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Home My WebLink About20143249.tiff LOCAL AGENCY OFFER AMENDMENT Local Agency Offer Amendment C 030-062 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. 20052ER1 ("Original Task Order") under the Master Agreement for the Flood Damaged Area in WCR 27.5 CR 48A Bridge over Big 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. 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. gfe..edidiejle Signature of Authorized Person (Local Agency) Office of Emergency Management - Director Title September 11, 2014 Date 2014-3249 e/lonays- 64.e.446._ CG: a'/7 /O-2o-ca) 36.001/5 Sheet of Report Number. U.S.Transportation Department DETAILED DAMAGE INSPECTION REPORT 20052_Weld_County D48-PR(RIK) Uon Federal HIp�aY Administration 23, Federal-aid Highways)(Title B ys) Inspection Date: x/2013 Location(Name of Road and Milepost) FHWA Disaster Number: CO-13-1 Weld County Site 04 Federal-ate Route Number: County Road 27.5(CR48A Bridge)Over Big Thompson River 02750 y Description of Damage (ONLY ONE ITFM MAY RF CHFCKFO) State: County: ❑ Emergency Repair ❑✓ Permanent Repair ❑ Debris Removal CO Weld Extreme rain amounts caused floodwaters that overtopped the roadway,scouring the embankments and shoulder Work Order Number: pavement. Permanent repairs are necessary to restore the embankments,grading,and stabilization to pre-dliaster condition. _ Cost Estimate Description of Work to Date _Cost (Equipment,Labor,and Materials) Unit Unit Price .Quantity Completed Remabtiag Ma or Earthwork Items CY $ 172.23 60 $ 10,334.00 Aggregate Base Course CY 0 $ - Surfacing-HMA TN 0 $ - Surfacing-Concrete SY 0 $ - Structure Repairs LS $ 111,000.00 1 $ 111,000.00 - Wails SF 4.- 0 $ - Drainal e LF 0 $ - Misc.Items LS $ 750.00 1 $ 750.00 General Construction Items LS $ 37,357.70 1 $ 37,357.70 Winter Work&Dewatering Items LS $ 7,972.09 1 $ 7,972.09 Minor Contract Revisions BLS $ 25,112.07 1 $ 25,112.07 Credit-(Pavement)Constructed in ER Phase J $ 5,218.11 1 Construction Estimate Subtotal $ 197,743.97 Right-of-Way $ 2,000.00 Preliminary Engineering $ 29,178.88 Construction Engineering $ 19,252,59 Indirects $ - Method Estimated Project Total $ 248,175.43 ❑ Local Forces ❑ Std Forces ❑ Contract • Environmental Assessment Recommendation Prepared By: Date: E Categorical Exclusion ❑ EA/EIS Ryan Sisson,P.E. 02/11/2014 Concurrence FHWA Engineer(Print Name): FHWA Engineer(Signature): Date: Q Yes ❑ No W. D. Daugherty, P. E, le .,(i:;(-- 03/03/2014 Concurrence State Engineer(Print Name): St�telEngineer(Signatu e): Date: Q Yes ❑ No Miranda Lange,P.E. Jj�Jk _Z��r J 1L� Concurrence Local /AAgency(Print/ri Name): Local ency(S nature): ��_ f Y, Date: f pYes ❑ No 47'1 Rcl. ...,,A /�':rr�;rL,-.-f'�t.-rG/ l '/y FHWA USE ONLY Form FHWA-1547 FEMA Eligible: 0 Yes 0 No CDOT 11.5.2013 EXHIBIT C -FUNDING PROVISIONS Task order#: 20052 ER1 Estimated Cost of Work Project Name: ERLA WCR 27.5 CR 4BA BRDGE OVER BIG T The est mated total cost the Work is as follows: t BUDGETED FUNDS a Federal Funds $80,887.00 (100%of Participating Costs) $56,245.00 (82.79%of Participating Costs) ,S 24.642.00 b. Local Funds 5 2 551.00 (0%of Participating Costs) (8 605%of Participating Costs) $2.561.00 c State Funds S 2,561.00 (8 605%of Participating Costs) $2,561.00 TOTAL BUDGETED FUNDS: $86,009.00 $86,009.00 2 'ESTIMATED PAYMENT TO LOCAL AGENCY*: a Federal Funds Budgeted(I u) 80,887.00 b. State Funds Budgeted(1c) IS 2 561,00 TOTAL ESTIMATED PAYMENT TO LOCAL AGENCY*:'$83,448.00 1 3 FOB COOT ENCUMBRANCE PURPOSES Encumhered W BS Element Phase Function Payable Participating Percentage Budgeted Funds Funds.' Design 302D ROW 31:1/3114 (AcaJReloc) ROW 3114 Incidentals Contt(%) 3301 20052.10.50 Miscellaneous 3404 $ 86,009.00 $86,009.00 Utilties 3988 Environmental 