Lead the Charge Application Form Lead the Charge Application Form "*" indicates required fields 1. General InformationOrganization Name:*Legal Name (if different):*(the “Applicant”)Organization Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Primary Contact Name*Contact Title*Contact Email Address:* Telephone Number:*How did you hear about the program?Please tell us where you head about the Lead The Charge ProgramTVRadioLinkedInFacebookTwitterInstagramYouTubeGoogleOnline news mediaMy Association(Other) Please Specify below(Other) Please SpecifyHow did you hear about the program?2. Project SummaryPlanned Start Date* MM slash DD slash YYYY Planned End Date* MM slash DD slash YYYY Funding Requested for the Project ($)***Note: funding requested must respect funding maximums per charger type as indicated in the FAQs.3. Mandatory Criteria3.1 Eligible Project: The Applicant confirms that their project meets the following requirements by completing the checkboxes:* You acknowledge that the business or organization is a legal entity validly incorporated or registered in Canada (including not-for-profit and for-profit organizations). You acknowledge that the business or organization is actively operating or conducting business in Manitoba. You acknowledge that the business or organization operates a physical location in Manitoba. You acknowledge that the business or organization has been in operation for at least one year. You acknowledge that the business or organization is in good standing with applicable governmental authorities and governing bodies. You acknowledge that the business or organization is compliant with the new measures announced by Finance Canada, as outlined below: Select All Zero Emission Vehicle Infrastructure Program: Incentive Eligibility in Response to New Measures Announced by Finance Canada As of October 1, 2024, the federal government has limited eligibility for support under the Zero Emission Vehicle Infrastructure Program (ZEVIP) to products made in countries which have negotiated free trade agreements with Canada. If your application is approved for funding, you must ensure that the charging equipment purchased is made in countries that have negotiated free trade agreements with Canada. You may be required to provide documentation to support your purchase. A comprehensive list of free trade agreements can be found here. To be considered for funding, the manufacturing country needs to have a free trade agreement with Canada that is “In Force”.3.2 Eligible Technology: Applicants must confirm that their project meets the following requirements by completing the checkboxes:* You acknowledge that all EV (Electric Vehicle) chargers will be installed in Manitoba. You acknowledge that all EV chargers will be new and purchased (not leased) equipment installed permanently (mounted or fixed models). You acknowledge that all EV chargers will be new installations or expansions of existing installations (not for the replacement of existing installations). You acknowledge that all EV chargers will be connected (defined as: “having the ability to communicate to other stations and/or to a server or the cloud through cellular/wireless signal or connected vehicle communications using software to report on usage and/or other capabilities such as providing real-time status of charging stations.”). You acknowledge that for all EV chargers with multiple connectors, each connector must be capable of charging a vehicle and support a dedicated parking spot simultaneously. You acknowledge that all EV Chargers that will be installed are certified (CSA (Canadian Standards Association), ULC, UL, or Interlink) for use in Canada and commercially available, as well as offer one or more of the following connectors: SAE J1772 standard plug head (Level 2 (208/240v)); SAE J1772 Combo (fast-EV chargers); CHAdeMO (fast-EV chargers); Proprietary charging connectors (no more than 75% of the charging connectors installed for the project will be proprietary charging connectors) Select All3.3 Project Completion Timeline.*The project completion date is September 30, 2027. If your project is not completed by this date, you are not eligible. You confirm that the project will be completed no later than September 30, 2027, unless otherwise approved in writing by Manitoba Motor Dealers Association (“MMDA”). No, the project will not be completed by September 30, 2027 If your project completion date is not within this timeline you are not eligible. 3.4 Project Specifics*Who will the installed EV charger be available to? Select from the listYour company's vehiclesYour customers’ vehiclesPublic UseCombination – please specify:Combination, specify:*a. Where will the installation be located?Public SpacesOn-streetWorkplaceLight-duty vehicle fleetsMulti Unit Residential BuildingsOtherThis program does not cover EV charger installations in residential spaces. We will contact you in the future when we have funding for residential installations.Untitled3.4 b Project Specifics*b. Will there be a cost to the user?Select from the listYes – by charging for parkingNoOther, specify:Other, specify:*3.4 c Project Specifics*c. Where is the applying organization locating the charging stations?Select from the listWinnipegRuralNorthern3.5 Program Delivery Approach*Please describe the approach and strategies you will use to implement your project, and explain how this approach will aid in maximizing the coverage of EV chargers across the province. (Provide as much detail as possible) 3.6 Project Overview*Please provide an overview of your project, including: A brief description and timeline of the project;Amount of funding requested (limited to the lesser of $100,000 or fifty percent (50%) of project costs);Overview of how the funds will be spent, number and types of chargers, and installation cost;Provide as much detail