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Home My WebLink About20143248.tiff LOCAL AGENCY OFFER AMENDMENT Local Agency Offer Amendment C 030-061 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. 20051 ER1 ("Original Task Order") under the Master Agreement for the Flood Damaged Area in WCR 17 CR 50A 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 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 2J® '�i/O relying on hislher representation to that effect. //v/�-iL�itheIW Signature of Authorized Person (Local Agency) Office of Emergency Management - Director Title September 11, 2014 Date 2014-3248 eon...../- swat, ed : oEm /6-20°2-0 /3COO4'S EG ©D7D Sheet of I Report Number: Department of DETAILED DAMAGE INSPECTION REPORT 20051_Weld_County_03A-ER anaportauen radar*Highway Inspection Date: Administration (Title 23, Federal-aid Highways) 10/30/2013 Location(Name of Road and Milepost) FHWA Disaster Number: CO-13-1 Weld County Site 03 Federal-aid Route Number: County Road 17(CRS0A Bridge)Over Big Thompson River 00017 Description of Damage (ONLY ONE ITEM MAY BE CHECKED) State: County: O Emergency Repair O Permanent Repair O Debris Removal CO Weld Extreme rain amounts caused floodwaters that overtopped the roadway and bridge,scouring the embankments and WOrk Order Number: shoulders,and washed out the north roadway approach at bridge abutments.Emergency repairs to restore essential traffic include backfilling embankments,shoulders,and roadway.Emergency repairs to protect the structure include placing riprap in the channel. 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 f--"nage LF 0 0 .. Items LS 0 0 General Construction Items LS 0 0 Winter Work&Dewatering Items LS 0 0 Engineering Services(See Attached) $ 25,900.00 ER Work to Restore Traffic(See attached) $ 29,262.57 Additiona ER Work(See Attached)* * $ 55,000.00 Deduction-PR Item(Pavement) $ (2,520.37) ER Work to Protect the Structure(See attached)* • $ 51,264.20 Construction Estimate Subtotal $ 158,906.40 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 Estimated Project Total $ 158,906.40 El Local Forces O State Forces ❑a Contract Environmental Assessment Recommendation Prepared By: Date: o Categorical Exclusion O ENEIS Kevin Delve,PE 7/28/2014 Concurrence FHWA Engineer(Print Name): FM A Engineer(Signature): Date: ❑ Yes O No Randy Jensen //ems yy!/___- 72°/jyy Concurrence State Engineer(Print Name): State Eng' rlf8lgn'ature): Date: Or r—❑ Yes O No Heather Paddock,PE r\ ----- i jag'ICI Concurrence Local lA A cy SiAgency(Print Name): Local nature): G Date:Yes O No s ,FHWA USE ONLY ( Form FHWA-1547 FEMA Eligible: O Yes O No CDOT 11.5.2013 EXHIBIT C -FUNDING PROVISIONS Task Order a: 20051 ER1 Estimated Cost of Work Project Name: ERLA WCR 17 CR 50A BRDGE OVER BIG T The estimated total cost the Work is as follows: �. I BUDGETED FUNDS • a Federal Funds $ 150.0$5.00 • (100%of Participating Costs) $107,643.00 (82 79%of Participating Costs) $42 442 00 b. Local Funds $4 411 50 (0%of Participating Costs) (R 605%of Participating Costs) $4.411.50 c State Funds $4.411.50 (8,605%of Panicipating Costs) $4,411.50 TOTAL BUDGETED FUNDS: $ 158,908.00 $ 158,908.00 2 f ESTIMATED PAYMENT TO LOCAL AGENCY*: a Federal Funds Budgeted 1 la) is 150,085.00 b Slate Funds Budgeted(lc) IS 4 411 50 TOTAL ESTIMATED PAYMENT TO LOCAL AGENCY*:I$ 154,49$.50 C 3 FOR CDOT ENCUMBRANCE PURPOSES Encumbered WBS Element Phase Function Pnyebte Participating Pereemege Budgeted Funds Funds°' Design 3020 ROW 3111/3114 lA(n/Reloc) ROW 3114 Incidentals Egoist O‘) 3301 20051.10.50 Miscellaneous 3404 $ 158,908.00 $158,908.00 unities 3988 Environmental 3403 • TOTAL ENCUMBERED FUNDS:I$ 158,908.001$ 158,908.00 *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 Hello