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STATE OF CALfFORNIA- DEPARTMENT OF TRANSPORTATION <br />PROGRAM SUPPLME=NT AND CERTIFICATION FORM <br />PSCF (REV. 0112010) <br />TO, <br />Claims Audits <br />3301 "C" Street, Rm 404 <br />Sacramento, CA 95816 <br />FROM, <br />_ Department of Transportation <br />Si <br />Encumbrance Document <br />VENDOR/ LOCAL AGENCY: <br />CITY OF SANTA ANA <br />$ 80,000.00 <br />PROCUREMENT TYPE; <br />Local Assistance <br />DATE PREPARED: <br />1124/2017 <br />Pagel of 1 <br />PROJECT NUMBER: <br />1217004033 <br />REQUISITION NUMBER 1 CONTRACT NUMBER: <br />1217000033 ATFL -5063(177) ll -121700000220 <br />ADA Not!(For individuals with sensory disabilities, this document is available In alternate formats. For information, call (915) 654-6410 of TDD (916) -3884 or write <br />Records and Farms Management, 1120 N. Street, MS -89, Sacramento, CA 95814. <br />