Agenda packet — City Council and Authorities Concurrent, October 10, 2023 (part 4 of 5)

Independent (able to bathe self safely)
Verbal assistance (able to bathe self with direction or intermittent monitoring; may need reminding to maintain personal hygiene)
Some human help (generally able to bathe self, but needs assistance) Lots of human help (requires direct assistance with most aspects of bathing; would be at if left alone)
Dependent (totally dependent on others for bathing)
Toileting (Rated Level )
Able to move to and from, on and off toilet or commode, empty commode, manage clothing and wipe and clean body after toileting, use and empty bedpans, ostomy and/or catheter receptacles and urinals, apply diapers and disposable barrier pads. Menstrual care: able to apply external sanitary napkin and clean body.

Independent (no assistance needed)
Verbal assistance (requires reminding and direction only) Some human help (requires minimal assistance with some activities, but the constant of the provider is not necessary)
Lots of human help (unable to carry out most activities without assistance) Dependent (requires physical assistance in all areas of care) Transferring In/Out of Bed/Chair (Rated Level )
Moving from one sitting or lying position to another sitting or lying position; e.g., from bed to or a wheelchair, or sofa, coming to a standing position and/or repositioning to prevent skin breakdown.

Independent (able to do all transfers safely)
Verbal assistance (able to transfer but needs encouragement or direction) Some human help (requires some help from another person; e.g., routinely requires a boost or assistance with positioning)
Lots of human help (unable to complete most transfers without physical assistance; would at risk if unassisted)
Dependent (totally dependent upon another person for all transfers) Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 (1)
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Example 5, Continued
Walking (Rated Level )
Walking or moving inside, moving from one area of indoor space to another without necessity of handrails. Can respond adequately to the presence of obstacles that must be stepped around.

Includes ability to go from inside to outside and back.

Independent (no assistance needed)
Verbal assistance (able to walk or move with encouragement, or reminders to watch for , or to use a cane or walker)
Some human help (requires minimal assistance from another person to negotiate a or to steady the person or guide them in the desired direction) Lots of human help (requires constant attention from another person, at risk of being lost or unsafe if not accompanied)
Dependent (totally dependent upon another person, must be carried, lifted, or pushed in a wheelchair or on a gurney at all times)
Dressing (Rated Level )
Putting on and taking off, fastening and unfastening garments and undergarments, special devices such as back braces, corsets, elastic stockings/garments and artificial limbs or splints. (1) Independent (able to put on, fasten and remove all clothing and devices without assistance; clothes self appropriately for health and safety)
(2) Verbal assistance (able to dress self, but requires reminding or directions with clothing selection) (3) Some human help (unable to dress self completely, without the help of another person, e.g., tying shoes, buttoning, zipping, putting on hose or brace, etc.) (4) Lots of human help (unable to put on most clothing items by self; without assistance would be inappropriately or inadequately clothed)
(5) Dependent (unable to dress self at all)
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 (1)
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steps
wheelchair
Example 5, Continued
Client/Elderly Care Receiver Instrumental Activities of Daily Living (IADL) Fields Meal Preparation (Rated Level )
Planning menus. Washing, peeling, slicing vegetables, opening packages, cans, and bags, mixing ingredients, lifting pots and pans, re-heating food, cooking, safely operating stove, setting the table, serving the meal, cutting food into bite-sized pieces. Washing, drying, and putting away the dishes. (1) Independent (no assistance needed)
(2) Verbal assistance (needs only reminding or guidance in menu planning, meal preparation, and/or cleanup)
(3) Some human help (requires another person to prepare and clean up main meals on less than a daily basis; e.g., can reheat food prepared by someone else, can prepare simple meals and/or needs help with cleanup on a less than daily basis)
(4) Lots of human help (requires another person to prepare and clean up main meal(s) on a daily basis) (5) Dependent (totally dependent upon another person to prepare and clean up all meals) Shopping (Rated Level )
Compile list, bending, reaching, and lifting, managing cart, or basket, identifying items needed, transferring items to home, putting items away, ordering prescriptions over the phone and picking them up, and buying clothing.
(1) Independent (can perform all tasks without assistance) (2) Verbal assistance (able to perform tasks, but needs only reminding or direction, guidance or reminder)
(3) Some human help (requires the help of another person for some tasks while shopping such as reaching and carrying items)
(4) Lots of human help (unable to carry out most activities without assistance) (5) Dependent (unable to perform any tasks for self)
Medication Management (Rated Level )
Physically and mentally able to identify, organize, schedule, handle, and consume (inject, instill or insert) the correct amount of the prescribed medication at the specified time according to a doctor's prescription.
(1) Independent (can identify, measure, organize, and self-administer prescribed medication) (2) Verbal assistance (able to perform tasks but needs verbal direction, guidance or reminder to do it, without risk to safety)
(3) Some human help (requires some human help such as scheduling medications, opening the container, measuring the amount of medication)
(6) Lots of human help (cannot perform some parts of this function; may require some human help with installing or injecting multiple medications)
(7) Dependent (cannot perform any part of this function) Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Example 5, Continued
Money Management (Rated Level )
Physically and mentally handles the receipt of monies, expenditures, and receipt and payment of bills in a timely and primarily correct manner.
(1) Independent (handles all financial matters)
(2) Verbal assistance (is able to perform all financial transactions but may need to be reminded to pay bills or obtain cash from bank)
(3) Some human help (for either physical or mental reasons may need assistance in doing banking, writing checks, etc.)
(4) Lots of human help (unable to carry out most activities without assistance) (5) Dependent (unable to attend to any part of the necessary financial transactions to receive and disburse funds to meet daily needs)
Using Telephone (Rated Level )
Obtains number, dials, handles receiver, can speak and hear response, and terminates call, may include use of instrument with loudspeaker or hearing devices. Able to use telephone during emergency situations to call 911 or other help.
(1) Independent (can obtain and dial number without assistance) (2) Verbal assistance (needs only reminder on how to use the phone) (3) Some human help (needs human assistance to obtain number or dial) (4) Lots of human help (currently not defined)
(5) Dependent (unable to use phone at all)
Heavy Housework (Rated Level )
Cleaning oven and stove, cleaning and defrosting refrigerator, moving light furniture to clean under and behind, vacuuming upholstery and under cushions, providing deep cleaning activities such as washing and cleaning baseboards, window tracks, cabinets, doors, drapes/blinds, etc. (1) Independent (able to perform all domestic chores)
(2) Verbal Assistance (able to perform domestic chores but needs direction) (3) Some human help (requires physical assistance from another person for some domestic chores) (4) Lots of human help (unable to carry out most domestic chores without assistance) (5) Dependent (totally dependent upon others for all domestic chores) Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Example 5, Continued
Light Housework (Rated Level )
Sweeping, vacuuming, mopping floors, washing kitchen counters and sinks, cleaning bathroom, taking out garbage, dusting and picking up.
(1) Independent (able to perform all light domestic chores) (2) Verbal assistance (able to perform domestic chores but needs direction) (3) Some human help (requires physical assistance from another person for some domestic chores) (4) Lots of human help (unable to carry out most domestic chores without assistance) (5) Dependent (totally dependent upon others for all domestic chores) Transportation (Rated Level )
Using private or public vehicles, cars, buses, trains, or other forms of transportation to get to medical appointments, purchase food, shop, pay bills, or arrange for services, to socialize and participate in entertainment or religious activities. Can arrange for getting and using public transportation; or get to, enter and operate a private vehicle.
(1) Independent (can arrange, get to, enter and travel in public or private vehicles) (2) Verbal assistance (can use public transportation or ride in a private vehicle when reminded to make arrangements)
(3) Some human help (requires physical assistance to make transportation arrangements; i.e.,calling, writing instructions about time and place, can ride with others if assisted into and out of the vehicle)
(4) Lots of human help (unable to carry out most activities without assistance) (5) Dependent (unable to travel at all by self)
Check if Declined to State ADL and IADL Functional Abilities Resources
The OAA defines “frail” as an older individual that is functionally impaired because the individual “is unable to perform at least two ADLs without substantial human assistance, including verbal reminding, physical cueing, or supervision; or due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another person.” (Section 102(a) (22)) Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
Introduction
Title III C Congregate and Home-Delivered Meal programs are required to perform a nutrition risk screening to identify individuals at nutrition risk or at risk for malnutrition. NAPIS reporting requirements define a person at nutrition risk as one who scores six or higher on the Determine Your Nutritional Risk Checklist (hereafter referred to as the “DETERMINE Checklist”) published by the Nutrition Screening Initiative (NSI).

Service Categories Required
The following programs require collecting the nutritional risk scores for registered clients.

Home-Delivered Meals
Congregate Meals
Nutritional Counseling
What to Include?
Title III C nutrition programs shall only use the DETERMINE Checklist to evaluate the client’s nutrition risk score.

The nutrition risk questionnaire must be filled out at initial intake or registration along with other client information then reported through the data collection system. After initial intake/registration, annually update and report nutrition risk information and other basic client data.

How to Determine Score?
Each question has a weighted point value. The sum determines the reported nutritional risk score.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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• If score is 0-5, then client is not at nutritional risk. • If score is 6 or greater, then client is at nutritional risk.

What is Reviewed?
CDA will review data to determine if the AAA is serving individuals at nutritional risk. CDA bases its target ranges on statewide analysis of the average number of participants at nutritional risk. Target percentages may be adjusted on an annual basis.

Program Target ercentage of all reported participants
For the Congregate Meals (C-1) 21% or higher at nutritional risk Home-Delivered Meals (C-2) 65% or higher at nutritional risk DETERMINE Checklist
The following is the DETERMINE Checklist with weighted/scored values. The interviewer may need to provide additional clarification.

Determine Your Nutritional Health Circle if
yes
I have an illness or condition that made me change the kind and/or amount of food I eat. 2
I eat fewer than 2 meals per day. 3
I eat few fruits or vegetables or milk products. 2
I have 3 or more drinks of beer, liquor or wine almost every day. 2 I have tooth or mouth problems that make it hard for me to eat. 2 I don’t always have enough money to buy the food I need. 4 I eat alone most of the time. 1
I take 3 or more different prescribed or over-the-counter drugs a day. 1 Without wanting to, I have lost or gained 10 pounds in the last 6 months. 2
I am not always physically able to shop, cook and/or feed myself. 2 Total Score:
(If equal to or greater than 6, the client is at nutritional risk) Declined to State
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 p
Case Information
Effective starting July 1, 2021, the Legal Assistance Service category is a registered service. In addition to required client data, the following case information is needed:

Case ID
Case Opened Date
Case Closed Date
Service Type
Service Level
NOTE: Legal Assistance data will now be reported through CARS. The final required CDA 1022 form will cover the fourth quarter of State Fiscal Year 2021. Thereafter, the 1022 form will no longer be accepted.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Introduction
There may be other questions added to provide more helpful client information. Some common ones are listed below. These are not required CARS elements and must not be reported in CARS.

Assessment Type
Assessment types (may be helpful) are as follows:

New Client
Annual Reassessment
Significant Change in Condition
Office Notes
Identification of intake/ assessment date and the staff reviewing the information is useful.

Contact Information
To assign a unique identification number to each participant data management systems may use any combination of name, address, phone number, or the last four digits of the participant’s Social Security Number for record identification. This avoids duplicating information by recording client level detail for each participant and will enable tracking the client’s services by provider and program.

First Name
Middle Name
Last Name
Other name(s)
Home Address
City
Mailing if Different
Telephone Number
Cell Number
Email Address
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Optional Client Level Detail, Continued
Living Arrangement with thers
This section can help to identify the following client living arrangements when not living alone:

Lives w/Spouse
Lives w/Child
Lives w/Relative
Lives w/Other(s)
Senior Apartment
Source of Support
This section can help to identify the following various types of caregiving support:

Family
Friend/ Neighbor
Paid Help
Unsure
None
Transportation Services
The following options can help to identify type(s) of transportation assistance needed:

Walks with No Assistance
(Non-Assisted)
Walks with Assistance
(Assisted)
Wheelchair ramp/lift
Other Characteristics
The following options can help to identify if other conditions or assistance are needed.

CHECK AIDS CURRENTLY USED:

Cane
Glasses/ Contacts
Hearing Aid
Oxygen
Pacemaker
TTY Phone
Walker
Wheelchair
Other:

ABILITY TO SPEAK ENGLISH:

Speaks English Non-English Language Need Interpreter
DO YOU RECEIVE HELP FROM OTHER ORGANIZATION(S)?
Yes
No
If so, which
one(s):

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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Emergency Identification
This section can allow the client to designate a contact person to call during or after an emergency event:

Emergency Contact Person
Name:__________________________________________________________________________ Address: _______________________________________
Relationship to Client: _____________________________
Telephone number: ( ) - _______
Disaster Registry
In case of an emergency declaration, the following identification can help build a Disaster Registry to identify those high-risk clients that may need evacuation assistance.

A client is considered High Risk under Emergency Declaration if any of the following exists.

Check all that apply.

Housebound seniors and people with physical disabilities that DO NOT have an existing network of support
Significant mobility, vision, or hearing impairment
Elderly or medically fragile
Disabling mental illness or developmental disability
Requires refrigeration of medication and/or is insulin dependent Reliance on life-support, oxygen, or dialysis
Not pplicable
Eligibility for Title III B Registered Services
To determine eligibility for registered Supportive Services (Title III B) the following question can be asked: Are you age 60 or over?
Yes
No
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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Eligibility for Title III C-1 & C-2
To determine eligibility for Congregate Meals (Title III C-1) and Home-Delivered Meals (Title III C-2) the following questions can be asked.

QUESTIONS FOR THE CONGREGATE MEALS (C-1) ELIGIBILITY:

Are you over 60?
Are you the spouse or domestic partner of an Elderly Nutrition Program (ENP) participant who is over the age of 60?
Are you a person with a disability, who resides in housing where the congregate site is located?
Are you a person with a disability who resides with and accompanies an ENP participant? Are you a volunteer under the age of 60? (May have a meal if it does not deprive a senior of a meal.)
QUESTIONS FOR HOME-DELIVERED MEALS (C-2) ELIGIBILITY:

Are you homebound due to an illness, disability, or isolation? Are you a spouse of a person who is homebound?
Are you an individual with a disability who resides with a homebound meal recipient? QUESTIONS TO DETERMINE EQUIPMENT CONDITIONS AND CLIENT ABILITIES:

Does the client have any dietary restrictions?
Does the client have a working refrigerator?
Does the client have a working microwave?
Is client physically and mentally able to open the food containers? Is client physically and mentally able to reheat a meal? Are there pets inside or outside the home?
Exhibit F: Sourcewise Provider Manual
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Eligibility for Title III E
To determine eligibility for Title III E, FCSP Caregivers of Older Adults or Elderly Relative, the following questions may be asked.

CAREGIVER CARING OF OLDER ADULTS CRITERIA
Is the n individual (of any age) with
Alzheimer’s disease or related disorder with neurological and organic brain dysfunction? Yes No
Is the Caregiver an adult (18 years of age or older) family member or another individual (e.g., friend or neighbor) who is an informal (i.e., unpaid) provider of in-home or community care to an “elderly” Care Receiver?
Yes No
If answered “yes” to both questions above, the individual is qualified for “Family Caregivers of Adults.” If requesting “Respite Care” or “Supplemental Services,” the Care Receiver must also have two or more ADL deficiencies or a cognitive impairment.

OLDER ELDER RELATIVE ELIGIBILITY CRITERIA
Is the Care Receiver an individual who is not more than 18 years of age or who is an individual (of any age) with a disability?
Yes No
In the case of a caregiver for a child, is the Caregiver a grandparent, step-grandparent, parent, or other older relative by blood, marriage, or adoption who is 55 years of age or older, living with the child, and identified as the primary caregiver through a legal or informal arrangement? Biological and adoptive parents are excluded.

Yes No
In the case of a caregiver for an individual with a disability, is the aregiver a parent, grandparent, or other relative by blood, marriage, or adoption who is 55 years of age or older, and living with the individual with a disability?
Yes No
If answered “yes” to either questions 1 and 2 and 3 above, the individual is qualified for der Elderly Relative Services.”
If the Care Receiver does not meet any of the criteria above, the Caregiver is ineligible to receive FCSP services, but may qualify to receive other services provided by the AAA.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947

1. Care Receiver an older individual (60 years of age or older) or a □ □

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Older

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Optional Client Level Detail, Continued
Resources to Determine Eligibility
The following links are to reference documents for the Title III E, Family Caregiver Support Program. www.aging.ca.gov/Data_and_Statistics/#Statistical
www.aging.ca.gov/Providers_and_Partners/Area_Agencies_on_Aging Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 CDA Statistical Fact Sheets and Program Narratives
Provide information on the program purpose, eligibility requirements, and history.

CDA Service Categories Data Dictionary
Provides category definitions.

Introduction
Some OAA programs do not require collecting any client-level demographic information. These programs target groups or provide sensitive services that may make client-level data collection difficult.

What to Include?
Report estimated total clients/audience by each service category for each quarter. AAAs will be required to report at least:

Nutritional Education
Information and Assistance
Disease Prevention and Health Promotion
Elder Abuse Prevention, and
Other NAPIS Services
There are no required client fields in non-registered services. It is optional for AAAs to collect this information based on the guidelines described in the required client fields for Registered Services.

What is Reviewed?
CDA reviews the estimated enrollments and service units on a quarterly and annual basis.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Chart Guidelines
Apply the following chart to determine if form(s) or records have the required data collection and reporting elements for Title III B, C, D, and VII B Non-Registered services.

CARS - Required Title III B, C, D, and VII Non-Registered Fields Service Category Service Units
Estimated
Clients/
Audience
Funding
Source
Transportation X One-way Trip X III B
Nutritional Education1 X Session per
Participant X III C
Information and Assistance1 X Contact X III B
Outreach X Contact X III B
Health Promotion1 X Contact X III D
Alzheimer's Day Care Services (“Other” NAPIS
Services)
X Day of
Attendance X III B
Cash/Material Aid (“Other” NAPIS Services) X Assistance X III B Community Education (“Other” NAPIS Services) X Activity X III B Comprehensive Assessment (“Other” NAPIS Services) X Hour X III B Disaster Preparedness Materials (“Other” NAPIS
Services)
X Product X III B
Elder Abuse Prevention, Education and Training 1
(“Other” NAPIS Services)
X Session X VII
Elder Abuse Prevention Educational Materials1
(“Other” NAPIS Services)
X Product X VII
Employment (“Other” NAPIS Services) X Activity X III B
Health (“Other” NAPIS Services) X Hour X III B
Housing (“Other” NAPIS Services) X Hour X III B
Interpretation/ Translation (“Other” NAPIS Services) X Contact X III B Mobility Management Activities (“Other” NAPIS
Services) X Hour X III B
Mental Health (“Other” NAPIS Services) X Hour X III B
Peer Counseling (“Other” NAPIS Services) X Hour X III B (X) Required Element
1Required service categories. Elder Abuse Prevention requires at least one reported service category.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 CARS Required Title III B, C, D, and VII Non-Registered Fields, Continued Service Category Service Units
Estimated
Clients/
Audience
Funding
Source
Personal Affairs Assistance (“Other” NAPIS Services) X Contact X III B Personal/Home Security (“Other” NAPIS Services) X Product X III B Public Information (“Other” NAPIS Services) X Activity X III B Registry (“Other” NAPIS Services) X Hour X III B
Residential Repairs/Modifications (“Other” NAPIS
Services) X Modification X III B
Respite Care (“Other” NAPIS Services) X Hour X III B
Senior Center Activities (“Other” NAPIS Services) X Hour X III B Telephone Reassurance (“Other” NAPIS Services) X Contact X III B Visiting (“Other” NAPIS Services) X Hour X III B
(X) Required Element
1Required service categories. Elder Abuse Prevention requires at least one reported service category.

Chart Guidelines
Apply the following chart to determine if form(s) or records have the required data collection and reporting elements for Title III E Non-Registered services.

CARS Title III E, FCSP Caring for Elderly or Caring for Child Required Non- Registered Fields
Service Category Service Units Estimated
Clients/Audience
Outreach (Access Assistance) X Contact X
Information and Assistance (Access Assistance) X Contact X Interpretation/Translation (Access Assistance) X Contact X Legal Resources (Access Assistance) X Contact X
Public Information (Information Services) X Activity X
Community Education (Information Services) X Activity X (X) Required Element
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 The following list contains web links of applicable laws/regulations/policies:

Area Plan Contract - www.aging.ca.gov/Contracts_Download_Page CCR - California Code of Regulations, Title 22 Division 1.8 - www.govt.westlaw.com/calregs CFR - Code of Federal Regulations, Title 45 Part 1321 - www.ecfr.gov OAA - Older Americans Act - www.acl.gov/about-acl/authorizing-statutes/older-americans-act OCA - California Welfare and Institutions (W&I) Code, Division 8.5 Mello-Granlund Older Californians Act - www.leginfo.legislature.ca.gov
NAPIS SPR – ACL National Aging Program Information System State Program Reports - www.acl.gov/programs/state-program-reports
PM - CDA Program Memoranda - www.aging.ca.gov/PM
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Title III - Intake and Assessment
Sample Forms

CALIFORNIA DEPARTMENT OF AGING

HOME AND COMMUNITY LIVING DIVISION
www.aging.ca.gov
July 2021
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 n _ CALIFORNIA
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Introduction
Because each AAA has tailored programs to meet their community needs, CDA does not have required intake or assessment forms. CDA has designed these sample templates to help the AAAs evaluate and create their own forms for collecting and recording required performance data elements.

What is Reviewed
CDA reviews the forms to ensure all required data collection elements are integrated.

AAAs may use these forms, revise them, or create forms to meet local needs. AAAs do not have to use these sample templates.

