HomeMy WebLinkAboutUpper Hoh Road/Olympi National Park Department of Public Works
O Consent Agenda
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Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Mark McCauley, County Administrator
From: Monte Reinders, P.E., Public Works Director/County Engineer/it;
Agenda Date: September 19, 2022
Subject: Grant Agreement with Western Federal Lands Highway Division
Upper Hoh Road/Olympic National Park MP 0.0 - 12.0
County Road No. 914207
County Project No. 18019410
Statement of Issue: Execution of a grant agreement with FHWA-Western Federal
Lands Highway Division (WFLHD) for mitigation work associated with the Upper Hoh
Road/Olympic National Park MP 0.0 - 12.0 FLAP (Federal Lands Access Program)
Project.
Analysis/Strategic Goals/Pro's Et Con's: WFLHD needs to complete revegetation work
and vegetation mitigation tasks as applicable to support WFLHD's responsibilities
under USACE permit NWS-2015-229. On behalf of WFLHD, Jefferson County will work
directly with The Nature Conservancy and/or its' contractor to accomplish the
required tasks. This grant agreement provides funding for Jefferson County to hire
and coordinate with The Nature Conservancy to complete the required work.
Fiscal Impact/Cost Benefit Analysis: The grant agreement amount is $25,000, which
will provide 100% funding for the required work. There is no match requirement.
Recommendation: Public Works recommends the Chairman of the Board sign and
return to Public Works the WFLHD Project grant agreement and four supplemental
documents. A fully executed version will be returned to the Board after execution by
WFLHD.
Department Contact: Mark Thurston, P.E., Project Manager, 385-9217.
Reviewed By:
y (a/
7//,
ark McCaul , County Administrate Date
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1. Award No. 2.
6905672240015
4. Awarded To
Jefferson County, Washington
623 Sheridan Street
Port Townsend, WA
98368-2439
DUNS No.: 179278197
Agreement No. 6905672240015
Page 1 of 9
Effective Date 3. CDFA No.
See Block 17 20.224
5. Sponsoring Office
U.S. Department of Transportation
Federal Highway Administration
Western Federal Lands Highway Division
6. Period of Performance 7. Total Amount
September 1, 2022 to April 15, 2023 Federal Share: $25,000
Recipient Share: $00
Total Value $25,000
8. Type of Agreement 9. Authority
Grant 23 U.S.C. Section 204
10. Procurement Request No. 11. Funds Obligated
HFLWCA220029PR $25,000
12. Submit Payment Requests To 13. Payment Office
See 'Payment' clause in General Terms and Conditions
14. Accounting and Appropriation Data
1517532013020.531. C E. V200.53.1753000000.41012
15. Description of Project
Upper Hoh River Road Phase 2, WA JEFF 91420(1)
16. Jefferson County 17. Federal Highway Administration
Signature Date
Name: Heidi Eisenhour
Title: Chair, Board of County
Commissioners
Approved as to form only:
2k4, �lwl�./L Sept. 7, 2022 for
Philip C. Hunsucker, Date
Chief Civil Deputy Prosecuting Attorney
Signature
Name: Angy Liljedahl
Title: Agreement Officer
Date
Agreement No. 6905672240015
Page 2 of 9
TABLE OF CONTENTS
TITLE _ I PAGE
A PROGRAM DESCRIPTION 3
B FEDERAL AWARD INFORMATION 6
C FEDERAL AWARD ADMINISTRATION INFORMATION 7
Agreement No. 6905672240015
Page 3 of 9
SECTION A - PROGRAM DESCRIPTION
1. STATEMENT OF PURPOSE
The purpose of this agreement is to complete revegetation work and vegetation
mitigation tasks as applicable to support the Federal Highway Administration -
Western Federal Lands Highway Division's (FHWA) responsibilities under USACE
permit NWS-2015-229 (Permit).
2. LEGISLATIVE AUTHORITY
23 U.S.C. Section 204.
3. PROJECT BACKGROUND AND SCOPE
The Western Federal Lands Highway Division (WFLHD) of the Federal Highway
Administration (FHWA), in partnership with Jefferson County, plans to construct
bank stabilization and bridge and culvert improvement projects in five locations
along the Upper Hoh River Road (UHRR).
The proposed project will develop and implement cost-effective, long-term bank
stabilization solutions at three locations along the UHRR. The project will also
replace or improve three existing bridge or culvert locations. The roadway at these
sites is at risk of washing away in a large flood. The purpose of the proposed
improvements is to prevent the road from washing away at these locations, and to
provide safe and consistent access to residents, businesses, and Olympic National
Park visitors via the UHRR.
The project area includes the UHRR between mileposts (MP) 3.7 and 10.2 and the
general area north and south of the road, including the Hoh River and its northern
banks. The UHRR extends generally east -west immediately north of the Hoh River,
in unincorporated western Jefferson County, Washington.
4. STATEMENT OF WORK
This agreement provides funding for mitigation work including: project management,
planting (plant material, transporting, labor and equipment) and selective
brush/thinning to insure that the mitigation work is successful. In addition,
intermittent seeding will be completed.
The work must be completed in accordance with Permits and in cooperation with
local land owners and County laws and regulations. In addition, the work must
comply with the standards, guidelines, and requirements associated with the Permit
Agreement No. 6905672240015
Page 4 of 9
A. Purchase and placement of seeds and seedlings
1. Jefferson County will work with local land management officials to identify
native local specifies of vegetation to place that will best promote the floodplain
development and protection. Sources of information may include contacting
United States Forest Service (USFS), The Nature Conservancy (TNC), and the
National Park Service for listings of local species. They may also consult with
books, public archives, and local Tribes for information.
2. The Government will conduct a planting assessment of the needs and
locations for the mitigation (planting and thinning) and demarcate limits.
3. Jefferson County will be responsible for obtaining landowner permission where
investigations will occur on private property and coordinate with the landowners
for any site specific restrictions or conditions regarding the selective clearing and
tree planting.
4. Jefferson County will coordinate with USFS and TNC, as needed, to verify
timing and access needs (if any).
5. Jefferson County will perform any necessary mitigation tasks according to
best management practices.
B. Summary of Deliverables and Schedules
1. Jefferson County will provide monthly updates to the FHWA on the mitigation
planting progress via e-mail
2. Jefferson County will send photos (with GPS location) of the planting and
selective clearing via email.
S. DELIVERABLES
Reference
Delivery Due On or
Task
Paragraph
Before Date
• Approved native plant list
AA.A.1
Prior to installation
• Temporary access agreement
A.4.A.2&3
Prior to installation
° Site photos of planting and selective clearing
A.4.A.4
Upon completion
of work
Agreement No. 6905672240015
Page 5 of 9
Note:
■ The Recipient will submit a progress report with each request for reimbursement
indicating dates covered, work that has been completed within the request for
reimbursement coverage dates, and anticipated dates of major project milestones (i.e.
survey completion, preliminary design completion, construction start, and construction
completion).
■ Submit electronic pdf files and one hard copy of all deliverables to FHWA.
6. KEY OFFICIALS
Government — FHWA/Federal Lands Highway Division
Contact: John Davis, Agreement Officer's Representative (AOR)
Voice: (202) 763-4310
Email: John.Davis@dot.gov
Financial Contact: Genise Dance
Voice: (360) 619-7534
Fax: (360) 619-7945
Email: Genise.Dance@dot.gov
Recipient- Jefferson County, WA
Primary Contact
Name: Mark Thurston
Address: 623 Sheridan Street
City, State, Zip: Port Townsend, WA, 98368-2439
Telephone: (360) 385-9210
Email: mthurston@co.jefferson.wa.us
Fax: (360) 385-9234
Secondary Contact
Name: Eric Kuzma
Address: 623 Sheridan Street
City, State, Zip: Port Townsend, WA, 98368-2439
Telephone: (360) 385-9167
Email: ekuzma@co.jefferson.wa.us
Fax: (360) 385-9234
Agreement No. 6905672240015
Page 6 of 9
SECTION B — FEDERAL AWARD INFORMATION
1. TYPE OF AWARD
The planned award type is a Grant.
2. COST SHARING OR MATCHING
None
3. PERIOD OF PERFORMANCE
The period of performance for this Agreement is in accordance with Block 6 on page
one of the Agreement.
4. DEGREE OF FEDERAL INVOLVEMENT
The FHWA does not anticipate substantial Federal involvement between it and the
Recipient during the course of this project. The anticipated Federal involvement is
communicating project updates, requesting photos of the progress, and general
communication related to project scope, schedule, and budget.
Agreement No. 6905672240015
Page 7 of 9
SECTION C - FEDERAL AWARD ADMINISTRATION INFORMATION
1. FEDERAL AWARD NOTICES
Only the AO can commit the FHWA. The award document, signed by the AO, is the
authorizing document. Only the AO can bind the Federal Government to the
expenditure of funds.
2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS
General terms, conditions, and governing regulations that apply to this agreement
are available online at:
https://www.fhwa.dot.gov/cfo/contractor reci 1 tandc eneraltermsconditions.cfm
The online list dated March 6, 2015 of "GENERAL TERMS AND CONDITIONS FOR
ASSISTANCE AWARDS" shall apply to the resulting award, except as noted below:
Paragraph 9 does not apply to contract documents and specifications prepared by
the Recipient or consultant of the Recipient for design and construction of the
programmed project.
A. INDIRECT COSTS:
This section is not applicable to this Agreement.
B. DATA RIGHTS
The Recipient must make available to the FHWA copies of all work developed in
performance with this Agreement, including but not limited to software and data.
Data rights under this agreement shall be in accordance with 2 CFR 200.315,
Intangible property.
C. PERSONALLY IDENTIFIABLE INFORMATION (PII)
Personally Identifiable Information (PII) as defined at CFR Part 200.79 and 2 CFR
200.82 at will not be requested unless necessary and only with prior written approval
of the AO with concurrence from the AOR.
