DAQ-2024-007667

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:
TAX ID:
CHARGE TO: Fund Agency Approp Unit Function Prog Object or BS
2158 480 2158 2113 2VWUDOT 7512
DATE DESCRIPTION TOTAL
3/18/2024 $21,386.59
$21,386.59
Reviewed and Approved By: Date:
Mat Carlile
Andrea Riddle
Project completed: September 21, 2023
Please note that this payment was part of a larger project and that
request is for a portion of the overall cost of the project.
Payment to UDOT for reimbursement of electrical power for DC Fast
Chargers at 216 South Main St. Monticello, UT 84535. The electrical power
bills to be reimbursed span from August 2020 through September 2023
($21,386.59). This reimbursement is for UDOT's participation in the VW
Environmental Mitigation Program through contract # 201217.
Transaction Id:______________________
UDOT #VC0000179400
4501 South 2700 West
SLC, UT 84114
Awardee Name: _UDOT Monticello ___

Award Amount (verify that the requested amount does not exceed total amount reimbursed to UDOT
pursuant to the Volkswagen Eligible Mitigation Action Agreement Between State of Utah, Department of
Transportation and State of Utah, Department of Environmental Quality, #201217, effective December
18, 2019, as amended March 23, 2022): $_1,047,6231
Project Summary
Address of EVSE location(s): 216 S Main St. Monticello, Utah (Two DC Fast Chargers);
Invoice: This is for reimbursement for electric power for the two DC Fast Chargers at this
location. The bills span from August 2020 through September 2023. Total invoice was
$21,402.62; however, payment will only be $21,386.59 because UDOT included late fees totally
$16.
o Payment for service date 10/22/20 to 11/22/20($116.32) and 11/22/20 to 11/22/20
($87.89) were combined ($204.21) on payment received on 1/26/21.
o Payment for service date 12/22/20 to 1/22/21($72.95) and 1/22/20 to 2/22/21
($120.48) were combined ($193.43) and payment received on 3/29/21. In addition, the
energy charger for the combined bills was $193.43; however, the account was credited
for only $193.40 on 3/29/2021 the $.03 were forwarded until paid for with May 2021
bill. The energy chargers for service date 3/22/21- 4/22/21 were $110.35 and payment
was $110.38 received on 5/10/2021 the extra $.03 was to reconcile balance from prior
bill.
o Payment for service date 11/22/21 to 12/22/21($701.51) and 12/22/21 to12/22/21
($710.57) were combined ($1412.08) there was also a $4 late fee total payment was
$1,416.08 and payment received on 1/14/22.
o Payment for service date 12/22/21 to 1/22/22($713.78) and 1/22/22 to 2/22/22
($628.80) were combined ($1342.58) there was also a $4 late fee total payment was
$1,346.58 and payment received on 3/14/22.
o Payment for service date 10/22/22 to 11/22/22($873.96) and 11/22/22 to 12/22/22
($786.75) were combined ($1660.71) there was also a $4 late fee total payment was
$1,664.71 and payment received on 1/14/23.
o Payment for service date 7/21/23 to 8/21/23($964.43) and 8/21/23 to 9/21/23
($975.42) were combined ($1939.85) there was also a $8 late fee but UDOT did not
include them in the total payment and payment received on 10/15/23.

Checklist of required documents (Provide a description of any modifications from the original, proposed
project).
Al-A.3.2.4. Until the Project End Date, December 31, 2023, UDEQ may reimburse UDOT up
to a maximum of $100,000 for the cost to supply electricity to Project DC fast chargers, if:
UDOT submits documentation (1) identifying the electricity supply cost, the dates of service,
and the amount of electricity used for specific Project EVSE at individual locations, and (2)
showing it made payments for the electricity it is seeking reimbursement;
UDOT certifies in writing that each Project EVSE in which UDOT is seeking reimbursement for
electrical costs under this paragraph (1) were powered with a dedicated electrical meter not

1 Please note that this payment was part of a larger project and that request is for a portion of the overall cost of
the project.
connected to non-Project electricity uses, and (2) did not charge any individual for connecting to the
Project EVSE during the period in which UDOT is seeking reimbursement.
Al-A.4.4. Procurement Code: UDOT shall procure each Project EVSE and related services described in
,i Al-A.3.1 in accordance with the Utah Procurement Code, Title 63G, Chapter 6a, Utah Code.
