HomeMy WebLinkAboutCAG2021-223 - Change Order - #1 - Lakeside Industries, Inc. - S. 212th Street Preservation - 09/24/2021Agreement Routing Form
KENT For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayorl Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)WasHrNoroN
?
oLoe
Originator:
C. Frame
Department:
PW Engineering
Date Sent:
9t29t2021
Date Required:
N/A
Authorized to Sign:
E Director or Designee E Mayor
Date of Council Approval:
412012021
Budget Account Number:
R90t13.64110.120
Budget? EYes EINo
Grant? EYes E No
Type: N/A
tro
flo
ELoFs
+atro
EooLgl
Vendor Name:
Lakeside lndustries, lnc.
Category:
Contract
Vendor Number:
34030
Sub-Category:
Change Order #1
Project Name: S 212th St. Preservation - 72nd Ave. S. to 84th Ave. S
Project Details:Time and materials associated with extra work from FA 001-003. Repairing
damage from the sidewalk removal, cutting back tree roots and additional work.
Agreement Amount: $3,842.06
Start Date: N/A
Basis for Selection of Contractor: gi6l
Termination Date: 71 Working DayS
Local Business? EYes E No*
*lf meets requirements per KCC 3.70.100, please complete "Vendor Purchase-Local Exceptions" form on Cityspace.
Notice required prior to disclosure?
EYes E No
Contract Number:
cAG2021-223
Date Received by City Attorney
l,Pi
Comments:
q
Date Routed to the Mayor's Office:
U'ca-flt\o
.a -gagc,e
Gg
.9UI
Date Routed to the City Clerk's Office:
ad(cw22l7l I 20 Visit Documents.KentwA.gov to obtain copies of all agreements
a
Clwv-
KENT
Wa3HtN6ToN
CHANGE ORDER NO. #L
NAME OF CONTMCTOR: Lakeside Industries. Inc. ("Contractor")
CONTRACT NAME & PROJECT NUMBER: S. 212th St. Preservation-72nd Ave. S. to 84th Ave. S.
ORIGINAL CONTRACT DATE: May 06, 2021
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 pafties, the project contract is modified as follows:
1. 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 :
Time and material associated with extra work from FA 001- FA 003
which includes repairing damage from sidewalk removal, cutting back
tree roots, additional curb and sidewalk removal that required hand saw
cutting that was out of the sequence of work and removal of a section
of curb to install the fufthest east loop stub up, along with replacing an
existing concrete pad that had existing damage.
2. The contract amount and time for performance provisions of Section II "Time of
Completion," and Section III, "Compensationr" are hereby modified as follows:
Original Contract Sum,
(including applicable alternates and
wssr)
$1,859,868.10
Net Change by Previous Change Orders
( incl. applicable WSST)
$o.oo
Current Contract Amount
(incl. Previous Change Orders)
$1,959,868.10
Current Change Order $3,842.06
Applicable WSST Tax on this Change
Order
$o.oo
Revised Contract Sum $1,863,710.16
CHANGE ORDER - 1 OF 3
Original Time for Completion
(insert date)
70
Revised Time for Completion under
prior Change Orders
(insert date)
70
Days Required (*) for this Change Order 1 calendar days
Revised Time for Completion
(insert date)
7t
In accordance with Sections L-04.4 and L-O4.5 of the Kent and WSDOT Standard
Specifications, and Section VII of the Agreement, the Contractor accepts all requirements of this
Change Order by signing below. Also, pursuant to the above-referenced contract, Contractor
agrees to waive any protest it may have regarding this Change Order and acknowledges and
accepts that this Change Order constitutes final settlement of all claims of any kind or nature
arising from or connected with any work either covered or affected by this Change Order, including,
without limitation, claims related to contract time, contract acceleration, onsite or home office
overhead, or lost profits. This Change Order, unless otherwise provided, does not relieve the
Contractor from strict compliance with the guarantee and warranty provisions of the original
contract, particularly those pertaining to substantial completion date.
All acts consistent with the authority of the Agreement, previous Change Orders (if any),
and this Change Order, prior to the effective date of this Change Order, are hereby ratified and
affirmed, and the terms of the Agreement, 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 that they are
authorized to enter into this contract modification, which is binding on the pafties of this contract.
3. The Contractor will adjust the amount of its performance bond (if any) for this project
to be consistent with the revised contract sum shown in section 2, above.
IN WITNESS, the parties below have executed this Agreement, which will
become effective on the last date written below.
CONTRACTORT
zoll
6ffiBy
cttb i/ *trftA€k
I ?DATE
Its 07sl*n
Print Name:
(signature)EAL HA'og
(signature)
Print Name: Chad Bieren, P.E.
Its Public Works Direcffi
CITY OF KENT:
(ZI B,L
DATE:9/a,l/zt
(titte)
CHANGE ORDER - 2 OF 3
4
ATTEST:
r
Kent City Clerk
APPROVED AS TO FORM:
(applicable if Mayorb signature requlred)
Kent Law Department
[In this fleld. you mdy enter the electrcnlc fll€path whe€ the contract has been savedl
CHANGE ORDER - 3 OF 3
File No. 2OO.2
KENT
CHANGE ORDER WORKSHEET NO. OO1
Construction Engineering Division - Public Works
S. 21zth St. Preservation 72ncl Ave. S. toProJect: 84th Ave. s. (East valley Highway)
Project Engineer: Drew Holcomb
Gapital ProjectsManader: Cameron Bloomer (KBA, Inc.)
Project No:
Fed-Aid Nor
Contractor:
19-3003
STPUL-12s0(009)
Lakeside Industries,
Tnc
Date: 9/8/2O2t
I.P Cha e
II. Reason and Bac round for chan e
sidewalks and other hardscape improvements (FA 001, FA 002 & FA 003)
work associated with the installationreate a bid item to provide compensation for misce aneous extra
Because the individual extra work items were small, each FA sheet captures time and material efforts
for multiple items. THey are described below.
FA 001 - PVC scuppers were found poured into the concrete sidewalk, the tops of which were only 2"
deep. They were damaged during sidewalk removal. The Contractor obtained new PVC piping and
repaired the damage. Tree roots had raised existing sidewalk panels and were in conflict with new ADA
compliant sidewalk grades. These roots were cut back with a chainsaw,
FA 002 - Additional tree root removal to avoid conflicts with the new ADA sidewalk grades. On the N
side of the 76th intersection, the plans did not call for sidewalk removal. Signal improvements including
a PPB and junction box replacements required the panels be removed removal. This was done after the
bulk of the demolition work was complete, and was out of sequence required hand sawing and small
quantities. During sidewalk demolition, as much of the existing hardscape as possible was left in place.
At 2locations on the south side of 2l2th, additional curb and sidewalk removal was required to install
conduit stubs for loops into existing junction boxes. This was out of sequence work requiring hand saw
cutting and removal of smaller quantities.
FA 003 - Removal of another section of curb to install the furthest east loop stub up, also out of
sequence and requiring hand saw cutting. The concrete pad around a luminaire base at the interurban
trail had existing damage, and grade changes required the pad be replaced.
Time and Material efforts associated with these extra work were tracked and agreed to in the field.
Pricing was determined using standard markups from section 1-09.6 of the contract. See attached
III. Method of Payment
Page 1
NEW PAY ITEMS J Notapp'caore
New Pay Items Total: $
DELETE EXISTING PAY ITEM(S) per 1-09,5 El Notappricabre
Delete Existing Pay Items Total: $
INCREASE/DECREASE TO EXISTING PAY ITEM(S) E Notappricabre
Increase / Decrease to Existing Pay ltems Total: $
*TOTAL ESTIMATED COST OF CHANGE ORDER:
3,842.O6
* Total of the Cost of Item Columns
7L
* This Change Order + Previous Total
IV. WORKING DAYS
*TOTAL WORKING DAYS:
sch
No Item Description Total Est.
Otv Unit Unit Price Total Estimated Gost of
Item
I CO 001 - Misc Hardscape Extra Work 1 LS $3,842.06 $3,842.06
$
$
Sch
No.Bid ltem No.Item Description Qtv Unit Unit Price Cost of Item
$
$
$
Sch
No.Bid Item No.Item Description Qtv Unit Unit Price Cost of ltem
$
$
$
3 o6
Original Gontract:70 Due This Change Order:1 Previous Total:70
Explanation/Justification for Additional Working Days:
Each item slowed the crew while working on critical path activies. The total amout of crew time impact was just
over 8 hours, and all parties agreed adding 1 day was fair and reasonable.
