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Home My WebLink About20143247.tiff LOCAL AGENCY OFFER AMENDMENT Local Agency Offer Amendment C 030-060 In accordance with Section 7 of the Master Agreement 14 HA4 64551 ("Master Agreement") between the State of Colorado, Department of Transportation ("COOT") 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. 20050ER1 ("Original Task Order") under the Master Agreement for the Flood Damaged Area in WCR 13 CR 44B Bridge over Little Thompson 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 and revised Task Order budget. 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. Signature of Authorized Person (Local Agency) Office of Emergency Management - Director Title September 11, 2014 Date 2014-3247 �avvl�ut Q tda Cc : oem na ©o.76 ioza_ozoy bCaoy5 Sheet of r.s.Depeernm d Report Number: 7renapertation DETAILED DAMAGE INSPECTION REPORT 200so_weld County_O2A-ER Federal Juinprawation'y (Title 23, Federal-aid Highways) Inspection once: 10/30/2013 _ocation(Name of Road and Milepost) nn,v:.al:.,ster Number: CO-13-1 Weld County Site 02 Federal-aid Route Number. County Road 13(CR44B Brill#e)Over Little Thompson River 00013 )escriptian of Damage (ONLY ONE ITEM MAY 8E CHECKED) State: County: C) prerefea Raper 0 hammer(Repair ❑ Debris Raman, CO Weld draw rain amounts caused flood sa•u:tot ovaraep sd rostlerby and bridge;scour or erobskrnertts,shauidors•and Work Order Number oedway approach;coaeYte teaaliM of the ap ioadt;and dwrraaed Scour protection al grid*abut-mints.Emerpteuy apairs to restore Sillieleillil traffic teciude bic f *boniest,axed shoulders.Ern meaty repeat to protect coucture nchrde placing ripen('In the channel Cost Estimate Description of Work to oat. Cost (Equipment,Labor,and Materials) Unit Unit Price Quantity Completed Remaining Major Earthwork items CY _ 0 0 regate Base Course CY 0 0 iurfac1n4-HMA TN 0 0 surfacing-Concrete SY 0. 0 structure Repairs LS 0 1 0 Walls SF 0 0 `•ainage iF 0 0 .c-items LS 0 r 0 ;eternal Construction Items IS 0 0 Engineering Services(See Attacfted) $ 24,400.00 i :R Work to Protect the Structure(See attached)• _ $ 43,524.20 IR Work to Restore Traffic(See attached)• • $ 32,682.44 lddltlonal ER Repairs to Protect Bridge(See attached) $ 12,550.00 )eduction-Debris Removal S (631.75) )eduction•PR Item(Pavement) S (6x628.03) Construction Estimate Subtotal `$ 105,896.86 Right-of-Way S - ' indicates item reimbursed at 80/20 rate due to work Preliminary Engineering Ert inert $ - rccuring during the Emergency Repair Extension Construction Engineering S - Indlrects _ $ - Aethod 0 Local Fuca 0 State Fonts p Cambi t Estimated Project Total $ 105,846.8b e nvironmental Assessment Recommendation Prepared Sy: Date: 0 Cate'ori al Exclaim ❑ FArtiS Kevin Delva,PE 7/26/2014 :oncutrence FiiWA Engineer(Print Name): -049A E r( Date: ifI ' Y6 ❑ No Randy Jensen !/�,- 1 f 14l 'o rence State Engineer(Print Name): St E ( tore,: IrOatee e Yes ❑ Nu Heather Paddock,PE61 :oncurrence Local (Printtj amee}: Loco 4inat ): Date: (� (MI Yes 0 No 1�lilt • // A4 Iry --e'' �� 7 f�-//7 ''WA USE ONLY Form FHWA-1547 IA Eligible: 0 Yes [3 No CDOT 11.5.2013 EXHIBIT C -FUNDING PROVISIONS Task Order ff: 2O050 ER1 Estimated Cost of Work Project Name: ERLA WCR 13 CR 44B BRDG OVER LTTL T The estimated tidal cost the Work is as follows I BUDGETED FUNDS a Federal Funds ,$98.406.00 1100%of Participating Costs) 3 62.373.00 _ (82.79%of Participating Costs) $36 033 00 b Local Funds S 3 745,50 (0%of Participating Costs) 18 605%of Participating Costs) $3.745.50 c Slate Funds $3,745.50 (8(105%of Participating Costs) 'S 3,745.50 I TOTAL BUDGETED FUNDS: $ 105,897.00 $ 105,897.00 2 fESTIMATEU PAYMENT TO LOCAL AGENCY': a Federal Funds Budgeted(la) 98,406.00 50 b State Funds Budgeted(le) �3 745. I TOTAL ESTIMATED PAYMENT TO LOCAL AGENCY•:)$ 102,151.50 1 j 3 FOR(:DO1 EN('UMBRAN(:E.PURPOSES Encumbered WBS Element Phase Function Payable P■did,.iine Perrenr.ge Budgeted Funds Funds Design 3020 ROW 3111/3114 (Aca/Retocl ROW 3114 Incidentals Contt(%) 3301 20050.10.50 Miscellaneous 3404 $ 105,897.00 $105,897.00 Unities 3988 Environmental 3403 TOTAI.ENCUMBERED FUNDS:I$ 105,897.001$105,897.00 '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 o(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 Fluids, hut 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, FIUD,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 Hello