DERA Heavy-Duty Truck Voucher Program
CLAIM FOR PAYMENT PACKET CHECKLIST
Claim for Payment Packets are submitted by the dealership for redemption of vouchers. When submitting a request for payment, submit a complete Claim for Payment Packet. An incomplete Claim for Payment Packet will lengthen the processing time and delay reimbursement of funding. Please include the following items in the packet:
Completed and signed DERA Heavy-Duty Truck Voucher Program Claim for Payment Form.
Please sign the Form in blue ink. The same individual at the dealership who signed the contract with the District must also sign the Claim for Payment Form. All Forms submitted must have original signatures.
The original voucher, signed and dated by the applicant.
Copy of finance documents (if applicable).
A copy of the final invoice for the purchase of the replacement truck.
The final invoice must be signed by the applicant and include final sales price, less the voucher amount.
Copy of warranty for the replacement truck.
Copy of DMV paperwork showing the replacement truck is registered to the applicant in California and is registered with a declared Gross/Combined Gross Weight Range (G/CGW) greater than 60,000 pounds.
DMV Form 4008 (Declaration of Gross Vehicle Weight/Combined Gross Vehicle Weight) is acceptable.
Post-inspection forms and required digital photographs of the replacement truck and the old truck in the dealership’s possession.
A copy of the title of the old truck signed and dated by the applicant.
The name and location of the dismantler that will destroy the old truck and the date the old truck was delivered to the dismantler. This information should be indicated on the Post-Inspection Form.
To expedite the claim process, please submit the Claim for Payment packet to the District at: San Joaquin Valley Air Pollution Control District Attention: Jeannine Tackett 1990 East Gettysburg Avenue Fresno, CA 93726-0244
Eligibility Criteria and Application Guidelines Page 11 of 14 Approved July 3, 2008