Forms
This section contains the following templates:

Sample 1
Title III B, C-1, C-2, and D (Cluster 1& 2, Registered) Personal Care, Homemaker, Chore, Home-Delivered Meals, Adult Day Care/Health, Case Management, Congregate Meals, Nutritional Counseling, Assisted Transportation, Other Non-Registered Services
Sample 2
Title III B, C-2 (Cluster 1)
Personal Care, Homemaker, Chore, Home-Delivered Meals, Adult Day Care/Health, Case Management
Sample 3
Title III B, C1, and D (Cluster 2)
Congregate Meals, Nutritional Counseling, Assisted Transportation Sample 4
Title III C-2
Home-Delivered Meals
Sample 5
Title III C-1
Congregate Meals
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 •
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Sample 6
Title III E (Group 1, Registered)
Caring for Elderly, Caring for Child
Sample 7
Title III E (Group 1)
Caring for Elderly
Sample 8
Title III E (Group 1)
Caring for Child
Sample 9
Title III B (Cluster III, Non-Registered)
Information and Assistance
Sample 10
Title III B
Legal Assistance
Exhibit F: Sourcewise Provider Manual
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[Page 1 of 2]
CDA Sample 1, Title III B, C-1, C-2, Registration-Assessment Form (2021) SAMPLE 1, TITLE III
Provider Name: Unique Participate ID: ___________________________ Registration/Assessment Date: ___________________
Termination Date: *Reason: Region/Site Name: Service Categories (Titles IIIB, IIIC and IIID):
*Personal Care (IIIB) (A, I) *Homemaker (IIIB) (A, I) *Chore (IIIB) (A, I) *Home-Delivered Meals (A, I, N) *Adult Day Care/Health (IIIB) (A, I) *Case Management (IIIB) (A, I) *Assisted Transportation (IIIB) *Congregate Meals (N) *Nutrition Counseling (N) Other: ____________________________ Notes: A-ADLs, I-IADLs, N-Nutritional Assessments on Page 2 SECTION 1 (Client)
(*) Required for All Registered Programs
PERSONAL DATA (Please print):

First Name: Middle Initial:

Last Name: *What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
Residential Address:

Street: City:
*Zip Code: Mailing Address:

Same as Residential? Yes Skip to Next Section
Street: City:
*Zip Code: *Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Race:
(Check all that
apply)
White Black
American Indian/Alaska Native
Asian:

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □ □ □ □ □ □ □ □ □
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CDA Sample 1, Title III B, C-1, C-2, Registration-Assessment Form (2021) SECTION 2 ADL and IADL (Activities of Daily Living and Instrumental Activities of Daily Living Annual Assessment) *Required for (III-C): Home Delivered Meals; (III-B): Personal Care, Homemaker, Chore, Adult Day Care, Case Management ADLs: 1
Independent
2 Verbal
Assistance
3 Some
Human Help
4 Lots of
Human Help
5 Dependent
Declined to
State
*Eating
*Bathing *Toileting
*Transferring In/Out of
Bed/Chair
*Walking
*Dressing
Notes:

IADLS: 1
Independent
2 Verbal
Assistance
3 Some
Human Help
4 Lots of
Human Help
5 Dependent
Declined to
State
*Meal Preparation *Shopping
*Medication Management
*Money Management
*Using Telephone
*Heavy Housework
*Light Housework
*Transportation
Notes:

SECTION 3 Nutritional Risk Assessment (Annual)
* Required for (IIIC): Home-Delivered Meals, Congregate Meals; Nutritional Counseling *Nutritional Risk Assessment: Circle if yes
I have an illness or condition that made me change the kind and/or amount of food I eat. 2 I eat fewer than 2 meals per day. 3
I eat few fruits or vegetables or milk products. 2
I have 3 or more drinks of beer, liquor or wine almost every day. 2 I have tooth or mouth problems that make it hard for me to eat. 2 always have enough money to buy the food I need. 4
I eat alone most of the time. 1
I take 3 or more different prescribed or over the-counter drugs a day. 1 Without wanting to, I have lost or gained 10 pounds in the past 6 months. 2 I am not always physically able to shop, cook, and/or feed myself. 2 Total Score:

Is Nutrition Risk total score 0-5 or 6+? 0 - 5 6+
Declined to State
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I don't
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[Page 1 of 2]
CDA Sample 2, Cluster 1 Title III B, C-1, C-2, Registration-Assessment Form (2021) SAMPLE 2, CLUSTER 1
Provider Name: Unique Participate ID: ___________________________ Registration/Assessment Date: ___________________
Termination Date: *Reason: Region/Site Name: Service Categories (Titles IIIB and IIIC):
*Personal Care (IIIB) (A, I) *Homemaker (IIIB) (A, I) *Chore (IIIB) (A, I) *Home-Delivered Meals (A, I, N) *Adult Day Care/Health (IIIB) (A, I) *Case Management (IIIB) (A, I) Notes: A-ADLs, I-IADLs, N-Nutritional Assessments on Page 2 SECTION 1 (Client)
(*) Required for All Registered Programs
PERSONAL DATA (Please print):

First Name: Middle Initial:

Street: City:
*Zip Code: Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City: *Zip Code: Emergency
Contact:

Name:

Relationship:

Phone #: ( )
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Race:
(Check all that
apply)
White Black
American Indian/Alaska Native
Asian:

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □ □ □ □ □
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CDA Sample 2, Cluster 1 Title III B, C-1, C-2, Registration-Assessment Form (2021) SECTION 2 ADL and IADL (Activities of Daily Living and Instrumental Activities of Daily Living Annual Assessment) *Required for (III-C): Home Delivered Meals; (III-B): Personal Care, Homemaker, Chore, Adult Day Care, Case Management ADLs: 1
Independent
2 Verbal
Assistance
3 Some
Human Help
4 Lots of
Human Help
5 Dependent
Declined to
State
*Eating
*Bathing *Toileting
*Transferring In/Out of
Bed/Chair
*Walking
*Dressing
Notes:

Is Nutrition Risk total score 0-5 or 6+? 0 - 5 6+
Declined to State
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I don't
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[Page 1 of 2]
CDA Sample 3, Cluster 2, Title III B, C-1, Registration-Assessment Form (2021) SAMPLE 3, CLUSTER 2
Provider Name: Unique Participate ID: ___________________________ Registration/Assessment Date: ___________________
Termination Date: *Reason: Region/Site Name: Service Categories (Titles IIIB and IIIC):
*Assisted Transportation *Congregate Meals (N) *Nutrition Counseling (N) Notes: Requires N-Nutritional Assessments on Page 2
SECTION 1 (Client)
(*) Required for All Registered Programs
PERSONAL DATA (Please print):

First Name: Middle Initial:

Street: City:
*Zip Code: Mailing Address:

Same as Residential? Yes Skip to Next Section
Street: City:
*Zip Code:

Emergency
Contact:

Name:

Relationship:

Phone #: ( )
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Race:
(Check all that
apply)
White Black
American Indian/Alaska Native
Asian:

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated
Transportation Service Needs:

Walks with no assistance (Non-Assisted)
Walks with assistance (Assisted)
Wheelchair ramp/lift
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □ □
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CDA Sample 3, Cluster 2, Title III B, C-1, Registration-Assessment Form (2021) SECTION 2 Nutritional Assessment (Annual)
* Required for (IIIC): Congregate Meals, Nutritional Counseling *Nutritional Assessment: Circle if yes
I have an illness or condition that made me change the kind and/or amount of food I eat. 2 I eat fewer than 2 meals per day. 3
I eat few fruits or vegetables or milk products. 2
I have 3 or more drinks of beer, liquor or wine almost every day. 2 I have tooth or mouth problems that make it hard for me to eat. 2 always have enough money to buy the food I need. 4
I eat alone most of the time. 1
I take 3 or more different prescribed or over the-counter drugs a day. 1 Without wanting to, I have lost or gained 10 pounds in the past 6 months? 2 I am not always physically able to shop, cook, and/or feed myself. 2 Total Score:

Is Nutrition Risk total score 0-5 or 6+? 0 - 5 6+
Declined to State
Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I don't
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[Page 1 of 2]
CDA Sample 4, Title III C-2, Home-Delivered Meals, Registration-Assessment Form (2021) SAMPLE 4, C-2
Name of Home-Delivered Meals
Provider This form is designed to be completed by
an intake staff. Items marked with an asterisk (*) are
required.

Route:

Intake Date: _________
Active Date: _________ Inactive Date: _________
Active Date: _________ Inactive Date: _________
Active Date: _________ Inactive Date: _________
*Unique Participant ID: *Termination Date: Reason: *Date of Birth:
/ /
New client
Annual reassessment
Change in information
First Name: Last Name: Home Address City: *Zip Code Home Phone: ( ) Alternate Phone: ( )
Emergency Contact Name:

Address:

Phone: ( ) Relationship: *Living Arrangement
# of household members:

Declined/not stated
*What is your approximate household income?
$ ___________________ per month year
Declined/not stated
*Rural Area:

Yes No
Declined/not stated
*What is your gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify: ______________________________ Declined/not stated
*What was your sex at
birth? (Check only one)
Male
Female
Declined/not stated
*How do you describe your sexual orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Ethnicity: (Check one)
Hispanic Yes No Declined/not stated
Language:

English Speaking Need interpreter Non-English/Language
*Race: (Check all that apply)
White Black American Indian/Alaska Native Asian:

Asian Indian Cambodian Chinese Filipino Japanese Korean Laotian Vietnamese Other Asian Hawaiian/Other Pacific Islander Guamanian Hawaiian Samoan Other Pacific Islander Declined/not stated
ADLs: ADLs and IADLs (Activities of Daily Living and Instrumental Activities of Daily Living) Please rate your functional abilities for the following activities.

ADLs Rated Value IADLs Rated Value IADLs Rated Value RATING SCALE 1 Independent
2 Verbal
Assistance
3 Some Human
Help
4 Lots of Human
Help
5 Dependent
6 - Declined to
State
Feeding Meal Preparation Light Housework
Dressing Shopping Heavy Housework
Bathing Manage Medication Notes:

Transferring In/Out
of Chair Money Management
Walking Telephone
Toileting Transportation
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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CDA Sample 4, Title III C-2, Home-Delivered Meals, Registration-Assessment Form (2021) Eligibility:

Are you homebound due to an illness, disability, or isolation? Are you a spouse of a home-delivered meal recipient?
Are you an individual with a disability who resides with a home-delivered meal recipient? Prioritization: *Nutritional Risk Assessment: Circle if yes I have an illness or condition that made me change the kind and/or amount of food I eat. 2 I eat fewer than 2 meals per day. 3
I eat few fruits or vegetables or milk products. 2
I have 3 or more drinks of beer, liquor or wine almost every day. 2 I have tooth or mouth problems that make it hard for me to eat. 2 always have enough money to buy the food I need. 4
I eat alone most of the time. 1
I take 3 or more different prescribed or over the-counter drugs a day. 1 Without wanting to, I have lost or gained 10 pounds in the past 6 months. 2 I am not always physically able to shop, cook, and/or feed myself. 2 Total Score:
*Is Nutrition Risk Total Score 0-5 or 6+ ? 0-5 6+
Declined to State
Yes No Comments
Do you have any dietary restrictions? Do you have a working refrigerator? Do you have a working microwave?
Are you physically and mentally able to open the food containers? Are you physically and mentally able to reheat a meal?
Are there pets?
Have you recently been discharged from the hospital?
Referral(s) Made:

Nutritional education/counseling for at risk client
Other:

Other:

Notes:
____________________________________________________ _________________________ Staff Completing Assessment Date Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I don't
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[Page 1 of 2]
CDA Sample 5, Title III C-1, Congregate Meals, Registration-Assessment Form (2021) SAMPLE 5, C-1
Name of Congregate Meal Provider
{Provider Name}
Please complete this form to the best of your
ability. Items marked with an asterisk (*) are
required.
*Unique Participate ID: _________
Referred by: __________________
Intake Date: ___________________
Staff: ________________________
Beginning Date: ________________
*Termination Date: _____________
*Reason: _____________________
Eligibility:

Age 60+
Spouse of congregate meal
participant
Disabled person residing where
the congregate site is located
Disabled person who resides
with and accompanies a congregate
meal participant
Volunteer
First Name: Last Name: *Date of Birth:

Home Address City: *Zip Code
Mailing Address: Same As Residential? Yes City: *Zip Code Home Phone: ( )
Alternate Phone: ( )
Emergency Contact Name:

Address:

Phone: ( ) Relationship:
*Living Arrangement
# of household members:

Declined/not stated
*What is your approximate household income?
$ ___________________ per month year
Declined/not stated
*Rural Area:

Yes No
Declined/not stated
*What is your gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________ Declined/not stated
*What was your sex at
birth? (Check only one)
Male
Female
Declined/not stated
*How do you describe your sexual orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Ethnicity: (Check one)
Hispanic Yes No Declined/not stated
Language:

English Speaking Need interpreter Non-English/Language
*Race: (Check all that apply)
White Black American Indian/Alaska Native Asian:

Asian Indian Cambodian Chinese Filipino Japanese Korean Laotian Vietnamese Other Asian Hawaiian/Other Pacific Islander Guamanian Hawaiian Samoan Other Pacific Islander Declined/not stated
Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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[Page 2 of 2]
CDA Sample 5, Title III C-1, Congregate Meals, Registration-Assessment Form (2021) *Nutritional Risk Assessment: Circle if yes
I have an illness or condition that made me change the kind and/or amount of food I eat. 2 I eat fewer than 2 meals per day. 3
I eat few fruits or vegetables or milk products. 2
I have 3 or more drinks of beer, liquor or wine almost every day. 2 I have tooth or mouth problems that make it hard for me to eat. 2 always have enough money to buy the food I need. 4
I eat alone most of the time. 1
I take 3 or more different prescribed or over the-counter drugs a day. 1 Without wanting to, I have lost or gained 10 pounds in the past 6 months. 2 I am not always physically able to shop, cook, and/or feed myself. 2 Total Score:

Is Nutrition Risk total score 0-5 or 6+ ?
0 - 5 6+
Declined to State
I understand that the information I am providing on this form is for registration purposes. I understand it will be kept confidential and that the Area Agency on Aging and service providers may use it to help identify other services for which may benefit. _________________________________________________________ ____________________________ Signature of participant or person completing the form Date Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I don't
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[Page 1 of 4]
CDA Sample 6, Title III E, Caregivers of Older Adults, Older Elderly Relative, Registration-Assessment Form (2021) SAMPLE 6, TITLE III E CAREGIVERS OF OLDER ADULTS, OLDER ELDERLY RELATIVE SECTION 1 Service Information
Provider Name: Registration/Assessment Date:
*Termination Date: *Reason: Region/Site Name:

Service Categories:

Caregivers of Older Adults Caregivers of Older Adults
Notes: Check Eligibility criteria below to determine for which program caregiver qualifies Title III E, Family Caregiver Support Program Services to be Provided Support Services:

Caregiver Assessment Caregiver Support
Caregiver Counseling Caregiver Training
Caregiver Peer Counseling Case Management
Respite Care Services:
(Care Receiver must have
2 or more ADL limitations, a
cognitive impairment, or be
grandparent/elder caregiver
to qualify)
In-Home Supervision
Homemaker Assistance
In-Home Personal Care
Home Chore
Out of Home Day
Out of Home Overnight
Supplemental Services: (Care Receiver must have 2 or more ADL limitations, a cognitive impairment, or be a grandparent/older caregiver to qualify)
Assistive Devices Home Adaptations for Caregiving Caregiving Services Registry Cash/Material Aid Access Assistance:

Information & Assistance Caregiver Outreach
Interpretation/Translation
Caregiver Legal Resources
Information Services:

Public Information on Caregiving
Community Education on Caregiving
SECTION 2 Eligibility Criteria
Caregivers of Older Adults Eligibility Criteria

1. Is the Care Receiver an older individual (60 years of age or older) or disease or related disorder with neurological and organic brain dysfunction? Yes No

2. Is the Caregiver an adult (18 years of age or older) family member or another individual (e.g., friend or neighbor) who is an informal (i.e., unpaid) provider of in- Yes No
Older Elderly Relative Eligibility Criteria

1. Is the Care Receiver an individual who is not more than 18 years of age or who is an individual (of any age) with a disability? Yes No

2. Is the Caregiver a grandparent, step-grandparent, or other older relative of a child by blood, marriage, or adoption who is 55 years of age or older, living with the child, and identified as the primary caregiver through a legal or informal arrangement. Biological and adoptive parents are excluded. Yes No If the Care Receiver does not meet any of the criteria above, the Caregiver is ineligible to receive FCSP services, but may qualify to receive other services provided by the Area Agency on Aging.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □
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□ □
home or community care to an "elderly" Care Receiver? D D If answered "yes" to both questions above, check "Family Caregiver Caring for Elderly" box in Section 1. If answered "no" check to see if individual qualifies for "Grandparent/Older Caregiver Caring for Child" component below. □ □
If answered "yes" to both questions above, check "Grandparent/Older □ □ Caregiver Caring for Child" box in Section 1. [Page 2 of 4]
CDA Sample 6, Title III E, Caregivers of Older Adults, Older Elderly Relative, Registration-Assessment Form (2021) SECTION 3 (FCSP Caregiver)
(*) Required for Family Caregiver Support Program Services Caregiver Personal Data (Please print):
*Unique
Participant ID
First Name:

Middle Initial:

Last Name:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Birth Date:

Home Phone: ( )
Residential Address:

Street:

City:
*Zip Code:

Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City:
*Zip Code:

Demographics:
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Federal Poverty
Level (FPL):

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated
*Race: (Check all that apply)
White Black American Indian/Alaska Native
Asian:

Husband Wife
Grandparent Domestic Partner
Daughter/Daughter-in-law
Son/Son-in-law
Brother Sister
Parents
Other Relative
Non-Relative
Declined/not stated
*Relationship
Status:

Single (never married) Married
Domestic Partner Separated
Divorced Widowed
Declined/not stated
*Employment:

Full Time Unemployed
Part Time Declined/not stated
Retired
Exhibit F: Sourcewise Provider Manual
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CDA Sample 6, Title III E, Caregivers of Older Adults, Older Elderly Relative, Registration-Assessment Form (2021) SECTION 4 (FCSP Care Receiver)
(*) Required for Family Caregiver Support Program Services Caregiver Personal Data (Please print):
*Unique
Participant ID
First Name:

Middle Initial:

Last Name:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Birth Date:

Home Phone: ( )
Residential Address:

Street:

City:
*Zip Code:

Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City:
*Zip Code:

Demographics:
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Federal Poverty
Level (FPL):

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated
*Race: (Select all that apply)
White Black American Indian/Alaska Native
Asian:

Single (never married)
Married
Domestic Partner
Separated
Divorced
Widowed
Declined/not stated
Exhibit F: Sourcewise Provider Manual
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CDA Sample 6, Title III E, Caregivers of Older Adults, Older Elderly Relative, Registration-Assessment Form (2021) SECTION 5 (FCSP Care Receiver)
ADL and IADL (Activities of Daily Living and Instrumental Activities of Daily Living) *Required for the Care Receiver only in Support Services, Respite Care, and Supplemental Services. (Not required for Care Receivers in FCSP Older Adults/Relative) ADLs: 1
Independent
2 Verbal
Assistance
3 Some
Human Help
4 Lots of
Human Help
5 Dependent
Declined to
State
*Eating
*Bathing
*Toileting
*Transferring In/Out of
Bed/Chair
*Walking
*Dressing
Notes:

IADLS: 1
Independent
2 Verbal
Assistance
3 Some
Human Help
4 Lots of
Human Help
5 Dependent
Declined to
State
*Meal Preparation
*Shopping
*Medication Management
*Money Management
*Using Telephone
*Heavy Housework
*Light Housework
*Transportation
Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 [Page 1 of 4]
CDA Sample 7, Title III E, Caregivers of Older Adults, Registration-Assessment Form (2021) SAMPLE 7, TITLE III E, CAREGIVERS OF OLDER ADULTS
SECTION 1 Service Information
Provider Name: Registration/Assessment Date:
*Termination Date: *Reason: Region/Site Name:

Title III E, Family Caregiver Support Program Services to be Provided Support Services:

Information & Assistance Caregiver Outreach
Interpretation/Translation
Caregiver Legal Resources
Information Services:

Public Information on Caregiving
Community Education on Caregiving
SECTION 2 Eligibility Criteria
Caregivers of Older Adults Eligibility Criteria

1. Is the Care Receiver an older individual (60 years of age or older) or disease or related disorder with neurological and organic brain dysfunction? Yes No

2. Is the Caregiver an adult (18 years of age or older) family member or another individual (e.g., friend or neighbor) who is an informal (i.e., unpaid) provider of in- Yes No
If the Care Receiver does not meet any of the criteria above, the Caregiver is ineligible to receive FCSP Caregivers of Older Adults services but may qualify to receive other services provided by the Area Agency on Aging.

Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □ □ □ □ □ □ □ □ □
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_ an individual (of any age) with Alzheimer's
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home or community care to an "elderly" Care Receiver? D D [Page 2 of 4]
CDA Sample 7, Title III E, Caregivers of Older Adults, Registration-Assessment Form (2021) SECTION 3 (FCSP Caregiver)
(*) Required for Family Caregiver Support Program Services Caregiver Personal Data (Please print):
*Unique
Participant ID
First Name:

Middle Initial:

Last Name:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Birth Date:

Home Phone: ( )
Residential Address:

Street:

City:
*Zip Code:

Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City:
*Zip Code:

Demographics:
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Federal Poverty
Level (FPL):

Husband Wife
Grandparent Domestic Partner
Daughter/Daughter-in-law
Son/Son-in-law
Brother Sister
Other Relative
Non-Relative
Declined/not stated
*Relationship
Status:

Single (never married) Married
Domestic Partner Separated
Divorced Widowed
Declined/not stated
*Employment:

Full Time Unemployed
Part Time Declined/not stated
Retired
Exhibit F: Sourcewise Provider Manual
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[Page 3 of 4]
CDA Sample 7, Title III E, Caregivers of Older Adults, Registration-Assessment Form (2021) SECTION 4 (FCSP Care Receiver)
(*) Required for Family Caregiver Support Program Services Caregiver Personal Data (Please print):
*Unique
Participant ID
First Name:

Middle Initial:

Last Name:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Birth Date:

Home Phone: ( )
Residential Address:

Street:

City:
*Zip Code:

Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City:
*Zip Code:

Demographics:
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Federal Poverty
Level (FPL):

Required for Support Services, Respite Car, and Supplemental Services.

Please rate your functional abilities for the following activities.