D. AVAILABLE FUNDING
The cost of the work to be reimbursed by FHWA is Not to Exceed the amount in block
11 of the cover page, unless an amendment to the Agreement is made in writing and
Agreement No. 6905672240015
Page 8 of 9
agreed to by both parties.
E. KEY PERSONNEL
This section is not applicable to this agreement.
F. SUBAWARDS AND SUBCONTRACTS APPROVAL
The Recipient has been determined to have a procurement system that is approved
and accepted by the Government, so are exempt from the requirements of 2 CFR
§200.330.
G. ORDER OF PRECEDENCE
This section is not applicable to this agreement.
H. DESIGNATION AS RESEARCH OR NON -RESEARCH AGREEMENT
This agreement is designated as: NON -RESEARCH
I. CONFERENCE SUPPORT RESTRICTIONS
The Recipient must obtain written approval from the AOR prior to incurring any costs
for conference support. See the definition of conference as contained in 2 CFR
200.432.
Food and beverage costs are not allowable conference expenses for reimbursement
under this Agreement.
Note: Costs of meals are allowable as a travel per diem expense for individuals on
travel status and pursuant to the Travel clause of this Agreement.
Agreement No. 6905672240015
Page 9 of 9
J. DISPUTES
The parties to this Agreement will communicate with one another in good faith and in
a timely and cooperative manner when raising issues under this provision. Any
dispute, which for the purposes of this provision includes any disagreement or claim,
between the FHWA and the Recipient concerning questions of fact or law arising
from or in connection with this Agreement and whether or not involving alleged
breach of this Agreement, may be raised only under this Disputes provision.
Whenever a dispute arises, the parties will attempt to resolve the issues involved by
discussion and mutual agreement as soon as practical. In no event will a dispute
which arose more than three months prior to the notification made under the
following paragraph of this provision constitute the basis for relief under this article
unless FHWA waives this requirement.
Failing resolution by mutual agreement, the aggrieved party will document the
dispute by notifying the other party in writing of the relevant facts, identify unresolved
issues and specify the clarification or remedy sought. Within five working days after
providing written notice to the other party, the aggrieved party may, in writing,
request a decision from the AO. The AO will conduct a review of the matters in
dispute and render a decision in writing within thirty calendar days of receipt of such
written request. Any decision of the AO is final and binding unless a party will, within
thirty calendar days, request further review as provided below.
Upon written request to one level above the AO or designee, made within thirty
calendar days after the AO's written decision or upon unavailability of a decision
within the stated time frame under the preceding paragraph, the dispute will be
further reviewed. This review will be conducted by one level above the AO.
Following the review, all parties will be notified in writing. Such resolution is not
subject to further administrative review and to the extent permitted by law, will be
final and binding. Nothing in this Agreement is intended to prevent the parties from
pursuing disputes in a United States Federal Court of competent jurisdiction.
Federal Lands Access Program
Project Memorandum of Agreement
Instructions, Tips, and Tricks
Federal Lands Access Program
Project Memorandum of Agreement
Project / Facility Name: Upper Hoh River Road Phase 2, WA JEFF 91420(1)
Project Route: Hoh River Road
State: Washington
County: Jefferson
owner of Federal Lands to which the Project Provides Access: Olympic National Park (FLMA)
Entity with Title or Maintenance Responsibility for Facility: Jefferson County (LPA)
Type of Work: The project is to include:
• Preliminary Engineering including environmental studies to support an environmental decision:
o Geotechnical Investigation
o Bank Stabilization design
o Bridge design (Canyon Creek and Tower Creek)
o Hydraulic Modeling
o Culvert design for MP 4.38
o R/W Acquisition
o Utility Agreements
o Environmental Studies
o Permitting
o NEPA Decision
■ Construction Engineering / Contract Administration
This Agreement does not obligate (commit to) the expenditure of Federal funds nor does it commit the
parties to complete the project. Rather, this agreement sets forth the respective responsibilities as
the project proceeds through the project development process and construction.
This agreement replaces Federal Lands Access Program Match Agreement dated: 09/11/14 between
FHWA-WFL, and Jefferson County.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 1 of 33 July 23, 2020
Parties to this Agreement: Jefferson County, Federal Highway Administration, the Western Federal
Lands Highway Division (FHWA-WFL).
The Program Decision Committee approved this project on 11/18/2013
AGREED:
Western Federal Lands Highway Division, FHWA-WFL
g/`?'�o )-0
Date
q-� w2,,t
Date
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 2 of 33 July 23, 2020
A. PURPOSE OF THIS AGREEMENT:
This agreement documents the intent of the parties and sets forth the anticipated responsibilities
of each party in the development, construction, and continued maintenance of the subject project.
The purpose of the agreement is to identify and assign responsibilities for Project Development,
Contract Advertisement, and Construction Administration as appropriate for this project, and to
ensure continued maintenance of the facility for public use if improvements are made. The parties
understand that any final decision as to design or construction will not be made until after the
environmental analysis required under the National Environmental Policy Act (NEPA) is completed
(this does not prevent the parties from assigning proposed design criteria to be studied in the NEPA
process.) Any decision to proceed with the design and construction of the project will depend on
the availability of appropriations at the time of obligation and other factors such as issues raised
during the NEPA process, a natural disaster that changes the need for the project, a change in
Congressional direction, or other relevant factors.
If Federal Lands Access Program (FLAP) funds are used for the development or construction of
this project, Jefferson County agrees to provide a matching share equal to 13.5% of the total cost
of the project, as detailed more fully in Section J below. When agency other than FHWA-WFL will
be expending FLAP funds, the parties agree to execute a separate obligating document. No
reimbursement will be made for expenses incurred prior to execution of the obligating document.
B. AUTHORITY:
This Agreement is entered into between the signatory parties pursuant to the provisions of 23
U.S.C. 204.
C. JURISDICTION AND MAINTENANCE COMMITMENT:
Jefferson County has jurisdictional authority to operate and maintain the existing facility and will
operate and maintain the completed project at its expense.
Maintenance responsibilities will include permit monitoring and maintenance. It is anticipated that
a portion of these costs will be shared with WFL through a cooperative agreement.
D. FEDERAL LAND MANAGEMENT AGENCY COORDINATION:
Jefferson County has coordinated project development with the Olympic National Park. The
Olympic National Park support of the project is documented in the Project Proposal by endorsing
the proposal.
Each party to this agreement who has a primary role in NEPA, design or construction should
coordinate their activities with the Olympic National Park.
E. PROJECT BACKGROUND / SCOPE:
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 3 of 33 July 23, 2020
This project is intended to stabilize 3 segments of eroding bank along the Hoh River, replace one
existing bridge, replace one undersized deep culvert with a bridge at Canyon Creek, provide
mitigation as required, and includes placing a new fish passage culvert near MP 4.3. The locations
are located between milepost 3.3 and 10.5 within Jefferson County. The first two sites located
between MP 3.3 and 4.4 will be treated as one site for bank stabilization. The next two sites are
bridge replacement at Tower Creek and bank stabilization immediately up river from the bridge.
The final site is located at Canyon Creed near MP 10.2. This location currently has a pipe that is
buried approximately 30 feet below the roadway surface that will be replaced with a bridge.
Mitigation for bank stabilization takes place in several locations within the corridor and consists of
creating small wetland and placing for engineered log jams. The culvert replacement at MP 4.3
upsizes the existing culvert from a 5' diameter culvert to a 20' concrete box culvert.
The bank stabilization sites are within the existing programmed budget, but the two bridge sites
are likely over the current programmed amount and are the lowest priority should funding be
insufficient. It is unknown today what the costs will be (dependent on the contractor bids), but
ultimately the intent is to improve all of the sites.
The mitigation site(s) identified are required by the Army Corps of Engineers and the Washington
Department of Fish and Wildlife for impacts associated with the in water work.
The project will be designed in accordance with the American Association of State Highway &
Transportation Officials (AASHTO) Policy on Geometric Design of Highway and Streets, current
addition.
F. PROJECT BUDGET:
This is the budget for the project and anticipated construction/engineering costs based on
information developed to date. Federal Lands Access Program funds in conjunction with matching
funds provided by Jefferson County and the Olympic National Park will fund this project as
detailed in Section K.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 4 of 33 July 23, 2020
Item
Total Current
Comments
Preliminary Engineering including
scoping and NEPA (PE)
$2,300,000
Includes mitigation designs, hydraulics
modeling, permit applications, EA, public
meetings, and design
Construction (CN) — Base (bank
stabilization and mitigation)
$9,530,000
Based on current engineers estimate
Tower Creek Bridge
$3,310,185
Based on current engineers estimate
Canyon Creek Bridge
$3,172,433
Based on current engineers estimate
Construction Engineering (CE)
$1,021,000
Construction Modifications (CM)
Contingency
$1,000,000
A portion of this will be for mitigation
costs —which will likely be included in the
base contract
TOTAL
$20,381,150*
Current anticipated project cost
*Does not include R/W expenditures provided by Jefferson County.
G. ROLES AND RESPONIBILITIES:
Jefferson County
• Will be responsible for project activities identified in Section P.
• Will appoint a representative who will be the primary contact for FHWA-WFL's Project
Manager
• Will provide appropriate match to all FLAP funds expended on the project even if the project
is terminated prior to completion
• Will be responsible for the acquisition of any rights -of -way and / or easements necessary to
complete the project.
• Upon completion of construction, a final inspection will be convened by FHWA-WFL with
attendees from Jefferson County, and if it is determined the project has been constructed
in substantial conformity with approved plans and specifications, Jefferson County will
provide written confirmation of its acceptance of the constructed project.
rH1AIn_WFi
Will be responsible for Federal NEPA document and decision,
• Preliminary design activities needed
• Mitigation designs
• Permitting as it relates to in stream work
• SHPO clearances
• Construction administration
• Upon completion of construction, permits will be transferred to Jefferson County to assume
the new owner responsibility and liability for all the terms and conditions in the permit,
including permit fees. FHWA-WFL will provide a copy of the Stormwater Pollution
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 5 of 33 July 23, 2020
Prevention Plan (SWPPP) to the new owner prior to the effective date of the proposed
transfer. FHWA-WFL will be responsible for the Permit Transfer Notification Fee.
