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Washington State Department of Transportation SR 19 ped/bike - 042026
f • Dgton State Local Agency Federal Aid Department ashin of Transportation9 Y Project Prospectus Prefix Route ( ) Date 01/12/2026 Federal Aid TAP-HLP 0019 008 DUNS Number 179278197 Project Number Local Agency ( WSDOT 91-6001322 1 Federal Employer LA-10459 I Project Number Use Only Tax ID Number Agency I CA Agency Federal Program Title Jefferson County ,(✓i Yes ❑No ❑20.205 ❑Other I Project Title SR-19 Rhody Dr.Ped/Bike Improvements South Start Latitude N 48.010265 Start Longitude W 122.765952 End Latitude N 48.012938 ,End Longitude W 122.776680 Project Termini From-To Nearest City Name Project Zip Code(+4) Center Rd W.Valley Rd Chimacum 98325-8702 Begin Mile Post End Mile Post Length of Project I Award Type 8.94 9.56 0.62 ✓ Local❑Local Forces❑State❑Railroad Route ID Begin Mile Point End Mile Point City Number County Number County Name SR-19 8.94 9.56 16 Jefferson WSDOT Region !Legislative District(s) 1 Congressional District(s) I Urban Area Number Olympic Region 1 24 6 1 Total Local Agency I ! Phase Start Federal Funds Phase Estimated Cost Funding Date (Nearest Hundred Dollar Nearest Hundred Dollar) (Nearest Hundred Dollar) Month Year I P.E. $535,900 $383,800 $152,100 June 2022 R/W $60,000 $60,000 ;June 2026 Const. 4$1,421,000 $1,421,000 January 2027 j Total i$2,016,900 $1,864,800 $152,100 Description of Existing Facility (Existing Design and Present Condition) Roadway Width J Number of Lanes 40 ft(12ft lanes, 8ft shoulders) 12 The existing facility is a state highway(SR-19)and the adjacent highway right of way,with the exception of the proposed pedestrian bridge right of way. Description of Proposed Work Description of Proposed Work(Attach additional sheet(s)if necessary) Design and construct pedestrian and bicycle facilities to serve Safe Routes to Schools and the commercial corridor on a state highway. This includes new infrastructure for a pedestrian stream crossing, bus stop and pedestrian intersection crossings. Local Agency Contact Person Title Phone Bruce Patterson Project Manager (360)385-9169 Mailing Address City State Zip Code 623 Sheridan Street Port Townsend WA 98368 By Project Prospectus Approving Authority 1._ I Title Public Works Director Date 4� DOT For,140-101 Revised 01/2022 Previous Editions Obsolete Page Agency Project Jefferson CountyI SR-19itlDr. Ped/Bike Improvements SiI Date IRhody p O 1/12/2026 Type of Proposed Work Project Type(Check all that Apply) Roadway Width Number of Lanes 4 ✓ New Construction ❑Path /Trail n 3-R El Reconstruction WI Pedestrian / Facilities ❑2-R ❑ Railroad ❑Parking ❑Other ❑ Bridge Geometric Design Data Description Through Route Crossroad ( n Principal Arterial n Principal Arterial Federal ❑ Urban C Minor Arterial n Urban El Minor Arterial Functional VI Rural ❑Collector 1 Rural n Collector Classification ['NHSn Major Collector n NHS n Major Collector ❑Minor Collector ❑ Minor Collector El Local Access n Local Access Terrain I✓I Flat ❑ Roll n Mountain LI Flat ❑Roll n Mountain Posted Speed 35 MPH 35 MPH Design Speed 45 MPH 45 MPH Existing ADT 8000 8000 Design Year ADT N/A N/A Design Year jN/A 'N/A Design Hourly Volume (DHV) N/A N/A Performance of Work _ Preliminary Engineering Will Be Performed By Others Agency Agency and Consultant 70 % 30 % Construction Will Be Performed By Contract Agency Contractor 100 % 0 0� Environmental Classification ❑Class I - Environmental Impact Statement(EIS) '4 Class II - Categorically Excluded (CE) Project Involves NEPA/SEPA Section 404 ,✓j Projects Requiring Documentation Interagency Agreement (Documented CE) n Class III - Environmental Assessment(EA) ❑ Project Involves NEPA/SEPA Section 404 Interagency Agreements Environmental Considerations This project will mainly be constructed withing the existing road shoulder and right of way along SR 19/The proposed design includes placement of a prefabricated pedestrian bridge alongside an existing bridge and will require purchase of right of way. This design will limit impacts to Chimacum Creek during construction. T Form 140-1 1 Page 2 Revised 01/2022 Previous Editions Obsolete Agency Project Title Date Jefferson County SR-I 9 Rhody Dr. Ped/Bike Improvements S(] 01/12/2026 Right of Way ❑No Right of Way Needed n Right of Way Needed *All construction required by the [✓1 No Relocation ❑Relocation Required contract can be accomplished within the existing right of way. Utilities Railroad ❑ No utility work required r( No railroad work required ❑All utility work will be completed prior to the start n All railroad work will be completed prior to the start of of the construction contract the construction contract L✓ All utility work will be completed in coordination ❑All the railroad work will be completed in coordination with the construction contract with the construction contract Description of Utility Relocation or Adjustments and Existing Major Structures Involved in the Project Minor utility work is anticipated due to excavations. [FAA Involvement Is any airport located within 3.2 kilometers (2 miles) of the proposed project?