HomeMy WebLinkAboutCAG2020-133 - Change Order - #3 - Northwest Cascade, Inc. - 76th Ave S Improvements - 03/01/2021KENT
Agreement Routing Form
For Approvals, Signatures and Records Management -
This form Lombines & replaces the Request for Mayor's signature and Contract Cover sheet torms.
(Print on pink or cherry colored paper)WASHINoTON
Comments;Date Received bY CitY AttorneY;
Date Routed to the MaYor's Office:
Date Routed to the CitY Clerk's Office:
Department:
PW Engineering
Originator:
S. Anderson
Date Required:
N/A
Date Sent:
31N21
Date of Council APProval:
N/A
Authorized to Sign:
El Director or Designee E MaYor
Grant? El Yes E No
Type: N/A
Budget Account Number:
R20082.64110j20
Budget? ElYes E No
Category:
Contract
Vendor Name:
Northwest Cascade, lnc.
Sub-Category:
Change Order #3
Vendor Number:
project Name: 76th Ave. s. lmprovements - s. 22}th St. to s. 214th st'
ofinterseotionintheconnectionswatermainduringworkunforeseenbeingperformedforCompensation4'of avoidtoDetails:ahadwatermain burytheforProjectTheAvenue76thoriginaldesign2andSouth.2thSouth 10'awith of plus.burywasitredesignedstormthewithsystem,conflicts existing
Basis for Selection of Contractor: $id
Terminarion Date: 136 Working DaYs
Agreement Amou nt $44,7 09.37
Start Date: May 5, 2020
Local Business? EYes E No"
*lf meets requirements per KCC i.70.100, please complete "vendor Purchase-Local Exceptions" form on cityspace'
Contract Number:
cAG2020-133
Notice required prior to disclosure?
EYes E No
dd(W)2113-1-10 Visit Documents.KentwA.gov to obtain copies of all agreements
S,t
KENT
WasHrN€rofl
CHANGE ORDER NO. #3
Nofthwest Ca-scade, tnc. ("Contractor")NAME OF CONTRACTOR:
CONTMCT NAME & PRO]ECT NUMBER:
ORIGINAL CONTMCT DATE:Mav 5,-2020
This Change Order amends the above-referenced contract; all other provisions of the
contract that are not inconsistent with this change order shall remain in effect. For valuable
consideration and by mutual consent of the parties-, the project contract is modified as follows:
l. Section I of the Agreement, entitled "Description of Work," is hereby modified to add
additional work or revise existing work as follows:
In addition to work required under the original Agreement and any prior
Amendments, contractor shall provide all labor, materials, and
equiPment necessary to:
Compensation for unforeseen work being pedormed during watermain
connections in the intersection of South ltZtn and 76th Avenue South.
fne originat Jesign for the watermain had a bury of 4'to avoid conflicts
with thE existing storm system, it was redesigned with a bury of 10'
plus.
Z, The contract amount and time for performance provisions of Section II "Time of
Completion ," and Section III, "COmpensation," are hereby modified as follows:
Original Contract Sum,
(including applicable alternates
wssT)
and
$4,472,667.25
Net Change by Previous
(incl. applicable WSST)
Change Orders $63,737.78
Current Contract Amount
(incl Previous Change Orders)
$4,536,405.03
th
Current Change Order $40,607.97
Applicable WSST Tax on this Change
Order
$4,101.40
Revised Contract Sum $4,581,114.40
CHANGE ORDER - 1 OF 3
!
120 working daYsOriginal Time for ComPletion
(insert date)
10 working daYsRevised Time for ComPlet
prior Change Orders
(insert date)
ion under
6 calendar daYsOrder*cs ha nredIthiforDau ge()ys Req
136 working daYsRevised Time for Com
(insert date)
pletion
In accordance with sections 1-04.4 and 1-04'5 0f the Kent and wsDoT standard
specifications, and section vll of tt'r. ngi""rent, the contractor accepts all requirements of this
change order uv signing below. nlsol pursuant to the above-referenced contract, contractor
agrees to waive any protest it may GuL regarding this change order and acknowledges and
accepts that this change order constitutes flnat setttement of all claims of any kind or nature
arising from or connectid with any *ort "ittr"r covered or affected by this Change order, including,
without timitation, claims related to contract time, contract acceleration, onsite or home office
overhead, or lost piofitt. This Chanll OiO"., unjess otherwise provided, does not relieve the
contractor from strict compliance *ith the guarantee and warranty provisions of the original
iontract, pafticularly those pertaining to substantial completion date'
All acts consistent with the authority of the Agreement, previous change orders.(if ?ny)'
and this change order, prior to tn" "*Litive date oithis change order,. are hereby ratified and
affirmed, and the terms of the ngree*"nt,-previous Change Orders (if any), and this Change Order
shall be deemed to have applied.
The parties whose names appear below swear under penalty of perjury -th.at they are
authorized to enter into this contract moOificatlon, which is binding on the parties of this contract'
3. The Contractor will adjust the amount of its peformance bond (if any) for this project
to be cgnsistent with the revised contract sum shown in section 2, above'
IN WITNESS, the parties betow have executed this Agreement' which will
become effective on the last date written below'
Print Name: .Gjrad Biererr.P.E.
tts ffiirqPublieWorkgll-reetql-
OF KENT:
(signature)
DATE
(title)
CONTRACTOR:
{title)
Print Name:
DATE:
Its
CHANGE ORDER .2OF 3
t
APPROVED AS TO FORM:
(applicabte tf Mayor's signature regulred)
Kent Law DePartmentKent CitY
ATTEST:
(
lrn thlg 1ield, You may enttr the eie.tbnic fllepsth {h@ the @nt@d h's been savedl
CHANGE ORDER - 3 OF 3
FILE NO: 2OO.2
T<ENTW^o{rroro'
CHANGE ORDER WORKSHEET NO' 3
Construction Enqineeri Division - Public Works
Project: 76th Av S ImProvements
Project Engineer:
Capital Projects
Mark Madfai
Phil McConnell
Project No.:
Fed-Aid No.:
Contractor:
19-3006
N/A
NorthWest Cascade
Mana r
Date: B-21 & 8-22-2020
I. PROPOSED CHANGE
Cha n I e of p ay m e nt d u e to c h a n I e of co n d iti o ns a n d u n fo rse en W o r k bei n g p erfo ed during
W ate rm a n co n n ecti o ns I n th e n ters ecti o n of S 2 1 th St a n d 7 6th A S
T he o n I n a de s r9 n fo r th e W ate r m a n h a d a b u ry of 4 to a VO id co nfl I cts wit h t h e e XI sti n g storm
syste m it WA s red esl I n ed W it h a b u ry of 1 0 p US
d d ito ti u ntered d u n ngDunngthewatermanconnectionprocess(3 )a n a n a m a n e n W a s en co
th at t U r n o n S it W a s e n e rg ized ca u S n I ft o od I ng o f t h at secti o n o f th e WO rk Th 5 W o rk h ad to b e
reperformed.
Due to the change of the design and the unknown issues presented and handled during the tie
ins. It was agreJd to price the watermain connections as a force account deducting all previous
ments issued for those connections
II. REASON AND BACKGROUND FOR CHANGE
rII. METHOD OF PAYMENT
NEW PAY Alot
DELETE EXISTING PAY 1{)9.5 Not
t
FOR ACCOUNT'NG USE ONIYChante Order No.
Sch. No.Item Description Total
Est. Qty
Qtv ts Unit Unit Price Estimated Cost of
ItemPE
Water tie-ins (3) change of 1 1 FA $4O,607.97 $40,607.97
condition adju stment
In depen d en t Esti mate Atta ched CFEATE PAY ITEM OI.{.LV Paym en t to be made PAY THIS PAY ESTIMATE
at later Qa tF !po!m plFt!c!of work
New Sub Reqrd?No
FORACCOUNI'NG USE oNtvChante Order No.Cost of ltemUnitPriceotvonDescril. NoSch, No.
- independent Estimate Attached - REQUIRED
REV. DATE: 3/27/18
FOR ACCOUNT'NG USE ONT.YChante Order No.
