Item C07 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 12/12/2013 Division: County Administrator
Bulk Item: Yes X No Department: Social Services
Staff Contact Person:—Sheryl Graham
AP '(64-s (305) 292-45 Iji , I
yuul
AGENDA ITEM WORDING: Request approval to apply for a Florida Department of Transportation
(FDOT) FTA Section 5310 Program Federal Fiscal Year 2014-2015 Capital Assistance Grant for the
purposes of purchasing a para transit vehicle (bus) to serve the transportation needs of the elderly and
persons with disability in Monroe County.
ITEM BACKGROUND: The Florida Department of Transportation Section 5310 Grant is generally
applied for on an annual basis by the Monroe County Social Services Transit department. This grant is
intended to enhance mobility for seniors and persons with disabilities by providing funding for
programs to serve the special needs of transit dependent populations beyond traditional public
transportation and in accordance with the Americans with Disabilities Act(ADA).
PREVIOUS RELEVANT BOCC ACTION: Ratification for Acceptance of Grant Award FTA
Section 5310 —for Year 13-14 is pending BOCC at the 12/12/13 meeting and prior approval granted by
the BOCC on 12/12/12 to apply for FTA Section 5310-Year 13-14.
CONTRACT/AGREEMENT CHANGES: New Agreement
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $100,000 (maximum) BUDGETED: Yes X No
COST TO COUNTY: $10,000 (match required-maximum) SOURCE OF FUNDS: Grant
funds
REVENUE PRODUCING: Yes N/A No AMOUNT PER: MONTH: YEAR:
APPROVED BY: County Atty. OMB/Purchasing oL Risk Management �
DOCUMENTATION: Included X Not Required To Follow
DISPOSITION: AGENDA ITEM #_
Revised 81/06
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: State of Florida, Department of Contract:
Transportation(FDOT)
Effective Date:
Expiration Date:
Contract Purpose/Description: Request approval to apply for a Florida Department of Transportation FTA
Section 5310 Program FFY 14-15Capital Assistance Grant funding for the purposes of purchasing a para-transit
vehicle(bus)to serve the transportation needs of the elderly and persons with disabilities in Monroe County-.
Contract Manager: Sheryl Graham 292-4511
01 Social Services/Stop I
(Name) (Ext.) (Department/Stop#)
For BOCC meeting on 12/12/2013 Agenda Deadline: 11/25/2013
CONTRACT COSTS
Total Dollar Value of Contract: approx. $100,000(maximum) Current Year Portion: $_
Budgeted?Yes X No 0 Account Codes: 001-61525
County Match: $10,000(maximum)
Additional Match: -0-
Total Match $10,000 ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
(Not included in dollar value above) (e.g.Maintenance,utilities,janitorial,salaries,etc)
CONTRACT REVIEW
Changes Date Out
Date In Needed Reviewer
Division Director Yes 0 NoF
Risk Management 11-()-55) Yes 0 No
O.M.B./Purchasing I Yes No ' fis fis
County Attorney 1'!'� Yes No
Comments:
OMB Form Revised 2/27/01 MCP#2
I tkq�j
V
Florida Department of Transportation
Rrcx SCOTT 1000 NW 11 Ph Avenue ANANTH PRASAD,P.E.
GOVERNOR
Miami, Florida 33172 SECRETARY
November 4, 2013
RE: FTA SECTION 5310 PROGRAM—Federal Fiscal Year 2014—2015
Dear Agency:
The Florida Department of Transportation(FDOT)—District Six anticipates the availabilifty of federal and
state capital assistance for Agencies based in Miami-Dade and Monroe Counties for Federal Fiscal Year
2014-2015 of the Federal Transit Administration(FTA)Section 5310 Program. This capital grant program
is available to private, nonprofit organizations and to public bodies approved by the State to purchase
vehicles to serve the transportation needs of the elderly and persons with disabilities.
Keeping a Community Transportation Coordination (CTC) agreement in effect is a requirement of
receiving vehicles through the FTA Section 5310 program, and a requirement for all agencies that have
Section 5310 vehicles, whether the agency applies or not to Federal Fiscal Year 2014-15 Section 5310
funding. All returning FTA Section 5310 applicants (with program vehicles) must have a current, fully
uv executed CTC agreement with their respective local county coordinator when applications are due. New
applicants (without program vehicles) have until January 31, 2014 to apply for the required CTC
agreement. Applications not meeting this requirement will not be accepted for funding consideration.
If your organization is interested in applying for assistance under the FTA Section 5310 Program,you are
strongly encouraged to attend one of the workshops below.
Monroe Countr Miami Dade County
Place Florida Department of Transportation FDOT District Six Office
Marathon Operations Center 1000 NW 11 I th Ave. -Auditorium
3100 Overseas Highway Miami, Florida 33172
(48.7 Mile Marker)
Marathon, Florida 33050
Time 1:00 P.M. (Section 5310 Workshop) 1:00 p.m.(Section 5310 Workshop)
10:00 a.m. (TransCIP Training) 9:30 a.m.(TransCIP Training)
Date Tuesday, December 3, 2013 Wednesday, December 4, 2013
Application packages will be distributed at the workshops. If your Agency cannot attend either workshop,
you may request a package in writing after December 4, 2013.
'ublic participation is solicited without regard to race,color,national origin,age,sex,religion,disability or
family status.
www.dot.stat:e.fl.us ®RECYCLED PAPER
Should you have any questions regarding this program, please feel free to contact Raymond Freeman at
(305) 470-5255 or you can contact me at (305)470-5295.
S'
Dionne hardson
2istic. '�
Freight, gistics&Passenger Operations Manager
cc: Harold Desdunes, P.E.—Florida Department of Transportation
Aileen Boucle, AICP -Florida Department of Transportation
Raymond Freeman- Florida Department of Transportation
Irma San Roman—Miami-Dade Metropolitan Planning Organization
Elizabeth Rockwell—Miami-Dade Metropolitan Planning Organization
James Murley—South Florida Regional Planning Council
Eric Swanson—South Florida Regional Planning Council
Carolyn Haia—Key West Department of Transportation
Cindy Wooten—Center for Urban Transportation Research
Mia Marin—Miami-Dade Transit
Maureen Grynewicz—Guidance/Care Center
---------- -2014
U.S.C. Section 5310
Formula Grants for the Enhanced Mobility of Seniors
and Individuals with Disabilities
OPERATING AND
CAPITAL ASSISTANCE
APPLICATION MANUAL
------------
-----------------
FLORIDA DEPARTMENT OF TRANSPORTATION
PUBLIC TRANSIT OFFICE
Table of Contents
Page
Introduction 3
General Program Information/Requirements 3
Threshold Criteria 4
Grant Award Process 7
General Instructions on Forms, Exhibits, and Certifications 7
Contents of Grant Applications 8
Checklist for Application Completeness 24
Exhibits to be Included in the Application 25
Appendix 34
2
Introduction
This application manual pertains to applications for Federal assistance under U.S.C. Section 5310, Formula
Grants for the Enhanced Mobility of Seniors and Individuals with Disabilities Program,as administered by the
Florida Department of Transportation(FDOT.) It contains program information,application forms,exhibits,
certifications&assurances, and instructions.
General Program Information / Requirements
Program Administration. The Federal government allocates funds to the State of Florida each year for the
Section 5310 Program. FDOT has been designated by the Governor to administer the program. FDOT is
responsible for the following services but, at its discretion, may contract with a service provider to perform
these services.
1. announcement of funding availability;
2. selection of projects for funding according to approved selection criteria;
3. development and processing of agreements;
4. oversight of recipient procurement actions;
5. oversight of recipient compliance with State and Federal requirements; and
6. provision of technical assistance regarding the Section 5310 Program.
Authorizing legislation for the program is shown in the Glossary of this manual under"authorizing Federal and
State Legislation."
The Federal goal of the Section 5310 Program is to provide assistance in meeting the needs of seniors and
individuals with disabilities where public transit services are unavailable, insufficient or inappropriate.
Application Deadlines. Application deadlines vary from District to District but usually fall between
December and February each year. FDOT District Offices evaluate grant applications within their respective
districts and,thereafter, submit Programs of Projects(POP)to the FDOT Central Office. The Central Office
compiles POPS from the various Districts and submits a statewide grant application for Federal funds to the
Federal Transit Administration(FTA)by April 1 of each year. The statewide application is usually approved
by FTA by July 1 of each year. The appropriation for State funds to match Federal funds is approved by the
State Legislature for implementation on July I of each year. Once Federal and State funds are available,
Districts may make grant awards.(See"Grant Award Process"). At least 55%of the available funding will be
awarded to capital projects. The Department reserves the right to increase that percentage up to 100% of
project selections as capital,as deemed best suited to meet the mobility needs of seniors and individuals with
disabilities where public transit services are unavailable, insufficient or inappropriate.
Grant Application Evaluation Criteria. Unless there is sufficient funding in a District to cover all eligible
requests, District Offices will use the following criteria to evaluate applications.
A.Service efficiency and effectiveness: This is demonstrated by the usual daily hours of eligible service and
vehicle occupancy. The emphasis is on the normal hours that agency vehicles are in service,not the hours the
applicant is open for business. Applicants providing transportation service for more hours and with fuller
vehicles will be ranked higher. The applicant's use of current vehicles(including mileage and maintenance
practices)will be considered in the review and ranking.
B. Extent to which the community at large is served by the applicant: Applicants serving the highest
community needs through social service agencies and providing the most trips to elderly and disabled
3
passengers will be ranked higher.
C. Extent to which elderly persons and persons with disabilities are served: Applicants that maximize
transportation benefits to elderly persons and persons with disabilities in their community will be evaluated on
the percentage of total riders/passengers served that are elderly and/or disabled. Those serving the highest
percentage will be ranked higher.
D. Need: Applicants that can demonstrate they serve, or propose to serve, the largest number of eligible
passengers, and have the most urgent financial needs will be ranked higher. FDOT has a goal to preserve
transportation infrastructure; therefore, maintaining current levels of service may be deemed a higher
priority/need than expanding into new services or expanding service area coverage. A detailed explanation of
the need and evidence of the need are required.
E. Fiscal and managerial capability: Applicants with well-documented budgets and good fiscal capability
demonstrated by the correctness and completeness of their application,by prior audits,proper maintenance of
vehicles as demonstrated by miles at replacement, and previous timeliness and accuracy of required reports,
will be ranked higher.
F. Prior Performance: Applicants who have a history of meeting contractual obligations and maintenance
requirements for Section 5310 vehicles will be ranked higher. New applicants will not be penalized for having
little or no history with FDOT,but previous applicants will be penalized for poor past performance.
Threshold Criteria
Threshold criteria are the minimum legal eligibility requirements. Applications must be for eligible services,
eligible service areas, eligible recipients, eligible expenses, and provide evidence of local matching funds.
Applicants must also ensure compliance with a number of other conditions placed on recipients of grants
including, but not limited to, coordination of transit services, civil rights preservation, vehicle maintenance
requirements,compliance with safety and drug free work place regulations,competitive procurement of goods
and services bought with grant funds, Americans with Disabilities Act and references to the Federal Transit
Administration's Master Agreement(http://www.fta.dot.gov/documents/17-Master.pdf).
Eligible Recipients. For the Section 5310 Program, funds may be awarded to public agency Community
Transportation Coordinators (CTC's), private-non-profit OTC's, and to private non-profit organizations
providing transportation to elderly persons and/or persons with disabilities under a coordination agreement
with a CTC. When the CTC is a private for-profit agency,the designated official planning agency responsible
for designating the CTC may apply for Section 5310 funds, then sub-contract with the CTC for provision of
service. Recipients must be either a CTC or providing service under the terms of a written agreement with a
CTC. Agencies must keep their CTC Agreements current and in force at all times when receiving an award
under the Section 5310 Program.
Legal Authority and Fiscal & Managerial Capability. Section 5310 applicants must have the legal
authority and fiscal/managerial capability to apply for Federal assistance. Applicants are required to have
sufficient local funds for match requirements (see below) and for maintenance and operation of
vehicles/equipment. Failure to properly manage,maintain,and operate vehicles/equipment could jeopardize
existing and future grants and may result in the removal of vehicles/equipment.
