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HomeMy WebLinkAbout1 - Original Submission_ 6thSt_Ph2_LAA Supplement for CNMOD_210714_140-041.v8cbDOT Form 140-041Revised 12/2020 Page 1 Local Agency Agreement Supplement Agency Supplement Number Federal Aid Project Number Agreement Number CFDA No. 20.205(Catalog of Federal Domestic Assistance) The Local Agency requests to supplement the agreement number noted above. All provisions in the basic agreement remain in effect except as modified by this supplement. The Local Agency certifies that it is not excluded from receiving Federal funds by a Federal suspension or debarment (2 CFR Part 180). Additional changes to the agreement are as follows: Project Description Name Length Termini Description of Work No Change Reason for Supplement Are you claiming indirect cost rate? Yes No Project Agreement End Date Does this change require additional Right of Way or Easements? Yes No Advertisement Date: Type of Work Estimate of Funding(1) Previous Agreement/Suppl. (2) Supplement (3) Estimated Total Project Funds (4) Estimated Agency Funds (5) Estimated Federal FundsPE%a. Agency b. OtherFederal Aid Participation Ratio for PE c. Other d. State e. Total PE Cost Estimate (a+b+c+d)Right of Way%f. Agency g. OtherFederal Aid Participation Ratio for RW h. Other i. State j. Total R/W Cost Estimate (f+g+h+i)Construction%k. Contract l. Other m. OtherFederal Aid Participation Ratio for CN n. Other o. Agency p. State q. Total CN Cost Estimate (k+l+m+n+o+p) r. Total Project Cost Estimate (e+j+q)The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a condition to payment of the Federal funds obligated, it accepts and will comply with the applicable provisions. Agency OfficialBy Title Washington State Department of TransportationBy Director, Local Program Date Executed DOT Form 140-041Revised 12/2020 Page 2 Agency Supplement Number Federal Aid Project Number Agreement Number CFDA No. 20.205(Catalog of Federal Domestic Assistance) VI. Payment and Partial Reimbursement The total cost of the project, including all review and engineering costs and other expenses of the State, is to be paid by the Agency and by the Federal Government. Federal funding shall be in accordance with the Federal Transportation Act, as amended, 2 CFR Part 200. The State shall not be ultimately responsible for any of the costs of the project. The Agency shall be ultimately responsible for all costs associated with the project which are not reimbursed by the Federal Government. Nothing in this agreement shall be construed as a promise by the State as to the amount or nature of federal participation in this project. The Agency shall bill the state for federal aid project costs incurred in conformity with applicable federal and state laws. The agency shall minimize the time elapsed between receipt of federal aid funds and subsequent payment of incurred costs. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead shall not be eligible for federal participation unless a current indirect cost plan has been prepared in accordance with the regulations outlined in 2 CFR Part 200 - Uniform Admin. Requirements, Cost Principles and Audit Requirements for Federal Awards, and retained for audit. The State will pay for State incurred costs on the project. Following payment, the State shall bill the Federal Government for reimbursement of those costs eligible for federal participation to the extent that such costs are attributable and properly allocable to this project. The State shall bill the Agency for that portion of State costs which were not reimbursed by the Federal Government (see Section IX). VII. Audit of Federal Consultant Contracts The Agency, if services of a consultant are required, shall be responsible for audit of the consultant’s records to determine eligible federal aid costs on the project. The report of said audit shall be in the Agency’s files and made available to the State and the Federal Government. An audit shall be conducted by the WSDOT Internal Audit Office in accordance with generally accepted governmental auditing standards as issued by the United States General Accounting Office by the Comptroller General of the United States; WSDOT Manual M 27-50, Consultant Authorization, Selection, and Agreement Administration; memoranda of understanding between WSDOT and FHWA; and 2 CFR Part 200.501 - Audit Requirements. If upon audit it is found that overpayment or participation of federal money in ineligible items of cost has occurred, the Agency shall reimburse the State for the amount of such overpayment or excess participation. IX. Payment of Billing The Agency agrees that if payment or arrangement for payment of any of the State’s billing relative to the project (e.g., State force work, project cancellation, overpayment, cost ineligible for federal participation, etc.) is not made to the State within 45 days after the Agency has been billed, the State shall effect reimbursement of the total sum due from the regular monthly fuel tax allotments to the Agency from the Motor Vehicle Fund. No additional Federal project funding will be approved until full payment is received unless otherwise directed by the Director, Local Programs. Project Agreement End Date - This date is based on your