NCDOT Team Information Form

Team Information Form

North Carolina NEVI Program
- Applicants should complete only ONE Team Information Form for each unique developer team as part of the NCDOT NEVI RFP Round II.
- Applicants should complete all information.
- Team Information Form must be submitted prior to submitting Site Information Form application(s).
- If you have any additional questions, please contact ncnevi@NCDOT.gov.
Note: You may save your progress using the "Save" button at the bottom of each page. You will be emailed a link to resume your application form later. We recommend saving your progress regularly to avoid losing input.
1. Applicant Information
R2-17-2R2-17-4R2-17-5R2-26-1R2-26-2R2-64-1R2-64-2R2-64-3R2-64-4R2-70-3R2-73-1R2-73-2R2-74-1R2-74-3R2-74-4R2-74-5
1.2 Business name:
1.3 Federal tax ID number:
1.4 NC Secretary of State ID number (SOSID):
Visit the NC SOSID Business Registration link for more information.
1.5 Unique Entity Identifier (UEI):
Visit the UEI section from the System for Award Management (SAM) website for more information.
1.6 Mailing address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1.7 Contact person name (authorized agent for all application and communication purposes):

First NameLast Name
1.8 Contact title:
1.9 Contact telephone number:
Please enter a valid phone number.Format: (000) 000-0000.
1.10 Contact email address:
example@example.com
1.11 Project manager name (primary point of contact during project implementation):

First NameLast Name
1.12 Project manager telephone number:
Please enter a valid phone number.Format: (000) 000-0000.
1.13 Project manager email address:
example@example.com
2. Applicant Background, Experience, and Team Organization
2.1 Applicant Team Organization

Provide an organizational table that clearly identifies the following team members/roles:
- Electric vehicle supply equipment (EVSE) station operator and owner
- Hardware supplier
- Network operator
- Project manager for construction
- Cybersecurity project manager for operations and maintenance (O&M)
- General contractor
- Electrical design firm
- Civil design firm
Upload PDF, Word, Excel, or image file(s).
Cancelof
YesNo
Provide the specific program and project details by completing the table below. Indicate whether the project is in development, under construction, or operational, and provide the expected or actual construction start date, as applicable (maximum of 5 projects).*
2.3 Complete the following table with prior experience of the Applicant Team of constructing and operating EV charging sites that have 100 kW or higher ports (maximum of 5 projects).*
3. Approach to Operations and Maintenance
3.1(a) Who is responsible for preventative maintenance?
3.1(b) For preventative maintenance, what is your site inspection frequency?
3.1(c) For preventative maintenance, what is your site preventative maintenance frequency?
YesNo
3.2(a) Who is responsible for corrective maintenance?
3.2(b) For corrective maintenance, what is your planned response time?
3.2(c) For corrective maintenance, what is your average historical response time to complete resolution?
YesNo
Free, no payment requiredContactless credit/debitEVM chip credit/debitAutomated toll-free phone number with live operatorAutomated toll-free phone number with Interactive Voice Response (IVR) touch-tone systemSMS link to secure payment portalPhone appCashOther
Free, no payment requiredContactless credit/debitEVM chip credit/debitAutomated toll-free phone number with live operatorAutomated toll-free phone number with Interactive Voice Response (IVR) touch-tone systemSMS link to secure payment portalPhone appCashOther
Free, no payment requiredContactless credit/debitEVM chip credit/debitAutomated toll-free phone number with live operatorAutomated toll-free phone number with Interactive Voice Response (IVR) touch-tone systemSMS link to secure payment portalPhone appCashOther
Trained on-site staffToll-free phone numberSMS numberWebsiteApp (must support live chat)Email
Trained on-site staffToll-free phone numberSMS numberWebsiteApp (must support live chat)Email
Trained on-site staffToll-free phone numberSMS numberWebsiteApp (must support live chat)Email
3.5(d) Who is responsible for answering and supporting each customer service option (if different, list for each proposed customer service option)?
3.5(e) What languages do your customer service mechanisms support?
3.6 Describe how EV charging prices will be established, taking into account NEVI requirements:
4. Approach to Cybersecurity and Data Management
YesNo
If yes, provide proof of which certification or authorization is held.

Upload PDF, Word, Excel, or image file(s).
Cancelof
YesNoNot applicable
YesNo
If yes, provide proof of which certification or authorization is held.

Upload PDF, Word, Excel, or image file(s).
Cancelof
YesNoNot applicable

4.2 Which of these items are included in your approach to cybersecurity? Include frequency, as appropriate, for each checked item.

Rows	Included in approach:	Frequency (as appropriate):
Third-party audits
Risk assessments
Penetration testing
Vulnerability scanning
Software updates
Network segmentation
Multi-factor authentication
Employee training
Network segmentation
Physical security

4.3(a) Who is responsible for responding to cybersecurity events, as defined in Attachment 1 – Technical Requirements?
4.3(b) What is your response time to cybersecurity events?
4.3(c) Who do you notify of a cybersecurity event, as defined in Attachment 1 – Technical Requirements?
4.3(d) What is the timeframe of notification of a cybersecurity event?
Should be Empty:

Team Information Form

1. Applicant Information

2. Applicant Background, Experience, and Team Organization

2.1 Applicant Team Organization

3. Approach to Operations and Maintenance

4. Approach to Cybersecurity and Data Management