Loading...
HomeMy WebLinkAboutCAG2023-006 - Change Order - #6 - Active Construction Inc. - S. 240th Street and Russell Road TIB Sidewalk Improvements - 11/06/2023 Agreement Routing Form • For Approvals,Signatures and Records Management KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. W A 5 H I N G T O N (Print on pink or cherry colored paper) Originator: Department: S. Anderson PW Engineering Date Sent: Date Required: > 11/7/23 0 a- Authorized to Sign: Date of Council Approval: C 0 Director or Designee ❑Mayor 12/13/2022 cc Budget Account Number: Grant? 0 Yes ❑No R20122.64110.120 Budget? 0 Yes ❑ No Type: N/A Vendor Name: Category: Active Construction, Inc. Contract Vendor Number: Sub-Category: C 2319336 Change Order#6 Project Name: S. 240th Street and Russell Road TIB Sidewalk Improvements E `2 Project Details:Provide and install temporary HMA on Russell Rd over the new storm pipe. C 4W C 40 Agreement Amount: $9,935.02 Basis for Selection of Contractor: E Bid a� Start Date: N/A Termination Date: 130 Working Days Cn Q Local Business? ❑Yes ❑ No* *If meets requirements per KCC 3.70.700,please complete"Vendor Purchase-Local Exceptions"form on Cityspoce. Notice required prior to disclosure? Contract Number: ❑Yes 0 No CAG2023-006 Date Received by City Attorney: Comments: C 0 3 � a, a, Cps Date Routed to the Mayor's Office: V1 Date Routed to the City Clerk's Office: I T`7/9_3 ae«W22313 , zo Visit Documents.KentWA.gov to obtain copies of all agreements • KEN W A S FI IN G T ON CHANGE ORDER NO. # 6 NAME OF CONTRACTOR: Active Construction, Inc. ("Contractor") CONTRACT NAME & PROJECT NUMBERS. 240th Street and Russell Road TIB Sidewalk Improvements ORIGINAL CONTRACT DATE: December 28, 2022 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: 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: Provide and install temporary HMA on Russell Rd over the new storm pipe. This work was tracked as force account on sheet #9. 2. 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, $1,943,943.00 (including applicable alternates and WSST) Net Change by Previous Change Orders $31,764.30 (incl. applicable WSST) Current Contract Amount $1,975,707.30 (incl. Previous Change Orders) Current Change Order $9,935.02 Applicable WSST Tax on this Change $0.00 Order Revised Contract Sum $1,985,642.32 CHANGE ORDER - 1 OF 3 Original Time for Completion 130 working days (insert date) Revised Time for Completion under 0 working days prior Change Orders (insert date) Days Required (f) for this Change Order 0 working days Revised Time for Completion 130 working days (insert date) In accordance with Sections 1-04.4 and 1-04.5 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 parties 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. CONTRACTOR: CITY OF KENT: Olgitelly signed by Ryan Burks pN'Q=US, Ryan B 1 1 r $-ryQnb(�activeconstruction.com, {� p y p Digitally signed by Chad Bieren Y 1' u1 CN3Ryan Burks Chad 1 ad BIG 1 G n Date:2023.11.06 14:04:58-08'00' BDate'2023.11.06 11:27:37-08'00' By Y• (signature) (signature) Print Name: Print Name: Chad Bieren, P.E. Its Its Public Works Director (title) (title) DATE: DATE: CF for AF EC KP CHANGE ORDER - 2 OF 3 ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent City trerk Kent Law Department C[[n this field,you may enter the electronic filepath where the contract has been saved] CHANGE ORDER - 3 OF 3 File No. 200.2 -, KENT CHANGE ORDER WORKSHEET NO. 6 Construction Engineering Division - Public Works Project: So 240th and Russell Rd TIB Sidewalk Project No: 22-3004 Improvements Project Engineer: Drew Holcomb TIB-Aid No: #P-P-106(P06)-1 Capital Projects Jason Bryant Contractor: ACI Manager: - Date: 9/28/2023 I. Proposed Change Provide and install temporary HMA on Russell Rd over the new storm pipe. This work was tracked as force account on sheet #9. II. Reason and Background for Change At the beginning of the project the City reuqested a price for temporary hot mix patch paving for the storm trench on Russel RD. ACI quoted a price of $315.00 per ton. The City opted to track the work as force account. A total of 91.75 tons was used during the project. Tracking the work as force account resulted in net savings of $28,901.25. The temp paving was tracked as force account on sheet #9. III. Method of Payment NEW PAY ITEMS ❑ Not applicable Schh. Item Description Total Est. Unit Unit Price Total Estimated Cost of No Qty Item 1 1 FA $9,935.02 $ 9,935.02 New Pay Items Total: $ 9,935.02 DELETE EXISTING PAY ITEMS) per 1-09.5 ❑ Notapplicable .No Bid Item No. Item Description Qty Unit Unit Price Cost of Item No. Page 1 Delete Existing Pay Items Total: $ - INCREASE/DECREASE TO EXISTING PAY ITEMS) ❑ Notapplicable Sch Bid Item No. Item Description Qty Unit Unit Price Cost of Item No. 7 $ Increase / Decrease to Existing Pay Items Total: $ - *TOTAL ESTIMATED COST OF CHANGE ORDER: $9,935.02 * Total of the Cost of Item Columns IV. WORKING DAYS Original Contract: 130 Due This Change Order: 0 Previous Total: 130 Explanation/Justification for Additional Working Days: *TOTAL WORKING DAYS: 130 * This Change Order + Previous Total Capital Projects Manager: — Date: Jason B ant Construction Engineering 2� Supervisor: w yt•✓ Date: Jason Barry Construction Manager: a/ Date: J A7 ric Conn Page 2 Bryant, Jason From: Ryan Burks <ryanb@activeconstruction.com> Sent: Monday, February 27, 2023 3:20 PM To: McConnell, Phil Cc: Eugene Carollo; Miranda Morse Subject: 22-044 - 240th and Russell Road - Temp Paving EXTERNAL EMAIL Phil, I was asked to provide a price per TON to temp pave back various locations on the project. Based on our conversation 10-15 tons is the total expected quantity at this time. Price and breakdown below HMA ($315 per TON) • 4 man crew • 1 teamster driver plus solo truck • Materials • Backhoe/roller/excavator Cold Mix($360 per ton) • 4 man crew • 1 teamster driver plus solo truck • Materials • Backhoe/roller/excavator Please let us know your thoughts. Thank you, C1f ICY N I;URKS I Project Manager/I stu-nator M: 253 797-9661 "GET ACTIVE" P.O. Box 430, Puyallup WA 98371 1 %v�rva,<€ctiyecozi tt°t€ction.cc>sp_ y<intirir