AG 17-181 RETURN TO: PW ADMIN EXT: 2700 ID#: 3 3 O B
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT/DIV: PUBLIC WORKS/ 5112 CHET
2. ORIGINATING STAFF PERSON: 'fC F F HU Y N F1 EXT: 27;21 3. DATE REQ.BY:
3. TYPE OF DOCUMENT(CHECK ONE):
o CONTRACTOR SELECTION DOCUMENT(E.G.,RFB,RFP,RFQ)
❑ PUBLIC WORKS CONTRACT 0 SMALL OR LIMITED PUBLIC WORKS CONTRACT
❑ PROFESSIONAL SERVICE AGREEMENT 0 MAINTENANCE AGREEMENT
o GOODS AND SERVICE AGREEMENT 0 HUMAN SERVICES/CDBG
o REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT(E.G.BOND RELATED DOCUMENTS)
❑ ORDINANCE o RESOLUTION
`(j,
CONTRACT AMENDMENT(AG#): 11/1 o INTERLOCAL
OTHER LOCAL AG,EN CV ACR E 1/1 r J i
4. PROJECT NAME: G K N p(2E-CG 1'-ZiJATIL' N7YZu,1 to GT
5. NAME OF CONTRACTOI OM
ADDRESS: TELEPHONE:
E-MAIL: FAX:
SIGNATURE NAME: TITLE:
6. EXHIBITS AND ATTACHMENTS:0 SCOPE,WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER
REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
CFW LICENSE# BL,E 12/311 UBI# EXP. / /
7. TERM: COMMENCEMENT DATE: COMPLETION DATE: I " CLINT,
8. TOTAL COMPENSATION:$ (INCLUDE EXPENSES AND SALES TAX,IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE-ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑YES ❑NO IF YES,MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED: o YES 0 NO IF YES,$ PAID BY: ❑CONTRACTOR ❑CITY
RETAINAGE: RETAINAGE AMOUNT: o RETAINAGE AGREEMENT(SEE CONTRACT) OR c RETAINAGE BOND PROVIDED
o PURCHASING: PLEASE CHARGE TO:
9. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATE APPROVED
II PROJECT MANAGER 1 -71 cl J 20{k
'DIVISION MANAGER
DIRECTO .4/
VDEPUTY DIRECTOR
IREODIItECTOR 4&45.;‘-R _ -7/4I/Q
o RISK MANAGEMENT (IF APPLICABLE)
❑ LAW DEPT % 1 Ctrif�> I
10. COUNCIL APPROVAL(IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
11. CONTVCCT SIGNATURE ROUTING
VWISENTTO VENDOR/CONTRACTOR DATE SENT: 7 lei 1,r) DATE REC'D:
o ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE,LICENSES,EXHIBITS
o CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE
(INCLUDE DEPT.SUPPORT STAFF IF NECESSARY AND FEEL FREE TO SET NOTIFICATION MORE THAN A MONTH IN ADVANCE IF COUNCIL APPROVAL IS NEEDED.)
INITIAL/DATE SIGNED
❑ FINANCE DEPARTMENT
❑ L3131-DEPT `
qArIGNATORY(MAYOR OR DIRECTOR) I-a.��,��,`6
§4CITY CLERK /i,/ 7���,�i■
ASSIGNED AG# AG#
1,SIGNED COPY RETURNED DATE SENT: 1 MIIM
RETURN ONE ORIGINAL
COMMENTS:
EXECUTE" "ORI INALS
lita(e C G ff t u ye...6e i f
1/2018
i
471` Wastaigton Mato Local Agency Agreement Supplement
Department of Transportation
;Agency Supplement Number
City of Federal Way 2
Federal Aid Project Number Agreement Number CFDA No. 20.205
NHPP- 1008(004) LA-9187 (Catalog of Federal Domestic Assistance)
The Local Agency requests to supplement the agreement entered into and executed on 4/20/2018
All provisions in the basic agreement remain in effect except as modified by this supplement.
