HomeMy WebLinkAbout11-112 - Green River Construction - 2010-2011 Small Drainage Program11- 112(h)
Council Approval N/A
,NILA dt
sy Sheet 1 of 1
CITY OF TUKWILA
CONTRACT CHANGE ORDER NO. 08
NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner" which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Make modifications to the proposed drainage system at Site #3 (Museum.of Flight) per Field
Directive #09 attached. This Change Order will reimburse for impacts to productivity of lowering
the drainage pipe along East Marginal way, changing out the casting in the intersection and credit
the reduced material costs for 8" vs. 12" ductile iron pipe. A time extension will also be provided to
include a weekend no work period.
This Change will be compensated under Schedule A Storm Drainage. There is a three day time
extension associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specified, and Will accept as full payment therefore the prices shown abov and below.
ACCE E Date 3� //L Contracto /t
By ki 40' W) Title
Origi I ContqV 788,005.50 r/ APPROVED BY THE CITY OF TUKWILA
Previous Change Order 29,711.20'
This Change Order 619.79 B
9 Y V
REV. CONTRACT AMOUNT 818,336.49
ORIGINAL: City Clerk (I of 2) Contractor (2 of 2) J
Note: Sales tax shall be included in the various unit prices, per Standard Specification 1 -07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 5 "di
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; le:
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
N
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 009
To: Green River Construction
6402S.144 1h St. #1
Tukwila WA 98168
Attn: Jerry Knudson
Date: 11/17/11
Project Name: 2010/2011
Project No.: 91041201
I Contract No.: 11 -112
Small Drainage Proj. I
Work to be performed:
Modify the drainage pipe elevations and size per the exhibit attached. Drop the main line run from
CB #2 to CB #3 by 12" to clear below the existing signal conduit. Downsize the pipe from CB #1 to
CB #2 to 8" ductile iron while maintaining the existing crown elevation to clear the unknown
concrete block between these. two structures. Provide Ethifoam pads between tight pipes at
crossings to ensure separation. Modify the CB #2 lid from a solid rectangular lid to a solid ring and
cover. Convert the Type 1 CB to the round lid using an appropriate adapter or cast in place brick
and grout transition. Track changes to original plan (plus and minus) using Force Account rules.
Reason for modification:
Potholing of existing utilities exposed conflicts with the existing installation plan. The revised plan
resolves these conflicts through changes in depth and pipe size.
Work under this Field Directive modification will be accomplished:
With work to start immediately and determination of any change to the contract price to be
tracked using Force Account Resolution of Utility Conflicts.
With impact to the contract completion date evaluated using Time Impact Analysis.
Performance of 0'a"' Id Directive is authorized by all signatures below:
Accepted by: �y
tractor's Rep —Name
T`
Date
hilt
Approved by.
City Construction Engineer
1L
Date
��'I` I act i
Verified by:
City Construction Inspector
Date
x
2011 SDP FA 11- 18- 11.xlS
FA Sheet No.:
001
DAILY REPORT OF
$i
FORCE ACCOUNT WORKED�
Project Name: 2011 Small Drainage
Project No: 91041201
Item No.: CO #08
Date: 11/17/12 11/21/12
Description of Work: Productivity impact for changes to scope of work at Site #3 (EMW). Extra
speed shoring at joint locations, new pipe type
and conversion of castings.
Work by Subcontractor
No
Prime Contractor: Green River Construction
Sub Contractor:
ffi W LABOR
STRAIGHT TIME
OVERTIME
DOLLAR
NAME CODE OCCUPATION
Hrs 1 Hourly Rate I
Hrs OT Rate I
AMOUNT
Joel Johnson ISuper ISuperintendant 1
1.501 61.33
106.55
92.00
David Knudson 1Fore IForeman 1
1.001 61.36
106.60
61.36
Denny Mellot IMec Op IMechanic and operator
1.501$ 59.81
103.94
89.72
Kyle Copland IPipe 1PipeLayer
1.001$ 47.91 1
83.48 1
47.91
Chris Parshal (Pipe lPipeLayer
1.50 47.91
83.48
71.87
Phil Knudson 1Lab (Laborer
1.50 47.43
82.66
71.15
Steve Hatfield (Truck ITruck Driver 1
1.001 45.63 1
79.56 1
45.63
I
1$ I
1$
SUBTOTAL LABOR:
479.64
LABOR OVERHEAD
PROFIT 29%
139.10
LABOR TOTAL
618.74
NT
EQUIPMENT OR ATTACHMENTS
OPERATED
STANDBY
DOLLAR
Equipment Equipment Description
Hrs I Hourly Rate I
Hrs (Standby Ratel
AMOUNT
GR -PC120 I PC 120 I
1.501$ 59.73 1
-1 15.31 1
89.60
GR -58OBH 1580 Backhoe (x2) I
2:001 33.30 1
1.001 8.37 1
74.97
GR 10T 110 CY Dump Truck I
1.001$ 45.68 1
1 8.79 1
45.68
GR -5T &Tools 15 CY Dump Truck/Small Tools 1
1:.501$ 34.97 1
1 8.24 J$
52.46
GR -ST1 IService Truck I:
1.501 20.85 1
1 I
31.28 1
I
I s I
I$ I$
SUBTOTAL
EQUIPMENT
293.99
EQUIPMENT OVERHEAD
PROFIT 21
61.74
EQUIPMENTTOTAL
355.73
'MATERIALS /SERVICES /RENTALS'
MATERIALS SERVICES l
Tax I Quantity I
Units l Unit Price I
AMOUNT
1 I
I I$
I$
I$
SUBTOTAL
OVERHEAD
PROFIT 21
TOTAL
Verification of Hours Worked:
TOTAL:
974.47
12%
MARKUP
(for
prime when subcontract work)
Contrajftor's PApreselative Date
SHEET TOTAL:
974.47
W e tivv Y(B Date Z_
Pay Estimate Entered.
Date:
By:
2011 SDP FA 11- 18- 11.xlS
Q*
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Aj a o K
Re: 20120/2011 Small Drainage Program #11 -112
Close -Out Information Ring Cover vs. Frame Grate Cost Difference
Dear Mike:
The following is.pur calculation for the cost difference between the ring 1 3t cover vs. frame
grate at Site
Ring Cover
East Jordan Iron Works #3427733 294.58
Frame Grate
Olympic Foundry #219780 218.00)
Difference
Markup 21%
Use Tax on Mat'I Diff 9.5 =Tc
Total
Sincerely,
Jerry Knudson
President
W/'0
zvZ
IL
i
INVOICE
AST.IORDAN 800.626.4653
.,RON WORKS EST.1883 www.ejiw.com
AVER YOUR INFRASTRUCTURE'
ast Jordan Iron Works, Inc.
Department 59601
P.O. Box 67000 r
Detroit, MI r
48267 -0596 OC U J
Sales Branch: Northwes Area Yard' 9
SOLD TO:
9012 1 MB 0.390 E0191X 10303 D386872946 P899346 0001:0001
GREEN RIVER CONSTRUCTION
6402 S 144TH ST STE 1
TUKWILA WA 98168 -4636
00371783A01 3715ZPT C1 PT GKT HL1 TUKWILA STM LO
STORM /SEAL OF TUKWILA,WASHINGTON
1908 2008 (HAZELNUT LOGO)
Non cancelable, Non returnable
DEPARTMENT 59601
P.O. BOX 67000
DETROIT, MI
48267 -0596
Green River Construction
6402 S 144th Street
Jerry 206 730 -2825
Tukwila, WA 98108
OC 25 2011.
269.02
A V
1 of 1
342773:
10/19/1
10/18/1
342773;
673:
41(
11/18/1'
269.02
EJIW is transitioning to electronic delivery (emailing and
FAX) of all customer invoices. Please send customer
number, email address or fax number to
Accountsreceivable@ejiw.com or fax a copy of your
invoice to 231- 536 -4619 with the information. Thank you!
i
I
A monthly FINANCE CHARGE will be added to any unpaid balance which is not paid when due. The FINANCE CHARGES are computed by a
AMOUNT 269
periodic rate of 1 112% per month (from and after the due date) which is an ANNUAL PERCENTAGE RATE OF 18% applied to the unpaid balances
after deducting payments made before the due dates and/or credits. Payments received on account are applied against the amounts first due. 0 o y 25.5E
We hereby certify that these goods were produced in compliance with all applicable requirements of Sec. 6, 7, 12 of the Fair Labor Standards Act,
as amended, and of regulations and orders of the United States Department of Labor issued under Sec. 14 thereof,. OGi
FREIGHT EJIW, Inc. terms conditions apply. Document available at www.ejiw.com TOT D 39
Invoice Page: 1
Olympic Foundry
QUALITY CASTINCS r"',
1900
Invoice No.: 0000219780
Olympic Foundry, Inc.
Invoice Date:
10/13/2011
5200 Airport Way South
Customer No.:
GrRiCoJAC
Seattle, WA 98108
(206) 764 -6200
Branch:
06
Salesperson::
Lee H.
0.00
Our Order No:
SO- M34919
SH Code:
PPAI
e e
Green River Construction 1729 2010/2011 SMALL DRAINAGE PROGRA
6402 S 144th Street Ste 1 13800 INTERNATIONAL BLVD
Tukwila, WA 98168 USA TUKWILA, WA 98168 -3169 USA
CusiorrieiP.O. Shi FOB..._ —Terms--
JERRY OurTruck Jobsite 1% 10 Net 30
Descriptione
12- 4520SET 06 SM60 CB FRAME /SOLID DI DT 1 218.000 T 218.00
12- 4525SET 06 SM60 CB FRAI& NED DI DT 17 218.000 .00
OCT 1 8201, I
d
Contact: Rhonda Subtotal 3,924.00
Shipping Handling 0.00
Sales Tax
Terms and Conditions of Sale Trade Discount 0.00
Payment/Credit Amount 0.00
Quantity variations must be reported within5 days of receipt of material. 3,924.00
All other claims and returns must be accompanied by an invoice within
30 days. All returns are subject to a re- stocking fee.
You may deduct $39.24 if paid by 10/23/2011
r'.
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
s
s
C.-
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
Close -Out Information -8" DI vs. 12" DI
Dear Mike:
The following is our calculation for the 8" DI vs. 12" DI credit to be taken by the City of Tukwila
Copies of our quote and invoice from Pacific States Cast Iron Pipe have been attached for your
rafarPnra
12" DI
8" DI
Difference
Markup 21%
Use Tax on Mat'I 9.5%
Total
Actual 8" DI installed:
Site #3 Museum of Flight
Site #4 Allentown
Total
25.29/LF
17.60/LF)`
7.69/LF
1.61/LF
S 17.3.1LE
10.03 /LF 14P
42 LF
132 LF
Credit calculation:
132 LF x $10.03 /LF 1,323.96 C(
$1,323.96 $58.00 (12" DI) 2�of 12" D1--
p
Sincerely,
Jerry Knudson 4 1 0 A 21�
President
Project: City of Tukwila Storm Sewer 2011
Location: Tukwila, Wa
Glenn Watkins
District Manager
POBox 770
Maple Valley, WA 98038
Office: (206)719 -4090
Fax: (801)377 -0338
Mobile: (206)719 -4090
Bid Date: 09/0112011
Bid Time: 8:00 AM
Quote No.: 3012
Revision:
We are pleased to quote you on the materials set forth below conforming to specifications in our catalog and subject to'Pacific States Cast Iron Pipe
Company's terms and conditions found at our website www.pscipco.com.
All prices are quoted F.O.B. foundry with freight charges allowed to the jobsite in minimum 40,000 pound truckload quantities, where accessible to
standard truck and trailer movements. Unloading charges are not included.
Prices are exclusive of any state or city sales or use tax which may apply. Payment terms are 11% 10 net 30 days. A service charge of eighteen
percent (18 per annum or the maximum allowed by law, whichever is greater, will be added on any unpaid amount.
Prices are based on supplying 3" to 4" pipe in 18' nominal lengths and 6" to 36" in 18' nominal lengths with standard cement lining and seal coating
inside and out, unless otherwise noted. Gaskets are quoted as standard SBR material, unless otherwise noted. Polywrap is not included unless it is
specifically itemized on the quotation. Layout drawings are not included.
Quoted prices are valid for a period of 45 days from the original quotation date. Due to continuing volatility in raw materials, energy, and transportation
costs, delivery must be taken within 90 days of the original purchase order. Orders that remain open after that 90 day period will be subject to price
review and /or cancellation, at our sole discretion. These terms supersede Paragraph 2 (Quotations) of McWane's standard Terms and Conditions, of
which all other provisions govern this agreement. Orders placed after the 45 day period will be subject to a price review and /or a price increase, at our
sole discretion.
Pacific States makes every effort to generate an accurate quote; however we do not guarantee its accuracy and completeness. We caution the
ordering party to check and verify the accuracy of all quantities and the compliance with the project specifications before submitting a bid and /or
PSCIPCO
PACIFIC STATES
CAST IRON PIPE COMPANY
�3
DIVISION OF MCVJANE, INC.
P.O. BOX 1219, PROVO, UTAH 84603
ak
TELEPHONE (AREA CODE 801) 373 -6910
1 I 1,200 LF
112 TJ X PE 50 CL SC /SC
Date: 2/2/2012
30,348.00
To: Green River Construction
Project: City of Tukwila Storm Sewer 2011
Location: Tukwila, Wa
Glenn Watkins
District Manager
POBox 770
Maple Valley, WA 98038
Office: (206)719 -4090
Fax: (801)377 -0338
Mobile: (206)719 -4090
Bid Date: 09/0112011
Bid Time: 8:00 AM
Quote No.: 3012
Revision:
We are pleased to quote you on the materials set forth below conforming to specifications in our catalog and subject to'Pacific States Cast Iron Pipe
Company's terms and conditions found at our website www.pscipco.com.
All prices are quoted F.O.B. foundry with freight charges allowed to the jobsite in minimum 40,000 pound truckload quantities, where accessible to
standard truck and trailer movements. Unloading charges are not included.
Prices are exclusive of any state or city sales or use tax which may apply. Payment terms are 11% 10 net 30 days. A service charge of eighteen
percent (18 per annum or the maximum allowed by law, whichever is greater, will be added on any unpaid amount.
Prices are based on supplying 3" to 4" pipe in 18' nominal lengths and 6" to 36" in 18' nominal lengths with standard cement lining and seal coating
inside and out, unless otherwise noted. Gaskets are quoted as standard SBR material, unless otherwise noted. Polywrap is not included unless it is
specifically itemized on the quotation. Layout drawings are not included.
Quoted prices are valid for a period of 45 days from the original quotation date. Due to continuing volatility in raw materials, energy, and transportation
costs, delivery must be taken within 90 days of the original purchase order. Orders that remain open after that 90 day period will be subject to price
review and /or cancellation, at our sole discretion. These terms supersede Paragraph 2 (Quotations) of McWane's standard Terms and Conditions, of
which all other provisions govern this agreement. Orders placed after the 45 day period will be subject to a price review and /or a price increase, at our
sole discretion.
Pacific States makes every effort to generate an accurate quote; however we do not guarantee its accuracy and completeness. We caution the
ordering party to check and verify the accuracy of all quantities and the compliance with the project specifications before submitting a bid and /or
placing an order.
Bid Item I Quantity
I Description
I Price
Total
1 I 1,200 LF
112 TJ X PE 50 CL SC /SC
I I 25.29
30,348.00
2 I 140 LF
18 TJ X PE 50 CL SC /SC
I a 17.60 I
2,464.00
r
32,812.00
a
ivies IN U C _H C 1 U K r i� U C 4 V I t t I j�� iv c r_.1 Vii_ K_L, 1 r r.
P age I of,
Invoice Page: 1
PSCIFCO Pacific States Cast Iron Pipe Company Invoice: 0000034148
P.O. Box 1219, 2550 S. Industrial Parkway Date: 10/7/2011
Provo, UT 84603 -0219 Customer: 27950
Phone: (801) 373 -6910, Fax: (801) 377 -0338 Warehouse: Main
REMIT TO: P.O. BOX 848312, DALLAS, TX 75284 -8312
Territory: Seattle
Sales Order: 0000015437
B.O.L.: 0000038162
Sold To
GREEN RIVER CONSTRUCTION CO
6402 S. 144TH SUITE 1
TUKWILA, WA 98168 -4636 USA
Ship Via
Tradewinds
Description
12 TJ X PE 50 CL SC /SC
12 TJ GASKET
GALLON PIPE LUBRICANT
LAST ITEM
Customer P.O.
STORM SEWER
QTY UOM Item
32.00 Each 41210501111
32.00 Each iG12RI0
1.00 Each I L1GLX
1
i
Contact: JERRY KNUDSON
Ship To
GREEN RIVER CONSTRUCTION CO.
6402 S. 144TH SUITE 1
206 730 -2825 JERRY
TUKWILA, WA 98168 -4636 USA
F.O.B
Terms
Plant Prepaid
1% Discount in 10 Days Net 30
Qty Shipped
UOM P Amount
580.000
LF X25.29 14,668.20
32.0001
Each """'0':00' 0.00
1.000.
Each 0.00 0.00
i
It�V
0 7
Subtotal
14,668.20
0.00
0.00
Trade Discount
0.00
Payment/Credit Amount
0.00
Balance
14,668.20
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
Request for Additional Days
Dear Mike:
We are requesting that the additional days be added to our contract.��
9.22.11 —Site 5 Evergreen Foods 1 ry
Waiting for decision on backfill of void under 24 pipe. a
9.30.11— Site 5 Evergreen Foods �°�1�`� I& AV
Regrading parking lot adjacent to new structure and resetting existing structures s%- C
10.17.11 Site 4 Allentown 1 Day
Extra 90LF storm CB at 12227
10.20.11— Site 4 Allentown
Added grading paving of thickened edge
10.28.11 10.31.11— Site 1 Wells Trucking
Additional contaminated soil export
11.23.11 Site 3 Museum of Flight
Sincerely,
Jerry Knudson C Z W010 -6 WF
President ,opt ID 0144- M>
Al "d W -�v A
2 Days 51/ 6011.'. fl aQS
1 DaY
V-16CROXIV- ID, TO
,jg .1 r',;.`%
X 44' .'e ,kl
f 11- 112(g)
Council Approval N/A
J�wILA, kk
o� sZ Sheet 1 of 1
�o CITY OF TUKWILA
2
CONTRACT CHANGE ORDER NO. 07
Ila
NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner" which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Make various modifications to the proposed drainage system at Site #1 (Wells Trucking) per Field
Directive #07 attached. The specific items in this Change Order include investigations and
modifications at existing CB #5 and rerouting an existing 4" drain line to CB #l: Other items listed
in the Field Directive are handled separately. Several items for this Change Order have been
previously paid under Minor Change. The amounts paid will be credited back to the Minor Change
item with the execution of this Change Order.
