Art3_County_FY17_BikePed_WalkBikeSB_Inv09_APPROVED_210429_GK 351 N.Mountain View Ave.9303,San Bernardino.CA 92415 ( Phone-909.387.9146 Fax: 909.387.6224
Public Health Andrew Goidrfraacm D Ag HE
C:C�L 1 N`F Y Administration
ctaf
Joshua Duuas,MRA,REHS
Assistant Director
Michael A. Sequeira,M.D.
Hearth Officer
IN-KIND MATCH REPORT
Email In-Kind Report to: Date: 4/20/2021
nguyenk@scag.ca,eov SCAG OWP#:225.3564.1
Kana Sato-Nguyen In-Kind Match Report#: 13
Senior Budget&Grants Analyst Reporting Period: January 1,2021-March 31.2021 Q I
Southern California Association of Governments
900 Wilshire Blvd, 17th Floor
Los Angeles,CA 90017 Project Title: San Bernardino Courtly Safe Routes to School
Cost Categories H-v y Hours Amount Fringe Rate Fringe fDC Rate° /DC Amount
Rao
Direct Labor ClassiftcatiotiLs):
Cent SRTS Project Coordinator S39.58 290.00 S11,082.58 51 66% S5,725.27 15.449% S2,596.65 S19,404.50
Health Education Specialist 11 S6.00 51.66% S0.00 15.449% SO.00 $0.00
PH Program Manager S66.36 18A0 S1,i94.47 51,66% S617.06 15,449% S279.86 52,091.39
Public Hith Prgm Coordinator SO.00 51.66% SO.001 15,449% S0.001 $0,00
Automatcd Systems Technician 50,001 51.66°/ SO-001 15.449°/n $0.001 SO.00
Automated Systems Analyst I S0.00 51.66% SO.001 15.449% S0.001 $0.00
Automated Systems Analyst 1 S0.00 51.66°i S0.001 15.449%, S0.001 S0.00
Subtotal- Direct Labor 298.00 $12,277.05 56,342.33 52,876.51 $21,495.69
Other Direct Costs(ODO)
Printing Services - - S0.00
HS Admin Charges SI,275.74 SI 175 74
County Counsel Charges S287_50 S287.50
CEHW Charges IS0.00
Email Costs $129.71)1 S 129.79
Promotional Items So.oO
Travel Costs S0.o0
Livescan/Background SO.00
Step Counters
50,00
Monitor SOM0
Computer Equipment imp
50.00
Cit of Rancho Cucamonga SO.00
City of Needles S0.00
City of Ontario SO 00
$0.00
SO.00
S0.00
50.00
50,00
Subtotal-ODCs: $1,693,03 LAWS1,693.03
TOTAL for 1\-KI\D?IATCH $t3,970.D8 523,188.03
92
1,Paul Chapman,certify that this in-kind match report and the information attached is true and correct.I also certify that all eligible and required documentation is on
file for this report and that I am the person duly authorized to sign this certification on behalf of my agency.I further certify that our agency is not using any federal
funds to match expenditure funds.
Chief Financial Officer
Signature Title
Paul Chapman ZI
Print Name Date
'lfapplicable,for credit of indirect costs for work provided as in-kind contribution,a sub-recipient must submit an approved Indirect Cost Allocation Plan(]CAP)or Indirect Cost Rate Proposal(ICRP)to
SCAG on an annual basis for SCAG's review.Ira sub-recipient has not received a negotiated indirect cost rate previously.then the sub-recipient may elect to cbaw a do minimis rate of 10%of modified
total direct costs(MTDC).
COL PAUL COOK
Firlit DI.Striel Second District Vice Chair,Third District Chairman,Founh W1191Ct FifthDistrIct
San Bernardino Associated Governments
Claim Form
Article 3 Grant Program
Project Name: Walk and Bike SB Grant Allocation No: 1,18-0702-0754-01
Claimant: County of San Bernardino
Address: 340 N.Mountain View Avenue
San Bernardino,CA 92415-0010
Attention: Paul Chapman
Phone No: (909)387-6630
E-mail Address: Paul.Chapman@dph.sbcounty.gov
Amount Requested
for Reimbursement: $ 23,188.92
Purpose: Please check one purpose.
(X) Article 3 Bicycle/Pedestrian Facilities,Public Utilities Code(PUC)99233.3
( ) Transit Stop Access Improvements,PUC 99233.3
Authorizing Signature:
(Claimant's Chief Adminstrator or Financial Officer)
Date: �a f 7_R_ 4.1
Signature I
Paul Chapman,Chief Financial Officer
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.
