05-012.00 WSDOT Dishman Mica Rd RehabWashington State
VTF
Department of Transportation
Agency City of Spokane Valley
Address C/O Public Works Department
11707 E. Sprague Avenue
Spokane Valley, WA 99206
Lola) Agency Agreement
CFDA No. 20.205
(Catalog of Federal Domestic Assistance)
Project No.
Agreement No.
For OSC WSDOT Use Only
The Local Agency having complied, or hereby agreeing to onmply, with the terms and conditions set forth in (1) Title 23. U.S. Code Highways, (2) the regulations issued
pursuant thereto, (3) Office of Management and Budget Circulars A -102, A -87 and A -133, (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 Govemmcm, relative to the above project, the
Washington State Department of Transpnnation will authorize the Local Agency to proceed on the project by a separate notification. Federal funds which are to be
obligated for the project tray not exceed the amount shown herein on lute r, column 3, Aithout written authority by the Slate, subject to the approval of the Federal
Highway Administratian. All project costs not reimbursed by the Federal Government shall be die responsibility of the Local Agency.
Project Description
Name Dishman -Mica Road Rehabilitation
Length 0.09 miles
Termini 1st Avenue to Sprague Avenue
Description of Work
This project will improve 0.09 miles of roadway by patching/repairing and removing and replacing the emoting asphalt
with a minimum of 4 inches of asphalt concrete pavement.
Agency Official
By
Washington State Department of Transportation
By
Title City Manager Assistant Secretary for Highways and Local Programs
City -o - Spokane— Yall.e_y Date Executed
DOT Form i4o•038 EF
Revised 10P02
Estimate of Funding
Estimated Total
Estimated, Agency
Estimated
Type of Work
Project Funds
Funds
Federal Funds
PE a. Agency
5,900.00
800.001
5,100.00
86.5 % b. Other
c. Other
Federal Aid d. State
Participation
Ratio for PE e. Total PE Cost Estimate a +b+c +d
5,900.00
800.00
5,100.00
Right of Way f_Agenc
aka —9. Other Consultant
h. Other
Federal Aid i. State
Participation
Ratio for RW i. Total R/W Cost Estimate f+ +h +t
Construction k. Contract
I. Other
M. Other
n. Other
% o. Agencyryry
II
Federal Aid State
Participation —
Ratio for CN Total CN Cost Estimate k +l +m +n +o+
I
r. Total Project Cost Estimate (e +j +q)
1 5,900.001
800-001
5,100.00
Agency Official
By
Washington State Department of Transportation
By
Title City Manager Assistant Secretary for Highways and Local Programs
City -o - Spokane— Yall.e_y Date Executed
DOT Form i4o•038 EF
Revised 10P02
Construction Method of Finari -..•f (Check MethodSOected)
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 cost (line 4, column 2) in the amount of
at $ per month for
Local Force or Local Ad and Award
0 Method C - Agency cost incurred with partial reimbursement
Provisions
months.
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 set forth
below. Adopted by official action on
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 shal I have the
full authority to tarty 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 r. 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 maintnined in accordance with local government
acoounting procedures prescribed by the Washington State Auditor's Office,
the U.S. Department of Transportation, and the Washington State Department
of Transportation. The records shali be open to insp=tion 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:
DOT Form 14M39 EF
Revised 10102
, Resolution /Ordinance No.
1. Preliminary engineering.
2, Right of way acquisition.
3. Project construction.
in the event that right of way acquisition, or actual construction of the road, for
which preliminary engineering is undertaken is not started by the closing of the tenth
fiscal year following the fiscal year in which the agreement is executed, 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 >X).
The Agency agrees that all stages of construction necessary to provide the initially
planned complete facility within the limits of this project will conform to at least the
minimum values set by approved statewide design standards applicable to this class
of highways, even though such additional work is financed without federal aid
participation.
The Agency agrees that on federal aid highway construction projects, the current
federal aid regulations which apply to liquidated damages relative to the basis of
federal participation in the project cost shall be applicable in the event the contractor
fails to complete the contract within the contract time.
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 Transportation
Equity Act for the 21st Cenniry (TEA 21), as amended, and Office of
Management and Budget circulars A -102, A -97 and A -133. The State shall not
be ultimately responsible for any of the costs of the project. The Aeencv shall be
ultimately responsible for all toss 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 mimimvx the time elapsed
between reccipt of federal aid funds and subsequent payment of incurred Costs.
Expenditures by the Local Agency for maintenance., general administration,
supendsion, and oilier overhead shall not be eligible for federal participation unless
an indirect cost plan has been approved by WSDOT.
