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V Original <br />❑ Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />Date: DRAFT Contractor's UBI Number: 601332812 <br />Name & Mailing Address of Public Agency Department Use Only <br />ity o Tukwila Assigned to: <br />6200 Southcenter Boulevard <br />Tukwila, WA 98188 Date Assigned: <br />UBI Number:179000208 <br />Notice is hereby given relative to the completion of contract or project described below <br />Project Name <br />Contract Number <br />Job Order Contracting <br />Boeing Access Road Bridge Rehabiltation 99410408 <br />117-108 <br />❑ Yes [i(No <br />Description of Work Done/Include Jobsite Address(es) <br />Boeing Access Road Bridge Rehabilitation. Site location between 1-5 and E Marginal Way over the BNSF railroad tracks. <br />Seismic retrofit, deck surfacing, concrete sidewalk addition, steel work, painting, grouting, retaining wall, and earthwork. <br />Federally funded transportation project? V Yes ❑ No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />E-mail Address <br />Affidavit ID* <br />PCL Construction Svc Inc. <br />iSeattleAccounting@pcl.com <br />1864804 <br />Contractor Address <br />Telephone # <br />3650 131ST AVE SE, STE 650, BELLEVUE, WA, 98006 <br />425-454-8020 <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: <br />I Bond Number: <br />Date Contract Awarded <br />Date Work Commenced <br />Date Work Completed <br />Date Work Accepted <br />6/5/2017 <br />10/30/2017 <br />5/6/19 <br />07/18/2019 <br />Were Subcontracters used on this project? If so, please complete Addendum A. Wyes ❑ No <br />Affidavit ID* - No L&I release will be granted until all affidavits are listed. <br />Contract Amount <br />$ 6,189,244.00 <br />Additions + <br />() <br />$ 716,587.31 <br />Reductions <br />Sub -Total <br />Sales Tax Rate 0 <br />(If various rates apply, please send abreakdown) <br />Sales Tax Amount <br />$ 6,905,831.31 <br />TOTAL $ 6 905 831.31 <br />Liquidated Damages $ <br />Amount Disbursed $ 6,905,831.31 <br />Amount Retained $ <br />NOTE: These two totals must be eaual <br />TOTAL $ 6,905,831.31 <br />Comments: <br />No Sales tax, Rule 171. <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: Han Kirkland <br />Email Address: Han. Kirkland@tukwilawa.gov <br />Department of Revenue Washington Sw�rouT iDelm rrmrrn of <br />Public Works Section Labor & Industries <br />(360) 704 5650 Contract Release <br />PWC@dor.wa.gov (855) 545-8163, option # 4 <br />ContractRelease@LNI . WA. GOV <br />REV 31 0020e (10/26/15) F215-038-000 10-2014 <br />Title: Public Works Analyst <br />Phone Number: 206.431.2445 <br />IdIr Employment Security <br />Department <br />Registration, Inquiry, <br />Standards & Coordination <br />Unit <br />(360)902-9450 <br />publicworks@esd.w�.gov <br />