Electric School Bus Pilot Program Enrollment

Required Documentation

To enroll in the Electric School Bus Pilot Program, applications must provide the following with application:

Proof of ownership or lease of electric school buses in number existing or ordered at least equal to the number of EV charging stations applied

Email completed application and required documents to: electric.vehicles@libertyutilities.com

Liberty Electric School Bus Pilot Program Enrollment Application

CUSTOMER INFORMATION

Customer name on electric account

Liberty Account Number (from utility bill)

Location where the electric vehicle (EV) charging station(s) is to be installed

Street Address

City

State

Zip

Contact Name

Phone Number

Email address

Description of proposed EV charging station(s) location (relative to buildings, areas, or parts of the property)

Are you signed up for e-bill/paperless billing?

Yes

How many Level 2 EV charging stations are requested with this application?

How many direct current fast charge (DCFC) charging stations are requested with this application?

VEHICLE INFORMATION

Where are you in the purchase journey? Please provide documentation.

Currently have an electric bus in the fleet

Ordered an electric bus

Applied for a grant to purchase an electric bus

Thinking about an electric bus

Currently have an electric bus in the fleet. Attach a schedule of owned electric buses with the below information and specify:

Vehicle Make

Vehicle Model

Vehicle Year

Date purchased/leased

Is bus DCFC capable? Yes or No

Ordered an electric bus. Attach a schedule of ordered electric buses with the below information and specify:

Expected arrival date

Vehicle Make

Vehicle Model

Vehicle Year

Is bus DCFC capable? Yes or No

Applied for a grant to purchase an electric bus. Expected award date:

Agreement

I accept the terms and conditions*

Print Name of Applicant

Date

SURVEY

I am interested in participating in the Electric School Bus Pilot Program because (check all that apply)

The program allows the school district to pilot electric school buses without the initial investment and operational responsibility of the charging stations

The program provides a turn-key approach to vehicle charging

We want to support the environmental benefits of driving an EV

Helps support the district’s sustainability goals

Healthier (cleaner air to breathe) commute for students and drivers

Cost-saving benefits to the school district

Our board/faculty and/or parents are asking us to electrify our buses

Other (specify)

*Acknowledgments

Applicant acknowledges that its participation in the Program is contingent upon the execution of the Participation Agreement and payment of Program Enrollment Fee.

Applicant will permit Liberty representatives to inspect the location of intended installation of the EV charging station(s) on a mutually satisfactory date and time.