ADLs Rated Value IADLs Rated Value IADLs Rated Value RATING SCALE 1 Independent
2 Verbal
Assistance
3 Some Human
Help
4 Lots of Human
Help
5 Dependent
6 - Declined to
State
Feeding Meal Preparation Heavy Housework
Dressing Shopping Light Housework
Bathing Manage Medication Notes:

Transferring In/Out
of Chair Money Management
Walking Telephone
Toileting Transportation
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 [Page 1 of 3]
CDA Sample 8, Title III E, Older Elderly Relative, Registration-Assessment Form (2021) SAMPLE 8, TITLE III E, OLDER ELDERLY RELATIVE
SECTION 1- Service Information
Provider Name: Registration/Assessment Date:
*Termination Date: *Reason: Region/Site Name:

Title III E, Family Caregiver Support Program Services to Be Provided Support Services:

Information & Assistance Caregiver Outreach
Interpretation/Translation
Caregiver Legal Resources
Information Services:

Public Information on Caregiving
Community Education on Caregiving
SECTION 2 Eligibility Criteria
Caregivers of Older Adults Eligibility Criteria

1. Is the Care Receiver an individual who is not more than 18 years of age or an individual (of any age) with a disability? Yes No

2. Is the Caregiver a grandparent, step-grandparent, or other older relative of a child by blood, marriage, or adoption who is 55 year of age or older living with the child, and identified as the primary caregiver through a legal or informal arrangement? Biological and adoptive parents are excluded Yes No If the Care Receiver does not meet any of the criteria above, the Caregiver is ineligible to receive FCSP Grandparent Caring for Child services but may qualify to receive other services provided by the Area Agency on Aging.

Notes:

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □ □ □ □ □ □ □ □ □
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[Page 2 of 3]
CDA Sample 8, Title III E, Older Elderly Relative, Registration-Assessment Form (2021) SECTION 3 (Grandparent/Older Caregiver)
(*) Required for Family Caregiver Support Program Services Caregiver Personal Data (Please print):
*Unique
Participant ID
First Name:

Middle Initial:

Last Name:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Birth Date:

Home Phone: ( )
Residential Address:

Street:

City:
*Zip Code:

Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City:
*Zip Code:

Demographics:
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Federal Poverty
Level (FPL):

Grandparent Parent
Other Relative
Non-Relative
Declined/not stated
*Relationship
Status:

Single (never married) Married
Domestic Partner Separated
Divorced Widowed
Declined/not stated
*Employment:

Full Time Unemployed
Part Time Declined/not stated
Retired
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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[Page 3 of 3]
CDA Sample 8, Title III E, Older Elderly Relative, Registration-Assessment Form (2021) SECTION 4 (Child)
(*) Required for Family Caregiver Support Program Services Caregiver Personal Data (Please print):
*Unique
Participant ID
First Name:

Middle Initial:

Last Name:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Birth Date:

Home Phone: ( )
Residential Address:

Street:

City:
*Zip Code:

Mailing Address:

Same as Residential? Yes Skip to Next Section
Street:

City:
*Zip Code:

Demographics:
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Federal Poverty
Level (FPL):

Single (never married)
Married
Domestic Partner
Separated
Divorced
Widowed
Declined/not stated
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ -
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CDA Sample 9, Information & Assistance Form (2021)
SAMPLE 9, INFORMATION & ASSISTANCE
Date: _______________________ Staff Completing Intake: ____________________________________ *Indicates optional demographic information that is kept confidential and anonymous. This information is important in understanding the people that we serve.

Demographic Data
*Unique
Participant ID:

Name:
*Birth Date:

Home Phone #: ( )
Email:

Address:
*What is your
gender?
(Check only one)
Male Female
Transgender Male to Female
Transgender Female to Male
Genderqueer/Gender Non-binary
Not Listed, please specify:
______________________________
Declined/not stated
*What was your
sex at birth?
(Check only one)
Male Female
Declined/not stated
*How do you
describe your
sexual
orientation or
sexual identity?
(Check only one)
Straight/Heterosexual
Bisexual
Gay/Lesbian/Same-Gender Loving
Questioning/Unsure
Not Listed, please specify:
______________________________
Declined/not stated
*Ethnicity:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Race:
(Check all that
apply)
White Black
American Indian/Alaska Native
Asian:

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated
Service Requested:

Action Taken/Referral:

Follow Up:

Type of I & A:

III B (If Requesting Services for an Older Individual)
III E Caregivers (If Requesting Services for an Older
Individual)
III E Relative (If Requesting Services for an Older
Individual)
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □ □
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[Page 1 of 1]
CDA Sample 10, Legal Assistance (2021)
SAMPLE 10, III B LEGAL ASSISTANCE
Date: _______________________ Staff Completing Intake: ____________________________________ *Required Information

PERSONAL DATA
*Unique
Participant ID:

Name:
*Birth Date:

Phone #: ( )
Email:

Not Hispanic/Latino
Hispanic/Latino
Declined/not stated
*Race:
(Check all that
apply)
White Black
American Indian/Alaska Native
Asian:

Yes (At or below FPL)
No (Above FPL)
Declined/not stated
*Lives Alone? Yes No
Declined/not stated
*Rural? Yes No
Declined/not stated

CASE INFORMATION
*Unique Case ID:
*Case Opened
Date:
*Case Closed
Date:
*Service Level:

Advice
Limited Representation
Representation
*Case Type:

Income
Health Care
Long Term Care
Nutrition
Housing
Utilities
Abuse/Neglect
Protective Services
Age Discrimination
Other/Miscellaneous
*Hours (Units):

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 □
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SOURCEWISE SERVICE PROVIDER GRIEVANCE POLICY
Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 I. Actions Subject to Appeal
A. A contracted or potential provider of service (service provider) has the right to appeal an adverse determination made by the Sourcewise (Area Agency on Aging).

The actions below shall be considered adverse determinations that are subject to appeal [Title 22 CCR §7704 (c)(l) - (c)(3)(C)J:

1. A reduction in the level of funding to an existing Contractor during an Agreement period; however, a reduction directly attributable to a reduction in the funding to Sourcewise by the State or federal government shall not be considered an adverse determination.

2. A cancellation or termination of an existing Agreement with the Contractor prior to the Agreement's expiration date.

3. Denial of an application to provide services when any of the following exist:
a) The presence of a conflict of interest, real or apparent, as specified in 45 CFR 92.36(b)(3);
b) The occurrence of a procedural error or omission, such as the failure of Sourcewise to include a federal mandate in its solicitation request; c) The lack of substantial evidence to support an action by Sourcewise.

II. Method of Notification
A. The service provider shall provide notification of appeals, and Sourcewise shall provide notification of subsequent appeals determinations, by certified or overnight mail, return receipt requested, or by personal delivery in writing.

B. Notices to Sourcewise shall be addressed to:

Sourcewise
Att: Joe Flynn
Chief Operating Officer
3100 De La Cruz Blvd, Suite 310
Santa Clara, CA 95054
c. Sourcewise shall transmit notification to the address listed on the service provider's appeal. Sourcewise shall include a copy of this Appeal Procedure for Service Providers with all notifications to service providers of adverse appeals determinations.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 111. Process
A. The service provider shall give notice of intent to appeal to the CEO of the Sourcewise within ten (10) business days of the Agency on Aging's notice of adverse determination. The notice of intent to appeal shall be in writing, must state the specific grounds upon which the action by Sourcewise is appealed, and must be accompanied by all supporting documents.

B. The CEO shall investigate the appeal and issue a written determination to the service provider within fifteen (15) business days of receipt of the appeal. The determination shall set forth the position of Sourcewise and specify applicable sections of the service provider's Agreement with Sourcewise, government regulations, government statutes, or other provisions relied upon.

C. If the service provider is dissatisfied with the Sourcewise CEO's determination, the service provider may appeal to Governing Board of Sourcewise within ten (10) business days of the date of the CEO of Sourcewise written determination. The appeal shall be in writing, shall specify the grounds upon which the determination is appealed, and must be accompanied by all supporting documents.

D. The President of the Governing Board of Sourcewise (Executive Committee) shall, within fifteen (15) business days of receipt of the service provider's appeal:

1. Review the service provider's appeal, considering any additional evidence or documentation provided by the CEO of Sourcewise;

2. Determine if the appeal should be denied, or if a recommendation should be made to the full Governing Board of Sourcewise at its next scheduled meeting to take action to grant the appeal; and

3. Provide written notification of its determination to the service provider.

E. If the service provider is dissatisfied with the Executive Committee's determination, the service provider may request a hearing before the full Sourcewise Governing Board. The service provider must request the hearing within ten (10) business days of the Executive Committee's written notification of determination. The hearing request shall be in writing, shall specify the grounds upon which the determination is appealed, and must be accompanied by all supporting documents.

F. If the Governing Board of Sourcewise does not accept and implement the Executive Committee's recommendation to grant the service provider's appeal:

1. Sourcewise shall provide written notification to the service provider of the Governing Board's decision within two (2) business days following the decision;

2. The service provider may request a hearing before the Governing Board of Sourcewise. The service provider must request the hearing within ten (10) business days of the date of the notification of the Sourcewise Governing Board's decision. The hearing request shall be in writing, shall specify the grounds upon which the determination is appealed, and must be accompanied by all supporting documents.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 G. Upon receipt of the service provider's request for a hearing before the Governing Board, Sourcewise will place the hearing on the agenda of the next regularly scheduled meeting of the Sourcewise Governing Board, and provide the service provider with a copy of the published agenda.

1. The hearing before the Sourcewise Governing Board shall consist of:
a) Receipt and review of all previously submitted documents concerning the appeal;
b) Submission in writing by the service provider of any additional information or documentation supporting the service provider's position;
c) An oral presentation by the service provider, not to exceed thirty (30) minutes; and
d) An oral presentation by the CEO of Sourcewise and/or Sourcewise staff, not to exceed thirty (30) minutes.

2. At the conclusion of the hearing, the Governing Board of Sourcewise shall vote to accept or deny the service provider's appeal.
a) If the appeal is denied, the Governing Board of Sourcewise shall notify the service provider in writing of the reason(s) the appeal was denied, including a statement that all appeal procedures to Sourcewise and its Governing Board have been exhausted, and of the service provider's right to appeal the Governing Board's decision to the California Department of Aging. Such notification shall include a copy of Sections 7700 through 7710 of Title 22 of the California Code of Regulations, which contains the process for appealing the determination to the California Department of Aging.

Exhibit F: Sourcewise Provider Manual
DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Grievance Form
To help us ensure that we understand your grievance and can respond promptly, please return your completed form to:

Contract#:

SOURCEWISE
Attn: Joe Flynn
Chief Operating Officer
3100 De La Cruz Blvd. Suite 310
Santa Clara, CA 95054
Contact Name: _________________________ _
Provider Name: ________________________ _
Address: ___________________________ _
City, State, Zip Code: ____________________ _
Contact Number: _______________________ _
Please describe your grievance:

Be as specific as possible. Include any names or dates as this may help resolve your grievance.

You can use the back of this form or attach additional information.

Please describe how you would like to see your grievance resolved:

Signature ________________________ Date ________ _

STATE OF CALIFORNIA

DEPARTMENT OF AGING

EQUIPMENT JUSTIFICATION FORM
CDA 7037 (REV /2022)
California Department of Aging Equipment Justification Form Instructions: Please answer the questions below; the responses must coincide with the budget.

AAA Name and Number:

AAA Procurement Contact:
:

Question Response
Please describe the item or
items to be purchased
Select the procurement
method(s) used to select vendor
(i.e., price quotes, competitive
bids, auction site). Check all that
apply.

Price Quotes
Competitive bids
Auction
Other (Describe):

Where will the equipment be
located?
Site name:
:

Please select the AAA program
the equipment will be funded by.

If more than one, please select
other and list all applicable
programs.

Program:

Other:

Please give a detailed justification
why the equipment is needed, and
how it will be used to benefit the
program.

The year the last time this item
was purchased and the quantity.

The expected refresh cycle of this
item.

Will the equipment be used solely
by the specified AAA Program(s)
from which the purchase will be
funded?
Yes No
If requesting a vehicle, provide a
list of the existing fleet vehicles,
and the reason the existing fleet
cannot meet ongoing program
needs.

DocuSign Envelope ID: FDC119A5-43CA-4631-9D5C-479C0FA68947 Exhibit G: Equipment Justification Form 12 Funding Source
and cost
of each item.
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California
partment
fAGING
City of Santa Clara
Agenda Report
1500 Warburton Avenue
Santa Clara, CA 95050
santaclaraca.gov
@SantaClaraCity
23-836 Agenda Date: 10/10/2023

REPORT TO COUNCIL

SUBJECT
Action to Accept Federal Community Project Funding for the De La Cruz, Lick Mill, Scott Boulevards Bicycle Improvements Project, and the Anna Drive Neighborhood Flood Protection Project; Authorize the City Manager to Execute All Documents Related to Accepting Federal Funding, and Approve the Related Budget Amendments

COUNCIL PILLAR
Deliver and Enhance High Quality Efficient Services and Infrastructures.

BACKGROUND
In early 2021, the United States House Appropriations Committee elected to bring back the Community Project Funding (CPF) program, also known as Congressionally Directed Spending (CDS), which allows annual member-requested projects as part of the Federal appropriations process. CPF projects are solicited and selected by the members of Congress and sent to the Federal Appropriations Committee for consideration on an annual basis. If selected by the Appropriations Committee, the individual scope and funding amount for each of the CPF/CDS projects is then written into law via the Federal Annual Appropriations bill.

In 2021 and 2022 the City submitted requests for CPF to Congressman Ro Khanna for the De La Cruz, Lick Mill, and Scott Boulevards Bicycle Improvements Project and the Anna Drive Neighborhood Flood Protection Project. Both projects were submitted for consideration to the Federal Appropriations Committee and approved for Federal funding (Attachments 1 and 2).

DISCUSSION
De La Cruz, Lick Mill, and Scott Boulevards Bicycle Improvements Project The De La Cruz, Lick Mill, and Scott Boulevards Bicycle Improvements Project (Bicycle Improvements Project) scope of work includes traffic analyses and design concept analysis, public outreach, design, and construction of bicycle facilities on: 1) De La Cruz Boulevard from Montague Expressway to Trimble Road, 2) Lick Mill Boulevard from Tasman Drive to Montague Expressway, and 3) Scott Boulevard from the Calabazas Creek Trail to Saratoga Avenue (Attachment 3, Bicycle Improvements Project Location Map). The goal is to enhance safety, improve mobility, and reduce vehicle emissions by implementing high priority bicycle projects identified in the Santa Clara Bicycle Plan while connecting local residential communities, schools, libraries, and major employers within Santa Clara. It is important to note that as part of the design concept analysis, vehicle lane and/or parking removals will be studied, and neighborhood outreach conducted.

The Bicycle Improvements Project was allocated federal funding in the amount of $2,725,000. The City is required to provide a non-federal local match of 11.47 percent ($354,000), resulting in a total project budget of $3,079,000. It is anticipated that study and design for the Bicycle Improvements City of Santa Clara Page 1 of 4 Printed on 10/5/2023
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23-836 Agenda Date: 10/10/2023
Project will be completed and authorized for construction by the federal fund administrator - the California Department of Transportation (Caltrans) - in early 2025. All construction work is required to be completed prior to the federal fund expenditure deadline of September 2030.

Anna Drive Neighborhood Flood Protection Project
In 2015, the City completed a Citywide Storm Drain Master Plan, which identified the need for citywide storm drain improvements. Overall needs were separated into four priority levels based on frequency of flooding events and flooding near critical facilities and infrastructure. The Anna Drive Neighborhood Flood Protection Project is identified as one of the higher priority projects and the scope of work generally consists of upsizing approximately 4,000 linear feet of storm drain pipelines ranging in diameters from 12-inch to 48-inch on Anna Drive between San Tomas Aquino Creek and McCormick Drive (Attachment 4).

The Anna Drive Neighborhood Flood Protection Project was allocated federal funding in the amount of $3,000,000. The City is required to provide a non-federal local match of 11.47 percent ($400,000) resulting in a total project budget of $3,400,000. It is anticipated that design for the Flood Protection Project will be completed and authorized for construction by the federal fund administrator - the California Department of Transporation (Caltrans) - in early 2026. All construction work is required to be completed prior to the federal fund expenditure deadline of September 2031.

Federal Funding Documents
Per CPF program requirements, Caltrans has been designated as the funding administrator for CPF funding in California. Staff is requesting that Council authorize the City Manager to execute all documents related to accepting Federal Funding for both the De La Cruz, Lick Mill, and Scott Boulevards Bicycle Improvements Project and the Anna Drive Neighborhood Flood Protection Project.

ENVIRONMENTAL REVIEW
The action being considered does not constitute a “project” within the meaning of the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15378(a) as it has no potential for resulting in either a direct physical change in the environment, or a reasonably foreseeable indirect physical change in the environment.

FISCAL IMPACT
The table below provides a breakdown of the Federal and local funds for both projects.

De La Cruz, Lick Mill, and
Scott Boulevards Bicycle
Improvements Project
Anna Drive
Neighborhood Flood
Protection Project
Federal Community Project
Funding
$2,725,000 $3,000,000
Required Local Match (minimum of

11.47%)
$354,000 $400,000
Total Project Budget $3,079,000 $3,400,000
Staff is requesting appropriation of $3,079,000 for the De La Cruz, Lick Mill, and Scott Boulevards Bicycle Project and $3,400,000 for the Anna Drive Neighborhood Flood Protection Project. These City of Santa Clara Page 2 of 4 Printed on 10/5/2023
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23-836 Agenda Date: 10/10/2023
funding amounts will support the study, design, and construction of these projects. Funding for these projects is being provided by Federal Community Project Funding and local City funds. For the De La Cruz, Lick Mill, and Scott Boulevards Bicycle Improvements Project, local match funds are available in the Streets and Highways Capital Fund - Pedestrian and Bicycle Enhancement Facilities Project that sets aside local matching funds for grant applications. For the Anna Drive Neighborhood Flood Protection Project, local match funds are available in the Storm Drain Capital Fund to be reallocated from the Laurelwood Pump Station Rehabilitation Project, which was funded by the General Fund Capital Project Reserve and has remaining unused funds. The table below summarizes the recommended budget amendments needed for each project.

Budget Amendment
FY 2023/24
Current Increase/
(Decrease)
Revised
Streets and Highways Capital Fund
Revenues
Other Agencies Revenue (Federal
Community Project Funding 2022)
$19,712,116 $2,725,000 $22,437,116
Expenditures
Pedestrian and Bicycle Enhancement
Facilities Project
$1,520,480 ($354,000) $1,166,480
De La Cruz, Lick Mill, and Scott Blvds Bicycle
Improvements (New Project)
$0 $3,079,000 $3,079,000
Storm Drain Capital Fund
Revenues
Other Agencies Revenue (Federal
Community Project Funding 2023)
$0 $3,000,000 $3,000,000
Expenditures
Laurelwood Pump Station Rehabilitation $850,843 ($400,000) $450,843 Anna Drive Neighborhood Flood Protection
Project (New Project)
$0 $3,400,000 $3,400,000

COORDINATION
This report has been coordinated with the Finance Department and City Attorney’s Office.

PUBLIC CONTACT
Public contact was made by posting the Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email [email protected] <mailto:[email protected]> or at the City of Santa Clara Page 3 of 4 Printed on 10/5/2023
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23-836 Agenda Date: 10/10/2023
public information desk at any City of Santa Clara public library.

RECOMMENDATION

1. Accept Federal Funding Under the Community Project Funding administered by the California Department of Transportation and Authorize the City Manager to Execute All Documents Related to Accepting Federal Funding; and

2. Approve the following FY 2023/24 budget amendments:

A. In the Streets and Highway Capital Fund, increase the Other Agencies Revenue estimate in the amount of $2,725,000 to recognize Federal Community Project funding, decrease the Pedestrian and Bicycle Enhancement Facilities Project in the amount of $354,000, and establish the De La Cruz, Lick Mill, and Scott Boulevards Bicycle Improvements Project in the amount of $3,079,000 (five affirmative Council votes required to appropriate additional revenue ); and
B. In the Storm Drain Capital Fund, increase the Other Agencies Revenue estimate in the amount of $3,000,000 to recognize Federal Community Project funding, decrease the Laurelwood Pump Station Rehabilitation Project in the amount of $400,000, and establish the Anna Drive Neighborhood Flood Protection Project in the amount of $3,400,000 (five affirmative Council votes required to appropriate additional revenue ).

Reviewed by: Craig Mobeck, Director of Public Works
Approved by: Jōvan D. Grogan, City Manager

ATTACHMENTS

1. Federal Allocation for Highway Infrastructure Funding 2022

2. Federal Allocation for Highway Infrastructure Funding 2023

3. Bicycle Improvements Project Location Maps

4. Anna Drive Neighborhood Flood Protection Project Location Map City of Santa Clara Page 4 of 4 Printed on 10/5/2023
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Memorandum
Subject: ACTION: Allocation of Highway Infrastructure Date: June 28, 2022 Programs Projects designated in Division L of the
Consolidated Appropriations Act, 2022 In Reply
[CFDA No. 20.205] Refer to: HISM-40
From: Peter J. Stephanos
Director, Office of Stewardship, Oversight,
and Management
To: Brian R. Bezio
Chief Financial Officer
Division Administrator
The Consolidated Appropriations Act, 2022 (Public Law 117-103) appropriates a total of $2,444,927,823 for Highway Infrastructure Programs (HIP) from the General Fund of the Treasury for fiscal year (FY) 2022. Of such amount, $846,927,823 is set aside for “Community Project Funding / Congressionally Directed Spending.” The project descriptions for the 309 projects can be found in the “Community Project Funding / Congressionally Directed Spending” table in the Joint Explanatory Statement incorporated by reference in Division L of the Consolidated Appropriations Act, 2022. State departments of transportation (DOTs) are the recipients for 307 projects totaling $845,719,823 and the Office of Federal Lands Highway (FLH) was allotted funding for two Gila River Indian Community projects totaling $1,208,000. These funds are in addition to any other funds, including contract authority, provided in FY 2022.

With this memorandum, we are allocating $845,719,823 for 307 projects to the States, as indicated in the attachment to this memorandum, to be administered in the Fiscal Management Information System (FMIS) (FMIS program code Y928; DELPHI fund value 1550574B50 050). This funding is not subject to any obligation limitation that applies to Federal-aid contract authority.

