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9 / 14

Acceptable forms of usage documentation can include, but are not limited to, maintenance records,

log books, fuel receipts, and BIT Inspection forms. Documentation must clearly identify the truck on application.

    • Applicant/business name and address.

    • Dealer name and address.

    • Make, model, and year of the truck and engine

    • Breakdown of total costs including tax, license and applicable fees.

  • Specification sheet for the replacement truck and its engine.

  • Applicable ARB Executive Order, including all attachments, for the engine in the replacement truck.

  • Proof of annual mileage or fuel usage for the past 24 months specific to the old truck on the application.

Pre-inspection

form

and

required

digital

photographs

of

the

old

truck

on

application.

Physical

inspection and photographs must be completed by the dealership. Self-inspection of the old truck by the applicant is NOT allowed and will result in an incomplete application.

PAYMENT PROCEDURES

Prior to receiving reimbursement, the dealer must submit a Claim for Payment Package to the District. The checklist for a complete Claim for Payment packet is available for the dealers, see page 8. Once the Claim for Payment Package is submitted and deemed complete, the District has 20 working days to process the claim.

DERA Heavy-Duty Truck Voucher Program

  • Copy of the old truck title, with no lien holder and indicating two years of ownership.

  • Copy of the old truck DMV Registration for the past 24 months.

  • Copy of proof of insurance for the past 24 months that is specific to the old truck.

  • Dated and itemized dealer quote for the replacement truck that includes:

Truck Replacement

  • The dealership shall redeem the value of the voucher after receipt and verification of a properly supported Claim for Payment Packet. Payment on the voucher takes place after the replacement truck has been delivered to the applicant, and the old truck has been delivered to a participating dismantler.

  • Only the DERA Heavy-Duty Truck Voucher Program Claim for Payment Form is accepted; a Claim for Payment Form is included in this document for your use on page 12. As a matter of policy, the District does not provide advance payments to dealerships or pay the applicant directly for the voucher.

  • All Claim for Payment Forms must be dated and signed by the dealership contract signing authority or they will be returned to the dealership. The contract signing authority is the same individual at the dealership who signed the agreement with the District to be a participating dealership.

  • Approximately one year after incentive funds have been issued, the applicant will receive an Internal Revenue Service (IRS) Form 1099. For information about the tax implications related to the receiving incentive funds, applicants should consult a tax advisor as the District does not provide tax advice.

Eligibility Criteria and Application Guidelines Page 9 of 14 Approved July 3, 2008

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