Art3_County_FY17_BikePed_WalkBikeSB_Inv06_APPROVED_200827_GK www.SB(oanty.gov
Public Health Corwin Porter
SAN BERNARDINO Director
COUNTY Administration
Josh Dallas
Interim Assistant Director
Erin Gustafson,M.D.,MPH
Interim Health Officer
IN-KIND MATCH REPORT
Email In-Kind Report to: Date: 8/18/2020
nguvenk(@scaz.ca.eov SCAG OWP#: 225.3564.1
Kana Sato-Nguyen In-Kind Match Report#: 10
Senior Budget&Grams;Analyst Reporting Period. April 1,2020-June 30,2020 Q2
Southern California Association of Governments
900 Wilshire Blvd, 17th Floor
Los Angeles,CA 90017 Project Title: San Bernardino County Safe Routes to School
Cost RateeCategories Hourly
Hours Amount Fringe Rate Fringe JDCRatea 7DC Amount
R
Direct Labor Classiftcationtsl:
Cant SRTS Project Coordinator $63.33 13050 $5,454.60 51.51% $2,809.65 14628%1 $1,208.901 $9,473.15
Health Education Specialist If $5A0 5L51% $278 14.628%1 $1.201 $9.38
PH Program Manager $167.42 1,00 $110.50 51.51% $56.92 14.628%1 $24.49 $19L91
Public Hlth Prgm Coordinator $80.19 4,00 $211.70 51.51% $109.05 14.628%1 $46.92 $36767
Automated Systems Technician $40.67 1.00 $26.84 51,51% $13.83 14.628%1 $5,95 $46.62
Automated Systems Analyst I 1 1 $0.19 51 51% so 101 14628%1 $0,041 $0.33
Automated Systems Analyst) I SI) It 51 fl%l S0061 14-628% $0.02 SmC)
Subtotal- Direct Labor' 136.50 1 S5,809.34 $2,992.391 1 $1,287.521 $10,089.25
Other Direct Costs t ODCsI
Printing Services $0 00
HS Admin Charges I SI,437711 $1,437.71
County Counsel Charges $230001 $230.00
CEHW Charges 1 $0 00
Email Costs $396.62
$396.62
Promotional Items S 1,479,02_ $I 47q 02
Travel Costs
$0 00
Livescan/Backgroand $0.00
Step Counters $0.00
Monitor
$0,00
Computer Equipment $0.00
City of Rancho Cucamonga s7..nn no $7,200.00
$0 00
Subtotal-ODCs: 510,743.35 $]1,743.35
TOTALfor IN-KIND MATCH $16,552.6') $20,832.60
1,Paul Chapman,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 and that I am the person duly authorized to sign this certification on behalf of my agency.I further certify that our agency is not using any B
federal fill match iture funds.
-' Interim Chief Financial Officer
Signature••••••ature
Title
Paul Chapman
c7
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 annual 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 runimis rate of
10%of modified total dust costs(MTDC).
a
San Bernardino Associated Governments
Check List
Article 3 Grant Program
Claimant: County of San Bernardino Date: 8/18/2020
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.
�M SrI"��20
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD-FY1920 Q4
Check List
Page 1
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: Paul Chapman
Phone No: (909)387-6630
E-mail Address: Paul.Chapman@dph.sbcounty.gov
Amount Requested
for Reimbursement: $ 20,832.60
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)
Date:
Signature
Paul Chapman,Interim Chief Financial Officer
Type Name&Title
tcT., 81,y (u
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 Q4
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
)Article 3 Cost(amount being requested for
reimbursement) Is 20,833
2) Local Match/ATP Funds Cost
Total $ 20,833
Project Costs to Date(include amount requested above)
Local Match/ATP Funds
3)Article 3 $ 152,483 Remaining 1,600,000
4) Local Match/ATP Funds $ 80,000 Article 3 Balance Remaining 167,517
Total $ 232,483 Total Amount Remaining 1,767,517
