EV Fast Charge Program Application
    This application is meant to be submitted by the EV Service Provider (EVSP) / EV Charge Vendor on behalf of the Site Host.  Vendors are expected to work closely with site hosts in order to 
    complete the application, and a brief consent form is provided for Vendors to have Site Hosts submit directly.  
    Please submit a separate application for each site, even if the site host decision maker has multiple properties.  
                                 Question                                                             Vendor Response                                             Response Type
    Contact Information - EV Service Provider (EVSP) 
    EVSP Company Name                                                                                                                                  Drop Down
    Contact Name                                                                                                                                       Open ended 
    (Person completing the application)
    Job Position Title                                                                                                                                 Open ended 
    Email Address                                                                                                                                      Open ended 
    Phone Number                                                                                                                                       Open ended 
    Alternative Phone Number                                                                                                 Y                         Open ended 
    Contact Information - Site Host Decision Maker                                                                     L
                                                                                                       ON
                                                                                                     
    Site Decision Maker Name                                                                 E
    (This person has the authority to sign Terms & Conditions and                    L                                                                 Open ended 
    Infrastructure Designs)                                                    P                                    se
                                                                     M
    Site Decision Maker Mailing Address                     A                                             U                                            Open ended 
                                                      S                                              t
    Job Position Title                                                                          o                                                      Open ended 
    Email Address                                                                    N                                                                 Open ended 
                                                                              o
    Phone Number                                                      D                                                                                Open ended 
    Alternative Phone Number                                                                                                                           Open ended 
    Contact Information - Site Host, Alternate Contact
    Site Host (SH) Contact Name 
    (Local contact who will be present for site walks and related site-                                                                                Open ended 
    specific needs)
    Job Position Title                                                                                                                                 Open ended 
    Email Address                                                                                                                                      Open ended 
    Phone Number                                                                                                                                       Open ended 
    Alternative Phone Number                                                                                                                           Open ended 
    Contact Information - Property Owner 
    Property Owner Contact Name                                                                                                                        Open ended 
    (This person has the authority to sign an Easement)
                                                                                             Page 1 of 5
                                 Question                                                           Vendor Response                                            Response Type
    Property Owner Mailing Address                                                                                                                  Open ended 
    Email Address                                                                                                                                   Open ended 
    Phone Number                                                                                                                                    Open ended 
    Alternative Phone Number                                                                                                                        Open ended 
    Basic Site Information
    Installation Street Address (Project Site)                                                                                                      Open ended 
    Installation City (Project Site)                                                                                                                Open ended 
    Installation Zip Code (Project Site)                                                                                                            5 digit number
    What is the latitude and longitude of the parking lot?                                                                                          lat & long
    Please provide a site map of the facility specifying any known                                                                                  Upload PDF or picture with supporting 
    transformers, areas of property where chargers can not be located,                                   Leave Blank                                detail to PowerAdvocate. Use naming 
    and a description of why.  This will be used to evaluate project                                                                                convention StreetAddress_SiteMap. 
    feasibility.
    Is the property owned or leased?                                                                                                                Drop down list
    If leased, how many years remain on the lease?                                                                                                  number greater than 0
                                                                                                                                            Y
    What is the electric Service Agreement ID number for the customer of                                                               L Please use electric distribution Service 
    record for this site?  Note, if customer is CCA service customer, please                                                  N Agreement ID, located on customer 
    be sure to use the electric distribution Service Agreement ID versus                                            O                               bill
    the generation one.                                                                                     E
                                                                                               PL
    Has this site ever applied to PG&E for a new EVSE service connection                                                           se yes/no
    (i.e., via Service Planning)?                                                    M                                     U
                                                                            A                                            
                                                                                                                     t
    If so, what is (was) the application number?                      S                                No                                           number
    Charger Details                                                                                  
                                                                                              o
                                                                                      D
    What is the model of the charger(s) you are planning to install?                                                                                Open ended
    Provide cut sheet of charger(s)                                                                                                                 Upload PDF to PowerAdvocate. Use 
                                                                                                         Leave Blank                                naming convention 
                                                                                                                                                    StreetAddress_Cutsheet_Model. 
