HomeMy WebLinkAboutCAG2020-413 - Original - Washington State Dept. of Transportation - Federal Aid Project Prospectus S 212th St Preservation - 12/16/2020ApprovalOriginator:Department:
Date Sent:Date Required:
Authorized to Sign:
o Director or Designee o Mayor
Date of Council Approval:
Budget Account Number:
Budget? o Yes o No
Grant? o Yes o No
Type:Review/Signatures/RoutingDate Received by City Attorney:Comments:
Date Routed to the Mayor’s Office:
Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
Project Details:
Agreement Amount:
Start Date:
Basis for Selection of Contractor:
Termination Date:
Local Business? o Yes o No*
*If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
o Yes o No
Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)
Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20
December 18, 2020
Preflx Route ()
FederalAid
Proiect Number
Local Agency
Project Number 19-3003
^-.W H$lli,lBlì 3ï"å?n"oorrar¡ on Local Agency Federal A¡d
Pro ect Prospectus
WSDOT
)
Description of Proposed Work
Description of Proposed Work (Attach additional sheet(s) if necessary)
The2l,2thPreservation project includes grinding, replacement of failing pavement and a full-width asphalt
concrete pavement overlay of the roadway from East Valley Highway to 72nd Ave. S. Curb ramps and
driveway upgrades as needed to meet ADA standards.
Local Agency Contact Person
Drew Holcomb
Title
Project Engineer
Phone
253-856-5561
Mailing Address
400 V/ Gowe
City
Kent
State
WA
Zip Code
98032
Project Prospectus
By (fu ßo-*
Approving Authority
Title f,Jo.;^ P,,lnl,. ln[*nìr. f)inr"-lrt oate Ìi)lt6laru,
Use Only
Date
DUNS Number 020253613
Federal Employer
Tax lD Number 916001254
CAAgency
Ev"r ü r,lo 20.205 n otner
Federal Program TitleAgency
City of Kent
Start Longitude W -122.228276
End Lonoitude W -122.243239
Start Latitude N 47 .412052
End Latitude ¡,147.4121L8
Project Title
S 212th St. Preservation
Nearest City Name
Kent
Project Zip Code (++¡
98032-232t
Project Termini From-To
72nd Ave. S 84th Ave. S. (EVH)
Length of Project
0.76 miles ! locat! tocat rorces ! shte ! Railroad
Award TypeBegin Mile Post End Mile Post
End Mile PointBegin Mile Point City Number County Number County Name
l70615 King
Urban Area Number
80389'
Legislative District(s)
33rd
Congressional District(s)
9rh
Route lD
1250
WSDOT Region
Northwest Region
Phase
Total
Estimated Gost
(Nearest Hundred Dollar)
Local Agency
Funding
lNearest Hundred Dollar)
Federal Funds
lNearest Hundred Dollarì
Phase Start
Date
Month Year
P.E.200,000 200,000 4 2019
RYW 0 0 2 2019
Const 3,046,050 1,646,050 1,400,000 1 2021
Total 3,246,050 1,846,050 1,400,000
Description of Existing Facility (Existing Design and Present Gondition)
Roadway Width
80 feet
Number of Lanes
7
Roadway has existing curb, gutter and sidewalk on both sides of the existing travel way.
Revised 0412015 Previous Editions 0bsolete
of Proposed Work
Roadway Width
80 feet
Number of Lanes
7
Agency
City of Kent
Project Title
S 2l2th St. Preservation
Date
Project Type (Check all thatApply)
E ruew Construction E Path / Trail n ¡-n
M Reconstruction ! eeOestrian / Facilities n z-n
I nailroad ! Parking n otrer
ë
Geometric Desi n Data
GrossroadThrough RouteDescription
Ø ur¡an
! Rurat
n runs
I erincipalArterial
Ø MinorRrterial
! collector
fltr,tajor Collector
! tvtinor Collector
f, tocal Access
Ø uroan
! nurat
E ruHs
Ø PrincipalArterial
I vinornrterial
! collector
! tr,ta¡or Collector
I tvtinor Collector
! tocal Access
Federal
Functional
Glassification
[7] rlat E nolt n MountainnFlatRollM
4040Posted Speed
Terrain
4040Design Speed
7,20027,000Existing ADT
Design YearADT
Design Year
Design Hourly Volume (DHV)
Performance of Work
Agency
100 yo
OthersPreliminary Engineering Will Be Performed By
City of Kent
Agency
o/oo/o
Contract
100
Construction Will Be Performed By
Contractor
Environmental Classification
! Class I - Environmental lmpact Statement (ElS)
E Project lnvolves NEPA/SEPA Section 404
lnteragency Agreement
n Class lll - EnvironmentalAssessment (EA)
n project lnvolves NEPA/SEPA Section 404
lnteragency Agreements
Ø Class ll - Categorically Excluded (CE)
fl ero¡ects Requiring Documentation
(Documented CE)
Environmental Considerations
There will be little to no environmental impacts created by this project as no major exposure of the ground to
the weather is planned. Erosion and sedimentation control measures will be taken during the construction
phase of the project.