as possible.3.7 Charger Types and Funding a. Level 2 Connectors (3.3KW to 19.2KW)How many chargers?Maximum funding per unit installedMaximum funding per unit installed for Indigenous businesses and communitiesb. Fast Charger (20KW to 49KW)How many chargers?Maximum funding per unit installedMaximum funding per unit installed for Indigenous businesses and communitiesc. Fast Charger (50KW to 99KW)How many chargers?Maximum funding per unit installedMaximum funding per unit installed for Indigenous businesses and communitiesd. Fast Charger (100KW and above)How many chargers?Maximum funding per unit installedMaximum funding per unit installed for Indigenous businesses and communities3.8 Proof of Ownership or Access: Applicants must provide reasonable proof of ownership or access to the land (i.e. tax bill, status of title, etc.) where the infrastructure is to be installed (to be attached to this Application).Max. file size: 256 MB. 3.9 Confirmation of Project Progress: Applicants must provide reasonable proof of expenditure or permits for the infrastracture (i.e. invoices, rural municipality or city permits, MB Hydro inspection confirmation, etc.).Max. file size: 256 MB. 4. Additional Terms4.1 The Applicant acknowledges and agrees to the additional terms and conditions set out below by completing the checkboxes:* You acknowledge that the organization or business will complete a due diligence checklist to be satisfactory to MMDA, and may be required to provide additional information upon MMDA’s request. You acknowledge and agree that the organization or business will retain books, records, and supporting documents relating to the project, including eligible expenditures, through and after the duration of the project, until February 28, 2027, and will provide us, as well as the Government of Canada, Minister of Natural Resources with access to such documentation for project auditing and program evaluation purposes. You acknowledge that the provision of funding to the organization or business for the project is subject to the organization or business entering into a formal agreement with MMDA, setting out detailed terms and conditions and addressing the respective obligations and liabilities between parties, in a form to be provided by MMDA. You acknowledge that although MMDA may issue a Letter of Conditional Approval, there shall be no commitment on the part of MMDA to provide any funding until a formal agreement, as referenced above, has been fully signed by the parties. Furthermore, the organization or business shall comply with the deadlines for submitting the required reporting documents and supplementary documentation for the project as outlined by MMDA. Failure to submit all requirements by the specified deadline will result in the project’s removal from the reporting quarter. You acknowledge and agree that the organization or business has not applied to or received funding from the Government of Canada, Minister of Natural Resources or any other delivery organizations in relation to this project and that any additional Government funding in addition to this program’s allowance shall be reported to MMDA immediately. You acknowledge and agree that the organization or business will immediately advise us of any changes to the project that may impact the eligibility of the project or the allocation of funds the project may be eligible to receive. You acknowledge that this funding program is subject to MMDA’s receipt of funding from the Government of Canada, Minister of Natural Resources, and that in the event of any reduction or cancellation of such funding from the Government of Canada, MMDA’s funding to a project approved hereunder may be reduced or canceled You acknowledge that all work to be performed pursuant to the project will be in compliance with all applicable local codes and bylaws. Select All4.2 Consent to Use and Disclosure of Information: Any personal information the Applicant provides on and with this Application or that MMDA otherwise obtains in connection with this Application is collected under the authority of the Personal Information Protection and Electronic Documents Act (Canada), as applicable. MMDA will use the information for the purposes of evaluating the Application, satisfying governmental reporting obligations, and for any other related purposes. By submitting this Application, the Applicant authorizes MMDA to share any information related to this Application with (a) MMDA’s employees, agents and advisors; and (b) the Government of Canada, Minister of Natural Resources for the purposes described in the previous paragraph. The Applicant further authorizes MMDA to make public announcements regarding the project identified in the Application, including its location, capacity, and the name(s) of the project partner(s), as well as the value of the funding. MMDA will not be liable for any losses or damages arising from or related to the use or sharing of the information related to the Application for the purposes stated above. 4.3 No Entitlement: Under no circumstances will the Applicant be entitled to recover any damages whatsoever associated with the Application or the program. A decision by MMDA to accept, decline or reject any application will be final and binding and not subject to appeal or judicial review. ACKNOWLEDGMENT: The individual signing this Application confirms that the individual (a) is authorized to act on the Applicant’s behalf and to sign this Application on the Applicant’s behalf and to bind the Applicant to the terms and conditions set out in this Application; (b) has reviewed and understood the application guidebook and all guidelines of submission for this program; and (c) attests that all the information provided in and with this Application is complete, accurate and true. Name* First Last Signature*Date* MM slash DD slash YYYY