011-05 - WSDOT - Supplement / Change Order 2j
1Washington State `
Department of Transportation
r
Local Agency Agreement Supplement
Agency Supplement Number
Port Orchard 2
Federal Aid Project Number Agreement Number CFDA No. 20.205
STPUS 6610(004) LA 5855 (Catalog of Federal Domestic Assistance)
The Local Agency desires to supplement the agreement entered into and executed on February 28, 2005
All provisions in the basic agreement remain in effect except as expressly modified by this supplement.
The changes to the agreement are described as follows:
Project Description
Name Tremont Street Widening Length 0.65 Mile
Termini
Description of Work
® No Change
Reason for Supplement
The reason for this request is to obligate the ROW funds to purchase the needed properties to construct the project.
Does this change require additional Right of Way or Easements? ❑ Yes ® No
Type of Work
Estimate of Funding
(1)
Previous
A reement/Su I.
(2)
Supplement
(3)
Estimated Total
Project Funds
(4)
Estimated Agency
Funds
(5)
Estimated
Federal Funds
PE a.Agency
oou, —
3, oc b ^
a qs, —
b. Other
. G 7 7, oGr',
000,'-
c.Other
b00, —
a,vtj�. —
1-:2
Federal Aid
Participation d.State
i8 oov
I
Ik ova,
o1`i3v, -
/S 6'70. "-
Ratio for PE e. Total PE Cost Estimate (a+b+c+d)
7oo u�o,
o� VC),
G Y 5p0, —
(c1)5 5o0, --
Right of Way f. Agency
883,749.00
883,749.00
119,306.12
764,442.88
86.5 % .Other /'��fi
235, 0.00
50,000.00
�2W,6ft.00
38�73:80
-00
Federal Aid h. Other
Participation
Ratio for RW i. State
15,NQ.00
10,000.00
a-5 998 f)0
i 3s0,_3 37-S AO
n. •-2+,69"0
'. Total R/W Cost Estimate (f+ +h+i)
250,000.
, ,
,
, , . 8
Construction k. Contract
`iy3 R , —
`�Y3 7119 —
,J 7 q%
516 3y3
I. Other
m. Other
n. Other
o. Agency
Federal Aid State M
Participation p.
Ratio for CN q. Total CN Cost Estimate k+l+m+n+o+)
1 ov o 00. -
q `I3. `/cJ
%'413 71 `i
221 90(, 1 I
i Z
r. Total Project Cost Estimate a+'+
,
,
, ,
,
, ,
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.
Agency Official Washington State De Irtment of Trans ortation
By .� By -
Title MA yr o P0,-t ha +d _ Director of Highways and Lbcal Programs
_ i
� Date Executed �.� 2007
DOT Form 140-041 EF
Revised 1/2007