Cities Index.
Attachment 2 - TDA Claims Forms

Camarillo City Council
September 25, 2024

Document
Attachment 2 - TDA Claims Forms
Meeting
September 25, 2024
Body
Camarillo City Council
Original file
397 KB
Text extracted from the city's file for reading and search. Open the original on camarillo.primegov.com. That file is the official record.

Transportation Development Act
Form A - Claim Form
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1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
3 Address 601 Carmen Drive
Camarillo, CA 93010
4 Name of Contact Person Mark Uribe
5 Title of Contact Person Director of Finance
6 Telephone Number of Contact Person 805-388-5320
7 Email Address of Contact Person [email protected] Purpose Claimed
Local Transportation Fund
8 Article 3, Pedestrian and Bicycles (PUC § 99234) -$
9 Article 4, Transit -$
10 Article 4.5, Community Transit (PUC §99233.7 & § 99275) -$ 11 Article 8(a), Streets & Roads/Pedestrians & Bicycles (PUC § 99400(a)) 2,000,000.00$ 12 Article 8(b), Passenger Rail (PUC § 99400(b)) -$
13 Article 8(c), Transit (PUC § 99400(c)) 1,353,017.00$ 14 Article 8(d), Transit Admin. and Planning (PUC § 99400(d)) -$ 15 Article 8(e), Transit Capital (PUC § 99400(e)) -$
16 Article 8(f), Commuter Vanpool (PUC § 99400(f)) -$
17 Article 8, Other -$
18 Total LTF Claimed 3,353,017.00$
19 Less funds released to
20 for Article
21 for purpose of
22 in the amount of -$
23 Amount of LTF to be sent to Claimant (Line 17 minus Line 21) 3,353,017.00$ Purpose Claimed
State Transit Assistance
24 STA Transportation and Rail 60,790.00$
25 SGR State of Good Repair 9,405.00$
26 Total STA & SGR Claimed 70,195.00$
27 Authorizing Signature
28 Name of Authorizing Agent Mark Uribe
29 Title of Authorizing Agent Director of Finance
30 Date 9/10/2024
(Updated 07/07/20)
Claimant acknowledges that payment by the County Auditor-Controller of an allocation made by the Ventura County Transportation Commission (VCTC) is subject to such monies being on hand and available for distribution and to the provision that such monies are used only in accordance with the terms of the allocation instruction issued by the VCTC. Claimant also certifies that the information on the claim forms are true and accurate to the best of their knowledge and that the claimant is eligible for the funds claimed and will use them for eligible expenditures per the TDA regulations. If the STA and SGR funds claimed are based on the estimates provided by the State of California, the funds paid to the local agency will be the actual amount received and may vary from the amounts claimed.

The following individual is hereby authorized to execute for and on behalf of the named entity, and to take any action necessary for the purpose of obtaining Local Transportation Funds and/or State Transit Assistant funds.

The above named claimant hereby applies for allocations of Transportation Development Act funds for the above fiscal year for the purposes and amounts specified below:

Form A - Claim Form
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form B3.1 - Financial Reporting Form LTF Article 8a
Line
1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
Prior FY Claim FY
3 Fiscal Year 2023/2024 2024/2025
4 Beginning LTF Article 8a Fund Balance (use audited amount if available) 3,859,363.00$ 2,154,297.87$ Estimated Revenues :
5 Federal grants (provide detail in notes)
6 LTF Article 8(a), Streets and Roads (PUC §99400(a)) 1,681,058.00$ 2,000,000.00$ 7 LTF Article 8(a), Pedestrians and Bicycles (PUC §99400(a)) -$ 8 LTF Unearned/Deferred Revenues
9 State grants (provide detail in notes)
10 Local (specify)____________________________________
11 Other (specify)____________________________________
12 Interest 108,777.27$ 31,896.00$
13 Total Estimated Revenues and Fund Balances 5,649,198.27$ 4,186,193.87$ Estimated Expenses:
14 Streets and Roads 3,494,900.40$ 3,947,697.00$ 15 Bicycles and Pedestrians
16 Other (provide detail in notes)
17 Total Estimated Expenses 3,494,900.40$ 3,947,697.00$ 18 Surplus/Deficit End of Year 2,154,297.87$ 238,496.87$ 19 Notes and Explanations: (as applicable)
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(Update (Updated 07/07/20)
Budget Comparison
Form B3.1 - Art8a
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form B3.2 - Financial Reporting Form LTF Article 8(b) to 8(f) Line
1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
Prior FY Claim FY Prior FY Claim FY
3 Fiscal Year 2023/2024 2024/2025 2023/2024 2024/2025
4 Beginning LTF Fund Balance (use audited amount if available) 189,621.00$ 701,292.53$ 82,000.00$ 231.98$ Estimated Revenues :
5 Federal grants (provide detail in notes) 1,744,844.00$ 1,859,425.00$ 84,227.68$ Local Transportation Funds by Article
6 Article 8(b), Passenger Rail (PUC § 99400(b))
7 Article 8(c), Transit (PUC § 99400(c)) 1,800,000.00$ 1,220,373.86$ 132,643.14$ 8 Article 8(d), Transit Admin. and Planning (PUC § 99400(d)) 9 Article 8(e), Transit Capital (PUC § 99400(e))
10 Article 8(f), Commuter Vanpool (PUC § 99400(f))
11 LTF Article 8 Other (specify) _____________________
12 LTF Unearned/Deferred Revenues (specify article) _________ 13 Fare Revenue Funds 142,965.57$ 138,500.00$
14 Local (specify in notes)
15 Other (specify in notes) 1,355.00$
16 Interest 27,672.48$
17 Total Estimated Revenues and Fund Balances 3,906,458.05$ 3,919,591.39$ 82,000.00$ 217,102.80$ Estimated Expenses:
18 Eligible Operating Costs 3,205,165.52$ 3,710,588.00$ 19 Transit Operating assigned to other (specify agency in notes) 20 Transit Capital TDA (specify projects in notes) 81,768.02$ 217,102.80$ 21 Transit Capital assigned to other (specify agency in notes) 22 Other (provide detail & cite code section in notes)
23 Total Estimated Expenses 3,205,165.52$ 3,710,588.00$ 81,768.02$ 217,102.80$ 24 Surplus/Deficit End of Year 701,292.53$ 209,003.39$ 231.98$ -$ FY 2024/25 Operating budget increase of 15.77% due to projected increases in dial-a-ride services and fuel increases. Capital expenditure increase reflects transit vehicle procurements and additional transition of Metrolink Station expenditures from STA to TDA.
25 Notes and Explanations: (as applicable)
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FY 23/24 Revenue (Operating) of $1,744,844 includes FTA reimbursements for bus, trolley, and DAR services (both local and regional). FY 24/25 Revenue (Operating) of $1,859,425 includes FTA reimbursements for bus, trolley, and DAR services (both local and regional). FY 24/25 Revenue (Capital) of $132,643.14 includes FTA reimbursement for transit vehicle replacement expenditures and Metrolink Station expenses.
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* Line 15FY 23/24 Ops Revenue of $1,355 is revenue from auctioned transit vehicles. * Line 16
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FY 23/24 Expenditure (Capital) of $81,768.02 is for Train Station Costs (landscaping/trees) FY 24/25 Expenditure (Capital) of $298,072.80 includes $148,068.20 for Train Station Costs (all) and $69,034.60 for transit vehicle replacement expenditures. * Line 21
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(Updated 07/07/20)
Operating Budget Comparison Capital Budget Comparison
If the operating budget has increased in excess of 15% above the preceeding year, or there is a substantial increase or decrease in the scope of operations or capital budget provision, please provide a statement identifying and substantiating the reason or need for the change (CCR 6632).

If not needed, please initial ____________ Otherwise, please provide statement below.