❑Yes l✓i No Remarks This project has been reviewed by the legislative body of the administration agency or agencies, or it's designee, and is not inconsistent with the agency's compre ensive plan for community development. Agency Je ,�oT i 1, Boars +f County Commissioners Date 4/ Z© 20 By - 011KV . or/Chairperson DOT Form 140-101 Page 3 Revised 01/2022 Previous Editions Obsolete Agency Supplement Number Jefferson County 2 Project Number Agreement Number ALN 20.205-Highway Planning TAP-HLP-0019(008) LA-10459 and Construction Federal Highway Administration(FHWA) 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 $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 09/2025 Page 2 •Previous Versions Obsolete• 411111. Washington State Wi" Department of Transportation Local Agency Agreement Supplement Agency Supplement Number Jefferson County 2 Project Number Agreement Number ALN, 20.205-Highway Planning TAP-HLP-0019(008) LA-10459 and Construction Federal Highway Administration(FHWA) 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 SR-19 Rhody Drive Pd-Bike Improvements-South Length 0.62 mi Termini SR-19 MP 8.94 to SR-19 MP 9.56 Description of Work 1 No Change Reason for Supplement Obligate additional funds for PE phase, and extend Project Agreement End Date Indirect Cost Rate❑ Yes / No Project Agreement End Date 12/31/2029 Advertisement Date Estimate of Funding _ yp (1) (2) (3) (4) (5) T e of Work Previous Supplement Estimated Total Estimated Agency Estimated Federal PE Agreement/Suppl. Project Funds Funds Funds 86.5 % g.Agency 0.00 b. Federal Aid Other SEE E X( "t' I B I T A Participation Ratio(s)for PE d'State Services 0.00 - e.Total PE Cost Estimate 0.00 0.00 0.00 0.00 0.00 RW ft Agency 0.00 % g,Other 0.00 ede�ral Aid h.Other 0.00 Participation Ratio(s)for RW i.State Services 0.00 j,Total R/W Cost Estimate 0.00 0.00 0.00 0.00 0.00 CN k,Contract 0.00 % Law 0.00 Federal Aid m. Other 0.00 Participation P.Other 0.00 Ratio(s)for CN o.Agency _ 0.00 p.State Services 0.00 p.Total CN Cost Estimate 0.00 0.00 0.00 0.00 0.00 ' r.Total Project Cost Estimate 0.00 0.00 0.00 0.00 0.00 The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures,and as a condition to payment of th Federal funds obligated, it accepts and will comply with the applicable provisions. Agency 6Ye Jol `hh Washington State Department of Transportation By • By Stephanie Digitally signed Title Je rso t CC Chair PProvcd as to form only: gned by Stephanie Tax y Director, Local Programs Dale:20260506 0056:20-07'00' Agency Date t/724/L, Date Executed Tax 04/0212026 DOT Form 140-041LP Revised 09/2025 Je sh .Luther, Datc Page 1 •Previous Versions Obsolete. Deputy Prosecuting Attorney Exhibit A Jefferson County SR 19 Rhody Drive Ped-Bike Improvements-South Segment TAP-00109(008) Local Agency Agreement: LA-10459 Supplement#2 VERS 3 2/14/2o2s (1) (2) (3) (4) (5) (6) Previous Supplement Estimated Total Estimated Agency Estimated State Estimated Federal Type of Work Agree/Suppl Project Funds Fund Funds PE a Agency(Fed.TAP) $ 80,850.00 $ - $ 80,850.00 $ 10,915.00 $ - $ 69,935.00 86.5% b Other(Consultant)(Fed.TAP) $ 89,980.00 $ 89,980.00 $ 12,147.00 $ - $ 77,833.00 Federal Aid d Other(Agency)(State CCPP) $ 21,553.00 $ - $ 21,553.00 $ 21,553.00 $ - Participation e Other(Consultant)(State CCPP) $ 197,247.00 $ 141,300.00 $ 338,547.00 $ - $ 338,547.00 $ - Ratio for PE, f State Services $ 5,000.00 $ - $ 5,000.00 $ 675.00 $ - $ 4,325.00 100%State Aid g Total PE Cost Estimate $ 394,630.00 $ 141,300.00 $ 535,930.00 $ 23,737.00 $ 360,100.00 $ 152,093.00 Right of Way h Agency $ - $ - 100.0% i Other(Consultant) $ - Federal Aid j Other $ - $ - $ - $ - Participation k State Services $ - $ - $ - $ - Ratio for R/W I Total R/W Cost Estimate $ - $ - $ - $ - $ - $ - Construction Y m Contract CWA $ - $ - $ - $ - 86.5% Y n Contract Local $ - $ - $ - $ - Federal Aid N o Contract STP $ - $ - $ - $ - Participation p Agency $ - $ - $ - $ - Ratio for CN Y q Agency Local $ - $ - $ - $ - N r Agency STP $ - $ - $ - $ - Y s Agency CWA $ - $ - $ - $ - Y State Local $ - $ - $ - $ - Y t State Services CWA) $ - $ - $ - $ - u Total CN Cost Estimate $ - $ - $ - $ - $ - $ - v Total Project Cost Estimate $ 394,630.00 $ 141,300.00 $ 535,930.00 $ 23,737.00 $ 360,100.00 $ 152,093.00 1 U 1) 6/6'1- 1/(4A/ • iftiskingt" p Stalli1}ansportatlia, Local Agency Agreement Supplement 'may !SupplementNt,1noer JEEFF t FtSUN(:UUN I Y 1 i Vedrai Wd Pry 1E;ect N. er •Avineri Numbly CrDA No 20.205-i••grui,,Pa^r 19 TAP-0013(008) LA 10459 and Cc^strtc;lor All provisions In the basic agreement retinae'in effect except as modified by MI supplenva t -he Local Agency cert.haa that it is not excluded floor receiving Federal funds by a Fedetsat buyperrswn or debarment "2 CFR Part 180) Addltonal changes to the agreement are es folores Project Description Name SR 19 RHOOY OR VC PTO-BIKE MPROVENtN'S-SQU'rr SEGMENT I,englh 0 d2 moons Termini SR 1914 P A 94(CENTER ROAD}TO Sit 13Id P 9 SA'wME.T VAL-F•'ROAD) Description of Work I No Change Realtor,tnr Supplement Oblgetc r i w PE Stale Fusels(CCPP)K Stilt airman('redenrt runos r.IA(';4oa•Ira Ayen-y lin.in a new PE Cuos,,Itart line l IAre you ciaiming indirect cost rale' YeS / NA I'ru,act Atreen•ent end(1•-ate Down ut.i 31 2112h Adverttantnrnt Dote Estimate el Fu ding Type of Work II, 1' •41 {S) Previat.s 1`f Estrnated-Oat Est Ta•edAgency Estimated:Meta 3‘gc erenl F _Xgret en:t5,.cp, Prow'cads F1,^ds Flocs jy llk.A8t'x a .1 Itli =ederatAtl P ^w SEE EXHIBIT A. ' Park:caear Other • Rao le,OE A...St$t.Sterce•y Illy' + rvfpePE Cos*Est rote ' on t' ' 't , ,• (I.P.i (I r*i Agit of Way:' n lutx' ,n.0?!r not o reeerai Ail w Other ' ialxr Part 4r41 a7 Ratio for RW :,S1a0rSv t IC_ w i 4..Ipyll'tiW Ceti EaMilk1l1'I"".) ''t� • i sr I(At IX; uou IIIx1 Conuct JLcanna tan► Vy' N Jr_Dv :K __ Fedenit Ann! - ....- li(xl ;Dart(piKM In K . 'Reif_for..N ice= V I L)Ulf :2 Stan Ssn ces ;art ti 4. ii 0o min (I I.7 Tpjty Gust ES?a91C 1•N•' ^ow K to a' Ttltat Crtaaq C04tFater'stetr rot- i(I tK i1 is r Ir txr II Ill n trtl The Local Agency Further stipulates that pursuant to sad Title C J.rcgu at Otis and pcbcielb and procedures and as a condition to payment of the Fwhoa'unos obligated.it aact:rots and WI I comp y with the aup'cable provisions Agency Official ^ Washington State Department of Transportation By By Sat? ha n ie Digitaly signed by T 1e ' ' - . . ' ' • ' ' Director, :oval Program p Stephanie Tax Agency Date gate c rzwr:uted Tax date 2024.07.3i :XJ' F inn 140.34. July a 2024 r'nyrl RAU MOW dt 2022 Ph.11r -fur;_:Kt`. C.Y.. -ha to C.o if Cur. ..sr.-d i,A:i.._t a. Agency Supplement Number JEFFERSON COUNTY 1 Federal Aid Project Number Agreement lumber CFDA No. 20.205-Highway Planning TAP-0019(008) LA 10459 and Corstnrct on 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 Fecerai 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 Penod 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 pnor 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 S750.000 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 Page 2 Revised 04/2022 Exhibit A - Jefferson County SR 19 Rhody Drive Ped-Bike Improvements - South Segment TAP-00109(008) Local Agency Agreement: LA-10459 Supplement 41 . . N 6/28/2024 (1) (2i 13) (4) (S) (6) Previous Supplement Estimated Total Estimated Agency Estimated State Estimated Federal Type of Work Agree/Suppl Project Funds Fund Funds •PE a Agency $ 170,830.00 $ (89,980.00) 5 80,850.00 $ 10,915.00' $ 69,935.00 86.5% b Other(Consultant) $ 89,980.00 $ 89,980.00 $ 12,147.00 $ 77,833.00 Federal Aid d Other(Agency) $ 21,553.00 $ 21,553.00 $ 21,553.00 Participation e Other(Consultant) S 197,247.00 $ 197;247.00 $ 197,247 00 Ratio for PE f State Services $ 5,000.00 $ 5,000.00 S 675.00 $ 4,325.00 g Total PE Cost Estimate $ 175,830.00 $ 218,800.00 $ 394,630.00 $ 23,737.00 $ 218,800.00 $ 152,093.00 Right of Way h Agency $ - $ • 100.0% i Other ;Corsultant) $ - 4 Federal Aid j Other $ - $ 5 - $ - Participation k State Services $ - $ $ - 5 - Ratio for R/W I Total R/W Cost Estimate $ $ $ $ 5 $ Construction Y m Contract CWA S - 5 - $ - 5 86.5% Y n Contract Local S - 5 $ - 5 - Federal Aid N o Contract 5-1) $ - 5 . 5 5 Participation p Agency 5 - 5 $ - $ - Ratio for CN Y a Agency local S $ 5 - $ N r Agency SIP S . i $ 5 - $ Y s Agency CWA 5 5 5 - $ - Y State Local 5 5 5 $ Y t State Services CWA) S $ 5 - $ u Total CN Cost Estimate 5 5 . 5 - $ ., - 5 - r Total Project Cost Estimate $ 175,830.00 $ 118,800.00 5 394,630.00 $ I3,737.00 5 218,800.00 S 152,093.00 l first-: c N AM. Washington State •/ Department of Transpoetation Local Agency Agreement Akaar":y Jefferson!'.runt{ CFOA No 20 205-Highway Planning and Conetfuctlon (Catai tc of Fete,Domwx Assn*wu sl Adorns 623 Sheridan Street project No Agreement No. Z—A 4151 l-_ Far WSDOT Lse Ot8yr The Load Agency havmra complied or hereby agreeing to comply,with the terms and conditions set forth in(t)Tile 23.U S Corte Highways (21 the regutatons issued pursuant thereto.(3)2 CFR Pan 200,(At 2 CFR Part 183 -oertfy,ng that the WON agency is not excluded from receiving Federal fords by a Federal suspensor,or debarment.(5)the Doh,ies and croc edcres promulgated by the Wastnngton State Department of Transportation,and(61 the federal aid protect agreement entered nto between the Stale and Federal Government.relabve to the above protect.the Washington State Department of Transourtat;on wilt authonre the:xJi+Agtncy to proceed on the oroler]by a separate noHticatron Federal funds whirl+are to oe obi gates for the proect may not ,steed the amount shown heron on line r column 3 *thous vrntten authority by the Slate.subect:d trw al*.ova of the Federal H phway Adnunrstrat,01 Al prayed ousts not reimbursed by the Fede,at Government shall be the rescons bbty of the Local Agency Project Description Name SR 19 tthorty U,ve Pend Hrke Improvements-South Jensen 061 rennin Center Road MP 6 94 to West Val ey Road MP 9 56 Description of Wort Deagn aria construct pedeatna^bicycle tac:ttres to serve sate•votes to wool and commeroal corridor or a state noway(SR 19) ,nodes new Infrastructure'or a Oedestrtar stream;rosins and Oedest'a^'nteree:bon crossings 'role:t Agreennent End Date December 31 2328 Claiming Indirect Cast Rale t 1 Yea No Proposer,Advertisement Date (It 12) -":-.3T Type of Work Ewald Total Eshrrated Agency Unmated Fetlerar ova Funds Funds Funds n IL Agency 170,63000 } 2306230 147,76600 - 0 ate.' - __. ». !Federal Aid h, REd State Services 5.000 00 675 00 i,32S ao PalliQPatio'Of o -! TQ E Gast EStmdte!a�4aq+ )'15.830 00 :3.13160 15"091 tX) of r t Nem Federal A d } _pau. tor nriflerRatty for Rih t.State Serv+tcas0.00 1Nt U qU tar action i Its)RAM Cost Estri*tfwo1 _ )-fir - i ! rrt; !Federal AA n °the, Partopabon Ratio for CN I :Y . _ __ p.State Ser aces Q.WI CN Cost.Estimate),a«,....o-o; 0 00 0 00 0.00 __ixt2r .ec:Cost ESL^talaia-.s ''5,N30.00 2_3.737.00 , 152(WI 00 Agency Offic a1 Washington State Department of Transportation By $ (. .