H. ROLES AND RESPONSIBILITIES— MILESTONE SCHEDULE:
Responsible Product/Service Schedule Start/Finish
Lead
FHWA-WFL, 30% Design November 2016
FHWA-WFL NEPA documentation I May 2017
FHWA-WFL NEPA Decision
FHWA-WFL 95% PS&E
FHWA-WFL Advertise/Award
FHWA-WFL Construction
July 2017
March 2018
September 2020/December 2020
March 2021/October 2023
I. PROPOSED DESIGN STANDARDS:
Preferred design alternatives will be determined through the NEPA process.
Criteria
Standard
Roadway Design Manual
AASHTO — A Policy on
Geometric Design
Functional Classification
Rural Collector
Surface Type
Asphalt
Design Volume
650 ADT
Design exceptions to standards, will be documented and sent to the Jefferson County for
concurrence.
J. FUNDING:
The project is largely funded by the Federal Lands Access Program administered by FHWA-WFL,
with matching funds provided by the National Park Service and Jefferson County,
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 6 of 33 July 23, 2020
Item
Total Funding
Preliminary Engineering
including scoping and NEPA (PE)
$1,325,180
Construction (CN) — FLAP
$9,677,115
Construction (CN) — Match
$942,705
Construction (CN) - PLHD
$1,115,508
Construction Engineering (CE)
$1,021,000
Construction Modifications
(CM) Contingency
$1,000,000
TOTAL
$15,080,803*
*This is the funding amount currently available. The design and CN costs are expected to exceed this amount (as shown
in the Budget Section above). The project will be broken into schedules/options to maximize the amount of
construction.
Funding Source
Amount
%
Comments
Federal Lands Access
Funds
13,023,295
63.7%
Local Matching Share
(Jefferson County)
$62,485
0.03%
R/W costs (cash)
Local Matching Share
(Jefferson County)
1,754,700
Toll Credit
Local Matching Share
(National Park Service)
$942,705
4.6%
NPS Cash
Total Matching Funds
$1,005,190 cash
$1,754,700 toll credit
13.5%
13.5% of total
projected costs
Total Projected Costs
$20,443,635
Anticipated Shortfall
$5,300,347
K. MATCHING SHARE REQUIREMENTS:
The purpose of this section is to document the intent of Jefferson to meet its match requirement
for the subject project as authorized under section 23 USC 201(b)(7)(13).
All FLAP expenditures associated with this project will need to be matched by a Non- Federal
source, by other Federal funds other than those made available under Titles 23 and 49 of the United
States Code, or by funds made available under 23 U.S.C. 202 and 203. The matching requirement
under the FAST Act will be met by Jefferson County with support from National Park Service.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 7 of 33 July 23, 2020
Jefferson County, the National Park Service and other agencies have committed to the project. The
forms of match shall be those consistent with the 'Federal -Aid Guidance Non -Federal Matching
Requirements' and as approved by FHWA-WFL. In the state of Washington, 13.5% of the total
project cost.
This project is authorized to use a Tapered Match. Under this approach, the non -Federal match is
imposed over the entire project rather than individual progress payments. Timing of all fund
transfers are specified in the Funding Plan. Tapered Match is authorized because it will result in an
earlier completion date.
Estimated costs and fiscal year (FY) for the funding are based on the best budgeting and scheduling
information known at the time. The final match will be determined based on actual expenditures
at the conclusion of project work. Matching cash funds in FHWA-WFL receipt may need to be
supplemented, or returned, once actual expenditures are determined. As noted under
Modifications, if costs increase over the amount within this agreement, FHWA-WFL will consult
with the agency(ies) providing Match before granting approval.
Maintain all project records, including source documentation for all expenditures and in -kind
contributions, for a period of three (3) years from the date of final acceptance. If any litigation
claim, negotiation, or audit has been started before expiration of the three-year period, the records
shall be retained until completion of the action and resolution of all issues that arise from it.
The following agencies have agreed to contribute the amounts shown which will reduce the federal
share by the same amount. The Funding Plan is as follows;
Agency + Phase I Form I Due I Value I Comments
Jefferson
County
Jefferson
County
Jefferson
County
Olympic
National Park
PE
CN
PE
CN
Toll Credit 9/1/20
Toll Credit 9/1/20
In -Kind Paid
$248,015 For anticipated PE
(less R/W cost)
TBD Will vary depending
on awarded value
$62,485 R/W Acquisition
CASH 1 9/1/20 1 $942,705
L. PROJECT TEAM MEMBERS — POINT OF CONTACT:
The following table provides the points of contact for this project. They are to be the first persons
to deal with any issues or questions that arise over the implementation of each party's role and
responsibility for this agreement.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 8 of 33 July 23, 2020
NAME / TITLE
ORGANIZATION
TELEPHONE NO. / E-MAIL
Monte Reinders, Public
Jefferson County
360-385-9242/
Works Director
mreinders@do.jefferson.wa.us
Mark Thurston, Project
Jefferson County
360-385-9210/
Manager
mthurston@co.jefferson.wa.us
Jon Christensen, Program
National Park Service
415-623-2278
Manager PWR
Jon—christensen@nps.gov
Lisa Turecek, Chief of
Olympic National Park
360-565-3150
Facilities and Maintenance
Lisa.turecek@nps.gov
Kirk Loftsgaarden, Project
Federal Highway Administration-
360-619-7512,
Manager
Western Federal Lands Highway Division
kirk.loftsgaarden@dot.gov
Federal Highway Administration-
360-619-7744,
Brent Coe, Project
Manager Branch Chief
Western Federal Lands Highway Division
Brent.Coe@dot.gov
M. CHANGES AMENDMENTS I ADDENDUMS_
The agreement may be modified, amended, or have addendums added by mutual agreement of all
parties. The change, amendment, or addendum must be in writing and executed by all of the
parties.
The types of changes envisioned include, but are not limited to, changes that significantly impact
scope, schedule, or budget; changes to the local match, either in type or responsibility; change that
alter the level of effort or responsibilities of a party. The parties commit to consider suggested
changes in good faith. Failure to reach agreement on changes may be cause for termination of this
agreement.
A change in composition of the project team members does not require the agreement to be
amended.
It is the responsibility of the project team members to recognize when changes are needed and to
make timely notifications to their management in order to avoid project delivery delays.
N. ISSUE RESOLUTION PROCEDURES MATRIX:
Issues should be resolved at the lowest level possible. The issue should be clearly defined in writing
and understood by all parties. Escalating to the next level can be requested by any party. When
an issue is resolved, the decision will be communicated to all levels below.
Jefferson County
I National Park
Service
FHWA-WFL
Time
Mark Thurston
Lisa Turecek
Kirk Loftsgaarden
15 Days
Monte Reinders
Jon Christensen
Brent Coe
15 Days
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 9 of 33 July 23, 2020
O. TERMINATION:
This agreement may be terminated by mutual written consent of all parties. This agreement may
also be terminated if either the NEPA process or funding availability requires a change and the
parties are not able to agree to the change. Any termination of this agreement shall not prejudice
any rights or obligations accrued to the parties prior to termination. If Federal access funds have
been expended prior to termination, the party responsible for the match agrees to provide a match
in the applicable percentage of the total amount expended on the project prior to the termination.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 10 of 33 July 23, 2020
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ATTACHMENT 1
2 CFR 200 Common Rule Requirements and other legal requirements
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A. GENERAL TERMS AND CONDITIONS
Background. To promote accelerated and efficient delivery of projects that benefit Federal Land
Management Agencies, the Secretary has exercised his discretion under 23 U.S.C. § 201(a) and § 204(a)(3)
to apply Title 23 U.S.C. Chapter 1 requirements (Federal Aid requirements) to Federal Lands Access Projects
delivered by State Departments of Transportation (DOTS) and local public agencies that are evaluated and
certified by State DOTS to deliver Federal Aid projects. In instances where a local public agency is not certified
to deliver Federal -aid projects and Federal Lands Access projects are delivered by the local public agency
cooperatively with Federal Lands Highway Division office oversight, the government -wide Common Rule (2
CFR 200) will be applied. This cooperative relationship will enable the FLH to identify any federal law issues
in cooperation with the local public agency which may arise in the project development and delivery process.
1. The Agreement provides funds on a reimbursable basis to the Servicing Agency for the project
described in the Access Program Project Memorandum of Agreement.
2. The Government's liability to make payments to the Servicing Agency under the Agreement is
limited to those funds obligated by the Government under the Agreement as indicated herein and by any
subsequent amendments agreed to in writing by all parties.
3. The Servicing Agency agrees to abide by and comply with all terms and conditions of the Agreement
and to abide by, and comply with, all requirements of applicable law, including those specified in this
Attachment, which are considered as an integral part of the Agreement.
4. In the case of any inconsistency or conflict between the specific provisions of the Agreement and
this Attachment, such inconsistency or conflict shall be resolved by giving preference to the Agreement.
5. The Servicing Agency shall be responsible for ensuring that the Project is designed and/or
constructed in accordance with the Agreement, and all applicable Federal laws, regulations and policies of
the Federal Highway Administration ("FHWA" also referred to herein as the "Government").
6. Reimbursement of costs incurred pursuant to the Agreement will be made pursuant to and in
accordance with 2 CFR Part 200 and the provisions of such regulations and procedures as the Government
may prescribe. Determination of allowable costs incurred by the Servicing Agency under the Agreement
shall be made in accordance with applicable government -wide cost principles under 2 CFR 200. Closeout of
the Agreement shall be based upon a determination that all applicable administrative actions and all required
work of the Agreement have been completed in accordance with 2 CFR Part 200. Upon the Government's
review of all financial, performance, and other reports required as a condition of the Agreement, the
Government may make any upward or downward adjustments to the allowable costs in accordance with 2
CFR 200.