actin%Lcc>zzstructi--- c�i_ A(1 is an Equal Opportunity Employer FOLLOW US: _ _. This c Inail nu s ag 'and any- ittachmctits accompanying it)may contain c.onftdenti<il information.The information is untended only for the use of the.intended recipicnt(s). tklivcry of this messagc to anyonc other than the intended recipicnt(e is not inmidu.l to waive,In), privik-ge or otherwise detract from the.c.onfidentiahty of the message. If you arc not the intended recipient,or it this mes tt e has been addre ssed to you it) error,do not read,diz dosc,reproduce,distribute,disseminate or otherwise use this tr-ausmission.rathct,please promptly tlotifyy the sender by reply e-mail, and then destroy all Copies of the tics age and its attachnicnt.�,if any. 1 FA Sheet No.: 9 DAILY REPORT OF FORCE ACCOUNT WORKED �- T Project Name: TIB Sidewalk Improvements Project No. 22-3003,22-3004 Item No.: 8018 Date 5/23/2023 Description of Work: Temp patch..storm trench on Russell Rd with HMA Work by Subcontractor? NO Prime Contractor. ACI Sub-Contractor STRAIGHT TIME OVERTIME DOLLAR NAME CODE OCCUPATION Hrs I Hourly Rate Hrs OT Rate AMOUNT Jahn A Foreman 7 95 31 $ 667 17 Keith Operator 0.5 90.4 $ 45.20 Jim S Laborer 3.5 6958 $ 24353 Cody P Operator 7 912 $ 638,40 Lavorato Truck Driver 13 91 2 $ 1,185.60 Wyatt Laborer 3 5 68 37 $ 341,85 SUBTOTAL-LABOR. $ 3,121,75 LABOR OVERHEAD&PROFIT @ 310% $ 96774 LABOR TOTAL $ 4,089.49 EQUIPMENT EQUIPMENT OR ATTACHMENTS OPERATED STANDBY DOLLAR Equipment# Equipment Description Hrs Hourly Rate Hrs Standby Rate AMOUNT 141 Dump Truck 3.5 9681 $ 338,84 441 Chevy 3500 7 31.97 $ 223,79 437 Roller 1 70,11 $ 70.11 152 Trailer 95 11,25 $ 106,88 492 Dump Truck 9.5 78.08 $ 741.76 506 85G Deere 5.5 10275 $ 565.13 SUBTOTAL-EQUIPMENT $ 2,046.51 EQUIPMENT OVERHEAD&PROFIT @ 21% $ 429,77 EQUIPMENT TOTAL $ 2,476.28 MATERIALS/SERVICES/RENTALS MATERIALS f SERVICES Quantity Units Unit Price DOLLAR AMOUNT Icon#45086041 14 tons $ 9175 $ 1,284.50 Kent Kangley 5 ea $ 30000 $ 1,50000 $ $ SUBTOTAL $ 2,78450 OVERHEAD&PROFIT @ 21% $ 584.75 TOTAL $ 3,369.25 Verification of Hours Worked: TOTAL. $ 9,935.02 12%MARKUP (for prime when n subcontract work) $ - 23 4co.. actors Representative Date SHEET TOTAL: $ 9,935.02 Owners Represent Date P E ate Entered: Date: By: ACTIVE ACICONSTRUCTION ADDITIONAL WORK SUMMARY INC. A.C.I. (CP-22-3003&22-3004)S 240th &Russell RD TIB Sidewalk Improvements PHASE CODE PROJECT JOB#22-044 WEEK WORK PERFORMED: 05.04.2023,05.23.2023-0.07 202 25. 3 8018 - DESCRIPTION OF WORK (514/23)DUGOUT STORM TRENCH ON RUSSELL RD FOR 1-2"HMA W/EXCAVATOR,PAVED HMA WITH EXCAVATOR&COMPACTED W/DOUBLE DRUM ROLLER.(5/23123)REMOVED 4'X50'OF ASPHALT THAT WAS PAVED OVER STORM TRENCH WI EXCAVATOR&LOADED INTO TRUCK. (5/24/23)REMOVED 4'X60.5'OF ASPHALT PAVED OVER STORM TRENCH ON RUSSELL RD.(5/25/23)REMOVED 56'X4',22'X1.75'OF ASPHALT PAVED OVER STORM TRENCH WITH EXCAVATOR&LOADED INTO TRUCK.ASPHALT TAKEN TO KENT KANGLEY 6/9123 WITH ACI TRUCK/TRAILER DRIVER ON OPERATOR I MANPOWER HOURS @ RATE TOTAL WORKING FOREMAN @ 1.0 7.00 @ $95.31 $667.17 OPERATOR I @ 1.0 20.00 @ $91.20 $1,824.00 OPERATOR II @ 1.0 0.50 @ $90.40 $45.20 LABORER III @ 1.0 5.00 @ $68.37 $341.85 LABORER IV @ 1.0 3.50 @ $69.58 $243.53 SUBTOTAL LABOR $3,121.75 31%MARK-UP $967.74 TOTAL LABOR $4,089.49 EQUIPMENT DESCRIPTION HOURS @ RATE TOTAL FOREMAN TRUCK-441 7.00 @ $31.97 $223.79 ROLLER-437 1.00 @ $70.11 $70.11 85G JOHN DEERE EXC-506 5.50 @ $102.75 $565.13 DUMP TRUCK-141 3.50 @ $96.81 $338.84 DUMP TRUCK-492 9.50 @ $78.08 $741.76 DUMP TRAILER-162 9.50 1 @ $11.25 $106.88 SUB-TOTAL EQUIPMENT $2,046.50 21%MARK-UP $429.76 TOTAL EQUIPMENT $2,476.26 MATERIALS UNIT @ RATE TOTAL ICON MATERIALS-TK#45086041 14.00 TN $91.75 $1,284.50 KENT KANGLEY-ASPHALT DUMP FEE 5.00 LDS $300.00 $1,500.00 SUB-TOTAL MATERIAL $2,784.60 21%MARK-UP $584.75 TOTAL MATERIAL $3,369.25 GRAND TOTAL $9,935.00 Note: �+ 1 Cn O TZ c� c cn C7 1 Cn ¢ U +® W co W U UJ _ = 0 z0U [r U U U 0U ¢ W Ir W J ❑ DOJO W U LLI = F¢- Q 00 Z � g O cn 0 U U U U U C�� U U U � Fw_ p Y Z Z Z Z Z Z Z Z 21 Z � 2 W Z W CL Q O w J J m � � CD z 0 < r W w � ' ¢ a a- rn Z O O W w ZLJJ � < �-- � o 0 wU) C) Q - ► rA - W > U �� j m � � ¢ m LL U '0>Z © z " t UOU F- O a a N r s 0 Z L LOIJ O Q u� �. C� � Na J cr LLJ Z in W O m 2 Q ui Q 0 D C3 Ll CL z W W W w O <c oC CC 2 ❑ Cl) Ir Y U) U Q 2 U U W W Q � � U z F- N OL U = O O0 cr Qw Y uj W J p F- U no O Q Cco cr m a v 0 U U U U U U U U U U � W- p H H H H H F- H H O = Wz LL 0 w o a o � F- w m � c� z F- = *'- w ti � w c� ; ¢ CL M w W o z o �- m m < o zLu z ww0aO UaF- u C �D O � aw FQ- F- a oe z � L • UOU O0 ¢U z U tr7 RE ~ a: 0 Z � N �' V 1 Z L l J M w U N Q a: z X w J t Z m 2 ¢ W Q p D 0 a z W w w p ¢ V oc 0 N N N ai f0 C U 0 0 L � Ui = O CD O O O O O O O O O O V) _ 0 0 0 0 0 0 0 0 0 y 0 0 0 0 0 0 0 O O 0 L L L L .� 0 0 0 0 0 0 0 0 0 O o 0 0 0 0 0 0 - 00 ',Z'„ 0000000 00 F„ x h�l V 0 0 0 0 0 0 0 0 � LO LO LO O LO LO 0 ri CO CO 04 M M Cl) Cl) a) ni N w iri � ` F°- o LO Cl) ` a a rn w F- ww '06 O as o > O pp JW �. W JW c co co coa ° �- U g o g Cj a vi C� Y 0 a U , O D Q t CD ow t': Oo s > Ca ofQW to' Ofo w LO W L _ wMW _' Q � 2 = oZo O ~ � ~ U o uS w ? 0 00 -j M a m Z O W Q o w a0a 0 0 0 Q Q r m p 0 � 2 t� w w Q = c ZW0 � � � I~— O J a p 2 O O LO Q :D — G E � UUmco wcn E x oa -8 a�'i o 'a a) C 'a m cn cn 00 G1 N m U o x N E U o E 0 in CD O G� N p O H N f' O U M ~ o p w -� "' � w LO V E U a O � J � �' � (p0 9' 0 � 0 O O m O J w co 0 U ., U o 0 N N y (6 'O U 0 ti s i O 0 LO = O O O O O N O O O O O N N O O O O O O O O O CD O O O L O O O O O O O O O O O O O L L L L L O O O O O O O Cl O O O O O 7 O O Cl O O O O O CD O O CDC 0 0 0 0 0 0 0 0 0 0 0 0 0 xi Fil U Q C O O O O O O O O O O O O O ? Cl00_ LO LOLOLOLO 0 Cl) O O O O O ~ N N rA � � Cl) 0 0 0 0 0 O o a O W O of W O J W W O J W W H 0 Of 0 W Q W O � e m W m W m W O �° F g oho g 0 w o a � z z z a O � W Ow $ OUW w QOf b N ofN w W � W W --� W = -� w p W 0 W o a 0 O o W o a 0 W C J � m J O J Z J O J Ln Z QM W .J OJc') m2 J DQM02 _ x 2 2 a z 0 a Z >- O c 2 W 0 0 u Z W 0I— � 220 O w 0UOU � Y E � UUccoo E � UOUc`oo D d � U N E" 00 0 -E LD 0 L •W w LD L U c N O LL V V m 00 m uF- CO) EO N EO N N ~ 0 00 H o O o O 2 U p N' � O w LLI U U V ti � � F 0 c 0 -j = 0 Lli cc Qua > m 4; a_ Q � d LLI � dQva- L o V p G 0 N N � yi (6 O � U ' 0 0 j z i O O C O O .