Art3_SanBernardino_FY21_Transit_SignedClaim San Bemardino Associated Governments
Claim Form
Article 3 Grant Program
Project Name: San Bernardino Bus Stop Improvements Grant Allocation No: L22-0702-0748-00
Claimant: City of San Bernardino
Address: 290 North D Street
San Bernardino,CA 92401-1703
Attention: Alex Qlshta
Phone No: 909-384-SO34
E-mail Address: Qishta_AI@sbcity.org
Award Amount $ 50,800.00
Purpose: Please check one purpose.
❑ Article 3 Bicycle/Pedestrian Facilities,Public Utilities Code(PUQ 99233.3
D Transit Stop Access Improvements,PUC 99233.3
Authorizing Signature:
(Authorized Agent specified in Authorizing Resolution)
Date:
Signature
�t
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.
Art3_SanBemardino_FY21_Transit_Claim-filled out
Claim Form Page 1