The change to the agreement are as follows:
Project Description
Name SW Campus Drive Preservation Project Length 1.5 mi
Termini 19th Ave SW to 1st Ave S
Description of Work ✓ No Change
Reason for Supplement
Obligate additional Construction Funds
Are you claiming indirect cost rate? ✓ Yes ❑No Project Agreement End Date 05/05/2020
Does this change require additional Right of Way or Easements?L7 Yes ✓ No Advertisement Date:5/30/2018
Estimate of Funding
I
Type of Work Previous (2) )
Estimated Total Estimated Agency EstimatedFederal
Supplement
Agreement/Suppl. Project Funds Funds I Funds
P86.5 %a.Agency
E , 67,751.00 67,751.00 9,146.00 58,605.00
b.Other 119,249.00 19,249.00 119,249.00
i
Federal Aid
Participation c.Other 0.00
Ratio for PE d.State 3,000.00 1 i 3,000.00 405.00 2,595.00
e.Total PE Cost Estimate(a+b+c+d)
90,000.00 0.00 1 90,000.00 28,800.00 61,200.00
Right of Way 0.00
f.Agency
g.Other 0.00
Federal Aid h.Other ! , 0.00
Participation
Ratio for RW i.State 0.00
j.Total R/W Cost Estimate(f+g+h+i) 0.00 0.00 0.00 ' 0.00 0.00
Construction k.Contract 988,756.00 988,756.00 133,482.00 855,274.00
86.5
I.Other (Contr.Additional Fund) 439,306.00 439,306.00 59,306.00 380,000.00
m.Other (Contr.Non-participating) 280,174.00 , 61,903.00 342,077.00 342,077.00
Federal Aidn.Other (Testing) 5,000.00 � 5,000.00 ; 675.00 4,325.00
Participation
(Ratio for CN o.Agency 33,070.00 33,070.00 4,464.00 28,606.00
p.State 3,000.00 I , 3,000.00 405.00 2,595.00
q.Total CN Cost Estimate(k+l+m+n+o+o) 1,310,000.00 501,209.00 1,811,209.00 540,409.00 1,270,800.00 i
r.Total Project Cost Estimate(e'+ ) i 1,400,000.00 I 501,209.00 1,901,209.00 569,209.00 , 1,332,000.00
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.
Agenc fficial Washington State Department of Transportation
By 7/1, 1 By
Title ayor Director, Local Program
Date Executed
DOT Form 140-041 Page 1
Revised 05/2015
`6
Agency Supplement Number
City of Federal Way 2
;Federal Aid Project Number 'Agreement Number CFDA No. 20.205
NHPP- 1008(004) LA-9187 %(Catalog of Federal Domestic Assistance)
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 05/2015
0 0
llvals#l�l rState ii, "4.ocal Agency Agreement Supplement
WAIF Department of Transportation
Agency Supplement Number
City of Federal Way 2
Federal Aid Project Number Agreement Number CFDA No. 20.205
NHPP-1008(004) LA-9187 (Catalog of Federal Domestic Assistance)
The Local Agency requests to supplement the agreement entered into and executed on 4/20/2018
All provisions in the basic agreement remain in effect except as modified by this supplement.