-1 By Stephanie D�igrtalysgne°by p Reo...7,4 a, Tile t. �e S t.f'2 Strati- Director Local Programs Tax Date 2022.44.1 5 Agency Date Uate Executed to:25GS 07'30 DOT Form 140-339 y. 8,26122 fob osge 1 Revise°04102 y Pb.ip C isamuelrer.Cove five Dawn Preteeieng Alta rwy 4 Construction Method of Financing (Check Method Selected) State Ad and Award Method A-Advance Payment y Agency Sure of total construction cost(bases on contract award) Method B-Withhold from gas tax the Agency's share of total construction coast (hne 5,column 2) in the amount of $ at$ per month for months Local Force or Local Ad and Award ,/ Method C-Agency cost Incurred with partial reimbursement 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 ob'igated, it accepts and will comply with the applicable provisions set forth below Adopted by official action on January 6 20C3 , Resolution/Ordinance No.Certification Acceptance Qua ifcation Agreement Provisions I.scope of Work The Agency shall provide a I the work,labor materials,and serwoesi necessary to perform the pried wh ch is descnbed arc set forth ,n°elan in the'Project Description'arc-Type of N/o'k When the Stale eels for and on toenail of the Agency the State shall be deemed an agent of the Agency and shall perform the services described and ind.catee in'Type of Worse Or the face of to s agreement,in accordance wife piens and speaficabcns as proposed by tee Agency and approved by the State and tie Fetters i ghway Administration When tee State acts fior the Agency but is not subsea to the flare of control by the Agency. the State srail rave the ngnt to perform the wok subject to the orti nary ecceourea of the State aid Fede'at Highway Atom nlstration It.Delegation of Authoray 'he State is wlltrg to fulfill the responstihties to tie FeOerai Goverment ey tee adr^intstraticn of this project The Agency agrees that the State:that have the full authority to carry cut this administ-atron The State snail review.process,and approve documents required for ledefat aid retmoursemert in accordance with fMM•rsl regthrements If the Stale advertsea and awards the cortfact the Stara will twiner act b'the Agency in all matters concerning the project as requested oy the Agency If the Local Agency advertises and awards the eroisot,Iris State shah revew the work to ensure conformity with the approved plena arc specftabons. ill.Project Administration Celan types of work and services shall be provded by the State on me project as•equested by the Agency and desct bed in the Type or Work above In addition,the State will furnish qua fled personnel for the suoervision and aspect on of the work in progress On Local Agency advertised and awarded protects,the supervision and inspection shall be limited to ensuing al`work is in conformance with approved plans,scadficat one and federal a d requirements.The selery of such engineer or other sjpery scar and all other salaries and costs incurrec by State forces upon the project coil be considered a cost thereof Ali costs re ated to his oraect,rcurred by employees of the Slate n the customary manner on highway payrolls and vouchers snarl be charges as costs of•he project IV.Availability of Records All orcysct records r support of all costs rtcurrec and actual expenditures Kept by the Agency are to be maintained in accordance with local government accounting procedures prescribed by the Washington Stale Auditor's Office the U S Decartmert of rranspo'atioe,and the Washington State Department of Transportation The•ewrds snail be open to meow:bon by the State and rode-at Government at all reasonable Imes are shag be'earned and made available to'suchiris/melon for a period of rot less than three years from the heal payment of any federal a d funds•o the Agency Copes of said reedits shall be furnished to the State any'or tede•al Government upon request V.Compliance with Provisions t tie Agency shall not flair any federal aid paniapa-ion costs on any dassrficat,or of work on tnis prc ect,nbt autrenzeo in writing by tie State for each dassiffcasor The ciassi cations of work for protects are I Prelim.nary engineering 2 Rpht of way acoursrtwn 3 Proect construction Once written authorization is given,the Agency agrees to show ccrtrnucus progress though monthly pilings Fatiure to show continuous progress may result the Agency's project becoming lead ve as describec n 23 CFR 630 and subject to de-obligation or federal aid funds andfor agreement closure If r,gnl of way acquta lion or acbia construction of the road'or which ore imirary engineering a undertaken is not started by tre close of the tenth f scal year following the fiscal yea'it which prelim nary engineering phase was e,itnonzed tree Aye-cy wit repay to the State pre sum or sums of fecerai funds paid to the Agency under the terms of this agreement(see Season IX) If actual construction of the road for which right cf way has teen purchased,s not started by