                                                                                            Page 2 of 5
                                   Question                                                               Vendor Response                                                Response Type
    What is the kW per charger proposed?                                                                                                                     Select [50kW, 150kW, 350kW, Other]
    If Other, please specify?                                                                                                                                number greater than 0
    What is the desired number of Fast Chargers to install on this site?                                                                                     number greater than 0
    If flexible, what is the minimum number of Fast Chargers that the                                                                                        number greater than 0
    customer would consider for this site?
    If flexible, what is the maximum number of Fast Chargers that the                                                                                        number greater than 0
    customer would consider for this site?
    The charger equipment can be owned by the site host, an EVSP or a                                                                                        Site host, EV Charge Company, Other 
    3rd party.  Who will own the EV charger equipment at this site?                                                                                          (please describe)
    How will the up front and ongoing costs be covered?                                                                                                      open ended
    What is the estimated total dollar value of up-front costs for                                                                                           number greater than 0
    equipment?
    What is the estimated annual cost to operate the equipment?                                                                                              number greater than 0
    Please describe the system's load management capabilities.  In your 
    response, please address the following:  
    - Experience using OpenADR (beyond certification)
    - Hardware and software capabilities to apply power sharing across co-                                                                                   open ended
    located vehicles/chargers
    - Hardware and software capabilities to control chargers remotely
    - Hardware and software capabilities to limit, schedule, or time 
    charging sessions
    Other Site Related Questions
    Is this site located inside of a Disadvantaged Community?                                                                                                Yes/ No
    Is this site located adjacent to a Disadvantaged Community?                                                                                              Yes/ No
    Assuming 2 - 50 kW chargers were installed, what is the estimated 
    utilization per charger on this site in each of the following years (100%                                  Leave Blank                                   intentionally blank
    = 24 hour utilization).
                                      2020                                                                                                                   %
                                                                                                 Page 3 of 5                                        Y
                                                                                                                                     NL
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                                                                                 A                                              
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                                                                                                           No
                                                                                                    o
                                                                                           D
                                   Question                                                               Vendor Response                                                Response Type
                                       2021                                                                                                                   %
                                       2022                                                                                                                   %
                                                                                                                                                     Y
                                       2023                                                                                                    L %
                                       2024                                                                                           N %
                                                                                                                             O
    What tools were used to inform the estimates provided?                                                         E                                          Open ended
    Is the site in a parking garage or open parking lot?                                             PL                                    se Select: Garage or Parking Lot or Other
                                                                                          M
    Is there a plan to integrate other renewable resources or storage with       A                                              U
    this site?  If so, please describe - providing the timeline for       S                                                 t                                 open ended 
    construction and any major dependencies.                                                               No
    What cellular service provider is used for the EVSE?                                            o                                                         open ended 
                                                                                           D
    Please provide the decibel-milliwatts (dBm) level of the cellular signal                                                                                  number
    at this location.
    Please describe the top three amenities anticipated to be used by                                                                                         Open ended.  Amenities can include 
    drivers who charge at this location and the hours of availability of                                        Leave Blank                                   retailers, restaurants, supermarkets, 
    each.                                                                                                                                                     restrooms, window squeegee/car 
                                                                                                                                                              cleaning supplies, public park, etc.
                                                                  Amenity #1                                                                                  open ended 
                                                                  Amenity #2                                                                                  open ended 
                                                                  Amenity #3                                                                                  open ended 
                                                         Hours of amenity #1                                                                                  00:00 - 24:00 h
                                                         Hours of amenity #2                                                                                  00:00 - 24:00 h
                                                         Hours of amenity #3                                                                                  00:00 - 24:00 h
    Is there a public restroom available on the premise?                                                                                                      Yes/ No
    If yes, what are the hours in which it is available?                                                                                                      00:00 - 24:00 h
    Are there existing EVSEs on this site?                                                                                                                    Yes/ No
    If so, how many?                                                                                                                                          Indicate number > 0 or n/a
    What type? (kW)                                                                                                                                           Indicate number > 0 or n/a
    Timelines
                                                                                                                                                              As soon as possible; within 6-9 months 
    If selected to the program, what is the desired activation date for                                                                                       of application submission; within 9 - 
    EVSEs?                                                                                                                                                    12 months of application submission 
                                                                                                                                                              date; within 12 - 18 months.
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