Emission Reduction Plan (Beta)

Mailing Address (All correspondence will go to this address)

Name of Recipient	---
Mailing Address (Street, Suite, City, State, Zip)	---

Employee Transportation Coordinator (ETC)

ETC Name	---
ETC Title	---
ETC Email	---
ETC Phone	---
Please upload a scanned copy of your ETC certification	---
Who provided the ETC certification?	---
Date of ETC Certification	---

Highest Ranking Official

Highest Ranking Official Name	---
Highest Ranking Official Title	---
Highest Ranking Official Email	---
Highest Ranking Official Phone	---

Overview

Which industry best describes your organization?

Health

Worksite #1

Site Name	---
Address (Street, Suite, City, Zip)	---
How many employees work at this location?	---
How many of the employees working at this location live in Santa Monica?	---

Management Commitment Letter Upload

Commitment Letter

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You may be exempt if:

Check all that apply

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Which transit lines stop with in 1/4 mile or 3 blocks from your worksite?

Big Blue Bus

2

Which of these services and amenities are available at your worksite?

Check all that apply

Locker Rooms or Showers, Bikes Permitted Inside Worksite

Survey Week

Survey Start Date	---
Survey End Date	---

Average Vehicle Ridership Target

What is your AVR target?

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