HomeMy WebLinkAboutCANCELLED - Washington State Department of Transportation Local Programs Olympic Discovery Trail Construction Funds - 090825Aftk
Washington State
wo Department of Transportation Local Agency Agreement Supplement
Agency Supplement Number
Jefferson County Public Works 1
Project Number Agreement Number ALN. 20.205 - Highway Planning
STBGR-2016(030) ILA 11085 and Construction
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 Olympic Discovery Trail- Anderson Lake Connection
Termini Larry Scott Trail to Anderson Lake State Park
Description of Work ✓ No Change
Length 3.15 miles
Construction of an Olympic Discovery Trail segment connecting Larry Scott Trail via Jefferson Transit Park & Ride, to Anderson Lake
State Park.
Reason for Supplement
Distribute Federal Aid funds from currently only Construction Contract, to allow Federal Aid funding of Construction Consultant,
Agency, and State Services also.
Indirect Cost Rate [_ ] Yes ✓ No Project Agreement End Date 12/31 /2028
Advertisement Date 12/25/2024
Type of Work
_
Estimate of Funding
(1)
Previous
A reement/Su .
()
Supplement
(3)
Estimated Total
Pro ect Funds
(4)
Estimated Agency
Funds
(5)
Estimated Federal
Funds
PE
0
a. Agency
0.00
0.00
0.00
0.00
%
b. Other
0.00
0.00
0.00
0.00
Federal Aid
Other
0.00
0.00
0.00
0.00
Participation
Rabo(s) for PE
d. State Services
0.00
0.00
0.00
0.00
e. Total PE Cost Estimate
0.00
0.00
0.00
0.00
0.00
Right of Way
f. Agency
0.00
0.00
0.00
0.00
0
Other
0.00
0.00
0.00
0.00
Federal Aid
Participation
h. Other
0.00
0,00
0.00
0.00
Rabo(s) for RW
i. State Services
0.00
0.00
0.00
0.00
L Total R/W Cost Estimate0.00
0.00
0.00
0.00
0.00
Construction
k. Contract
1,756,453.00
-66,700.00
1,689,753.00
228,117.00
1,461,636.00
86.5 %
L Other (Non -Fed.)
2,633,503.00
126,700.00
2,760,203.00
2,760,203.00
0.00
Federal Aid
Participation
M. Other (Consultant)
40,000.00
-24,439.00
15,561.00
2,101.00
13.460.00
n. Other (Cnslt't, Ag'ncy, State)
0.00
104,757.00
104,757.00
104,757.00
0.00
Ratio(s) for CN
o. A enc
181,459 00
-135, t 81.00
46,278.00
6,248.00
40,030.00
State Services
10,000.00
-5.137.00
4,863.00
657.00
4,206.00
g. Total CN Cost Estimate
4,621,415.00
0.00
4,621,415.00
3,102,083.(X)
1,519,332.(x)
r. Total Pro ect Cost Estimate
4:621,415.00
0.00
4,621,415.00
3,102,083.00
1,519,332.00
The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a
cond' to to pay ent of the Federal funds obligated, it accepts and will comply with the applicable provisions.
Age c ffi 'al Washington State Department of Transportation
By
Heidi our, Chair, Board of, ff rson Cyommissioners By
Agency Date: _ Director, Local Programs
Approved as to fort _ fOrg at 08/25
PhilipC Hunsucker, Chi wil e Pr,
Attorney Date Executed
Jefferson County Dept of Prosecuting Attorney's Office
DOT Form 140-041 LP Revised 12/2024 ` Previous Versions Obsolete " Page 1
Agency
Supplement Number
Jefferson County Public Works
1
Project Number
Agreement Number
ALN 20.205 - Highway Planning
STBGR-2016(030)
LA 11085
and Construction
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.
Vill. 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 $1,000,000 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).
DOT Form 140-041 LP Revised 12/2024 Page 2
• Previous Versions Obsolete •
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. 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.
9. 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".
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.
10. Advertisement Date - At construction authorization only, enter the proposed project advertisement date (mm/dd/yy).
11. Type of Work and Funding (Round all amounts to the nearest whole dollar).
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 increase/decrease to total 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.
e. State Services — All authorized phases must have funding for state services. Enter the estimated amounts in columns 1
through 5 as described above.