3403 TOTAL.ENCUMBERED FUNDS: $ 86,009.00 $ 86,009.00 '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-I33 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 030-062 Task Order#15 HA4 71622 Reimbursement Request# 1 Request for Reimbursement Date 7/31/2014 Labor Equipment Material Contractor 202/Contracted Construction $ 16,995.99 208/General Services(Engineering) $ 2,726.60 $ 20,493.37 209/ Inspection $ 364.84 $ 70.00 221/ Final Design 301/Class A Patching $ 735.60 $ 600.00 $ 984.45 304/Mechanical Patching $ 1,032.42 $ 300.00 $ 1,538.08 306/Paving 307/Shoulder Work $ 1,134.86 $ 855.00 314/ Hauling Asphalt 401/Site Work $ 2,375.20 $ 1,881.00 404/Culvert Repair/Cleaning $ 178.07 $ 99.00 410/Tree Trimming with Contractor $ 577.73 $ 567.00 $ 1,263.50 411/ Bridge Repair $ 165.65 $ 315.00 $ 2,507.49 600/ Hauling Solids $ 2,783.27 $ 4,852.00 $ 8,496.54 800/Signing $ 647.91 $ 147.00 900/General Administration $ 144.49 901/Travel Time Employees $ 493.43 $ 228.00 902/Work Support Activities $ 1,609.64 $ 604.00 907/ Moblization of Equipment $ 295.78 $ 385.00 908/Traffic Control $ 103.55 $15,369.04 $10,903.00 $ 13,526.56 $ 38,752.86 Total $ 78,551.46 A Not included in invoice by Weld County All labor by Weld County was excluded by Weld County $15,369.04 202/Contracted Construction $ 16,995.99 208/General Services(Engineering) Ayres $ 5,673.45 Ayres $ 1,482.50 $15,369.04 $ - $ - $ 24,151.94 B Not Included Total (A-B) $ 39,520.98 Requested Total $ 39,030.48 C Weld County Request for Reimbursement CDOT Project#C 030-062 Task Order#15 HA4 71622 Reimbursement Request#1 Request for Reimbursement Date 7/31/2014 Exceptions to the Invoice Ayes Invoice 153002 Mileage paid at$.77/mile $ 75.71 Miles C $ 0.21 $ 15.90 (Pay mileage at$.56/mile) Equipment Rent $ 198.35 $ 198.35 (Equipment Rent not allowed by Weld County Contract) Martin Materials Invoice 12288899 $ 984.45 (Insufficient backup to show that the asphalt was delivered to the site.Wrong canceled check.) Martin Materials Invoice 12288915 $ 1,538.08 (Insufficient backup to show that the asphalt was delivered to the site.Wrong canceled check.) $ 2,736.78 D Recommended Payment(C-D) $ 36,293.70 Weld County Request for Reimbursement CDOT Project#C 030-062 Task Order#15 HA4 71622 Reimbursement Request#2. Request for Reimbursement Date 7/31/2014 Labor Equipment Material Contractor 202/Contracted Construction $ 16,995.99 208/General Services(Engineering) $ 2,726.60 $ 20,493.37 209/Inspection $ 364.84 $ 70.00 221/ Final Design 301/Class A Patching $ 735.60 $ 600.00 $ 984.45 304/ Mechanical Patching $ 1,032.42 $ 300.00 $ 1,538.08 306/ Paving 307/Shoulder Work $ 1,134.86 $ 855.00 314/Hauling Asphalt 401/Site Work $ 2,375.20 $ 1,881.00 404/Culvert Repair/Cleaning $ 178.07 $ 99.00 410/Tree Trimming with Contractor $ 577.73 $ 567.00 $ 1,263.50 411/Bridge Repair $ 165.65 $ 315.00 $ 2,507.49 600/Hauling Solids $ 2,783.27 $ 4,852.00 $ 8,496.54 800/Signing $ 647.91 $ 147.00 900/General Administration $ 144.49 901/Travel Time Employees $ 493.43 $ 228.00 902/Work Support Activities $ 1,609.64 $ 604.00 907/ Moblization of Equipment $ 295.78 $ 385.00 908/Traffic Control $ 103.55 $15,369.04 $10,903.00 $ 13,526.56 $ 38,752.86 Total $ 78,551.46 A Not included in invoice by Weld County All labor by Weld County was excluded by Weld County $15,369.04 208/General Services(Engineering) Ayres $ 5,673.45 Ayres $ 1,482.50 Included in Invoice#1 $ 39,030.45 $15,369.04 $ - $ - # $ 46,186.40 B Not Included Total (A-B) $ 61,555.44 Calculated Requested Total $ 16,996.02 C Weld County Request for Reimbursement CDOT Project 4$C 030-062 Task Order# 15 HA4 71622 Reimbursement Request#1 Request for Reimbursement Date 7/31/2014 Exceptions to the Invoice None $ - D Recommended Payment(C-D) $ 16,996.02 Use $ 16,995.99 Hello