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0 ki1JA(, : OUjREO Return ORIGINAL A-2021-129 <br />: 'rr,,EFO executed o COTC, <br />W ROCBA 30 <br />r AUNLIL <br />PROGRAM SUPPLEMENT NO. 00000OW57 Adv Project ID Date: May 10, 2021 <br />to 1221000089 Location: 12-ORA-0-SA <br />ADMINISTERING AGENCY -STATE AGREEMENT Project Number: HSIPSL-5063(204) <br />FOR STATE FUNDED PROJECTS NO 12-5063S21 E.A. Number: <br />Locode: 5063 <br />This Program Supplement, effective05/06/21, 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 date 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 Stale 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: Bristol Street and Santa Clara Avenue <br />TYPE OF WORK: Upgrade Signals <br />Estim_ated Cost State Funds Matching Funds <br />STATE $23.800.00 LOCAL OTHER <br />$23,800.00 <br />$0.00 <br />CITY OF SANTA ANA <br />By A — <br />Title PWA- EtecutiveDirector <br />SO <br />Date � lh I �S, _ f <br />IL <br />Attest <br />�' ;� APPROY®!1S TD FORM <br />Daisy Gomez 1��`- <br />Clerk of the Council 7oae bi. Fmk Mwuor Ciry Atrmney <br />$0.00 <br />STATE OF CALIF RNI <br />Departme of T nsp <br />By -- <br />Chief ffice of Project Implementation <br />Divis n of Local Assistance <br />Date — 7/30/2021 <br />I hereby certify upon my personal knowledge that budgeted funds are available for this encumbrance: <br />Accounting Officer ,-e t/ JV Date s A c /2 CL <br />S23.800.00 <br />Program Supplement 12--506-W57- SERIAL Page 1 of 3 <br />