Art3_County_FY17_BikePed_WalkBikeSB_Inv03 www.59county.gov
SAN BERNARDINO Public Health Trudy Raymundo
Director
COUNTYAdministration Corwin Porter
Assistant Director
Maxwell Ohikhuare,M.D.
Health Officer
IN-KIND MATCH REPORT
Email In-Kind Report to: Date: 10/30/2019
nguvenkPscaR.ca Rov SCAG OWP#: 225.3564.1
Karat Sato-Nguyen In-Kind Match Report#: 7
Senior Budget&Grants Analyst Reporting Period: July I,2019-September 30,2019 Q3
Southern California Association of Governments
900 Wilshire Blvd, 17th Floor
Los Angeles,CA 90017 Project Title: San Bernardino County Safe Routes to School
Cost Categories Hourly
8 Rate Hours Amoant Fringe Role Fringe IOC Rate• [DC Amount
Direct Labor Classification/sJ:
Cont SRTS Project Coordinator $32.73 226501 $7,412,87 51,51% $3,818,37 14.628% $1,642.91 $12,874.15
Health Education Specialist 11 $0.00 000 $0.00 51,51% $0.00 14.628% $0.00 $0.00
PH Program Manager $63.23 2600 $1,644.01 51.51% $846,83 14.628% $364.36 $2,855.20
Automated Systems Technician $25,00 200 $50.00 51.51% $25.76 14,628% $11.08 $86.84
Automated Systems Analyst 1 $35.27 0.75 $26 45 51.51% $13.62 14.628% $5.86 $45 93
Automated Systems Analyst l $3050 0.50 $1525 51.51% S7% 14.628% $3,38 $26.49
Subtotal- Direct Labor 255.75 S9,148.58 " S4,712.44 a $2,027.59 $15,898.61
Other Direct Costs(ODCS)
Printing Services .00
HS Admin Charges $855.R7 $8$0$0
County Counsel Charges 55.00
87
CEHW Charges .
00
Email Costs $0.00
Promotional Items $105.28 $105.28
Travel Costa $470 $0.00
$470.96
LivescanBackground $0.00
,
Step Counters $999R Oli
Monitor $9,998.00
$0.00
$0,00
$0.00
$0 00
Subtotal-ODCs: . $11,430.11 _ SI LZ0.11
TOTAL for IN-KIND MATCH $20,578.69 S27,318.72
�/r ,0A /II
I,Joshua Dugas,certify that this in-kind match report and the information attached is true and correct 1 also certify that all eligible and requuired documentation is on
file for this report and that 1 am the person duly authorized to sign this certification on behalf of my agency. I further certify that our agency is not using any federal
funds to in x,i nditur,funds.
Chief Financial Officer
Sig Title
Joshua Dugas told-111 1
Print Name Date
'If applicable,for credit of indirect costs for work provided as in-kind contribution,a sub-recipient must submit an approved Indirect Cost Allocation Plan(ICAP)or Indirect Cost Rate Proposal
(ICRP)to SCAG on mr manual basis for SCAG's review.If a sub-recipient has not received a negotiated indirect cost rate previously,then the sub-recipient may elect to charge a de minims rate of
10%of modified total direct costs(MTDC).
San Bernardino Associated Governments
Check List
Article 3 Grant Program
Claimant: County of San Bernardino Date: 10/29/2019
Please see below instructions and checkmark the items included in your submittal.
✓ 1. Claim Form (one-time submission)
Please submit a completed Claim Form prior to requesting reimbursement of funds. An authorizing
resolution is required with the Claim Form (see #2).
2. Authorizing Resolution (one-time submission)
Resolution authorizing the filing of the claim form and authorizing the submission of reimbursement
requests throughout the duration of the project. Please submit resolution with Claim Form.
✓ 3. Reimbursement Request Form (as needed)
This form is required for every reimbursement requested.
I
✓ 4. Back-up Documentation (required with Reimbursement Request Form)
Please attach documentation supporting the amount requested (e.g., invoices,paychecks,
purchase orders, etc.)
5. Certified Copy of Minute Action (completed projects only)
Certified copy of minute action authorizing the filing of the final claim and verifying project completion.
6. Photos of Completed Project (completed projects only)
7. Other(optional)
Attach any other information you wish to submit to support your claim.
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD- FY1920 01
Check List Page 1
San Bernardino Associated Govemments
Claim Form
Article 3 Grant Program
Project Name: Walk and Bike SB Grant Allocation No: L18-0702-0754-01
Claimant: County of San Bernardino
Address: 340 N.Mountain View Avenue
San Bernardino,CA 92415-0010
Attention: Joshua Dugas
Phone No: (909)387-6222
E-mail Address: Joshua.Dugas@dph.sbcounty.gov
Amount Requested
for Reimbursement: $ 27,318:72
Purpose: Please check one purpose.
(X) Article 3 Bicycle/Pedestrian Facilities,Public Utilities Code(PUC)99233.3
( ) Transit Stop Access Improvements,PUC 99233.3
Authorizing Signature:
(Claiman/tr'I,s Chief Adminstrator or Financial Officer)
�"// G�
A/ Date:
SI u e
Joshua Dugas,Chief Financial 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.
