SBCTA Claim Form_ Hermosa Ave Complete Streets San Bernardino County Transportation Authority
Claim Form
Article 3 Grant Program
Project Name: Hermosa Avenue Complete Streets Project Grant Allocation No: L26-Art3-RCH-15
Claimant: City of Rancho Cucamonga
Address: 10500 Civic Center Drive
Rancho Cucamonga,CA 91730
Attention: Marlena Perez,Principal Civil Engineer
Phone No: (909)774-4058
E-mail Address: Marlena.Perez@cityofrc.us
Award Amount $ 537,000.00
Purpose: Please check one purpose.
J Article 3 Bicycle/Pedestrian Facilities,Public Utilities Code(PUC)99233.3
_J Transit Stop Access Improvements,PUC 99233.3
Note:this form only needs to be completed and submited with the full award amount cr>ce
Authorizing Signature:
(Authorized Agent specified in Authorizing Resolution)
Date: _1912_ ZG
Signature
Jason Welday,Director of Engineering Services/City Engineer
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_Renctw FY25—BikePed_HermosaAve_Claim
Claim Form — Page t