B.l. No.Item9-ctt .!!9,Cost ofUnit P
tr Independent Estimate Attached - REQUIRED
FILE NO: 2OO.2KENT
TO EXISTING PAY Not
TOTAL ESTIMATED COST OF CHANGE ORDER *
*Total ofthe Cost of Item Columns
THIS PAY ESTIMATE 607.97
IV. WORKING DAYS
TOTAL WORKING DAYS*2L6
*This Change Order + Previous Total
All work, materials and measurements to be in accordance with the Standard specifications
and Contract Special Provisions for the type of work described.
Capital Projects Manager:Date:-?
McCo
Gonstruction Engineeri ng
Supervisor:z./tz/ztDate:
2
697.97
Previous Total
*
2roOriginal Contract 200
Work i
Due This Change Orde 1:lr
Construction Manager:
E c Gonnor
Date:
REV, DATE: 3/27118
FA Sheet No.
TEFORCE ACCOUNT WORKED
DAILY REPORT OF
Project Name 76th Av S lmorovements
Item No.: Schedule ll
Prime Contractor: NW Gascade
Project No: 19-3006
Description of Work 212s1 St watermain connections
Dale8121 &2212020
Work by Subcontractor?:
Sub-Contractor:
DOUBLE TIMEOVERTIME DOLLAR
AMOUNTOT RateHrsHrsRateHouCODEOCCUPATIONNAME 16$1 117.2887laborerohn Hanson#.20$119.60I89.Sean 1.20$1 19.6089.70Ron Garne#770.83163122.96BforemanDon 245.92163122.962foremanosh
1 63.14foremanBlaine .421478Bob.80.85IREG h 3.84124110.69
3112.82 I
3171112
LABoRoVERHEAD&PRoFIT,INCLUDINGSICKLEAVEFoRTHEMEDICALLEAVE@31%
24
567
SUBTOTAL - LABOR:
STANDBYOPERATED DOLLAR
AMOUNTHrsHrsRate
EQUIPMENT OR ATTACHMENTS
pment #922.506.80F35O FOREMAN TRUCKc594 330.69$6.18131CASE 58OLD169 195.80$9.'13
M107 101.8863wheeledM316116.042.611Genie towable towerT213 152.92$6lnter Water truckK010 823.20$1Kenworth 19CY Dtruckc707 1,234.80$68.601Kenworth 1gCY Dtruckc706 I 75765.11Peterbilt'10CY Dtruckc548 2 .40103.60JD Loader 744JD't83 723.06$740.17'lF450 foreman truckc665
$1 639.68168.32JD Loader 644KD2',t9
$1 507.6862.82JD 120C ExcavatorD1 81 .501$78.70JD 245 G LC ExcavatorD223 71.72$35.86F350 foreman truckc524
SUBTOTAL. EQUIPMENT
EQUTPMENT OVERHEAD & PROFIT @ 21%
EQUIPMENT TOTAL $
DOLLAR AMOUNTUnitsLJnit Price
MATERIALS / SERVICES
1B" connection -
4
10 " connection -
540.12" Dl
LF12" Dl
1LF8',Dl
LF 37.31
15EA1
.601EA7
1
8" Dl
12" 45 bends
12" MJ kits
12"x10" reducer
10'MJ kit
10" FL gasket and bolts
8'valve -
EA $ 79.33 $158.66
1 EA $ 34.84 s 34.84
I EA $ (1.600.00)$(1,600.00)
valve 1 .43 18'
8'MJ kit 3
1 kit 15.84 84
8'FL and bolts
12"valve -EA 700
EA 1 7',!1 719.19
12" gate valve
107.84
8" Dl LP Sleeve EA
10" Dl LP Sleeve 1
12x8MJxFL tee 1
10" MJ cap 1 78.84
HMA -6.I TN I
TN .66
HMA 766
Gravel Borrow -TN
I 731
Gravel Borrow
csBc,-
$18.75 $178.13
CSBC TN
SUBTOTAL 111
TOTAL $111
TOTAL
(for
607.97
erification of Hours Worked
12% MARKUP
prime when subcontraci work)$
SHEET TOTAL:.97
Contractoas Date
Owner's Date
nts
Bill ro: COK
NORTEWA$"I CASCADT; lilc.
Nwc PRotEfi#4255
IJESCRIITION: 212th lotmcctioo- Fridayrsarurdav
LIICATION; 76th Are Sorlh ImpBv@ells
Irbos Ctoup 3 - Gmcol laborm
labgrfrCtou! 4 - PiPe layer
latlord Creut 4 - ?ips ljYG
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c594 2Al4 FORD F350
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3
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SICK LEAVS
SM,4LLTOOTS:
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LASORTOTAL:
s520.54
s?80.E1
s?5,1?.3.1
NIIO? 1998 DYNA-PAC
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c665 20lJ FORD
5501- 5[
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Nr3!6 2015 I-AYMOR sM300
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T3O2 2OO8 ALLMAND 2220!5E vonNl"El)
KOIO i9'I4 IN|ER,\ATIONA 4370 WATERIRUCK
C1i1 7$01 KENWORTII TSOOB IOCYDT'!'PTRK
c7a6 200.1 KENWORTH fi009 loclDrti',tPTRK
c543 1990 PFTtsRl]lLT 118 locYDlJl4P'lRK
rrr8:] 2006 Joll}\ DEER! 744J
viatid items
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D2l9 2Al3 IOttNtBFltr 644K
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Rate 2.75
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MATERIALI'OTAI-:
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$26136
1*3557.40
t2'/a t{ARKliP: $381'15
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DAILY FORCE ACCOUNT SHEET/PROTEST ED WORK SHEET
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ATIVE:
"',EAHLF*TEEii{T
10245 Estate LN sE 4'
Olalla" WA 98359
lnvoice
Office: 253-853-6608
CEL: 253-225-t035
FAX: 253-858-8813
apevans@scafinest.com
Date lnvoice #
812812020 19044
BillTo
Northwest Cascade Inc.
Isaac Lewis
10412 John Bananola WaY E
Puyallup, WA 98374
Job SiteJob #TormsPld/IO#
S 212 StJ'16 Ave S - KentTrafrc ControlDue on receiPtPo 4255
Total AmountRateHoursllemOfficerDate
3l 8.00
90.00
424.00
848.00
r,946.00
t82.25
106.00
90.00
106.00
r06.00
139.00
139.00
3
l
4
I
l4
2,75
Night Traffic Conhol
Traffic Confiol
Night Traffic Control
Night Traffic Connol
Prcmium Rate
PrEmium Rate
Clark
Clark
Raveica (late cancellation - 4 hour min)
Cls*
Clark
Peloquin
8ll'112020
81t7t2020
8/t'|12020
azl/2a20
8l2lr2n20
8n2/2020
Total $4,008.25Thank you for Your business.
