Art3_County_FY17_BikePed_WalkBikeSB_Inv05_APPROVED_200701_GK 351 North Mt.View Avenue,San Bernardino,CA 92514 Phone:909.387.9146 Fax:909.387.6228
;Public Health Corwin Porter
SAN B. RN s.R I-)I\i() Interim Director
COUNTY Administration
Erin Gustafson,M.D.,MPH
I Acting Health Officer
IN-KIND MATCH REPORT
Email In-Kind Report to: Date: 6/8/2020
nguyenkPscae.ca.ggy- SCAG OWP#: 225.3564.1
Kana Sato-Nguyen In-Kind Match Report#: 9
Senior Budget&Grants Analyst Reporting Period: January 1,2020-March 30,2020 Q 1
Southern California Association of Governments
900 Wilshire Blvd, 17th Floor
Los Angeles,CA 90017 Project Title: San Bernardino County Safe Routes to School
Cost Categorrer HRH y Hours Amount Fringe Rate Fringe IDCRaWe IDC Amount
Direct Labor Classification(s):
Cont SRTS Project Coordinator $33,10 275.00 $9,103.80 51.51% $4,689.37 14.628% $2,017.66 $15,810.93
Health Education Specialist II $38.90 0.00 $0.00 51.51% $0.00 14.628% $0.00 $0.00
PH Program Manager $64,56 42,00 $2,711.70 51.51%1 $1,396.79 14.628% $600.99 $4,709.48
Automated Systems Technician $0.00 0.00 $0.00 51.51% $0.00 14.628% $0.00 $0,00
Automated Systems Analyst I $0,00 0.00 $0,00 51.51% $0.00 14.628% $0.00 $0.00
Automated Systems Analyst 1 $0.00 0.00 $0.00 51.51% $0.00 14.62811/a $0.00 $0.00
Subtotal- Direct Labor 317.00 $11,815.51 $6,096.16 $2,618.65 $20,820.31
Other Direct Costs(OD Cs
Printing Services $1,24" y,11'-
HS Admin Charges
County Counsel Charges $575.00
CEHW Charges
Email Costs
Promotional Items :`° $2,649.79 `, r':✓. '' ,°' $2,649.74
Travel Costs
Livescan/Background
Step Counters trAgWAM,
Monitors..'
Computer Equipment $1,324.50i Mr> $1,324.50
r: $0.00
SubtoUl-ODCs: $8,409.09 $%409.09
TOTAL for IN-HIND MATCH $20,224.59 $28,929.40
I,Joshua Dugas,certify that this in-kind match report and the information attached is true and correct.I also certify that all eligible and required documentation is on
file for this report Ad that I 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 match e p iture al.
Chief Financial Officer
S ignature Title
Joshua Dugas 6 /l0 /;u
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 an amoral 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 minimis rate of
10%of modified total direct costs(MTDC).
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San Bernardino Associated Governments
Check List
Article 3 Grant Program
Claimant: County of San Bernardino Date: 6/8/2020
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.
✓ 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 Q3
Check List Page 1
�M BIRO 4V /�
San Bernardino Associated Governments
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: $ 28,929.40
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:
(Claimant's Chief Adminstrator or Financial Officer)
J /� Date:
Signat
Joshua Du as,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.
co 3 S I-1-0 10'." 11l7/'
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD-FY1920 Q3
Claim Form Pagel
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) $ 28,929
2)Local Match/ATP Funds Cost
Totall $ 28,929
Project Costs to Date(include amount requested above)
Local Match/ATP Funds
3)Article 3 $ 131.650 Remaining 1,600,000
4)Local Match/ATP Funds $ 80.000 Article 3 Balance Remaining 188,350
Total $ 211,650 Total Amount Remaintng 1,788,350
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: G 11~oLo
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD-FY1920 Q3
Reimbursement Request Page 1
EMACS Salaries
LD Program Id 2903
Prod Time Y
Period End2 Pay Pwiad ,
Feb , Tatal
Name Januaty
Friis,Mark_ 5,751.98 4,710.68 3,330.51 13,793.17
_—_ Rigsby,Scott� 1.565.15 1,662.95 880.39 4108.49
Grand Total _ 7,317.13 6,373.63_ 4,210.90 17,901.66
Salary 11,815.50
Benefits 51.51% 6,086.16 -'
17,901.66 l
Indirect 14.628% 2,618.65
