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It75- No-{- V- +. <br />Return FULLY EXECUTED <br />N-2022-270 <br />o:Pwf-ci-� <br />copy to COTC M-30 <br />t <br />SUPPLEMENT NO. F167 <br />Rev. 1 <br />Adv. Project ID <br />Date: <br />August 31, 2022 <br />CAPROGRAM <br />N to <br />1217000081 <br />Location: <br />12-ORA-0-SA <br />ADMINISTERING AGENCY -STATE AGREEMENT <br />Project Number: <br />BRLS-5063(184) <br />FOR FEDERAL -AID PROJECTS NO <br />12-5063F15 <br />E.A. Number: <br />w <br />Locode: <br />5063 <br />This Program Supplement hereby adopts and incorporates the Administering Agency -State Agreement for Federal Aid <br />which was entered into between the Administering Agency and the State on 04/28/2017 and is subject to all the terms and <br />conditions thereof. This Program Supplement is executed in accordance with Article I of the aforementioned Master <br />Agreement under authority of Resolution No. 2017-005 approved by the Administering Agency on <br />(See copy attached). <br />The Administering Agency further stipulates that as a condition to the payment by the State of any funds derived from <br />sources noted below obligated to this PROJECT, the Administering Agency accepts and will comply with the special <br />covenants or remarks set forth on the following pages. <br />PROJECT LOCATION: Fairview Avenue over the Santa Ana River, Br. No. 55C-0513 <br />TYPE OF WORK: Bridge Replacement - Widening (2 additional lanes) <br />Estimated Cost Federal Funds <br />Z001 $1,604,806.00 LOCAL <br />$1,812,726.00 $207,f <br />CITY OF S,,AIINTA ANA <br />By h�4 <br />Title Executive Director of Public Works <br />Date <br />Attest <br />,vClerk of the <br />Z <br />LENGTH: 0.2(MILES) <br />COPY °yf <br />OTHER <br />STATE OF CALIFORNIA <br />Department of Transportation <br />By <br />Chief, Office of Project Implementation <br />Division of Local Assistance <br />Date <br />I hereby certify upon my personal knowledge that budgeted funds are available for this encumbrance: <br />Accounting Officer _ ' `/ Date 8/31/2022 <br />$0.00 <br />$1, 604,806.00 <br />Program Supplement 12-5063F15-F167-R1- Page 1 of 7 <br />