Form B3.2 - Art8b-f
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form B4 - Financial Reporting Form STA
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1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
Prior FY Claim FY Prior FY Claim FY
3 Fiscal Year 2023/2024 2024/2025 2023/2024 2024/2025
4 Beginning STA Fund Balance (use audited amount if available) -$ 173,565.75$ 113,951.85$ Estimated Revenues :
5 Federal grants (provide detail in notes) 27,399.00$ 432,504.00$ 698,967.40$ State Transit Assistance (request/estimate)*
6 STA Operation (CCR 6730(a)) 16,326.76$
7 STA Capital (CCR 6730(b)) 48,513.48$ 60,790.00$ 8 STA Rail Service (CCR 6730(c))
9 STA General Public (CCR 6731(b))
10 STA Elderly & Disabled (CCR 6731(b))
11 STA Specialized Services (CCR 6731(c))
12 STA PUC § 99314 Unearned/Deferred Revenues (at agency) 12,866.66$ 13 State - Other than TDA (provide detail in notes)
14 Fare Revenue Funds
15 Local (specify in notes)
16 Other (provide detail & cite code section in notes)
17 Interest
18 Total Estimated Revenues and Fund Balances 56,592.42$ -$ 654,583.23$ 873,709.25$ Estimated Expenses:
19 Eligible Operating Costs 56,592.42$
20 Transit Operating assigned to other (specify agency in notes) 21 Capital TDA (specify projects in notes) 540,631.38$ 873,709.25$ 22 Capital assigned to other (specify agency in notes)
23 Other (provide detail & cite code section in notes)
24 Total Estimated Expenses 56,592.42$ -$ 540,631.38$ 873,709.25$ 25 Surplus/Deficit End of Year -$ -$ 113,951.85$ -$ In FY 24/25, all STA revenues directed to be used for capital expenditures (bus procurement). Metrolink expenditures
shifted to TDA. Several vehicles ordered in FY 23/24 will be delivered in FY 24/25.
26 Notes and Explanations: (as applicable)
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FY 23/24 Revenue (Operating) of $27,399 is for FTA reimbursement of Metrolink Station water and electricity expenses. FY 23/24 Revenue (Capital) of $432,504 is for FTA reimbursement of vehicle expenses. FY 24/25 Revenue (Capital) of $698,967.40 is for FTA reimbursement of vehicle expenses. * Line 6
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FY 2023/24 Unearned Revenues of $12,866.66 reflects STA revenue received after year-end on 9/29/2023.
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FY 23/24 Expenditures (Capital) of $540,631.38 is for procurement of 1 cutaway bus, 1 trolley bus, and 2 transit vans. 80% funded by FTA and 20% funded with STA.

FY 24/25 Expenditures (Capital) of $873,709.25 is for procurement of 1 minivan, and 8 transit vans. 80% funded by FTA and 20% funded with STA. * Line 22
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(Updated 07/07/20)
If not needed, please initial ____________ Otherwise, please provide statement below.

Operating Budget Comparison Capital Budget Comparison
* If the STA funds claimed are based on the estimates provided by the State of California, the funds paid to the local agency will be the actual amount received and may vary from the amounts claimed.

If the operating budget has increased in excess of 15% above the preceeding year, or there is a substantial increase or decrease in the scope of operations or capital budget provision, please provide a statement identifying and substantiating the reason or need for the change (CCR 6632).

Form B4 - STA
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form B5 - Financial Reporting Form SGR
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1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
Prior FY Claim FY
3 Fiscal Year 2023/2024 2024/2025
4 Beginning SGR Fund Balance (use audited amount if available) 3,040.00$ 11,321.00$ Estimated Revenues :
5 Federal grants (provide detail in notes) 68,109.94$
State Transit Assistance (request/estimate)*
6 State of Good Repair 8,281.00$ 9,405.00$ 7 State of Good Repair Unearned/Deferred Revenues (at agency) 8 State - Other than TDA (provide detail in notes)
9 Local (specify in notes)
10 Other (specify in notes)
11 Interest
12 Total Estimated Revenues and Fund Balances 11,321.00$ 88,835.94$ Estimated Expenses:
13 Eligible Capital Costs (specify projects in notes) 85,137.42$ 14 Other (provide detail in notes)
15 Total Estimated Expenses -$ 85,137.42$ 16 Surplus/Deficit End of Year 11,321.00$ 3,698.52$ 17 Name(s) of SGR project for the above request: Funding Year Amount transit vehicle procurement (rolling stock) 2024/2025 9,095.00$ transit vehicle procurement (rolling stock) 2023/2024 310.00$ 18 Total SGR amount request 9,405.00$
19 Notes and Explanations: (as applicable)
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FY 24/25 FTA revenue of $68,109.94 is 80% reimbursement of $85,137.42 mini-van procurement.
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FY 24/25 procurement of transit vehicle, $85,137.42, includes use of current and prior year SGR revenues for 20% local match after 80% FTA grant reimbursement. * Line 14
(Updated 07/07/20)
Capital Budget Comparison
* If the SGR funds claimed are based on the estimates provided by the State of California, the funds paid to the local agency will be the actual amount received and may vary from the amounts claimed.

