HomeMy WebLinkAbout25-218 Office of Traffic Safety Grant Agreement for Pedestrian and Bicycle Safety
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State of California – Office of Traffic Safety
GRANT AGREEMENT
GRANT NUMBER
PS26029
1. GRANT TITLE
Pedestrian and Bicycle Safety Program
2. NAME OF AGENCY 3. Grant Period
Cupertino From:
To:
10/01/2025
09/30/2026 4. AGENCY UNIT TO ADMINISTER GRANT
Cupertino Public Works
5. GRANT DESCRIPTION
Best practice strategies will be conducted to reduce the number of persons killed and injured in crashes
involving pedestrians and bicyclists. The funded strategies may include classroom education, bicycle rodeos,
community events, presentations, and workshops. These countermeasures should be conducted in
communities with high numbers of pedestrian and/or bicycle related crashes including underserved
communities, older adults, and school-aged children. Coordinated efforts such as Safe Routes to School
initiatives, Safe System Approach, and working with community based organizations are highly encouraged to
prevent fatalities and injuries of vulnerable non-motorized road users.
6. Federal Funds Allocated Under This Agreement Shall Not Exceed:
Allocation is contingent upon availability of federal funds.
$184,000.00
7. TERMS AND CONDITIONS: The parties agree to comply with the terms and conditions of the following which are by this
reference made a part of the Agreement:
• Schedule A – Problem Statement, Goals and Objectives and Method of Procedure
• Schedule B – Detailed Budget Estimate and Sub-Budget Estimate (if applicable)
• Schedule B-1 – Budget Narrative and Sub-Budget Narrative (if applicable)
• Exhibit A – Certifications and Assurances
• Exhibit B* – OTS Grant Program Manual
• Exhibit C – Grant Electronic Management System (GEMS) Access
*Items shown with an asterisk (*), are hereby incorporated by reference and made a part of this agreement as if attached
hereto. These documents can be viewed at the OTS home web page under Grants: www.ots.ca.gov.
We, the officials named below, hereby swear under penalty of perjury under the laws of the State of California that we are
duly authorized to legally bind the Grant recipient to the above described Grant terms and conditions.
IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.
8. Approval Signatures
A. GRANT DIRECTOR B. AUTHORIZING OFFICIAL
NAME:
TITLE:
EMAIL:
PHONE:
ADDRESS:
Birgit Werner
Safe Routes to School Community Coordinator
bwerner@cupertino.gov
(408) 777-3117
Cupertino City Hall
10300 Torre Avenue
Cupertino, CA 95014
ADDRESS: Chad Mosley
Director of Public Works
chadm@cupertino.gov
(408) 777-7604
Cupertino City Hall
10300 Torre Ave
Cupertino, CA 95014
{{_es_signer2_signature}} {{_es_signer2_date}} {{_es_signer4_signature}} {{_es_signer4_date}}
(Signature) (Date) (Signature) (Date)
C. FISCAL OFFICIAL
D. AUTHORIZING OFFICIAL OF OFFICE OF TRAFFIC SAFETY
ADDRESS: Kristina Alfaro
Director of Administrative Services
kristinaa@cupertino.gov
(408) 777-3220
Cupertino City Hall
10300 Torre Avenue
Cupertino, CA 95014
ADDRESS: Stephanie Dougherty
Director
stephanie.dougherty@ots.ca.gov
(916) 509-3030
2208 Kausen Drive, Suite 300
Elk Grove, CA 95758
{{_es_signer3_signature}} {{_es_signer3_date}} {{_es_signer6_signature}} {{_es_signer6_date}}
(Signature) (Date) (Signature) (Date)
Birgit Werner (Nov 25, 2025 11:57:12 EST)Nov 25, 2025
Kristina Alfaro (Nov 25, 2025 09:12:43 PST)Nov 25, 2025
Nov 25, 2025
Stephanie Dougherty (Nov 25, 2025 13:42:24 PST)
Stephanie Dougherty Nov 25, 2025
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E. ACCOUNTING OFFICER OF OFFICE OF TRAFFIC SAFETY 9. SAM INFORMATION
NAME: Carolyn Vu
SAM #:
REGISTERED
ADDRESS:
CITY:
ZIP+4:
DQ4CLU1A74G9
10300 Torre
Avenue
Cupertino
95014-3202
ADDRESS: 2208 Kausen Drive, Suite 300
Elk Grove, CA 95758
10. PROJECTED EXPENDITURES
FUND CFDA ITEM/APPROPRIATION F.Y. CHAPTER STATUTE PROJECTED
EXPENDITURES
402PS-26 20.600 0521-0890-101 2025 04/25 BA/25 $184,000.00
AGREEMENT
TOTAL $184,000.00
AMOUNT ENCUMBERED BY THIS DOCUMENT
I CERTIFY upon my own personal knowledge that the budgeted
funds for the current budget year are available for the period and
purpose of the expenditure stated above.
$184,000.00
PRIOR AMOUNT ENCUMBERED FOR THIS
AGREEMENT
$ 0.00
OTS ACCOUNTING OFFICER’S SIGNATURE DATE SIGNED TOTAL AMOUNT ENCUMBERED TO DATE
{{_es_signer5_signature}} {{_es_signer5_date}} $184,000.00
Carolyn Vu (Nov 25, 2025 09:56:24 PST)Nov 25, 2025
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Schedule A
GRANT NUMBER
PS26029
1. PROBLEM STATEMENT
Describe the city, county, or jurisdiction this grant will impact.
Cupertino, located in Santa Clara County, is characterized by a mixed-use land pattern, encompassing
residential neighborhoods, commercial districts, and office space. It is home to multiple educational
institutions, including 13 public schools (seven elementary, three middle, and three high schools), one
community college, and several private schools. The City’s layout reflects a balance between urban and
suburban elements.
Describe the problem(s) to be addressed, supported by current and relevant crash data. (most
recent calendar year data/stats).
Cupertino faces several distinct traffic safety challenges. The first is its location near the heart of Silicon
Valley, where two major highways (Interstate 280 and State Route 85) intersect. Cupertino is also adjacent
to two County expressways (Foothill and Lawrence) and home to many multi-lane arterial roads. The
bridges and interchanges connecting all these highways are fast-paced, high-traffic areas with multiple travel
lanes and extremely busy on- and off-ramps, which create physical and psychological barriers to walking
and biking.
The second challenge is Cupertino’s own heritage as orchard land in the Valley of Heart’s Delight. Cupertino
was not incorporated as a city until 1955, during the height of America’s love affair with the automobile. As a
result, most of the City’s neighborhoods are sprawling housing tracts joined by multi-lane arterial roads.
There is no downtown, rather multiple shopping districts which were all originally designed with cars in mind.
This geographical spread of useful destinations presents a time and distance challenge for walking and
biking.
Cupertino’s third challenge is its cultural diversity. While a point of pride, it also means that driving styles
from all over the world meet and literally collide on the City’s streets.
