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Art3_Yucaipa_FY17_BikePed_OakGlen_ClaimSigned San Bernardino Associated Governments Claim Form Article 3 Grant Program Project Name: Oak Glen Rd Bike&Pedestrian Facility Grant Allocation No: L18-0702-0752-00 Claimant: City of Yucaipa Address: 34272 Yucaipa Blvd Attention: Phone No: (909)797-2489 E-mail Address: kkunkel@yucaipa.org Amount Requested for Reimbursement: $ 89,728.00 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: 5/30/2023 Signature Fermin Preciado,Director of Development Services/City Engineer 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. Ar13 Yucaipa_FY17_BikePed_OakGlen_Claim(1) Claim Form Page 1