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Home My WebLink About20140150.tiff PEs1A Form DAM.DEC OS U.S.DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY PROJECT WORKSHEET PAPERWORK BURDEN DISCLOSURE NOTICE Pudic reporting burden for this form Is estimated to average 90 minutes per response.Burden means the time,effort and financial resources expended by persons to generate, maintain,disclose,or to provide information to us.You may send comments regarding the burden estimate or any aspect of the collection.including suggestions for reducing the • burden to:Information Collections Management,U.S. Department of Homeland Security, Federal Emergency Management Agency,500 C Street,SW,Washington,DC 20472, Papenrork Reduction Project(OMB Control Number 1660-0017).You are not required to respond to this collection of information•unless a valid OMB number appears in the upper right corner of this form.NOTE:Do not send your completed questionnaire to this address_ DECLARATION NO. PW REF NO. DATE FIPS NO. CATEGORY EMMIE NO. FEMA 4145 DR CO WELCO07 11125/13 123-99123-00 C APPLICANT WORK COMPLETED AS OF: DATE: PERCENT: Weld County 11/15/13 90% DAMAGED FACILITY COUNTY Bridge-20.5-38 over Boulder Creek Weld LOCATION LATITUDE LONGITUDE • CR 20.5 40.13863 -105.02043 Was this site previously damaged? r Yes it No C Unsure DAMAGE DESCRIPTION AND DIMENSIONS: See Attached • SCOPE OF WORK: Fund at 76% See Attached PROJECT COST ITEM CODE NARRATIVE QUANTITY UNIT UNIT PRICE COST 1 0000 WORK COMPLETED . $ - 2 9003 Contracts 1.00 Ls $17,520.58 $ 17,520.58- 3 9007 Force Account Labor 1.00 LS $4,013.49 $ 4,013.49 4 9008 Force Account Equipment 1.00 LS $301.50 $ 301.50 5 0000 WORK TO BE COMPLETED $ - 6 9999 Repair 1.00 LS $10400 $ 104.00 7 9901 Direct Administrative Costs(Estimated) 1.00 LS $640.00 $ 640.00 $ - SUBTOTAL FROM COST CONTINUATION PAGE(S) $ - TOTAL PROJECT COST $ 22,579.57 PREPARED BY: Kathleen Ruvarac TITLE: TAC Bridge Specialist FEMA PAC CREW LEADER: Mark Spahr o/ STATE PAC CREW LEADER: Kevin Kuretich L APPLICANT: Roy Rudisill 041 // /r DATE:/�/�70y PHONE: 970-304.6540 Nation PW TemplateWE June 2011 Excel 200712010 REPLACES AU.PREVIOUS VERSIONS eonataJ apVeLik, 1—i5- e2o1y 2014-0150 3 oog5 CC- et, &c,o ,PbJ d u 9111'{ FEMA Form 90-120 FEDERAL EMERGENCY MANAGEMENT AGENCY SPECIAL CONSIDERATIONS DISASTER ~ APPLICANT NAME PW REF NO. FIPS N.O. DATE 4145 I CO Weld County WE.CO07 123-99123-00 11/25113 1. Does the damaged facility or item of work have insurance and/or is it an insurable risk? (e.g.,buildings,equipment,vehicles,etc.) C•Yes r: No C` Unsure 2. Is the damaged facility located within a floodplain or coastal high hazard area,or does it have an impact on a floodplain or wetland? r:Yes r No r Unsure Flood Map 01301300300J 3. Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an Otherwise Protected Area? C Yes c No t^ Unsure 4. Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g.,footprint.material,location,capacity,use Wunder)) r-Yes cC No C' Unsure 5. Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal? r:Yes C' No C' Unsure 6. Is the damaged facility on the National Register of Historic Places or the state historic listing? Is it older than 50 years? Are there more,similar buildings near the site? r Yes r: No r Unsure Facility Constructed In: 7. Are there any pristine or undisturbed areas on,or near,the project site? Are there large tracts of foresUand? r Yes r: No r' Unsure 8. Are there any hazardous materials at or adjacent to the damaged facility and/or item of work? C Yes Co. No r- Unsure 9. Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work? r:Yes r No r Unsure EHP Review will be conducted 10 t Yes r No r: Unsure PREPARED EY: I Kathleen Ruvarac National PLY Template V2.6 June 2012 Excel 2007/2010 • FEDERAL EMERGENCY MANAGEMENT AGENCY HAZARD MITIGATION PROPOSAL(HMP) DISASTER APPLICANT PW REF NO, PIPS NO. CATEGORY 4145 I CO Weld County WELCO07 123-99123-00 C SCOPE OF WORK: See attached • • ESTIMATE OF WORK • ITEM CODE DESCRIPTION QUANTITY UNIT UNIT PRICE COST 1 0000 WORK TO BE COMPLETED 2 9999 Rip Rap 142.2 CY $83,17 $11,826.77 3 9999 Geotextile Fabric 85.3 SY $3.07 $261.87 Total In-Kind RepairlReplacement Cost of Damaged Element(s) $16,920.58 Total HMP Cost of Total Eligible Cost 71.44% Eligibility 100%Rule (Do Not Include in the PW) $12,088.65 TECHNICAL SPECIALIST FOR MITIGATION(SIGNATURE) Agency Date RECOMMENDED BY(SIGNATURE) TITLE Agency Date CONCURRENCE BY STATE INSPECTOR Agency Date CONCURRENCE BY APPLICANT Agency Date NOTE:Signature by the Federal inspector is not an approval of this work, and signature by the state and Local Representative is not a commitment to perform the work. Nallonnl PW rertg121e V28 June 2012 U.1 200712010 0 0 712010 FEDERAL EMERGENCY MANAGEMENT AGENCY HAZARD MITIGATION PROPOSAL (HMP) SUMMARY DISASTER APPLICANT PW REF NO, FIPS NO. CATEGORY 4145 I CO Weld County WELCO07 123.99123-00 C ❑ Mitigation activity will be performed on sites in this project. ❑ If there Is no mitigation activity explain why not. ❑ Codes and Standards ❑ Good Construction Practices Q Mitigation Policy ❑ 15 percent El 100 percent list ❑ -Benefit/Cost Ratio(Attach B/C analysis) ❑ Other: Enter cost of mitigation project as percent of in-kind repair or as dollar amount: Dollar Amount: $12,088.65 Percent: 71.44% O Check here if you wish to attach a Hazard-Mitigation Proposal Prepared By: 'Kathleen Ruvarac I 11/25/2013 National PW Tempbte V2.6 June 2012 Excel 2007@010 FEDERAL EMERGENCY MANAGEMENT AGENCY 9901-DIRECT ADMINISTRATIVE COSTS (SUBGRANTEE) DISASTER APPLICANT PW REF NO. CATEGORY 4145 I CO i Weld County WELCO07 C COUNTY DATE FIPS NO. WORK STATUS Weld 11125/13 123.99123-00 Work To Be Completed The sub-grantee is claiming actual or estimated Direct Administrative Costs associated with this Project .• Worksheet in accordance with PA Policy 9525.9. Al!costs must be documented at the time of grant closeout. LABOR SUMMARY NAME TITLE HOURS ATE w! COST FRINGE PW Development through Closeout Various 8 $ 50.00 $ 400.00 _ I $ $ - $ - $ - • $ $ - $ - . I , $ - LABOR SUBTOTAL $ 400.00 • EQUIPMENT SUMMARY • COST CODE DESCRIPTION t HOURS OR RATE COST MILES 8805 Truck, Pickup 8 $ 30.00 $ 240.00 $ - I I $ - $ - $ - I $ - $ $ l $ - _ F $ EQUIPMENT SUBTOTAL $ 240.00 MATERIAL SUMMARY i OFFICE SUPPLIES DESCRIPTION QUANTITY UNIT PRICE COST . ! $ - $ $ - $ - OTHER MATERIAL DESCRIPTION QUANTITY UNIT PRICE COST $ - - $ $ - $ - MATERIAL SUBTOTAL $ - DIRECT ADMINISTRATIVE COSTS TOTAL $ 640.00 I certify that the above information was obtained from our records, invoices, or other documents that are on file at our offices and available for audit. . Certified by: Title: I Date: Roy Rudisili Or/e_G'fsii, Director-OEM /'//—rG� NatIcnn!PW Template 1/2.6 June 2012 Excel 2007/2010 FEDERAL EMERGENCY MANAGEMENT AGENCY COST SUMMARY RECORD APPLICANT PW REF NO. CATEGORY FIPS NO. DISASTER Weld County WELCO07 C 123-99123-00 4145 I CO CLAIM COST COMMENTS(FEMA USE ONLY) ELIGIBLE COSTS FORCE ACCOUNT LABOR $ 4,013.49 $ 4,013.49 REGULAR TIME FORCE ACCOUNT LABOR OVERTIME - FORCE ACCOUNT 301.50 $ 301.50 EQUIPMENT MATERIALS • $ RENTAL EQUIPMENT $ CONTRACTS $ 17,520.58 $ 17,520.58 DIRECT ADMINISTRATIVE COSTS 640.00 $ 640.00 TOTAL $ 22,475.57 $ 22,475.57 I certify that the above information was transcribed from timesheets,payroll records,equipment log,invoices,stock records or other documents which are available for audit. Certified by: Title: Date: Roy Rudisill ,V,Z,..€4.04eZ1 Director-OEM Applicant's records have been reviewed and found correct with the exceptions as noted. • • •6G61U1.CNCrt0ENGYMM*L WENT AOENGY • • EMPLOYEE PAYROLL DATA APPLICANT PW REF NO. CATEGORY FIPS NO. DISASTER 12 Weld Couely WELCO0T C 123-89123.00 FEMA f 4145 DR J CO EMPLOYEE NAME TITLE • STATUS' HOURLY RATE BENEFITS FRINGE ' OR REG __VAC 5101( HOB BET $5 %EOC UNEMP_ REALTH LIFE __WC OTHER_ BENEPrt3 l.4157 NAME,FIRST NAME JOB DESCRIPTION SEE BELOW $ DAYS7YEAR 7. % % % NIMONH % % REG OT Example:Doe.,J5%, Examplo.Po5oemen FT S1900 10 5 t2 A20% 1.45% 730000 $500 21.91% 7.45% WN'a FT 537.53 42.17% 4217% 42.17% 0.4.o FT 54197 4217% 4217% 42.17% _ %nmi FT $41.44 4217% 42.17% 42.17% Ton' FT $21.24 J2.17°n 4217% 4217% Elko FT $22.60 42.17% 4217% 4217% • Dickens FT $24.77 - 42.17% 42.17% 42.11% (Tooker FT • 043.88 42.17% 4217% 42.17% Howard FT 558.99 — 42.17% 4217% 42.17% SlE7hon FT $34.811 42.17% 4217% 4217% Holbrook FT 33515 42.17% 4217% 4217% Mc00nald FT $41.96 42.17:5 42.1771 4217% • • • Certified By: I CERTIFY THAT THE INFORMATION BELOW WAS TRANSCRIBED FROM PAYROLL Date: RECORDS OR OTHER DOCUMENTS WHICH ARE AVAILABLE FOR AUDIT. 