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STATE OF CALIFORNIA <br />DEPARTMENT OF FINANCE <br /> <br /> SACRAMENTO 14, CA[.[FORNIA <br /> <br />Application No. . <br />Date ]Received <br />Date of Resolution <br />Resolution No. . <br />Authorized Start <br /> <br /> APPLICATION FOR AN ALLOTMENT FOR CONSTRUCTION OF A <br /> PUBLIC WORKS PROJECT <br /> [Under provisions of Chapter 20, Statutes of 1946 (First Extra SesSion) as amended, and <br /> Rules and Regulations prescrii~:! thereunder] <br />To: STATE DIRECTOR OF FINANCE: <br /> Application is hereby made for an allotment of the State's share of the estimated cost of Construction of a public works <br />project. The authorized agent signing this application on behalf of local agency hereby certifies that the statements set forth on this <br />and attached sheets are true to the best of his knowledge and belief. <br /> <br /> 1. APPLICANT ........ {~.~__~i~___~L~_ Jk~__.al[~i. ~- ~O.l[~l[ ................ DATE ..................................... <br /> <br /> 2. LOCAL AGENCY'S RESOLUTION NO .................................................. DATE .............................. <br /> <br /> 3. ASSIGNMENT RESOLUTION(S) (II dny) NO.(S) .......................................................... DATE(S) ..................................... <br /> <br /> 4. SHORT TITLE OF PROJECT__.__~_--~---___~___~___~--~-~--~--~--~_--~_I~ .......................................... <br /> L DESCRIPTION AND SCOPE OF PR~JE~T~-~-~~)-~--~--)--~-`~-~--~---~---~--~--~?-~8~ ............. <br /> ........... ..................................................................... <br /> <br /> 6. Funds or sources from which money is being made available by Local Agency for paying that portion of the cost of the project not <br /> requested as an allotment from the State (also show amounts)____~.__~ ~. ~__ _8._?__~_ _~___~___1.._~ __ ~_~ ............. <br /> <br /> .............................. l lJ[ama ............................................................................................. <br /> <br /> 7. ESTIMATED COST OF CONSTRUCTION. (Do no~ include cost o~ plans, speci~cations and estimates) <br /> <br /> a. Right of Way ([or county roads only) ................ $ <br /> b. Supervision and Inspection (Constructio~ Engineering) .... . ........ $ <br /> c. Construction Contract Cost ...................... $ <br /> <br /> d. Day Labor Construction Cost (o~]Jer ~ban/~y ¢onl:ra£~) ............ $ <br /> <br /> e. Contingencies .... 1~ ............... <br /> <br /> f. TOTAL COST. (Sum o~ a) b) ¢) d, e,) ......... $ <br /> g. Cost incurred before date of application ............... $ <br /> h. Cost to be incurred after date of application (~ mings g) ............ $ <br /> 8. Previous Allotments for construction of this project (ii any). (Nos .) ...... <br /> <br /> 9. If the application is for a county road project, is the local agency applying for State aid without matching? <br /> Yes ............. No ............. Amount so applied for ......... <br /> <br />10. TOTAL AMOUNT OF THIS APPLICATION ............... <br /> <br />1 1. Present status of project ..................... ~l~]ll~l~..._~_~h~.~ ................................................................................................ <br /> · Estimated earliest date construction can be starced___ __t~L_~J~q!i~_W___~--~t__~_~-__ -~.~ _~_~.]~--__._~___-~- _~__~_~_~__~___~__~__~_ ............................. <br /> <br />13. Local Agency desires w file claims for reimbursement (Checl¢ *vhich) [~[Monthly [] Quarterly [] Semi-annually <br /> [] One lump sum upon completion [] Other (explain) <br /> <br />14. Architectural and/or engineering services will be rendered by ........... J~ii~_~l~kl.~ ..................................................... <br /> <br />1 ~. Construction will be done by ................... ~ ........................................................................................................... <br /> <br />16. Signature of person designated by resolution as "Authorized Agent." <br /> <br />Title ............................................... Mailing Address ......... : ........................................................... <br /> <br /> <br />