YTv\,4VA 'ram
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD-FY2021 O3
Claim Form Page i
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County of San Bernardino
County Counsel
385 North Arrowhead Avenue,4th Floor
San Bernardino, CA 92415-0140
Telephone(909)387-5455
Fax(909)387-5452
PUBLIC HEALTH DEPARTMENT November 30, 2020
Attn: Delaney Fountain Reference No. 184591
Mail Code: 0010
351 Mountain View Ave
San Bernardino CA 92415-0010
CLIENT: 0611 - PUBLIC HEALTH DEPARTMENT
Re: CON2021 Contract Review FY2021
Professional Services
Date ATTY Services Hours Amount
11/02/20 AEE Review and advise County Health Officer 2.25 517.50 Li O C)&>
Employment Contract.
11/04/20 AEE Review and advise BAI-DPH-1 1-1 7-20-TB Local 1.25 287.50 �7j b1
Control Award_2020-21
11/04/20 AIC Review and approve execution version of lease 0.25 57.50 D gZ
amendment for Needles health clinic
11/04/20 AIC Review and approve execution version of lease 0.25 57.50 o55 2-
amendment for Adelanto health clinic �� 3
11/05/20 KMR E-mail with OES re DPH site use agreement template 0.25 57.50
for COVID testing sites
11/06/20 AEE Review and advise DAP Documents for Review and 1.25 287.50 3 7 1 S
Signing- CDC and Ryan White Part A
11/10/20 AEE Review and advise BAI-DPH-12-15-20-Santa Cruz 1.25 287.50 JyOD
HIO A-1. (Clinic Ops, health records)
11/10/20 AEE Review and advise Signature authority for learner 1.25 287.50 04-;0 O
agreement with AZ College. (clinic ops)
11/10/20 AEE Review and advise MOU with Public Health regarding 1.00 230.00 04 00
the GPP split with ARMC.
11/16/20 AIC Review contract terms for equipment and software 2.00 460.001005
purchase from Rantizo; prepare summary of
non-standard terms; emails with Julie Surber and
Stephanie Shea
11/20/20 AEE Review and advise SRTS MOU with the City of 1.25 287.50 Z 9()3
Needles.
11/23/20 AEE Review and advise Renewal Quote for Prime Call 1.50 345.00 60tu Z
Integrated Maintenance Service Plan. Email Alicia
Flowers.
11/23/20 AEE Review and advise BAI-DPH-12-15-20-CON-PEI El 1.50 345.00 3 L
Sol.
CONFIDENTIAL
Attorney-Client Privilege
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HS Charges for PP 20/20 through 21/20
A B C D E F G
HS Code PH Prgm code Intemal Order PP 24/20 PP 25/20 TOTAL INDIRECT COST
1 22%
3 1400 4000 1003687 $ 3,577.71 $ 2,604.77 $ 6,182.48 $ 1,360.15
4 1408 500 1003628 $ 793.28 $ 1,550.51 $ 2,343.79 $ 515.63
5 1411 1308 1007335 $ 144.23 $ 360.59 $ 504.82 $ 111.06
6 1412 1305 1007332 $ 216.35 $ - $ 216.35 $ 47.60
7 1413 1300 1003655 $ 504.83 $ - $ 504.83 $ 111.06
8 1417 3248 1008324 $ 537.42 $ 565.33 $ 1,102.75 $ 242.61
9 1418 3250 1003683 $ - $ 450.73 $ 450.73 $ 99.16
10 1426 2600 1003662 $ 126.21 $ 216.34 $ 342.55 $ 75.36
11 1429 3242 1007357 $ 144.23 $ 288.46 $ 432.69 $ 95.19
12 1442 5100 1003693 $ 18.03 $ 90.15 $ 108.18 $ 23.80
13 1443 5400 1003696 $ 18.03 $ 90.15 $ 108.18 $ 23.80
14 1444 5100 1003693 $ 18.03 $ 90.15 $ 108.18 $ 23.80
15 1461 1049 1008273 $ - $ 144.23 $ 144.23 $ 31.73
16 1465 0475 1007405 $ 52.47 $ 104.93 $ 157.40 $ 34.63
17 1468 1900 1003658 $ 324.53 $ 414.69 $ 739.22 $ 162.63
