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Art3_ FY25_VV Replacement Damaged Shelters Signed Claim Form_Claim San Bernardino County Transportation Authority Claim Form Article 3 Grant Program Project Name: VVTA Systemwide Replacement of Damaged Bus ShOtartt Allocation No:,L26-Art3-VVT-25 Claimant:'VVTA Address: 17150 Smoke Tree Street Hesperia,CA 92345 Attention: Dana Fleming Phone No: (760)995-3479 E-mail Address: dfleming@vvta.org Award Amount 5 39,456.00 Purpose: Please check one purpose. ❑ Article 3 Bicycle/Pedestrian Facilities,Public Utilities Code(PUQ 99233.3 0 Transit Stop Access Improvements,PUC99233.3 Authorizing Signature: (Authorized Agent specified in Authorizing Resolution) &(A Date: 12/1/2025 Signature Nancie Goff,Chief Executive 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. Art3_WTA_FY25_Transit—Replacement Damaged Shelters_Claim.xlsx Claim Form Page 1