7. The Servicing Agency agrees to carry out and complete the Project without undue delays and in
accordance with the terms of the Agreement, including the Project Schedule set out in the Agreement, or in
the Access Program Project Memorandum of Agreement if no Schedule is included in this Agreement, and
comply with such regulations and procedures as the Government may prescribe.
8. The Servicing Agency agrees to retain all documents relevant to the Project for a period of three
years from completion of the Project and receipt of final reimbursement from the Government. The
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Servicing Agency agrees to furnish the Government, upon request, all documents and records pertaining to
the Project.
9. The Government is subject to the Freedom of Information Act (FOIA). The Servicing Agency should
therefore be aware that all materials submitted by the Servicing Agency related to the Agreement will
become agency records and thus are subject to FOIA and to public release through individual FOIA requests.
10. The Government shall not be responsible or liable for any damage to property or any injury to
persons that may arise from, or be incident to, performance or compliance with this the Servicing Agency's
work under the Agreement. The Government will be responsible for damages or injuries caused by the
negligence of its own employees, to the extent permitted under the Federal Tort Claims Act, 28 U.S.C. 2671-
2680.
11. To the extent that the State has not already enacted legislation regarding texting while driving, the
Government encourages the Servicing Agency to adopt and enforce workplace safety policies to decrease
crashes caused by distracted drivers including policies that bar text messaging while driving company -owned
or rented vehicles, or government -owned, leased, or rented vehicles or privately -owned vehicles when on
official government business or when performing any work for or on behalf of the Government. See
Executive Order 13513 "Federal Leadership on Reducing Text Messaging While Driving", Oct. 1, 2009
(available at http://edocket.access.jzpo.gov/2GO9/E`9-24203.htm ) and DOT Order 3902.10 "Text Messaging
While Driving", Dec. 30, 2009, as implemented by Financial Assistance Policy Letter (No. FAP-2010-01, Feb.
2, 2010, available at http://www.dot.gov/sites/doLdevZfiles/docs/FAPL 2010.O1. df)This includes, but is
not limited to, the Servicing Agency:
a. considering new rules and programs or re-evaluating existing programs to prohibit text
messaging while driving;
b. conducting education, awareness, and other outreach for employees about the
safety risks associated with texting while driving; and
c. encouraging voluntary compliance with the agency s text messaging policy while off duty.
The Servicing Agency is encouraged to insert the substance of this clause in all contracts and subcontracts.
B. APPLICABLE FEDERAL LAWS AND REGULATIONS
By entering into the Agreement, the Servicing Agency assures, certifies, and agrees to comply with all
applicable Federal laws, regulations, policies, guidelines, and requirements as they relate to the use of
Federal funds for this Project including, but not limited to, the following:
General Federal Legislation
■ Fair Labor Standards Act - 29 U.S.C. § 201, et seq.
• Hatch Act - 5 U.S.C. §§ 1501, et seq.
• Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Title - 42 U.S.C. §§4601,
et seq.
• National Historic Preservation Act of 1966— 16 U.S.C. § 470, et seq.
• Archaeological Resources Protection Act —16 U.S.C. 470aa, et seq.
• Native American Graves Protection and Repatriation Act - 25 U.S.C. § 3001, et seq.
• National Environmental Policy Act of 1969 - 42 U.S.C. §§ 4321, et seq.
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■ Wild and Scenic Rivers Act, P.L. 90-542, as amended —16 U.S.C. §§ 1271, et seq.
■ Federal Water Pollution Control Act, as amended - 33 U.S.C. §§ 1251-1376
• Clean Air Act — 42 U.S.C. § 7401, et seq.
■ Single Audit Act of 1984 - 31 U.S.C. §§ 7501, et seq.
• Americans with Disabilities Act of 1990 - 42 U.S.C. § 12101, et seq.
• Section 504 of the Rehabilitation Act of 1973, as amended - 29 U.S.C. § 794
• Title VI of the Civil Rights Act of 1964 - 42 U.S.C. §§ 2000d et seq.
■ Limitation on Use of Appropriated Funds to Influence Certain Federal Contracting and Financial
Transactions — 31 U.S.C. § 1352
• Magnuson -Stevens Fishery Conservation and Management Act —16 U.S.C. § 1855
■ Farmlands Protection Policy Act of 1981— 7 § U.S.C. 4201
■ Noise Control Act of 1972 — 42 U_S.C. § 4901, et seq.
• Section 4(f) of the Department of Transportation Act of 1966, 49 U.S.C. 303 and 23 U.S.C. § 138
• Resource Conservation and Recovery Act of 1976 (RCRA), as amended --
42 U.S.C. §§ 6901, et seq.
• Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as
amended --42 U.S.C. §§ 9601-9657
• Safe Drinking Water Act -- 42 U.S.C. §§ 300f-300j-6
• Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976 —42
U.S.C. § 6901, et seq.
• Migratory Bird Treaty Act 16 U.S.C. § 760c-760g
■ The Federal Funding Transparency and Accountability Act of 2006, as amended (Pub. L. 109-282, as
amended by section 6202 of Public Law 110-252)
• Cargo Preference Act of 1954 — 46 U.S.C. § 55305
• Buy America Act — 23 U.S.C. § 313 (see
htt2:llwww.fhwa.dot.govlconstruction(contractslbuyam Qa.cfm)
Nondiscrimination — 23 U.S.C. § 140
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General Federal Regulations
• Suspension and Debarment-2 CFR Parts Part 180
• Non -procurement Suspension and Debarment — 2 CFR Part 1200
External Programs — 23 CFR Part 230
■ Manual on Uniform Traffic Control Devices — 23 CFR Part 655
• Environmental Impact and Related Procedures — 23 CFR Part 771
■ Procedures for Abatement of Highway Traffic and Construction Noise — 23 CFR Part 772
• Procedures Implementing Section 4(f) of the Department of Transportation Act — 23 CFR Part 774
• DOT's oversight of DOJ's ADA regulations for non -transit programs, including the ADA
Accessibility Guidelines, required by the DOJ regulations at — 28 CFR Part 35
• Procedures for predetermination of wage rates — 29 CFR Part 1
Contractors and subcontractors on public building or public work financed in whole or part by loans
or grants from the United States — 29 CFR Part 3
+ Labor standards provisions applicable to contracts governing federally financed and assisted
construction (also labor standards provisions applicable to non -construction contracts subject to the
Contract Work Hours and Safety Standards Act) — 29 CFR Part 5
• Permitting Requirements under the National Pollutant Discharge Elimination System — 40 CFR Part
122.
• Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of
Labor (Federal and federally assisted contracting requirements) — 41 CFR Parts 60, et seq.
Uniform administrative requirements, cost principles, and audit requirements for Federal
Awards — 2 CFR Part 200
• New Restrictions on Lobbying-49 CFR Part 20
• Nondiscrimination in Federally Assisted Programs of the Department of Transportation —Effectuation
of Title VI of the Civil Rights Act of 1964 — 49 CFR Part 21
Uniform relocation assistance and real property acquisition for Federal and Federally assisted
programs —49 CFR Part 24
• Nondiscrimination on the Basis of Sex in Education Programs or Activities Receiving Federal
Financial Assistance — 49 CFR Part 25
• Participation by Disadvantaged Business Enterprises in Department of Transportation Financial
Assistance Programs —49 CFR Part 26
* Nondiscrimination on the Basis of Handicap in Programs and Activities Receiving or Benefiting from
Federal Financial Assistance-49 CFR Part 27
■ Enforcement of Nondiscrimination on the Basis of Handicap in Programs or Activities Conducted by the
Department of Transportation —49 CFR Part 28
• Denial of public works contracts to suppliers of goods and services of countries that deny
procurement market access to U.S. contractors — 49 CFR Part 30
• Government -wide Requirements for Drug -Free Workplace (Financial Assistance) — 49 CFR Part 32
DOT's implementing ADA regulations for transit, including the ADA Accessibility Guidelines in Part
37, Appendix A — 49 CFR Parts 37 and 38
■ Procedures for Transportation Workplace Drug and Alcohol Testing Programs —49 CFR Part 40
■ 23 C.F.R. Part 710 applies unless otherwise agreed to by FHWA
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The Servicing Agency, when contracting for work to be performed under this Agreement, will include in the
prime contract the applicable provisions required under 2 CFR 200.326.
The Servicing Agency, when contracting for construction services, shall ensure that all laborers and mechanics
employed by contractors or subcontractors on the construction work shall be paid wages at rates not less
than those prevailing on the same type of work on similar construction in the immediate locality as
determined by the Secretary of Labor in accordance with sections 3141, 3146, and 3147 of title 40.
C. ASSURANCES AND CERTIFICATIONS
TITLE VI ASSURANCE
(Implementing Title VI of the Civil Rights Act of 1964, as amended)
ASSURANCE CONCERNING NONDISCRIMINATION IN FEDERALLY -ASSISTED PROGRAMS AND
ACTIVITIES RECEIVING OR BENEFITING FROM FEDERAL FINANCIAL ASSISTANCE
(Implementing the Rehabilitation Act of 1973, as amended, and the Americans With
Disabilities Act, as amended)
49 CFR Parts 21, 25, 27, 37 and 38
The United States Department of Transportation fUSDOT)
Standard Title Vf Non -Discrimination Assurances
DOT Order No, 1050.2A
By entering into the Agreement, the Servicing Agency (also herein referred to as the "Recipient"), HEREBY
AGREES THAT, as a condition to receiving any Federal funds from the U.S. Department of Transportation
(DOT), through the Federal Highway Administration (FHWA), is subject to and will comply with the following:
Statutory/Regulatory Authorities
• Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits
discrimination on the basis of race, color, national origin);
• 49 CFR Part 21 (entitled Non-discrimination In Federally -Assisted Programs Of The Department Of
Transportation —Effectuation Of Title VI Of The Civil Rights Act Of 1964);
+ 28 CFR section 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of the Civil
Rights Act of 1964);
The preceding statutory and regulatory cites hereinafter are referred to as the "Acts" and
"Regulations," respectively.
