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Home My WebLink AboutPS&E_5433(014)_2011-05_Fed. Inv.# 24_signedSTATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION LOCAL AGENCY INVOICE LAPM 5-A (REV 01/2020) Reset Form -11 Print Invoice Billing No: 24 SECTION 1: INVOICE Local Agency Name Remittance Address Tax ID City of La Quinta 78-495 Calle Tampico 95-3740431 La Quinta, CA 92253 Date Caltrans District Federal/State Proj. No. Advantage Project I❑ Invoice No. Billing No. Final Inactive Invoice Project 03117/20 D8 San Bernardino BRLKS 5344(014) 0813000144-L-N 24 24 ❑ Project Description Dune Palms Road Bridge over the Coachella Valley Stormwater Channel, CP# 2011-05 Fund ® Federal Authorized ❑ PA&ED ❑ RMI ❑ CE ❑ NI Type{s}: ❑ state Phasejsj: ® PF ❑ RfVV Util ❑ CON ❑ FA ❑ E&P ❑ RIW Eng ❑ PS&E ❑ RIW Acq Preliminary Total Engineering Federal Appropriation Code H1 CO IM240 Participating Cost (E-76 Auth. Date) I From: 09/04/13 Participating Cost To: 02/29/20 Total Indirect Cost to Date: $ $ 0.00 Total Direct Cost to Date: $ 1,547,415.35 $ 1,547,415.35 Total Cost to Date: $ 1,547,415.35 $ 1,547,415.35 Less: Non -Participating Cost $ $ 0.00 Other $ $ 0.00 Other $ $ 0.00 Other $ $ 0.00 Total Participating Cost to Date: $ 1,547,415.35 $ 1,547,415.35 Less: Participating Cost not Reimbursed {Local Funds} $ $ 0.00 Total Participating Cost: $ 1,547,415.35 $ 1,547,415.35 Federal Reimbursement Ratio: 88.53% Reimbursable Amount to Date: $ 1,369,926.80 $ 1,369,926.80 Less: Cumulative Amount Paid on All Previous Invoices $ 1,338,924.35 $ 1,338,924.35 Reimbursable Participating Cost: $ 31,002.45 $ 31,002.45 Less: State Withheld Retention $ $ Q.00 Amount Exceeding Authorized Fund $ $ 0.00 Other $ $ 0.00 Amount of This Claim: $ 31,002.46 $ 31,002.45 TOTAL INVOICE AMOUNT: $ 31,002.45 Refer to your Finance Letter Authorized Federal Fund Amount $ 1,549,275.00 $ 1,549,275.00 Less: Cumulative Amount Paid on All Previous Invoices $ 1,338,924.35 $ 1,338,924.35 Funds Remaining Prior to this Claim $ 210,350.65 $ 210,350.65 ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION LOCAL AGENCY INVOICE LAPM 5-A (REV 01/2020) Reset Form Billing No: 24 SECTION 2: INDIRECT COST CALCULATION Indirect Cost: Phase FY OffioelDepartment Direct Cost Base Expense � Approved Indirect Cost Rate Subtotal °�a $ 0.00 Phase PE PA&E❑ E&P PS&E RI1N CE NI FA Total Indirect Cost to Date $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 CERTIFICATION By signing this invoice, all local agency signatories certify to the best of mylour knowledge and belief that the invoice is true, complete, and accurate. The expenditures, disbursement, and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal/State award. Ilwe are aware of any false, fictitious, fraudulent information, or the omission of any material fact may subject melus to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Section 3729-3730 and 3801-3812). Ilwe certify that the cost claimed follow pertinent and applicable guidelines and all Federal/State regulations. All consultant and contractor agreements have been reviewed and approved in accordance with LAPM Chapter 10 Consultant Selection and Chapter 16 Administer Construction Contracts. Ilwe understand that Caltrans may review this invoice and support documentation for reasonableness at this time and that all invoices related documentation is subject to future detailed review by the Federal Highway Administration andlor Caltrans. Signature of Local Agency Representative Date 40_0_*� 03/17/2020 Print Name Title Bryan McKinney Public Works Director 1 City Engineer For questions regarding this invoice, please contact: Contact Name Title Phone Number E-mail Nick Nickerson Project Manager 1(760) 323-5344 nnickerson@naiconsulting.com Comments STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION LOCAL AGENCY INVOICE LAPM 5-A (REV 01/2020) Reset Form Billing No: 24 SECTION 3: BILLING SUMMARY Federal/State Project No. BRLKS 5344(014) Preliminary Engineering Description p e.g., Staff Time, Consultants, etc.) Work Performed (elates) From To Vendor Receipt/ Invoice Number rf applicable) pp ) Total Direct Cost (current invoice period only] Less Note- Participating Cost (current invoice period only) Total Participating Cost (current invoice period only) Bengal Engineering 11/01/2019 11/30/2019 4079 $4,167.05 $4,167.05 Bengal Engineering 12/01/2019 12/31/2019 4107 $1,229.09 $1,229.09 Bengal Engineering 01/01/2020 02/29/2020 4121 $27,158.89 $27,158.89 Coachella Valley Water District 02/04/2020 02/04/2020 020420A $2,400.00 $2,400.00 Planit Reprographics 02/24/2020 02/24/2020 885134 $E4.12 $64.12 Total Participating Cost (all ham): $35,019.15 $0.00 $35,019.15 $35,019.15 Note: The Billing Summary must accompany all Local Agency invoices. Expenditures prior to authorization are not eligible for reimbursement. Each line needs to be detailed enough to verify the accuracy of the charge. Consultant charges need to be itemized similar to the agency charges. Comments STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION LOCAL AGENCY INVOICE LAPM 5-A (REV 0112020) Reset Form Billing No: 24 SECTION 4: CHECKLIST Local Agency Name: City of La Quinta Billing No: 24 Federal I State Project No: BRLKS 5344(014) Local Agency Caltrans Frequency Confirm NIA Concur 1 Executed Program Supplement Agreement (PSA) on file with Local Agency. All Invoices 2 Submittal of one signed original and one copy of completed Local Agency Invoice (LAPM All Invoices ® ❑ 5-A) which includes Section 1: Invoice, Section 2: Indirect Cost Calculation, Section 3: Billing Summary (submit contractor pay estimate for construction invoices), and Section 4: Checklist. 3 Reimbursable work claimed is after E-76 (Federal Authorization to Proceed) date All Invoices ® ❑ and/or California Transportation Commission (CTC) State Allocation date. 4 Work performed is prior to any lapsing 1 expiring funds. All Invoices ® ❑ • Check Finance Letter Reversion Date (Federal) • Verify Cooperative Work Agreement Approval (Federal / State) • CTC State Allocation Letter Fund Expiration Deadline (State) 5 Invoice is consistent with current approved Finance Letter. All Invoices ® ❑ • Phases of Work • Fund Types (e.g., CMAQ, RSTP, etc.) • Reimbursement Ratios • Available Balance of Federal / State Funds • Cost incurred prior to authorized Agreement End Date (AED) 6 Invoiced amount shall be greater than 2% of the total Federal and/or State funds or $1,000, All Invoices ® ❑ whichever is greater, unless authorized by District Local Assistance Engineer (DLAE) to prevent inactivity. 7 Percentage of work complete is consistent with total Federal / State funds invoiced All Invoices ® ❑ (i.e., project should not be 80% expended if only 20% complete). 8 Remaining balance should not be less than Caltrans required retention All Invoices prior to ® ❑ ($40,000 or 2% of the Federal I State funds, whichever is greater). Final Invoice 9A All consultant agreements I amendments must follow the Caltrans procurement and All Invoices ® ❑ ❑ oversight processes outlined in Local Assistance Procedures Manual Chapter 10. The following Exhibits must be sent to and received by the appropriate entities rip or to invoicing: • Submit Exhibit 10-C to Division of Local Assistance HQ — Office of Guidance and NI First Consultant ❑ ® ❑ Oversight Invoices • Submit Exhibits 10-01 and 10-02 to DLAE First Federal ❑ ® ❑ Consultant Contracts • Submit Exhibit 10-K to Independent Office of Audits and Investigations All Consultant ❑ Contracts a $150K 9B Submit copy of executed contract to the DLAE within 30 days of contract award or All First Consultant ❑ ® ❑ concurrently with first invoice, whichever is earlier. Invoices • For on -call contracts, submit copy of issued task order and Exhibit 10-02 for the task order. ❑ ® ❑ 10 Verification of Project Award: Attach LAPM Exhibit 15-L (Federal projects), LAP Exhibit 22- First Construction ❑ ® ❑ A (State ATP projects), and/or LAPM Exhibit 23-A (STIP projects). Invoice 11 Submit contractor pay estimate with Billing Summary. Construction Invoices ❑ ® ❑ 03/17/2020 Bryan McKinney, Public Works Director / City Engineer Signature of Local Agency Representative Date Print Name and Title Signature of Caltrans District Reviewer Date Print Name/Title/Phone Number Comments