�. N N O O O O O M N y' 00000 O ` L L L L .� 00000 C O O O O O 00000 O s. V C O O O O O � o0000 tA j/j jq N fA C O r iO 0� M O .5 a O J wW OF- w Cr o ofOf J w c m w m o F a vi F-- U) WF- > WW LLI Q x W C O O J Lo a z OO J O Q CV) Q O = O 2 CC Q z � � � 0 2 0 ,�j Q � UUao c � x L m F. 00 p 'a •N 3 N o rl U- M C C N V C C O p x 00 c0 p U 7 N F" C4 E O u L N O C� ~ F- a o � ^C ti = O o z O O a a� - J 'tW00 } 0 � z U r aQvdLO d o V ~ Q ti � Customer No: 60020 Invoice No: 3584688 Inv Date: 05/04/23 Page: Page 1 of 1 1508 Valentine Ave SE Customer Job: 22-044 Pacific,WA 98047 Active Construction ICON Materials PO Box 430 1508 Valentine Ave SE Puyallup WA 98371 Pacific,WA 98047 206-575-3200 ap@activeconstruction.com RECEIVED MAY 0 9 2023 22-044 I PC 8018 Delivered To: 240TH RUSSEL RD,KENT AGI Date C6ode - Material Descrip CITY UM Unit Price Matt Total Tax Total Plant:04500 Auburn Asphalt 05/04/23 12144230-1/2"PG 581-1-22(64.22) 14.00 TON 91.75 1,284.50 0.00 1.284.50 05/04/23 467750-Fuel Surcharge-Ton 14.00 TON 0.35 4.90 0.00 4.90 Total Invoice: 28.00 1,289.40 0.00 1,289.40 Ticket number(s)shipped from plant 04500-Auburn Asphalt `45086041 We Appreciate You and Your Business! New Portal Website as of Sept.2021-https://mycentralpremix.myamatportaLcom/Questions?Accounts Receivable Department Contact 509-536-3042. Finance Charges will be applied to any late invoices at a rate of 1.5%per month per credit agreement or the State's Lawful Amount Invoice Amount: 1,289.40 Amount Paid: Customer Name: Active Construction Customer No: 60020 If you have any questions about your invoice please call 206-575-3200 Invoice#: 3584688 Date: 0514123 Remit Payment To: ICON Materials Customer Job: 22-044 PO Box 742421 Los Angeles,CA 90074 Due Date: 06/03/23 Please provide your email address below it you would like to start receiving your Invoices via email P&m4tN ;"ter �,�I � � INVOICE ACCOUNTING:9125 10th AVENUE SOUTH,SEATTLE,WA 98108 (206)768-1000 PAYMENT TO: A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. Kangley Rock and Recycling 9125 10th AVENUE SOUTH SEATTLE,WA 0: ACCOUNT ID DELIVERY ADDRESS 019371 240TH / RUSSELL RD SOLD TO: ACTIVE CONSTRUCTION INC "' FGF1VF'(- PO BOX 430 INVOICE# DATE PLANT PUYALLUP, WA 98371-0162 JUN 15 2023 85421 06 09 23 022 JOB/P.O.# ORDER NUMBER PAGE: 1 022044 770481 ITEM DESCRIPTION QUANTITY UNIT PRICE TAX TOTAL PO NUMBER: 22-044 91012S DUMP FEE ASPHLT RUBBLE SOLO 5 . 00 LD 300 . 000 N 1500 . 00 TICKETS : 022-501301 022-501357 022-501444 022-501507 022-501546 SUBTOTAL 1500 . 00 SALES TAX j Total Yds Concrete $ Supplies $ Misc $ Labor $ 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 INVOICE TOTAL 1, 500 . 