General Assurances
In accordance with the Acts, the Regulations, and other pertinent directives, circulars, policy, memoranda,
and/or guidance, the Servicing Agency hereby gives assurance that it will promptly take any measures
necessary to ensure that:
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"No person in the United States shall, on the grounds of race, color, or national origin, be excluded from
participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or
activity,"for which the Recipient receives Federal financial assistance from DOT, including the FHWA.
The Civil Rights Restoration Act of 1987 clarified the original intent of Congress, with respect to Title VI and
other Non-discrimination requirements (The Age Discrimination Act of 1975, and Section 504 of the
Rehabilitation Act of 1973), by restoring the broad, institutional -wide scope and coverage of these non-
discrimination statutes and requirements to include all programs and activities of the Servicing Agency, so
long as any portion of the program is Federally assisted.
Specific Assurances
More specifically, and without limiting the above general Assurance, the Servicing Agency agrees with and
gives the following Assurances with respect to its receipt of funds for this project:
1. The Servicing Agency agrees that each "activity," "facility," or "program," as defined in
§§ 21.23 (b) and 21.23 (e) of 49 CFR § 21 will be (with regard to an "activity") facilitated, or will be (with
regard to a "facility") operated, or will be (with regard to a "program") conducted in compliance with
all requirements imposed by, or pursuant to the Acts and the Regulations.
2, The Servicing Agency will insert the following notification in all solicitations for bids and requests for
proposals for work or materials, regardless of funding source:
a. "The Servicing Agency, in accordance with the provisions of Title VI of the Civil Rights
Act of 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d to 2000d-4) and the Regulations,
hereby notifies all bidders that it will affirmatively ensure that any contract entered
into pursuant to this advertisement, disadvantaged business enterprises will be
afforded full and fair opportunity to submit bids in response to this invitation and
will not be discriminated against on the grounds of race, color, or national origin in
consideration for an award."
3. The Servicing Agency will insert the clauses of Appendix A of this Assurance in every contract or
agreement subject to the Acts and the Regulations.
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4. The Servicing Agency will insert the clauses of Appendix B of this Assurance, as a covenant running
with the land, in any deed from the United States effecting or recording a transfer of real property,
structures, use, or improvements thereon or interest therein to a Recipient.
5. That where the Servicing Agency receives Federal financial assistance to construct a facility, or part of
a facility, the Assurance will extend to the entire facility and facilities operated in connection
therewith_
6. That where the Servicing Agency receives Federal financial assistance in the form, or for the acquisition
of real property or an interest in real property, the Assurance will extend to rights to space on, over,
or under such property.
7. That the Servicing Agency will include the clauses set forth in Appendix C and Appendix D of this
Assurance, as a covenant running with the land, in any future deeds, leases, licenses, permits, or similar
instruments entered into by the Servicing Agency with other parties:
a. for the subsequent transfer of real property acquired or improved under the applicable
activity, project, or program; and
b. for the construction or use of, or access to, space on, over, or under real property acquired or
improved under the applicable activity, project, or program.
That this Assurance obligates the Servicing Agency or any transferee for the longer of the following
periods:
a. the period during which the property is used for a purpose for which the Federal funds
were extended, or for another purpose involving the provision of similar services or
benefits; or
b. the period during which the Servicing Agency retains ownership or possession of the
property.
The Servicing Agency will provide for such methods of administration for the program as are found by
the Secretary of Transportation or the official to whom he/she delegates specific authority to give
reasonable guarantee that it, other recipients, sub -recipients, grantees, contractors, subcontractors,
consultants, transferees, successors in interest, and other parties funded in whole or part from the
funds provided under this Agreement will comply with all requirements imposed or pursuant to the
Acts, the Regulations, and this Assurance.
10. The Servicing Agency agrees that the United States has a right to seek judicial enforcement with
regard to any matter arising under the Acts, the Regulations, and this Assurance_
By signing the Agreement, the Servicing Agency also agrees to comply (and require any sub- recipients,
contractors, successors, transferees, and/or assignees to comply) with all applicable provisions governing the
FHWA's access to records, accounts, documents, information, facilities, and staff. The Servicing Agency also
recognizes that it must comply with any program or compliance reviews, and/or complaint investigations
conducted by the FHWA. The Servicing Agency must keep records, reports, and submit the material for review
upon request to FHWA, or its designee in a timely, complete, and accurate way.
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Additionally, the Servicing Agency must comply with all other reporting, data collection, and evaluation
requirements, as prescribed by law or detailed in program guidance.
The Servicing Agency gives this ASSURANCE in consideration of and for obtaining any Federal funds, and/or
discounts, or other Federal -aid and Federal financial assistance extended after the date hereof to the recipients
by the U.S. Department of Transportation.
This ASSURANCE is binding on the Servicing Agency, contractors, subcontractors and their subcontractors',
transferees, successors in interest, and any other participants in the funds provided under this Agreement.
APPENDIX A
During the performance of this contract, the contractor, for itself, its assignees, and successors in interest
(hereinafter referred to as the "contractor") agrees as follows:
1. Compliance with Regulations: The contractor (hereinafter includes consultants) will comply with
the Acts and the Regulations relative to Non-discrimination in Federally -funded programs of the
U.5. Department of Transportation, Federal Highway Administration (FHWA), as they may be
amended from time to time, which are herein incorporated by reference and made a part of this
contract.
2. Non-discrimination: The contractor, with regard to the work performed by it during the contract,
will not discriminate on the grounds of race, color, or national origin in the selection and retention
of subcontractors, including procurements of materials and leases of equipment. The contractor will
not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations,
including employment practices when the contract covers any activity, project, or program set forth
in Appendix B of 49 CFR Part 21.
3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all
solicitations, either by competitive bidding, or negotiation made by the contractor for work to be
performed under a subcontract, including procurements of materials, or leases of equipment, each
potential subcontractor or supplier will be notified by the contractor of the contractor's obligations
under this contract and the Acts and the Regulations relative to Non-discrimination on the grounds
of race, color, or national origin.
4. Information and Reports: The contractor will provide all information and reports required by the
Acts, the Regulations, and directives issued pursuant thereto and will permit access to its books,
records, accounts, other sources of information, and its facilities as may be determined by the
Servicing Agency or the FHWA to be pertinent to ascertain compliance with such Acts, Regulations,
and instructions. Where any information required of a contractor is in the exclusive possession of
another who fails or refuses to furnish the information, the contractor will so certify to the Servicing
Agency or the FHWA, as appropriate, and will set forth what efforts it has made to obtain the
information.
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Sanctions for Noncompliance: In the event of a contractor's noncompliance with the Non-
discrimination provisions of this contract, the Servicing Agency will impose such contract
sanctions as it or the FHWA may determine to be appropriate, including, but not limited to:
a, withholding payments to the contractor under the contract until the contractor
complies; and/or
b. cancelling, terminating, or suspending a contract, in whole or in part.
6. Incorporation of Provisions: The contractor will include the provisions of paragraphs one through six
in every subcontract, including procurements of materials and leases of equipment, unless exempt by
the Acts, the Regulations and directives issued pursuant thereto. The contractor will take action with
respect to any subcontract or procurement as the Servicing Agency or the FHWA may direct as a
means of enforcing such provisions including sanctions for noncompliance. Provided, that if the
contractor becomes involved in, or is threatened with litigation by a subcontractor, or supplier
because of such direction, the contractor may request the Servicing Agency to enter into any litigation
to protect the interests of the Servicing Agency. In addition, the contractor may request the United
States to enter into the litigation to protect the interests of the United States.
APPENDIX B
CLAUSES FOR TRANSFER OF REAL PROPERTY ACQUIRED OR IMPROVED UNDER THE ACTIVITY, FACILITY, OR
PROGRAM
The following clauses will be included in deeds, licenses, leases, permits, or similar instruments entered into
by the Servicing Agency under the terms of the Agreement:
1. The (grantee, lessee, permittee, etc. as appropriate) for himself/herself, his/her heirs, personal
representatives, successors in interest, and assigns, as a part of the consideration hereof, does hereby
covenant and agree (in the case of deeds and leases add "as a covenant running with the land"] that:
In the event facilities are constructed, maintained, or otherwise operated on the property
described in this (deed, license, lease, permit, etc.) for a purpose for which a U.S. Department
of Transportation activity, facility, or program is extended or for another purpose involving
the provision of similar services or benefits, the (grantee, licensee, lessee, permittee, etc.)
will maintain and operate such facilities and services in compliance with all requirements
imposed by the Acts and Regulations (as may be amended) such that no person on the
grounds of race, color, or national origin, will be excluded from participation in, denied the
benefits of, or be otherwise subjected to discrimination in the use of said facilities.
2. With respect to licenses, leases, permits, etc., in the event of breach of any of the above Non-
discrimination covenants, the Servicing Agency will have the right to terminate the (lease, license,
permit, etc.) and to enter, re-enter, and repossess said lands and facilities thereon, and hold the same
as if the (lease, license, permit, etc.) had never been made or issued.*
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3. With respect to a deed, in the event of breach of any of the above Non-discrimination
covenants, the Servicing Agency will have the right to enter or re-enter the lands and facilities
thereon, and the above described lands and facilities will there upon revert to and vest in and
become the absolute property of the Servicing Agency and its assigns.*
(*Reverter clause and related language to be used only when it is determined that such a clause is
necessary to make clear the purpose of Title VI.)
