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TfWashington State
,p Department of Transportation
Local Agency Agreement Supplement
Agency
Supplement Number
Grant County Public Works
1
Federal Aid Project Number
Agreement Number
CFDA No. 20.205 - Highway Planning
STPR-E 131(009)
LA 10364
and Construction
All provisions in the basic agreement remain in effect except as modified by this supplement.
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 Dodson RD. Ph 2, Ph 3, Ph 4 Length 10.98
Termini 4 -NW to SR 282
Description of Work ✓ No Change
Reason for Supplement
CN Authorization
Are you claiming indirect cost rate? ]Yes v/ No Project Agreement End Date December 31, 2025
Advertisement Date September 20, 2022
The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a
condition to payment of the Federal funds obligated, it accepts and will comply with the applicable provisions.
Agent Official Washington State Department of Transportation
By By
Director, Local Program
Danny
/7,
e, BOCC Chair Date Executed
w
DOT Form 140-041 Page 1
Revised 04/2022
Estimate of Funding
Type of Work
YP
(1)
2
()
(3)
(4)
(5)
Previous
Supplement
Estimated Total
Estimated Ag yenc
Estimated Federal
Agreement/Suppl.
Project Funds
Funds
Funds
PE
86.5 °
a.Agency
599000.00
599000.00
7,965.00
51,035.00
�°
b. Other (Other Funds -City)
1 5,000.00
59000.00
500.00
Federal Aid
c. Other
0.00
Participation
Ratio for PE
d. State Services
19000.00
15000.00
135.00
865.00
e. Total PE Cost Estimate a+b+c+d
655000.00
0.00
659000.00
139100.00
51,900.00
Right of Way
0.00
f. Agency
. Other
0.00
Federal Aid
h. Other
0.00
Participation
Ratio for RW
i. State Services
0.00
i. Total R/W Cost Estimate f+ +h+i
0.00
0.00
0.00
0.00
0.00
Construction °
�°
k. Contract
254635936.00
29463,936.00
332,631.00
291315305.00
86.5
1. Other (Contract Other Funds)
274,797.00
274,797.00
2749797.00
m. Other
0.00
Federal Aid
n
n. Other
0.00
Participation
Ratio for CN
o.Agency
1179330.00
117,330.00
159840.00
1019490.00
. State Services
500.00
500.00
675.00
49325.00
. Total CN Cost Estimate k+i+m+n+o+
0.00
2019063.00
2019063.00
623,943.00
2,237,120.00
Ir. Total Project Cost Estimate e+i+
65,000.00
2019063.00
2,92603.00
6379043.00
292899020.00
The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a
condition to payment of the Federal funds obligated, it accepts and will comply with the applicable provisions.
Agent Official Washington State Department of Transportation
By By
Director, Local Program
Danny
/7,
e, BOCC Chair Date Executed
w
DOT Form 140-041 Page 1
Revised 04/2022
Agency
Supplement Number
Grant County Public Works
1
Federal Aid Project Number
Agreement Number
CFDA No. 20.205 - Highway Planning
STPR-E131(009)
LA 10364
and Construction
VI. Payment and Partial Reimbursement
The total cost of the project, including all review and engineering costs and other expenses of the State, is to be paid
by the Agency and by the Federal Government. Federal funding shall be in accordance with the Federal Transportation
Act, as amended, 2 CFR Part 200. The State shall not be ultimately responsible for any of the costs of the project. The
Agency shall be ultimately responsible for all costs associated with the project which are not reimbursed by the Federal
Government. Nothing in this agreement shall be construed as a promise by the State as to the amount or nature of federal
participation in this project.
The Agency shall bill the state for federal aid project costs incurred in conformity with applicable federal and state laws.
The agency shall minimize the time elapsed between receipt of federal aid funds and subsequent payment of incurred
costs. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead
shall not be eligible for federal participation unless a current indirect cost plan has been prepared in accordance with
the regulations outlined in 2 CFR Part 200 - Uniform Admin. Requirements, Cost Principles and Audit Requirements for
Federal Awards, and retained for audit.
