Art3_Mountain Transit_FY26_Transit_Moonridge_Claim_Claimant:
Please see below instructions and checkmark the items included in your submittal.
1.
2.
3.
4.
5.
6.
7.
8.
Mountain Transit
Claim Form (one-time submission) – required prior to, or along with, your first reimbursement request.
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.
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.
Backup Documentation (required with Reimbursement Request Form) – invoices, paychecks, purchase orders, 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:
Backup Summary itemizing reimbursement request expenses.
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.
Photos of Completed Project (completed projects only) – required when project is complete and should be attached to final reimbursement request.
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.
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
Date:
Project Name:
Claimant:
Address:
Attention:
Phone No:
E-mail Address:
Award Amount
Purpose:
Authorizing Signature:
(Authorized Agent specified in Authorizing Resolution)
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.
Transit Enchancements Moonridge Road
Mountain Transit
188000
Please check one purpose.
Article 3 Bicycle/Pedestrian Facilities, Public Utilities Code (PUC) 99233.3
Transit Stop Access Improvements, PUC 99233.3
Date:
Grant Allocation No:
L26-Art3-MRT-21
Claimant:
Section I: Required for all Reimbursement Requests (1-5)
Grant Information (completed by SBCTA)
Project Name
Transit Enchancements Moonridge Road
A: Current Request for Reimbursement
TDA Article 3 Reimbursement Amount Requested
Local Match
ATP Funds Utilized
1) Total Spent*
*Shares will be automatically calculated based on non-rounded formula.
B: Project Costs to Date (include amount requested above)
2) TDA Article 3
3) Local Match
4) ATP (if applicable)
Total
C: Balance Remaining
TDA Article 3
Local Match
ATP Funds (if applicable)
Total
5) Check to verify expenses claimed are consistent with the approved scope.
Construct Transit Enchancements at Moonridge Road.
By signing below, I certify that the information on this Financial Reporting form is true and accurate to the best of my knowledge.
Signed:
Mountain Transit
(Authorized Agent specified in Authorizing Resolution)
Total Project Cost
235000
0
0
0
0
188000
47000
0
235000
Total Project Miles (if applicable)
Article 3 Award Amount
188000
Minimum progressive reimbursement amount 20%
37600
Enter total only
0
0
0
0
1
1
0
1
Section II: Required for Progressive Reimbursements ONLY (1-3)
A: Project Completion (turns red if % completed is significantly less than invoice)
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.
Allocation #:
Percent
Article 3
0.8
1) Overall % Completed
2) Mileage Completed (if applicable)
Date:
L26-Art3-MRT-21
Local Match
47000
ATP Funds
(if applicable)
0
Share Completed:
Project Title:
Date
Total
Transit Enchancements Moonridge Road
Recipient's Name
Brief Description of Purchase
Amount
(include proof of payment)
0
Allocation Number
- select -
L26-Art3-FON-17
L26-Art3-LLA-18
L26-Art3-ONT-19
L26-Art3-MBT-20
L26-Art3-MRT-21
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-OMN-22
L26-Art3-VVT-23
L26-Art3-VVT-24
L26-Art3-VVT-24
L26-Art3-VVT-24
L26-Art3-VVT-24
L26-Art3-VVT-24
L26-Art3-VVT-25
L26-Art3-VVT-26
Claimant
-
City of Fontana
City of Loma Linda
City of Ontario
Basin Transit
Mountain Transit
Omnitrans
Omnitrans
Omnitrans
Omnitrans
Omnitrans
Omnitrans
Omnitrans
Omnitrans
VVTA
VVTA
VVTA
VVTA
VVTA
VVTA
VVTA
VVTA
Project Name
-
City of Fontana Citywide Transit Stop Improvements
City of Loma Linda ADA Improvements at Bus Stops
City of Ontario Bus Stop Improvements
Basin Transit Mohawk Apt @ Monteresy Business Center Bus Stop Improvement
Transit Enchancements Moonridge Road
Omnitrans Application 3 Omnitrans Bus Stop Improvements Colton & Montclair
Omnitrans Application 8 Omnitrans Bus Stop Improvements Redlands & Fontana
Omnitrans Application 1 Omnitrans Bus Stop Improvements Fontana
Omnitrans Application 2 Omnitrans Bus Stop Improvements Highland & Loma Linda
Omnitrans Application 7 Omnitrans Bus Stop Improvements Ontario
Omnitrans Application 5 Omnitrans Bus Stop Improvements Rialto
Omnitrans Application 6 Omnitrans Bus Stop Improvements San Bernardino
Omnitrans Application 4 Omnitrans Bus Stop Improvements - County
VVTA Apple Valley - Apple Bear Bus Stop Project
VVTA Victorville - Seneca Rd E of Rodeo Drive
VVTA Victorville - Seneca Rd W of Hesperia Rd
VVTA Victorville - Seneca Rd at Mesa Rd
VVTA Victorville - Hesperia at Cherry Hill
VVTA Victorville - Hesperia at Crestview
VVTA Systemwide Replacement of Damaged Bus Shelters
VVTA Systemwide Trash Receptacles
Total Project Cost
0
197571.45
52650
82335
155292
235000
34000
32000
109000
58000
72000
10000
73000
57000
175014
25695
20561
17552
13727
13727
49320
9409
Art 3 Award Amount
0
149400
42120
82335
124234
188000
34000
32000
109000
58000
72000
10000
73000
57000
140012
20556
16449
14042
10962
10962
39456
7528
ATP Funds
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0