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Home My WebLink About20143251.tiff LOCAL AGENCY OFFER AMENDMENT Local Agency Offer Amendment C 030-065 In accordance with Section 7 of the Master Agreement 14 HA4 64551, ("Master Agreement") between the State of Colorado, Department of Transportation ("CDOT") and Weld County ("Local Agency"), the authorized person signing below for Local Agency hereby submits this Local Agency Offer Amendment to CDOT for modification of Task Order No. 20055ER1 ("Original Task Order") under the Master Agreement for the Flood Damaged Area in WCR 54 CR 41A Bridge over South Platte River ("Project Location"). All terms not defined in this Local Agency Offer Amendment shall have the meanings given in the Master Agreement and/or Original Task Order. The Local Agency hereby requests that the Original Task Order, and all prior amendments thereto, if any, be modified as follows: Exhibit C as revised to include the State match. In connection with this Local Agency Offer Amendment, the Local Agency approves the attached documents and incorporates them by reference, if applicable: • Task Order Scope • Task Order Budget • Local Agency Contract Administration Checklist • Damage Inspection Report (Form FHWA 1547) Local Agency hereby requests modification of the Original Task Order for the Project Location. •Person signing for the Local Agency hereby swears and affirms that he/she are authorized to act on the Local Agency's behalf(as indicated In Exhibit B of the Master Agreement)and acknowledge that the State is relying on his/her representation to that effect. Q / . !/v Signature of Authorized Person (Local Agency) Office of Emergency Management - Director Title September 11, 2014 Date /}nt O464L. 2014-3251 e6: 080) EC, 0070 /0-20-02c14 Ze,CO 45 Sheet of U.S.o.p.rbnentor Report Number: Transportation DETAILED DAMAGE INSPECTION REPORT 20055_Weld_County_078-PR(RfK) _ Federal Highway Admk9atrabon (Title 23, Federal-aid Highways) Inspection Date: 10/30/2013 Location(Name of Road and Milepost) FHWA Disaster Number: CO-13-1 Weld County Site 07 Federal-aid Route Number: County Road 54{CR41A Bridge)Over South Platte River 00054 Description of Damage (ONLY ONE ITEM MAY RF CHECKED) State: County: ❑ Emergency Repair Q Permanent Reparr ❑ Debris Removal CO Weld Extreme rain amounts caused floodwaters that washed out approx.120feet of roadway;overtopped the roadway and Work Order Number: damaged 330 feet of shoulder,embankment,and pavement. Ptrmanent repairs are necessary to restore pavement to predisaster condition once emergency repairs are complete. i Cost Estimate Description of Work to Date Cost (Equipment,Labor,and Materials) Unit Unit Price . Quantity,Compieted ,Remaining Major Earthwork Items CY $ 206.46 600 $ 123,877.48 Aggregate Base Course CY 0 $ - Surfadng-HMA TN 0 Surfacing-Concrete SY 0 $ - Structure Repairs LS $ - 1 $ - Wails SF 0 $ - Drainage LF 0 $ - Misc.Items LS $ - 1 $ _ - General Construction Items IS $ 37,906.51 1 $ 37,906.51 Winter Work&Dewatering Items LS , $ 16,178.40 1 $ 16,178.40 Minor Contract Revisions 1LS $ 26,694.36 1 $ 26,694.36 Credit-(Pavement)Constructed in ER Project $ 10,822.06 , I , Construction Estimate Subtotal $ 215,478.80 Right-of-Way $ 2,000.00 Preliminary Engineering $ 30,998.51 Construction Engineering $ 20,465.67, Indirects , S - Method Estimated Project Total $ 268,942.98 ❑ tncai Fames ❑ State Forces ❑ Contract 1 Environmental Assessment Recommendation Prepared By: Date: ❑ Categorical Exclusion ❑ ENELS Ryan Sisson,P.E. 02/11/14 Concurrence FHWA Engineer(Print Name): FHWA Engineer(Signature): Date: ❑ Yes O No W. D. Daugherty, P. E. _.'" ' I, 03/03/2014 Concurs nce State Engineer(Print Name): St t Engineer(Signature): Date: ( Yes ❑ No Miranda Lange,P.E. /�• t r j /t 14.0 114- Concurrence Local envy Print Name): Luca Agency(;i/ignaturee•): Date: [3 yes ❑ No C�t �ttr 1•1{ � Eh/le/7,2=u- . �f' -Z ' /� FHWA USE ONLY Form FHWA-1547 FEMA Eligible: O Yes ❑ No COOT 11.5.2013 Revised 5/8/14 Sheet of Report Number: U.S.Dopartmantof DETAILED DAMAGE INSPECTION REPORT Transportation 2QQ55_Weld_County_074 ER Federal Highway Administration (Title 23, Federal-aid Highways) Inspection Date: A 10/30/2013 Location (Name of Road and Milepost) FHWA Disaster Number: CO-13.1 Weld County Site 07 Federal-aid Route Number: County Road 54(CR41A Bridge)Over South Platte River 00054 Description of Damage (ONLY ONE ITEM MAY BE CHECKED) State: County: Q Emergency Repair ❑ Permanent Repair ❑ Debris Removal CO Weld Extreme rain amounts caused floodwaters that washed out approx.120 Feet of roadway;overtopped the roadway and Work Order Number: damaged 330 feet of shoulder,embankment,and pavement.Emergency repairs to restore essential traffic include restoring the roadway.subgrade,embankments,and roadside elements.Emergency repairs to protect structure include placing riprap and seeding the embankment. Cost Estimate Description of Work to Date Cost (Equipment, Labor,and Materials) Unit Unit Price Quantity Completed Remaining Major Earthwork Items CY 0 0 Aggregate Base Course CY 0 0 Surfacing-HMA TN 0 0 Surfacing-Concrete SY 0 0 Structure Repairs _LS 0 1 0 Walls SF 0 0 Drainage LF 0 0 Misc. Items LS 0 0 General Construction Items LS 0 0 Winter Work&Dewatering Items LS 0 0 Minor Contract Revisions LS 0 0 ER Work to Restore Traffic(See attached) $ 101,921.25 Deduction- Debris Removal $ (4,814.80) Deduction-(Pavement)PR Item __ $ (10,822.06) ER Work to Protect the Structure(See attached)* * $ 118,795.50 Engineering Services(See Attached) Per Randy Jensen $ 57,732.50 Construction Estimate Subtotal $ 262,812.39 Right-of-Way $ - * Indicates item reimbursed at 80/20 rate due to work Preliminary Engineering $ - occuring during the Emergency Repair Extension Construction Engineering $ - Indirects $ - Method ❑✓ Local Forces ❑ State Forces O Contrail Estimated Project Total $ 262,812.39 Environmental Assessment Recommendation Prepared By: Date: Q Categorical Exclusion ❑ EA/EIS Adam Hanks,P.E. 04/23/14 f17 p Concurrence y--� I I V/-lin a i E L FHWA£ngir .°,91 t' QR eDCouL=DOTFHWAWkewood YI,WSL WA TA Yes ❑ No it5S1 1 V FHWALakewoodCO,en-JOSHUA O KIEL Date.201405 1208:41:09.06'00' Conc nce State Engineer(Print Name): St t Engineer(Signatu e): Date: �f— DY es ❑ No Miranda Lange,P.E. 5701— LocalrAgency(P ' t Name): *Loc I Agen (Signs re): Date. �/ a-Yes ❑ No v11,1 Sw// 7/g/ �G >r., fir,,-// FHWA USE ONLY Form FHWA-1547 FEMA Eligible: O Yes ❑ No COOT 11.5.2013 For estimate purposes only. ALL reimbursements up through 3/30/14 are eligible for 100%. Any after are subject to regular reimbursable share. - Josh Kiel EXHIBIT C -FUNDING PROVISIONS Task Order#: 20055 ER1 Estimated Cost of Work Project Name: ERLA WCR 54 CR 41A BRDGE OVER S PLATTE the estimated total cost the Work is as follows: I BUDGETED FUNDS a. Federal Funds $242.368.00 (100%of Participating Costs) $144,017.00 (82.79%of Participating Costs) S 98.351.00 b. Local Funds $10.222.50 (0%of Participating Costs) (8.605%of Participating Costs) $ 