Form A2 - Goods Movement Emission Reduction Program Application
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2GOODS MOVEMENT EMISSION REDUCTION PROGRAM APPLICATION (Year 4)
FORM A2: Equipment Information – Heavy-Duty Truck Replacement
(Complete 1 Form per truck)
I. EXISTING TRUCK AND ENGINE INFORMATION
Truck Information
Drayage and “Dray-off” trucks are NOT eligible for funding
"Drayage and Dray-off Trucks" are defined by Section C.15 of the Drayage Truck Regulation (13 CCR §2027) which states that any in-use on-road vehicle with a
gross vehicle weight rating (GVWR) greater than 26,000 pounds that is used for transporting cargo, such as containerized, bulk, or break-bulk goods, that
operates:
(A) on or transgresses through port or intermodal rail yard property for the purpose of loading, unloading or transporting cargo, including transporting
empty containers and chassis; or
(B) off port or intermodal rail yard property transporting cargo or empty containers or chassis that originated from or is destined to a port or intermodal
rail yard property .
Vehicle Identification Number (VIN):
Fleet ID Number (Unit #):
Truck Make:
Truck Model Year:
License Plate Number:
Manufacturer Gross Vehicle Weight Rating (GVWR):
lbs
Odometer Reading:
(Refer to the tag found in the door jamb of your truck for the correct GVWR. Please attach a photograph of
Dash
Hub
this tag. NOTE: This is NOT the number registered with the DMV)
Has the truck previously received grant funding?
If yes, when and where did you receive it from?
No
Yes
If truck has previously received funds from this program, the new grant amount will be reduced by the amount previously received.
Engine Information
Engine Model Year:
Engine Serial Number:
Fuel Type:
Diesel
Other:
Is a diesel particulate filter currently installed on your truck?
No
Yes If yes: Date of installation:
Level of filter:
Vocation and Vehicle Miles Traveled (VMT) Information
Vocation (Types of goods typically transported – Choose 1 box only)
“Goods” are defined as having the same meaning in Commercial Code section 2105, which essentially requires that:
1) The goods must be movable, and 2) The goods being moved must be part of a transaction that involves a contract for the sale of the goods.
Agricultural
Concrete Mixer
Dry Bulk Blower
Vacuum Pneumatic Trailer
Aggregates
Container
Hazardous Materials
Wood/Paper Products
Bulk or Break Bulk
Dairy
Heavy Equipment/Metals
Restaurant/Grocery
Building/Construction
Dump Truck
Poultry
Other
Estimated Percentage of Annual Vehicle Miles Traveled (VMT) in CA Trade Corridors
(Total percentage cannot be over 100%)
% Bay Area
% Central Valley
% LA/Inland Empire
% San Diego/Border
%
% Outside CA
Other in CA
Power Take-off (PTO) Usage
(if applicable)
Current PTO hour meter reading:
Does PTO operate while the main truck engine is operating?
Yes
No
II. PROPOSED NEW EQUIPMENT AND FUNDING REQUESTED
What type of project are you selecting?
New vehicle must be equipped with an engine meeting 0.20 g/bhp-hr or less NO
emission level (FEL and CERT values) and 0.01 g/bhp-hr or
X
less PM (CERT value) (MY2010 emission standard), and must be the same weight classification range as the existing truck (except under
conditions listed in Appendix A of 2013 Guidelines).
Replacement Engine Emission Level
Fuel Type:
(Please check only 1 box below)
Existing Truck
Diesel
Electric (Zero-Emission)
0.20 NOx - New truck
0.20 NOx - Used truck
CNG
LNG
Hybrid
(2013 or newer engine)
Class 8
*
*
For zero-emission projects only:
$50,000 or $
$40,000 or $
(33,001 lbs or greater, HHD engine)
What is the status of your HVIP application?
*
*
Class 7
Application submitted
$35,000 or $
$35,000 or $
(26,001 – 33,000 lbs, MHD or HHD engine)
Application not submitted
*
Class 6
Funding not available
Complete (HVIP Voucher #
)
$25,000 or $
(19,501 – 26,000 lbs, MHD engine)
(Used Class 6 Not Eligible)
*
You may request an amount lower than the maximum allowable shown to enhance the project cost-effectiveness score.
Proposed future operation within CA during Contract term (choose one):
At least 90%
100%
(Choosing 90% operation in CA during contract term may impact the competitive ranking for a project.)
Source of funds to cover costs of equipment after grant is applied:
Private (cash/loan)
Local
Other state
Federal
Did you attach one completed copy of Form A2 for each piece of equipment included in your application?
Did you initial and attach all required documents described on page 2? (see next page)
Office Use Only
Form A2
Clear Form
PRINT
App: # _______________________
Date Received:_________________
Page 1 of 2
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