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V Original <br />❑ Revised # <br />NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT <br />Date: June 2, 2020 Contractor's UBI Number: 602 271 532 <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: 602286020 <br />Notice is hereby given relative to the completion of contract or proiect described below <br />Project Name <br />Contract Number <br />118-127 <br />Job Order Contracting <br />2018 Annual Small Drainage - Project #91841201 <br />❑ Yes [i(No <br />Description of Work Done/Include Jobsite Address(es) <br />Construct the following drainage improvements: 1) Catch basin retrofits on Interurban Ave S., S 180th St and Todd <br />Blvd; 2) Pipe abandonment on T.I.B. 3) Gilliam Creek outfall access, 4) S 180th St bridge retaining wall (flood <br />protection) and 5) Levee 205 pipe lining <br />Federally funded transportation project? ❑ Yes V No (if yes, provide Contract Bond Statement below) <br />Contractor's Name <br />E-mail Address <br />Affidavit ID* <br />Ceccanti Inc <br />ijake@ceccantiinc.com <br />not filed <br />Contractor Address <br />Telephone # <br />4116 Brookdale Rd. E., Tacoma, WA 98446 <br />253-537-2990 <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 />June 19, 2017 <br />September 19, 2018 <br />April 12, 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 />Additions ( + ) <br />Reductions (- ) <br />Sub -Total <br />Sales Tax Rate 10 % <br />(If various rates apply, please send abreakdown) <br />Sales Tax Amount <br />$ 520,304.00 <br />$ 48,957.66 <br />$ 32,652.14 <br />$ 536,609.52 <br />26235.42 <br />TOTAL $ 562 844.94 <br />Liquidated Damages $ <br />0.00 <br />Amount Disbursed $ <br />536,014.47 <br />Amount Retained $ <br />26,830.47 <br />NOTE: These two totals must be eaual <br />TOTAL $ 562,844.94 <br />Comments: <br />The contract had two schedules, Schedule A, which was tax exempt per Rule 171, and Schedule B, <br />which was taxed. The change order was included in Schedule B, and was also taxed. <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: Mike Perretti <br />Email Address: mike.perfetti@tukwiiawa.gov <br />Department of Revenue Washington Svite iDelm rrmrrn of <br />Public Works Section Lab r & Industries <br />(360) 704-5650 Contract Release <br />PWC@dor.wa.gov (855) 545-8163, option # 4 <br />ContractRelease@LN I. WA.GOV <br />REV 31 0020e (10/26/15) F215-038-000 10-2014 <br />Title: Habitat Project Manager <br />Phone Number: 206-433-7192 <br />Alff Employment Security <br />Department <br />Registration, Inquiry, <br />Standards & Coordination <br />Unit <br />(360)902-9450 <br />publicworks@esd.wa.gov <br />2 <br />