Reviewed by
Mat Carlile _______________
Lisa Burr ________________
Andrea Riddle_______________
Locations Service Dates Payment Payments Energy
Costs
Support
Docs
8/12/20 to 8/22/20 11/30/2020 $17.29 $17.29 1
8/22/20 to 9/21/20 11/30/2020 $51.87 $51.87 2
9/21/20 to 10/21/20 11/30/2020 $74.90 $74.90 3
10/21/20 to 11/22/20 1/26/2021 $116.32 4*
11/22/20 to 12/22/20 1/26/2021 $87.89 4*
12/22/20 to 1/22/21 3/29/2021 $72.95 5**
1/22/21 to 2/22/21 3/29/2021 $120.48 5** and ^
2/22/21 to 3/22/21 4/12/2021 $89.38 $89.38 6
3/22/2021 to 4/22/21 5/10/2021 $110.38 $110.35 7^
4/22/21 to 5/22/21 6/7/2021 $99.75 $99.75 8
5/22/21 to 6/22/21 7/12/2021 $152.52 $152.52 9
6/22/21 to 7/22/21 8/9/2021 $134.11 $134.11 10
7/22/21 to 8/19/21 9/28/2021 $138.41 $138.41 11
8/19/21 to 9/21/21 10/14/2021 $149.01 $149.01 12
9/21/21 to 10/21/21 11/14/2021 $667.15 $667.15 13
10/21/21 to 11/21/21 1/15/2022 $705.51 14***
11/21/21 to 12/21/21 1/15/2022 $710.57 14***
12/21/21 to 1/21/22 3/15/2022 $717.78 15****
1/21/22 to 2/21/22 3/15/2022 $628.80 15****
2/21/22 to 3/21/22 4/8/2022 $717.38 $717.38 16
3/21/21 to 4/21/22 5/8/2022 $771.45 $771.45 17#
4/21/22 to 5/22/22 6/14/2022 $802.61 $802.61 18
5/22/22 to 6/21/22 7/14/2022 $733.16 $733.16 19
6/21/22 to 7/21/22 8/15/2022 $745.85 $745.85 20
7/21/22 to 8/21/22 9/13/2022 $839.25 $839.25 21
8/21/22 to 9/21/22 10/13/2022 $811.62 $811.62 22
9/21/22 to 10/21/22 11/14/2022 $898.99 $898.99 23
10/21/22 to 11/21/22 1/14/2023 $877.96 24*****
11/21/22 to 12/21/22 1/14/2023 $786.75 24****
12/21/22 to 1/21/23 2/14/2023 $839.05 $839.05 25
1/21/23 to 2/21/23 3/15/2023 $822.34 $822.34 26
2/21/23 to 3/21/23 4/12/2023 $887.28 $887.28 27
3/21/23 to 4/21/23 5/15/2023 $987.74 $987.74 28
4/21/23 to 5/21/23 6/14/2023 $1,058.48 $1,058.48 29
5/21/23 to 6/21/23 7/13/2023 $1,076.91 $1,076.91 30
6/21/23 to 7/21/23 8/15/2023 $960.88 $960.88 31 &32
7/21/23 to 8/21/23 10/15/2023 $964.43 32#
8/21/23 to 9/21/23 10/15/2023 $975.42 32
$21,402.59 $21,402.59
$21,386.59
# late fee of $4
Total
Total Reimbursement
^Engery charger were $193.43 account was credited for $193.40 on 3/29/2021 the $.03 were
forwarded until paid for with May 2021 bill. The energy chargers for 3/22/21- 4/22/21 were
$110.35 and payment was $110.38 received on 5/10/2021.
The late fees paid by you are as follows:

As a result, we have adjusted the reimbursement amount for you. The new amount is
$21,386.62 after deducting the total late fees of $16 from the original amount of $$21,402.59.
84535
*****Payment for service date 10/22/22 to 11/22/22($873.96) and 11/22/22 to 12/22/22
($786.75) were combined ($1660.71) there was also a $4 late fee total payment was $1,664.71
and payment received on 1/14/23.
#Payment for service date 7/21/23 to 8/21/23($964.43) and 8/21/23 to 9/21/23 ($975.42)
total payment and payment received on 10/15/23.
$1,416.08
$1,346.58
$204.21
$1,664.71
$1,939.85
$193.40
*Payment for service date 10/22/20 to 11/22/20($116.32) and 11/22/20 to 11/22/20 ($87.89)
were combined ($204.21) on payment received on 1/26/21.
**Payment for service date 12/22/20 to 1/22/21($72.95) and 1/22/20 to 2/22/21 ($120.48)
were combined ($193.40) and payment received on 3/29/21.
***Payment for service date 11/22/21 to 12/22/21($701.51) and 12/22/21 to12/22/21
($710.57) were combined ($1412.08) there was also a $4 late fee total payment was $1,416.08
and payment received on 1/14/22.
****Payment for service date 12/22/21 to 1/22/22($713.78) and 1/22/22 to 2/22/22
($628.80) were combined ($1342.58) there was also a $4 late fee total payment was $1,346.58
and payment received on 3/14/22.
Page:of1 1
CREATION DATE:
STATE OF UTAH GENERAL ACCOUNTING EXPENDITURE
DOCUMENT TOTAL:
PRINT DATE: FY:
DOCUMENT DESCRIPTION:
VENDOR LINES:
ENTERED BY:
LAST USER:
BFY:
DOCUMENT NAME:
PERIOD:
11-24-2020
2021 5 1 November 24, 2020
lbarker
lbarker
$144.06
ALIAS/DBA:
VNDR LN: VENDOR NUMBER:
LEGAL NAME:
ADDRESS:
SNGL CHK FL:
PYMT DT:
DISB TYPE:
AMOUNT:
HDLG CD:
1
PO Box K
true
11/24/20
Check
53394C
Cortez, CO 81321-0676 US
$144.06EMPIRE ELECTRIC
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
1 $17.29
2800 6816810 7203 XED 73261 10U UDOT
ACCOUNT # 25788 - 216 S MAIN ST MONTICELLO UT 84535
AP01
25788 082720 1 08-27-2020
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
2 $51.87
2800 6816810 7203 XED 73261 10U UDOT
ACCOUNT # 25788 - 216 S MAIN ST MONTICELLO UT 84535
AP01
25788 092820 1 09-28-2020
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
3 $74.90
2800 6816810 7203 XED 73261 10U UDOT
ACCOUNT # 25788 - 216 S MAIN ST MONTICELLO UT 84535
AP01
25788 102820 1 10-28-2020
$51.87
Vendor # 53394C
Page:of1 1
CREATION DATE:
STATE OF UTAH GENERAL ACCOUNTING EXPENDITURE
DOCUMENT TOTAL:
PRINT DATE: FY:
DOCUMENT DESCRIPTION:
VENDOR LINES:
ENTERED BY:
LAST USER:
BFY:
DOCUMENT NAME:
PERIOD:
01-21-2021
2021 7 1 January 21, 2021
lbarker
lbarker
$204.21
ALIAS/DBA:
VNDR LN: VENDOR NUMBER:
LEGAL NAME:
ADDRESS:
SNGL CHK FL:
PYMT DT:
DISB TYPE:
AMOUNT:
HDLG CD:
1
PO Box K
true
01/21/21
Check
53394C
Cortez, CO 81321-0676 US
$204.21EMPIRE ELECTRIC
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
1 $204.21
2800 6816810 7203 XED 73261 10U UDOT
ACCOUNT # 25788 - 216 S MAIL ST MONTICELLO UT 84535
AP01
25788 12/28/20 1 12-28-2020
Customer: 44328 Name: UTAH DEPARTMENT OF TRANSP, PORT OF E Phone Ext Addl Phone Ext
Addl Name: Home: Home:
Address: PO BOX 141510 Mobl: Mobl:
SALT LAKE CITY UT 84114-1415 Busn: 801-628-3303 Busn:
Fax: Fax:
Account: 25788 Cycle Code: 4 Invoice Group: 0
Name: UTAH DEPARTMENT OF TRANSP, PORT OF E Phone Ext Addl Phone Ext
Addl Name: Home: Home:
Address: PO BOX 141510 Mobl: Mobl:
SALT LAKE CTY UT 84114 Busn: 801-864-4475 Busn:
Fax: [phone] Fax:
Provider: EEA - ELECTRIC SERVICE Service: ELEC - ELECTRIC SERVICE
AR Information:
Total AR: 926.56 Budget Due: .00 Annual Due: .00
Total Current: 926.56 Curr Budget: .00 Curr Annual: .00
Total 30 Days: .00 Past Budget: .00 Past Annual: .00
