HomeMy WebLinkAboutWashington State Military Department and State Enhanced 911 Fund No. D21-031 - 071921 ( no ins required ) SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION DATE SUBMITTED
Jefferson County
7A2/2
PROJECT DESCRIPTION CONTRACT NUMBER
Jefferson County Snow Creek Road Culvert Upsizing
Hazard Mitigation Grant Program D21-031
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1. AUTHORIZING AUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE
Kate Dean Commissioner Dist. 1, 1/21-12/24
Heidi Eisenhour Commissioner Dist. 2, 1/21-12/24
I 4 Greg Brotherton Commissioner Dist. 3, 1/19-12/22
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NAT PRINT OR TYPE NAME TITLE
Monte Reinders PublicWorksDirector
Eric Kuzma Asst. Public Works Director
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3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME TITLE
Mark Thurston Engineer IV, Project Manager
74444
Eric Kuzma Asst. Public Works Director
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Department of Public Works
O Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Mark McCauley, Interim County Administrator
From: Monte Reinders, P.E., Public Works Director/County Engineer
Agenda Date: July 19, 2021
Subject: Hazard Mitigation Grant Agreement with the Washington State
Military Department for
Snow Creek Road MP 0.84 Culvert Replacement
County Project Number 18020310
Statement of Issue: Execution of the attached Signature Authorization Form is
necessary to obtain hazard mitigation funds for the Snow Creek Road MP 0.84 Culvert
Replacement project.
Analysis/Strategic Goals/Pro's Et Con's: The culvert at Snow Creek Road Milepost 0.84
is located under a 40 ft. deep fill, is badly deteriorated and at risk of failure. An
alternatives analysis and preliminary design for culvert replacement has been
completed. Public works has been awarded a FEMA Hazard Mitigation Grant for the
project. The grant will be used to complete final design, permitting, right of way, and
construction. The grant agreement requires signature by the Public Works Director. By
executing the attached Signature Authorization Form, the Board wilt authorize the
Public Works Director to sign the grant agreement.
Fiscal Impact/Cost Benefit Analysis: The remaining cost for final design and
construction is estimated to be $1,663,750. The FEMA Hazard Mitigation grant will
provide $997,500 in federal funding and $166,250 in state funding. Public Works intends
to apply for a Public Works Board loan to cover remaining funds.
Recommendation: The Board is requested to sign the Signature Authorization Form and
return to Public Works for further processing.
Department Contact: Mark Thurston, Project Manager, 385-9210.
Reviewed By:
744
Mark McCauley terim County Ad n' trator Date
CONTRACT REVIEW FORM 76Z/- 5
CONTRACT WITH: Washington State Military Department (FEMA) D21-031
(Contractor/Consultant) Contract No.
COUNTY DEPARTMENT: Public Works
Contact Person(Project Manager): Mark Thurston, ext. 210
Return to: Chris Spall, ext. 208
AMOUNT: $1,163750 PROCESS: ✓ Exempt from Bid Process
Revenue: 180.000.010.33397.01 - Cooperative Purchase
Expenditure: 180.000.010.59500 - Competitive Sealed Bid
Matching Funds Required: $500,000 _ Small Works Roster
Sources(s)of Matching Funds County Road Funds/PWB Loan _ Vendor List Bid
RFP or RFQ
Other
APPROVAL STEPS:
Step I: Confirm compliance with JCC 3.55.110 (No persons involved in county contracting or procurement can
accept, direc ly or indirectly, from anyone to which contract might be awarded, any rebate, gift, money or
anything of va e wha ,ver, except for the use and benefit of the county.)
CONFIRMED•l a 7/3/21
Signature Date
Step 2: Conti I Con.actor/Consultant has not
been debarred by any federal, state or local agency
CONFIRMED. N/A 23/ c ,.rye 7//3/Z/
ature Date
Step 3: RISK MANAGEMENT REVIEW
Electronically approved by Risk Management on 7/2/2021.
/
Step 4: PROSECUTING ATTORNEY REVIEW
Electronically approved as to form by PAO on 7/1/2021.
(1) State language--cannot change; (2) Need to sign steps 1 & 2 of the
Contract Review Form.
Step 5: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT
AND PROSECUTING ATTORNEY
Step 6: CONTRACTOR SIGNS
Step 7: SUBMIT TO BOCC FOR APPROVAL
Version 2021 05 11 Electronic