These funds remain available for obligation through September 30, 2025. Any such amounts not obligated on or before September 30, 2025, shall expire. Once the period for obligation has expired, these funds will only remain available for adjusting and liquidating obligations as authorized in accordance with title 31, United States Code (U.S.C.), section 1553.

U.S. Department
of Transportation
Federal Highway
Administration

PETER JOHN
STEPHANO$
Digitally signed by PETER JOHN

STEPHANOS
Date: 2022.06.28 13:25:36 -04'00'
2 Obligated earmark balances are available for expenses properly charged to the account and incurred until September 30, 2030. After that date, any unexpended balances of obligated earmark funds shall be cancelled in accordance with 31 U.S.C. 1552 and shall no longer be available for obligation or expenditure.

Demo IDs have been assigned for each project to properly track these funds to ensure that they are only obligated and expended for the specific project for which they were designated.

Each project has been assigned a unique Demo ID that links the funding to the specific project description as listed in the Joint Explanatory Statement accompanying the Consolidated Appropriations Act, 2022. Since the project description defines the scope of work on which the funds may be legally expended, the funding for the project can only be utilized for the activities within the scope and physical limits of the project as defined by the project description. The Demo IDs under which these funds are being distributed are also included in the attachment to this memorandum.

Except as otherwise provided, these funds are to be administered as if apportioned under chapter 1 of title 23, U.S.C. Therefore, these projects are to be administered as title 23 projects in accordance with the applicable statutory and regulatory provisions contained in title 23, U.S.C. and Code of Federal Regulations (CFR), as well as other applicable Federal requirements, such as the National Environmental Policy Act (42 U.S.C. 4321, et seq.) and the Disadvantaged Business Enterprise Program. The State, through its DOT in accordance with 23 U.S.C. 302, is the direct recipient of these funds and is responsible for administration of these funds. If the State DOT acts as a pass-through entity of Federal assistance, the State DOT maintains the passthrough responsibilities specified in 2 CFR 200.332.1 The Federal share for these State projects is governed by 23 U.S.C. 120, as amended by the Infrastructure Investment and Jobs Act (IIJA) (Public Law 117-58, also known as the “Bipartisan Infrastructure Law”) (BIL). It is generally 80 percent (See 23 U.S.C. 120(b)).

The Federal share for projects on the Interstate System is 90 percent unless the project adds lanes that are not high-occupancy-vehicle or auxiliary lanes (See 23 U.S.C. 120(a)). For projects that add single occupancy vehicle capacity, that portion of the project will revert to the 80 percent level. An upward sliding scale adjustment is available to States having public lands (Sliding Scale Rates In Public Land States). States may use a lower Federal share on Federal-aid projects as provided in 23 U.S.C. 120(h). These funds may not be used as the non-Federal match for other Federal programs unless there is specific statutory authority (2 CFR 200.306(b)(5)). The Consolidated Appropriations Act, 2022, does not provide authority for use of these funds as a non-Federal match for other Federal programs, including Federalaid programs under title 23, U.S.C.

Generally, Project Agreements should not be modified to replace one Federal fund category with another unless specifically authorized by statute (23 CFR 630.110(a)). For additional information on earmarked funds, see Q&As on Obligation of Earmarked Funds for FederalAid Projects. 1 Tribal projects funded from these amounts are to be administered as if allocated under chapter 2 of title 23, U.S.C.
3 Earmarked funds shall not participate in costs incurred prior to the date of project agreement (23 CFR 630.106(b)).

By copy of this memorandum, we request that the Office of the Chief Financial Officer:
1) create the Demo IDs identified in the attached table, and 2) process these allocations.

If there are any questions, please contact Tony DeSimone at 317-226-5307 or by email at [email protected] or Amy Inglis at 605-776-1009 or by email at [email protected].

Attachment
4 FHWA: HIPA: AINGLIS: 06/27/2022
S:\ HIPA10\Correspondence\FY_2022\Legislative Projects - Demos\20220627 Allocation of HIP Projects
cc:

