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STATE OF CALIFORNIA. DEPARTMENT OF TRANSPORTATION <br />PROGRAM SUPPLMENT AND CERTIFICATION FORM <br />PSCF (REV. 0112010) <br />TO: <br />Claims Audits <br />3301 "C" Street, 11 404 <br />Sacramento, CA 95816 <br />FROM: <br />Department of Transportation <br />SUBJECT: <br />Encumbrance Document <br />VENDOR/ LOCAL AGENCY: <br />CITY OF SANTA ANA <br />$ 20,000.00 <br />PROCUREMENT TYPE: <br />Local Assistance <br />DATE PREPARED, <br />12/16/2016 <br />Page 1 of i <br />PROJECT NUMBER: <br />1217000017 <br />REQUISITION NUMBER! CONTRACT NUMBER: <br />1217000017 ATPL-5063(774] ll -121700000180 <br />ADA Noth For individuals with sensory disabilities, this document is available in alternate formats. For Information, call (915) 654-6410 of TDD (916) -3860 or write <br />Records and Forms Management, 1120 N. Street, MS -80, Sacramento, CA 95814, <br />