Eligible Expenses. Section 5310 funds may be used for the capital and/or operating expense of transportation
services to elderly persons and/or persons with disabilities.Eligible expenses are limited to buses,vans or other
paratransit vehicles(including sedans and station wagons),radios and communications equipment,wheelchair
lifts and restraints,vehicle rehabilitation,vehicle overhaul,data processing hardware/software,other durable
goods such as spare components with a useful life of more than one(1) year and a per unit cost over $300,
4
-----------
initial installation costs,vehicle procurement/testing,vehicle inspection and vehicle preventative maintenance,
operating costs associated with providing transit service,costs associated with transit service that exceeds the
requirements of the Americans with Disabilities Act of 1990, projects that improve access to fixed route
service and decrease reliance by individuals with disabilities on complementary paratransit,and alternative to
public transportation that assist seniors and individuals with disabilities with transportation. An applicant
applying for preventative maintenance costs must have a District approved maintenance plan and a cost
allocation if activities are performed in house. The Federal share for eligible capital expenses may not exceed
eighty percent(80%).
Ineligible Expenses. Ineligible expenses include expenses associated with preparation of grant applications,
project planning, administration, and extended warranties; expenses incurred prior to Federal and State
approval of a grant application; expenses incurred prior to the execution of a grant award; and expenses
incurred prior to the Department's approval of plans, specifications, and third party contracts for
vehicles/equipment to be purchased with Section 5310 funds.
Matching funds for Section 5310 Capital Assistance. Applicants may not borrow funds to use as match nor
may they place liens on Section 5310-funded vehicles or equipment.The breakdown of funding for the Section
5310 Grant program is 80/10/10 for capital projects,meaning the Federal share of eligible capital costs may not
exceed 80%of the total award. State funds may support up to 10%of eligible capital costs with the remaining
10%being supported by a local match.At the time an order is placed for vehicles/equipment,the applicant is
required to provide a purchase order for its 10%local match to be paid to the vendor. The required 10%local
match must be paid at the time of time of delivery.
Matching funds for Section 5310 Operating Assistance. The Section 5310 federal share of eligible
operating expenses may not exceed 50%. Some combination of state,local,or private funding sources must be
identified and committed to provide the required non-federal share. The non-federal share may be cash,or in
kind. Funds may be local,private,state,or(up to one half)unrestricted Federal funds. Funds may not include
any borrowed against the value of capital equipment funded in whole or in part by State and/or Federal
sources.
The Section 5310 Program permits up to one half the required match to be derived from other unrestricted
Federal funds. Federal funds are unrestricted when a Federal agency permits its funds to match Section 5310.
Essentially,all Federal Social Service Programs using transit services are unrestricted;other USDOT Programs
are not.
Contract revenue from the provision of transportation services to social service agencies may also be used as
local match. The costs associated with providing the contract revenue service must be included in the project
budget if using contract revenue as match.
Non-cash items such as donations of goods or services, volunteered services, or in-kind contributions are
eligible to be counted towards the local match only if the value of such is formally documented,supported and
pre-approved by the District Office. Any funds committed as match to another Federal program may not be
used to match Section 5310 funds. Operating assistance funds will be awarded through a joint participation
agreement with the Department.
Americans with Disabilities Act(ADA). Applicants shall comply with the Americans with Disabilities Act,
(ADA) of 1990, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; U. S. DOT
regulations, Transportation Services for Individuals with Disabilities (ADA)"at 49 CFR Part 37; and FTA
regulations,Transportation for Elderly and Handicapped Persons,49 CFR Part 609.
Administrative requirements. Applicants shall supply the appropriate Regional Planning Council
(RPQ/locaI clearinghouse agency (see Appendix) a copy of its application for Federal Assistance. Each
5
applicant shall request the RPC/Clearinghouse to provide a letter of approval of the application to the
appropriate MOT District Office. Copies of correspondence to the RPC/Clearinghouse agency should be
contained in the grant application.
First time private-non-profit applicants must attach a Certificate of Incorporation to their application.
Section 5310 projects located in an urbanized area or within a metropolitan area planning boundary must be
listed in the Transportation Improvement Program/Biennial Element(TIP/BE)of the respective urbanized area.
Although applications for such projects may be accepted by the MOT District Office prior to their listing in a
TIP/BE,a grant award will not be final for such projects until all administrative requirements are completed,
including being listed in the appropriate TIP/BE.
Use of Section 5310-funded vehicles or equipment. Section 53 10-ftmded vehicles/equipment must be used
in the small urbanized or rural area for which was awarded to transport the elderly and disabled. They may be
used to provide transportation to employment,medical care,education,shopping,socialization,etc. Incidental
use of vehicles as cargo carriers(i.e. meals on wheels),and work vehicles(i.e.carrying crews and equipment
from site to site and/or standing idle between work sites)is permitted as long as it does not interfere with the
primary use of the vehicle(s). In such cases, the number of vehicles requested in an application must be
justified by the number of people transported--not meal delivery or tool handling requirements. The need and
planned use of the requested vehicles must be detailed in the Proposed Project Description(Exhibit B).
Lease of vehicles. Vehicles purchased with Section 5310 funds may be leased to local public bodies or
agencies, non-profit agencies, or private-for-profit operators only for the services identified in the grant
application. The lease between the applicant and the lessee shall contain the terms and conditions that must be
met in providing transportation service to the elderly and persons with disabilities, and must be approved by
the appropriate FDOT District Office. When vehicles are operated by an agency other than the one named as
applicant in the grant application,control and responsibility for the operation of the vehicles remains with the
applicant.
Small urbanized vs. rural areas. Small urbanized areas are those with populations between 50,000 and
199,999. To be considered rural, an area will have population under 50,000.
6
Grant Award Process
To notify an applicant (recipient) approved by FDOT for an award, FDOT will send a "Notice of Grant
Award" to the recipient with instructions to sign and return it to the Department. (See sample notice in the
Appendix.) Thereafter, the agency will contact the MOT Contractor to arrange for purchase of
vehicles/equipment. A signed Notice of Grant Award is a legally binding agreement.
By signing a Notice of Grant Award grant recipients agree to comply with all applicable requirements as
contained in U.S.C.49 Section 5310 of the Federal Transit Act of 1991,as amended.This is accomplished by
ensuring adherence with all federally-required certifications and assurances made in Exhibits F and Exhibit G.
Grant applicants/recipients must also make certain assurances and certifications to FDOT, as provided in
Exhibit H. Additionally, grant recipients will be required to report to FDOT and FTA certain performance
measures as determined by FTA.
General Instructions on Forms, Certifications, and Exhibits
Each form, exhibit, and certification provides FDOT with information it must have to make required
assurances to the Federal government or to make decisions on project selection. It is important that each
required form, exhibit, and certification be complete and correct. Applicants should be aware that there are
criminal sanctions for furnishing false information in order to obtain federal grants(18 U.S.C. 1001).
The original application should be prepared on white, 8.5 X 11"paper and securely clipped(no binders or
dividers, please) and submitted to the appropriate FDOT District Office, as shown in the Appendix of this
manual. Each District Office requires at a minimum one(1)original and additional copies,as determined by
the District, to be submitted. Application forms, resolutions, exhibits, and certifications should be
arranged in the order listed in the "Checklist for Application Completeness", as provided in this
manual, to assure the application is complete. Incomplete, illegible, or unsigned applications may be
rejected.
The original application must be accompanied by the required cover letter and two (2) fully-executed
Resolution forms (see Appendix for sample), which includes minimum required language, from the
applicant's governing board. Resolutions should authorize 1)submission of the application;2)signing of the
application and certifications/assurances by a designated individual; 3)acceptance of the grant award by the
designated individual; and 4)be printed on company letterhead.
All signatures should be in blue ink by the individual designated by the governing board of the
applicant agency. Blue ink distinguishes an original signature from a photocopy. Only original
signature resolutions, applications, and acceptance of grant awards are acceptable. The additional
copies,if required by the District Office, may be photocopies.
Questions regarding Section 5310 applications or the application process should be directed to the FDOT
District Office in the applicant's service area, as shown in the Appendix of this manual.
7
CONTENTS OF
APPLICATIONS
Pale
PART A: APPLIES TOALL APPLICATIONS 9
PART B: REQUEST FOR OPERATING ASSISTANCE 13
PART C: REQUEST FOR CAPITAL ASSISTANCE 18
8
PART A
APPLIES TO ALL APPLICATIONS
Pnv
Grant Application Instructions 10
Standard Form 424: Application for Federal Assistance 11
9
PART A
APPLIES TO ALL APPLICATIONS
Grant Application Instructions.
The standard Application for Federal Assistance(Form 424)must be filled out in its entirety for Section
5310 applications, and for the local clearinghouse submission. The standard form is located on the next
page of this manual. It can also be found on the Internet in an interactive Adobe format at
http://www.dot.state.fl.us/transit/Pages/Fonn 424.pdf.This form must be used for ALL applications.
No pre-application process is used in this program; therefore, all submissions are applications.
The code assigned to the Section 5310 Program in the Catalog of Federal Domestic Assistance is
20.513. This code should be shown in Section 10 of the form followed by the title: "Formula Grants
for the Enhanced Mobility of Seniors and Persons with Disabilities Program."
Executive Order 12372 requires a review of all Federal grants to ensure compliance with the local and state
planning process. Therefore,prior to submission of an application to the FDOT District Office, copies of
the application must be submitted to the appropriate Local Clearinghouse/Regional Planning Council(See
Appendix). The appropriate clearinghouse agency should be contacted to determine the number of copies
required for local review.
Letters from the local clearinghouse supporting the application must be submitted to the District
Office before a Section 5310 Award can be made.
NOTE: Applicants for Section 5310 Assistance should send their applications to the LOCAL
CLEARINGHOUSE/REGIONAL PLANNING COUNCIL; NOT TO THE STATE
CLEARINGHOUSE.
AGENCIES APPLYING ONLY FOR OPERATING ASSISTANCE: Standard Form 424 should
cover only the Operating Assistance being applied for by the applicant.
AGENCIES APPLYING ONLY FOR CAPITAL ASSISTANCE: Standard Form 424 should cover
only the Capital Assistance being applied for by the applicant.
AGENCIES APPLYING FOR BOTH OPERATING AND CAPITAL ASSISTANCE: Standard
Form 424 should cover both Operating Assistance and Capital Assistance being applied for by the
applicant.
10
Form 424
Item Entry: Item I Entry:
1. Select Type of Submission. 11. Enter a brief descriptive title of the project.If more than one program is
involved,you should append an explanation on a separate sheet.If
appropriate(e.g.,construction or real property projects),attach a map
showing project location.For preapplications,use a separate sheet to
provide a summary description of this project.
2. Date application submitted to Federal agency(or State if 12. List only the largest political entities affected(e.g,,State,counties,cities).
applicable)and applicant's control number(if applicable).
3. State use only(if applicable). 13 Enter the proposed start date and end date of the project.
47 Enter Date Received by Federal Agency 14. List the applicant's Congressional District and any District(s)affected by the
Federal identifier number:If this application is a program or project
continuation or revision to an existing award,enter the
present Federal Identifier number.If for a new project,
leave blank.
5. Enter legal name of applicant,name of primary 15 Amount requested or to be contributed during the first funding/budget period
organizational unit(including division,if applicable),which by each contributor.Value of in kind contributions should be included on
will undertake the assistance activity,enter the appropriate lines as applicable.If the action will result in a dollar change to
organization's DUNS number(received from Dun and an existing award,indicate only the amount of the change.For decreases,
Bradstreet),enter the complete address of the applicant enclose the amounts in parentheses.If both basic and supplemental
(including country),and name,telephone number,e-mail amounts are included,show breakdown on an attached sheet.For multiple
and fax of the person to contact on matters related to this program funding,use totals and show breakdown using same categories as
application. item 15.
6. Enter Employer Identification Number(EIN)as assigned by 16. Applicants should contact the State Single Point of Contact(SPOC)for
the Internal Revenue Service. Federal Executive Order 12372 to determine whether the application is
subject to the State intergovernmental review process.
7. Select the appropriate letter in the 17. This question applies to the applicant organization,not the person who signs
space provided. as the authorized representative.Categories of debt include delinquent audit
disallowances,loans and taxes.
A.State I.State Controlled
Institution of Higher
B.County Learning
C.Municipal J.Private University
D.Township K.Indian Tribe
E.Interstate L.Individual
F.Intermunicipal M.Profit
Organization
G.Special District
N.Other(Specify)
H.Independent School District
O.Not for Profit
Organization
8. Select the type from the following list: 18 To be signed by the authorized representative of the applicant.A copy of the
governing body's authorization for you to sign this application as official
•"New"means a new assistance award. representative must be on file in the applicant's office.(Certain Federal
agencies may require that this authorization be submitted as part of the
•"Continuation"means an extension for an additional application.)
ftinding/budget period for a project with a projected
completion date.
•"Revision"means any change in the Federal
Government's financial obligation or contingent liability from
an existing obligation.If a revision enter the appropriate
letter:
A.Increase Award B.Decrease Award
C.Increase Duration D.Decrease Duration
9. Name of Federal agency from which assistance is being requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and title of the program under which
assistance is requested.
