Laserfiche WebLink
City of Tukwila My WebLink |HelpSearch Tips |About |Sign Out
o� 4. <br />Original <br />❑ Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />Date: June 29, 2017 <br />Contractor's UBI Number: 601173970 <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 hereby given relative to the completion of contract or project described below <br />Project Name <br />Contract Number <br />Job Order Contracting <br />TO & South 144th Street Midblock Crossing Project <br />116-162 <br />❑ Yes VNo <br />Description of Work Done /Include Jobsite Address(es) <br />Installation of Rectangular Rapid Flashing Beacon system; installation of new junction boxes, <br />channelization and signage; and removal and replacement of existing sidewalks and curb ramps. <br />Federally funded transportation project? ❑ Yes Rf No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />E -mail Address <br />lAffidavit ID* <br />Westwater Construction Company <br />Imick.westwater@comcast.net <br />1717123 <br />Contractor Address <br />Telephone # <br />16209 SE 173rd Place, Renton, WA 98058 <br />425 - 891 -3362 <br />If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. <br />[K Retainage Bond ❑ Contract /Payment bond (valid for federally funded transportation projects) <br />Name: Merchants Bonding Company (Mutual) <br />JBond Number: WA100139 <br />Date Contract Awarded <br />Date Work Commenced <br />Date Work Completed <br />Date Work Accepted <br />November 21, 2016 <br />December 19, 2016 <br />February 17, 2017 <br />Were Subcontracters used on this project? If so, please complete Addendum A. Yes ❑ No <br />Affidavit ID* - No L &I release will be granted until all affidavits are listed. <br />Contract Amount <br />Additions ( +) <br />Reductions ( - ) <br />Sub -Total <br />Amount of Sales Tax 0.0 <br />(If various rates apply, please send a breakdown) <br />TOTAL <br />$ 88,300.00 <br />$ 0.00 <br />$ 9,577.73 <br />$ 78,722.27 <br />$ 0 <br />$ 78,722.27 <br />jvv1C: tnese two totals must ne <br />Liquidated Damages $ <br />0.00 <br />Amount Disbursed $ <br />78,722.27 <br />Amount Retained $ <br />0.00 <br />TOTAL $ 78,722.27 <br />Note: The Disbursing Officer must 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.jaber @tukwilawa.gov <br />Department of Revenue Washington sate Deparunem of <br />C Public Wo5650 rks Section <br />(360) 704 Labor & Industries <br />- Contract Release <br />PWC @dor.wa.gov (855) 545 -8163, option # 4 <br />ContractRel ease @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 />publjcworks@esd.wa.gov <br />2 <br />