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M Senior Mobility Program <br />oevA 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 />Source(s) of Agency Contributions: <br />Agency hereby certifies that this report Is a true, complete and correct statement of <br />program revenue, costs and operating data. <br />Please send this report by email to CrSPROGRAMS@OCTA.NET or by tax to 714-560-5927. <br />If there are any questions, please contact JOANNE JACOBSEN by email atJJACOBSFN@OCTA,NET <br />or JP GONZALEZ by email atJG0NZAVZ1@0CTA NET, <br />EXHIBIT 1 <br />25A -17 <br />MW --- — --- <br />Service Contract <br />Senior Center <br />—9.0% <br />Drivers / Operators Dlspatchers <br />0,0%—$ <br />Medical <br />Vehicle Maintenance / Fuel / Insurance <br />0.0% <br />$ <br />Marketing Outreach <br />Shopping <br />010% <br />$ <br />010% <br />Administration <br />0.0% <br />Personal Care <br />0.0% <br />Social/ Recreational <br />OCTA Contribution <br />0.0% <br />$ <br />0.0% <br />AgencyContribution <br />$ <br />0.0% <br />$ <br />0.0% <br />Program Revenue <br />0.0% <br />$ <br />Source(s) of Agency Contributions: <br />Agency hereby certifies that this report Is a true, complete and correct statement of <br />program revenue, costs and operating data. <br />Please send this report by email to CrSPROGRAMS@OCTA.NET or by tax to 714-560-5927. <br />If there are any questions, please contact JOANNE JACOBSEN by email atJJACOBSFN@OCTA,NET <br />or JP GONZALEZ by email atJG0NZAVZ1@0CTA NET, <br />EXHIBIT 1 <br />25A -17 <br />MW --- — --- <br />Service Contract <br />0.0%-$ <br />—9.0% <br />Drivers / Operators Dlspatchers <br />0,0%—$ <br />0,0% <br />Vehicle Maintenance / Fuel / Insurance <br />0.0% <br />$ <br />Marketing Outreach <br />010% <br />$ <br />010% <br />Administration <br />0.0% <br />$ <br />0.0% <br />OCTA Contribution <br />0.0% <br />$ <br />0.0% <br />AgencyContribution <br />$ <br />0.0% <br />$ <br />0.0% <br />Program Revenue <br />0.0% <br />$ <br />Source(s) of Agency Contributions: <br />Agency hereby certifies that this report Is a true, complete and correct statement of <br />program revenue, costs and operating data. <br />Please send this report by email to CrSPROGRAMS@OCTA.NET or by tax to 714-560-5927. <br />If there are any questions, please contact JOANNE JACOBSEN by email atJJACOBSFN@OCTA,NET <br />or JP GONZALEZ by email atJG0NZAVZ1@0CTA NET, <br />EXHIBIT 1 <br />25A -17 <br />