APPLICATION FOR FEDERAL ASSISTANCE Version 7/03
1.TYPE OF SUBMISSION:
Application—place an x in the box Pre-application—place an x in the box
construction construction
non-construction non-construction
2.DATE SUBMITTED Applicant Identifier
3.DATE RECEIVED BY STATE State Application Identifier
4.DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
15.APPLICANT INFORMATION
Legal Name: Organizational Unit:
Department:
Organizational DUNS: Division:
Address: Name and telephone number of person to be contacted
on matters involving this application(give area code)
Street: X: First Name:
City: Middle Name:
County: Last Name:
State: Zip Code Suffix:
Country: Email:
6.EMPLOYER IDENTIFICATION NUMBER(EIN): Phone Number(give area code)
(Replace these boxes with numerals)
Fax Number(give area code)
8.TYPE OF APPLICATION: 7.TYPE OF APPLICANT:(See back of form for Application
� New u Continuation :r❑!Revision Types)
If Revision,enter appropriate letter(s)in box(es) 1i
(See back of form for description of letters.)
Other(specify) Other(specify)
10.CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 9.NAME OF FEDERAL AGENCY:
(Replace these boxes with numerals)
TITLE(Name of Program):
11.DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
12.AREAS AFFECTED BY PROJECT(Cities, Counties,States,etc.):
13.PROPOSED PROJECT 14.CONGRESSIONAL DISTRICTS OF:
Start Date: Ending a.Applicant b.Project
Date: 1
15.ESTIMATED FUNDING: 16.IS APPLICATION SUBJECT TO REVIEW BY STATE
EXECUTIVE ORDER 12372 PROCESS?
a.Federal $ 00 a. Yes. 0 THIS PREAPPLICATION/APPLICATION
WAS MADE AVAILABLE TO THE STATE EXECUTIVE
ORDER 12372 PROCESS FOR REVIEW ON:
b.Applicant $ DATE:
c.State $ .00 b.No 0 PROGRAM IS NOT COVERED BY E.O.12372.
d.Local $ 00 0 PROGRAM HAS NOT BEEN SELECTED BY
STATE FOR REVIEW
a.Other $ 00 17.IS THE APPLICANT DELINQUENT ON ANY FEDERAL
DEBT?
f.Program Income $ 00 Yes. If"Yes"attach an explanation.
No
g.TOTAL $ 00
18.TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATIONIPREAPPLICATION ARE TRUE AND
CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE
APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a.Authorized Representative
Prefix: First Name: Middle Name:
Last Name: Suffix:
b.Title: c.Telephone Number(give area code)
d.Signature of Authorized Representative: e.Date Signed:
Previous Edition Usable. Authorized for Local Reproduction. Standard Form 424(Rev.9-2003);Prescribed by OMB
Circular A-102
12
PART B
APPLIES TO ALL APPLICANTS FOR
OPERATING ASSISTANCE
Page
Transportation-Related Operating and Administrative
Expenses&Revenues; Grant Request Information 14
Form B-1: Operating&Administrative Expenses and 16
Grant Request Form
Form B-2: Operating&Administrative Revenues 17
13
PART B
APPLIES TO ALL APPLICANTS FOR OPERATING
ASSISTANCE
Transportation-Related Operating and Administrative
Expenses & Revenues; Calculation of Grant Request
Information regarding the applicant's transportation-related operating and administrative expenses and
revenues must be provided with the application for Operating Assistance. Forms B-1 and B-2, as provided
in this manual, should be used for this purpose. Form B-1 provides space for the applicant to show
operating and administrative expenses of the service operated/contracted by the applicant. Form B-I also
provides space to calculate a grant request. However, the grant request cannot be completed until Form B-
2 is completed. Form B-2 provides space for the applicant to show the sources of revenue proposed to pay
for the expenses shown in Form B-1.
The budget line items shown on the forms were originally defined in the Transportation Accounting
Consortium's Model Uniform Accounting System for Rural and Specialized Transportation Providers
(TAC Manual). The account numbers in parentheses are the object code numbers for these line items in
the TAC manual and in FTA National Transit Data Reports(NTD). Defmitions for expense and revenue
line items are included in the Appendix of this manual.
Applicants should show the transportation-related operating and administrative expenses and revenues of
their agency for the proposed project as projected for the year the Section 5310 Grant Award is to be used.
For example,the projected expense and revenue budgets for year FY 2014/2015 should be used if Section
5310 Assistance is requested by the applicant for use in FY 2014/2015.
INSTRUCTIONS FOR COMPLETING FORM B-1.
Applicants should complete both the"Total Expense"and"FTA Eligible Expense"columns of Form B-1.
In completing the form,Community Transportation Coordinators(CTCs)may use expense information
from the budget in their most current Transportation Disadvantaged Service Plan(TDSP). The"Total
Expense"column should show all operating and administrative expenses associated with the proposed
transportation service. The definitions for each line item code, as provided in the Appendix of this manual,
apply. The"FTA Eligible Expense"column should include only those expenses that are eligible under
FTA rules for service provided in non-urbanized areas. This means, for example, that expenses for charter
service, school bus service, transportation service not open to the general public, service exclusively inside
an urbanized area, depreciation expense, and other ineligible expenses would not appear in the"FTA
Eligible Expense"column.
After completing the expense columns on Form B-1, applicants should next complete Form B-2 (see
instructions below.)
Note: In completing Form B-1 and B-2,applicants serving both small urban and rural areas should
use the same mechanism for segregating small urban and rural expenses as they do for segregating
small urban and rural revenues. (See"Services Across Urbanized/Non-urbanized Area
Boundaries" shown under"Threshold Criteria" in this manual.)
14
-----------1-1-1-1------- -----------
INSTRUCTIONS FOR COMPLETING FORM B-2.
Applicants should complete both the"Total Revenue"and"Revenue Used as FTA Match"columns of
Form B-2. In completing Form B-2,CTCs may use revenue information from the budget in their most
current TDSP. The"Total Revenue"column should show all revenues used to pay for the expenses shown
in Form B-1, as noted previously. The definitions for each line item code,as provided in the Appendix of
this manual, apply. The"Revenue Used as FTA Match"column separates total revenues from revenues
accepted by FTA as match. This includes revenues in object codes 410, 411, 412, and 430. It also
includes revenues in object code 413 EXCEPT for any FTA or other USDOT funds. In other words, FTA
or other USDOT revenues should be deducted from the amount shown in object code 413 in the"Total
Revenue"column, and the balance should be shown in the"Revenue Used as FTA Match"column.
Next,both columns should be totaled and the total of(b)"Total Rural Passenger Fares"(401)and(e)
"Grand Total Revenues"transferred to the grant request section of Form B-1.
INSTRUCTIONS FOR COMPLETING THE GRANT REQUEST ON FORM B-1.
To calculate the grant request on Form B-1:
• Enter the total(a)from the FTA Eligible Expense column of Form B-1.
• Enter the rural passenger fare revenue(b)from the first row of Form B-2 (object Code 40 1-rural
revenue).
• Subtract the passenger fare revenue(b) from the FTA Eligible Expense(a)to determine the
operating deficit(c).
• Complete the Section 5310 request(d). Applicants may request no more than 50%of the
operating deficit. Total revenues may not exceed total costs. Therefore, it maybe necessary to
adjust the Section 5310 request to an amount less than 5 0%of the deficit calculated.
15
PART B
APPLIES TO ALL APPLICANTS FOR OPERATING ASSISTANCE
FORM B-1
TRANSPORTATION-RELATED OPERATING and ADMINISTRATIVE
EXPENSES
Name of Applicant:
State Fiscal period from to
EXPENSE CATEGORY TOTAL EXPENSE VrA ELIGIBLE EXPENSE
Labor (501) $
Fringe and Benefits(502)
Services(503)
Materials and Supplies(504)
Vehicle Maintenance(504.01)
Utilities(505)
Insurance(506)
Licenses and Taxes(507)
Purchased Transit Service(508)
Miscellaneous(509)
Leases and Rentals(512)
Depreciation(513)
TOTAL $ $ (a)
SECTION 5310 GRANT REQUEST
Total FTA Eligible Expenses(from Form B-1, above) $
Rural Passenger Fares(from Form B-2) $ (b)
Operating Deficit $
[FTA Eligible Expenses(a)minus Rural Passenger Fares(b)]
Section 5310 Request $ (d)
(No more than 50%of Operating Deficit)
Grant Total All Revenues(from Form B-2) $ *(e)
Note: If Grand Total Revenues(e)exceeds FTA Eligible Expenses (a),reduce the Section 5310
Request(d)by that amount.
16
PART B
APPLIES TO ALL APPLICANTS FOR OPERATING ASSISTANCE
FORM B-2
TRANSPORTATION-RELATED OPERATING and ADMINISTRATIVE REVENUES
Name of Applicant:
State Fiscal period from to
OPERATING REVENUE TOTAL REVENUE REVENUE USED AS
CATEGORY FTA MATCH
Passenger Fares for Transit Service Total= $
(401) Rural=$ (b)
Special Transit Fares(402)
School Bus Service Revenues(403)
Freight Tariffs(404)
Charter Service Revenues(405)
Auxiliary Transportation Revenues
(406)
Non-transportation Revenues(407)
Total Operating Revenue $ $
OTHER REVENUE
CATEGORY
Taxes Levied directly by the Transit
System(408)
Local Cash Grants and Reimbursements
(409)
Local Special Fare Assistance(4 10)
State Cash Grants and Reimbursements
(411)
State Special Fare Assistance(412)
Federal Cash Grants and
Reimbursements(413)
Interest Income(414)
Contributed Services(430)
Contributed Cash(43 1)
Subsidy from Other Sectors of
Operations(440)
Total of Other Revenue $
GRAND TOTAL $ $ (e)
ALL REVENUE
17
PART C
APPLIES TO ALL APPLICANTS
FOR CAPITAL ASSISTANCE
Pau
Transportation-Related Operating and Administrative
Expenses&Revenues Information 19
Form C-1: Operating and Administrative Expenses 20
Form C-2: Operating and Administrative Revenues 20
Current Vehicle and
Transportation Inventory Information 21
Form C-3: Current Vehicle Inventory Form 22
Capital Request Information 21
Form C-4: Capital Request Form 23
18
PART C
APPLIES TO ALL APPLICANTS FOR CAPITAL ASSISTANCE
Transportation-Related Operating and Administrative
Expenses & Revenues
Information regarding the applicant's transportation-related operating and administrative expenses and
revenues must be provided with the application. Forms C-1 and C-2 are included in this manual for that
purpose. These forms should provide information about operating and administrative expenses of the
vehicles or service operated/provided by the applicant, as described in Exhibits A and B of the application,
and information about the sources of revenue used to pay for these expenses.
The budget line items shown on the forms were originally defined in the Transportation Accounting
Consortium's Model Uniform Accounting System for Rural and Specialized Transportation Providers
(TAC Manual). The account numbers in parentheses are the object code numbers for these line items in
the TAC Manual and in FTA National Transit Data Reports(NTD). Definitions for expense and revenue
line items are included in the Appendix of this manual.
Applicants should show the transportation-related operating and administrative expenses and revenues of
their agency as projected for the year the Section 5310 Grant Award is requested. For example, the
projected expense and revenue budgets for year FY 2014/2015 should be used if Section 5310 Assistance
is requested by the Agency for use in FY 2014/2015.
19
PART C
APPLIES TO ALL APPLICANTS FOR CAPITAL ASSISTANCE
FORM C-I
TRANSPORTATION-RELATED OPERATING and ADMINISTRATIVE EXPENSES
Name of Applicant:
State Fiscal period from to
EXPENSE CATEGORY EXPENSE $
Labor (501) $
Fringe and Benefits(502)
Services(503)
Materials and Supplies(504)
Vehicle Maintenance(504.01)
Utilities(505)
Insurance(506)
Licenses and Taxes(507)
Purchased Transit Service(508)
Miscellaneous(509)
Leases and Rentals(512)
Depreciation(513)
TOTAL EXPENSE
FORM C-2
OPERATING and ADMINISTRATIVE REVENUES
OPERATING REVENUE CATEGORY REVENUE $
Passenger Fares for Transit Service(401)
Special Transit Fares(402)
Other(403—407)(identify by appropriate code)
TOTAL OPERATING REVENUE $
OTHER REVENUE CATEGORY
Taxes Levied Directly by the Transit System(408)
Local Cash Grants and Reimbursements(409)
Local Special Fare Assistance(410)
State Cash Grants and Reimbursements(411)
State Special Fare Assistance(412)
Federal Cash Grants&Reimbursements(413)
Interest Income(414)
Contributed Services(430)
Contributed Cash(43 1)
Subsidy from Other Sectors of Operations(440)
TOTAL OF OTHER REVENUE =$
GRAND TOTAL ALL REVENUE Is
20
PART C
APPLIES TO ALL APPLICANTS FOR CAPITAL ASSISTANCE
Current Vehicle and Transportation Equipment Inventory Form
Applicants must complete the"Current Vehicle and Transportation Equipment Inventory"(Form C-3), as
shown in this manual. The form must include a current list of all vehicles and equipment used by the
applicant to transport individuals, including those bought in previous years with Federal funds; those
bought with other than Federal funds; those now on order; and those to be ordered with grant awards made
in previous years. All columns of the form must be completed. An asterisk(*) should be placed next to
the model year of vehicles to be replaced with the grant being applied for with this application. Vehicles
can only be listed as"replacement"once. If a replacement award is given for a vehicle, that vehicle cannot
be listed for replacement again. Vehicles operated by the applicant's contractor or lessee should also be
identified, and the name of the contractor/lessee shown in Exhibit B of the application.
