Installation and Operation of Level 2 Electric Vehicle Supply Equipment - Green St Parking Lot, Concord, NH

New Hampshire VW Environmental Mitigation Trust Request for Proposals Installation and Operation of Level 2 Electric Vehicle Supply Equipment Green Street Parking Lot, Concord, NH RFP # NH-VW-2020-01 April 28, 2020 New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 1 Contents SECTION 1 –INFORMATION AND INSTRUCTIONS ......................................................................................... 2 1.1 Purpose ............................................................................................................................................... 2 1.2 Designated Contact Person ................................................................................................................. 2 1.3 Schedule of Events .............................................................................................................................. 2 1.4 Questions

............................................................................................................................................ 2 1.5 Proposal Submittal .............................................................................................................................. 2 1.6 Public Disclosure of Bid or Proposal Submissions ............................................................................... 3 1.7 Cost of Proposal Preparation .............................................................................................................. 5 1.8 Anticipated Contract Term .................................................................................................................. 5 1.9 Contract Award ................................................................................................................................... 5 1.10 Contracting Process .......................................................................................................................... 5 SECTION 2 – LOCATION AND SITE DETAILS ................................................................................................... 5 SECTION 3 – PROJECT SCOPE ........................................................................................................................ 6 3.1 Scope of Services Requested .............................................................................................................. 6 3.2 Equipment Requirements ................................................................................................................... 7 3.3 Determination of Electricity Consumed .............................................................................................. 8 SECTION 4 – APPLICATION REQUIREMENTS ................................................................................................. 8 SECTION 5 – PROPOSAL EVALUATION AND AWARD .................................................................................. 10 5.1 Evaluation Criteria ............................................................................................................................. 10 5.2 Scoring ............................................................................................................................................... 10 SECTION 6 – CONTRACTUAL REQUIREMENTS ............................................................................................ 11 SECTION 7 – ATTACHMENTS INDEX ............................................................................................................ 11 New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 2 SECTION 1 –INFORMATION AND INSTRUCTIONS 1.1 Purpose The New Hampshire Department of Environmental Services (NHDES), on behalf of the Office of Strategic Initiatives (OSI) and the Department of Administrative Services (DAS), is seeking proposals from qualified Vendors to furnish, install, maintain and operate electric vehicle supply equipment (EVSE) on a state-owned property in Concord, NH for a period of five years, with an optional two-year extension. 1.2 Designated Contact Person Timothy White, Supervisor Mobile Source Section New Hampshire Department of Environmental Services 29 Hazen Drive, PO Box 95 Timothy.White@des.nh.gov 603-271-5552 Due to COVID-19 staff are working remotely. Therefore, email is the preferred contact method. 1.3 Schedule of Events Event Date/Deadline Time RFP Issued 4/28/20 9:00 AM Question Period Closes 5/5/20 4:00 PM Responses to Questions Posted 5/11/20 4:00 PM Proposal Due Date and Time 6/8/20 4:00 PM Anticipated Contract Start Date August 2020 1.4 Questions Questions regarding this Request for Proposals (RFP) must be submitted by email to the Designated Contact Person in Section 1.2 prior to the close of the question period specified in Section 1.3. All questions and responses will be posted on the OSI website at https://www.nh.gov/osi/energy/programs/vw-trust-funding.htm by the date indicated. 