DAQ-2024-007649

Request For Payment from
VW EVSE
Division of Air Quality
Department of Environmental Quality
State of Utah
195 North 1950 West
Salt Lake City, UT 84116
PAYABLE TO:
2038 West Alpine Loop Rd.
TAX ID:
CHARGE TO: Fund Agency Approp Unit Function Prog Object or BS
2158 480 2158 2113 2VWTIMPCAV 7512
DATE DESCRIPTION TOTAL
11/28/2022 $7,860.80
$7,860.80
Reviewed and Approved By: Date:
Mat Carlile
Andrea Riddle
Project completed: September 30,2022
Payment to Timpanogos Cave National Monument for reimbursement for
purchase, installation, warranty, and networking costs for One-dual Port Level
2 EVSE Unit ($7,860.80). This payment comes from the Contract 200197 for
Timpanogos Cave National Monument through the VW Settlement funds.
Transaction Id:______________________
Timpanogos Cave National Monument
American Fork, UT 84003
Awardee Name: _Timpanogos Cave National Monument___

Award Amount (verify that the requested amount does not exceed this amount): $_10,966

Project Summary
Proposed number of EVSEs (type and quantity of each) One Dual-port Level 2 EVSE unit
Actual number of EVSEs (type and quantity of each) One Dual-port Level 2 EVSE unit
Proposed address of EVSE location(s): 2038 West Alpine Loop Rd. American Fork, UT 84003
Actual address of EVSE location(s): 2038 West Alpine Loop Rd. American Fork, UT 84003
Bid amount: $10,966
Invoice amount $9,826, It appears that the vendor did not charge Timpanogos Cave National
Monument for the installation. Because Timpanogos Cave National Monument did not meet the
definition of government entity we could only reimburse up to 80% of the total costs of the project.
Therefore, the reimbursement payment will be $7,860.80 for this project.

Checklist of required documents (Provide a description of any modifications from the original, proposed
project).
A site map showing the location of the EVSE funded by this funding assistance;
Installation start date of the EVSE project May 2, 2019 (See email Shannon Stephens
November 21, 2022) ;
The date the EVSE was placed into September 30, 2022 (See email Shannon Stephens
November 21, 2022)
A photo of the EVSE funded by this funding assistance and placed into service;
The estimated hours per day and days per year the EVSE funded by this funding assistance
will be used: 8 hours a day 180 days a year (See email Shannon Stephens November 21,
2022)
A final purchase invoice for each EVSE, installation, maintenance, and other itemized actual
costs from the Funding Assistance Application. The invoice shall include:
a. the invoice date;
b. the itemized purchase cost for each item or service listed in the competitive bid; and
c. the applicant as the purchaser;
If costs are higher than the original bid, are the increased costs reasonable?
If items purchased are different from competitive bid did entity document that they meet
procurement rules for changed items (see Terms and Conditions section II B.); and
Proof of payment.
Did the applicant use the State Cooperative Agreement? No
o If yes, did the invoice include shipping? N/A

Reviewed by
Mat Carlile _______________
Becky Close________________
Andrea Riddle_______________
Locations Vendors Attachment B-
Bid Item
Application Bid
$
VW $
2038 West Alpine
Loop Rd. American
Fork, UT 84003
CT4021-GW1-
Dual-port Level 2
EVSE unit
$5,263.00 $4,210.40
Shipping $147.00 $117.60
5 Year Network
Plan
$2,210.00 $1,768.00
5 Year Warranty
(Assure Plan)
$2,116.00 $1,692.80
Bollard Concrete 90 72
Installavlid $1,140.00 $912.00
$10,966.00 $8,772.80
Original Bid
LilyPad
$ Timp
Cave
Finial Invoice Items Final Invoice $ VW $ Timp Cave $
$1,052.60 CT4021-GW1-Dual-port Level 2
EVSE unit
$5,263.00 $4,210.40 $1,052.60
$29.40 Shipping $147.00 $117.60 $29.40
$442.00 5 Year Network Plan $2,210.00 $1,768.00 $442.00
$423.20 5 Year Warranty (Assure Plan) $2,116.00 $1,692.80 $423.20
18 Bollard Concrete $90.00 $72.00 $18.00
$228.00 Installavlid $0.00 $0.00 $0.00
$2,193.20 Totals $9,826.00 $7,860.80 $1,965.20
$7,860.80Grand Total Payment amount for Project
Final Invoice Amount
Invoice #
484
484
484
484
484
484
Steed
Constructi
on Pavement 1 $4,778.95 $4,778.95 $2,389.48 $2,896.98
Upgrades
#REF! 19537-01