Capital Request Form
Applicants must complete the"Capital Request", Form C-4, provided in this manual. The upper part of
the form(vehicle requests)covers vehicles; the lower(equipment requests), covers other capital equipment
such as radios, computer software, computer hardware, etc.
The applicant should not complete the"GMIS Code"on the form but should provide enough information
about the desired vehicle(s)/equipment to enable FDOT to complete the Code in accordance with FTA
requirements.
NOTE: In the case of vehicles, applicants should be sure to indicate whether the new vehicle is to
replace(R)an older vehicle or expand(E)the fleet by buying a new vehicle. The length of the
vehicle,the number of passenger seats&wheelchair positions,lift or ramp,and the type of fuel is
also important because this affects the cost(applicants will be required to pay the difference if diesel
vehicles are requested). The make of the vehicle should not be shown on the form.
Applicants should refer to"What's on the Market", located in the Appendix,to identify the most
appropriate vehicle type for its needs, and the estimated cost. The appropriate FDOT District Office or the
Center for Urban Transportation Research(see"What's on the Market")may be contacted for assistance.
21
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Sub-total $
(a) Replacement(R)or Expansion(E).
(b)Provide a brief description including the length and type vehicle,type of fuel,lift or ramp,number of seats
and wheelchair positions. Do not show the Make. For example,22' gasoline bus with lift, 12 amb. seats,2 wlc
positions(due to the higher cost of diesel vehicles the applicant shall be required to pay the difference in cost over
that of a gasoline vehicle).
(c) Show mobile radios and identify the type of radio (i.e. two way radio or stereo radio), computer
hardware/software,etc.under"Equipment Request."
VEHICLE SUBTOTAL$ +EQUIPMENT SUBTOTAL$ =$ W.
(x)X 80% =$ [Show this amount on Form 424 in block 15(a)]
23
Cheddist for Application Completeness
Name of Applicant:
Check One: First Time Applicant: Previous Applicant:
The following must be included in the Section 5310 Grant application in the following order:
This checklist
Applicant's cover letter(use FDOT provided cover letter)
Two(2)copies of the governing board's Resolution
Exhibit A-1: Fact Sheet
Application for Federal Assistance(Form 424,Code 20.513)
Operating and Administrative Expense and Revenue Form
Current Vehicle and Transportation Equipment Inventory Form
Capital Request Form
Exhibit A: Current System Description
Exhibit B: Proposed Project Description
Exhibit C: Public Hearing Notice and Publisher's Affidavit(for public agencies only)
Exhibit D: Coordination
Exhibit E: Single Audit
Exhibit F: Federal Certifications and Assurances
Exhibit G: Certification of Equivalent Service(if grant is for non-accessible vehicles)
Exhibit H: Applicant Certification and Assurance to FDOT
Exhibit K: Applicant Certification of Transportation Disadvantaged Service Plan(TDSP)
Date application was submitted to Local Clearinghouse/Regional Planning Council:
(send one(1)copy of letter received from the Local Clearinghouse/RPC to FDOT)
Additional documents required for first-time applicant(if a private-non-profit agency)
Copy of Certification of Incorporation
24
EXHIBITS
(TO BE INCLUDED IN ALL APPLICATIONS)
Page
A and A-1 —Current System Description and Fact Sheet 26-27
B—Proposed Project Description 20
C- Public Hearing 29
D—Coordination 29
E—Single Audit 30
F—Federal Certifications and Assurances 31
G—Certification of Equivalent Service (Non-Accessible Vehicles) 32
H—Applicant Certification and Assurance to FDOT 33
K—Coordinate Public Transit-Human Services Transportation Plan 34
25
---------------—------
EXHIBIT A - Not to exceed two (2) pages
Current System Description
Applicants must submit Exhibit A as part of their application. Exhibit A should provide a short description of who the
applicant is and what services they provide. It is requested that applicants in District 2 provide the System Description in
a question/answer format. The following information shall be included in the narrative in a detailed manner:
1. An overview of the organization including its mission,program goals and objectives
2. Organizational structure,type of operation,number of employees,and other pertinent organizational information
3. Who is responsible for insurance,training and management,and administration of the agencies transportation
programs
4. Who provides maintenance
5. Number of transportation related employees
6. Who will drive the vehicle,number of drivers, CDL certifications, etc.
7. A detailed description of service routes and ridership numbers
8. Exhibit A-1 (below)
If the applicant is a Community Transportation Coordinator(CTC),relevant pages of a Transportation Disadvantaged
Service Plan(TDSP) and Annual Operating Report(AOR)containing the above information may be provided.
Evaluators will rely heavily on an applicant's narrative in determining the amount of funds/vehicles/equipment awarded.
GRANT WRITING TIP: Refer to the Evaluation Criteria in the General Program Information/Requirements
Section of this manual. An applicant's narrative should cover the points that will be evaluated.
26
EXHIBIT A-I -- FACT SHEET
CURRENTLY IF GRANT IS AWARDED
(Estimates are acceptable.)
1. Number of total one-way trips served
by the agency PER YEAR(for all
purposes)*
2. Number of one-way trips provided to
elderly and persons with disabilities
(including New Freedom Trips)PER
YEAR*
3. Number of individual Elderly and
Disabled and New Freedom
unduplicated riders(first ride per rider
per fiscal year) PER YEAR
4. Number of vehicles used to provide
Elderly and Disabled and New Freedom
service ACTUAL
5.Number of vehicles used to provide
Elderly and Disabled and New Freedom
service eligible for replacement
ACTUAL
6. Vehicle miles traveled to provide
Elderly and Disabled and New Freedom
service PER YEAR
7.Normal number of days that vehicles
are
in operation to provide Elderly and
Disabled and New Freedom service
PER WEEK
8. Posted hours of normal operation to M—F: M—F:
provide Elderly and Disabled and New Saturday: Saturday:
Freedom service PER WEEK Sunday: Sunday:
Total WEEK): Total (WEEK):
One way passenger trip is the unit of service provided each time a passenger enters the vehicle, is transported,
then exits the vehicle. Each different destination would constitute a passenger trip.
27
---------------—-----
EXHIBIT B
Proposed Project Description
Applicants must submit Exhibit B as part of their application. The proposed project description should be thorough as
evaluators will rely heavily on the narrative in reviewing and ranking a grant application. It is requested that applicants in
District 2 provide the Project Description in a question/answer formal. The project description should not repeat the
current system description shown in Exhibit A. Exhibit B shall include, but not be limited to:
I. Is the project to continue the existing level of services, to expand present service, or to provide new service?
How will a grant award be used? More hours? Service in a larger geographic area? Shorter headways? More
trips? Please explain in detail.
2. If a grant award will be used to maintain services as described in Exhibit A, specifically explain how it will be
used in the context of total service.
3. Give a detailed explanation of the need for the vehicle and provide evidence of the need.
4. Will a grant award be used to replace existing equipment or purchase additional vehicles/equipment? Provide
details.
5. Identify vehicles/equipment being replaced and list them on the "Current Vehicle and Transportation
Equipment Inventory" form,provided elsewhere in this manual.
6. Describe agency's maintenance program and include a section on how vehicles will be maintained without
interruptions in service(who, what,where, and when).
7. If vehicles/equipment are proposed to be used by a lessee or private operator under contract to the applicant,
identify the proposed lessee/operator.
a. Include an equitable plan for distribution of vehicles/equipment to lessees and/or private operators.
8. Each applicant shall indicate whether they are a government authority or a private non-profit agency,provide a
brief description of the project which includes the counties served,whether the applicant shall service minority
populations and whether the applicant is minority-owned.
New Agencies:
9. Fully explain Your Transportation Program
a. Service hours,planned service, routes and trip types
b. Staffing—include plan for training on vehicle equipment such as wheelchair lifts, etc.
C. Records maintenance
d. Vehicle maintenance—who, what,when and where
e. CDL requirements
f. System safety plan
9. Drug free work place
10. Have you met with the CTC and, if so, how are you providing a service that they cannot? Provide detailed
information supporting this requirement.
GRANT KWITING TIP. Refer to the Evaluation Criteria in the General Program InformationlRequirements
Section of this manual,and be sure Exhibit B covers the points that will be evaluated.
28
EXHIBIT C
Public Hearing
An opportunity for a public hearing is required ONLY for Public Agencies requesting Capital grants under
Section 5310. An application for Section 5310 submitted by a public agency should contain a copy of the notice of
public hearing(identified as Exhibit Q and an affidavit of publication. If Exhibit C is not applicable,this should
be stated in the application.
A sample public notice is located in the Appendix of this manual. A public notice should contain all pertinent
information relating to the project(such as number and types of vehicles as well as the estimated cost of the vehicles)and
should be published at least one time in a newspaper of general circulation in the applicant's service area,no less than 15
or more than 30 days prior to the submission of an application.The notice should state that persons requesting a hearing
must notify the applicant of the request, in writing, and send a copy of the request for a hearing to the FDOT District
Office.
The deadline for hearing requests must be prior to the date applications are due at the District Office. If a hearing is
requested:
I. A hearing must be conducted;
2. The FDOT District Office must be notified of the date, time, and location of the hearing; and
3. A copy of the minutes of the hearing(to include a discussion of issues raised and resolution of issues)must be
submitted to the FDOT District Office,before a Section 5310 award can be made.
EXHIBIT D
Coordination
If the applicant is a Community Transportation Coordinator(CTC),this information should be shown in Exhibit D of the
application. Attached to Exhibit D should be a copy of the CTC's certification.
If the applicant is not a CTC, a copy of the written coordination agreement between the applicant and the CTC in the
appropriate service area should be identified as Exhibit D and included in the application. The agreement must be
specific as to how the services to be provided will complimentary to the services the CTC provides,and how duplication
and fragmentation of services will be avoided. If the applicant's service extends into areas covered by more than one
CTC,copies of all applicable coordination agreements should be included in the application. An executed Commission
for the Transportation Disadvantaged Coordination Contract or similar document may serve as the written coordination
agreement. Applications submitted without the appropriate coordination agreement may be rejected by FDOT. Grant
awards will not be made without an appropriate coordination agreement.
29
Exhibit E
Attachment I
Certification of Exemption from Single Audit Act
IT IS HEREBY CERTIFIED THAT the applicant:
I Will not receive$500,000 or more for the current Fiscal Year from all federal sources combined, and is,
therefore, exempt from the Single Audit Act as described in OMB A-13 3; and
2. In the event the applicant does receive$500,000 or more in total from all federal sources during the current
fiscal year, the applicant will comply with the Single Audit Act and submit to the District Office a copy of
its most recent audit conducted in compliance with the Act.
(Typed name and title of authorized individual) (Signature of authorized individual) (Date)
30
EXHIBIT F
Federal Certifications and Assurances
The last page(Appendix A)of the annual Federal Register Notice that applies to Federal Certifications and Assurances
provides applicants with a single signature page on which an applicant and its attorney must certify compliance with the
requirements of the various Federal Transit Administration grants or cooperative agreements. The Federal Register
Notice is revised annually and is usually available around January I of each year. Applicants may obtain a copy of the
current year document through the internet at http://www.fta.dot.,gov/fundinfz/jzrants financing 93.html(then, follow
instructions on where to proceed.)If unable to access the form,applicants may contact their FDOT District Office for
assistance. The appropriate signed Federal certification/assurance form must be included in the application when it is
submitted to the FDOT District Office.
GRANT WRITING TIP. All applicants must use the current year form and it must be the actual form from the
Federal Transit Administration(FTA). This form cannot bean edited version of a Prior year's forms or a recreation
of the form.