The change to the agreement are as follows: '
Project Description
Name SW Campus Drive Preservation Project Length 1.5 mi
Termini 19th Ave SW to 1st Ave S
Description of Work ✓ No Change
Reason for Supplement
Obligate additional Construction Funds
Are you claiming indirect cost rate? Yes No Project Agreement End Date 05/05/2020
Does this change require additional Right of Way or Easements?I Yes ✓ No Advertisement Date:5/30/2018
Estimate of Funding
T e of Work (1) 2 (3) I (4) (5)
YP 1 Previous ( ) Estimated Total 1lEstimated Agency Estimated Federal
Agreement/Suppl. Supplement Project Funds I Funds Funds
PE
86.5 %a.Agency 67,751.00 67,751.00 19,146.00 58,605.00
b.Other 19,249.00 19,249.00 19,249.00
Federal Aid c.Other 0.00
Participation
Ratio for PE d.State 3,000.00 3,000.00 405.00 2,595.00
e.Total PE Cost Estimate(a+b+c+d) 90,000.00 0.00 90,000.00 28,800.00 61,200.00
(Right of Way f A enc 0.00
9 Y
q.Other 0.00 ,
Federal Aid h.Other 0.00
Participation
Ratio for RW i.State 0.00
j.Total R/W Cost Estimate(f+q+h+i) 0.00 0.00 0.00 0.00 0.00
Construction 988,756.00 988,756.00 133,482.00 855,274.00
86.5 %k.Contract
I.Other (Contr.Additional Fund) 439,306.00 439,306.00 59,306.00 380,000.00
m.Other (Contr.Non-participating) 280,174.00 61,903.00 342,077.00 342,077.00
Federal Aid n.Other (Testing) 5,000.00 5,000.00 675.00 4,325.00
Participation
Ratio for CN o.Agency 33,070.00 33,070.00 4,464.00 28,606.00
1
p.State 3,000.00 3,000.00 405.00 2,595.00
q.Total CN Cost Estimate(k+l+m+n+o+a) 1,310,000.00 1501,209.00 1,811,209.00 540,409.00 1,270,800.00
r.Total Project Cost Estimate(e+j+a) 1,400,000.00 501,209.00 1,901,209.00 569,209.00 1,332,000.00
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 pr+visions.
Agenc fficial Washing •n . - Department , Transportation
By 7/1 / By mow• _
Air
Title ayor Director, Local rogram
Date Executed
DOT Form 140-041 JUL 1 7 2018 Page 1
. Revised 05/2015
• •
Agency Supplement Number
City of Federal Way 2
Federal Aid Project Number Agreement Number CFDA No. 20.205
NHPP-1008(004) LA-9187 .(Catalog of Federal Domestic Assistance)
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$750,000 or more in federal
awards from all sources during a given fiscal year shall have a single or program-specific audit performed for that year in
accordance with the provisions of 2 CFR Part 200.501. Upon conclusion of the audit, the Agency shall be responsible for
ensuring that a copy of the report is transmitted promptly to the State.
XVII.Assurances
Local Agencies receiving Federal funding from the USDOT or its operating administrations (i.e., Federal Highway
Administration, Federal Transit Administration, Federal Aviation Administration) are required to submit a written policy
statement, signed by the Agency Executive and addressed to the State, documenting that all programs, activities and
services will be conducted in compliance with Section 504 and the Americans with Disabilities Act(ADA).
DOT Form 140-041 Page 2
Revised 05/2015
RETURN TO: PW ADMIN EXT: 2700 ID#: 5 3 3 3
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT/DIV: PUBLIC WORKS/
2. ORIGINATING STAFF PERSON: EXT: 3. DATE REQ.BY:
3. TYPE OF DOCUMENT(CHECK ONE):
o CONTRACTOR SELECTION DOCUMENT(E.G.,RFB,RFP,RFQ)
o PUBLIC WORKS CONTRACT o SMALL OR LIMITED PUBLIC WORKS CONTRACT
o PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
o GOODS AND SERVICE AGREEMENT o HUMAN SERVICES/CDBG
o REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT(E.G.BOND RELATED DOCUMENTS)
o ORDINANCE 7^(Si ❑ RESOLUTION
(
CONTRACT AMENDMENT AG#): I `
o INTERLOCAL
❑ OTHER �/`� �'�j ��,,�! 1 y i� fl I ( �/
4. PROJECT NAME: !�'CJ iv �1' �I C,S-6"y (}'� C' J C av ` u1/4c, C1 ,
5. NAME OF CONTRACTOR: V V
ADDRESS: TELEPHONE:
E-MAIL: FAX:
SIGNATURE NAME: TITLE:
6. EXHIBITS AND ATTACHMENTS:o SCOPE,WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER
REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN o REQUIRED LICENSES 0 PRIOR CONTRACT/AMENDMENTS
CFW LICENSE# BL,EXP. 12/31/ UBI# ,EXP. /_/_
7. TERM: COMMENCEMENT DATE: COMPLETION DATE:
S. TOTAL COMPENSATION:$ (INCLUDE EXPENSES AND SALES TAX,IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE-ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑YES ❑NO IF YES,MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED: o YES ❑NO IF YES,$ PAID BY: o CONTRACTOR ❑CITY
RETAINAGE: RETAINAGE AMOUNT: ❑RETAINAGE AGREEMENT(SEE CONTRACT) OR c RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO:
9. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATE APPROVED
o PROJECT MANAGER
o DIVISION MANAGER
o DEPUTY DIRECTOR
o DIRECTOR
o RISK MANAGEMENT (IF APPLICABLE)
o LAW DEPT
10. COUNCIL APPROVAL(IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
11. CONTRACT SIGNATURE ROUTING i
o SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:
o ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE,L NSES,EXHIBITS
o CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE
(INCLUDE DEPT.SUPPORT STAFF IF NECESSARY AND FEEL FREE TO SET NOTIFICATION MORE THAN A MONTH IN ADVANCE IF COUNCIL APPROVAL IS NEEDED.)
INITIAL/DATE SIGNED
o FINANCE DEPARTMENT
o LAW DEPT
/ S�IGNATORY(MAYOR OR DIRECTOR) Lill .l
❑'CITY CLERK p
' ASSIGNED AG# AG# \14441
1r�,�1C�' SIGNED COPY RETURNED DATE SENT: 1 4 V' '
❑RETURN ONE ORIGINAL
COMMENTS:
EXECUTE" "ORIGINALS
1/2018
1i 1. )$
A
VIIn Local Agency Agreement Supplement
Department of Transportation
Agency Supplement Number
City of Federal Way 1
Federal Aid Project Number Agreement Number CFDA No. 20.205
NHPP-1008(004) LA-9187 (Catalog of Federal Domestic Assistance)
The Local Agency requests to supplement the agreement entered into and executed on
All provisions in the basic agreement remain in effect except as modified by this supplement.
The change to the agreement are as follows:
Project Description
Name SW Campus Drive Preservation Project Length 1.5 miles
Termini 19th PI SW to 1st Ave S
Description of Work ✓ No Change
Reason for Supplement
Obligation of Construction Funds
Are you claimingindirect cost rate? Yes No Agreement End Date May5,2020
✓ Project9
Does this change require additional Right of Way or Easements? 1 Yes ✓ No Advertisement Date:May 5,2018
Estimate of Funding
Type of Work
Previous i (2) Estimated Total I Estimated Agency Estimated)Federal
Supplement
Agreement/Suppl.I Project Funds Funds I Funds
PE 67,751.00 1 67,751.00 9,146.00 158,605.00
86.5 % a.Agency
b.Other Agency NonParticipating 19,249.00 19,249.00 19,249.00
Federal Aid 0.00
Participation c.OtherI
Ratio for PE d.State 3,000.00 3,000.00 405.00 2,595.00
e.Total PE Cost Estimate(a4'c+d) 90,000.00 0.00 90,000.00 28,800.00 61,200.00
Right of Wayo f.Agency 0.00
g.Other 0.00
Federal Aid h.Other 0.00
Participation
Ratio for RW i.State 0.00
j.Total RNV Cost Estimate(f.a+n+i) 0.00 0.00 0.00 0.00 0.00
!C8o6nstructio% k.Contract 988,756.00 988,756.00 133,482.00 855,274.00
I.Other Contr.Non-participating 280,174.00 280,174.00 ' 280,174.00
m.Other Material Testing 5,000.00 5,000.00 ' 675.00 4325.00
Federal Aid n.Other 0.00
Participation
Ratio for CN o.Agency 33,070.00 33,070.00 4,464.00 28,606.00
D.State 3,000.00 3,000.00 405.00 2,595.00
a.Total CN Cost Estimate(k+l+m+n+o+o) 0.00 11,310,000.00 1,310,000.00 1419,200.00 890,800.00
r.Total Project Cost Estimate(e+j+n) 90,000.00 1,310,000.00 1,400,000.00 448,000.00 952,000.00
The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a
conditio j�to payment ederal funds obligated, it accepts and will comply with the applicable pr.visions.
Age cy •fficia Washington S t Department o ransportation
s
By 4, a tts k........ By
Title Mayor Director, Local P 'gram
Date Executed APR 2 0 2018
DOT Form 140-041 Page 1
Revised 05/2015
Agency Supplement Number
City of Federal Way 11
Federal Aid Project Number 'Agreement Number 1CFDA No. 20.205
NHPP-1008(004) LA-9187 '(Catalog of Federal Domestic Assistance)
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 05/2015
RETURN TO: PW ADMIN EXT: 2700 ID #: %j 1I
CITY OF FEDERAL WAY{ LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT /DIV: PUBLIC WOORKSS1/ ��'1 3 ,, S
j
2. ORIGINATING STAFF PERSON: JI + t4 f V ExT: T7 t 1 3. DATE REQ. BY:
3. TYPE OF DOCUMENT (CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC
❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G.
❑ ORDINANCE ❑ RESOLUTION
❑ CONTRACT AMENDMENT (AG #): XINTERLOCAL
WORKS CONTRACT
BOND RELATED DOCUMENTS)
❑ OTHER
4. PROJECT NAMES CA. rn r sDrive- f 5c V h l �J
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5. NAME OF CONTRACTOR: V / O 1
ADDRESS: TELEPHONE:
E -MAIL: VYlOi h OVA t1,4. d - DV FAX:
SIGNATURE NAME: a / e CiX TITLE:
6. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE
REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS
CFW LICENSE # BL, EXP. 12/31/ UBI # , EXP. / /
❑ ALL OTHER
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7. TERM: COMMENCEMENT DATE: 11 l g-L I —1 l COMPLETION DATE: ) % I L % 1.1
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8. TOTAL COMPENSATION: $ CO `/ gOG pL L� (INCLUDE
EXPENSES AND SALES TAX, IF ANY)
TITLES AND HOLIDAY RATES)
$
(IF CALCULATED ON HOURLY LABOR CHARGE A�IACH SCHEDULES OF EMPLOYEES
REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT:
IS SALES TAX OWED: ❑ YES ❑ NO IF YES, $
PAID BY: ❑ CONTRACTOR
❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE
CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE To:
9. DOCUMENT / CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
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Al. DEPUTY DIRECTOR — Z
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❑ RISK MANAGEMENT (IF APPLICABLE)
)y LAW DEPT
10. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE:
11. CONTRACT SIGNATURE ROUTING l �J ( j
SENT TO VENDOR /CONTRACTOR DATE SENT: ` I b) 1/ l n DATE REC'D: 11 `"" ` 1I
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
VREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE
(INCLUDE DEPT. SUPPORT STAFF IF NECESSARY AND FEEL FREE TO SET NOTIFICATION MORE THAN A MONTH IN ADVANCE IF COUNCIL APPROVAL
INITIAL / DATE SIGNED
IS NEEDED.)
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SIGNATORY (MAYOR 1 b 1,
❑ CITY CLERK 2 1 111 WO s
AG# AG 11181
,ASSIGNED
SIGNED COPY RETURNED DATE SENT: Z
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❑ RETURN ONE ORIGINAL 1 %
COMMENTS:
EXECUTE " " ORIGINALS
NoA vtvi a "ad EP I-Aw or 4o exec IA+ , dt .