APPENDIX C
CLAUSES FOR CONSTRUCTION/USE/ACCESS TO REAL PROPERTY ACQUIRED UNDER THE ACTIVITY,
FACILITY OR PROGRAM
The following clauses will be included in deeds, licenses, permits, or similar instruments/agreements
entered into by Servicing Agency pursuant to the provisions of this Agreement:
1. The (grantee, licensee, permittee, etc., as appropriate) for himself/herself, his/her heirs, personal
representatives, successors in interest, and assigns, as a part of the consideration hereof, does
hereby covenant and agree (in the case of deeds and leases add, "as a covenant running with the
land") that (1) no person on the ground of race, color, or national origin, will be excluded from
participation in, denied the benefits of, or be otherwise subjected to discrimination in the use of
said facilities, (2) that in the construction of any improvements on, over, or under such land, and
the furnishing of services thereon, no person on the ground of race, color, or national origin, will
be excluded from participation in, denied the benefits of, or otherwise be subjected to
discrimination, (3) that the (grantee, licensee, lessee, permittee, etc.) will use the premises in
compliance with all other requirements imposed by or pursuant to the Acts and Regulations, as
amended, set forth in this Assurance.
2. With respect to (licenses, leases, permits, etc.), in the event of breach of any of the above Non-
discrimination covenants, the Servicing Agency will have the right to terminate the (license,
permit, etc., as appropriate) and to enter or re-enter and repossess said land and the facilities
thereon, and hold the same as if said (license, permit, etc., as appropriate) had never been made
or issued.*
3. With respect to deeds, in the event of breach of any of the above Non-discrimination
covenants, the Servicing Agency will there upon revert to and vest in and become the absolute
property of the Servicing Agency and its assigns.*
(*Reverter clause and related language to be used only when it is determined that such a clause is
necessary to make clear the purpose of Title VI.)
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APPENDIX D
During the performance of this contract, the contractor, for itself, its assignees, and successors in interest
(hereinafter referred to as the "contractor") agrees to comply with the following non-discrimination statutes
and authorities; including but not limited to:
Pertinent Non -Discrimination Authorities:
+ Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits
discrimination on the basis of race, color, national origin); and 49 CFR Part 21.
• The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C.
§ 4601), (prohibits unfair treatment of persons displaced or whose property has been acquired
because of Federal or Federal -aid programs and projects);
• Federal -Aid Highway Act of 1973, (23 U.S.C. § 324 etseq.), (prohibits discrimination on the basis
of sex);
■ Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits
discrimination on the basis of disability); and 49 CFR Part 27;
■ The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits
discrimination on the basis of age);
■ Airport and Airway Improvement Act of 1982, (49 USC § 471, Section 47123), as amended,
(prohibits discrimination based on race, creed, color, national origin, or sex);
• The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and
applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section
504 of the Rehabilitation Act of 1973, by expanding the definition of the terms "programs or
activities" to include all of the programs or activities of the Federal -aid recipients, sub -recipients
and contractors, whether such programs or activities are Federally funded or not);
• Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of
disability in the operation of public entities, public and private transportation systems, places of
public accommodation, and certain testing entities (42 U.S.C. §§ 12131 — 12189) as implemented by
Department of Transportation regulations at 49 CFR parts 37 and 38;
• The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. § 47123) (prohibits
discrimination on the basis of race, color, national origin, and sex);
■ Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations
and Low -Income Populations, which ensures discrimination against minority populations by
discouraging programs, policies, and activities with disproportionately high and adverse human
health or environmental effects on minority and low-income populations;
Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and
resulting agency guidance, national origin discrimination includes discrimination because of limited
English proficiency (LEP). To ensure compliance with Title VI, you must take reasonable steps to
ensure that LEP persons have meaningful access to your programs (70 Fed. Reg. at 74087 to 74100);
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Title IX of the Education Amendments of 1972, as amended, which prohibits you from
discriminating because of sex in education programs or activities (20 U.S.C. 1681 et seq).
A. ASSURANCE OF DISCLOSURE OF LOBBYING ACTIVITIES
Certification for Contracts, Grants, Loans, and Agreements
The person signing this Agreement for the Servicing Agency certifies, to the best of his or her knowledge and
belief, that:
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 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
grant agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or grant agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence a n officer or employee of any 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
grant agreement, the undersigned shall complete and submit Standard Form-LLL (Rev. 7-97), "Disclosure of
Lobbying Activities," in accordance with its instructions.
The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts and contracts under grants, loans and grant agreements) and
that all subcontractors 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 is a prerequisite for making or entering into this
transaction imposed by 31 U.S.C. § 1352, title. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS
The Servicing Agency certifies that it will, or will continue, to provide a drug -free workplace by:
1. Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the Servicing Agency's
workplace, and specifying the actions that will be taken against employees for violation of such
prohibition.
2. Establishing an ongoing drug -free awareness program to inform employees about:
a. The dangers of drug abuse in the workplace;
b. The Servicing Agency's policy of maintaining a drug -free workplace;
PROJECT NUMBER/NAME Page 24 of 37 July 23, 2020
c. Any available drug counseling, rehabilitation, and employee assistance programs;
and,
d. The penalties that may be imposed upon employees for drug abuse violations occurring in
the workplace;
3. Making it a requirement that each employee to be engaged in the performance of work supported
by the Agreement be given a copy of the statement required by paragraph 1.
4. Notifying the employee in the statement required by paragraph 1 that, as a condition of
employment supported by the Agreement, the employee will:
a. Abide by the terms of the statement; and
b. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute
occurring in the workplace no later than five calendar days after such conviction.
5. Notifying the agency in writing, within ten calendar days after receiving notice under paragraph
4.b. from an employee or otherwise receiving actual notice of conviction. Employers of convicted
employees must provide notice, including position title, to FHWA. Notice shall include the order
number of the Agreement.
6. Taking one of the following actions, within 30 days of receiving notice under paragraph 4(b), with
respect to any employee who is so convicted:
a. Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended, or
b. Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State or local health, law
enforcement, or other appropriate agency.
7. Making a good faith effort to continue to maintain a drug -free workplace through implementation
of paragraphs 1, 2, 3, 4, 5, and 6.
8. The Servicing Agency may, but is not required to, provide the site for the performance of work
done in connection with the Agreement. For the provision of services pursuant to the Agreement,
workplaces include outstations, maintenance sites, headquarters office locations, training sites and
any other worksites where work is performed that is supported by the Agreement. If the Servicing
Agency does so, the Servicing Agency shall identify the Places of Performance by listing the street
address, city, county, state, zip code. Also identify if there are workplaces on file that are not identified
in this section of the Agreement.
C. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS --
PRIMARY COVERED TRANSACTIONS
2 CFR Parts 180, 1200, 48 CFR Part 9, and 49 CFR Part 32
These assurances and certifications are applicable to all construction contracts, design -build contracts,
subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other
Upper Hoh River Road Phase 2,
WAJEFF 91420(1) Page 25 of 33 July 23, 2020
covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more — as defined in
2 CFR Parts 180 and 1200, and 48 CFR Part. 9.
By entering into this Agreement the Servicing Agency is providing the assurances and certifications for
First Tier Participants and Lower Tier Participants as set out below.
1. Instructions for Certification — First Tier Participants:
a. The prospective first tier participant is providing the certification set out below.
b. The inability of a person to provide the certification set out below will not necessarily result in
denial of participation in this covered transaction. The prospective first tier participant shall submit
an explanation of why it cannot provide the certification set out below. The certification or
explanation will be considered in connection with the department or agency's determination
whether to enter into this transaction. However, failure of the prospective first tier participant to
furnish a certification or an explanation shall disqualify such a person from participation in this
transaction.
c. The certification in this clause is a material representation of fact upon which reliance was
placed when the contracting agency determined to enter into this transaction. If it is later
determined that the prospective participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal Government, the contracting agency may
terminate this transaction for cause of default.
d. The prospective first tier participant shall provide immediate written notice to the contracting
agency to whom this proposal is submitted if any time the prospective first tier participant learns
that its certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
e. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant,"
"person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 C.F.R.
Parts 180 and 1200, "First Tier Covered Transactions" refers to any covered transaction between
a recipient or subrecipient of Federal funds and a participant (such as the prime or general
contractor). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier
Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who
has entered into a covered transaction with a recipient or subrecipient of Federal funds (such as
the prime or general contractor). "Lower Tier Participant" refers to any participant who has
entered into a covered transaction with a First Tier Participant or other Lower Tier Participants
(such as subcontractors and suppliers).
f. The prospective first tier participant agrees by submitting this proposal that, should the
proposed covered transaction be entered into, it shall not knowingly enter into any lower tier
covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily
excluded from participation in this covered transaction, unless authorized by the department or
agency entering into this transaction.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 26 of 33 July 23, 2020
g. The prospective first tier participant further agrees by submitting this proposal that it will
include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting
agency, entering into this covered transaction, without modification, in all lower tier covered
transactions and in all solicitations for lower tier covered transactions exceeding the $25,000
threshold.
h. A participant in a covered transaction may rely upon a certification of a prospective participant
in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily
excluded from the covered transaction, unless it knows that the certification is erroneous. A
participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise
ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as
the eligibility of any lower tier prospective participants, each participant may, but is not required
to, check the Excluded Parties List System website (htt s: www.e Is. ov ), which is compiled by
the General Services Administration.
i. Nothing contained in the foregoing shall be construed to require the establishment of a system
of records in order to render in good faith the certification required by this clause. The knowledge
and information of the prospective participant is not required
to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
j. Except for transactions authorized under paragraph (f) of these instructions, if a participant in
a covered transaction knowingly enters into a lower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in
addition to other remedies available to the Federal Government, the department or agency may
terminate this transaction for cause or default.
2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First
Tier Participants:
a. The prospective first tier participant certifies to the best of its knowledge and belief,
that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from participating in covered transactions by any Federal
department or agency;
2. Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State or
local) transaction or contract under a public transaction; violation of Federal or State antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property;
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 27 of 33 July 23, 2020
3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal, State or local) with commission of any of the offenses enumerated in
paragraph a.2, of this certification; and
4. Have not within a three-year period preceding this application/proposal had one or more
public transactions (Federal, State or local) terminated for cause
or default.
b. Where the prospective participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.
