Art3_Redlands_FY11_Transit_ClaimClaimant:
The Check-List below are items that must be included with your submission for reimbursement
1.
2.
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6.
City of Redlands
Claim Form
Financial Reporting Form
(Complete the estimated column for anticipated interest, refunds and expenditures)
Request for Progress Payment (projects over $200,000)
(Certified copy of resolution or minute action authorizing the filing of the claim and requesting progress payments)
Governing Body Authorization (Completed Projects)
(Certified copy of minute action or resolution authorizing the filing of the claim and Project acceptance)
Project Completion Report
(Council's Project acceptance can be used. Pictures of completed project must be included.)
Other (optional)
(List any other information you wish to submit to support your claim)
Date:
Fiscal Year:
Claimant:
Address:
Amount:
PURPOSE:
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 allocation instruction.
FY 2011-2012 Award (December 2011)
City of Redlands
35 Cajon Street, Suite 15A
Redlands, CA 92373
0
( ) Article 3, PUC Section 99234a Pedestrian Facilities
( ) Article 3, PUC Section 99234a Bicycle Facilities
(X) Article 3, PUC Section 99234a Pedestrian Access to Transit Facilities
Attention:
Phone #:
Authorizing Signature:
(Claimant's Chief Adminstrator or Financial Officer)
(Signature)
(Type Name & Title
Risa Jones
(909)798-7584 X6
Claimant:
1. Project Name:
I certify that the information on this Financial Reporting form is true and accurate to the best of my knowledge.
City of Redlands
Transit Stop Access Project (S-1212-040)
Total Project Expenditure
TDA Article 3 (SB 821)
* Local Match
Signed:
Project
Budget
Cost
39900
39900
Date:
%
TDA
Budget
1
Project
Actual
Cost
0
0
0