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HP SIZE CODE COST CODE COMMENTS UNIT PRICE Truck,Pickup,(Example) Example: Doe.John Chevrolet 1500 250 8073 Truck,Pickup(1 ton)_1 Pinkham 8802 Truck,Pickup(1 ton)_2 Elliott 8802 Truck,Pickup(1 ton)_3 Dickens 8302 Truck,Pickup(1 314 ton)_1 Dunker 8805 Truck,Pickup(1/2 ton)_1 Habrcok 8801 Truck,Pickup(1/21o5)_2 McDonald 8801 Truck,Pickup(1/2 t❑n)_3 Stephen 8801 — -- I • J EQUIPMENT INVENTORY PAGE 1 OF 1 i 1• o a S S e I 0 w a ' n i O O U ' U '- i L I 4 w w w Lo, In w ... w w w w w w w en w w w w w» w w w n w o o al ID i i— % I i. 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UUJIuIIIII , aO : � . « j • 2 } IF / o o !_} } ( 0 In @ Ili / , _ ° f \ -O \ \ EU f / / / I I _ \ t ; kj \ \ ) � / g ® . o ] -.52 . § 5 \ , / ( > > 0' e F. ..?"'-d ) / \ k \ j0 2 7 % \ ( \ \ \ j - . 0 tY_ Weld County CAT C CR 20.5-36 over Boulder Creek.docx 1/10/2014 9:58:40 AM Page 1 of 5 Damage Description and Dimensions CR 20..5-3B over Boulder Creek,Category C,Permanent Bridge Repair Lat—N40.13863 Long.—W105.02043 During the incident period of September 11,2013 to September 30,2013,Weld County,Colorado received heavy rainfall and debris in the creeks,streams and rivers which caused damage to numerous roads and bridges in Weld County. This project worksheet addresses damages to bridge WEL020.5- 003.0B over Boulder Creek,in Section 17,T2N,R68W. On November 15,2013, Kathleen Ruvarac, FEMATAC Bridge Specialist,David Ray,FEMA Hazard Mitigation Specialist,Glenn Cadman,California Emergency Management Agency assisting the State of Colorado Emergency Management Agency,and Donald Dunker,Weld County Public Works Engineer, performed a site investigation at this location to document damages. The bridge was open and repairs completed at the time of inspection. The 132.5 ft long x 32 ft wide concrete and steel structure traverses the Boulder Creek in Weld County, CO. The bridge is a double(2)span concrete/steel bridge consisting of a 4 inch asphalt overlay on corrugated steel deck, Eight(8)-W33x130 steel girders,concrete abutments and wing walls,and one(1) concrete intermediate pier.The deck is flanked on both sides with a galvanized W rail beam on 6 inch x 4 inch steel posts welded to the exterior girders. The damages to the facility include scour and washout on the north side of the intermediate pier exposing approximately 3 feet of pier wall. Additionally, 50 ft of barbed wire tied to the wingwall at the southwest corner was damaged.The bridge was closed after the event. Embankment material lost at the intermediate pier is estimated to be 32 ft in length along pier x 30 ft in width in east span x 3 ft in depth=111.1 CY. The Applicant has provided pictures of the facility after the event and during repair operations. These photos are attached to this project worksheet. Due to the high water elevation in the creek at the time of inspection,the full extent of damages incurred as a result of this disaster may not have been observed and documented. The applicant provided previous bridge Inspection reports for the facility dated June 30,2010 and May 21,2012. The bridge in built in 1978 and had a sufficiency rating of 91.6 in 2010 and 83.8 in 2012. Scour was noted at the northwest wingwall.The channel conditions noted flow is directed at the northwest wing and is at a bend in the alignment.The bridge inspection reports identified recommended maintenance activities to clean debris around bearing and on abutment seat and add large rip rap at the Northwest wingwall. The applicant noted additional rubble rip rap was washed away downstream during this event at the northwest wingwall.The field measurement is 15 ft in length x 6 ft in width x 1.5 ft in depth,5 CY. Weld County CAT C CR 20.5-36 over Boulder Creek.docx 1/10/2014 9:58:40 AM Page 2 of 5 The deck condition is noted as very good (8) on a scale of 0 to 9. The superstructure and substructure are noted as satisfactory(6). The channel was observed beginning to slump(6). Scope of Work WORK COMPLETED 1)Contracts: The applicant hired a contractor,Mountain Constructors, Inc., P.O.Box 405, Platteville,CO 80538(970) 786-6161. Invoice attached to project worksheet for work performed 10-2 through 10-14,2013= $22,670.58. Hauled and dumped with(5 CY)Rubble Rip Rap at the northwest wingwall. Dewatering operations and embankment material fill at the north side of the intermediate pier. Filled in with (72.5 TNS, 39.7 CY)Aggregate base course with a unit weight of 135 lbs/cf(placed and compacted) and 71.4 CY embankment(granular fill) material (placed and compacted). Total Fill Materials=39.7 CY+71.4 CY= 111.1 CY The project specialist compared the repair cost for labor and construction of similar bridge repairs with the bid and subsequent invoice received from Mountain Constructors, Inc.for$22,67O58 and found the costs for Mobilization$8,000.00 and Traffic Control$3,500.00 totaling$11,500.00,approximately 50% of the repair cost of the facility.These costs are deemed to be high and the project specialist has reduced the reimbursement for Mobilization to$4,000.00 and Traffic Control to$1,750.00. The applicant hired an environmental consulting firm to prepare application for ACOE Section 404 Nationwide permit,Tiglas Ecological Services,5015 Swainsona Drive, Loveland,CO 80537. Invoice attached to project worksheet for work performed 9-29-2013=$600.00 Total Contracts: $17,520.58 2) Force Account: The applicant utilized force account labor and equipment to monitor facility and install barrier walls during the flood event and repair operations. Labor-$4,013.49 Equipment-$301.50 The project specialist compared the repair cost for construction of similar CDOT roadway repairs with the Applicant's force account labor and equipment and found the repair estimate to be reasonable. The applicant has provided payroll data for employees as an hourly rate including fringe benefits. Weld County CAT C CR 20.5-36 over Boulder Creek.docx 1/10/2014 9:58:40 AM Page 3 of 5 WORK TO BE COMPLETED 1) Install 50 ft of barbed wire at the southwest wingwall—50 ft x$2.08/LF(607-01000 Fence Barbed Wire with Metal Posts CDOT Avg. Unit Price 2013)=$104.00 Project Notes 1. Following the September 2013 flooding,applicant used contract services and/or force account resources to re-open roads/bridges and repair damage as soon as possible. At several damage sites, repairs appear to have returned the facility to its pre-disaster design,function and capacity with no known remaining work to be completed. However at other sites due to the onset of winter conditions, applicant was unable to complete the restoration,thus leaving work to be completed. Finally, at some sites, applicant has expressed concern that unanticipated work may be still be required as a result of conditions beyond their control,such as possible subsequent settlement resulting from saturated soil conditions following the flood or where high water levels or erosion/deposition prevented a complete damage assessment. 2. This PW addresses all validated flood related damages at the specified site, including completed work and work to be completed(which damages were known to the applicant and reported to FEMA by the effective date of this PW). In the event that applicant identifies subsequent, currently unknown flood related damage at such site,applicant is advised to contact the State of Colorado Office of Emergency Management to report the damage and request an inspection prior to its repair. In the event that the State validates the damage as a direct result of the September 2013 flooding,the State will request FEMA prepare a version of this PW to address the eligible cost of repair. 