17te State will pay for Suite inured 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 fnr that portion of State costs which were not reimbursed by the
Federal Government (see Section IX).
Project Construction Costs
Project construction financing will be accomplished by one of the three
methods as indicated in this agreement
Method A — The Agency will place with the )within (20) days after the
execution of the construction contract, an advan c v the amount of the
Agency's share of the total construction cost based on the contract award. The
State will notify the Agency of the exact amount to be deposited wish the State.
The State will pay all costs incurred under the contract upon presentation of
progress billings Oom the contractor. Following such payments, the State will
submit a billing to the Federal Govemment for the federal aid participation
share of die cost. When the project is substantially completed and final actual
costs of the project can be determined, the State will present the Agcncy with a
final billing showing the amount due the State Or the amount due the Agency.
This billing will be cleared by either a payment from the Agency to die State or
by a refund from the State to the Agency.
Method B — The Agency's share of the total construction cost as shown on
the face of this agreement shall be withheld from its monthly fuel tax
allotments. The face of this agreement establishes the months in which the
withholding shall take place and the exact amount to be withheld each month.
The extent ofwithholding %till be confirmed by Icnw from the State at the tune
of contract award. Upon receipt of progress billings from the conuractor, the
State will submit such billings in the Federal Government for payment of its
participating portion of such billings.
Method C — The Agency may submit vouchers to the State in the format
prescribed by the State, in duplicate, not more than once per month for those
costs eligible for Federal participation to the extent that such costs are directly
attributable and pmperiy allocable to this project. Expenditures by the Local
Agency for maintenance, general administration, supervision, and other
overhead shall not be eligible for Federal participation unless claimed under a
previously approved indirect cost plan.
The State shall reimburse the Agency for the Federal share of eligible project
costs up to the amount shown on the face of this agreement. At the time of
audit, the Agency will provide documentation of all costs incurred on the
project.
The Suite shall bill the Agency for all costs incurred by the State relative to
the project. The State shall also bill the Agency for the federal funds paid by
the State to the Agency for project costs which are subsequently determined to
be ineligible for federal participation (see Section DQ.
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 FMWA; and Office of Management
and Budget Circular A -133.
If upon audit it is found that overpayment or participation of federal
money in ineligible items ofeost has occurred, the Agency shall reimburse
the State for the amount of such overpayment or excess participation (see
Section DQ,
VIII. Single Audit Act
The Agency, as a subr cipicni of federal finds, shall adhere to the federal
Office of Management and Budget (OMB) Circular A -133 as well as all
applicable federal and state statutes and regulations. A subrecipient who
expends $300,000 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 OMD Circular A -133. Upon
conclusion of the A -133 audit, the Agency shall be responsible for ensuring
that a copy of the report is transmined promptly to the State.
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 (r. e., 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 suer, 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 the Assistant Secretary for Highways and Local Programs.
DOT Form 140 -039 EF
Revised W02
j.
X. Traffic Control; ,_ling, Marking, and Roadway
Maintenance
The Agency Kill not permit any changes to be made in the provisions for parking
regulations and traffic control on this project without prior approval of die State and
Federal Highway Administration. The Agency will not install or permit to be
installed any signs, signals, or markings not in conformance with the standards
approved by the Federal Highway Administration and MUTCD. The Agency will,
of its own expense, maintain the improvement covered by this agreement
XI. Indemnity
The Agency shall hold the Federal Government and the State harmless from and
shall process and defend at its own expense all claims, demands, or suits, whether at
law or equity brought against the Agency, State, or Federal Govemmenl, arising
from the Agency's execution, performance, or failure to perform tiny of the
provisions of this agreement, or of any other agreement or contract connected with
this agreement, or arising by reason of the participation of the State or Federal
Government in the project, PROVIDED, nothing herein shall require the Agency to
reimburse the State or the Federal Government for damages arising out of bodily
injury to persons or damage to property caused by or resulting from the sole
negligence of the Federal Government or the State.
No liability shall attach to the State ar Federal Government except as expressly
provided herein.
XII. Nondiscrimination Provision
The Agency shall not discriminate on the basis of race, color, national origin, or
sex in the award and performance of any USDOT - assisted contract and/or
agreement or in the administration of its DBE program or the requirements of 49
CFR. Par 26. The Agency shall take all necessary and reasonable steps under 49
CFR Part 26 to ensure nondiscrimination in the award and administration of
USDOT- assisted contracts and agreements. The WSDOT's DBE program, as
required by 49 CFR Pan 26 and as approved by USDOT, is incorporated by
reference in this agreement implementation of this program is a legal obligation
and failure to carry out its terms shall be treated as a violation of this agreement
Upon notification to the Agency of its failure to carry out its approved program, the
Department may impose sanctions as provided for under Part 26 and may, in
appropriate cases, refer the rnauer for enforcement under 18 U.S.C. 1001 and/or the
Proertun Fraud Civil Remedies Act of 1986 (31 U.S.C. 3 801 ci scq,).
