011-05 - WSDOT - Supplement / Change Order 7Adbk
wr'Ii ashi
o Department of Tranapoft-AJon
Local Agency Agreement Supplement
Agency
Supplement Number
Port Orchard
7
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 change to the agreement are as follows:
Project Description
Name Tremont Street Widening
Termini Port Orchard Boulevard to SR 16
Description of Work ❑ No Change
Length 0.67 miles
Final Ad Ready PS&E (95% to 100% ) requires storm water outfall revision at SR 16 (mods to storm plan/profile/report & additional
wetlands delineation and Topo) and TIB Rapid Action Program requires VE/Constructablity Review.
Reason for Supplement
Transfer of Right of Way funds to PE to fund Eligible Non Federal Line and WSDOT Review Cost
Are you claiming indirect cost rate? ❑ Yes ✓ No Project Agreement End Date December 31, 2021
Does this change require additional Right of Way or Easements? ❑ Yes ✓ No Advertisement Date: March 1, 2017
Estimate of Funding
Type of Work
(1)
2
(3)
(4)
(5)
Previous
Supplement
Estimated Total
Estimated Agency
Estimated Federal
Agreement/Suppl.
Project Funds
Funds
Funds
PE
86.5% a. A enc
3,000.00
3,000.00
405.00
2,595.00
%
b.Other Consultant
1,036,803.00
221,389.00
1,258,192.00
169,856.00
1,088,336.00
Federal Aid c. Other Eligible Non Fed
221,389.00
-221,389.00
0.00
0.00
0.00
i Participaton
Ratio for d. State
18,000.00
68,312.00
86,312.00
11,652.00
74,660.00
e. Total PE Cost Estimate a+b+c+d
1,279,192.00
68,312.00
1,347,504.00
181,913.00
1,165,591.00
of Way f. A enc
r86g
2,476,837.00
-289,702.00
2,187,135.00
295,263.00
1,891,872.00
%
g. Other Consultant
50,000.00
50,000.00
6,750.00
43,250.00
Federal Aid Eligible Non Fed
.Other g
0.00
0.00
0.00
Participationh
Ratio for RW i. State
20,000.00
20,000.00
2,700.00
17,300.00
i. Total R/W Cost Estimate t +{,+i
2,546,837.00
-289,702.00
2,257,135.00
304,713.00
1,952,422.00
Construction
% k. Contract
0.00
1. Other
0.00
m. Other
0.00
Federal Aid
n.Other
0.00
Participation
Ratio for CN o.Agency
0.00
p. State
0.00
q. Total CN Cost Estimate k+l+m+n+o
0.00
0.00
0.00
0.00
0.00
r. Total Project Cost Estimate e
3,826,029.00
-221,390.00
3,604,639.00
486,626.00
3,118,013.00
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.
Age cy Official Washington State Department of Transportation
By By
Title Ma�-ityPort Orchard Director, Local Program
Date Executed
DOT Form 140-041 Page 1
Revised 05/2015