HomeMy WebLinkAbout20140424.tiff FEMA Form 90-91.DEC C9
U.S.DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
PROJECT WORKSHEET
PAPERWORK BURDEN DISCLOSURE NOTICE
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burden to: Information Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW,Washington, DC 20472,
Paperwork Reduction Protect(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 WELCO15 12/05/13 123.99123.00 C
APPLICANT WORK COMPLETED AS OF:
Weld County DATE: PERCENT:
11119/13 95%
DAMAGED FACILITY COUNTY
Road-CR 58 Weld
LOCATION LATITUDE LONGITUDE
CR 58 Near South Platte River 40.40833 -104.61388
Was this site previously damaged? C Yes (' No C' Unsure
DAMAGE DESCRIPTION AND DIMENSIONS:
See Attached
SCOPE OF WORK:
Fund at 75%
See Attached •
PROJECT COST
ITEM CODE NARRATIVE QUANTITY UNIT UNIT PRICE COST
1 0000 WORK TO BE COMPLETED $ -
2 9999 Repair Estimate 1.00 LS $76223.54 $ 76,223.54
3 9901 Direct Administrative Costs(estimated) 1.00 LS $1,000.00 $ 1,000.00
$
$
$
SUBTOTAL FROM COST CONTINUATION PAGE(S) $T•
OTAL PROJECT COST $ 77,223.54
PREPARED BY: Kathleen Ruvarac TITLE: TAC Bridge Speclatist
FEMA PAC CREW LEADER: Mark Spahr STATE PAC CREW LEADER: Kevin K.--
APPLICANT: Roy Rudisill `/G PHONE 2014-0424
NOIIOn01PW Tomblin V2A Juno 2912 Eliot 200112010 Gr-
Cdrzclf itt— -42-«F Be,OOcIC
cc` f11 661 oern t Pw I otar a2/!/1/
FEMA Form 90.120
FEDERAL EMERGENCY MANAGEMENT AGENCY
SPECIAL CONSIDERATIONS
DISASTER APPLICANT NAME PW REF NO. FIPS NO. DATE
4145 I CO Weld County WELCOI5 123.99123.00 12105113
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 floodplaln or wetland?
r:Yes r No C Unsure
Location 1 -Zone B-Areas between limits of the 100 year flood and and 500 year flood;etc.Location 2-Zone C -Areas of minimal
flooding. Flood Map Panel 0802660637C dated September 28, 1982
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 k:No C Unsure
4. Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g.,footprint,material,locaffon,capacity,use or function)
r Yes G No C Unsure
5. Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal?
F Yes r 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?
C Yes G No C Unsure Facility Constructed In:
7. Are there any pristine or undisturbed areas on,or near,the project site? Are there large tracts of forestland?
C Yes 6'No C Unsure
8. Are there any hazardous materials at or adjacent to the damaged facility and/or item of work?
C Yes G No C Unsure
9. Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work?
6-Yes r No C Unsure
EHP to conduct review
10
C Yes C No G Unsure
PREPARED BY: 'Kathleen Ruvarac
National PW Tamplale V25June 2012 Extol 20111/2010
Weld County CAT C CR 58 near South Platte River JIMP_HMP 2/6/2014 1:27:51 PM Page 1 of 1
406 Hazard Mitigation Plan
Work To Be Completed
The applicant has indicated that the installation of turf reinforcement mat on the roadside shoulders
and embankment slopes will re-direct channel flow across the slopes reducing erosion at the facility and
alleviating future damages.
1) Turf Reinforcement Mat-254 ft in length x 19 ft in width within the right of way=536.2 SY x 1.2
factor for toe in excess of material=643.5 SY x$10.00/SY(CDOT Item Number 216-00301)=$6,435.00
This HMP is considered cost effective per FEMA Disaster Assistance Policy 9526.1,Section VII. 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.
Location 1—SOW Item#1=$50,201.88
$6,435.00/$50,201.88=12.8%
The net cost of mitigation/cost of damages is 12.8%<100%.This HMP is for cost estimating purposes
only. The Final design is the obligation of the Applicant and/or their agent.