The Agency hereby agrees that it will incorporate or cause to be incorporated into
any contract for construction work, or modification thereoL as defined in the rules
and regulations of the Secretary of Labor in 41 CFR Chapter 60, which is paid for in
whole or in part with funds obtained from the Federal Government or borrowed an
the credit of the Federal Govemmeni pursuant to a grant, contract, loan, insurance,
or guarantee or understanding pursuant to any federal program involving such grant,
contract, loan, insurance, or guarantee, the required contract provisions for
Federal -Aid Contracts (FHWA 1273), located in Chapter 44 of the Local Agency
Guidelines.
The Agency further agrees that it will be bound by the above equal opportunity
clause with respect to its own employment practices when it participates in
federally assisted construction work: Provided, that if the applicant so
participating is a State or Local Government, the above equal opportunity clause
is not applicable to any agency, instrumentality, or subdivision of such
government which does not participate in work on or under the contract.
The Agency also agrees:
(1) To assist and cooperate actively with the State in obtaining the compliance of
contractors and subcontractors with the equal opportunity clause and rules.
regulations, and relevant orders of the Secretary of Labor.
(2) To furnish the State such information as it may require for the supervision of
such compliance and that it will otherwise assist the State in die discharge of its
primary responsibility for securing compliance.
(3) To refrain from entering into any contract or contract modification subject to
Executive Order 11246 of September 24, 1965, with a contractor debarred from, or
who has not demonstrated eligibility for, government contracts and federally
assisted construction contracts pursuant to the Executive Order.
(4) To cam out such sanctions and penalties for violation of the equal
opportunity clause as may be imposed upon contractors and subcontractors by the
State, Federal Highway Administration, or the Secretary of Labor pursuant to Part
U, subpart D of the Executive Order.
In iidd iEinn, the Agtmey agrees [h81 if it 1`xil� fI '.' [o comply wItlh thug
under[a! ffigs, the "StaEe may lake and' ur all of [he foilowing actions:
(a) CLmcel, iernrin Roc, nr suspend Lhis ogreernem in whol' -` or in Part;
(b) Kfiraira from eXiend ing any fkth -r assi97ance [O [he Agcnc} under thr
pfogram u$h respect [o which the failur OT rcrLml occurred unlit Sa[isfaclgry
E,ssura mr a of future compl iance has been received from the Agency; and
(c) Reihr thM cOSC to the Department of J uS[ice fur appropriRtc legal prxerd ings_
XIII_ Liquidated Damages
71:. Agency hcrcby argrrs Lha[ Lhe Iiquidaied damages prnvisions Of 23 CFR
Part 635, SubpRrt 127, as supplenicutcd, Tcintive to the arnuun[ of Federal
participatirui in ilk.- project m5t, shal l be apJ3142ble ie the evuLt the cnntracmr
fails [o comptetc the conLraet wilhiti 14e coa nlc[ Timm, I'al]uTe to include
liquidated durkaees provision will not Teliirvr [he A @WL- -Y f70m rcduC #inn of
federal pnnivipRtion in a:cwxLmm Wish Qis paragraph,
XIV. Termination for Public Convenience
The SeLaerary of the Washington 5tste Drparrmeai of Transpomtirm may
[eritsinatc the cawtrad in whole, or from tithe 10 time in part, whenever
(1) The rc4uisitr frderd.1 funding becomes unavailable through Edlure of
appropriation or urherwise,
(2) The contrac[nr is pre+'emed from proceeding wiLh the work as a d imrt
rc5u la Of an E.Kecutive prdcT Of the 1 ?reside0t u'itlt respect to the prOSrcutiou Of
war Or in th" interest of notional defense, Or an Execut1vt t}Tdrr of rh:.
President or Governor Ofthe SIM with respect to the Rrtser,'a[iou Ofcnrr
TmpunxS_
(3 ) The cone -2d r is ptevensed from proDnedina with 1ht work by mason of
a pTelirninmyr spcciP I, oT permanent restraining order of a court of oornpe[ew
j urisd iction where the issuance Of su°-h order is primarily caused by the aces oT
omissions of persons or agencies ether than the conlraciaz.
