13-126.00 WSDOT: Mansfield Ave ConnectionAGENCY
� Washington State
VI/ Department of Transportation Local Agency Agreement Supplement
Agency
Supplement Number
City of Spokane Valley
1
Federal Aid Project Number
Agreement Number
CFDA No. 20.205
CM-1223(002)
LA 7624
Catalo of Federal Domestic Assistance
The Local Agency requests to supplement the agreement entered into and executed on 11/21/2011
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 Mansfield Ave Connection
Termini Pines Rd to 200 ft east of Houk Road
Description of Work ® No Change
Reason for Supplement
(1) Increase PE for additional consultant services used,
(2) Request RW funds
Does this chance require additional Riaht of Wav or Easements? ® Yes ❑ No
Length 0.21 miles
Type of Work
yp
Estimate of Funding
(�)
Previous
Agreement/Suppl.
(2)
Supplement
(3)
Estimated Total
Project Funds
(4)
Estimated Agency
Funds
(5)
Estimated
Federal Funds
PE a. Agency
100,000.00
100,000.00
13,500.00
86,500.00
86.5 % b. Other Consultant
21,000.00
37,000.00
58,000.00
7,830.00
50,170.00
c. Other
Federal Aid d. State
5,000.00
5,000.00
675.00
4,325.00
Participation
Ratio for PE e. Total PE Cost Estimate (a +b +c +d)
126 000.00
37 000.00
163,000.00
22,005.00
140,995.00
Right of Way f. Agency
14,600.00
14,600.00
1,971.00
12,629.00
86.5 % . Other Consultant
81 823.00
81 823.00
11 046.00
70 777.00
Federal Aid h. Other RW purchases & relocations
719,629.00
719,62 -00
97,150-00
622,479-00
Participation
Ratio for RW i. State
5,000.00
5,000.00
675.00
4,325.00
j. Total RAN Cost Estimate (f +g +h +i)
821,052.00
821,052.0
4
710,210.09
Construction k. Contract
I. Other
m. Other
%
n. Other
Federal Aid
Participation o. Agency
Ratio for CN . State
q. Total CN Cost Estimate k+l+m+n+o
r. Total Project Cost Estimate e '
2 6.000.00�
858.052.00
984.052.001
2 0
The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a condition
to p
Ag
By
uaie r_xecutec
v a LV IJ
DOT Form 140 -041 EF
Revised 03/2011
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