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Home My WebLink AboutAgreements/Contracts - Public Works�Washington State �Department of Transportation Agency Local Agency Agreement Supplement Grant County Supplement Number Project Number � STPUS-9913(004) Agreement Number LA10057 ALN. 20.205 -Highway Planning All provisions in the basic agreement remain in effect except as modified by this supplementnnd . ------ The The Local Agency certifies that it is not excluded from receiving Federal funds by a Federal suspension or debarment (2 CFR Part 180). Additional changes to the agreement are as follows: Project Description Name Grape &Maple Termini 0.12 to 0.25 (Grape), 0.00 to 0.75 (Maple) Length 0.88 Description of Work ✓ No Change Reason for Supplement Extend Project Agreement End Date. Indirect .Cost Rate [Yes No Type of Work 86.5 % a. b. Federal Aid C. Participation d. Ratio(s) for PE erf Federal Aid Participation Ratio(s) for RW DOT Form 140-041 Revised 09/2024 • Previous Versions Obsolete • Project Agreement End Date 12/31/2025 Advertisement Date 3/2025 1 Estimate of F u n d i n () Previous (2) (3) (4) . (5 ) 4 reement/Su Supplement Estimated Total Estimated Agency Estimated Federal $ 123;000.00 Pro'ect Funds Funds Funds $ 0.00 $ 12370 00.00 7106,365.-oo $ 16, 605.00 $ 2, 000.00 $ 0.00 $ 125, 000.00 $ 0.00 $ o.00 Fs-o- .00 $ 2,000.00 $ 270.00 E12�5'000.00 $ 16, 875.00 $ o.00 J $ o.00 $ 1,730.00 $ 108,125.00 $ 0.00 Page 1 - -•~• ~`NN""�J LI saL Pui �uarIL w sala i Itle z3, regulations and policies and procedures, and as a condition to payment of the Federal funds obligated, it accepts and will comp ly with the applicable provisions. Age cy O 'cial Washington hington State Department of Transportation By By y �.y� Director Local Agency Date � �� cal Programs � � Date Executed DOT Form 140-041 Revised 09/2024 • Previous Versions Obsolete • Page 2 Hgency Supplement Number Grant County Project Number 1 Agreement Number ALN 20.205 - Hi STPUS-9913(004) LA10057 anC Highway Planning d t ' VI. Payment and Partial Reimbursement ins ruction The total cost of the project, including all review and engineeringcosts an by the Agency and b the Federal d other expenses of the State, is to be paid Y Government. Federal funding shall be in accordance with the Feder Act, as amended, 2 CFR Part 200. The State shall not be ultimatelyal Transportation responsible for any of the costs of the project. The Agency shall be ultimately responsible for all costs associated with the project Government. Nothingin this agreement P ject which are not reimbursed by the Federal g ent shall be construed as a promise by the State as to the amount or participation in this project. nature of federal The Agency shall bill the state for federal aid project costs incurred in confo rmity with applicable federal and state laws. The agency shall minimize the time elapsed between receipt of federal aid p funds and subsequent payment of incurred costs. Expenditures by the Local Agency for maintenance, general administrate shall not be eligible for federal participation unless a cur on, supervision, and other overhead rent indirect cost plan has been prepared in accordance with the regulations outlined in 2 CFR Part 200 -Uniform Admen. Requirements, Cost Principles and Audit Requirements for Federal Awards, and retained for audit. The State will pay for State incurred costs on the project. Followingpayment, p y nt, the State shall bill the Federal Government for reimbursement of those costs eligible for federal participation to the exte nt ent that such costs are attributable and properly allocable to this project. The State shall bill the Agency for that onion of St ate tate costs which were not reimbursed by the Federal Government (see Section IX). VII. Audit of Federal Consultant Contracts The Agency, if services of a consultant are required, shall be responsible f ' p or audit of the consultant's records to determine -- - eligible. federal -aid-costs on the project: -The report of said audit shall be in th e Agency's files and made available to the State and the Federal Government. An audit shall be conducted by the WSDOT Internal Audit Office in acco rdance with generally accepted governmental auditing standards as issued by the United States General AccountingOffice States; WSDOT Manual M 27-50 C by the Comptroller General of the United Consultant Authorization, Selection, and Agreement Administration; memoranda understanding between WSDOT and FHWA; and 2 CFR Part 200.501 -Audit of If upon audit it is found that overpayment udit Requirements. p yment or participation of federal money in ineligible items of cost has occurred, Agency shall reimburse the State for the amount of such overpayment or the excess participation. IX. Payment of Billing The Agency agrees that if payment or arrangement for payment of an of Y y he State s billing relative to the project (e.g., State force work, project cancellation, overpayment, cost ineligible for federal eral participation, etc.) is not made to the St within 45 days after the Agency has been billed, the State shall