MassEVIP Public Access Charging Program Application

This form is for applying for incentives from the Massachusetts Department of Environmental Protection's Massachusetts Electric Vehicle Incentive Program (MassEVIP).

If you have any questions, contact MassEVIP: email MassEVIP.MassDEP@mass.gov

Eligibility

Please answer the following questions.

If the answer to questions 1 or 2 is yes, or if the answer to questions 3, 4a, 5, 6, 7a, 8 or 9 is no, the applicant is NOT eligible for funding through the PAC Program

1. Has the applicant already ordered and/or purchased the charging station?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

2. Is the location a residence?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

3. Does the project location have parking accessible by the general public?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

4. Does the applicant agree to allow practical access to, and use of, the parking space and charging station by the general public a minimum of 7 days per week, 24 hours per day, unless there is a restriction, in which case, 12 hours per day?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

5. Is the proposed charging station able to charge electric vehicles (EVs) produced by multiple EV manufacturers?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

6. For each port installed, will the applicant designate at least one parking space for plug-in EV use only?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

7. Does the applicant own the location identified in this application where the charging station is to be installed?*
7a. If no, does the applicant have evidence that the charging station installation is allowed on the property (e.g., written permission of owner or pertinent language in lease, license agreement, or easement, etc.)?*

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

8. Has the applicant read and is the applicant prepared to meet the requirements presented in MassEVIP Public Access Charging Requirements? https://www.mass.gov/media/1959621/download

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

8. Is your Electric Vehicle Supply Equipment (EVSE) listed in the State Appliance Standards Database at https://spl.mendixcloud.com/index.html OR is it a DC charging station of 36kW or less?

For more details see https://www.mass.gov/info-details/appliance-efficiency-standards-compliance-for-sellers-and-installers

Stop: you are NOT eligible for funding through the Public Access Charging (PAC) Program.

Consistent with the terms of the VW Environmental Mitigation Trust, all documentation and records submitted in support of funded applications shall be made publicly available to the fullest extent provided by law.

IRS W-9 Form

The applicant is required to upload a copy of a new IRS W-9 form, using the 2022 Massachusetts Form template. The W-9 must be printed, signed and dated with a pen. W-9 forms with a digital signature or using an older template will not be accepted. We cannot process your application without a W-9 completed on this specific 2022 W-9 Form.pdf.

Does the applicant certify that the 2022 MA W-9 Form will be submitted?*
Upload IRS W-9 form*
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Complete and upload a W-9 form. This application may be saved and returned to later by clicking “Save and Resume Later” at the bottom of this form. However, any previously uploaded docs will not be saved and will need to be re-uploaded.

If the applicant does not have a W-9 please contact us via email: MassEVIP.MassDEP@mass.gov

Applicant Information

Contact person*
Legal address - must match W-9*
Format as (123) 456-7890
Are you applying on behalf of a municipality? *

Electric Utility Information

Which electric utility serves the project location?*

Is the applicant participating in the Eversource, National Grid, or Unitil EV charging station program?

What is the application status?

In the attachment section please provide submitted application or, if utility program application has been approved, attach approval letter or equivalent. 

MassDEP will not fund installation costs for projects funded through the National Grid, Eversource, or Unitil EV charging station programs.

Location Information

Is the location new construction (e.g., an office building not yet built)?*

Note: Applicants have 24 months to install charging stations at new construction locations and 6 months to install charging stations at existing location.

Is the location a Government-owned property*?*

*“Government” means a State or local government agency (including a school district, municipality, city, county, special district, transit district, joint powers authority, or port authority, owning fleets purchased with government funds), and a tribal government or native village.

Address where charging station will be installed*

Latitude and longitude

Please provide the latitude and longitude (x/y coordinates) for your planned charging station location. If you’re not sure how to get the coordinates they can be found at:

Google Maps - instructions:

  1. open googlemaps.com on your pc or mobile device
  2. enter your facility address or location
  3. right click (pc) or tap (mobile) the specific location of the planned EV charging station - a popup window should open to display the coordinates
  4. if using the google maps app on your mobile device, you may have to drop a pin, then click on that pin to get the coordinates

Be sure your coordinates are in decimal format, with at least 6 decimal places. There should be a “-“ at the front of your longitudinal (Y) coordinate. A local coordinate for example, would be (X) 42.275404, (Y) -71.303471.

Charging Station Vendor Information

Vendor contact person*
Charging station vendor's address*
Format as (123) 456-7890

Electric Vehicle Charging Station Hardware Information

The applicant has additional charging station manufacturer and model numbers to add 1
The applicant has additional charging station manufacturer and model numbers to add 2*
$

ONLY include costs that cover:  

  • A console wired into the electrical supply
  • A cable and connector to plug into the EV
  • Cable management strategy (e.g., coil, retractable, etc.)
  • Mounting, either pedestal or wall
    • Pedestal: hard-wired to a permanent pole or box
    • Wall: hard-wired to a wall and typically includes a mounting plate
  • Separate payment module
  • Shipping/Freight for above

If you have more than three charging station models for this location, email MassEVIP.MassDEP@mass.gov

Is the applicant applying for installation costs?*

MassDEP will not fund installation costs for projects funded through the National Grid, Eversource or Unitil EV charging station programs

Installation Vendor Information

Installation vendor is same as charging station hardware vendor?*
Installation vendor's address*
$

ONLY include costs that cover: 

  • Upgrading electric supply 
  • Construction costs related to installation (including ADA EV parking space) 
  • Signage and pavement painting 
  • Shipping/Freight for above

Incentive Request

The applicant is not applying for installation costs.

$
  • Non-government owned property: 80% of charging station hardware cost or, if applicant cost share is >20%, remainder of charging station hardware cost
  • Government owned property: 100% of charging station hardware cost or, if applicant cost share is >0%, remainder of charging station hardware cost

Incentive Request

The applicant is applying for installation costs.

$
  • Non-government owned property: 80% of charging station hardware cost or, if applicant cost share is >20%, remainder of charging station installation cost
  • Government owned property: 100% of charging station installation cost or, if applicant cost share is >0%, remainder of charging station hardware cost
$
  • Non-government owned property: 80% of charging station hardware cost or, if applicant cost share is >20%, remainder of charging station installation cost
  • Government owned property: 100% of charging station installation cost or, if applicant cost share is >0%, remainder of charging station hardware cost
$

Attachments

There is a 25MB limit for all attachments combined

Attach vendor quote with charging station costs separately identified, e.g., as a separate line item. For complex projects, other documentation such as a site map rendering can be attached here. Do NOT send brochures, flyers, or other marketing materials.*
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Attach vendor quote for charging station installation with costs separately identified, e.g., as a separate line item, if applicable. *
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Attach submitted application or approval letter or equivalent for Eversource, National Grid or Unitil EV charging station program as applicable.
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Additional Funding Source(s)

List non-MassEVIP PAC Program funding sources that will be used to pay the applicant’s cost share to acquire and install the charging station hardware identified in this application. 

Pick one*
$

Certified Signature

Under the pains and penalties of perjury, I hereby certify that I have personally examined and am familiar with the information submitted herein, including all attachments, and to the best of my knowledge, the information submitted to MassDEP in this Application, is true, accurate, and complete. I also hereby certify that I have authority to apply for MassDEP’s grant award. I am also aware that, in the event it is determined any grant funding was awarded based on false information, I or any organization on whose behalf I sign this Application, will be required to return the grant money.

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