Payments/Gredits $0.00
Balance Due $4,008.2s
Northwest Gascade GonstructionJob Hame: City of Kent 76th Ave $ lmprovJob Code42550/8/16oler16ot8,t40/8110atSt'16ot8t17wa17onDaily Reporttftf$i..fi$iffftf6,tffiyl::'::..i rj .-. .;:rtt'!:qiiJ'airr"rjji:'r!: il r'li'!:'"n'r"i;r, .'. " ,,Mird-{60-75)Dug all 3 connections back filled hoe packed with compaction test.paved on 212th cold mixed 76th'', :.'i rr, "r i.''' :'' .ffiffiffi;ffi.1,$1iit. $; t!; ir'i:. : - .[Delays"were caused by the availibiliiy of ihe water departnent to operate valves]Ltready pcor subgrade, resulting in a larg amount of orrer excavationlffurthui delay was caused while-waiting for the water departrnent to locate the correct valve(s) to stop the leak at the abandonment pointlitne oversaturation from draining water mains and the leaking nearby storm systems resutled in a much larger and more dificult excavation at all 3 of the tie in locationslitf,e tie in location was considerably deeper than the original plan at both locations in 212thlithe inspector did not allotv two connections to be worked on at the same time furthur delaying the final conneclionliOue toifre water from the storm and not being able to shutdown the water main, the excavation and bac*fill were way wider and the restoration will be wider as well)(Paddy took over for Josh who left sick. lsaac spent Saturday on-site as well)1761SIGLER, DONALD LAB-FORE 016117onnotgt170/8/1681293axg- *010314iata7788COFFEY, SEAN PIPE LAYERGARNER, RONALDngr.rsor'r, .r<ir-tNPIPE LAYERnFin. r-nenot2to0/2y06589489074395694'c'- indicates a camPleted item'(R)'- lndrbates a rawotk quantitY.GRAEBER,JR, KENWORTMAN, WLLIAMCORKREY,JOSHUA OPER.FOREot4loot4toRODY, BLANEr-en, noeEntSMITH, DARRELLOPER.FOREOPERATOR toFennron I'OPERATR HHoCeAnrC r-rn-Date:Printed on: 0V24n020 16:54:43Page 1
Northwest Cascade ConstructionJob Name: Glty of Kent 76th Ave S lmprov1761SIGLER, DONALD LAB-FORE8129COFFEY. SEANP]PE TAYER3918GARNER,RONALD PIPELAYER010314HANSON, JOHN APPR. LABR8278RODY, BLANELEA, ROBERT -OPER-FORE7788OPERATOR L6589SMITH. DARRELL OPEMTOR L4890GRAEBER.JR,KEN OPERATRHH7439WORTMAN, WLLIAM OPERATR HH5694CORKREY,JOSHUA OPER-FORE1761SIGLER, DONALD LAB.FORE8129COFFEY, SEANPIPE LAYER3918GARNER. RONALD PIPE LAYER0/610ot4t16Daily ReportJob Gode4255ot4tool^t17*--* l/s/i60/8/160/8/16ot8t40/8u00/0/160101160/0/160t6/0010314 HAN$ON. JOHN-52n- ' noix, arnr'reAPPR. TABR*--- oPi:R:FoREOPERATOR Lol8't10' "'6la/16 __-alanTot$t170t2otBt't70/8/160/8/'t6018/160t814oTaio77886589- indicates a comPleted item.LEA, ROBERTsr'ninltiAndelt'(R)'- indicates a rework guantity.OPEMTOR LDate:Pintedon: AAr'2020 16:54:430/8t/10PWe 20/8116
Northwest Gascade ConstructionJob Name: City of Kent 76th Ave S lmprov4890GMEBER,JR, KEN OPERATR HH74395694WORTMAN, WLLIAM OPERATR HHCORKREY,JOSHUA OPER-FORE0/0/100/0/10otztoHours; 203 Broken Out: (0n41129)176181293918oioCra5278778865894890i$e5594c :inoEaiei a ComptetedSIGLER, DONALD LAB.FORECOFFEY, SEAN PIPE LAYERGARNER,RONALD PIPELAYERHANSON, JOHNAPPR. LABRRODY, BLANEOPER-FORELEA, ROBERTOPERATOR LSMITH,DARRELL OPERATORLGRAEBER,JR Eru OPERAT -.'WORTMAN, WLLIAM OPERATR HHCORKREY,JOSHUA OPER.FOREot4t0ot4taTotals for LaborDaily ReportototTotoiol8l4Job Code4255otafi7otgt170nor\t170/8/160/8/16oislroaM40/8/100/8/16ot8117aN17ot2'(R)' - indicates a rework quanfuDate:Printed on: AU24/2020 16:54:43Page 3
Job Code4255Northrrvest Gascade ConstructionJob Name: Gity of Kent 76th Ave S lmprovDaily ReportStartTime: 7:30 Brsak (1):Lunch: 0:30Break (2):I[eal (2):End Time: 9:301125.12445205521102255227522862305'c'- indicatesa campleted3 Match Paved QuantitYlnspector Note12 GVat36+64.3428.67Rlnspector Note13 Northern 12" Gate Valve was deleted by inspectorlnepector Note14 caP existing mainslnspector Note15 We used both boxes at all three connections. Boxes are 9' X 8'9'X8'X2(sides))Q(boxes)X3(locations) = 8o4 SFlnspector Not€16 From stock Pilelnspector Nots17 ICON ticket nurnber45057767lnspector Note2 guys t hour each to set up t hour each to take down4'(R)'- indicates a rewotk quantitY.Date:Printed on: OB7r2020 16:54:43Page 4
1Northwest Cascade ConstructionJob Name: Gity of Kent 76th Ave S lmprovJob Code4255Daily Report23102316rCclndiCates d campieted nem.'(R)'- indicates a rework quantityxlnspector Note5 foreman is TCS durnig set up & take downInspector Note6 started at 7:30 PM on Friday, changed officers al about 4;30 PM on Saturday, finished at I PM on Saturadaylnspector NoteDate:Printed on: AA24AO20 16:54:43Page 5
Northwest Cascade ConstructionJob Name: Gity of Kent 76th Ave S lmprovTime Card: Date - 0812112020c594ONE TON FOREMAND169TRACTOR LOADER BAM107ROLLER/COMPACTORM3'163.WHEEL SWEEPER TTOWABIE LIGTIT_IOWT302TMILER MOUNTEDAK010WATERTRUCKc70710 CY DUMP TRKT213c548Daily Report4Job Code4255Foreman -1761 Revision -3 Shift2525124c41218c70610 CY DUMP TRKio cY DUrvtP TRKD183ARTICULATED \IVHEELc665ONE TON FOREMAND219ARTICULATED WHEELD181CRAWLER MOUNTEDa223CRAWLER MOUNTEDc524ONE TON FOREMAN{: i nli cffi;e- comitete{ iC n'(R)' - indicates a rework quantity.25122518182424252xDate:Printed on: OAr " eO20 16:54:43Page 6
Northwest Cascade ConstructionJob Name: City of Kent 76th Ave S lmprovc5s4D169ONE TON FOREMANTRACTOR LOADER BADaily Report48Job Code425525M107trlsiOROLLERYCOMPACTORs-wHEEt- sweeiEn r254412q6"412182518182424252T213TOWABLE LIGHTTOWT302K01oTRAILER MOUNTED AWATER TRUCKc7a7CzooCsae .10 CY DUMP TRK10 CY DUMP TRKD18310 CY DUMP TRKrnrcur-.rieb wneilc66sONE TON FOREMAND219oiei-ARTICULATED WHEELCRAWLER MOUNTEDD223c524CRAWLER MOUNTEDONE TON FOREMAN'ii - indbates a camiieGdile:m--*" ''(R)' - indicates a rewark quantity.4xDate:Printed on: O8/24n020 16:54:43Page 7
Northwest Gascade ConstructionJob Name: Gity of KentT6th Ave S lmprovc594ONE TON FOREMAND169Ml07TRACTOR LOADER BAROLLER/COMPACTORM3163.WHEEL SWEEPERTT213TOWABLE TIGHTTOWT302TRAILER MOUNTED AK010WATERTRUCKc707-czboC54b10 CY DUMP TRK10 CY DUMP TRK10 CY DUMP TRKD183ARTICULATED lAftIEELc665ONE TON FOREMANozTs- AnrrcuLnfro wneelD181CRAWLER MOUNTEDD223CRAWLER MOUNTEDc524ONE TON FOREMAN'(R)'- indicates a rework quant@.Daily ReportII882521818252544124B412182518182424252II84sJob Gode4255Date:Printed on: 08/ '12020 16:54:43Page I