effect reim bursate ement of the total sum due from the regular monthly fuel tax allotments to the Agency from the Motor Vehicle Fund. No additional ditional Federal project funding will be approved until full payment is received unless otherwise directed b the Director Project Agreement End Date -This date ' Y ,Local Programs. is based on your projects Period of Performance (2 CFR Part 200.30 Any costs incurred after the Project Agreement End Date are NOT eligible9). for federal reimbursement. All eligible costs incurred prior to the Project Agreement End Date must be submitted for reim bursement within 90 days after the Project Agreement End Date or they become ineligible for federal reimbursement. VIII. Single Audit Act The Agency, as a subrecipient of federal funds, shall adhere to the federal regulations outlined in 2 CFR Part 200.501 as well as all applicable federal and state statutes and regulations. A subreci ie awards from all sources duringa even p nt who expends $750,000 or more in federal g fiscal year shall have a single or program -specific audit performed f accordance with the provisions of 2 CFR Part 200.501. Upon conclusion p or that year in p on of the audit, the Agency shall be responsible for ensuring that a copy of the report is transmitted promptly to the State. XVII. Assurances Local Agencies receiving Federal funding from the USDOT or its operating p g administrations (i.e., Federal Highway Administration, Federal Transit Administration, Federal Aviation Administratio n) are required to submit a written policy statement, signed by the Agency Executive and addressed to the State do cumenting that all programs, activities and services will be conducted in compliance with Section 504 and the Americans with Disabilities Act (ADA). DOT Form I n-041 R ' d UV ou 09/2024 • Previous Versions Obsolete • Page 3 Instructions 1. Agency — Enter the agency name as entered on the original agreement. 2. Supplemental Number— Enter the number of the supplement. Supplement numbers swill be assigned in sequence beginning with Number 1 for the first supplement. 3. Project Number — Enter the federal aid project number assigned b WSDOT th Y on e original agreement. 4. Agreement Number— Enter the agreement number assigned by WSDOT on the original agreement. 5. Project Description — Enter the project name, length, and termini. 6. Description of Work — Clearly describe if there is a change in work such as the addition ed u dition or deletion of work elements and/or changes to the termini. If the work has not changed, , put a check mark in the "No Change" box. 7. Reason for Supplement — Enter the reason for this supplement, i.e., increase PE fu nding to cover design changes presented in the revised prospectus; request funding of construction phase, decrease construction funding to the contract bid amount. If the supplement is authorizing a construction phase, the project's proposed advertis space provided. p ement date must be included in the 8. Indirect Cost Rate —Check the Yes box if the agency will be claimingindirect costs son the project. For those projects claiming indirect costs, supporting documentation that clearly shows the indirect cost rate being utilized must be provided with the supplement. Indirect cost rate approval y your cognizant agency or through your agency's self -certification and su ortin documentation is required to be available for review by FHWA, WSDOT and /or State A pp g .not be claiming indirect costs on the project. See Section 23 AuditorCheck the No box if the agency will .5 for additional guidance. 9. Project Agreement End Date — Enter your previously established Project Agreement g ent End Date. If authorizing a new phase of the project, update the Project Agreement End Date base � d on the following guidance: a. For PE and RW — WSDOT recommends agencies estimate when the phase will be com pleted mpleted and add three years to determine the "Project Agreement End Date". b. For Construction — WSDOT recommends agencies estimate when construction will determine the "Project Agreement End Date". be completed and add three years to c. If an extension to a Project Agreement End Date is required between phase authorizations, Adequate 'u p the need for the extension must be described in the Reason for Supplement. Ade q justification to approve the extension must be submitted with the supplement. See Section 22.3 for additional guidance. 10. Advertisement Date - At construction authorization only, enter the ro osed p p project advertisement date (mm/dd/yy). 11. Type of Work and Funding (Round all amounts to the nearest whole dollar). a. Column 1 Enter the amounts from column 1 of the original local agencya supplemented, enter the amounts by type of work from co agreement. • If the agreement has already been column 3 of the last supplemental agreement. b. Column 2 — Enter increase/decrease to total amounts requested by type e of work. C. Column 3 —Add the amounts in columns 1 and 2. d. Columns 4 and 5 — Enter the appropriate amounts based on the participation ratio o recorded on the original agreement. 