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Washington State
Department of Transportation
Agency Grant County Public Works
Address
124 Enterprise Street
Ephrata, WA 98823
K21-142
CFDA No. -20.205
(Catalog or Federal Domestic Assistance)
Project No.
Agreement No.
For OSC WSDOT Use Only
The Local Agency having complied, or hereby agreeing to comply, with the terms and conditions set forth in (1) Title 23, U.S. Code
Highways, (2) the regulations issued pursuant thereto, (3) 2 CFR Part 200, (4)_2 CFR Part 180 — certifying that the local agency is not
excluded from receiving Federal funds by a Federal suspension or debarment, (5) the policies and procedures promulgated by the
Washington State Department of Transportation, and (6) the federal aid project agreement entered into between the State and Federal
Government, relative to the above project, the Washington State Department of Transportation will authorize the Local Agency to
proceed on the project by a separate notification. Federal funds which are to be obligated for the project may not exceed the amount
shown herein on line r, column 3, without written authority by the State, subject to the approval of the Federal Highway Administration.
All project costs not reimbursed by the Federal Government shall be the responsibility of the Local Agency.
Project Description
Name U -SE Overlay
Termini MP 5.2 to MP 12.59
Description of Work
Length 7.39 Miles
This project will resurface the existing HMA pavement with an HMA overlay, shoulder finishing, guardrail, traffic control and other
work on road U -SE.
Project Agreement End Date December 31, 2023 Claiming indirect Cost Rate
August, 2021 ❑Yes � No
Proposed Advertisement Date Au g
�►ge y i ial
By
Title (,�A4 4 "4,�
a.,
DOT Form
C
Revised 12/2020
Washington State
Department of Transportation
By Director, Local Program
CVMVwI'S.-5i";Dat:e Executed
Page i
Estimate of Funding
(1)
(2)
(3)
Type of Work
Estimated Total
Estimated Agency
Estimated Federal
Project Funds
Funds
Funds
PE a. A enc
b. Other
Federal Aid c, Other
Participation d. State
Ratio for PE
e. Total PE Cost Estimate a+b+c+d
0.00
0.00
0.00
Right of Way f. Agency
.Other
Federal Aid
h. Other
Participation
Ratio for RW i, State
'. Total R/W Cost Estimate f+ +h+i
0.00
0.00
0.00
Construction k. Contract
2,102, 830.00
283, 882.00
1, 818, 948.00
% 1. Other
m. Other
Federal Aid n. Other
Participation o.Agency
951170.00
127848.00
82,322.00
Ratio for CN , State
2,000.00
270.00
1,730.00
. Total CN Cost Estimate k+i+m+n+o+
2,20000.00
297,000.00
1,9037000.00
r. Tofia! Project C)§t Estimate e+i+
2,200,000.00
297,000.00
1,9039000.00
�►ge y i ial
By
Title (,�A4 4 "4,�
a.,
DOT Form
C
Revised 12/2020
Washington State
Department of Transportation
By Director, Local Program
CVMVwI'S.-5i";Dat:e Executed
Page i