the dose of the tenth rascal year ldlowing the(scat year ir wn,c'i the right of way phase was authorized.tee Agency will repay to the State the sum or aims of fecerai C O t f cum 140.039 Page 2 Revrseu Ou2022 I I- ends wild to the Agency under the terms of this agneernert(see Secton iX) The Agency agrees that al stages Of construction necessary Oa provide the really panned compete fealty within the limits Cl this pr0iec wail conform to at least tee minimum values set by approvec statewide 7esigr standards spp.icable to Mrs Class of highways, even though such addiboral work is financed without federal aid part ipabon The Agency agrees that on federal aid highway construction protects the current federal sic egulatlona which apply tc liquidated damages ndatrve to the basis of federal participation in the project cost snail be apo icicle in the event the contractor fads to complete ire contract warm mn the contract time Vt Payment and Partin Reimbursement 1 he toles cost cf the prcwect including ail review and er;neemg costs and other expenses of the Sete,is to be pad Cy tow Agency and by the Federal Government Feder*funding shall be in accordance carte tee Federal Traraporiatton Act as amended.2 CFR Pert 200 The State steel not De ultimately responsible for any of the costs of the project The Agency snal be ultimately responsible'or all costs associated with the project which are rot reimbursed by the Federal Government Nothing r this agreement shad be construed as a promise oy the State as to the amount or nature of federal participation in this project The Agency snail a lI the state for federal aid project costs incurrec in conformity with applicable federai aria state laws The agency snarl minimize the time elapsed betweer receipt of federal aid funds and subsequent payment of incurred costs Expenditures by the Local Agency for maintenance,genera acmmistrabon,supervision,arc other overhead snail not be seeable►or Were-participation uriess a current ndirect out plan has been oreparec,n accordance with tie regulations outlined in 2 CFR Part 200-Uniform Admit- Requirements,Cost Prnripies end Audit Requirements for Federal Awards and retained for audit The State will pay for State incurred costs on tie project Following payment,the State shall bill the Federal Government for eimbursement of hose costs eligible for federal participation to the extent that such costs are attributable and properly allocable'c his protect. Tee State seal;bill the Agency for that portion o'State costs which were not reimbursed by the Federal Government Isee Section IX) i Protect Construction Zosts Project construction frnanorg will be acccmprsheo by one of the three methods as indicated in this agreement Method A-The Agency will place with the State,w thin(20)days after the execution of the Construction contract,an advance in tie amount of the Agency's share of the total construction cost based on the contract award.The State will ratify the Agency of the exact amount to be deposited with the Slate.The State will pay all costs incurred under tie contract upon presentation of progress bill ngs from the contractor Fallowing sect payments tee State will suet**bitting to the Federal Government'or the'went'Inc participation share of the cost.When the aroma is sibsterlt.aly completed and ti'+at actual costs of the protect car be delerm nee ine Slate wit present the Agency win a Final bilrng sharing the arrburt due lie State ar the amount due tow Agency Trig berg will be cleared by either a payment from the Agency tc the State or by a refund from the State to the Agency Method 8-The Agency's share retie total construction cost as shown Or the face of this agreement shall be wetted'ran its monthly fuel tax allotments.The face Of the agreement estaolishes the months in which the withholding small take place and the exact amount to be withnete earn menet The extent of withholding will be confirmed by letter from the State at the time of contact tweed. Upon receipt of progress billings from the contractor the State reel submit such beings to the Federal Government far payment of its particpatrrg portion o'such beings Method C-The Agency may submit vouchers to the State in tee format prescribed by the State tr dup sate,not more than once per morn for those costs ehg one for Faders;participation to tie extent that such costs are s reedy attributable and properly atocable to this project Expenditures by me Local Agency for maintenance,general administration,supervision,aro other overhead shall not be Ogee for Federal pa^Ucpetion unless claimed under a previously approved indirect cost plan. The State shall reimburse theAgency for tee Federal share of eligible project coats up to tee amount shown on the'ace of this agreement At the time or audit.tee Agency will crovede daurientatron o'al Costs ncurred on he Di-eject The Slate straw bill the Agency for a costs incurred by tie State relative to me pre;sct The State snail also tali the Agency for the tederr tunas paid by the State to tie Agency for p^ojecr costs which are subsequently deterrnired to tin'nehgie;a for federal participation(see Section IX). VII.Audit of Federal Consultant Contracts The Agency if services of a cornultert are required.shall be