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Sn A <br />r, LYJ Original <br />x ❑ Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORDS CONTRACT <br />Date: February 21, 2017 Contractor's UBI Number: 602286010 <br />Name & Mailing Address of Public Agency Department Use Only <br />City of u wl a Assigned to: <br />6200 Southcenter Boulevard <br />Tukwila, WA 98188 Date Assigned: <br />UBI Number: 179000208 <br />Notice is herebv Liven relative to the completion of contract or vroiect described below <br />Project Name <br />Contract Number <br />113-209 <br />Job Order Contracting <br />V <br />TUC Transit Center, Andover Park West St and Water Projects <br />$ <br />❑ Yes No <br />Description of Work Done /Include Jobsite Address(es) <br />Construction of a new on- street transit center, corridor reconstruction and water main replacement, on <br />Andover Park West from Tukwila Parkway to Strander Boulevard. <br />Federally funded transportation project? ly1 Yes ❑ No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />E -mail Address <br />Affidavit ID* <br />Road Construction Northwest, Inc. lanthony@rcnw.com <br />1695955 <br />Contractor Address <br />Telephone # <br />2500 East Valley Road, Suite C -3, Renton, WA 98057 <br />425- 251 -1636 <br />If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. <br />❑ Retainage Bond ❑ Contract/Payment bond (valid for federally funded transportation projects) <br />Name: <br />I Bond Number: <br />Date Contract Awarded <br />Date Work Commenced <br />Date Work Completed <br />Date Work Accepted <br />November 18, 2013 <br />February 10, 2014 <br />April 3, 2015 <br />Were Subcontracters used on this project? If so, please complete Addendum A. WYes ❑ No <br />Affidavit ID* - No L &I release will be granted until all affidavits are listed. <br />Contract Amount <br />$ <br />5,960,574.00 <br />Additions ( +) <br />$ <br />365,311.40 <br />Reductions ( -) <br />$ <br />144,323.47 <br />Sub -Total <br />$ <br />6,181,561.93 <br />Amount of Sales Tax 9.5 <br />(If various rates apply, please send a breakdown) <br />$ <br />79233.50 <br />TOTAL <br />$ <br />6,260,795.43 <br />Liquidated Damages $ <br />0.00 <br />Amount Disbursed $ <br />5,951,717.31 <br />Amount Retained $ <br />309,078.12 <br />TOTAL $ 6,260,795.43 <br />trvli . l/t rJr twu tuttff3 nufJt ur rf ttuf <br />Comments: <br />Y ,4A - <br />Note: The Disbursing Officer mint submit this completed notice immediately after acceptance of the work done under this contract. <br />NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. <br />Submitting Form: Please submit the completed form by email to all three agencies below. <br />Contact Name: Diane Jaber <br />Email Address: diane.iaber(�i.)tukwilawa.gov <br />CDepartment of Revenue <br />Public Works Section <br />wa9hingtO State oe mmnent of <br />Labor & Industries <br />(360) 704 -5650 <br />Contract Release <br />PWC @dor.wa.gov <br />(855) 545 -8163, option # 4 <br />ContractRelease @LNI. WA.GOV <br />REV 31 0020e (4/28/14) F215- 038 -000 04 -2014 <br />Title: Fiscal Specialist <br />Phone Number: (206) 433 -1871 X 1871 <br />.� Employment Security <br />>�� Department <br />Registration, Inquiry, <br />Standards & Coordination <br />Unit <br />(360) 902 -9450 <br />publicworks@esd.wa.gov <br />2 <br />