FEDERAL EMERGENCY MANAGEMENT AGENCY
HAZARD MITIGATION PROPOSAL(I-IMP)
DISASTER APPLICANT - PWREF NO. FIPS NO. CATEGORY
4145 I CO Weld County WELCOI6 1238912340 C
SCOPE OF WORK:
See attache •
d
ESTIMATE OF WORK
ITEM CODE DESCRIPTION QUANTITY UNIT UNIT PRICE COST
1 9999 Turf Reinforcement Mat 643.50 SY $10.00 $6,435.00
Total behind RepaltlReplacement Cost of Damaged Element(s) $50,201.86 Total HMP Cost
%of Total Eligible Cost 12.82%
Eligibility 16%Rule (Do Not Include in the pW) $6,436.00
TECHNICAL SPECIALIST FOR MITIGATION(SIGNATURE) Agency Date
RECOMMENDED BY(SIGNATURE) (TITLE Agency Date
•
CONCURRENCE BY STATE INSPECTOR - f Agency Date
CONCURRENCXBY AP LIC NT Agency, / ate
/
KO/ i d,a,// r,; j z ( ..441 `/c-1{c
NOTE:Signature by the Federal Inspector Is not an approval of this work, and signature by the state and Local Representative llnot a commitment to
perform the work
Imllonal @NTomplatoWAI June 2012 E[<m 200712010
FEDERAL EMERGENCY MANAGEMENT AGENCY
HAZARD MITIGATION PROPOSAL (HMP) SUMMARY
DISASTER APPLICANT PW REF NO. " PIPS NO. CATEGORY
4145 I CO Weld County WELCO75 123499123-00 C
0 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
• Mitigation Policy
O 15 percent
❑ 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: $6,435.00 Percent: 12.82%
❑ Check here if you wish to attach a Hazard-Mitigation Proposal
Prepared By: Ifiathieen Ruvarac I 12/5/2013
Nallonaf PW Temolah V2a Juna 2012 Emil 2001/2010
•
Ruvarac, Kathleen
From: Fosha, Rosellen •
Sent: Tuesday, February 04, 2014 12:58 PM
To: Ruvarac, Kathleen
Subject: FW: Reinforced Turf Mat(no project written) -USFWS
Regarding your Weld County Roads project with matting. It is okay to use the material the Applicant is willing to provide
FOR THIS PROJECT ONLY.
Rose
From:Weinert,Joann
Sent:Tuesday, February 04, 2014 12:55 PM
To: Fosha, Roselien
Subject: Fw: Reinforced Turf Mat(no project written) -USFWS
This is my ok for Kathy's project
From: FEMA-DR4145-CO-EHP
Sent:Tuesday, February 04, 2014 11:50 AM
To: Weinert,Joann
Subject: RE: Reinforced Turf Mat(no project written) -USFWS
Sounds good to me.Sorry for my late reply. Enjoy your time at home.
From:Weinert,Joann
Sent: Monday, February 03, 2014 1:33 PM
To: FEMA-DR4145-CO-EHP
Subject: RE: Reinforced Turf Mat(no project written) -USFWS
Colleen,
No floodplain, stream or ditch. Preble is only'Range' (no trappings)close to the 2 mile range. I am going to allow it, if
that's OK with you.
Joann
From: FEMA-DR4145-CO-EHP
Sent: Monday, February 03, 2014 10:26 AM
To: Weinert, Joann
Cc: Fosha, Rosellen
Subject: RE: Reinforced Turf Mat(no project written) -USFWS
Is it within 300ft of a stream, ditch, or floodplain? If no,then I don't see a problem with it. If it is within 300ft of one of
these, are there positive trapping results within 2 miles?-Colleen
From: Weinert,Joann
Sent: Friday,January 31, 2014 4:42 PM
To: FEMA-DR4145-CO-EHP
Cc: Fosha, Roselien
Subject: RE: Reinforced Turf Mat(no project written) -USFWS
t
Project specialist would like to use the matting(see attached)on road shoulder adjacent to the travel lane. This site is
not on a riverbank.The site is within Preble Habitat Area.
jofnn`Weinert
Environmental Specialist
FEMA Branch 1
Greeley CO
202-294-2069
Joann.weinertna,fema.dhs.gov
2
Weld County CAT C CR 58 near South Platte River 2/7/2014 11:37:17 AM Page 1 of 4
Damage Description and Dimensions
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 CR 58 east of South
Platte River and Bridge 58-47A over Patterson Ditch, in Section 12,T5N, R65W.
On November 19, 2013, Kathleen Ruvarac, FEMATAC Bridge Specialist, David Ray, FEMA Hazard
Mitigation Specialist,Gary Moore, FEMA Environmental, Historical, Preservation Specialist,and Donald
Dunker, Weld County Public Works Engineer, performed a site investigation at this location to document
damages. The road and bridge was open and repairs completed at the time of inspection.
Location 1
CR 58 east of South Platte River,Category C,Permanent Road Repair
Lat: N40.40833
Long: -W104.61388
Flooding of South Platte River resulted in damages on CR 58 include washout of asphalt, roadway base
and embankment material on the westbound travel lane and adjacent shoulder.
Embankment Material lost in roadway void in the westbound travel lane measuring 254 ft in length x 12
ft in width x 3 ft in depth=338.7 CY and on north shoulder measuring 254 ft in length x 17 ft in width x 3
ft in depth=479.8 CY,totaling 818.5 CY.
One asphalt patch on roadway measured 254 ft in length x 12 ft in width=3,048 SF x 0.5 ft in depth=
1,524 CF x 146 LB/CF x 1 ton/2000 LB=111.3 INS asphalt
Ditch cleaning each side of the road to remove debris at the site is estimated to be 375 ft in length on
the north shoulder and 325 ft in length on the south shoulder adjacent to the travel lanes,totaling 700
LF.
Location 2
Bridge 58-47A over Patterson Ditch, Category C, Permanent Bridge Repair
Lat: N40.41003
Long:-W104.62029
Flooding of Patterson Ditch resulted in damages to Bridge 58-47A including washout of asphalt, roadway
base and embankment material on the east and west approaches behind the backwalls and wingwalls.
The double span concrete bridge, 75 ft in length x 32 ft in width,traverses the Patterson Ditch and
consists of a concrete deck,one (1)concrete intermediate pier and integral concrete backwall and
wingwalls. Bridge inspection reports were not provided by the applicant.
Material lost in first roadway patch on the east approach behind the backwall is estimated to be 40 ft in
length x 31 ft in width x 10 ft in depth=459.3 CY.
Weld County CAT C CR 58 near South Platte River 2/7/2014 11:37:17 AM Page 2 of 4
Material lost in second roadway patch is estimated to be 18 ft in length x 7 ft in width x 3 ft in depth=-
14.0 CY.
Material lost in third roadway patch is estimated to be 4 ft in length x 3 ft in width x 3 ft in depth=1.3
CY.
Total Material: 474.6 CY
One asphalt patch on roadway behind the east backwall measured 40 ft in length x 31 ft in width= 1,240
SF x 0.5 ft in depth =620 CF x 146 LB/CF x 1 ton/2000 LB=45.3 TNS asphalt
A second asphalt patch on roadway measured 18 ft in length x 7 ft in width=126 SF x 0.5 ft in depth=
63 CF x 146 LB/CF x 1 ton/2000 LB=4.6 TNS asphalt
A third asphalt patch on roadway measured 4 ft in length x 3 ft in width= 12 SF x 0.5 ft in depth=6 CF x
146 LB/CF x 1 ton/2000 LB=0.4 INS asphalt
Total Asphalt: 50.3 TNS
In addition, Rip Rap was washed away at each wingwall and is estimated to be(15 ft in front of each
wingwall x 4 wingwalls,totaling 60 ft in length x 5 ft in width towards the channel x 3 ft in depth=33.3
CY.
The Applicant has provided pictures of the road and bridge facilities dated 9-15-2013 documenting
damages. These photos are attached to this project worksheet.
Scope of Work
WORK TO BE COMPLETED
Location 1
1—Fill void in roadway travel lane,embankment and north shoulder-818.5 CY x 1.82(Conversion
Factor CY ABC Class 6 Material to Tons= 1,489.7 tons x$33.70/ton(CDOT Item Number 304-06000
Aggregate Base Course Class 6 x 2 due to economies of scale as compared with number of CDOT annual
projects)=$50,201.88
2—Install asphalt on roadway westbound travel lane= 111.3 tons x$81.70/ton(COOT Item Number
403-33741 Hot Bituminous Pavement(Grading S) (75)(PG 64-22) =$9,093.21
3—Ditch cleaning each side of roadway=700 LF x$3.40/LF(FEMA Cost Code 3070 Ditch Cleaning and
shaping)=$2,380.00
Total Location 1=$61,675.09
Location 2
1—Structural Backfill behind east abutment backwall at first roadway patch location—459.3 CY x
$14.68/CY(CDOT Item Number 206-00100 Structural Backfill)=$6,742.52
Weld County CAT C CR 58 near South Platte River 2/7/2014 11:37:17 AM Page 3 of 4
2-Fill voids in roadway travel lane in the second and third asphalt patch locations—15.3 CY x 1.82=27.8
tons x$33.70/ton (COOT Item Number 304-06000 Aggregate Base Course Class 6 x 2 due to economies
of scale as compared with number of COOT annual projects)=$936.86
3-Install asphalt at three locations on the westbound travel lane=50.3 tons x$81.70/ton (CDOT Item
Number 403-33741 Hot Bituminous Pavement(Grading S) (75) (PG 64-22)=$4,109.51
4—Replace Rip-Rap in front of wingwalls—33.3 CY x$83.17/CY(CDOT Item Number 506-00218 Rip Rap
18 inch)=$2,769.56
Total Location 2=$14,558.45
Total:$76,223.54 cost estimate prepared by project specialist using 2013 COOT Average Unit Prices
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.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.