This Change will be compensated under Schedule A Storm Drainage. There is a two day time
extension associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specif
ACie d will accept as full pa ment therefore the prices shown above and beloG��� /!2!�
CE TE Date 3� Contractor
By Title
Ori al Contra 788,005.50 APPROVED BY THE CITY OF TUKWILA
Previous Change Order
This Change Order
REV. CONTRACT AMOUNT
20,912.79' Date
8.798.41
817,716.70 *arf
ORIGINAL: City Clerk (1 of 2) Contractor (2 of 2)
M ote: Sales tax shall be included in the various unit prices, per Standard Specification 1- 07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 p yip d L 1
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
M
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite 9200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 007
To: Green River Construction Date: 10/12/11 j
6402S. 144' St. #1 Project Name: 2010/2011 Small Drainage Proj. 1 1
Tukwila WA 98168 Project No.: 91041201 I
Attn: Jerry Knudson I Contract No.: 11 -112
Work to be performed:
Make various modifications to the proposed Wells Trucking (Site 1) drainage system per the
attached Exhibit. Change MH #3 and MH #4 castings to locking solid metal lids to avoid surface
water infiltration at these locations. Grade existing gravel parking area near MH 43 to drain to
existing private water collection feature with oil water separator. Attach the existing underdrain pipe
that currently discharges onto the sidewalk near CB #1 to new MH 92. Perform potholing
surrounding the existing MH #5 to investigate existing connections to this manhole and determine
feasibility of adding an additional barrel section to the manhole to bring the flat top lid within City
standards for future access. Once potholing is complete provide a cost estimate to add the barrel
section if requested.
Reason for modification:
The Wells trucking site has extensive heavy industry traffic continuously moving through the
parking area where we are placing our storm pipe. The original plan showed the installation of
vaned grates on two of our new structures to avoid surface water ponding in the parking area. This
option could introduce untreated and contaminated water into the public system which discharges
directly into a salmon bearing stream. The proposed solution will provide increased protection to the
salmon stream by routing the private runoff through the existing private detention /treatment system
prior to discharge. Additional investigation is also requested to ensure an accurate understanding
of how the private drainage system currently works.
Work under this Field Directive modification will be accomplished:
With work to start immediately and determination of any change to the contract price to be
tracked by Force Account Property Restoration and existing unit price items for Additional
Drainage Connection, CSTC, and Potholing.
Any impact to the project completion date will be evaluated based on Time Impact Analysis.
Performance of this Field Directive is authorized by all signatures below:
Accepted by: cJ� ilr�'in
actor Rep Name
V, C�
Approved by.
City Construction Engineer Date
Verified by:
City Construction Inspector Date
x
x
A�
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
Awe
IL
Field Directive 47
October 25, 2011
Site 1- CB #5 Rehab Existing unsuitable soil
Labor
Denny Mellott
Eq Op
4.0 Hrs $59.81/Hr
Joel Johnson
Supr /Eq Op
8.0 Hrs $61.36/Hr
Chris Parshall
Laborer
8.0 Hrs $47.91/Hr
Kyle Copeland
Laborer
3.0 Hrs $47.91/Hr
Labor Subtotal
Markup 29%
Total Labor
Eouipment
580M Backhoe
UHO 330
Service Truck
Trash Pumps
Discharge Hose
Equipment Subtotal
Markup 21%
Total Equipment
Material
Sandbags
Sand Cement
Dump Fees
Material Subtotal
Markup 21%
Total Material
C**o1r
239.24
490.88
383.28
383.28
1,496.68
434.04
1,930.72
I le, Hrs $47.48/Hr 0 39.84 �S!
�Irs $166.68/Hr 8 9;44
C>� 8.0 Hrs $20.85/Hr 166.80
�9�$9f
2.0 EA EA 3D8� ""42=
�Wh* S incl
-@8- 1,5
s('7, 48��.f 15,•`x'7 -�"S'2 J1�
25 EA $7.25/EA 181.25
3 Sets $22.50 /Sets 67.50
1 Load $125.00 /Ld S 125.00
373.75
78.49
452.24
Subcontractor
Pacific Concrete Services #35164
Vactor truck with dump fees
Markup 12%
Total Sul
Potholes Extra
Total
1,018.00
Y 122.16
l
a
<A $8 /EA
1,140.16
5, 347
1 NC�1. 'P. W G v, 4 7
Washifrigton State
Department of Transportation Daily Report of Force Account Worked
Contract Number Date Item Number Item Name
Prime Contractor Subcontractor/ Lower Ter Subcontractor
Line Station Group Basls of Material Acceptance RAMS Number
Description of Work Performed
Time Worked Record
l Workers andlor Equlpment I Occupation of Workers or I Hours Workodl }v O.T. Amount
j i Working f EqutpmentSIze Reg. 1. O.T. I Rate Rate
1, I
I
ti( 4 Lai
101���: I I I I I
12
13l��
14 l I I
17 1.,.. l I I
u Y' A lQ I r L i I lJ
201 ORS
Calculated By Checked By Date
Total
Ledger Entry Number Entered By f Date Entry Vedfied I pate
lnsp ctor tgnatura Contractor's Representative Signature. Title
DO Form 422 -0OSEF
Revised 0912008
PACIFIC CONCRETE SERVICES
Invoice
26220 79th Ave So
Kent, WA 98032 -7327
Date
Invoice
253.856.2572 Phone
lo/zs /2o11
35164
2 53.859.5087 Fax
Bill To
Job Name
Green River Construction
Wells Trucking
6402 S 144th St Suite #1
21677 E. Marginal Way S
Tukwila, WA 98168 -4609
Tukwila, WA
P.O. Number
Terms Due Date
Rep
Date Complete
I I
Net 30 11/24/2011 I
SM
I I
1 10/25/2011
(111
Quantity Description
Rate
Amount
3 Hours Vac Truck Clean (1) type 2 Catch Basin
145.00
435.00
400 Gallons Dump Fee Liquids
0.32
128.00
3 Yards Dump Fee Solids
135.00
405,00
1 Tank Wash Out required to eluninate. sludge
50.00
50.00
Total $1,018.00
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
PAY
Total
0�_
099 3
Directive #7
W�"""
Field
October 28, 2011,,
Site 1- Existing CB #S
Labor
w
Bob Parshall Eq Op
2.0 Hrs $59.81/Hr
119.62
Joel Johnson Supr /Eq Op
2.0 Hrs $61.36/Hr
122.72
Phil Knudson Laborer
2.0 Hrs $47.27/Hr
S
94.54
Labor Subtotal
336.88
Markup 29%
97.70
Total Labor
434.58
Equi pment
S90M Backhoe
2.0 Hrs $47.48/Hr
94.96
PC 120
2.0 Hrs $75.34/Hr
150.68
Service Truck
2.0 Hrs $20.85/Hr
S
41.70
Equipment Subtotal
287.34
Markup 21%
S
60.34
Total Equipment
347.68
Material
2'- 54" Section
1.0 EA $429.00/EA
429.00
54" Flat Top
1.0 EA $318.00/EA
318.00
20 "x24" Frame Grate
1.0 EA $253.75/EA
253.75
1n nTnnc Q S ?O 5Q /Tr
X361 r F nntaminatc i o
A
VAK't' W t(�(
Material Subtotal
l9OO M
Markup 21%
5
Aq-6-ffr"
zt0 L
Total Material
Total
0�_
099 3
Wasbington Stafie
./AO Department of Tfransportafion
Contract Number Date
t o
Prime Contractor
Daily Repott of Force Account Worked"
Item Number Item Name
Subcontractor i Lower ner Subcontractor
Une Station Group
Basis of Material Acceptwco RAMS Number
Description Work Perform d
Time Worked Record
Workers andfor Equipment
Worktnq
Occupation of Workers or
Eauipmant Sfze
I Hours Worked l Reg.
Reg. O.T. Rata
O.T. Amount
I Rate
2 `��.hG f G r f
I
r z
I
I
I
I
PC-
I
I
I
I
.L
1 i
6 s te �-���c I
2
i
i
I
I
eA
I
I I
I
vIn 5-
121
141 I
I
171 1
I
I I
I•.
I
;201
Calculated By I Rate
Checked By
Date
Total
Ledger Entry Number Entered By
Date
Entry Vedttecr flats
k !n ctor' ignaiure. Contractor's Representative Signature Title
DO'1 hem s a oanoo p
r k
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
Labor
Bob Parshall
Joel Johnson
Phil Knudson
Labor Subtotal
Markup 29%
Total Labor
Field Directive 47
October 28, 2011
Site 1- E Existing CB
Eq Op 2.0 Hrs $59.81/Hr
Supr /Eq Op 2.0 Hrs $61.36/Hr
Laborer 2.0 Hrs $47.27/Hr
Equipment
580M Backhoe
PC 120
Service Truck
Equipment Subtotal
Markup 21%
Total Equipment
Material
2' 54" Section
54" Flat Top
11-,20 "x24" Frame Grate
a Q /8" Crushed Rock
:Dump Fees Contaminated Soils
Material Subtotal
Markup 21%
Use Tax on Mat'I Only 9.5%
Total Material
2.0 Hrs $47.48/Hr
2.0 Hrs $75.34/Hr
2.0 Hrs $20.85/Hr
1.0 EA $429.00/EA
1.0 EA $318.00/EA
1.0 EA $253.75/EA
10.0 Tons $20.50 /Tn
15 Tons $71.00 /Tn
119.62
122.72
94.54
336.88
97.70
94.96
150.68
41.70
287.34
60.34
2,270.75
476.86
Total
434.58
347.68
11"Oa. S
2�$
`ma
4442
TA
s
A 3
GRANITE PRECASTING CONCRETE
4116 BAKERVIEW SPUR
BELLINGHAM, WA 98226
Phone: (360) 671 -2251
Fax: (360) 671 -0780
Job Number: 3573
Ship to: SMALL DRAINAGE PROGRAM- TUKWILA
TUKWILA, WA
Sold to: GREEN RIVER CONSTRUCTION
6402 S. 144TH STREET, STE. #1
TUKWILA, WA 98168
INVOICE 18041
CUSTOMER
10/28/2011 I i I NET 10TH I 1
KAt
A16494613
IQty Item
Description
Weight Unit Price TX
Extension
Structure:
1 CUS
54'X 2' SPECIAL MANHOLE RISER
$429.00
$429.00
1 54TSR
54" FLATTOP ROUND HOLE
$318.00
$318.00
Structure Total
$747.00
Taxable
$747.00
Non- Taxable
$0.00
Sub Total
$747.00
Tax
r $0.00
Invoice Total
$747.00
Less Deposit
$0.00
Invoice Balance
$747.00
l
Invoice
Olympic Foundry
QUALITY CASTINGS S(NCE
1900
Olympic Foundry, Inc,
5200 Airport Way South
Seattle, WA 98108
(206) 764 -6200
1 00
Page: 1
Invoice No.:
0000219780
Invoice Date:
10/13/2011
Customer No.:
GrRiCoJAC
Branch:
06
Salesperson::
Lee H.
Our Order No:
SO- M34919
SH Code:
PPAI
Green River Construction 1729 2610/2011 SMALL DRAINAGE PROGRA
6402 S 144th Street Ste 1 13800 INTERNATIONAL BLVD
Tukwila, WA 98168 USA TUKWILA, WA 98168 -3169 USA
0:
JERRY OurTruck Jobsite 1% 10 Net 30
0 I=
12- 4520SET 06 SM60 CB FRAME /SOLID DI DT 1 218.000 218.00
12- 4525SET 06 SM60 5 DDT 17 218.000 TM6 66
I
Oct 8 ?011
LAD
Contact: Rhonda Subtotal 3,924.00
Shipping Handling 0.00
Sales Tax 0.00
Terms and Conditions of Sale Trade Discount 0.00
Payment/Credit Amount 0.00
Quantity variations must be reported within 5 days of receipt of material. 3.924.00
All other claims and returns must be accompanied by an invoice within
30 days. All returns are subject to a re- stocking fee.
You may deduct $39.24 if paid by 10/23/2011
Washington State
/JF Department of Transportation
Contract Number
Date
to
Prime Contractor
Line Station
Descriptlon qf Work Perform d
t-t— I
Group
Daily Repott of Force Account Worked
Item Number Item Name
Subcontractor I Lower Tler Subcontractor
Basis of Material Acceptance
RAMS Number
Q>
Time Worked Record
Workers and/or Equipment
Working
OCCUPSUDn of Workers or 1 hours Worked 1 Reg, O.T.
Equipment Slzo Reg. O.T. Rate Rate
I
2
e 4 lr -e— �-O
7
10
C-
12
1 31
141
v;
2o]
Calculated By Date
Checked By Date
Total
Ledger Entry Number
Entered By
I Date Entry Vedfled I IDate
Amount
Ins -,toeIqnatu(e.,. Contractor's Representative Signature We
Do Rev1s orm 422-006 EF
ed 0312008
Sd
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
fmv
AY 1�
Labor
Joel Johnson
Chris Parshall
Labor Subtotal
Markup 29%
Total Labor
Field Directive #7
November 4, 2011
Site 1- Connecting 4" pipe to CB 1
Supr /Eq Op
Laborer
Equipment
580M Backhoe
Service Truck
Equipment Subtotal
Markup 21%
Total Equipment
Material
4" PVC
4" Bends
4" MH Adap
4" Wye
4" Fernco
9" CO Casting
Material Subtotal
Markup 21%
Use Tax on Mat'I Only 9.5%
Total Material
1.5 Hrs $61.33/Hr
92.00
1.5 Hrs $47.43/Hr S
71.15
163.15
47.31
1.5 Hrs $47.48/Hr
71.22
1.5 Hrs $20.85 /Hr
31.28
102.50
21.53
14.0 LF $0.97/LF
13.58
3.0 EA $6.50 /EA
19.50
1.0 EA $13.35/EA
13.35
1.0 EA $4.53/EA
4.53
1.0 EA $7.80 /EA
7.80
1.0 $79.00 /EA
79.00
137.76
28.93
13.09
210.46
124.03
179.78
Total 514.27
AW
Washington State
Department of Transportation Daily Report of Force Account Worked
Contract Number Date Item Number Item Name
Prime Contractor Subcontractor I Lower Tier Subcontractor
Line Station
Group Basis of Material Acceptance
Description of Work Performed
Time Worked Record
Workers and/or Equipment
Occupation of Workers or
Working
Equipment Size
2
V
3
4
5 4 t k,
6 All
7
P
10
121
13
14
151
1
16
17
18
191
1
201
Calculated By Date
Checked By
Ledger Entry Number Entered By
Date
Inspectbes Signature
Contractoi's Representative Signature
RAMS Number
lHoursWorkedl Reg. O.T.
Reg. O.T. Rate Rate
I Date
Entry Verified
Tide
Total
I Date
Amount
DOT Form 422-008 EF
Revised 0312008
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246-2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
_Request for Additional Days
Dear Mike:
We are requesting that the additional days be added to our contract.`
9.22.11— Site 5 Evergreen Foods 1
Waiting for decision on backfill of void under 24" pipe.
9.30.11— Site 5 Evergreen Foods j l
Regrading parking lot adjacent to new structure and resetting existing structures 1�s af'b Cgs
10.17.11— Site 4 Allentown 1 Day;°`
Extra 90LF storm CB at 12227
10.20.11— Site 4 Allentown
Added grading paving of thickened edge
10.28.11 10.31.11— Site 1 Wells Trucking
IV Additional contaminated soil export
11.23.11— Site 3 Museum of Flight
Sincerely,
Jerry Knudson
President
e,-�- M 1 AV
2 Days
1 Day
11 -1120)
Council Approval N/A
JF WILA, gs
Sheet 1 of 1
y J CITY OF TUKWILA
1 CONTRACT CHANGE ORDER NO. 06
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner' are not prejudiced; and
C. All claims against the "Owner' which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Remove various sections of abandoned concrete pipe at Site 44 (Allentown) not shown on the plans
per Field Directive #08, and tracked w/FA 48, FA 411 and FA #12, attached. These items have
previously been paid under Minor Change and need to be wrapped into a Change Order to finalize
payment. The amounts paid will be credited back to the Minor Change item with the execution of
this Change Order.
This Change will be compensated under Schedule A Storm Drainage. There is no time extension
associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specifie and will accept as full payment therefore the prices shown above and below.
ACCE T Date 3A712— Contractore��t J It
By T T itle
Origi I Contrac 788,005.50 APPROVED BY THE CITY OF TUKWILA
Previous Change Order
This Change Order
REV. CONTRACT AMOUNT
19,868.00V Date 3 l
1.044.79 By A40-,-r 1�7•
o
808,918.29
ORIGINAL: City Clerk (1 of 2) Contractor (2 of 2)
A ote: Sales tax shall be included in the various unit prices, per Standard Specification 1- 07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 6 10/ a C11—(G1N�S
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is
issued.
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 006
To: Green River Construction Date: 10/12/11
6402S.144 th St. #1 I Project Name: 2010/2011 Small Drainage Proj
Tukwila WA 98168 Project No.: 91041201
Attn: Jerry Knudson Contract No.: 11 -112
Work to be performed:
Resolve various utilitiy conflicts at Allentown drainage installation (Site 4) per the exhibit attached.
Normal water service adjustments should be done with Inspector verification to assure adequate
separation following adjustment. Track these adjustments using Force Account Resolution of
Utility Conflicts. The abandoned concrete culvert removal can be accomplished and tracked using
Force Account. Property Restoration.
Reason for modification:
Various minor modifications to existing utilities were required to place the proposed storm system.
Normal RUC items can be performed under verbal field direction by the inspector however the
concrete pipe removal was not a true obstruction and requires a specific directive.
Work under this Field Directive modification will be accomplished:
With work to start immediately and determination of any change to the contract price to be
tracked by Force Account as detailed above.
With no change in contract completion date.
Performance oft Is Fiel Directive is authorized by all signatures below:
Accepted by: C.r�2
o tra torts Rep —Name
l�
T' a �l
Approved by.
City Construction Engineer Dat-
Verified by:
City Construction Inspector Datt
x
x
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila i
2010/2011 Small Drainage Program, Contract 11 -112
Field Directive 46
October 11, 2011
Site 4 Unknown pipe at 12222; then removed 16'
Labor
Denny Mellott
Eq Oq
1.5 Hrs $59.81/Hr
89.72
Joel Johnson
Supr /Eq Op
1,5 Hrs $61.36/Hr
92.04
Phil Knudson
Laborer
1.5 Hrs $47.27/Hr
70.91
Kyle Copeland
Laborer
1.5 Hrs $47.91/Hr
71.87
Labor Subtotal
324.54
Markup 29%
94.12
Total Labor
418.66
Equi pment
UHO 135
1.5 Hrs $84.99/Hr
127.49
580M Backhoe
1.5 Hrs $47.49/Hr
71.22
Service Truck
1.5 Hrs $20.85/Hr
31.28
Equipment Subtotal
229.99
Markup 21%
48.30
Total Equipment
278.29
Material
Material Subtotal
Markup 21%
Total Material 0.00
Total 696.95
0
a P
AIM
'#M"NpWtadm t ily Report of Forco Account Worked
Gprttrect Nvmb+r 3 f !!ern tlem Name
Mitre Ca tMdor SUDaWWrww) LOW Tw SL&Wdact"
L" t $Won Grow Suit of A4aOdel A=epMoS RAMS rFtxidbet
D"a"m of WO* Perfumed .rte' 1-44_ A./
TIMO worked .Romm
wmtm wN., E*� owvpwm of or j o. -r.
war" B.wWMstlt elmo u r.