Revised 0412015 Previous Editions Obsolete
Page2
Agency
City of Kent
Project Title
S 2l2th St. Preservation
Date
Right of Way
Ø no Right of Way Needed
* All construction required by the
contract can be accomplished
within the exiting right of way.
! nignt of Way Needed
n ruo Relocation n Relocation Required
Utilities Railroad
n ruo utility workrequired
nrul utility work will be completed prior to the start
of the construction contract
Ø rul utility work will be completed in coordination
with the construction contract
n ¡lo railroad work required ,'
nnll railroad work will be completed prior to the start of
the construction contract
M nll the railroad work will be completed in coordination
with the construction contract
Description of Utility Relocation orAdjustments and Existing Major Structures lnvolved in the Project
Sidewalk sections, curb ramps and pedestrian signals will be upgraded as required to meet ADA standards
FAA lnvolvement
ls a located within 3.2 kilometers (2 miles of the project?lves Øruo
Remarks
N/A
This project has been reviewed by the legislative body of the administration agency or agencies, or it's
designee, and is not inconsistent with the agency's comprehensive plan for community development.
Agency
Date Mayor/Chairperson
DOT Form 140-101
Revised 0412015
By
Previous Editions 0bsolete
Page 3
Address
4oo w Gowe St
Kent, WA 98032
Washington State
Department of lTansportation Local Agency Agreement
Agency f,i¡y of Kent CFDA No. 20.205
(Catalog or Federal Domestic Assistance)
Project No.
Agreement No.
For OSC WSDOT Use Only
The LocalAgency having complied, or hereby agreeing to comply, with the terms and conditions set forth in (1) Title 23, U.S. Code
Highways, (2) the regulations issued ptrrsuant thereto, (3) 2 CFR Part 200, (4) 2 CFR Part 180 - certifying that the local agency is not
excluded from receiving Federal funds by a Federal suspension or debarment, (5) the policies and procedures promulgated by the
Washington State Department of Transportation, and (6) the federal aid project agreement entered into between the State and Federal
Government, relative to the above project, the Washington State Department of Transportation will authorize the Local Agency to
proceed on the project by a separate notification. Federal funds which are to be obligated for the project may not exceed the amount
shown herein on line r, column 3, without written authority by the State, subject to the approval of the Federal Highway Administration.
All project costs not reimbursed by the Federal Govemment shall be the responsibility of the Local Agency.
Project Description
Name S zl2rhS;'. PreservationGrant Length 0.76miles
Termini 72nd Ave. S to 84th Ave. S. (East Valley Hwy)
Description of Work
Tlne 2l2th Preservation project includes grinding, replacement of failing pavement sections and a full-width asphalt concrete
pavement overlay of the entire roarlway from East Valley Highway to72nd Ave. S. Curb ramps and associated sidewalks and
driveways will be upgraded as required to meet ADA standards.