Salary& Indirect 20,520.31
LD Program ld 2903
Prod Time Y
Sum OVZUM HOU Pity iy End2
Janan ■ MamJh Grand Total
Desw Name
Friis,Mark 116.00 95.00 64.00 275.00
Ri sb Scott 15.00 17.00 9.00 42.00
Grand Total 132.00 112.00 73.00 317.00
Position Hours Rate Salary Benefits Total Indirect
Cont SRTS Project Coordinator 275.00 33.10 9,103.80 4,689.37 13,793.17 2,017.66
Health Education Specialist II - #DIVIOI - - - -
PH Program Manager 42.00 64.56 2,711.70 1,396.79 4,108.49 600.99
Automated Systems Technician - #DIVIO! - - - -
Automated Systems Analyst I - #DIVIO! -
Automated Systems Analyst I - #DIVIO! - - -
317.00 11,815.50 6,086.16 17,901.66 2,618.65
County of San Bernardino - BMACS
Report ID: SBLD010 LABOR DISTRIBUTION - KAJOR PROGRAM BY PROGRAM BY .7OBCODg Page No. 155
Program 29
Pay Period End: 03/27/20 Run 1D: V08 Run Date o4/04/20
N.7 ProgOGP PHLTH - public Health Run Time 14:37;48
:
WORK ---------
-------- NON-WORK
_____- _T_o-
PROGRAM JOBCD Y-T-➢ Y-T-➢ Y T-D YUNITS AMOUNT UNITS AMOUNT UNITS AMOUNT UNITS AMOUNT
2903 Safe Routes to S- ,n 1 01675 Automated Systems Analyst I 1 $63
01679 Automated Systems Technician 2 $76
08044 Health Education Specialist 1I 19 $1,120
16378 PH Program Manager 1 $90 97 $9,436
28737 Cont SRTS Project Coordinator 14 $851 748 $37,223 10 $350 25 $875
PROGRAM (2903) TOTALS 15 $949 867 $97,918 10 $350 25 $875
�1i9oo r
HPPRPTS-SBLD010-PHLTH Page 136 of 221
County of San Bernardino - EMACS
Report ID: 5BLDO10 LABOR DISTRIBUTION - MAJOR PROGRAM BY PROGRAM BY JOBCODE Page No. 136
Pay Period End: 12/20/19 Rua ID: V01 Run Date 12/28/19
LDGROUP : PHLTH - Public Health MJ Program: 29 Run Time 14:53:52
--- WORK -------------- NON-WORK ---------------
Y-T-D Y-T-D Y-T-D Y-T-D
PROGRAM JOBCD UNITS AMOUNT UNITS AMOUNT UNITS AMOUNT UNITS AMOUNT
2903 safe Routes to School, 01675 Automated Systems Analyst I 1 $63
01679 Automated Systems Technician 2 476
08044 Health Education Specialist II 19 $1,120
16378 PH Program Manager 6 $587 55 $5,328
26137 Cant SRTS Project Coordinator 49 $2,405 473 $23,429 10 $350
PROGRAM (2903) TOTALS 55 $2,992 550 $30,016 10 $350
https://view.sbcounty.gov/CAOMWebViewerl2/print.jsf 1/2/2020
Description of Funded P 2903-SAFE ROUTES TO SCHOOL
Budget Period 2020
_—
Value a --
._....—._�.(Multi le P-. .Items) --._
Sum of Amount to be checked against payment bud Period
Commitment Item Commitment item name Reference Document 00 Number Text 7 9 8 Grand Total
40609972 OTHER GRANTS 1$ 000276 2903 SRTS FY 19120 Q1 (27,318,72) (27,318,72)
1800000284 2903 SRTS FY 19/20 Q2 (25,499.19) (25,499.19)
_ 52002116,.. COMPUTER HARDWARE EX 4200048613 PHL CAL CARD FEBRUARY 2020 1,324.50 1,324,50
52002135 SPECIAL DEPT EXPENSE 4200048613 PHL CAL CARD FEBRUARY 2020 2,649.79 2,649.79
55405012 SRVCS&SUPP TRSF OU 4200044175 COUNTY COUNSEL NOV 2019 172.50 172.50
4200045516 COUNTY COUNSEL DEC 2019 402.50 402,50
52412410 DATA PROCESSING(ISF 4200046578 December 2019 Emails 106.90 106.90
4200045947 January 2020 Emails 105.92 105.92
4200047541 February 2020 Emails 103.56 103.56
55406010 SALARIES&BENE TRSF 4200046353 HS ADMIN PP24-25119 461.46 451.46
4200045559 HS ADMIN PP26-01120 920.27 920.27
4200048250 HS ADMIN PP02-04120 1,580.09 11580,09
65405014 OTHER CHRGS TRSF OUT 4200045353 HS ADMIN PP24-25/19 90.29 90.29
4200045559 HS ADMIN PP26.01120 184.05 184,05
4200048250 HS ADMIN PP02-04/20 316.02 316.02
62002895 RENTS&LEASES-E UIP 4200047927 Copies charges July'19-Jan'20 1.24 1.24
Q.._..
Grand Total (24,990.75) 5,976.20 (25,393.27) (44,408.82)
JAN FEB MAR TOTAL
Query (24,990.75) 5,975.20 (25,393.27) (44,408.82)
Less Revenue 27,318.72 25,499.19 l 52,817.91
Accrual -
Step Counters
Total 2,327.97/ 5,975.201 105.92 8,409.09
Category Grant In-Kind Match Total
S&B 17,901.66 17,901.66 r
S&S 8,409.09 l 8,409.09
r
Indirect 2,618.65 2,618.65
28,929.40 / 28,929.40