3. Instructions for Certification - Lower Tier Participants:
(Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA
approval or estimated to cost $2S,000 or more - 2 C.F.R. Parts 180 and 1200)
a. The prospective lower tier participant is providing the certification set out below.
b. The certification in this clause is a material representation of fact upon which reliance was
placed when this transaction was entered into. If it is later determined that the prospective lower
tier participant knowingly rendered an erroneous certification, in addition to other remedies
available to the Federal Government, the department, or agency with which this transaction
originated may pursue available remedies, including suspension and/or debarment.
c. The prospective lower tier participant shall provide immediate written notice to the person to
which this proposal is submitted if at any time the prospective lower tier participant learns that its
certification was erroneous by reason of changed circumstances.
d. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant,"
"person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts
180 and 1200. You may contact the person to which this proposal is submitted for assistance in
obtaining a copy of those regulations. "First Tier Covered Transactions" refers to any covered
transaction between a recipient and subrecipient of Federal funds and a participant (such as the
prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction
under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the
participant who has entered into a covered transaction with a recipient or subrecipient of Federal
funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant
who has entered into a covered transaction with a First Tier Participant or other Lower Tier
Participants (such as subcontractors and suppliers).
e. The prospective lower tier participant agrees by submitting this proposal that, should the
proposed covered transaction be entered into, it shall not knowingly enter into any lower tier
covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily
excluded from participation in this covered transaction, unless authorized by the department or
agency with which this transaction originated.
f. The prospective lower tier participant further agrees by submitting this proposal that it will
include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and
Upper Hoh River Road Phase 2,
WA JEFF 31420(1) Page 28 of 33 July 23, 2020
Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier
covered transactions and in all solicitations for lower tier covered transactions exceeding the
$25,000 threshold.
g. A participant in a covered transaction may rely upon a certification of a prospective participant
in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily
excluded from the covered transaction, unless it knows that the certification is erroneous. A
participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise
ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as
the eligibility of any lower tier prospective participants, each participant may, but is not required
to, check the Excluded Parties List System website (httjRs:llwww.epls.0 ), which is compiled by
the General Services Administration.
h. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
and information of participant is not required to exceed that which is normally possessed by a
prudent person in the ordinary course of business dealings.
i. Except for transactions authorized under paragraph a of these instructions, if a participant in
a covered transaction knowingly enters into a lower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in
addition to other remedies available to the Federal Government, the department or agency with
which this transaction originated may pursue available remedies, including suspension and/or
debarment.
4. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier
Participants:
a. The prospective lower tier participant certifies, by submission of this proposal, that neither it
nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from participating in covered transactions by any Federal department or
agency.
b. Where the prospective lower tier participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to
this proposal.
D. ASSURANCE OF ADEQUATE FINANCIAL SYSTEMS AND CONTROL OF PROJECT COSTS
1, The Servicing Agency will be reimbursed in accordance with the terms of this
Agreement.
2. The Servicing Agency shall have entered into obligations for services and goods associated
with the Project prior to seeking reimbursement from the Government. Reimbursement will
only be made for expenses incurred after execution of a project agreement.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 29 of 33 July 23, 2020
3. The Servicing Agency shall ensure that the funds provided by the Government are not
misappropriated or misdirected to any other account, need, project, line -item, or unrelated
activity.
4. Any Federal funds not expended in conjunction with the Project will remain the property
of the Government.
5. Financial Management System: By signing this Agreement, the Servicing Agency verifies
that it has, or will implement, a financial management system adequate for monitoring the
accumulation of costs and that it complies with the financial management system
requirements of 2CFR Part 200.302. The Servicing Agency's failure to comply with these
requirements may result in Agreement termination.
6. Allowable Costs: Determination of allowable costs will be made in accordance with the
applicable Federal cost principles, e.g., 2 CFR Part 200. Disallowed costs are those charges
determined to not be allowed in accordance with the applicable Federal cost principles or
other conditions contained in this Agreement.
E. TRANSPARENCY ACT REQUIREMENTS
Pursuant to the Federal Funding Transparency and Accountability Act of 2006, as amended (Pub. L. 109-282,
as amended by section 6202 of Public Law 110-252, hereafter referred to as "the Transparency Act" or "the
Act") and the OMB Interim Final Rule (75 FR 55663 (September 14, 2010) (available at
htt www. o. ov fds s k FR-2010-09-14 df 2010-22705. df) (codified at 2 CFR Part 170), the
Servicing Agency is required to report as required under the Act: The Servicing Agency shall also report
information for its prime contractor,
1. Reporting Obligations
a. Applicability. Unless the Servicing Agency (hereinafter in this section referred to as "you") are
exempt as provided in paragraph 4. of this section, you must report each action that obligates
$25,000 or more in Federal funds for a prime contract to an entity (see definitions in subsection 5.
of this section).
b. Where and when to report.
1. You must report each obligating action described in subsection 1.a. of this section to
http://www,fs rs.gov.
2. For contractor information, report no later than the end of the month following the month
in which the contract was executed. (For example, if the obligation was made on November 7,
2010, the obligation must be reported by no later than December 31,
2010.)
c. What to report. You must report the information about each obligating action that the
submission instructions posted at http://www.fsrs.gov specify.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 30 of 33 July 23, 2020
2. Reporting Total Compensation of Executives.
a. Applicability and what to report. You must report total compensation for each of your five
most highly compensated executives for the preceding completed fiscal year, if-
1. the total Federal funding authorized to date under this award is $25,000 or more;
2. in the preceding fiscal year, you received—
i. 80 percent or more of your annual gross revenues from Federal procurement contracts
(and subcontracts) and Federal financial assistance subject to the Transparency Act, as
defined at 2 CFR 170,320 (and subawards); and
ii. $25,000,000 or more in annual gross revenues from Federal procurement contracts
(and subcontracts) and Federal financial assistance subject to the Transparency Act, as
defined at 2 CFR 170.320 (and subawards); and
i6. The public does not have access to information about the compensation of the
executives through periodic reports filed under section 13(a) or 15(d) of the Securities
Exchange Act of 1934 (15 U.S.C. 4 78m(a), 78o(d)) or section 6104 of the Internal
Revenue Code of 1986. (To determine if the public has access to the compensation
information, see the U.S. Security and Exchange Commission total compensation filings
at http://www.sec.gov/answers/execomp.htm.)
b. Where and when to report. You must report executive total compensation described in
subsection 2.a.. of this section:
1. As part of your registration profile at httos://www.sam.gov
2. By the end of the month following the month in which this award is made, and annually
thereafter.
3. Reporting of Total Compensation of Prime Contractor's Executives.
a. Applicability and what to report. Unless you are exempt as provided in subsection 4. of this
section, for each prime contractor receiving funds for which reimbursement will be sought, you
shall report the names and total compensation of each of the prime contractor's five most highly
compensated executives for the prime contractor's preceding completed fiscal year, if-
1. in the prime contractor's preceding fiscal year, the contractor received—
i 80 percent or more of its annual gross revenues from Federal procurement contracts
(and subcontracts) and Federal financial assistance subject to the Transparency Act,
as defined at 2 CFR 170.320 (and subawards); and
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 31 of 33 July 23, 2020
ii. $25,000,000 or more in annual gross revenues from Federal procurement contracts
(and subcontracts), and Federal financial assistance subject to the Transparency Act
(and subawards); and
2. The public does not have access to information about the compensation of the executives
through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of
1934 (15 U.S,C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. (To
determine if the public has access to the compensation information, see the U.S. Security and
Exchange Commission total compensation filings at
http://www.sec.gov/answers/execomp.htm.)
b. Where and when to report. You must report the prime contractor's executive total
compensation described in subsection 3.a. of this section:
1. To http./Iwww.fsrs.gov.
2. By the end of the month following the month during which you executed the prime
contract. For example, if a prime contract is executed on any date during the month of
October of a given year (i.e., between October 1 and 31), you must report any required
compensation information of the prime contractor by November 30 of that year.
4. Exemptions.
If, in the previous tax year, you or the prime contractor had gross income, from all sources, under $300,000,
you are exempt from the requirements to report prime contracts and the total compensation of the five most
highly compensated executives of any prime contractor.
S. Definitions. For purposes of this section:
a. Entity means all of the following, as defined in 2 CFR Part 25:
1. A Governmental organization, which is a State, local government, or Indian tribe;
2. A foreign public entity;
3. A domestic or foreign nonprofit organization;
4. A domestic or foreign for -profit organization;
5. A Federal agency, but only as a contractor or subcontractor to a non -Federal entity.
b. Executive means officers, managing partners, or any other employees in management
positions.
c. Total compensation means the cash and noncash dollar value earned by the executive during
the Servicing Agency's or prime contractor's preceding fiscal year and includes the following (for
more information see 17 CFR 229.402(c)(2)):
Upper Huh River Road Phase 2,
WA 1EFF 91420(1) Page 32 of 33 July 23, 2020
1. Salary and bonus.
2. Awards of stock, stock options, and stock appreciation rights. Use the dollar amount
recognized for financial statement reporting purposes with respect to the fiscal year in
accordance with the Statement of Financial Accounting Standards No. 123 (Revised 2004)
(FAS 123R), Shared Based Payments.
3. Earnings for services under non -equity incentive plans. This does not include group life,
health, hospitalization or medical reimbursement plans that do not discriminate in favor of
executives, and are available generally to all salaried employees.
4. Change in pension value. This is the change in present value of defined benefit
and actuarial pension plans.
5_ Above -market earnings on deferred compensation which is not tax -qualified
6. Other compensation, if the aggregate value of all such other compensation (e.g.
severance, termination payments, value of life insurance paid on behalf of the employee,
perquisites or property) for the executive exceeds $10,000.
