Art3_Redlands_FY23_BikePed_OBT IV_ClaimClaimant:
Please see below instructions and checkmark the items included in your submittal.
1.
2.
3.
4.
5.
6.
7.
8.
City of Redlands
Claim Form (one-time submission) – required prior to, or along with, your first reimbursement request.
Authorizing Resolution (one-time submission) – required within SIX months of the project award by SBCTA Board or prior to requesting reimbursement of funds, whichever comes first. Resolution
should authorize the filing of the claim form, authorize the submission of reimbursement requests and designate the individuals authorized to certify project completion (Authorized
Agent). Sample language is available upon request.
Reimbursement Request Form (as needed) – this form is required every time a reimbursement is requested. Please note, progress payments are only eligible on awards over $200,000, the
requested amount must be a minimum of 20% of the award total, and the local match share percentage must be met regardless of reimbursement amount requested. Additionally, there is a
20% retention until project completion.
Backup Documentation (required with Reimbursement Request Form) – invoices, paychecks, purchase orders, contracts, etc. to support both the reimbursement and match amounts noted on the
Reimbursement Request Form. Please note, staff administration and/or contract project management expenses are NOT eligible match expenses. However, staff expenses may qualify for local
match under select circumstances. Please identify whether supporting documentation includes staff expenses under one of the following allowable conditions:
Backup Summary itemizing reimbursement request expenses.
Certification of Completion (completed projects only) – prior to filing the final request for reimbursement, written verification of project completion by the agency’s Authorized Agent
is required (see Authorizing resolution above). Sample language is available upon request.
Photos of Completed Project (completed projects only) – required when project is complete and should be attached to final reimbursement request.
Other (optional) – Claimants may attach additional information not included in this list to support the claim or reimbursement request. SBCTA may request additional information as necessary.
Award is for an ATP Safe Routes to School (SRTS) program project, not a SRTS infrastructure project.
Necessary staff time directly related to in-house completion of design, right-of-way acquisition, or construction including inspection and/or construction management.
Note: No travel costs or per diems allowed for staff time
Date:
Project Name:
Claimant:
Address:
Attention:
Phone No:
E-mail Address:
Award Amount
Purpose:
Note: this form only needs to be completed and submited with the full award amount once.
Authorizing Signature:
(Authorized Agent specified in Authorizing Resolution)
Signature
Type Name & Title
Condition of Approval:
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.
Orange Blossom Trail Phase IV
City of Redlands
1089700
Please check one purpose.
Article 3 Bicycle/Pedestrian Facilities, Public Utilities Code (PUC) 99233.3
Transit Stop Access Improvements, PUC 99233.3
Date:
Grant Allocation No:
L24-0702-0746-00
Claimant:
Complete fields in yellow below.
Section 1: Required for ALL Reimbursement Requests
Grant Information (completed by SBCTA)
Project Name
Orange Blossom Trail Phase IV
A: Current Request for Reimbursement
TDA Article 3 Reimbursement Amount Requested
Local Match
ATP Funds Utilized
1) Total Spent*
*Shares will be automatically calculated based on non-rounded formula.
B: Project Costs to Date (include amount requested above)
2) TDA Article 3
3) Local Match
4) ATP (if applicable)
Total
C: Balance Remaining
TDA Article 3
Local Match
ATP Funds (if applicable)
Total
5) Check to verify expenses claimed are consistent with the approved scope below.
Installation of Class I recreational multi-use trail from I-10 to California St, resulting in about 8 miles of continuous Orange Blossom interconnect trail.
By signing below, I certify that the information on this Financial Reporting form is true and accurate to the best of my knowledge.
Signed:
City of Redlands
(Authorized Agent specified in Authorizing Resolution)
Progressive Reimbursement
must not go below 20% retention
until project completion
Total Project Cost
1282000
Progressive Reimbursement Invoice should be for a minimum of 20% of TDA Article 3 award amount
0
0
0
0
217940
1089700
192300
0
1282000
Total Project Miles (if applicable)
Article 3 Award Amount
1089700
217940
Enter total only
0
0
0
0
1
1
0
1
.55
Section 2: Required for Progressive Reimbursements ONLY
A: Project Completion (turns red if % completed is significantly less than invoice)
B: Summary of Project Status
3) If either number turned red above, please provide a project schedule that demonstrates how the project will be completed on schedule within the budget. Provide attachments as needed.
C: Provide a copy of any contract(s) associated with reimbursable work.
Allocation #:
Percent
Local Match
0.15
1) Overall % Completed
2) Mileage Completed (if applicable)
Date:
L24-0702-0746-00
Local Match
192300
ATP Funds
(if applicable)
0
Share Completed:
0
Project Title:
Date
Total
Orange Blossom Trail Phase IV
Recipient's Name
Brief Description of Purchase
Amount
Include proof of payment with redacted account number.
0
Allocation Number
- select -
L24-0702-0731-00
L24-0702-0731-01
L24-0702-0733-00
L24-0702-0736-00
L24-0702-0737-01
L24-0702-0737-02
L24-0702-0740-00
L24-0702-0745-00
L24-0702-0745-01
L24-0702-0746-00
L24-0702-0747-00
L24-0702-0747-01
L24-0702-0749-00
L24-0702-0751-03
Claimant
-
Town of Apple Valley
Town of Apple Valley
City of Big Bear Lake
City of Colton
City of Fontana
City of Fontana
City of Highland
Rancho Cucamonga
Rancho Cucamonga
City of Redlands
City of Rialto
City of Rialto
City of Twentynine Palms
City of Victorville
Project Name
-
McConnell Park Multi-Use Path
Central Road Class II Bikeway
Stanfield Marsh Outdoor Recreation & Education Trail Segment II (SMORE II)
South La Cadena Bicycle Improvement
Rectangular Rapid Flashing Beacons (x7)
Catawba SRTS Sidewalk
9th St. Transit Stops, Sidewalk, and Bikeway Improvements
Cucamonga Creek Channel: Foothill Blvd. to Base Line Rd.
Day Creek Channel Bike Trail: Jack Benny Dr. to Base Line Rd.
Orange Blossom Trail Phase IV
Frisbie Middle School SRTS
Bemis Elementary SRTS
Channel Trail Class I
Village Drive Sidewalk
Total Project Cost
0
480852
795000
607036
320000
70000
792697
834872.8
204415
568000
1282000
1684755
1102685
495000
558000
Art 3 Award Amount
0
240426
397500
303518
208000
52500
396348
404172
78000
107250
1089700
1095090.75
716745
420750
250000
Matching Funds
0
240426
397500
303518
112000
17500
396349
404172
42000
57750
192300
589664.25
385940
74250
308000
ATP Funds
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Reallocated Funds
0
0
0
0
0
0
0
26528.8
84415
403000
0
0
0
0
0