12. Signatures —An authorized official of the local agency signs the Supplemental Agreement and enters their title and date of
signature (mm/dd/yy). Note: Do NOT enter a date on the Date Executed line.
DOT Form 140-041 LP Revised 12/2024 Page 3
• Previous Versions Obsolete .
Department of Public Works
O Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Josh Peters, County Administrator
From: Monte Reinders, P.E., Public Works Director/County Engineer
Agenda Date: September 8, 2025
Subject: Execution of Local Agency Agreement Supplement #1 with WSDOT
for construction funding for Olympic Discovery Trail- Anderson
Lake Connection project, County Project No. 18019893, Road No.
850200
Statement of Issue: Execution of Local Agency Agreement with Washington State
Department of Transportation (WSDOT) Local Programs for distribution of construction
funding for Olympic Discovery Trail- Anderson Lake Connection project, Project No.
18019893, Road No. 850200.
Analysis/Strategic Goals/Pro's &t Con's: Jefferson County was allocated Federal funding
through the Surface Transportation Block Grant. The proposed trail project runs from the
south end of Larry Scott Trail to the northern boundary of Anderson Lake State Park.
Construction funds were obligated in December 2024. This Supplement is intended to
distribute the grant funds to all eligible categories of construction expenditures.
Fiscal Impact/Cost Benefit Analysis: The grant amount is $1,519,332. Construction will be
funded at 33.65% by this grant. The remaining construction funding is from WA State
Recreation and Conservation Office (RCO) WA Wildlife and Recreation -Trails grant #20-1745.
Recommendation: Public Works recommends that the Board execute the Local Agency
Agreement Supplement #1 with WSDOT Local Programs and return to Public Works for further
processing. After WSDOT executes the agreement, Public Works will return document to
Board.
Department Contact: John Fleming, P.E., Project Manager, 360-385-9160.
Reviewed By:
1
� � 3
Jo Peters, County Administrator Date
CONTRACT REVIEW FORM I Clear For:-::]
orm 1
(INSTRUCTIONS ARE ON THE NEXT PAGE) pt v�6_�s _Z�j
CONTRACT WITH: Washington State Department of Transportation, Local Programs Contract No: WA -
Contract For: Olympic Discovery Trail Construction Funds Tern: 12/31/2028
COUNTY DEPARTMENT: Public Works
Contact Person: Chris Spall
Contact Phone: 360-385-9208
Contact email: cspallOco jefferson wa us
AMOUNT: $1.519,332.00
Revenue:
Expenditure:
Matching Funds Required:
Sources(s) of Matching Funds
Fund #
Munis Org/Obj
Exempt from Bid Process
Cooperative Purchase
Competitive Sealed Bid
Small Works Roster
Vendor List Bid
RFP or RFQ
✓ Other: Grant
APPROVAL STEPS:
STEP I: DEPARTMENT CERTIFIES COMPLIANCFD;g ITRJM, ._55.080 AND CHAPTER 42.23 RCW.
DN: C-US, 8/19/2025
CERTIFIED: a N/A:� John Flemin Q:,,,er, «",
Sij'gXtR��0819 Is 2131 07W Date
STEP 2:
COUNTY
AGENCY.
PROCESS:
STBGR-2016(030)
18019893
yes
RCO WWRP-T 20-1725
DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
(CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
CERTIFIED: R N/A: R
Dqilally signed by John f',erhmg
DN C=US
'Ileming@co jegeison wa us,
John Fleming 0.JeNersonCounty,OU=Public 8/19/2025
Works, CN=Jahn Fleming
Dale:2 .
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 8/28/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
VS
electronically approved as to form by PAO on 8/28/2025.
upplemental state grant contract addressing how funds are being
distributed. Thank you for adding the original agreement.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL.
