Art3_MBTA_FY21_Transit_BikeLockers_InvTDA Article 3: Claims/Change Request
Type of Request TDA Article 3: Claims
Project Title Transit Center Bicycle Lockers - 29 Palms & Yucca Valley
Project Type Transit Project
Contact Name Cheri Holsclaw
Agency Morongo Basin Transit Authority
Contact Phone 760-366-2986
Contact Email cheri@mbtabus.com
Type of Claim Reimbursement Request & Claim Form &
Authorizing Resolution
Claim Form & Authorizing Resolution
Signed Claim Form Article3 Claim Form.pdf 746.04KB
Authorizing Article3 Resolution.pdf 299.17KB
Resolution
Reimbursement Request
Reimbursement Article3 Request Reimb.pdf 523.15KB
Request Form
Backup Article3 Invoices and Check Stubs.pdf 244.81 KB
Documentation
Completion
Verification (if
applicable)
Minute Action Item (if
applicable)
Photos (for Bike Lockers 29.jpg 72.24KB
completed projects) Bike Lockers YV.jpg 75.08KB
Other
San Bernardino County Transportation Commission
Local Transportation Fund - Article 3 Pedestrian, Bicycle Facilities
and Access to Transit
Claim Form
Claimant: Morongo Basin Transit Authority Date: 1/31/2022
The Check-List below are items that must be included with your submission for reimbursement
x 1. Claim Form
x 2. Financial Reporting Form
(Complete the estimated column for anticipated interest, refunds and expenditures)
N/A 3. 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)
x 4. Governing Body Authorization (Completed Projects)
(Certified copy of minute action or resolution authorizing the filing of the claim and
Project acceptance)
x 5. Project Completion Report
(Council's Project acceptance can be used. Pictures of completed project must be
included.)
N/A 6. Other (optional)
(List any other information you wish to submit to support your claim)
Check List Page 1
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San Bernardino County Transportation Commission
Local Transportation Fund - Article 3
Pedestrian, Bicycle Facilities and Access to Transit
Claim Form
Fiscal Year: 2021
Claimant: Morongo Basin Transit Authority Attention: Cheri Holsclaw
62405 Verbena Road Phone M 760-366-2986
Joshua Tree CA 92252 mailto: cheri@mbtabus.com
Amount: $28,163.82
PURPOSE: ( ) 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
Authorizing Signature:
i
Cheri Holsclaw, Interim General Manager
(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 allocation
instruction.
Art3Claim_BikeLockers.xlsx
Claim Form
Page 2
Date Check No Item Amt Article 3 Amt Vendor Inv No
01/27/22 45958 13,020,00 13,020.00 TSR Construction 2021-02
11/30/21 45752 7,571.91 7,571.91 American Bicycle Co 2083
01/18/22 44070 7,571.91 7,571.91 American Bicycle Co 2150
28,163.82 28,164
Preliminary F.I.N.562670017
INX
X As Bid r: SR LIC-AM:881123X As Marked As Built mnstl ,t,don nt`�liuJpe �on, PROJECTN0.2021-02
82h4 AVENIDA LEON
INVOICE#1/1FI1,;AL RANCHO CUCAMONGA,CA 91730
Project: P:909 3312249
INSTALLATION OF BICYCLE LOCKERS F:909 987 7519
(Final Invoice 1/25/2022)
MBTA
As-Built
Item Description Unit Price Unit Quanta Total 1PREVIOUSIVIONTICURPENT MONTHI TOTAL TO DATE
o n
BID-Items 1 through 4
1 I TRANSPORT AND INST.MBTA BICYCLE LOCKERS S 1,900.00 EA 4 6,000 0% 0 4 6.000 100% S 6,000.00
2 IREMOVE EX.LANDSCAPE,RELOCATE EX.IRRIGATION S 1,300.00 LS 1 1,300 0% 0 1 1,300 100% S 1,300.00
3 4"THICK CONCRETE SLAB $ 40.00 SF 43 1,720 0% 0 43 1,720 100% S 1,720.00
4 TRANSPORT AND INST.MBTA BICYCLE LOCKERS S 2,000.00 EA 2 4,000 0% 0 2 4,000 100% S 4,000.00
5
6
7
8
9
10
II
12
13
14
15
16
17
18
19
10
21
SO S13,020 S 13,020.00
1 C.C.O.1.
TOTAL CONTRACT CHANGE ORDERS
S
GRAND TOTAL AMOUNT S 13,020.00
LESS 0%RETENTION
S -
NETTAMOUNTDUE S 13,020.00
LESS PREVIOUS PAYMENTS .
S NET AMOUNT DUE TO THIS INVOICE $13,020.00
CONTRACTOR'S SIGNATURE!GABRIEL ZAPIRTAN
PROJECT MANAGER'S SIGNATURE
BICYCLE LOCKERS INV.ds 1 Of 1 1/24122
MORONGO BASIN TRANSIT AUTHORITY
45959
TSR CONSTRUCTION 1/27/2022
BIKE LOCKERS 13,020.00
PACIFIC WESTERN
13,020.00
PRODUCT SSLT104 USE WITH 91663 ENVELOPE Deluxe Corporation 1-800-328-0304 or www.deluxe.com/shop - yr k
� 63235493001
e
AMERICAN BICYCLE SECURITY COMPANY INVOICE
COMPOSITE PLASTIC PRODUCTS LTD.
