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Home My WebLink AboutCAG2023-501 - Change Order - #2 - ICON Materials - 84th Ave S EVH Preservation - S 212th St to S 196th St - 7/24/24 Agreement Routing Form • For Approvals,Signatures and Records Management T This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. K E N WASH 1 N O T O N (Print on pink or cherry colored paper) Originator: Department: C. Frame PW Engineering Date Sent: Date Required: 7/24/2024 N/A O L aAuthorized to Sign: Date of Council Approval: Q 0 Director or Designee ❑Mayor 9/5/2023 Budget Account Number: Grant? El Yes ❑No R90126.64110.120 Budget? El Yes ❑ No Type: Federal Vendor Name: Category: ICON Materials Contract Vendor Number: Sub-Category: C 34467 Change Order#2 0a Project Name: 84th Ave S EVH Preservation - S 212th St to S 196th St E LL y� New bid item to provide compensation for the removal of concrete below 8"milling area for Portland C Project Details:Cement Concrete Paving in the left turn and left through lanes northbound and southbound 84thth Ave S (EVH). C Go Go Agreement Amount:$19,396.44 Basis for Selection of Contractor: Bid d � Start Date: N/A Termination Date: 90 Working Days IDS Q Local Business? ❑Yes ❑No* *If meets requirements per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace. Notice required prior to disclosure? Contract Number: ❑Yes 121 No CAG2023-501 Date Received by City Attorney: Comments: 01 C ;+ 3 11Z N M Im Date Routed to the Mayor's Office: Date Routed to the City Clerk's Office: adaW2237_L2o Visit Documents.KentWA.gov to obtain copies of all agreements • KENT WASHINGTON CHANGE ORDER NO. 2 NAME OF CONTRACTOR: ICON Materials ('Contractor") CONTRACT NAME & PROJECT NUMBER: 84th Ave S (EVH) Preservation - S 212th St-S 1961h St ORIGINAL CONTRACT DATE: September 27, 2023 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: This change order creates a new bid item to provide compensation for the removal of concrete below 8" milling area for Portland Cement Concrete Paving in the left turn and left through lanes northbound and southbound 84th Ave S (EVH). 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, $2,260,556.00 (including applicable alternates and WSST) Net Change by Previous Change Orders $22,365.96 (inch applicable WSST) Current Contract Amount $2,282,921.96 (incl. Previous Change Orders) Current Change Order $19,396.44 Applicable WSST Tax on this Change $0.00 Order Revised Contract Sum $2,302,318.40 CHANGE ORDER - 1 OF 3 Original Time for Completion 90 working days (insert date) Revised Time for Completion under 00 working days prior Change Orders (insert date) Days Required (f) under Minor Change 00 working days Orders Days Required (f) for this Change Order 00 working days Revised Time for Completion 90 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: Digitally signed by Chad Biere n , � � �� Chad Bieren Date:2024.07.23 By: �y�Q/L �d� By: 13:49:11-07'00' (signature) (signature) Print Name:Tyler Townsend Print Name: Chad Bieren, P.E. Its Project Manager Its Public Works Director (title) (title) DATE: July 23,2024 DATE: A:F EC KP CHANGE ORDER - 2 OF 3 ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) Lk Kent ity Clerk Kent Law Department C[In this field,you may enter the electronic filepath where the contract has been saved] I CHANGE ORDER - 3 OF 3 File No. 200.2 �- KENT W, H .cr Oe CHANGE ORDER WORKSHEET NO. 02 Construction Engineering Division - Public Works Project: 84th Ave reservation 212th St to S project No: 20-3015 196th St Project Engineer: Drew Holcomb Fed-Aid No: STBGUL-1073(006) Capital Projects Sean Flint, KBA, Inc. Contractor: ICON Materials a CRH Manager: Company Date: 7/16/2024 I. Proposed Change This change order creates a new bid item to provide compensation for the removal of concrete below 8" milling area for Portland Cement Concrete Paving in the left turn and left through lanes of Northbound and Southbound 84th Ave S (EVH) II. Reason and Background for Change During milling operations as shown on plan sheet 12, unanticipated concrete was discovered —6" below existing pavement surface. Project specifications require 8" depth of Portland Cement Concrete in these areas, existing concrete had to be removed and hauled from site for disposal. III. Method of Payment NEW PAY ITEMS ❑ Not applicable SNo' Item Description Total t Est. