Reg 2019-05-06 Item 4D - Final Acceptance - Andover Park East Water and Sewer Replacement with Titan Earthwork for $3,887,443.57

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❑ Original ❑ Revised # NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Date: 3/19/19 Contractor's UBI Number: 602605763 Name & Mailing Address of Public Agency City of Tukwila 6200 Southcenter Boulevard, Tukwila, WA 98188 UBI Number: 179 000 208 Department Use Only Assigned to: Date Assigned: Notice is hereby riven relative to the corn pie! on of contract or project described below Project Name Andover Park East Water & Sewer Replacement 99940103 Contract Number 16-111 Job Order Contracting ❑ Yes VNo Description of Work Done/Include Jobsite Address(es) Water and sewer line replacement and upgrade along Andover Park East between Strander Blvd and Tukwila Parkway. Federally funded transportation project? ❑ Yes Qf No (if yes, provide Contract Bond Statement below) Contractor's Name TITAN Earthworks LLC E-mail Address info@Titanearth.com Affidavit ID* 809250 Contractor Address 1585 Valentine Ave SE Te 206-325-3004 ephone # If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. VRetainage Bond E .f Contract/Payment bond (valid for federally funded transportation projects) Name: Berkley Insurance Company Bond Number: 0203356/0203354 Date Contract Awarded August 1, 2016 Date Work Commenced September26, 2016 Date Work Completed March 15, 2018 Date Work Accepted Were Subcontracters used on this project? If so, please complete Addendum A. [Yes ❑ No Affidavit ID* - No L&I release will be granted until all affidavits are listed. Contract Amount Additions (+ ) Reductions (- ) Sub -Total Amount of Sales Tax (If various rates apply, please send a breakdown) TOTAL $ 3,504,684.14 $ 602,701.52 $ 464,782.86 $ 3,642,602,80 244840.77 $ 3,887,443.57 Liquidated Damages $ 0.00 Amount Disbursed $ 3,887,443.57 Amount Retained $ 0.00 NOTE: These two totals must be e 9 ual TOTAL $ 3,887,443.57 Comments: The tax rate changed in the middle of the project so 9.5% tax was applied to payments made before the tax change on 4/1/17 and 10% was used for all payments after the change. The tax was applied only to the schedules that were not for Roadway. Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Submitting Form: Please submit the completed form by email to all three agencies below. Contact Name: Diane Jaber Email Address: diane.jaber@tukwilawa.gov rfa Department of Revenue Public Works Section (360) 704-5650 PWC@dor.wa.gov Washington State Department of Labor & Industries Contract Release (855) 545-8163, option # 4 ContractRelease@LNI. WA. GOV Title: Fiscal Specialist Phone Number: (206) 433-1871 x1871 Employment Security Department Registration, Inquiry, Standards & Coordination Unit (360) 902-9450 publicworks@esdwa.gov REV 31 0020e (4/28/14) F215-038-000 04-2014 17