The State will pay for State incurred costs on the project. Following payment, the State shall bill the Federal Government
for reimbursement of those costs eligible for federal participation to the extent that such costs are attributable and properly
allocable to this project. The State shall bill the Agency for that portion of State 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 for audit of the consultant's records to determine
eligible federal aid costs on the project. The report of said audit shall be in the 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 accordance with generally accepted governmental
auditing standards as issued by the United States General Accounting Office by the Comptroller General of the United
States; WSDOT Manual M.27-50, Consultant Authorization, Selection, and Agreement Administration; memoranda of
understanding between WSDOT and FHWA; and 2 CFR Part 200.501 -Audit Requirements.
If upon audit it is found that overpayment or participation of federal money in ineligible items of cost has occurred, the
Agency shall reimburse the State for the amount of such overpayment or excess participation.
IX. Payment of Billing
The Agency agrees that if payment or arrangement for payment of any of the State's billing relative to the project (e.g.,
State force work, project cancellation, overpayment, cost ineligible for federal participation, etc.) is not made to the State
within 45 days after the Agency has been billed, the State shall effect reimbursement of the total sum due from the regular
monthly fuel tax allotments to the Agency from the Motor Vehicle Fund. No additional Federal project funding will be
approved until full payment is received unless otherwise directed by the Director, Local Programs.
Project Agreement End Date - This date is based on your projects Period of Performance (2 CFR Part 200.309).
Any costs incurred after the Project Agreement End Date are NOT eligible for federal reimbursement. All eligible costs
incurred prior to the Project Agreement End Date must be submitted for reimbursement 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 subrecipient who expends $750,000 or more in federal
awards from all sources during a given fiscal year shall have a single or program -specific audit performed for that year in
accordance with the provisions of 2 CFR Part 200.501. Upon conclusion 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 administrations (i.e., Federal Highway
Administration, Federal Transit Administration, Federal Aviation Administration) are required to submit a written policy
statement, signed by the Agency Executive and addressed to the State, documenting that all programs, activities and
services will be conducted in compliance with Section 504 and the Americans with Disabilities Act (ADA).
DOT Form 140-041 Page 2
Revised 04/2022
Instructions
1. Agency — Enter the agency name as entered on the original agreement.
2. Supplemental Number — Enter the number of the supplement. Supplement numbers will be assigned in sequence beginning
with Number 1 for the first supplement.
3. Project Number — Enter the federal aid project number assigned by WSDOT on the 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 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 funding 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 advertisement date must be included in the
space provided.
8. Claiming Indirect Cost Rate — Check the Yes box if the agency will be claiming indirect costs on 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 by your cognizant agency or through your agency's self -certification and supporting
documentation is required to be available for review by FHWA, WSDOT and /or State Auditor. Check the No box if the agency will
not be claiming indirect costs on the project. See Section 23.5 for additional guidance.
9. Project Agreement End Date — Enter your previously established Project Agreement End Date. If authorizing a new phase of the
project, update the Project Agreement End Date based on the following guidance:
a. For PE and RW — WSDOT recommends agencies estimate when the phase will be completed and add three years to
determine the "Project Agreement End Date".
b. For Construction — WSDOT recommends agencies estimate when construction will be completed and add three years to
determine the "Project Agreement End Date".
c. If an extension to a Project Agreement End Date is required between phase authorizations, the need for the extension must
be described in the Reason for Supplement. Adequate justification to approve the extension must be submitted with the
supplement. See Section 22.3 for additional guidance.
10. 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 agency agreement. If the agreement has already been
supplemented, enter the amounts by type of work from column 3 of the last supplemental agreement.
b. Column 2 — Enter increase/decrease to total amounts requested by type 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 recorded on the original agreement.
11.Signatures —An authorized official of the local agency signs the Supplemental Agreement and enters their title and date of
signature (mm/dd/yy). (Vote: Do NOT enter a date on the Date Executed line.
DOT Form 140-041 Page 3
Revised 04/2022