121. 1 I I
131 I I I I I I
1t 1
1S! 1
I la]
171 I
181 1
cowai+ a 1 Data f t cad By
LedW Ef&y Number Ennd ay 6 DaEe Erb vffined
Total
M
1+w1G4 h Contrecloea kopm Slpt,1(ur9 rift
Dot 4W
j f
>iav W
Poe PV Z
Green River Construction, Inc. wood
Daily Report of Force Account Worked Q"
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
Material
Material Subtotal
Markup 21%
Total Material 0.00
Total 173.92
COIN
o�
Field Directive #6
October 13, 2011
Site 4—Unknown
pipe at C68, then removed 9' 12"
concrete pipe
Labor
Denny Mellott Eq Oq
.5 Hrs $59.81/Hr
29.91
Joel Johnson Supr /Eq Op
.5 Hrs $61.36/Hr
30.68
Phil Knudson Laborer
.5 Hrs $47.27/Hr
23.64
Labor Subtotal
84.23
Markup 29%
24.43
Total Labor
108.66
Equi pment
UHO 135
.5 Hrs $84.99/Hr
42.50
Service Truck
.S Hrs $20,85/Hr
S
11.43
Equipment Subtotal
53.93
Markup 21%
11.33
Total Equipment
65.26
Material
Material Subtotal
Markup 21%
Total Material 0.00
Total 173.92
COIN
o�
AM
VrAf pcwe Daily Roport of Force Account WorMd
C&*ad Numbof t7eJe F>eTS! t ��#EAY
p� mot t Lara� T� Ste'
LW*) Stilton #atoe 8atls of htstwW A=apWmS !&abet
Desralpdc» 4yorR �f f� �l
V ✓1 1 r t t"./ TC7
r:=
ON ZIAI�I AMOL
Vt
t
1 DdW
Tole!
Yer�d pad
Time Worked Record
Work"$ 4rAvm gqwprma
oocu of ltf lwWo or
Sft
fD�
121
t41
15�
191
171
!8i
!D1
201
I
CaDa.aabed $y i oat&
Cb6tkad By
LOW Ej�*y Number Enww Bar
1 tits
r:=
ON ZIAI�I AMOL
Vt
t
1 DdW
Tole!
Yer�d pad
r-A- `:'t 2.
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
Labor
Denny Mellott
Joel Johnson
Phil Knudson
Labor Subtotal
Markup 29%
Total Labor
Field Directive #6
October 13, 2011
Site 4 Unknown pipe at CB1, then removed 8' 12"
concrete
pipe
Eq Oq 5 Hrs $59.81/Hr
29.91
Supr /Eq Op .5 Hrs $61.36/Hr
30.68
Laborer .5 Hrs $47.27/Hr
5
23.64
84.23
24.43
DV__
f WL
VOL
108.66
Equi pment
UHO 135
Service Truck
Equipment Subtotal
Markup 21%
Total Equipment
Material
Material Subtotal
Markup 21%
Total Material
Total
\11_'
.5 Hrs $84.99/Hr
.5 Hrs $20.85 /Hr
42.50
S 11.43
53.93
S 11.33
65.26
0.00
173.92
Ab
.u►
IDsHy Report of Fore Account Worked
Coidract tram r�,t /e ms tt� tie y "t
Prdne C&*IW" &AMOMactat t Laves Twr Sub rx
Um 18tsl m Group 660 of MMSM tm►ce RAMS timber
rsw*tlon of Walk Pftk med 1, *4
y t�
L. r� ef.- fir. ct I 1'
fima Worked Record
1 www swApmtnt 00modion at 0r ROM
4
8 I
a�
;t}I I
121 I
131 1
1 #I l
,a1 I
,t1
1�1
201 I
SW 13Y 1 Dale
aT,
III
I I
ra� Er I
I I
I I I
I I I
I 1 i
I i
I I I
Lo Entry t%mbar
i
lmspe t3tonsSu CanttsCtprsF4eptesrtriadve6dgriatwt TV*
�R Ot QA
row
I Dete
11- 112(e)
Council Approval N/A
J ,WtLA, k"
Sheet 1 of 1
y CITY OF TUKWILA
�N 2
Jso$ CONTRACT CHANGE ORDER NO. 05
l la
NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner" which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Perform drainage modifications at Site #4 (Allentown) per Field Directive #08 attached. Add new
drainage features and pavement thickened edge to channel roadway runoff to the observed low point.
Quantity adjustments to be included in this Change Order include new ductile iron pipe, catch basin,
thickened pavement edge and an extra drainage connection. These quantities will be credited from
previous payment with the execution of this Change Order.
This Change will be compensated under Schedule A Storm Drainage. There is a 1.5 day time
extension associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specifie and will accept as full payment therefore the prices shown above and below.
ACC TE Date 3 Contractor
By Title
OrigiWal Contrac 788,005.50/ APPROVED BY THE CITY OF TUKWILA
Previous Change Order 11,773.51 3 1 i
This Change Order 8.094.49 By le
REV. CONTRACT AMOUNT 807,873.50
Sy r
RIGINAL: City Clerk (1 of 2) Contractor (2 of 2)
ote: Sales tag shall be included in the various unit prices, per Standard Specification 107.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 15"- 09161
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 008
To: Green River Construction I Date: 10/17/11
6402S.144 th St. #1 1 Project Name: 2010/2011 Small Drainage Proj.
Tukwila WA 98168 Project No.: 91041201
Attn: Jerry Knudson I Contract No.: 11 -112
Work to be performed:
Modify drainage features at Site 4 (Allentown 44t Ave S) per the exhibit attached. Additional
thickened edge, drainage pipe and structure placement will be tracked and paid using existing unit
price items. Additional pavement restoration for driveway approaches will also be tracked for unit
price compensation. Total additional quantities are all within minor bid items and are not eligible for
a unit price adjustment.
Reason for modification:
Additional drainage issues were identified by site review after all original drainage features were in
place and we were marking up final restoration items. Inconsistencies in driveway tie -ins, gaps in
thickened edge, and an additional low point structure needs to be installed to address these issues.
The additional drainage items will ensure low side properties do not continue to see runoff cross the
Right of Way line and enter their property from the street.
Work under this Field Directive modification will be accomplished:
With unit price quantity adjustments made for additional compensation.
With contract completion date evaluated using Time Impact Analysis.
Performance of thi ie Directive is authorized by all signatures below:
Accepted by:
`tractorsrs Rep Name
l Ti v Da `I
Approved by:
City Construction Engineer Date
Verified by: I M, 1� 0:A) 3�i1
City Construction Inspector Date
x
x
W m
GREEN RIVER CONSTRUCTION CO, INC.
6402 South 1 44th, Suite #11
Tukwila, Washington 98168
Office: (206) 246-9456 Fax: (206) 246-2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite 4100
Tukwila, Washington 98188
M OO
G I
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11-112
Close-Out Information 8" DI vs. 12" DI
Dear Mike:
The following is our calculation for the 8" DI vs. 12" DI credit to be taken by the City of Tukwila
Copies of our quote and invoice from Pacific States Cast Iron Pipe have been attached for your
reference. A
12" DI
8" DI
Difference
Markup 21%
Use Tax on Mat'l 9.5%
Total
Actual 8" DI installed:
Site 43 Museum of Flight
Site 44 Allentown
Total
25.29/LF
17.60/LF)
7.69/LF
1.61/LF
L��F
42 LF
90 LF
132 LF
Credit calculation:
132 LF x $10.03/LF 1,323.96
$1,323.96 $58.00 (12" DI) 2L -34,Zo f 1 DI
Sincerely,
Jerry Knudson 07—
President
PSCIPCO PACIFIC STATES
CAST IRON PIPE COMPANY
DIVISION OF MMANE, INC.
L
E` -fi P.O. BOX 1219, PROVO, UTAH 84603
TELEPHONE (AREA CODE 801) 373 -6910
Date: 2/2/2012
To: Green River Construction
Project: City of Tukwila Storm Sewer 2011
Location: Tukwila, Wa
Glenn Watkins
District Manager
POBox 770
Maple Valley, WA 98038
Office: (206)719 -4090
Fax: (801)377 -0338
Mobile: (206)719 -4090
Bid Date: 09/01/2011
Bid Time: 8:00 AM
Quote No.: 3012
Revision:
We are pleased to quote you on the materials set forth below conforming to specifications in our catalog and subject to Pacific States Cast Iron Pipe
Company's terms and conditions found at our website www.pscipco.com.
All prices are quoted F.O.B. foundry with freight charges allowed to the jobsite in minimum 40,000 pound truckload quantities, where accessible to
standard truck and trailer movements. Unloading charges are not included.
Prices are exclusive of any state or city sales or use tax which may apply. Payment terms are 1% 10 net 30 days. A service charge of eighteen
percent (18 per annum or the maximum allowed by law, whichever is greater, will be added on any unpaid amount.
Prices are based on supplying 3" to 4" pipe in 18' nominal lengths and 6" to 36" in 18' nominal lengths with standard cement lining and seal coating
inside and out, unless otherwise noted. Gaskets are quoted as standard SBR material, unless otherwise noted. Polywrap is not included unless it is
specifically itemized on the quotation. Layout drawings are not included.
Quoted prices are valid for a period of 45 days from the original quotation date. Due to continuing volatility in raw materials, energy, and transportation
costs, delivery must be taken within 90 days of the original purchase order. Orders that remain open after that 90 day period will be subject to price
review and /or cancellation, at our sole discretion. These terms supersede Paragraph 2 (Quotations) of McWane's standard Terms and Conditions, of
which all other provisions govern this agreement. Orders placed after the 45 day period will be subject to a price review and /or a price increase, at our
sole discretion.
Pacific States makes every effort to generate an accurate quote; however we do not guarantee its accuracy and completeness. We caution the
ordering party to check and verify the accuracy of all quantities and the compliance with the project specifications before submitting a bid and /or
)lacing an order.
Bid Item l Quantity I Description
1,200 LF 112 TJ X PE 50 CL SC /SC
140 LF 18 TJ X PE 50 CL SC /SC
Price %U it i Total
25.29 I 30,348.00
17.60 „;R' 2,464.00
32,812.00
A A
MANUFACTURERS OF DUCTILE IRON PRESSURE PIPE Page 1 of 1
Invoice �nvo�ce Page: l
PSCIPCO Pacific States Cast Iron Pipe Company Invoice: 0000034148
p.0. Box l2l9.2503. Industrial Parkway
Date: 10/7/2011
Provo, DT 84603'0210 Customer: 27950
Phone: (8Ol)373'69lC\ Fax: (8Ol)]77'O338 \Pozobouou: &{uio
�.O. BOX 8483l2 DALLAS, TX7Su84'83lz
Territory: Seattle
Sales Order: 0000015437
B4O.L.: 0000038162
|3oQIo
GREEN RIVER CONSTRUCTION CO
6402 G. 144TH SUITE l
7I7KWIL/\,WAV8l68'4636 USA
Ship To
GREEN RIVER CONSTRUCTION CO.
6402 S. 144TH SUITE l
206-730-2825 JERRY
Customer P.O. Sh Via
F.O.B Tunoo
8TOD]� S8\�BR 7ruduw�dx
Plant Prepaid lY6 Discount bol0DoyuN 30
`o
QTY U0M Item Description
Qty.8hippxd U0&{ Amount i
32� i O�ucb 4l2lO50llll l%7}J{985OCLSC/SC
58&000 LF l4�6814,668.20
32.00 8uob �2TJG&8��T
32.000 Bucb ~~~~(�88 080
1.00 Each !GALLON PIPE LUBRICANT
1.000 Each 0.00 0.00
LA8TlT8&d
i
'�1
|\`Y~
1
/,�y'
i
Subtotal 14,66820
--freight 0.00
0.00
Trade Discount 0.00
Puymont/Crodit&mount 0.00
Contact: JERRY K0lJD8ON
Balance �l4�0D�J
AT)JUSTMENTS CAN BE MADE FOR DAMAGES OR LOSS UNLESS YOU IMMEDIATELY FURNISH PACIFIC STATES CAST IRON PIPE COMPANY A FREIGHT BILL INSPECTION REPORT, OR DELIVERY
11"T NTH A NOTATION OF THE DAMAGE OR SHORTAGE SHOWN THEREON OVER THE SIGNATURE OF THE TRANSPORATIOIN COMPANY'S AGENT OR DRIVER. THE PRODUCTS OF PACIFIC
Q 'MENTS OF THE FAIR LABOR STANDARDS ACT OF 1 193S AS A.MIENDED.
_CAST IRON PIPE COMPANY LISTED ON THIS INVOICE WERE PRODUCED IN COMPLIANCE WITH THE REQUIRE
E CHARGE OF 1.5% WILL BE ADDED AFTER THE DUE DATE. COMPLETE TERMS AND CONDITIONS CAN BE FOUND AT WWW.PSCIPCO.COM/TERMS.HTML.
PL�.r I�EAD THEM CAREFULLY.
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
Labor
Denny Mellott
Joel Johnson
Kyle Copeland
Chris Parshall
Kellie Newnom
Labor Subtotal
Markup 29%
Total Labor
Field Directive #6
October 17, 2011 Site 4 -Field engineering for storm line to be added
Eq Oq
Supr /Eq Op
Laborer
Laborer
Flagger
2.0 Hrs $59.81/Hr
2.0 Hrs $61.36/Hr
2.0 Hrs $47.91/Hr
2.0 Hrs $47.91/Hr
2.0 Hrs $40.93/Hr
119.62
122.72
95.82
95.82
S 81.86
515.84
149.59
665.43
Equipment
580M Backhoe
Service Truck
Equipment Subtotal
Markup 21%
.Total Equipment
Material
6" Pipe
6" Sand Collar
6" Cap
Material Subtotal
Markup 21%
Use Tax on Mat'I Only 9.5%
Total Material
Tota I
2.0 Hrs $47.48/Hr
2.0 Hrs $20.85/Hr
4.0 LF $1.40 /LF
1.0 EA $23.00 /EA
1.0 EA $6.95/EA
94.96
41.70
136.66
28.70
t,r e
er, g'a rc :d a5ot'-.•.`C ii+'d t .t$`�1 'b L-
J
165.36
46.40
877.19
F�'x "Y e.*.�s�t1 �'s f �?;.N 6 v u�'a y$ i.�:r. �•en
'`y6.. "a ttl :'a,�,
C c A" (+'a 'vee,•;•`' key Fs+ i t 3 q1 wvhp.
Uki ID
5.60
23.00
6.95
35.55
7.47
3.38
an State
of Transportation
,-otAract Number Date
Prime Contractor
Daily Report of Force Account Worked
Item Number Item Name
Subcontractor/ Lower Tier Subcontractor
Line Station Group
Basis of Material Acceptance RAMS Number
Qescnption of Work Performeq
A&W
VO Y11—
Worked Record
4— r!,
VIorkereandlor Equipment
Working
Occupation of Workers or
Equipment Size
Hours Workedl Reg. O.T. Amount
Reg. O.T. Rate Rate
I,
yJ
L-p e �loo► I lea �b
2
31
'4
7 e 4, w� 4. Q,-- r
8 1
121
13
141
171
201
Calculated By Date
Checked By
Date
Total
Ledger Entry Number Entered By
I Date
Entry Verified Date
Inspectors Signature
Contractor's Representative Signature Me
DOT Form 422-008 5F
Revised 0312008
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
Request for Additional Days
Dear Mike:
We are requesting that the additional days be added to our contract.
AO s
9.22.11– Site 5 Evergreen Foods 1
Waiting for decision on backfill of void under 24 pipe.
9.30.11– Site 5 Evergreen Foods
Regrading parking lot adjacent to new structure and resetting existing structures Mejs sk
4
10.17.11 Site 4 Allentown 1 Day V �+WA
Extra 90LF storm CB at 12227'
4vis i e
10.20.11– Site 4 Allentown �F-10W z
Added grading paving of thickened edge
10.28.11 10.31.11– Site 1 Wells Trucking
Additional contaminated soil export
11.23.11– Site 3 Museum of Flight
Sincerely,
Jerry Knudson
President
2 Days
1 Da M}q7 Py- R�
2�dnj
G-
931041"-`
1
c•
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
Request for Additional Days
Dear Mike:
We are requesting that the additional days be added to our contract.
9.22.11— Site 5 Evergreen Foods
Waiting for decision on backfill of void under 24 pipe.
a
9.30.11— Site 5 Evergreen Foods
Regrading parking lot adjacent to new structure and resetting existing structures tin
10.17.11 Site 4 Allentown 1 Day
Extra 90LF storm CB at 12227
10.20.11 Site 4 Allentown
Added grading paving of thickened edge
10.28.11 10.31.11— Site 1 Wells Trucking
Additional contaminated soil export
11.23.11 Site 3 Museum of Flight
V,}5 SLIP tf1 ALP.,2
Sincerely,
Jerry Knudson
President
l me
2 Days
1 Day
ar :�P,;`'�"a ate;
P
11- 112(d)
Council Approval N/A
Sheet 1 of 1
or y,
CITY OF TUKWILA
CONTRACT CHANGE ORDER NO. 04
,mss
NOTE: This change order is not effective until approved by the "Owner' and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner' which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Deliver extra 18" and 24" HDPE pipe sections from Site #2 (TIB) and Site 95 (Evergreen Foods) to
a City designated staging area. This Change Order compensates for additional material'left over
after a reduction in material quantity at Evergreen Foods. The pipe lengths desired are as follows:
18" HDPE SDR -21 Pipe 2 14.5' and 1 13.5' (Total length 42.5')
24" HDPE SDR -26 Pipe 1 50' and 1 15' (Total length 65')
This Change will be compensated under Schedule A Storm Drainage. There is no time extension
associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specifi nd will accept as full payment therefore the prices shown abov below.