1 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: S-2-7-2-D
A3 Claim County of San Bernardino SRTS ATP Cycle 3_5316BOD-FY1920 Q4
Reimbursement Request Page 1
EMACS Salaries
LD Program Id 2903
Prod Time Y
Sum of Sum r Amount Pay Period End2 Pay Period End a
April May June Grand Total
-
Position 04 LD Factor Total
Friis,Mark _.3,192.10 2,097.62 2,644.88 7,934.60 Cant SRTS Project Coordinator 7,934.60 329.65 8,264.25
Rigsby Scott 9782 97.82 Health Education Specialist II - 8.18 8.18
Baeza,Dori Nilsa 318.43 318.43 PH Program Manager 97.82 69.60 167.42
Almanza Theresa 39 83 39 83 Public Hlth Prgm Coordinator 318.43 2.32 320.75
Grand Total _ 3,192.10 _ 2,235.27 2,963.31 8,39 68 Automated Systems Technician 39.83 0.84 40.67
Automated Systems Analyst I - 0.29 0.29
Query Total 8,390.68 Automated Systems Analyst I 0.17 0.17
LD Factor.73% 411.05 8,390.68 411.05 8 801 73
8,801.73
Salary 5,809.34
Benefits 51.51% 2,992 39
8,801.73
Indirect 14.628% 1,287.52
Salary&Indirect 10,089.25
LD Program Id 2903
Prod Time Y
Sum of Sum Hours Pay Period End2 Pay Period End
-
Friis,Mark 52;50_ 34.50 43.50 130.50
Ri sbY Scott ____ __ 1.00 1.00
Baeza,Dod Nilsa 4.00 400
Almanza Theresa 1.00 1.00
Grand Total 5250 3650 47 50 136.50
Position Hours Rate Salary Benefits Total Indirect
Cent SRTS Project Coordinator 130.50 63.33 5,454.60 2,809.65 8,264.25 1,208.90
Health Education Specialist II 5.40 2.78 8.18 1.20
PH Program Manager 1.00 167.42 110.50 56.92 167.42 24,49
Public Hlth Prgm Coordinator 4.00 80.19 211.70 109.05 320.75 46.92
Automated Systems Technician 1.00 40.67 26.84 13.83 40.67 5.95
Automated Systems Analyst I 0.19 0.10 0.29 0.04
Automated Systems Analyst 1 0.11 0.06 0.17 0.02
136.50 5,809.34 2,992.39 8,801.73 1,287.52
l / �
COunty of San Bernardino - EMACS
Report ID: SBLDOIO LABOR DISTRIBUTION - MAJOR PROGRAM BY PROGRAM BY JOBCODE Page No. 169
LDGROUP : 2H LTH - Public Health Pay Period End: 06/19/20 Run ID: V14 Run Date 06/27/20
NJ Program: 29 Run Time 14:3]:18
WORK _________________ NON-WORK
PROGRAM UNITS AMOUNT
JOBCO UNITS AMOUNT UNITS AMOUNT Y-T-0 Y-T-D
UNITS AMOUNT UNIT$ AMOUNT
2903 Safe Routes to School 01675 Automated Systems Analyst I 1 116
08044 Health Ed Syscation Technician 3 ,120
08094 Health Education Specialist II 14 $1$318
16372 Public Hlth Pram Coordinator 4 ,534
16378 PH Program Manager 99 45,539
"t8]3] Cont SRTS Project Coordinator 21 $1,2]] 878 $95,15] 25 $8]5
PROGRAM (2903) TOTALS 21 $1,2]] 1,004 $56,308 25 $875
30S
(44,009)�
c,o�3 �P ,c 1� ✓ g)3<40 �
1-4 1
�� g� , D l S
Report ID: SBLDOIO County of San Bernardino - EMACS
LABOR DISTRIBUTION - MAJOR PROGRAM BY PROGRAM BY JOBCODE Page No. 155
LDGROUP : PHLTH - Public Health Pay Period End: 03/27/20 Run ID: V08 Run Date 04/04/20
NJ Program: 29 Run Time 14:37:48
____ WORK ____ NON-WORK _______________
PROGRAM ,iOBCD UNITS AMOUNT UNITS AMOUNT UNITS AMOUNT UNITS MOON
UNITS AMOUNT
2903 Safe Routes to School 01695 Automated Systems Technician
I 1 $63
08044 Health Automated Ed Systems Technician 2 120
08094 Health Education Specialist II 19 $9,436
1637$ PH Program Manager 1 8$9851 97 $9,223
28]3] Cont SRTS Project Coo rdi na[or 19 $851 798 $37,223 10 $350 25 $875
PROGRAM (2903) TOTALS 15 $949 80 $47,918 10 $350 25
$e]5
Description of Funded 12903-SAFE ROUTES TO SCHOOL
Budget Period 2020
Value Tvpe (M ltiple Items)
Sum of Amount to be checked against payment bud Period