In front of schools at pick-up and drop-off time, hundreds of families are all trying to get their children to or
from school at the same time. Parents driving through this daily cite traffic safety as their number one
concern about letting their children walk or bike to school.
In 2014, a 14-year-old boy was struck and killed biking to a Cupertino high school. This tragic incident
galvanized the residents, schools, school districts, and City staff to work together to address safety for active
road users. As a result, in 2016, the comprehensive Bicycle Transportation Plan was adopted, identifying a
network of low-stress bicycle facilities to create a safer City to bike through. The City established its Safe
Routes to School Program, coordinating a walk audit at every public school in the City. In 2018, the City
adopted its Pedestrian Transportation Plan, which identified areas within the City that needed walkability
improvements. As a result of these efforts, hundreds of road safety improvements have been identified,
including protected bike lanes, green bike lanes, bulb-outs at corners to shorten crossing distances for
pedestrians, new and enhanced crosswalks, more comprehensive signage, wider sidewalks, and new trails.
The City has worked diligently to install these improvements and continued to develop new plans to even
greater road safety, including recently adopting a Local Roadway Safety Plan (in 2023) and a Vision Zero
Policy (in 2024). A project to develop a comprehensive Active Transportation Plan was kicked off in January
2025.
With all this energy and commitment, the City has improved its roadways for active users in the last ten
years. However, data shows that crashes are still occuring. According to the City's crash data, bike and
pedestrian involvement is on the rise. From 2022 to 2024, there was an increase each year in the number of
fatal and/or injury crashes involving bicyclists and pedestrians in Cupertino. Pedestrians who were injured in
traffic-related crashes increased from 10 in 2022, to 14 in 2023, to 20 in 2024. There were two pedestrian
fatalities in crashes in 2024. Bicyclists who were injured in traffic-related crashes increased from 16 in 2022,
to 21 in 2023, to 26 in 2024. There was one cyclist fatality in 2023.
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Define the target population the grant intends to serve and how they are affected by the problem(s).
The target population is children who go to Cupertino schools, with a special emphasis on elementary and
middle school students. This demographic is almost entirely under the age of 15 and is particularly
vulnerable to traffic-related hazards due to their limited experience and understanding of road safety. As
they navigate their way to and from school and engage in recreational activities throughout the City, these
young residents are frequently exposed to traffic environments that require advanced awareness and safety
skills which they typically do not yet possess.
Although school is the natural destination for young residents to start walking and biking, it unfortunately can
be one of the most dangerous places. Traffic congestion around schools is an inescapable hazard. The
sheer number of drivers on the roads in front of schools who are in a rush to get their child to class on time
creates a dangerous situation for all road users, but especially for young bicyclists and pedestrians. The new
requirements for fences around school campuses further exacerbates this by funneling all traffic to a limited
number of entrances, which are typically near motor vehicle pathways. And with budget cuts, schools cannot
support staff supervision on campus for more than 10-15 minutes in the morning, so students may not arrive
early to avoid the rush.
The way to school is also an issue. Developing cognitive abilities in this age group mean students are just
learning the judgment and decision-making skills necessary for even simple traffic scenarios. Unfortunately,
the presence of major highways and busy intersections in Cupertino make for anything but simple traffic
scenarios. Drivers also have difficulties avoiding conflicts given that elementary school children are less
predictable, smaller, and therefore harder to see, especially around and above today’s larger motor vehicles.
Additionally, as Cupertino continues to develop and grow, increasing traffic volumes heighten the risks. The
City's urban landscape, while offering many amenities, unfortunately presents numerous conflicts between
vehicles and other roadway users which increases the potential for crashes.
2. PERFORMANCE MEASURES
A. Goals:
1. Reduce the number of persons killed in traffic crashes.
2. Reduce the number of persons injured in traffic crashes.
3. Reduce the number of pedestrians killed in traffic crashes.
4. Reduce the number of pedestrians injured in traffic crashes.
5. Reduce the number of pedestrians killed under age 15 in traffic crashes.
6. Reduce the number of pedestrians injured under age 15 in traffic crashes.
7. Reduce the number of pedestrians killed over age 65 in traffic crashes.
8. Reduce the number of pedestrians injured over age 65 in traffic crashes.
9. Reduce the number of bicyclists killed in traffic crashes.
10. Reduce the number of bicyclists injured in traffic crashes.
11. Reduce the number of bicyclists under age 15 killed in traffic crashes.
12. Reduce the number of bicyclists under age 15 injured in traffic crashes.
13. Increase bicycle helmet usage.
B. Objectives: Target Number
1. Issue a news release announcing the kick-off of the grant by December 31st. The
kick-off news releases and media advisories, alerts, and materials must be
emailed to the OTS Public Information Officer at pio@ots.ca.gov, and copied to
your OTS Coordinator, for approval 7 days prior to the issuance date of the
release.
1
2. Participate in the following campaigns: National Walk to School Day, National
Bicycle Safety Month, California's Pedestrian Safety Month and National
Pedestrian Safety Month.
4
3. Conduct pedestrian and/or bicycle safety presentations. 63
4. Distribute pedestrian/bicycle safety items to increase safety and visibility at no cost
to youth or community members in need, who received traffic safety education
4
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during bicycle rodeos, presentations, workshops, trainings, and community events.
Report quarterly the dates and locations where pedestrian/bicycle safety items
were distributed.
5. Conduct bicycle helmet usage surveys pre and post-grant activities. Bicycle
helmet usage surveys should occur at the start and end of the grant. A pre-survey
will be required to determine the base year helmet use rate and a post-survey will
be required to determine the operational rate. Pre and post surveys should be
conducted at the same location. Upload completed survey to GEMS.
2
6. Conduct bicycle rodeos. 31
7. Conduct community bicycle rides providing bicycle safety education to promote
safe bicycling in the community with an effort to reach bicyclists.
6
8. Participate in quarterly meetings with countywide pedestrian and/or bicycle safety
stakeholders to collaborate on events, share best practices, and leverage
resources.
4
9. Conduct pedestrian Walking Field Trips or on-foot safety training with an effort to
reach youth.
32
10. Execute subcontracts referenced in the budget. Prior to finalizing the subcontract,
grantee should work with the OTS to ensure all costs in the sub contract are
allowable. Upon execution of subcontract, upload a copy of the subcontract and
request a revision to the grant budget to add new budget line items for associated
costs under contractual services. If not yet executed, provide ETA.
1
11. Provide Middle School Traffic Safety Bicycle Education program to all three middle
schools located in Cupertino. Program will include an off-site bike ride in the
community.
3
12. Provide Elementary School Pedestrian Education to all 7 elementary schools
located in Cupertino, targeting kindergarteners and their families.
7
3. METHOD OF PROCEDURE
A. Phase 1 – Program Preparation (1st Quarter of Grant Year)
• Develop operational plans to implement the “best practice” strategies outlined in the objectives
section.
• Conduct all training needed to implement the program, in the first quarter.
• Purchase all grant related supplies and materials to implement the program, in the first quarter.
• Items with a unit cost of $5,000 or more (including tax and shipping) must comply with Buy
America.
Media Requirements
• Issue a news release approved by the OTS PIO announcing the kick-off of the grant by
December 31 and after the grant is signed and executed, but no sooner than October 1, the start
of the grant year. The kick-off release must be approved by the OTS PIO. If you are unable to
meet the December 31 deadline to issue a kick-off press release, communicate reasons to your
OTS grant coordinator and OTS PIO.
B. Phase 2 – Program Operations (Throughout Grant Year)
Media Requirements
The following requirements are for all grant-related activities:
• Send all media advisories, alerts, videos, graphics, artwork, posters, radio/PSA/video scripts,
storyboards, digital and/or print educational materials for grant-related activities to the OTS PIO
at pio@ots.ca.gov for approval and copy your OTS grant coordinator. Optimum lead time would
be 7 days before the scheduled release but at least 3 business days prior to the scheduled
release date for review and approval is appreciated.
• Send all PowerPoint presentations, online presentations and trainings for grant-related activities
to the OTS PIO at pio@ots.ca.gov for approval and copy your OTS grant coordinator. Certified
training courses are EXEMPT from the approval process.
• The OTS PIO is responsible for the approval of the design and content of materials. The agency
understands OTS PIO approval is not authorizing approval of budget expenditure or cost. Any
cost approvals must come from the OTS grant coordinator.
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• Pre-approval is not required when using any OTS-supplied template for media advisories, news
releases, social media graphics, videos or posts, or any other OTS-supplied educational material.
However, copy the OTS PIO at pio@ots.ca.gov and your OTS grant coordinator when any
material is distributed to the media and public, such as a news release, educational material, or
link to social media post.
• If an OTS-supplied template, educational material, social media graphic, post or video is
substantially changed, the changes shall be sent to the OTS PIO at pio@ots.ca.gov for approval
and copy your OTS grant coordinator.
• News releases, social media posts and alerts on platforms such as NextDoor and Nixle reporting
immediate and time-sensitive grant activities (e.g. enforcement operations, day of event
highlights or announcements, event invites) are EXEMPT from the OTS PIO approval process.
The OTS PIO and your OTS grant coordinator should still be notified when the grant-related
activity is happening (e.g. car seat checks, bicycle rodeos, community presentations, DUI
checkpoints, etc.).
• Enforcement activities such as warrant and probation sweeps, court stings, etc. that are
embargoed or could impact operations by publicizing in advance are EXEMPT from the PIO
approval process. However, announcements and results of activities should still be copied to the
OTS PIO at pio@ots.ca.gov and your OTS grant coordinator with the embargoed date and time
or with “INTERNAL ONLY: DO NOT RELEASE” message in subject line of email.
• Any earned or paid media campaigns for TV, radio, digital or social media that are part of a
specific grant objective, using OTS grant funds, or designed and developed using contractual
services by a subgrantee, requires prior approval.
• Social media posts highlighting state or national traffic safety campaigns (Distracted Driving
Month, Motorcycle Safety Awareness Month, etc.), enforcement operations (DUI checkpoints,
etc.), or any other grant-related activity such as Bicycle rodeos, presentations, or events, are
highly encouraged but do not require prior approval.
• Submit a draft or rough-cut of all digital, printed, recorded or video material (brochures, posters,
scripts, artwork, trailer graphics, digital graphics, social posts connected to an earned or paid
media campaign grant objective) to the OTS PIO at pio@ots.ca.gov and copy your OTS grant
coordinator for approval prior to the production or duplication.
• Use the following standard language in all press, media, and printed materials, space permitting:
Funding for this program was provided by a grant from the California Office of Traffic Safety,
through the National Highway Traffic Safety Administration.
• Space permitting, include the OTS logo on all grant-funded print materials, graphics and paid or
earned social media campaign grant objective; consult the OTS PIO and copy your OTS grant
coordinator for specifics, format-appropriate logos, or if space does not permit the use of the OTS
logo.
• Email the OTS PIO at pio@ots.ca.gov and copy your OTS grant coordinator at least 21 days in
advance, or when first confirmed, a short description of any significant grant-related traffic safety
event or program, particularly events that are highly publicized beforehand with anticipated media
coverage so OTS has sufficient notice to arrange for attendance and/or participation in the event.
If unable to attend, email the OTS PIO and coordinator brief highlights and/or results, including
any media coverage (broadcast, digital, print) of event within 7 days following significant grant-
related event or program. Media and program highlights are to be reflected in QPRs.
• Any news releases, work plans, scripts, storyboards, artwork, graphics, videos or any educational
or informational materials that received OTS PIO approval in a prior grant year needs to be
resubmitted for approval in the current grant year.
• For additional guidance, refer to the OTS Grants Materials Approval Process
Guidelines and OTS Grants Media Approval Process FAQs on the OTS website.
• Contact the OTS PIO or your OTS grant coordinator for consultation when changes from any of
the above requirements might be warranted.
C. Phase 3 – Data Collection & Reporting (Throughout Grant Year)
1. Prepare and submit grant claim invoices (due January 30, April 30, July 30, and October 30)
2. Prepare and submit Quarterly Performance Reports (QPR) (due January 30, April 30, July 30, and
October 30)
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• Collect and report quarterly, appropriate data that supports the progress of goals and objectives.
• Provide a brief list of activity conducted, procurement of grant-funded items, and significant
media activities. Include status of grant-funded personnel, status of contracts, challenges, or
special accomplishments.
• Provide a brief summary of quarterly accomplishments and explanations for objectives not
completed or plans for upcoming activities.
• Collect, analyze and report statistical data relating to the grant goals and objectives.
4. METHOD OF EVALUATION
Using the data compiled during the grant, the Grant Director will complete the “Final Evaluation” section in
the fourth/final Quarterly Performance Report (QPR). The Final Evaluation should provide a brief summary
of the grant’s accomplishments, challenges and significant activities. This narrative should also include
whether goals and objectives were met, exceeded, or an explanation of why objectives were not completed.
5. ADMINISTRATIVE SUPPORT
This program has full administrative support, and every effort will be made to continue the grant activities
after grant conclusion.
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Schedule B
GRANT NUMBER
PS26029
FUND NUMBER CATALOG
NUMBER (CFDA)
FUND DESCRIPTION TOTAL AMOUNT
402PS-26 20.600 State and Community Highway
Safety
$184,000.00
COST CATEGORY FUND
NUMBER
UNIT COST OR
RATE
UNITS TOTAL COST TO
GRANT
A. PERSONNEL COSTS
Straight Time
$0.00
Overtime
$0.00
Category Sub-Total $0.00
B. TRAVEL EXPENSES
In State Travel 402PS-26 $1,000.00 1 $1,000.00
$0.00
Category Sub-Total $1,000.00
C. CONTRACTUAL SERVICES
Pedestrian and Bicycle Traffic Safety
Education Program ($176,633)
402PS-26 $0.00 1 $0.00
> Kindergarten Pedestrian Education 402PS-26 $2,171.00 7 $15,197.00
> Elementary Grade School Pedestrian
Education - Classroom Presentation
402PS-26 $944.00 25 $23,600.00
> Elementary Grade School Pedestrian
Education – Walking Field Trip
402PS-26 $1,617.00 25 $40,425.00
> Elementary Grade School Bike
Education – Classroom Presentation
402PS-26 $944.00 25 $23,600.00
> Elementary Grade School Bike
Education – Bike Rodeo
402PS-26 $2,009.00 25 $50,225.00
> Middle School Bike Education -
Workshops
402PS-26 $3,931.00 6 $23,586.00
Category Sub-Total $176,633.00
D. EQUIPMENT
$0.00
Category Sub-Total $0.00
E. OTHER DIRECT COSTS
Pedestrian/Bicycle Safety Items 402PS-26 $6,367.00 1 $6,367.00
Category Sub-Total $6,367.00
F. INDIRECT COSTS
$0.00
Category Sub-Total $0.00
GRANT TOTAL $184,000.00
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Schedule B-1
GRANT NUMBER
PS26029
BUDGET NARRATIVE
PERSONNEL COSTS
-
TRAVEL EXPENSES
In State Travel - Costs are included for appropriate staff to attend conferences and training events
supporting the grant goals and objectives and/or traffic safety. Local mileage for grant activities and
meetings is included. All conferences, seminars or training not specifically identified in the Budget Narrative
must be approved by OTS. All travel claimed must be at the agency approved rate. Per Diem may not be
claimed for meals provided at conferences when registration fees are paid with OTS grant funds.
CONTRACTUAL SERVICES
Pedestrian and Bicycle Traffic Safety Education Program ($176,633) - Grantee will seek a contractor to
assist with fulfilling the goals and objectives of this grant by conducting pedestrian and/or bicycle traffic
safety education activities that may include presentations, on-foot safety trainings, bike rodeos, community
bike rides, helmet fittings and distributions, bike repair workshops, and outreach at community events. Other
activities may be conducted if approved by OTS.
Prior to finalizing the subcontract, grantee will work with the OTS to ensure all costs are allowable. Upon
execution of subcontract, grantee will provide a copy to the OTS and will request a grant budget revision to
include the detailed costs of the subcontract in the grant budget as a prerequisite for claiming these costs.
> Kindergarten Pedestrian Education - Provide fundamental street crossing skills so students can safely
walk or bike to school. Includes kindergarten-appropriate content includes the basics of “Stop, Look, and
Listen.” Education program includes presentation, walking practice session either on the City Streets or on
the school blacktop, and parent question-and-answer session.
> Elementary Grade School Pedestrian Education - Classroom Presentation - Provide in-person, grade-
appropriate content including how to cross a street safely and common dangers associated with walking.
Sessions are structured as a classroom presentation.
> Elementary Grade School Pedestrian Education – Walking Field Trip - Grade-appropriate content
includes how to cross a street safely and common dangers associated with walking. Sessions are structured
as a walking field trip in the neighborhood.
> Elementary Grade School Bike Education – Classroom Presentation - Provide in-person, grade-
appropriate content includes helmets and other safety gear, hand signals, where to ride in the street, how to
navigate intersections, the shoulder check, common dangers associated with biking, and the benefits of
biking. Sessions are structured as a classroom presentation.
> Elementary Grade School Bike Education – Bike Rodeo - Grade-appropriate content includes helmets
and other safety gear, hand signals, where to ride in the street, how to navigate intersections, the shoulder
check, common dangers associated with biking, and the benefits of biking. Sessions are structured as a
safety skills education course on the school blacktop.
> Middle School Bike Education - Workshops - Reinforce bicycle traffic safety concepts, with an emphasis
on defensive biking. Middle-school-appropriate content includes helmets and other safety items, basic bike
maintenance, rules of the road, navigating intersections, the shoulder check and common dangers
associated with biking. Consultant to bring bicycles and helmets for any students who need them (up to 15).
Workshop includes classroom presentation, bicycle safety skills course on the school blacktop, and biking
field trip in the neighborhood.
EQUIPMENT
-
OTHER DIRECT COSTS
Pedestrian/Bicycle Safety Items - Cost may include bicycle headlights/taillights, reflectors, and reflective
items such as arm and leg bands, tape, or zipper pulls; to be distributed at no cost during bicycle rodeos,
on-foot pedestrian trainings, presentations, workshops, community events and other pedestrian or bicycle
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traffic safety related events to increase safety and visibility. Additional items may be purchased if approved
by OTS.
INDIRECT COSTS
-
STATEMENTS/DISCLAIMERS
There will be no program income generated from this grant.
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Exhibit A
GRANT NUMBER
PS26029
Appendix A to Part 1300—Certifications and Assurances for Highway Safety Grants
(23 U.S.C. Chapter 4 or Section 1906, Public Law 109-59, as amended by Section 25024, Public Law 117-
58)
The officials named on the grant agreement, certify by way of signature on the grant agreement signature page,
that the Grantee Agency complies with all applicable Federal statutes, regulations, and directives and State
rules, guidelines, policies, and laws in effect with respect to the periods for which it receives grant funding.
Applicable provisions include, but are not limited to, the following:
GENERAL REQUIREMENTS
The State will comply with applicable statutes and regulations, including but not limited to:
• 23 U.S.C. Chapter 4—Highway Safety Act of 1966, as amended;
• Sec. 1906, Public Law 109-59, as amended by Sec. 25024, Public Law 117-58;
• 23 CFR part 1300—Uniform Procedures for State Highway Safety Grant Programs;
• 2 CFR part 200—Uniform Administrative Requirements, Cost Principles, and Audit Requirements
for Federal Awards;
• 2 CFR part 1201—Department of Transportation, Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for Federal Awards.
NONDISCRIMINATION
(applies to subrecipients as well as States)
The State highway safety agency [and its subrecipients] will comply with all Federal statutes and implementing
regulations relating to nondiscrimination (“Federal Nondiscrimination Authorities”). These include but are not
limited to:
• Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 78 stat. 252), (prohibits discrimination
on the basis of race, color, national origin);
• 49 CFR part 21 (entitled Non-discrimination in Federally-Assisted Programs of the Department of
Transportation—Effectuation of Title VI of the Civil Rights Act of 1964);
• 28 CFR 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of the Civil Rights Act
of 1964);
• The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. 4601),
(prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal
or Federal-aid programs and projects);
• Federal-Aid Highway Act of 1973, (23 U.S.C. 324 et seq.), and Title IX of the Education Amendments
of 1972, as amended (20 U.S.C. 1681-1683 and 1685-1686) (prohibit discrimination on the basis of
sex);
• Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. 794 et seq.), as amended, (prohibits
discrimination on the basis of disability) and 49 CFR part 27;
• The Age Discrimination Act of 1975, as amended, (42 U.S.C. 6101 et seq.), (prohibits discrimination
on the basis of age);
• The Civil Rights Restoration Act of 1987, (Pub. L. 100-209), (broadens scope, coverage, and
applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section
504 of the Rehabilitation Act of 1973, by expanding the definition of the terms “programs or activities” to
include all of the programs or activities of the
Federal aid recipients, subrecipients and contractors, whether such programs or activities are Federally-
funded or not);
• Titles II and III of the Americans with Disabilities Act (42 U.S.C. 12131-12189) (prohibits
discrimination on the basis of disability in the operation of public entities, public and private
transportation systems, places of public accommodation, and certain testing) and 49 CFR parts 37
and 38
11/24/2025 9:28:29 AM Page 13 of 21
The preceding statutory and regulatory cites hereinafter are referred to as the “Acts” and “Regulations,”
respectively.
GENERAL ASSURANCES
In accordance with the Acts, the Regulations, and other pertinent directives, circulars, policy, memoranda,
and/or guidance, the Recipient hereby gives assurance that it will promptly take any measures necessary to
ensure that:
“No person in the United States shall, on the grounds of race, color, or national origin, be excluded from
participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity, for which the Recipient receives Federal financial assistance from
DOT, including NHTSA.”
The Civil Rights Restoration Act of 1987 clarified the original intent of Congress, with respect to Title VI of the
Civil Rights Act of 1964 and other non-discrimination requirements (the Age Discrimination Act of 1975, and
Section 504 of the Rehabilitation Act of 1973), by restoring the broad, institutional-wide scope and coverage of
these nondiscrimination statutes and requirements to include all programs and activities of the Recipient, so
long as any portion of the program is Federally assisted.
SPECIFIC ASSURANCES
More specifically, and without limiting the above general Assurance, the Recipient agrees with and gives the
following Assurances with respect to its Federally assisted Highway Safety Grant Program:
1. The Recipient agrees that each “activity,” “facility,” or “program,” as defined in
49 CFR part 21 will be (with regard to an “activity”) facilitated, or will be (with regard to a “facility”)
operated, or will be (with regard to a “program”) conducted in compliance with all requirements
imposed by, or pursuant to the Acts and the Regulations.
2. The Recipient will insert the following notification in all solicitations for bids, Requests For
Proposals for work, or material subject to the Acts and the Regulations made in connection with all
Highway Safety Grant Programs and, in adapted form, in all proposals for negotiated agreements
regardless of funding source:
“The [name of Recipient], in accordance with the provisions of Title VI of the Civil Rights Act of
1964 (78 Stat. 252, 42 U.S.C 2000d to 2000d-4) and the Regulations, hereby notifies all bidders
that it will affirmatively ensure that in any contract entered into pursuant to this advertisement,
disadvantaged business enterprises will be afforded full and fair opportunity to submit bids in
response to this invitation and will not be discriminated against on the grounds of race, color, or
national origin in consideration for an award.”
3. The Recipient will insert the clauses of appendix A and E of this Assurance (also referred to as DOT
order 1050.2A) [1] in every contract or agreement subject to the Acts and the Regulations.
4. The Recipient will insert the clauses of appendix B of DOT Order 1050.2A, as a covenant running
with the land, in any deed from the United States effecting or recording a transfer of real property,
structures, use, or improvements thereon or interest therein to a Recipient.
5. That where the Recipient receives Federal financial assistance to construct a facility, or part of a
facility, the Assurance will extend to the entire facility and facilities operated in connection therewith.
6. That where the Recipient receives Federal financial assistance in the form of, or for the acquisition
of, real property or an interest in real property, the Assurance will extend to rights to space on,
over, or under such property.
7. That the Recipient will include the clauses set forth in appendix C and appendix D of this DOT Order
1050.2A, as a covenant running with the land, in any future deeds, leases, licenses, permits, or
similar instruments entered into by the Recipient with other parties:
a. for the subsequent transfer of real property acquired or improved under the applicable
activity, project, or program; and
b. for the construction or use of, or access to, space on, over, or under real property acquired
or improved under the applicable activity, project, or program.
8. That this Assurance obligates the Recipient for the period during which Federal financial assistance
is extended to the program, except where the Federal financial assistance is to provide, or is in the
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form of, personal property, or real property, or interest therein, or structures or improvements
thereon, in which case the Assurance obligates the Recipient, or any transferee for the longer of the
following periods:
a. the period during which the property is used for a purpose for which the Federal financial
assistance is extended, or for another purpose involving the provision of similar services or
benefits; or
b. the period during which the Recipient retains ownership or possession of the property.
9. The Recipient will provide for such methods of administration for the program as are found by the
Secretary of Transportation or the official to whom he/she delegates specific authority to give
reasonable guarantee that it, other recipients, sub-recipients, sub- grantees, contractors,
subcontractors, consultants, transferees, successors in interest, and other participants of Federal
financial assistance under such program will comply with all requirements imposed or pursuant to
the Acts, the Regulations, and this Assurance.
10. The Recipient agrees that the United States has a right to seek judicial enforcement with regard to
any matter arising under the Acts, the Regulations, and this Assurance.
By signing this ASSURANCE, the State highway safety agency also agrees to comply (and require any sub-
recipients, sub-grantees, contractors, successors, transferees, and/or assignees to comply) with all applicable
provisions governing NHTSA's access to records, accounts, documents, information, facilities, and staff. You
also recognize that you must comply with any program or compliance reviews, and/or complaint investigations
conducted by NHTSA. You must keep records, reports, and submit the material for review upon request to
NHTSA, or its designee in a timely, complete, and accurate way. Additionally, you must comply with all other
reporting, data collection, and evaluation requirements, as prescribed by law or detailed in program guidance.
The State highway safety agency gives this ASSURANCE in consideration of and for obtaining any Federal
grants, loans, contracts, agreements, property, and/or discounts, or other Federal-aid and Federal financial
assistance extended after the date hereof to the recipients by the U.S. Department of Transportation under the
Highway Safety Grant Program. This ASSURANCE is binding on the State highway safety agency, other
recipients, sub-recipients, sub-grantees, contractors, subcontractors and their subcontractors', transferees,
successors in interest, and any other participants in the Highway Safety Grant Program. The person(s) signing
below is/are authorized to sign this ASSURANCE on behalf of the Recipient.
THE DRUG-FREE WORKPLACE ACT OF 1988 (41 U.S.C. 8103)
The Subgrantee will provide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession or use of a controlled substance is prohibited in the grantee's workplace, and
specifying the actions that will be taken against employees for violation of such prohibition;
b. Establishing a drug-free awareness program to inform employees about:
1. The dangers of drug abuse in the workplace;
2. The grantee's policy of maintaining a drug-free workplace;
3. Any available drug counseling, rehabilitation, and employee assistance programs;
4. The penalties that may be imposed upon employees for drug violations occurring in the
workplace;
5. Making it a requirement that each employee engaged in the performance of the grant be
given a copy of the statement required by paragraph (a);
c. Notifying the employee in the statement required by paragraph (a) that, as a condition of
employment under the grant, the employee will—
1. Abide by the terms of the statement;
2. Notify the employer of any criminal drug statute conviction for a violation occurring in
the workplace no later than five days after such conviction;
d. Notifying the agency within ten days after receiving notice under subparagraph (c)(2) from an
employee or otherwise receiving actual notice of such conviction;
e. Taking one of the following actions, within 30 days of receiving notice under
subparagraph (c)(2), with respect to any employee who is so convicted—
1. Taking appropriate personnel action against such an employee, up to and including
termination;
2. Requiring such employee to participate satisfactorily in a drug abuse assistance or
11/24/2025 9:28:29 AM Page 15 of 21
rehabilitation program approved for such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency;
f. Making a good faith effort to continue to maintain a drug-free workplace through
implementation of all of the paragraphs above.
POLITICAL ACTIVITY (HATCH ACT)
(applies to subrecipients as well as States)
The State will comply with provisions of the Hatch Act (5 U.S.C. 1501-1508), which limits the political activities
of employees whose principal employment activities are funded in whole or in part with Federal funds.
CERTIFICATION REGARDING FEDERAL LOBBYING
(applies to subrecipients as well as States)
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any Federal grant,
the making of any Federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or
cooperative agreement;
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in connection with
this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and
submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its
instructions;
3. The undersigned shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under
grant, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each such failure.
RESTRICTION ON STATE LOBBYING
(applies to subrecipients as well as States)
None of the funds under this program will be used for any activity specifically designed to urge or influence a
State or local legislator to favor or oppose the adoption of any specific legislative proposal pending before any
State or local legislative body. Such activities include both direct and indirect (e.g., “grassroots”) lobbying
activities, with one exception. This does not preclude a State official whose salary is supported with NHTSA
funds from engaging in direct communications with State or local legislative officials, in accordance with
customary State practice, even if such communications urge legislative officials to favor or oppose the adoption
of a specific pending legislative proposal.
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
(applies to subrecipients as well as States)
INSTRUCTIONS FOR PRIMARY TIER PARTICIPANT CERTIFICATION (STATES)
11/24/2025 9:28:29 AM Page 16 of 21
1. By signing and submitting this proposal, the prospective primary tier participant is providing the
certification set out below and agrees to comply with the requirements of 2 CFR parts 180 and
1200.
2. The inability of a person to provide the certification required below will not necessarily result in
denial of participation in this covered transaction. The prospective primary tier participant shall
submit an explanation of why it cannot provide the certification set out below. The certification or
explanation will be considered in connection with the department or agency's determination
whether to enter into this transaction. However, failure of the prospective primary tier participant to
furnish a certification or an explanation shall disqualify such person from participation in this
transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed
when the department or agency determined to enter into this transaction. If it is later determined that
the prospective primary tier participant knowingly rendered an erroneous certification, in addition to
other remedies available to the Federal Government, the department or agency may terminate this
transaction for cause or default or may pursue suspension or debarment.
4. The prospective primary tier participant shall provide immediate written notice to the department
or agency to which this proposal is submitted if at any time the prospective primary tier participant
learns its certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
5. The terms covered transaction, civil judgment, debarment, suspension, ineligible,
participant, person, principal, and voluntarily excluded, as used in this clause, are defined in
2 CFR parts 180 and 1200. You may contact the department or agency to which this proposal is
being submitted for assistance in obtaining a copy of those regulations.
6. The prospective primary tier participant agrees by submitting this proposal that, should the
proposed covered transaction be entered into, it shall not knowingly enter into any lower tier
covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4,
debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency entering into this transaction.
7. The prospective primary tier participant further agrees by submitting this proposal that it will include
the clause titled “Instructions for Lower Tier Participant Certification” including the “Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered
Transaction,” provided by the department or agency entering into this covered transaction, without
modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions and will require lower tier participants to comply with 2 CFR parts 180 and 1200.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart
9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it
knows that the certification is erroneous. A participant is responsible for ensuring that its principals
are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify
the eligibility of its principals, as well as the eligibility of any prospective lower tier participants, each
participant may, but is not required to, check the System for Award Management Exclusions
website
( https://www.sam.gov/).
9. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge and
information of a participant is not required to exceed that which is normally possessed by a prudent
person in the ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a
covered transaction knowingly enters into a lower tier covered transaction with a person who is
proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction, in addition to other remedies available to
the Federal Government, the department or agency may terminate the transaction for cause or
default.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS—PRIMARY TIER
COVERED TRANSACTIONS
1. The prospective primary tier participant certifies to the best of its knowledge and belief, that it and
11/24/2025 9:28:29 AM Page 17 of 21
its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participating in covered transactions by any Federal department
or agency;
b. Have not within a three-year period preceding this proposal been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public (Federal, State, or local)
transaction or contract under a public transaction; violation of Federal or State antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the offenses
enumerated in paragraph (1)(b) of this certification; and
d. Have not within a three-year period preceding this application/proposal had one or more
public transactions (Federal, State, or local) terminated for cause or default.
2. Where the prospective primary tier participant is unable to certify to any of the Statements in this
certification, such prospective participant shall attach an explanation to this proposal.
INSTRUCTIONS FOR LOWER TIER PARTICIPANT CERTIFICATION
1. By signing and submitting this proposal, the prospective lower tier participant is providing the
certification set out below and agrees to comply with the requirements of 2 CFR parts 180 and
1200.
2. The certification in this clause is a material representation of fact upon which reliance was placed
when this transaction was entered into. If it is later determined that the prospective lower tier
participant knowingly rendered an erroneous certification, in addition to other remedies available to
the Federal Government, the department or agency with which this transaction originated may
pursue available remedies, including suspension or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to
which this proposal is submitted if at any time the prospective lower tier participant learns that
its certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
4. The terms covered transaction, civil judgment, debarment, suspension, ineligible, participant,
person, principal, and voluntarily excluded, as used in this clause, are defined in 2 CFR parts
180 and 1200. You may contact the person to whom this proposal is submitted for assistance in
obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed
covered transaction be entered into, it shall not knowingly enter into any lower tier covered
transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4,
debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that it will include
the clause titled “Instructions for Lower Tier Participant Certification” including the “Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered
Transaction,” without modification, in all lower tier covered transactions and in all solicitations for
lower tier covered transactions and will require lower tier participants to comply with 2 CFR parts
180 and 1200.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart
9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it
knows that the certification is erroneous. A participant is responsible for ensuring that its principals
are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify
the eligibility of its principals, as well as the eligibility of any prospective lower tier participants, each
participant may, but is not required to, check the System for Award Management Exclusions
website
( https://www.sam.gov/).
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
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records in order to render in good faith the certification required by this clause. The knowledge and
information of a participant is not required to exceed that which is normally possessed by a prudent
person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a
covered transaction knowingly enters into a lower tier covered transaction with a person who is
proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction, in addition to other remedies available to
the Federal Government, the department or agency with which this transaction originated may
pursue available remedies, including suspension or debarment.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION—LOWER TIER
COVERED TRANSACTIONS
1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participating in covered transactions by any Federal department or
agency.
2. Where the prospective lower tier participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.
BUY AMERICA
(applies to subrecipients as well as States)
The State and each subrecipient will comply with the Buy America requirement (23 U.S.C. 313) when
purchasing items using Federal funds. Buy America requires a State, or subrecipient, to purchase with Federal
funds only steel, iron and manufactured products produced in the United States, unless the Secretary of
Transportation determines that such domestically produced items would be inconsistent with the public
interest, that such materials are not reasonably available and of a satisfactory quality, or that inclusion of
domestic materials will increase the cost of the overall project contract by more than 25 percent. In order to use
Federal funds to purchase foreign produced items, the State must submit a waiver request that provides an
adequate basis and justification for approval by the Secretary of Transportation.
CERTIFICATION ON CONFLICT OF INTEREST
(applies to subrecipients as well as States)
GENERAL REQUIREMENTS
No employee, officer, or agent of a State or its subrecipient who is authorized in an official capacity to
negotiate, make, accept, or approve, or to take part in negotiating, making, accepting, or approving any
subaward, including contracts or subcontracts, in connection with this grant shall have, directly or indirectly,
any financial or personal interest in any such subaward. Such a financial or personal interest would arise when
the employee, officer, or agent, any member of his or her immediate family, his or her partner, or an
organization which employs or is about to employ any of the parties indicated herein, has a financial or
personal interest in or a tangible personal benefit from an entity considered for a subaward. Based on this
policy:
1. The recipient shall maintain a written code or standards of conduct that provide for disciplinary
actions to be applied for violations of such standards by officers, employees, or agents.
a. The code or standards shall provide that the recipient's officers, employees, or agents
may neither solicit nor accept gratuities, favors, or anything of monetary value from
present or potential subawardees, including contractors or parties to subcontracts.
b. The code or standards shall establish penalties, sanctions, or other disciplinary actions
for violations, as permitted by State or local law or regulations.
2. The recipient shall maintain responsibility to enforce the requirements of the written code or
standards of conduct.
DISCLOSURE REQUIREMENTS
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No State or its subrecipient, including its officers, employees, or agents, shall perform or continue to perform
under a grant or cooperative agreement, whose objectivity may be impaired because of any related past,
present, or currently planned interest, financial or otherwise, in
organizations regulated by NHTSA or in organizations whose interests may be substantially affected by NHTSA
activities. Based on this policy:
1. The recipient shall disclose any conflict of interest identified as soon as reasonably possible,
making an immediate and full disclosure in writing to NHTSA. The disclosure shall include a
description of the action which the recipient has taken or proposes to take to avoid or mitigate such
conflict.
2. NHTSA will review the disclosure and may require additional relevant information from the recipient.
If a conflict of interest is found to exist, NHTSA may (a) terminate the award, or (b) determine that it
is otherwise in the best interest of NHTSA to continue the award and include appropriate provisions
to mitigate or avoid such conflict.
3. Conflicts of interest that require disclosure include all past, present, or currently planned
organizational, financial, contractual, or other interest(s) with an organization regulated by NHTSA
or with an organization whose interests may be substantially affected by NHTSA activities, and
which are related to this award. The interest(s) that require disclosure include those of any
recipient, affiliate, proposed consultant, proposed subcontractor, and key personnel of any of the
above. Past interest shall be limited to within one year of the date of award. Key personnel shall
include any person owning more than a 20 percent interest in a recipient, and the officers,
employees or agents of a recipient who are responsible for making a decision or taking an action
under an award where the decision or action can have an economic or other impact on the
interests of a regulated or affected organization.
PROHIBITION ON USING GRANT FUNDS TO CHECK FOR HELMET USAGE
(applies to subrecipients as well as States)
The State and each subrecipient will not use 23 U.S.C. Chapter 4 grant funds for programs to check helmet
usage or to create checkpoints that specifically target motorcyclists.
POLICY ON SEAT BELT USE
In accordance with Executive Order 13043, Increasing Seat Belt Use in the United States, dated April 16, 1997,
the Grantee is encouraged to adopt and enforce on-the-job seat belt use policies and programs for its
employees when operating company-owned, rented, or personally-owned vehicles. The National Highway
Traffic Safety Administration (NHTSA) is responsible for providing leadership and guidance in support of this
Presidential initiative. For information and resources on traffic safety programs and policies for employers,
please contact the Network of Employers for Traffic Safety (NETS), a public-private partnership dedicated to
improving the traffic safety practices of employers and employees. You can download information on seat belt
programs, costs of motor vehicle crashes to employers, and other traffic safety initiatives at
www.trafficsafety.org. The NHTSA website ( www.nhtsa.gov) also provides information on statistics,
campaigns, and program evaluations and references.
POLICY ON BANNING TEXT MESSAGING WHILE DRIVING
In accordance with Executive Order 13513, Federal Leadership On Reducing Text Messaging While Driving,
and DOT Order 3902.10, Text Messaging While Driving, States are encouraged to adopt and enforce
workplace safety policies to decrease crashes caused by distracted driving, including policies to ban text
messaging while driving company-owned or rented vehicles, Government-owned, leased or rented vehicles, or
privately-owned vehicles when on official Government business or when performing any work on or behalf of
the Government. States are also encouraged to conduct workplace safety initiatives in a manner
commensurate with the size of the business, such as establishment of new rules and programs or re-
evaluation of existing programs to prohibit text messaging while driving, and education, awareness, and other
outreach to employees about the safety risks associated with texting while driving.
11/24/2025 9:28:29 AM Page 20 of 21
INSTRUCTIONS FOR ADDING OR UPDATING GEMS USERS
1. Each agency is allowed a total of FIVE (5) GEMS Users.
2. GEMS Users listed on this form will be authorized to login to GEMS to complete and submit Quarterly
Performance Reports (QPRs) and reimbursement claims.
3. Complete the form if adding, removing or editing a GEMS user(s).
4. The Grant Director must sign this form and return it with the Grant Agreement.
CURRENT GEMS USER(S)
1. Chelsea Biklen
Title: Safe Routes to School Staff Media Contact: No
Phone: 408-777-3200
Email: chelseab@cupertino.gov
2. David Stillman
Title: Transportation Manager Media Contact: No
Phone: (408) 777-3249
Email: davids@cupertino.gov
3. Birgit Werner
Title: Safe Routes to School Community Coordinator Media Contact: No
Phone: (408) 777-3117
Email: bwerner@cupertino.gov
State of California – Office of Traffic Safety
OTS-55 Grant Electronic Management System (GEMS) Access
Exhibit C
GRANT NUMBER
PS26029
GRANT DETAILS
Grant Number: PS26029
Agency Name: Cupertino Public Works
Grant Title: Pedestrian and Bicycle Safety Program
Agreement Total: $184,000.00
Authorizing Official: Chad Mosley
Fiscal Official: Kristina Alfaro
Grant Director: Birgit Werner
11/24/2025 9:28:29 AM Page 21 of 21
Complete the below information if adding, removing or editing a GEMS user(s)
GEMS User 1
Add/Change {{[]c11_es_:signer1}} Remove Access {{[] c12_es_:signer1}}
Add as a media contact? Yes {{[]c1_es_:signer1}} No{{[]c2_es_:signer1}}
{{UserName1_es_:signer1 }} {{UserTitle1_es_:signer1 }}
Name Job Title
{{UserEmail1_es_:signer1 }} {{UserPhone1_es_:signer1 }}
Email address Phone number
GEMS User 2
Add/Change {{[]c13_es_:signer1}} Remove Access {{[]c14_es_:signer1}}
Add as a media contact? Yes {{[]c3_es_:signer1}}No {{[]c4_es_:signer1}}
{{UserName2_es_:signer1 }} {{UserTitle2_es_:signer1 }}
Name Job Title
{{UserEmail2_es_:signer1 }} {{UserPhone2_es_:signer1 }}
Email address Phone number
GEMS User 3
Add/Change {{[]c15_es_:signer1}} Remove Access {{[]c16_es_:signer1}}
Add as a media contact? Yes {{[]c5_es_:signer1}}No {{[]c6_es_:signer1}}
{{UserName3_es_:signer1 }} {{UserTitle3_es_:signer1 }}
Name Job Title
{{UserEmail3_es_:signer1 }} {{UserPhone3_es_:signer1 }}
Email address Phone number
GEMS User 4
Add/Change {{[]c17_es_:signer1}} Remove Access {{[]c18_es_:signer1}}
Add as a media contact? Yes {{[]c8_es_:signer1}}No {{[]c7_es_:signer1}}
{{UserName4_es_:signer1 }} {{UserTitle4_es_:signer1 }}
Name
Job Title
{{UserEmail4_es_:signer1 }} {{UserPhone4_es_:signer1 }}
Email address Phone number
GEMS User 5
Add/Change {{[]c19_es_:signer1}} Remove Access {{[]c20_es_:signer1}}
Add as a media contact? Yes {{[]c9_es_:signer1}}No {{[]c10_es_:signer1}}
{{UserName5_es_:signer1 }} {{UserTitle5_es_:signer1 }}
Name Job Title
{{UserEmail5_es_:signer1 }} {{UserPhone5_es_:signer1 }}
Email address
Phone number
Form completed by: {{Sig_es_:signer1:signature}} Date: {{Dte1_es_:signer1:date}}
As a signatory I hereby authorize the listed individual(s) to represent and have GEMS user access.
{{Sig_es_:signer2:signature}} {{Name1_es_:signer2:fullname }}
Signature Name
{{Dte2_es_:signer2:date}} Grant Director
Date Title
Birgit Werner (Nov 25, 2025 11:54:41 EST)Nov 25, 2025
Birgit Werner (Nov 25, 2025 11:57:12 EST)Birgit Werner
Nov 25, 2025
Grant Agreement - PS26029
Final Audit Report 2025-11-25
Created:2025-11-24
By:Pamela Goldberg (pamela.goldberg@ots.ca.gov)
Status:Signed
Transaction ID:CBJCHBCAABAA763MKKtgMURRv99VHQvLMzms5dNpU7BN
"Grant Agreement - PS26029" History
Document created by Pamela Goldberg (pamela.goldberg@ots.ca.gov)
2025-11-24 - 5:28:43 PM GMT
Document emailed to bwerner@cupertino.gov for signature
2025-11-24 - 5:28:51 PM GMT
Email viewed by bwerner@cupertino.gov
2025-11-24 - 5:29:13 PM GMT
Signer bwerner@cupertino.gov entered name at signing as Birgit Werner
2025-11-25 - 4:54:39 PM GMT
Document e-signed by Birgit Werner (bwerner@cupertino.gov)
Signature Date: 2025-11-25 - 4:54:41 PM GMT - Time Source: server
Document emailed to bwerner@cupertino.gov for signature
2025-11-25 - 4:54:44 PM GMT
Email viewed by bwerner@cupertino.gov
2025-11-25 - 4:55:00 PM GMT
Signer bwerner@cupertino.gov entered name at signing as Birgit Werner
2025-11-25 - 4:57:10 PM GMT
Document e-signed by Birgit Werner (bwerner@cupertino.gov)
Signature Date: 2025-11-25 - 4:57:12 PM GMT - Time Source: server
Document emailed to Kristina Alfaro (kristinaa@cupertino.gov) for signature
2025-11-25 - 4:57:14 PM GMT
Email viewed by Kristina Alfaro (kristinaa@cupertino.gov)
2025-11-25 - 4:57:32 PM GMT
Document e-signed by Kristina Alfaro (kristinaa@cupertino.gov)
Signature Date: 2025-11-25 - 5:12:43 PM GMT - Time Source: server
Document emailed to Chad Mosley (chadm@cupertino.gov) for signature
2025-11-25 - 5:12:45 PM GMT
Email viewed by Chad Mosley (chadm@cupertino.gov)
2025-11-25 - 5:12:57 PM GMT
Document e-signed by Chad Mosley (chadm@cupertino.gov)
Signature Date: 2025-11-25 - 5:48:32 PM GMT - Time Source: server
Document emailed to Carolyn Vu (Carolyn.Vu@ots.ca.gov) for signature
2025-11-25 - 5:48:34 PM GMT
Email viewed by Carolyn Vu (Carolyn.Vu@ots.ca.gov)
2025-11-25 - 5:56:06 PM GMT
Document e-signed by Carolyn Vu (Carolyn.Vu@ots.ca.gov)
Signature Date: 2025-11-25 - 5:56:24 PM GMT - Time Source: server
Document emailed to Stephanie Dougherty (stephanie.dougherty@ots.ca.gov) for signature
2025-11-25 - 5:56:26 PM GMT
Email viewed by Stephanie Dougherty (stephanie.dougherty@ots.ca.gov)
2025-11-25 - 9:39:42 PM GMT
Document e-signed by Stephanie Dougherty (stephanie.dougherty@ots.ca.gov)
Signature Date: 2025-11-25 - 9:42:24 PM GMT - Time Source: server
Agreement completed.
2025-11-25 - 9:42:24 PM GMT