Project Agreement End Date December 31,2024 Claiming lndirect Cost Rate
!v"" y' ¡¡o
Proposed Advertisement Date January 19' 2021
0Yo
FederalAid
Participation
Ratio for RW
Agency OfficialBvfu&*
Titl" -{nl'*,,n ?ubl¡..' Vonl<s tire'':Iur
Wash i n gton State Department of Transportation
By
Director, Local Programs
Date Executed
DOT Form 140-039
Revised 0512020
Type of Work
E stimate of Fund nd
(1)
Estimated Total
Proiect Funds
(2)
Estimated Agency
Funds
(3)
Estimated Federal
Funds
PE a. Aoencv
0 Yo b. Other
FederalAid c other
Participation
Ratio for PE
d. State
e. Total PE Cost Estimate fa+b+c+dl
200,000.00 200,000.00
200,000.00 200.000.00 0.00
0.00
0.00 0.00 0.00
Construction i. Contract86.5 Yo I ôther Contract (non-participate)
m. Other Consultant (non-partic)
FederalAid
Participation
Ratio for CN
n. Other Agency (non-participate)
o Aoenev
o. State
o. Total CN Cost Estimate lk+t+m+n+o+ol
1,537,573.00 207,573.00 1.330.000.00
1,098,287.00 1,098,287.00
250,032.00 250,032.00
74,233.00 74,233.00
80.925.00 10,925.00 70,000.00
5,000.00 5,000.00
3,046,050.00 1,646,050.00 1,400,000.00
r. Total Proiect Cost Estimate re+¡+o)3,246,050.00 1,846,050.00 1.400.000.00
Page 1
Construction Method of Financing (Gheck Method Selected)
State Ad and Award
Method A - Advance Payment - Agency Share of total construction cost (based on contract award)
Method B - Withhold from gas tax the Agency's share of total construction coast (line 5, column 2) in the amount of
t at $ Per month for months'
Local Force or Local Ad and Award
/ Method C - Agency cost incurred with partial reimbursement
The LocalAgency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and
as a condition to payment of the federal funds obligated, it accepts and will comply with the applicable provisions
set forth below. Adopted by official action on
, , Resolution/Ordinance No.
Provisions
l. Scope of Work
The Agency shall provide all the work, labor, materials, and services necessary to perform the project which is described and set
forth in detail in the "Project Description" and "Type of Work'"
When the State acts for and on behalf of the Agency, the State shall be deemed an agent of the Agency and shall perform the
services described and indicated in "Type of WorK' on the face of this agreement, in accordance with plans and specifications as
proposed by the Agency and approved by the State and the Federal Highway Administration'
When the State acts for the Agency but is not subject to the right of control by the Agency, the State shall have the right to perform
the work subject to the ordinary procedures of the State and Federal Highway Administration.
ll. Delegation of Authou'lty
The State is willing to fulfill the responsibilities to the Federal Government by thê admlnlsträtlon of thls project. The Agency agrees
that the State shall have the full authority to carry out this administration. The State shall review, processr and approve documents
required for federal aid reimbursement in accordance with federal requirements. lf the State advertises and awards the contract, the
State will further act for the Agency in all matters concerning the project as requested by the Agency. lf the Local Agency advertises and
awards the project, the State shall review the work to ensure conformity with the approved plans and specifications.
lll. Project Administration
Certain types of work and services shall be provided by the State on this project as requested by the Agency and described in the
Type of Work above. ln addition, the State will furnish qualified personnel for the supervision and lnspectlon of the work in progress' On
Local Agency advertised and awarded projects, the supervision and inspection shall be limited to ensuring all work is in conformance
with approved plans, specifications, and federal aid requirements. The salary of such engineer or other supervisor and all other salaries
and costs incurred by State forces upon the project will be considered a cost thereof. All costs related to this project incurred by
employees of the State in the customary manner on highway payrolls and vouchers shall be charged as costs of the project.
lV. Availability of Records
All project records in support of all costs incurred and actual expenditures kept by the Agency are to be maintained in accordance
with local government accounting procedures prescribed by the Washington State Auditor's Office, the U.S. Department of
Transportation, and the Washington State Department of Transportation. The records shall be open to inspection by the State and
Federal Government at all reasonable times and shall be retained and made available for such inspection for a period of not less than
three years from the flnal payment of any federal aid funds to the Agency. Copies of said records shall be furnished to the State and/or
Federal Government upon request.
V. Compliance with Provisions
The Agency shall not incur any federal aid participation costs on any classification of work on this project until authorized in writing
by the State for each classification. The classifications of work for projects are:
1. Preliminary engineering.
2. Right of way acquisition.
3. Pro¡ect construction.
Once written authorization is given, the Agency agrees to show continuous progress through monthly billings. Failure to show
continuous progress may result the Agency's project becoming inactive, as described in 23 CFR 630, and subject to de-obligation of
federal aid funds and/or agreement closure.
lf right of way acquisition, or actual construction of the road for which preliminary engineering is undertaken is not started by the
close of the tenth fiscal year following the fiscal year in which preliminary engineering phase was authorized, the Agency will repay to
the State the sum or sums of federal funds paid to the Agency under the terms of this agreement (see Section lX)'
lf actual construction of the road for which right of way has been purchased is not started by the close of the tenth fiscal year
following the fiscal year in which the right of way phase was authorized, the Agency will repay to the State the sum or sums of federal
funds paid to the Agency under the terms of this agreement (see section lX).