The signature page for Federal Certifications and Assurances should be signed by an individual authorized by
the applicant's governing board to sign and submit applications, and its attorney. Blue ink is required as it
distinguishes an original signature from a photocopied signature.
Federal Certifications and Assurances Required of Each Applicant:
• Authority of applicant and its representative
• Standard Assurances
• Debarment and Suspension, and other Responsibility Matters
(http://www.fta.dot.gov/funding/thirdpai-tyj2rocurement/bppin/grants financing—6195.html#BM22)
• Drug Free Workplace Certification
(http://www.fta.dot.gov/funding/thirdpartyprocurement/'bppm/grants financing-6195.html#BM3 1)
• Intergovernmental Review Assurance
• Federal Transit Administration Master Agreement(http://www.fta.dot.gov/documents/17-Mqgg�pffi
• Nondiscrimination Assurance
• Assurance of Nondiscrimination on the Basis of Disability Procurement Compliance.
A. Applicants for Federal Assistance may signify compliance with the above certifications and assurances by
placing an"X"at the top of Appendix A next to the statement that reads: "The Applicant agrees to comply
with applicable requirements of Categories 0 1-24". If an applicant chooses to do this,no additional notation
is necessary, except for the signature on the reverse.
OR
B. The applicant may signify compliance with certifications and assurances applicable only to the Section
5310 Program, specifically, Category XIII,by placing an"V in Category 01, "Certifications and
Assurances Required for Each Applicant"(to cover the above-noted items),as well as an"V in Category 12
entitled"Alcohol Misuse and Prohibited Drug Use"and Category 17 "Elderly Individuals and Individuals
with Disabilities Formula Program and Pilot Program."
A description of the certifications required by the Section 5310 Program is provided in the annual Federal Register
Notice.
31
EXHIBIT G
Certification for Agencies Requesting Non-Accessible Vehicles
If the applicant wants to purchase non-accessible vehicles for demand responsive service,
the following"Certification of Equivalent Service"must be completed and included in the application.
CERTIFICATION OF EQUIVALENT SERVICE
The certifies that its demand responsive service offered to individuals with
disabilities, including individuals who use wheelchairs, is equivalent to the level and quality of service offered to
individuals without disabilities. Such service, when viewed in its entirety, is provided in the most integrated setting
feasible and is equivalent with respect to:
1. Response time;
2. Fares;
3. Geographic service area;
4. Hours and days of service;
5. Restrictions on trip purpose;
6. Availability of information and reservation capability; and
7. Constraints on capacity or service availability.
In accordance with 49 CFR Part 37,public entities operating demand responsive systems for the general public which
receive financial assistance under 49 U.S.C.5314 and 5311 of the Federal Transit Administration(FTA)funds must file
this certification with the appropriate state program office before procuring any inaccessible vehicle. Such public entities
not receiving FTA funds shall also file the certification with the appropriate state office program. Such public entities
receiving FTA funds under any other section of the FTA Programs must file the certification with the appropriate FTA
regional office. This certification is valid for no longer than one year from its date of filing.
Executed this day of 320
(Name and title of authorized representative)
(Signature of authorized representative)
32
EXHIBIT H
Applicant Certification and Assurance to MOT
To be completed and signed by an individual authorized by the governing board of the applicant
agency and submitted with the grant application.
The certifies and assures to the Florida Department of Transportation in
regard to its Application for Assistance under U.S.C. Section 5310 dated
1) It shall adhere to all Certifications and Assurances made to the federal government in its Application.
2) It shall comply with Section 341.051 Florida Statutes and Chapter 14-73 Florida Administrative Code.
3) It has the fiscal and managerial capability and legal authority to file the application.
4) Local matching funds will be available to purchase vehicles/equipment at the time an order is placed.
5) It will carry adequate insurance to maintain,repair,or replace project vehicles/equipment in the event of loss or
damage due to an accident or casualty.
6) It will maintain project vehicles/equipment in good working order for the useful life of the vehicles/equipment.
7) It will return project vehicles/equipment to the Department if,for any reason,they are no longer needed or used
for the purpose intended.
8) It recognizes the Department's authority to remove vehicles/equipment from its premises, at no cost to the
Department, if the Department determines the vehicles/equipment are not used for the purpose intended,
improperly maintained, uninsured, or operated unsafely.
9) It will not enter into any lease of project vehicles/equipment or contract for transportation services with any third
party without prior written approval of the Department.
10) It will notify the Department within 24 hours of any accident or casualty involving project vehicles/equipment,
and submit related reports as required by the Department.
11) It will submit an annual financial audit report to the Department, if required by the Department.
Date: Signature:
Typed name and title
33
-------------
EXHIBIT K
Coordinated Public Transit-Human Services Transportation Plan
To be completed and signed by an individual authorized by the governing board of the applicant
agency and submitted with the grant application.
The certifies and assures to the Florida Department of Transportation in
regard to its Application for Assistance under U.S.C. Section 5310 dated
1) This grant request is derived from a coordinated plan compliant with Federal Transit Administration Circular
FTA C 9070.IF.
2) The name of this coordinated plan is provided below.
3) The agency that adopted this coordinated plan is provided below.
4) The date the coordinated plan was adopted is provided below.
5) The page number of the coordinated plan that this application supports.
Date: Signature:
Typed name and title
34
APPENDIX
Pase
Definitions—Operating and Administrative Expenses 36
Definitions—Operating and Administrative Revenues 37
What's on the Market 38
Sample Resolution Form 40
Required Cover Letter 41
Sample Public Notice(pertains to Exhibit C) 42
Sample Notice of Grant Award 43
Local Clearinghouses/Regional Planning Councils 44
FDOT District Office Contacts 46
Glossary 48
35
49 U.S.C. 5335,Definitions-Operating and Administrative Expenses
(National Transit Data Report -NTD)
http:4www.ntdprogram.gov/ntdpro�,,ram/Glossarv.htm
(501) labor - The pay and allowances due employees in exchange for the labor services they render in behalf of the
transit system.
(502) fringe and benefits -Payments or accruals to others(insurance companies, governments,etc.)on behalf of an
employee and payments or accruals direct to an employee arising from something other than his performance of a piece
of work.
(503) services-Labor and other work provided by outside organizations for fees and related expenses.
(504) materials and supplies -Tangible products obtained from outside suppliers or manufactured internally.
(504.01)vehicle maintenance-Cost of fuel and lubricants, tires and tubes, vehicle maintenance parts.
(505)utilities-Payments made to various utilities for utilization of their resources(e.g.,electric,gas,water,telephone,
etc.)
(506) insurance - Cost elements covering protection of the transit system from loss through insurance programs;
compensation of others for their losses due to acts for which the transit system is liable;and recognition of the cost of a
miscellaneous category of corporate losses.
(507)license and taxes -Taxes and fees levied against the transit system by Federal, state,and local governments.
(508)purchased transit service-The payment or accrual to other transit systems for providing transportation service.
(509)miscellaneous -Those expenses which cannot be attributed to any of the other major expense categories.
(512)leases and rentals -Payments for the use of capital assets not owned by the transit system.
(513)depreciation-Charges that reflect the loss in service value of the transit system's assets.
36
49 U.S.C.5335, Definitions-Operating and Administrative Revenue
National Transit Data Report(NTD)
http:/',Iwww.ntdprogram.p,ov/ntdprot-yrainiGlossary.htm
(401)passenger fares for transit services-Revenue earned from carrying passengers along regularly scheduled routes.
(402)special transit fares-Revenues earned for rides given in regular transit service,but paid for by some organization
rather than by the rider,and for rides given along special routes for which revenue may be guaranteed by a beneficiary of
the service.
(403)school bus service revenues-Revenues earned from operating vehicles under school bus contracts.
(404)freight tariffs-Revenues earned from carrying freight on runs whose primary purpose is passenger operations.
(405) charter service revenues-Revenues earned from operating vehicles under charter contracts.
(406)auxiliary transportation revenues-Revenues earned from operations closely associated with the transportation
operations(e.g., concessions, advertising, automobile ferriage, etc.)
(407) nontransportation revenues -Revenues earned from activities not associated with the provision of the transit
system's transit service (e.g., sale of maintenance services, rental of revenue vehicles, rental of buildings and other
property, investment income,parking lot revenue, etc.)
(408) taxes levied directly by transit system - Tax revenues to transit systems that are organized as independent
political subdivision with their own taxation authority.
(409)local cash grants and reimbursements-Funds obtained from local government units to assist in paying the cost
of operating transit services.
(410)local special fare assistance-Funds obtained from local government units to help cover the difference between
full adult fares and special reduced fares. (Includes local social service contract funds).
(411) state cash grants and reimbursements -Funds obtained from state government to assist in paying the cost of
operating transit services. (Includes Commission for the Transportation Disadvantaged grant funds).
(412) state special fare assistance-Funds obtained from state government to help cover the difference between full
adult fares and special reduced fares. (Includes state social service contract funds).
(413)federal cash grants and reimbursements-Funds obtained from the Federal government to assist in paying the
cost of operating transit services. Include and identify the source of unrestricted Federal Funds used as match.
(414)interest income-Revenues earned from the lending or deposit of funds.
(430)contributed services -The receipt of services(not cash)from another entity where such services benefit transit
operations and the transit operator is under no obligation to pay for the services,
(431)contributed cash -The receipt of funds from another entity where such funds benefit transit operations and the
transit operator is under no obligation to repay the funds.
(440)subsidy from other sectors of operations -Funds obtained from other sectors of a transit company's
operations to help cover the cost of providing transit service.
37
WHAT'S ON THE MARKET
F� f���pmn�o � transit vehicles.The Auto
�mo�m� om"m"'="ll�^",=°~''~~`~~`~~~- -'--"�� -- - - -
and Light / Some of vehicles
w+"°"'"=~`^"^~~ '~~'~~^ U�ehd\ow(ngoo��gohemofexp��ad
have entered the oummunnyuanspor�onnmamexm the last years.They generally fall.into
minimum life nf service years and mileage:
FFlOT M'n'M1Um Service Life and/or 200'000 miles:
COMMUTER VAN 9-PASSENGER CENTER AISLE VEHICL
The commuter vans intended use ieaaa pool vehicle for commuters or a special purpose vehicle for publictransit systems and/or other
governmental agencies. ^
ee� No dtor ramp available.Optional stretcher securement system with limited passenger seating, io
available. Pricing does not reflect all options available with this contract.
GVWR Seating Capacity Price Wheelchair Positions Contract# Order Packet&Pricing
9,000# 2-9 $33,900-$38,000 Stretcher Option TRIPS-09-CV-GM-Ford Order Packet
GVWR/Length Ambulatory Seating Price Wheelchair Contract# Order Packet&Pricing
Capacity Positions
MINIVANS—PENDING CONCLUSION OF RFIP PROCESS
The extended low floor minivans with mobility ramp intended use is as a Paratransit or a supervisor vehicle,providing public
transportation for a maximum capacity of six(6)ambulatory passengers or a maximum of two(2)wheelchair passengers and three(3)
ambulatory passengers. These configurations exclude the driver.
GVWRJLength Ambulatory Seating Price Wheelchair Contract# Order Packet&Pricing
Capacity Positions
Pending Pending Pending 2 Pending Pending
STANDARD CUTAWAY
Each dealer offers a variety of models built on a variety of chassis'and chassis weights. Please contact the dealer directly for questions
nn capacity and floor plans.
Transit Plus First Class Getaway Bus Rivers Bus Atlantic Bus Sales
Coach Sales
TRIPS-I I-CA-TP TRIPS-I I-CA-FCCSC TRIPS-I 1-CA-G13 TRIPS-I I-CA-RB TRIPS-I I-CA-ABS
Contract Contract Contract Contract Con tract
Order Packet Order Packet
Order Packet Order Packet Order Packet
SMALL CUTAWAY LOW FLOOR(Formally TvDe D)
Small low floor chassis transit vehicle with wheel chair ramp, produced by two different manufacturers and dealers.
38
( )'Indicates number uf seats without wheel chairs.
GVWR/Length Seating Capacity Price Wheelchair Positions Contract ii Order Packet&Pricing
FDO0F Minimum Service Life _ 7 years and/m[ 25O,00M 0M'|eS:
MEDIUM DUTY
Medium duty Champion CTS 31'and 34'high level floor rear enginecity-type coach for light duty fixed route service and offered by
Transit Plus, Inc. Pricing does not reflect all options available.
( )—Indicates number of seats without wheel chair positions.
