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Page 22 of 36 <br />20016287.14 <br />Exhibit A: Form of Project Supplements <br /> <br />SECTION A: Primary Agreement <br />The San Mateo County Transportation Authority (TA) and [Project Sponsor] (Sponsor) entered <br />into a Primary Grant Agreement on ________, 20__ (Primary Agreement). <br />This Project Supplement is entered into on ________, 20__ pursuant to the Primary Grant <br />Agreement and is subject to the terms set forth therein. <br />SECTION B: Project Background <br />Measure(s): <br />☐ Original Measure A <br />☐ New Measure A <br />☐ Measure W <br />Program Category: <br />Measure A Measure W <br />☐ Transit <br />☐ Highways <br />☐ Local Streets/Transportation <br />☐ Grade Separations <br />☐ Pedestrian and Bicycle <br />☐ Alternative Congestion Relief Programs <br />☐ Countywide Highway Congestion <br />Improvements <br />☐ Local Safety, Pothole & Congestion Relief <br />Improvements – Local Investment Share <br />☐ Local Safety, Pothole & Congestion Relief <br />Improvements – Grade Separation <br />☐ Bicycle and Pedestrian Improvements <br />☐ Regional Transit Connections <br /> <br />Program Subcategory (if applicable): <br />Project: [Add project name] <br />Scope of Work: [Specify phase(s)] <br />Scope of Work Costs: [Specify amount programmed and allocated for each phase] <br />TA Technical Assistance (if applicable): <br />Date Funding Programmed: <br />Date Funding Allocated: <br />6.C. - Page 28 of 44 <br />46