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PROJECT COST ESTIMATE/REQUEST AND CLOSURE FORM Return to Roads Finance: <br />Attn: Marc Walsh <br />MS: KSC-TR.0315 <br />rRrOr �Ca,, 1121661 'Project Title: Bridge Inspection City of Tukwila <br />Start Year: 2017 Start Date: <br />2/1/17 <br />Emliram No <br />Function No, Project Location: Various location In the City of Tukwila <br />Is this a multi- Estimated <br />year project. Yes Year of final <br />KC Road Log <br />Yes/No: completion: <br />Service No. <br />Number:_�] <br />Estimated project expenditures by year: <br />Permit Nod Type: Reimbursable org: 5626 <br />Division No: <br />Related CID <br />Project No: <br />2016 $3,675.00 2018 <br />-Project <br />2017 2019 <br />PROJECT DESCRIPTION: <br />TASK <br />TASK DESCRIPTION: <br />Inspection of 8 City owned bridges <br />55.02-08 <br />Bridge Inspection <br />$3,800.00 <br />Routine Inspections on Tuk-1, 7, 8, 11, 12,13,16 and 24 <br />90.00.34 <br />Administration, Tech support, Report Prep, UBIT and driver <br />$2,900.00 <br />Provide inspection reports to WSDOT and the city after completion of the inspections. <br />Fracture Critacal inspection on Beacon Hill Tukwila 13 <br />1 <br />Inspection of 1t2 owned structure No. 4001 with the city of Kent <br />Equipment <br />$110.00 <br />Contingency <br />$640.00 <br />TOTAL: <br />$7,450.00 <br />AIRS CUST MER NUMBER: 73- BR: SR: <br />l 1 ­—REQUIRED FIELDS IF PROJECT IS REIMBURSABLE ..... <br />ESTIMATED: <br />ACTUAL: <br />Enter Customer BilliM Information below <br />LABOR. <br />$6,700.00 <br />Customer Contact Name: <br />Robin Tischmak, City Engineer <br />$110.00 <br />ER&R EQUIPMENT: <br />Customer Billing Company Name: <br />City of Tukwila <br />VENDOR EQUIPMENT: UBIT <br />Customer Billing Address No. 1: <br />6300 Soutficenter Blvd. Suite 100 <br />FIR FLAGGING: <br />Customer Billing Address No. 2: <br />Tukwila, WA 98188-2644 <br />$640.001 <br />CONTRACT: <br />Customer Contact Phone Number: <br />206-431-2456 <br />$7,450.00 <br />$0.00 <br />TOTALS: <br />I <br />Roads Project Mgr: Margaret Germeaux Roads PM Phone No: <br />206477-3539 <br />OPEN SIGNATURES: (REQUIRED) <br />REQUESTOR NAME DATE <br />AUTHORIZER NAME DATE <br />FIELD PROCESSING: N-L DATE <br />IFINANCE PROCESSING: NAME, DATE. <br />CLOSURE D.Te <br />CLOSURE SIGNATURES: <br />REQUESTOR: NAME <br />AUTHORZER: NAME <br />FIELD PROCESSING: NAME <br />FINANCE PROCESSING: NAM[:: <br />(AE.UARED) CLOSURE DATE: <br />DATE <br />DATE <br />DATE <br />DATE <br />ROADSCEFORM.XLS REV 8/7/2010 <br />