00 KANGLEY ""` Kangl YPIRock&#Recycling Locations (Plant 21) ROCK A RECYCLING 32500 SE Kent-Kangley Rd.,Ravensdale,WA98051 ACCOUNTING:9125 TENTH AVENUE SOUTH BLACK RIVER (P,lant#22)-(206)658-0912 DELIVERY TICKET 510IXonster Rd.Renton,WA98055 SEATTLE,WA 98108 • (206)768-1000 LAKE FRANCIS (Plant#23)-(206)658-0872 ACCOUNTING (206)768-1000 22501 SE Lake Francis Rd.Maple Valley,WA 98038 FAX (206)763-2730 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY,INC. Cedar Mountain Reclamation SALES& 17877 Cedar Grove Rd.SE,Maple Valley,WA 98038 ORDER DESK 206 768-1000 Plant#20-(206)658-0913 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE GUSTOMER NO. ORDER NO. PROJECT PLANT# CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB AL1 Ftjlj f USSS—L.-s sL) COLLECT ON DELIVERY(C.O.D.) ❑CASH ❑CHECK# L7 CHARGE CARD# EXP. / SPECIAL INSTRUCTIONS ❑VISA ❑MASTERCARD ❑DISCOVER • �•�� • • AMOUNT 6 Net DRIVER TRUCK NO. ORDERED BY • • 1 DISPATCHER TAX CODE TIME DUE ; /- J RELEASE—CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS KANGLEY ROCK&RECYCLING,A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL OR PERSONAL PROPERTY • ' '/ CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE.DETAILS ON REVERSE. r t CUSTOMER SIGNATURE r PRINT NAME DATE • REV 10-2022 INVOICE COPY KANGLEY Kangley Rock&Recycling Locations PIT21 ROCK & RECYCLING 32500KANGLEY SE Kent `Plant#Ad. R BLACK RIVER (Plant#22)--(a206)658-0912 98051 DELIVERY TICKET ACCOUNTING:9125 TENTH AVENUE SOUTH 510 Monster Rd.Renton,WA98055 SEATTLE,WA 98108 • (206)768-1000 LAKE FRANCIS (Plant#23)-(206)658-0872 ACCOUNTING (206)766-1000 22501 SE Lake Francis Rd.Maple Valley,WA98038 FAX (206)763-2730 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY,INC. Cedar Mountain Reclamation SALES& 17877 Cedar Grove Rd.SE,Maple Valley,WA 98038 ORDER DESK 206)768-1000 Plant#20-(206)658-0913 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO. ORDER NO. PROJECT PLANT# 22 CUSTOMER NAME CUSTOMER P.O. JOB NO, DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY(C.O.D.) ❑CASH ❑CHECK#------ ❑CHARGE / SPECIAL INSTRUCTIONS CARD 11 EXP. ❑VISA ❑MASTERCARD [I DISCOVER ••� ' • • • QUANTITY • •D I I I I DRIVER TRUCK NO. ORDERED BY DISPATCHER TAX CODE TIME DUE • IELEASE—CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS KANGLEY ROCK&RECYCLING,A DIVISION JF GARY MERLINO CONSTRUCTION CO MY, INC, FOR ANY DAMAGE TO HIS REAL OR PERSONAL PROPERTY •• -•,AUSED BY DELIVERY OF MATERIALS,d ABOVE,DETAILS ON REVERSE. r� :USTOMER SIGNATURE 'RINT NAME DATE • .V 10-2022 INVOICE COPY KANGLEY ?011� Kangley Rock&Recycling Locations 21) ROCK & RECYCLING 32500KANGLEYKent PIT(Plant#Rd. 32500 SE Kent-Kangley Rd.,Ravensdale,WA 98051 ACCOUNTING:9125 TENTH AVENUE SOUTH BLACK RIVER (Plant#22)-(206)658-0912 DELIVERY TICKET 510 Monster Rd.Renton,WA 98055 SEATTLE,WA 98108 • (206)768-1000 LAKE FRANCIS (Plant#23)-(206)658-0872 ACCOUNTING (206)768-1000 22501 SE Lake Francis Rd.Maple Valley,WA 98038 FAX (206)768-2730 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY,INC. Cedar Mountain Reclamation SALES& 17877 Cedar Grove Rd.SE,Maple Valley,WA 98038 Plant#20-(206)658-0913 - ORDER DESK 206 768-1 00 0 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO, ORDER NO. PROJECT PLANT# CUSTOMER NAME CUSTOMER P.O. JOB NO. I DELIVERY TICKET NO. JOB ADDRESS, HUSSE 1.i__IRIS► COLLECT