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4/2017
Washington) State
WAIF Deft of Transportation
Agency City of Federal Way
Address 33325 8th Ave S
Federal Way, WA 98003
Local Agency Agreement
CFDA No. 20.205
(Catalog or Federal Domestic Assistance)
Project No. Nit PP- loot (0°4
Agreement No. 9 ii?
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) the policies and procedures promulgated by the
Washington State Department of Transportation, and (5) 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 Govemment shall be the responsibility of the Local Agency.
Project Description
Name SW Campus Drive Preservation Project
Termini 19th Ave SW to 1st Ave S
Description of Work
Planing, pavement repair, asphalt overlay, replace signal loops, pedestrian push button upgrade, and upgrade curb ramps.
Length 1.5 mi
Project Agreement End Date 12/31/2019
Proposed Advertisement Date
Claiming
Indirect Cost Rate
Yes ✓ No
Type of Work
Estimate of Funding
(1)
Estimated Total
Project Funds
(2)
Estimated Agency
Funds
(3)
Estimated Federal
Funds
PE a.Agency
67751
9146
58605
%
86.5 �0 b. Other Agency Non Participating
19249
19249
Federal Aid c. Other
Participation
d. State
3000
405
2595
Ratio for PE
e. Total PE Cost Estimate (a4b4c4d)
90,000.00
28,800.00
61,200.00
Right of Way f. Agency
g. Other
Federal Aid h. Other
Participation
Ratio for RW i. State
j. Total RNV Cost Estimate (f+o+h i)
0.00
0.00
0.00
Construction k. Contract
I. Other
m. Other
Federal Aid n. Other
Participation
o. Agency
Ratio for CN
p. State
q. Total CN Cost Estimate (k4i nw o4p)
0.00
0.00
0.00
r. Total Project Cost Estimate (e+i a)
90,000.00
Washinaton State
28,800.00
Department of
61,200.00
ftansoortation
Aaencv Official -, /I
By
Title
May
DOT Form 140 -039
Revised 05/2015
/v7/-1/1
By
Director, Local Pr i grams
Date Executed
NOV 02 2017
Page 1
Construction Method of Financing (Check Method Selected)
State Ad and Award
Method A - Advance Payment - Agency Share of total construction cost (based on contract award)
Method B - Withhold from gas tax the Agency's share of total construction coast (line 5, column 2) in the amount of
$ at $ per month for months.
Local Force or Local Ad and Award
Method C - Agency cost incurred with partial reimbursement
The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and
as a condition to payment of hte federal funds obligated, it accepts and will comply with the applicable provisions
set forth below. Adopted by official action on
September 19 , 2017 , Resolution /Ordinance No. 17 -725
Provisions
I. Scope of Work
The Agency shall provide all the work, labor, materials, and services necessary to perform the project which is described and set
forth in detail in the "Project Description" and "Type of Work."
When the State acts for and on behalf of the Agency, the State shall be deemed an agent of the Agency and shall perform the
services described and indicated in "Type of Work" on the face of this agreement, in accordance with plans and specifications as
proposed by the Agency and approved by the State and the Federal Highway Administration.
When the State acts for the Agency but is not subject to the right of control by the Agency, the State shall have the right to perform
the work subject to the ordinary procedures of the State and Federal Highway Administration.
II. Delegation of Authority
The State is willing to fulfill the responsibilities to the Federal Government by the administration of this project. The Agency agrees
that the State shall have the full authority to carry out this administration. The State shall review, process, and approve documents
required for federal aid reimbursement in accordance with federal requirements. If the State advertises and awards the contract, the
State will further act for the Agency in all matters concerning the project as requested by the Agency. If the Local Agency advertises and
awards the project, the State shall review the work to ensure conformity with the approved plans and specifications.