FOR REFERENCE ONLY
Original Agreement
41t
Washington State
�if Department of Transportation Local Agency Agreement
Agency Jefferson County Public Works CFDA No. 20.205 • Highway Planning and Construction
(Catalog of Federal Damesuc Assistance)
Address 623 Sheridan SI Project No. STBGR-2016(030)
Port Townsend, WA 9636&2439
Agreement No. I
For WSDOT Use Only I
The local Agency having complied, or hereby agreeing to comply, with the terms and conditions set forth in (1) Title 23, US Code
Nighways, (2) the regulations issued pursuant thereto. (3) 2 CFR Part 200.(4) 2 CFR Part 160 - certifying that the incal agency is not
excluded from receiving Federal funds by a Federal suspension or debamlent, (5) the andoes and procedures promulgated by the
Washington State Department of Transprirtation, and (6) the federal aid project agreement entered into between the State and Federal
Government, relative to the above project, the Washington State Department of Transportation will authonze the Local Agency to
proceed on the pr*ct by a separate noWkAmn Federal funds which are to be obligated tot the project may not emceed the amount
shown herein on fine r, calumr 3, without written authority by the State, subject to the approval of the Federal Highway Administration
All project costs not reimbursed by the Federal Govemmen i shall be the responsibility of the Lnca{ Agency
Project Description
Name Olympic Discovery Trail -Anderson take Connection Length 3 15 miles
Termini Larry Scott Trar to Anderson Lake State Park
Description of Worts
Construction of an Olympic Discovery Trail segment connecting the Larry Scott Trail, via Jefferson Transit Park di Ride, to Anderson
1 ake State Park ItiL' j,
't>r
�y
Project Agreement End Date 11213112101 Claiming Indirect Cost Rate
Proposed Advertisement Date 10l0 r 12,25i2024 !_Yes r/ No
Type of Work
Federal Aid c r
Participation
RabDfor PE--_—__—
e. TOM PE Cost Et0KklA-0 !gl _ . _-
Rlght of way f &MM
0 % g. after _
Federal Aid
Participation ti`9IW-
Rato far RW t. State_Servilm -
Cottixxion kT��C4tE;m�
ns
86.5 n3 k Ct2ntrao
1 Qlher (Non Fed)
r4._Other (Consukant)
Federal Aid
Park"hor .0.
r
Ratio for CN g, Agency
AsStafg SCCWC�S __ _ _ _
i
4 L8r.8aI Chl Cost Estimate +hm«,+mD)
A _. _ r. TQj61 Prcyw Skrt!atexn-g:
Agency ORcial
9y Kate Dean
Title Chair, Boarfm County Comissioners
Agencycy Date. &I/)j 1 {Jo' 2. I
DOT Form 144(Y39 Approved as to fa n
Revised r)w2n22 Date August 1 2924
Philip C Hunsucker, Chief Civil Deputy Prosec4iing
Anomey. Jefferson Canty Dept of Prosecuting
Atto,ney's office
EElirttat<e_Qt Fund
(')
(T (3)
Estimated Total
Estiniaued Agency EdmoW Federal
PrIle dFurds
runds -Funds
U.00
O.lN1 O.IKI
0.01111
0.00 0.00
1,756,453.00
237.121.00 1,519,==
2,033,503.00
2,633,503 00 000
40,000.0G
=`-
40.000.00 01W
0:00
0.00 MIX
181,459_00
181,459 00 0.00
1 Q_000.00
_
10,000.00 000
4,621,415.(>V
3,102,083.00 1,519,332.M
4,621,415.00
3,102,083.00 1.5 i 9,332f10
Washington Sti a Department of Transportadon
By
Director, Local
Digitally signed by
Programs Stephanie'StephanieTax
Date Executed
Tax Date:2024.12.19
15:40:50 -07'W
Page 1
funds paid to the Agency under the terms of this agreement (see Section IX)
The Agency agrees that all stages of construction necessary to provide the initially planned complete facility within the limits of this
project will conform to at least the minimum values set by approved statewide design standards applicable to this class of highways,
even though such additional work is financed without federal aid participation.
