HomeMy WebLinkAboutNorth Liberty - Forevegreen Rd Extension - Phase 2
Page 4
The following information must be provided for all Surface Transportation Block Grant project proposals
and will be provided to the MPOJC Transportation Technical Advisory Committee (TTAC) and Urbanized
Area Policy Board for evaluation. MPOJC staff may contact you if additional information is required. You
will have the opportunity to explain the project at a meeting of the MPOJC TTAC. MPOJC staff will score
the projects; the TTAC may modify scores.
Project Sponsor:_____________________________________________________________________
Contact Person (Name and Title):_______________________________________________________
Street Address:______________________________________________________________________
City:_____________________________________State:_______ ZIP Code:_____________________
Phone Number:________________________ Email Address: _______________________________
Unique Entity Identifier (UEI):__________________________________________________________
(To verify existing UEI or to register, go to System for Award Management at https://SAM.gov. The entity
name associated with the UEI must match the entity listed on this application as the project sponsor.)
Metropolitan Planning Organization (MPO):_______________________________________________
If more than one Agency or Organization is involved in this project, please state the agency or
organization, contact person, mailing address, and telephone number of the second agency. (Attach an
additional page if more than two agencies are involved.)
Agency or Organization:_______________________________________________________________
Contact Person (Name and Title):_______________________________________________________
Street Address:______________________________________________________________________
City:________________________________ State:___________ ZIP Code:______________________
Phone Number:___________________________ Email Address:____________________________
Unique Entity Identifier (UEI):___________________________________________________________
Project Title:________________________________________________________________________
Project Description:(Provide summary details of only the project scope that is the subject of the funding
request. i.e. number of proposed through lanes, turn lanes, and other critical features.)
If this project includes land acquisition, how many acres?______________
PROJECT SPONSOR INFORMATION
PROJECT INFORMATION
Cities of North Liberty and Coralville
Ryan Rusnak, Planning Director
360 North Main Street
North Liberty Iowa 52317
319-626-5747 rrusnak@northlibertyiowa.org
North Liberty: EQNKTW1PCN66
Metropolitan Organization of Johnson County
City of Coralville
Scott Larson, City Engineer
1512 7th Street
Coralville Iowa 52241
319-248-1720 slarson@coralville.org
QNVXMHKSJNN8
Forevergreen Road Extension - Phase 2
.25
This joint project between the Cities of North Liberty and Coralville would construct Forevergreen
Road Extension - Phase 2 from the western limits of the eastern section of future Forevergreen
Road extension - Phase 1 to Naples Avenue. The intersection of Forevergreen Road/Naples Avenue
is planned as a roundabout. The newly constructed urban section would include tow vehicle travels
lanes, a 10-foot-wide off-street multi-use trail on the north side, and a storm system.
Page 5
Check all boxes that apply to indicate the categories that best describe your project.
Trails and Bicycles Roadways and Bridges
Facilities for pedestrians and bicycles including
safe routes for non-drivers
Construction, rehabilitation, preservation, or
operational improvements of street facilities
Conversion and use of abandoned railway
corridors
Bridge improvements including construction,
rehabilitation, or preservation
Scenic Historic Environmental
Construction of turnouts, overlooks, and viewing
areas
Vegetation management practices in
transportation rights-of-way
Inventory, control, or removal of outdoor
advertising
Highway related stormwater management
Historic preservation and rehabilitation of historic
transportation facilities
Reduction of vehicle-caused wildlife mortality or
restoration of habitat connectivity
Archaeological activities relating to impacts from
another eligible activity
Other
Does the project comply with the adopted MPOJC Complete Streets Policy? Yes No
Which of the following facilities are included in the proposal?
Turn Lanes Separated trail or wide sidewalk (8’ or wider)
ITS/Signalization Improvements Marked on-street bike facility
Geometric Improvements Facilities to reduce modal conflict
Is the focus of the project to address a safety concern at an intersection or midblock location, or
improve safety at a location with a collision history involving bicyclists or pedestrians (refer to
pages 22-25)?
Yes No
Upon completion, will the project be open to the public?
Yes No
Do you intend to charge a fee to users?