1.5 Proposal Submittal Applicants shall submit an electronic copy, inclusive of a signed cover page, of the proposal to the Designated Contact Person via email by the date and time specified in Section 1.3. Applicants should consider file size when submitting an electronic proposal and strive to keep attachments in a single email below 15 megabytes. Multiple emails may be necessary to transmit a single proposal. To guard against applications potentially being overlooked due to being quarantined by the agency’s spam protection software it is strongly recommended that an email with no attachments be sent to the contact person initially stating that email(s) containing a proposal are to follow. New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 3 The original signed hard copy of an Applicant’s proposals must be submitted to the Designated Contact Person at the mailing address in Section 1.2 and be postmarked by the date and time specified in Section 1.3. If a proposal contains any confidential business information Applicants must follow the procedures in Section 1.6 below and must submit the specified redacted copy both in hard copy and electronically. Should there be any discrepancies between the electronic copy and the hard copy, the electronic copy will govern. Proposals received after the deadline will not be considered. No changes or additions to a proposal will be accepted after the specified due date and time. If necessary, Applicants may be contacted for clarification of information submitted. 1.6 Public Disclosure of Bid or Proposal Submissions Notwithstanding NH RSA 91-A:4, no information shall be available to the public, or to the members of the general court or its staff concerning specific responses to this RFP invitation from the time this RFP is published until the closing date for responses. Generally, the full contents of any bid or proposal (including all materials submitted in connection with it, such as attachments, exhibits, addenda, and vendor presentations) become public information upon completion of final contract or purchase order negotiations with the selected vendor. Certain information concerning bids or proposals, including but not limited to pricing or scoring, is generally available to the public even before this time, in accordance with the provisions of NH RSA 21-G: 37. To the extent consistent with applicable state and federal laws and regulations, as determined by the State, including, but not limited to, NH RSA Chapter 91-A (the “Right-to- Know” Law), the State shall, after final negotiations with the selected vendor are complete, attempt to maintain the confidentiality of portions of a bid or proposal that are clearly and properly marked by a bidder as confidential. Any and all information contained in or connected to a bid or proposal that a bidder considers confidential shall be clearly designated in the following manner: If the bidder considers any portion of a submission confidential, they shall provide a separate copy of the full and complete document, fully redacting those portions by blacking them out and shall note on the applicable page or pages of the document that the redacted portion or portions are “confidential.” Use of any other term or method, such as stating that a document or portion thereof is “proprietary”, “not for public use”, or “for client’s use only”, is not acceptable. In addition to providing an additional fully redacted copy of the bid submission to the person listed as the point of contact in Section 1.2 of this document, the identified information considered to be confidential must be accompanied by a separate letter stating the rationale for each item designated as confidential. In other New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 4 words, the letter must specifically state why and under what legal authority each redaction has been made. Submissions which do not conform to these instructions by failing to include a redacted copy (if required), by failing to include a letter specifying the rationale for each redaction, by failing to designate redactions in the manner required by these instructions, or by including redactions which are contrary to these instructions or operative law may be rejected by the State as not conforming to the requirements of the bid or proposal. The State will generally assume that a bid or proposal submitted without an additional redacted copy contains no information which the bidder deems confidential. Bids and proposals which contain no redactions, as well as redacted versions of submissions that have been accepted by the State, may be released to the public, including by means of posting on State web sites. The State shall have no obligation to maintain the confidentiality of any portion of a bid, proposal or related material, which is not marked in accordance with the foregoing provisions. It is specifically understood and agreed that the bidder waives any claim of confidentiality as to any portion of a response to this RFP that is not marked as indicated above, and that unmarked (or improperly marked) submissions may be disseminated to any person, without limitation. Marking an entire bid, proposal, attachment or full sections thereof confidential without taking into consideration the public’s right to know shall neither be accepted nor honored by the State. Notwithstanding any provision of this request for submission to the contrary, proposed pricing shall be subject to public disclosure REGARDLESS of whether or not marked as confidential. If a request is made to the State by any person or entity to view or receive copies of any portion of a proposal and if disclosure is not prohibited under NH RSA 21-G:37 or any other applicable law or regulation, bidders acknowledge and agree that the State may disclose any and all portions of the proposal or related materials which is not marked as confidential. In the case of bids, proposals or related materials