The Agency agrees that on federal aid highway construction projects, the current federal aid regulations which apply to liquidated
damages relative to the bases of federal participation in the project cost shall be applicable in the event the contractor fads to complete
the contract within the contract time
Vt. Payment and Palmist 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 shah be ultimately responsible for all
costs associated with the project which are not reimbursed by the Federal Government. Nothing in this agreement sha€I 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 stale for federal aid project costs incurred in conformity with applicable federal and state laws. The agency
shah 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 indired cost plan has been prepared in accordance w.ih 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 Mil the Federal Government for
reimbursement of those costs eligible for federal participation to the extent that such costs are attributable and property allocable to
this project The State shall bill the Agency for that portion of State casts which were rot reimbursed by the Federal Government (see
Section IX)
1. Project Construction Costs
Project construction financing will be accomplished by one of the three methods as indicated in this agreement.
Method A - The Agency will place with the State, within (20) days after the execution of the oonstruction contract. an advance in the
amount of the Agency's share of the total construction cost used on the contract award. The State wilt notify the Agency of the exact
amount to be deposited with the State. The State will pay all costs incurred under the contract upon presentation of progress billings
from the contractor. Following such payments, the State wwili submit a billing to the Federal Government for the federal aid participation
share of the cost When the project is substantially completed and final actual costs of the project can be determined, the State will
present the Agency with a final bailing showing the amount due the State or the amount due the Agency. This billing will be cleared by
either a payment from the Agency to the State or by a refund from the State to the Agency
Method B - The Agency's share of the total construction cost as shown on the face of this agreement shall be withheld from its
monthly fuel tax allotments The face of this agreement establishes the months in which the withholding shall take place and the exact
amount to be withheld each month The extent of withholding will he confirmed by letter from the State at the time of contract award
Upon receipt of press odlings from the contractor, the State will submit such billings to the Federal Government for payment of its
participating portion of such billings.
Method C - The Agency may submit vouchers to the State in the format prescribed by the State, in duplicate, not more than once
per month for those costs eligible for Federal participation to the extent that such costs are directly attributable and property allocable
to this project. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead shall not be
eligible for Federal participation unless claimed under a previously approved indirect cost plan.
The State shall reimburse the Agency for the Federal share of eligible project costs up to the amount shown on the face of this
agreement. At the We of audit, the Agency will provide documentation of all costs incurred on the project. The State shall bill the
Agency for all costs incurred by the State relative to the project. The State shall also bill the Agency for the federal funds paid by the
State to the Agency for project costs which are subsequently determined to be ineligible for federal participation (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 shah 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 (see Section IX).
VIIi. Single Audit Act
The Agency, as a subrecipient of federal funds, shalt 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
DOT Form 140 039 Page 3
Revised 0412022
(c) Refer the case to the Department of Justice for appropriate legal proceedings.
XIII. Liquidated Damages
The Agency hereby agrees that the liquidated damages provisions of 23 CFR Part 635, Subpart 127, as supplemented. relative to
the amount of Federal participation in the project cost, shall be applicable in the event the contractor faits to complete the contract within
the contract time. Failure to include liquidated damages provision will not relieve the Agency from reduction of federal participation in
accordance with this paragraph.
XIV. Termination for Public Convenience
The Secretary of the Washington State Department of Transportation may terminate the contract in whole, or from time to time in
part, whenever.
(1) The requisite federal funding becomes unavailable through failure of appropriation or otherwise.
(2) The contractor is prevented from proceeding with the work as a direct result of an Executive Order of the President with
respect to the prosecution of war or in the interest of national defense, or an Executive Order of the President or Governor of
the State with respect to the preservation of energy resources.
(3) The contractor ntractor is prevented from proceeding with the work by reason of a preliminary. special, or permanent restraining
order of a court of competent jurisdiction where the issuance of such order is primarily caused by the acts or omissions of
persons or agencies other than the contractor.
(4) The Secretary is notified by the Federal Highway Administration that the project is inactive.
(5) The Secretary determines that such termination is in the best interests of the State.
XV. Venue for Claims andlor Causes of Action
For the convenience of the parties to this contrail, it is agreed that any claims andlor causes of action which the Local Agency
has against the State of Washington, growing out of this contract or the project with which it is concerned, shall be brought only in the
Superior Court for Thurston County.