Yes No If yes, how much will the fee be and how will the revenue be used?___________
PROJECT CATEGORY
Not Applicable
✔✔
✔
✔
✔
✔
✔
Page 6
Project Costs: Complete the table below by identifying the estimated project costs. Costs should reflect
estimated costs in the execution year when funds are anticipated to be programmed and the project is
ready to proceed. COLUMN 1 is the total project cost to the project sponsor and will include all costs
whether STBG reimbursement is intended or the costs will be paid entirely with local or other funds. Most
project sponsors do not intend to request reimbursement toward all project costs. The amount listed in
COLUMN 1 for each type of cost should also be placed in either COLUMN 2 or COLUMN 3. The costs
listed in COLUMN 2 are those that are not intended to be claimed for STBG reimbursement. Costs listed
in COLUMN 3 are costs the project sponsor does intend to claim for reimbursement. No row should have
costs in all three columns and the total of COLUMN 2 plus the total of COLUMN 3 should equal the total
of COLUMN 1.
COLUMN 1
Total Estimated
Project Cost to
Project Sponsor
COLUMN 2
No STBG
Reimbursement
Planned
COLUMN 3
Intend to Claim
STBG
Reimbursement
Right-of-way Acquisition: $$$
Preliminary Design/Engineering: $$$
Construction: $$$
Construction Engineering: $$$
Other (please identify) :$$$
Other (please identify) :$$$
Total: $$$
LINE A: Total to be Claimed for Reimbursement (Total COLUMN 3)Ψ
LINE B:Surface Transportation Block Grant Funding Request (Maximum 80% of Total COLUMN 3)Ψ
LINE C:Required Local Match (Difference LINE A –LINE B; Minimum 20% of Total COLUMN 3)Ψ
LINE D:Total Cost to Project Sponsor*(LINE C + Total COLUMN 2)Ψ
* The Project Sponsor is also responsible for all cost overruns
Funding Gap: After completing the Matching Funds section below, return to this section to show your calculation of
the existing funding gap that exists on your project.
LINE E:Total SECURED matching funds (Sum of all match sources listed as secured below)Ψ
LINE F:Existing funding gap (Difference LINE D –LINE E)Ψ
Matching Funds: Please list each funding source separately (including your own local funds
secured for the project) and provide all of the following information:
x Amount: List the funding amount secured or anticipated from each funding source.
x Source: Identify the funding source.
x Funds are secured or anticipated: A grant amount that has been confirmed by a funder in
writing is a secured funding source. In identifying the applicant’s own contribution, the
amount must be identified as a line item in an internal budget document or some other
documentation must be able to be provided for the funding to be considered secured versus
anticipated. Identifying funds under the presumption that a board or council will commit a
certain amount through a future action would be considered an anticipated funding source. If
you intend to apply for or have not yet received written confirmation of an award, these are
considered anticipated.Only funding sources marked as secured should be included
when calculating the total matching funds identified in LINE E above.All funding
sources listed as secured will be required to provide proof that the award has been made or
funds have otherwise been secured for your project. If you check secured and do not
provide documentation, adjustments will be made to accurately reflect only secured and
ESTIMATED PROEJCT COSTS, FUNDING GAP, AND MATCHING FUNDS
10,000 10,000
605,000 605,000
5,675,000
495,000 495,000 5,675,000
10,000 10,000
6,795,000 1,120,000 5,675,000
5,675,000
Utility Relocate
2,264,000
3,411,000
4,531,000
0
4,531000
Page 7
documented funding sources in scoring your application.
x Funding type: Identify if funds are from a federal, state, local, or private source.
x Intended use of these funds: In many cases, the intended use will be the same as this
application; however, if the funds are for a particular item then indicate the funder’s intent.
x Conditions on the use of funds: If the funder has any conditions on the funding, please list
these. A common condition may be a date funds need to be spent by or a date the project
must be completed by.
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆ Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆ Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆Local:܆ Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆ Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆ Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆ Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated:܆Funds are: Federal:܆State:܆Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
Amount:Source:
Funds are: Secured܆Anticipated: ܆Funds are: Federal:܆State:܆ Local:܆Private:܆
Intended use of these funds:
Conditions on the use of funds:
$2,265,000 GO Bonds (City of North Liberty)
For costs related to the City's portion for construction of the roadway section.
$2,625,000 GO Bonds (City of Coralville)
For costs related to the City's portion for construction of the roadway section.
✔
✔
Anticipated NEPA Clearance (already in progress)
Concept Statement Submittal
Preliminary Plans Submittal
Check Plans Submittal
Buffer Period (Ease, Acq., Bridge and Floodplain Reviews) - START
Buffer Period (Ease, Acq., Bridge and Floodplain Reviews) - END
Final Plans
Bid Letting (DOT)
Award Construction Contract
Construction - START
Construction - END
Audit Complete / Project Closed
2025 - June
2028 - April
2028 - October
2028 - December
2029 - January
2029 - June
2029 - July
2029 - October
2029 - November
2030 - March
2031 - June
2031 - December
X
A Concept Statement for the overall Forevergreen Road Extension project (12th Avenue to 1st Avenue) was
submitted to the Iowa DOT in January 2025. This project has been discussed and coordinated through
several meetings with the Iowa DOT and FHWA team, and the Concept Statement was submitted to cover
the entire 1.3 mile project corridor to allow development of a major project path for a Phase 1 project
utilizing a February 17, 2026 letting date. The DOT Office of Location and Environment required that an
evaluation of the entire project corridor is required to achieve NEPA clearance before developing individual
project phases.
The City of North Liberty and the City of Coralville jointly submitted a funding application that was allocated
$2.5M in Community Project Funding (aka Earmark) in 2023 through the Highway Infrastructure Program
(HIP) with the City of Coralville as the lead sponsor (Demo ID IA259). These funds remain available for
obligation through September 30, 2026, and will be utilized for construction costs of the Phase 1 portion of
the overall project.
This application applies to the Phase 2 portion of the overall project.
Page 9
The following documents and narratives must be submitted with this application. In the upper right
corner of each document or narrative write the corresponding letter shown below.
A.
A NARRATIVE assessing existing conditions, outlining the concept of the proposed project, and
providing adequate project justification. Assess your project in regard to the transportation
system relative to its functional relationship, proximity, or impact to an existing or planned
transportation facility. If a regional project, assess the value of this project from a regional
perspective and how it will be a functional addition to the transportation system and the region as
a whole if no additional development funds are received. If a statewide or multi -regional project,
assess the value of this project from a statewide or multi-regional perspective.
B.
A DETAILED MAP identifying the location of the project and any known environmentally
sensitive areas/features.
C.
A SKETCH-PLAN of the project; including a typical cross-section of transportation facilities.
D.
An ITEMIZED BREAKDOWN of the total project costs. This documentation does not need to be
a detailed, line-item type of estimate. However, it must accomplish two objectives: first, it must
show the method by which the cost estimate was prepared; and second, it must enable a
reviewer to determine if the cost estimate is reasonable. The manner in which these objectives
are achieved may vary widely depending on the type, scope and complexity of the project.
Absent a fully itemized list of costs, some general guidelines for possible methods of estimating
each type of project cost are provided in Attachment A (page 13).
E.
An anticipated TIME SCHEDULE for the total project development. Funding for projects which
fail to make satisfactory progress may be rescheduled or removed from the program by the Iowa
Department of Transportation.
F.
An OFFICIAL ENDORSEMENT of the project from the authority to be responsible for its
maintenance and operation. The authority must provide written assurance that it will adequately
maintain the completed project for its intended public use for a minimum of 20 years following
project completion.
G.
If applicable, a LETTER OF SUPPORT for the project from the scenic or historic byway board.
The board’s letter should also address the project’s relationship to the byway’s intrinsic qualities,
how the project will have a statewide or multi -regional impact, and whether the project is included
in the byway’s current corridor management plan.
H.
A NARRATIVE discussing the public input process that was followed and the extent to which
adjacent property owners and others have been informed of the proposed project and an
assessment of their acceptance.
I.
A MINORITY IMPACT STATEMENT for the project.
The undersigned is an official authorized to represent the applying organization. The person signing this
document must have the authority to contractually bind the organization.
Certification
I certify that all proposed activities will be carried out; that all grant money received will be utilized solely
for the purposes for which it is intended; that records documenting the planning process and
implementation will be maintained and submitted when requested, and the Iowa DOT is hereby granted
access to inspect project sites and/or records.
To the best of my knowledge and belief, all information included in this application is true and accurate,
including the commitment of all physical and financial resources. This application has been duly
authorized by the applying organization. I understand that the attached official endorsement(s) binds the
participating authority to assume responsibility for adequate maintenance of any new or improved
facilities.