E. SINGLE AUDIT INFORMATION FOR SERVICING AGENCIES
To maximize the transparency and accountability of funds authorized under the Act as required by Congress
and in accordance with 2 CFR 200 "Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards", the Servicing Agency agrees to maintain records that identify adequately
the source and application of FHWA funds.
Upper Hoh River Road Phase 2,
WA JEFF 91420(1) Page 33 of 33 July 23, 2020
View Burden Statement
OMB Number: 4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
" 1. Type of Submission:
O Preapplication
Q Application
O Changed/Corrected Application
' 2. Type of Application: * If Revision, select appropriate letter(s):
(�) New
O Continuation " Other (specify):
O Revision
* 3 Date Received: 4. Applicant Identifier:
N/A
5a. Federal Entity Identifier:
5b Federal Award Identifier:
State Use Only:
6. Date Received by State: j
7. State Application Identifier: _
8. APPLICANT INFORMATION:
*a. Legal Name: [Jefferson County, Washington
-
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. Organizational DUNS:
1792781970000
916001322
d. Address;
* Streetl: 623 Sheridan Street
Street2:
* City: Port Townsend
County/Parish:
* State: WA: Washington
Province:
*Country: USA: UNITED STATES
" Zip / Postal Code: 983 68-2 9 3 9
I
j
e. Organizational Unit:
Department Name:
Division Name:
Public Works
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: C j ' First Name:
Middle Name: E
* Last Name: Thurston
Suffix: j
_Mark
Title: 'Project Manager
Organizational Affiliation:
* Telephone Number: 360.385. 9210
Fax Number: 360. 385. 9234
*Email: mthurston@co.je€fersan.wa.us
j
Application for Federal Assistance SF424
* 9. Type of Applicant 1: Select Applicant Type:
B: County Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
1 Highway Administration
11. Catalog of Federal Domestic Assistance Number:
20.224
CFDA Title:
* 12. Funding Opportunity Number:
* Title:
V/A
13. Competition Identification Number:
N/A
Title:
NIA
14. Areas Affected by Project (Cities, Counties, States, etc.):
Add Attachment
Delete Attachment View Attachment
* 15. Descriptive Title of Applicant's Project:
WA JEFF 91420(1); Upper Hoh River Road Phase 2
Attach supporting documents as specified in agency instructions.
View Attachments
Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant 6th * b. Program/Project 6th
Attach an additional list of Program/Project Congressional Districts if needed
f
Add Attachment Delete Attachment View Attachment
17. Proposed Project:
*a Start Date: 08/29/2022 *b.End Date: 12/31/2023
18. Estimated Funding ($):
`a. Federal 25, 000.00
*b Applicant 0.001
* c. State 0 . 0 0
* d. Local 0.00
* e. Other 0. 00
* f. Program Income 0 . 00
*g.TOTAL 25,000.00
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
O a. This application was made available to the State under the Executive Order 12372 Process for review on -
O b. Program is subject to E.O.12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)
O Yes 0 No
If "Yes", provide explanation and attach
Add Attachrnent I Delete Attachment I View Attachment
21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
** I AGREE
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix: * First Name: Heidi 1
Middle Name:
* Last Name: Eisenhour
Suffix:
' Title Jefferson Co. Board of County Comrni:ssi<iners
*Telephone Number: (360) 385-9100 Fax Number: C
*Email:Ijeffbocc@co.jefferson.wa.us
* Signature of Authorized Representative:
* Date Signed:
View Burden Statement
ASSURANCES - NON -CONSTRUCTION PROGRAMS
OMB Number: 4040-0007
Expiration Date: 02/28/2022
i
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
SEND
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
l Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2• Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.§§1681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. §§6101-6107), which prohibits discrimination on
the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, Q) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally -assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole
or in part with Federal funds.
Previous Edition Usable Standard Form 424B (Rev.
Authorized for Local Reproduction 7-97)Prescribed by OMB Circular
A-102
9. Will comply, as applicable, with the provisions of the Davis- 13
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract _
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333), regarding labor standards for federally -assisted
construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205 ).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
14.
Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO
11593(identification and protection of historic
properties), and the Archaeological and Historic
Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead -based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
F I
APPLICANT ORGANIZATION
TITLE
DATE SUBMITTED
Standard Form 424B (Rev. 7-97) Back
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 OMB Number: 4040-0013
Expiration Date: 02/28/2022
Review Public Burden Disclosure Statement
1. * Type of Federal Action:
2. * Status of Federal Action:
3. * Report Type:
Q a, contract
Oa. bidloffer/application
O a. initial fling
eb. grant
O b, initial award
O b. material change
Oc, cooperative agreement
O c. post -award
Od, loan
Oe, loan guarantee
Of loan insurance
4. Name and Address of Reporting Entity:
OPrime O SubAwardee
'Name Jefferson county
"Street 1 623 Sheridan street Street 2
'City port Townsend State WA: Washington Zip 9u
Congressional District, if known:
5. If Deporting Entity in No.4 is Suhawardee, Enter Name and Address of Prime*
6. * Federal Department/Agency:
7. * Federal Program Name/Description:
Federal Highway Administration
IV/A
CFDA Number, ifapplicable: J
8. Federal Action Number, if known:
9. Award Amount, if known:$
25,000.00
r/A
10. a. Name and Address of Lobbying Registrant:
Prefix First Name IN/A Middle Name
'Last Name iv/A Suffix
' Street 1 Street 2
' City Stale Zip
b. Individual Performing Services (including address if different from No. 10a)
Prefix ' First Name Ivi A Middle Name
'Last Name N/A suffix
' Street 1 Street 2
' City Stale Zip r�
11, Information requested through this form is authorized by title 31 U.S,C, section 1352. This disclosure of lobbying activities is a material representation affect upon which
reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C- 135Z This information will be reported to
the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
" Signature:
;Name: Prefix +First Name 4 t i d I Middle Name
'Last Name riseE— Suffix I�
Title: my commissioners Telephone No. (360) 395-9100 Date:
Fedora! Use Only:: Authorized for Local Reproduction
Standard Form-LLL(Rev. 7-97)
Additional Required Statements and Assurances for Grant Awards
from Federal Highway Administration - Western Federal Lands
Date: 06/27/2022
Agency Name: Jefferson County, Washington
WA JEFF 91420(1); Upper Hoh River Road Phase 2
Project Number and Name:
1.)
The Applicant must provide a statement to indicate whether your organization has previously
completed an A-133 Single Audit and, if so, the date that the last A-133 Single Audit was
completed.
Has your organization had a Single Audit
compeleted? Yes
If Yes, to Question Number 1, please provide
the date the last Single Audit was completed. 03/31/2022
2.)
The Applicant must provide a statement regarding Conflicts of Interest. The Applicant must
disclose in writing any actual or potential personal or organizational conflict of interest in its
application that describes in a concise manner all past, present or planned organizational,
contractual or other interest(s), which may affect the Applicants' ability to perform the proposed
contract in an impartial and objective manner. Actual or potential conflicts of interest may include
but are not limited to any past, present or planned contractual, financial, or other relationships,
obligations, commitments or responsibilities, which may bias the Applicant or affect the
Applicant's ability to perform the agreement in an impartial and objective manner. The AO will
review the statement(s) and may require additional relevant information from the Applicant. All
such information, and any other relevant information known to DOT, will be used to determine
whether an award to the Applicant may create an actual or potential conflict of interest. If any such
conflict of interest is found to exist, the AO may (a) disqualify the Applicant, or (b) determine that
it is otherwise in the best interest of the United States to contract with the Applicant and include
appropriate provisions to mitigate or avoid such conflict in the agreement pursuant to 2 CFR
200.112.
Are there any actual or potential personal or organizational
conflict of interest as delineated in the Question Number 2 No
above?
Page 1 of 4
If Yes, to Question Number 2, please provide the
circumstances involving the actual or potential conflict of
interest.
3.)
The Applicant must provide a statement regarding indicating whether a Federal or State
organization has audited or reviewed the Applicant's accounting system, purchasing system, and/or
property control system. If such systems have been reviewed, provide summary information of the
audit/review results to include as applicable summary letter or agreement, date of audit/review,
Federal or State point of contact for such review.
Has a Federal or State organization audited or reviewed
the Applicant's accounting system, purchasing system,
and/or property control system? Yes
If Yes, to Question Number 3, please provide the
following:
Date of Audit/Review: 03/31/2022
Federal/State Point of Contact Information:
Name: Washington State Auditor 6
Phone Numbed 564-999-0950
Page 2 of 4
Summary information of the audit/review results:
Accountability Audit for period January 1, 2020 through December 31, 2020
"County operations complied, in all material respects, with applicable state laws, regulations, and
its own policies, and provided adequate controls over the safeguarding of public resources."
Areas examined:
Cost Allocation Plans
Payroll
Public Works Department - Cash receipting, accounts receivable and disbursements
Use of Restricted Funds
Procurement - Public works and architectural and engineering services
Compliance with Public Works Projects - Prevailing wages and change orders
Open Public Meetings
Financial Condition
4.)
The Applicant must provide a statement regarding Terminated Contracts - List any
contract/agreement that was terminated for convenience within the past 3 years, and any
contract/agreement that was terminated for default within the past 5 years.
Has the Applicant had any contract(s)/agreement(s)
terminated for convenience in the last 3 years, or default in No
the past 5 years?
If Yes, to Question Number 4, please briefly explain the
circumstances in each instance below
Page 3 of 4
5.)
The Applicant must provide a statement disclosing any violations of Federal criminal law involving
fraud, bribery, or gratuity violations. Failure to make required disclosures can result in any of the
remedies described in 2 CFR 200.338 entitled Remedies for Noncompliance, including suspension
or debarment. (See also 2 CFR Part 180 and 31 U.S.C. 3321).
Has the Applicant had any violations of Federal criminal
law involving fraud, bribery, or gratuity violations.? No
If Yes, to Question Number 5, please briefly explain the
circumstances in each instance below:
Heidi Eisenhour, County Commissioner
Name and Title of Signature Authority
Page 4 of 4