XVI. Certification Regarding the Restrictions of the Use of Federal Funds for Lobbying
The approving authority certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or
an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment,
or modification of any federal contract, grant, loan, or Cooperative agreement.
(2) if any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or an employee
of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit the Standard Form - LLL, 'Disclosure Form to Report Lobbying,' in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at
all tiers (including subgrants, and contracts and subcontracts under grants, subgrants, loans, and cooperative agreements) which
exceed $100,000, and that all such subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.
Submission of this certification as a prerequisite for making or entering into this transaction imposed by Section 1352. True 31. U S.
Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than S10,000 and not more than
$100,000 for each such failure.
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 compiance with
Section 504 and the Americans with Disabilities Act (ADA)�
Additional Provisions
DOT Form 140-039 Page 5
Revised 0412022
• Line k - Enter the estimated cost of the contract.
• Lines I, m, 3 n - Enter other estimated costs such as utility and construction contracts or non -federally matched
cxmtract costs
• Line o - Enter estimated costs of all construction related agency worts
• Line p - State Services Every project must have funding for state services Enter the estimated amounts in columns 1
through 3
• Line q - Total Construction Cost Estimate Total of lines k + I + m + n + o +p.
d. Total Project Cost Estimate
• Line r Total Cost Estimate of the Protect. Tota of lines e + j + q
'Please emember. if the federal aid participation rate a-tered is not the maximum rate allowed by FHWA, then the
participation rate entered becomes the maximum rate allowed
b. Signatures - An authorized official of the local agency signs the agreement and enters their title and date of signature (mmlddl
yy). Note: Do NOT enter a date or the Date Executed line.
7. Method of Construction Financing - Choose the method of financing for the construction portion of the project.
a. Method "A" is used when the state administers the contract for the agency.
b. Method "B" is also used when the state administers the contract for the agency.
c. Method "C" is used with projects administered by the local agency. The agency will submit oillings monthly through the
state to FHWA for all eligible costs. The billings must document the payment requests from the contractor. If state -force
work, such as audit and construction engineering, is to receive federal participation, it w ll be billed to the agency ano FHWA
simultaneously at the indicated ratio. To show continuous progress agencies should bill monthly until agreement is closed.
8 ResolutionslOrdinances - When someone other than the County Execut ve/Chairman. County Commissioners/Mayor is
authorized to sign the agreement, the agency must submit to WSDOT with the agreemert a copy of the ResolutionlOrdinance
designatng that individual
9 Parties to the Agreement - Submit one onginaly signed agreement form to the Region Local Programs Engineer It is
the responsibility of the loca! agency to submit an additional, originally signed agreement form if they need an executed
agreement for their files. The agreement is first executed by the agency official(s) authorized to enter into the agreement
It ;s then transmitted to the state for execution by Local Programs. The agreement s dated at the time of final execution by
LocaPrograms
DOT Form 140-039 Page 7
Revised 04/2022
CONTRACT REVIEW FORM Clow Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Washington State Department o+ Tfarsportanon Contract No: PW 2024-m
Contract For. Olympic Discovery Trail Construction Funds Term t 23t.'2028
COUNTY DEPARTMENT: Pew-,
Contact Person: C" sp.i,
Contact Phone: MO 3M 92M
Contact email: C4P&i@C0 0"W"M «. is
AMOUNT: sts19.332.00
Revenue:
Expenditure:
Matching Funds Required:
Sources(s) of Matching Fluids
Fund #
Munis Org/Obj
rfA
RCO WWRP ', 20 ' M
County Caortal Fund 0302
PROCESS: Exempt from Bid Process
Cooperative Purchase
Competitive Sealed Bid
Small Works Roster
Vendor List Bid
RFP or RFQ
✓ Other: Grant
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES CO, PLIANCE ITH JCC 3.55.080 AND CHAPTER 42.23 RCW
CERTIFIED: ❑ N/A:a uz�
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PRO SED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: ❑ N/A: Q C- 16 l o'l it_
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Lacerfiche):
Electronically approved by Risk Management on 81112024.
State agreement -
STEP d PROSECUTING ATTORNEY REViFW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 81112024.
tJ State language cannot change.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL