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PROJECT COST ESTIMATE/REQUEST AND CLOSURE FORM <br />Return to Roads Finance: <br />Attn: Marc Walsh <br />MS: KSC -TR -0315 <br />Project No. <br />Project Title: Bridge Washing "Asset Flag *: <br />Start Year: <br />Is this a multi- <br />year project - <br />Yes /No: <br />2013 '' <br />Start Date: <br />Estimated year <br />of final <br />completion: <br />Program No. <br />Function No. <br />Project Location: Beacon Ave. <br />Service No. <br />KC Road Log <br />City of Tukwila Number: <br />Planning Unit 10 <br />Estimated project expenditures by year: <br />Permit No: <br />Related CIP <br />Project Type: Org: 1676 Division No: Project No: <br />2011: 2013: xxx <br />PROJECT DESCRIPTION: <br />T <br />TASK <br />TASK DESCRIPTION: <br />2012: 2014: <br />Pressure wash bridge, inside prior to inspection <br />TBD <br />Bridge structure cleaning <br />City to provide traffic control and assist with disposal <br />TOTAL: $0.00 <br />AIRS CUSTOMER NUMBER: 73- BR: SR <br />1 REQUIRED FIELDS IF PROJECT IS REIMBURSABLE****** 1 1. <br />LABOR: <br />ER &R EQUIPMENT: <br />VENDOR EQUIPMENT: <br />MATERIALS: <br />CONTRACT: <br />10% CONTINGENCY: <br />TOTALS: <br />ESTIMATED: <br />ACTUAL: <br />Enter Customer Billing Information below <br />Customer Contact Name: Grant Griffin <br />$4,319.20 <br />$832.00 <br />Customer Billing Company Name: City of Tukwilla <br />$450.00 <br />Customer Billing Address No. 1: <br />,, Customer Billing Address No. 2: <br />Customer Contact Phone Number: <br />$560.00 <br />$6,161.20 <br />$0.00 <br />(REQUIRED) (REQUIRED) <br />_ Roads Project Mgr: Roads PM Phone No: <br />OPEN SIGNATURES: (REQUIRED) CLOSURE DATE <br />CLOSURE SIGNATURES: (REQUIRED) CLOSURE DATE: <br />REOUESTOR: NAME: DATE =.: <br />REQUESTOR: NAME: DATE: <br />AUTHORIZER: NAME DATE fie'. <br />AUTHORIZER: NAME: DATE: <br />FIELD PROCESSING: NAME: DATE: <br />FIELD PROCESSING: NAME: DATE: <br />FINANCE PROCESSING: NAME: DATE: .;: <br />FINANCE PROCESSING: NAME: DATE: <br />ROADSCEFORM.XLS <br />REV 8/1/2010 <br />