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Date: <br />g Original <br />❑ Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />Contractor's UBI Number: 602286020 <br />Name & Mailing Address of Public Agency <br />City of Tukwila <br />6200 Southcenter Boulevard <br />Tukwila, WA 98188 <br />UBI Number: 179000208 <br />Department Use Only <br />Assigned to: <br />Date Assigned: <br />Notice is hereby given relative to the completion of contract or project described below <br />Project Name <br />Duwamish Gardens Habitat Project 90630102 <br />Contract Number <br />15-112 <br />Job Order Contracting <br />❑ Yes V No <br />Description of Work Done/Include Jobsite Address(es) <br />Construction of a 2+ acre salmon habitat restoration site and public park along the Duwamish River. <br />Federally funded transportation project? ❑ Yes IYJ No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />McCann Trucking & Excavating <br />E-mail Address <br />Arlene@RCNW <br />Affidavit ID* <br />744399 <br />Contractor Address <br />P.O. Box 481 Renton, WA 98057 <br />Te <br />425-228-2316 <br />ephone # <br />If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. <br />❑ Retainage Bond ❑ Contract/Payment bond (valid for federally funded transportation projects) <br />Name: Bond Number: <br />Date Contract Awarded <br />May 18, 2015 <br />Date Work Commenced <br />June 15, 2015 <br />Date Work Completed <br />February 1, 2017 <br />Date Work Accepted <br />Were Subcontracters used on this project? If so, please complete Addendum A. (Yes ❑ No <br />Affidavit ID* - No L&1 release will be granted until all affidavits are listed. <br />Contract Amount <br />Additions (+ ) <br />Reductions (- ) <br />Sub -Total <br />Amount of Sales Tax <br />9.5 <br />2,235,020.05 <br />$ 62,879.59 <br />$ 88,925.57 <br />$ 2,208,974.07 <br />(If various rates apply, please send a breakdown) $ <br />TOTAL <br />209931.44 <br />$ 2,418,905.51 <br />Liquidated Damages $ 0.00 <br />Amount Disbursed $ 2,308,456.79 <br />Amount Retained $ 110,448.72 <br />NOTE: These two totals must be equal <br />TOTAL $ 2,418,905.51 <br />Comments: <br />All but one invoice had Sales Tax at 9.5% with a total of $208,353.36. Only the last invoice after 4/1/17 <br />was at 10% for $1,578.08. Total sales tax was $209,931.44. <br />Note: The Disbursing Officer must submit this cd�m®leted notice immediately after acceptance of the work done under this contract. <br />NO PAYMENT SHALL BE MADE FROM RE+th1ED 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 <br />Public Works Section <br />(360) 704-5650 <br />PWC@dor.wa.gov <br />0 Washington State Department of <br />Labor & Industries <br />Contract Release <br />(855) 545-8163, option # 4 <br />ContractRelease@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 />publicworks@esd.wa.gov <br />6 <br />