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Home My WebLink AboutNBIL(537)_3-A_RFA CON(AC Conv.)_22-12-00STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION PROJECT AUTHORIZATION/ADJUSTMENT REQUEST LAPM 3-A (REV 01/2022) Local Assistance Procedures Manual Page 1 of 2 Print Request Instructions Reset Form ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. Date 12/14/2022 Federal Project Number BR-NBIL(537) Agency City of La Quinta Caltrans District 08 Congressional District 36 Project Contact Bryan McKinney, P.E. Title Public Works Director / Engineer Email bmckinney@laquintaca.gov Phone (760) 777-7045 Project Title Dune Palms Road Bridge / Dune Palms Road over Coachella Valley Stormwater Channel - CP# 2011-05 HBP Project Location Dune Palms Road Spanning the Coachella Valley Stormwater Channel from Corporate Center to South of Blachhawk Way/Westward Ho. Bridge Number(s) 00L0070 Description of Work Bridge construction and road widening. Replace low-water crossing with an all-weather crossing including road approaches and necessary bank concrete slope scour countermeasures. Functional Classification Major Collector Located on SHS CRS Map No. 17W13 ITS Risk N/A Project Oversight Locally Administered Estimated Phase Completion Date 12/31/2024 PED 12/31/2025 Authorization Adjustment PE R/W CON CE NI PE R/W CON CE NI Advance Construction CTC Allocation Required Federal Amount Requested $10,000,000.00 Invoking Section 1440 of the FAST ACT? (aka At-Risk PE)?No PROJECT FUNDING Previously Authorized Phase(s)PE R/W CON CE NI Federal Fund Type Project Cost Federal Participating Cost Federal Funds State Match Funds Local Match Funds Other Funds Reimb. Rate P/L R/W TC 1,548,409.00 1,318,000.00 1,166,826.00 381,583.00 88.54 + - PREV AUTH R/W subtotals 1,548,409.00 1,318,000.00 1,166,826.00 0.00 381,583.00 0.00 CON TC FA 18,927,386.00 15,794,104.00 4,944,866.00 13,982,520.00 N/A +PREV AUTH HBP 0.00 8,077,220.00 0.00 (8,077,220.00)N/A L + CON subtotals 18,927,386.00 15,794,104.00 8,077,220.00 0.00 4,944,866.00 5,905,300.00 CE TC SF 2,171,896.00 2,171,896.00 249,116.00 1,922,780.00 N/A +PREV AUTH HBP 0.00 0.00 1,922,780.00 0.00 (1,922,780.00)N/A L + CE subtotals 2,171,896.00 2,171,896.00 1,922,780.00 0.00 249,116.00 0.00 Total Project Cost 22,647,691.00 19,284,000.00 11,166,826.00 0.00 5,575,565.00 5,905,300.00 COST ESTIMATE Detail your project costs with the cost estimate template(s) created on the following pages (applicable templates are created based on the phases selected for authorization and/or adjustment). If the cost estimate template(s) created cannot be used or a different format is preferred (e.g., Excel spreadsheet), indicate which phase(s) other documentation will be submitted to support your authorization and/or adjustment request: Any existing inputs and calculations on cost estimate templates will be cleared when selected. Construction/Construction Engineering STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION PROJECT AUTHORIZATION/ADJUSTMENT REQUEST LAPM 3-A (REV 01/2022) Print Request Instructions Reset Form Date 12/14/2022 Federal Project Number BR-NBIL(537) Page 2 of 2 ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. REQUIRED SUPPORTING DOCUMENTS Include the following items with this form [(P= required, ● = required if applicable)]. This list does not represent all documents required to be in the agency's project files. The District Local Assistance Engineer may request additional documents for authorization/adjustment. Project Document FTIP Document (Include CMAQ Emissions Benefits Calculations, Back-up List and EPSP Approval if applicable) NEPA Approval Document (LAPM Exhibit 6-F / 6-G) Right of Way Certification (LAPM Exhibit 13-A / 13-B) FHWA Specific Authorization to Relocate Utilities (LAPM Exhibit 14-C) Cost-Effectiveness/Public Interest Finding (LAPM Exhibit 12-F) Detail Cost Estimate CON/CE ADJ ● ● ● ● ● ✔ RESPONSIBLE CHARGE CERTIFICATION I certify that the information provided in this request is accurate and correct. Any changes to the project scope, cost, or schedule will be communicated to the District Local Assistance Engineer. This Agency agrees to comply with the applicable terms and conditions set forth in Title 23, U.S. Code, Highways, and the policies and procedures promulgated by the Federal Highway Administration (FHWA) and California Department of Transportation relative to the above- designated project. I understand that this Agency is responsible for all costs incurred prior to receiving authorization to proceed. In addition, this Agency will be responsible for all costs in excess of the federal and/or state funds encumbered to complete the above-designated project. Signature of Full-Time Public Employee in Responsible Charge Date 12/14/2022 Print Name Bryan McKinney, P.E. Title Public Works Director / City Engineer REMARKS