Northwest Cascade ConstructionJob Name: Gity of Kent 76th Ave S lmprovc594oregM107M316izrsONE TON FOREMANTRACTOR LOADER BATOWABLE LIGHTTOWT302TRAILER MOUNTED AK010e707WATERTRUCK10 CY DUMP TRKc706,IO CY DUMP TRK10 CYDUMPTRK _c548oisrARTICULATED WHEELc665ONE TON FOREMAND219braiARTICULATED WHEELCRAWLER MOUNTEDD223c524CRAWLER MOUNTEDONE TON FOREMANx'c'- indicates a fimpteieaffim.'(n' - indicates a rework quanw.Daily Repoft121825Totals for Equipment Hours: 288 Broken Out: (288/0/0)ROLLER/COMPACTORt\AftiEel suaepen rJob Code42552525*412484121825i818242425;'IDate:Printed on: 0U242,020 16:54:43Page 9
Northwest Cascade ConstructionJob Name: City of KentT6th Ave S lmprovJob Gode4255Daily ReportStartTime: 7:30 Break (1):ErhcfcaGs a compniea i:tem-***'(R)'- indkates a rewod< quantitY.Luncht 0:30Break (2):Meal(21:End Time: 9:30Dat€:Printed on: OWIQA20 fi:54:43Page 10
Northwest Cascade ConstructionJob Name: City of Kent 76th Ave S lmprovJob Gode4255Daily ReportMird-(60-75);Sunny;Normal GroundRegrade sidewalk after fixing waler meter and cut 2" down at back of walk for the repaired curb. Remove 24" plug from storm and replace with a 12" in the new swale. Lay half acrossing of 12" Dl at Sta 25+605694CORKREY,JOSHUA OPER-FORE0548908129GRAEBER,JR,KEN OPERATRHH1.52.5COFFEY, SEAN PIPE LAYER1.54Totals for LaborHours: 13 Broken Out; (13/0/0)5Code569448908129NameCORKREY, JOSHUAGRAEBER,JR, KENCOFFEY, SEANBegin EndStart07:0007:0007:00Brcak (1) Lunch Break (2) Meal (2)End Diem Subsistence Note$12:0011:0011:001000.140152'c'- fiAicateE a campielr,d item.'(R)'- rndrbafes a rework quantity.1Qlnepector NoteoDate:Printed on: 0W242,020 16:54:43Page 11
Northwest Gascade ConstructionJob Name: Gity of KentT6th Ave S lmprovDaily ReportJob Code4255lnspector NotePGl LABOR-0001 3 Regrade walk, change plugs and cut for curb at back of walkln$Pector Note't -inaiCAes a comPleted item.'(R)' - indicates a rework quanti$DatePrinted on: 08/ "t202A 16:54:43Page 12
Northwest Cascade ConstructionJob Name: City of Kent 76th Ave S lmprovTime Gard: Date - 08/2112020v - iidi;;i6'i d iomite{editem.^ *'(R)'- indicates a rework quantity.Daily ReportTotals for Equipment Hours: 0Broken Out: (0/0/0)Job Code4255Foreman -5694 Revision-0 ShiftDate:Printed on: A8n4n020 16:54:43Page 13
d
lgH.D' FoHJ#"s
ffilf-' PO Box 84368, Seattle, WA 98124
Corporate Office
3033 136th Pl SE, Ste 100, Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425-654-8800 . Fax 425'641-8885
IN.HOUSE
COPY
Page 1 of 2
lnvoice
Number t5496898 PADS
# 143940
Ship to SOUTH2't44176TH
KENT WA 98032
Ben Pimentel06118120
lnv
06693127
ro: NoRTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373-0399
#/;255 76TH AVE SOUTHShipVia: FACTORY TRUCKFoB: FACTORY
Oty OtY
Ship'd BO'dLine
Extended T
Price X
Unit
PricePart #
UoM DescriPtlon
386.07
173.55
87.00
251.94
2,068,55
328.98
1,372.06
568.22
1,384.74
575.47
69.80
'11
3
1
1
2
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
IFC33MML
8" MJ SLEEVE LONG PATTERN DI, A\AM/A C153
LESS ACCESSORIES (53 LBS)
IFC44MML
10" MJ SLEEVE LONG PATTERN DI, A\A/WA C153
LESS ACCESSORIES (68 LBS)
IFC55MML
12" MJ SLEEVE LONG PATTERN DI' A\^^A/A C153
LESS ACCESSORIES (82 LBS)
IFK33MML
8'' MJ 45 ELBOW DI, A\A^/VA C153, C/L LESS
ACCESSORIES (5e LBS)
IFK44MML
1O^ MJ 45 ELBOW DI, A\AM/A C153, C/L LESS
ACCESSORIES (86 LBS)
IFK55MML
12'' MJ 45 ELBOW DI, A\AM/A C153, C/L LESS
ACCESSORIES (109 LBS)
IFI5SMML
12'' MJ 22-1I2ELBOW DI, A\^/VVA C153, C/L LESS
ACCESSORIES (90 LBS)
IFT554FFF
12" X 10" FL TEE Dt, A\ M/A C1 10, c/L (394 LBS)
IFT551FFF
12" X 4" FL TEE Dl, A\ M/A C1 10' C/L (322 LBS)
IFT555FFF
12" FLTEE Dl, A\AM/A C110, C/L (408 LBS)
IFT553FFF
12" X8" FL TEE Dl, A\^fuVA C110, C/L (346 LBS)
IFDlMXTL
4" MJ CAP TAPPED DI,2" IP, SSB, A\AM/A C153
LESS ACCESSORIES (10 LBS)
Serving the Pacific Northwest si
wwwhdfowler'com
128.69
173.55
87.00
125.97
188.05
164.49
686.03
568.22
692.37
575.47
34.90
2
2
1
2
1
2
nce 1911
10
11
12
13
14
15
17
2
4
5
8
I
H.D. FOWLER
COMPANY
REMIT: PO Box 84368, Seattle, WA 98124
Corporate Office
3633 136th Pl SE, Ste 100, Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425-654-8800 * Fax 425-641'8885
IN-HOUSEd Page 2 of 2
lnvoice
Number t5496898 COPY
E:[S$EIffiPADS
# 143940
21441 76TH AVE SOUTH
KENT WA 98032
ShiP to:
Order Writer:
Ben Pimentel
lnv Date:
06118120
Order#
c,6693127
ro: NoRTHWEST cAscADE
PO BOX 73399
PUYALLUP WA 98373-0399
PO/JOB:
#/;255 76TH AVE SOUTH
Due: 07110120
ShipVia: FACTORY TRUCK
Terms: NET 10TH
FoB: FACTORY
PROX
atv
Ship'd
T
x
Line
Extended
Price
Unit
PricePaft#
Description
atv
BO'd UoM
11,492.24
11,492.24
157.68
438.64
3,278.82
89.72
153.16
2 EA IFD4MXTL
10,,MJ CAp TAppED Dt, 2'lp, ssB, AlnM/A C153
LESS ACCESSORIES (35 LBS)
EA IFDsMXTL
12', MJ CAp TAppED Dt,2" tp, ssB, A\AMIA C153
LESS ACCESSORIES (44 LBS)
EA IFT552FFF
12" X6" FL TEE DI, A\A/WA C110, CIL (295 LBS)
EA IFL1IMML
4'' MJ 90 ELBOWDI, AWWA C153, C/L LESS
ACCESSORIES (26 LBS)
EA IFTSgF
3" FL TEE Dl, A\ M/A c110, cll (40 LBS)
78.84
109.66
4
546.47o
2 44.86
2 76.58
RECEIVED BY
SIGNATURE: -
Sub total
Freight
Tax
Grand Total
Serving the Pacific Northwest since 1911
PRINTED NAME:lsaac
wwwhdlowler.com
18
19
21
20
24
Corporate Office
3633 136th Pl SE' Ste '100, Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425-654-8800 " Fax 425-641-8885
Page I of 6
6H.D. FowJ#s
REMIT: PO Box 84368, Seattle, WA 98124
lnvoice
Number
Ih[-HOUSE
15505398 COPYPAWH
# 143940
1417 Thornton Ave SW
Pacific WA 98047
Ship to HD Fowler ComPanY -Pacific
Ben Pimentel
Orderlnv
a6126120
Order#
c,6693223
NORTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373.0399
To
#255 76TH AVE SOUTH
B
Ship Via: OUR TRUCK
Due: 0711Terms:
FOB:H. D. FOWLER COMPANY
ET1 OX
Otv OtY
Ship'd BO'd
Part #
UoM DescriPtion
T
x
Extended
Price
Line
Unit
Price
1,348.61
168.42
325.20
231.36
6.48
4.56
6,728.40
332.60
371.22
10
11
1
2
I
3
4
5
6
8
17
EA IFZWARG3K
8'' WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
WEDGE ACTION GLAND & GASKET (BOXED WTH
BLACK LETTERING)
EA IFZWARG4K
lO" WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
WEDGE ACTION GLAND & GASKET (BOXED WlrH
BLACK LETTERING)
EA IFZWARG4
1O'WEDGE ACTION MJ RETAINER GLAND FOR DIP
FT BNRODsG
3/4" PLATED ALL THREAD A36 ROD 1O FT LENGTH
IMPORT
EA BNSB3
3/4" STAR BOLT 4-112" LONG
EA BNGN3
3/4'' PI.ATED NUT, A3O7 GRADE A, IMPORT
EA BNGW3
3/4" PIATED WASHER, USS, A3O7 GRADE A'
IMPORT
EA IFZWARG5K
12'' WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
WEDGE ACTION GLAND & GASKET (BOXED WITH
BLACK LETTERING)
EA IFZWARG1K
4" WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
WEDGE ACTION GLAND & GASKET (BOXED WlrH
BLACK LETTERING)
RL WIl2BLU5OO
12 GA BLUE WIRE 5OO' ROLL
Serving the Pacific Northwest since 191 1
wwwhdfowler'<om
555{
{
{
3
120
24
24
24
63
10
79.33
56.14
2.71
9.64
0.27
0.19
106.80
33.26
61.876
Corporate Office
3633 136th Pl SE, Ste 100, Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425-654-8800 ' Fax 425'641-8885
IN*HOUSE
Page 2 of 6Al
I6{H.D. FoH#,F$
REMIT: PO Box 84368, Seattle, WA 98124
!il;J;:, t5505398 PAWH
# 143940
COPY
1417 Thornton Ave SW
Pacific WA 98047
Ship to:HD Fowler ComPanY -Pacific
Order Writer:
Ben Pimentel
lnv Date:
06126t20
Order#
06693223
TO: NORTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373-0399
#/'255 76TH AVE SOUTH
Due: 07110120
Ship Via: OUR TRUCKFoB: H. D. FOWLER COMPANY
Terms: NET 1 OTH PROX
Aty OtY
Ship'd BO'd
Part #
UoM DescriPtionLine
Extended T
Price X
Unit
Price
1 10.85
44.55
70,11
347.04
306.81
317.52
75.33 Y
15.00
4.84
10.79
5.05
54.12
36.95
4.95
7.79
38.56
34.09
35,28
25.11
7.50
2.42
27.06
EA TF3M.DBRry
DBRA/.2 PKG DIRECT BURIAL WIRE CONNECTOR
600v
EA WruTAPEDET3B
3'' DETECTABLE TAPE WATER BLUE lOOO'ROLL
EA GFN7X6
2'' X 6'' SCH 40 GALVANIZED NIPPLE A53 ERW
EA GFL77
2'' SCH 40 GALVANIZED 90 ELBOW IMPORT
EA GFN7X48
2" x+s" scH 40 cALVANIzED NIPPLE A53 ERw
EA BVGTNL
2" BRASS GATE VALVE THREADED NRS 2OO WOG
NO-LEAD
EA FPDS7g
2-112'' MNST X 2" MIPT BRASS HOSE ADAPTER
EA PEHTHs
GRANULAR CHLORINE (HTH), 5 LB JUG.HAZ
EA BNBKITI
4" BTACK BOLT & NUT KIT 8 PER 5/8'' X 3", A
3O7,GRADE A,IMPORT
EA FGNEFF1
EA BNBKIT4
1O'' BLACK BOLT & NUT KIT 12 PER 718" X3-314" A
3O7,GRADE A,IMPORT
Serving the Pacific Northwest since 191 1
wwwhdfowler.com
24
3
I
I
I
I
I
3
2
2
1
1
2 t
EA BNBKIT3
8'' BLACK BOLT & NUT KIT 8 PER 314" X3'112", A
3O7,GRADE A,IMPORT
EA FGNEFF3
10.79
5.05
{
12
13
14
15
16
17
18
19
20
21
22
23
24
6H.D. F'HJ#$
neluttf, PO Box 84368, Seattle, WA 98124
il#';:. 15505398
Corporate Office
3633 136th PISE, Ste 100, Bellevue, WA 98006
PO Box '160, Bellevue, WA 98009-0160
Phone 425-654-8800 - Fax 425'641-8885
IN-HOUSE
COPY
Page 3 of 6
PAWH
# 143940
1417 Thornton Ave SW
Pacific WA 98047
Ship to HD Fowler ComPanY -Pacific
Ben Pimentel
Orderlnv
06126120
Order#
06693223
TO: NORTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373-0399
76TH AVE SOUTHShip Via: OUR TRUCK
Due
FoB: H. D. FOWLER COMPANY
T
x
Extended
Price
Line
Unit
PricePart #
UoM DescriPtion
Atv OtY
Ship'd BO'd
703.56
264.68
494.28
62.16
22.80
83.10
810.00
122.26
168.88
483.1 0
2 EA FGNEFF4
10" 1/8" FULL FACE GASKET, NEOPRENE, 150#
EA BNBKIT5
12" Bl-AcK BOLT & NUT KIT 12 PER 718" x3-314"' A
3O7,GRADE A,IMPORT
EA FGNEFF5
12" 118" FULL FACE GASKET, NEOPRENE, 150#
EA IFZWARG2K
6'' WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
WEDGE ACTION GLAND & GASKET (BOXED WlrH
BI-ACK LETTERING)
EA BNBKIT2
6'' BLACK BOLT & NUT KIT 8 PER 314" X3'114" A
3O7,GRADE A,IMPORT
EA FGNEFF2
6" 1/8'' FULL FACE GASKET, NEOPRENE, 150#
EA FTHBLK
12'X 12" X 4" CONCRETE HYDMNT BLOCK
FOGTITE
EA MHSCNsNST
5'' STORZ X4-112" NST ADAPTER WTH CAP AND
CABLE
EA RO281438X7
14.38 X 2" P 2A2 SADDLE BODY ONLY 13'20 - 14'38
t
27.06
26
26
12
10.18
41.19
10.36
o
3.806
b
13.85
o
135.00
61.13
2
4
ROMAC
EA ROUBS1438 42.22
2
14.38 S S STRAP WITH NUTS FOR SADDLE RANGE
13.20 -'14.38 ROMAC
EA FOFBsOOTNL
FBsOO-7-NL 2'MIP X MIP BALLCORP CORP STOP
NO.LEAD FORD
Serving the pacific Northwett since 1911
241.55
26
27
28
29
30
33
34
35
36
37
Corporate office
3633 136th Pl SE, Ste 100, Bellevue, WA 98006
PO Box 160, Bellevue' WA 98009-0160
Phone 425-654-8800 - Fax 425-641-8885
IN-HOUSE
COPY
Page 4 of 6
I -11'@*D. Folg*hE$
nEUtt: PO Box 84368, Seattle, WA 98124
lnvoice
Number 15505398 PAWH
# 143940
1417 Thornton Ave SW
Pacific WA 98047
Ship to:HD Fowler ComPanY -Pacific
Ben Pimentel
lnv Date:
06126t20
Order#
o6693223
ro: NoRTHWEST CAScADE
PO BOX 73399
PUYALLUP WA 98373.0399
#/;255 76TH AVE SOUTHShip Via: OUR TRUCK
Due:
H. D. FOWLER COMPANY
Terms:
FOB:
PR
Oty OtY
Ship'd BO'd
Part #
UoM DescriPtion
T
x
Extended
Price
Line
Unit
Price
313.32
80.98
50.52
1,263.64
119.92
3.64
167.36
86,68
168.88
119.78
53.76
156.66
40.49
25.26
631.82
14.99
0.91
10.46
43.34
42.22
59.89
26.88
16
4
2
2
2
2
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
BFSTTINL
2'BRASS 90 STREET ELBOW IMPORT NO-LEAD
BFN7X48
2" X48" SCH 40 BMSS NIPPLE
BFLTTNL
2'BRASS 90 ELBOW DOMESTIC NO-LEAD
BFN7X8
2" X8" SCH 40 BRASS NIPPLE
AV202C
2" 2O2C.2COMBINATION AIR RELEASE & VACUUM
VALVE CI BODY SS TRIM 5/64'' ORIFICE 3OOPSI
VALMATIC
IFFSTSTFS
2'IP COMPANION FIANGE, DI/CINORMALLY BARE
FrNrsH (6 LBS)
FGRRST
2" 118" RING GASKET RED RUBBER, 150#
MH1295P39
BREAKABLE BOLT & NUT FOR 129 (1995 AND
OLDER) 5/8" x 3" PI-ATED
RO281438X4
14.38 X 1" lP 2)2SADDLE BODY ONLY 13'20 - 14'38
ROMAC
ROUBS1438
14.38 S S STRAP WITH NUTS FOR SADDLE RANGE
13.20 - 14.38 ROMAC
FOF85OO4NL
FBsOO-4.N1 1'' MIP X MIP BALLCORP CORP STOP
NO-LEAD FORD
FOC1644NL
C16-44-NL 1'FIP X PEP PACK JOINT COUPLING
NO-LEAD FORD
5erving the Pacific Northwest
www.hdfowler.com
since 191 I
8
4
2
4
2
2
38
39
40
41
42
43
44
45
46
47
48
49
Corporate Office
