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❑ Original <br />❑ Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />Date: August 1, 2018 <br />Contractor's UBI Number: 603 050 702 <br />Name & Mailing Address of Public Agency <br />City of Tukwila <br />6200 Southcenter Blvd <br />Tukwila WA 98188 <br />UBI Number: 602286020 <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 />Interurban Ave S (S 143rd St - Fort Dent Wy) 90310402 <br />Contract Number <br />14-067 <br />Job Order Contracting <br />❑ Yes LitfNo <br />Description of Work Done/Include Jobsite Address(es) <br />Construct full roadway improvements to Interurban Avenue South from South 143rd Street to Fort Dent <br />Way. Included sidewalks, pavement restoration, drainage and lighting. <br />Federally funded transportation project? d Yes ❑ No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />Walsh Construction Co II LLC <br />E-mail Address <br />emeifert@walshgroup.com <br />Affidavit ID* <br />758714 <br />Contractor Address <br />929 W Adams St, Chicago IL 60607 <br />Te <br />ephone # <br />If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. <br />❑ Retainage Bond g Contract/Payment bond (valid for federally funded transportation projects) <br />Name: Travelers Casualty and Surety of America Bond Number: 106080531 <br />Date Contract Awarded <br />May 5, 2014 <br />Date Work Commenced <br />July 21, 2014 <br />Date Work Completed <br />June 16, 2016 <br />Date Work Accepted <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 listed. <br />Contract Amount <br />Additions (+ ) <br />Reductions (- ) <br />Sub -Total <br />Sales Tax Rate <br />9.5 <br />(If various rates apply, please send a breakdown) <br />Sales Tax Amount <br />Inc..,te. CN <br />Comments: <br />7,496,650.20 <br />1,321,808.33 <br />0.00 <br />8,818,458.53 <br />Liquidated Damages $ 0.00 <br />Amount Disbursed $ 8,917,921.31 <br />Amount Retained $ 0.00 <br />$ 99462.78 <br />TOTAL $ 8.917.921.31 <br />NOTE: These two totals must be equal <br />TOTAL $ 8,917,921.31 <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 />tta <br />Department of Revenue <br />Public Works Section <br />(360) 704-5650 <br />PWC@dor.wa.gov <br />REV 31 0020e(10/26/15) F215-038-000 10-2014 <br />Washington State Department of <br />Labor & Industries <br />Contract Release <br />(855) 545-8163, option # 4 <br />ContractReiease@LNI. WA.GOV <br />Title: Fiscal Specialist <br />Phone Number: 206-433-1871 <br />Employment Security <br />Department <br />Registration, Inquiry, <br />Standards 8 Coordination <br />Unit <br />(360) 902-9450 <br />publicworks@esd.wa.gov <br />16 <br />