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Home My WebLink About23-112 - Lakeside Industries, Inc - 2023 Overlay Program & S 119th St Bridge Raised Crosswalk 23-112 Council Approval 6/12/23 23-112 15th June 23 15th June 23 6200 Southcenter Boulevard Tukwila, WA 98188 ooc oign Envelope ID: EoArB1ou-5xmn-4owo-9sox-3cA7aFaoo4Ao PAYMENT AND PERFORMANCE BOND Bond to City of Tukwila, Washington Bond No. 107847234 We, Lakeside Industries, /pc, , and Travelers Casalty and Surety Company ofAmerica . (Principal)(Surety)� Connecticutcorponation^ ond as a suretyuorporado� �u�hoh�ed bm become a surety upon Bonds of Contractors with municipal corporations in Washington Sbata, are jointly and severaily bound to the City of Tukwila, Washington ("Owner"), in the penal sum of One Miliion Two Hundred Ninety Six Thousand Four Hundred Eighty One and 50/100ths Dollars ($1.2oU.4V1un ), the payment of which sum, on de0aOd, we bind ourselves and our sunoessnrs, hnirs, adminhmtrotorn, axeoutono, or personal reprasentodves, as the case may be. This Payment and Performance Bond is provided to nncsnethepmrformannmmfPr|noipa| in connection with a contract dated June 15 , 20 between Principal and Owner for a project entitled 2023 OVERLAY PROGRAM , Contract No.szz-Bm�o��" ("�ntra��~). The imit| (Ca| 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 |ohoranu, 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 Ovvner, its oODuero, and agents harmless from and against all claims, |iobWiUeo, causes of action, darmageo, and costs for such payments for |abor, equipnnent, and materials by satisfying all claims and demands incurred under the Comtract, and reimbursing and paying Owner all expenses that Owner may incur in making good any default by Principai; and • Indemnifies and holds Owner harmless from all claims, |iabQitias, causes of ao1ion, damages and costs, including property damages and personal ijuries, 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 Pjeot. The liability of Surety shall be Iimited to the penaP sum of this Payment and Performance Bond. No change, extension of time, olteratiVn, 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 chanQe, extension of time, altmnstion, or addition to the terms of the Contract or the Work, with the exception that Surety shall be notified if the Contract tirne is extended by more than twenty percent (20%). If any modification or change increases the total amount to be paid under the Contnact. Surety's obligation under 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. 2023 OVERLAY PROGRAM MAY 2023 DocuSign Envelope IDE5A7B1D3-5389-4060-9603-3CA72FADC4A8 Performance & Payment Bond C-3 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 day of , 20 Lakeside Industries, Inc. Princip Signatifrig-of Authorized Official ele.f.gibc/vr Title Name and address of local office of agent and/or Surety Company: Travelers Casualty and Surety Company of America Surety AA3424 Al - Signature of Authorized Official By Susan B. Larson Attorney in Fact (Attach Power of Attorney) CONN. Parker, Smith & Feek 2233 112th Ave NE Bellevue, WA 98004 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. 2023 OVERLAY PROGRAM MAY 2023 TRAVELERS J Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS. That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, arid St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute arid appoint Susan B. Larson of BELLEVUE Washington , their true and lawful Attorney(s)-in-Fact lo 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 his instrument to be signed, and their corporate seals to be hereto affixed, this 21st day of April, 2021. State of Connecticut By. City of Hartford ss. Robert L. Rane enior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himselfas a duly authorized officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2026 Anna P. Nowik, Nota This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies, 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, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this day of Kevin E. Hughes, Assi tant Secretary To verify the authenticity of this Power of Attorney, please call us at 1-800-421-3880. Please refer to the above-named Attorney(s)-in-Fact and the details of the bond to which this Power of Attorney is attached RETAINAGE BOND Bond No. 107847235 KNOW ALL MEN BY THESE PRESENTS, that Lakeside Industries, Inc. as Principal authorized to do business in the State of Wasiington and Travelers Casualty and Surety Company of America as Suretyocorporation organized and existing under the laws of the State of Connecticut and authorized to Lransactbusiness in the State of Washington as Surety, are jinUyandsaverah/hekd and bound unto City of Tukwila as Obligee in the penal sum of Sixty-four Thousand Eight Hundred Twenty-four & 07/100 5% of the Principal's bid. WHEREAS, on the day of Dollars ($ 64,824.07 Principal, herein, executed a contrac:t with Lhe Obligee, for ), which is the said 2023 Overlay Program, City of Tukwila Project Nos. 82310401 & 92210301 WHEREAS, said contract and RCW 60.28 require the Obligee to withhold from the Principal the sum of 5% from monies earned on estimates during the progress of the construction, hereinafter referred to as earned retained funds. AND NOW WHEREAS, Princip has requested that the Obligee not retan any earned retained funds as allowed under RCW 60.28. NOW, THEREFORE, the condition of this obligation is such that the Principal and Surety are held and boundunVothebonoficishoscfdle trust fund created by RCW 60.28 in the penal sum ofi 596ofthe final contract cost which shall include any increases due to change orders, increases in quantities of work or the addition of any new item of work. If tIi Principal shall use the earned retained funds, which will' not be retained, for the trust fund purposes of RCW 60.28, then this obligation shall be null and void; otherwise, it shall remain in full force and effect. This bond andamypnoceodsthonafromshoNbemedesubiecttoa||o[aimns and liens and in the same manner and priority as set forth for retained percentages in RCVV 60.28. PROVIDED HOWEVER, that: 1. The Uability of the Surety under this bond shall not exceed 5% of the total amount earned by the Principal if no monies are retained by the Obligee on estimates during the progress of construction. 