3633 136th Pl SE, Ste '100, Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425-654-8800 . Fax 425-641 -8885
IN-HOUSE
COPY
Page 5 of 6
J --t'@H.D. FoH,hFS
REMIT: PO Box 84368, Seattle, WA 98124
lnvoice
Number r5505398 PAWH
# 143940
1417 Thornton Ave SW
Pacific WA 98047
Ship to:HD Fowler ComPanY -Pacific
Order Writer:
Ben Pimentel
lnv Date:
06126120
Order#
06693223
ro: NoRTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373-0399
f/,255 76TH AVE SOUTHShipVia: OUR TRUCK
0t20Due:
FoB: H, D. FOWLER COMPANY
Terms: NET P
Part #
UoM DescriPtion
T
x
Extended
otv otv Price
Line ShiP'd BO'd
Unit
Price
183.39
253.32
424.92
202.02
6.75
61 .13
241.55
80.19
2.25
84.44
EA FO72
1" IPS STIFFENER #72 ALSO CAN BE USED AS
1-114'CTS STIFFENER #53 FORD
EA RO281438X6
14.38 X 1-112" lP 202 SADDLE BODY ONLY 13'20 -
14.38 ROMAC
EA ROUBS1438
14.38 S S STMP WITH NUTS FOR SADDLE RANGE
13.20 - 14.38 ROMAC
EA FOFBSOO6NL
FB5OO-6-NL 1.112" MIP X MIP BALLCORP CORP
STOP NO-LEAD FORD
EA FOC1466NL
C14-66-NL 1.112" FTP X CTS PACK JOINT COUPLING
NO-LEAD FORD
EA FO54
1-1l2'' CTS STIFFENER #54 FORD
EA RO281438X7
14.38 X 2" lP 2}2SADDLE BODY ONLY 13'20 - 14'38
ROMAC
EA ROUBS1438
14.38 S S STRAP WTH NUTS FOR SADDLE MNGE
13.20 - 14.38 ROMAC
EA FOFB5OOTNL
FB5OO-7.N12'' MIP X MIP BALLCORP CORP STOP
NO.LEAD FORD
EA FOC1477NL
C14-77-NL2'' FIP X CTS PACK JOINT COUPLING
NO.LEAD FORD
EA FO55
2" CTS STIFFENER #55 FORD
01
2
3
61.13
6
42.22
3 141.64
67.34
3
3
2.25
1
61.13
2 42.22
1
241.55
1
80.1 I
1
Serving the Pacific Northwest since
wwwhdfowler.com
1911
2.25
50
51
52
53
54
55
56
57
58
59
60
d H.D. FOWLER
COMPANV
REMIT: PO Box 84368, Seattle, WA 98124
lnvoice
Number
Corporate Office
3633 136th Pl SE, Ste '100, Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425-654-8800 . Fax 425-641-8885
IN-HOUSE
Page 6 of 6
15505398 COPYPAWH
# 143940
1417 Thornton Ave SW
Pacific WA 98047
Ship to HD Fowler ComPanY -Pacific
Order Writer:
Ben Pimentel
lnv Date:
06126120
Orde#
06693223
NORTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373-0399
To
#/,255 76TH AVE SOUTH
Due: 07110120
Ship Via: OUR TRUCKFoB: H. D. FOWLER COMPANY
Terms: NET 1 OTH PROX
Oty OtY
Ship'd BO'd
Part #
UoM DescriPtion
Extended T
Price X
Unit
PriceLine
18,785.57
7,54
18,793.11
77.00
125.00
2,08
2.20
2.28
5100FT EPBLUET4lOO
1'' IPS BLUE SIDR.7 250 PSI POLY PIPE 1OO'ROLL
BLUE OUTSIDE & BLACK INSIDE
FT EPBLUE96IOO
1-112" CTS BLUE SDR-g 250 PSl POLY PIPE 1OO'
ROLL BLUE OUTSIDE & BLACK INSIDE
FT EPBLUE9T1OO
2'' CTS BLUE SDR.g 250 PSI POLY PIPE 1OO'ROLL
BLUE OUTSIDE & BLACK INSIDE
EA \ MrSSC6816l
314" .1.112" SS WORM DRIVE HOSE CLAMP
EA W\ruSSC68241
1-1116" - 2" SS WORM DRIVE HOSE CLAMP
EA W /SSC6832|
1-9116'' -2-112" SS WORM DRIVE HOSE CLAMP
0.51
100 0.77
100 1.25
4
4
4
0.52
0.55
0.57
RECEIVED BY
SIGNATURE:
Sub total
Freight
Tax
Grand TotalDATE:
Serving the Pacific Northwest since 191 1
www.hdfowler.com
PRINTED NAME
61
62
65
63
64
66
4
I6{H'D. FosJ#s
REMIT: Po Box 84368, Seattle, WA 98124
ffif:'. t55 14703
sur Pvrsat vl llLs
3633 136th Pl SE, Ste 100, Bellevue, WA 98000
PO Box 160, Ballevue, WA 98009-0160
Phone 425654-8800 * Fax 425€41-8885
Pacific Braflch
1417 Thornton AvE SW
Pacific, WA 98047
(253) 863-8600 Fax (253) 863-8681
Pagel ot 2
16
2
3
5
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I
1417 Thomton Ave SW
Pacific WA 98047
Ben Pimenteln72A06719337
NORTHWEST CASCADE
PO BOX 73399
PUYALLUP WA 98373.0399
76TH AVE SOUTHShip via: WLL CALLFoB; H. D. FOWLER
Part #
UoM Description
Unit
Price
T
x
ExtendedatvatyPriceLine Ship'd BO'd
136.31
1,067,43
208.29
180.21
70.15
22.75
55.99
12' X 8" FL TEE DI, AVVWA C1 10, C/L (346 LBS)
EA IFL33MML
8" MJ 90 ELBOW DI, A\MA/A C153, C/L LESS
ACCESSORIES (68 LBS)
EA MVK4S2OOMFN
8" AVK GATE VALVE, MJ X FLG, RESILIENT
SEATED, ATMVA C5O9 FULL BODY DI, LESS MJ
ACC
EA IFZWARG3K
S" WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
I ,EDGE ACTION GLAND & GASKET (BOXED WlrH
BLACK LETTERING)
EA IFT3s2MMML
8'' X 6'' MJ TEE DI, AVIM/A C153, C/L LESS
ACCESSORIES (80 LBS)
EA IFP3M
8" MJ PLUG DI. SSB, AVWA C153, LESS
ACCESSORIES (26 LBS)
EA IFZBG3
S" GASKETAND T-BOLT KIT FOR C153 MJ
FITTINGS
EA IFZWARG3K
8'WEDGE ACTION MJ KIT FOR DI PIPE WBOLTS'
WEDGE ACTION GI-AND & GASKET (BOXED WITH
BIACK LETTERING)
Serving the Pacific Northwest since 191 1
www.hdfowler,com
136.31
1067.43
69.43
180.21
70.15
22.75
s5,99
1
I
3
1
I
1
1
H.D. FOIfiILER
COMPANY
REMIT; PO Box 84368, Seaftle, WA 98124
3633 136th Pl SE, Sle 100. Bellevue, WA 98006
PO Box 160, Bellevue, WA 98009-0160
Phone 425€54-8800' Fax 425'641-8885
Pecific Branch
1417 Thomton Ave SW
Pacific, WA 98047
(253) 863-8600 Fax (253) 863-8681
Page { of {
lnvoice
Number 15593919
I
2
HD FowlerComPanY - Pacific
1417 Thornton Ave SW
Pacific WA 98047
$hip to:
Order Writer:
Jeff Workman
lnv Date:
09t23t20
Oder#
c/6811294
ro: NoRTHWEST cAscADE
PO BOX 73399
PUYALLUP WA 98373.0399
76TH AVE SOUTH
PO/JOB:Dua: 10110120
ShipVia: WLL CALL
Terme: NET 10TH PROX
FoB: H. D. FOWLER
Part#
UoM DescriPtion
Unit
Price
T
x
ExtendedOUatvPriceLine Ship'd BO'd
15,257.00
15,257,00
15,257.25 FT IP5OSGTJ
12" CL 50 DI PIPE TJ 18.25'LENGTH ASPHALTIC
COATED ANSI/A\IWA C151 IPQ1,51 AND CEMENT
LINED ANSUA\AM/A C1C/}IPC1.4WTH SBR GASKET
EA TYLUBEQ
PIPE LUBE QUART
33.44
6 -lNc-
Sub total
Freight
Tax
Grand Total
Serving the Pacific Northwest since 1911
www.hdfowler.com
chris
