20A - AA - AGMT - ELDERLY AND DISABLED TRANSIT GRANT

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Standard Agreement DOT -213 City of Santa Ana 642572 Page 25 of 29 EXHIBIT C APPENDIX A I iTLE V1 PROGRAM CHECKLIST Every three years, on a date determined by FTA, each recipient is required to submit the following information to the Federal Transit Administration (FTA) as part of their Title VI Program. Subrecipients shall submit the information below to their primary recipient (the entity from whom the subreeipient receives funds directly), on a schedule to be determined by the primary recipient. General Requirements (Chapter 111) .4/I recipients nanst subunit: ❑ Title VI Notice to the Public, including a list of locations where the notice is posted ❑ Title V1 Complaint Procedures (i.e., instructions to the public regarding how to file a Title VI discrimination complaint) Cl Title VI Complaint Form ❑ List of transit - related Title VI investigations, complaints, and lawsuits ❑ Public Participation Plan, including information about outreach methods to engage minority and limited English proficient populations (LEP), as well as a summary of outreach efforts made since the last Title Vi Program submission ❑ Language Assistance Plan for providing language assistance to persons with limited English proficiency (LEP), based on the DOT LEP Guidance ❑ A table depicting the membership of non- elected committees and councils, the membership of which is selected by the recipient, broken down by race, and a description of the process the agency uses to encourage the participation of minorities on such committees ❑ A Title V3 equity analysts if the recipient has constructed a facility, such as a 'vehicle storage facility, maintenance facility, operation center, etc. ❑ A copy of board meeting minutes, resolution, or other appropriate documentation showing the board of directors or appropriate governing entity or official(s) responsible for policy decisions reviewed and approved the Title VI Program. For State DOT's, the appropriate governing entity is the State's Secretary of Transportation or equivalent. The approval must occur prior to submission to FTA. ❑ Additional information as specified in chapters IV, V, and VI, depending on whether the recipient is a transit provider, a State, or a planning entity (see below) ❑ The State of California shall include a description of how the agency monitors its subrecipients for compliance with Title VI, and a schedule of subrecipient Title VI Program submissions Rev. 03/25/2014 agm-6' 20A -30