GVWR/Length Ambulatory Seating Price Wheelchair Positions Contract Order Packet&Pricing
Capacity
26,500#/3 1' 0- 18(27) F$1 73,000-$18 1,000 0-7 TRIPS-09-MD-TP Order Packet
FDO7- Minimum Service Life 10 years and/or 350'000 miles:
MEDIUM DUTY
Medium duty chassis built onbyElDomdo through Florida Transportation Systems dealer.The E-Z Rider 31'low floor rear engine city-
typ*ooaohdaoignedformodarahndutyfixednoubsoan/ioa. PhdngdoeonotmMactaUoptionaavaUablo.
( )—Indicates number of seats without wheel chair positions.
GVWR/Length Ambulatory Seating Price Wheelchair Positions Contract# Order Packet&Pricing
Capacity
39
Sample
RESOLUTION FORM
A RESOLUTION of the (Governing Board) authorizing the signing
and submission of a grant application and supporting documents and assurances to the Florida Department of
Transportation, and the acceptance of a grant award from the Department.
WHEREAS, (Applicant)
has the authority to apply for and accept grant awards made by the Florida Department of Transportation as authorized by
Chapter 341, Florida Statutes and/or by the Federal Transit Administration Act of 1964, as amended;
NOW,THEREFORE,BE IT RESOLVED BY THE (Governing Board)_
,FLORIDA:
1. This resolution applies to Federal Program(s)under U.S.C. Section(s)
2. The submission of a grant application(s),supporting documents,and assurances to the Florida Department
of Transportation is approved.
3. (Authorized Individual by Name and Title) is authorized to sign the
application and accept a grant award, unless specifically rescinded.
DULY PASSED AND ADOPTED THIS 120
By:
(Signature)
(Typed name&title)
ATTEST:
(seal)
40
REQUIRED
COVER LETTER
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
GRANT APPLICATION
(agency name) submits this Application for the Section 5310 Program Grant and agrees to
comply with all assurances and exhibits attached hereto and by this reference made a part thereof, as itemized in the
Checklist for Application Completeness.
(agency name)further agrees,to the extent provided by law(in case of a government agency in
accordance with Sections 129.07 and 768.28,Florida Statutes)to indemnify,defend and hold harmless the Department
and all of its officers, agents and employees from any claim, loss, damage, cost, charge, or expense arising out of the
non-compliance by the Agency,its officers,agents or employees,with any of the assurances stated in this Application.
This Application is submitted on this day of , 20 _ with two (2) original resolutions or
certified copies of the original resolution authorizing (Name&Title) to sign this Application.
Agency Name
By Date
Title
41
Sample
Public Notice
(Pertains to Exhibit Q
All interested parties within- (counties affected) are hereby advised that public agency) is applying to the
Florida Department of Transportation for a capital grant under Section 5310 of the Federal Transit Act of 1991, as
amended, for the purchase of (description of equipment)to be used for the provision of public transit services within
(defined area of operation)
A Public Hearing has been scheduled at (date, time, location), for the purpose of advising all interested parties of
service being contemplated if a grant is awarded, and to ensure that contemplated services would not represent a
duplication of current or proposed services provided by existing transit or paratransit operators in the area.
This hearing will be conducted if and only if a written request for the hearing is received by (two days prior to
the scheduled hearing).
Requests for a hearing must be addressed to (Public Agency name and address) and a copy sent to (name and address
of appropriate FDOT District Office.
All public notices must include the following language:
Florida Law and Title VI of the Civil Rights Act of 1964 Prohibits Discrimination in
Public accommodation on the basis of race, color, religion, sex, national origin,
handicap, or of marital status.
Persons believing they have been discriminated against on these conditions may file a
complaint with the Florida Commission on Human Relations at 850-488-7082 or 800-
342-8170 (voice messaging)
42
Sample
NOTICE OF GRANT AWARD
(To be completed, signed,and sent to the Applicant/Recipient by the FDOT District Office)
Based on the Agency's Application for Federal Assistance under U.S.C.Section 5310 dated- ,on file in
the Department,the Florida Department of Transportation hereby makes the following grant award to:
(Name and Address of Recipient)
Award Year Description Estimated Value Estimated matching funds required
Please contact the FDOT Contractor,Lazara Stinnette,at either 813-974-0695 or Istinnetteracutr.usf.edu
to arrange purchase of the above items. See FDOT Section 5310 Procedure 725-030-0104,page 10 at
http://www2.dot.state.fl.us/proceduraldocuments/procedures/bin/725030010.pdf.
FLORIDA DEPARTMENT OF TRANSPORTATION
Date Award Approved by
(Signature)
Typed Name and Title
ACCEPTANCE OF GRANT AWARD
(To be completed and signed by the recipient and returned to the FDOT District Office)
The undersigned accepts the above-described award and:
(Check all appropriate)
a. Reaffirms its assurances to FTA and FDOT as stated in Exhibits F,G,and H of its application.
b. Requests purchase of the vehicles/equipment in(month/year.)
AGENCY:
(Name)
Date Accepted by
(Signature)
Typed Name and Title_
Agency vendor number as registered in My Florida Marketplace:
43
Local Clearinghouses 1 Regional Planning Councils (RPQ
CLEARINGHOUSE/RPC COUNTIES COVERED
-----------------------------------------------------------------------------------------------------------------------------
West Florida RPC Bay, Escambia,Holmes, Okaloosa, Santa Rosa, Walton
4081-A East Olive Road Washington
Pensacola,FL 32514
850-332-7976 Contact: Ms. Terry Joseph
800-226-8914 Email: terry.joseplikwfrpc.or
-----------------------------------------------------------------------------------------------------------------------------
Apalachee RPC Calhoun, Franklin, Gadsden, Gulf,Jackson, Jefferson,
2507 Callaway Road, Suite 200 Leon,Liberty, Wakulla
Tallahassee, FL 32303
850488-6211 Contact: Mr. Keith McCarron
Email: keith.mccarronLtheamc.com
------------------------------------------------------------------------------------------------------------------------------
North Central Florida RPC Alachua,Bradford, Columbia, Dixie, Gilchrist, Hamilton,
2009 N.W. 67 Place Lafayette, Madison, Suwannee, Taylor,Union
Gainesville,FL 32653-1603
352-955-2200 ext 103 Contact: Mr. Marlie Sanderson
Email: msanderson(&ncfipc.org
------------------------------------------------------------------------------------------------------------------------------
Northeast Florida RPC Baker, Clay, Duval,Flagler,Nassau,Putnam, Saint Johns
6850 Belfort Oaks Place
Jacksonville,FL 32216 Contact: Mr. Eric Anderson
904-279-0880 ext 178 Email: eamderspm(ii,nefrpc.or
------------------------------------------------------------------------------------------------------------------------------
Withlacooehee RPC Citrus, Hernando, Levy,Marion, Sumter
1241 S.W. 10th St
Ocala, F132674-2788 Contact: Mr. Michael Arnold
352-732-1315 ext 228 Email: mamold&wrpc.cc
------------------------------------------------------------------------------------------------------------------------------
East Central Florida RPC Brevard, Lake, Orange, Osceola, Seminole,Volusia
309 Cranes Roost Boulevard
Suite 2000 Contact: Mr. Hugh W. Harling, Jr.
Altamonte Springs, FL 32701 Email: hharling(aJecfrpc.org
407-262-7772
-----------------------------------------------------------------------------------------------------------------------------
Central Florida RPC Desoto, Hardee, Highlands,Okeechobee, Polk
Post Office Drawer 2089
Bartow, FL 33830 Contact: Ms. Marcia Staszko
863-534-7130 ext 103 Email: mstaszko(d)cfrpc.org
------------------------------------------------------------------------------------------------------------------------------
Tampa Bay RPC Hillsborough, Manatee, Pasco, Pinellas
4000 Gateway Center Boulevard
Suite 100
Pinellas Park, FL 33782-6141 Contact: John Meyer
727-570-5151 ext 10 Email: j hnm(ti,tbrpc.org
727-550-5118 fax
------------------------------------------------------------------------------------------------------------------------------
44
Local Clearinghouses / Regional Planning Councils (continued)
CLEARINGHOUSE/RPC COUNTIES COVERED
-----------------------------------------------------------------------------------------------------------------------------
Southwest Florida RPC Charlotte, Collier,Glades, Hendry, Lee, Sarasota
1926 Victoria Avenue
Fort Myers, FL 33901 Contact: Ms. Nicole Gwinnett
239-338-2550 ext 232 Email: ngwinnett(&swf Wc.or
------------------------------------------------------------------------------------------------------------------------------
Treasure Coast RPC Indian River, Martin, Palm Beach, Saint Lucie
421 Southwest Camden Avenue
Stuart, Florida 34994 Contact: Ms. Stephanie Heidt
772-221-4060 Email: sheidt(,,�tcjpc.org
------------------------------------------------------------------------------------------------------------------------------
South Florida RPC Broward,Miami-Dade, Monroe
3440 Hollywood Blvd. Ste 140
Hollywood, FL 33021 Contact: Ms. Kathe Lerch
954-985-4416 Email: klerch(&sfTc.co
------------------------------------------------------------------------------------------------------------------------------
45
FDOT District Office Contacts
District Contacts Address
I Manager: Terry Beacham P.O. Box 1249
(863) 519-2388 801 North Broadway
Bartow, FL 33830-1249
Transit Unit
Contact: Debi W. Stephens Modal Development Office/Public Transit
Fort Myers Operations Center
10041 Daniels Parkway
Fort Myers, Florida 33913
(239)461-4321
Fax: (239)2353
Counties Covered: Charlotte, Collier,DeSoto, Glades, Hardee, Hendry,Highlands, Lee,Manatee, Okeechobee,
Polk, Sarasota
2 Manager: Doreen Joyner-Howard 2250 Irene StreetMS 2813
(904)360-5650 Jacksonville, FL 32202
Transit Unit
Contact: Janell Damoato (904) 360-5687
Counties Covered: Alachua,Baker, Bradford, Clay, Columbia, Dixie,Duval,Gilchrist, Hamilton, Lafayette,
Levy,Madison,Nassau,Putnam, St Johns, Suwannee, Taylor, Union
3 Manager: Mike Lewis P. O. Box 607
(850) 330-1545 Chipley,FL 32428-9990
Transit Unit
Contact: Kathy Rudd (850) 330-1549
Bay, Escambia,Gulf, Holmes, Jackson, Santa Rosa, Walton, Washington
Vanessa Strickland (850) 330-1534
Calhoun,Franklin, Gadsden,Jefferson, Leon, Liberty, Okaloosa,Wakulla
Counties Covered: Bay, Calhoun, Escambia, Franklin,Gadsden, Gulf, Holmes, Jackson,Jefferson, Leon,
Liberty, Okaloosa, Santa Rosa,Wak-ulla, Walton, Washington
4 Manager: Nancy Ziegler 3400 W. Commercial Blvd.
(954) 7774492 Ft. Lauderdale,FL 33309
Transit Unit
Contact: Larry Merritt (954) 777-4683
Counties Covered: Broward, Indian River,Martin, St Lucie, Palm Beach
46
------------
FDOT District Office Contacts (continued)
5 Manager: Brenda Young 133 South Semoran Blvd.
(407)482-7852 Orlando, FL 32807
Transit Unit
Contact: Diane Poitras (407)482-7860
Counties Covered: Brevard, Flagler, Lake,Marion, Orange, Osceola, Seminole, Sumter,Volusia
6 Manager: Dionne Richardson 1000 NW 11 11h Ave., Room 6111
(305)470-5292 Miami, FL 33172
Transit Unit
Contact: Raymond Freeman (305)470-5255
Counties Covered: Miami-Dade,Monroe
7 Manager: George Boyle 11201 N. McKinley Dr. (MS-7500)
(813)975-6409 Tampa,FL 33612
Transit Unit
Contact: Tracy G. Dean (813)975-6195
Counties Covered: Citrus,Hernando, Hillsborough,Pasco,Pinellas
To send e-mail to any of the above: first name.last nameradot.state.fl.us
47
Glossary
ambulatory-A person who is able to walk and move about freely without being confined to a bed or wheelchair,
applicant—An agency applying for Section 5310,5311,and/or 531 l(f)Federal Assistance. See also"new applicant"
and"recurring applicant."
authorizing Federal and State Legislation: Legislation authorizing the Section 5310,5311,and 531 l(f)programs are:
Transportation Equity Act for the 2 1"Century(TEA-2 1);49 U.S.C.Sections 5310 and 5311;FTA Circular 9070.IF(for
Section 5310)and Circular 9040.117(for Section 5311 and 531 I(f); Section 341.051,Florida Statutes;and Chapter 14-
73, Florida Administrative Code. The Section 5310 FTA Circular can be found at
littp://www.dot.state.fl.us/transit'Pages/'FTA Section 5310 Circular.pdf. The Section 531IFTA Circular can be found
at Section 5311 Circular..pdf.