12. Signatures — An authorized official of the local agency signs the Supplemental Agreement greement and enters their title and date of signature (mm/dd/yy). Note: Do NOT enter a date on the Date Executed line. DOT Form 140-041 Revised 09/2024 • Previous Versions Obsolete • Page 4 Washington State Department of Transportation Federal Aid Project Number Local Agency Project Number Prefix STPUS CRP 18-05 Agency CA Agency Grant County Public Works Yes E Project Title Grape &Maple Dr (SRI 7 to Stratford Road) Project Termini From -To SR 17 Stratford Begin Mile Post End Mile Post See Map See Man Local Agency Federal Aid Project Prospectus Route ( ) Date 12/11/24 9913 004 DUNS Number 01-020-2562 WSDOT Federal Employer 91-6001319 Use Only Tax ID Number Federal Program Title No Z 20.205 ❑Other Start Latitude N 47-08-59.01 End Latitude N 47-09-11.21 Nearest City Name Moses Lake Length of Project 0_RR Award Type Route ID Begin Mile Point End Mile Point City Number I LVl Count Number er See Map See Map See Map N/A 13 IAI nnT o/1/YI/1N -----�-�• 11• Start Longitude W 119-17-38.28 End Lon itude W 119-16-41.97 Project Zip Code (+4) 98837-4332 al Forces[] State[:] Railroad County Name Grant - 6-%IZ11VIULIVI, "'��tJJ Uongressional District(s) Urban Area Number North Central Region 13 4 18 Total Local Agency Phase EstimFederal Funds Phase Start Estimated Cost Funding Nearest Hundred Dollar Nearest Hundred Dollar Date Nearest Hundred Dollar Month Year P.E. 125,00.00 16,900.000 108 100.00 04/2021 R/W 130,000.00 130,000.00 0.00 O l /2023 Const. 114009000.00 1899000.00 11211,000.00 000.00 > OS/2025 Total 19655,000.00 335,900.00 1,319 100.00 Description of Existing Facility (Existing Design and Present Condition) g t Condition) Roadway Width Number of Lanes Grape - 24'. Maple - 22' 2 Grape Drive - 0.13 Miles is currently 24' wide, existingroad surface i Maple Drive - 0.75 Miles is currently � . s showing signs of deterioration, no S/W p rrently 22 wide, existing road surface is showing signs i sl of deterioration, oratlon, no S/W Description of Proposed Work Description of Proposed Work (Attach additional sheet(s) if necessary) Work will include grading, drainage, curb, gutter, and sidewalk HM items. A, widening, traffic control and other Local Agency Contact Person Bob B ers anti Mailing Address 124 Enterprise Street AM Project Prospectus Title DOT Form 140-101 Revised 01 /2022 Title Design/Construction Engineer City phrata Approving Authority unty Road Engineer Previous Editions Obsolete Phone (509) 754-6082 State Zip Code WA 98823-1987 Date i2• Page 1 Agency Grant County Public Works Project Title Date Grape &Maple Dr (SRI 7 to Stratford Road) 12/11/24 Type of Proposed Work Project Type (Check all that Apply) ❑ New Construction ❑Path /Trail 3-R ❑ Reconstruction. []✓ Pedestrian /Facilities ❑ 2-R ❑ Railroad ❑Parking ❑Other [-] Bridge e �I%J1 11101 Mow U1 VVUUK Preliminary Engineering Will Be Performed By Grant County Public Works Construction Will Be Performed By Contractor Environmental Classification ❑ Class I -Environmental Impact Statement (EIS) ❑ Project Involves NEPA/SEPA Section 404 Interagency Agreement F]Class III -Environmental Assessment (EA) ❑ Project Involves NEPA/SEPA Section 404 Interagency Agreements Environmental Considerations NEPA documents to be completed during PE Phase Roadway Width I Number of Lanes 28' 2 Others Agency 100 % Contract Agency 100 % �✓ Class II -Categorically Excluded (CE) ❑✓ Projects Requiring Documentation (Documented CE) T Form 140-101 Revised 01/2022 Previous Editions Obsolete Page 2 Agency Grant County Public Works Project Title Grape &Maple Dr (SR17 to Stratford Road) Date 12/ 11 /24 Right of Way ❑ No Right of Way Needed R' ❑ fight of Way Needed *All construction required by the contract can be accomplished N � ❑ o Relocation Relocation Re Required within the existing right of way. Utilities Railroad Z No utility work required [:] No railroad work required ❑All utility work will be to prior completed p p the start EJ All railroad work will be completed r' to the p of the construction contract prior start of the construction contract [:]All utility work will be completed in coordin ation nation ❑✓ All the railroad work i will be completed n with the construction contract coordination with the constructio p n contract Description of Utilitv Relocatinn nrArhiczfman+c nnr4 r:v;ef;�,4 KA,,;— - -- ...-J„, . L1%AWLUJ%,%.J JJvvivcu III «ic riUJCCa No utility issues known at this time. "Railroad work" will consist of res urfacing, work within the easement is not anticipated to disturb the structural integrity. UTC Rail CrossingChange an ge Petition in progress. rAA Involvement Is any airport located within 3.2 kilometers (2 miles) of the Droaosed nroiect? F� Vac n nv„ Remarks This project has been reviewed by the lPnic1ati%19Z hnAii ^-F +k� - - - •�•�• - �- �vuy lI Qul 1111 I1�A► duun agency or agencies, or it's designee, and is not inconsistent wit he a ncy's com rehensive Ian t p ,� p for community development. Agency Date By ayor/Uhairperson DOT Form 140-101 Revised 01/2022 Previous Editions Obsolete Page 3