HISM-1 (Stephanos, Peter)
HISM-40 (Marrero, Moises; Bartz, David; Amy Inglis, DeSimone, Anthony) HIF (Young, Charlena; Sullivan, Amy)
HCF ([email protected]; Sim, Miranda; Kwok, Lily) HPLS (Arnade, Tim; Lomax, Brian; Zaidi, Alina; Dane, Heather) FHWA-#ALLDA-OfficialMailbox
FHWA-#ALLDFS-OfficialMailbox
FHWA Financial Management-All
Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total AL AL207 Baldwin County - Eastern Shore Trail construction 633,050 633,050 633,050 633,050 AL AL208 Fairground Road Expansion 702,941 702,941 702,941 702,941 AL AL209 Millry Road Resurfacing 265,000 265,000 265,000 265,000 Alabama 1,600,991 1,600,991 1,600,991
AK AK177 Kotzebue Cape Blossom Road 27,662,000 27,662,000 27,662,000 27,662,000 Alaska 27,662,000 27,662,000 27,662,000
AZ AZ078 Highline Canal Recreational Path Lighting Replacement, Guadalupe 501,824 501,824 501,824 501,824 AZ AZ079 Gila River Indian Community Traffic Sign Replacement *See Note 1 915,000 915,000 0 0 AZ AZ080 32nd Street and Thomas Road Intersection Safety Improvements 960,000 960,000 960,000 960,000 AZ AZ081 Shelby Drive Business Development Improvements to Roadways 500,000 500,000 500,000 500,000 AZ AZ082 Snowflake Street Light and Sidewalk Improvements to SR 77 1,200,000 1,200,000 1,200,000 1,200,000 AZ AZ083 SR 87 Capacity and Safety Improvements - Gila River Indian Community *See Note 1 293,000 293,000 0 0 Arizona 4,369,824 3,161,824 3,161,824
AR AR147 Future I-57 Corridor 5,000,000 5,000,000 5,000,000 AR AR148 Future I-69 Corridor Improvements 18,000,000 18,000,000 18,000,000 18,000,000 AR AR149 Highway 67 Corridor Improvements 18,000,000 18,000,000 18,000,000 18,000,000 AR AR150 Future I-49 18,000,000 18,000,000 18,000,000 18,000,000 Arkansas 59,000,000 59,000,000 54,000,000
CA CA870 Tillotson Parkway Extension 320,000 320,000 320,000 320,000 CA CA871 Interstate 15 Smart Freeway Pilot Project 5,000,000 5,000,000 5,000,000 5,000,000 CA CA872 Bradley Road Bridge Over Salt Creek 5,000,000 5,000,000 5,000,000 5,000,000 CA CA873 Concord Smart Signals Project 1,200,000 1,200,000 1,200,000 1,200,000 CA CA874 Iron Horse Trail Bridge, Nature Park, and Pedestrian Safety Project 350,000 350,000 350,000 350,000 CA CA875 Danville Townwide Traffic Signal Modernization/ITS Project 1,000,000 1,000,000 1,000,000 1,000,000 CA
CA876 Traffic and Safety Improvement Along the Alameda de las Pulgas Corridor 2,000,000 2,000,000 2,000,000 2,000,000
CA CA877 Santa Clarita Circulation and Safety Improvement 1,500,000 1,500,000 1,500,000 1,500,000 CA CA878 Henry Mayo Hospital Ingress and Egress Access Improvement 1,120,000 1,120,000 1,120,000 1,120,000 CA CA879 State Route 91 Improvement Project 3,000,000 3,000,000 3,000,000 3,000,000 CA CA880 Pennsylvania Avenue Widening Project, Beaumont 1,500,000 1,500,000 1,500,000 1,500,000 CA
CA881 County of Los Angeles Rosemead Boulevard Complete Street Improvements 1,500,000 1,500,000 1,500,000 1,500,000
CA CA882 US 101/SR 92 Area Improvement Project 1,000,000 1,000,000 1,000,000 1,000,000 CA CA883 La Media Improv. Siempre Viva to Truck Rte, San Diego, CA 400,000 400,000 400,000 400,000 CA CA884 Telfair Avenue Multi-Modal Bridge Over Pacoima Wash Project 5,000,000 5,000,000 5,000,000 5,000,000 CA CA885 Bicycle and Pedestrian Safety Near Woodside High School 800,000 800,000 800,000 800,000 CA
CA886 Accessible Recreational Trails at Rockville Trails Preserve (Solano County, California) 431,250 431,250 431,250 431,250
CA
CA887 Accessible Pedestrian Pathways and Parking at Lake Solano County Park 867,648 867,648 867,648 867,648
CA CA888 E. Sir Francis Drake Blvd Gap Closure 700,000 700,000 700,000 700,000 CA CA889 Hammond Trail Bridge Replacement 5,000,000 5,000,000 5,000,000 5,000,000 CA CA890 California State University, Fullerton Titan Gateway Bridge 5,000,000 5,000,000 5,000,000 5,000,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total CA CA891 Golden Avenue Bridge Replacement Project 2,200,000 2,200,000 2,200,000 2,200,000 CA
CA892 City of Carlsbad's Carlsbad Barrio Street Lighting and Traffic Circles Project 5,000,000 5,000,000 5,000,000 5,000,000
CA CA893 Doheny Village Connectivity Improvements 1,870,000 1,870,000 1,870,000 1,870,000 CA CA894 Sacramento Vision Zero School Safety Project 2,200,000 2,200,000 2,200,000 2,200,000 CA CA895 Southport Levee Recreation Trail 1,800,000 1,800,000 1,800,000 1,800,000 CA CA896 La Verne Gold Line Station Pedestrian Bridge 4,000,000 4,000,000 4,000,000 4,000,000 CA CA897 City of Bishop Streets and Sidewalk Improvements 1,000,000 1,000,000 1,000,000 1,000,000 CA CA898 City of Highland Victoria Avenue Improvements 2,000,000 2,000,000 2,000,000 2,000,000 CA CA899 City of Needles First Year Paving Replacement Phase 3 757,803 757,803 757,803 757,803 CA CA900 City of Hesperia Maple Avenue Street Improvements 2,000,000 2,000,000 2,000,000 2,000,000 CA CA901 City of Watsonville, Lee Road Trail Project Phase 1 1,000,000 1,000,000 1,000,000 1,000,000 CA
CA902 Crow Canyon Road Iron Horse Trail Bicycle-Pedestrian Overcrossing 2,000,000 2,000,000 2,000,000 2,000,000
CA CA903 Safe Routes to Schools Mini-grant Program, Alameda 1,700,000 1,700,000 1,700,000 1,700,000 CA CA904 Kelseyville Sidewalk Project 450,000 450,000 450,000 450,000 CA
CA905 Avenue 95/96 Farm to Market Corridor Repairs, Terra Bella to Pixley, Tulare County, CA 3,000,000 3,000,000 3,000,000 3,000,000 CA CA906 Mt. Whitney Avenue Complete Streets 3,000,000 3,000,000 3,000,000 3,000,000 CA CA907 Bayshore Bikeway, Barrio Logan Segment 2,150,000 2,150,000 2,150,000 2,150,000 CA CA908 Bayshore Bikeway Segment 5 300,000 300,000 300,000 300,000 CA
CA909 24th Street First and Last Mile Connections to Trolley Station, National City 3,332,781 3,332,781 3,332,781 3,332,781
CA CA910 24th Street Trolley Pedestrian Bridge Feasibility Study, National City 294,700 294,700 294,700 294,700 CA CA911 De La Cruz Blvd, Lick Mill Blvd, and Scott Blvd Bicycle Projects 2,725,000 2,725,000 2,725,000 2,725,000 CA CA912 South Milpitas Boulevard Extension Bridge 3,000,000 3,000,000 3,000,000 3,000,000 CA
CA913 Pedestrian and Safe Routes to School Improvements in SNAIL and Braly Corners Neighborhoods 880,000 880,000 880,000 880,000 CA CA914 Highways to Boulevards Regional Study 480,000 480,000 480,000 480,000 CA CA915 7th Street Connection Project 2,000,000 2,000,000 2,000,000 2,000,000 California 91,829,182 91,829,182 91,829,182
CO CO130 SH 93 Widening and Relocation Design, City of Golden 2,320,000 2,320,000 2,320,000 2,320,000 CO CO131 Commerce City Quiet Zones 615,000 615,000 615,000 615,000 CO CO132 Glenwood Springs South Bridge Project 1,000,000 1,000,000 1,000,000 1,000,000 Colorado 3,935,000 3,935,000 3,935,000
CT CT189 East Industrial Road Reconstruction (Branford) 2,250,000 2,250,000 2,250,000 2,250,000 CT CT190 Town of Southbury Pedestrian Safety Improvements 444,946 444,946 444,946 444,946 CT CT191
West Avon Road, Country Club Road, Scoville Road Sidewalk Replacement in the Town of Avon 424,000 424,000 424,000 424,000 CT CT192 Norwalk Safe Sidewalks, Crossings, and Trails Project 1,400,000 1,400,000 1,400,000 1,400,000 CT CT193 City of Stamford Safe Routes to Schools and Access to Public Transit Facilities 2,000,000 2,000,000 2,000,000 2,000,000 CT CT194 Reconstruction of Route 34, Project 36-184 5,000,000 5,000,000 5,000,000 5,000,000 Connecticut 11,518,946 11,518,946 11,518,946
DE DE039 Munchy Branch Road Multi-Use Trail 1,120,000 1,120,000 1,120,000 1,120,000 Delaware 1,120,000 1,120,000 1,120,000
Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total FL FL389 River Road Regional Interstate Connector South Phase Design 1,000,000 1,000,000 1,000,000 1,000,000 FL FL390 Town of Windermere Safe Route to School Project Phase 1 760,000 760,000 760,000 760,000 FL FL391 Dixie Highway Corridor Improvements 600,000 600,000 600,000 600,000 FL FL392 Lake Wales Street Resurfacing, ADA, and Street Tree Improvements 800,000 800,000 800,000 800,000
Florida 3,160,000 3,160,000 3,160,000
GA GA347
Cass-White Road from Busch Drive to Great Valley Parkway- Phase II 5,000,000 5,000,000 5,000,000 5,000,000 GA GA348 Dried Indian Creek Corridor Protection and Connection Initiative 900,000 900,000 900,000 900,000 GA GA349 Fairview Road Multi-use Trail, Newton County 800,000 800,000 800,000 800,000 GA GA350 Flat Shoals Parkway (SR 155) Sidewalk Improvements - Columbia Drive to Flakes Mill Road 800,000 800,000 800,000 800,000 GA GA351 Dekalb County, Pleasantdale Road Pedestrian Improvements 600,000 600,000 600,000 600,000 GA GA352 Chattahoochee RiverLands Pilot Project, Environmental Review & Final Design for Phase II 2,500,000 2,500,000 2,500,000 2,500,000 GA GA353 Cumberland Multi-Modal Path 1,700,000 1,700,000 1,700,000 1,700,000 GA GA354 Derrydown Way Complete Streets Project 600,000 600,000 600,000 600,000 GA GA355 Big Shanty Widening, Kennesaw, Georgia 2,000,000 2,000,000 2,000,000 2,000,000 GA GA356 City of Alpharetta- Bus Shelter Construction 150,000 150,000 150,000 150,000 GA GA357 Atlanta BeltLine 5,000,000 5,000,000 5,000,000 5,000,000 GA GA358 Truman Linear Park Trail 3,000,000 3,000,000 3,000,000 3,000,000 Georgia 23,050,000 23,050,000 23,050,000
HI HI048 County of Kauai - Level 3 Electric Vehicle Charging Network 905,000 905,000 905,000 905,000 HI HI049 City and County of Honolulu - Oahu Electric Vehicle Chargers 1,960,000 1,960,000 1,960,000 1,960,000 HI HI050 County of Maui - Honoapiilani Highway Realignment Project 23,000,000 23,000,000 23,000,000 23,000,000 Hawaii 25,865,000 25,865,000 25,865,000
IL IL578
St. Clair County - Greenmount Road from Lebanon Avenue to South of Frank Scott Parkway Widening 2,500,000 2,500,000 2,500,000 2,500,000 IL IL579
St. Clair County - Greenmount Road from Route 161 to Lebanon Avenue Widening 2,500,000 2,500,000 2,500,000 2,500,000 IL IL580
Barrington - Pedestrian Grade Separation at Main Street and the Canadian National Railroad 500,000 500,000 500,000 500,000 IL IL581 Deer Park Boulevard - Road Program 614,000 614,000 614,000 614,000 IL IL582 Iron Bridge Road to MacArthur Boulevard Extension 3,000,000 3,000,000 3,000,000 3,000,000 IL IL583 Grand Avenue and George Street Traffic Safety Enhancement 650,000 650,000 650,000 650,000 IL IL584 US Route 6 Multi-Use Path Extension 900,000 900,000 900,000 900,000 IL IL585
National Parkway and Higgins Road (IL 72) Pedestrian Signal Improvements 200,000 200,000 200,000 200,000 IL IL586 Lincoln Avenue Reconstruction 3,500,000 3,500,000 3,500,000 3,500,000 IL IL587 Lincoln Park ADA Accessibility Improvements 1,000,000 1,000,000 1,000,000 1,000,000 IL IL588 Wolf Road Sidewalk, City of Prospect Heights 1,126,734 1,126,734 1,126,734 1,126,734 IL IL589
St. Clair County - Frank Scott Parkway East/Thouvenot Lane Widening 5,000,000 5,000,000 5,000,000 5,000,000 IL IL590 West Grand Avenue - Highway/Rail Grade Separation 3,100,000 3,100,000 3,100,000 3,100,000 IL IL591
Alton Great Streets - Phase 1 Implementation: Broadway between Ridge Street and Third Street 500,000 500,000 500,000 500,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total IL IL592 Randall Road from Alexandra Boulevard to Polaris Drive/Acorn Lane 8,000,000 8,000,000 8,000,000 8,000,000 IL IL593 Chicago - State/Lake Loop Elevated Station Improvements 1,000,000 1,000,000 1,000,000 1,000,000 IL IL594 Decatur/Macon County Reas Bridge Replacement Project 3,500,000 3,500,000 3,500,000 3,500,000 IL IL595 Marion Main, Bainbridge, Penecost Streets Project 600,000 600,000 600,000 600,000 Illinois 38,190,734 38,190,734 38,190,734
IN IN264 Marquette Greenway Trail/Cline Avenue to Bridge Street 682,080 682,080 682,080 682,080 Indiana 682,080 682,080 682,080
IA IA247 Tower Terrace Road Corridor (Phase 7 Improvements) 5,000,000 5,000,000 5,000,000 5,000,000 IA IA248 Reconstruction of Iowa Highway 38 2,000,000 2,000,000 2,000,000 2,000,000 IA IA249
Mahaska Oskaloosa Driving Economic Success (MODES) Planning Study 850,000 850,000 850,000 850,000 IA IA250 Raccoon River East Pedestrian Bridge 1,000,000 1,000,000 1,000,000 1,000,000 IA IA251
Bridge Replacement - PPCB on County Highway R57 over North River, FHWA# 335290 1,600,000 1,600,000 1,600,000 1,600,000 IA IA252 Chaplain Schmitt Island Trail Connection 615,000 615,000 615,000 615,000 IA IA253 Scott County Bridge Replacement 600,000 600,000 600,000 600,000 Iowa 11,665,000 11,665,000 11,665,000
KS KS137 Passing Lanes in Edwards and Ford Counties 6,000,000 6,000,000 6,000,000 6,000,000 KS KS138 Passing Lanes in Kiowa, Meade, and Pratt Counties 6,000,000 6,000,000 6,000,000 6,000,000 Kansas 12,000,000 12,000,000 12,000,000
KY KY187
Improved Access via Economy Road from KY-52 to the Central Kentucky Regional Airport 5,000,000 5,000,000 5,000,000 5,000,000 KY KY188
Breckinridge County: Improve KY 86 from Jesse Priest Road to Rosetta Corners 2,000,000 2,000,000 2,000,000 2,000,000 KY KY189
Washington County: Improve U.S. 150 from KY 1872 to Mayfield Lane 2,000,000 2,000,000 2,000,000 2,000,000
KY KY190 Sidewalk Rehabilitation, Louisville, KY 1,000,000 1,000,000 1,000,000 1,000,000 Kentucky 10,000,000 10,000,000 10,000,000
LA LA214 US 190: LA 437 - US 190 BUS Bridge Replacement Project 5,000,000 5,000,000 5,000,000 5,000,000 LA LA215 Re-Building University Avenue: Gateway to Our Future 5,000,000 5,000,000 5,000,000 5,000,000 LA LA216
City of Ruston, Louisiana E. Kentucky Ave: Safety and Capacity Improvements Project 5,000,000 5,000,000 5,000,000 5,000,000 LA LA217 Morrison Road Improvements, New Orleans, LA 5,000,000 5,000,000 5,000,000 5,000,000 Louisiana 20,000,000 20,000,000 20,000,000
ME ME089 Augusta: Bangor Street Improvements 4,800,000 4,800,000 4,800,000 4,800,000 ME ME090 Camden - US Route 1 Reconstruction 5,000,000 5,000,000 5,000,000 5,000,000 ME ME091 Dover-Foxcroft, Dover Bridge #5118 Replacement 7,200,000 7,200,000 7,200,000 7,200,000 ME ME092 Edgecomb to Boothbay - State Route 27 8,000,000 8,000,000 8,000,000 8,000,000 ME ME093 Livermore Falls - State Route 17 Reconstruction 4,000,000 4,000,000 4,000,000 4,000,000 ME ME094 Newport - US Route 2 4,000,000 4,000,000 4,000,000 4,000,000 ME ME095 Pittsfield - State Route 11 Rehabilitation 3,200,000 3,200,000 3,200,000 3,200,000 ME ME096 Presque Isle - US Route 1 Reconstruction 1,200,000 1,200,000 1,200,000 1,200,000 ME ME097 Searsport - US Route 1 Reconstruction 9,200,000 9,200,000 9,200,000 9,200,000 ME ME098 Vassalboro - State Route 32 800,000 800,000 800,000 800,000 Maine 47,400,000 47,400,000 47,400,000
MD MD170 Fleet Electrification Anne Arundel County 5,000,000 5,000,000 5,000,000 5,000,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total MD MD171 Cecil County Belvidere Road Expansion 500,000 500,000 500,000 500,000 MD MD172
Frederick East Street Rails with Trails: Liberty Road Bridge Crossing 535,000 535,000 535,000 535,000
MD MD173
Garrett Trails - Eastern Continental Divide Loop Trail (Otto Lane - New Germany) 975,000 975,000 975,000 975,000
MD MD174
MD 4 Corridor and Thomas Johnson Bridge Capacity Improvements Project 1,000,000 1,000,000 1,000,000 1,000,000 MD MD175 Reconstruction of MD 97 at Montgomery Hills 1,000,000 1,000,000 1,000,000 1,000,000 MD MD176 Route 218 Suitland Road Improvements 2,500,000 2,500,000 2,500,000 2,500,000 MD MD177 Russell and Monroe Street Ramp Bridge Replacements 1,000,000 1,000,000 1,000,000 1,000,000 Maryland 12,510,000 12,510,000 12,510,000
MA MA270
Design and Construction of the Wakefield Broadway Commuter Rail Crossing 1,200,000 1,200,000 1,200,000 1,200,000 MA MA271 Border to Boston Trail Engineering and Design 1,200,000 1,200,000 1,200,000 1,200,000 MA MA272 Separated Bicycle Lane Network Build Out, Cambridge 958,218 958,218 958,218 958,218 MA MA273 Assabet River Rail Trail extension - Stow 750,000 750,000 750,000 750,000 MA MA274 Wellington Greenway Phase IV 500,000 500,000 500,000 500,000 MA MA275 Chris Walsh Aqueduct Trail Connectivity Project 220,000 220,000 220,000 220,000 MA MA276 City of Northampton - Rocky Hill Greenway Shared Use Trail 3,600,000 3,600,000 3,600,000 3,600,000 Massachusetts 8,428,218 8,428,218 8,428,218
MI MI323
Emmet County Road Commission - Lake Shore Drive Reconstruction Project 1,440,000 1,440,000 1,440,000 1,440,000 MI MI324 Beck Road Business Corridor Improvement Project 4,797,600 4,797,600 4,797,600 4,797,600 MI MI325 Pinckney Multi-Modal Pathway and Connectors 2,000,000 2,000,000 2,000,000 2,000,000 MI MI326 Grandville Avenue Project 700,000 700,000 700,000 700,000 MI MI327 Michigan Avenue Corridor Improvement 1,000,000 1,000,000 1,000,000 1,000,000 MI MI328 South Westnedge Avenue Reconstruction 500,000 500,000 500,000 500,000 Michigan 10,437,600 10,437,600 10,437,600
MN MN268 Annandale Highway 24 and Hemlock Intersection 2,000,000 2,000,000 2,000,000 2,000,000 MN MN269 Highway 212 Rural Freight Mobility and Safety: Carver County 2,500,000 2,500,000 2,500,000 2,500,000 MN MN270 Stearns County Bridge 6819 along County State Aid Highway (CSAH) 75 1,000,000 1,000,000 1,000,000 1,000,000 MN MN271 Extension of CSAH 116/Fletcher Bypass, City of Rogers, MN 3,501,040 3,501,040 3,501,040 3,501,040 MN MN272 Highway 5 Mobility and Lake Minnewashta Causeway Bridge, Carver County, MN 2,000,000 2,000,000 2,000,000 2,000,000 MN MN273 City of Jordan US 169 Multi-Use Trail Underpass 1,124,000 1,124,000 1,124,000 1,124,000 MN MN274 Bruce Vento Trail Extension 1,300,000 1,300,000 1,300,000 1,300,000 MN MN275 Central Greenway Regional Trail Improvements 1,000,000 1,000,000 1,000,000 1,000,000 MN MN276 Moorhead Center Avenue Reconstruction 500,000 500,000 500,000 500,000 Minnesota 14,925,040 14,925,040 14,925,040
MS MS227
SR 7 and University Avenue in Oxford Roundabout Interchange Lafayette County 5,000,000 5,000,000 5,000,000 5,000,000 MS MS228 City of Hattiesburg 4th Street Sidewalk Project 500,000 500,000 500,000 500,000 MS MS229 Artesia Road Connector 2,500,000 2,500,000 2,500,000 2,500,000 MS MS230 Interstate 10 Corridor Improvements 4,500,000 4,500,000 4,500,000 4,500,000 MS MS231 Lefleur's Bluff Education and Tourism Complex 1,000,000 1,000,000 1,000,000 1,000,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total MS MS232 Rankin County I-20 Connector Loop 5,000,000 5,000,000 5,000,000 5,000,000 MS MS233 The Morgantown Road Safety Improvement Project 2,400,000 2,400,000 2,400,000 2,400,000 MS MS234 Bozeman-Reunion Crossing Interconnectivity System 4,000,000 4,000,000 4,000,000 4,000,000 MS MS235 Beatline Parkway 150,000 150,000 150,000 150,000 MS MS236 Biloxi Beach Connector Phase I 2,163,000 2,163,000 2,163,000 2,163,000 MS MS237 East Brandon Bypass 640,000 640,000 640,000 640,000 MS MS238 Star Landing Road 5,000,000 5,000,000 5,000,000 5,000,000 Mississippi 32,853,000 32,853,000 32,853,000
MO MO251 MLK Park Pedestrian Bridge at Brush Creek 2,800,000 2,800,000 2,800,000 2,800,000 MO MO252 Chester Bridge 13,000,000 13,000,000 13,000,000 13,000,000 MO MO253 I-70 / US 63 Interchange 4,300,000 4,300,000 4,300,000 4,300,000 Missouri 20,100,000 20,100,000 20,100,000
NE NE103 84th Street Pedestrian and Bicycle Safety Improvements 5,000,000 5,000,000 5,000,000 5,000,000 Nebraska 5,000,000 5,000,000 5,000,000
NV NV095
Carson City Public Works Department - Western Nevada Safe Routes to School Vulnerable User Pedestrian Safety Infrastructure Improvement Project 1,000,000 1,000,000 1,000,000 1,000,000 NV NV096 The Kiss and Drop Project, Yerington 598,000 598,000 598,000 598,000 NV NV097
Regional Transportation Commission of Southern Nevada Bike Share Expansion 142,500 142,500 142,500 142,500 NV NV098 Historic Westside Complete Streets, Las Vegas 3,000,000 3,000,000 3,000,000 3,000,000 NV NV099 Arlington Avenue Bridges Project 2,000,000 2,000,000 2,000,000 2,000,000 NV NV100 Boulder Highway Reimagined Project 2,000,000 2,000,000 2,000,000 2,000,000 NV NV101 Carson City - Williams Street Complete Streets Project 2,000,000 2,000,000 2,000,000 2,000,000 NV NV102 Highway 50 (Williams Avenue) Project 1,616,000 1,616,000 1,616,000 1,616,000 NV NV103 Las Vegas - Charleston Boulevard Underpass 2,000,000 2,000,000 2,000,000 2,000,000 NV NV104
SR28 Central Corridor Sand Harbor to Spooner – Secret Harbor to Skunk Harbor Trail and Safety Improvements 2,000,000 2,000,000 2,000,000 2,000,000 NV NV105
Western Nevada Safe Routes to School Vulnerable User Pedestrian Safety 500,000 500,000 500,000 500,000 Nevada 16,856,500 16,856,500 16,856,500
NH NH088 Cotton Mill Transfer Bridge ADA Accessibility 300,000 300,000 300,000 300,000 NH NH089 Mechanic Street Sideway Project 290,250 290,250 290,250 290,250 NH NH090 Mason Street Bridge 600,000 600,000 600,000 600,000 NH NH091 Hanover Multi-Use Path 350,000 350,000 350,000 350,000 NH NH092 Keene Transportation Heritage Trail 394,800 394,800 394,800 394,800 NH NH093 Walnut Street Oval 1,000,000 1,000,000 1,000,000 1,000,000 New Hampshire 2,935,050 2,935,050 2,935,050
NJ NJ307
Borough of Bernardsville Boylan Terrace Neighborhood Pedestrian Connection 1,427,500 1,427,500 1,427,500 1,427,500 NJ NJ308 Pedestrian Walkway Improvements Along Rt. 53 and Tabor Road 136,330 136,330 136,330 136,330 NJ NJ309 Broad Street, East/West Grand Street Traffic Light Replacement, City of Elizabeth 532,240 532,240 532,240 532,240 NJ NJ310 Hoboken Electric Vehicle Fast Charging Station Project 250,000 250,000 250,000 250,000 New Jersey 2,346,070 2,346,070 2,346,070
NM NM100 Allison Road Corridor 1,500,000 1,500,000 1,500,000 1,500,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total NM NM101 Pinon Hills Extension Project - Right of Way 1,250,000 1,250,000 1,250,000 1,250,000 NM NM102 2nd Street and Rio Bravo Reconstruction 2,000,000 2,000,000 2,000,000 2,000,000 NM NM103 Downtown Clovis Reconstruction Project 3,500,000 3,500,000 3,500,000 3,500,000 NM NM104 I-25 Comanche/Montgomery Interchanges 3,500,000 3,500,000 3,500,000 3,500,000 NM NM105 NM 31/NM 128 Preliminary Engineering 1,500,000 1,500,000 1,500,000 1,500,000 NM NM106 NM 404 widening project from I-10 to NM 213 2,750,000 2,750,000 2,750,000 2,750,000 NM NM107 Reconstruction of I-25 La Bajada in Santa Fe County 3,500,000 3,500,000 3,500,000 3,500,000 NM NM108 US 84 Full Depth Reclamation between Ft. Sumner and Santa Rosa 2,500,000 2,500,000 2,500,000 2,500,000 NM NM109 I-40, Milepost 6 to 22 west of Gallup, New Mexico 1,000,000 1,000,000 1,000,000 1,000,000 NM NM110 Quay County Bridge No. 1042 Replacement 2,500,000 2,500,000 2,500,000 2,500,000 New Mexico 25,500,000 25,500,000 25,500,000
NY NY782 New York State Route 100B - Dobbs Ferry Road Sidewalk Project 1,000,000 1,000,000 1,000,000 1,000,000 NY NY783 Bedford Harris Road/Babbitt Road Safety Improvements 650,000 650,000 650,000 650,000 NY NY784 Sullivan County O&W Rail Trail 1,100,000 1,100,000 1,100,000 1,100,000 NY NY785 The Riverline - First Gateway, Buffalo 900,000 900,000 900,000 900,000 NY NY786 Utica Harbor Pedestrian Bridge 2,000,000 2,000,000 2,000,000 2,000,000 NY NY787
Ogdensburg-Prescott International Bridge Girder Span and LeadBased Paint Project 3,000,000 3,000,000 3,000,000 3,000,000 NY NY788
City of Newburgh - Completion of the Replacement of Lake St. Bridge 1,750,000 1,750,000 1,750,000 1,750,000
NY NY789 Dryden Rail Trail Bridge 700,000 700,000 700,000 700,000 NY NY790 South Albany Street Over Six Mile Creek Bridge Replacement 1,400,000 1,400,000 1,400,000 1,400,000 New York 12,500,000 12,500,000 12,500,000
NC NC194 Downtown Pineville Intersection Redesign 1,435,000 1,435,000 1,435,000 1,435,000 NC NC195 Town of Black Mountain Emergency Signals Project 30,000 30,000 30,000 30,000 North Carolina 1,465,000 1,465,000 1,465,000
OH OH413
Franklin County Reynoldsburg-New Albany Road at Havens Road Project 3,000,000 3,000,000 3,000,000 3,000,000 OH OH414
SR 63 widening from its existing two (2) lanes to four (4) lanes between Union Road and east of SR 741. 5,000,000 5,000,000 5,000,000 5,000,000 OH OH415 I-675 / Grange Hall Interchange Project 400,000 400,000 400,000 400,000 OH OH416 Village of New Richmond Route 52 Highway Safety Mitigation Project 2,929,745 2,929,745 2,929,745 2,929,745
OH OH417 City of Madeira Miami Ave Revitalization & Complete Streets Project 3,397,799 3,397,799 3,397,799 3,397,799 OH OH418 City of Pataskala Safe Travel Plan 135,000 135,000 135,000 135,000 OH OH419 City of Cincinnati - Western Hills Viaduct 1,000,000 1,000,000 1,000,000 1,000,000 Ohio 15,862,544 15,862,544 15,862,544
OK OK155 Garvin/Pontotoc County Project 5,000,000 5,000,000 5,000,000 5,000,000 OK OK156
Grady County Project - Adding shoulders and resurfacing SH-19 between Alex and Lindsay, Oklahoma, OK-HD-4. 5,000,000 5,000,000 5,000,000 5,000,000 OK OK157 Ponca City Multi-Modal Transportation Infrastructure Project 2,000,000 2,000,000 2,000,000 2,000,000 OK OK158 I-35 Bridges over NE 63rd Street in Oklahoma City 3,125,000 3,125,000 3,125,000 3,125,000 OK OK159 I-35/SH-9W Interchange in Newcastle 3,125,000 3,125,000 3,125,000 3,125,000 OK OK160 I-40/Douglas Blvd Reconstruction and Widening in Oklahoma City 10,000,000 10,000,000 10,000,000 10,000,000 OK OK161 SH-136 from US-412 in Guymon 3,125,000 3,125,000 3,125,000 3,125,000 OK OK162 SH-152 in Washita County 3,125,000 3,125,000 3,125,000 3,125,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total OK OK163 SH-20 in Hominy 3,125,000 3,125,000 3,125,000 3,125,000 OK OK164 SH-3 from Lane to Farris 3,125,000 3,125,000 3,125,000 3,125,000 OK OK165 US-169 SW Ramp over I-244 in Tulsa 3,125,000 3,125,000 3,125,000 3,125,000 OK OK166 US-277 between Cement and Bailey Turnpike 3,125,000 3,125,000 3,125,000 3,125,000 OK OK167 US-281/SH-45 Junction in Waynoka 3,125,000 3,125,000 3,125,000 3,125,000 OK OK168 US-283 North of the Red River in Elmer 3,125,000 3,125,000 3,125,000 3,125,000 OK OK169 US-64/SH-14 Junction in Alva 3,125,000 3,125,000 3,125,000 3,125,000 OK OK170 US-70 Bypass in Madill 3,125,000 3,125,000 3,125,000 3,125,000 Oklahoma 59,500,000 59,500,000 59,500,000
OR OR200 Oregon City Quiet Zone 2,000,000 2,000,000 2,000,000 2,000,000 OR OR201 North Fork Road Improvements Project, Marion County 1,440,000 1,440,000 1,440,000 1,440,000 OR OR202 I-84 Exit 216 EB Snow Zone/Truck Parking 2,000,000 2,000,000 2,000,000 2,000,000 OR OR203 Tualatin Valley Highway Safety Improvements 1,000,000 1,000,000 1,000,000 1,000,000 Oregon 6,440,000 6,440,000 6,440,000
PA PA739 Chester County Electric Vehicle Charging Station Project 645,609 645,609 645,609 645,609 PA PA740
Independence Street Downtown Makeover (Implementation project from GoShamokin Revitalization Plan) 2,675,000 2,675,000 2,675,000 2,675,000 PA PA741
Trail extension and tunnel preconstruction, Westmoreland Heritage Trail - Middle Gap Development, Westmoreland County, PA 1,000,000 1,000,000 1,000,000 1,000,000 PA PA742 Knox Kane Pedestrian Highway Crossing Safety 322,435 322,435 322,435 322,435 PA PA743
North Avenue Streetscape, Safety and Signal Improvements, Pittsburgh 2,000,000 2,000,000 2,000,000 2,000,000 PA PA744 Monaca Streetscape Project 750,000 750,000 750,000 750,000 PA PA745 Rehabilitation of Bridge No. 29 - Brewery Bridge, City of Latrobe 500,000 500,000 500,000 500,000 Pennsylvania 7,893,044 7,893,044 7,893,044
RI RI093 Purgatory Road Sidewalks 960,000 960,000 960,000 960,000 RI RI094 Fred Lippitt Woonasquatucket River Greenway 3,400,000 3,400,000 3,400,000 3,400,000 RI RI095 Woonsocket - Lead Remediation for Bridges 2,500,000 2,500,000 2,500,000 2,500,000 RI RI096 Bike Path Connection - Washington Secondary Bike Path Extension 3,200,000 3,200,000 3,200,000 3,200,000 RI RI097 Centerville Road (RI-117) and Toll Gate Road Repaving in Warwick and West Warwick 1,000,000 1,000,000 1,000,000 1,000,000 RI RI098 East Bay Bike Path Bridges 5,000,000 5,000,000 5,000,000 5,000,000 RI RI099 Henderson Boulevard Connection 1,000,000 1,000,000 1,000,000 1,000,000 Rhode Island 17,060,000 17,060,000 17,060,000
SC SC147 Charleston Airport Connector Road Project 16,172,000 16,172,000 16,172,000 16,172,000 SC SC148 I-73 15,000,000 15,000,000 15,000,000 15,000,000 SC SC149 Whiskey Road Corridor - Powderhouse Road Connector 8,000,000 8,000,000 8,000,000 8,000,000 South Carolina 39,172,000 39,172,000 39,172,000
SD SD186 North Sioux City Northshore Drive Realignment Project 17,000,000 17,000,000 17,000,000 17,000,000 SD SD187 I-29 85th Street Interchange 30,000,000 30,000,000 30,000,000 30,000,000 South Dakota 47,000,000 47,000,000 47,000,000
TN TN283 Jefferson Street Multimodal Cap and Connector, Nashville, TN 3,000,000 3,000,000 3,000,000 3,000,000 TN TN284 Smart City Testbed Expansion 1,600,000 1,600,000 1,600,000 1,600,000 Tennessee 4,600,000 4,600,000 4,600,000
TX TX467 Veterans Memorial Blvd Phase II 5,000,000 5,000,000 5,000,000 5,000,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total TX TX468 Temple Outer Loop West Phase I 5,000,000 5,000,000 5,000,000 5,000,000 TX TX469 City of Austin IH-35 Cap & Stitch Study 1,500,000 1,500,000 1,500,000 1,500,000 TX TX470 US 190 4-Lane Divided Highway with Grassy Median Between Hearne, Texas, and Bryan, Texas 3,000,000 3,000,000 3,000,000 3,000,000 TX TX471
FM 2154 (Wellborn Road) / FM 2347 (George Bush Drive) Interchange 3,000,000 3,000,000 3,000,000 3,000,000 TX TX472 FM 1179 East Widening from FM 158 to Steep Hollow Road 3,000,000 3,000,000 3,000,000 3,000,000 TX TX473 Restoration of the Roma-Miguel Aleman International Suspension Bridge 5,000,000 5,000,000 5,000,000 5,000,000 TX TX474 City of Austin MoKan Trail 1,000,000 1,000,000 1,000,000 1,000,000 TX TX475 Sharpstown Multi-Use Trail Phase 1 1,000,000 1,000,000 1,000,000 1,000,000 Texas 27,500,000 27,500,000 27,500,000
UT UT130 Ephraim Road Safety & Economic Development Project 4,000,000 4,000,000 4,000,000 4,000,000 UT UT131 Utah Military Installation Development Authority - 3-Gate Trail site acquisition and construction 3,000,000 3,000,000 3,000,000 3,000,000 UT UT132 Industrial Road Improvements 3,000,000 3,000,000 3,000,000 3,000,000 Utah 10,000,000 10,000,000 10,000,000
VT VT073 Lamoille Valley Rail Trail 2,000,000 2,000,000 2,000,000 2,000,000 Vermont 2,000,000 2,000,000 2,000,000
VA VA270
George Washington Memorial Parkway - Traffic and Safety Context Sensitive Solutions, Belle Haven to City of Alexandria 300,000 300,000 300,000 300,000 VA VA271 Coalfields Expressway Pre-Engineering Project 1,995,000 1,995,000 1,995,000 1,995,000 VA VA272 Waxpool Road/Loudoun County Parkway Intersection Improvements 2,000,000 2,000,000 2,000,000 2,000,000 VA VA273 Glencarlyn Park Pedestrian Bridge 800,000 800,000 800,000 800,000 VA VA274 Bluemont Junction Trail 325,000 325,000 325,000 325,000 VA VA275
Pohick Road Sidewalk (I-95 to Richmond Highway) in Fairfax County, VA 1,000,000 1,000,000 1,000,000 1,000,000 VA VA276
Eastern Shore Rails to Trails Project, Cape Charles to Route 13 Segment 2,500,000 2,500,000 2,500,000 2,500,000 VA VA277
Ettrick Train Station Revitalization- Bessie Lane Realignment and Reconstruction 1,000,000 1,000,000 1,000,000 1,000,000 VA VA278 Poindexter Sidewalks Extension (South Norfolk) 2,400,000 2,400,000 2,400,000 2,400,000 VA VA279 Lawson Road Pedestrian Crossing of Tuscarora Creek 935,000 935,000 935,000 935,000 VA VA280 Centerville Turnpike Phase III 6,000,000 6,000,000 6,000,000 6,000,000 VA VA281 Coliseum Drive Extension Project, Phase B 1,500,000 1,500,000 1,500,000 1,500,000 VA VA282 Capital Bikeshare for Underserved Areas 1,000,000 1,000,000 1,000,000 1,000,000 VA VA283 Fall Line Trail 2,000,000 2,000,000 2,000,000 2,000,000 VA VA284 Mayo Bridge Rehabilitation 5,000,000 5,000,000 5,000,000 5,000,000 Virginia 28,755,000 28,755,000 28,755,000
WA WA324 SR-20 - Campbell Lake Road Roundabout 1,740,000 1,740,000 1,740,000 1,740,000 WA WA325 City of Spokane Northeast Infrastructure Wellesley-Freya to Havana 3,500,000 3,500,000 3,500,000 3,500,000 WA WA326 Mountlake Terrace Town Center - Transit Connection Corridor 2,000,000 2,000,000 2,000,000 2,000,000 WA WA327 Scriber Creek Trail Redevelopment- Phase 2 1,000,000 1,000,000 1,000,000 1,000,000 WA WA328
Project FIRST (Fast Tracking Improvements to Reach Strategic Targets) Improvements to Vancouver SE 1st Street Corridor 2,500,000 2,500,000 2,500,000 2,500,000 WA WA329 Edgewater Bridge Replacement 3,000,000 3,000,000 3,000,000 3,000,000 Consolidated Appropriations Act, 2022
(Public Law 117-103) Division L, Title I, Highway Infrastructure Programs State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-103 Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-103
Amount available under P.L.
117-103
Allocation of Y928 Funds
This Memorandum
Obligation Authority
This Memorandum
(DELPHI Code
1550574B50.2022.050Y928500)
Project State Total Project State Total Project State Total WA WA330 South Barker Road Corridor 3,000,000 3,000,000 3,000,000 3,000,000 Washington 16,740,000 16,740,000 16,740,000
WV WV105 Coalfields Expressway 500,000 500,000 500,000 500,000 West Virginia 500,000 500,000 500,000
WI WI180 Brown County South Bridge Regional Connector Project 5,000,000 5,000,000 5,000,000 5,000,000 Wisconsin 5,000,000 5,000,000 5,000,000
846,927,823 846,927,823 846,927,823 845,719,823 845,719,823 840,719,823 840,719,823 Note 1: A separate allocation will be provided through Federal Lands Highway Memorandum
Subject: ACTION: Allocation of Highway Infrastructure
Programs Projects designated in Division L of the
Consolidated Appropriations Act, 2023
[CFDA No. 20.205]
Date: March 21, 2023
In Reply
Refer to: HISM-40
Digitally signed by PETER JOHN

STEPHANOS
Date: 2023.03.21 14:06:25 -04'00'

PETER JOHN
STEPHANOS From: Peter J. Stephanos
Director, Office of Stewardship, Oversight,
and Management
To: Brian R. Bezio
Chief Financial Officer
Division Administrators
The Consolidated Appropriations Act, 2023 (Public Law 117-328) appropriates a total of $3,417,811,613 for Highway Infrastructure Programs (HIP) from the General Fund of the Treasury for fiscal year (FY) 2023. Of such amount, $1,862,811,613 is set aside for “Community Project Funding / Congressionally Directed Spending.” The project descriptions for the 562 projects can be found in the “Community Project Funding / Congressionally Directed Spending” table in the Joint Explanatory Statement incorporated by reference in Division L of the Consolidated Appropriations Act, 2023, and are also included in the attachment to this memo. With this memorandum, FHWA is allocating $1,851,971,613 for 557 projects to State departments of transportation (DOTs). The Office of Federal Lands Highway (FLH) will distribute funding for five tribal community projects totaling $10,840,000. These funds are in addition to any other funds, including contract authority, provided in FY 2023. This funding is not subject to any obligation limitation that applies to Federal-aid contract authority.

