JUNE 2016 INSTRUCTIONS FOR THE REIMBURSEMENT REQUEST FORM (CP74)
The REQUEST FOR PAYMENT FROM EXTREME WINTER RECOVERY REAPPROPRIATIONS is on the back of these instructions. If you need more than one REQUEST FOR PAYMENT FROM EXTREME WINTER RECOVERY REAPPROPRIATIONS form for a quarterly reimbursement, type at the top of each whether the form is 1 of 1, 1 of 2, 2 of 2, etc. Only forms entered on-line and mailed to your CHIPS Representative will be accepted.
A. MUNICIPAL DESCRIPTION: type in the name of the municipality (County of, Town of, etc.) and the 6 digit NYSDOT municipal code.
B. PROJECT LISTING
1. Type the route number or name of the specific street, highway, bridge, or “other” project for which reimbursement is being requested. NOTE: If reference is made to “various” streets, traffic control devices, etc., you must indicate “see attached list” and attach a list of each street, traffic control device, etc., along with its project cost/reimbursement requested.
2. Type the location of the project by identifying both the “from” (where the project begins) and the “to” (where the project ends). This requirement also applies to any projects in an “attached list”. If project type is “Other” and it is an equipment purchase, describe the equipment next to “Route/Name/Other.”
3. Select the one project type that best describes the major component of the project. The six standard project type definitions are: (1) Highway Resurfacing; (2) Highway Reconstruction; (3) Traffic Control Devices; (4) Bridge/ Culvert Rehabilitation; (5) Bridge/Culvert Replacement; and (6) Other (specify the actual project).
4. Select the one project sub type that best describes the specific work activity for each project.
5. Type the actual or estimated total project cost for each project for which you are requesting reimbursement under a particular quarterly payment. Refer to the first paragraph of the “Eligible Project Costs and Payment Reimbursements” discussion on p. 4 of the Program Guidelines and be aware that the “total project cost” for a project often exceeds its requested reimbursement for a particular quarterly payment.
6. Type the reimbursement requested for each project. If the requested amount represents the final Extreme Winter Recovery Reappropriation reimbursement for a project, select “yes” for final project payment. If you expect the requested amount for a particular project to be followed by additional payment requests in the current State Fiscal Year for that project, select “no” for final project payment.
7. Do not type in a figure for Total Amount Claimed. This total will be automatically calculated at the bottom of each form after individual project entries have been completed.
C. CERTIFICATION
1. Select the expenditure eligibility period (month/day/year - month/day/year) for which you are requesting reimbursement, as follows:
a. For unreimbursed expenditures made during the current State Fiscal Year (SFY), the expenditure eligibility period will be the expenditure eligibility dates specified in the quarterly NYSDOT “payment” letters; and/or
b. For unreimbursed expenditures made during a previous SFY, reimbursement eligibility is limited to only those local expenditures actually made within an 18 month period prior to the currently scheduled quarterly payment date specified in the most recent NYSDOT payment letter. Do not select dates which cross state fiscal years (SFY); a separate form must be submitted for each April 1 – March 31 SFY for which expenditures are incurred.
2. The required certification statement should be signed by the appropriate municipal official.
3. Enter the phone number of the municipal official who signs the CP74 form.
4. Select the date (month/day/year) on which this Certification statement was signed. This signature date should fall within or after the expenditure dates which you entered on the CP74(s).
5. Type the e-mail address (if applicable) of the municipal official who signs the CP74 form.
6. Use the “Print, Sign, & Mail to Regional CHIPS Rep” button to print the form(s) only after all required info has been entered. Sign the completed form(s), make one copy for your files, and then mail to your NYSDOT Regional CHIPS Representative.