The Person Completing This Form Should Be an Employee of the OPO, APD, Or Holder

REQUEST FOR ISSUANCE OF ARB OFFSET CREDITS FOR AN EARLY ACTION PROJECT
ARB Staff Use Only / ARB Form Tracking Number: / Date Request Received: / Date Request Processed: / ARB Staff Use Only
Date Request Reviewed: / Date Revisions Requested: / Date Approved:
PART I. ENTITY SUBMITTING REQUEST
Is this form being submitted by the Offset Project Operator (OPO), Authorized Project Designee (APD), or a holder of early action offset credits (Holder)?
Notes:

The entity submitting request must be the same as the entity listing the early action project. A Holder may requestissuance only if neither the OPO nor APD listed the early action project.
The person completing this form should be an employee of the OPO, APD, or Holder.

/ OPO
APD
Holder
OPO/APD/Holder Name:
Person Completing Form: / Phone Number: / Email Address:
PART II. EARLY ACTION PROJECT INFORMATION
Early Action Offset Project Name: / EAOP Project ID#: / ARB Project ID#:
Early Action Quantification Methodology: Version:
CAR U.S. Livestock Project Version: 1.0 2.0 2.1 2.2 3.0
CAR Urban Forest Project Version: 1.0 1.1
CAR U.S. Ozone Depleting Substances Project Version: 1.0
CAR Forest Project Version: 2.1 3.0 3.1 3.2
CAR Coal Mine Methane Project Version: 1.0 1.1
VCS VMR0001*
VCS VMR0002*
(*Note: See instructions for full name.)
(CAR = Climate Action Reserve; VCS = Verified Carbon Standard)
Part III. Verification summary
Note: Please Provide a Separate Issuance Request for Each Desk Reviewing Finding or Each Offset Verification Statement.
Name of Offset Verification Body: / VB ID Number: / Reductions Verified (MT):
Reporting Period Start Date: / Reporting Period End Date: / Date of Desk Review: / Date of OVS (if applicable):
Part IV. ISSUANCE INstructions

Is this issuance request for all Early Action Offset Credits issued for the reporting period indicated in Part III, except for any credits issued to a forest buffer account?

/ Yes
No

What is the total number of Early Action Offset Credits for which issuance of ARB Offsets Credits is being requested?

/ Number of Credits:

How many credits, if any, were issued to the EAOP’s forest buffer account for this reporting period? (mark “0” or “n/a” if none)

/ Number of Credits:

Provide the CITSS and EAOP Account Information for the Entity Submitting Request in Part I.

CITSS Account Name: / CITSS ID#:
CA
Entity Name as Listed with EAOP: / EAOP Account Number: / Number of Credits:

Provide the CITSS and EAOP Account Information for any other holders of early action offset credits for which the issuance of ARB Offsets Credits is being requested.