ACC PTE Date a����, Contractor �vo4
C�P l 4'
B T itle
O /evious, Contr t 788,005.50 APPROVED BY THE CITY OF TUKWILA
P Change Order 6,075.06 Date 0/
This Change Order 5.698.45' G
REV. CONTRACT AMOUNT 799,779.01 Maya/ G�G/
ORIGINAL: City Clerk (1 of 2) Contractor (2 of 2)
X ote: Sales tax shall be included in the various unit prices, per Standard Specification 1- 07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 /Sr,JJ 02 6 Y_ 16 //fAt-�S
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
You are hereby directed to make the herein described changes to the plans and specifications or ao
the following described work not included in the plans and specifications on this contract:
FA Sheet No.:
DAILY REPORT OF
FORCE ACCOUNT WORKED
Project Name: 2011 Small Drainage Project No: 91041201
Item No.: CO #04 Date: Future Date
Description of Work: Transportation cost to deliver extra HDPE pipe to City Staging Area.
002
Work by Subcontractor No
Prime Contractor: Green River Construction Sub Contractor:
LABOR
NAME CODE OCCUPATION
Joel Johnson (Super ISuperintendant i
Phil Knudson (Lab (Laborer 1
I I I
I I
STRAIGHT TIME I OVERTIME
Hrs I Hourly Rate I Hrs I OT Rate
1.501$ 61.33 1 1 106.55 I
1.001$ 47.43 1 I 82.66 1
DOLLAR
AMOUNT
92.00
47.43
I$ I I$ I$
I$ I I$
I$ I I$ I$
SUBTOTAL LABOR:
LABOR OVERHEAD PROFIT 29%
LABOR TOTAL
EQUIPMENT
EQUIPMENT OR ATTACHMENTS
Equipment Equipment Description
GR -580BH 1580 Backhoe
GR -10T 110 CY Dump Truck
OPERATED I
STANDBY
Hrs I Hourly Rate I
Hrs (Standby
Rate
1 1.501$ 33.30 1
J
8.37 1
1 1.001$ 45.681
J
8.79 1
Is I
Is
Is
Is I
Is
Is
Is I
Is
Is
SUBTOTAL
EQUIPMENT
EQUIPMENT OVERHEAD PROFIT
21
EQUIPMENT TOTAL
MATERIALS /SERVICES /RENTALS
139.43
40.43
179.86
DOLLAR
AMOUNT
49.95
45.68
95.63
20.08
115.71
MATERIALS SERVICES I Tax I Quantity I Units I Unit Price I AMOUNT
I I I I I$
I I I I
Is
I I I I Is
SUBTOTAL
OVERHEAD PROFIT 21
TOTAL
Verification of Hours Worked: TOTAL: 295.57
12% MARKUP (for
prime when subcontract work)
Contra*r's ReRresentAive_ n Date'7� SHEET TOTAL: 295.57
Date
Pay Estimate Entered: PC-04 W /(,.0.444
Date:
By:
2011 SDP FA 02- 23- 12.xls
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
Close -Out Information HDPE Pipe Qty Difference
Dear Mike:
The original plans called out for 60 LF of 18" HDPE at Site 42 and 125 LF of 24" HDPE at Site #5.
We actually installed the 60 LF of 18" but only 85 LF of the 24 for a difference of 40 LF. It was agreed
that GRC would be reimbursed for the costs associated with the pipe quantity difference. The following
is our calculation.
24" HDPE (12992405)
Freight Charges (12993153)
Fusion Charges (13009491)
Use Tax @9.5% on Mat'I
Subtotal
Markup 21%
Total
40LF +f
Sincerely,
32.38/LF
11.08/LF
12.30/LF
3.08 /LF�
7 -n.. 3,
4 Z4&4=F
f'
Jerry Knudson,
President
f If 717) e Elf
-y
40 SE 30t St., Bellevue, WA 98005
i Box 160, Bellevue, WA 98009 -0160
FOWL ne 425-746-8400 Fax 425-641-8885
D ER
C OMPANY A C r C'filc Branch
x 160, Bellevue, WA 98009 -016) 43 Thornton Avenue SW
1b. 7,
voice y
ci ic, WA 98047
Number
12992405 PADS (253) 863-8600 Fax (253) 863-8681
077400
Ship to. VARIOUS SITE ADDRESSES
2 GREEN RIVER CONST. CO. TUKWILA WA 98188
6402 S 144th St Ste 1 Order# Inv Date: Order Writer:
Tukwila WA 98168-4636 03692687 09/06/11 Jan Brooks
3/3
Terms: NEI 10 IN PRUA Due: 177971 PO/JOB:
t:r)R• PAr.TC)PY Shia via: DIRECT 2010-2011 SMALL DRAINAGE PRO
1v
I
Sub total 7,N0'-00
Freight__ 0.00
Tax 0
Grand Total 110 .00
RRY Serving the Pacific Northwest since 1911
www.hdfovvler.com
_ZZ.48 6' 2,248.00
M,3-
mF corporate uttices
13440 SE 30th St., Bellevue, WA 98005
PO Box 160 Bellevue WA 98009 -0160
vrz H.D. FOWLER Phone 425- 746 -8400 Fax 425- 641 -8885
COMPANY
Pacific Branch
y_` Box 160, Bellevue, WA 98009 -0160 1417 Thornton Avenue SW
oice
Nu111ber 12993153 PAWN Pacific, WA 98047
077400 (253) 863 -8600 Fax (253) 863 -8681
Ship to:
VARIOUS SITE ADDRESSES 1/1
I„ L„ �I' I �I� "IIIII'I�I'll�ll'll���l�l�'ll
2 GREEN RIVER CONST. CO. TUKWILA WA 98188
6402 S 144th St Ste 1 order# Inv Date: order Writer:
Tukwila WA 98168 -4636
03692680 09/07/11 Jan Brooks
erms: NET 1071 PHUA [due: 1U71 U/1 FuljoB:
FOB: FACTORY Ship Via:.DIRECT 2010 -2011 SMALL DRAINAGE PRO
FRT/ BILLABLE FRT ON PO P1377906 18" 24"
FUSION PIPE
SEPD5 2011 SEP
By
�1
T
Sub total 2,770.00
Freight 0.00
Tax 0.00
Grand Total 2,770.00
.ir -'l IZY �IJ() L Serving the Pacific Northwest since 1911
www.hdfowler.com
FOW
COMPANY
PO 86x 160, Bellevue, WA 98009 -0160
Invoice
Number 13009491 BEWH
077400
To:
Corporate Offices
13440 SE 30th St., Bellevue, WA 98005
PO Box 160, Bellevue, WA 98009 -0160
Phone 425 746 -8400 e Fax 425 641 -8885
r .r
Ship to: VARIOUS SITE ADDRESSES
2 GREEN RIVER CONST. CO. TUKWILA WA 98188
6402 S 144th St Ste 1 urd F4 Inv uate: ur ed®r W
Tukwila WA 98168 -4636
03743860 09/29/11 eric antonelli
Fi erms: NET 10TN X Due: ii 011 @l`I`1° j E
FOB: H. D. FOWLER COMPANY Ship Via: SALESPERSON DELI 7E00-20 SMALL DRAINAGE PRO
(r
3
n
s'
4
5
d cc
Qty Qty
Par#
Unit
Ex{ended
T'
Ship'd
BO'tl
UoM
Deception
Pnpe
Pnce
13u FOSiaN IG MN
fuu.IJ66
(20 -36 MUST BE RENTED WITH HDFCO
TECHNICIAN AS OPERATOR *SET UP FOR 24"
WELDING FULL DAY ON 9/21
1
0
EA
MSFMTECH DAILY RATE FOR FUSION TECH (8
600.000
600.00
Y
HOURS ON SITE) *FULL DAY ON SITE WELDING
ON 9/21
1
0
EA
MSFMTECH DAILY RATE FOR FUSION TECH (8
300.000
300.00
Y
HOURS ON SITE) *HALF DAY WELDING ON SITE
ON 9/27
160
0
EA
MSFMDELIVERY PER MILE ROUND TRIP FUSION
1.500
240.00
DELIVERY/TRAVEL CHARGE *40 MILES ROUND
TRIP TO JOBSITE FROM BELLEVUE. TWO
DIFFERENT TRIPS TAKEN FOR TOTAL OF 160
MILES OF TRAVEL
1
0
EA
MSFIV1123 6 DAILY RATE OF 1236 FUSION MACHINE
350.000
350.00
(20"-36") MUST BE RENTED WITH HDFCO
TECHNICIAN AS OPERATOR *SET UP FOR 18"
WELDING HALF DAY ON SITE ON 9/27
ab
Ir
Cell -!8
Serving the Pacific Northwest since 1911
�b
Sub total
Freight
Tax
Grand Total
2,190.00
0.00
85.50
2,275.50
I
w
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246 -9456 Fax: (206) 246 -2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 20120/2011 Small Drainage Program #11 -112
Close -Out Information HDPE Pipe, Extra Material
Dear Mike:
The original plans called out for 60 LF of 18" HDPE at Site #2 and 125 LF of 24" HDPE at Site #5.
Because of the way the pipe was manufactured, Green River Construction took delivery of more pipe
than was needed. If the City of Tukwila wanted to purchase the pipe, the following prices would apply.
24" Pipe Available: 42 LF
24" HDPE (12992405) 32.38/LF
Freight Charges (12993153) 11.08/LF
Use Tax on Pipe 3.08 /LF
Total 46.54/LF
18" Pipe Available: 37 LF
18" HDPE (12992405) 20.34/LF
Freight Charges (12993153) 11.08/LF
Use Tax on Pipe 1.93/LF
Total 33.35/LF V
Sincerely,
Jerry Knudson m
President
;g 4
t
40 4 KV 1 )`f7' 1 Wt{
v
H.D. FOWLER
LL COMPANY
Box 160, Bellevue, WA 98009 -0160
mbe 12993153 PAWH
#077400
Inlinll�I�IIIIIiIIIIiIIIiiIIIII "11
2 GREEN RIVER CONST. CO.
6402 S 144th St Ste 1
Tukwila WA 98168 -4636
3
r i erms: A Due: i
FOB: FACTORY Ship Via:.DIRECT
%-UI PUICILt' vi n�cz
13440 SE 30th St., Bellevue, WA 98005
PO Box 160, Bellevue, WA 98009 -0160
Phone 425 -746 -8400 e Fax 425 641 -8885
Pacific Branch
1417 Thornton Avenue SW
Pacific, WA 98047
(253) 863 -8600 Fax (253) 863 -8681
Ship to: VARIOUS SITE ADDRESSES
TUKWILA WA 98188
Order# Inv Date: Order Writer:
03692680 09/07/11 Jan Brooks
PU /JOB:
2010 -2011 SMALL DRAINAGE PRO
FRT BILLABLE FRT ON PO P1377906 18" 24"
FUSION PIPE
SEP 5 2011
r1j
y �b`
L9 i y C
SEp 12 20??
By
1
�m o. OD 2-4� 1-(6- 4 -�O(S A�
F RY
too
Serving the Pacific Northwest since 1911
www.hdfowler.com
Sub total 2,770.00
Freight 0.00
Tax 0.00
Grand Total 2,770.00
1/1
D. FOWLE
COMPAN
ox 160, Bellevue, WA 98009 -016
umber 12992405 PADS
#077400
I'D SE 30th St., Bellevue, WA 98005
Bellevue, WA 98009 -0160
I r c ne 425 746 -8400 Fax 425 641 -8885
P c ic Branch
141 Thornton Avenue SW
ci WA 98047
(253) 863 -8600 Fax(253)863 -8681
Ship to: VARIOUS SITE ADDRESSES 3/3
1111111 I III 11111111111111 [lift
r
2 GREEN RIVER CONST. CO. TUKWILA WA 98188
6402 S 144th St Ste 1 Order# Inv Date: Order Writer:
Tukwila WA 98168 -4636
03692687 09/06/11 Jan Brooks
Terms: Ift I QUA Due: 1i 1 PO /JOB:
FOB: FACTORY Ship Via: DIRECT 2010 -2011 SMALL DRAINAGE PRO
i
j 1
100 0
LENGTHS PE3408 "P''
FT NS -DRPH -6272 18" HDPE SDR -21 PIPE (50FT)
PE4710
Sy .t
v
Llj
;RY Serving the Pacific Northwest since 1911
www.hdfowler.com
Sub total
Freight
Tax
Grand Total
2,248.00
N..
1�
7, 05.00
0.00
.0
,10 .00
11- 112(c)
Council Approval N/A
tA. W
A. Sheet 1 of 1
CITY OF TUKWILA
CONTRACT CHANGE ORDER NO. 03
;9oa
kin
NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner" which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Modify the drainage system at Site 2 (TIB) as detailed in Field Directives #4 and 45. The
compensation provided in this Change Order will include all effort to connect an existing 4"
underdrain, substitute relevant structures to provide a working system, modify the existing MH on
the shoulder of TIB and compensate for an extra custom Manhole structure not used.
This Change will be compensated under Schedule A Storm Drainage. There is no time extension
associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specifi nd will accept as full payment therefore the prices shown above nu belo
AC EPT D: Date �A Contract
By Title
Or* final Contr 788,005.50 APPROVED BY THE CITY OF TUKWILA,
Previous Change Order 1,100.25y Date
This Change Order 4.974.81
REV. CONTRACT AMOUNT 794,080.56
A iRIGINAL: City Clerk (1 of 2) Contractor (2 of 2)
ote: Sales tax shall be included in the various unit prices, per Standard Specification 1- 07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 1 -0-df 69 (6 //IAt'�
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
�h
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 004
To: Green River Construction Date: 10/05/11
6402 S. 144`' St. #1 Project Name: 2010/2011 Small Drainage Proj.
Tukwila WA 98168 Project No.: 91041201
Attn: Jerry Knudson Contract No.: 11 -112
Work to be performed:
Reroute and connect the additional 4" underdrain pipe to the lower overflow debris cage structure
as shown on the exhibit attached. Shift MH #3 and MH #2 slightly to the south and modify inverts to
fit the proposed contours. All of the site restoration features will shift slightly south as well however
the overall quantities and placement details will be mostly unchanged. For further direction see FD
#005. The only extra cost to the contract from this Field Directive should be the additional 4" drain
details.
Reason for modification:
Upon excavation for MH #3 (Site 2) we discovered an active 4" drain line which discharged at grade
below the pipe we were scheduled to connect to with the manhole. This pipe is believed to be the
discharge from the adjacent wall system just uphill from the work zone. This pipe needs to be
connected to MH #2 to allow continued functioning of the drainage system. The other changes in
project features are considered of mutual benefit and do not change the operation of the system.
Work under this Field Directive modification will be accomplished:
With work to start immediately and determination of the change to the contract price to be
tracked by Force Account Resolution of Utility Conflict and unit price for additional connection.
With no change in contract completion date.
Performance of is Fit Id Directive is authorized by all signatures below:
Accepted by: .A-
of tracto s ep -Name
Approved by:
Verified by:
Ti
City Construction Engineer
alb
City Construction Inspector
117V(
De ie
Date
Revegetation design
1l! 41-
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
Field Directive #4
September 26, 2011
Site 2 -Tie in unknown 4" drain line
Labor
Joel Johnson
Supr /Eq Op
Denny Mellott
Eq Oq
Chris Parshall
Laborer, Gen'[
Phil Knudson
Laborer, Gen'I
Labor Subtotal
1.0 Hrs $47.27/Hr
Markup 29%
47.27
Total Labor
1.0 Hrs $61.36/Hr
61.36
1.0 Hrs $59.81/Hr
59.81
1.0 Hrs $47.91/Hr
47.91
1.0 Hrs $47.27/Hr
S
47.27
1 Set $22.50 /Set
216.35
S
62.74
Equipment
PC 200EX
Service Truck
Pump
Cut Saw
Equipment Subtotal
Markup 21%
Total Equipment
Material
4" PVC
4" Bend
4" Coupler
4" MH ADP
Sand Cement
Material Subtotal
Markup 21%
Total Material
1.0 Hrs $95.42/Hr
95.42
1.0 Hrs $20.85 /Hr
20.95
100.00
S
75.00
291.27
S
61.17
14 LF $0.97/LF
13.58
1 EA $6.50 /EA
6.50
1 EA $8.50 /EA
8.50
1 EA $13.35/EA
13.35
1 Set $22.50 /Set
S
22.50
64.43
5
13.53
Q�- P
u�-
279.09
352.44
77.96
Total 709.49
WOO ==Of rrwAporwian Daily Report of Force Amount Worked.
ContractManbef CM Item Number llemNwe
Prime Ca*amr SubomtWcw i Lower Tier SLd=r*jjCkw
Lk* I slaw Croup BOVS of Witerial Acaptance RAM$ N=hsr
DesaiprOon of Work Pert rnbd
Time Worked Record
Wbrx*maraarErMvma t
WOW"
41
'ectupatio* of warkoza Or f_jv_V_rkWodmd1 Rea. Amount
Stre FM*.
-3 A
PC
6zry Y,
7
a
eL/
I bY
14
19
Ucuiged $y i Date
Total
LedgW ETWV NUMM Date .En" Vented i i Date
DOT Form 422A8 EF
Rtybod 0/20s
Cor#Wort Represerietlyt 8Vtk6Iw8 TV&
13
j
X
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 005
To: Green River Construction I Date: 10/11 /11
6402S.144 1h St. #1 Project Name: 2010/2011 Small Drainage Proj.
Tukwila WA 98168 Project No.: 91041201
Attn: Jerry Knudson Contract No.: 11 -112
Work to be performed:
Modify manhole placement on TIB (Site 2) per the exhibit attached. Move structure proposed for
MH #1 location to MH #2 location. Shift structures #2 and #3 slightly from original locations to allow
better alignment with existing core holes. Reuse the base at MH #1 location and attach 18" HDPE
pipe to existing structure. Replace flat top lid at MH #1 location with a new lid and orient as shown
on the original plan. Replace ladder to align with new grate position. Provide dual directional
vaned grate to capture water from either direction.
Reason for modification:
The core holes in MH #1 and MH #2 were placed incorrectly. By the time the error was discovered
the structures were on site ready to be placed. The final configuration will allow the system to work
as designed while simplifying restoration requirements and disruption on the shoulder of TIB.
Work under this Field Directive modification will be accomplished:
Work to be compensated per the original contract price and unit price items with the exception
of modifications to the existing structure (at MH #1 location). Pay an additional Connect to
Existing Drainage Structure item to attach the HDPE to this structure. Pay invoice price for
materials only for the new MH section #1 and deliver to City storage yard. Track cost to modify
existing structure at MH #1 location (including new lid section, ladder placement, and custom
vaned grate) per Force Account and pay by Change Order.
With no change in contract completion date.
Performance of
Accepted by:
Approved by:
Verified by:
Id Directive is authorized by all signatures below:
City Construction Inspector
i
R 4 I t
Date
pLI poi
Dak i
City Construction Engineer
x
x
fA, 4L3
Green River Construction, Inc.
