Art3_Victorville_FY17_BikePed_BearValley_Inv1_CLOSEDSan Bernardino Associated Governments
Check List
Article 3 Grant Program
City of Victorville Date:4/6/2020
Please 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 authorizing
resolution 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 reimbursement
requests throughout the duration of the project. Please submit resolution with Claim Form.
x 3. Reimbursement Request Form (as needed)
This form is required for every reimbursement requested.
x 4. Back-up Documentation (required with Reimbursement Request Form)
Please attach documentation supporting the amount requested (e.g., invoices, paychecks,
purchase orders, etc.)
5.Certified Copy of Minute Action (completed projects only)
Certified copy of minute action authorizing the filing of the final claim and verifying project completion.
6. 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.xlsx
Check List Page 1
Approved by
Ginger Koblasz
on May 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:
494,390.50$
Purpose:Please check one purpose.
( )
Authorizing Signature:
(Claimant's Chief Adminstrator or Financial Officer)
Date: 4/6/2020
Signature
Brian Gengler, City Engineer
Type Name & Title
Amount Requested
for Reimbursement:
City of Victorville
14343 Civic Drive
PO Box 5001 Victorville, CA 92393-5001
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)
Article 3 Claim Form Updated Version.xlsx
Claim Form Page 1
Bear Valley Rd: Between Jacaranda Ave and Fish Hatchery Rd bike Path Project
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
1,118,000$ 559,000$ 50% 559,000$ 50%
Instructions: Please complete 1 through 4 below.
Amount
494,391$
754,216$
1,248,606$
526,805$ (233,000)
792,000$ 32,195
1,318,805$ (200,805)
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: 04/06/2020
Total Amount Remaining
Grant Information (completed by SANBAG)
Bear Valley Rd: Between Jacaranda Ave and Fish Hatchery Rd bike Path Project
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
792,000.00$ 559,000.00$
1 6,000.00$ 300.00$ 00771865 Contractor
2 218,390.00$ 10,919.50$ 00772923 Contractor
3 125,010.00$ 6,250.50$ 00774101 Contractor
4 150,403.65$ 7,520.18$ 00774398 Contractor
5 228,643.35$ 11,432.17$ 00774751 Contractor
6 344,436.00$ 17,221.80$ 00775308 Contractor
7 131,103.68$ 6,555.18$ 00775731 Contractor
-$ Pending Contractor Pending Pending
1,203,986.68$ 60,199.33$ 754,215.63$ 389,571.71$
8 Dow Jones LMG National Publishing 277.30$ 00314704 Advertising 277.30$
9 Daily Journal Corporation 184.80$ 00768809 Advertising 184.80$
11 1,450.00$ 00320569 Engineering 1,450.00$
12 4,000.00$ 00775046 Engineering 4,000.00$
13 3,475.00$ 00771826 Engineering 3,475.00$
14 520.00$ 00774383 Geotech 520.00$
15 21,790.00$ 00775713 Geotech 21,790.00$
16 13,720.00$ 00775074 Geotech 13,720.00$
17 9,276.25$ 00776105 Geotech 9,276.25$
18 4,535.00$ 00774798 Geotech 4,535.00$
19 647.20$ 00776330 Survey 647.20$
20 484.00$ 00770080 Permit 484.00$
21 3,950.00$ 00769799 Environmental 3,950.00$
23 1,360.00$ 00774746 Survey 1,360.00$
24 1,200.00$ 00774746 Survey 1,200.00$
25 4,455.00$ 00775304 Survey 4,455.00$
Bear Valley Rd: Between Jacaranda Ave and Fish Hatchery Rd bike Path Project
170,110.00$
584,105.63$
43,060.50$
346,511.21$
Sub-Total Construction Contract:
Funding SourceBackup of Summary
Iten No.Payee Invoice Amount Retention Check Amount Check No. Category
1,203,986.68$
Lewis, Gary Alan 1,360.00$
Lewis, Gary Alan
Lewis, Gary Alan
1,200.00$
4,455.00$
4,535.00$
Winship Stake & Lath, Inc.647.20$
State Water Resources Control Board 484.00$
RCA Associates LLC 3,950.00$
184.80$
ABI Engineering Consultants
Geocon West Inc.
Geocon West Inc.
Geocon West Inc.
Geocon West Inc.
ABI Engineering Consultants
ABI Engineering Consultants
1,450.00$
4,000.00$
3,475.00$
520.00$
21,790.00$
Riverside Construction 5,700.00$
Riverside Construction 207,470.50$
Riverside Construction 327,214.20$
Riverside Construction 124,548.50$
277.30$
Geocon West Inc.
13,720.00$
9,276.25$
60,199.33$ Retention
Riverside Construction 118,759.50$
Riverside Construction 142,883.47$
Riverside Construction 217,211.18$
ATP Funds TDA Article 3
792,000.00$ 559,000.00$
Bear Valley Rd: Between Jacaranda Ave and Fish Hatchery Rd bike Path Project
Funding SourceBackup of Summary
Iten No.Payee Invoice Amount Retention Check Amount Check No. Category
Riverside Construction 5,700.00$ 26 3,740.00$ 00774216 Survey 3,740.00$
27 1,020.00$ 00773914 Survey 1,020.00$
28 2,805.00$ 00774216 Survey 2,805.00$
29 1,019.24$ 00774757 Permit 1,019.24$
30 3,500.00$ 00769899 Permit 3,500.00$
31 16,000.00$ 00772322 Permit 16,000.00$
32 130.00$ Permit 130.00$
33 5,280.00$ 022451 Permit/Utility 5,280.00$
10,000.00$ Pending Construction Support Pending Pending
114,818.79$ -$ 104,818.79$
2,522,792.15$ 60,199.33$ 754,215.63$ 494,390.50$
37,784.37$ 64,609.50$ Funds Remaining For Future Reimbursement
Total of This Claim 494,390.50$
Special District Water
130.00$
5,280.00$
David Evans and Associate -$
1,019.24$
3,500.00$
Southern California Edison 16,000.00$
San Bernardino County
Lewis, Gary Alan 2,805.00$
Sub-Total Other Construction Cost:
Lewis, Gary Alan
Lewis, Gary Alan
3,740.00$
1,020.00$
Southern California Edison
Southern California Edison
104,818.79$
Total 2,512,792.14$
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