STATE OF CALIFORNIA

DEPARTMENT OF GENERAL SERVICES OFFICE OF FLEET AND ASSETMANAGEMENT FLEET ACQUISITION CERTIFICATION OFA 161 (Rev.07/2017)

FLEET ACQUISITION CERTIFICATION1

This certification addresses provisions in both Executive Order B-2-11, acquisition of state fleet assets, and State Administrative Manual (SAM) Section 4121.1, pure zero emission vehicles (ZEV) exemption.

Section I: Executive Order B-2-11

Executive Order B-2-11, states the following:

IT IS ORDERED that state agencies and departments are prohibited from purchasing any vehicles for non-emergency use except when:

oTheagencyordepartment hasfullyrelinquisheditsvehiclesandequipmentpursuantto its analysis and plan approved byDGS;

oThepurchaseis necessarytoprotectthehealthandsafetyorsecurityofthepublic;

oThepurchaseisnecessarytoprovidecriticalservicesandfunctions;or

oThe purchase will result in significant costsavings.

The Director of the Department of General Services must approve all such acquisition requests, subject to the review of the Secretary of the Government Operations Agency.

Name of Agency requesting vehicle acquisition exemption under the terms of Executive Order B-2-11:

Is seeking an exemption to acquire the following vehicle(s):

Vehicle Type / Additional or Replacement / Purchase, DGS Lease, Commercial Lease or Donation / Quantity / Total Cost

Continued on attached additional pages


1 Long term fleet rentals/leases over 30 consecutive calendar days or more than four (4) consecutive work weeks (excluding weekends and holidays) are considered the same as purchases and must follow all fleet acquisition and reporting procedures.

Vehicle Type / Additional or Replacement / Purchase, DGS Lease, Commercial Lease or Donation / Quantity / Total Cost
TOTALS:

This acquisition request is justified under the terms of Executive Order B-2-11 for the following reasons (please check all that apply and provide a detailed explanation as appropriate):

□1. This purchase is for emergency vehicles which are not restricted by Executive Order B-2-11. Explainhow/why:

□2. This purchase is for non-emergency vehicles that meet at least one of the three exemptioncriteriaoutlinedinExecutiveOrderB-2-11asindicatedbelow:

□The purchase is necessary to protect the health and safety orsecurity

ofthe public. Explainhow/why:

□Thepurchaseisnecessarytoprovidecriticalservicesandfunctions.

Explain how/why:

□The purchase will result in significant cost savings. Explainhow/why:

Section II: Pure ZEV Exemption (Complete only if applicable)

SAM Section 4121.1, Priority Level 1: Pure Zero Emission Vehicle Exemption (if applicable):

State departments, when requesting the purchase of additional or replacement vehicles shall select vehicles in light-duty categories subject to this policy based on the following priority structure:

Priority 1: Pure ZEVs (Battery Electric & Fuel Cell Vehicles) Priority 2: Plug-in Hybrid Electric Vehicles

Priority 3: Hybrid-Electric Alternative Fuel Vehicles

SAM Section 4121.1 allows for an exemption from the Priority Level 1: Pure ZEV requirement by meeting the criteria listed below. Departments shall select the applicable criteria and complete the Pure ZEV table below listing all assets being requested to be exempted from Priority Level 1: Pure ZEV. Departments must complete the table on this form adding more lines as needed to fit all vehicles; attachments with a list of vehicles will not be accepted.

Pure ZEV Exemption Criteria:

☐1. Range Limitations:

☐Directorate level certification that the vehicle(s) being requested will be used more than 72 times in a 12-month period, or 36 times in a 3-month period, for trips lasting less than 24 hours that exceed the mileage range of the Pure ZEV on contract in that vehicle category;

or

☐2. Charging and Fueling Infrastructure:

☐Directorate level certification that the vehicle(s) being requested will be used more than 72 times in a 12-month period, or 36 times in a 3-month period, for trips lasting more than 24 hours in locations with limited and/or unreliable fueling/charging stations.

Pure ZEV Exemptions
Line Item # / Make / Model / Criteria

Department Director Certification:

I, the undersigned, certify that the proposed fleet acquisitions, on this plan are vital, mission critical and in compliance with Public Contract Code10295.2. (a); and, Executive Order B-2-11, and that, if applicable, the requested assets on the pure ZEV table meet the exemption criteria selected above pursuant to SAM Section 4121.1.

Department DirectorSignature:

(The signature shall be by the Director or the Chief Deputy Director. If there is no Director or Chief Deputy Director within the state entity, the signature shall be by the highest level of the executive staff within the applicable state entity. Designees are not acceptable.)

Print Name andTitle:

Date:

Agency Secretary Signature (if Department reports to anAgency):

Print Name andTitle:

Date:

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Agency or DepartmentName:

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