3. The Applicant will notify FEMA and the State of their intent to perform permanent work related to this site before any work commences in the field.Failure to do so may jeopardize the sub-grant for permanent work related to the work in this sub-grant. 4. Pursuant to 44 CFR 13.42, Grantees and Subgrantees are required to retain records, including source documentation, to support expenditures/costs incurred against the grant award,for 3 years from the date of submission to FEMA of the final Financial Status Report. 5. The applicant must obtain all required federal, state,and local permits prior to the commencement of work. 6. The subgrantee is requesting direct administrative costs that are directly chargeable to this specific project. Associated eligible work is related to administration of the PA project only and in accordance with 44 CFR 13.22. These costs are treated consistently and uniformly as direct costs in all federal awards and other subgrantee activities and are not included in any approved indirect costs. Weld County CAT C CR 20.5-3B over Boulder Creek.docx 1/10/2014 9:58:40 AM Page 4 of 5 7. Project was reviewed for 406 Hazard Mitigation and a copy of 406 HMP proposal is attached with this project. 8. The applicant is aware that all projects are subject to an insurance review as stated in 44 C.F.R. Sections 206.252 and 206.253.If applicable,an insurance determination will be made either as anticipated proceeds or actual proceeds in accordance with the applicant's insurance policy that • may affect the total amount of the project. • 9. 90%sampling of the timesheets have been reviewed and found to be complete by the FEMA project specialist. A copy of the applicant's payroll policy and example timesheets and equipment logs were attached to a previously submitted project worksheet (WELDC07) as supporting documentation. 10. 100%of all received invoices,and cancelled checks(or other proofs of payment)have been reviewed and are attached as supporting documentation. 11. The applicant is required to adhere to State and Federal Government Procurement rules and regulations and maintain adequate records to support the basis for all purchasing of goods and materials and contracting services for projects approved under the Public Assistance program, as stated in 44 CFR 13.36.The applicant has advised they have followed their normal procurement procedures. • • Weld County CAT C CR 20.5-36 over Boulder Creek.docx 1/10/2014 9:58:40 AM Page 5 of 5 406 Hazard Mitigation Plan WORK TO BE COMPLETED The applicant has indicated that installing rip rap and geotextile fabric at the north side of the intermediate pier downstream of the bridge will fill the scour at the bridge facility and alleviate future damages at the site. 1)Geotextile Fabric-32 ft in length along pier x 12 ft in width towards the channel (10 ft in width+2 ft overlap)x 2 sides of the channel =85.3 SY x$3.07/SY(420-00112 Geotextile—Drainage-Class 3 CDOT Avg. Unit Price 2013) = $261.87 2) Rip Rap-32 ft in length x 10 ft in width towards the channel x 6 ft in depth x 2 sides of the channel= 142.2 CY K$83.17/CY(506-00218 Rip Rap 18 inch CDOT Avg. Unit Price 2013) =$11,826.77 Total=$261.87+$11,826.77=$12,088.64 This HMP is considered cost effective per FEMA Disaster Assistance Policy 9526.1,Section V€I. B.2. Certain mitigation measures(Appendix A),determined cost effective, as long as the mitigation measure does not exceed 100%of the eligible cost of the eligible repair work on the project. Appendix A.5.Gabion baskets, rip rap,sheet piling, and geotextile fabric installation-installation to control erosion. Bridge Repair Cost—Contractor Invoice-$16,920.58 The net cost of mitigation/cost of damages is 71%< 100%. This HMP is for cost estimating purposes only. 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