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Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Philip Morley, County Administrator
From: Frank Gifford, Public Works Director ~
Agenda Date: April 8, 2013
Subject: Public Works Trust Fund Loan Disbursement Request #1
Statement of Issue: On March 5, 2012, Jefferson County Public Works entered into a Public
Works Trust Fund (PWTF) loan contract with the State Public Works Board for $lOM as part of the
funding and financing plan for the Port Hadlock Wastewater Facility project. The loan disbursement
request requires approval and signature from the Board of Commissioners.
Analysis/Strategic Goals/Pro's Fr Con's: The PWTF is being used to reimburse the County for
its share of matching funds for the facility final design services. The Environmental Protection
Agency has also contributed matching funds to this work through a Special Appropriations Act
Project Grant to the County.
Fiscal Impact/Cost Benefit Analysis: The Disbursement Request is for County contributions to
final design from August 2012 through February 2013, in the amount of $259,111.73. The loan
terms are 35 years (5-year payment deferral + 30-year payment schedule including interest accrued
during deferral period) at 0.5% interest. Payment on loan disbursements begins June 1, 2017.
Recommendation: Jefferson County Public Works recommends that the Board sign the
disbursement request provided and return it to the Public Works Department for further
processing.
Department Contact: Joel Peterson, 385-9173
Reviewed By:
ilip r , Co nt ministrator Date
s~_E."~ ; ~INASHINGTON STATE
:5 = t~EPA12TMENT OF CG7MM1=12~F
°ai ~,~ AGENCY NUMBER
Short Code
Commerce Contract Number
VOUCHER DISTRIBUTION
Form 19-1A 1030
PC12-951-052
DEPARTMENT OF COMMERCE
CONTRACTS ADMINISTRATION UNIT (CAU)
PO BOX 42525
OLYMPIA, WA 98504-8300 INSTRUCTION TO VENDOR OR CLAIMANT:
Submit this form to claim payment far materials, merchandise or services.
Show complete detail for each item.
VENDOR OR CLAIMANT (Warrant is to be payable to:)
Jefferson County
623 Sheridan St
Port Townsend WA • 98368
Vendor's Certfficate: I hereby certify under perjury that the kerns and totals listed herein are
proper charges for materials, merchandise or services furnished to the State of Washington, and
that all goods furnished andlor services rendered have been provided without discrimination
because of age, sex, marital status, race, creed, color, national origin, handicap, religion or
Vietnam era or disabled veterans status.
Contact Person: Joel Peterson By:
Phone: 360-385-9173 (SIGN IN BLUE INK)
Email: eterson co.'efferson.wa.us
Contract Period: March 5, 2012 to March 5, 2017
VOUCHER NUMBER: t (TITLE) (DATE)
DATE DESCRIPTION
(refer to Attachment 1 of your executed Contract) BUDGET PREVIOUSLY
REQUESTED AMOUNT THIS INVOICE
AWARD REMAINING
BALANCE
LOAN AMOUNT AT CONTRACT EXECUTION $~ O~~QQ~OOQ,00
03/25/13 Final Engineering Design 7/2012 to 3/2013 $0.00 $259,111.73
$9,740,888.27
$9,740,888.27
TOTALS $0.00 $0.00 $259,111.73 $9,740,888.27
CDR COMlNE. ~ .. .
ftCLCi1.SL D1V1~!~ :::~:: ~ ::::::::::::::::~:~:~:~:::::::::::::
... ...................................
Allowable Costs : S Reimbursement : S
Advance : S Apply to Advance : S
Match: Year I Dollars 1 Coding PROGRAM APPROVAL DATE
DOC DATE CURRENT DOC. NO. REFERENCE DOC NO. VENDOR NUYBER and SUFFIX
SWV0002430 10
ACCOUNT NO. ASD NUMBER
26044 VENDOR MESSAGE
TRANS
CODE
MASTER
INDEX
SUB OBJ sue
SUB
OBJ
GL
ACCT
SUBSID
AMOUNT
INVOICE
PC 12-951-052
SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT DATE WARRANT TOTAL
ACCOUNTING APPROVAL FOR PAYMENT DATE
Revised 214111 A19-1 a basic form with advance block
~'~'ash~ngton State
Public Works Board
liflf Plum Street SF..
Post Office BoY 42525
Qiympia, Washin~~ton 985Q4-2525
PROJECT STATUS REPORT
This form must be completed each time you submit a reimbursement request. Reirnbursemerat
requests will .not be processed unless accompanied by a current Project Status Report.
Client Name: Jefferson County
Contract Number: PC12-951-052
Project Name; Port Hadlock Wastewater System
Anticipated Project
Completion Date: 3/5/2017
Approximately, what percentage of the project is 20 0~
complete?
When do you expect the project to be completed 03 / 05 / 20~ 7
{monthiday/year}?
Ad~nii~istrative services provided b~- t17e ~~Jashin~}}ton State Department of Corn~ncrce
(360) 7'?5-310 Fax (361)) 586-8440 ~~t+~~w.p~x-U.wa.~u~-