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MSenior Mobility Program EXHIBITC <br />OCTA Monthly Reporting Form <br />Service for the - Month of: July <br />Program Name: <br />Participating Agency: <br />Agency Contact: <br />Contact Number: <br />Year of: 2016 <br />- - One- WayTrips ,Service Hours :,Service Miles <br />Trip Category Jul 2016 ':FYTD jut 2016 FYTD 'Jul 2016 FyTD' <br />Senior Center - <br />Medical - .. -- — — — ..._...-- --- --- <br />Shcpping _ <br />Personal Care Social/ Recreational <br />7otaf <br />OCTA Contribution <br />_ <br />Agency Contribution <br />Program Revenue <br />Source(s} of Agency Contributions: <br />Agency hereby certifies that this report is a true, complete and correct statement of <br />program revenue, casts and operating data. <br />Please send this report by email to CTSPROGRAMS @OCTA.NET or by fax to 714 -566 -5427. <br />If there are any questions, please Contact JOANNE JACOBSEN by email atJJACOBSEN @OCTA.NET <br />or JP GONZALEZ by email at JGONZALEZI @OCTA.NET. <br />EXHIBIT 1 <br />2513-19 <br />' 'Jul 2016 <br />- <br />Cost Category <br />Eost ' <br />- Asa % <br />Cost ', <br />As a 46" <br />Service Contract <br />$ <br />- <br />0.0% <br />$ - <br />OA% <br />Drivers / Operators / Dispatchers <br />S <br />0.0% <br />$ - <br />0.0% <br />— ---- -- -_.. _ce /F. --..-- <br />Vehicle Maintenance /Fuel /Insurance <br />$ <br />__ - - - - -- <br />- <br />- - -- — .0% <br />0.0% <br />- <br />$ - <br />-- <br />0.0% <br />Marketing Outreach <br />OCTA Contribution <br />_ <br />Agency Contribution <br />Program Revenue <br />Source(s} of Agency Contributions: <br />Agency hereby certifies that this report is a true, complete and correct statement of <br />program revenue, casts and operating data. <br />Please send this report by email to CTSPROGRAMS @OCTA.NET or by fax to 714 -566 -5427. <br />If there are any questions, please Contact JOANNE JACOBSEN by email atJJACOBSEN @OCTA.NET <br />or JP GONZALEZ by email at JGONZALEZI @OCTA.NET. <br />EXHIBIT 1 <br />2513-19 <br />