Total 60 Days: .00
Total 90 Days: .00
Payment Information:
Payment Date: 01/22/2024 Payment Amt: -718.05
Location:2410206 Srv Map Loc: 0890870460840 Emergency Addr: 216 S MAIN ST
Srv Desc: Electric Vehicle Charger District Office: MC - MONTICELLO
Srv Address: 216 S MAIN ST Board Dist: 2 - ROBERT A BARRY
Srv Area: 3 - MONTICELLO
Billing History Usage Summary:
Usage Act Dmd Bld Dmd KVAR Usage KVA Use
188 52.661 52.661 .000 .000
526 51.163 51.163 .000 .000
------------------ ------------------ ------------------ ------------------ ------------------
Totals: 714 103.824 103.824 .000 .000
Averages: 357 51.912 51.912 .000 .000
Billing History Revenue Summary:
EMPIRE ELECTRIC ASSOCIATION
02/06/2024 03:32:41 pm CUSTOMER PROFILE/BILLING HIST Page: 1
07033 coop.nisc.cis.batch.module.support.customerprofile.CustomerProfileMainBO Amy
Rev YrMo
Oct 2020
Nov 2020
10/
/2020
Rev YrMo Bill Dt Revenue Demand Device PCA Other Tax Adjust Total
Oct 2020 10/28/2020 73.09 .00 .00 1.81 .00 .00 .00 74.90
Nov 2020 11/30/2020 111.25 .00 .00 5.07 .00 .00 .00 116.32
------------------------------ ------------------ ------------------ ------------------ ------------------ ---------------- ------------------
Totals: $184.34 $.00 $.00 $6.88 $.00 $.00 $.00 $191.22
Averages: $92.17 $.00 $.00 $3.44 $.00 $.00 $.00 $95.61
EMPIRE ELECTRIC ASSOCIATION
02/06/2024 03:32:41 pm CUSTOMER PROFILE/BILLING HIST Page: 2
07033 coop.nisc.cis.batch.module.support.customerprofile.CustomerProfileMainBO Amy
10/
/2020
Vendor # 53394C
STATE OF UTAH
STATE OF UTAH
Customer: 44328 Name: UTAH DEPARTMENT OF TRANSP, PORT OF E Phone Ext Addl Phone Ext
Addl Name: Home: Home:
Address: PO BOX 141510 Mobl: Mobl:
SALT LAKE CITY UT 84114-1415 Busn: 801-628-3303 Busn:
Fax: Fax:
Account: 25788 Cycle Code: 4 Invoice Group: 0
Name: UTAH DEPARTMENT OF TRANSP, PORT OF E Phone Ext Addl Phone Ext
Addl Name: Home: Home:
Address: PO BOX 141510 Mobl: Mobl:
SALT LAKE CTY UT 84114 Busn: 801-864-4475 Busn:
Fax: [phone] Fax:
Provider: EEA - ELECTRIC SERVICE Service: ELEC - ELECTRIC SERVICE
AR Information:
Total AR: 926.56 Budget Due: .00 Annual Due: .00
Total Current: 926.56 Curr Budget: .00 Curr Annual: .00
Total 30 Days: .00 Past Budget: .00 Past Annual: .00
Total 60 Days: .00
Total 90 Days: .00
Payment Information:
Payment Date: 01/22/2024 Payment Amt: -718.05
Location:2410206 Srv Map Loc: 0890870460840 Emergency Addr: 216 S MAIN ST
Srv Desc: Electric Vehicle Charger District Office: MC - MONTICELLO
Srv Address: 216 S MAIN ST Board Dist: 2 - ROBERT A BARRY
Prim Rate Sched:GS3TO Srv Area: 3 - MONTICELLO
Billing History Usage Summary:
Rev YrMo Usage Act Dmd Bld Dmd KVAR Usage KVA Use
Dec 2020 294 57.017 57.017 .000 .000
Jan 2021 344 49.428 49.428 .000 .000
------------------ ------------------ ------------------ ------------------ ------------------
Totals: 638 106.445 106.445 .000 .000
Averages: 319 53.223 53.223 .000 .000