Division of Turtle Storage Ltd. DATE INVOICE#
P.O. Box 7359
Ventura, CA 93006 11/24/2021 2083
Phone: (805)933-36881 Fax: (805)933-1865
BILL TO SHIP TO
Morongo Basin Transit Authority Morongo Basin Transit Authority
62405 Verbena. Rd 62405 Verbena. Rd
Joshua Tree,CA 92262 Joshua Tree,CA 92252
Attn: James (760)366-3046
P.O. NUMBER TERMS SHIP PROJECT REP
1123212TSMG 50% Dep&Bal Due at shipment ASAP BC
QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
6 #301 Model#301 Bike-Shell Bike Locker-Molded 1,939.00 11,634.00T
one-piece fiberglass composite(no assembly
required); includes all installation hardware.
Maximum handle bar width is 35".Maximum
bicycle height is 43".
-Bicycle Capacity: 1 bike capacity per locker.
-Dimensions: 49" H X 30"W X 74.5" L
Options:
-Locking System: PN#010: Stainless Steel
Padlock/U-Lock Handle Lock replaces standard
lock. Padlocks/U-Locks not included.
-Standard Color: Tan
DISCOUNT L... Discount-Bike Lockers -580.00 -680.00
1 FREIGHT-Pa... Packing Materials 630.00 630.00
1 FREIGHT Includes lift gate on the truck.*JOB SITE* 1,350.00 1,350.00
1 SURCHARGE SURCHARGE FOR MATERIAL COST 1,163.00 1,163.00T
INCREASES
DEPOSIT-To... *****INVOICE FOR DEPOSIT,AMOUNT DUE IS -7,571.91
SHOWN BELOW AS TOTAL *** THE BALANCE
DUE AT SHIPMENT IS DEDUCTED AT RIGHT
Subtotal $6,625.09
Sales Tax (7.75%) $946.82
---------------------
Thank you for your business.
Total USD $7,671.91
-----------------------------------------
64Df0G
AMERICAN BICYCLE SECURITY COMPANY 11/30/2021
Date Type Reference Original Amt. Balance Due Discount Payment
11/24/2021 Bill 2083 7,571.91 7,571.91 7,571.91
Check Amount 7,571.91
PACIFIC WESTERN 7,571.91
PRODUCT SSLT104a USE WRH 91663 ENVELOPE Deluxe Corporation 1-800-328-0304 or www.deluxe.com/shop "»
�.�63235493001
s
AMERICAN BICYCLE SECURITY COMPANY INVOICE
COMPOSITE PLASTIC PRODUCTS LTD. DATE INVOICE#
Division of Turtle Storage Ltd.
P.O. Box 7359 1/14/2022 2160
Ventura,CA 93006
Phone: (805)933-3688 1 Fax:(805)933-1865
BILL TO SHIP TO
Morongo Basin Transit Authority Morongo Basin Transit Authority
62406 Verbena Rd. 62405 Verbena. Rd
Joshua Tree,CA 92262 Joshua Tree,CA 92262
Attn:James(760)366-3046
P.O. NUMBER TERMS SHIP PROJECT REP
1123212TSMG 60% Dep& Bal Due at shipment ASAP BC
QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
6 #301 Model#301 Bike-Shell Bike Locker-Molded 1,939.00 11,634.00T
one-piece fiberglass composite(no assembly
required); includes all installation hardware.
Maximum handle bar width is 36". Maximum
bicycle height is 43".
-Bicycle Capacity: I bike capacity per locker.
-Dimensions:49" H X 30"W X 74.5" L
Options:
-Locking System: PN#010: Stainless Steel
Padlock/U-Lock Handle Lock replaces standard
lock.Padlocks/U-Locks not included.
-Standard Color:Tan -580.00 -680.00
DISCOUNT L... Discount-Bike Lockers 630.00 630.00
1 FREIGHT-Pa... Packing Materials 1,350.00 1,360.00
1 FREIGHT Includes lift gate on the truck.*JOB SITE* 1,163.00 1,11 63.00T
SURCHARGE SURCHARGE FOR MATERIAL COST
INCREASES
BALANCE DUE INVOICE FOR BALANCE DUE AT SHIPMENT -7,571.91
THE DEPOSIT IS DEDUCTED AT RIGHT
Subtotal $6,626.09
Sales Tax (7.75%) $946.82
---------------------------------------------
Thank you for your business.
Total USA $7,571.91
------------------- -- --
-----------------
AMERICAN BICYCLE SECURITY COMPANY 45916
Date Type Reference 1/18/2022
1/14/2022 Bill 2150 Original Amt. Balance Due Discount
7,571,91 7,571.91
Payment
7,571.91
Check Amount 7,571.91
PACIFIC WESTERN
HODUCT SSLT104 a USE WITH 91663 ENVELOPE
Deluxe Corporation 1-600-326-0304 or www.deluxe.corNshop 7,571.91
63235493001
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