HomeMy WebLinkAbout102-24 - WSDOT - Supplement / Change OrderDocusign Envelope ID: 040742E9-EC65-461A-ADD1-14B845419C15
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Washington State
f Deaartment of Transaortation
Supplement - Local Programs
State Fundinq Aqreement
Agency
Supplement Number
City of Port Orchard
Project Number
Agreement Number
HLP-SR23(013)
LA10834
1
All provisions in the AGREEMENT identified above remain in effect except as expressly modified by this supplement.
The changes to the agreement are described as follows:
Project Title Sidney Road Non -Motorized
Termini SR 16 to SW Hovde Rd
Description of Work ✓ No Change
Construct sidewalk, curb ramps, curb, gutter, stormwater improvements, and bike lanes from north of the SR-16 overpass to SW
Hovde Rd. RRFBs will be installed at two intersections. Sewer main will be installed from SW Berry Lake Rd to south of SW Hovde Rd
Reason for Supplement
Authorize construction phase
Advertisement Date: 5/19/2025
Indirect Cost Rate []Yes ❑✓ No
Type of Work
Estimate of Funding
(1)
Previous Agmt. /
Su I. Funds
(2)
Supplement
Funds
(3)
Estimated
Total Funds
(4)
Estimated Agency
Funds
(5)
Estimated
State Funds
a. Agency
PE b. Other Consultant
$ 177,860.00
$ 177,860.00
$ 177,860.00
or C. Consultant (Ineligible/Nonfunded)
$ 99,596.00
$ 99,596.00
$ 99,596.00
Planning d. State Services
$ 5,000.00
$ 5,000.00
$ 5,000.00
e. Total PE Cost Estimate
$ 282,456.00
$ 0.00
$ 282,456.00
$ 104,596.00
$ 177,860.00
RW f. Agency
g. Other
h. Other
i. State Services
j. Total R/W Cost Estimate
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
CN k. Contract
$ 1,216,890.00
$ 1,216,890.00
$ 0.00
$ 1,216,890.00
1. Contract(Ineligible/Nonfunded)
$ 1,539,543.00
$ 1,539,543.00
$ 1,539,543.00
M. Contract (Eligible/Nonfunded)
$ 607,995.00
$ 607,995.00
$ 607,995.00
n. Other
o. Agency
$ 10,000.00
$ 10,000.00
$ 10,000.00
p. State Services
$ 5,000.00
$ 5,000.00
$ 5,000.00
q. Total CN Cost Estimate
$ 0.00
$ 3,379,428.00
$ 3,379,428.00
$ 2,162,538.00
$ 1,216,890.00
r. Total Project Cost Estimate
$ 282,456.00
$ 3,379,428.00
$ 3,661,884.00
$ 2,267,134.00
$ 1,394,750.00
AGENC 96b p4
6tX',SW, STATE
BY: �a�rsa� . BY:
Director, Local Programs
Title: Mayor
5/8/2025
Agency Date:
Date Executed:
DOT Form 140-087ALP Revised 12/2024
9 Previous Versions Obsolete •
Docusign Envelope ID: 040742E9-EC65-461A-ADD1-14B845419C15
Instructions — Supplement Local Programs State Funding Agreement
1. Agency — Enter the agency name as entered on the original agreement.
2. Supplement Number — Enter the number of the supplement. Supplement numbers will be assigned in sequence
beginning with Number 1 for the first supplement to the original agreement.
3. Project Number — Enter the project number assigned by WSDOT on the original agreement.
4. Agreement Number — Enter the agreement number assigned by WSDOT on the original agreement.
5. Project Title — Enter the project's title.
6. Termini — Enter the begin and end points of the project.
7. Description of Work — Clearly describe if there is a change in work such as the addition or deletion of work
elements and/or changes to the termini. If the work has not changed since the previous supplement, or original
agreement if Supplement Number 1, put a check mark in the "No Change" box.
8. Reason for Supplement — Enter the reason for this supplement. Examples: Increase PE to current estimate;
authorize construction phase; adjust construction to award amount.
9. Advertisement Date — At construction phase authorization only, enter the proposed construction contract
advertisement date.
10. Indirect Cost Rate
a. Check the Yes box if the agency will be claiming indirect costs on the project. For those projects claiming
indirect costs, supporting documentation that clearly shows the indirect cost rate being utilized by the agency
must be provided with the Local Programs State Funding Agreement. Indirect cost rate approval by your
cognizant agency or through your agency's self -certification and supporting documentation is required to be
available for review by WSDOT and/or State Auditor.
b. Check the No box if the agency will not be claiming indirect costs on the project.
11. Type of Work and Funding (Round all amounts to the nearest whole dollar).
a. Column 1— Enter the amounts by type of work from column 1 of the original Local Programs State Funding
Agreement. If the agreement has already been supplemented, enter the amounts by type of work from column 3
of the last Supplement — Local Programs State Funding Agreement.
b. Column 2 — Enter increase/decrease to total amounts requested by type of work.
c. Column 3—Add the amounts in columns 1 and 2.
d. Column 4 — Enter the amount of agency funds by type of work. Note: Column 4 amounts plus column 5
amounts must equal amounts in column 3 by type of work.
e. Column 5 — Enter the amount of state funds by type of work. Note: Column 4 amounts plus column 5 amounts
must equal amounts in column 3 by type of work.
f. State Services — All authorized phases must have funding for state services. Enter the estimated amounts in
columns 1 through 5 as described above.
12. Signatures —An authorized official of the local agency signs the Supplemental Agreement and enters their title
and date of signature (include month, day, and year). Note: Do NOT enter a date on the Date Executed line.
DOT Form 140-087ALP Revised 12/2024
• Previous Versions Obsolete •