responsible for audit of the consultants records to determine eligible federal aid costs on the project.The report of said audit shall ben tit Agency's files and made available to the State and the Federal Government An audit Wail be conducted by the WS0O1 Internal Audit dtfce n accordance with generally accepted governmental audetr'g standards as issued try the United States General Accounting Office oy true Cormptroaer General of the Ureted States.WSOO'Manual M 27-50 Consultant Authontation,Select on,and AgreementAdmtiistration,memoranda of understanding between WSOOT and FHWA•and 7 CFR Pan 200.50' -Audit Requirements It upon acid*it,s toned that overpayment or participation of federal money in•neli idle terra of cost has occurred the Agency shall reenburse the State for the amount of such overpayment or excess participation(see Section IX) VIII,Single Audit Act The Agency.as a subrecprertt of federal funds,she(adhere to!tie feasts(regulations outlined•r 2 CFR earl 200 50' as we i as ail applicable federal aria state statutes and regu ations A subreacrent wet expends S750,000 or more n federal awards from ail sources during a given fiscal yeas shall have a single or program-specific a.„dit cerfonned for that year in accordance with,the provisions of 2 CFR Part 200 501 Uoon cordusion of lee audit,the Agency snag be responsible for ensuring that a copy of the report is t-anamitted DOT Form.140-039 Page 3 Revised 04/2022 promctly to:he State IX.Payment of Billing The Agency agrees that f payment or arrangement for payment of any of tee Slated biting relative to the protect(e g,State force wore protect cancelatan cverpaynert.cost rekgrbe tzar federal pancoation,etc)is not made to the State wnhir 45 days after the Agency nas beer o lled the State seal effect re retturnerneet of the total semi due from the regedr monthly fuel tax altobnents to the Agency'ram the Motor Vehicle Fund No acdit anal Federal prated funding will be approves until full paymerl is received unless otherwise directed by the Director,Local Programs Protect Agreement End Date Thrs cats s oared on your protects Period of Performance((2 CFR Part 200 308; Any costs iruanreo after the Protect Agreement End Date are MOT a able for federal reimbursement AM erg oe costs incurred pho- to the Protect Agreement End Date must be son-meet,for reirribursemenrt within 60 days after the Prc)ect Agreement End Date or they become'naicgrbfe for federal rermbursemert X.Traffic Control,Signing,Marking,and Roadway Maintenance The Agency will not permit any changes to be made in the pray*ors'or parteng rearlattons and traffic contra'on ttua ern,ect without prior approval of the State and Federa -fignway Administration The Agency we no: rstall or permit to be instated any srgrs egrets.or markings not in conformance with the starderds approved by the Federal Highway Adm nis:ranon and MUTCD The Agency eel at its owr expense maintain the improvement covered by this agreement. Xi Indemnity The Agency shall hold the Federal Government end the State harness from aria seal process and defend at is owe expense all dams,demands,or suds,whether at law or equity brought against the Agency,State.or Federal Government,arising frcm tee Agency's executor,performance,or failure to paeorm any of the provisions of this agreement or of any other agreement or contract connectei with the agreement,or artsmg by reason of the parbapabon of the Stale or Federal Government in the project,PROVIDED nothing herein shad require the Agency to re mburse ter State or tee Federal Government for damages arisuy Lae of bodily injury to persor.s or carnage to property caused ty or esaulting from the sole negligence of the Federal Government or the State xt.Nondiscrimination Provision No lability shall attach to the State o"Federal Government except as express y prrovded here n me Agency anal not oiscnmrnate on tee bass of race.colcr nit crag org n,or sex in tee award and performance of any USDGT- assisted contract arake agreement ere the admin-stration o'its DBE program or the requirements of 49 CFR part 25 Tee Agency shall take all necessary and reasonable steps under 49 CFR Part 26 to ensure nondiscrimination in the award aria adnirnstration of USDOT assisted contracts and agreements The WSDOT's DBE program.as required by 49 CFR Part 26 and as approved by USDOT -s ncorporated by reference in this agreement implerrentabon of this program is a legal obligaton and failure to tarry out is terms sea I be treated as a violator of the agreement Jpcn notification to tee Agency of its failure to tarry Out es approved program.the Decartmert may impcse sanctions as provided for uraer Part 26 and may ,n appropriate oases refer the matter for enforcement under 18 u S C 1001 and/or the Program Fraud Civil Remecles Act of 1986(31 L,S C 3801 et seq) The Agency hereby agrees that it will rrcocporate or cause to be ncarporated into any contract for coretiuctor work, or modrfrcat+on Tereof as reined in tee rules and regulations of the Secretary of Labor in 41 CFR Chapter 60,which is paid nor in emcee or in pat with `„nos obtained front the Federal Government or borrowed or the credo of the Federal Government pursuant to a grant.contract,loan, Insurance,or guarantee or understandurq