Daily Report of Force Account Worked
City of Tukwila
2010/2011 Small Drainage Program, Contract 11 -112
(o /3
Field Directive #5
October;e, 2011
Site 2 Replacing Tie -in MH flat top
Labor
Denny Mellott
Eq Op
Joel Johnson
Supr /Eq Op
Chris Parshall
Laborer
Phil Knudson
Laborer
Labor Subtotal
3.5 Hrs $47.43/H r
Markup 29%
165.45
Total Labor
3.5 Hrs $S9.81 /Hr
209.34
3.5 Hrs $61.33/Hr
214.76
3.5 Hrs $47.43/Hr
167.69
3.5 Hrs $47.43/H r
S
165.45
757.24
S
219.60
Equi pment
580M Backhoe
Dump Truck 5 CY
Service Truck
Compressor Jack Hammer
Equipment Subtotal.
Markup 21%
Total Equipment
Material
48" Flat top
20 "x24" Frame Grate
Sand Cement
Cold Mix
Material Subtotal
Markup 21%
Total Material
Connection to existing CB
Total
3.5 Hrs $47.48/Hr
166.18
3.5 Hrs $50.00 /Hr
175.00
3.5 Hrs $20.85/Hr
72.98
100.00
514.16
107.97
1.0 EA $256.50/EA
256.50
1.0 EA $253.75/EA
253.75
1 Set $22.50 /Set
22.50
S
100.00
632.75
S
132.88
Z-
976.84
622.13
765.63
Wr to -3
Contract Number
Date
Prime Contractor
Line Station
Group
Daily Report of Force Account Worked
Item Number Item Name
RAMS Number
Subcontractor/ Lower'ner Subcontractor
Basis of Material Acceptance
Des ceiption 4 Work Performed
Tune Worked Record
Workers and/or Equipment Occupation of Workers or Hours Worked Reg, I O.T. I
Amount,
Working Equlpment Size ttoq. O.T. Rate Rate
3 Mot
11 -wl�.y tv►.�c_(Iv�' `I OP��tl� -�S` 1�3/ I I
7
121 &e re J
13 Cd a tl"; I I I
15 e t I
16 1 I I I
17I
1
201 'fliv kq?�j
Calculated By Date Checked By Date
Ledger Entry Numb Entered By I Date Entry Verified
:Y Inspector'stignature Contractor's Representative Signature Title
Total
I. Date
DOT Form 422 -008 EF
Revised 03/2008
W �Il
GREEN RIVER CONSTRUCTION CO., INC.
6402 South 144th, Suite #1
Tukwila, Washington 98168
Office: (206) 246-9456 Fax: (206) 246-2274
February 2, 2012
City of Tukwila
Department of Public Works
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
I
P
W 0
Re: 20120/2011 Small Drainage Program #11-112
Close-Out I nformation 48" x 6" Base
Dear Mike:
The following is our cost for the cored MH that we were unable to use at Site #2.
Granite Precasting Concrete #44883
48" x 6' Base w/Hole 365.95
Use Tax 9.5% 34.77
Total 400.72 P/
Sincerely,
Jerry Knudson
President
GRANITE PRECASTING CONCRETE
4116 BAKERVIEW SPUR INVOICE 44883
BELLINGHAM, WA 98226 Invoice Date: 9/16/2011
Phone: (360) 671 -2251
Fax: (360) 671 -0780 n y w- i° ;3 �f
r
Job Number: 5268
I� C
Ship to: 2010 2011 SMALL DRAINAGE PROGRAM 1
SEE MAP c s AI;
I!
TUKWILA, WA 98188 f 1"
Sold to: GREEN RIVER CONSTRUCTION By
6402 S. 144TH STREET, STE. #1 s
TUKWILA, WA 98168
ar AK• mv* r T, �+',c, �c^ .yl"�r '>T ;I�v'X d`
9/16/2011 Mike Hudson -103 NET 10TH 1
S wCC+•' sT`� r .2 "7 N r ^.r, 1 a m� N
r .v[:x.�..9...ia..,.: ..'1'Mad s'.s35xb9mLi +ma �azzur�a a� f+.:s �,v ee"�.'., U,uv.': 1�;.?�'tar�md4�. xi�aaF�wb� ^.`.�.rw.�?e�V�3��k,..s�. i_sv a�.._.i..y...,_as:. �.,.sE. o3v?r y 5?:
DMB A16494611
Qty Item
Structure:
1 CBR -04
1 CBR -06
1 048TSP
1 048X01R
1 048X06BWC
2 048RG
1 L05P
Structure:
1 048X01 R
1 048X06BWC
2 048RG
1 L05P
Structure:
1 CBR -06
1 048TSP
1 048X04R
1 048X05BHKO
2 048RG
1 L04P
Description
TUKWILA INTE
4" CB RISER
6" CB RISER
48" FLATTOP/ SQUARE HOLE
48" X 1' RISER
48" X 6' BASE W/ HOLE
48" GASKET
5 STEP POLY MH LADDER
TUKWILA INTE
48" X V RISER
48" X 6' BASE W/ HOLE
48" GASKET
5 STEP POLY MH LADDER
TUKWILA INTE
4" CS RISER
r
48" FLATTOP/ SQUARE HOLE
48" X 6' BASE W/ HOLE
48" GASKET
Weight Unit Price TX Extension
180
Structure
1
CBR -04
1
048TSP
950
048X06BWC
i
04bKt,
1
L05P
Structure:
1 CBR -06
1 048TSP
1 048X04R
1 048X05BHKO
2 048RG
1 L04P
Description
TUKWILA INTE
4" CB RISER
6" CB RISER
48" FLATTOP/ SQUARE HOLE
48" X 1' RISER
48" X 6' BASE W/ HOLE
48" GASKET
5 STEP POLY MH LADDER
TUKWILA INTE
48" X V RISER
48" X 6' BASE W/ HOLE
48" GASKET
5 STEP POLY MH LADDER
TUKWILA INTE
4" CS RISER
r
48" FLATTOP/ SQUARE HOLE
48" X 6' BASE W/ HOLE
48" GASKET
Weight Unit Price TX Extension
180
$41.00
260
$42.00
1,580
$111.15
950
$96.85
6,838
$365.95
0 $0.00
20 $0.00
Structure Total
NEEDS DEBRIS CAGE BY OTHERS
950 $96.85
6,979 $365.95
0 $0.00
20 $0.00
Structure Total
5 STEP POLY MH LADDER
WELLS TRUCK
$41.00
6" CB RISER
1,1,,1..15
48" FLATTOP/ SQUARE HOLE
$365.95
y
48" X 4' RISER
48" X 5' BASE HIGH K.O.�,"\
$0.00
48" GASKET
$330.20
4 STEP POLY MH LADDER
L
$0.00
17
Structure:. WELLS TRUCK
180
$41.00
1,580
1,1,,1..15
7,028
$365.95
y
0
$0.00
20
$0.00
Structure Total
$41.00
$42.00
$111.15
$96.85
$365.95
$0.00
$0.00
10
$656.95
I0 \S
$9
$365.95
$0.00
$0.00
$462.80
$41.00
$111.15
$365.95
$0.00
$0.00
$518.10
260
$42.00
$42.00
1,580
$111.15
$111.15
3,600
$204.10
$204.10
4,912
$330.20
$330.20
0
$0.00
$0.00
17
$0.00
$0.00
Structure Total
$687.845
6
11- 112(b)
Council Approval N/A
ti Sheet 1 of 1
CITY OF TUKWILA
CONTRACT CHANGE ORDER NO. 02
1908
NOTE: This change order is not effective until approved by the "Owner' and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner" which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE:
Modify the restoration details at Site 2 (TIB) and Site 5 (Evergreen Foods) as requested in Field
Directive #2 and Field Directive #3. Payment for each new material will be per PSIPE unit price
with scope defined in the contract for similar PSIPE materials and will not exceed the total value
listed below. The total cost of restoration will be partially offset by reductions in other unit price
quantities.
15 Western Red Cedar at 12.95 ea.
30 Big Leaf Maple at 12.95 ea.
This Change will be compensated under Schedule A Roadside Development. This change also
includes a''V2 day time extension for additional restoration to the pavement at Site 5.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specified, d will accept as full payment therefore the prices shown above d below.
ACCEP E Date 3,h1/� Contracto4
By Title /vldAI��
OrigiContract 788,005.50 APPROVED BY THE CITY OF TUKWILA
Previous Change Order 517.50 /Date 3 9
This Change Order 582.75 By
REV. CONTRACT AMOUNT 789,105.75
ORIGINAL: City Clerk (1 of 2) Contractor (2 of 2)
Note: Sales tax shall be included in the various unit prices, per Standard Specification 1- 07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171 5f-d f a <�/Z( (3 tA/* —S
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite 4200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 002
To: Green River Construction Date: 9/29/11
6402 S. 144`' St. #1 Project Name: 2010/2011 Small Drainage Proj.
Tukwila WA 98168 Project No.: 91041201
Attn: Jerry Knudson Contract No.: 11 -112
Work to be performed: r_wc`
Modify the restoration plantings at Site 2 (TIB) and Site 5 _-e4@4;i6c acility) per the
exhibit attached. Provide unit price for Western Red Cedar and Big Leaf Maple and any impact
caused by quantity modification to the Topsoil and Vine Maple as noted.
Reason for modification:
Final review of the restoration details produced comments which are reflected in the plan markups.
The modifications seem minor and we would like to make the changes unless it dramatically
impacts the price to install.
Work under this Field Directive modification will be accomplished:
On a unit price basis as detailed above.
With no change in contract completion date.
Performance of this ield irective is authorized by all signatures below:
Accepted by:
Congo Rep —Nam
T r a� ►I .14111
Approved by:
t City Construction Engineer Date
Verified by:
n
City Construction Inspector Date
x
x
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 003
To: Green River Construction I Date: 10/03/11
6402S.144 th St. #1 1 Project Name: 2010/2011 Small Drainage Proj.
Tukwila WA 98168 Project No.: 91041201
Attn: Jerry Knudson Contract No.: 11 -112
Work to be performed:
Modify the pavement restoration limits and drainage feature repair at Site 5 (Evergreen Foods) per
the exhibit attached. Extend pavement replacement and reslope the localized pavement
depression to drain to private system. Shift proud MH lid back into alignment with lower sections
and grout in place prior to paving.
Reason for modification:
Final review of the restoration details showed a challenging pavement edge to reconnect our
pavement patch to. In addition, the existing pavement surface in this area did not drain exclusively
to the private system, instead routing a significant portion of the water from the parking area directly
to the creek and /or through the public system. The new pavement boundaries will channel water
through the orifice structure on the private side before discharging into the public system.
Work under this Field Directive modification will be accomplished:
With work to start immediately and determination of the change tc
tracked by Force Account Property Restoration and unit price items.
With no change in contract completion date.
Performance of t is Fiel Directive is authorized by all signatures below:
Accepted by: k
Co a is Rep Name
Title
Approved by
City Construction Engineer
Verified by: AAA �41bou
City Construction Inspector
the contract price to be
/r4/1,
IN A
Date_
Dat
x
GREEN RIVER CONSTRUCTION CO INC
64U2 South l44th Suite #1
Tukwila, Washington 98l68
Office: (206) 246 Fax: (206) 246
February 2,2OlZ
City of Tukwila
Department of Public Works
6]OUSouthcenter Boulevard, Suite #l0U
Tukwila, Washington 98188
Attn: Mr. Mike Ronda
Re: 202ZO/2OI1 Small Drainage Program #Il'1l2
Request for Additional Days
Dear Mike:
VVe are requesting that the additional days be added to our contract.
Mr
9.ZZ.11-Site 5 Evergreen Foods 1
Waiting for decision nnbackƒiUof void under I4"pipe. -�m�u�t�
9.30.l1-Site 5 Evergreen Foods
Regrading parking lot adjacent to new structure and resetting existing stru
lO.I7.11- Site 4Allentown l Day
Extra yOLF storm &CBat1ZIZ7
1O.JO.11- Site 4Allentown
Added grading paving of thickened edge
1O.Z8.11&lU31.Il- Site 1 Wells Trucking
Additional contaminated soil export
1l.Z3.l1-Site 3-Museum of Flight
Jerry Knudson
President
lDay
v�— 9 m~�-
^���8��m
"m-
11- 112(a)
Council Approval N/A
A w N Sheet 1 of 1
CITY OF TUKWILA
,9 -.0;3
CONTRACT CHANGE ORDER NO. 1
DATE: 09 /29/11 BUDGET NO.:
PROJECT NO.: 91041201 CONTRACT NO.: 11 -112 a)
PROJECT NAME: 2011 Small Drainage Project
TO: Green River Construction CO. Attn: Jerry Knudson, President
You are hereby directed to make the herein described changes to the plans and specifications or do
the following described work not included in the plans and specifications on this contract:
NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is
issued.
Conditions: A. The following change, and work affected thereby, is subject to all
contract stipulations and covenants;
B. The rights of the "Owner" are not prejudiced; and
C. All claims against the "Owner" which are incidental to or as a consequence of this
change are waived.
D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates
for approval in advance of all Change Orders.
CHANGE: Provide an access point through the Gilliam Creek (site #9) trash rack per the Field
Directive #1 attached. The use of Galvanized hardware as opposed to the stainless bolts previously
discussed will be permitted. Replaceable bar material should be the same base metal and
treatment methods as the rest of the structure.
This Change Order will be added to the Storm Drainage portion of the contract. There is no time
extension associated with this Change Order.
We the undersigned Contractor, have given careful consideration to the change proposed and
hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials,
except as may otherwise be noted above, and perform all services necessary for the work above
specified, and will accept as full payment therefore the prices shown above and belo X.
ACCE E Date: 11, 41// Contractor: 12 p� d L
t 94
Y
B 4 Title: 15 L; r
Origir,iA Contra 788,005.50 APPROVED BY THE CITY OF TUKWILA
Previous Change Order 0.00 Date: NINP W_42eh
This Change Order 517.50 By:
r Mayo/
REV. CONTRACT AMOUNT 788,523.00 61
ORIGINAL: City Clerk (I of 2) Contractor (2 of 2)
Note: Sales tax shall be included in the various unit prices, per Standard Specification 1- 07.2(2) (APWA Supplement 1 -99)
and WAC 458 -171
cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file:
1 ,5J 2 o9 1611UA-e-S
CITY OF TUKWILA PUBLIC WORKS DEPARTMENT
6300 Southcenter Boulevard, Suite #200
Tukwila, Washington 98188
Phone: (206) 433 -0179
FIELD DIRECTIVE 01
To: Green River Construction Date: 08/11/11
6402S.144 1h St. #1 Project Name: 2010/2011 Small Drainage Proj.
Tukwila WA 98168 I Project No.: 91041201
Attn: Jerry Knudson Contract No.: 11 -112
Work to be performed:
Modify the Gilliam Creek (Site #9) trash rack structure per the attached Exhibit to provide access
through the trash rack for routine maintenance and construction. The access will be provided by
creating three removable bar sections at the center of the trash rack as shown.
Use galvanized hardware as apposed to the stainless bolts previously discussed. Replacable bar
material should be the same base metal and treatment methods as the rest of the structure.
Reason for modification:
In the original design no provision was made to allow man access /egress from the inlet end of the
culvert following the installation of the trash rack. In addition, installation actually requires the trash
rack assembly to be bolted to the substructure mount points. This would require accessing the
culvert from the downstream end and potentially removing the flap gate. With a one way structure
and open flow to the river this creates a potentially hazardous confined space condition.
For routine maintenance City personnel will either remove the bolts for reuse or cut them off and
provide new hardware after each access operation.
Work under this Field Directive modification will be accomplished:
For a lump sum increase of $517.50 to the contract price.
With no change in contract completion date.
Performance of this Field Directive is authorized
by I signatures below:
Accepted by: J F V f
o tra
Contractor's Rep Name
l
Approved b
pp Y
J City Construction Engineer
Verified by:
City Construction Inspector
e b
Date
Date
�I
1
o
rr O ww. 4
CL- cy-- 1
a a
a
Q U
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N 1
Cl
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1 a�
m
t7
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1
C -1
AGREEMENT FORM 11-112
CONTRACT NO. Council Approval 7/18/11
THIS AGREEMENT is made and entered into on this of b v4 ;:I 20�, by and between
the City of Tukwila, Washington "Owner and Gcem Q,vin nSar c a "Contractor Now,
therefore the parties agree as follows:
1. Project. Contractor shall complete all work and furnish all labor, tools, materials, and equipment for
the project entitled 2010 /2011. Small Drainage Program Project No..91041201, including all changes to the
Work and force account work, in accordance with the Contract Documents, as described in Section. 1 -04,2 of
the Supplemental General Requirements.
2. Payrrients. Owner shall pay Contractor at the unit a. nd lump sum prices, and by force account as
specified in tine Proposal according to the Contract Documents as to time, manner, and condition of payment.
The payments to Contractor include the costs for all labor, tools, materials and equipment for the Work.
3. Com})letion Date. Contract time shall commence upon Owner's Notice to Proceed date. The Work
under this Agreement shall be completed within the time specified in the Proposal. If the Work under this
Agreement is not completed within the time specified, as detailed in the Contract Documents, Contractor shall
pay liquidated. damages and all engineering inspection and supervision costs to Owner as specified in the
Proposal.
4. Attorney's Fees. In the event litigation is commenced to enforce this.Agreemerit, the prevailing party
shall be entitled to recover its costs, including reasonable attorney's and expert witness fees.
5. Disclaimer. No liability of Contractor shall attach to Owner by reason of entering into this Agreement,
except as expressly provided in this Agreement.
6. Counterparts. This Agreement is executed in two (2) identical counterparts, by the parties,, each of
which shall for all purposes be deemed an original.
CITY OF TUKWILA, WASHINGTON
(.Owner)
By d t�•
Ma
C
Attest:
This Ll day of AA 20 __1
City Clerk f/
Approved as to Form:
City Attorney"
Address for cliving notices:
6300 SAd s %E loo
VX
(Con actor)
By:
Title:
Attest: T
This day oft 20
Contractor's License No.
Address for giving notices:
i S e a oz16iva�"
Page 24 Agreement Form
P,ovided to Builders Exchange of VITA, Inc. For usage Conditions see •,1, a.com Always Verify Scale
C -2
PAYMENT AND PERFORMANCE BOND
Bond to City of Tukwila, Washington
Bond No. 105637172
We, Green River Construction, Inc. and Travelers Casualty and Surety Company of America
(Principal) (Surety)
a Connecticut corporation, and as a surety corporation authorized to become a surety upon
Bonds of Contractors with municipal corporations in Washington State, are jointly and severally
bound to the City of Tukwila, Washington "Owner in the penal sum of
Seven Hundred Eiqhtv -Eight Thousand Five and 50/ 100ths Dollars
788.005.50 the payment of which sum, on demand, we bind ourselves and our
successors, heirs, administrators, executors,. or personal representatives, as the case may be.