DOT Form 140-039
Revised 0512020
Page 2
The Agency agrees that all stages of construction necessary to provide the initially planned complete facility within the limits of this
project will conform to at least the minimum values set by approved statewide design standards applicable to this class of highways,
even though such additional work is financed without federal aid participation.
The Agency agrees that on federal aid highway construction projects, the current federal aid regulations which apply to liquidated
damages relative to the basis of federal participation in the project cost shall be applicable in the event the contractor fails to complete
the contract within the contract time.
Vl. Payment and Partial Reimbursement
The total cost of the project, including all review and engineering costs and other expenses of the State, is to be paid by the Agency
and by the Federal Government. Federal funding shall be in accordance with the Federal Transportation Act, as amended, 2 CFR Part
200. The State shall not be ultimately responsible for any of the costs of the project. The Agency shall be ultimately responsible for all
costs associated with the project which are not reimbursed by the Federal Government. Nothing in this agreement shall be construed as
a promise by the State as to the amount or nature of federal participation in this project
The Agency shall bill the state for federal aid project costs incurred in conformity with applicable federal and state laws. The agency
shall minimize the time elapsed between receipt of federal aid funds and subsequent payment of incurred costs. Expenditures by the
Local Agency for maintenance, general administration, supervision, and other overhead shall not be eligible for federal participation
unless a current indirect cost plan has been prepared in accordance with the regulations outlined in 2 CFR Part 200 - Uniform Admin
Requirements, Gost Principles and Audit Requirements for Federal Awards, and retained for audit.
The State will pay for State incurred costs on the project. Following payment, the State shall bill the Federal Government for
reimbursement of those costs eligible for federal participation to the extent that such costs are attributable and properly allocable to
this project. The State shall bill the Agency for that portion of State costs which were not reimbursed by the Federal Government (see
Section lX).
1. Project Construction Costs
Project construction financing will be accomplished by one of the three methods as indicated in this agreement.
Method A - The Agency will place with the State, within (20) days after the execution of the construction contract, an advance in the
amount of the Agency's share of the total construction cost based on the contract award. The State will notify the Agency of the exact
amount to be deposited with the State. The State will pay all costs incurred under the contract upon presentation of progress billings
from the contractor. Following such payments, the State will submit a billing to the Federal Government for the federal aid participation
share of the cost. When the project is substantially completed and final actual costs of the project can be determined, the State will
present the Agency with a final billing showing the amount due the State or the amount due the Agency. This billing will be cleared by
either a payment from the Agency to the State or by a refund from the State to the Agency.
Method B - The Agency's share of the total construction cost as shown on the face of this agreement shall be withheld from its
monthly fuel tax allotments. The face of this agreement establishes the months in which the withholding shall take place and the exact
amount to be withheld each month. The extent of withholding will be confirmed by letter from the State at the time of contract award.
Upon receipt of progress billings from the contracto¡ the State will submit such billings to the Federal Government for payment of its
participating portion of such billings.
Method C - The Agency may submit vouchers to the State in the format prescribed by the State, in duplicate, not more than once
per month for those costs eligible for Federal participation to the extent that such costs are directly attributable and properly allocable
to this project. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead shall not be
eligible for Federal participation unless claimed under a previously approved indirect cost plan.
The State shall reimburse the Agency for the Federal share of eligible project costs up to the amount shown on the face of this
agreement. At the time of audit, the Agency wíll provide documentation of all costs incurred on the project. The State shall bill the
Agency for all costs incurred by the State relative to the project. The State shall also bill the Agency for the federal funds paid by the
State to the Agency for project costs which are subsequently determined to be ineligible for federal participation (see Section lX).
Vll. Audit of Federal Consultant Gontracts
The Agency, if services of a consultant are required, shall be responsible for audit of the consultant's records to determine eligible
federal aid costs on the project. The report of said audit shall be in the Agency's files and made available to the State and the Federal
Government.