DOCUMENTATION AND NARRATIVE INFORAMTION
Page 10
The award of STBG funds and/or any subsequent funding or letting of contracts for design, construction,
reconstruction, improvement, or maintenance; or the furnishing of materials shall not involve direct or
indirect interest, prohibited by Iowa Code Sections 314.2, 362.5, or 331.342, of any state, county, or city
official, elective or appointive. Any award of funding or any letting of a contract in violation of the foregoing
provisions shall invalidate the award of funding and authorize a complete recovery of any funds
previously disbursed.
If funding assistance is approved for the project described in this application, I understand that an
executed agreement between the applicant and the Iowa DOT is required before the project can be
started, costs incurred, or such funding assistance authorized for use in implementing the project.
Representing: _______________________________________________________________________
Printed Name____________________________________ Title________________________________
Signature________________________________________________ Date_______________________
City of North Liberty
Ryan Rusnak Planning Director
2/24/2025
,
IOWA CITY
COMMUNITY
SCHOOL DISTRICT
CITY OF NORTH LIBERTY
BEAUMONT,
BARBARA G
FOUR D'S ACRES, LLC KARL JOSEPH
KREDER JR
GAY D KEDER
CITY OF
CORALVILLE
KERKHOFF, SCOTT M
KERKHOFF, TERI J
DAVIDSON, JAY R
DAVIDSON, BEVERLY J
CITY OFCORALVILLE
SPENCER-JONES, ILIANA
SPENCER-ORTEGA, HECTORWEINMAN, GARY
KEMPF, JAMES
KEMPF, MICHELLE
NA
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8
PVI STA: 11+77.29
PVI ELEV: 756.31
AD: -4.00%
K: 50.00
200' VC
BV
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:
1
0
+
7
7
.
2
9
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:
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:
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:
7
5
0
.
8
1
HP STA: 10+77.29
HP ELEV: 757.81 PVI STA: 31+50.00
PVI ELEV: 767.81
AD: -8.50%
K: 44.12
375' VC
BV
C
S
:
2
9
+
6
2
.
5
0
BV
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E
:
7
5
5
.
6
3
EV
C
S
:
3
3
+
3
7
.
5
0
EV
C
E
:
7
6
4
.
0
6
HP STA: 32+49.26
HP ELEV: 764.95
PVI STA: 72+40.00
PVI ELEV: 779.06
AD: -4.06%
K: 49.32
200' VC
BV
C
S
:
7
1
+
4
0
.
0
0
BV
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:
7
7
6
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5
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:
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.
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0
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:
7
7
7
.
5
5
HP STA: 72+65.76
HP ELEV: 778.11PVI STA: 43+00.00
PVI ELEV: 774.81
AD: -6.00%
K: 66.67
400' VC
BV
C
S
:
4
1
+
0
0
.
0
0
BV
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:
7
7
0
.
8
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:
4
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0
.
0
0
EV
C
E
:
7
6
6
.
8
1
HP STA: 42+33.33
HP ELEV: 772.15
PVI STA: 53+25.00
PVI ELEV: 750.69
AD: -5.50%
K: 36.36
200' VC
BV
C
S
:
5
2
+
2
5
.
0
0
BV
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:
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4
9
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:
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5
.
0
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:
7
4
6
.
6
9
HP STA: 52+79.55
HP ELEV: 749.60
PVI STA: 63+83.70
PVI ELEV: 781.22
AD: -11.50%
K: 30.43
350' VC
BV
C
S
:
6
2
+
0
8
.
7
0
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:
7
6
8
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:
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+
5
8
.
7
0
EV
C
E
:
7
7
4
.
2
2
HP STA: 64+36.96
HP ELEV: 776.65PVI STA: 21+50.00
PVI ELEV: 702.81
AD: 12.00%
K: 70.83
850' VC
BV
C
S
:
1
7
+
2
5
.
0
0
BV
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:
7
2
6
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:
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5
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0
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EV
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:
7
3
0
.
4
4
LP STA: 21+14.58
LP ELEV: 715.47 PVI STA: 35+50.00
PVI ELEV: 759.81
AD: 4.00%
K: 75.00
300' VC
BV
C
S
:
3
4
+
0
0
.
0
0
BV
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:
7
6
2
.
8
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:
3
7
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0
.
0
0
EV
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E
:
7
6
2
.