Certified Payroll ReportDepartment of Labor andlndustriesPrevailing Wage ProgramPO Box 44540Olympia WA 98504-4540(360) 902-5335Prime Contractor XSubcontractor IFinalWeek ofPayroll trProject Name76th Ave S lmprovementsCountyKingProject or Contract#19-3006Project AddressCompany NameNORTHWEST CASCADE INCPhone(253) 848-2371AddressPO BOX 73399CityStateWAZip+4PUYALLUP98373Net Wages$867.08$1,550.58$628.28$1 ,279.5{$1,837.21DeduciionsOtherWorkers'Compensation:$8.23, UnionDues: $452.28,Other: $3.04Workers'Compensation:$11.79, UnionDues: $551.88,Other: $82.90Workers'Compensation:$4.34, UnionDues: $357.91,Other: $2.07Workers'Compensation:$9.27, UnionDues: $367.92,Other: $4.67Compensation:WithholdingTax$151.90$351 .84$99.50$341.59$803.69FICA$91.91$173.45$62.55$140.80$244.58TotalHourly"UsualBenefits"$12.64/hr$12.64/hr$22.47|hr$12.64/hr$22.47|hrGross AmountEarned / GrossPayroll$1,201.53$1,574.44$2,224.32I$2,722.44$817.60 /$1 ,'154.65$1 ,793.92I$2,143.83$3,044.25$1,112.16$89.37$0.00$476.64$476.64$1,271.04$664.30$153.30$0.00$0.00$489.28$1 ,304.64$866.25Rateof Pay$39.72$59.58$79.44$39.72$59.58$79.44$51 .1 0$76.65$102.20wo.77$61.16$81 .54TotalHours28.001.500.0012.008.0016.0013.002.000.000.008.0016.0017.50Day and DateWed8t26Hours Worked Each Day8.000.500.000.000.000.000.000.000.000.000.000.000.00Tue8t258.000.500.000.000.000.000.000.000.000.000.000.000.00Mon8t248.000.500.000.000.000.000.000.000.000.000.000.005.50Awarding Agency NameKENT. CITY OFPhone(253) 856-5500Awarding Agency Address220 - 4rH AVE S KENT, WA - 98032-5895Sun8t230.000.000.000.000.000.000.000.000.000.000.000.000.00Sat8t220.000.000.000.000.0016.000.000.000.000.000.0016.000.00Fri8t210.000.000.004.008.000.005.002.000.000.008.000.004.00Thu8t204.000.000.008.000.000.008.000.000.000.000.000.008.00ea?-Ec(utFr-Eos3ERGOTDTRGOTDTRGOTDTRGOTDTRGNameAndAddressAndrew Ahrens6625 South PugetSound AveTacoma, WA -98409Sean Coffey3555 SE PinetreeDrPort Orchard, WA98366Joshua Corkrey'161 1 3 249th St CTEGraham, WA -98338Ronald Garner5905 S J STTacoma, WA -98408Ken Graeber25822 15th Pl sFor the week endingMonth Day Year8t26t2020Work ClassificationandSoc Sec# of Employee1. LaborersPipe Layerffailor(King)2. LaborercPipe Layerffailor(King)3. Power EquipmentOperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(King)4. LaborersPipe Layerffailor(King)5. Power EquipmentOperatorsF700-065-000 certified payroll report 05-09Employee Benefits Distribution and Signature Certification on Reverse S
$859.21$816.46$2,227.49$1,013.95$2,489.04$120.13$249.62$13.77, UnionDues: $1,031 .69Other: $221.11Workers'Compensation:$9.15, UnionDues: $367.92,Other: $3.10Workers'Compensation:$7.14, UnionDues: $605.52,Other: $137.34Workers'Compensation:$14.30, UnionDues: $1,208.92,Other: $7.47Workers'Compensation:$7.23, UnionDues: $605.85,Other: $3.19Workers'Compensation:$17.27, UnionDues: $1,462.54Other: $9.31Workers'Compensation$0.85, UnionDues: $61.32,Other: $0.39Workers'Compensation:$2.02, UnionDues: $57.28,Other: $0.78$194.83$153.93$400.1 I$104.97$788.14$7.25$25.69$93.67$95.05$225.61$96.27$281.28$11.54$23.73$12.64/hr$22.47|hr$22.47|hr$12.il/hr$1 1.14lhrI$4,152.10$1,224.56!$1 ,527.88$1 ,242.42$1 ,815.44$2,949.18I$4,083.97$1,258.43I$1,831 .46$3,627.00I$5,047.58$150.92 /$201 .48$310.24 t$359.12$594.00$1,584.00$0.00$334.00$890.56$1,135.92$106.50$0.00$2,116.00$833.1 8$0.00$1 ,1 50.56$107.87$0.00$1,778.40$912.60$936.00$150.92$0.00$0.00$38.$310.241$0.00$0.00$77$74.25$99.00$27.83$41.75$55.66$47.33$71 .00$94.66$52.90$79.35$105.80$47.94$71 .91$95.88$46.80$70.20$93.60$37.73$75.468.0016.000.008.0016.0024.OO1.500.0040.0010.500.0024.OO'1.500.0038.0013.0010.004.000.000.008.000.000.000.000.000.000.000.008.000.500.008.001.000.008.000.500.008.001.000.000.000.000.000.000.000.000.000.000.000.000.008.000.500.008.000.500.008.000.500.008.000.500.004.000.000.008.000.000.000.000.000.000.000.008.000.500.008.000.500.000.000.000.008003.500.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000000.000.000.000.000.000.000.0016.000.000.0016.000.000.000.000.008.000.000.000.000.000.000.0010.000.000.000.000.000.000.008.000.000.008.000.000.000.000.008.000.000.000.000.000.008"008.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.008.000.500.008.000.500.006.000.000.000.000.000.000.000.000"00OTDTRGOTDTRGOTDTRGOTDTRGOTDTRGOTDTRGOTDTRGOTDTDes Moines, WA -981 98John HansonGillette Dr SEPort Orchard, WA -98366Johnny Harrison22O5 62nd Ave E 8-301Fife, WA - 98424David Honeywell10444 Littlerock RsSWOlympia, WA -9851 2David Jones2416 381st St SRoy, WA - 98580Robert Lea47032441h st cr EGraham, WA -98338Jodi Lewis7312 1417th St CTEPuyallup, WA -98375Ann Orn7803 Samurai DrSELacey, WA - 98503Shovel, Excavator, Backhoes,Tractors: 15 To 30 Metric Tons(King)6. LaborersApprenticeLaborer registered on or after6t1t2012Step 1(King)7. Power EquipmentOperatorsShovel, Excavator, Backhoes,Tractors: 15 To 30 Metric Tons(King)8. Power EquipmentOperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(King)9. Power EquipmentOperatorsShovel, Excavator, Backhoes,Tractors: 15 To 30 Metric Tons(King)'10. Power EquipmentOperatorcShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(King)11. LaborersTraffic Control Supervisor(King)12. LaborersTraffic Control Supervisor(Kins)F700-065-000 certified payroll report 05-09Employee Benefits Distribution and signature certification on Reverse Sid€
$914.93$140.32$1,780.13$1,439.07$1 19.63$1,095.09$1,658.56$992.1 2Workers'Compensation:$6.17, UnionDues: $494.01,Other: $3.44Workers'Compensation:$1.10, UnionDues: $6'1.32,Other: $0.46Workers'Compensation:$9.59, UnionDues: $383.25,Other: $12.26Workers'Compensation:$8.89, UnionDues: $588.85,Other: $5.94Workers'Compensation:$1.09, UnionDues: $61.32,Other: $0.39Workers'Compensation:$12.32, UnionDues: $666.90,Other: $3.93Workers'Compensation:$9.59, UnionDues: $614.50,Other: $5.74Compensation:$11.90, UnionDues: $643.92,Other: $3.69$298.54$1 1.48$428.89$453.06$11.39$208.98$362.72$223.09$104.08$13.60$190.37$162.07$11.86$1 19.07$173.07$111.32$12.64/hr$12.64/hr$22.47|hr$12.64/hr$12.64/hr$22.47|hr$12.64/hr$1,251.30I$1 ,821.17$177.72 I$228.28$2,214-66I$2,804.49$1,829.68I$2,657.88$155.12 /$205.68$1 ,556.42I$2,106.29$2,013.48I$2,824.18$1 ,367.84I$1,986.04$670.80$580.50$0.00$177.72$0.00$0.00$421.84$0.00$1,792.82$38s.20$288.88$1 ,1 55.60$1 55.1 2$0.00$0.00$1,326.7I$229.64$0.00$383.52$0.00$1,629.96$1,272.40$95.44$0.00$51 .60$77.40$103.2$44.43$66.65$88.86$52.73$79.1 0$105.46$48.15$72.22$96.30$38.78$58.1 7$77.56$34.02$51.03$68.04$47.94$71.91$95.88$31.81$47.72$63.6213.007.500.004.000.000.008.000.0017.008.004.0012.004.000.000.0039.004.500.008.000.0017.0040.002.000.007.000.000.000.000.000.000.000.000.000.000.000.000.000.000.008.002.500.000.000.000.008.000.500.006.001.000.004000.000.000.000.000.000.000.000.004.000.000.008.000.500.000.000.000.008.000.500.000.002.500.000.000.000.000.000.000.000.000.000.000.000.000.008.000.500.000.000.000.008.000.500.