projects Period of Performance (2 CFR Part 200.309). Any costs incurred after the Project Agreement End Date are NOT eligible for federal reimbursement. All eligible costs incurred prior to the Project Agreement End Date must be submitted for reimbursement within 90 days after the Project Agreement End Date or they become ineligible for federal reimbursement. VIII. Single Audit Act The Agency, as a subrecipient of federal funds, shall adhere to the federal regulations outlined in 2 CFR Part 200.501 as well as all applicable federal and state statutes and regulations. A subrecipient who expends $750,000 or more in federal awards from all sources during a given fiscal year shall have a single or program-specific audit performed for that year in accordance with the provisions of 2 CFR Part 200.501. Upon conclusion of the audit, the Agency shall be responsible for ensuring that a copy of the report is transmitted promptly to the State. XVII. Assurances Local Agencies receiving Federal funding from the USDOT or its operating administrations (i.e., Federal Highway Administration, Federal Transit Administration, Federal Aviation Administration) are required to submit a written policy statement, signed by the Agency Executive and addressed to the State, documenting that all programs, activities and services will be conducted in compliance with Section 504 and the Americans with Disabilities Act (ADA). Instructions 1.Agency – Enter the agency name as entered on the original agreement. 2.Supplemental Number – Enter the number of the supplement. Supplement numbers will be assigned in sequence beginning with Number 1 for the first supplement. 3.Project Number – Enter the federal aid project number assigned by WSDOT on the original agreement. 4.Agreement Number – Enter the agreement number assigned by WSDOT on the original agreement. 5.Project Description. Enter the project name, length, and termini. 6.Description of Work – Clearly describe if there is a change in work such as the addition or deletion of work elements and/or changes to the termini. If the work has not changed, put a check mark in the “No Change” box. 7.Reason for Supplement – Enter the reason for this supplement, i.e., increase PE funding to cover design changes presented in the revised prospectus; request funding of construction phase; decrease construction funding to the contract bid amount. If the supplement is authorizing a construction phase, the project’s proposed advertisement date must be included in the space provided. 8.Change Requiring Additional Right of Way or Easements – Check the Yes box when the supplement covers a change in scope (Description of Work or Termini) that requires additional property rights than was previously expected, or when it’s determined that property rights are necessary and the project was previously submitted as no right of way required. Check No when this is the case. 9.Claiming Indirect Cost Rate – Check the Yes box if the agency will be claiming indirect costs on the project. For those projects claiming indirect costs, supporting documentation that clearly shows the indirect cost rate being utilized must be provided with the supplement. Indirect cost rate approval by your cognizant agency or through your agency’s self-certification and supporting documentation is required to be available for review by FHWA, WSDOT and /or State Auditor. Check the No box if the agency will not be claiming indirect costs on the project. See Section 23.5 for additional guidance. 10.Project Agreement End Date – Enter your previously established Project Agreement End Date. If authorizing a new phase of the project, update the Project Agreement End Date based on the following guidance: a.For PE and RW – WSDOT recommends agencies estimate when the phase will be completed and add three years to determine the “Project Agreement End Date”. b.For Construction – WSDOT recommends agencies estimate when construction will be completed and add three years to determine the “Project Agreement End Date”. c.If an extension to a Project Agreement End Date is required between phase authorizations, the need for the extension must be described in the Reason for Supplement. Adequate justification to approve the extension must be submitted with the supplement. See Section 22.3 for additional guidance. 11.Type of Work and Funding – Complete this section in the manner described in Appendix 22.52.05. a.Column 1 – Enter the amounts from column 1 of the original local agency agreement. If the agreement has already been supplemented, enter the amounts by type of work from column 3 of the last supplemental agreement. b.Column 2 – Enter additional amounts requested by type of work. c.Column 3 – Add the amounts in columns 1 and 2. d.Columns 4 and 5 – Enter the appropriate amounts based on the participation ratio recorded on the original agreement. 12.Signatures – An authorized official of the local agency signs the Supplemental Agreement, and writes in their title. Submit one originally signed supplement form to the Region Local Programs Engineer. It is the responsibility of the local agency to submit an additional, originally signed agreement form if they need an executed agreement for their file. Note: Do NOT enter a date on the Date Executed line.