2. Any suit under this bond must be instituted within the time period provided by applicable iaw. Suret By: Attorney -in -Fact Susan B. Larson Parker, Smith & Feek, Inc. 2233 112th Ave NE, Bellevue, WA 98004 Name and Address of Local Agent Lakeside Industries, inc. Principal LeE VICE - f2 -e IDEAJT DocuSign Envelope ID: E5A161D3-b389-41060-9603-3CA72FADC4A8 P-1 PROPOSAL (unit price) Contractor's Name LA k 4..514 tc1vSfrc5 x,. Contractor's State License No. LA k 4(2.7113'D City of Tukwila Project Nos. 132310401 & 92210301 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 2023 OVERLAY PROGRAM, which project includes two schedules of work. Schedule A consists of, but is not limited to Hot Mix Asphalt (HMA) overlay of up to Nine (9) sites including planing bituminous pavement, grinding and reuse of asphalt pavement, removing pavement and pavement repairs, installation of concrete curbs, sidewalks, driveways and ramps, installation junction boxes, signal modification, adjusting surface utilities to grade, installing new channelization and signage, providing all necessary traffic control labor and devices; one project site within Schedule B includes, but is not limited to, installation of a raised cement concrete crosswalk and a new RRFB Systems; the; work shall include providing temporary erosion/water pollution control and other items necessary to complete the Work as shown on the Contract Documents; and has read and thoroughly understands these Documents which govern all Work embraced in this improvement and the methods by which payment will be made 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 accordance with the Contract Documents. As evidence of good faith, (cheek ane) '6 bid bond or 0 cash, 0 cashier's check, 0 certified check, or 0 postal 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, should 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 SIXTY (60) working 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 1-08.9 of the Standard Specifications for every working day work is not Physically Complete after the expiration of the Contract time stated above. In addition, Bidder shall compensate Owner for actual engineering inspection and supervision costs and any other legal fees incurred by Owner as a result of such delay. 2023 OVERLAY PROGRAM MAY 2023 Proposal P-2 Schedule A: 2023 Annual Overlay & Repair Program Project No. 82310401 Note: Unit prices for all Hems, 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. Include applicable sales tax shall be Included In the various unit and lump sum prices, per section 1-07,2(1) and WAC 458-20-171. Schedule A: 2023 Annual Overlay & Repair Program Item No. Spec i Item Description i Qty Unit Unit Price Amount ROADWAY IMPROVEMENTS Al 1-04 Unexpected Site Changes 1 FA 5 55,500.00 $ 55,500.00 A2 1-05 ADA Features Surveying 1 LS J1 . A3 1-07 Resolution of Utility Conflicts 1 FA 6,000.00 6,000.00 A4 1-07 SPCC Plan 1 LS 55 " 0 . oo 5r.oo A5 1-09 Mobilization 1 LS 741/ $00 - w 6/ II/ 000 .00 A6 1-10 Project Temporary Traffic Control 1 LS I oi, C 0.0 1yoic-00.400. A7 2-02 Asphalt Pavement Removal Incl. Haul 220 SY A8 2-02 Cement Conc. Curb Removal Incl, Haul 580 LF 2c/.00 /tf 2 . 0 A9 2-02 Cement Conc. Sidewalk Removal Incl. Haul 340 SY 7 0 0 . oo A10 2-02 Removal of Structure and Obstruction LS 79O . 7ro 0 .w All 2-02 Asphalt Pavement Planing and Reuse 4090 1 SY Al2 2-03 Roadway Excavation Incl. Haul 90 CY ,r.ve /1 2.W. A13 4-04 Crushed Surfacing Top Course 640 TON / A14 5-04 Pavement Repair Excavation Incl. Haul 50 CY /5-0,00 7, S -O0 Al 5 5-04 HMA CL 1/2" PG 58H-22 2340 TON 1/ . 7 94100.01, A16 5-04 HMA for Pavement Repair CI 1/2" PG 58H-22 100 TON /5-0 .00 IS- evo 0 ; • 0 A17 5-04 Temporary Pavement 180 TON /0o, 00 /Et 000 / A18 5-04 Thickened Edge 2630 LF /.5-0 1 A19 5-04 Planing Bituminous Pavement 14630 SY 5-1 fe) rOi ta_S--. oo A20 7-05 Adjust Manhole 14 EA 470. 00 a 1 ' A21 7-05 Adjust Catch Basin 41 EA . ' Z 7 Lf7ooo A22 7-05 Adjust Water Valve 11 EA 9?)-. 00 cil y J ' DocuSign Envelope ID: E5AtalD3-5389-4060-9603-3CA72FADC4A8 Proposal Schedule A: 2023 Annual Overlay & Repair Program Project No. 82310401 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 10 for definition of pay items. Include applicable sales lax shall be included in the various unit and lump sum prices, per section 1-07.2(1) and WAC 458-20-171. P-3 Item No, Spec Item Description Qty Unit Unit Price Amount A23 7-12 Adjust Water Meter Box 6 EA G70.00 1€ZO.,O r A24 8-01 Erosion/Water Pollution Control 1 FA $ 10,750.00 $ 10,750,00 A25 8-01 Inlet Protection 57 EA A26 8-04 Cement Conc. Curb and Gutter 480 LF tf4 .00 I/ OtO. co A27 8-06 Cement Conc. Driveway 100 SY 1.4.00 1 feivo .00 A28 8-06 Cement Conc. Driveway Entrance 30 SY f 10.112 , 0 A29 8-07 Wheel Stop 21 EA 2,76i, oo of .00 A30 8-13 Adjust Monument Case and Cover 1 EA tf ,00 if 95- .00 A31 8-14 Cement Conc. Sidewalk 310 SY f3.vo ZS/130.00 A32 8-14 Cement Conc. Curb Ramp Type Parallel 4 EA ;/ T00,00 /,..ri, 200 • ea A33 8-14 Cement Conc, Curb Ramp Type Perpendicular A 1 EA / A34 8-14 Cement Conc. Curb Ramp Type Single Direction A 1 EA "ri ?no 6 0 51, 7" - A35 8-20 Adjust Junction Box 1 EA ccc. oo crr. #0 TRAFFIC CONTROL DEVICES A36 8-05 Speed Cushion 3 EA A37 8-09 Raised Pavement Marker Type 1 102 EA 4,z c 'IP . 0 A38 8-09 Raised Pavement Marker Type 2 14 EA e zr- Pr. co A39 8-21 Permanent Signing 1 LS iqi 4,00,00 . A40 8-22 Plastic Shared Lane Symbol 6 EA 5 $7, 00 7I1Z . 0 A41 8-22 Plastic Stop Line 106 LF (0. ro VI). ov A42 8-22 Plastic Crosswalk Line 210 SF 6 .377 1,3 61700 / A43 8-22 Plastic Line, 4 Inch 1010 LF ' Z.35-- A44 8-22 Paint Line, 4 Inch 3680 LF 0 ,85- 3 /1f-, tio A45 8-22 Painted Access Parking Symbol Space 1 EA //O. 00 Ho. oP A46 8-23 Temporary Pavement Markings 2680 LF • 967 iCi ra .ao 1 DocuSign Envelope ID: E5A7B1D3-5389-4060-9603-3CA/21-ADC4A8 ry Proposal Schedule A: 2023 Annual Overlay & Repair Program Project No. 82310401 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 10 for definition of pay items Include applicable sales tax shall be included In the various unit and lump sum prices, per section 1-07.2(1) and WAC 458-20-171. P-4 Item No. Spec Item Description Qty Unit Unit Price Amount ROADSIDE DEVELOPMENT A47 8-02 Property Restoration 1 FA $ 13,500.00 $ 13,500.00 A48 8-12 Black Vinyl Coated Chain Link Fence 20 LF 3K.00 7I cioa .00 FRANCHISE UTILITY ITEMS A49 8-19 Adjust Gas Valve 2 EA tf1(5,00 7?0 .cc' Schedule A TOTAL BID .................... .. mmmmmmmmm •mi mmmmmmmmmmm $ 0q0 6 2Z • c6) Proposal P-5 Schedule B: S 119th St Bridge/ 42nd Ave S Raised Crosswalk and RRFB Project No. 92210301' 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 10 for definition of pay items. include applicable sales tax shall be included in the various unit and lump sum prices, per section 1-07.2(1} and WAG 458-20-171. Schedule B: S 119th St Bridge/ 42nd Ave $ Raised Crosswalk and RRFB Item No. Spec Item Description Qty Unit Unit Price Amount B1 1-04 Unexpected Site Changes 1 FA $ 5,000.00 $ 5,000.00 B2 1-05 Construction Surveying 1 LS B3 1-07 SPCC Plan 1 LS 0 B4 1-09 Mobilization 1 LS B5 1-10 Project Temporary Traffic Control 1 LS , IP sI -.0. B6 2-02 Removal of Structures and Obstruction 1 LS ft 0 p B7 2-03 Roadway Excavation incl. Haul 70 CY B8 4-04 Crushed Surfacing Top Course 45 TN L5111 -N B9 5-04 HMA CI. 1/2" PG 58h-22 33 TN 115- G-115 B10 5-05 Cement Concrete Pavement 20 CY gl, (CS 5-00 1 B11 7-10 Modify Existing Storm Drainage System 1 LS 0.co _, (,2_ B12 8-01 Erosion Control and Water Pollution Prevention 1 FA 4 7,500.00 $ 7,500.00 B13 8-01 Inlet Protection 2 EA K tio B14 8-02 Property Restoration 1 FA $ 5,500.00 $ 5,500.00 B15 8-04 Cement Conc. Traffic Curb and Gutter 60 LF 1, 4'61-0 - B16 8-04 Cement Conc. Traffic Curb 50 LF 71-- OD - B17 8-06 Cement Conc. Driveway Entrance 20 SY kV) lee 618 8-09 RPM, Type 1 32 EA 4 r.15 irU7 - B19 8-09 RPM, Type 2 4 EA 5,v'; ;•'.; DoouSign Envelope ILY EOMB1D3-O389-4060-9603-3CA/2FADC4A8 Proposal P-6 Schedule B: S 119th St Bridge/ 42nd Ave S Raised Crosswalk and RRFB Project No. 92210301 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 shalt prevail, and totals shall be corrected to conform thereto Refer to Division 10 for definition of pay items. Include applicable sales tax shall be included in the various unit and lump sum prices, per section 1.07.2(1) and WAC 458-20-171. Item No. Spec Item Description Qty Unit Unit Price Amount B20 8-14 Cement Conc. Sidewalk 50 SY B21 8-20 Solar Powered RRFB System, Complete 1 LS B22 8-22 Permanent Signing 1 LS I. :23 8-22 Plastic Crosswalk Line BO SF 19,9 B24 8-22 Plastic Yield Line Symbol 14 EA B25 8-30 Bollards 2 EA - B26 8-30 Metal Safety Railing 50 LF 15 - B27 8-32 Resolution of Utility Conflicts 1 LS Schedule B TOTAL BID TOTAL BID (Schedule A + Schedule B) .. ......... ........................ ....... .$ $ omnusignEnvelope ID: En*enox'oxoV FAeC4Ao P-7 Bids Submitted on Compute Printouts Bidders, at theft option, in lieu of hand writing in the unit prices in figures in ink on the Bid forms above, may submit an original computer printout sheet with their bid, as long as the following requirements arenet' 1. Each sheet of the cornputer printout must contain the exact sarne information as shown on the hard- copy bid form — P ard-oopyb|dfomn—P jectNarne.Schedu|eNamle.00|unnnheadinga—inthaordershown.tota|s.etc. 2. The computer printout of the Bid Proposal 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 portion 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 sum pricesshovvn on ble 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 Bid 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 the computer printout will be used to determine the bid. Put this certification on the Iast sheet of the Bid computer printout, and sign: (YOUR FIRM'S NAME) certifies that the unit prices shown on this complete computer print-out for alt 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 prices and no other information from this print-out. (YOUR FIRM'S NAME) acknowledges and agrees that the total bid amount shown will be read as its total bid and further agrees that the official total Bid amount will be determined by multiplying the unit Bid prices shown in this print-out by the respective estimated quantities shown on the Bid form then totaling all of the extended ammmunta. Signed: Title: Date: 2023 OVERLAY PROGRAM MAY 2023 DocuSrgn Envelope ID: E5A751D3-5 89-4060-9603-3CA72FADC4A5 Proposal P-8 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 2 5/12123 3 igviltef 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 signing 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 complete and submitted for the the entire Bid Schedules. Partial or incomplete bids will not be considered. The Basis for determining the low bidder shall be the lowest TOTAL BID. Schedule A BID: $ Irdq0,bl7.(0 Schedule B BID: $ /051 erg .o0 TOTAL BID (Sch A Sch B): $ 11-616 Lfer Note: Unit prices for all items, all extensions and the total amount of bid must be shown. Ali entries must be typed or entered in ink. The Surety Company which will furnish the required Payment and Performance Bond is bo,P'z-5 r% 000 rex. of 7-.23,- I2-R,Av4.- NE 3/1<t'. WA (Address) (Name) Bidder: TVI cIVSirt' Signature of Authorized Official: Printed Name and Title: 511.0,/,‘ (a?) k et 6"c "(-/- Address: 2gGIO AUN voi 14_1 — Blext ic D;0,,e1Qd.s'E Circle One: Individual Partnership / State of Incorporation: NiV11/4 Joint Venture / Phone No.: 2. 3 Date: 5— 1 4-102.3 This address 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 a 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 or extension for one or more bid item(s), the proposal will be rejected. 2023 OVERLAY PROGRAM MAY 2023 k. volt 1803 DocuS$gn Envelope ID: E5A7B1D3-5389-4050-9503-3CA72FADC4A8 P-9 BID SECURITY Bid Deposit: The undersigned Principal hereby deposits a Bid Deposit with the City of Tukwila in the form of a cash deposit, certified or cashier's check, or postal money order in the amount of dollars ($ ). -- OR — Bid Bond: The undersigned, Lakeside Industries, Inc (Principal), and Travelers Casualty and Surety Company of America (Surety), are held and firmly bound unto the City of Tukwila (Owner) in the penal sum of Five Percent (5%) of the total bid, including sales tax dollars ($ --5%-- ), which for the payment of which Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. The liability of Surety under this Bid Bond shall be limited to the penal sum of this Bid Bond. Conditions: The Bid Deposit or Bid Bond shall be an amount not less than five percent (5%) of the total bid, including sales tax and is submitted by Principal to Owner in connection with a Proposal for 2023 OVERLAY PROGRAM, Project Nos. 82310401 & 92210301, according to the terms of the Proposal and Bid Documents. Now therefore, a. If the Proposal is rejected by Owner, or b. If the Proposal is accepted and Principal shall duly make and enter into an Agreement with Owner in accordance with the terms of the Proposal and shall furnish a bond for the faithful performance of said Project and for the payment of all persons performing labor or furnishing materials in connection therewith, with Surety or Sureties approved by Owner, then this Bid Security shall be released; otherwise it shall remain in full force and effect and Principal shall forfeit the Bid Deposit or Surety shall immediately pay and forfeit to Owner the amount of the Bid Bond, as penalty and liquidated damages. The obligations of Surety and its Bid Bond shall be in no way impaired or affected by any extension of time within which Owner may accept bids; and Surety does hereby waive notice of any such extension. Signed and dated this 16th Lakeside Industries, Inc. day of May Principal Signature of Authorized Official ojed. Title Name and address of local office of agent and/or Surety Company: 20 23 Travelers Casualty and Surety Company of America Surety By Attorney in Fact (Attach Power of Attorney) Susan B. Larson .0010 1104 I, VO•V HARTFORD, CONN. Lo Parker, Smith & Feek 2233 112th Ave NE Bellevue, WA 98004 IN/11,1411410 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, 2023 OVERLAY PROGRAM MAY 2023 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal 0„,glAill1X111111111111111111110n, TRAVELERS J Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casually and Surety Company, and St. PaulFire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Susan B. Larson of BELLEVUE Washington their true and lawful Attorney(s)-in-Facl 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 21st day of April, 2021. State of Connecticut By: City of Hartford ss. Robert L. Rane enior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes !herein contained by signing on behalf of said Companies by himself as a duly authorized officer. 4trin&P4i, IN WITNESS WHEREOF, I hereunto set my hand and official seal My Commission expires the 30th day of June, 2026 "PM Anna P. Nowik, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies, 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 pari 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, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect Dated this 16th day of May , 2023 Kevin E. Hughes, Assi tant Secretary To verify the authenticity of this Power of Attorney, please call us at 1-800-421-3880. Please refer to the above-named Attorney(s)-in-Fact and the details of the bond to which this Power of Attorney is attached. DocuSign Envelope ID: E5A7E3103-.5389-4060-.9603-3CA72FADC4A6 P-10 NON -COLLUSION DECLARATION STATE OF WASHINGTON ) ) ss. COUNTY OF KING The undersigned, being first duly sworn, on oath states that the person, firm, association, partnership, 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 in restraint of free competitive bidding in connection with the City of Tukwila project named 2023 OVERLAY PROGRAM, Project Nos. 82310401 & 92210301. La IC C., I. d v 1-p: c. tv.c. Si • nee' nd sworn to befor ay) y Signat re of Nota Name o rm Signature of Authorized Official igfet, Title on this 1 day of Mo. 9 Public in and fcr-t-l)e State of Washington, residing at kvtft WA /)te My a ppoincromtvottniffts: 4.-•J w4,', ..•••• Om. arm SEAL fro 4,437:44 cf) I /0024 44171411.24: Si -04 .4. To report brdi11 eiOctivities call: NOTICE TO ALL BIDDERS 1-800-424-9071 The U.S. Department of Transportation (USDOT) operates the above toll-free "hotline" Monday through Friday, 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 under the direction of the USDOT Inspector General. All information will be treated confidentially and caller anonymity will be respected. 2023 OVERLAY PROGRAM MAY 2023 DocuSogn Envelope IL): E5A/B103-5389-4060-9603-3CAZ2FADDIA8 P-11 RESPONSIBLE BIDDER DETERMINATION FORM Attach additional sheets as necessary to fully provide the information required. Name of Bidder: L ice's; at, Th,c. Address of Bidder: 113‘10 /toe! -c. Vot1(11 - B/cv I's DiovA,trvA R AA yli, Vaik 11 \NA 61106g) City i State Zip Code Contractor's License No. /...11 -Ne WAState IJBI No. 6o1. )01.. '07 Dept. of L&I License Bond Registration No. U551q13 VVorker's Comp. Acct. No. 700, 27-1 Bidder is a(n): 0 Individual 0 Partnership 0 Joint Venture Incorporated in the state of WA If Out -of -State Corporation, has Bidder complied with WA Corporation laws? YES 111 NO List business names used by Bidder during the past 10 years if different than above: Bank Reference Year F-01 r 4. 11(fti) EiLt. Bank Account Officer LIZ5- ' IS Officer's Phone No. of regular full-time employees: 116 Number of projects in the past 10 years completed: ahead of schedule IOJ.0 on schedule behind schedule Total value of contracts in hand (gross): $ 50 km; Bidder has been in business continuously from 1 4.17 4 Bidder has had experience in work comparable to that required for this Project: As a prime contractor for 11 61 years. As a subcontractor for 9 years. Describe the general character of work performed by your company: A5 Phok I- .P°0/ List major equipment anticipated for this project; state whether Contractor -owned, or if it will be rented or leased from others. 5te. At1-ck ck imcvo- 4 1 2023 OVERLAY PROGRAM MAY 2023 DocuSign Envelope ID: EbArB1D3-b389-41060-960-3CA721-ADC4A8 Responsible Bidder Determination Form P-12 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 5 kau 11./ 4 -e - Ron Title PrOit AisAINIX-C.-r SV pClr'i'Kirti;,jetAt. 5 vrte fte, froN÷. Fo rzw,Av, How Lonq With Bidder iq yewc 72 yeAr-S ,yr.rs b 0•4M1 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)? I Yes EJ No Surveyor's Name: OvoviCo List all other anticipated subcontractors Bidder intends to use on this project. Indicate previous experience working with these firms, if any. Subcontractor ?J')f if-f;c Scope of Work IA 3. ' tv No of Previous Contracts Worked with Bidder rol Wt)wi ,?1 & e (tic le a ZO ,eCL 20 ovAkco vvi ir 3 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 Project Name Completed Amount Owner/Reference Name and Phone tok i- it 2.. 2023 OVERLAY PROGRAM MAY 2023 DocuSign Envelope E5Alki1D3-b 89-4060- 6 'AZ2FADC4A8 Responsible Bidder Determination Form P-13 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 the courts: Name of Client and Project NoN Total Claims Amount of Contract Arbitrated Settlement Amount or Litigated of Claims a Bidder, or any representative or partner thereof, ever failed to complete a contract? No 0 Yes If yes, give details: Has Bidder, or any representative or partner thereof, been assessed with liquidated damages within the past 5 years? EiNo 0 Yes If yes, give details: Has Bidder, or any representative or partner thereof, ever been indicted, pled guilty, pled no contest, or been convicted of any offense that has resulted in your firm being barred from bidding or performing work for any State, Local or Federal agency? tiNo 0 Yes If yes, give details: Has Bidder, or any representative or partner thereof, ever been indicted, pled guilty, pled no contest, or been convicted of any illegal restraints of trade, including collusive bidding? fiNo 0 Yes If yes, give details: Bidder ever had any Payment/Performance Bonds called as a result of its work? o 0 Yes If yes, please state: Project Name Contracting Party Bond Amount Bidder ever been found guilty of violating vioating any State or Federal employment No 0 Yes If yes, give details: 2023 OVERLAY PROGRAM MAY 2023 IDocuSign Envelope ID: E5A7131D3-5389-4060- 03-3CA21-ADC4A8 Responsible Bidder Determination Form P-14 Has Bidder ever file for protection under any provision of the federal bankruptcy laws or state insolvency laws? No D Yes If yes, give details: D s the Bidder owe any delinquent taxes to the Washington State Department of Revenue? No 0 Yes If yes, does the Bidder have an approved payment plan with the Washington State Department of Revenue? 0 No 0 Yes Ha., any adverse legal judgment been rendered against Bidder in the past 5 years? rErNo 0 Yes If yes, give details: Has Bidder or any of its employees filed any claims with Washington State Workman's Compensation or other i surance company for accidents resulting in fatal injury or dismemberment in the past 5 years? No 0 Yes If yes, please state: Date Type of Iniury Agency Receiving Claim Attach additional sheets as needed. The undersigned warrants under penalty of Perjury that the foregoing information is true and accurate to the best of his/her knowledge. The undersigned authorizes the City of Tukwila to verify all information contained herein. Signature of Bidder Title: cf." re` 4 Date: 5// (7 /2- 3 2023 OVERLAY PROGRAM MAY 2023 DocuSign Envelope 11): EbArE31D3-5389-4060-9603-3CA/21LADC4A8 P-1 5 PROPOSED EQUIPMENT AND LABOR SCHEDULE (Use additional sheets if required) Equipment to be used: DESCRIPTION/TYPE YEAR CONDITION OWN/RENT c, A f A. ct, cof Labor to be used: L- 0 t s T4 st(r5 Lot Ice 5 c, Name of Bidder Signature of Authorized Official r• riiirfool Title 2023 OVERLAY PROGRAM MAY 2023 DocuSign Envelope ID: E5A(B1D3-53 -4060-9503-3CAUFAUC4A8 P-16 PROPOSED SUBCONTRACTORS Name of Bidder t. 5,4relf L"I' )4? -e) in accordance with RCW 39.30.060 as amended, every bid that totals $1 million or more shall include below the names of the subcontractors with whom the Bidder, if awarded the contract, will subcontract for performance of the work of: HVAC (heating, ventilation, and air conditioning); plumbing as described in chapter 18.106 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 bid to be performed by Bidder % Name 44 «11 Nw 019VvIto Schedule/Bid Item Numbers Subcontractor will perform A2 ,42? 4,k desi riM 4-3T 1)-5Y 80 0.17 /I giu Alf Atif % of Total Bid 73/4 A5 gZi 2 re 37, 31, Yer it 14I U.. 7 t4 ZItif144 A-10 - 436 iO4 2023 OVERLAY PROGRAM MAY 2023 P-17 CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUS The bidder hereby certifies that, within the three-year period imrnediately preceding the bid solicitation date May 2nd, 2023 , the bidder is not a "willful" violator, as defined in RCW 49.48.082, of any provision of chapters 49.46, 49.48v or 49.52 RCW, as determined by a final and binding citation and notice of assessment issued by the Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction. [ certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Bidder's Business Name Official* Si~o ��f-t- PMntedNarme frowA �� ell Title s //6 //z3 m_vm/U Date City Check One: Sole Proprietorship 0 Partnership 0 Joint Venture 0 Corporation V State of Incorporation, or if not a corporation, State where business entity was formed: W A If a co -par nership, give firm name under which business is transacted: *Ifmcorporation, 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),Ifo ADDENDUM NO. 1 City of Tukwila, Washington 2023 Overlay Program Project No: 82310401 DATE OF ADDENDUM ISSUE: May 9, 2023 DATE OF BID OPENING: May 16, 2023 NOTE TO ALL PLANHOLDERS: This Addendum No. 1, containing the following revisions, additions, deletions, and/or clarifications, is hereby made a part of the Plans and Contract Provisions (Contract Documents) for the above-named project. Bidders shall take this Addendum into consideration when preparing and submitting their bids. Bidders shall acknowledge receipt and acceptance of this Addendum No. 1 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledge may result in disqualification of the Bidder's submittal. CONTRACT PROVISIONS 1. Special Provisions: SUPPLEMENT section 1-05.14 with the following: Water District 125 will be performing work on their watermain within the 37th Ave S project limits through September 20, 2023. The Contractor shall schedule work on this site to proceed after all other project sites to allow completion of the water line work. Shall the contractor complete all work, excluding 37th prior to WD 125 completion, no additional cost for demobilization or remobilization will be authorized. ALL OTHER REQUIREMENTS OF THE CONTRACT DOCUMENTS REMAIN IN EFFECT. Bidders shall acknowledge receipt and acceptance of this Addendum No. 1 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledge may result in disqualification of the Bidder's submittal. Sincerely, Joh Hart ey, Deputy Public Works Director City of Tukwila Receipt acknowledged, and conditions agreed to this day of At , 2023 Bidder Signature 2023 Overlay Program Addendum No.1 Page 1 of 1 ADDENDUM NO. 2 City of Tukwila, Washington 2023 Overlay Program Project No: 82310401 DATE OF ADDENDUM ISSUE: May 12, 2023 DATE OF BID OPENING: May 16, 2023 NOTE TO ALL PLANHOLDERS: This Addendum No. 2, containing the following revisions, additions, deletions, and/or clarifications, is hereby made a part of the Plans and Contract Provisions (Contract Documents) for the above-named project. Bidders shall take this Addendum into consideration when preparing and submitting their bids. Bidders shall acknowledge receipt and acceptance of this Addendum No. 2 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this wriften acknowledge may result in disqualification of the Bidder's submittal'. CONTRACT PROVISIONS Proposal Pages o REMOVE page P-2 arid REPLACE with the attached Page P-2 ALL OTHER REQUIREMENTS OF THE CONTRACT DOCUMENTS REMAIN IN EFFECT. Bidders shall acknowledge receipt and acceptance of this Addendum No. 2 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledge may result in disqualification of the Bidder's submittal. Sincerely, BRYCE CORRIGAN, PE accuracy and integrity of this document 2023.05.12 Receipt acknowledged, and conditions agreed to this 1 Zday of Mt , 2023 Bidder Signature, 2023 Overlay Program Addendum No.2 Page 1 of 2 ADDENDUM NO. 3 City of Tukwila, Washington 2023 Overlay Program Project No: 82310401 DATE OF ADDENDUM ISSUE: May 15, 2023 DATE OF BID OPENING: May 16, 2023 NOTE TO ALL PLANHOLDERS: This Addendum No. 3, containing the following revisions, additions, deletions, and/or clarifications, is hereby made a part of the Plans and Contract Provisions (Contract Documents) for the above-named project. Bidders shall take this Addendum into consideration when preparing and submitting their bids. Bidders shall acknowledge receipt and acceptance of this Addendum No. 3 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledge may result in disqualification of the Bidder's submittal. CONTRACT PROVISIONS Proposal o Per 1-02.6 include the attached P-17 Certification Wage Law Compliance Form with your proposal. o REMOVE Page P-5 and REPLACE with the attached Page P-5 ALL OTHER REQUIREMENTS OF THE CONTRACT DOCUMENTS REMAIN IN EFFECT. Bidders shall acknowledge receipt and acceptance of this Addendum No. 3 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledge may result in disqualification of the Bidder's submittal. Sincerely, BRYCE CORRIGAN, PE accuracy and integrity of this document 2023.05.15 Receipt acknowledged, and conditions agreed to this I 3 day of , 2023 Bidder Signature 2023 Overlay Program Addendum No.3 Page 1 of 3 Lakeside Industries, Inc. AUTHORIZED SIGNATURES -COVIN'GTON Division - List the name and title of those individuals in your organization who are authorized to execute proposals, contracts, bonds and other documents and/or instruments on behalf of the organization. Specify If more than one signature Is required. Note: Signature must appear next to name. NAME SIGNATURE TITLE OPERATIONS MANAGER WHITE, SHAUN PROJECT MANAGER The undersigned, being duly sworn, deposes and says that the foregoing Is a true statement of facts concerning the Individual, corporation, co -partnership or Joint venture herein named, as of the date Indicated: Sworn to before me this a hof LAKESIDE INDUSTRIES, INC. (Name of Firm, be exact) 05/24/22 Authorized Signers 120 Covington rW U13120141 :52:39 ie, 1241 • A 1241 • A A A 1241 A ' 12!41 • 1 A 1241 A 1241 A 1241 •A 1241 A. 1241. 