This Payment and Performance Bond is provided to secure the performance of Principal in
connection with a contract dated 20 11 between Principal and Owner
for a project entitled 2010/2011 Small Drainage Program Contract No. "Contract
The initial penal sum shall equal 100% of the Total Bid Price, including sales tax, as specified in the
Proposal submitted by Principal.
NOW, THEREFORE, this Payment and Performance Bond shall be satisfied and released only
upon the condition that Principal:
Faithfully performs all provisions of the Contract and changes authorized by Owner in the
manner and within the time specified as may be extended under the Contract;
Pays all laborers, mechanics, subcontractors, lower tier subcontractors, material men,
and all other persons or agents who supply labor, equipment, or materials to the Project;
Indemnifies and holds Owner, its officers, and agents harmless from and against all
claims, liabilities, causes of action, damages, and costs for such payments for labor,
equipment, and materials by satisfying all claims and demands incurred under the Contract,
and reimbursing and paying Owner all expenses that Owner may incur in making good any
default by Principal; and
Indemnifies and holds Owner harmless from all claims, liabilities, causes of action,
damages and costs, including property damages and personal injuries, resulting from any
defect appearing or developing in the material provided or workmanship performed under the
Contract.
The indemnities to Owner shall also inure to the benefit of the Consulting Engineers and other
design professionals retained by Owner in connection with the Project.
This bond shall remain in full force and effect at 10% of the total bid price for one (1) year after
Final Completion of the Contract, to insure against all defects and corrections needed in the
material provided or workmanship performed.
The liability of Surety shall be limited to the penal sum of this Payment and Performance Bond.
No change, extension of time, alteration, or addition to the terms of the Contract or to the Work to
be performed under the Contract shall in any way affect Surety's obligation on the Payment and
Performance Bond. Surety hereby waives notice of any change, extension of time, alteration, or
addition to the terms of the Contract or the Work, with the exception that Surety shall be notified if
the Contract time is extended by more than twenty percent (20
Page 25 Payment and Performance Bond
Payment Si Performance Bond
if any modification or change increases the total amount to be paid under the Contract, Surety's
obligation tinder this Payment and Performance Bond shall automatically increase in a like amount.
Any such increase shall not exceed twenty -five percent (25 of the original amount of the
Payment and Performance Bond without the prior written consent of Surety.
This Payment and Performance Bond shall be governed and construed by the laws of the State of
Washington, and venue shall be in King County, Washington.
IN WITNESS WHEREOF, the parties have executed this instrument in two (2) identical
counterparts this 3rd day of August 2011
een iver Construction, Inc.
Principal
icln e of Authorized Official
Title
Travelers Casualty and Surety Company of
America
n Surety
Signaturb of Authorized Official
By Julie R. Truitt, Atto'rnev -in -Fact
Attorney in Fact
(Attach Power of Attorney)
Name and address of local office of
agent and /or Surety Company:
C -3
Propel lncuranr
1201 Pacific Avenue, Suite 1000
Tacoma, WA 98402
Surety companies executing bonds must appear on the current Authorized Insurance List in the State of
Washington per Section 1 -02.7 of the Standard Specifications.
Page 26
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
POWER OF ATTORNEY
TRAVELERS Farmington Casualty Company St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America
St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St. Paul Guardian Insurance Company
Attorney -In Fact No. 22 935
Certificate No. 003769499
KNOW ALL MEN BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance
Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and
Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty
Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under
the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin
(herein collectively called the "Companies and that the Companies do hereby make, constitute and appoint
Eric Zimmerman, Karen Swanson, Brent E. Heilesen, Anne E. Strieby, James B. Binder, Peter J. Comfort, Jennifer L. Snyder, Lisa Kerstetter, Julie R. Truitt,
Peggy A. Firth, Tamarie Ellingsen, Steve Marinkovich, Melinda Carlson, and Christopher Kinyon
of the City of Tacoma State of Wa shington their true and lawful Attorneys) -in -Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or;proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 15th
day of July 2010.
Farmington Casualty Company r j St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company 1 Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America
St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St. Paul Guardian Insurance Company
GI.SU,� C�1977
6�6i N Fry .0 u" 9
�,,n ?tN j S E A �a SEALa3 t ytd �w a .ps� a
State of Connecticut
City of Hartford ss.
By:
Georg6 Thompson, error ice President
On this the 15th day of July 2010 before me personally appeared George W. Thompson, who acknowledged
himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters,
Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety
Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do,
executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
OPP In Witness Whereof, I hereunto set my hand and official seal. My Commission expires the 30,th day of June, 2011. Marie C. Tetreault, Notary Public
58440 -4 -09 Printed in U.S.A,
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity
and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice
President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf
of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking
shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President,
any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds
and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
I, Kori M. Johanson, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance
Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and
Surety Company, Travelers Casualty and Surety Company of America, and United.States Fidelity and Guaranty Company do hereby certify that the above and foregoing
is a true and correct copy of the Power of Attorney executed by said Companies; which is in•full forceand effect and has not been revoked.
0 a
IN TESTIMONY WHEREOF, I have hereunto set my hand a_nd affixed the seals of said Companies this day of 20 f
4
Kori M. Johans�a/Assistant Secretary
pI.SU,� F\PE� W INSG j \Ng�q a tY ANO 30R ������ttY
Z 6 o 1977 G "t i f t E a NRRrwaD, itaaao T� 1896
o =.SEAL
CANN. c Ca7N. �e A
�y �N s vcnr+cb a'•....... 'Ian -f i b v.'•... aD s gar t Yf ,p
To verify the authenticity of this Power of Attorney, call 1- 800 421 -3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the
above -named individuals and the details of the bond to which the power is attached.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
Client#: 121099 GREERIVE8
DATE (MM /DD /YYYY)
ACORU. CERTIFICATE OF LIABILITY INSURANCE 7/26/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER I (:NAME: ONTACT Christine Maden
Propel Insurance PHONE g00 499 -0933 FAX 253- 752 -8659
(A/C, No. Ext): I (A/C, Nol:
Tacoma Commercial Insurance I ADDRESS: CLM @propelinsurance.com
1201 Pacific Ave, Suite 1000 PRUDUL;.,t
CUSTOMER ID
Tacoma, WA 98402
INSURER(S) AFFORDING COVERAGE NAIC
INSURED I INSURER A: Continental Western Insurance C I
Green River Construction Co Inc
I INSURER B: I
6402 South 144th Street, #1
I INSURER C I
Tukwila, WA 98168
I INSURER D
INSURER E: I
INSURER F
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE FOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I TYPE OF INSURANCE: INSIt IjyVD I POLICY NUMBER
I(MM /DD E /YYYY) I(MM/DD/YYYY) I LIMITS
A
GENERAL LIABILITY X X CWP2912671
12/08/2010 12/08/20111 EACH OCCURRENCE 1$1,000,000
X
MMERCIAL GENERAL LIA131LITY
TO RENTED
PREMISES (Ea occurrence) $100,000
H DAMAGE
CLAIMS -MADE a OCCUR
I MED EXP (Any one person) 1$5,000
X
PD Ded: $1,000
I PERSONAL &ADV INJURY 1$1,000,000
GENERAL AGGREGATE 1$2,000,000
PER:
I PRODUCTS COMP /OP AGG I $2,000,000
GEN'L AGGREGATE LIMIT APPLIES
POLICY I AI %r.T F LOC
Is
A
AUTOMOBILE LIABILITY X CWP2912671
12108/2010 12/08/2011
COMBINED SINGLE LIMIT
(Ea accident)
$1.000.000
X
ANY AUTO
BODILY INJURY (Per person)
Is
ALL OWNED AUTOS
BODILY INJURY (Per accident) I
SCHEDULED AUTOS
PROPERTY DAMAGE
X
HIRED AUTOS
(Per accident)
X
NON OWNEDAUTOS
I Is
Is
A
UMBRELLA LIAB X OCCUR CU2912672
12/08/2010 12/08/20111 EACH OCCURRENCE 1$2,000,000
EXCESS LIAB CLAIMS -MADE
I AGGREGATE 1$2,000,000
I Is
H DEDUCTIBLE
RETENTION
I Is
WORKERS COMPENSATION (WA Stop Gap)
WC Y LIMIT X OTH -I
ER
AND EMPLOYERS' LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE i CWP2912671
12/08/2010 12/0812011
E.L. EACH ACCIDENT 1$1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH)
I E.L. DISEASE EA EMPLOYEEI $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE POLICY LIMIT 1$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Re: 201012011 Small Drainage Program Project No. 91041201
The City of Tukwila and its officers, elected officials, employees, agents, engineering Consultants,
(See Attached Descriptions)
CERTIFICATE HOLDER
City of Tukwila
6300 South Center Blvd., Ste 100
Tukwilla, WA 9,8188
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S713144/M563877 BEB00
on
DESCRIPTIONS (Continued from Page 1)
Construction Managemanet Consultants and volunteers are named as Additional Insured per attached
endorsement.
AMS 25.3 (2009/09) 2 of 2
#S713144IM563877
Why We Are Using the Latest ACORD 25 Certificate of Insurance
In September 2009, ACORD revised the ACORD 25 Certificate of Insurance form. One of the major
changes was the removal of the cancellation notice provision. For the following reasons, we are
unable to issue an older edition of this form, modify the current form, or complete a proprietary form
you provide
Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this
certificate is able to provide the cancellation notice you desire by endorsement. For example, the
insured can canc=el immediately, so it would be impossible for the insurer to give you the notice you
request. State law also grants the insurer the right to cancel for reasons such as nonpayment with
less notice than you require.
For the reason just cited, if our agency was to issue a certificate that provides the cancellation
notice you request, we would do so with the full knowledge that.it would be impossible to actually
give that amount of notice under certain circumstances. As such, the certificate could be alleged to
constitute a misre=presentation or fraud which could subject our agency and staff to serious civil
and criminal penalties.
If a certificate purports to provide a policy right different from that provided by the policy itself, then
the certificate effectively purports to be a policy form. Policy forms must be filed and approved by
our state department of insurance. Use of nonfiled policy forms is illegal and could result in legal
sanctions distinct: from the assertion that the certificate is fraudulent.
Under the ACORD Corporation's licensing agreement, the prior editions of superseded forms can
be used for one year from the time the new forms are introduced. Beginning in September 2010,
this is another reason we cannot use an older edition of the ACORD 25. Doing so would violate
ACORD's licensing agreement and, as a copyrighted document, federal copyright law.
Likewise, we are unable to modify the new certificate to add a notice of cancellation. ACORD forms
are designed to be completed, not altered. ACORD's Forms Instruction Guide says that a
certificate should not be used "To waive rights To quote wording from a contract—To quote any
wording which amends a policy unless the policy itself has been amended." In addition, our
insurance company contracts only allow us to issue unaltered ACORD forms.
We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our
insurance company contracts only allow us to issue unaltered ACORD forms. Many proprietary
certificates include broad, vague or ambiguous language that may or may not be incompliance with
state laws, regulations, and insurance department directives. Therefore, we cannot issue any
proprietary certific=ates.
We appreciate your understanding of the legal restrictions on our ability to fully comply with your
request
Green River Construction Co Inc
CW P2912671
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED OWNERS, LESSEES OR
CONTRACTORS COMPLETED OPERATIONS AUTOMATIC
STATUS WHEN REQUIRED BY WRITTEN CONTRACT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Section 11— Who Is An Insured is amended to include as an additional insured any person or organization
for whom you are performing operations when you and such person or organization have agreed in writing
in a contract or agreement that such person or organization be added as an additional insured on your
policy. Such person or organization is an additional insured only with respect to "bodily injury" and
"property damaige" caused, in whole or in part, by "your work" at locations specified in the written contract
or agreement and included in the "products completed operations hazard
With respect to the insurance afforded to these additional insureds, this insurance does not apply to
"bodily injury" or "property damage" that occurs prior to the execution of, or subsequent to the expiration
of, the contract or agreement in which you agreed that such person or organization be added as an
additional insured on your policy.
CL CG 20 14 0 Includes copyrighted material of Insurance Services Page 1 of 1
Offices, Inc., with Its permission
Green River Construction Co Inc
CWP2912671
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS' COMMERCIAL GENERAL LIABILITY
ENHANCEMENT ENDORSEMENT
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. MEDICAL PAYMENTS
If SECTION I COVERAGE C MEDICAL PAY-
MENTS is not otherwise excluded from this
Coverage Part:
1. The Medical Expense Limit provided by this
policy, subject to the terms of SECTION III
LIMITS OF INSURANCE, shall be the
greater of
a. $10,000; or
b. The Medical Expense Limit shown in the
Declarations of this Coverage Part.
B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND
SPRINKLER LEAKAGE DAMAGE TO PREM-
ISES YOU RENT
If damage to premises rented to you under Cov-
erage A. is not otherwise excluded from this pol-
icy, the following applies:
1. The last paragraph of SECTION I COV-
ERAGE A.2. Exclusions is deleted and re-
placed by the following:
Exclusions c. through n. do not apply to
damage by fire, lightning, explosion or sprin-
kler leakage to premises while rented to your
or temporarily occupied by you with permis-
Sion of the owner. A separate limit of insur-
ance applies to this coverage as described
in SECTION III LIMITS OF INSURANCE.
2. Paragraph 46. of SECTION 111 LIMITS OF
INSURANCE is deleted and replaced by the
following:
6. Subject to 5. above, the greater of
a. $300,000; or
b. the Damage To Premises Rented
To 'You Limit shown in the Declara-
tions;
is the most we will pay under COVER-
AGE A for damages because of "prop-
erty damage" to any one premises, while
rented to you, or temporarily occupied by
you wit) the permission of the owner
arising out of any one fire, lightning, ex-
plosion or sprinkler leakage incident.
3. Paragraph 4.b.(1)(b) Other Insurance of
SECTION I'V COMMERCIAL GENERAL
LIABILITY CONDITIONS is deleted and re-
placed by the following:
(b) That Is Fire, Lightning, Explosion or
Sprinkler Leakage insurance for prem-
ises rented to you or temporarily occu-
pied by you with the permission of the
owner;
4. Paragraph 9.a, of SECTION V DEFINI-
TIONS is deleted and replaced by the follow-
ing:
a. A contract for a lease of premises.
However, that portion of the contract for
a lease of premises that Indemnifies any
person or organization for damage by
fire, lightning, explosion or sprinkler
leakage to premises while rented to you
or temporarily occupied by you with
permission of the owner is not an "in-
sured contract
C. NON -OWNED WATERCRAFT
1. Paragraph g.(2� of SECTION I COVER-
AGE A.2. Exclusions is deleted and re-
placed by the following:
A watercraft you do not own that is:
(a) Less than 51 feet long; and
(b) Not used to carry persons or property for
a charge.
D. SUPPLEMENTARY PAYMENTS
SECTION I SUPPLEMENTARY PAYMENTS
COVERAGES A AND B is amended as fol-
lows:
1. The limit of insurance In paragraph 1.b, is
increased from $250 to $2,500; and
2. The limit of insurance in paragraph 1.d. is
increased from $250 to $500.
E. AUTOMATIC ADDITIONAL INSURED
SPECIFIED RELATIONSHIPS
The following is added to Paragraph 2. of SEC-
TION II WHO ISAN INSURED:
e. Any person or organization described in
paragraph f. below, whom you and such per-
son or organization have agreed in writing in
a contract or agreement that such person or
organization be added as an additional in-
sured on your policy.
CL CG 00 20 03 07 Includes copyrighted m aerial of Ins urance Services Page 1 of 6
Office, Inc„ with Its permission
Green River Construction Co Inc
CWP2912671
Such person or organization is an insured
(c) The ownership, maintenance, or use
provided:
of any elevators.
(1) The written or oral contract or agree-
F. ADDITIONAL INSURED OWNERS, LESSEES
ment is:
OR CONTRACTORS AUTOMATIC STATUS
(a) Currently in effect or becomes effec-
1. SECTION 11 WHO IS AN INSURED is
tive during the policy period; and
amended to include as an additional insured
(b) Executed prior to an "occurrence" or
any person or organization for whom you are
performing operations when you and such
offonse to which this insurance
would apply.
person or organization have agreed in writ-
ing in a contract or agreement that such per
(2) They are not specifically designated as
son or organization be added as an addi-
an additional insured under any other
tional insured on your policy. Such person or
provision of, or endorsement added to,
organization is an additional insured only
this policy.
with respect to liability for "bodily injury',
f. Only the fallowing persons or organizations
"property damage" or "personal and adver-
tising injury' caused, in whole or in part, by.
are additional insureds under this endorse-
ment, and coverage provided to such addi-
a. Your acts or omissions; or
tional insureds is limited as provided herein:
b. The acts or omissions of those acting on
(1) The manager or lessor of a premise
your behalf;
leased to you, but only with respect to li-
ability wising from the ownership, main-
in the performance of your ongoing opera
tenanco or use of that part of the prem-
tions for the additional insured.
ises leased to you and subject to the fol-
A person's or organization's status as an ad-
lowing additional exclusions:
ditional Insured under this policy ends when
This Insurance does not apply to:
your operations for that additional insured
(a) Any "occurrence" which takes place
are completed.
aft(-.:r you cease to be a tenant of that
2. With respect to the insurance afforded to
premises.
these additional insureds, the following addi-
(b) Stnictural alterations, new construc-
tional exclusions apply:
tion or demolition operations per-
This insurance does not apply to:
forrned by or on behalf of the man
ager or lessor.
a. �"Bodily injury", "property damage" or
personal and advertising injury arising
(2) Any person or organization from whom
out of the rendering of, or the failure to
you lease equipment, but only with re-
render, any professional architectural,
spect to liability for "bodily injury", "prop-
engineering or surveying services, in-
erty damage" or "personal and advertis-
cluding:
ing injui" caused, In whole or In part, by
your maintenance, operation or use of
(1) The preparing, approving, or failing
equipment leased to you by such per-
to prepare or approve, maps, shop
son(s) or organization (s).
drawings, opinions, reports, surveys,
field orders, change orders or draw
I
However, this insurance does not apply y
ings and specifications; or
to any occurrence' which takes place
after the equipment lease expires.
(2) Supervisory, inspection, architec-
(3) Any state or political subdivision, subject
tural or engineering activities.
to the ft >Ilowing additional provision:
b. "Bodily Injury" or "property damage"
This insurance applies only with respect
occurring after:
to the 'following hazards for which the
(1) All work, including materials, parts
state or political subdivision has issued a
or equipment furnished in connec-
permit in connection with premises you
lion with such work, on the project
own, rent, or control and to which this in-
(other than service, maintenance or
surance: applies:
repairs) to be performed by or on
(a) Thee existence, maintenance, repair,
behalf of the additional insured(s) at
the location of the covered opera
construction, erection, or removal of
advertising signs, awnings, cano-
tions has been completed; or
piest, cellar entrances, coal holes,
(2) That portion of "your work" out of
driveways, manholes, marquees,
which the injury or damage arises
hoist away openings, sidewalk
has been put to its intended use by
vaults, street banners, or decora-
any person or organization other
tions and similar exposures; or
than another contractor or subcon-
(b) They construction, erection, or re-
tractor engaged in performing op-
moval of elevators; or
eratlons for a principal as a part of
the same project.
CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 2 of 6
office, Inc., with Its permission
Green River Construction Co Inc
CWP2912671
3. The insurance provided by this endorsement
is primary insurance and we will not seek
contribution under any insurance policy un-
der which such additional insured is a
named insured, if such policy was procured
and paid for by such additional insured, or a
parent or related entity of such additional in-
sured.
4. With respect to the insurance afforded to
these additional insureds, SECTION III
LIMITS OF INSURANCE is amended as fol-
lows:
The limits applicable to the additional in-
sured are those specified in the written con-
tract or agmement or the limits stated in the
Declarations, whichever is less. If no limits
are specified in the written contract or
agreement, the limits applicable to the addi-
tional insured are those specified in the Dec-
larations. The limits of insurance are inclu-
sive of and not in addition to the limits of in-
surance shown in the Declarations.
G. PROPERTY DAMAGE TO BORROWED
EQUIPMENT
1. Paragraph 2.j. of SECTION I COVER-
AGES, COVERAGE A BODILY INJURY
AND PROPERTY DAMAGE LIABILITY is
amended ais follows:
Paragraphs (3) and (4) of this exclusion do
not apply to tools or equipment loaned to
you, provided they are not being used to per-
form operations at the time of loss.
2. SECTION III LIMITS OF INSURANCE is
deleted and replaced by the following:
The most we will pay in any one "occur-
rence" for "property damage" to borrowed
equipment is $15,000. This limit of insur-
ance Is the most we will pay regardless of
the number of
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims
or bringing "suits
3. Deductible
Our obligation to pay damages on behalf
of the insured applies only to the amount
of damages in excess of $250 as appli-
cable to "property damage" as the result
of any one "occurrence regardless of
the number of persons or organizations
who sustain damages because of that
"occurrence
c. We may pay any part or all of the de-
ductible amount to effect settlement of
any claim or suit and, upon notification
of the action taken; you shall promptly
reimburse us for such part of the de-
ductible amount as we have paid.
H. BROADENED NAMED INSURED
Paragraph 3. of SECTION II WHO IS AN IN-
SURED is deleted and replaced by the following:
Any organization, other than a joint venture, over
which you maintain ownership or majority inter-
est of more than 50% will be a Named Insured if
there is no other similar insurance available to
that organization. However:
a. Coverage under this provision is afforded
only until the 180th day after you acquire or
form the organization or the end of the policy
period, whichever is earlier.
b. COVERAGE A does not apply to "bodily in-
jury" or "property damage" that occurred be-
fore you acquired or formed the organiza-
tion.
c. COVERAGE B does not apply to "personal
and advertising injury" arising out of an of-
fense committed before you acquired or
formed the organization.
I. CONSTRUCTION PROJECT GENERAL AG-
GREGATE LIMIT
For all sums which the insured becomes
legally obligated to pay as damages caused
by "occurrences" under COVERAGE A
(SECTION 1), and for all medical expenses
caused by accidents under COVERAGE C
(SECTION 1), which can be attributed only to
ongoing operations at a single construction
project away from premises owned by or
rented to the insured:
a. A Single Construction Project General
Aggregate Limit applies to each con-
struction project away from premises
owned by or rented to the insured, and
that limit Is equal to the amount of the
General Aggregate Limit shown in the
Declarations.
b. The Single Construction Project General
Aggregate Limit is the most we will pay
for the sum of all damages under COW
ERAGE A, except damages because of
"bodily injury" or "property damage" in-
cluded in the "products completed op-
erations hazard and for medical ex-
penses under COVERAGE C regardless
of the number of:
b. The terms of this insurance, including (1) Insureds;
those with respect to our right and duty (2) Claims made or "suits" brought; or
to defend the insured against any "suits" (3) Persons or organizations making
seeking those damages; and your duties claims or bringing "suits
in the event of an occurrence claim, or
"suit" apply irrespective of the application
of the deductible amount.
CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 3 of 6
Office, Inc., with its permission
Green River Construction Co Inc
CWP2912671
c. Any payments made under COVERAGE
J. KNOWLEDGE OF OCCURRENCE
A for damages or under COVERAGE C
for medical expenses shall reduce the
The following is added to paragraph 2. Duties In
Single Construction Project General Ag-
The Event Of Occurrence, Offense, Claim Or
Suit of SECTION IV COMMERCIAL GEN-
gregate Limit for that construction pro-
sect away from premises owned by or
ERAL LIABILITY CONDITIONS:
rented to the insured. Such payments
e. A report of an "occurrence offense, claim
shall not reduce the General Aggregate
or "suit" to:
Limit shown in the Declarations nor shall
they reduce any other Single Construc-
(1) You, if you are an individual,
tion Project General Aggregate Limit for
(2) A partner, if you are a partnership,
any other separate construction project
away from premises owned by or rented
(3) An executive officer, if you are a
to the insured.
corporation, or
d. The Iimlits shown in the Declarations for
(4) A manager, if you are a limited liability
Each Occurrence, Fire Damage and
company,
Medical Expense continue to apply.
However, instead of being subject to the
is considered knowledge and requires you to
"occurrence
General Aggregate Limit shown in the
notify us of the offense, claim,
or "suit" as soon as practicable.
Declarations, such limits will be subject
to the applicable Single Construction
f. We are considered on notice of an
Project General Aggregate Limit.
"occurrence offense, claim or "suit" that is
2. For all sums which the insured becomes
reported to your Workers' Compensation
insurer for an event which later develops into
legally obligated to pay as damages caused
by "occurrences" under COVERAGE A
an "occurrence offense, claim or "suit" for
(SECTION II), and for all medical expenses
which there is coverage under this policy.
However, we will only be considered on
caused by accidents under COVERAGE C
(SECTION 1), which cannot be attributed
notice if you notify us as soon as you know
only to ongoing operations at a single desig-
the claim should be addressed by this policy rather than your Workers' Compensation
Hated construction project away from preen-
policy.
ises owned Iby or rented to the insured:
a. Any payments made under COVERAGE
K. UNINTENTIONAL OMISSIONS
A for damages or under COVERAGE C
The following is added to paragraph 6. Repre-
for medical expenses shall reduce the
sentations of SECTION IV COMMERCIAL
amount available under the General Ag-
GENERAL LIABILITY CONDITIONS:
gregate Limit or the Products Completed
d. If you unintentionally fail to disclose any ex-
Operations Aggregate Limit, whichever
is applic able; and
posures existing at the inception date of your
policy, we will not deny coverage under this
b. Such payments shall not reduce any
Coverage Part solely because of such failure
Single Gonstructlon Project General Ag-
to disclose. However, this provision does
gregate Limit.
not affect our right to collect additional pre
mium or exercise our right of cancellation or
a for liability arising out of the
3. When coverage Y 9
non renewal.
"products completed operations hazard" is
provided, any payments for damages be-
This provision does not apply to any known
cause of "bodily injury" or "property damage"
injury or damage which is excluded under
Included in the "products completed opera-
any other provision of this policy.
lions hazard" will reduce the Products-
L. MENTAL ANGUISH
Completed !operations Aggregate Limit, and
not reduce r:he General Aggregate Limit nor
Paragraph 3. of SECTION V DEFINITIONS is
the Single Construction Project General Ag-
deleted and replaced by the following:
gregate Limit.
3. "Bodily injury" means bodily injury, sickness
4. If the applicable construction project away
or disease sustained by a person, including
from premises owned by or rented to the in-
mental anguish or death resulting from any
sured has been abandoned, delayed, or
of these at anytime.
abandoned and then restarted, or if the au-
M. WAIVER OF TRANSFER OF RIGHTS OF RE-
thorized contracting parties deviate from
COVERY AGAINST OTHERS
plans, blueprints, designs, specifications or
timetables; the project will still be deemed to
ra h pars 8. Transfer Of Rights Of Recovery
Paragraph 9
be the same: construction project.
Against Others To Us of SECTION IV COM-
MERCIAL GENERAL LIABILITY CONDITIONS
5. The provisions of Limits Of Insurance
is amended by the addition of the following:
(SECTION III) not otherwise modified by this
endorsement shall continue to apply as
stipulated.
CL CG 00 20 03 07 Includes copyrighted m ateriat of Ins urance Services Page 4 of 6
Office, Inc., with its permission
Green River Construction Co Inc
CWP2912671
We waive any right of recovery we may have be-
cause of payments we make for injury or dam-
age arising oul of your ongoing operations or
"your work" done under a contract requiring such
waiver with that person or organization and in-
cluded in the "products completed operations
hazard
However, our rights may only be waived prior to
the "occurrence" giving rise to the injury or dam-
age for which we make payment under this Cov-
erage Part. The insured must do nothing after a
loss to impair our rights. At our request, the in-
sured will bring "suit" or transfer those rights to
US and help us enforce those rights.
N. LIMITED JOB SITE POLLUTION
1. Exclusion f„ under Section I Coverage A
is replaced by the following:
2. Exclusions
This insurance does not apply to:
f. Pollution
(1) "Bodily injury" or "property dam-
age" arising out of the actual, al-
leged or threatened discharge,
dispersal, seepage, migration,
release or escape of "pollut-
ants":
(a) At or from any premises,
site or location on which any
Insured or any contractors
or subcontractors working
directly or indirectly on any
Insured's behalf are per-
forming operations if the
operations are to test for,
monitor, clean up, remove,
contain, treat, detoxify or
neutralize, or in any way re-
spond to, or assess the ef-
fects of, "pollutants or
(b) At or from a storage tank or
other container, ducts or
piping which is below or par-
tially below the surface of
the ground or water or
which, at any time, has been
buried under the surface of
the ground or water and
then subsequently exposed
by erosion, excavation or
any other means if the ac-
tual, alleged or threatened
discharge, dispersal, seep-
age, migration, release or
escape of "pollutants" arises
at or from any premises, site
or location which any in-
sured or any contractors or
subcontractors working di-
rectly or indirectly on any in-
sured's behalf are perform-
ing operations if the "pollut-
ants" are brought on or to
the premises, site or loca-
tion in connection with such
operations by such insured,
contractor or subcontractor.
Subparagraph (b) does not
apply to "bodily injury" or
"property damage" arising
out of heat, smoke or fumes
from a "hostile fire
(2) Any loss, cost or expense aris-
ing out of any:
(a) Request, demand, order or
statutory or regulatory re-
quirement issued or made
pursuant to any environ-
mental protection or envi-
ronmental liability statutes or
regulations that any insured
test for, monitor, clean up,
remove, contain, treat, de-
toxify or neutralize, or in any
way respond to, or assess
the effects of, "pollutants
or
(b) Claim or suit by or on behalf
of a governmental authority
for damages because of
testing for, monitoring,
cleaning up, removing, con-
taining, treating, detoxifying
or neutralizing or in any way
responding to or assessing
the effects of, "pollutants
However, this paragraph does
not apply to liability for those
sums the insured becomes le-
gally obligated to pay as dam-
ages because of "property dam-
age" that the insured would
have in the absence of such re-
quest, demand, order or statu-
tory or regulatory requirement,
or such claim or "suit" by or on
behalf of a governmental author-
ity.
2. With respect to "bodily injury" or "property
damage" arising out of the actual, alleged or
threatened discharge, dispersal, seepage,
migration, release or escape of "pollutants
a. The "Each Occurrence Limit" shown in
the Declarations does not apply.
b. Paragraph 7. of Limits Of Insurance
(Section Ill) does not appy.
c. Paragraph 1. of Section III Limits Of
Insurance is replaced by the following:
The Limits Of Insurance shown in this
endorsement, or in the Declarations and
the rules below fix the most we will pay
regardless of the number of:
(1) Insureds;
CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 5 of 6
Office, Inc., with Its permission
Green River Construction Co Inc
CWP2912671
(2) Claims made or "suits" brought; or
(3) Persons or organizations making
claims or bringing "suits
d. The following are added to Section III
Limits Of Insurance:
8. Subject to 2. or 3. above, whichever
applies, the most we will pay for the
sum of
a. Damages under Coverage A;
and
b. Medical expenses under Cover-
age C
because of "bodily injury" or "prop-
erty damage" arising out of the ac-
tual, alleged or threatened dis-
charge, dispersal, seepage, migra-
tion, release or escape of "pollut-
ants" is $100,000.
9. Subject to 8. above, the Medical
Expense Limit is the most we will
pay under Coverage C for all medi-
cal expenses because of "bodily in-
jury" sustained by any one person
arising out of the actual, alleged or
threatened discharge, dispersal,
seepage, migration, release or es-
cape of "pollutants
O. OTHER INSURANCE
If this policy includes a Coverage Form or an
Endorsement which provides coverage for loss
or damage covered by one or more of the Ex-
tensions of this endorsement, the limit and the
coverage provided by this endorsement are de-
leted and replaced by the limit and coverage
provided by that Coverage Form or Endorse-
ment.
CL CIS 00 20 03 07 Includes copyrighted m aterial of Insurance Services Page 6 of 6
Office, Inc., with Its permission
P -1
PROPOSAL
Contractor's Name.
Contractor's State License No..
City of Tukwila Project No. 97041201
To the, Mayor and City Council
City of Tukwila, Washington
The undersigned (Bidder) hereby certifies that he personally examined the location and
construction details. of Work outlined in the Contract Documents for the City of Tukwila (Owner)
project titled 2010/2011 Small Drainage Program which includes drainage improvements: at up to
nine (9) locations, including, but not necessarily limited to; removing and replacing existing storm
drain pipes and drainage structures, installation of new storm drain pipes: and drainage structures,
slipline pipe liner rehabilitation of existing storm drains, steel trash rack fabrications and
installations, providing temporary erosion/water pollution control, removing and replacing HMA
paving, concrete curbs installation of traffic loops, compliance with Hydraulic Project Approval for
in -water work, site .restoration, and other items necessary to complete the Work as described .in the
Contract Documents; and has read and thoroughly understands these Documents which govern all
Work embraced in. this 'improvement and the methods by whic4 payment will. barnacle for said
Work and thoroughly understands the nature of said Work; and hereby proposes to undertake
and complete all Work embraced in. this improvement in accordance with these Contract
Documents and at the following schedule of rates and prices.
The: Bidder' understands that the. quantities .mentioned. herein are approximate only and are :subject.
to increase. or decrease, and hereby proposes to perform all quantities of work: as either increased
or decreased in. with the Contract Documents.
As evidence of good faith (check one) Mbid bond or cash, cashier's check,.❑ certified check,
or postail money order made payable. to *the .City of Tukwila equal to five. percent (5 .of the
Total Bid Price is attached hereto. Bidder understands that, °stipuld this offer be, accepted by
Owner Within ninety (90) calendar days after the day of Bid Opening and the:Bidder fails or, refuses
to enter Into an. Agreement and furnish the required Payment and Performance Bond and liability
insurance within ten (10) calendar days after Notice of Award,, the Contract shall be null and void
and the. Bid' Deposit or Bond accompanying this Proposal shall be forfeited and become the
property of Owner as liquidated damages, all, as provided for in the Bid Documents:
Bidder shall attain Physical Completion of all Work in all. respects within one hundred [100]
calendar days from the.. date stated in the written Notice to Proceed. If the work is: not completed
within this time period, Bidder shall pay Liquidated damages to Owner as specified in Section i mo&9
of the Standard -Specifications for every calendar day work is not Physically Complete after the
expiration of the,Contract time stated above. In addition, Bidder shall compensate.. Owner for actual
enginearing inspection and supervision costs and any other legal fees incurred by Owner.as a
result of such delay.
gage 10 Proposal
)rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
Proposal
P -2
201012011. Small Drainage Program
Project No. 91041201
Note;
Unit prices.for all items, all extensions, and the total amount bid
must be shown. Where conflict occurs between the unit
price and the total Amount specified for any item, the unit price shall prevail, and totals shall
be.corrected.to conform thereto. Refer
to Division `f 0 for d6finition of pay items. Sales tax $half be included
In the various unit and lump sum prices; per Standard
Specification section 1- 07.211) and WAG 468-20-171.
SCHEDULE
A Sites 1 through 9
Item
No.
Item Description
City
Unit
Unit Price
Amount.
ROADWAY
1A
Minor Change:
1
FA
15
15,000.00
1
Mobilization
1.
LS
wo0> oz)
ew,IV
2
Temporalr Water Pollution I Erosion Control
1
LS
12" 5??D.
/Z,.m,67
3
Resolution of Utility Conflicts
1
FA
20 000.00:
20;000:00
4
PrQject.Temparary Traffic Control
1
LS
Z;
D
5
Clearing, and Grubbing
1
LS
6
Pavement Removal
520
Sy
7
Removal of Extruded Curb
20
LF
DD
8
Unsuitable Foundation Excavation Incl. Haul
75
CY
9
Gravel Borrow including Haul
600
TN
10
Contaminated. Soil. Excavation Incl. Haul
500
TN
7/-OV
11
Controlled iQertsity Fill
20
CY
Itq.6V
12
Crushed Surfacing Top Course
595
T.N
13
HMA 112 IPG 64 -22
235
TN
3&ZIXAD
14
HMA Thickened Edge
320
LF
15
Cement Concrete Extruded Curb
20
LF
7, o a
16
Traffic Laoi) Replacement, Complete
1
LS.
ox 0
age 3
rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa,com Always Verify Scale
Proposal P -3
2010/2011 'Smaill Drainage Program
Project No. 91041201
Note: Unit prices for all items, all extensions, and the total amount bid must be shown. Where conflict occurs between the unit
price and the total amount specified for any item, the.unit price shall prevail, and totals.shalI be. corrected to conform thereto. Refer
to Division 10 for definition of pay items. Sales tax. shall be included in the. various unit and lump sum prices, per Standard
Specification section 1- 07.2(1) and WAC 458 -20 -171,
SCHEDULE A SiteS through 9, cont'd
.Item Item Description Qty Unit Unit Price Amount
No.
TRAFFIC CONTROL DEVICES
17 Storm brain Marker 16 EA Jam bpd
18 Replace Existing Channelization
ROADSIDE DEVELOPMENT
19 Remove and Replace Water Service
Connection.
20 Topsoil/Firie.Compost
21 Hydroseed
22 Erosion Control Blanket
1 LS�'"
5 EA /Sze 75
70 CY 38
165 SY
380 SY
23
PSIPE Azer CirinatumNine Maple, 1 Gal. Cont.
1.10
IyAV!;�
PSI PE Malhonia Aguifolium /Oregon Grape, 1
110
24
Gal. Cont.