3. Applicant has completed a substantial percentage of the work but will not have cost data
available within the fourteen day Pocket Guide rule. Per Field Operations Pocket Guide,Section 7,Cost
Estimates, Page 26, "If the applicant has not produced cost data within two weeks of the site inspection,
the Project Specialist will prepare the PW on the basis of an estimate for the work accomplished".
Applicant and FEMA personnel jointly conducted all inspections and agreed to use CDOT costs for in-
I pace costs to derive estimates on this project worksheet.Applicant underst
ands fonds that all actual support
Weld County CAT C CR 58 near South Platte River 2/7/2014 11:37:17 AM Page 4 of 4
documentation,invoices, FA records,contract and proof of payment will be required for final
reconciliation and or closeout process.Attached is the CDOT average in-place cost for materials.
4. 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.
5. 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.
6. The applicant must obtain all required federal,state,and local permits prior to the
commencement of work.
7. 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.
8. Project was reviewed for 406 Hazard Mitigation and a 406 HMP proposal is attached to this
project worksheet.
9. 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.
10. 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.
FEDERAL EMERGENCY MANAGEMENT AGENCY
9901-DIRECT ADMINISTRATIVE COSTS (SUBGRANTEE)
DISASTER APPLICANT PW REF NO. CATEGORY
4145 j CO Weld County WELCO16 C
COUNTY DATE FIPS NO, WORK STATUS
Weld 12/05/13 123.99123.00 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. All costs must be documented at the time of grant closeout
LABOR SUMMARY
NAME TITLE HOURS RATE wr COST
FRINGE
PW Development Through Closeout 25 $ 40.00 $ 1,000.00
$
$
LABOR SUBTOTAL $ 1,000.00
EQUIPMENT SUMMARY
COST CODE DESCRIPTION HOURS OR RATE COST
MILES
$
$ •
$
$
$
$
$
. $
$
$
EQUIPMENT SUBTOTAL $
MATERIAL SUMMARY
OFFICE SUPPLIES DESCRIPTION QUANTITY UNIT PRICE COST
$
$
$ .
$
OTHER MATERIAL DESCRIPTION QUANTITY UNIT PRICE COST
•
$
$
MATERIAL SUBTOTAL $
DIRECT ADMINISTRATIVE COSTS TOTAL $ 1,000.00
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: Date:
Roy Rudisill ite.%,("7 Director-OEM ;//g./�
National PW Talnpint.V2.0 June 2012 Excel 200712010
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S) Compacted Subgrade `�•••
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•HMA
•ABC(Class 6)—
TYPICAL
CROSS SECTION
Dens 11 1 ` /ry/OX) Tum Lanes as Required by Public Works.
�,M4 r /1 / 3 CA-siltal.{—)
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/-'- 14,14.4' iF.N 4(/
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I••The allowable class and thickness of Hot
Milt Aspbalt(BMA)end Aggregate Base
Course(ABC)shall be detennlncdby the
guidelines described in the Pavement
DeeignChapter.
2. The finestepee and beckslopes shall be
no sleeper Wen 3:1 with a preference of
4:1-6:1.
NOT TO SCALE 3• All aideslopes shall be seeded and mulched.
4. Additional ROW may be required by Public
"Length of Aux.Lanes Will Vary Works to meet site specific requirements.
According to Posted/Design Speed
Requttemems S. Signing and striping per approved plan.
Computer Filo Information WELD COUNTY
ces,00,tn ovtaW ''uN PUBLIC WORKS DEPARTMENT
tisIN•S aoeaUacettortti Me S&kit RURAL LOCAL
reaaan:TAP8SCUdmlaWropouti\Weide uiJNle.awwomeaawJfl ^�`°"t
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WELD COUNTY ENGINEERING&CONSTRUCTION CRITERIA Page i 10
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