18 1470 2903 1007347 $ - $ 486.79 $ 486.79 $ 107.09
19 1476 3701 1009447 $ 468.76 $ - $ 468.76 $ 103.13
20 1478 3715 1008304 $ 1,720.96 $ 1,099.78 $ 2,820.74 $ 620.56
21 1479 3765 1008300 $ 793.28 $ 612.98 $ 1,406.26 $ 309.38
22 1499 99.60,1010.52.04 99.60.1010.52.04 $ 112.92 $ - $ 112.92 $ 24.84
23 2909 2909 1009201 $ 397.92 $ - $ 397.92 $ 87.54
24 3241 3241 1009298 $ - $ 221.07 $ 221.07 $ 48.64
25 3261 3261 1007365 $ 375.81 $ 221.07 $ 596.88 $ 131.31
26
27 $ 19,957.72
28
$ 4,390.70
29
$ 24,348.42
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HS Charges for PP 26/20 through 27/20
A B C D E F G
PH Prgm INDIRECT COST
1 HS Code code Internal Order PP26/20 PP27/20 TOTAL 22%
2 1400 4000 1003687 $ 2,401.30 $ 2,457.11 $ 4,858.41 $ 1,068.85
3 1408 500 1003628 $ 1,171.87 $ 324.53 $ 1,496.40 $ 329.21
4 1415 3261 1007365 $ 176.85 $ 1,484.84 $ 1,661.69 $ 365.57
5 1417 3248 1008324 $ 1,042.23 $ 994.60 $ 2,036.83 $ 448.10
6 1418 3250 1003683 $ 252.42 $ 288.46 $ 540.88 $ 118.99
7 1423 2300 1007343 $ 144.23 $ 288.47 $ 432.70 $ 95.19
8 1426 2600 1003662 $ 955.55 $ 757.23 $ 1,712.78 $ 376.81
9 1429 3242 1007357 $ 72.12 $ 288.47 $ 360.59 $ 79.33
10 1442 5100 1003693 $ 18.03 $ 18.03 $ 36.06 $ 7.93
11 1443 5400 1003696 $ 18.03 $ 18.03 $ 36.06 $ 7.93
12 1444 5100 1003693 $ 18.03 $ 18.03 $ 36.06 $ 7.93
13 1461 1049 1008273 $ 216.36 $ 216.36 $ 47.60
14 1465 0475 1007405 $ 324.52 $ 162.27 $ 486.79 $ 107.09
15 1468 1900 1003658 $ 360.58 $ 252.42 $ 613.00 $ 134.86
16 1470 2903 1007347 $ 198.32 $ 252.41 $ 450.73 $ 99.16
17 1478 3715 1008304 $ 2,756.83 $ 252.40 $ 3,009.23 $ 662.03
18 1479 3765 1008300 $ 540.87 $ 1,965.17 $ 2,506.04 $ 551.33
19 1499 9903 99.60.1010.52 $ 945.23 $ 945.23 $ 207.95
20 2909 2909 1009201 $ 44.21 $ 44.21 $ 9.73
21 3241 3241 1009298 $ 486.35 $ 44.21 $ 530.56 $ 116.72
22
23 $ 22,010.61
24 $ 4,842.33
25 $ 26,852.94
26
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HS Charges for PP O1/21 through 02/21
A B C D E F G
HS Code PH: Internal Order PP OiJ21 PP 02/21 TOTAL INDIRECT COST
code 22%
2 1400 4000 1003687 $ 1,810.22 $ 2,628.82 $ 4,439.04 $ 976.59
3 1406 3253 1007362 $ 144.23 $ 144.23 $ 31.73
4 1408 500 1003628 $ 108.17 $ 36.06 $ 144.23 $ 31.73
5 1415 3261 1007365 $ 811.32 $ 775.25 $ 1,586.57 $ 349.05
6 1417 3248 1008324 $ 612.99 $ 144.23 $ 757.22 $ 166.59
7 1418 3250 1003683 $ 739.20 $ 667.08 $ 1,406.28 $ 309.38
8 1426 2600 1003662 $ 72.12 $ 72.12 $ 15.87
9 1429 3242 1007357 $ 360.59 $ 360.59 $ 79.33
10 1442 5100 1003693 $ 667.08 $ 432.70 $ 1,099.78 $ 241.95
11 1449 1000 1003652 $ 108.17 $ 108.17 $ 23.80
12 1465 0475 1007405 $ 54.09 $ 54.09 $ 108.18 $ 23.80
13 1467 0843 1008274 $ 216.35 $ 216.35 $ 47.60
14 1468 1900 1003658 $ 360.58 $ 360.58 $ 79.33
15 1470 2903 1007347 $ 108.17 $ 108.17 $ 23.80
16 1476 3701 1009447 $ 36.06 $ 36.06 $ 7.93
17 1478 3715 1008304 $ 108.17 $ 396.63 $ 504.80 $ 111.06
18 1479 3765 1008300 $ 270.43 $ 468.76 $ 739.19 $ 162.62
19 1499 9903 99.60.1010.52 $ 221.07 $ 1,402.84 $ 1,623.91 $ 357.26
20 3241 3241 1009298 $ 132.64 $ 309.50 $ 442.14 $ 97.27
21
22 $ 14,257.61
23 $ 3,136.68
24 $ 17,394.29
25