Local Assistance Program Guidelines

EXHIBIT 20-B
Sample Resolution

SAMPLE RESOLUTION
APPROVING AN EEM PROJECT
Resolution No: _____
RESOLUTION OF THE

_____________________________________________________ (Governing Body)

OF

APPROVING
(NONPROFIT ORGANIZATION/SPECIAL PURPOSE LOCAL AGENCY))

THE APPLICATION FOR GRANT FUNDS FOR THE ENVIRONMENTAL ENHANCEMENT AND
MITIGATION (EEM) PROGRAM UNDER SECTION 164.56 OF THE STREETS AND HIGHWAYS CODE
FOR THE FOLLOWING PROJECT: __________________________________________________(Project Name)
WHEREAS, Senate Bill 117 (Statutes of 1999, Chapter 739) established the EEM Program as a
permanent program funded at $10 million annually by the Legislature for grant funds to local, state and
federal governmental agencies, and nonprofit organizations for projects to enhance the environment and mitigate the
environmental impacts of modified or new public transportation facilities; and
WHEREAS, the State Resources Agency of California has established the procedures and criteria for reviewing grant
proposals and is required to submit to the California Transportation Commission a list of recommended projects from which
the grant recipients will be selected; and
WHEREAS, said procedures and criteria established by the State Resources Agency of California require a resolution
certifying the approval of application by the applicant's governing body before submission of said application to the State;
and
WHEREAS, the application contains assurances with which the applicant must comply; and
WHEREAS, the applicant, if selected, will enter into an agreement with the State of California, Department of
Transportation, to carry out the environmental enhancement and mitigation project;
NOW, THEREFORE, BE IT RESOLVED THAT THE ____________________________________________________
(GOVERNING BODY)
1. Approves the filing of an application for the Environmental Enhancement and Mitigation Program for grant assistance.
2. Certifies that said applicant will make adequate provisions for operation and maintenance of the project.
3. Appoints
as agent of
the
to
(NONPROFIT ORGANIZATION/SPECIAL PURPOSE LOCAL AGENCY)
conduct all negotiations, execute and submit all documents, including, but not limited to applications, agreements,
amendments, and payment requests, which may be necessary for the completion of the aforementioned project.
Approved and Adopted the
day of
certify the foregoing Resolution Number

, 20

. I, the undersigned, hereby

was duly adopted by

(GOVERNING BODY)
Following roll call vote:
Ayes:
Noes:
Absent:
______________________________________________________
(CLERK/SECRETARY FOR THE GOVERNING BODY)

LPP 03-03

Page 20-23
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-B
Sample Resolution

REQUEST FOR CTC ALLOCATION VOTE

Local Agency Letterhead

To:

(DLAE Name )
District Local Assistance Engineer
Caltrans, Office of Local Assistance
(District Address)

Date:____
Project Number:
Project Title:

Dear (DLAE Name):

We request the California Transportation Commission allocate from the Environmental Enhancement and Mitigation
(EEM) $_______________.
This is the amount requested in the EEM program application for
_____________________ (project location and description and what will be accomplished. The funding is for:

Preliminary Eng.
Right-of-Way
Construction
Const. Eng.
Acquisition of Property
TOTAL

Total Cost
$__________
$__________
$__________
$__________
$__________
$__________

CTC Allocation Share

$__________
$__________
$__________
$__________
$__________
$ _________

Status of Projects:
Environmental:
CEQA - Define project clearance type and date.
NEPA - Define project clearance type and date (if applicable).
Engineering:
The project development was/will be completed on (date) (if applicable).
R/W: The project right-of-way acquisition is scheduled to begin (date) (if applicable).
Construction: The project advertisement is scheduled for (date) (if applicable).
The project was adopted in the CTC Program Adoption Resolution for FY20xx-20xx for amount of $___________ under
EEM Program for FY 20xx-20xx. We request the CTC vote the funds at its next available meeting.
Please advise us as soon as the fund allocation has been voted. You may direct any questions to (Name) at (phone
number) and (e-mail).
CERTIFICATION: I hereby certify I will:
1. Sign the Applicant-State Agreement (Agreement) within 90 days of the date on the Agreement cover letter from
Caltrans.
2. Begin this project as soon as the Agreement is executed.
3. Let Caltrans know by April of the fiscal year in which the funds were allocated if we will not be able to implement the
project, this allowing another project to receive an allocation. We understand our project will be put at the bottom of
the list.
4. If property is being acquired, an Agreement Declaring Restrictive Covenants will be recorded and submitted to
Caltrans.

Sincerely,
Signed: _________________
Title: _________________
http://www.dot.ca.gov/hq/LocalPrograms/EEM/homepage.htm

LPP 03-03

Page 20-23
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-B
Sample Resolution

EXHIBIT A1 - COST PROPOSAL

(This must be completed by APPLICANT for all projects, except for acquisition-only projects, and returned with ApplicantState Agreement to the STATE.)

APPLICANT:
PROJECT NAME:
COUNTY:

Direct Labor:
(Labor rates must be calculated as actual dollar earned per hour and cannot include overhead costs)
Classification
Name
Hours
Rate
Total
Project Manager
@

@
@
@
Total Direct Labor Costs
Fringe Benefits:
(Benefits, such as vacation, medical, and retirement, etc., must be calculated as rates earned per hour)
Other Costs: (Itemize with description, quantity, unit price, and total cost; estimates acceptable)
Travel Costs
Equipment and Supplies
Other Direct Costs
Subcontractor Costs:
(Attach scope of work and detailed cost estimate for each subcontractor)
Volunteer Services:
Classification
Volunteer

Name

Hours

Rate

Total

@
@
@

Total Volunteer Labor Costs

Donations:
(Itemize with description, quantity, unit price, and total cost; estimates acceptable)

Materials
Other
Total Project Cost:

LPP 03-03

Page 20-23
October 10, 2003

Local Assistance Program Guidelines

LPP 03-03

EXHIBIT 20-B
Sample Resolution

Page 20-23
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-D
EEM Applicant-State Agreement

EXHIBIT C - SAMPLE OF EEM PROJECT INVOICES

(Prepare On Letterhead of Applicant & Address)
Remittance Address
Date of Invoice
(For all invoices)

District Director
District Local Assistance Engineer:
Department of Transportation
Division of Local Assistance
Street or P.O. Box
City, CA Zip Code
Attn:

Billing No.: 1, 2, or Final

Invoice No: Local Agencys Invoice
No._________
Project Completion Date: Final Date or
Ongoing (if not final)
Project Location_____________
Tax Identification No. ________
County: County Name
Expenditure Authorization No.
__________
Advantage # ___________

, EEM Coordinator

Reimbursement for Environmental Enhancement and Mitigation (EEM) funds is claimed pursuant to State Project No.
EEM-20XX (0 ), Applicant-State Agreement No. ________, Agreement date_______.
Description of work covered by this Invoice: _________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Preliminary
Engineering

Construction
Engineering

Acquisition and
Incidentals

Construction Contract

Total Costs to Date**

Less: Nonparticipating Costs

to Date

Total State Participating Costs

to Date

Reimbursement Ratio

Total Reimbursement

Less: Amount Claimed on

previous invoice

Amount this Invoice:

GRAND TOTAL Amount this Invoice: $ ___________

I certify that the work covered by this invoice has been completed in accordance with approved plans and specifications; the costs shown in
this invoice are true and correct; and the amount claimed, including retention as reflected above, is due and payable accordance with the
terms of the agreement.
___________________________________________
____________
Signature, Title and Unit of Local Agency Representative
Phone No
___________________________________________
Contact Name (for questions about this invoice)

_____________
Phone No

** Note: The State will make the payment(s) on a reimbursement basis of its proportionate share of actual costs incurred to date after expenses and debts
have been paid by the applicant; timesheets, mileage logs, invoices, receipts, cancelled warrants, and other documents as applicable are required by the
State as supporting documentation prior to each reimbursement.

LPP 03-03

Page 20-45
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-D
EEM Applicant-State Agreement

(APPLICANT: Complete the section below for EEM projects involving acquisition of real property rights, or rights thereto,
if you requests that State funds be deposited directly into an Escrow Account. This invoice with the required documents must
be submitted 60 days prior to the close of escrow. For the list of required documents, see Exhibit H of EEM Guidelines at
website: http://www.dot.ca.gov/hq/LocalPrograms/EEM/homepage.htm
Caltrans will transfer funds to escrow account 30 days prior to escrow close.)
Pursuant to Exhibit D of above referenced Applicant-State Agreement,
(Name of Applicant)
requests and authorizes that the Environmental Enhancement and Mitigation (EEM) fund warrants be made out in
the name of the _____________________________________________________ Title Company and mailed to
Address) ___________________________________, Attention: _________________________________
For Escrow No. __________. Title Company Tax I.D. No. is:________________ Escrow Close Date: ______

I certify that the work covered by this Invoice has been completed in accordance with approved plans and.
specifications; the costs shown in this Invoice are true and correct; and the amount claimed is due and payable
within the terms of the Agreement. I will remit to the State any interest accrued on EEM funds depositing into an
escrow, or other, account.

I further certify, if applicable, that acquisition of real property, or rights thereto, (has been) (will be) acquired in
accordance with applicable State laws and regulations.
I further certify, if property or a conservation easement was or is being acquired, that acquisition of real property
or rights thereto, has been acquired in accordance with applicable State laws and regulations, AND:

attached is a signed, notarized Agreement Declaring Restrictive Covenant (ADRC) including the legal description of the
property and the original EEM program application; and
immediately upon escrow closing the ADRC will be recorded and the original will be sent to the Caltrans address stated
on the ADRC; or
if escrow has closed, applicant will attach the signed, notarized and RECORDED ADRC, including the legal description
of the property and the original EEM program application here.

APPLICANT understands that failure to submit a RECORDED ADRC immediately upon escrow closing will put EEM
project funding at risk.

APPLICANT REPRESENTATIVE NAME & TITLE

Approved For Payment:
CALTRANS: (check appropriate line)
Approved For Payment For Direct Deposit into Escrow: (Invoice can only be approved if Applicant has
provided a signed and notarized ADRC, including a legal description AND the original application).
Approved for Reimbursement: (Invoice can only be approved if the RECORDED ADRC with legal
description and original invoice is attached.)

DISTRICT RIGHT-OF-WAY DIVISION CHIEF (if applicable)

LPP 03-03

Page 20-45
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-D
EEM Applicant-State Agreement

EXHIBIT D REMARKS AND COVENANTS

(APPLICANT; If your EEM projects involve acquisition of real property, or rights thereto, and you
requests EEM funds be deposited directly into an escrow account, you MUST complete the following
paragraph below when you sign the Applicant-State Agreement. It is required to ensure timely
payment.)*
Pursuant to the terms of Applicant-State Agreement No. __________ , dated __________________
and effective immediately, the ________________________________________________________
(Name of Applicant)
requests and authorizes that the EEM fund warrants be made out in the name of the
_____________________________________________________________________ and mailed to
(Name of Title Company)
_______________________________________________________________________________
(Address of Title Company)
Phone No. _________________ Attention: ____________________________________________
(Name of Escrow Agent)
For Escrow No. ___________________. Title Company Tax I.D. #__________________________
Escrow Close date: ___________

*APPLICANT will remit to the STATE interest accrued on this account immediately upon close of
escrow.

LPP 03-03

Page 20-45
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-F
Local Assistance Program Guidelines
Change of EEM Applicant Status Request Letter: Pre-Allocation Vote

CHANGE OF EEM APPLICANT STATUS REQUEST LETTER: PRE-ALLOCATION VOTE

(On original applicants letterhead)
(Name), Local Assistance Engineer/EEM Coordinator
Department of Transportation, District ___
Office of Local Assistance
(Address) (City), CA (ZIP)
Dear M__________________:

Date: _________________

We hereby request to be placed on the next California Transportation Commission (CTC) agenda for
approval to change applicant status from the (original applicant agency) to the (new applicant agency)
for the Environmental Enhancement and Mitigation (EEM) Program (project name), project no.__.
Attached is a completed and signed Resources Agency EEM Program Application cover page, along
with signed Assurances from the same application for the (new applicant agency). Also enclosed is an
adopting Resolution by their governing board certifying willingness to carry out the project, and a
501(c)(3) (if applicable). The (new applicant agency) also agrees to execute an EEM Program
Applicant-State Agreement in their name, along with providing tax identification information to the
Caltrans Local Program Accounting Office in order to do business with Caltrans.
We also hereby request to be placed on the CTC agenda for an allocation vote along with the change of
applicant status request. If the CTC approves the transfer of applicant status, the allocation vote will be
in the name of the (new applicant agency). It is hereby mutually agreed by the signatures below that all
rights, duties, obligations, responsibilities, benefits, payments, maintenance, and title of APPLICANT
for this project be transferred from the (original applicant agency) to the (new applicant agency).
(If this is for a property acquisition then include this paragraph):
It is understood the California's Department of Transportation's approval of the transfer is conditioned
upon receipt of a signed Assignment and Assumption Agreement (AAA) by (original applicant agency)
and (new applicant agency). The AAA will include as attachments the previously executed EEM
Applicant-State Agreement and the original application. The AAA must be received by the EEM
Program no later than 10 working days after the close of escrow.
Please have documentation prepared with the (new applicant agency) as the sole responsible applicant.
__________________
(Signature)
(Name and title)
(Old applicant agency)
(Address)
(City), CA (ZIP)
Attachments
APPROVED/DISAPPROVED:

LPP 03-03

_________________
(Signature)
(Name and title)
(New applicant agency)
(Address)
(City), CA (ZIP)) Email address:

Page 20-67
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-F
Local Assistance Program Guidelines
Change of EEM Applicant Status Request Letter: Pre-Allocation Vote

________________________________________CALTRANS EEM PROGRAM MANAGER

LPP 03-03

Page 20-67
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-G
Local Assistance Program Guidelines
Change of EEM Applicant Status Request Letter: Post-Allocation Vote

CHANGE OF EEM APPLICANT STATUS REQUEST LETTER:

POST-ALLOCATION VOTE
(On original applicant's Letterhead)
(Name), Local Assistance Engineer
Department of Transportation, District ____
Office of Local Assistance
(Address) (City), CA (ZIP)

Date: _____________

Dear M________________:
We hereby request approval to transfer the applicant status from the (original applicant agency) to the
(new applicant agency)__ for the Environmental Enhancement and Mitigation (EEM) Program project,
the____(project name) _, project no. ____________. We also request to be placed on the next California
Transportation Commission agenda for their approval of this transfer
Attached is a completed and signed Resources Agency EEM Program Application cover page, along
with signed Assurances from the same application for the ____(new applicant agency)___. Also
attached is an adopting resolution by their governing board certifying willingness to carry out the
project, and their classification as non-profit organization under section 501(c)(3) of the IRS code (if
applicable).The___(newapplicantagency)___alsoagreestoexecuteanEEMProgramApplicantState
Agreement, along with providing tax identification information to the Caltrans Local Program
AccountingOfficeinordertodobusinesswithCaltrans.
(If this is for a property acquisition then include this paragraph):
ItisunderstoodtheCaliforniaDepartmentofTransportation'sapprovalofthetransferisconditioned
uponreceiptofasignedAssignmentandAssumptionAgreement(AAA)by____(originalapplicant
agency)___and ___(new applicant agency)__ The AAA will include as attachments the previously
executedEEMApplicantStateAgreementandtheoriginalapplication.TheAAAmustbereceivedby
theEEMProgramnolaterthan10workingdaysafterthecloseofescrow.
Pleasehaveallnecessarydocumentationpreparedwiththe(newapplicantagency)listedasthesole
responsibleapplicant.
____________________
(Signature)
(NameandTitle)

___________________
(Signature)
(NameandTitle)

(Original Applicant Agency)

(Address)
(City), CA (ZIP)

(New Applicant Agency)

(Address)
(City), CA (ZIP)

Email Address______

APPROVED/DISAPPROVED:

LPP 03-03

Page 20-69
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-G
Local Assistance Program Guidelines
Change of EEM Applicant Status Request Letter: Post-Allocation Vote

______________________________________ CALTRANS EEM PROGRAM MANAGER

Department of Transportation, 1120 N Street, MS 1, Sacramento, CA 95814

LPP 03-03

Page 20-69
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-H
Invoice Payment (Prepared By Applicant)

INVOICE PAYMENT REQUEST MEMO FOR PROJECTS INVOLVING

ACQUISITION OF REAL PROPERTY OR A CONSERVATION EASEMENT
(Prepared by applicant on applicant letterhead. Invoices with requests for direct deposit of EEM funds into an escrow
account MUST be submitted to the District Local Assistance Engineer 60 days before the close of escrow date.)
To:

District ___ Local Assistance Engineer (DLAE)

California Department of Transportation
Office of Local Assistance
(Address)_______________________________

From:

(Applicant Name and Address)

Date:

Subject: (EEM Project Name, County)

(Applicant: Select A or B, depending on action needed, and attached appropriate documents)

A. Please remit EEM funds into Escrow Account as previously directed in the Applicant-Status Agreement,
Exhibit D, Remarks and Covenants. Please find the following required documents attached.
1. One original unrecorded EEM Agreement Declaring Restrictive Covenants or EEM Restrictive.
Covenants Agreement for Conservation Easements, with notarized signatures. Attach the property legal
description and original application (if a scope change has been approved, the scope change approval letter
must be attached as well).
2.

One original and two copies of the signed Invoice. (On applicant letterhead)

3. Copy of escrow instructions.

4. Copy of current appraisal.
5. Copy of Preliminary Title Report, with legal description of property or easement.
6. Close of escrow date________________(must show date).
At close of escrow we will record the ADRC or RCACE and send you the original with other
documents shown below.
B. We have closed escrow. Attached are the documents to close out the project.
1. Certified copy of recorded Grant Deed or Deed of Conservation Easement (CE).
2. Copy of closing escrow statement.
3. One original signed Final Project Expenditure Report* (On applicant letterhead)

4. One original recorded ADRC

5. Final invoice
(Applicant Representative Signature)
(Name and Title)

LPP 03-03

Page 20-71
October 10, 2003

Local Assistance Program Guidelines

EXHIBIT 20-I
Invoice Payment (Prepared By District)

INVOICE PAYMENT REQUEST MEMO FOR PROJECTS INVOLVING

ACQUISITION OF REAL PROPERTY OR A CONSERVATION EASEMENT
(Prepared by District. Do not submit to Local Program Accounting until 60 days prior to close of escrow.)
To:

Local Program Accounting.

Accounting Office - MS 33
California Department of Transportation

Cc.

HQ EEM Program Coordinator

Date:

Local Assistance Division - MS 1

From:
District______, Local Assistance Engineer: ________
Subject: (EEM Project Name, County).
(District: Circle A or B, depending on action needed, and attach appropriate documents.)
A. Attached are the documents needed to release funds to escrow account. I understand that Caltrans cannot

remit the EEM funds until 30 days prior to escrow close date as shown below.
1.

One original signed Invoice* and two copies (on applicant letterhead).

2.

Copy of escrow instructions

3. Signed original and two copies of the Final Project Expenditure Report (prepared by applicant
on applicant letterhead)
4.

Copy of current appraisal

5.

Copy of Preliminary Title Report, with legal description of property or easement.

6. Close of escrow date__________________(must show date).

B. Escrow has closed. Attached are documents to close out the project.
1. Certified copy of recorded Grant Deed or Deed of Conservation Easement (CE).
2. Copy of closing escrow statement.
3.

One original signed Final Project Expenditure Report* (on Applicant letterhead).

(District: Send the original recorded EEM ADRC or EEM RCACE, with notarized signatures (with completed
Exhibits) to EEM Coordinator HQ.
___________________________________________________
Signature, Name and Title

LPP 03-03

Page 20-73
July 18, 2002

Local Assistance Program Guidelines

EXHIBIT 20-I
Invoice Payment (Prepared By District)

FINAL PROJECT EXPENDITURE REPORT

(AGENCY LETTER HEAD)
Date:
Name, District Director
Department of Transportation
Street or P.O. Box
City, CA Zip Code
Attention: Name, District Local Assistance Engineer
Final Project Expenditure Report
Description/Location of Work:
Project Completion Date:
Expenditure Authorization State Project Number:
State-Local Entity Agreement Number:
State Funds Allocated:
Expenditures Incurred:

Total $

A. Payment to Contractor (Attach final pay estimate)

B. Other Project Costs:
Preliminary Engineering
Construction Engineering
Any Additional Construction
Right-of-Way (Capital and Support)
C. Liquidation Damages
D. Outstanding Contractors Claims
E. Property Acquisition (for land acquisition projects only)
F. Others (specify)
Sources and Amounts of Additional Funds used:
State Funds Allocated but not used:
CERTIFICATION
I CERTIFY THAT: To the best of my knowledge and belief, the information in this report is a true and an
accurate record of project costs. The work was performed in accordance with the CTC approved scope
and State funding for the project.
______________________________________________________

Signature, Title and Unit of Local Agency Representative

PROJECT VERIFICATION: This verification of completion also constitutes approval to pay costs
shown in the Final Invoice included in the Report of Expenditures. I have reviewed the job site and found
the project completed in accordance with the scope and description of the project authorization document.
SIGNATURE:_________________________________________ Date:_______________________
District Local Assistance Engineer
SIGNATURE: __________________________________________ Date: ______________________
District Landscape Architect (if applicable)

LPP 03-03

Page 20-73
July 18, 2002

Local Assistance Program Guidelines

EXHIBIT 20-N
Scope Change Request

SCOPE CHANGE REQUEST

(USE Local Agency Letterhead)

Date:
TO District Local Assistance Engineer: ____________________
Attention: EEM Coordinator: ________________________________
Address of District Office: _________________________________

RE: Request to Amend Project Scope for project # EEM 20xx(XXX)

Dear ______:
The (Local Agency) requests that the Department of Transportation approve proposal to amend the project scope for the
above-captioned project to permit (explain request and attach a chart comparing the original project commitments
what the money was going to purchaseand what the new proposal is). The new project scope will still fulfill the
commitments, goals, intentions made in project scope as stated in the (Applicant-State Agreement #) and the
application for project EEM20xx (XXX). (Attach a map if the request includes change of location from original
location approved.)
Please refer to the attached supporting documentation for additional information and a comparison of the original
proposal to the new proposal. The proposed funding is
Original CTC Request

New CTC Request

Status of Project:
Environmental:
CEQA Categorical Exemption Section 15313, Class 13. To be filed upon approval of scope change.
NEPA NEPA is not required for this project.
Engineering:
The PS&E development is not applicable to this project.
Construction: Is not applicable to this project.
The project was adopted in the 20xx/20xx Environmental Enhancement and Mitigation program.
Please advise us as soon as Caltrans has made a determination regarding this scope change. You may direct any
questions to _(Name)_ at (phone) and (e-mail)_______.

Sincerely,

Name and Title

Signature

Attachments

LPP 03-03

Page 20-105
October 10, 2003