community transportation coordinator (CTQ - A transportation entity recommended by an MPO, or by the
appropriate designated official planning agency, as provided for in Sections 427.015(1), Florida Statutes, in an area
outside the purview of an MPO, to ensure that coordinated transportation services are provided to the transportation
disadvantaged population in a designated service area.
contractor—means the administering entity of the Florida Vehicle Procurement Program(FVPP)who is under contract
to the Florida Department of Transportation to establish statewide vehicle contracts for the purpose of procuring vehicles
at the lowest cost possible while ensuring that the best product is available for the program. The Contractor is also
responsible to coordinate, assist as needed, and report in all procurement activities under the Section 5310 Program.
designated official planning agency — means a planning entity so designated by the Florida Commission for the
Transportation Disadvantages to conduct planning and support functions for the transportation disadvantaged services.
disabled person—See elderly individual and persons with disabilities.
district office— means the Department of Transportation District Public Transportation Office or District Office of
Modal Development and/or staff.
district program of projects—means a district listing of each applicant agency for which a grant award is proposed,a
description of the equipment to be awarded, and the proposed federal, state and local share of the project cost. The
district program of project includes certification by the District Office that all applicants and projects so proposed either
meet all program requirements or will meet all program requirements before a Notice of Grant Award is executed.
elderly individual—includes, at a minimum, all persons 65 years of age or older. Grantees may use a definition that
extends eligibility for service to younger(e. g., 62 and older,60 and over)persons.
eligible expenses—Eligible expenses are limited to buses,vans,or other paratransit vehicles,radios and communications
equipment,and wheelchair lifts and restraints,vehicle rehabilitation,vehicle overhaul(which may be calculated as up to
twenty percent of the agency's annual vehicle maintenance costs), associated capital maintenance, including costs of
tires,tubes and replacement parts which exceed 0.05 percent of the depreciated value of the vehicle for which are used,
microcomputer hardware/software, initial installation costs,vehicle procurement, inspection and acceptance costs and
other durable goods such as spare components with unit cost over$300 and a useful life of more than one year. The
Federal share for eligible capital expenses may not exceed eighty percent(80%).
eligible expenses,capital,5311 -Section 5311 funds may be used for the capital expense of transportation services to
the general public in non-urbanized areas. Eligible expenses are limited to buses, vans or other paratransit vehicles
(including sedans and station wagons),radios and communications equipment,wheelchair lifts and restraints, vehicle
rehabilitation, microcomputer hardware/software, initial installation costs, vehicle procurement, inspection and
acceptance costs,construction or rehabilitation of transit facilities including design, engineering,and land acquisition,
and other durable goods such as spare components with unit cost over$300 and a useful life of more than one year. The
cost associated with pre-award and post delivery audits also qualify as eligible expenses.
eligible expenses, capital, 5311(f)- Eligible expenses include intercity bus service planning and marketing and the
purchase of buses,vans or other paratransit vehicles(including sedans and station wagons),radios and communications
48
equipment, wheelchair lifts and restraints, vehicle rehabilitation, passenger shelters, intermodal facility projects (see
above),bus stop signs and similar passenger amenities,data processing hardware/software,other durable goods such as
spare components with a useful life of more than one year, initial installation costs, vehicle procurement/testing,
inspection and acceptance costs, and costs associated with pre-award and post delivery audits.
eligible expenses,operating-For the Section 5311 program(formerly Section 18),eligible operating expenses include
the total administrative, management, and operation costs directly incident to the provision of public transportation
services less operating revenues. The federal share for net eligible operating costs may not exceed 50%.
eligible recipient,5310—Federal Transit Administration Section 5310 funds may be awarded only to private nonprofit
organizations providing transportation to elderly persons and person with disabilities,and to public bodies approved by
the State of Florida to coordinate services for elderly persons and persons with disabilities (i.e., the Community
Transportation Coordinator). Recipients must be either the Community Transportation Coordinator(CTC)or providing
service under the terms of a coordination or transportation operator contract with the CTC. Agencies must keep their
CTC Agreements current and in force at all times when in possession of a vehicle purchased through the Section 5310
Program.
eligible recipient,5311 and 531 l(f)—For the Section 5311 program(formerly Section 18),political subdivisions of the
State of Florida and agencies thereof,Indian Tribes and private nonprofit agencies designated as CTCs,per Chapter 427,
F.S., who provide public transportation in non-urbanized areas, are eligible recipients for the Section 5311 program.
Private for-profit agencies may receive funds through contractual arrangements with eligible recipients.
eligible service, 5310—Transit service provided to transportation disadvantaged persons and to elderly and disabled
social service client groups when public transit services are unavailable,insufficient or inappropriate for elderly persons
and persons with disabilities. Although all transportation disadvantaged persons may benefit from the program,services
should be designed for the maximum benefit of elderly persons and persons with disabilities. Vehicles may be used in
public transit service on an incidental basis (after services have been provided in accordance with the terms of the
application and/or the Joint Participation Agreement for specified clientele.)
eligible service,5311 —Public transit service provided in non-urbanized areas on a regular and continuing basis and
service provided to non-sponsored transportation disadvantaged persons and to social service clients is eligible.Services
may be designed to maximize usage by transportation disadvantaged persons in general,as long as there is no restriction
on public use of the service. Services may not be designed exclusively to serve the transportation requirements of social
service agencies without regard for the mobility needs of the community as a whole. Charter,sightseeing,and exclusive
school bus services are not eligible services. Since the goal of Section 5311 is to enhance access of people living in non-
urbanized areas to activities, Section 5311 projects may include the transportation of non-urbanized area residents to and
from urbanized areas.
eligible service—5311(f) [intercity bus service]—Regularly scheduled service for the general public which operates
with limited stops over fixed routes connecting two or more urban areas not in close proximity,which has the capacity for
transporting baggage carried by passengers, and which makes meaningful connection with scheduled service to more
distant points, if such service is available. Package express service may also be included, if incidental to passenger
transportation.
expanded service -Adding a new service to an already existing system.
MOT control number- Is assigned by the District once the vehicle has been purchased, received and titled to the
recipient with the Department of Transportation as the first lienholder.
human service transportation- means transportation services provided by or on behalf of a human service agency to
provide access to agency services and/or to meet the basic, day-to-day mobility needs of transportation-disadvantaged
populations, especially individuals with disabilities, older adults,and people with low incomes.
incurred -Commitment or obligation to spend funds for goods to be received or services to be rendered.
individual with a disability—means an individual who,because of illness,injury,age,congenital malfunction,or other
incapacity or temporary or permanent disability(including an individual who is a wheelchair user or has semi-ambulatory
capability),cannot use effectively,without special facilities,planning or design,public transportation service or a public
49
transportation facility.
intercity bus feeder service-The"coordination of rural connections between small transit operations and intercity bus
carriers" may include the provision of service which acts as a feeder to intercity bus service. The feeder service is not
required to have the same characteristics as the intercity service with which it connects,as defined above. For example,
feeder service may be demand responsive,while intercity service is,by definition,fixed route. Examples of eligible costs
include marketing and extended hours of service in order to connect with scheduled intercity service. Note: The
funding of intercity bus feeder service shall be at the discretion of the District Office.
intercity bus service- See eligible service—5311(f).
Job Access and Reverse Commute Program (JARC) — means the Federal Transit Administration formula grant
program for projects relating to the development and maintenance of transportation services designed to transport welfare
recipients and eligible low-income individuals to and from jobs and activities related to their employment,and for public
transportation projects designed to transport residents of urbanized areas and nonurbanized areas to suburban
employment opportunities.
joint participation agreement(JPA)-A contract between the Department of Transportation and a local sponsor of a
transportation project,defining a project and the Department's participation. JPAs maybe for one year or multiple years
(up to five years), at the discretion of the Department.
locally developed,coordinated public transit-human services transportation plan—means a plan that identifies the
transportation needs of individuals with disabilities, older adults, and people with low incomes,provide strategies for
meeting those local needs,and prioritizes transportation services for funding and implementation. Projects considered for
Section 5310 funding must serve identified needs of the disabled population. A locally developed Transportation
Disadvantages Services Plan(TDSP)will qualify in most instances. All stakeholders identified in the circular must be
included in the development of the TDSP.
metropolitan planning organization(MPO)—MPOs are the policy and planning bodies,designated by the Governor,
responsible for transportation planning in urbanized areas.
new applicant—An applicant for Section 5310,5311,and/or 53 11(f)assistance that has not received an award in the last
two fiscal years.
New Freedom Program — means the Federal Transit Administration formula grant program for new public
transportation services and public transportation alternatives beyond those required by the Americans with Disabilities
Act of 1990 that assist individuals with disabilities with transportation, including transportation to and from jobs and
employment support services.
new service-A first time applicant starting a new service.
non-ambulatory-A person who has a mobility impairment that prevents them from being able to walk or move about
freely.
nonprofit organization — A corporation or association determined by the U. S. Secretary of the Treasury to be an
organization described by 26 U.S.C. Section 501(c)which is exempt from taxation under 26 U.S.C. Section 501(a)or
one incorporated within Florida which is certified as not for profit by the Secretary of State.
non-urbanized area -The area outside of an urbanized area,as defined by the U.S. Bureau of the Census.
notice of grant award—mean a form used to notify a successful Section 5310 applicant that they have been selected to
receive a grant award and for the applicant to accept the grant being offered as a Section 5310 grant recipient.
one-way passenger trips-A person who rides a transportation vehicle in one direction between two points for a specific
purpose.
operating revenue-For Section 5311,operating revenue includes the sum of all fares paid by passengers,whether such
fares are paid at the time service is provided or via a prepaid arrangement such as passes or tokens. Operating revenue
excludes revenues from contracts with social service agencies that pay for transportation of social service clients.
50
other than urbanized(non-urbanized area)—means any area outside of an urbanized area. The term"nonurbanized
areas" includes rural areas and urban areas under 50,000 in population not included in an urbanized area.
private organization — means a non-public organizations, bodies which are not municipalities or other political
subdivisions of the State of Florida; are not public agencies or instrumentalities of one or more states; are not Indian
Tribes (except private nonprofit corporations formed by Indian Tribes); are not public corporations, boards or
commissions established under the law of any state;or are not subject to direct control by public authority,Federal,State,
county, or municipal.
program of projects — means a list of projects to be funded in a grant application submitted to the Federal
Transportation by the Florida Department of Transportation. The program of projects(POP)lists the subrecipients and
indicates whether they are private non-profit agencies or local governmental authorities, designates the areas served
(including rural areas),and identifies any tribal entities. In addition,the POP includes a brief description of the projects,
total project cost and Federal share for each project,and the amount of funds used for program administration from the
ten percent(10%) allowed.
public agency-An authority,commission,committee,council,department,division,bureau,board,section or any other
unit or entity of the state or of a town, city, municipality, county or other local governing body.
public transit-The transporting of people by conveyances or systems of conveyances,traveling on land or water,local
or regional in nature, and available for use by the general public. Public transit specifically includes those forms of
transportation commonly known as "paratransit" characterized by their non-scheduled,non-fixed route nature.
recipient—means the Florida Department of Transportation,a State Agency designed by the Governor to receive funds
apportioned by formula to the States under Section 5310(b)(1),or a local government authority when Federal Highway
Administration(FHWA)funds are flexed to Section 5310 to support services for individuals with disabilities.
recurring applicant—An applicant for Section 5310,5311,and/or 53 11(f)Federal Assistance who applies every year.
subrecipient— means a private non-profit organization, if the public transportation service provided is unavailable,
insufficient,or inappropriate;or a governmental authority that is approved by the State to coordinate services for elderly
individuals and individuals with disabilities or certifies that there are non any non-profit organizations readily available in
the area to provide the services.
transit development plan (TDP) - A locally adopted document, addressing a minimum five-year time frame. It is
prepared by the public transit provider, in cooperation with the appropriate Metropolitan Planning Organization. It is
consistent with the applicable approved local government comprehensive plan. The TDP includes an assessment of the
need for transit services in the local area, identifies the local transit policies, existing services and proposed service
improvements, capital and operating costs of the proposed services, existing and proposed sources of funding and a
staged implementation plan. A TDP is updated annually.
transportation disadvantaged-Those persons who because of physical or mental disability, income status,or age,or
who for other reasons,are unable to transport themselves or to purchase transportation and are,therefore,dependent upon
others to obtain access to health care, employment, education, shopping, social activities, or other life-sustaining
activities,or children who are handicapped or high-risk as defined in Chapter 411.202 F.S.
transportation disadvantaged service plan (TDSP) — a plan developed by the CTC and approved by the Local
Coordinating Board that identifies service gaps and provides recommended strategies to provide service in areas of need.
