thisformshouldbecompletedandexecutedforallits.docVIP

This form should be completed and executed for all ITS Projects or Projects with ITS elements. The form should be sent to LACMTA Countywide Planning and Development (CP D) for any planned ITS projects or proposed funding involving Local, State or Federal funds programmed or administered through the LACMTA. Name of Sponsoring Agency: Contact Name: Contact Phone: Contact Email: Project Description: [insert TEXT Identify the ITS elements being implemented and the relevant National Architecture User Service(s), see Attachment A. See last page of this document. [insert TEXT Outline of the concept of operations for the project. [insert TEXT Identify participating agencies roles and responsibilities. [insert TEXT By signing and self-certifying this form, the agency commits itself to follow the ITS requirements listed below during project design and implementation. Please be advised that your project may be subject to further review and documentation by FHWA or FTA during project design and implementation phases: Perform a lifecycle analysis for the ITS project elements and incorporate these costs into the Operations and Maintenance plan as part of the system engineering process, Maintain and operate the system according to the recommendations of the operations and Maintenance plan upon project completion, Use the systems engineering process and document the system engineering steps, and Use the Los Angeles County Regional ITS Architecture interface standards, if required, and conform to the regional configuration management process. Signature: __________________________________________________________ _____________________ Agency Representative Date Please return this Project Self Certification Form to: LACMTA, Department of CPD, Attention: Ms. Martha Welborne, Executive Director Countywide Planning, Countywide Planning and Development (CPD), Los Angeles County Metropolitan Transportation Authority (LACMTA), One Gateway Plaz