Charge Ready Program
Proof of Project Milestone and
Rebate Assignment Instructions
Follow these instructions to complete Step 3 on the Charge Ready Enrollment Portal.
You are responsible for verifying the sections we complete, and completing all remaining sections, if applicable. Please contact your Account
Manager if you have any questions.
Step 3 - Certification
Customer Participant
Completed by SCE and by Customer Participant
1.
Customer Participant:
Completed by SCE. The SCE Customer that applied to the Charge Ready Program and was approved by SCE pursuant to Step 2 – Agreement.
2.
Contact Person Name:
Completed by SCE based on your Step 1 - Notice of Intent. Please update if the contact information has changed from Step 1 - Notice of Intent.
3.
Contact Person Title:
Enter the title of the individual signing this application.
4.
Mailing Address:
Completed by SCE based on your Step 1 - Notice of Intent. Please update if the contact information has changed from Step 1 - Notice of Intent.
5.
City, State, Zip:
Completed by SCE based on your Step 1 - Notice of Intent. Please update if the contact information has changed from Step 1 - Notice of Intent.
6.
Business Phone:
Completed by SCE based on your Step 1 - Notice of Intent. Please update if the contact information has changed from Step 1 - Notice of Intent.
7.
Email Address:
Completed by SCE based on your Step 1 - Notice of Intent. Please update if the contact information has changed from Step 1 - Notice of Intent.
Charging Station Vendor
Completed by Customer Participant
8.
Vendor Name (Seller):
Charging station vendor approved by SCE to participate in the Charge Ready Program, as selected by Customer Participant.
9.
Vendor Contact Person Name:
Individual representing the charging station vendor approved by SCE, as selected by Customer Participant.
10.
Email Address:
Email address of the Individual representing the charging station vendor approved by SCE, as selected by Customer Participant.
11.
Business Phone:
Phone number of the individual representing the charging station vendor approved by SCE, as selected by Customer Participant.
Additional Charging Station Vendor
Completed by Customer Participant
Use this section if you will procure charging stations from more than one approved charging station vendor. This entire section is optional.
12.
Vendor Name (Seller):
Charging station vendor approved by SCE to participate in the Charge Ready Program, as selected by Customer Participant.
13.
Vendor Contact Name:
Individual representing the charging Station vendor approved by SCE, as selected by Customer Participant.
14.
Email Address:
Email address of the Individual representing the charging station vendor approved by SCE, as selected by Customer Participant.
15.
Business Phone:
Phone number of the individual representing the charging station vendor approved by SCE, as selected by Customer Participant.
Form 14-967
01/2016
Charging Station Purchase
Completed by SCE and Customer Participants
16.
Level 1 Charge Ports Requested by Customer Participant:
Number of Level 1 Charge Ports requested by Customer Participant in Step 2 – Agreement (completed by SCE).
In the table below, Customer Participant must specify the following for each model of Level 1 charging station, if any:
Manufacturer
Name of the approved
manufacturer of the charging
station
17.
Model Number
Model Number of the
approved charging station
Quantity
Number of approved
charging stations ordered
by Customer Participant
Number of Charge Ports per Station
Number of SAE J1772 connectors for
each approved charging station model
Level 2 Charge Ports Requested by Customer Participant:
Number of Level 2 Charge Ports requested by Customer Participant in Step 2 – Agreement (completed by SCE).
In the table below, Customer Participant must specify the following for each model of Level 2 “A” or Level 2 “B” charging station, if
any:
Level 2 “A”:
Manufacturer
Name of the approved
manufacturer of the charging
station
Model Number
Model Number of the
approved charging station
Quantity
Number of approved
charging stations ordered
by Customer Participant
Number of Charge Ports per Station
Number of SAE J1772 connectors for
each approved charging station model
Quantity
Number of approved
charging stations ordered
by Customer Participant
Number of Charge Ports per Station
Number of SAE J1772 connectors for
each approved charging station model
Level 2 “B”:
Manufacturer
Name of the approved
manufacturer of the charging
station
Form 14-967
01/2016
Model Number
Model Number of the
approved charging station
Proof of Project Milestone Checklist
Required Documentation
18.
Please upload a fully executed copy of a Valid Charging Station Purchase Contract.
Upload proof of procurement of the charging stations in accordance with Step 2 - Agreement. Acceptable documents (contract or
purchase order) must include:
- Execution Date
- Charging station vendor name (as approved by SCE) and address
- Model numbers of charging stations approved by SCE and quantity (Model numbers must match the model numbers selected
in question #16 and/or #17.)
- Amount agreed upon by Customer Participant for the approved charging stations and installation, net of any rebates or discounts
- Delivery date for the charging stations
- Copy of the corresponding invoice, displaying cost of charging stations and installation cost separately, issued by the charging
station vendor*
19.
Please return the Signed Easement Agreement as requested separately by SCE or its designated vendor.
SCE or its designated vendor will work with you to prepare and sign an easement agreement. The easement agreement does not
have to be uploaded through the Charge Ready Enrollment Portal, but must be signed and returned at the same time as this form is
signed.
For Fleet only, please upload the following:
20.
Fleet spreadsheet
Use the template provided and follow the instructions shown on the first tab.
21.
Scanned DMV registrations*
For each vehicle identified in the fleet spreadsheet, provide a valid and current DMV registration. All DMV registrations must be
scanned and aggregated into a single PDF file.
22.
Scanned purchase or lease agreements for recent vehicles
If vehicles were procured less than three months ago, provide a copy of the purchase or lease agreement. A purchase or lease
agreement must include date of order or lease start date and length, payment status (paid or payment terms), and Customer
Participant signature. All agreements must be scanned and aggregated into a single PDF file.
*You may submit these documents separately, but SCE will not process rebate payments before we receive them.
Rebate Assignment (If Applicable)
Customer Participant may assign the rebate amount payable by SCE pursuant to the terms and conditions of the Charge Ready Program to
a single charging station vendor.
Charging Station Vendor
Customer Participant
23.
Signed by:
Provide an electronic signature by the Customer
Participant Contact Person or another representative of
the Customer Participant with the relevant authority to
approve this assignment.
25.
Name:
Enter the name of the individual signing this assignment.
26.
Title:
Enter the title of Customer Participant’s representative.
27.
Date:
Enter the date of execution of this assignment.
Form 14-967
01/2016
24.
Vendor Name:
Select the name of the charging station vendor designated to
receive the rebate amount payable by SCE pursuant to the terms
and conditions of the Charge Ready Program. Only one charging
station vendor may be designated per application.
Certification by Customer Participant
28.
Customer Participant Signature:
Electronic signature by the Customer Participant Contact Person or another representative of the Customer Participant with the
relevant authority to sign this form.
29.
Name Printed:
Name of the individual signing this form.
30.
Title:
Title of the individual signing this form.
31.
Date:
Date of execution of this form.
Disclaimer: The information provided in this document is a summary of Schedule Charge Ready Program Pilot (CRPP). For more
details, please refer to Schedule CRRP (tariff). In case of any discrepancy between this document and Schedule CRPP, the tariff will prevail.