Laserfiche WebLink
City of Tukwila My WebLink |HelpSearch Tips |About |Sign Out
Date: <br />[VI Original <br />II Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />10-9-2018 <br />Contractor's UBI Number: 601 006 854 <br />Name & Mailing Address of Public Age <br />y <br />City of Tukwila <br />6200 Southcenter Blvd Tukwila, WA 98188 <br />UBI Number: 91-6001519 <br />DepartmentIse Only <br />Assigned to: <br />Date Assigned: <br />Notice is herebyiven relative to the corn plet' on of contract or project described below <br />Project Name <br />2018 Annual Overlay Program 91810401 <br />Contract Number <br />18-071 <br />Job Order Contracting <br />111 Yes F'No <br />Description of Work Done/Include Jobsite Address(es) <br />Hot Mix Asphalt (HMA) Overlay at the following locations: Southcenter Blvd, 58th Ave S, 5.133rd St and <br />Ft dent park. <br />Federally funded transportation project? [1] Yes g No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />ICON Materials <br />E-mail Address <br />mark.eichelberger©iconmated <br />Affidavit ID* <br />833761 <br />Contractor Address <br />1508 Valentine Ave SE Pacific, WA 98047 <br />Te <br />206-575-3200 <br />ephone # <br />If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. <br />gRetainage Bond El Contract/Payment bond (valid for federally funded transportation projects) <br />Name: Fidelity and deposit Company of Maryland Bond Number: 9283910 <br />Date Contract Awarded <br />5-11-2018 <br />Date Work Commenced <br />5-18-2018 <br />Date Work Completed <br />7-20-2018 <br />Date Work Accepted <br />Were Subcontracters used on this project? If so, please complete Addendum A. VYes 111No <br />Affidavit ID° - No L&1 release will be granted until all affidavits are listed. <br />Contract Amount <br />Additions ( + ) <br />955,945.50 <br />Reductions ( - ) 59,112.09 <br />Sub -Total 896,833.41 <br />Sales Tax Rate n/a rule 171 % <br />(If various rates apply, please send a breakdown) <br />Sales Tax Amount <br />TOTAL $ 896.833 41 <br />Liquidated Damages $ 0.00 <br />Amount Disbursed $ 896,833.41 <br />Amount Retained 5 0.00 <br />NOTE: These two totals must be equal <br />Comments: <br />TOTAL <br />896,833.41 <br />Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. <br />NC) 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: <br />Email Address: <br />Diane Jaber <br />Diane,jaber@tuk ilawa.gov <br />Department of Revenue <br />Public Works Section <br />(360) 704-5650 <br />PVVCgclor.wa gov <br />1N,oI5n9von STA to Doporonont of <br />Labor & Industries <br />Contract Release <br />(855) 545-8163, option # 4 <br />ContractReleasegLNI.VVA GOV <br />Title: Fiscal Specialist <br />Phone Number: 206-433-1871 <br />Employment Security <br />Department <br />Registration, Inquiry, <br />Standards & Coordination <br />Unit <br />(360) 902-9450 <br />publicworksgesd wa gov <br />REV 31 0020e (l0/26/15) F215-038-000 10-2014 <br />2 <br />