8
1
LP STA: 35+50.00
LP ELEV: 761.31
PVI STA: 67+50.00
PVI ELEV: 766.56
AD: 6.55%
K: 38.17
250' VC
BV
C
S
:
6
6
+
2
5
.
0
0
BV
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:
7
7
1
.
5
6
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:
6
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+
7
5
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0
0
EV
C
E
:
7
6
9
.
7
5
LP STA: 67+77.67
LP ELEV: 768.51
PVI STA: 50+18.18
PVI ELEV: 746.09
AD: 5.50%
K: 36.36
200' VC
BV
C
S
:
4
9
+
1
8
.
1
8
BV
C
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:
7
5
0
.
0
9
EV
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:
5
1
+
1
8
.
1
8
EV
C
E
:
7
4
7
.
5
9
LP STA: 50+63.64
LP ELEV: 747.18
PVI STA: 57+50.00
PVI ELEV: 733.69
AD: 11.50%
K: 43.48
500' VC
BV
C
S
:
5
5
+
0
0
.
0
0
BV
C
E
:
7
4
3
.
6
9
EV
C
S
:
6
0
+
0
0
.
0
0
EV
C
E
:
7
5
2
.
4
4
LP STA: 56+73.91
LP ELEV: 740.21
-1.50%
-5.50%6.50%
-1.51%
-2.00%2.00%2.55%
-4.00%
1.50%
-4.00%
-4.00%
7.50%
NORTH
PROJECT NUMBER:SHEET NUMBER SHIVE-HATTERY 2112304220 D.01S-H PROJECT NO. 2112304220 JOHNSON
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2
2
0
FOREVERGREEN ROAD EXTENSION - PLAN VIEW
FOREVERGREEN ROAD EXTENSION - PROFILE VIEW
CITY OF CORALVILLE
CITY OF CORALVILLE
FOREVERGREEN ROAD EXTENSION
000000000 55+00+05+555 000000+00+00+05+05+5+0555+5+555555555555+
1E
888888888888888888888888888888888888
========11111111111111155555555555555555000000000000000..
000000000000000000000000000
00000000000000000''
+0++++++00+0+0+00 0000+0
2
54' x 13' CONSPANN
O-900 (543 sf)
2
3
RRRRRRRRRRRRRRRRR=======77777777777777777666666666666666666666666555555555555...00000000000000000''''
5555555
4
PHASE 1 - EAST
1ST AVENUE
CONNECTION
PHASE 2
NAPLES AVENUE
EAST CONNECTION
PHASE 3
NAPLES AVENUE
WEST CONNECTION
PHASE 4
NAPLES AVENUE ROUNDABOUT
1
S
T
A
V
E
N
U
E
N
O
R
T
H
L
I
B
E
R
T
Y
R
O
A
D
NA
P
L
E
S
A
V
E
N
U
E
FOREVERGREEN RD
12
T
H
A
V
E
PHASE 1 - WEST
12TH AVENUE
CONNECTION
1W
$1,235,000$5,675,000$8,575,000$2,315,000
$2,000,000
Varies
FOREVERGREEN ROAD EXTENSION PHASE 2 - TYPICAL SECTION
FOREVERGREEN ROAD EXTENSION PHASE 2 - TYPICAL SECTION
Varies
FOREVERGREEN ROAD EXTENSION - PHASE 2
OPINION OF ANTICIPATED CONSTRUCTION COSTS
Concept Phase - February 2025
2030
ITEM DESCRIPTION UNIT QUANTITY UNIT COST EXTENDED COST
1 EARTHWORK, CLASS 10 CY 90,000 9.00$ 810,000$
2 CLEARING AND GRUBBING ACRE 6.00 10,500$ 63,000$
3 CROSSROAD - PIPE CULVERTS LF 400 205$ 82,000$
4 CROSSROAD - BOX CULVERTS LF 300 525$ 157,500$
5 DRAINAGE CHANNEL REALIGNMENT LF 400 1,050$ 420,000$
6 MODIFIED SUBBASE CY 2,400 40$ 96,000$
7 LONGITUDINAL SUBDRAIN AND OUTLETS, 6-INCH LF 5,100 25$ 127,500$
8 PCC PAVEMENT, 9-INCH (ROAD WIDTH 31' B-B)SY 6,070 67$ 406,690$
9 PCC TRAIL, 10-FOOT WIDTH SY 2,800 52$ 145,600$
10 STORM SEWER - ROADWAY PIPE LF 2,300 105$ 241,500$
11 STORM SEWER - ROADWAY STRUCTURES EACH 36 5,200$ 187,200$
12 WATER MAIN AND HYDRANTS, 12-INCH LF 1,750 236$ 413,000$
13 RETAINING WALLS SF 7,500 100$ 750,000$
14 WETLAND MITIGATION LS 1 410,000$ 410,000$
15 SIDE ROAD CONNECTIONS LS 1 40,000$ 40,000$
16 TRAFFIC CONTROL LS 1 15,000$ 15,000$
17 STREET LIGHTING LS 1 55,000$ 55,000$
18 MOBILIZATION LS 1 310,000$ 310,000$
OPINION OF CONSTRUCTION COST - SUBTOTAL 4,730,000$
CONTINGENCY (20%)945,000$
OPINION OF CONSTRUCTION COST - TOTAL 5,675,000$
PROPERTY ACQUISITIONS AND EASEMENTS 10,000$
PRIVATE UTILITY RELOCATIONS 10,000$
OPINION OF PROJECT COSTS - SUBTOTAL 5,695,000$
ENGINEERING FEDERAL-AID (DESIGN | BID | CONSTRUCTION)1,100,000$