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CD .4 440 pi _, p 51) 01,3 .0 p 0-4 p UT 01 p) ta .4.02 0) ,...4 .41., 0 CD UT CO 00 '1,1 CO COI02 CO CO 0 0)' Z .' 0) 8 C7 40 C I , . -1 0 0 CD CO 0 CO r4 0 0 N 0) cal --4 (4 cc) ...... 0 .12. r+J ...o. IV IV IV DT " A 4.) 01 .15. ID ce to al ,a3 May 23, 2023 City of Tukwila 6200 Southcenter Boulevard Tukwila, WA 98188 Attn: Mayor & City Counsel Re: 2023 Tukwila Overlay Program Project — Recommendation of Award Dear Mayor & City Counsel, As requested, KPG Psomas has completed the verification for Lakeside Industries Inc. for the 2023 Tukwila Overlay Program Project for their bid amount of $1,296,481.50. As part of our review, we contacted all of their listed references. Three of the Fifteen provided references were able to be contacted. All of the feedback we received was positive and included comments such as: "No issues", "Project completed on time and under budget", "Responsive and Excellent quality of work" and I am happy to say that all of the refences mentioned that they would be happy to work with them again on future projects. We have checked the status of Lakeside Industries Inc on the Washington State Labor and Industries web page to confirm they are currently licensed, bonded, and insured, no strikes or debarment records arose federally or statewide. KPG Psomas acknowledges that Lakeside Industries Inc is a qualified bidder, and this is a responsive bid for the 2023 Tukwila Overlay Program project. We recommend the City of Tukwila award the project to Lakeside Industries Inc. We have enclosed the contractor verification Package & Reference checks for your review. Respectfully, Jamison Baker Resident Engineer KPG Psomas, Inc. Cc: Enclosures: Lakeside Industries Inc Verification Package t) Labor&Industries.(https.//Ini.wa.gw) Contractors LAKESIDE INDUSTRIES INC Owner or tradesperson LEE, MICHAEL JAMES Principals LEE, MICHAEL JAMES, PRESIDENT WOOLSTON, DAX EDWARD, TREASURER LEE, SHARON MARIE, CHIEF EXECUTIVE OFFICER LEE, MAUREEN THERESE, CHIEF EXECUTIVE OFFICER OSTERHAUS, MARY PATRICIA, CHIEF EXECUTIVE OFFICER LEE, RHOADY ROBERT, CHIEF EXECUTIVE OFFICER LEE, TIMOTHY GEORGE, CHIEF EXECUTIVE OFFICER DARNELL, LARRY, TREASURER (End: 06/17/2008) LEE, JEANNE M, VICE PRESIDENT (End: 06/22/2012) WAGGONER, HENRY R, SECRETARY (End: 07/02/2018) WHITE, JOHN C, AGENT (End: 07/02/2018) LEE, R R SR, PARTNER (End: 11/27/2007) STUTGIS, ROBERT E, PARTNER (End: 11/27/2007) Doing business as LAKESIDE INDUSTRIES INC WA UBI No. 601 106 847 PO BOX 7016 ISSAQUAH, WA 98027-7016 425-313-2600 KING County Business type Corporation License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor Active Meets current requirements. License specialties GENERAL License no. LAKESI*274JD Effective — expiration 04/04/1973— 07/31/2024 Bond TRAVELERS CAS & SURETY CO Bond account no. 105116927 $12,000.00 Received by L&I Effective date 06/17/2008 07/01/2008 Expiration date Until Canceled Insurance American Contractors Ins Co Ri $10,000,000.00 Policy no. GL22A00092 Received by L&I Effective date 05/27/2022 06/01/2022 Expiration date 06/01/2023 insiruiraince Ilrolist.oiry Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Certifications & Endorsements OMWBE Certifications No active certifications exist for this business. Apprentice Training Agent Registered training agent. R.. Hueck tllneiiir elligilblie programs and accujlpatiioini s. Workers' Comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Self Insured. 700,227-00 This business is certified to cover its own workers' comp costs. No premiums due. Doing business as LAKESIDE INDUSTRIES INC Estimated workers reported N/A L&I account contact - Email: @Ini.wa.gov Public Works Requirements Verify the contractor is eligible to perform work on public works projects. Required Training— Effective July 1, 2019 Exempt from this requirement. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace Safety & Health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 09/08/2017 Inspection no. 317946123 Location 8705 Ne 117th Ave Vancouver, WA 98662-3247 Moll ors SIAM OF WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage WAUBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: May 22, 2023 601 106 847 700,227-00 LAKESIDE INDUSTRIES INC LAKESIDE INDUSTRIES INC Self Insured. This business is certified to cover its own workers' comp costs. No premiums due. Estimated Workers Reported N/A (See Description Below) Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor? Yes License No. LAKESI*274JD License Expiration 07/31/2024 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.1 2.050 and 51.1 6.190). < Business Lookup License Information: Entity name: LAKESIDE INDUSTRIES, INC. Business name: LAKESIDE INDUSTRIES INC. Entity type: Profit Corporation UBI #: 601-106-847 Business ID: 001 Location ID: 0001 Location: Active Location address: 6505 226TH PL SE STE 200 ISSAQUAH WA 98027-8905 Mailing address: PO BOX 7016 ISSAQUAH WA 98027-7016 Excise tax