Form B5 - SGR
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form C - Assurances
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1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
3 Article
Initial Assurance
4 C1 180-Day Certified Fiscal Audit:

If VCTC does NOT have a TDA audit performed on behalf of the claimant , the claimant certifies that it has submitted a satisfactory, independent fiscal audit, with required certification statement, to VCTC and to the State Controller pursuant to PUC § 99245 & CCR § 6664, for the prior year (project year minus two). Claimant assures that this audit requirement will be completed for the current fiscal year (project year minus one).

Applies to All Claims: Article 3, 4, 4.5, 8(a), 8(c), STA and SGR 5 C2 Timely and Reviewed Fiscal Audits:

Claimant staff will make every effort to provide information to the auditors in a timely manner so that the audits can be completed before the 180 day requirement. Audits will be reviewed by claimant/agency staff and are the responsibility of the agency.

Applies to All Claims: Article 3, 4, 4.5, 8(a), 8(c), STA and SGR 6 C3 State Controller Annual Report
Claimant certifies that it has submitted a State Controller's report in conformance with the uniform system of accounts and reports, to VCTC and to the State Controller, pursuant to PUC § 99243, § 99245, CCR § 6637 and/or § 6665 as applicable, for the prior year (project year minus two). Claimant assures that this report will be completed for the current fiscal year (project year minus one) in a timely manner.

Applies to All Claims: Article 3, 4, 4.5, 8(a), 8(c), STA and SGR 7 C4 Passed-through TDA Funds Retain TDA Requirements:

Claimant certifies that any TDA funds received from another agency will remain classified as TDA even when passed-through from another agency. These funds will be classified as TDA in the financial records and reported accordingly. These funds will retain TDA requirements.

Applies to All Claims: Article 3, 4, 4.5, 8(a), 8(c), STA and SGR 8 C5 Interest Accrual:

Claimant will accurately account for TDA revenues and expenses and accrue interest accordingly. Interest will be spent on allowable expenses.

Applies to All Claims: Article 3, 4, 4.5, 8(a), 8(c), STA and SGR 9 C6 Unmet Transit Needs:

Claimant certifies that all reasonable transit needs are satisfied and is eligible to receive Article 8(a) local streets and roads.

Applies to 8(a) (Streets and Roads)
10 C7 Revenue Ratios:

Claimant is responsible for preparing the revenue ratio calculation(s) and certifies that it intends to maintain for the project year a ratio of fare revenues to operating costs of at least (a) 20 percent if the claimant is serving an urbanized area, (b) 10 percent if the claimant is serving a non-urbanized area, or (c) as determined by VCTC pursuant to CCR § 6633.2(c) and PUC § 99268. If the required ratio is not met, the "non-compliance with required revenue ratios" outlined in the TDA regulations will be implemented.

Applies to 4, 4.5, 8 (transit), STA
Claimant Assurances: (Initial Each Section Below OR N/A if not applicable to the claim) Form C - Assurances
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form C - Assurances
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1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
3 Article
Initial Assurance
Claimant Assurances: (Initial Each Section Below OR N/A if not applicable to the claim) 11 C8 Revenue Ratios for Exclusive Services to Seniors and Disabled:

Claimant filing a claim pursuant to PUC 99268.5 certifies that, for the purpose of that claim, it provides services using vehicles for the exclusive use of elderly and handicapped persons.