pursuant to any federal program nvorvieg such g-ant contract,loan, irsurarw.or guarantee, tee required contract provls,ons for Federa:Aril Co tracts(FHWA 12/3; located in Chapter 44 of the Local Agency&idetrtes I ne Agency further agrees that It wet be bound by the above aqua opportunity ta.rse with respect to its own employment practces wean it partrcysarrs in federally assisted construduon wore Provided that if the applicant so part::;spacing is a Stale or Local Government,the above equal opponurity clause is not*percale e to any agency. meth-mentality or a,.bdivrsinn or such government which does not participate in wore on or under tho contract The Agency also agrees (I)To assist and oaaperate actively vete the State in dbtarn rig t^e compirance tit cortrarxdrs and subcontractors win the equal apportun;ty clause are,rules regulations and re.evart orders of the Secretary o1 Labor (2)To furnish the State such information as it may requ re for ma supervision of sucrt co'npiiance and that.1 wit otherwise assist fee State in the discharge of is primary responsibility for securing compliance (3)To refrain'rem enter rag into any contract or contract modnccatror subted to Executive Order it 246 of September 24, 1965 vete a contractor debarred from or who nas not yer onstrated e.grb Iffy for.gove!nmert contracts and federally assisted construction contracts pursuant to the Executive Order (4)To carry out sucn sarictrorts and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by tee State.Federal Hrgnway,AdTlnistrattol or the Secretary of Labor pursuant to.Part II subpart 0 of the Fxecutive Order n add lt o^,tee Agency agrees that A it fads or ref;rate to,.ornery with these urderta.crags.the State may take any or all of Me Wowing act ens (a)Cancel,terminate.or suaoend this agreement in whole or n oarf. (a)Refrain from extending any further ass stance to the Agency under tee program with respect to which the failure or refusal occurred until satisfactory ass i'rice of future compliance has been race wed horn the Agency anc leCet Form'40.039 'age 4 Reresed 04/2022 tc)Refer the case to the Departrrert of Justice for appropriate egal proxed rigs XIII.Liquidated Damages The Agency hereby agrees teat the liquidated da-nages provisions of 23 CFR Part 635 Suboar.117,as supplemented relative to tine amount of Feder&parteepat.on in the protect wit seal be appl cao+e in the evert the contractor falls to compete the CCrtract with:" the eontrac trine Facture to nc i.de!.qudated damages prov s on will rot relieve the Agency from reduce on of federa+partscipat on a art ores rce with this paragraph XIV.Termination for Public Convenience Tne Secretary et the Wasrungtor State Depart-ere of Transport/Men may teri hate the contract r*flake or from trre to tine I Dart wherever (1 The*thistle federal find in;becomes urava'able through failure of aporoorriaton or otherwse (2)The Contractor,s prevented from proceeding with the work as a d rec result of an Fxecutve Order of the President with respell to the prosecution of war or re the interest of national defense or ar Executive Order of the President or Governor of the State wee respect to the preservation of energy resources 3i The contractor a prevented from proceed.rg with the wok by redeye or a pret.rmeary specie..or pe.mareet reel-air rg order of a ilium of competent,ursd Cron where Ire issuance or suet orders primarily caused by the acts Or omissions of persons or agencies other than the contractor la;The Secretary is notified by the Federal Highway Administration that the protect is nac•ve ;5;The Secretary determines teat such•ermmnatior s.n the best interests at the State XV Venue for Claims and/or Causes of Action For're corvenrence of the panics to this convect it is agreed feat any evens are/or causes or action which the_ors.Agency 'as against the State of Wasnr+gton growing out of this contract or the project*in which it is concerned shall be brought cry in t^e Superior Court for Teeeattn County XVI,Certification Regarding the Restrictions of the Use of Federal Funds for Lobbying Tie approv rg )utnurdy certifies to the beat of es J'her krowtedge arc belie` that r t;No federal appropriated funds have beer paid or will be paid by or on behalf of the undersigned :c any person fcr infuercrg or attempting to influence an officer or employee of any federal agency,a member of Congress an officer or employee of Congress or an empoyee of a rrenoer of Congress in co/led on w th the award rig of any federa contract the making of any ceders grant the making el pry federal loan.the entering into of any cooperative agreement and tee ettens or ccrte.uation renewal a•reridmert er modification of any federal contract,grant loan or cooperative agreement ;21 I'any funds other than ledete approor ated funds have been paid or will be paid to any peach for mfluenung or attempt,eg IC r+fuence an officer or employee cf any federal agency.a'retreat of Congress a"officer or employee of Congress or an employee or a member of Congress n connection with this federal aoneract grant.loan,or cooperat re agreement the undersgned shalt complete and submit t^e Standard Form-LLL. 