that contain portions marked confidential, the State shall assess what information it believes is subject to release; notify the bidder that the request has been made; indicate what, if any, portions of the proposal or related material shall not be released; and notify the bidder of the date it plans to release the materials. The State is not obligated to comply with a bidder’s designation regarding confidentiality. The State shall have no obligation to advise a bidder that an individual or entity is attempting to electronically access, or has been referred to, materials which have been made publicly available on the State’s web sites. By submitting a proposal, the bidder agrees that unless it obtains and provides to the State, prior to the date specified in the notice described in the paragraph above, a court order valid and enforceable in the State of New Hampshire, at its sole expense, enjoining the release of New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 5 the requested information, the State may release the information on the date specified in the notice without any liability to the bidder. 1.7 Cost of Proposal Preparation Preparation costs of any proposal in response to this RFP are the sole responsibility of the Applicant. 1.8 Anticipated Contract Term The anticipated Contract term is from the effective date of the Contract for a period of five years. At the option of the State, a two-year extension may be offered. 1.9 Contract Award The selected Applicant will be notified in writing, which may include email. The State reserves the right to negotiate the final terms and conditions of the Contract with selected Applicant whose proposal is selected, and to reject any selected Applicant with whom the State cannot agree to terms and conditions meeting the State’s needs. 1.10 Contracting Process The selected Applicant must enter into a contractual agreement with OSI. Such Contract is not valid until approved by the Governor and Executive Council. The selected Applicant must be in receipt of a Notice to Proceed before any work may begin. Any project costs incurred prior to receipt of a Notice to Proceed are ineligible expenses under this solicitation. All proposals will remain confidential until a Contract is approved by the Governor and Executive Council. SECTION 2 – LOCATION AND SITE DETAILS The project location is a state-owned parking lot located at 33 Green Street, Concord NH. Access to the lot is via School Street to the west of the Green Street/School Street intersection. The property, which is currently utilized as restricted parking for members of the General Court, is owned by the New Hampshire Department of Administrative Services (DAS) and also accommodates a DAS boiler building. The four parking spaces designated for EV charging will be available to the general public. The Green Street parking lot contains 28 parking spaces. Four of the parking spaces located on the southeastern corner of the lot, and nearest to the boiler building and electrical panel, will be dedicated for electric vehicle charging. Two 24-inch high round concrete foundations are located adjacent to the paved parking surface and are positioned for each to access two parking spaces. The concrete foundations include a ground connection and one-inch PVC conduit with a pull rope connection to the interior of the boiler building near the electrical breaker panel. Modifications to the foundations will be allowed if necessary to accommodate the proposed charging pedestal. Any said modifications must be approved in advance by the State of New Hampshire, Department of Administrative Services. New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 6 The Green Street Parking Lot is lit by pole-mounted lights located on the northern, southern and western limits of the site. The southern light pole standard is located adjacent to the western concrete EVSE foundation. Power at the site is 208/120 AC from a 208 VAC Three Phase panel. The panel has spare capacity to accommodate the needed circuits for the two Level 2 EVSE charging stations. Access to the power supply by the selected Vendor will be available 24 hours per day, 7 days per week by contacting the DAS designated personnel. Potential Applicants are asked to please contact the Designated Contact Person in Section 1.2 of this RFP as soon as possible if an in-person review of the panel is necessary to complete a proposal. Photographs of the site, including the electrical panel and Google Map aerial views, are located in Attachment A. General maintenance of the site including snow removal is provided by DAS. The State will not provide any onsite support for the operation and maintenance of the chargers. SECTION 3 – PROJECT SCOPE 3.1 Scope of Services Requested The State shall provide the selected Vendor use of four parking spaces that will be publicly accessible in the above described location at no cost to the Vendor. The selected Vendor shall procure, install, operate, maintain, market and potentially remove at the end of the contract period two networked dual-connector Level 2 EVSE at the location specified in Section 2 above for a minimum of five years, with a two-year extension if mutually agreed upon and approved. In addition to the provision and installation of the physical charging equipment, Applicants must also describe the services that will be provided relative to the operation and maintenance of the charging stations for the contract term. At a minimum: 1. The EVSE must be connected to a network and shall provide multiple payment options, real- time station location and availability information, and may include options such as reservations, messaging, and summary reports. 2. The selected Vendor must provide payment management, station status and customer support services. 3. The EVSE must display a phone number by which a customer may reach a network operator 24 hours per day, seven days per week, to initiate a charging session and/or report a problem with the charger. 4. The selected Vendor must provide for on-site signage and pavements markings that clearly designate the four parking spaces for EV charging only. 5. The selected Vendor must provide for routine maintenance of the EVSE. New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 7 6. Applicants must describe in their proposal strategies for maximizing use of the chargers, including any strategies to minimize “dead-head” time when a fully charged vehicle remains at the charger. 7. The selected Vendor must ensure that the EVSE are operational 97 percent of the time on an annual basis, and must initiate the process for making any needed repairs within 24 hours following notice of a malfunction or other operational issue. 8. The selected Vendor shall ensure compliance with the statutory requirements of Sections 236:133 and 236:134 of the NH Revised Statutes Annotated. (Attachment B). 9. The selected Vendor is responsible for compliance with all applicable local, state and federal codes relative to the EVSE and shall acquire any building permits required by the authority having jurisdiction at their expense, including a building permit from the New Hampshire Department of Safety, Division of the Fire Marshal. 10. Any electrical work shall be completed by a properly licensed electrician. 11. The selected Vendor shall disclose the location and characteristics of the electric vehicle charging station, including, but not limited to, the address, voltage, and timing restrictions, to the federal database operated by the United States Department of Energy Alternative Fuels Data Center. 12. Prior to being awarded a contract the Vendor shall be required to submit proof of Comprehensive General Liability prior to performing any services for the State. The coverage shall have appropriate riders against all claims of bodily injury, death or property damage, in amounts of not less than $1,000,000 per occurrence and $2,000,000 aggregate. Coverage shall also include automobile liability and State of New Hampshire workers’ compensation as defined by the State. The certificate shall name the State of New Hampshire, Department of Administrative Services as additional insured. 3.2 Equipment Requirements The Level 2 EVSE shall: 1. Have a J1772 Standard EV Connector designed for more than 10,000 cycles; 2. Have a minimum output power of 7.2 kW; 3. Be connected to a network; 4. Comply with the Open Charge Point Protocol (OCPP); 5. Be Energy Star rated by the US Environmental Protection Agency; 6. Be listed and labeled by a Nationally Recognized Testing Laboratory (NRTL); 7. Have a cord management system that keeps the cord out of the way without the user having to coil or uncoil the charging cord; 8. Have an internal electric metering system capable of determining kWh used by the EVSE; and 9. Be warrantied for the duration of the contract period. New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 8 3.3 Determination of Electricity Consumed The Applicant will be required to describe in their proposal how the State can determine and recover the cost of the electricity associated with the ESVE operations. The EVSE will not be separately metered. SECTION 4 – APPLICATION REQUIREMENTS Applications must follow the format provided below and shall include the following: 1. A completed Cover Sheet as found in Attachment C. 2. Applicant information, including: a. The legal name of the Applicant; b. The structure of the organization (e.g. sole proprietorship, partnership, corporation, etc.); c. The year the company was established as currently being operated; and d. A certified financial statement including, but not limited to a Dun and Bradstreet rating (may be included as an attachment). 3. A brief narrative description of the proposed solution. 4. A detailed itemized description of the proposed solution, including: a. Make and model of proposed EVSE b. Number of charging ports and type c. Hardware – electrical, including: i. Input power ii. Output power iii. Cross-vendor software compatibility iv. Operating condition limitations v. Environmental Protection Agency Energy Star rating vi. NRTL certification d. Hardware - mechanical, including: i. Cable management system ii. Theft deterrence e. Management software, including: i. Remote management capability ii. Cross-vendor hardware compatibility iii. Network protocol iv. Demand response capability v. Data availability and reporting, including, but not limited to: 1. The type of interface, and any associated costs, required for the state to access available data 2. Total energy used (kWh/day) – describe the capability of the unit to meter electricity usage accurately 3. In-use time and number of sessions New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 9 4. Real-time availability of the EVSE 5. Other vi. Sample sales and usage reports. vii. Other site-host services that may be available f. Customer payment options g. Price