With this memorandum, we are requesting the Budget Execution Team in the Office of Budget to allocate in the Fiscal Management Information System (FMIS) $1,851,971,613 for 557 projects to the States, as indicated in the attachment to this memorandum (FMIS program code Y926; DELPHI fund value 1530569B50.)
These funds remain available for obligation through September 30, 2026. Any such amounts not obligated on or before September 30, 2026, shall expire. Once the period for obligation U.S. Department
of Transportation
Federal Highway
Administration
2 has expired, these funds will only remain available for adjusting and liquidating obligations as authorized in accordance with title 31, United States Code (U.S.C.), section 1553.

Obligated earmark balances are available for expenses properly charged to the account and incurred until September 30, 2031. After that date, any unexpended balances shall be cancelled in accordance with 31 U.S.C. 1552 and shall no longer be available for obligation or expenditure.

Demo IDs have been assigned for each project to properly track these funds to ensure that they are only obligated and expended for the specific project for which they were designated.

Each project has been assigned a unique Demo ID that links the funding to the specific project description as listed in the Joint Explanatory Statement accompanying the Consolidated Appropriations Act, 2023. Since the project description defines the scope of work on which the funds may be legally expended, the funding for the project can only be utilized for the activities within the scope and physical limits of the project as defined by the project description. The Demo IDs under which these funds are being distributed are also included in the attachment to this memorandum.

Except as otherwise provided, these funds are to be administered as if apportioned under chapter 1 of title 23, U.S.C.1
Therefore, these projects are to be administered as title 23 projects in accordance with the applicable statutory and regulatory provisions contained in title 23, U.S.C. and Code of Federal Regulations (CFR), as well as other applicable Federal requirements, such as the National Environmental Policy Act (42 U.S.C. 4321, et seq.) and the Disadvantaged Business Enterprise Program. The State, through its DOT in accordance with 23 U.S.C. 302, is the direct recipient of funds allocated by this memorandum and is responsible for administration of these funds. If the State DOT acts as a pass-through entity of Federal assistance, the State DOT maintains the passthrough responsibilities specified in 2 CFR 200.332 and 23 U.S.C. 106(g)(4).

The maximum Federal share for these State projects is governed by 23 U.S.C. 120, as amended. It is generally 80 percent (See 23 U.S.C. 120(b)). The maximum Federal share for projects on the Interstate System is 90 percent unless the project adds lanes that are not highoccupancy-vehicle or auxiliary lanes (See 23 U.S.C. 120(a)). For projects that add single occupancy vehicle capacity, that portion of the project will revert to the 80 percent level. An upward sliding scale adjustment is available to States having public lands (Sliding Scale Rates In Public Land States). States may use a lower Federal share on Federal-aid projects as provided in 23 U.S.C. 120(h). These funds may not be used as the non-Federal match for other Federal programs unless there is specific statutory authority (2 CFR 200.306(b)(5)).

The Consolidated Appropriations Act, 2023, does not provide authority for use of these funds as a non-Federal match for other Federal programs, including Federal-aid programs under title 23, U.S.C.

Generally, Project Agreements should not be modified to replace one Federal fund category with another unless specifically authorized by statute (23 CFR 630.110(a)). For additional information on earmarked funds, see Q&As on Obligation of Earmarked Funds for FederalAid Projects. 1 Tribal projects funded from these amounts are to be administered as if allocated under chapter 2 of title 23, U.S.C. 3 Earmarked funds shall not participate in costs incurred prior to the date of project agreement (23 CFR 630.106(b)).

By copy of this memorandum, we request that the Budget Execution Team (HCFB-12) in the Office of Budget:
1) enter the Demo IDs identified in the attached table, and 2) process these allocations.

If there are any questions, please contact Tony DeSimone at 317-226-5307 or by email at [email protected].

Attachment
Project State Total Project State Total Project State Total CA CA916 Yerba Buena Island West Side Bridges Seismic Retrofit Project 2,200,000 2,200,000 2,200,000 2,200,000 CA CA917 Reche Canyon Road Realignment to Hunts Lane 4,166,000 4,166,000 4,166,000 4,166,000 CA CA918 Little 3rd Street Project 2,560,000 2,560,000 2,560,000 2,560,000 CA CA919 3rd Street Corridor Project 3,000,000 3,000,000 3,000,000 3,000,000 CA CA920 Riley Street Safety Improvements 4,000,000 4,000,000 4,000,000 4,000,000 CA CA921
White Rock Road — 0.5 Mile East of Rancho Cordova Parkway to Rio Del Oro Parkway 4,000,000 4,000,000 4,000,000 4,000,000 CA CA922 Capital SouthEast Connector—D3a Class I Multi-Use Path 4,000,000 4,000,000 4,000,000 4,000,000 CA CA923 Old Town Streetscape Project Phase 2 2,000,000 2,000,000 2,000,000 2,000,000 CA CA924
Laguna Creek Inter-Regional Trail Crossing at State Route 99 (SR–99) 2,000,000 2,000,000 2,000,000 2,000,000
CA CA925
Bridge Replacement at Las Posas Road (U.S. 101) and Ventura Boulevard 4,000,000 4,000,000 4,000,000 4,000,000
CA CA926 Limonite Gap Pedestrian Bridge 1,600,000 1,600,000 1,600,000 1,600,000 CA CA927 Ontario Avenue/I–15 Multimodal Corridor Enhancements 2,000,000 2,000,000 2,000,000 2,000,000 CA CA928 I–15 Express Lanes Southern Extension 3,000,000 3,000,000 3,000,000 3,000,000 CA CA929 Scott Road/Bundy Canyon Road Improvements 4,000,000 4,000,000 4,000,000 4,000,000 CA CA930 I–215 and Keller Road Interchange Project 2,600,000 2,600,000 2,600,000 2,600,000 CA CA931 Magnolia Avenue Bridge Widening Project 2,000,000 2,000,000 2,000,000 2,000,000 CA CA932 Auto Center Drive Bridge Improvements 2,000,000 2,000,000 2,000,000 2,000,000 CA CA933 Prado Road Bridge Replacement project 2,065,000 2,065,000 2,065,000 2,065,000 CA CA934 Arroyo Grande Swinging Bridge Rehabilitation 500,000 500,000 500,000 500,000 CA CA935 U.S. 101 High Occupancy Vehicle Project Segment 4D North 7,000,000 7,000,000 7,000,000 7,000,000 CA CA936 City of Los Angeles Cool Pavement and Shade Structures 2,500,000 2,500,000 2,500,000 2,500,000 CA CA937 Colorado Street/Boulevard Corridor Complete Street in Arcadia CA 3,000,000 3,000,000 3,000,000 3,000,000 CA CA938 Glendora People Movement Project in Glendora CA 5,000,000 5,000,000 5,000,000 5,000,000 CA CA939 Madera County State Route 41 Expressway Final Design Project 1,950,000 1,950,000 1,950,000 1,950,000 CA CA940 Calwa Complete Streets Project 4,000,000 4,000,000 4,000,000 4,000,000 CA CA941 Citywide Traffic System Upgrade Phase 2 Project 631,200 631,200 631,200 631,200 CA CA942 Ygnacio Valley Road Fiber Infrastructure 2,520,000 2,520,000 2,520,000 2,520,000 CA CA943 Lamorinda Smart Signal System Project 4,185,000 4,185,000 4,185,000 4,185,000 CA CA944 School Street Safe Routes to School Project 3,100,000 3,100,000 3,100,000 3,100,000 CA CA945 Village to Hakone Gardens Walkway Project 1,520,000 1,520,000 1,520,000 1,520,000 CA CA946 Middle Avenue Pedestrian/Bicycle Rail Crossing 4,000,000 4,000,000 4,000,000 4,000,000 CA CA947 Boulder Creek Complete Streets Improvements project 1,500,000 1,500,000 1,500,000 1,500,000 CA CA948 Bernardo Avenue Undercrossing 2,500,000 2,500,000 2,500,000 2,500,000 CA CA949 Resurfacing Sharp Park Priority Development Area 800,000 800,000 800,000 800,000 CA CA950 Spooky Knoll Trail 400,000 400,000 400,000 400,000 CA CA951
Highway 1/Frenchman’s Creek Intersection and Bike/Pedestrian Improvements 2,000,000 2,000,000 2,000,000 2,000,000
CA CA952 Stevenson Bridge Rehabilitation Project 3,387,619 3,387,619 3,387,619 3,387,619 CA CA953
Jepson Parkway Phase 2B (Access to Travis AFB and Canon Road Safety Improvements) 4,000,000 4,000,000 4,000,000 4,000,000 CA CA954
SR128/I–505 Overcrossing (Br. 22–0110)/Russell Blvd Bicycle and Pedestrian Improvements 2,000,000 2,000,000 2,000,000 2,000,000 CA CA955
I–505 Vaca Valley Parkway Corridor Multi-Modal Improvement Project 4,000,000 4,000,000 4,000,000 4,000,000
Consolidated Appropriations Act, 2023
(Public Law 117-328) Division L, Title I, Highway Infrastructure Programs Allocation of Y926 Funds
This Memorandum
Obligation Authority
This Memorandum
DELPHI Code
1530569B50.2023.050Y926500
State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-328
Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-328
Amount available under P.L. 117-
328
Project State Total Project State Total Project State Total Consolidated Appropriations Act, 2023
(Public Law 117-328) Division L, Title I, Highway Infrastructure Programs Allocation of Y926 Funds
This Memorandum
Obligation Authority
This Memorandum
DELPHI Code
1530569B50.2023.050Y926500
State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-328
Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-328
Amount available under P.L. 117-
328
CA CA956
Avenue M Corridor and US Air Force Plant 42 Access Improvement Project 1,500,000 1,500,000 1,500,000 1,500,000
CA CA957 Sequoia Avenue Grade Crossing Safety Improvements 4,000,000 4,000,000 4,000,000 4,000,000 CA CA958 Safe Routes to School Safety Project 1,313,000 1,313,000 1,313,000 1,313,000 CA CA959
Avenue M and Sierra Highway Grade Separation Environmental Review and Planning Project 2,000,000 2,000,000 2,000,000 2,000,000 CA CA960 SR 132 West Project Phase 2 7,000,000 7,000,000 7,000,000 7,000,000 CA CA961 State Route 99/120 Connector Project Phase 1B 5,000,000 5,000,000 5,000,000 5,000,000 CA CA962 SR–52 Congestion Improvement Project 2,500,000 2,500,000 2,500,000 2,500,000 CA CA963 South Escondido Access Improvement Project 1,400,000 1,400,000 1,400,000 1,400,000 CA CA964 City of Sunnyvale Stevens Creek Trail Extension Project 3,000,000 3,000,000 3,000,000 3,000,000 CA CA965
Thornton Avenue Alternate Route Corridor Pavement Rehabilitation 2,000,000 2,000,000 2,000,000 2,000,000
CA CA966 Anna Drive Neighborhood Flood Protection Project 3,000,000 3,000,000 3,000,000 3,000,000 CA CA967 The OC Loop — Segments A and B 3,000,000 3,000,000 3,000,000 3,000,000 CA CA968 SR–91 Improvements 5,000,000 5,000,000 5,000,000 5,000,000 CA CA969 Fix 5 Cascade Gateway Project 3,000,000 3,000,000 3,000,000 3,000,000 CA CA970 Roe Road Extension Project 1,800,000 1,800,000 1,800,000 1,800,000 CA CA971 Cohasset Road Widening and Fire Safety Project 1,400,000 1,400,000 1,400,000 1,400,000 CA CA972
Vision Zero—Bancroft Avenue and Williams Street Bicycle Corridor 4,000,000 4,000,000 4,000,000 4,000,000
CA CA973 SR–74 Improvements, Orange County, California 4,000,000 4,000,000 4,000,000 4,000,000 CA CA974
Lomas Santa Fe Drive Roadway and Corridor Improvements—Solana Beach, California 7,000,000 7,000,000 7,000,000 7,000,000 CA CA975 Wallis Annenberg Wildlife Crossing 2,500,000 2,500,000 2,500,000 2,500,000 CA CA976 Manhattan Beach Safe Cycling Project 1,000,000 1,000,000 1,000,000 1,000,000 CA CA977 Pacific Palisades Pedestrian Trail 1,150,000 1,150,000 1,150,000 1,150,000 CA CA978 Safe Routes to School Initiative, Christopher High School 1,500,000 1,500,000 1,500,000 1,500,000 CA CA979 Anaheim Street Corridor Project 7,000,000 7,000,000 7,000,000 7,000,000 CA CA980
Pebbly Beach Road Revetment Repairs and Structural Improvements 2,000,000 2,000,000 2,000,000 2,000,000
CA CA981 I Street Bridge Deck Conversion for Active Transportation 4,933,861 4,933,861 4,933,861 4,933,861 CA CA982 City of Sacramento ZEV Fleet Infrastructure Program 4,300,000 4,300,000 4,300,000 4,300,000 CA CA983 Grant Line Road Realignment 2,500,000 2,500,000 2,500,000 2,500,000 CA CA984 Covina Metrolink Access and Connectivity Project 4,000,000 4,000,000 4,000,000 4,000,000 CA CA985
Azusa Avenue Pedestrian Handicap Accessibility & Signal Synchronization Improvements Project 7,000,000 7,000,000 7,000,000 7,000,000 CA CA986 Donald & Bernice Watson Greenbelt Trail Improvement Project 1,600,000 1,600,000 1,600,000 1,600,000 CA CA987 Parkway-Denholm Traffic Calming and Street Improvement Project 4,000,000 4,000,000 4,000,000 4,000,000 CA CA988
Arrow Highway Street Improvement Project from West City Limit to East City Limit 2,400,000 2,400,000 2,400,000 2,400,000 CA CA989
First Avenue Bridges Replacement over Mojave River and Overflows 2,000,000 2,000,000 2,000,000 2,000,000
CA CA990 Cedar Street Improvements 2,000,000 2,000,000 2,000,000 2,000,000 CA CA991 Wildwood Canyon Interchange 2,000,000 2,000,000 2,000,000 2,000,000 CA CA992
US 101 Auxiliary Lane — South of Salinas, Monterey County, California 1,000,000 1,000,000 1,000,000 1,000,000
CA CA993 Bayview Community-Based Transportation Implementation 2,500,000 2,500,000 2,500,000 2,500,000 Project State Total Project State Total Project State Total Consolidated Appropriations Act, 2023
(Public Law 117-328) Division L, Title I, Highway Infrastructure Programs Allocation of Y926 Funds
This Memorandum
Obligation Authority
This Memorandum
DELPHI Code
1530569B50.2023.050Y926500
State Demo ID Project Description in Explanatory Statement Accompanying Pub. L. No. 117-328
Designated Amounts
in Explanatory
Statement
Accompanying
Pub. L. No. 117-328
Amount available under P.L. 117-
328
CA CA994 Downtown Mobility Phase 3A 3,144,000 3,144,000 3,144,000 3,144,000 CA CA995 Interstate 10 and Monroe Street Interchange 1,500,000 1,500,000 1,500,000 1,500,000 CA CA996 Dillon Road Corridor 2,700,000 2,700,000 2,700,000 2,700,000 CA CA997 Desert Hot Springs Bridges Over Water Project 2,500,000 2,500,000 2,500,000 2,500,000 CA CA998 South Whittier Communities Bikeways Access Project 2,500,000 2,500,000 2,500,000 2,500,000 CA CA999 Third Street Grade Separation Project 3,000,000 3,000,000 3,000,000 3,000,000 CA CAA01
Mission Boulevard Pavement Rehabilitation — Phase 3, Ben Nevis to Bellegrave 2,300,000 2,300,000 2,300,000 2,300,000
CA CAA02 Napa Valley Vine Trail: Yountville to St. Helena Gap Closure 4,000,000 4,000,000 4,000,000 4,000,000 CA CAA03
State Route 121/12 & 8th Street East Intersection Improvements, Sonoma 1,500,000 1,500,000 1,500,000 1,500,000
CA CAA04 Unincorporated Fontana Safe Routes to School 1,500,000 1,500,000 1,500,000 1,500,000 CA CAA05
Mt. Vernon Avenue and Potomac Avenue Pedestrian Improvements 4,000,000 4,000,000 4,000,000 4,000,000
CA CAA06 Bayshore Bikeway: Barrio Logan 3,500,000 3,500,000 3,500,000 3,500,000 CA CAA07 Brandt Road Bridge Replacement Project 4,000,000 4,000,000 4,000,000 4,000,000 CA CAA08 Lawndale Citywide Traffic Signs Replacement Project 1,000,000 1,000,000 1,000,000 1,000,000 CA CAA09 Hawthorne Crenshaw Blvd. Mobility Improvement Project 4,000,000 4,000,000 4,000,000 4,000,000 California 270,125,680 270,125,680 270,125,680
*Note 1: A separate allocation will be provided through Federal Lands Highway

MONTAGUE
EXPWY

TRIMBLE
ROAD
LOCATION MAP:

DE LA CRUZ BOULEVARD BICYCLE

IMPROVEMENTS PROJECT

DE LA CRUZ BOULEVARD
(Montague Expwy to
Trimble Road)

TASMAN DR

MONTAGUE EXPWY
LOCATION MAP:

LICK MILL BOULEVARD BICYCLE

IMPROVEMENTS PROJECT

LICK MILL BOULEVARD
(Tasman Dr to
Montague Expwy)
HWY101

CENTRAL
EXPWY

SAN TOMAS
EXPWY

EL CAMINO REAL

PROJECT LOCATION

SCOTT BOULEVARD

CALABAZAS CREEK TRAIL TO

SARATOGA AVE
LOCATION MAP:

SCOTT BOULEVARD BICYCLE

IMPROVEMENTS PROJECT

SCOTT BOULEVARD
(Calabazas Creek Trail to
Saratoga Ave)
LOCATION MAP:

ANNA DRIVE NEIGHBORHOOD FLOOD PROTECTION PROJECT

ANNA DRIVE
(Anna Drive from San Tomas Expy to McCormick Drive)
N
City of Santa Clara
Agenda Report
1500 Warburton Avenue
Santa Clara, CA 95050
santaclaraca.gov
@SantaClaraCity
23-1074 Agenda Date: 10/10/2023

REPORT TO COUNCIL

SUBJECT
Action on a Request for a Special Permit to Allow Outdoor Display of Goods for Sale at 2213 El Camino Real from October 11, 2023 through November 30, 2023

COUNCIL PILLAR
Promote and Enhance Economic, Housing and Transportation Development

BACKGROUND
The applicant, Hayoung Lee, on behalf of the grocery store, New India Bazar, requests a Special Permit pursuant to Zoning Code Section 18.60.030 to allow for seasonal Outdoor Display and sales at a site located at 2213 El Camino Real. The property is zoned for commercial use (CT - Thoroughfare Commercial) and is developed with commercial uses. Neighboring land uses include single-family residential and commercial development. The Thoroughfare Commercial zoning district does not identify outdoor seasonal sales as a use permitted by right or through issuance of a Use Permit. However, City Code Section 18.60.030 allows activities to be performed in any non-industrial Zoning District for any use not otherwise regulated within the Zoning Code upon issuance of a Special Permit by the City Council.

DISCUSSION
Granting of a Special Permit requires the City Council to make certain findings consistent with City Code Section 18.60.030 (c) as follows:
(1) The facility, under the circumstances of the particular case, is essential or desirable to the public convenience or welfare;
(2) The facility will not be detrimental to the health or safety of the persons residing in the neighborhood;
(3) The facility will not be detrimental to the property or improvements in the neighborhood; (4) The facility will not impair the integrity or character of the zoning district; and (5) The facility will not create a significant increase in the traffic to and from the premises or in the on-street parking within five hundred (500) feet.

The temporary outdoor display is proposed to begin with set up on October 11, 2023 and end with the breakdown of the event completed by November 30, 2023 to coincide with a festival period.

