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STATE OF CALIFORNIA. DEPARTMENT OF TRANSPORTATION <br />PROGRAM SUPPLMENT AND CERTIFICATION FORM <br />PSCF (REV. 01/2010) <br />TO: <br />Claims Audits <br />3301 "C" Street, Rm 404 <br />Sacramento. CA 95816 <br />Department of Transportation <br />SUBJECT'. <br />Encumbrance Document <br />VENDOR/ LOCAL AGENCY: <br />CITY OF SANTA ANA <br />$ 500,000.00 <br />PROCUREMENTTYPE: <br />Local Assistance <br />8/19/2016 <br />REQUISITION NUMBER /CONTRACT NUMBER. <br />1216000017 STPL-506311691 RQS -121 <br />Page 1 of 1 <br />ADA Notk For individuals with sensory disabilities, this document is available in alternate formats. For information, call (915) 654-6410 of TDD (916) -3880 or write <br />Records and Forms Management, 1120 N. Street, MS -89, Sacramento, CA 95814. <br />