17-107.01 WSDOT: Citywide Signal Backplates 11- 107 . d1
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-Aft pniry
Am Washington State
Depar#> t ofT >o 1� Local Agency Agreement Supplement
Agency Supplement Number
City of Spokane Valley 1
Federal Aid Project Number Agreement Number CFDA No. 20.205
HSIP-000S(463) LAA-9093 (Catalog of Federal Domestic Assistance)
The Local Agency requests to supplement the agreement entered into and executed on 7/25/2017
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 Citywide Signal Backplates Length n/a
Termini City Wide
Description of Work ✓ No Change
This project will add reflectorized borders to traffic signal backplates at signalized intersections.
Reason for Supplement
Obligating CN Funds
Are you claiming indirect cost rate? 1 Yes ,/ No Project Agreement End Date 12/31/19
Does this change require additional Right of Way or Easements?I !Yes I No Advertisement Date:8/31/17
Estimate of Funding
(1) (3) (4) (5)
Type of Work (2)
Previous Supplement Estimated Total Estimated Agency Estimated Federal
Agreement/Suppl. Project Funds Funds Funds
PE 9,320.00 -9,120.00 200.00 200.00
100 %a.Agency
b.Other 0.00
Federal Aid 0.00
Participation c.Other
Ratio for PE d.State 1,000.00 1,000.00 1,000.00
e.Total PE Cost Estimate(a+b+c+d) 10,320.00 -9,120.00 1,200.00 0.00 1,200.00
Right of Wayo f.Agency 0.00
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+a+h+i) 0.00 0.00 0.00 0.00 0.00
Construction
100 % k.Contract 0.00
I.Other Spokane County 24,321.00 24A21.00 24,321.00
m.Other Materials 81,047.00 81,047.00 81047
Federal Aid n.Other 0. 0
Participation
Ratio for CN o.Agency 7,487.00, 7,487.00 7,487.00
p.State 9,775.00 9,775.00 9,775.00
q.Total CN Cost Estimate(k+l+m+n+o+o) 0.00 122,630.00 122,630.00 0.00 122,630.00
r.Total Project Cost Estimate(e+j+a) 10,320.00 113,510.00 123,830.00 0.00 123,830.00
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 th- applicable pj.visions.
Agency Official Wa hington S •t.- e.. . ent . Transportation
By 3/-/7 By )10.464e
Titleit c
Capital Improvement Manager D e tor, Local 'rogram
Date Executed AUG 1 8 2017
DOT Form 140-041 Page 1
RR Revised 05/2015
Agency Supplement Number
City of Spokane Valley 1
Federal Aid Project Number Agreement Number CFDA No. 20.205
HSIP-000S(463) LAA-9093 (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 retainedfor 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 allotmentsto the Agency from,the Motor Vehicle Fund. N9 additjonal,Fesleral 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 9dministrations (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