NCDOT Team Information Form

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.

Note: You must resubmit this form each time you finish a review session to save your progress.

Administrative Review Status:

Sec 1. Applicant Information:

Sec 2. Applicant Background:

Sec 5. Miscellaneous:

Administrative Review Notes:

Administrative Review Requirements (1):

Rows	Yes	No
Applicant has provided Applicant’s unique entity identifier within the application
Applicant does not appear on any list of suspended or debarred individuals or entities, as defined by the State of North Carolina
Applicant is not barred or suspended from consideration for work with the federal government and does not appear on the Federal Excluded Parties List
Applicant is registered to do business in the state of North Carolina and has provided Applicants Federal Tax ID Number within the application

1. Admin Review Total

1.1 Cluster name(s) this Part 1 Form applies to (select all that apply):

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

Administrative Review Requirements (2):

Rows	Yes	No
Application includes an organizational chart, as defined

2. Admin Review Total

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

2.1 file upload:

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

NCDOT Evaluation:

Identified station owner:

Identified party responsible for EVSE O&M:

Identified party responsible for site O&M:

Identified general contractor:

Identified electrical designer:

Identified civil designer:

Additional notes (2):

2.2 Has the Applicant had experience developing, constructing, and/or operating NEVI-funded projects?

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).

NCDOT Evaluation:

Number of confirmed projects (2a):

Objective score (2a):

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).

NCDOT Evaluation:

Number of confirmed projects (2b):

Objective score (2b):

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?

3.1(d) Do you monitor EVSE remotely 24/7?

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?

3.3 Do you plan to continue to operate the site after the required 5 years of O&M?

3.4(a) Confirm all proposed payment options (check all that apply):

3.4(b) Which proposed payment options are accessible to persons with disabilities (check all that apply)?

3.4(c) Which proposed payment options are accessible to persons with limited English proficiency (check all that apply)?

3.5(a) Confirm all proposed customer service options (check all that apply):

3.5(b) Which proposed customer service options will be accessible to persons with disabilities (check all that apply)?

3.5(c) Which proposed customer service options will be accessible to persons with limited English proficiency (check all that apply)?

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:

SME Information:

Contactless credit/debit supported:

Contactless credit/debit limited English proficiency:

Contactless credit/debit users with disabilities:

Toll-free phone and/or SMS supported:

Toll-free phone and/or SMS limited English proficiency:

Toll-free phone and/or SMS users with disabilities:

At least one customer service option:

Additional notes (3):

Note whether frequencies, etc. are within industry standards or not.

4.1(a) Has the station operator already obtained a third-party certification or authorization, such as Federal Risk and Authorization Management Program (FedRAMP) Certification, Government Risk and Authorization management Program (GovRAMP) certification, SOC 2 Type 2, or ISO 27001?

If yes, provide proof of which certification or authorization is held.

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

If no, does the station operator plan to obtain a third-party certification or authorization?

4.1(b) Has the network provider (EVSP) already obtained a third-party certification or authorization, such as FedRAMP Certification, GovRAMP certification, SOC 2 Type 2, or ISO 27001?

If yes, provide proof of which certification or authorization is held.

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

If no, does the EVSP plan to obtain a third-party certification or authorization?

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?

SME Information:

Valid station operator 3rd party cybersecurity:

Valid network provider 3rd party cybersecurity:

Additional notes (4):

If no 3rd party certifications, then provide information on frequencies, etc. being within industry standards or not.

Administrative Review Requirements (5):

Rows	Yes	No
All sections of Attachment 3, Applicant Team, are completed

5. Admin Review Total

Team Information Form

Submission Review

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

5. Miscellaneous