Page 2
Gapital Projects Manager:Date:9/8/2O2L
Date: /d/zr
Date:z/
r'4'/L
Gonstruction Engineeri ng
Supervisor:
/c*Kuehne
Construction Manager: _ 4. ,._fi-r'-
Eric Connor
meron rnG.
Page 3
b.DAILY REPORT OF FORCE ACCOUNT WORKED/l
CONTRACTOf,Lakeside lndustries DAIE 6125t2021
SUBCON?RACTOR FAY EST#
PrcJect No.i tg-3@3
ITEM*
Foderal Ald No.sTPUL.t250{009}
DESCRIPIION OF WORI
PERFORMED]
Romove addltlonrl C&G fo get loop slub lnlo existing J-gox tn Itlo stdewrlk on
lh€ oest ond, 6oulh sido of the proi.ct Rcmow con6llt6 pld rreund illsflng
rlgnll polo.t Ttttl.
FA'
Contdctor
FA'
3
ueon -----------__l TOTAL COST $696.20
WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT
Jgn6s Kunb Labor. Group 5 2.00 $ 61.S $ 85.27 $123.32
Bralhovde lJnder 15 Tor 2.AO $ 81.04 s 109.42 $182.08
3616b WakEfidd Appr€ntic6 Labor, 800/0 2.00 $ s0.74 s 88.89 s101.48
$s $0.0(
$$$0,0c
LABOR SUBTOTAI $386.88
29% OVERHEAD AND PROFIT, BONDING.INSURANCE AND TAX
EQUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE STDBY HRS STDBY RATE AMOUNT
18036 - 2019 Ford F550 Ouf,p Trucl(2 I 32.87 $55.74
12443 -2017 Ford F45O Flslbed 1 t 24-43 $$24.43
31223 -2020 JO310SL Backime 0 1 $ 42.86 I $42.86
-2017 Sulllva 0 2 I 14.94 $29.88
8t62.91
2T% OVERHEADAND PROFIT, BONDING, INSURANCE AND TA,I $34rr
narrruats enotor sffigt-----l
VENOOR & INVOICE #MATERIAL SUB TOTAL AMOUNT
t0.oc t0-00
$0.00 $0.00
$0.00
MATERIALS SUBTOTAL INCLUDING T$i $0.00
21% OVERHEADAND PROFIT, BONDING, INSUMNCE ANDTA}$0.00
TOTAL $o,oo
\ENDOR & INVOICE #WORK AMOUNT
$0.0(
$0.0c
SUBCONIRACTOR INV SUBTOTAI.s0.0c
TA}$0,00
PRIME Sultotal ot Labor, Equipmnt, & Matsdrl Won $696-20
SUBCONTRACTOR Subtotal ot Labor, Equlpment, Mrtqitl, & Subcontncior hyohed Worl $0.00
itarkups on work perfomed by Submnfactoc up to 525,000-12/0, $25,000.$100,000 = 10% Grcat€r lhan 9100,000 = 7olo o9t
Subcodrsctor Mrrk{p 00.m
TOTAL COST
o
ll checkod, lhis wod( is tn dtspute. sy signing fiiil
n€edad lo sccompllsh th! tesk. Enttlomont to bo de,tenninod ft e lal€l dato.W
Fom Date 72020
t.l\ e,t f,r"t-
Customer
t'-rc-71
Date
|771, rg
,a r\
#
Project Name
5 L:l tt^ r,rr?.e.
EWO#
V4 LAKESIDE INDUSTRIES, INC:'Extra Work Verification*
Ernployees on Projca Class Totd tlrs R*g OT
a:AlJ lr- n,l.-q] r'r 2u ':
1 t,'\u b1-l<
t, it +t.t 1,,z I
l-o\rzr,.z 7.
LSI Equipment L$I #Total Hrs
| .'rn
r'tq, lygl
tr Lor
l?t'tt
1lwT
I7l??l
.l
Trucking LSI#Total Hrs
* I\4[arkup per WSDOT spccification unless otherwise agreed upon in rvriting;
Labor, [4aterials, and Equipment lv{arkup 29% / $ubcontractorlr4arhup-21%
Owner's Representative Signature
)" I \/,,r-"- i,./t,
Datc
(: (,1: t lz r
Date
P.O. Box 7016,Issaquah, WA 98027 .\425)313-2b00. (42S) 113-2bZZ/FlyX
Ali EQUAL OPI'OltTUNl'n'EMPLOyDR , WA s.l' CONT RDG NQ ?zj.or LA.Kli.lit-.2:rJD . ()R. su c(!NT. RL;ci No. ccn t{s5{l
Description of Work
y14{J
f Y Lr"'t r. (-uL ,:/t 6'
l"
"tL 'l\u tr a .'l t/(i.J( /tsC!.
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lr{aterials
Qtv UOM lbtal
/ Supplicrs / Rental Eguipment
;:t- ? I
"a DAILY REPORT OF FORCE ACCOUNT WORKED
CONTRACTOF Lakeside lndustries DATE 6t10t2021
PAY ESTI
Proioct r9-3003
ItEt{ iFodoral Ald sTPUL.t250l009l
DESCRIPTION OF Clornsd 8nd repelr drrln plpe lh|{'s wls drmrged durlng sidqwslk removal,
hund to be 2 in delp and powad F{lally lnto the erlsilng stdemlt(, Uso
Chaheaw nr tsrove lree roots that hsd raissd the exi6ting sid€wstk
FA'
Contrsctgt
FA'
001
TOTALCOST $1,375.24
WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT
C€moron psrattr croup lll Plant Olor 1.75 s 81.04 $ 109.42 $141.82K!nl:Labor, Greup 5 4.75 $ 61.66 't.0 $ 85.27 i378.1€
Nahan Hill 60e/6 4.00 $ 41.86 s 55.27 $166.6{
$$$0.e
$$s0.00
LABOR
29% OVERHEAD BONDING,INSURANCE $199.12
EOUIPMENT ryPE EOUIPMENT SIZE REG HRS RE€ RATE STDBY HRS STDEY RATE AMOUNT
12443 - 2017 Fotd F4S0 Ftatbod 't.i s 24.43 $036.65
18036 - 2019 Ford F550 Dump Truck 2 I 32.87 $W5.74
TENTAL - Volvo 145 Exc€vatot 1.5 s 't26.46 $$189.69
21% OVERHFAD AND BONDING, INSURANCEAND s61.34
VENDOR & INVOICE #MATERIAL SUB TOTAL AMOUNT
lldondon Hardwarg & 1.16187 k STIHL 6'PMM3 55 Mini Saw Chain MFc# OIPMMO Ss $39.98 u.M w.o2:€rgus$ & 9413175 BirEfi Couple 1 EA and 1O FT $62.1f 98.28 N68.44
SUBTOTAL INCLU
$o.00
$112.46
21% OVERHEAD AND PROFIT INSURANCE AND
TOTAL
& tNVOtCE #
$23.62
$136,08
AMOUNT
$0.00
$0.00
60-0c
TA}$0.00
PRIME Srato{al of Labor, Equlpmont, E Matodsl Wort $1,375,21
SUBCONTRACTOR Subtottl of Lrbor, Equtpmsnt, t$atortrl, & SubcontEctor lnvolc6d
Markups on mrk periotrned Subcontractor: up lo = 10% Gr€aler thtr
$0.0(
0tt
Subcod'actor iilr*{p $0.00
TOTAL COSTilthi$
nooded to lho tasft. Enllthment lo b0 ddomin€d et e leter dete.
Form Date 7/2020
@LaxnsrDE lxuusrRrEs, INC.Extra Work Verification*
Customer
Project Name
5 zt?
[,]-f al lr,nv
Date
$-rt -Zl
Itt ? t l1 7r\tr).N1
Employees on Project Class Total Hrs R"g OT
b ( lttl,tq.pt
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LSI Equipment LSI#Total tLs
Z
I]t2t
l.{
Trucking LSI #Total Hrs
ttl f.,l(r
,l (r t C)11<(
i ( ,+,, tlt /" a,
t
tt v,, lr tt/t,) , 1/
gt t'11 t tttt- .ra(/lPe
,tv
lt
* Markup per WSDOT spccification unlcss otherwise agrced upon in rvriting:
Labor, Mater.ials, and Equipment N{arkup * 29% ,/ Subconkactor I,Iarkup - 21%
Owner'.s
,tl t
Representative Signature Date
.11f, I r
Foreman's4-SignatureV\*Datei!{
P.O, Box 70i6, Issaquah, \VA 98027 , (425) 313-2600 . (425) 313-2622/FAX
AN IQLTAL Ot'l'oR"l'UNITY nilPLOyER . WA.liT CONT lrE(; NO 2?3-0r t.A.KliSI.r27.UD . OR 51 (:ONlt fiE(i NO. CCn 10854?