An audit shall be conducted by the WSDOT lnternal Audit Office in accordance with generally accepted governmental auditing
standards as issued by the United States General Accounting Office by the Comptroller General of the United States; WSDOT Manual
M 27-50, ConsultantAuthorization, Selection, and AgreementAdministration; memoranda of understanding between WSDOT and
FHWA; and 2 CFR Part 200.501 - Audit Requirements.
lf upon audit it is found that overpayment or participation of federal money in ineligible items of cost has occurred, the Agency shall
reimburse the State for the amount of such overpayment or excess participation (see Section lX).
Vlll. Single Audit Act
The Agency, as a subrecipient of federal funds, shall adhere to the federal regulations outlined in 2 CFR Part 200.501 as well as all
applicable federal and state statutes and regulations. A subrecipient who expends $750,000 or more in federal awards from all sources
during a given fiscal year shall have a single or program-specific audit performed for that year in accordance with the provisions of 2
CFR Part 200.501. Upon conclusion of the audit, the Agency shall be responsible for ensuring that a copy of the report is transmitted
promptly to the State.
DOT Form 140-039
Revised 0512020
Page 3
lX. Payment of Billing
The Agency agrees that if payment or anangement for payment of any of the State's billing relative to the project (e.9., State force
work, project cancellation, overpayment, cost ineligible for federal participation, etc.) is not made to the State within 45 days after
the Agency has been billed, the State shall effect reimbursement of the total sum due from the regular monthly fuel tax allotments to
the Agency from the Motor Vehicle Fund. No additional Federal project funding will be approved until full payment is received unless
otherwise directed by the Director, Local Programs.
projectAgreement End Date - This date is based on your projects Period of Performance (2 CFR Part 200.309).
Any costs incurred after the project Agreement End Date are NOT eligible for federal reimbursement. All eligible costs incurred prior
to the project Agreement End Date must be submitted for reimbursement within 60 days after the Project Agreement End Date or they
become ineligible for federal reimbursement.
X. Traffic Control, Signing, Marking, and Roadway Maintenance
The Agency will not permit any changes to be made in the provisions for parking rdgulations and trafüc control on this project
without prior approval of the State and Federal Highway Administration. The Agency will not install or permit to be installed any signs,
signals, or markings not in conformance with the standards approved by the Federal Highway Administration and MUTCD. The Agency
will, at its own expense, maintain the improvement covered by this agreement.
Xl,Indemnity
The Agency shall hold the Federal Govemment and the State harmless from and shall process and defend at its own expense
all claims, demands, or suits, whether at law or equity brought against the Agency, State, or Federal Government, arising from the
Agency,s execution, performance, or failure to perform any of the provisions of this agreement, or of any other agreement or contract
connected with this agreement, or arising by reason of the participation of the State or Federal Government in the project' PROVIDED'
nothing herein shall require the Agency to reimburse the State or the Federal Government for damages arising out of bodily injury to
persons or damage to property caused by or resulting from the sole negligence of the Federal Government or the State.
Xll. Nondiscrimination Provision
No liability shall attach to the State or Federal Government except as expressly provided herein.
The Agency shall not discriminate on the basis of race, color, national origin, or sex in the awärd and performance of alty USDOT-
assisted contract and/or agreement or in the administration of its DBE program or the requirements of 49 CFR Part 26. The Agency
shall take all necessary and reasonable steps under 49 CFR Part 26 to ensure nondiscrimination in the award and administration of
USDOT-assisted contracts and agreements. The WSDOT's DBE program, as required by 49 CFR Part 26 and as approved by USDOT'
is incorporated by reference in this agreement. lmplementation of this program is a legal obligation and failure to carry out its terms
shall be treated as a violation of this agreement. Upon notification to the Agency of its failure to carry out its approved program, the
Department may impose sanctions as provided for under Part 26 and may, in appropriate cases, refer the matter for enforcement under
1B U.S.C. 1001 arrd/or the Program Fraud Civil Remedies Act of 1986 (31 U.S. C. 3801 et seq.).