(4) The 5 tc &MT determines that such tcrminaiion is in the best Laierests Of
the Sta[e_
QOT FGtm 1 0-7 FF
RemSEd 10102
- -,
V. Venue for Cl�-- land1br Causes of Action
Far the convenience of 11tc part ics t0 this mnLmcl, it is agreed Oral any cka bas
aitdfor cause of R:.tion which Lhc LML91 Agency has ago inst the S Lu[r of
Washington, grOVA'ing out of this conLrdu ow Lhe prOjec[ with which ii is
concrrnrd, Shull be bioughl oply in the Sup-riw Court 16TThurs[oI1 COLIJIM
XVL Certification Regarding the; Restrictlons of the Use
of Federal Funds far Lobbying
The approving authority o-- rtifre5, u, the best of his Or her kncr lctigc and belief,
that;
(1) N O federal tlppTopriR[rd funds have, been paid or will be pa id, by Or on bChRlf
of the undcrsignrd, [o any person for M[Icaci ng of attcmptin r [o iniguence an
ofl:icrr or employee of any fcdcFP I agency, a member Of Congress, alt officer or
employee of Congres% nr im rmpl0,'ee of a tttembey of Congress in crimcclinn with
the awudine of my federal Cols6e:lti [hc rnRkingof any fedeail the makutg of
any federal loan, the altering inw Of any cooperative agreement, and tht extension,
continuation, renewal, amendmek4 or mpdifimtion of an3t frdend COMM: grantr
lark, or cOOperatj!5'c REOeement
(2) Lf any funds other titan federal appropriated funds have beck paid OT will he
pnld to Rny person For inilueociC�g or ammp #ing io infkuencc an ofl'iUer or employee
of any federal a member of Congress, an of rer Or ernploycc ofCong ass,
or an employee of a member Of COagress Ju conuc[ion with Ihis federal contra--4
grant, loan, or coopemdvc agreement, th a undersi�nrd shall cumpie[e and submi[
the Staudard Form - I,.LI„ Disclosure Form [o Report L.abbying," in accordance
wjtb its instaactionS.
(3 ) The [mdm igncd anal] reauirr the[ Lbe language of this ccrrifiic"on b-
Incltadcd in the awiLrd dat u nentS for alJ subawar& Rt all tiers (including sub+gano,
and contraers and sub - .insects under grants, subpar nrs, IOaus, and cooperative
agreenreuts) which exceed S 1013,004, and that all such subr=ipients she 11 certify
and dis:losr R:wrdingl ±'_
This Ocrtification is R material rep sucation of bier upon which Telian:x wm
placed xhvn this [reasac[ioa "5 made pr rnirre4! into_ SabntisSion Of this
cer[Ification as a.prcrequisite for making at eiltering into this transaction imposed
by Src[ion 1352, Tile 31. U.S. Godc, Any person who fails to file Lh t tequired
certIficadca she Il be subject w a civil penalty of not less than $ ] 0, 00 and not anon
than 5100,000 fur =h sueh failure,
Additional Provisions
ACIL
7 Washington State
VAIV Department of Transportation
Federal Aid
Project Number
Local Agency
Project Number
Prefix
STPUS
SRTC04 -5
ocal Agency Federal Aid
Project Prospectus
Route
4041 Date 2/22/2005
WSDOT \ Federal Employer REDACTED
Use Only) Tax ID Number
Agency
Total
Estimated Cost
Nearest Hundred Dollar
Local Agency
Funding
(Nearest Hundred Dollar
Federal Program Title
City of Spokane Valley
P.E.
$5,900
® 20.205 ❑ 20.209 ❑ Other
Project Title
1105
RNV
Start Latitude N
Start Longitude W
Dishman-Mica Road Rehabilitation
Const.
$51,200
$6,900
$44,300
06/05
End Latitude N
End Longitude W
Project Termini From
$49,400
To
1 st Avenue
Number of Lanes
3
Sprague Avenue
From: To:
Length of Project
Award Type
7.39 7.48
0.09 miles
1 ® Local ❑ Local Forces ❑ State ❑ Railroad
Federal Agency
City Number
County Number
County Name
WSDOT Region
® FHWA ❑ Others
1223
32
1 Spokane
I EAST
Congressional District
Legislative Districts
Urban Area Number
1
TMA / MPO / RTPO
5
1 4
1 2
SRTC
Phase
Total
Estimated Cost
Nearest Hundred Dollar
Local Agency
Funding
(Nearest Hundred Dollar
Federal Funds
Nearest Hundred Dollar
Phase Start'
Date
Month Year
P.E.
$5,900
$800
$5,100
1105
RNV
$0
$0
$0
Const.