ON DELIVERY(C.O.D.) CASH ❑CHECK# O CHARGE -- — SPECIAL INSTRUCTIONS CARD# EXP. ❑VISA ❑MASTERCARD ❑ DISCOVER PRODUCT TOTAL QUANTITY UW. DESCRIPTION TONS UNIT PRICE AMOUNT CODE TONS i DRIVER TRUCK NO. ORDERED BY • • 1 DISPATCHER TAX CODE TIME DUE : 1 RELEASE—CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS KANGLEY ROCK&RECYCLING,A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY INC. FOR ANY DAMAGE TO HIS REAL OR PERSONAL PROPERTY • ' - CAUSED BY DELIVERY OF MATERIALS LISTED,A9OVE.DETAILS ON REVERSE. CUSTOMER SIGNATURE • PRINT NAME DATE REV 10-2022 INVOICE COPY KANGLEY K angl y Ro k&Recycling Locations e0NROCK & RECYCLING BLACK RIVER{Plant#22)'-R(206)6 e09 2985t DELIVERY TICKET ACCOUNTING:9125 TENTH AVENUE SOUTH 510 Monster Rd.Renton.WA98055 SEATTLE,WA 98108 • (206)768-1000 LAKE FRANCIS (Plant#23)-(206)658-0872 ACCOUNTING (206)768-1000 22501 SE Lake Francis Rd.Maple Valley,WA 98038 FAX (206)763-2730 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY,INC. Cedar Mountain Reclamation SALES& 17877 Cedar Grove Rd,SE,Maple Valley,WA98038 ORDER DESK 206 768-1©d0 Plant#20-(206)658-0913 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO. ORDER NO. PROJECT PLANT# €r' 7 l CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADD .L f L 1 COLLECT ON DELIVERY(C.O.D.) ❑CASH ❑CHECK# ❑CHARGE N ' i SPECIAL INSTRUCTIONS CARD# EXP. ❑VISA ❑MASTERCARD 0 DISCOVER PRODUCT CODE • • •• AMOUNT •. DRIVER TRUCK NO. ORDERED BY • DISPATCHER TAX CODE TIME DUE . RELEASE—CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS KANGLEY ROCK&RECYCLING.A DIVISION OF GARY MERLINO CONSTRUCTION PCVPANY. INC. FOR ANY DAMAGE TO HIS REAL OR PERSONAL PROPERTY = ` • CAUSED BY DELIVERY OF MATERI", 6tSTED ABOVE.DETAILS ON REVERSE. CUSTOMER SIGNATURE PRINT NAME DATE • REV 10-2022 INVOICE COPY KANGLEY KANGLEY Y PIT Ro Pk&#Recycling Locations ROCK & RECYCLING BLACK4RIVFR(Piaai#22)-((P06>6 8 09 2 98051 DELIVERY TICKET ACCOUNTING:9125 TENTH AVENUE SOUTH 510 Monster Rd.Renton,WA96055 SEATTLE,WA 98108 • (206)768-1000 LAKE FRANCIS (Plant#23)-(206)658-0872 ACCOUNTING (206)768-1000 22501 SE Lake Francis Rd.Maple Valley,WA 98038 FAX (206)763-2730 A DIVISION OF GARY MERUNO CONSTRUCTION COMPANY,INC. Cedar Mountain Reclamation SALES& 17877 Cedar Grove Rd.SE,Maple Valley,WA 98038 ORDER QESK (206 768-1000 Plant#20-(206)658.0913 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT —' DATE T STOMER NO. ORDER NO._ PROJECT PLANT# CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. I JOB ADDRESS, COLLECT ON DELIVERY(C.O.D.) KW ❑CASH ❑CHECK# ❑CHARGE CARD# EXP. SPECIAL INSTRUCTIONS ❑VISA ❑MASTERCARD 0 DISCOVER PRODUCTTOTAL AMOUNT QUANTITY •D DESCRIPTION •NS ONS UNIT PRICE DRIVER TRUCK NO. ORDERED BY DISPATCHER TAX CODE TIME DUE RELEASE—CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS KANGLEY ROCK&RECYCLING,A DIVISION OF GARY MERLINO CONSTRUCTION COMPANYj`INC. FOR ANY DAMAGE TO HIS REAL OR PERSONAL PROPERTY • �' CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE.DETAILS ON REVERSE. CUSTOMER SIGNATURE • " • PRINT NAME DATE REV 10-2022 INVOICE COPY