CHAIR AND COMMISSIONERS Reference No.: 2.5d.(X)

CALIFORNIA TRANSPORTATION COMMISSION Month DD-DD, YYYY

Page 3 of 3

M e m o r a n d u m
To: CHAIR AND COMMISSIONERS
CALIFORNIA TRANSPORTATION COMMISSION /

CTC Meeting: Month DD-DD, YYYY

Reference No.: 2.5e.(X)

Action Item
From: NORMA ORTEGA
Chief Financial Officer /

Prepared by: District Director Name

District XX - Director
Subject: SUPPLEMENTAL FUNDS ALLOCATION FOR PREVIOUSLY VOTED
PROJECT (PPNO XX-XXXX)
RESOLUTION FP-XX-XX

ISSUE

Should the California Transportation Commission (Commission) approve the California Department of Transportation’s (Department’s) request for additional $X,XXX,XXX (Total Supplemental Funds Request amount) for the PROGRAM (example: State Highway Operation Protection Program (SHOPP) or State Transportation Improvement Program (STIP)) PROGRAM CATEGORY (example: Seismic Safety Retrofit, Roadside Safety Improvement, Pavement Rehabilitation) project (PPNO XXXX) on ROUTE (example: Interstate 5 (I-5)), in COUNTY NAME (example: Los Angeles County), to be awarded?

RECOMMENDATION

The Department recommends that the Commission allocate $X,XXX,XXX (Total Supplemental Funds Request amount) for the previously approved PROGRAM and PROGRAM CATEGORY project (example: SHOPP Pavement Rehabilitation project) (PPNO XXXX) on ROUTE, in COUNTY NAME, to be awarded.


RESOLUTION

Resolved, that $X,XXX,XXX in Construction Capital (Construction Capital Component Funds Request amount) be allocated from the Budget Act of 20XX, Budget Act Items 2660-XXX-XXXX and 2660-XXX-XXXX and $ X,XXX,XXX (Construction Support Component Funds Request amount) in Construction Support be allocated from Budget Act Item 2660-XXX-XXX, to provide funds to award the following project.

Dist-Co-Rte / Construction Component / Original
Allocated
Amount / Awarded
Amount / Total Authorized Amount / Supplemental
Funds
Request / Revised
Amount / % Over Original Allocated Amount
XX-XXX-XX / Capital / $X,XXX,XXX / $ X,XXX,XXX / $ X,XXX,XXX / $ X,XXX,XXX / XX.X% / $X,XXX,XXX
Support / $ X,XXX,XXX / $ X,XXX,XXX / $ X,XXX,XXX / $ X,XXX,XXX / XX.X% / $X,XXX,XXX
Total Supplemental
Funds Request / $ X,XXX,XXX

Total Authorized Amount = Awarded Amount + G-12 Adjustment

% Over Total Authorized Amount = __ Supplemental Funds Request _

Awarded Amount

PROJECT DESCRIPTION

Describe in detail the project location, scope of work, and other relevant information related to this supplemental funds request. DO NOT USE THE CTIPS PROJECT DESCRIPTION.

REASON FOR INCREASE

Use the following terms when making reference to the different project development phases:

·  Project Initiation Document (PID) phase

·  Project Approval and Environmental Document (PA&ED) phase

·  Plans, Specifications and Estimate (PS&E) phase

·  Right of Way (R/W) phase

·  Construction (CON) phase

Explain in detail the reason(s) for the cost increase and the need for additional funds. Include options that were considered and special considerations. Start with a summary sentence listing the reason(s) for the cost increase: “The cost estimate increase to advertise this project is due to reason #1, reason #2, etc.”

Reason #1 (XX percent of the Support Cost Increase)

This section explains in detail reason #1. Include efforts to mitigate, options that were considered and reason(s) it was not successful.

Reason #2 (XX percent of the Support Cost Increase)

This section explains in detail reason #2. Include efforts to mitigate, options that were considered and reason(s) it was not successful.

RISK ANALYSIS

This section summarizes potential risks identified in the current phase Risk Register (example: PS&E phase Risk Register) that are related to the reason(s) for the cost increase to award this project.

EXPECTED IMPACTS

This section summarizes identified potential risks during the Construction phase that may impact the Construction Capital and/or Construction Support.

CONSEQUENCES

The Department has determined that re-advertising this project will not result in lower bids. If this request for an additional $X,XXX,XXX (Total Supplemental Funds Request amount) is not approved, the Department will not be able to award this PROGRAM PROGRAM CATEGORY project and construction will be delayed.

REQUIRED SIGNATURES

Signatures are required only for internal distribution to the HQ Supplemental Executive Committee. This section will be removed after the HQ Supplemental Executive Committee review meeting. The final Book Item cover page will be signed by the District Director and the Chief Financial Officer.

Name (Print) / Signature / Title / Date
XXXXXXXXXXXXX / Project Manager / XX/XX/XX
XXXXXXXXXXXXX / SFP or District Director / XX/XX/XX

Attachment (Vote Box to be generated by OCTCL)

“Provide a safe, sustainable, integrated and efficient transportation system

to enhance California’s economy and livability”