Commitment Item Commitment item name Reference Document Number Text 40609972 10 12 _11 Grand Total
6202002/35 _ OTHER GRANTS 180000038E 2903 SRTS FY 19/20 Q3 (28,929.40)2135 SPECIAL DEPT EXPENSE 40)
4200050264 PHL CAL CARD MARCH 2O20 1,479.02 (21,479.02
55405012 SRVCS&SUPP TRSF OU 4'200052462 1,230.00
62412410 DATA PROCESSING(ISF 4200050277 COUNTY COUNSEL.APR 2020 230.00 102.94
March 2020 Emails 102.94 102.94
4200051754 April 2020 Emails 102.19 102.19
420005426E May 2020 Emails 99.56 99.56
-- 4200055096 June 2020 Emails(estimate) 99.56 99.5E
55405010 SALARIES&BENE TRSF 42000.50554 HS ADMIN PP05-06/20 86.82
82
4200050965 04.18
HS ADMIN PP07.OS/20 ]09.18 ]04.18
4200054511 HS ADMIN PP09-10/20 555.64 555.64
4200054527 HS ADMIN PP11-12/20 451.45 451.45
55405014 OTHER CHRGS TRSF OUT 4200050554 HS ADMIN PP05-06/20 17.36
4200050965 17.3E
HS ADMIN PP07-OS/20 20.84 20.89
4200054511 HS ADMIN PP09-10/20 111.13 111.13
r G ---- _ 4200054527 HS ADMIN PPl1-12/20
Grand Total -- _ _ -_- -- _ _-_ - -_..-.-- 90.29 _ 90.29
1,686.14 (27,521.77) 457.21 (25.878.42)
APR MAY JUN TOTAL
Query 1,686.14 (27,521.77) 457.21 (25,378.42)
Less Revenue 28,929.40 28,929.40
Posted to FY21 7,192.37 7,192.37
Step Counters
Total 1,686.14 - 1,407.63 7,649.58 10,743 35
Category Grant In-Kind Match Total
S&B 8,801.73 - 8,801.73
S&S 10,743.35 - 10,743.35
Indirect 1,287.52 1,287.52
20,832.60 20,832.60
Value Type (Multiple Items)
Description of Funded Program 2903-SAFE ROUTES TO SCHOOL
Commitment item Text Reference Document Number Sum of Amount to he 5105906615 checked a aims a ment bud
52002135 - ---- - - - - - Y
—.— 7,200.00
52412410 June 2020 Emails adjustment 4200059001 (7-63)
Grand Total ------
7,192.37 /
INVOICE PCB LIIMI111-4Z
CITY OF RANCHO CUCAMONGA Enic=eDate=2
R127594 J
Post Office Box807 16/19
Rancho Cucamonga, CA 91729-0807 Terms: Net 30
Telephone: (909)477-2700 City of Rancho Cucamonga
Facsimile: (909)477-2845 Federal Taxpayer ID#95-3213002
TO: DEPARTMENT OF PUBLIC HEALTH Note:Pa
due
172 W. 3RD STREET, 6TH FLOOR Payments from
rmtheconsideredof the inv
at 30 days from the date of the invoice.
ATTN: PATTY CASTILLO If payment is not received within Bo
SAN BERNARDINO, CA 92415 days,the invoice will be forwarded to
the ClWs collection agent.Their
collection procedure may adversely
Customer Number. 042138 affect your credit rating.
Transaction Date Description Amount
12/16/19 GENERAL ADMIN GRANT INCOME 7, 200 . 00
$150 . 00 PER HOUR FOR 48 HOURS
Approvoi Date: ✓
Program Code: W
Signature:
Total Due =7, 200 . 001
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT
Please make checks payable to Customer Number 042138
CITY OF RANCHO CUCAMONGA Invoice Number AR127594
Finance Department Invoice Date 12/16/19
Post Office Box 807 Total Amount Due $ 7, 200. 00
Rancho Cucamonga, CA 91729-0807
Total Payment $
19-20 Year End Adjustments Pivot-Manual Adj
Sum of Amount
Cost Center GLACCOUNT Internal Order Description REFERENCE Total
9300291000 52002042 1003675 MAY 26,2020-DUNE 25,2020 IT CELL PHONES MA1920009 48.42
52002042 1003677 MAY 26,2020-DUNE 25,2020 IT CELL PHONES MA1920009 135.81
52002042 1007348 MAY 26,2020-JUNE 25,2020 IT CELL PHONES MA1920009 29.65
52002043 1003677 #12 June 2020 Comnet Equip Svcs MA1920007 120.64
55405012 _ 1007348 COUNTY COUNSEL JUNE 2020 MA1920015 805.00
9300291000 Total _ 1,139_.52_
Grand Total 1,139.52
8/12/2020 5:12 PM