Hours of operation for the outdoor display and sales will be the same as the grocery store. The outdoor display will support cultural activity as well as the economic vibrancy of the host business City of Santa Clara Page 1 of 3 Printed on 10/5/2023
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23-1074 Agenda Date: 10/10/2023
with no foreseeable impacts. The proposed sales activity will be consistent and compatible with the primary use of the property.

The proposed temporary outdoor display event would occur under the existing covered overhang in front of the tenant space. Temporary screens will be placed under the store’s awning to insulate the outdoor sales space between the front of the store and the parking lot. Accessibility for those with disabilities will be maintained at all times within the display area. Merchandise will include festival goods such as garlands, idols, bowls, and color sands, but no food items. The property is owned by 2213 El Camino Real LLC, which has provided written authorization for the temporary use.

The proposed temporary use, with limited duration and operations proposed, is not anticipated to adversely impact the surrounding land uses in that the event will occur over a limited time period and will be subject to conditions which reduce potential negative impacts, including a condition of approval that the use be conducted in a manner that does not create a public or private nuisance.

Operating the temporary event would not impair the integrity or character of the zoning district since the event will allow the purchase of the same goods that are already sold within the building. Parking is not projected to be impacted by the proposed use.

The Special Permit is subject to revocation should a problem arise.

Draft Permit and Conditions
The proposed permit would be subject to conditions of approval as follows:

1. Special Permit shall be valid from October 11, 2023 through November 30, 2023, with set-up beginning on October 11, 2023, and breakdown/clean-up to be completed by November 30, 2023;

2. Hours of operation: 9 AM to 10 PM;

3. The applicant shall obtain and comply with all applicable Santa Clara Building Division and/or Fire Department directives, permits, and requirements, including but not limited to temporary electrical and tent permits;

4. The applicant shall obtain an amplified music permit, if amplified music is to be used, and shall comply with City Code Section 9.10.040, noise and sound regulation;

5. The applicant shall obtain temporary sign permits for all temporary signs advertising the events;

6. There shall be no “searchlight” beams, streamers, or roof-mounted balloons during the events;

7. Upon conclusion of the outdoor display event, the area shall be cleaned and returned to its prior condition; and

8. The use shall operate in a manner that does not create a public or private nuisance.

ENVIRONMENTAL REVIEW
The action being considered is categorically exempt from formal environmental review under the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15304(e) (Class 4 - “Minor Alterations to Land”) as it consists of “minor temporary use of land having negligible or no permanent effects on the environment, including carnivals, and sales of Christmas trees, etc.”

FISCAL IMPACT
There is no cost to the City other than administrative staff time and expense.

COORDINATION
This report has been coordinated with the City Attorney’s Office.

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23-1074 Agenda Date: 10/10/2023

PUBLIC CONTACT
Public contact was made by posting the Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email [email protected] <mailto:[email protected]> or at the public information desk at any City of Santa Clara public library.

RECOMMENDATION

1. Determine the issuance of the Special Permit to be categorically exempt from formal environmental review pursuant to CEQA Guidelines section 15304(e) (Class 4 - “Minor Alterations to Land”); and

2. Adopt the findings listed in the Report in accordance with City Code Section 18.60.030 and approve the request of a Special Permit to allow for outdoor display and sales events at 2213 El Camino Real from October 11, 2023 through November 30, 2023, subject to conditions.

Reviewed by: Andrew Crabtree, Director of Community Development Approved by: Jōvan D. Grogan, City Manager

ATTACHMENTS

1. Special Permit Plan

2. Project Description
City of Santa Clara Page 3 of 3 Printed on 10/5/2023
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OUTDOOR DISPLAY
LAYOUT
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627 Hanover Street, Livermore, California 94551 Cell: (510)593-8736 [email protected] City of Santa Clara, Planning Division
1500 Warburton Avenue, Santa Clara, CA 95050
Project: Temporary outdoor merchandize display and install 9ft tent screen at existing operating grocery store ‘New India Bazar’
Address: 2213 El Camino Real
Project Description:

Requesting temporary outdoor merchandise display at walkway and installing approximately 9 ft high tent screen between post at existing covered overhang walkway at single story retail building during 3 months festival period during business hours (September, October & November).

Display merchandize will be festival goods (Indican garland, cray idols, portable table, bowls, color sands, and other related goods) and there will no food items.

Proposed display layout will not block accessibility and will provide min. 44” wide passage way between display.

Proposed screen is not a permit wall which not change building area which is located existing covered overhang area nor parking space.

• nnovative 's pace
Architecture - Planning - Site Development
City of Santa Clara
Agenda Report
1500 Warburton Avenue
Santa Clara, CA 95050
santaclaraca.gov
@SantaClaraCity
23-1075 Agenda Date: 10/10/2023

REPORT TO COUNCIL

SUBJECT
Resolution Increasing the Transient Occupancy Tax Rate from 11.5% to 12.5% effective January 1, 2024; and Introduction of an Ordinance Amending Section 3.25.030 of the Santa Clara City Code to Reflect the Increase in the Transient Occupancy Tax Rate

COUNCIL PILLAR
Enhance Community Engagement and Transparency

BACKGROUND
In November 2020, Santa Clara voters approved Measure E which authorized the City to levy an additional Transient Occupancy Tax (TOT) rate by up to 4% from the rate of 9.5% to up to 13.5%.

The ballot passed with 73.57% of voters supporting the measure. In FY 2021/22, 2 percent of the 4 percent potential rate increase was implemented effective January 1, 2022.

Outreach regarding the TOT rate increases was conducted in March 2023 with the large hotels in the City. Public discussion regarding the TOT rate increase was also part of the budget deliberations in May and June 2023.

On June 27, 2023, as part of the Council approval of the FY 2023/24 and FY 2024/25 Adopted Budget, direction was provided to staff to bring forward a separate resolution to increase the TOT by one percentage point effective January 2024. The budget also assumes the remaining one percentage point increase that is allowed by voters would be implemented in January 2025.

DISCUSSION
The introduction of a resolution to increase the TOT rate by one percentage point from 11.5% to

12.5% is consistent with the City Council direction provided as part of the adoption of the FY 2023/24 and FY 2024/25 Biennial Operating Budget. The TOT rate increase was a critical strategy as part of the multi-pronged approach of using reserves, reducing expenditures, and generating new revenues in order to balance the General Fund budget.

The voter-approved tax was approved to maintain and protect the level of essential city services including 9-1-1 emergency medical/disaster preparedness, police and fire protection, bicycle and pedestrian safety, roadways and storm drains, and other vital services including parks, recreation, libraries and senior services. The revenue generated from the TOT is collected in the City’s General Fund revenue for these services, which preserve the quality of life in neighborhoods, ensure the safety of our community, and pay for critical infrastructure needs.

In addition to the proposed resolution to modify the tax rate, a modification to section 3.25.030 of the Santa Clara City Code is also recommended to reflect the revision to the TOT rate.

City of Santa Clara Page 1 of 2 Printed on 10/5/2023
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23-1075 Agenda Date: 10/10/2023
In addition to the outreach conducted in March and June 2023, and to ensure a smooth transition to the new TOT rate, letters were sent to all Santa Clara hotel owners and operators regarding the potential TOT rate increase consideration for the October 10, 2023 City Council meeting. If approved by the Council, staff will provide further notification of the tax rate change and will post information on the City’s website.

ENVIRONMENTAL REVIEW
The action being considered does not constitute a “project” within the meaning of the California Environment Quality Act (“CEQA”) pursuant to section 15378(a)(4) of Title 14 of the California Code of Regulations in that it is a fiscal activity that does not involve any commitment to any specific project which may result in a potential significant impact on the environment.

FISCAL IMPACT
The FY 2023/24 and FY 2024/25 Adopted Budget factors in additional revenue from a one percentage point increase in the TOT rate effective January 1, 2024. This additional revenue is estimated at $1.7 million annually.

COORDINATION
This report has been coordinated with the City Attorney’s Office.

PUBLIC CONTACT
Public contact was made by posting the Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email [email protected] <mailto:[email protected]> or at the public information desk at any City of Santa Clara public library.

The hotels citywide were also notified of the Council Agenda date for the consideration of the proposed TOT rate increase.

RECOMMENDATION

1. Approve a resolution increasing the Transient Occupancy Tax rate from 11.5% to 12.5% effective January 1, 2024; and

2. Approve the introduction of an ordinance amending section 3.25.030 of the Santa Clara City Code to reflect the increase in the Transient Occupancy Tax rate.

Reviewed by: Kenn Lee, Director of Finance
Approved by: Jōvan D. Grogan, City Manager

ATTACHMENTS

1. Resolution increasing the Transient Occupancy Tax rate

2. Ordinance amending section 3.25.030 of the Santa Clara City Code City of Santa Clara Page 2 of 2 Printed on 10/5/2023
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Resolution/Transient Occupancy Tax Rate Increase Page 1 of 2 Rev: 7/27/2023
RESOLUTION NO. _____

A RESOLUTION OF THE CITY OF SANTA CLARA, CALIFORNIA

ADOPTING AN INCREASE IN THE TRANSIENT OCCUPANCY
TAX RATE TO 12.5% PURSUANT TO MEASURE E
WHEREAS, On November 3, 2020, 73.57% of Santa Clara voters approved the following ballot measure (Measure E) that allowed for an increase of up to four percentage points in the City’s Transient Occupancy Tax (TOT) from the starting rate of 9.5%; WHEREAS, the tax increase is designed to generate General Fund revenue that is used to continue to deliver high quality City services, prepare for disasters and emergencies, preserve the quality of life in neighborhoods, ensure the safety of our community, and pay for critical infrastructure needs;
WHEREAS, the TOT rate was increased from 9.5% to 11.5%, effective January 1, 2022, consistent with the FY 2021/22 and FY 2022/23 Biennial Operating Budget; WHEREAS, the City’s current Transient Occupancy Tax (TOT) rate is 11.5%; WHEREAS, the FY 2023/24 and FY 2024/25 Biennial Operating Budget assumed a one percentage point increase in the TOT rate effective January 1, 2024, from 11.5% to 12.5%, to generate additional revenue estimated at $1.7 million annually.

NOW THEREFORE, BE IT RESOLVED BY THE CITY OF SANTA CLARA AS FOLLOWS:

1. That in accordance with the authority granted to the City Council by the voters in November 2020 under Measure E, the Transient Occupancy Tax rate shall be 12.5% effective on and after January 1, 2024.

2. Effective date. This resolution shall become effective immediately.

I HEREBY CERTIFY THE FOREGOING TO BE A TRUE COPY OF A RESOLUTION PASSED

AND ADOPTED BY THE CITY OF SANTA CLARA, CALIFORNIA, AT A REGULAR MEETING THEREOF HELD ON THE 10th DAY OF OCTOBER 2023, BY THE FOLLOWING VOTE:

AYES: COUNCILORS:

NOES: COUNCILORS:

ABSENT: COUNCILORS:

ABSTAINED: COUNCILORS:

ATTEST: ______________________________

NORA PIMENTEL, MMC

ASSISTANT CITY CLERK

CITY OF SANTA CLARA
Attachments incorporated by reference: None
Ordinance/Transient Occupancy Tax Rate Increase Page 1 of 3 Rev: 09/2019
ORDINANCE NO. _____

AN ORDINANCE OF THE CITY OF SANTA CLARA,
CALIFORNIA, AMENDING SECTION 3.25.030 (“TAX
IMPOSED”) OF CHAPTER 3.25 (“TRANSIENT OCCUPANCY
TAX”) OF “THE CODE OF THE CITY OF SANTA CLARA,
CALIFORNIA” TO REFLECT THE INCREASED TAX RATE
BE IT ORDAINED BY THE CITY OF SANTA CLARA AS FOLLOWS:

WHEREAS, On November 3, 2020, 73.57% of Santa Clara voters approved the following ballot measure (Measure E) that allowed for an increase of up to four percentage points in the City’s TOT from the starting rate of 9.5%;
;
WHEREAS, the TOT rate was increased from 9.5% to 11.5%, effective January 1, 2022, consistent with the FY 2021/22 and FY 2022/23 Biennial Operating Budget; WHEREAS, concurrently with this ordinance amendment, pursuant to the authorization granted by the voters in Measure E, the City Council is adopting a resolution increasing the TOT rate from 11.5% to 12.5%, which will be effective January 1, 2024; and WHEREAS, the City Code currently reflects a TOT rate of 11.5%, which must be amended to be consistent with the TOT rate increase.

NOW THEREFORE, BE IT FURTHER ORDAINED BY THE CITY OF SANTA CLARA AS FOLLOWS:

SECTION 1: That Section 3.25.030 (entitled “Tax Imposed”) of Chapter 3.25 (entitled “Transient Occupancy Tax”) of Title 3 (entitled “Revenue and Finance”) of “The Code of the City of Santa Clara, California” (“SCCC”) is amended to read as follows:

Transient Occupancy Tax Rates. To maintain and protect the level of essential city services including 9-1-1 emergency medical/disaster preparedness, police and fire protection, bicycle and pedestrian safety, roadways and storm drains, and other vital services including parks, recreation, libraries and senior services, shall a measure increasing the hotel tax rate up to 4%, generating up to approximately 7 million dollars annually, paid only by hotel/motel guests, until ended by voters, be adopted? Ordinance/Transient Occupancy Tax Rate Increase Page 2 of 3 Rev: 09/2019
“3.25.030 Tax imposed.
(a) For the privilege of occupancy in any hotel, each transient is subject to and shall pay a tax as imposed from time to time by City Council resolution. Said tax shall be a percentage of the rent charged by the operator to the occupant. (b) On and as of January 1, 2024 and continuing thereafter until further change by City Council resolution, the amount of the tax imposed is twelve and one-half percent (12.5%) of the rent charged by the operator.
(c) Said tax constitutes a debt owed by the transient to the City, which is extinguished only by payment to the operator or to the City. The transient, or any person paying rent on the transient’s behalf, shall pay the tax to the operator of the hotel at the time the rent is paid. If the rent is paid in installments, a proportionate share of the tax shall be paid with each installment. The unpaid tax shall be due upon the transient’s ceasing to occupy space in the hotel. If for any reason the tax due is not paid to the operator of the hotel, the Director of Finance may require that such tax shall be paid directly to the Director of Finance.”
SECTION 2: Ordinances Repealed. With exception of the provisions protected by the savings clause, all ordinances (or parts of ordinances) in conflict with or inconsistent with this ordinance are hereby repealed.

SECTION 3: Savings clause. The changes provided for in this ordinance shall not affect any offense or act committed or done or any penalty or forfeiture incurred or any right established or accruing before the effective date of this ordinance; nor shall it affect any prosecution, suit or proceeding pending or any judgment rendered prior to the effective Ordinance/Transient Occupancy Tax Rate Increase Page 3 of 3 Rev: 09/2019
date of this ordinance. All fee schedules shall remain in force until superseded by the fee schedules adopted by the City Council.

SECTION 4: Effective date. This ordinance shall, by its terms, take effect on and as of January 1, 2024; however, prior to its final adoption it shall be published in accordance with the requirements of Section 808 and 812 of “The Charter of the City of Santa Clara, California.”
PASSED FOR THE PURPOSE OF PUBLICATION this 10th day of October 2023, by the following vote:

AYES: COUNCILORS:

NOES: COUNCILORS:

ABSENT: COUNCILORS:

ABSTAINED: COUNCILORS:

ATTEST: ___________________________

NORA PIMENTEL, MMC

ASSISTANT CITY CLERK

CITY OF SANTA CLARA
Attachments incorporated by reference: None
City of Santa Clara
Agenda Report
1500 Warburton Avenue
Santa Clara, CA 95050
santaclaraca.gov
@SantaClaraCity
23-1140 Agenda Date: 10/10/2023

REPORT TO COUNCIL

SUBJECT
Action on Council and Authorities Concurrent and Stadium Authority Meetings for 2024

COUNCIL PILLAR
Enhance Community Engagement and Transparency

BACKGROUND
Setting the Council and Authorities Concurrent and Stadium Authority meetings in advance allows for the proper planning and agenda management.

Pursuant to Charter Section 707, the City Council shall hold regular meetings at least twice each month.

DISCUSSION
The proposed 2024 calendar of meetings includes the Charter required two Council meetings per month. It also proposes that each Council meeting be a Joint Stadium Authority to allow Stadium Authority business to be considered at every meeting. The calendar takes into consideration regularly attended conferences (i.e., League of California Cities, American Public Power Association, etc.), avoids major observed holidays and includes a five-week summer recess from July - August.

ENVIRONMENTAL REVIEW
The action being considered does not constitute a “project” within the meaning of the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15378(b)(5) in that it is a governmental organizational or administrative activity that will not result in direct or indirect changes in the environment.

FISCAL IMPACT
There is no additional cost to the City other than administrative time.

COORDINATION
This report has been coordinated with the City Manager’s Office.

PUBLIC CONTACT
Public contact was made by posting the Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email [email protected] or at the public information desk at any City of Santa Clara public library.

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23-1140 Agenda Date: 10/10/2023

RECOMMENDATION
Set the 2024 calendar year Council and Authorities Concurrent and Stadium Authority as reflected on the attached calendar.

Reviewed by: Nora Pimentel, Assistant City Clerk
Approved by: Jōvan D. Grogan, City Manager

ATTACHMENTS

1. Proposed 2024 Meetings Calendar
City of Santa Clara Page 2 of 2 Printed on 10/5/2023
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COUNCIL & AUTHORITIES MEETINGS

S M T W T F S S M T W T F S S M T W T F S
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Council Recess
Council and Authorities Concurrent Meeting
Stadium Authority Meeting Published Calendars of Certain City Officials

STADIUM AUTHORITY MEETINGS
2024
November December
April May June
July August September
October
City Holiday
KEY
January February March
Yearly Calendar Template by Vertex42.com http://www.vertex42.com/ExcelTemplates/yearly-calendar.html © 2013 Vertex42 LLC. Free to Print. 0 □
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City of Santa Clara
Agenda Report
1500 Warburton Avenue
Santa Clara, CA 95050
santaclaraca.gov
@SantaClaraCity
23-1167 Agenda Date: 10/10/2023

REPORT TO COUNCIL

SUBJECT
Action on Silicon Valley Power’s Updated Sponsorship List of Annual Events and Activities and Continued Delegation of Authority to City Manager to Approve Additional Sponsorships of up to $10,000

COUNCIL PILLAR
Deliver and Enhance High-Quality Efficient Services and Infrastructure

BACKGROUND
For many years, the City of Santa Clara’s Electric Utility department, Silicon Valley Power (SVP), has sponsored events and activities in and around the City of Santa Clara. Many supported events are organized by the City of Santa Clara (City) and include 4th of July All-City Picnic, the Art and Wine Festival, the Holiday Tree Lighting. Other community events have included the Firehouse Fun Run, Santa Clara Unified School District’s STEAM Expo and Arbor Day. SVP also supports City Council and City staff’s attendance to Joint Venture Silicon Valley’s annual State of the Valley Conference.

SVP’s purpose in providing the sponsorships and support is to meet the goals of its customer and community engagement plans. Sponsorships allows SVP to promote itself as a community resource and service provider, to inform the public of the SVP programs that are available to customers, and to support educational opportunities related to energy efficiency, electrification, sustainability, and safety.

On June 4, 2019, the City Council approved a list of annual sponsorships and delegated authority to the City Manager to approve additional sponsorships of up to $10,000 per event that meet the criteria set forth in this report, and the formal process and application to be developed by SVP. As stated in the Council Report, the SVP Sponsorship Application process intended to include criteria and processes that are similar to the Community Grant Policy:
· Promote SVP programs and energy initiatives
· Provide a benefit to SVP customers
· Be open to the general public, and not discriminate against any protected characteristic under state or federal law

DISCUSSION
Attachment 1 includes the updated list of sponsorships and sponsorships amounts. As expected, some of the amounts have increased from the 2019 levels. Staff would specifically like to highlight the increase from $50,000 to $65,000 for City sponsored Parks and Recreation events. The Parks and Recreation Department is currently proposing to fund the following events from these funds:

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23-1167 Agenda Date: 10/10/2023
• Sunset Cinema Series
• Concerts in the Park
• Fourth of July All-City Picnic
• 41st Annual Art & Wine Festival
• Children’s Halloween Party
• Holiday Tree Lighting
Staff will continue to review City events, and the funds could shift to other activities in the future.

Attachment 2 is the Silicon Valley Power Sponsorship Application. Staff typically receives 10-15 requests a year, and this total number includes the annual requests from organizations already on the list approved by Council.

ENVIRONMENTAL REVIEW
The proposed actions do not constitute a “project” within the meaning of the California Environmental Quality Act (“CEQA”) pursuant to section 15378(b)(4) of Title 14 of the California Code of Regulations as the proposed actions will allow for funding of community events and do not involve a commitment to a specific project which may result in a potentially significant impact on the environment.

FISCAL IMPACT
Funding is budgeted under the Advertising and Community Promotion account in the Administrative Service program, in the Publics Benefits program, and the Key Accounts program in the Electric Utility Fund. The FY 2023/24 Adopted Operating Budget includes $356,100 budgeted in the above programs.

COORDINATION
This report has been coordinated with the Finance Department and City Attorney’s office.

PUBLIC CONTACT
Public contact was made by posting the Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email [email protected] <mailto:[email protected]> or at the public information desk at any City of Santa Clara public library.

RECOMMENDATION

1. Approve Silicon Valley Power’s annual sponsorship support of the events and activities listed in Attachment 1; and

2. Authorize the City Manager to approve additional sponsorships of up to $10,000 per event through the execution of the Silicon Valley Power Sponsorship Application in substantially the form set forth in Attachment 2.

