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INSURANCE NOi REQUIRED ReturnORIG1NAL <br />N WORK MAY PROCEED executed copy to COTC, <br />CLERK Of COUNCIL M-30 A-2021-127 <br />= DAPROGRAM SUPPLEMENT NO. 00000OW87 Adv Project ID Date: June 8, 2021 <br />—, to 1221000097 Location: 12-ORA-0-SA <br />ADMINISTERING AGENCY -STATE AGREEMENT Project Number: LRSPL-5063(205) <br />FOR STATE FUNDED PROJECTS NO 12-5063S21 E.A. Number: <br />Q. PMIR L79a 04101) (20 L5 Locode: 6063 <br />This Program Supplement, effective06/04/21, hereby adopts and incorporates Into the Administering Agency -State <br />Agreement No. 12-5063S21 for State Funded Projects which was entered into between the ADMINISTERING <br />AGENCY and the STATE with an effective dale of 07/19/21 and is subject to all the terms and conditions thereof. This <br />PROGRAM SUPPLEMENT is executed in accordance with Article I of the aforementioned Master Agreement under <br />authority of Resolution No. 2021-039 approved by the ADMINISTERING AGENCY on July 6, 2021 (See <br />copy attached). <br />The ADMINISTERING AGENCY further stipulates that as a condition to the payment by the State of any funds derived <br />from sources noted below encumbered to this project, Administering Agency accepts and will comply with the Special <br />Covenants and remarks set forth on the following pages. <br />PROJECT LOCATION: Throughtout the City of Santa Ana <br />TYPE OF WORK: Planning,Programming and Monitoring <br />$180,000.00 <br />STATE $147,000.00 LOCAL <br />$33,000.00, <br />CITY OF SANTA ANA STATE OF <br />By <br />Title <br />Date <br />Attest <br />De <br />60 0,L. Scobv— BY <br />Daisy Gomez <br />i�Ni�-EYccu�Jc ire�ioT"terkofthe Council OIL Ch <br />AIITROVEDASTOFORM Dh <br />OTHER <br />$0.00 <br />of <br />fice of Project Implementation <br />of Local Assistance <br />'_.____ 7/19/2021 <br />J M. J§tmk. Awfmm City Ammaey Date - - — <br />I hereby certify upon my personal knowledge that budgeted funds are available for this encumbrance: <br />Accounting Officer <br />Program Supplement 12--506-W87• SERIAL <br />Date —�ko-1z1 $147.000.00 <br />Page 1 of 3 <br />