Applies to 4, 4.5, 8 (transit), STA
12 C9 50-Percent Allocation and Alternative Method Limitation:

The expenditure of the funds received by an operator, city or county may in no year exceed 50 percent of the amount required to meet operating, maintenance, and capital and debt service requirements of the system after deduction therefrom of approved federal grants estimated to be received. Alternatively, the operator may by allocated additional funds that could not be allocated to it because of those requirements, if it maintains, for the fiscal year, a ratio of fare revenues to operating costs as defined by § 99247 (see PUC § 99268.1, § 99268.2 and § 99405 and CCR § 6633.1).

Applies to 4, 4.5, 8 (transit), STA
13 C10 Retirement System or Private Pension Plan:

Claimant filing a claim pursuant to PUC § 99260 certifies that (a) the current cost of its retirement system is fully funded with respect to the officers and employees of its public transportation system (PUC § 99271(a)); or (b) the operator is implementing a plan approved by VCTC which will fully fund the retirement system for such officers and employees within 40 years (PUC § 99271(a)); or (c) the operator has a private pension plan which sets aside and invests, on a current basis, funds sufficient to provide for the payment of future pension benefits and which is fully compliant with the requirements stated in PUC § 99272 and § 99273.

Applies to 4, 4.5, 8 (transit)
14 C11 Use of Federal Funds:

Claimant certifies that it is making full use of federal funds available under the FTA Act in accordance with PUC § 99286.7,CCR § 6754(a)(3) and/or § 6634 as applicable.

Applies to 4, 4.5, 8 (transit), STA
15 C12 Staffing:

Claimant certifies that it is in compliance with PUC § 99264 that it does not routinely staff, with two or more persons, a vehicle for public transportation purposes designed to be operated by one person.

Applies to 4, 4.5, 8 (transit)
16 C13 Reduced Fares:

Claimant certifies that if it offers reduced fares to seniors, the same reduced rate is offered to disabled persons and disabled veterans (PUC § 99155). Claimant further assures that it will honor the federal Medicare identification card or a card issued pursuant to § 22511.55 of the Vehicle Code as sufficient identification to receive reduced fares.

Applies to 4, 4.5, 8 (transit)
17 C14 CHP Certification:

Claimant certifies that, it has on file a California Highway Patrol Certification having been conducted in the last 13 months indicating their compliance with § 1808.1 of the Vehicle Code.

Applies to 4, 4.5, 8 (transit), STA
Form C - Assurances
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form C - Assurances
Line
1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
3 Article
Initial Assurance
Claimant Assurances: (Initial Each Section Below OR N/A if not applicable to the claim) 18 C15 Accessible Vehicles:

Claimant certifies that it is in compliance with PUC § 99155.5 regarding dial-a-ride and paratransit services being accessible to handicapped persons, and that the service be provided to persons without regard to vehicle ownership and place of residence.

Applies to 4, 4.5, 8 (transit)
19 C16 Budget Increase of 15% or more
Claimant certifies that the transit operator's operating budget has not increased more than 15% over the preceding year, and does not include a substantial increase or decrease in the scope of operations or capital budget provisions for major new fixed facilities. If the budget does include such changes, documentation is attached that identifies and substantiates the reason or need for the changes (PUC § 99266, § 99268 and CCR § 6633.1 and § 6632).

Applies to 4, 4.5, 8 (transit)
20 C17 Part-Time Employees
Claimant certifies that in accordance with PUC § 99243 and it is not precluded from employing part-time drivers or contracting with common carriers of persons operating under a franchise or license. Claimant further certifies that no person who was a full-time employee on June 28, 1979, shall have his or her employment terminated or his or her regular hours of employment, excluding overtime, reduced as a result of it employing part-time drivers or contracting with such common carriers.

Applies to STA (transit)
21 C18 Operator's Qualifying Criteria
Claimant certifies that it meets and will maintain the efficiency standards pursuant to PUC § 99314.6 when claiming State Transit Assistance funds for transit operations.