Billing History Revenue Summary:
EMPIRE ELECTRIC ASSOCIATION
02/06/2024 02:30:51 pm CUSTOMER PROFILE/BILLING HIST Page: 1
07033 coop.nisc.cis.batch.module.support.customerprofile.CustomerProfileMainBO Amy
Rev YrMo Bill Dt Revenue Demand Device PCA Other Tax Adjust TotalDec 2020 12/28/2020 85.06 .00 .00 2.83 .00 .00 .00 87.89Jan 2021 01/28/2021 71.29 .00 .00 1.66 .00 .00 .00 72.95
Totals:$156.35 $.00 $.00 $4.49 $.00 $.00 $.00 $160.84Averages:$78.18 $.00 $.00 $2.25 $.00 $.00 $.00 $80.42
EMPIRE ELECTRIC ASSOCIATION
02/06/2024 02:30:51 pm CUSTOMER PROFILE/BILLING HIST Page: 2
07033 coop.nisc.cis.batch.module.support.customerprofile.CustomerProfileMainBO Amy
------------------------------ ------------------ ------------------ ------------------ ------------------ ---------------- ------------------
Page:of1 1
CREATION DATE:
STATE OF UTAH GENERAL ACCOUNTING EXPENDITURE
DOCUMENT TOTAL:
PRINT DATE: FY:
DOCUMENT DESCRIPTION:
VENDOR LINES:
ENTERED BY:
LAST USER:
BFY:
DOCUMENT NAME:
PERIOD:
04-06-2021
2021 10 1 April 06, 2021
lbarker
lbarker
$89.38
ALIAS/DBA:
VNDR LN: VENDOR NUMBER:
LEGAL NAME:
ADDRESS:
SNGL CHK FL:
PYMT DT:
DISB TYPE:
AMOUNT:
HDLG CD:
1
PO Box K
true
04/06/21
Check
53394C
Cortez, CO 81321-0676 US
$89.38EMPIRE ELECTRIC
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
1 $89.38
2800 6816810 7203 XED 73261 10U UDOT
ACCT # 25788 - 216 S MAIN ST MONTICELL UT 84535
AP01
25788 03/29/21 1 03-29-2021
Page:of1 1
CREATION DATE:
STATE OF UTAH GENERAL ACCOUNTING EXPENDITURE
DOCUMENT TOTAL:
PRINT DATE: FY:
DOCUMENT DESCRIPTION:
VENDOR LINES:
ENTERED BY:
LAST USER:
BFY:
DOCUMENT NAME:
PERIOD:
05-04-2021
1 May 04, 2021
lbarker
lbarker
$110.38
ALIAS/DBA:
VNDR LN: VENDOR NUMBER:
LEGAL NAME:
ADDRESS:
SNGL CHK FL:
PYMT DT:
DISB TYPE:
AMOUNT:
HDLG CD:
1
PO Box K
true
05/04/21
Check
53394C
Cortez, CO 81321-0676 US
$110.38EMPIRE ELECTRIC
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
1 $110.38
2800 6816810 7203 XED 73261 10U UDOT
ACCT 2578 - 216 S MAIN ST MONTICELLO UT 84535
AP01
25788 04/28/21 1 04-28-2021
Page:of1 1
CREATION DATE:
STATE OF UTAH GENERAL ACCOUNTING EXPENDITURE
DOCUMENT TOTAL:
PRINT DATE: FY:
DOCUMENT DESCRIPTION:
VENDOR LINES:
ENTERED BY:
LAST USER:
BFY:
DOCUMENT NAME:
PERIOD:
06-02-2021
2021 11 1 June 02, 2021
lbarker
lbarker
$99.75
ALIAS/DBA:
VNDR LN: VENDOR NUMBER:
LEGAL NAME:
ADDRESS:
SNGL CHK FL:
PYMT DT:
DISB TYPE:
AMOUNT:
HDLG CD:
1
PO Box K
true
06/02/21
Check
53394C
Cortez, CO 81321-0676 US
$99.75EMPIRE ELECTRIC
ACCT LINE DESC:
ACCT LN:
VNDR INV LN:VNDR INV DT:
REF ACTG LN:
BFY:
REF VNDR LN:
PERIOD:FY:
VNDR INV #:
LINE AMOUNT:EVENT TYPE:
PRG PRDPHASEPROGMFUND SOBJUNIT DPT REVAPPR OBJ ACTY FUNCREV BSADEPT
REF DOC:
1 $99.75
2800 6816810 7203 XED 73261 10U UDOT
ACCOUNT 25788 - SERV ADD 216 S MAIN ST MONTICELLO UT 84535
AP01
25788 05/27/21 1 05-27-2021
INVOICE #
INVOICE #
Empire Electric 53394C 216 S Main
2800 810 7203 XED 6816 73261 10U