REVISED SUBMITTAL I
San Bernardino County Transportation Authorit%
Claim Form
Article 3 Grant Program
Project Name: Bicycle Path&Pedestrian Facilities Project Grant Allocation No: L18-0702-0734-00
Claimant: City of Chino
Address: 13220 Central Avenue
Chino,CA 91710
Attention: Mussette Ayala,Senior Management Analyst
Phone No: 909-334-3546
E-mail Address: Mayala@cityofchino.org
Award Amount $ 353,091.00
Purpose: Please check one purpose.
_] Article 3 Bicycle/Pedestrian Facilities,Public Utilities Code(PUC)99233.3
El 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:
(Authorize nt specified in Authorizing Resolution)
Date:
Signa re
Dr. Linda Reich,City Manager
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_Chino_F Y 17_Bi kePed_Facdities_C laim
Claim Form Page 1
Claimant: City of Chino Date: 7/30/2025
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.
0 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.
El 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.
San Bernardino County Transportation Authority ATTACHMENT 1
Reimbursement Request
Article 3 Grant Program
Claimant: City of Chino Allocation #: L18-0702-0734-00
Complete fields in yellow belov,
Grant Information (completed by SBCTA)
Project Name
Total Project Article 3 Award Percent Local Match ATP Funds
Cost Amount Article 3 (if applicable)
Bicycle Path & Pedestrian Facilities Project $1,110,000.00 $353,081.00 31.81% $756,919.00 $0.00
rogrrsmve cu,o-_ ..
Section 1: Required for ALL Reimbursement Requests invoice should be for a $70,6 6.20 Section 2: Required for Progressive Reimbursements ONLY
.minimum of 20%of TDA
A:Current Request for Reimbursement Article 3owardamount A:Project Completion(turns red if%completed is significantly less than invoice)
TDA Article 3 Reimbursement Amount Requested $271,672.80 100% 1)Overall%Completed
Local Match ;582,798.19 5.70 2)Mileage Completed(if applicable) Share Completed: 100.00%
ATP Funds Utilized 50.00 B:Summary of Project Status
1)Total Spent' $854,470.99 .."ter total only 3)If either number turned red above,please provide a project schedule that demonstrates
'Shores will be automatically calculated based on non-rounded formula. how the project will be completed on schedule within the budget.Provide attachments as
B:Project Costs to Date(include amount requested above) needed.
2)TDA Article 3 $353,081.00 100.0%
3)Local Match $757,533.84 100.1%
4)ATP(if applicable) S0.00 0.0%
Total $1,110,614.84 300.19E
P.ogrrssrvr k.--- ,,,rmrnr $70,616,20
wst not go brow.W.rrtrnhon
C:Balance Remaining „•,.,.rt,r,m,'rr.•,_
TDA Article 3 $0.00 0.0%
Local Match -$614.84 -0.1%
ATP Funds(if applicable) $0.00 0.0%
Total -$614.84 -0.1%
5)Check to verify expenses claimed are consistent with the approved scope.
Total Project Miles(if applicable) 5.7
Scope per Match 6,2024 SBCTA Board approval.
Class II:12th St-B St to Chino Ave
Class III: Class III
7th St-B St to C St Park Place(Chino HIS)-10th St to Benson Ave
9th St-B St to C St Rosario St-Sequoia Ave to Magnolia Ave
loth St-Riverside Rd to Chino Ave Sequoia Ave-C St to Rosario St
B St-Monte Vista Ave to 71 h St Tronkell Ave-Benson Ave to Oaks Ave
B St 9th St to Benson Ave Washington Ave-Telephone Ave to 10 St
Benson Ave Park PI to Tronkell Ave C:Provide a copy of any contract(s)associated with reimbursable work.
IC St Monte Vista Ave to Swquoia Ave
By signing below, I certify that the information on t i Financial Reporting form is true and accurate to the best of my knowledge.
Signed: Date:
(Autho zed Agent specified in Authorizing Resolution)
Ar13_Chino_FY 17_BikePed_Facilities_Claim_REVI SE D
Reimbursement Request Page 1
Project Title: Bicycle Path & Pedestrian Facilities Project
Amount
Date Recipient's Name Brief Description of Purchase Include proof of payment
with redacted account
numb=,
11/21/22 CHINO VALLEY UNIFIED SCHOOL DISTRICT CONSTRUCTION PROJECT $ 68,262.35
1/30/23 CHINO VALLEY UNIFIED SCHOOL DISTRICT CONSTRUCTION PROJECT $ 166,549.74
6/5/23 CHINO VALLEY UNIFIED SCHOOL DISTRICT CONSTRUCTION PROJECT $ 368,713.75
6/26/23 CHINO VALLEY UNIFIED SCHOOL DISTRICT CONSTRUCTION PROJECT $ 250,945.15
Total $ 854,470.99
City of Chino
Itemization of Contractor/Consultant Invuices for TDA Bicycle and Pedestrian Facilities Project SBCTA Grant
Period Covered: From:July 1,2022 To:June 30,2023
Initial Award Amount $353,081.00
Available Award Amount Prior to FY22-23 $271,672.80
q►edc City 68.2 SBCTA 31.9 Full Invoice
Project Description Vendor Name Number Check Amount Invoice Date Invoice Number Percent Percent Amount
Chino Valley Unified 767321 $ 294,745.15 6/26/2023 CityofChrnotl2B S 171,144 59 S 79,800.56 $ 250,945.15
School District
Chino Valley Unified 766097 $ 368,713.75 6/5/2023 CityofChinotr5 $ 251,462.78 5 117,250.97 $ 368,713 75
School District
Chino Valley Unified
765055 5 166,549 74 1/30/2023 GtyofChinoit4 $ 113,586 92 S 52.962.82 $ 166.549 74
Bicycle Path and Pedestrian Facilities Proles G7802 School District
Chino Valley Unified 764968 $ 100,874.57 11/21/2022 CityofChino#3' S 46,554.92 5 21,707.43 $ 68,262.35
School District
Project G7802 Subtotals for FY22-23 $ 582,749.21 $ 271,721.78 S 854,470.99
•The City is only requesting$21,658.45 from Invoice
No.CityofChinoa3 to not exceed the total amount of Exceeded Amount for Grant -548.98
$353,081 that was granted by SBCTA for this request. Total City Expenditures for FY22-23 $582,798.19
Total Reimbursement Request for FY22.23 $271,672.80
Remaining Award Amount after FY22-23 $0.00