10222.50 c. State Funds $10.222.50 (8.605%of Participating Costs) $ 10,222.50 ( TOTAL BUDGETED FUNDS: $262,813.00 $262,813.00 2 (ESTIMATED PAYMENT TO LOCAL AGENCY': a. Federal Funds Budgeted(la) is242,368.00 b State Funds Budgeted(lc) IS 10 992 50 TOTAL ESTIMATED PAYMENT TO LOCAL AGENCY": 252 590.50 1 3 FOR CDOT ENCUMBRANCE PURPOSES Encumbered WBS Element Phase Function Payable Participating Percentage Budgeted Funds Funds Design 3020 ROW 3111/3114 (Acd/Reloc) ROW 3114 Incidentals Const 1%) 3301 20055.10.50 Miscellaneous 3404 $262,813.00 $262,813.00 Utilties 3988 Environmental 3403 TOTAL ENCUMBERED FUNDS:i$262,813.001$262,813.00 "The"Total Estimated Payment to Local Agency"amount assumes that that the entire budgeted amount in Section 1 will be encumbered.Local Agency is not entitled to payment for any amounts that are not encumbered. "The Agreement Funds payable by the State to Local Agency pursuant to this Agreement is limited to the aggregate amount of encumbered funds identified in Section 3 above multiplied by the Payable Participating Percentage for Federal Funds or State Funds identified in Section 3. Page 1 of 2 Single Audit Act All state and local government and non-profit organizations receiving more than$500,000 from all funding sources defined as federal financial assistance for Single Audit Act of 1984,as amended (PL 98-502; PL 104-156)(collectively the"Single Audit Act"),purposes shall comply with the audit requirements of OMB Circular A-133(Audits of States,Local Governments and Non-Profit Organizations)and OMB Circular A-133 Compliance Supplement,as amended.See also,49 CFR 18.20 through 18.26.The Single Audit Act requirements applicable to the Local Agency receiving Federal Funds are as follows: i.Expenditure less than$500,000 If the Local Agency expends less than$500,000 in Federal Funds(all federal sources, not just highway funds)in its fiscal year then this requirement does not apply. ii.Expenditure exceeding than$500,000-Highway Funds Only If the Local Agency expends more than$500,000 in Federal Funds,but only received federal highway funds(Catalog of Federal Domestic Assistance,CFDA 20.205)then a program specific audit shall be performed.This audit will examine the"financial" procedures and processes for this program area. iii. Expenditure exceeding than $500,000-Multiple Funding Sources If the Local Agency expends more than$500,000 in Federal Funds,and the Federal Funds are from multiple sources(FTA,HUD,NPS,etc.)then the Single Audit Act applies,which is an audit on the entire organization/entity. iv. Independent CPA Single audit shall only be conducted by an independent CPA,not by an auditor on staff. An audit is an allowable direct or indirect cost. THE REST OF THIS PAGE INTENTIONALLY LEFT BLANK Page 2 of 2 Weld County Request for Reimbursement CDOT Project#C 030-065 Task Order#15 HA4 71577 Reimbursement Request#1 Request for Reimbursement Date 7/31/2014 Labor Equipment Material Contractor 202/Contracted Construction $ 43,779.94 203/Contracted Design $ 24,946.41 207/ Field Testing 208/General Services(Engineering) $ 3,997.09 210/ Lab Testing $ 304.70 217/Surveying 219/Genral Services(Engineering Companies) $ 4,553.50 301/Class A Patching $ 473.51 $ 40.00 304/Mechanical Patching $ 1,510.01 $ 646.00 $ 3,213.21 305/Milling $ 826.18 $ 1,212.50 $ 1.08 306/Paving $ 102.19 $ 4,837.14 308/Sweeping $ 351.22 $ 276.50 314/ Hauling Asphalt $ 1,082.07 $ 2,346.00 400/Blading for Road Construction $ 1,541.32 $ 2,102.00 401/Site Work $ 7,501.12 $ 