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m Senior Mobility Program <br />®cTA Monthly Reporting Form <br />Service for the- Monthof: July <br />Program Name: <br />Participating Agency: <br />Agency Contact: <br />Contact Number: <br />Year of: 2016 <br />h, pP <br />Tri{iCat egory P5, '� ,�. ..,' ,'� ,'`'.; .r <br />One WayTnps <br />SennceHours <br />�Servrce,Mles�f <br />`.:1u120W <br />,,?F1TDN. <br />.'JuY2036 <br />YTD <br />' nyJu12016 <br />Senior Center <br />- <br />- <br />Medical <br />- <br />- <br />- <br />- <br />Shopping <br />- <br />Personal Care <br />- <br />- <br />- <br />- <br />- <br />- <br />Social / Recreational <br />- <br />- <br />- <br />TIf <br />1, / u.,, nt �,� <br />hh^_i g# 3n J`Ar 4 }i <br />]: sE4"' p l`y f _:rt <br />Cosx;[ategory „ v T , <br />Jul <br />C 7 v 5 <br />Yt� •�3 a'YY ^�1 <br />, Cosy , _,_, <br />Asa % <br />Cost , <br />qs a 6y <br />Service Contract <br />$ - <br />0.0% <br />$ - <br />0.0% <br />Drivers / Operators [Dispatchers <br />$ - <br />0.0% <br />$ - <br />0.0°% <br />Vehicle Maintenance / Fuel / Insurance <br />$ - <br />0.0% <br />$ - <br />0.09i <br />Marketing Outreach <br />$ - <br />0.0% <br />$ - <br />0.0% <br />Administration <br />$ - <br />0.0% <br />$ - <br />0.0% <br />Ttitas. lis . r. , <br />- <br />NUN <br />OCTA Contribution <br />$ - <br />0.0% <br />$ - <br />0.0% <br />Agency Contribution <br />$ - <br />0.0% <br />$ - <br />0.0% <br />Program Revenue <br />$ - <br />0.0%j <br />$ - <br />0.0% <br />Source(s) of Agency Contributions: <br />Agency hereby certifies that this report is a true, complete and correct statement of <br />program revenue, costs and operating data. <br />Please send this report by email to CTSPROGRAMS@OCTA.NET or by fax to 714-560-5927. <br />If there are any questions, please contact JOANNE JACOBSEN by email at JJACOBSEN@OCTA.NET <br />or JP GONZALEZ by email at JGONZALEZI@OCTA.NET. <br />