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Art3_Victorville_FY23_BikePed_Village Drive Sidewalk_ClaimClaimant: City of Victorville Date: 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, 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: 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: Village Drive Sidewalk Grant Allocation No: L24-0702-0751-03 Claimant: City of Victorville Address: Attention: Phone No: E-mail Address: Award Amount 250000 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 Victorville Allocation #: L24-0702-0751-03 Complete fields in yellow below. Grant Information (completed by SBCTA) Project Name Total Project Cost Article 3 Award Amount Percent Local Match Local Match ATP Funds (if applicable) Village Drive Sidewalk 558000 250000 0.553763440860215 309000 0 Progressive Reimbursement Invoice should be for a minimum of 20% of TDA Article 3 award amount 50000 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 0 1) Overall % Completed Local Match 0 2) Mileage Completed (if applicable) Share Completed: 0 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* 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 0 3) Local Match 0 4) ATP (if applicable) 0 Total 0 0 C: Balance Remaining Progressive Reimbursement must not go below 20% retention until project completion 50000 TDA Article 3 250000 1 Local Match 309000 1 ATP Funds (if applicable) 0 0 Total 559000 1.00179211469534 5) Check to verify expenses claimed are consistent with the approved scope below. Total Project Miles (if applicable) .46 Installation of 5.5' wide sidewalk along the east side of Village Dr between Tawney Ridge Ln and Puesta Del Sol Dr. C: Provide a copy of any contract(s) associated with reimbursable work. 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: Village Drive Sidewalk Date Recipient's Name Brief Description of Purchase Amount Include proof of payment with redacted account number. Total 0 Allocation Number Claimant Project Name Total Project Cost Art 3 Award Amount Matching Funds ATP Funds Reallocated Funds - select - - - 0 0 0 0 0 L24-0702-0731-00 Town of Apple Valley McConnell Park Multi-Use Path 480852 240426 240426 0 0 L24-0702-0731-01 Town of Apple Valley Central Road Class II Bikeway 795000 397500 397500 0 0 L24-0702-0733-00 City of Big Bear Lake Stanfield Marsh Outdoor Recreation & Education Trail Segment II (SMORE II) 607036 303518 303518 0 0 L24-0702-0736-00 City of Colton South La Cadena Bicycle Improvement 320000 208000 112000 0 0 L24-0702-0737-01 City of Fontana Rectangular Rapid Flashing Beacons (x7) 70000 52500 17500 0 0 L24-0702-0737-02 City of Fontana Catawba SRTS Sidewalk 792697 396348 396349 0 0 L24-0702-0740-00 City of Highland 9th St. Transit Stops, Sidewalk, and Bikeway Improvements 834872.8 404172 404172 0 26528.8 L24-0702-0745-00 Rancho Cucamonga Cucamonga Creek Channel: Foothill Blvd. to Base Line Rd. 204415 78000 42000 0 84415 L24-0702-0745-01 Rancho Cucamonga Day Creek Channel Bike Trail: Jack Benny Dr. to Base Line Rd. 568000 107250 57750 0 403000 L24-0702-0746-00 City of Redlands Orange Blossom Trail Phase IV 1282000 1089700 192300 0 0 L24-0702-0747-00 City of Rialto Frisbie Middle School SRTS 1684755 1095090.75 589664.25 0 0 L24-0702-0747-01 City of Rialto Bemis Elementary SRTS 1102685 716745 385940 0 0 L24-0702-0749-00 City of Twentynine Palms Channel Trail Class I 495000 420750 74250 0 0 L24-0702-0751-03 City of Victorville Village Drive Sidewalk 558000 250000 308000 0 0