* OPINION OF PROJECT COSTS - TOTAL 6,795,000$
* Costs for easements, acquisitions, and utility relocations are estimates based on conceptual stage project information
DESCRIPTION: Construct new 31' B-B PCC urban roadway from Naples Avenue to 1st Avenue, connecting to the Phase 1 East roadway project
limit. Work includes 10-foot PCC trail, retaining walls, 12-inch water main, box culverts, stream realingment, tree clearing and grading.
Page 11
Minority Impact Statement Form 105101 (02-20)
Pursuant to 2008 Iowa Acts, HF 2393, Iowa Code 8.11, all grant applications submitted to the State of
Iowa that are due beginning Jan. 1, 2009, shall include a Minority Impact Statement. This is the state's
mechanism for requiring grant applications to consider the potential impact of the grant project's
proposed programs or policies on minority groups.
Please choose the statement(s) that pertains to this grant application. Complete all the
information requested for the chosen statement(s). Submit additional pages as necessary.
The proposed grant project programs or policies could have a disproportionate or unique
positive impact on minority persons.
Describe the positive impact expected from this project:
Indicate which groups are impacted:
Women Persons with a disability Blacks Latinos Asians
Pacific Islanders American Indians Alaskan Native Americans Other__________
The proposed grant project programs or policies could have a disproportionate or unique
negative impact on minority persons.
Describe the negative impact expected from this project:
Present the rationale for the existence of the proposed program or policy :
Page 12
Provide evidence of consultation with representatives of the minority groups impacted :
Indicate which groups are impacted:
Women Persons with a disability Blacks Latinos Asians
Pacific Islanders American Indians Alaskan Native Americans Other__________
The proposed grant project programs or policies are not expected to have a disproportionate or
unique impact on minority persons.
Present the rationale for determining no impact:
I hereby certify that the information on this form is complete and accurate, to the best of my knowledge.
Name
Title
Definitions
"Minority Persons,” as defined in Iowa Code 8.11, means individuals who are women, persons with a
disability, Blacks, Latinos, Asians or Pacific Islanders, American Indians, and Alaskan Native Americans.
“Disability,” as defined in Iowa Code 15.102, subsection 7, paragraph “b,” subparagraph (1):
b.As used in this subsection:
(1)"Disability" means, with respect to an individual, a physical or mental impairment that
substantially limits one or more of the major life activities of the individual, a record of physical
or mental impairment that substantially limits one or more of the major life activities of the
individual, or being regarded as an individual with a physical or mental impairment that
substantially limits one or more of the major life activities of the individual.
"Disability" does not include any of the following:
(a)Homosexuality or bisexuality.
(b)Transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity
disorders not resulting from physical impairments or other sexual behavior disorders.
(c)Compulsive gambling, kleptomania, or pyromania.
(d)Psychoactive substance abuse disorders resulting from current illegal use of drugs.
“State Agency,” as defined in Iowa Code 8.11, means a department, board, bureau, commission,
or other agency or authority of the State of Iowa.