'Disclosure Forre to Report Lobby rg • r accordance with its instructions i31 Tee undersigned snail require that the language of this certfratron be irclucec in the aware douments'or ail suoawards at of t ens(nciueing suogrants.and twine`Ts and s bcontracts under grar•ts subg•arrs oahs arc cooperative agreerrentsj which exceed 5100,00O3 and that a I such subrecrprents shad cert fy and'lactose accoroingly This cart fcatior s a material represen•at cr of re-upon wnicr reba^ce was o:aced weer this trarsac for was mace ur entered nto Seem as cn of this cert,fiatior as a prerequ s to'or treeing or entering into this traesad•en mposed oy Section 1352 i,tle 3' U S Code Ary petscr who fa.Is to rite the required cert heater,shal be sut;ect to a cavil penalty of not less than 513 000 and not more than S'CC 000'or size such fa lure XVII.Assurances Luca;agenc as receiv rig Federal funding from;he USDOT or is operating acmrn stratrons t e Federal Highway Admre stratran Federal Transit Admmrsi•ebon Fellers Aviation Administration+ace required to subrr t a wr/en policy statement signed by tr'e Age^cy Executive and addressed to tee State.docurneerttng that all programs act v ties and Sere des wit be conducted ^comp iarCe with Section 5C4 aiw the Arrer cans wee D Sabi rt+es Act l,A0A) Additional Provisions 01 furn '40.C39 Paye 5 9ewsee 04r102? 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: Eric Kuzma, Public Works Director Agenda Date: April0, 2026 Subject: WSDOT Local Agency Agreement LA-10459 Supplement # 2 and Local Agency Federal Aid Project Prospectus for SR19 Rhody Drive Ped-Bike Improvements - South Segments County Project No. 18020950, WSDOT Project No.TAP-0019(008) Statement of Issue: Approve and sign the WSDOT Local Agency Agreement LA-10459 Supplement #2 and the Local Agency Federal Aid Project Prospectus (Prospectus) for SR19 Rhody Drive Ped-Bike Improvements - South Segment, County Project No. 18020950, WSDOT Project No. TAP-0019(008). Analysis/Strategic Goals/Pro's Et Con's: The SR19 Rhody Drive Ped.-Bike Improvements - South Segment project is included in the adopted 2026-2031 Transportation Improvement Plan (TIP) as Item No. 7. This project will provide pedestrian and bicycle facilities along SR19 in Chimacum, from Chimcum High/Middle/Elementary Schools to 800-ft east of the 4 way intersection with SR-19, Chimacum Road and Center Road. The project also includes ADA accessible sidewalks, crosswalks, a bicycle lane, and a pedestrian bridge across Chimacum Creek. Execution of Supplemental #2 will provide additional funds for the preliminary engineering (PE) phase of this project, with construction advertisement scheduled for early 2027. Due to WSDOT operational delays, this is the third time the BoCC is being asked to re- sign these documents. Fiscal Impact/Cost Benefit Analysis: In 2022, the County was awarded Transportation Alternatives Program (TAP) funding from WSDOT for preliminary engineering (PE) in the amount of $175,830, the amount includes a 13.5% match requirement. In March 2024, WSDOT's Connecting Communities Pilot Program (CCPP) grant (100% grant) was awarded to the County for PE and right-of- way (ROW) in the amount of $260,000 ($218,800 for PE and $41,200 for ROW). In January 2025, an additional CCPP grant (100% grant) was awarded to the County for PE in the amount of $141,300. Therefore, the total PE funding is $535,930 and the total ROW funding is $41,200. Supplement #2 is intended to obligate the 2025 CCPP grant Department of Public Works O Consent Agenda Page 2 of 2 amount of $141,300 for the PE Phase of the SR19 Rhody Drive Ped-Bike Improvements - South Segment. Recommendation: Public Works recommends that the Board approve and sign the WSDOT Local Agency Agreement LA-10459 Supplement #2 and the Local Agency Federal Aid Project Prospectus (Prospectus) for SR19 Rhody Drive Ped-Bike Improvements - South Segment, County Project No. 18020950, WSDOT Project No. TAP-0019(008) and return all the documents to Public Works for further processing. Department Contact: Bruce Patterson, P.E., Project Manager, 385-9169. Reviewed By: 1'0 Josh eters, County Administrator Date CONTRACT REVIEW FORM Clear Form (INSTRUCTIONS ARE'ON THE'NEXT PAGE)CONTRACT WITH: Washington DOT Contract No: Pk/oXak-- Contract For: SR 19 Rhody Drive Ped-Bice Improvements-South Segment(18020950) Term: 12/31/29 COUNTY DEPARTMENT: Public Works Contact Person: Bruce Patterson Contact Phone: 360-385-9169 Contact email: bpatterson@co.jefferson.wa.us AMOUNT: $141,300.00 PROCESS: Exempt from Bid Process Revenue: WSDOT C.C.P,P. (100%) Cooperative Purchase _ Expenditure: 18000010.595.410000 _ Competitive Sealed Bid Matching Funds Required: No Small Works Roster Sources(s)of Matching Funds — Vendor List Bid Fund # 180 RFP or RFQ Munis Org/Obj 18033403.334061.20950 i Other: AAA Supplemental#2 APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES COMPLI E WITH JCC 3.55.080 AND CHAPTER 42.23 RCW. CERTIFIED: I I N/AE i3--- - ignature ate STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL AGENCY. ( �--� CERTIFIED: El N/A: a K- -- �� -j/Ze,( p Signature Date ST P 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 4/6/2026. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 4/2/2026. Reviewed and approved by jbl on 04/02/2026 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 1