Art3_Fontana_FY21_BikePed_KathyBinksSRTS_InvAClaimant: City of Fontana Date: 45419
Please see below instructions and checkmark the items included in your submittal.
1. Claim Form (one-time submission) – required prior to, or along with, your first reimbursement request.
2. 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.
3. 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.
4. Backup Documentation (required with Reimbursement Request Form) – invoices, paychecks, purchase orders, 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:
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
5. Backup Summary itemizing reimbursement request expenses.
6. 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.
7. Photos of Completed Project (completed projects only) – required when project is complete and should be attached to final reimbursement request.
8. 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.
Project Name: Kahy Binks Elementary School SRTS Grant Allocation No: L22-0702-0737-00
Claimant: City of Fontana
Address: 8353 Sierra Ave
Fontana, CA 92335
Attention: Cybele Collins
Phone No: (909) 350-6559
E-mail Address: ccollins@fontanaca.gov
Award Amount
160000
Purpose: Please check one purpose.
Article 3 Bicycle/Pedestrian Facilities, Public Utilities Code (PUC) 99233.3
Transit Stop Access Improvements, PUC 99233.3
Note: this form only needs to be completed and submited with the full award amount once.
Authorizing Signature:
(Authorized Agent specified in Authorizing Resolution)
Date:
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.
Claimant: City of Fontana Allocation #: L22-0702-0737-00
Complete fields in yellow below.
Grant Information (completed by SBCTA)
Project Name Total Project Cost Article 3 Award Amount Percent Article 3 Local Match ATP Funds (if applicable)
Kahy Binks Elementary School SRTS 382907 160000 0.417856032927055 222307 0
Progressive Reimbursement Invoice should be for a minimum of 20% of TDA Article 3 award amount 32000
Section 1: Required for ALL Reimbursement Requests Section 2: Required for Progressive Reimbursements ONLY
A: Current Request for Reimbursement A: Project Completion (turns red if % completed is significantly less than invoice)
TDA Article 3 Reimbursement Amount Requested 160000 1) Overall % Completed
Local Match 284120.18 2) Mileage Completed (if applicable) Share Completed: -2146826273
ATP Funds Utilized 0 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.
1) Total Spent* 444120.18 Enter total only
*Shares will be automatically calculated based on non-rounded formula.
B: Project Costs to Date (include amount requested above)
2) TDA Article 3 158017.73 0.9876108125
3) Local Match 286102.45 1.28697004592748
4) ATP (if applicable) 0
Total 444120.18 1.15986435348531
C: Balance Remaining Progressive Reimbursement must not go below 20% retention until project completion 32000
TDA Article 3 1982.26999999999 0.0123891874999999
Local Match -63795.45 -0.286970045927479
ATP Funds (if applicable) 0 0
Total -61813.18 -0.161431313608788
5) Check to verify expenses claimed are consistent with the approved scope.
Total Project Miles (if applicable) NA
Summary: Installation of sidewalks, ramps, curb and gutters, closing existing gaps along east side of Cypress Ave & west side of Junper Ave, north of Baseline Ave, as they approach Kathy
Binks Elementary School.
By signing below, I certify that the information on this Financial Reporting form is true and accurate to the best of my knowledge.
Signed: Date:
(Authorized Agent specified in Authorizing Resolution)
Project Title: Kahy Binks Elementary School SRTS
Date Recipient's Name Brief Description of Purchase Amount Include proof of payment with redacted account number.
44895 San Bernardino, County of Notice of Exemption 50
44846 KOA Corporation Design Services PP #1 23678.61
44907 KOA Corporation Design Services PP #2 11581
44907 KOA Corporation Design Services PP #3 1586
44951 KOA Corporation Design Services PP #4 15260
44992 KOA Corporation Design Services PP #5 3046.5
44992 KOA Corporation Design Services PP #6 3359.5
45152 KOA Corporation Design Services PP #7 1246.23
45201 KOA Corporation Design Services PP #8 500.5
45257 KOA Corporation Design Services PP #9 572
45257 KOA Corporation Design Services PP #10 168.75
45349 KOA Corporation Design Services PP #11 3588.53
45107 Daily Journal Corporation Notice Inviting Bids 1305.3
45107 Herald News Publishing Inc. Notice of Exemption 890.82 Shows notice inviting bits
45197 Fenagh, LLC Geotechnical Services PP #1 1590
45223 Fenagh, LLC Geotechnical Services PP #2 2650
45257 Fenagh, LLC Geotechnical Services PP #3 1680
45209 CT&T Concrete Paving, Inc. Construction Invoice CT6487 PP #1 128228.5
45267 CT&T Concrete Paving, Inc. Construction Invoice CT6545 PP #2 193508.59 321737.09
45225 TKE Engineering, Inc Surveying Services Invoice 2023-567 1440
331293.21
various Employee # 2356 Staff Time 85.85
various Employee # 3561 Staff Time 26972.36
various Employee # 4861 Staff Time 2114.6
various Employee # 5836 Staff Time 7575.12
various Employee # 84206 Staff Time 913.91 160000
various Employee # 84218 Staff Time 264.14 158017.73
various Payroll Audit Staff Time Adjustments FYE 2022-23 5205.96 1982.26999999999
various Staff Time FYE 2022-23 Workmans Comp 542.33
various Staff Time FYE 2022-23 Risk Allocation 2320.69
various Staff Time FYE 2023-24 Pers Allocation 2025
various Staff Time Staff Time OT Adjustments -90.28
various Staff Time Staff Time OT Adjustments 259.67 48189.35
444120.18