can be submitted online at https://ww2.valleyair.org/grants/ag-burn- alternatives-grant-program/ (Access Code: WLCXUYgH)
Claim for Payment Packet can also be submitted via mail, email, and/or fax.
4. Complete the post-inspection site visit with District staff.
The submission of a complete Claim for Payment Packet triggers the post-inspection site visit. District staff will complete an inspection report and take photographs during the site visit, including the final disposition of agricultural material. Be sure to clearly identity any and all final disposition location(s) of agricultural material.
5. District will issue payment after the post-inspection is completed and the Claim for Payment Packet reviewed.
6. Payment will typically be made within 60 working days from receipt of complete Claim for Payment Packet.
CLAIM FOR PAYMENT PACKET
Please make sure to submit the following for a complete Claim for Payment Packet:
1. Completed and signed Voucher.
The same individual who signed the Application with the District and listed as the Signing Authority must also sign the Voucher.
2. Completed Claim for Payment Form.
3. Completed Breakdown of Services and Costs Form.
4. Completed Disclosure of Co-Funding Form.
5. Invoice(s) from contractor services.
Invoice(s) must itemize services conducted.
Name on the invoice(s) must match the
name of voucher recipient and name on IRS Form W-9 exactly.
6. Documentation of any additional incurred costs by the participating grower, if additional costs are beyond those on the invoice for contracted services. Additional costs must be itemized and applicable payment date(s) identified.
7. Proof of Payment (copies of cancelled checks, receipts or finance documents).
Name of the payer must match the name of voucher recipient and name on IRS Form W-9 exactly.
Central Region Office * 1990 East Gettysburg Avenue * Fresno, CA 93726‐0244 * www.valleyair.org Page 6 of 6 To submit Claim for Payment packet and to check
status of project, please visit:
https://ww2.valleyair.org/grants/ag-burn-alternatives-
grant-program/