011-05 - WSDOT - Supplement / Change Order 6Washington State
wo Department of transportation Local Agency Agreement Supplement
Agency
Supplement Number
Port Orchard
Federal Aid Project Number
Agreement Number
CFDA No. 20.205
STPUS-6610 004
LA 5855(Catalog
of Federal Domestic Assistance
The Local Agency requests to supplement the agreement entered into and executed on February 28, 2005
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 Tremont Street Widening Length 0.65 miles
Termini Port Orchard Boulevard to SR 16
Description of Work ® No Change
Reason for Supplement
Obligate additional right-of-way funding.
Does this change require additional Right of Way or Easements? ❑ Yes ® No
Type of Work
yp
Estimate of Funding
(1)
Previous
Agreement/Suppl.
(2)
Supplement
(3)
Estimated Total
Project Funds
(4)
Estimated Agency
I Funds
(5)
Estimated
Federal Funds
PE a. Agency
3,000.00
3,000.00
405.00
2,595.00
86.5 0/0 b. Other
977,000.00
977,000.00
131,895.00
845,105.00
c.Other
2,000.00
2,000.00
270.00
1,730.00
Federal Aid d. State
Participation
18,000.00
18,000.00
2,430.00
15,570.00
Ratio for PE e. Total PE Cost Estimate (a+b+c+d)
1,000,000.00
1,000,000.00
135,000.00
865,000.00
Right of Way f. Agency
2,255,623.00
285,191.00
2,540,814.00
343,010.00
2,197,804.00
86.5 % Other
50 000.00
50 000.00
6,750.00
43 250.00
.
Federal Aid h. Other
Participation
Ratio for RW i. State
10 000.00
3,826.00
13 826.00
1,867.00
11,959.00
j. Total RAN Cost Estimate (f+g+h+i)
Construction k. Contract
I. Other
% m.Other
Federal Aid n. Other
Participation o. Agency
Ratio for CN . State
_
q. Total CN Cost Estimate k+l+m+n+o
r. Total Project Cost Estimate e
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 Offi ' Washington State Department of Transportation
By — -- By
Title Mayor Pro Temp Director of Highways and Local Programs
^ �m r)a ' o?p) I Date Executed
AT S T v-
DOT Form 140-041 EF
Revised 03/2011
riciatJ. KYrkpatrick, MMC, City Cler