/ Federal Fiscal Year 2017
DERA Application Form
Minnesota Clean Diesel Program
Diesel Emissions Reduction Act (DERA)
Doc Type: Application
  • Before submitting the application form, review the 2017 DERA Request for Grant Application (RFGA).
  • This form must be submitted electronically as per instructions listed in Section 9of the RFGA.
  • If you wish to request multiple technologies, list all projects in one application.

Responderinformation

Organization name:

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Date of application(mm/dd/yyyy):

Contact name: / Contact title:

Mailing address (PO Boxes will not be accepted):

City:

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State:

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Zip code:

County:

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Phone:

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Email:

Project information (All questions must be answered unless otherwise stated.)

Project title:

Estimated start date (mm/dd/yyyy):

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Estimated end date (mm/dd/yyyy):

MPCA anticipates work may begin First Quarter 2017

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Projects must be completed by September30, 2017

Project budget projection

Grant funds requested: / $ / + / Cash match: / $ / =Total Project Cost: / $

Project category being applied for (check all that apply)

Category one (1):Certified engine repower or replacement / Category two (2):Vehicle orequipment replacement / Category three (3):Retrofits-emission control technology / Category four (4):Idle reduction technology / Category five (5): EPA/CARB verified clean alternative fuel conversion

Organization background

How many and what types of diesel powered vehicles or equipment do you have?Please describe your full diesel inventory, not just the projects you are applying for in the grant. (Example: I own and operate 15 garbage trucks).

Does your company currently have an idle reduction policy? Yes No
If yes, please describe:

Approximately what percentage of your diesel vehicles and/or equipment are model year 2007 or newer:%

Approximately what percentage of your diesel vehicles and/or equipment are model year 2006 or older:%

For what tasks do you use your diesel vehicles or equipment, and on average, how long do you keep your vehicles or equipment?Please describe your full diesel inventory, not just the projects you are applying for in the grant. (Example: I operate a waste management business. The 15 garbage trucks collect waste from residential neighborhoods and each run eight hours a day, three days a week.On average, we keep our trucks for eight years.)

For Verified Engine Rebuild/Upgrade projects only(Section 1C. of RFGA), please answer the following questionsonly:

1) Can manufacturers provide engine upgrade kit/systems?

2) If so, what tier level/emission benefits will be realized?

3) How will this grant help you achieve your goals?

Project location

Where in Minnesota will the proposed project vehicles and/or equipment operate? Please list counties.

Project evaluation

This information will be used to evaluate and score the project based on the piece of equipment/vehicle/engine that is being replaced, repowered, retrofitted, etc. (Current equipment/vehicle).

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Current vehicle or equipment type and year of manufacture
Ex. 1998 dump truck / Estimated Remaining years of service / Annual fuel usage in gallons or hours of operation in Minnesota(specify gal or hrs) / Annual fuel usage in gallons or hours of operation in the 7 County Metro Area(specify gal or hrs) / Estimated hours running idle per year / Horsepower (hp)
and Tier-level if off-road / On-road: Class or gross weight (in lbs)
Project 1:
Project 2:
Project 3:
Project 4:

To create a new row, your cursor in the last column of the last row and hit tab

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Project summary and budget chart

Complete one line per project. You must solicit a minimum of two bids per project.Attach allbids to this application.Bids should include estimated time of delivery or estimated completion time of project.

Grant = grant dollars to be spent on project

Cash Match = dollar amount of project to be funded by the applicant’s cash match

Match % = total project cost divided by cash match

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New vehicle or equipment type and year of manufacture
Ex. 1998/dump truck / Project category / Brief project description
Ex. Purchase and install diesel particulate filter / Grant amount
Ex. $5,000 / Cash match
Ex. $5,000 / Match %
Ex. 50% / Total project cost
Ex. $10,000
Project 1:
Project 2:
Project 3:
Project 4:

To create a new row, please place your cursor in the last column of the last row and hit tab.

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Have you or your organization received an MPCA grant before? Yes No

If yes, please list what MPCA grant projects you have or your organization has managed since 2011, and whether projects were managed in accordance with the terms and conditions specified in the Minnesota Pollution Control Agency (MPCA) grant or loan agreement.If you have a record of poor performance with the state, you may provide an explanation below:

Exceptions to Sample Grant Agreement

Please note any exceptions to the Sample Grant Agreement (Attachment A). Any suggestions for alternate language in the Sample Grant Agreement must be presented here. The State is under no obligation to accept wording changes submitted by the applicant.

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