The TDSP may serve as the Local Coordinated Human Services Transportation Plan. The TDSP is updated annually but
includes a five year planning window.
transportation improvement program(TIP)—means a continuing,cooperative and comprehensive planning process
that delineates transportation improvements recommended for federal and state funding during the program period. The
MPO submits the TIP to the Florida Department of Transportation as required by Chapter 339, Florida Statutes.
transportation operator contract—a written contract between the CTC and the transportation operator prepared at the
local level that outlines the terms and conditions for any services to be performed.
51
unrestricted Federal funds—funds received by Section 5311 and/or 5 3 11(f)applicants pursuant to service agreements
with state or local social service agencies or private social service organizations,and used to match Section 5311 and/or
5 3 11(f)funds, even though the original source of such funds may have been another Federal program.
urbanized area—means an area encompassing a population of not less than 50,000 people that has been defined and
designated in the most recent decennial census as an"urbanized area"by the Secretary of Commerce. Small urbanized
areas as used in the context of Federal Transit Administration formula grant programs are urbanized areas with a
population of at least 50,000 but less than 200,000.
End of Manual
5310 Grant Application Revision (30 September 2013)
Revised by Jon M. Ausman,Federal Grants Manager
FDOT Public Transit Office
605 Suwannee Street(MS 26)
Tallahassee,Florida 32399-0450
Email: j on.ausman Adot.state.fl.us
Work: 850-414-4519
52
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 11/20/2013 Division: County Administrator
Bulk Item: Yes X No Department: Social Services
Staff Contact Person: Sheryl Graham 305-292-4511
Kuko-3 'f//f/Jj
AGENDA ITEM WORDING: Request Ratification for the Acceptance of Grant Award FTA Section
5310—YEAR 38 (FFY 2013-2014) Capital Assistance Grant for the purpose of purchasing a para-
transit vehicle (bus) to serve the transportation needs of the elderly and persons with disabilities in
Monroe County.
ITEM BACKGROUND: The Florida Department of Transportation Section 5310 Grant is generally
applied for on an annual basis by the Monroe County Social Services Transit department. This grant is
intended to enhance mobility and accessibility for seniors and persons with disabilities by providing
funding for programs such as Monroe County Social Services Transportation (MCT) to purchase
vehicles. These vehicles are equipped to serve the special needs of transit dependent populations
beyond traditional public transportation and in accordance with the Americans with Disabilities Act
(ADA).
PREVIOUS RELEVANT BOCC ACTION: Due to a deadline with the granting agency, Florida
Department of Transportation, Deputy County Administrator executed the Acceptance of Grant Award
FTA Section 5310— Year 38(13-14) on 11/13/13. Prior approval granted by the BOCC on 12/12/12 for
a request to apply FDOT Section 5310 Capital Assistance Grant-YR 38 (13-14).
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $10,000 (maximum) BUDGETED: Yes X No
COST TO COUNTY: $10,000 (match required-maximum) SOURCE OF FUNDS: GRANT
REVENUE PRODUCING: Yes N/A No— AMOUNT PER: MONTH: YEAR:
APPROVED BY: County Atty. OMB/Purchasing Risk Management
DOCUMENTATION: Included X Not Required— To Follow
DISPOSITION: AGENDA ITEM #
Revised 8/ 6
-------------------------
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: State of Florida, Department of Contract:
Transportation(FDOT)
Effective Date:
Expiration Date:
Contract Purpose/Description: Request Ratification for the Acceptance of Grant Award FTA Section 5310—Year
38(13-14) 5310 Capital Assistance Grant funding for the purposes of purchasing a para transit vehicle(bus)to
serve the transportation needs of the elderly and persons with disabilities in Monroe County.
Contract Manager: Sheryl Graham 305-292- Social Services/Stop 1
4511
(Name) (Ext.) (Department/Stop#)
For BOCC meeting on 12/12/2013 Agenda Deadline: 11/25/2013
CONTRACT COSTS
Total Dollar Value of Contract: approx. $10,000(maximum) Current Year Portion:
Budgeted?Yes X No 0 Account Codes: 00t
County Match: $10,000(maximum)
Additional Match:
Total Match$10,000 ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (e.g.Maintenance,utilities,janitorial,salaries,etc)
CONTRACT REVIEW
Changes Date Out
Date In Needed Reviewer
Division Director Yes 0 No 0
Risk Management
'- Li Yes- No
O.M.B./Purchasing Yes El No 11
County Attorney Yes 0. No
Comments:
OMB Form Revised 2/27/01 MCP#2
ORIGII TA
Florida Department of Transportation
RICK SCOTT 1000 NW 11 I'Avenue ANANTH PRASAD,P.E.
GOVERNOR Miami, Florida 33172 SECRETARY
DATE: October 23, 2013
TO: Monroe County Board of County Commissioners
1100 Simonton Street, Room No. 1-180. Cato Building
Key West, Florida 33040
Attn: Ms. Anna M. Haskins, Social Needs Coordinator
FROM. Ms. Dionne Richardson, Freight& Logistics Passenger Operations Manager -- -
SUBJECT: NOTICE OF GRANT AWARD FTA SECTION 5310— YEAR 38(FFY 2013—2014)
Based on your Agency's recent Application for Capital Assistance under the FTA Section 5310
Program,the Florida Department of Transportation makes the following grant award to your agency.
Vehicle Description Estimated Agency's Estimated
Total Cost Minimum Contribution
21' Ford Cutaway Body on $63,178.00 $6,318.00
Chassis transit bus,with gas
w/chair lift with 7 amb. pass. seats
2 w/c pos.
ACCEPTANCE OF GRANT AWARD - Financial Contract No. 413360-1-94-01
By signing below the Agency reaffirms its assurances to FTA and FDOT as stated in Exhibits
F, G, and H of its application. Agency acknowledges and agrees to the following:-
(1) Maintain a Community Transportation Coordination (CTC)Agreement with its respective
county during the useful life of the vehicle.
(2) Name the Department as an insurance certificate holder on vehicles obtained through this
program and provide evidence of insurance coverage to the Department.
(3) Submit an Annual Certification of Use by January 15'" of each year. (Attachment 1).
(4) Provide Monthly Operating Reports to the Department as shown on (Attachme
a ; F F/
ORIGINAL
Page-2-
(5) E-VERIFY- VENDORSICONTRACTORS
(a) shall utilize the U.S. Department of Homeland Security's E-Verib,system to verify the
employment eligibility of all new employees hired by the Vendor/Contractor during the
term of the contract, and
(b) shall expressly require any subcontractors performing work or providing services pursuant
to the state contract to likewise utilize the U.S. Department of Homeland Security's
E-Verify system to verify the employment eligibility of all new employees hired by the
subcontractor during the contract term.
AGENCY: moij(6e, &V14-Li 80C� ALA NWVoe-
FEID#
Accepted by:
(Authorized Signature)
Date: L.2-O 13
Name: YVI
Title: 1 V-C C+-0 Q C� st/LZgxAs
APPROVED: FLORIDA DEPARTMENT OF TRANSPORTATION
Ms. Dionne Richardson,Freight& Logistics Passenger Operations Manager
Date:
NOTE: THIS FUVD1NG EXPIRES.TUNE 30, 2015.
To order your Agency's new vehicle, please contact FDOT's Contractor, ivs. Lazara Stinnette, tel.
(813) 974-0695 or Email:Istinnetteedcutnusf.edu.
Attachments(2)
J:\carolN s5310grantaward 20101et
ORIGINAL
FTA FISCAL YEAR 2013 CERTIFICATIONS AND ASSURANCES
FEDERAL FISCAL YEAR 2013 CERTIFICATIONS AND ASSURANCES FOR FEDERAL TRANSIT
ADMINISTRATION ASSISTANCE PROGRAMS
(Signature page alternative to providing Certifications and Assurances in TEAM-Web)
Name of Applicant: M f1roc-- mohrct-
The Applicant agrees to comply with applicable provisions of Groups 01—24.
OR
The Applicant agrees to comply with applicable provisions of the Groups it has selected:
Group Description
OL Required Certifications and Assurances for Each Applicant.
02. Lobbying.
01 Private Sector Protections.
04. Procurement and Procurement System.
05. Rolling Stock Reviews and Bus Testing.
06. Demand Responsive Service.
07. Intelligent Transportation Systems.
08. Interest and Finance Costs and Leasing Costs.
09. Transit Asset Management and Agency Safety Plans.
10. Alcohol and Controlled Substances Testing.
11. Fixed Guideway Capital Investment Program(New Starts,Small Starts,and Core Capacity)
and Capital Investment Program in Effect before MAP-2 1.
12. State of Good Repair Program.
13. Fixed Guideway Modernization Grant Program.
14. Bus[Bus Facilities Programs.
15. Urbanized Area Formula Programs and Job Access and Reverse Commute(JARC)Program.
16. Seniors/Elderly/Individuals with Disabilities Programs and New Freedom Program.
17, Rural/Other Than Urbanized Areas/Appalachian Development/Over-the-Road Bus
Accessibility Programs.
18. Public Transportation on Indian Reservations and"Tribal Transit Programs.
19. Low or No Emission/Clean Fuels Grant Programs.
20. Paul S Sarbanes Transit in Parks Program,
21. State Safety Oversight Program.
22. Public Transportation Emergency Relief Program.
73. Expedited Project Delivery Pilot Program.
24. Infrastructure Finance Programs.
----------
FTA FISCAL YEAR 2013 CERTIFICATIONS AND ASSURANCES
FEDERAL FISCAL YEAR 2013 FTA CERTIFICATIONS AND ASSURANCES SIGNATURE PAGE
(Required of all Applicants for FTA funding and all FTA Grantees with an active Capital or Formula Project)
AFFIRMATION OF APPLICANT
Name of Applicant: MOM-a—O 96C-r—JM or\ree— CouiVLy <-Xx-x1aJ : few-was
Name and Relationship of Authorized Representative:
BY SIGNING BELOW,on behalf of the Applicant,I declare that the Applicant has duly authorized me to make these
Certifications and Assurances and bind the Applicant's compliance.Thus,the Applicant agrees to comply with all
Federal statutes and regulations,and follow applicable Federal guidance,and comply with the Certifications and
Assurances as indicated on the foregoing page applicable to each application its authorized representative makes to the
Federal Transit Administration(FTA)in Federal Fiscal Year 2013,irrespective of whether the individual that acted on
its Applicant's behalf continues to represent the Applicant.
FTA intends that the Certifications and Assurances the Applicant selects on the other side of this document should
apply,as provided,to each Project for which the Applicant seeks now,or may later seek FTA funding during Federal
Fiscal Year 2013.
The Applicant affirms the truthfulness and accuracy of the Certifications and Assurances it has selected in the
statements submitted with this document and any other submission made to FTA,and acknowledges that the Program
Fraud Civil Remedies Act of 1986,31 U.S.C.3801 et seq.,and implementing U.S.DOT regulations,"Program Fraud
Civil Remedies,"49 CFR part 31,apply to any certification,assurance or submission made to FTA.The criminal
provisions of 18 U.S.C. 1001 apply to any certification,assurance,or submission made in connection with a Federal
public transportation program authorized by 49 U.S.C.chapter 53 or any other statute
��In signing this u t,I declar nder penalties of perjury that the foregoing Certifications and Assurances,and any
other st" T
ts made by ehalf ofke }Applicant
true and accurate.
mr
Si
fia Date:
11
Name-- C(—eCJ(FJ--
Authorized Representative of Applicant
AFFIRMATION OF APPLICANT'S ATTORNEY
For(Name of Applicant): Molarojz— 00--Iq� ImQan�,
As the undersigned Attorney for the above named Applilt,I hereby affirm to the Applicant that it has authority under
State,local,or tribal government law,as applicable,to make and comply with the Certifications and Assurances as
indicated on the foregoing pages.I further affirm that,in my opinion,the Certifications and Assurances have been
legally made and constitute legal and binding obligations on the Applicant.
I further affirm to the Applicant that,to the best of my knowledge,there is no legislation or litigation pending or
imminent that might adversely affect the validity of these Certifications and Assurances,or of the performance of its
FTA Project or Projects.
Signature Date:
Name
Attorney for Applicant
Each Applicant for FTA funding and each FTA Grantee with an active Capital or Formula Project must provide an
Affirmation of Applicant's Attorney pertaining to the Applicant's legal capacity. The Applicant may enter its signature
in lieu of the Attorney's signature,provided the Applicant has on file this Affirmation.,signed by the attorney and dated
this Federal fiscal year.