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.0017.000.000.000.000.000.000.000.000.000.000.000.0017.000.000.000.000.004.000.000.000.000.008.000.000.008.004.00'12.000.000.000.007.000.000.008.000.000.008.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.008.001.000.000.000.000.008.000.500.00RGOTDTRGOTDTRGOTDTRGOTDTRGOTDTRGOTDTRGOTDTRGOTDTBlane Rody38618 Ski Park RdEatonville, WA -98328Thomas Shaffer10425 196 St Ct EGraham, WA -98338Donald SiglerPO Box 45Roy, WA - 98580Darrell SmithPO Box 462Yelm, WA - 98587Donald Sotelo912 150th St CT ETacoma, WA -98445Elazada Wagner908 30th st NEAuburn, WA - 98002Wlliam Wortman3904 96th St ETacoma, WA -98446MatthewVwatt812 12lh Ave SEPuyallup, WA -9837213. PowerEquipmentOperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(King)14. LaborersGeneral Laborer(King)15. LaborersGeneral Laborer(Kins)16. PowerEquipmentOperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(Kins)17. LaborersGeneral Laborer(Kins)18. FlaggersJoumey Level(Kins)19. PoweruipmentOperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(Kins)20. LaborersApprenticeLaborer registered on or after6t1t2012Step 1(King)F700-065-000 certified payroll report 05-09Employee Benefits Distribution and Signature Certification on Reverse Si(
F700-065-000 certified payroll report 05-09Employee Benefits Distribution and Signature Certification on Reverse Side
AffirmationDepartment of Labor and lndustriesPrevailing Wage ProgramPO Box 44540Olympia WA 98504-4540TitleMail ClerkThe par$ signing this report pays orsupervises the payment of the personsemployed by:(Name of contractor or subcontractor)NORTHWEST CASCADE INCFor the week ending8t2612020For the week startingat20t2020Printed name of party signing this reportSamantha OliverProject Name:76th Ave S lmprovementsToday'sDate9t4t2020(F) OtherBenefits$0.75$1 .15$1 .15(E) ApprovedApprenticeProgram$0.00$0.00$0.00idayHourly(D)Hol$0.00$0.00$0.00(C) HourlyVacation$8.57$6.70$6.70(B) HourlyMedical$1 3.1 5$4.79$4.79(A) HourlyPension$22.47$12.64$12.64Total Hourly"UsualBenefits"(A+B+C+D+E+F)3. Joshua CorkreyPower Equipment OperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric TonsKinq)2. Sean CoffeyLaborersPipe Layerffailor(Kino)1. Andrew AhrensLaborersPipe Layerffailor'USUAL BENEFITS' DISTRIBUTIONPleasein"hour" termsWork ClassificationF700-065-000 certified payroll report 05-09Employee Benefits Distribution and signature certification on Reverse Side
$1 .15$0.75$1.15$0.75$0.75$0.75$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$6.70$8.57$6.70$8.57$8.57$8.57$4.79$13.15$4.79$13.15$1 3.1 5$13.15$12.64$22.47$12.64$22-47$22.47$22.474. Ronald GarnerLaborersPipe Layer/TailorKinq)5. Ken GraeberPower Equipmeni OperatorsShovel, Excavator, Backhoes,Tractors: 15 To 30 Metric Tons(Kino)6. John HansonLaborersApprenticeLaborer registered on or after6t1t2012Step 17. Johnny HarrisonPower Equipment OperatorsShovel, Excavator, Backhoes,Tractors: 15 To 30 Metric Tons8. David HoneywellPower Equipment OperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(Kinq)9. David JonesPower Equipment OperatorsShovel, Excavator, Backhoes,Tractors: 15 To 30 Metric TonsF70O-065-000 certified payroll report 05-09Employee Benefits Distribution and signature certification on Reverse side
$0.75$1 .15$0.60$0.75$1 .15$1 .15$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$8.57$6.70$5.03$8.57$6.70$6.70$13.15$4.79$5.51$13.15$4.79$4.79$22.47$12.64$11.14$22.47$12.64$12.6410. Robert LeaPower Equipment OperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(Kino)11. Jodi LewisLaborersTraffic Control Supervisor(Kinq)12. Ann OrnLaborersTrafiic Control Supervisor(Kinq)13. Blane RodyPower Equipment OperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons{Kino)14. Thomas ShaflerLaborersGeneral Laborer(Kino)15, Donald SiglerLaborersGeneral Laborer(Kinq)F700-065-000 certified payroll report 05-09Employee Benefits Distribution and Signature Certification on Reverse Side
$0.75$1 .15$1 .15$0.75$1 .15$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$8"57$6.70$6.70$8.57$6.70$1 3.1 5$4.79$4.79$13.15$4.79$22.47$12.64$12.64$22.47$12.6416. Darrell SmithPower Equipment OperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons(Kinq)17. Donald SoteloLaborersGeneral Laborer(Kino)18. Elazada WagnerFlaggersJourney Level(Kinq)19. William WortmanPower Equipment OperatorsShovel, Excavator, Backhoe,Tractors Under 15 Metric Tons20. fi,latihew WyattLaborersApprenticeLaborer registered on or after6t1t2012Step 1(Kino)F700-065-000 certified payroll report 05-09Employee Benefits Distribution and Signature Certification on Reverse Side
The party signing below AFFIRMS the following: l(1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete.(2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to thecontract; and the classifications as reported above for each worker, laborer or mechanic conform with the actualwork performed by such worker, laborer or mechanic.(3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees.(4) All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either direcily orindirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legallypermissible, have been made by any person either directly or indirectly from the full wages earned.(5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship andTraining Council.Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties.SignatureSamantha OliverTitleMail ClerkPrinted name of party signing this reportSamantha OliverNotesWeek Ending 8126120Job# 4255soF700-065-000 certified payroll report 05-09Employee Benefits Distribution and Signature Certification on Reverse Side