HomeMy WebLinkAboutCAG2023-150 - Other - Skycorp LTD - Notice of Completion of Public Works Contract - 12/04/2023 Department Use Only
Y NOTICE OF COMPLETION OF
s. PUBLIC WORKS CONTRACT Assigned to: Date Assigned:
Date 12/04/2023 Form Version Original Revision Reason
Awarding Agency Information Prime Contractor Information
Name KENT, CITY OF/PARKS & UBI 173000002 Name SKYCORP LTD UBI 603077334
REC
Address 220 -4TH AVE S KENT,WA-98032 Address 526 NW AVE SUITE 11 ARLINGTON,WA-98223
Email Address kjennings@kentwa.gov Email Address skycorpltd@yahoo.com
Contact Name KateLynn Phone 253-856-5075 Contact Name SKYCORP Phone 360-926-8989
Jennings x LTD
Project Information
Project Name Upper Mill Bay Contract# 173570 Affidavit ID 1214580
Jobsite Address
Date Awarded Date Work Commenced Date Work Completed Date Work Accepted
02/22/2023 05/01/2023 05/15/2023 12/04/2023
Federally Funded Transportation Project If yes, attach Contract Bond Statement. ❑
Bond Waived? Retainage Waived?❑ Subcontractors Used? If yes, complete Addendum A.
Detailed Description of Work Completed Demolition residential House
DOR Tax Information
*Right-click on the total field and select Update Field to auto-calculate.
Contract Amount $45,750.00 Liquidated Damages $ 0.00
Additions (+) $8,200.00 Amount Disbursed $42,092.62
Reductions (-) $9,688.57 Amount Retained $6,639.21
Sub-Total* $44,261.43 Other $ 0.00
Sales Tax Amount $4,470.40 Sales Tax Rate If multiple rates,attach a list. 10.10%
TOTAL* $48,731.83 TOTAL* 1 $48,731.83
These two totals must be equal.
Apprentice Utilization Information
Was Apprentice Utilization Required? If yes, complete this entire section. ❑ Engineer's Estimate $ 0.00
Utilization % 0.00% Was a Good Faith Effort approved?
Comments
The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract.
NO PAYMENT SHALL BE MADE FROM THE RETAINED FUNDS until receipt of all release certificates and affidavits.
Submitting Form: Submit the completed form by email to all three agencies below.
Department of Revenue washington State oeparronentof Employment Security Department
Public Works Section "Labor& Industries Registration,Inquiry,Standards&
(360)704-5650 Contract Release Coordination Unit
PWC@dor.wa.gov (855)545-8163,option#4 (360)890 3499
ContractRelease@LNI.WA.GOV publicworks@esd.wa.gov
Addendum A: Please List all Subcontractors and Sub-tiers Below
This addendum can be submitted in other formats.
Provide known affidavits at this time. No L&I release will be granted until all affidavits are listed.
Subcontractor's Name: UBI Number: Required Affidavit ID*
GRECO LLC 603521639 1245404
HYDROSEEDER, THE 602321388 1263217