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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. 1121661 <br />Program No <br />Function No <br />Service No. <br />Planning Unit <br />Permit No: <br />Project Title: ;Bridge Inspection City of Tukwila <br />1* <br />Project Location: iVarious location in the City of Tukwila <br />J <br />KC Road Log <br />Number: <br />Project Type: Reimbursable Org: 5626 Division No: <br />Related CIP <br />Project No: <br />:(e <br />Start Year: <br />Is this a multi- <br />year project - <br />Yes/No: <br />2016 Start Date: l 2/1/16 <br />Yes <br />Estimated <br />year of final <br />completion: <br />PROJECT DESCRIPTION: <br />Inspection of 5 City owned bridges <br />Routine Inspections on Tuk -14, 18, 20, 21, & 22 <br />Provide inspection reports to WSDOT and the city after completion of the inspections. <br />TASK <br />55.02.08 <br />90.00.34 <br />TASK DESCRIPTION: <br />Estimated project expenditures by year: <br />2016 $3,675.00 2018 r <br />2017 I 2019 <br />Bridge Inspection <br />$2,015.00 <br />Administration, Tech support, Report Prep, UBIT and driver <br />$1,225.00 <br />Equipment <br />Contingency <br />TOTAL: <br />$110.00 <br />$325.00 <br />$3,675.00 <br />1 <br />AIRS CUSTOMER NUMBER: 73- <br />BR: SR: <br />LABOR: <br />ER &R EQUIPMENT: <br />VENDOR EQUIPMENT: UBIT <br />RR FLAGGING: <br />CONTRACT: <br />TOTALS: <br />ESTIMATED: <br />ACTUAL: <br />$3,240.00 <br />$110.00 <br />$325.00 <br />$3,675.00 <br />$0.00 <br />OPEN SIGNATURES: <br />* * * ** *REQUIRED FIELDS IF PROJECT IS REIMBURSABLE * * * * ** <br />Customer Contact Name: <br />Enter Customer Billing Information below <br />i <br />I Robin Tischmak, City Engineer <br />Customer Billing Company Name: City of Tukwila <br />Customer Billing Address No. 1: '6300 Southcenter Blvd. Suite 100 <br />Customer Billing Address No. 2: Tukwila, WA 98188 -2544 <br />Customer Contact Phone Number: 206 -431 -2456 <br />(REQUIRED) <br />Roads Project Mgr: <br />'Margaret Holwegner <br />(REQUIRED) <br />Roads PM Phone No: <br />206-477-3539 <br />(REQUIRED) CLOSURE DATE' <br />REOUESTOR: NAME: 3(1 DATE: <br />AUTHORIZER: NAME: i DATE: <br />FIELD PROCESSING: NAME: DATE: <br />FINANCE PROCESSING: NAME: DATE: <br />CLOSURE SIGNATURES: <br />REOUESTOR: NAME: <br />AUTHORIZER: NAME: <br />FIELD PROCESSING: NAME: <br />FINANCE PROCESSING: NAME: <br />(REQUIRED) CLOSURE DATE <br />DATE: <br />DATE: <br />DATE: <br />DATE: <br />ROADSCEFORM.XLS <br />REV 8/1/2010 <br />