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COOPERATIVE AGREEMENT NO. C-1-3262 <br />EXHIBIT A <br />ATTACHMENT <br />Senior Mobility Program O�CGO m <br />Luca/ rax Dollars ac Nbrk Monthly Reporting Form OCTA <br />Agency Information <br />Service for the - <br />Participating Agency: <br />Agency Contact Name: <br />Contact Number / Email: <br />Financial Summaries <br />Cost Category <br />Direct Cost: Contracted Services <br />Direct Cost: In -House Labor <br />Direct Cost: Vehicle Expenses <br />Direct Cost: Marketing / Outreach <br />Subtotal Direct Costs <br />IndirectCosts7 ❑Yes <br />Total Expenses <br />Month of: Ju <br />Year of: 2021 <br />Ju12021 <br />FYTD <br />Cost <br />% of Total <br />Cost <br />% of Total <br />0.0% <br />$ <br />0.0% <br />-- <br />0.0% <br />$ <br />0.09/. <br />0.094. <br />$ <br />0.091. <br />0.0% <br />$ <br />0.091. <br />0.0% <br />$ <br />0.0% <br />0.0%1 <br />$ <br />0.0% <br />Above Total Expenses Paid By... <br />Jul 2021 <br />% of Total <br />FYTD <br />96of Total <br />OCTA Contribution <br />$ - <br />0.0% <br />$ <br />0.0% <br />Agency Contribution <br />$ <br />0.0% <br />$ <br />0.0% <br />Total Contributions <br />$ <br />0.0% <br />$ <br />0.0% <br />Above Agency Contribution Sources <br />Jul 2021 <br />%of Total <br />FYTD <br />%of Total <br />General Fund / In -Kind <br />0.0% <br />$ <br />0.0% <br />General Donations <br />0.0% <br />$ <br />0.0% <br />Transportation Fees / Rider Fares <br />0.0% <br />$ <br />0.0% <br />Title IIIB Funds <br />0.0% <br />$ <br />0.0% <br />Other: <br />0.0% <br />$ <br />0.09t. <br />Other: <br />0.0% <br />$ <br />0.0% <br />Other: <br />0.0% <br />$ <br />0.0% <br />Total Agency Contributions <br />$ <br />0.0%1 <br />$ <br />0.0% <br />Declaration and Submission <br />Agency hereby certifies that this report is a complete and correct statement of the program's financial data. <br />Submitted By: Must be by the Finance Director or Designee <br />Signature: <br />Date: <br />THIS REPORT IS DUE NO LATER THAN 60 DAYS AFTER THE END OF THE SERVICE QUARTER <br />Please send this report by email to CTSPROGRAMS@OCTA. NET. <br />