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MTC Claim Application - Document I(b) TDA Eligibility Statement - Article 4.5 & 8 FY 2011 -12 Operator: City of Pleasanton Submittal Date: 5/3/2011 This form must be signed and dated 1. The Calculated Fares-Plus-Local-Match Recovery Ratio from Document "H- 4.5 &8" is: I 75.7% Select the eligibility statement below, pertaining to the service(s) for which operating funds are being requested, and enter the calculated ratio shown above in the appropriate cell highlighted yellow. Pursuant to PUC §99275.5 (for Article 4.5 claimants) or PUC §99405(c) (for Article 8 claimants), operator qualifies under MTC Resolution No. 1209, Revised as a "Special Transit Service" claimant, and is required to achieve a fares - plus - local- match recovery ratio (as defined in MTC Resolution No. 1209, Revised) of a minimum ten percent. 2. The Calculated FY 2011 -12 Budgeted Fares -Plus -Local -Match Recovery Ratio is: OR Pursuant to PUC §99275.5 (for Article 4.5 claimants) or PUC §99405(c) (for Article 8 claimants), operator DOES NOT qualify under MTC Resolution No. 1209, Revised as a "Special Transit Service" claimant, and is required to achieve a fares - plus -local -match recovery ratio (as defined in MTC Resolution No. 1209, Revised) of a minumum twenty percnt. 3. The Calculated FY 2011 -12 Budgeted Fares - Plus -Local -Match Recovery Ratio is: OR In accordance with PUC §99268.12, and MTC Resolution No. 1209, Revised, the operator is in a county with 500,000 population or less and serves an urbanized area, and in a prior fiscal year MTC made findings (or is requested to make findings for the budget fiscal year) related to the size and density of the urbanized area in which the services to the general public are provided, and the proportion of the operator's ridership which is transit dependent (including elderly, handicapped and low income patrons), and MTC has set (or is requested to set) the required fares - plus -local -match recovery ratio at less than twenty percent, but not less than fifteen percent. 4. The Calculated FY 2011 -12 Budgeted Fares - Plus -Local -Match Recovery Ratio is: I OR In accordance with PUC §99270.2 (applicable to newly- designated urbanized areas) the operator is requesting a recovery ratio exemption. 5. The Calculated FY 2011 - 12 Budgeted Fares - Plus - Local - Match Recovery Ratio is: I This claim covers which year of the exemption (check one): 6. ❑ 1st of 5 years ❑ 2nd of 5 y ears ❑ 3rd of 5 years ❑ 4th of 5 years ❑ 5th of 5 years Non - Compliance With Fare or Fares - Plus - Local- Support Recovery Ratio Requirement Operator has failed to comply with fare or fares - plus - local- support recovery ratio requirement during the following fiscal years: _ 7.Itype the fiscal years in here _ I (see instructions for a discussion of the "Penalty Due to Noncompliance" in accordance with PUC §99268.9) The undersigned attest that to the best of their knowledge, the budgeted recovery ratio(s) shown above is /are accurate and correct. Sign Date Susan Andrade -Wax, Director of Community Services Sign _ Date Emily Wagner, Finance Director MTC Programming and Allocations Section February 2005 Page 1of 1