Applies to STA (transit)
The undersigned herby certifies that the above statements are true and correct. 22 Authorizing Signature:
23 Print Name and Title: Mark Uribe
24 Date:
(updated June 2019)
Form C - Assurances
09 / 10 / 2024
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form D - Capital Projects and Reserves
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1 Fiscal Year 2024/2025
2 Claimant City of Camarillo
F:\Departments\COMMON FOLDER\Finance\TDA\FY 2024-25\[TDA Claim forms - FY24-25 (Camarillo - no links).xlsx]Form D - Capital 3 Project Name
Source of
Funding Type
Total Estimated
Cost
Estimated
Expended Funds
to Date
Estimated
Expended Funds
this Fiscal Year
Estimated
Remaining Funds
Reserved
Expected
Completion Date Description of Project and Use of Funds Overlay/Resurfacing TDA 8a 7,681,094.27$ 3,494,900.40$ 3,947,697.00$ 238,496.87$ 6/30/2025 Annual pavement rehab to provide asphalt overlay/resurfacing to local streets as -$ recommended by the City of Camarillo Pavement Management Plan.

Transit vehicle
replacements FTA 1,254,809.02$ 432,504.00$ 822,305.02$ -$ 6/30/2025 Replacement of 12-15 transit vehicles of various sizes dependent on vehicle costs STA 266,675.23$ 108,127.38$ 158,547.85$ -$ 6/30/2025 and delivery dates. Four vehicles procured in FY 23/24 with another 8 ordered in SGR 17,027.48$ -$ 17,027.48$ -$ 6/30/2025 FY 23/24 but expected delivery in FY 24/25. Another 3 vehicles in process of TDA 8c 30,000.92$ -$ 30,000.92$ -$ 6/30/2025 being ordered in FY 24/25. -$
Metrolink Maintenance FTA 29,000.00$ 29,000.00$ -$ 6/30/2025 Maintenance services at Camarillo Metrolink Station owned by VCTC.

TDA 8c 119,068.20$ 119,068.20$ -$ 6/30/2025 -$
-$
-$
-$
-$
-$
-$
-$
-$
4 Total 9,397,675.12$ 4,035,531.78$ 5,123,646.47$ 238,496.87$ (updated June 2019)
Form D - Capital
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36
Transportation Development Act
Form F - Checklist
Form
Number Document Name Article 3
Bike/Ped
Article 4
Transit
Article 4.5
Community
Transit
Article 8(a)
Streets &
Roads
Article
8(b)-8(f)
Transit
STA
State of
Good
Repair
A Claim Form X X X X X X X
B Financial Reporting Form
B1 Financial Reporting, Bike/Ped (Art.3) X
B2.1 Financial Reporting, Transit (Art. 4) X
B2.2 Financial Reporting, Transit (Art. 4.5) X
B3.1 Financial Reporting, Street & Road (Art. 8a) X
B3.2 Financial Reporting, Transit (Art. 8(b)-8(f)) X
B4 Financial Reporting, Transit (STA) X
B5 Financial Reporting, Transit (SGR) X
C Assurances
C1 180-Day Certified Fiscal Audit X X X X X X X
C2 Timely, Reviewed Fiscal Audits X X X X X X X
C3 State Controller Annual Report X X X X X X X
C4 Passed-through TDA Funds X X X X X X X
C5 Interest Accrual X X X X X X X
C6 Unmet Transit Needs X
C7 Revenue Ratios X X X X
C8 Revenue Ratios Exclusive Service X X X X
C9 50-Percent Allocation Limit X X X X
C10 Retirement System X X X
C11 Use of Federal Funds X X X X
C12 Staffing X X X
C13 Reduced Fares X X X
C14 CHP Certification X X X X
C15 Accessible Vehicles X X X
C16 Budget Increase X X X
C17 Part-Time Employees X
C18 Operator’s Qualifying Criteria X
D Capital Projects and Reserves X X X X X X
F TDA Checklist X X X X X X X
E Local Agency Resolution X X X X X X X
E1 Agenda item for Resolution X X X X X X X
G Authorized Agent Form (State) X
H Certification and Assurances (St) X
I Board Resolution (State) X
J Project List X
Submitted by:

Signature: Name:

Title:

Date: Phone:

Email:
(updated 06/18/20)
Mark Uribe
Director of Finance
805-388-5320
[email protected]
Form F - Checklist
09 / 10 / 2024
Doc ID: fd584f5533bec14e5a4baf63b6bdeb042a8d8d36

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