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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 />vroec ram 1131308 <br />Project Title: Bridge Inspection City of Tukwila - UBIT <br />Start Year: 2017 Start Date: <br />2/1/17 <br />Program No, <br />Function No. <br />Project Location: various location In the City of Tukwila <br />Is this a multi- Estimated <br />year Project No year of final <br />12131/2017 <br />KC Road Log <br />Y../N.: c—pld.n; <br />Service No. <br />Number: <br />Planning and <br />Estimated Promect expenditures by year: <br />Permit N., <br />Project Type: Reimbursable Ong: <br />5626 Division No: <br />Related CIP <br />Protect NO: <br />2016 2018 <br />2017 2019 <br />PROJECT DESCRIPTION: <br />TASK <br />TASK DESCRIPTION: <br />UBIT In%pecton on Bridge Tuk-02, <br />03, 06, 09 and 14 (5) US inspections <br />55.02-08 <br />< BHdgelnspecfion <br />4,500.00 <br />Provide hspecton reports to WSDOT and the city after completion of the Inspections. <br />55.02.08 <br />Administration, Tech support, Report Prep, FC Rept <br />$3,280.00 <br />Fracture Critical inspeciton on Tukwila 14 <br />90.00.34 <br />Vendor Equipment <br />$6,325.00 <br />Railroad Flagger <br />Equipment <br />$150.00 <br />Contingency <br />$770.W <br />TOTAL: <br />$15,025.00 <br />AIRS CUSTOMER NUMBER: 73- <br />BR: SR: <br />1 1 ­"'REOUIRED FIELDS IF PROJECT IS REIMBURSABLE—... <br />ESTIMATED: <br />ACTUAL: <br />Enter Customer 19111ina Information below <br />LABOR: <br />$7,780.00 <br />Customer Contact Name: <br />Robin Tischmak, Senior Transportation Engineer <br />$150.00 <br />ER&R EQUIPMENT: <br />4i Customer Billing Company Name: <br />City of Tukwila <br />$6,325.00 <br />VENDOR EQUIPMENT: UBIT <br />Customer Billing Address No. 1: <br />6300 Southcenter Blvd. Suite 100 <br />FIR FLAGGING: <br />Customer Billing Address No. 2: <br />Tukwila, WA 98188-2544 <br />$770.001 <br />CONTRACT: <br />Customer Contact Phone Number: <br />206-433-0179 <br />$15,025.00 <br />�Mgr: <br />— <br />4�1011111 <br />TOTALS: <br />Roads Project Margaret Germeaux Roads PM Phone No: <br />206-477-3539 <br />OPEN SIGNATURES; <br />REQUESTOR NAM. <br />AU7HOFU2ER NAME <br />FIELD PROCESSING NAME <br />FNMCEPROCESSING: NAME <br />(REQUIRED) <br />CLOSURE DATE <br />DA TF <br />DATE <br />DATE .......... 4,FINANCEPROCESSING: <br />CLOSURE SIGNATURES: <br />­U1­R NAME <br />'.:AUTHORIZER: NAME. <br />FIELDPROCESS— NAME <br />NAME <br />IRE.UIRED) <br />IJATE. <br />DATE <br />DATE'. <br />DATE <br />CLOSURE DATE <br />ROADSCEFORM XLS REV 8/1T2010 <br />