and reseller permit status: Click here Secretary of State status: Chick here 1i% New search Back to results Page 1 of 2 Endorsements niter Eindorsermieirnts held at this taxa l License Yq Count Deta'illls ` Latus IE.raliniiirtiation date IFliirst issuance Mack Diamond Generall BUS16-0024 Active Feb -29-2024 Mar -20-2019 Business •••• Non••••Resident Bothell) Generall Business 2318 Active Feb -29-2024 Apr -06-2022 Non Resident Bremerton Generall Business 29694 Active Feb -29-2024 Mar -01-2012 Non --Resident Carnation General) Business Active Feb -29-2024 Aug -26-2021 Nolen -Resident Clyde Hilll General) Business Active Feb -29-2024 May -16-2022 Noln..Resident Concrete General) Business •••• 3467 Active Feb -29-2024 Jun -17-2020 Non --Resident lEndorsements Ilhieid at this incai License # Count Detaiis Status lExpiration data First issuance d Lima GeneraII Business 2020 Active Feb -29-2024 Feb -24-2021 Non -Resident Ilssaquah GeneraII Business Active Feb -29-2024 Aug -12-2008 Kallama Generall Business Active Feb -29-2024 Apr -15-2020 Non....Resident Kirklland GeneraII Business Active Feb -29-2024 Jul -15-2019 Non....Resident La Center General Bu ss•••• 19-0026 Active Feb -29-2024 Jan -01-2018 Non....Resident IVIercerlIsIland Generall 220388 Active Feb -29-2024 Apr -13-2022 Business Non....Resident Minor Work Permit Active Feb -29-2024 Jul -23-2008 Newc:astlle Generall Business Active Feb -29-2024 Apr -20-2022 •••• Non -Resident Normandy Park Generall Active Feb -29-2024 Apr -14-2022 Business Non -Resident Governing People May include governing people not registered with Secretary of State Governing Ipeopie LEE III, RHOADY LEE, JAIME LEE, MAUREEN LEE, MICHAEL LEE, SHARON LEE, TIMOTHY OSTERHAUS, MARY PATRICIA WOOLSTON, DAX Registered Trade Names Registered trade 'names Status LAKESIDE INDUSTRIES Active LAKESIDE INDUSTRIES BELLINGHAM DIVISION Active Title First issued Feb -09-1996 Feb -13-2018 Registered trade names LAKESIDE INDUSTRIES INC. Status Active IFirst issued Feb -21-2023 LAKESIDE INDUSTRIES, INC. - FERNDALE SCALE Active Feb -20-2018 View Additionall The Business Lookup information is updated nightly. Search date and time: 5/22/2023 9:44:16 AM Contact us How are we doing? Take our survey! Don't see what you expected? Check iif your browser is supported Last updated by DOUGLAS STILLGEBAUER an Sep 29, 2022 at 10:54 AM SAMoov® LAKESIDE INDUSTRIES, INC. LAKESIDE INDUSTRIES, INC. Unique Entity ID VTR5L2GMBN23 Registration Status Active Registration Physical Address 6505 226TH PL SE STE 200 Issaquah, Washington 98027-8905 United States CAGE / NCAGE 05ZW8 Expiration Date Sep 29, 2023 Mailing Address Pob 7016 Issaquah, Washington 98027-7016 United States Purpose of Registration All Awards aim Doing Business as (blank) Congressional District Washington 08 Division Name (blank) State / Country of Incorporation Washington / United States Division Number (blank) URL (blank) Registration Dates Activation Date Sep 30, 2022 Submission Date Sep 29, 2022 Initial Registration Date Mar 20, 2002 Entity Dates Entity Start Date Apr 1,1972 Fiscal Year End Close Date Nov 30 Immediate Owner CAGE (blank) Legal Business Name (blank) Highest Level Owner CAGE (blank) Legal Business Name (blank) Executive Compensation Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions. Proceedings Questions Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions. a',N""glii'liiW1ii9ii"i"l':.''w^::1II" Active Exclusions Records? No I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes Business Types Entity Structure Corporate Entity (Not Tax Exempt) Profit Structure For Profit Organization Entity Type Business or Organization Organization Factors (blank) https: /Lsanagnv/entity/FTR5L2GMBN_23/enreData?status=Aetive Page 1 of 2 Last updated by DOUGLAS STILLGEBAUER an Sep 29, 2022 at 10:54 AM Socio -Economic Types LAKESIDE INDUSTRIES, INC. Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA -certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. 101111., Accepts Credit Card Payments Yes Debt Subject To Offset No EFT Indicator 0000 CAGE Code 05ZW8 Electronic Business 0 Diana Reeves Doug Stillgebauer Pob 7016 Issaquah, Washington 98027 United States Pob 7016 Issaquah, Washington 98027 United States Government Business 0 MICHAEL Lee MICHAEL Lee Pob 7016 Issaquah, Washington 98027 United States Pob 7016 Issaquah, Washington 98027 United States Past Performance 0 Doug Stillgebauer Doug Stillgebauer Pob 7016 Issaquah, Washington 98027 United States Pob 7016 Issaquah, Washington 98027 United States :"'U111'mi1u'II"1'; 'IEI's d " NAICS Codes Primary Yes NAICS Codes 237310 212321 324121 NAICS Title Highway, Street, And Bridge Construction Construction Sand And Gravel Mining Asphalt Paving Mixture And Block Manufacturing umiul;""19PatRx11"""11"1w'1w� "","''',. Yes, this entity appears in the disaster response registry. Bonding Levels Dollars (blank) (blank) States Oregon Washington https: /Lsanagnv/entity/FTR5L2GMBN_23/enreData?status=Aetive Counties (blank) Metropolitan Statistical Areas (blank) Page 2 of 2 Search Parameters CERTIFICATIONS Airport Concessionaire Disadvantaged Business Enterprise (ACDBE) Combination Business Enterprise (CBE) Disadvantaged Business Enterprise (DBE) Disadvantaged Business Enterprise (FAA Only) (DBE (FAA Only)) Minority Business Enterprise (MBE) Minority/Women Business Enterprise (MWBE) Small Business Enterprise (SBE) Socially and Economically Disadvantaged Business Enterprise (SEDBE) Women Business Enterprise (WBE) BUSINESS NAME/DBA LAKESIDE INDUSTRIES INC Show directory information and instructions Edit Parameters 1 Clear Parameters Search Results 7s;hiaarnru�.rs�ditro,dnaPii)tParameters, SewarchAgaiirh. 0 firms with 0 certifications found