setting options (e.g. duration, energy, other) h. Pricing differential for different customer classes (e.g. network members versus non-members) i. Owner costs, including: i. Equipment, including installation and commissioning ii. Warranty (basic and for term of contract) iii. Network fees iv. Maintenance fees v. Any and all other costs vi. Bundled pricing options j. Maintenance plan, including a description of how the required 97 percent annual uptime will be achieved k. Any other anticipated revenue streams, such as advertising l. Signage, including: i. On-site signage ii. Pavement markings iii. Directional signage m. Marketing strategies n. Strategies to manage the parking spaces to ensure maximum usage o. Options for the EVSE at the end of the Contract period, such as removal, transfer of ownership, or other 5. How the installation will comply with manufacturer’s requirements and all applicable local, state and national codes. 6. Vendor experience, including: a. A list of locations (all or 30, whichever is less, with a preference for Northeast locations if limiting), including the name of the entity and name and phone number of a contact person, where the Applicant has provided and maintained publicly available EVSE on publicly owned property b. The number of EVSE provided c. The time period the EVSE were installed and operational d. The name and contact information for any public agencies that have chosen to cancel or not renew EVSE contracts with your company during the last five years 7. Qualifications of the contractor(s) that will perform the EVSE installation and the number of EVSE installations completed to date by the Applicant’s electrical contractor and/or the contractor’s electricians. New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 10 8. A minimum of two references for similar projects. SECTION 5 – PROPOSAL EVALUATION AND AWARD Proposals passing all screening criteria will be scored based on the Evaluation Criteria identified in this section. Members of the Evaluation Committee will be determined by NHDES and OSI. NHDES and OSI reserve the right to decide whether a proposal is or is not acceptable in terms of meeting the requirements of this RFP and to accept or reject any or all proposals received. During the evaluation and selection process, the Evaluation Committee may schedule an interview with an Applicant, either by telephone or in person, for the purpose of clarification and verification of information provided in the application. Any such interview may not be used to change or add to the contents of the original application. Applicants will not be reimbursed for time spent answering clarifying questions. In evaluating proposals, NHDES and OSI reserve the right to take any of the following steps: 1. Consult with prior clients on the performance of the Applicant or of particular persons proposed for this solicitation; 2. Schedule presentations or interviews with representatives of the Applicant or persons proposed for the project; 3. Conduct a review of past performance, including a review of reports, analyses, or other materials that would reflect the Applicant’s performance; and 4. Request additional data or supporting material. 5.1 Evaluation Criteria Proposals will be evaluated based on the following: 1. Project Cost; 2. Company qualifications, including previous experience, financial strength, staff qualifications, and references; 3. The proposed solution including specifications of equipment proposed, the timeline for bringing EVSE online; the pricing structure; and marketing strategies; and 4. Overall quality of an Applicants proposal, including responsiveness to the specifics of the RFP. 5.2 Scoring Points will be awarded as follows: Scoring Category Points 1. Project Cost 55 2. Company Qualifications 15 3. Proposed Solution and Customer Cost 20 4. Overall Quality and Responsiveness 10 New Hampshire VW Environmental Mitigation Trust RFP #NH-VW-2020-1 April 28, 2020 11 SECTION 6 – CONTRACTUAL REQUIREMENTS The selected Vendor will be required to agree to the provisions of the State of New Hampshire’s P-37 contract form and any additional provisions based on the specific requirements of this RFP and the Applicant’s response to it. The selected Vendor will be required to provide, in a timely manner, all documents necessary for approval of the Contract by the Governor and Executive Council, including, but not limited to: a. A current Certificate of Good Standing from the NH Secretary of State; b. A notarized Certificate of Authority for the individual signing the Contract; and c. A Certificate of Insurance naming the State of New Hampshire. The effective date of the Contract will be the date of approval by the Governor and Executive Council. No work may begin prior to the effective date and subsequent written Notice to Proceed. Such notice may be delivered via email. SECTION 7 – ATTACHMENTS INDEX 1. Attachment A – Photographs and Aerial Overview of the Site 2. Attachment B – Revised Statutes Annotated 3. Attachment C – Proposal Cover Sheet 1 ATTACHMENT A PHOTOGRAPHS AND AERIAL OVERVIEW OF THE SITE 4 EV parking spaces outlined in green, red arrows show EVSE foundations Location of EVSE foundations relative to the electrical panel inside the building 2 View of the EV charging spaces from the parking lot entrance West foundation detail. Light pole to the right. 