<p> State of California California State Transportation Agency DEPARTMENT OF TRANSPORTATION</p><p>M e m o r a n d u m</p><p>To: CHAIR AND COMMISSIONERS CTC Meeting: MONTH DD-DD, YYYY CALIFORNIA TRANSPORTATION COMMISSION Reference No.: 2.5e.(X) Action Item</p><p>From: NORMA ORTEGA Prepared by: District Director Name Chief Financial Officer District XX - Director</p><p>Subject: CAPITAL OUTLAY SUPPORT PROGRAMMING ACTION FOR PREVIOUSLY APPROVED PROJECTS (PPNO XX-XXXX ) RESOLUTION FA-16-XX</p><p>ISSUE</p><p>Should the California Transportation Commission (Commission) approve the California Department of Transportation’s (Department’s) request for an additional $X,XXX,XXX (Supplemental Funds Request Amount) in Capital Outlay Support (Support Cost) 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) for a revised amount of $X,XXX,XXX (Sum of Programmed Amount + G-12 Adjustment + Supplemental Funds Request)?</p><p>RECOMMENDATION</p><p>The Department recommends that the Commission approve an additional $X,XXX,XXX (Supplemental Funds Request Amount) in Support Cost to complete the PHASE (full name and acronym) (example: Plans, Specifications & Estimate (PS&E) phase) for the PROGRAM and PROGRAM CATEGORY project (example: SHOPP Pavement Rehabilitation project) (PPNO XXXX) on ROUTE, in COUNTY NAME for a revised amount of $ X,XXX,XXX (Sum of Programmed Amount + G-12 Adjustment + Supplemental Funds Request).</p><p>“Provide a safe, sustainable, integrated and efficient transportation system to enhance California’s economy and livability” PROJECT INFORMATION</p><p>Program Fiscal Year Dist-PPNO County Program Code EA Route Project Description Project ID Program Category PROGRAM XX-XXXX COUNTY XX-XX PROJECT DESCRIPTION XXXXXXXXXX XXXXX ROUTE XX.XX.XXX.XXX CATEGORY</p><p>REQUESTED PHASE FUNDING INFORMATION</p><p>PROGRAM % Over Original Department Total Supplemental Total Programmed G-12 Authorized Funds Authorized Revised Phase Amount Adjustment Amount Request Amount Amount PA&ED $x,xxx,xxx $x,xxx,xxx $x,xxx,xxx $x,xxx,xxx XX.X% $x,xxx,xxx PS&E $x,xxx,xxx $x,xxx,xxx $x,xxx,xxx $x,xxx,xxx XX.X% $x,xxx,xxx R/W Supp $x,xxx,xxx $x,xxx,xxx $x,xxx,xxx $x,xxx,xxx XX.X% $x,xxx,xxx</p><p>% Over Total Authorized Amount = _____Supplemental Funds Request ______Original Programmed Amount + G-12 Adjustment</p><p>Revised Amount = Original Programmed Amount + G-12 Adjustment + Supplemental Funds Request</p><p>BACKGROUND</p><p>Describe in detail the project location, scope of work, and other relevant information related to this supplemental request. DO NOT USE THE CTIPS PROJECT DESCRITION. Example: This project is located on Interstate 5, in the cities of Los Angeles, Glendale and Burbank, from Main Street to south of Verdugo Avenue. The work involves (1) upgrading curb ramps to meet current ADA design standards, (2) replacing bridge railing along the north side of the Pasadena Avenue Overcrossing with concrete barrier, (3) cold plane and overlay of the pavement on the Broadway and Pasadena Avenue off-ramps, and (4) replacing signal poles, pull boxes and loop detectors. </p><p>REASON FOR INCREASE</p><p>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</p><p>Explain in detail the reason(s) for the cost increase and the need for additional funds. (Include how much has been expended) The Department has expended $XX,XXX,XXX in Support Cost to prepare about XX percent of the PHASE phase, and the remaining tasks include completion of TASKS/MILESTONES (example: PS&E package, advertising and awarding the construction CHAIR AND COMMISSIONERS Reference No.: 2.5e.(X) CALIFORNIA TRANSPORTATION COMMISSION June 28-29, 2017 Page 3 of 3</p><p> contract). Start with a summary sentence listing the reason(s) for the cost increase: “The PHASE phase Support Cost estimate increase for this project is due to reason #1, reason #2, etc.</p><p>Reason #1 ( XX percent of the Support Cost Increase) This paragraphs explains in detail reason #1. Include efforts to mitigate, options that were considered and reason(s) it was not successful.</p><p>Reason #2 ( XX percent of the Support Cost Increase) This paragraphs explains in detail reason #2. Include efforts to mitigate, options that were considered and reason(s) it was not successful.</p><p>RISK ANALYSIS</p><p>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. </p><p>EXPECTED IMPACTS</p><p>This section summarizes identified potential risks during the Construction phase that may impact the Construction Capital and/or Construction Support. </p><p>If Applicable: “Construction Capital and Support Cost will be updated at the completion of contract documents for funds allocation and are expected to be higher due to this REASON(S).”</p><p>CONSEQUENCES</p><p>If this request for an additional $ X,XXX,XXX (Supplemental Funds Request Amount) in Support Cost to complete the PHASE phase is not approved, this PROGRAM PROGRAM CATEGORY project will be re-programmed and construction will be delayed</p><p>REQUIRED SIGNATURES</p><p>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.</p><p>Name (Print) Signature Title Date XXXXXXXXXXXXX Project Manager XX/XX/XX</p><p>XXXXXXXXXXXXX SFP or District Director XX/XX/XX</p><p>“Provide a safe, sustainable, integrated and efficient transportation system to enhance California’s economy and livability”</p>