12-150.01 WSDOT: Pines & Grace Intersection Safety Project r ice- I SI) • 0 i
•
V.711 Washington State
Deparbnenton •
Local Agency Agreement Supplement
Agency Supplement Number
City of Spokane Valley l •
Federal Aid Project Number Agreement Number CFDA No. 20.205
HSIP-0027(013) LA-7796 - (Catalog of Federal Domestic Assistance)
The Local Agency requests to supplement the agreement entered into and executed on • \c3 `\0`\-L
All provisions in the basic agreement remain in effect except as'modified by this supplement.
The changes to the agreement are as follows:
Project Description •
Name Pines Rd and Grace Ave Intersection Safety Project Length 740+/-
Termini SR 27 MP 87.24 and MP 87.38
Description of Work ® No Change '
•
Widen SR 27 with a center turn lane
Reason for Supplement
Request ROW funds
•
Does this change require additional Right of Way or Easements? 0 Yes ®No Advertisement Date:
Estimate of Funding
Type of Work • (1) (2) • (3) (4) (5)
Previous Supplement Estimated Total Estimated Agency Estimated
Agreement/Suppl. Project Funds Funds Federal Funds
PE a.Agency 67,200.00 67,200.00 67,200.00
100 % b.Other •
c.Other
Federal Ald •
d.State 1,000.00 1,000.00 1,000.00
Participation
Ratio for PE e.Total PE Cost Estimate(a+b+c+d) 68,200.00 68,200.00 68,200.00
Right of Way 1.Agency 242,416.00 242,416.00 242,416.00
100 % g.Other ROW Consultant 36.584.00 36.584.00 36.584.00
Federal Aid h. Other
Participation •
Ratio for RW I.State 1.000.00 1.000.00 1.000.00
J.Total R/W Cost Estimate(f+g+h+l) 280.000.00 280.000.00 280,000.00
Construction k.Contract
I. Other
% m.Other •
•
Federal Aid n.Other
Participation o.Agency •
Ratio for CN p.State
q.Total CN Cost Estimate(k+1+m+n+o+p)
r.Total Project Cost Estimate(e+(+4) • 68.200.00 280.000.00 348.200.00 348.200,00
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 appiicabi= •rovisi,ns.
Agency Official Washin t on State b - ailment of Tr sportation
By .. By //�. - .
Title Pv/Z I C LiA4trif y Dae,cC7i4(. Director of Local Prograde •
OCT 15 2014
. Date Executed .
DOT Form 140-041 EF
Revised 03/2014