3 East foundation detail 4 Electrical panel showing spare capacity for EVSE 5 Aerial Overview 1 ATTACHMENT B REVISED STATUTES ANNOTATED SECTIONS 266:133 AND 266:134 Electric Vehicle Charging Stations Section 236:133 236:133 Operation of Electric Vehicle Charging Stations; Signage. – I. The department of transportation shall coordinate with the Federal Highway Administration (FHWA) to ensure sufficient and up-to-date coverage of uniform signage on federal highways using the "Alternative Electric Vehicle Charging Symbol Sign." II. The department of transportation shall develop and install uniform signage consistent with FHWA's Manual on Uniform Traffic Control Devices for use on state roadways to direct drivers to charging and hydrogen fueling stations. III. All publicly funded chargers installed after the effective date of this paragraph that are accessible to the public shall be equipped to enable universal access. IV. An owner of an electric vehicle charging station shall not be deemed to be a "utility," "public utility," or "public service company" solely by virtue of the fact that such an owner is an owner of an electric vehicle charging station. All electricity distribution companies shall make available in tariffs terms and rates for electronic vehicle charging stations and offer such information to the public. V. The public utilities commission shall: (a) Within 2 years, consider and determine whether it is appropriate to implement any of the following rate design standards for electric companies and public service companies: (1) Cost of service; (2) Prohibition of declining block rates; (3) Time of day rates; (4) Seasonal rates; (5) Interruptible rates; (6) Load management techniques; and (7) Demand charges. (b) Consider and determine whether it is appropriate to implement electric vehicle time of day rates for residential and commercial customers. The standards for determination of such implementation shall include consideration whether such implementation would encourage energy conservation, optimal and efficient use of facilities and resources by an electric company, and equitable rates for electric consumers. VI. The owner or operator of a public electric vehicle charging station that requires payment of a fee shall provide multiple payment options that allow access by the public. VII. The owner or operator of a public electric vehicle charging station shall disclose the location and characteristics of each such public electric vehicle charging station, including, but not limited to, the address, voltage, and timing restrictions, to the federal database operated by the United States Department of Energy Alternative Fuels Data Center. Source. 2018, 262:1, eff. Aug. 11, 2018. 2 Electric Vehicle Charging Stations Section 236:134 236:134 Prohibitions and Restrictions. – I. No person shall park in a space equipped with a public electric vehicle charging station, unless such person is operating a plug-in hybrid electric vehicle or battery electric vehicle. II. The owner or operator of a public electric vehicle charging station may impose restrictions on the amount of time that an electric vehicle may be charged at the charging station. III. Owners or operators of public electric vehicle charging stations that require payment of a fee shall not require persons desiring to use such public electric vehicle charging station to pay a subscription fee or otherwise obtain a membership in any club, association, or organization as a condition of using such public electric vehicle charging station, but may have different price schedules that are conditioned on a subscription or membership in a club, association, or organization. Source. 2018, 262:1, eff. Aug. 11, 2018. 1 ATTACHMENT C PROPOSAL COVER SHEET NH Department of Environmental Services – RFP # NH-VW-2020-01 COVER SHEET This form MUST be completed, signed and attached to the front of your proposal. Primary Contact (Applicant): Title: Organization: Phone: Fax: Address: Email: City: State/Prov: Zip: Alternate Contact: Title: Organization: Phone: Fax: Address: Email: City: State/Prov: Zip: AN INDIVIDUAL AUTHORIZED TO COMMIT THE APPLICANT MUST SIGN THIS FORM BELOW AND ANSWER THE FOLLOWING QUESTIONS: YES NO Do you accept all of the terms and conditions in the State of NH Form Number P- 37 (Attachment D)? (If not, explain your exceptions on a separate page) Does this proposal include more than one organization? (If yes, complete the Team Commitment form (provided on next page)) This offer is valid for 180 days AUTHORIZED SIGNATURE I, the undersigned, am authorized to commit my organization to this proposal. Signature: Printed Name: Title: Organization: Date: Phone/email: 2 TEAM COMMITMENT This form must be completed if the proposal includes more than one organization. The following organizations are team members or sub-contractors participating in this proposal. The individuals signing below are authorized to commit their organizations to this proposal. By signing, each entity agrees that they have worked with the Applicant in the development of the project proposal and intend to perform the work described in the project proposal if the Applicant is selected. Please use additional forms if obtaining multiple signatures on a single page is difficult, or additional space is needed. Organization: Authorized Signature: Date: Printed Name: Title: Organization: Authorized Signature: Date: Printed Name: Title: Organization: Authorized Signature: Date: Printed Name: Title: Organization: Authorized Signature: Date: Printed Name: Title: