• 2016 Measure B Local Streets & Roads Pavement Program Complete Streets Self-Declaration Form

  • The 2016 Measure B Program requires all capital projects to consider Complete Streets improvements and to incorporate pedestrian, bicycle, and transit infrastructure or information technology improvements identified in local, regional, or countywide planning documents if they fall within the project limits, unless an exception is declared and approved by the 2016 Measure B Program.

  • INSTRUCTIONS

    • Use this form only for pavement programs funded by 2016 Measure B Local Streets and Roads. For capital projects that receive 2016 Measure B funding and congestion relief projects funded through 2016 Measure B Local Streets & Roads should use a different Complete Streets Form, which can be found here.
    • Transit operations and education/encouragement programs funded by 2016 Measure B are not required to fill out this form.
    • You can navigate through the form by clicking individual tabs on the top of this form. 
    • You can save your work by clicking the "Save" button at the bottom of the page. You will be prompted to either sign up with an email account, or "skip create an account". If you chose not to create an account, you will be asked to enter an email address to receive a shareable link. You or your colleague may use the same link to continue working on the application. Note: if you have submitted the project checklist and wish to make edits, you must go back to the submission and click "submit" again to save the changes. There will not be a "save" button in the re-submission.
    • The form must be signed by the Public Works Director, Agency Manager, equivalent senior level staff, or his/her designee (please click on the last tab).
    • Submit form when requesting funding. Submit an updated form with each new funding request or when project enters another major phase.
    • VTA 2016 Measure B Program Office will post the completed form on the Transparency Website.
    • Please email 2016MeasureB@vta.org if you have any questions.

  • PART A: LOCAL AGENCY INFORMATION

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  • PART B: GENERAL FUNDING REQUEST INFORMATION

    The following information must be for the funding request for FISCAL YEAR (FY) 2025.

  • PART C: STREET SEGMENT SELECTION

    Purpose of this section is to document the planned locations of work for FY 25 funds.
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  • PART D: STRIPING PLANS

    The following questions refer to your agency’s general process for developing striping plans and determining any additional civil work to include in pavement management programs.

  • PART E: ANTICIPATED COMPLETE STREETS INFRASTRUCTURE

    The following questions refer to the current funding request- specifically the attached list of street segments. The Complete Streets infrastructure listed below demonstrates options a local jurisdiction should consider integrating into pavement management programs. If it is unknown whether particular infrastructure will be provided, note in the “additional details” field. If only some street segments will include the checked items, clarify in the “additional details” field.

  • PART F: EXCEPTIONS

  • 18. For the list of roadway segments attached to this form, describe any exceptions you anticipate which would prevent you from installing pedestrian, bicycle, or transit related striping and signage that is included in local, regional, or countywide adopted planning documents. Explain why you do not anticipate providing the signing and striping.

    NOTE: Generally, the following are reasonable explanations for omitting specific Complete Streets infrastructure from a pavement maintenance or rehabilitation/repair project:

    • The cost of providing the Complete Streets elements is disproportionate to the overall cost of the project, as set forth in the Federal Highway Administration’s Accommodating Bicycle and Pedestrian Travel.
    • A roadway user is legally prohibited from using the transportation facility.
    • There is an absence of existing and future need.

  • PART 17: REVIEW & SIGN

  • The completed Checklist must be reviewed and signed by Public Works Director, Agency Manager or equivalent senior level staff or his/her designee. 

    Please forward the URL of this form to the signee to enter the email and name for DocuSign. The signee does not need a DocuSign to complete this signature process.

    You can click "Print PDF" to save a copy of this Checklist.

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