4,743.00 $ 225.00 402/Compaction $ 799.40 $ 341.50 403/Culvert Install $ 1,479.90 410/Tree Trimming with Contractor $ 899.23 $ 94.00 $ 3,724.00 600/Hauling Solids $ 8,780.43 $ 16,172.00 $ 25,495.72 $ 2,737.50 601/Haul to Stock Pile $ 29.51 $ 60.00 602 /Loading Trucks $ 425.32 $ 624.00 800/Signing $ 376.97 $ 116.00 900/General Administration $ 62.39 901/Travel Time Employees $ 2,578.24 $ 819.00 902/Work Support Activities $ 4,358.57 $ 5,426.00 907/Mobilization of Equipment $ 727.16 $ 720.00 908/Traffic Control $ 454.35 S 105.00 909/Debris Cleanup $ 124.78 $37,180.98 $ 35,843.50 $ 35,252.05 $ 79,866.13 Total $ 188,142.66 A Weld County Request for Reimbursement CDOT Project#C 030-065 Task Order# 15 HA4 71577 Reimbursement Request# 1 Request for Reimbursement Date 7/31/2014 Not included in invoice by Weld County All labor by Weld County was excluded by Weld County $37,180.98 AISA $ 21,837.70 Cowboy $ 21,942.24 Atkins $ 185.00 Atkins $ 4,553.50 Waste $ 124.78 $37,180.98 $ - $ - # $ 48,643.22 B Not Included Total (A-B) $ 85,824.20 Requested Total $ 102,318.46 C Exceptions to the Invoice By CDOT Atkins $ 11.76 (Meals) Martin Materials Invoice 12451479 $ 3,213.23 (Insufficient backup to show that the asphalt was delivered to the site.) Martin Materials Invoice 12620865 $ 4,837.15 (Insufficient backup to show that the asphalt was delivered to the site.) Bestway Concrete Company Invoice 184778 $ 1,749.60 (No evidence this was delivered to the project) Bestway Concrete Company Invoice 184773 $ 2,958.20 (No evidence this was delivered to the project) $ 12,769.94 D Recommended Payment(C-D) $ 89,548.52 Weld County Request for Reimbursement CDOT Project#C 030-065 Task Order#15 HA4 71577 Reimbursement Request# 1 Request for Reimbursement Date 7/31/2014 Labor Equipment Material Contractor 202/Contracted Construction $ 43,779.94 203/Contracted Design $ 24,946.41 207/Field Testing 208/General Services(Engineering) $ 3,997.09 210/ Lab Testing $ 304.70 217/Surveying 219/Genral Services(Engineering Companies) $ 4,553.50 301/Class A Patching $ 473.51 $ 40.00 304/Mechanical Patching $ 1,510.01 $ 646.00 $ 3,213.21 305/Milling $ 826.18 $ 1,212.50 $ 1.08 306/Paving $ 102.19 $ 4,837.14 308/Sweeping $ 351.22 $ 276.50 314/ Hauling Asphalt $ 1,082.07 $ 2,346.00 400/ Blading for Road Construction $ 1,541.32 $ 2,102.00 401/Site Work $ 7,501.12 $ 4,743.00 $ 225.00 402/Compaction $ 799.40 $ 341.50 403/Culvert Install $ 1,479.90 410/Tree Trimming with Contractor $ 899.23 $ 94.00 $ 3,724.00 600/ Hauling Solids $ 8,780.43 $ 16,172.00 $ 25,495.72 $ 2,737.50 601/Haul to Stock Pile $ 29.51 $ 60.00 602/Loading Trucks $ 425.32 $ 624.00 800/Signing • $ 376.97 $ 116.00 900/General Administration $ 62.39 901/Travel Time Employees $ 2,578.24 $ 819.00 902/Work Support Activities $ 4,358.57 $ 5,426.00 907/Mobilization of Equipment $ 727.16 $ 720.00 908/Traffic Control $ 454.35 $ 105.00 909/ Debris Cleanup $ 124.78 $37,180.98 $ 35,843.50 $ 35,252.05 $ 79,866.13 Total $ 188,142.66 A Weld County Request for Reimbursement CDOT Project#C 030-065 Task Order# 15 HA4 71577 Reimbursement Request#1 Request for Reimbursement Date 7/31/2014 Not included in invoice by Weld County All labor by Weld County was excluded by Weld County $37,180.98 AISA $ 21,837.70 Cowboy $ 21,942.24 Atkins $ 4,553.50 Waste $ 124.78 Invoice#1 $ 102,318.46 $37,180.98 $ - $ - # $ 150,776.68 B Not Included Total(A-B) $ 187,957.66 Requested Total $ 185.00 C Exceptions to the Invoice By CDOT None $ - 0 Recommended Payment(C-D) $ 185.00 Hello