Reviewed by: Manuel Pineda, Chief Electric Utility Officer Approved by: Jōvan D. Grogan, City Manager

ATTACHMENTS

1. Silicon Valley Power’s Updated Sponsorship List of Annual Events and Activities City of Santa Clara Page 2 of 3 Printed on 10/5/2023
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23-1167 Agenda Date: 10/10/2023

2. Silicon Valley Power Sponsorship Application
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City of Santa Clara Events Level $$
City of Santa Clara Events - includes: 65,000$
Sunset Cinema Series $ 5,000
Concerts in the Park $ 10,000
Fourth of July All-City Picnic $ 10,000
Annual Art & Wine Festival $ 25,000
Children’s Halloween Party $ 5,000
Holiday Tree Lighting $ 10,000
Misc. Department Events (pre-covid- historic 2019) 10,000$ Public Works Arbor Day $ 5,000
Library STEM/STEAM Community Event $ 5,000
Santa Clara Unified School District STEAM Event 5,000$
Silicon Valley Bike to Work/Wherever 3,000$
Firehouse Run 1,000$
HAAS Berkeley Intitute POWER Conference 15,000$
Joint Venture State of the Valley Conference 5,000$
Utility Energy Forum 3,000$
Consortium for Energy Efficiency (CEE) - Research projects 5,000$ Consortium for Energy Efficiency (CEE)- Integrated home Competition 2,000$
Silicon Valley Youth Climate Action Summit 5,000$
TOTAL 119,000$
Note: Most events are annual
Attachment 1
Silicon Valley Power's Updated Sponsorship List of Annual Events and Activities

SILICON VALLEY POWER

SPONSORSHIP

APPLICATION
1 | Page

TO BE COMPLETED BY APPLICANT
Name of Individual/Entity/Non-Profit Organization:

Address:

Tax ID #:

Contact Person Name and Title:

Contact Person E-mail:

Contact Person Phone: n/a
Are you a non-profit organization? Yes No
If yes, please attach proof of non-profit status to this application.

Please mark what type of event/activity you are requesting grant/sponsorship funding for:

Youth competition or performance Other Type of Eligible Event/Activity

EVENT/ACTIVITY FOR WHICH GRANT/SPONSORSHIPFUNDS ARE BEING SOUGHT Event/Activity Name:

Event/Activity Date:

Event/Activity Start Time:

Event/Activity End Time:

Event/Activity Description:

Event/Activity Venue:

Event/Activity Address:

Organization/Event/Activity Website:

Expected # of Attendees:

Attachment 2 1_S1L1CON
. VALLEY
POWER
(In' o, SAH1'A (t.AJIA
P~ The Centef of Wh.at'a Pou ible
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SILICON VALLEY POWER

SPONSORSHIP

APPLICATION
2 | Page

DESCRIPTION OF EVENT/ACTIVITY FOR WHICH SPONSORSHIP FUNDS ARE BEING SOUGHT Describe in detail what the funds will be used for and how it will benefit Silicon Valley Power customers.

Describe how your event or activity addresses energy efficiency, electrification, sustainability, reliability, safety or decarbonization.

Describe how Silicon Valley Power or SVP’s customer programs could be promoted at your event or activity.

Is your event or activity open to the public? Yes No
Is your event or activity political or religious in nature? Yes No Have you received grant funding from the City of Santa Clara in the past? If yes, please describe when, how much was received, and how the funds were used.

Amount of Grant Request:

By my signature below, I make the following representations and acknowledge agreement to the following terms and conditions:
• Upon approval of this application, as evidenced by the signature of the City Manager below, this application becomes a binding contract between the entity named above and the City of Santa Clara.
• I am the duly authorized representative of the entity named above and can bind the entity to the terms of this Agreement.
• If funds are provided by the City, the funds will be used for the purposes set forth above. • In no event shall the City’s financial responsibility exceed the approved amount, set forth below.
1_S1L1CON
. VALLEY
POWER
(In' o, SAH1'A (t.AJIA
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SILICON VALLEY POWER

SPONSORSHIP

APPLICATION
3 | Page
• I bear full responsibility for any and all tax consequences of receiving grant funds including, but not limited to, issuance of a 1099 by the City.
• There is no agency, employment, joint venture or other such relationship created by virtue of award of the grant.
• Applicant shall defend and indemnify the City and its employees from and against any claim, injury, liability, loss, cost and/or expense or damage including all costs and reasonable attorney’s fees, arising from or alleged to arise from the activity or event. • If applicable, the applicant shall satisfy the City’s insurance requirements. • The representations made by applicant in this Application are material terms of the agreement. The City may cancel this agreement at any time upon discovery that any of the information set forth above is inaccurate or that these terms have been violated.

Applicant Signature: _________________________________ Date:

TO BE COMPLETED BY CITY STAFF
Silicon Valley Power Sponsorship Application Granted? Yes No If yes, list amount of grant:

If no, provide reason for denial:

If no, has notification been sent to applicant? Yes No
Is insurance required for applicant? Yes No
Additional requirements for applicant:

City Manager Signature: _________________________________ Date:
1_S1L1CON
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POWER
(In' o, SAH1'A (t.AJIA
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City of Santa Clara
Agenda Report
1500 Warburton Avenue
Santa Clara, CA 95050
santaclaraca.gov
@SantaClaraCity
23-637 Agenda Date: 10/10/2023

REPORT TO COUNCIL

SUBJECT
Action on Amendments to Council Policy 035 (“Naming of Facilities”) as recommended by the Governance and Ethics Committee

BACKGROUND
At the March 13, 2023 Governance and Ethics Committee (Committee) meeting, the Committee approved the amendments brought forth for Council Policy 035 (“Naming of Facilities”). These recommendations to the policy were brought forward with input from the Task Force on Diversity, Equity, and Inclusion to bring greater diversity to the naming of buildings and facilities in the City of Santa Clara.

As background, at the March 13, 2023 meeting, the Committee approved the following amendments to Council Policy 035 to expand on current criteria and procedures which included:
a) Expanding the purpose of the policy to clearly state that naming actions maintain current and future alignment with the City’s Mission Statement and Code of Ethics and Values. b) Expanding the criteria for naming proposals to honor the important contributions and accomplishments of individuals from underrepresented communities, present an opportunity to foster a more welcoming, equitable, and inclusive environment, as well as to reflect and connect with the City’s diverse community.
c) Maintaining an inventory list of all Santa Clara facilities and buildings that have been named, including any available background of why the name was selected (“Named City Facilities List”).

In addition, at the September 11, 2023 Governance and Ethics Committee meeting, staff brought forward an additional amendment which further addresses naming rights of City facilities and buildings. The proposed amendment was approved by the Committee and includes the following:
d) Naming Rights Agreement: Agreements may provide a financial benefit to the City with sponsorships or naming rights agreements for City-owned facilities which aligns with the City’s mission and values.

The Governance and Ethics Committee approved the amendments (Attachment 1) to bring forward with the revised policy and a resolution to the full City Council for their consideration and approval.

DISCUSSION
As recommended by the Governance and Ethics Committee, staff has brought forth the amended Council Policy 035 (Attachment 2) and Resolution (Attachment 3) to the full City Council for their consideration and approval.

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23-637 Agenda Date: 10/10/2023

FISCAL IMPACT
There is no fiscal impact other than administrative staff time.

COORDINATION
This report was coordinated by the City Manager’s and Mayor and Council offices.

PUBLIC CONTACT
Public contact was made by posting the City Council agenda on the City’s official-notice bulletin board outside City Hall Council Chambers. A complete agenda packet is available on the City’s website and in the City Clerk’s Office at least 72 hours prior to a Regular Meeting and 24 hours prior to a Special Meeting. A hard copy of any agenda report may be requested by contacting the City Clerk’s Office at (408) 615-2220, email [email protected] <mailto:[email protected]> or at the public information desk at any City of Santa Clara public library.

RECOMMENDATION
Adopt a Resolution amending Council Policy 035 on Naming of Facilities.

Reviewed by: Maria Le, Assistant to the City Manager
Approved by: Jōvan D. Grogan, Chief Operating Officer, City Manager’s Office

ATTACHMENTS

1. Council Policy 035 Proposed Amendments (Redline)

2. Council Policy 035 Amended (Clean)

3. Resolution
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City of Santa Clara
Council Policy Manual

NAMING OF FACILITIES
Revised //2023
Council Policy 035 Page 1 of 3
Reso. No. _________
PURPOSE To establish the criteria and procedures for the naming of City of Santa Clara (City) buildings and facilities. The policy’s overarching objectives are to establish and maintain a system to ensure that decisions on naming opportunities are made in an equitable and consistent manner and that the naming actions maintain current and future alignment with the City’s Mission Statement and Code of Ethics and Values.

POLICY The City Council shall name municipal buildings/facilities in recognition and consideration of the following:
• Individuals, living or deceased, who have made outstanding contributions to the City or Santa Clara community
• Individuals, living or deceased, who have made contributions of local, state, national or worldwide significance
• Honoring the important contributions and accomplishments of individuals from underrepresented communities
• Opportunities to foster a more welcoming, equitable, and inclusive environment as well as to reflect and connect with the City’s diverse community
• Geographic location, demographic information, or prominent environmental feature(s) of the area that the building/facility is located
• Naming Rights Agreement: Agreements may provide a financial benefit to the City with sponsorships or naming rights agreements for City-owned facilities which aligns with the City’s mission and values.

Naming proposals will require thorough research to ensure alignment with this policy and with the City’s Mission Statement and Code of Ethicsand Values.

The renaming of existing municipal buildings/facilities shall be discouraged and shall occur only under extraordinary circumstances, after thorough study. The process of renaming may be done only after undertaking thorough and comprehensive research and deliberation.

Individuals after whom buildings are named, and who later are found to violate the City’s Code of Ethics and Values or Mission Statement City of
Santa Clara
The Center of What's Possible
City of Santa Clara
Council Policy Manual

NAMING OF FACILITIES
Revised //2023
Council Policy 035 Page 2 of 3
Reso. No. _________
may have their names removed from the buildings that bear their names.

Naming Proposals
PROCEDURE 1. Proposals for naming of municipal buildings or facilities shall be referred to the responsible Department.

2. Upon receipt of a naming or renaming proposal of a City building or facility, the Department Head will review if the proposed name is reflective of at least one of the following criteria:
a. An individual, living or deceased, who has made outstanding contributions to the City or Santa Clara community
b. An individual, living or deceased, who has made contributions of local, state, national, or worldwide significance
c. Honors the most important contributions and accomplishments of individuals from communities underrepresented in the Named City Facilities List.
d. Presents an opportunity to foster a more welcoming, equitable, and inclusive environment as well as to reflect and connect with the City’s diverse community
e. Geographic location and demographic information of the area that the building or facility is located
f. Prominent geographic or environmental feature(s) of the area that the building or facility is located
The City will maintain an inventory list of all Santa Clara facilities and buildings that have been named, including any available background of why the name was selected (“Named City Facilities List”). Any naming proposal will be reviewed against the Named City Facilities List to confirm that it is not duplicative of previously approved proposals.

If the naming or renaming proposal is reflective of at least one of the criteria, the Department Head will refer the proposal to the appropriate City Board, Commission, or Committee.

If the naming or renaming proposal is not reflective of at least one of City of
Santa Clara
The Center of What's Possible
City of Santa Clara
Council Policy Manual

NAMING OF FACILITIES
Revised //2023
Council Policy 035 Page 3 of 3
Reso. No. _________
the criteria, the Department head will extend appreciation of input to the proposer and explain City’s policy regarding naming of facilities.

3. After the Department Head forwards the proposal, the City Board, Commission, or Committee, shall review all naming proposals at a publicly noticed meeting and make a recommendation to the, Governance and Ethics Committee which shall consist of three City Councilmembers appointed by vote of the Council, and the City Manager.

4. The Governance and Ethics Committee shall review all naming recommendations at a publicly noticed meeting, and make a recommendation to the City Council for final approval.

5. The City Council shall consider the naming recommendation(s) at a publicly noticed meeting, and will have final approval of all naming recommendations.

6. Upon Council approval, the approved naming recommendation shall be added to the Named City Facilities List with all associated information.

Renaming Proposals
The process for renaming existing municipal buildings/facilities will follow the same steps as outlined in this procedure. In addition, it will require the proposer to include any and all research supporting the claim that there has been a violation of the City’s Code of Ethics and Values or Mission Statement.

City of
Santa Clara
The Center of What's Possible
City of Santa Clara
Council Policy Manual

NAMING OF FACILITIES
Revised 10/12/2023
Council Policy 035 Page 1 of 3
Reso. No. _________
PURPOSE To establish the criteria and procedures for the naming of City of Santa Clara (City) buildings and facilities. The policy’s overarching objectives are to establish and maintain a system to ensure that decisions on naming opportunities are made in an equitable and consistent manner and that the naming actions maintain current and future alignment with the City’s Mission Statement and Code of Ethics and Values.

Naming proposals will require thorough research to ensure alignment with this policy and with the City’s Mission Statement and Code of Ethicsand Values.

NAMING OF FACILITIES
Revised 10/12/2023
Council Policy 035 Page 2 of 3
Reso. No. _________
may have their names removed from the buildings that bear their names.

Naming Proposals
PROCEDURE 1. Proposals for naming of municipal buildings or facilities shall be referred to the responsible Department.

If the naming or renaming proposal is reflective of at least one of the criteria, the Department Head will refer the proposal to the appropriate City Board, Commission, or Committee.

If the naming or renaming proposal is not reflective of at least one of City of
Santa Clara
The Center of What's Possible
City of Santa Clara
Council Policy Manual

NAMING OF FACILITIES
Revised 10/12/2023
Council Policy 035 Page 3 of 3
Reso. No. _________
the criteria, the Department head will extend appreciation of input to the proposer and explain City’s policy regarding naming of facilities.

4. The Governance and Ethics Committee shall review all naming recommendations at a publicly noticed meeting and make a recommendation to the City Council for final approval.

5. The City Council shall consider the naming recommendation(s) at a publicly noticed meeting and will have final approval of all naming recommendations.

6. Upon Council approval, the approved naming recommendation shall be added to the Named City Facilities List with all associated information.

City of
Santa Clara
The Center of What's Possible
Resolution/Amending Council Policy 035 Naming of Facilities Page 1 of 2 Rev: 07/11/23
RESOLUTION NO. _____

A RESOLUTION OF THE CITY OF SANTA CLARA, CALIFORNIA
AMENDING COUNCIL POLICY 035 ENTITLED “NAMING OF
FACILITIES”
BE IT RESOLVED BY THE CITY OF SANTA CLARA AS FOLLOWS:

WHEREAS, the Naming of Facilities policy details the process for the naming of municipal buildings and facilities, and includes the procedure to ensure that it meets the policy requirements;
WHEREAS, the amended Naming of Facilities policy details the process for the naming of municipal buildings and facilities, and updates the procedure to expand on criteria and procedures;
WHEREAS, the amended policy expands the purpose of the policy to clearly state that naming actions maintain current and future alignment with the City’s Mission Statement and Code of Ethics and Values;
WHEREAS, the amended policy expands the criteria for naming proposals to honor the important contributions and accomplishments of individuals from underrepresented communities;
WHEREAS, the amended policy presents an opportunity to foster a more welcoming, equitable, and inclusive environment, as well as to reflect and connect with the City’s diverse community;
WHEREAS, the amended policy includes maintaining an inventory list of all Santa Clara facilities and buildings that have been named, including any available background of why the name was selected (“Named City Facilities List”); and
WHEREAS, amending the policy on naming of facilities and standardized Resolution/Amending Council Policy 035 Naming of Facilities Page 2 of 2 Rev: 07/11/23
procedure for naming City buildings and facilities, and would bring greater diversity to the naming criteria of buildings and facilities.

WHEREAS, amending the policy on naming of facilities and standardized procedure for naming City buildings and facilities, would bring greater diversity to the naming criteria of buildings and facilities.

WHEREAS, Naming Rights Agreement: Agreements may provide a financial benefit to the City with sponsorships or naming rights agreements for City-owned facilities which aligns with the City’s mission and values.

NOW THEREFORE, BE IT RESOLVED BY THE CITY OF SANTA CLARA AS FOLLOWS:

1. That Resolution No. 19-8752 adopting amended Council Policy 035 (“Naming of Facilities”), attached here as Attachment 1, is hereby repealed in its entirety.

2. That Council Policy 035 entitled "Naming of Facilities," attached here as Attachment 2, is hereby approved and adopted.
//
//

3. Effective date. This resolution shall become effective immediately.

I HEREBY CERTIFY THE FOREGOING TO BE A TRUE COPY OF A RESOLUTION PASSED

AND ADOPTED BY THE CITY OF SANTA CLARA, CALIFORNIA, AT A REGULAR MEETING THEREOF HELD ON THE 12TH DAY OF OCTOBER, 2023, BY THE FOLLOWING VOTE:

AYES: COUNCILORS:

NOES: COUNCILORS:

ABSENT: COUNCILORS:

ABSTAINED: COUNCILORS:

ATTEST: ______________________________

NORA PIMENTEL, MMC

ASSISTANT CITY CLERK
Resolution/Amending Council Policy 035 Naming of Facilities Page 3 of 2 Rev: 07/11/23

CITY OF SANTA CLARA
Attachments incorporated by reference:

1. Resolution No. 198752

2. Council Policy 035 entitled “Naming of Facilities”
RESOLUTION NO. 19-8752

A RESOLUTION OF THE CITY OF SANTA CLARA, CALIFORNIA
AMENDING COUNCIL POLICY 035 ENTITLED "NAMING OF
FACILITIES"
BE IT RESOLVED BY THE CITY OF SANTA CLARA AS FOLLOWS:

WHEREAS, amending the policy on naming of facilities will establish one standardized procedure for naming City buildings and facilities, and will clarify the naming criteria; WHEREAS, the amended Naming of Facilities policy details the process for the naming of municipal buildings and facilities, and updates the procedure to ensure that it meets the policy requirements; and
WHEREAS, the amended Naming of Facilities policy, attached hereto as Attachment 1, provides guidance for the naming of municipal buildings and facilities, establishes a clear and consistent process for evaluating naming criteria, as well as streamlines the procedure for naming facilities.

NOW THEREFORE, BE IT FURTHER RESOLVED BY THE CITY OF SANTA CLARA AS FOLLOWS:

1. That the current Council Policy 035 entitled "Naming of Facilities" is hereby rescinded in its entirety.

2. That Council Policy 035 entitled "Naming of Facilities," attached hereto as Attachment 1, is hereby approved and adopted, and the City Manager is directed to number (and renumber, as appropriate) the Council Policy Manual such that they are organized in a logical fashion.

II
II
II
II
II
II
Resolution/Amendment of Naming of Facilities Policy
Rev: 6/10/19

Page 1 of 2 ends

3. Effective date. This resolution shall become effective immediately

I HEREBY CERTIFY THE FOREGOING TO BE A TRUE COPY OF A RESOLUTION PASSED

AND ADOPTED BY THE CITY OF SANTA CLARA, CALIFORNIA, AT A REGULAR MEETING THEREOF HELD ON THE 4TH DAY OF SEPTEMBER, 2019, BY THE FOLLOWING VOTE:

AYES: COUNCILORS:

NOES: COUNCILORS:

ABSENT: COUNCILORS:

ABSTAINED: COUNCILORS:

Chahal, Davis, Mahan, O'Neill, and
Watanabe and Mayor Gillmor
None
Hardy
None
ATTEST:
~ ~
NORAPIMENTE[ MM

ASSISTANT CITY CLERK CITY OF

SANTA CLARA
Attachments incorporated by reference:

1. Council Policy 035 entitled "Naming of Facilities"
Resolution/Amendment of Naming of Facilities Policy
Rev: 6/10/19

Page 2 of 2 ends

, City of
Santa Clara
City of Santa Clara
Council Policy Manual
The Center of What's Possible

PURPOSE
POLICY

PROCEDURE
Revised 9/4/2019
Resolution No. 19-8752

NAMING OF FACILITIES
To establish the criteria and procedures for the naming of City of Santa Clara buildings and facilities.

The City Council shall name municipal buildings/facilities in recognition of the following:
• Individuals, living or deceased, who have made outstanding contributions to the City of Santa Clara or Santa Clara community • Individuals, living or deceased, who have made contributions of local, state, national, or worldwide significance
• Geographic location, prominent environmental feature(s), or historical significance, of the area that the building/facility is located For the purpose of this Policy, the term "facility" shall mean property, other than streets, owned by the City of Santa Clara, portions thereof, and amenities or appurtenances thereto. Examples of a "facility" include: a City park, a meeting room within a City building, a trail, or a park bench.

The renaming of existing municipal buildings/facilities shall be discouraged and shall occur only under extraordinary circumstances, after thorough study. A proposal for the renaming of an existing building or facility shall be subject to the same procedure as set forth below for the original naming of the building or facility.

1. Proposals for naming of municipal buildings or facilities shall be referred to the responsible Department Head for the facility, detailing consistency with the policy criteria for naming of facilities.

2. Upon receipt of a naming or renaming proposal of a City building or facility, the Department Head will review if the proposed name is in accordance with at least one of the criteria as outlined in this policy:
a. An individual, living or deceased, who has made outstanding contributions to the City of Santa Clara or Santa Clara community
b. An individual, living or deceased, who has made contributions of local, state, national, or worldwide significance
c. Geographic location, prominent environmental feature(s), or historical significance, of the area that the building/facility is located
Council Policy 035 Page 1 of 2
City of
Santa Clara
City of Santa Clara
Council Policy Manual
Th e Center of What's Possible
Revised 9/4/2019
Resolution No. 19-8752

NAMING OF FACILITIES
If the naming or renaming proposal is reflective of at least one of the criteria, the Department Head will refer the proposal to the City Board, Commission, or Committee responsible for acting in an advisory capacity to the City Council for the building or facility at issue (e.g., a naming proposal for a park facility shall be referred by the Director of Parks and Recreation to the Parks and Recreation Commission).

If the naming or renaming proposal is not reflective of at least one of the criteria, after conferring with the City Manager's Office, the Department Head will express appreciation regarding the naming proposal to the proposer and explain the City's policy and the City's decision to decline the proposal.

4. The Governance and Ethics Committee shall review all naming recommendations at a publicly noticed meeting and deny the recommendation or make a recommendation to the City Council for final approval.

5. The City Council shall consider the naming recommendation at a publicly noticed meeting and will have final approval of all naming recommendations.

In the event the City Council denies a naming proposal, the City Manager's Office will express appreciation regarding the naming proposal to the proposer and explain the City's policy, and the City's decision to decline the proposal.

6. The City Council shall have the sole discretion to decide the naming of a facility.

Council Policy 035 Page 2 of 2
City of Santa Clara
Council Policy Manual