Division of Local Assistance Exhibit SLPP-C new

Request for Funding Allocation (SLPP-C Project)

Request for Funding Allocation

state-local partnership Program -competitive(slpp-c) Projects

Local Agency Letterhead

To: (DLAE Name) Date :

District Local Assistance Engineer

Caltrans, Office of Local Assistance

(District Address) PPNO: None

DLA Project No.:______

EA (multiphase): ______

(Brief Project Description)

(Location)______

(County)______

Assembly District: ____

Senate District: ____

Dear (DLAE Name):

This project is on the local highway system. We request that the California Transportation Commission (CTC) allocate (total dollar amount of this request) of Proposition 1B Bond State-Local Partnership Program – Competitive (SLPP-C) funding for this project.

Indicate cycle and date that the above project was adopted by the CTC :_Cycle No:-__ _& Date:______

We agree to fund any increase in the project cost from the time of application.

Project Description:

Enter description of project location and scope from the Project Nomination Information submitted to the CTC at the time of applying for these funds.

Output/Outcome:

Enter action(s) to be taken and quantifiable benefits or results.

A.  Fund Allocation Summary
SLPP-Competitive (as adopted) /

Fund Allocation

Project Component / Amount / Fiscal Year / Previous / This Request / Total
Construction / $______/ _____/_____ / $______/ $______/ $______
Total / $______/ $______/ $______/ $______
B.  Total Project Funding Plan

List all funding sources for the construction component. (If attached Project Application includes this detail and it is still current, it is not necessary to repeat the information here. It does however, need to be reflected by fund type & amount in the local agency project finance letter.)

Division of Local Assistance Exh SLPP-C new

Request for Funding Allocation (SLPP-C Project)

C.  Project description or scope changes

Has the project description or scope changed from the Project Application/Project Nomination Information?

o  Yes

o  No

If the answer to question C is “Yes”, then changes in the project description or scope from the adopted SLPP-Competitive program of projects will require approval by the California Transportation Commission as stipulated in State-Local Partnership Program Guidelines adopted by the Commission.

If yes: please indicate change in project description or scope:

Also, please indicate concurrence of applicant agency if different from implementing agency:

D.  Funds and costs

1) Does this project use any federal funds for any phase of work?

o  Yes

o  No

If “Yes”, then a NEPA Environmental Document is required and must have been approved prior to start of final design (PS&E). NOTE: A separate request for federal authorization to proceed (E-76) is required prior to the start of reimbursable work on phases of work receiving federal funds.

Please note that for this construction component, federal funds can only be used for supplementary funding, i.e., funding that is required beyond the SLPP funds & the required dollar for dollar local match.

2) This request is for Construction. Based on the requested funding approval date shown below, we estimate that we will award a contract for this project on ______(enter date) and complete the contract on ______(enter date)

E.  Status of Project

1) Completion of Environmental Document:

CEQA - Describe document type: ______and date:______

If the project is not exempt from the requirements of CEQA please indicate the date the local agency submitted the CEQA documentation to the CTC (& attach copy of the letter to the CTC): ______

NEPA - Describe document type (if applicable) ______and date: ______

2) Right of Way Certification:

If this project includes federal Construction funds, indicate the date right of way was certified (or will be certified) for the project. ______

3) Construction

The expected date the project will be ready to advertise is: ______

We understand that the CTC expects us to award the construction contract within 6 months of the allocation.

F.  Consultant Contracts

Are there any consultant contracts (for construction engineering) > $250,000?

o  Yes

o  No

If “Yes”, then what is the status of preaward audit?

o  Completed (attach “Audit Deposition Letter”)

o  To be completed by Caltrans (send “Preaward Audit Request Letter” to DLAE)

o  To be completed by local agency or hired “Certified Public Accountant” at a later date (submit Audit and Deposition Letter to DLAE prior to entering into consultant contract).

Local Assistance Program Guidelines Exhibit 16-B

Request for Funding Allocation (TLSP)

G.  Committed required dollar for dollar local match and supplementary funding for full funding

We certifiy that we have the required dollar for dollar match (local uniform developer fees) and the supplementary funding for full funding of the project component as follows: Local Match funds total: $ . Supplementary local funds total: $______. Supplementary federal funds total: $ ,

H.  Allocation of Funds

We request that the Commission allocate these funds at the ______(mon/yr) CTC meeting.

(Refer to the Caltrans CTC Liaison website for the submittal dates at the following URL.

http://www.dot.ca.gov/hq/transprog/ctcliaison.htm)

We understand that the SLPP-Competitive Program requires a match of one dollar of eligible local matching funds for each dollar of SLPP program funds.

I.  Local Agency Certification:

An authorized representative of the implementing agency must sign the request. This Request for Funding Allocation has been prepared in accordance with the State-Local Partnership Program Guidelines adopted by the California Transportation Commission on______(indicate mon/yr). I certify that the information provided in this request is accurate and correct. I understand that if the required information has not been provided this form will be returned and the funding allocation may be delayed. Please advise us as soon as the fund allocation has been approved. You may direct any questions to ______at ______

(name) (phone number)

Signature ______Title:______Date:______

J.  Caltrans District Local Assistance Engineer Acceptance:

I have reviewed the information submitted in the Request for Funding Allocation and agree it is complete and has been prepared in accordance with the State-Local Partnership Program Guidelines adopted by the California Transportation Commission.

Signature ______DLAE______Date: ______

(Title)

Attachments to this request for funding allocation:

-  Competitive Grant SLPP Project Application/Nomination

-  Notice of Exemption or copy of agency letter to CTC

-  Finance Letter (refer to sample letter format in Local Assistance Program Guidelines Exhibit 23-C (for State-only funded projects) or Exhibit 23-D (for State/Federal funded projects))

- Others (as required, e.g. Preaward Audit Request or Audit Disposition letter)

-  - NEPA environmental document (if applicable) & FSTIP Sheet (if applicable)

Distribution: (1) Original + 1 copy to DLAE