III. Project Administration
Certain types of work and services shall be provided by the State on this project as requested by the Agency and described in the
Type of Work above. In addition, the State will furnish qualified personnel for the supervision and inspection of the work in progress. On
Local Agency advertised and awarded projects, the supervision and inspection shall be limited to ensuring all work is in conformance
with approved plans, specifications, and federal aid requirements. The salary of such engineer or other supervisor and all other salaries
and costs incurred by State forces upon the project will be considered a cost thereof. All costs related to this project incurred by
employees of the State in the customary manner on highway payrolls and vouchers shall be charged as costs of the project.
IV. Availability of Records
All project records in support of all costs incurred and actual expenditures kept by the Agency are to be maintained in accordance
with local government accounting procedures prescribed by the Washington State Auditor's Office, the U.S. Department of
Transportation, and the Washington State Department of Transportation. The records shall be open to inspection by the State and
Federal Government at all reasonable times and shall be retained and made available for such inspection for a period of not less than
three years from the final payment of any federal aid funds to the Agency. Copies of said records shall be furnished to the State and /or
Federal Government upon request.
V. Compliance with Provisions
The Agency shall not incur any federal aid participation costs on any classification of work on this project until authorized in writing
by the State for each classification. The classifications of work for projects are
1. Preliminary engineering.
2. Right of way acquisition.
3. Project construction.
Once written authorization is given, the Agency agrees to show continuous progress through monthly billings. Failure to show
continuous progress may result the Agency's project becoming inactive, as described in 23 CFR 630, and subject to de- obligation of
federal aid funds and /or agreement closure.
If right of way acquisition, or actual construction of the road for which preliminary engineering is undertaken is not started by the
close of the tenth fiscal year following the fiscal year in which preliminary engineering phase was authorized, the Agency will repay to
the State the sum or sums of federal funds paid to the Agency under the terms of this agreement (see Section IX).
If actual construction of the road for which right of way has been purchased is not started by the close of the tenth fiscal year
following the fiscal year in which the right of way phase was authorized, the Agency will repay to the State the sum or sums of federal
funds paid to the Agency under the terms of this agreement (see Section IX).
DO Harm 140 -039 Page 2
Revised 05/2015
XUI. Liquidated Damages
The Agency hereby agrees that the liquidated damages provisions of 23 CFR Part 635, Subpart 127, as supplemented, relative to
the amount of Federal participation in the project cost, shall be applicable in the event the contractor fails to complete the contract within
the contract time. Failure to include liquidated damages provision will not relieve the Agency from reduction of federal participation in
accordance with this paragraph.
XIV. Termination for Public Convenience
The Secretary of the Washington State Department of Transportation may terminate the contract in whole, or from time to time in
part, whenever:
(1) The requisite federal funding becomes unavailable through failure of appropriation or otherwise.
(2) The contractor is prevented from proceeding with the work as a direct result of an Executive Order of the President with
respect to the prosecution of war or in the interest of national defense, or an Executive Order of the President or Governor of
the State with respect to the preservation of energy resources.
(3) The contractor is prevented from proceeding with the work by reason of a preliminary, special, or permanent restraining
order of a court of competent jurisdiction where the issuance of such order is primarily caused by the acts or omissions of
persons or agencies other than the contractor.
(4) The Secretary is notified by the Federal Highway Administration that the project is inactive.
(5) The Secretary determines that such termination is in the best interests of the State.
XV. Venue for Claims and/or Causes of Action
For the convenience of the parties to this contract, it is agreed that any claims and /or causes of action which the Local Agency
has against the State of Washington, growing out of this contract or the project with which it is concerned, shall be brought only in the
Superior Court for Thurston County.
XVI. Certification Regarding the Restrictions of the Use of Federal Funds for Lobbying
The approving authority certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or
an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment,
or modification of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or an employee
of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit the Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at
all tiers (including subgrants, and contracts and subcontracts under grants, subgrants, loans, and cooperative agreements) which
exceed $100,000, and that all such subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.
Submission of this certification as a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.
Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
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).
Additional Provisions
DOT Form 140 -039 Page 5
Revised 05/2015