Job #
/Z?tr't/
EWO #
Dcs*iption of Work
4, rta./,
*
/4. I
/ ( :o\
Matcrials Qtv UOM Total
jl lu I lt*-(4ln
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Subconlractors / Suppliars / Rental Equipment
#FERGU$ON"rltJ d,lRt'.,, tdi iduuloro.* 11.' t Ji .rtuA€-&]ri-Eit;o.,= I j'.X r,L:t;$l,S:it I5iEI i) ri.) irOMLPO. llo_Atst€ Locuil!611510 .tER r'l0-sHtP qfiCIJSTOMCR A.PHACONTNACT NO.I, r tiU00;Lr.rl([5 inL ri{nUbl ti Ll:::iPt sC,{ /Ulril5rlrl$Ut-ri.i, , '){"){it? r'{ f ': ll tCt(. llFt]tldutltiBro No.ORDER DATEOROERED FT.11,1!rllil , : rmtl coDEuiln PAICE0E$cililrotlros8,tssSHIP WI80xlsU/MCNI:SS}IIP DATELEN6I}S!t .iTOTATDELIVERED AY8!HIIIS(r;ti' i./ltltu'rFr,lrpSH]P VIAlNstqucnolrsHoutt H0$rAmeP0. flo.sult rs.sHIPIoilo BEIURT,IS ARotvEt wtlfiourPROPTB AUIHRETUENED$U8IOIAIsuBJ[Cr ]0 HAIDT-$t6 CHARGfS."r0IAt ouE::q.ry]-El!! sloE roR l[lPo8IAt{I rEft}ls AttD cofillTt0}is 0r SArE Alt0 LilrilTAllor,ts0I llrAfiBlr.,il-€usrouER'sSIG}IAIURETENMS:
CUSIilo!
116187
JOBNOT PUROI{A3EOnoEto
soloTo;
LAKESIDE INOUSTRIE$KENT DIV
18808 SE2SrTHST
COVINGTON WA 98042
253-631-361 1
REFEiEIICE:
CHECKED ID
SxlP TO!
000
McLENDON HARDWARE . KENT
23662 1O4TH AVE SE
KENT, WA 98031
PHONE: 12531 850-2722
Ask sbout our price Matching Guarantee
PAGE NO 1
DATE'TllIE!6lnn1 9:0i
TAXABLE
I{ON.TMABLE
SUSTOTAL
39.98
39.98
rru( AfytouNT 4.04
TOTAL 44.O2
lEili6r CLEAXT
BTUETARPSTDTERi.S CM4254B
DuzolJeTllml tERillIAtr 1714
IAXI 867 TAXABLE.KENT
i14.02
INVOICE: Hl7532/7
" PAID IN FULL *
lsHAuN wHtlE)0.00
illttr iltil
TOTWT:0.00
MID:9107
LlNE UM SKU DESCRIPTION PRICE/ PEF E\TFNSION
1
2
4
2 1 61PMM3 55 MINI SAW CHAIN
61PMM3 55
$44,02
REF:717532
2 19.99
'EA
39.98
APP:646133
DAILY REPORT OF FORCE ACCOUNT
Lakeside lndustries 6116t2021
SUBCONIRACTON PAY EST'
Protsct No,l ts3003
ITEM I
Fed€El AId No-il?uL.l260(000)
OESCRIPTFI{ OFWORJ(
PERFORilED:
Tolrl houE tor sxtE mrt porfomd 6/l I , 8171, and €'ia.
8/14 - Rernvr iddltionrl sldrmlk prml mtr ZGtt for DWS, out of typical rcrt
rcquance
8/'!6 - Sawand dsm cu6 to tor loop stubs on the S, rld" of 228th. Z locrfiqN
w'rerc CeO ms to frmaln peJ phn6.
FAI
Contraciq
FN
2
TOTAL COST i1,77O,62
WORKER'S NAIVE WORKER'S OCCUPATION REG HRS REG RAIE OT HRS OT RATE AMOUNT
lvsyne Camarcn )pe.atorGmup lll Plant Ofl6r '1.00 $ 81.04 $ 109.42 $81.0,4
Jemes KunE rbor, Grcup 5 7,50 s 61.66 0.5 $ 8s.27 t505.0!