The Agency hereby agrees that it will incorporate or cause to be incorporated into any contract for construction work, or modification
thereof, as defined in the rules and regulations of the Secretary of Labor in 41 CFR Chapter 60, which is paid for in whole or in part with
funds obtained from the Federal Government or borrowed on the credit of the Federal Government pursuant to a grant, contract, loan,
insurance, or guarantee or understanding pursuant to any federal program involving such grant, contract, loan, insurance, or guarantee,
the required contract provisions for Federal-Aid Contracts (FHWA 1273), located in Chapter 44 of the Local Agency Guidelines-
The Agency further agrees that it will be bound by the above equal opportunity clause with respect to its own employment
practices when it participates in federally assisted construction work: Provided, that if the applicant so participating is a State or Local
Government, the above equal opportunity clause is not applicable to any agency, instrumentality, or subdivision of such government
which does not participate in work on or under the contract.
The Agency also agrees:
(1) To assist and cooperate actively with the State in obtaining the compliance of contractors and subcontractors with the equal
opportunity clause and rules, regulations, and relevant orders of the Secretary of Labor.
(2) To furnish the State such information as it may require for the supervision of such compliance and that it will otherwise assist the
state in the discharge of its primary responsibility for securing compliance.
(3) To refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965' with
a contractor debarred from, or who has not demonstrated eligibility for, government contracts and federally assisted construction
contracts pursuant to the Executive Order.
(4) To carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors
and subcontractors by the State, Federal Highway Administration, or the Secretary of Labor pursuant to Part ll, subpart D of the
Executive Order.
ln addition, the Agency agrees that if it fails or refuses to comply with these undertakings, the State may take any or all of the
following actions:
(a) Cancel, terminate, or suspend this agreement in whole or in part;
(b) Refrain from extending any further assistance to the Agency under the program with respect to which the failure or refusal
occurred until satisfactory assurance of future compliance has been received from the Agency; and
(c) Refer the case to the Department of Justice for appropriate legal proceedings.
DOT Form 140-039
Revised 0512020
Page 4
Xlll. Liquidated Damages
The Agency hereby agrees that the liquidated damages provisions of 23 CFR Part 635, Subpart 127 , as supplemented, relative to
the amount of Federal participation in the project cost, shall be applicable in the event the contractor fails to complete the contract within
the contract time. Failure to include liquidated damages provision will not relieve the Agency from reduction of federal participation in
accordance with this paragraph.
XlV. Termination for Public Gonvenience
The Secretary of the Washington State Department of Transportation may terminate the contract in whole, or from time to time in
part, whenever:
(1) The requisite federal funding becomes unavailable through failure of appropriation or otherwise.
(2) The contractor is prevented from proceeding with the work as a direct result of an Executive Order of the President with
respect to the prosecution of war or in the interest of natíonal defense, or an Executive Order of the President or Governor of
the State with respect to the preservation of energy resources.
(3) The contractor is prevented from proceeding with the work by reason of a preliminary special, or permanent restraining
order of a court of competent jurisdiction where the issuance of such order is primarily caused by the acts or omissions of
persons or agencies other than the contractor.
(4) The Secretary is notified by the Federal HighwayAdministration that the project is inactive.
(5) The Secretary determines that such termination is in the best interests of the State.
XV. Venue for Claims and/or Gauses of Action
For the convenience of the parties to this contract, it is agreed that any claims and/or causes of action which the Local Agency
has against the State of Washington, growing out of this contract or the project with which it is concerned, shall be brought only in the
Superior Court for Thurston County.
XVl. Gertification Regarding the Restrictions of the Use of Federal Funds for Lobbying
The approving authority certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any federal agency, a member of Congress, an offlcer or employee of Congress, or
an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment,
or modification of any federal contract, grant, loan, or cooperative agreement.
(2) lf any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or an employee
of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit the Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at
all tiers (including subgrants, and contracts and subcontracts under grants, subgrants, loans, and cooperative agreements) which
exceed $100,000, and that allsuch subrecipients shallcertify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.
Submission of this certification as a prerequisite for making or entering into this transaction imposed by Section 1352, Ttle 31 , U.S.
Code. 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.
XVll. Assurances
Local agencies receiving Federal funding from the USDOT or its operating administrations (i.e., Federal HighwayAdministration,
Federal Transit Administration, Federal Aviation Administration) are required to submit a written policy statement, signed by the Agency
Executive and addressed to the State, documenting that all programs, activities, and services will be conducted in compliance with
Section 504 and the Americans with Disabilities Act (ADA).
Additional Provisions
DOT Form 140-039
Revised 05l2O2O
Page 5