Art3_Victorville_FY15_BikePed_MojaveRiverwalk_InvSan Bernardino Associated GovernmentsCheck List Article 3 Grant ProgramCity of VictorvilleDate:4/28/2020Please see below instructions and checkmark the items included in your submittal. x 1.Claim Form (one-time submission)Please submit a completed Claim Form prior to requesting reimbursement of funds. An authorizingresolution is required with the Claim Form (see #2).x 2.Authorizing Resolution (one-time submission)Resolution authorizing the filing of the claim form and authorizing the submission of reimbursementrequests throughout the duration of the project. Please submit resolution with Claim Form.x3. Reimbursement Request Form (as needed)This form is required for every reimbursement requested.x4. Back-up Documentation (required with Reimbursement Request Form)Please attach documentation supporting the amount requested (e.g., invoices, paychecks,purchase orders, etc.)x5.Certified Copy of Minute Action (completed projects only)Certified copy of minute action authorizing the filing of the final claim and verifying project completion.x6. Photos of Completed Project (completed projects only)7. Other (optional)Attach any other information you wish to submit to support your claim.Claimant:Article 3 Claim Form Updated Version.xlsxCheck ListPage 1Approved byGinger Koblasz on 5/1/2020
San Bernardino Associated Governments
Claim Form
Article 3 Grant Program
Project Name: Grant Allocation No:
Claimant:
Address:
Attention:
Phone No:
E-mail Address:
178,980.05$
Purpose:Please check one purpose.
( )
Authorizing Signature:
(Claimant's Chief Adminstrator or Financial Officer)
Date: 4/28/2020
Signature
Brian Gengler, City Engineer
Type Name & Title
Approval of this claim and payment by the County Auditor to this claimant are subject to monies being available
and to the provision that such monies will be used only in accordance with the approved allocation instruction.
Transit Stop Access Improvements, PUC 99233.3
Brian Gengler, City Engineer
760-955-5156
bgengler@victorvilleca.gov
Condition of Approval:
Article 3 Bicycle/Pedestrian Facilities, Public Utilities Code (PUC) 99233.3(x)
Amount Requested
for Reimbursement:
City of Victorville
14343 Civic Drive
PO Box 5001 Victorville, CA 92393-5001
Article 3 Claim Form Updated Version.xlsx
Claim Form Page 1
Mojave Riverwalk Multi-Use Bicycle Facility
San Bernardino Associated Governments
Reimbursement Request
Article 3 Grant Program
Claimant:City of Victorville
Total Project
Cost
Article 3
Award
Amount
Percent
Article 3
Local Match
Amount
Percent Local
Match
4,700,000$ 180,428$ 4% 4,519,572$ 96%
Instructions: Please complete 1 through 4 below.
Amount
178,980.05$
4,483,302$
4,662,282$
178,980$ 36,270
4,483,302$ 1,448
4,662,282$ 37,718
I certify that the information on this Financial Reporting form is true and accurate to the best of my knowledge.
The same authority that signs the Claim Form must sign this form.
Signed:Date: 4/28/2020
Total Amount Remaining
Grant Information (completed by SANBAG)
Mojave Riverwalk Multi-Use Bicycle Facility
Project Name
3) Article 3
4) Local Match
Total
Total
Project Costs to Date (include amount requested above)
1) Article 3 Project Cost (amount being requested for
reimbursement)
2) Local Match Project Cost
Local Match Amount Remaining
Article 3 Balance Remaining
Article 3 Claim Form Updated Version.xlsx
Reimbursement Request Page 1
ATP Funds TDA Article 3 Local Match3,760,000.00$ 180,428.00$ 727,540.53$ 80.55% 3.87% 15.59%1232,350.00$ 11,617.50$ 0031634121,423,453.00$ 71,172.65$ 0031166243923,426.13$ 46,171.31$ 0031696341,059,066.00$ 52,953.30$ 003173625809,654.80$ 40,482.74$ 003181596220,018.60$ 11,000.93$ 003189567003197548Sully Miller Partial Retention payment 2(5,686.31)$ (5,686.31)$ 003212714,667,968.53$ 227,712.12$ 3,760,000.00$ 180,428.00$ 727,540.53$ Iten No.PayeeInvoice AmountMojave Riverwalk Multi-Use Bicycle Facility179,763.77$ $ 727,540.53 180,428.00$ Check No.Check Amount769,172.06$ Backup of SummaryRetentionTotal of This ClaimFunding Source180,428.00$ 2,127,812.83$ $ 1,452,423.40 Sully Miller209,017.67$ Sully Miller Partial Retention payment 1200,000.00$ 27,712.12$ Sully Miller877,254.82$ Sully Miller1,006,112.70$ Sully MillerTotal4,662,282.22$ Sully Miller220,732.50$ Sully Miller1,352,280.35$ TDA Article 3 corrected reimbursement amount is $178,980.05. This project was originally awarded TDA Article 3 in the amount of $180,428.00 with a local match of $4,519,57 for a total project cost of $4,700,000, However, since the total project came in under budget at $4,662,282, the reimbursement share is applied to the adjusted total at the original share.
Vendor No.Vendor NameEFT No.EFT DateEFT AmountPaid AmountInvoice NumberInvoice DateVOIDVendorNumberEFTDateEFTNumberTo TheOrder OfPayCity of VictorvilleP.O. Box 5001Victorville, CA 92393-5001(760) 955-5000EFT COPYNON-NEGOTIABLEEFT Number:City of Victorville, Victorville, CA 92393PageofDescriptionDisc TakenGross Amount719403/13/201900316341$228,921.50Two Hundred Twenty Eight Thousand Nine Hundred Twenty One Dollars and 50 cents ******00316341SULLY-MILLER CONTRACTING CO135 SO. STATE COLLEGE BLVDSUITE 400BREA, CA 92821-581900316341117194SULLY-MILLER CONTRACTING CO03/13/2019$228,921.500031634103/01/2019EST#1 PO 5226232350.00$232,350.000.00PO SETUP FOR RIVERWALKPROJECTPO# 2019522603/01/2019EST#1 RET PO5226-11617.50-$11,617.500.00CITY HELD RETENTION03/11/2019EST#6 PO 11018620.00$8,620.000.00HWY 395/LA MESA TRAFFICSIGNALPO# 2019110103/11/2019EST#6 RET PO 1101-431.00-$431.000.00CITY HELD RETENTIONItem 1
Vendor No.Vendor NameEFT No.EFT DateEFT AmountPaid AmountInvoice NumberInvoice DateVOIDVendorNumberEFTDateEFTNumberTo TheOrder OfPayCity of VictorvilleP.O. Box 5001Victorville, CA 92393-5001(760) 955-5000EFT COPYNON-NEGOTIABLEEFT Number:City of Victorville, Victorville, CA 92393PageofDescriptionDisc TakenGross Amount719404/03/201900316624$1,352,280.35OneMillionThreeHundredFiftyTwoThousandTwoHundredEightyDollarsand35cents******00316624SULLY-MILLER CONTRACTING CO135 SO. STATE COLLEGE BLVDSUITE 400BREA, CA 92821-581900316624117194SULLY-MILLER CONTRACTING CO04/03/2019$1,352,280.350031662403/28/2019EST#2 PO52261423453.00$1,423,453.000.00PO SETUP FOR RIVERWALKPROJECTPO# 2019522603/28/2019EST#2 RET PO5226-71172.65-$71,172.650.00CITY HELD RETENTIONItem 2
Vendor No.Vendor NameEFT No.EFT DateEFT AmountPaid AmountInvoice NumberInvoice DateVOIDVendorNumberEFTDateEFTNumberTo TheOrder OfPayCity of VictorvilleP.O. Box 5001Victorville, CA 92393-5001(760) 955-5000EFT COPYNON-NEGOTIABLEEFT Number:City of Victorville, Victorville, CA 92393PageofDescriptionDisc TakenGross Amount719405/01/201900316963$1,112,367.80OneMillionOneHundredTwelveThousandThreeHundredSixtySevenDollarsand80cents******00316963SULLY-MILLER CONTRACTING CO135 SO. STATE COLLEGE BLVDSUITE 400BREA, CA 92821-581900316963117194SULLY-MILLER CONTRACTING CO05/01/2019$1,112,367.800031696304/27/2019EST#3 PO 5226923426.13$923,426.130.00SETUP FOR RIVERWALK PROJECTPO# 2019522604/27/2019EST#3 RET PO 5226-46171.31-$46,171.310.00CITY HELD RETENTION04/02/2019EST#8 PO 1334247487.35$247,487.350.00SAFE ROUTE TO SCHOOLPROJECTPO# 2019133404/02/2019EST#8 RET PO 1334-12374.37-$12,374.370.00CITY HELD RETENTIONItem 3
Vendor No.Vendor NameEFT No.EFT DateEFT AmountPaid AmountInvoice NumberInvoice DateVOIDVendorNumberEFTDateEFTNumberTo TheOrder OfPayCity of VictorvilleP.O. Box 5001Victorville, CA 92393-5001(760) 955-5000EFT COPYNON-NEGOTIABLEEFT Number:City of Victorville, Victorville, CA 92393PageofDescriptionDisc TakenGross Amount719406/05/201900317362$1,006,112.70One Million Six Thousand One Hundred Twelve Dollars and 70 cents ******00317362SULLY-MILLER CONTRACTING CO135 SO. STATE COLLEGE BLVDSUITE 400BREA, CA 92821-581900317362117194SULLY-MILLER CONTRACTING CO06/05/2019$1,006,112.700031736205/31/2019EST #4 PO 52261059066.00$1,059,066.000.00EST #4 PAYMENT RIVERWALKPO# 2019522605/31/2019EST #4 RET PO 5226-52953.30-$52,953.300.00RET HELD EST #4 RIVERWALKItem 4
Item 5
Item 6
Vendor No.Vendor NameEFT No.EFT DateEFT AmountPaid AmountInvoice NumberInvoice DateVOIDVendorNumberEFTDateEFTNumberTo TheOrder OfPayCity of VictorvilleP.O. Box 5001Victorville, CA 92393-5001(760) 955-5000EFT COPYNON-NEGOTIABLEEFT Number:City of Victorville, Victorville, CA 92393PageofDescriptionDisc TakenGross Amount719412/18/201900319754$430,332.83Four Hundred Thirty Thousand Three Hundred Thirty Two Dollars and 83 cents ******00319754SULLY-MILLER CONTRACTING CO135 SO. STATE COLLEGE BLVDSUITE 400BREA, CA 92821-581900319754117194SULLY-MILLER CONTRACTING CO12/18/2019$430,332.830031975412/17/2019RET RLS PO1335230332.83$230,332.830.00RETENTION RELEASE FORVILLAGE DRIVE PROJECT12/18/2019RET RLS PO5226/1472200000.00$200,000.000.00PARTIAL RELEASE OF ESCROWRETENTION FOR MOJAVERIVItem 7
Item 8
Copy of Meeting Minutes https://victorville.granicus.com/MetaViewer.php?view_id=6&clip_id=1977&meta_id=175641