A3 Claim County of San Bernardino SRTS ATP Cycle 3 5316BOD-FY1920 Q7 l o%//( /
Claim Forth
Page 1
San Bernardino Associated Governments
Reimbursement Request
Article 3 Grant Program
Claimant: County of San Bernardino
Grant Information (completed by SANBAG)
Article 3
Total Project Award Percent
Project Name Cost Amount Article 3 Local Match ATP Funds
Walk and Bike SB $ 2,000,000 $ 320,000 16.0% $ 80,000 $ 1,600,000
Instructions: Please complete I through 4 below.
Amount
1)Article 3 Cost(amount being requested for
reimbursement) $ 27.319
2)Local Match/ATP Funds Cost
Total $ 27,319
Proiect Costs to Date(include amount requested above)
Local Match/ATP Funds
3)Article 3 $ 77,222 Remaining 1,600,000
4)Local Match/ATP Funds $ 80,000 Article 3 Balance Remaining 242,778
Total $ 157,222 Total Amount Remaining 1,842,778
I certify that the information on this Financial Reporting form is true and accurate to the best of my knowledge.
The same authority that signs the Claim Form must sign this form.
Signed: Date: ILIM/l
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD-FY1920 o1
Reimbursement Request l o/,;z y/19 Page 1
EMACS Salaries
LID Program Id 2903
Prod Time Y
PeriodSum of Sum LD Amount Pay End2 Pay Period
TotalJuly August September Grand
,Descr Name
Friis,Mark 2,801.59 4,313.99 4,115.66 11,231.24
Rigsby,Scott 1,145.22 858.90 486.71 2,490.83
Almanza,Theresa 75.76 75.76
Hinckley,Kevin Joel Delaney 40.08 40.08
Pinto,Ivan E. 23.11 23.11
Grand Total 4,010.00 5,248.65 4,602.37 13,861.02
Salary 9,148.58
Benefits 51.51% 4,712.44
13,861.02
Indirect 14.628% 2,027.59
LD Program Id 2903 Salary& Indirect 15,888.61
Prod Time Y
Period,Sum of Sum Hours Pay End2 Pay Period End
July August September Grand Total
,Descr Name 56.50 87.00 83.00 226.50
Rigsby Scott 12.00 9.00 5.00 26.00
Almanza,Theresa 2.00 2.00
Hinckley,Kevin Joel Delaney 0.75 0.75
Pinto Ivan E. 0.50 0.50
Grand Total 69.75 98.00 88.00 255.75
Hours Rate Salary Benefits Total Indirect Total Amount
226.50 32.73 7,412.87 3,818.37 11,231.24 1,642.91 12,874.15
26.00 63.23 1,644.01 846.83 2,490.83 364.36 2,855.19
2.00 25.00 50.00 25.76 75.76 11.08 86.84
0.75 35.27 26.45 13.62 40.08 5.86 45.94
0.50 30.50 15.25 7.86 23.11 3.38 26.49
9,148.58 4,712.44 13,861.02 2,027.59 15,888.61
County of San Bernardino - EMACS
Report ID: SBLD0l0 LABOR DISTRIBUTION - MAJOR PROGRAM BY PROGRAM BY JOBCODE Page No. 120
Pay Period End: 09/27/19 Run ID: U21 Run Date 10/05/19
LDGROUP : MOTH - Public Health Run Time 15:20:56
MJ Program: 29
_________________ WORK _________________ -----------.___ NON-WORK _______________
T-D
Y-ITS AMOUNT
WITS AMOUNT
PROGRAM JOHCD UNITS AMOUNT UNITS AMOONT UNITS AMOUNT UNITS AMOUNT
2903 Safe Routes to School 01605 Automated Systems Analyst I 1 $63
O1679 Automated Systems Technician 2 $06
16398 PH Program Manager 4 $391 26 $2,491
28037 Cont SETS Project Coordinator 50 $2,479 229 $11,231
PROGRAM (2903) TOTALS 54 $2,871 256 $13,861
Description of Fi 2903-SAFE ROUTES TO SCHOOL Description of F 2903-SAFE ROUTES TO SCHOOL
Budget Period 2020 Budget Period 2019
Value Type (Multiple Items) Value Type (Multiple Items)
Sum of Amoun Column Labels Sum of Amoun Column Labels
Row Labels 1 2 3 Grand Total Row Labels 3 Grand Total
40609972 8,724.67 8,724.67 52002135 9,998.00 9,998.00
52002135 207.38 (207.38) - Grand Total 9,998.00 9,998.00
52942940 470.96 470.96
52412410 105.28 105.28
55405010 719.22 719.22
55405014 136.65 136.65
Grand Total 207.38 8,622.57 1,326.83 10,156.78
JUL AUG SEP TOTAL
Query 207.38 8,622.57 1,326.83 10,156.78
Less Revenue (8,724.67) (8,724.67)
Accrual (207.38) - 207.38 -
Step Counters 9,998.00 9,998.00
Total - 105.28 11,324.83 11,430.11
i
Category Grant In-Kind Match Total
S&B 13,861.02 ' - 13,861.02
AS 11,430.11- - 11,430.11
Indirect 2,027.59 ' - 2,027.59
27,318.72 - 27,318.72 '