FA 1.0,000.00.
10
PSIPE Rubus Parvifoliia/Thimbleberry, 1 Gal.
110
25
Cont.
PSIPE. Syrnphoricarpus Albus/Snowberry, 1
110
26
Gal. Cant.
27
Property Restoration
1
28 Remove and Replace Chainlink Fence
29 Remove and Replace Mailbox
EA 121,
/4/2-qSD
EA �Zy�
IyAV!;�
EA
EA f f'
FA 1.0,000.00.
10
25 LF 1 5z r
3 EA
/1S 3 7S
'age 12
'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
Proposal P -4
2010/2011 Small] Drainage Program
Project No. 91041201
Note Unit prices for gill items, all extensions, and the total amount bid must be shown. Where conflict occurs between the unit
price and the total amount specified for any Item,, the unit price shall prevail, and totals shall be corrected to conform thereto. Refer
to Division 10 for definition of pay items, Sales tax.shall be included in the various unit and lump sum prices, per Standard
Specification section 1 -07.2(1) and WAC 458- 20471.
SCHEDULE.A Sites 1 through 9, cont'd
.Item Item Description Qty Unit Unit Price Amount
No.
STORM DRAINAGE
30 Shoring or Extra Excavation Class B 1 LS 3
31 Construction Geotextile for Separation
Trash Rack and Access for Control Structure,
32 Complete
33 Trash Rack for Inlet Pipe, Complete
34 Storm Drain Pipe, 12" Ductile .Iron
35 Stone Drain Pipe, 18" PVC
36 Storm Drain. Pipe, 18" HOPE
37* Storm Drain Pipe, 24" HDPE
38 Storm Drain Pipe, 24" HD PE Bend W/ Vent,
39 Remove /Abandon. Existing Stone Drain Pipe
40 Connect to Existing Drainage Structure
41 Catch Basin, Type 1
42 Catch Basin Type 2, 48 In. Diam.
43 Catch Basin Type 2, 54 In. Diam.
44 Overflow Debris Cage, 48 In. Diam.
'age 13
'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
265
SY
33/2,5: Da
1
LS
1
Ls
1,070
LF
275
LF
7"J7 0 Z
66
LF
4o37O• 6P
125
LF
1
EA
425
LF
4
EA
/S�•l�
(aD�D
13
EA
/DD .v�
/ydG10.
6
EA
3�v�.d a
ZpyLY�,d7�
1
EA
1
EA
'age 13
'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
Proposal P -5
2010!2011 Small Drainage Program
Project No. 91041201
Note:' Unit prices for all items; all extenslons, and the total amount.bid must be shown. Where Conflict acours between the.unit
price and the total amount specified for any item, the unit price.shali prevail, and totals shall be. corrected to,conform.thereto. Refer
to DiVlsion: 10 for. definition of pay items. Sales.tax shall be included.)n the various unit'and lump sum prices, per standard
Spec)fication section 1 07.2 {t) and WAC 45 8
SCHEDULE -A Sites 1 through 9, cont'd
Item Item Description
No.
45 Construct Outfall
46 Trench .Blt:if f Pillow, Complete
46A Existing Drainage Structure Modifications, Site
1 Cornple'le-
47 Pothole Existing .Utilities:
48 Rehabilitate 36 CMP Pipe Site 5
49 Rehabilitate. 36" CMP Pipe, Site 6
.50 Rehabilitate 36 "'CMP Pipe, Site 7
5i Rem ove Piipe bbstruction
52 Temporary Water Bypass System
53 High Visibiliity Fence
54 Quarry Spalls:& Light Loose Rip Rap for
Channel Protection.
0
Qty Unit Unit Price
Amount
1 i_s
1 LS
1 LS
5 E4
1 Ls 1 -/731e,tV y73iff 0
1 LS /Z
1 LS AD
1 FA 5.,00.0:00 5
1 LS
200 LF
1 60 TN CIS 7720, vD
Total Bit!" 7��Cos I S&I
•r►.iis.auu►u...u.:.:.•i a•ru.. tiu.: a. i...ia.... r..�r r:.
All 4applicable sales tax shall be included in the total base bid price, per Standard Specification
section 1- 07.2(2) (APWA.Supplement 1 -99) and WAC 458 -171.
Note: Determination of low bidder will be based solely on the Total Bid' (Schedule A).
'age 4
'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement we www.bxwa.com Always Verity Scale
Proposal!
Bids Submitted on Computer Printouts
W.
Bidders, at Their option, in lieu of hand writing in the unit prices in.figures in ink on the Bid forms above, may
submit an oNginal computer printout sheet with theirbid, as long as the following requirements are: met:
1. Eachi sheet of the computer printout must contain the exact same information as shown on the hard
copy bid for)n Project Name, Schedule Dame, .column headings in the,order shown totals,. etc.
2. The'computer printout of the .Bid Propo al must have the exact certification language shown below,
signed by the appropriate officer of the firm.
3. If a. computer printout is used, the bidder. must still execute that port ion of the unit price Bid form which
acknowledges the Bid Guaranty, Time of Completion and all. addenda that may have been. issued, :etc.
If any of these, things are missing .or out.of order, the bid may be rejected by the Owner.
The unit and lump sure prices shown on acceptable printouts will be the unit prices used to tabulate the Bid
and used in the Contract if awarded by the .City. In the event of conflict between the two. unit Bid prices will
prevail over the extended (Total) prices. If the Bi submitted by the bidder contains both the form on these. Bid
Proposal sheets, And also a computer printout, completed according to the instructions, the unit bid prices
shown on thq computer printout will be used to determine the bid.
Put this-certification on the, last sheet of'the Bid computer-printout, and sign:.
(YOURFiR,iT'S.NAME). certifies. that the unit prices shown. on this complete computerprnt= out.for all of. the bid
items contained in this Proposal are the unit and lump sum..prices intended. and that. its Bid will be tabulated
Using these .unit pricey and no .other information from this print -out.. ('YOUR FIRM's NAND acknowledges
And agrees:
the iotal bid amount shown will be.read as its .total -bid and further agreas.that:Ehe official total
Bid amount. will. be .determined by. multiplying the unit Bid prices shown in this punt -out by the respective
estimated cluadtities shown on the Bid form-then totaling all of the extended amounts.
Signed:
Title:
Date:
Dage 15
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Proposal
P -7
By signing below, Bidder acknowledges receipt and understanding of the following Addenda to the
Bid Documents:
Addendum Addendum
No. Date of Receipt No.. Date of Receipt
1 1i�1 li_i 3
2 4
NOTE: Failure .to acknowledge receipt of Addenda may be considered as an irregularity in the
Bid Proposal and.Owner reserves the right to determine whether the bid will. be disqualified.
By signin.G below, Bidder certifies. that Bidder has reviewed the insurance provisions of the Bid
Documents and will provide the required coverage.
The below signed bidder acknowledges that bids must be submitted for'the 'Total Bid'. Partial bids
will not be considered.
It :is understood that Owner may accept or reject. all bids. The basis for determination of the low
bidder shatI be based solely on the'Total Bid', The Owner reserves the right to accept:any, all, or
no Additivo Items at time of Award, or any time thereafter:
The ,Surety Company which will.furnish the required Payment and Performance Bond is
of
(Address)
Bidder:
Bignature of. Authorized Official: o
Printed Name and Title:
Address; �QL /5�S/ T�/,�,ii
Circle One: Individual Partnership State of Incorporation: r.L114
Joint'Venture../ or oration>
Phone No.: �'9vs Qate: 4 %L. 2 -!/t
This addewis and phone number is the one to which all communications regarding. this proposal should be
sent:
NOTES:
1. If the Bidder is a co- partnership, give firm name under which business is transacted; proposal must be
executed by a partner. If the Bidder is a corporation, proposal must be executed in the corporate name by
the president or vice president (or any other corporate officer accompanied by evidence of authority to
sign)..
2. A bid must be .received on all items. if either a unit price or an extension is left blank..(but not both). for
bid item, the Owner will multiply or divide the available entry by the quantity,. as. applicable, and enter it on.
the bid form.: If .there. is no unit price_,gs.extension for one.ot rnore bid item(s), the proposal will.be rejected.
'age 16
3 rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
6 t �i O .Dep h
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i h-e form of ca sh deposit, oertiftea _or cash qrqpr. 1h.
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Travelers- an
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Pmpf-.l Tngurar
PO Box 2940.
'Tacoma, WA 98401
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Page 17 Bid Security
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
POWER OF ATTORNEY
TR AVELERS J Farmington Casualty Company St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America
St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St. Paul Guardian Insurance Company
Attorney -In Fact No. 221935
Certificate No. 003769436
KNOW ALL MEN BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance
Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and
Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty
Company is a corporation duty organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under
the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin
(herein collectively called th(; "Companies and that the Companies do hereby make, constitute and appoint
Eric Zimmerman, Karen Swanson, Brent E. Heilesen, Anne E. Strieby, James B. Binder, Peter J. Comfort, Jennifer L. Snyder, Lisa Kerstetter, Julie R. Truitt,
Peggy A. Firth, Tamarie Elllingsen, Steve Marinkovich, Melinda Carlson, and Christopher Kinyon
of the City of TacomE! State of WashinLton their true and lawful Attorneys) -in -Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or gtaranteeing bonds and undertakings required or permitted in any actions or- proceedings allowed by law.
IN WTTNFS$ WHEREOF, the Compani h ave caused this instrument affixed, to be signed and their corporate seals to be hereto axed, this
J 15th
day of l:
Farmington Casualty Company
Fidelity and Guaranty Insurance Company.
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
J P+ `MS(, 'J 1Y ANye ,�1TSy r
2
CjnI
'o epyy n OdMI N 1896
t D 7951 i o "S E H bL,,'D r o
b ar F~ I� ��FAUG d !S A�,T 1Y.... TT
State of Connecticut
City of Hartford ss.
By: Aliv_J94,41
George( Thompson, nior ice President
15th July 2010
On this the day of before me personally appeared George W. Thompson, who acknowledged
himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters,
Inc., St. Paul Fire and Mariiae Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety
Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do,
executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal.
TAI?
In
My Commission expires the 30th day of June, 2011. Marie C. Tetreauh, Notary Public
58440.4 -09 Printed in U.S.A.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity
and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice
President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf
of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking
shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretay or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President,
any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds
and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
1, Kori M. Johanson, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance
Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and
Surety Company, Travelers Casualty and Surety Company of America, and United _States Fidelity and Guaranty Company do hereby certify that the above and foregoing
is a true and correct copy of the Power of Attorney executed by said Comp2niizs, whic)} is iii full force' atld effect and has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of saidG'oriipanies this 6� day of 20
Kori M. Johansri./Assistant Secretary
aRSV�r )7
rf RSA t o
To verify the authenticity of this Power of Attorney, call 1 -800- 421 -3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the
above -named individuals and the details of the bond to which the power is attached.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
NON COLLUSION DECLARATION
STATE.OF= WASHINGTON
ss.
COUNTY OF KING
The undersigned, being first duly sworn, on oath states that the person, firm, association,
partnershil), joint venture, or corporation named in the Bid Proposal has (have) not, either directly
or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any
action .1m. restraint of free competitive bidding in: connection with the City of Tukwila project named
2010/2011' Small. Drainage Program, Project No. 91041201.
�1Y aE�iJ�
Name of
8ignatur f Authorized.0ificial
Title
anal .sworn to before me. on this day of /!/ham 20
Signatu� ,j!' ti F n d for the State of Washington, residing at '1�l'tG�
r dsio>y ���i���
My as �i�pt��
G 2
SEAM TA p'$' b" O
t� WAS 1
NOTICE TO ALL BIDDERS
To report bid rigging activities call:
1- 800 424 -9071
The U.S. Department of Transportation USDOT) operates the above toll -free "hotline* Monday
through F=riday, 8:00 a.m. to 5:00 p.m., eastern time: Anyone with knowledge of possible- bid
rigging, bidder collusion, or other fraudulent activities should use the "hotline" to report such
activities.
The "hotline," is part of USDOT's continuing effort to identify and investigate highway construction
contract fraud and abuse and is operated undeir.the direction of the USDOT Inspector General. All
information will be. treated confidentially and caller anonymity will be respected.
gage 18 Non Collusion Declaration
provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
P -10
RESPONSIBLE BIDDER DETERMINATION FORM
Attach additional sheets as. necessary to fully provide the information required.
Name of EJdder: rte if .0 0_ ZC�.
Address of Bidder. _d02—".5. /�Y"�7�
City state Zip Code
Contractor's License No. l01 WA State U.BI No. S 9y=7
Dept. of L &I
License Scind Registration No. rzone Worker's Comp. Acct. No. 57/,
Bidder is ai(n): U Individual O Partnership O Joint Venture IY�ncorporated in the .state of &t 4
List business :names used by Bidder during the past 10 years if different than above:.
Bidder has been in business continuously from. /g 7�
Yea f�
Bank. Reference: J4 s /Z
BanCl AccoOht Officer Officer's Phone N o;
No. of regular f uli -time employees:
Number of projects in the. past 10 years completed: ahead of schedule /Aolon schedule
behind schedule
Bidder has had experience in work.. comparable to that required. for this Project:.
As a prime.contractor for years.
As a subcontractor for /8 years;
List the supervisory personnel to be employed by the Bidder and available for work on this. project
(project Manager, Principal Foreman, Superintendents, and Engineers):
!Name
Title
i
....L tea/
How Long With Bidder
'age 19 Responsible Bidder DAermination Form
'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
Responsllble Bidder Determination Form P -1
Name the Surveyor to be used.on this Project, who will directly supervise all surveying activities..
Attach a resume outlining the experience and qualifications of the Surveyor. Is the Surveyor
licensed in the.State.of Washington (a PLS)? avles No
Surveyor's Name:
List all those projects, of similar nature and size, completed by.Bidder within the past 10 years.
Include a reference for each. Any attached preprinted project listing must include all this
information. Bidder must have at least 10 years experience working on projects of similar nature
and size.
Year Contract
Proiect Name Completed Amount Owner /Reference Name and Phone
List all projects undertaken, in the last 10 years which have resulted in partial or final settlement of
the Contract by arbitration or litigation in fe courts:
Total Claims. Amount of
Contract Arbitrated Settlement
Name of Client and Proiect Amount :or Litioated of Claims
Ha5�,-€3idder, or any representative or partner thereof, ever failed to complete a contract?
o O Yes. If yes, give details:
HH Bidder. ever -had any Payment/Performance Bonds called as a result of. its work?
6I�vo D Yes. If yes, please state:
Proiect Name Contractino Partv Bond Amount
'age 20
'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.I>xm.com Always Verify Scale
Responsible Bidder Determination Form P -1 2
Hays' Bidder ever- been found guilty of violating any State or Federal employment laws?
C#'No O Yes if yes, give details:
Has. Bidder ever fileVor protection. under any provision of the federal bankruptcy laws or state
insolvency laws? O'No 0 Yes If yes, give details:
N any adverse legal judgment been rendered against Bidder in: the past 5 years?
o 0 Yes If yes, give details:
Has Bidder or any of its employees filed any claims with Washington State. Workman's
Compensation or other in company for accidents resulting in fatal injury or dismemberment
in the past 5 years? ta'No I] Yes If yes,. please state:
Date Type of in"um Aaencv Receiving Claim
The undersigned warrants under penalty of Perjury that the foregoing information is true and
accurate: to the best of his
wiedge. The. undersigned authorizes the City of. Tukwila to verify
all information contained
Signature of. Bidder
Titl e: Date: 41 illl
Dage 21
provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
P -13
PROPOSED EQUIPMENT AND LABOR SCHEDULE
(Use additional sheets if required)
Equipment to,be used:
DESCRIPTION/TYPE
YEAR
CONDITION
I OWN /RENT
Labor to be used: f �Q�G c°r� �-�+c
Name of Bidder
Title
gage 22 Proposed Equipment and Labor Schedule
Drovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com Always Verify Scale
P -14
PROPOSED SUBCONTRACTORS
Name of Bidderdz dj8e-
In accordance With RCW 39.30.060 as amended, every bid that totals $1 million or more .shall include below the
names of the stibcontractors with whom the Bidder, If awarded the contract; will subcontract for performance of the
work of: HVAG, (heating, ventiiation, and air conditioning); plumbing as described in chapter 18.1.06 RCW; and
electrical as described in chapter 19.28 RCW,. or to name itself for the work. The Bidder shall not list more than one
subcontractor for each category of work identified, unless subcontractors vary with bid alternates, in which case the
Bidder must indicate which subcontractor will be used for which alternate. Failure of the Bidder to submit as part of the
bid the names of such subcontractors or to name itself to perform such work or the naming of two or more
subcontractors. to perform the same work shall render the prime contract bidder's bid nonresponsive and, therefore,
void.
The successful Bidder must have.the written permission of the Owner to make any change to this list.
Percent of total bld to be performed by Bidder 63.
Sehedule/Bld item Numbers
0 of
Subcontractor will perform
Total Bid
W, 62>
o
z�22
AAA
gage 23 Proposed Subcontracb)rs
?rovided to Builders Exchange of WA, Inc_ For usage Conditions Agreement see www.bxwa.com Always Verify Scale
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Resume
PROJECT ROLE
President
EDUCATION
Course Work, Civil Engineering
Shoreifine Community College
REGISTRATION
Professional Land Surveyor, State of Washington,
Oregon and Idaho
DANIEL K. ROUPE, P.L.S.
PRESIDENT I PROFESSIONAL LAND
SURVEYOR
Mr. Roupe has 32 years of experience as
Professional Land Surveyor of Record on many
ALTA/ASCM Land Title surveys, commercial site
surveys, construction surveys and topographic and
boundary surveys as well as boundary line
adjustments and final plats and short plats.
AFFIILIATIONS
Land Surveyors Association of Washington,
Oregon and Idaho
REPRESENTATIVE EXPERIENCE
AIdeivood Water Wastewater District, City of Mukilteo
Topographic surveying in right of ways for water main replacement for Srightwater and the City of
Mukil'.teo.
Crista MinistHes,.Shoreline, Washington
Mr. Roupe was responsible for overseeing the collection.of all the necessary field data for the preparation
of an ALTA/ACSM Land Title Survey. As Survey Department Manager and Professional Land Surveyor of
Record, Mr. Roupe prepared the final survey documents for the topographic survey on the 70 -acre site.
Issaquah School District, Issaquah, Washington
As Survey Department Manager and Professional Land Surveyor of Record, Mr. Roupe was responsible for
overseeing the construction staking for water, sewer, and storm facility improvements including final
preparation of easements and the boundary and topographic survey.
City of Edmonds, Edmonds, Washington
As Sur-vey Department Manager and Professional Land Surveyor of Record, Mr. Roupe was responsible for
the final topographic surveying documents for the demolition, design and construction of various water
mains.