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X <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />Date: 8/21/2019 11:33:56 AM Contractor's UBI Number: 601173970 <br />Name & Mailing Address of Public Agency <br />TUKWILA, CITY OF <br />6300 S CENTER BLVD #101 <br />TUKWILA 98188 <br />UBI Number: 916001519 <br />Original <br />Revised # <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 />S 140th St. Intersection Improvements (S 141st St. RRFB Pedestrian <br />Crossings) <br />Contract Number <br />19-031 <br />Job Order Contracting <br />Yes X No <br />Description of Work Done/Include Jobsite Address(es) <br />S 140TH STREET AND TUKWILA INTERNATIONAL <br />channelization. <br />BOULEVARD, <br />Installation of two RRFB crosswalks with new curb ramps and <br />Federally funded transportation project? <br />Yes X <br />No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />E-mail Address <br />Affidavit ID* <br />westwater construction company <br />mick.westwater@comcast.net <br />868846 <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 <br />the following and List Surety's Name & Bond Number. <br />X Retainage Bond <br />Contract/Payment bond (valid for federally funded transportation projects) <br />Name: Merchants Bonding Company <br />Bond Number: WAC54907 <br />Date Contract Awarded <br />Date Work Commenced <br />Date Work Completed <br />Date Work Accepted <br />2/19/2019 <br />3/18/2019 <br />5/3/2019 <br />5/9/2019 <br />Were Subcontracters used on this project? If so, please complete Addendum A. <br />X 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 />Sales Tax Rate 0.000% <br />(If various rates apply, please send a breakdown) <br />Sales Tax Amount $0.00 <br />TOTAL $220,948.00 <br />NOTE: These two totals must be equal <br />$221,300.00 <br />$0.00 <br />$352.00 <br />$220,948.00 <br />Liquidated Damages $0.00 <br />Amount Disbursed $220,948.00 <br />Amount Retained $0.00 <br />TOTAL $220,948.00 <br />Comments: <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: Scott Bates <br />Email Address: scott.bates@tukwilawa.gov <br />Department of Revenue <br />Public Works Section <br />t�Y.. 704-5=50 <br />Washingum Sups. avagtirms of <br />Labor & Industries <br />Contract Release <br />(BBE5) 54 —E. , o ptiar 4 4 <br />CortraotRelea gLNI.WA.3D1 <br />Title: Project Manager <br />Phone Number: 206-431-2193 <br />Employment Security <br />Department <br />Registration, Inquiry, <br />Standards & CDar dinatio <br />Unit <br />(SEO'. 2-9450 <br />p� tliva arks=;.xa.;�ti <br />REV 31 0020e (04/28/14) F215-038-000 04-2014 <br />8 <br />