1. / CITSS Account Name: / CITSS ID#:
CA
Entity Name as Listed with EAOP: / EAOP Account Number: / Number of Credits:
2. / CITSS Account Name: / CITSS ID#:
CA
Entity Name as Listed with EAOP: / EAOP Account Number: / Number of Credits:
Note: For more than two other holders, please expand this section or provide information on an attachment.
Part V. ATTESTATIONS AND OPO/APD/HOLDER SIGNATURE
_____
Initial / I certify under penalty of perjury under the laws of the State of California the GHG reductions and GHG removal enhancements for
Project Name: / from / Reporting Period
Start Date: / to / Reporting Period
End Date:
have been measured in accordance with the
Check the appropriate early action quantification methodology (including version):
Climate Action Reserve U.S. Livestock Project Protocol, Version 1.0
Climate Action Reserve U.S. Livestock Project Protocol, Version 2.0
Climate Action Reserve U.S. Livestock Project Protocol, Version 2.1
Climate Action Reserve U.S. Livestock Project Protocol, Version 2.2
Climate Action Reserve U.S. Livestock Project Protocol, Version 3.0
Climate Action Reserve Urban Forest Project Protocol, Version 1.0
Climate Action Reserve Urban Forest Project Protocol, Version 1.1
Climate Action Reserve U.S. Ozone Depleting Substances Project Protocol, Version 1.0
Climate Action Reserve Forest Project Protocol, Version 2.1
Climate Action Reserve Forest Project Protocol, Version 3.0
Climate Action Reserve Forest Project Protocol, Version 3.1
Climate Action Reserve Forest Project Protocol, Version 3.2
Climate Action Reserve Coal Mine Methane Project Protocol,Version 1.0
Climate Action Reserve Coal Mine Methane Project Protocol,Version 1.1
Verified Carbon Standard VMR0001 Revisions to ACM0008 to Include Pre-drainage of Methane from an Active Open Cast Mine as a Methane Emission Reduction Activity Methodology, v1.0
Verified Carbon Standard VMR0002 Revisions to ACM0008 to Include Methane Capture and Destruction from Abandoned Coal Mines Methodology, v1.0
and all information required tobe submitted to ARB is true, accurate, and complete.
_____
Initial / I understand I am voluntarily participating in the CaliforniaGreenhouse Gas Cap-and-Trade Program under title 17, article5, and by doing so, I am now subject to all regulatoryrequirements and enforcement mechanisms of this program andsubject myself to the jurisdiction of California as the exclusivevenue to resolve any and all disputes.
_____
Initial / I understand that the offset project activity and theimplementation of the offset project must be in accordance withall applicable local, regional, and national environmental andhealth and safety regulations that apply based on the offsetproject location. I understand that offset projects are not eligibleto receive ARB offset credits for GHG reductions or GHGremoval enhancements that are not in compliance with therequirements of this Article.
In signing this form, I certify under penalty of perjury of the laws of California that the information contained in this form is true, accurate, and complete. I further certify that I am an Account Representative of the entity listed in Part I of this form.
Signature: / Printed Name:
Title: / DatE:

Background for Request of Issuance of ARB Offset Creditsfor an Early Action Project

Section 95990 of the Cap-and-Trade Regulation allows an Offset Project Operator (OPO), Authorized Project Designee (APD) or Holder of early action offset credits to request issuance of ARB Offset Credits (ARBOC) for early action offset credits. This form is designed to help an OPO, APD, or Holder meet the requirements of section 95990 in requesting issuance of ARB Offset Credits.

Where to Submit Information Contained in This Form

Please complete the information on the form using your computer. Then print and sign the form. Since ARB is requesting a “wet” signature for the issuance requests, please mail this form and its attachments to this address:

Offset Verification Staff (CCPEB)

Air Resources Board

Mail Stop 6B

P.O. Box 2815

Sacramento, CA 95812

To expedite review, a scanned copy of the completed and signed information, along with the attachments, may be emailed to ARB at .

This form is also available from the ARB website at:

Detailed Instructions for Request of Issuance of ARB Offset Creditsfor an Early Action Project

This form is protected with restricted editing to facilitate completing the form. If the applicant wishes to unprotect the form, the password is “form”.

Part I.Entity Submitting Request:

Indicate whether the Offset Project Operator (OPO), Authorized Project Designee (APD), or a holder of early action offset credits (EAOC) is submitting the information requesting ARBOC issuance.
As required by section 95990(i) in the Cap-and-Trade Regulation, the entity requesting issuance must be the same as the entity listing the early action project. In general, the OPO or APD should be the entity requesting issuance. A holder of EAOCs may request issuance only if neither the OPO nor APD listed the early action project.
List the person who is submitting the information with their contact information (phone and email). This person should be an employee of the OPO or APD, or a Holder, whichever entity is the one submitting the information.

Part II. Early Action Project Information:

Provide the early actionproject’s name. The name should exactly match the name as listed with an approved Early Action Offset Program. To assist in identifying the project, also provide the project’s identification numbers as issued both by ARB and by the approved Early Action Offset Program (EAOP) listing the project.
Indicate the approved Early ActionQuantification Methodology used by the offset project.

Note: Full names for Mine Methane Capture methodologies:

VCS VMR0001 = VCS VMR0001 Revisions to ACM0008 to Include Pre-drainage of Methane from an Active Open Cast Mine as a Methane Emission Reduction Activity Methodology, v1.0
VCS VMR0002 = VCS VMR0002 Revisions to ACM0008 to Include Methane Capture and Destruction from Abandoned Coal Mines Methodology, v1.0

Part III. Verification Summary:

This part requests a summary of the desk review or full offset verification services by an ARB-accredited verification body for Offset Project Data Reports. For each Reporting Period for which an ARB-accredited verifier issued a Positive Desk Review Finding or a Positive or Qualified Positive Offset Verification Statement, provide the following information:
the name of the ARB-accredited offset verification body
the verification body’s ARB ID number (which is the number of the Executive Order accrediting the verification body)
the number of metric tons (MT) of GHG emission reductions or GHG removal enhancements positively reviewed or verified
the start and end dates of the Reporting Period
the date on which the(final) Desk Review Finding (DRF) was issued
if applicable, the date on which a Positive or Qualified Positive Offset Verification Statement (OVS) was issued; if not applicable, the entity submitting request may leave this field blank or mark “n/a”
A separate issuance request form should be submitted for each Reporting Period, as identified by ARB. Each issuance request form will thus correspond to a separate Early Action Desk Review Findings form.

Part IV. Issuance Instructions:

Indicate whether the issuance request is for all early action offsets credited issued for this reporting period.
Provide the total number of early action offset credits for which the issuance of ARB Offset Credits is being requested.
Provide the number of early action offset credits issued to the Early Action Offset Program’s (EAOP) forest buffer account, if any. If no credits were issued to a buffer account, you may indicate “0” (zero) credits or “n/a” (not applicable).
Note: For Forest Projects, ARB may have adjust the number of ARB offset credits issued to the entity submitting request so that the Forest Buffer Account is adequately maintained. ARB will contact the entity submitting request if an adjustment needs to be made for this reason.
For the entity submitting issuance request, provide their Compliance Instrument Tracking System Services (CITSS) account name and CITSSidentification number. The CITSS ID is six characters in length, with two letters followed by four numbers (e.g., “CA1234”). DO NOT PROVIDE THE ENTITY’s CONFIDENTIAL CITSS ACCOUNT NUMBER, which begins with the CITSS ID number followed by a hyphen and more numbers.
For the entity submitting request, also provide their account information as listed with an approved Early Action Offset Program (EAOP), including the name and number of their account and the number of credits in their EAOP account for which the entity is requesting issuance of ARB Offset Credits.
If there are any other holders of early action offset credits for which issuance is being requested, also provide their CITSS and EAOP account information. If there are no other holders of early action offset credits for which issuance is being requested, Part IV.E may be left blank. If there are any other holders of early action offset credits who do not have a CITSS account and issuance is being requested for their early action offset credits, please consult with ARB offset verification staff.

Part V. Attestations and OPO/APD/Holder Signature:

Section 95990(h)(6) of the Cap-and-Trade Regulation requires three attestations for ARBOC issuance for an early action project. Those attestations are provided in this section. The person identified under Part I (entity submitting request) should initial each attestation (no typed or printed initials).
The first attestation requires the entity submitting request to provide some information to complete the statement. The project name should match the name entered in Part II. The dates covering the Reporting Period in Part IIIshould also be provided. Check also the box indicating the approved Early Action Quantification Methodology used by the early action project.
The individual signing the document must be registered in CITSS as the Primary Account Representative or Alternate Account Representative of the entity submitting the issuance request. The individual signing the document may be an employee and/or representative of another entity; but to sign the document, the individual must be an Account Representative on the CITSS account of the entity submitting the issuance request.
Please provide the individual’s signature, printed name, corporate title, and date signed.

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