;El€b Wekei€ld App.enti6 Labw,80%7.00 $ 50.74 $ 68.89 $355.18
!00.00
$6 $0.00
LABOR SUBTOTAI.$s4J.31
29Yo OVERHEAO AND PROFIT, BONDING,INSURANCE AND $272.98
LAEOR
EOUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE STDBY HFS STOBV RATE AMOUNT
12143 - 2017 Fad F450 Flatbsd $ 24-43 $$73.29
18036 - 2019 Ford F550 Dump Teck I 32.87 5 $164.35
52051 .2017 Sulivan AirCompresor $ 14.94 $$'t12.05
s349.69
2I% OVERHEAD AND PROFIT, BONDIN6, INSURANCE AND TNI $73.43
TOTAL
VENDOR & INVOICE #MATERIAL SUB TOTAL IAX AMOUNT
White Cap 42857691 Diamqnd Blade $99.99 $10.10 $1 10.09
$0,00 $0.00
s0.00
IUATERIALS SUBTOTAL INCLUDING TAX s110.09
21% OVERHEAD AND PROFIT BONDING, INSUMNCE AND TAX $23.12
TOTAL tl3t.2t
VENDOR & INVOCE #WORK DESCRIPTION AMOUNT
s0-0{
$0.0!
Suscor.nRAcroElNV suBTdiAi s0.00
TA.}s0.00
PRIME Subtottl ol L.rbor, Equipmnt A Mlt€rlNl Wort($1.7/0.6i
SUBCONTRACTOR Subtottl ot Lrbor,Equlpmnl, Matrrl8l, & Subcontrctorlnvolcod Worl $0.0c
Markups on work p€rform€d by Subcontractor up to $25,00(F12%, $25,000$100,000 = 10% cEaterth6n g1o0,O0O = 7%o%
$0.00
TOTAL COST sl,770.62
o lf oheckctl, this work is in dlspulo, By signing thlr fomt partles are agreoing to lhe dlrlo 8nd efloft
ns€dsd to accompllsh lie taslL Enlitl€mnt to bi ddsrmlnd ai a laGr dde,
Fom Dat6 72020
@LnrnsrDE IxousrRIES, INC.Extra Work Verification*
Customer
(. 11 ,t LrnL
Project Name
5 ;,?.,^ tr1
trrorv,l',n
Employees on Project Class Total Hrs Rcg OT
lrlt, t'n I
| ,1,' rt 3 1f (
fr I I {,t 7
LSI Equipmcnt L$I#Total Hrs
fcqrr
I JI
f(
L,ftt4
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1t ^7,.
Tlucking L$I #Total Hrs Subcontractors / Supplicrs / Rental Equiprnent
'/ t-'t! l,'t^f:rJ rt
lt
* Markup per WSDOT spccification unlcss othenvisc agreed upon in rvriting:
Labor, Materials, and Equipment Markup - 29% / Subcontractor ir{arkup Zl%
Date
/{'' l( 2 |
Datc
I'].O. Box 7016, Issaquah, WA 98027 . (,125) 313-2600 . (4:5) 313-2622/FAX
AN EQIIAL Otl'Ol{TUNlTy li[tPl( ]]'Elt ' \VA- ST (10*-T: ttLc. NO. l! i-tl L,1. liE.Sl '27,lJD . ()lt. 5 t'. C( )NT t{Eti N(.t (-'(;lt lo!ii.t.,l
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Date job #
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Description of Work
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Materirls Qty UOM Total
--:::l *hil,r'-\6 ru!,, 11 7yL,,, rt.rtllft (rc {t l{ .r'{
*iitiU#5lIltfiE0lt r'0
7810 s 1$Tl sl slE t01
$Nl'tlrl 9t0l2l10l
o61l{nu loi{6:oi
CREOII CIRD
vlsh !:Ali
cildf; iffiuMno$g$ilt'oo' vl$AcRrDIr
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?820 SOUTI{ 2t0TH STREST
BUILDINTJ C SUITE IOI
KENT, WA,9803?
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SIGN DATE; l4-JUN-102t lll44rl0
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R€PORT PISCREPANCIES WITIIIN 24 IIR$.
IF YOU DIDN'T RECEIVE THESERVICE YOU EXPECTED CALLSTEVE I{UFFMAN 9I6.8E9-5I56
NO REF'IJNDS OR EXCIIANCES ON NON $TOCK MERCIIANDISE
SEE REVERSE SIDS FOR TERMS AND CONDITIONS
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