$51,200
$6,900
$44,300
06/05
Total
$57,100
$7,700
$49,400
Description of Existing Facility (Existing Design and Present Condition)
Roadway Width
40
Number of Lanes
3
Dishman-Mica Road between 1st Avenue and Sprague Avenue is a three -lane, principal arterial in the City of Spokane Valley's
road system that carries approximately 13,400 vehicles per day. The current structural condition of Dishman-Mica Road
between 1st Avenue and Sprague Avenue is failed, with a pavement surface condition rating of 29 based on the WSDOT rating
methods and a remaining life of 9 years based on non - destructive testing. This project has severe rutting and flushing, along
with some breakup of the pavement including alligatoring and cracking of the asphalt.
Description of Proposed Work
Roadway Width Number of Lanes
❑ New Construction ® 3 -R ❑ 2 -R 40 3
This project proposes to improve 0.09 miles of roadway by patching/repairing and removing & replacing the existing asphalt
with a minimum of 4 inches of asphalt concrete pavement.
Local Agency Contact Person Phone
Steve M. Worley, PE at` on and 'Imgineer (CIP) 921 -1000
Mailing Address `taX %n {orb ty State Zip Code
11707 E. F-•-- s cont`dentra 82 32 330 to any -)okane Valley WA 99206
t corta�r at to RCW erta%n�r\g V a \ \eY
rs C\OC n cted P%3 our f\nd\ngs o Spokane re \j\eNN
�„ beet' reds cu�ents Pursuant �c�a\
has b r a rev\eW is d obta\r lud Approving Professional Engineer
aV Pets k Jot do 0, an __� ur Capital Projects Engineer Date
Vou m acted or SvN\Ci 215
red `G`Pa\ Co Ce 47_.156. 550' Page 1 of 3 ■ Supersedes Previous Editions ■
pursuant to R
Agency Project Title Date
City of Spokane Valley Dishntan -Mica Road Rehabilitation 2122 /2005
Geometric Design Data
Year
Property
Damage
Accidents
Iniu Accidents
Fatal Accidents
Description
Number of
Accidents
Through Route
Number of
Accidents
Crossroad
Contractor
100 %
❑ Principal Arterial
❑ Principal Arterial
Federal
Urban
❑ Minor Arterial
❑ Collector
Urban
❑ Minor Arterial
❑ Collector
Functional
❑ Major Collector
❑ Major Collector
Classification
❑ Rural
❑ Minor Collector
❑ Rural
❑ Minor Collector
❑ Access Street/Road
❑ Access Street/Road
Terrain
® Flat
❑ Roll ❑ Mountain
❑ Flat
❑ Roll ❑ Mountain
Posted Speed
35
Design- Speed
NIA
Existing ADT
19575
Design Year ADT
NIA
Desi n Year
NIA
Design Hourly Volume (DH
N/A
Accident - 3 Year Experience
Year
Property
Damage
Accidents
Iniu Accidents
Fatal Accidents
Total Number
of Accidents
Number of
Accidents
Number of
Injuries
Number of
Accidents
Number of
Fatalities
Contractor
100 %
%
Performance of Work
Preliminary Engineering Will Be Performed By
Others
Agency
City of Spokane Valley
%
100 %
Construction Will Be Performed By
Contract
Agency
Contractor
100 %
%
I Environmental Classification I
® Final ❑ Preliminary
❑ Class I - Environmental Impact Statement (EIS)
❑ Project Involves NEPA/SEPA Section 404
Interagency Agreement
❑ Class III - Environmental Assessment (EA)
❑ Project Involves NEPAISEPA Section 404
Interagency Agreement
Environmental Considerations
® Class II - Categorically Excluded (CE)
❑ Projects Requiring Documentation
(Documented CE)
DOT Form 140 -101 EF Page 2 of 3
Revised 1712002
Agency Project Title Date
City of Spokane Valley I Dishman -Mica Road Rehabilitation 1 2/22/2005
Right of Way
® No Right of Way Required
❑ Right of Way Required
All construction required by the
❑ No Relocation ❑ Relocation Required
contract can be accomplished
within the existing right of way.
Description of Utility Relocation or Adjustments and Existing Major Structures Involved in the Project
FAA Involvement
Is any airport located within 3.2 kilometers (2 miles) of the proposed project? ❑ Yes ® No
Remarks
This project has been reviewed by the legislative body of the administration agency or agencies, or it's designee, and is
not inconsistent with the agency's comprehensive plan for community development.
Agency
City of Spokane Valley
Date BY LJ t'lil �l
Mayor/Chairperson
DOT Form 140 -10i EF Page 3 of 3
Revised }212002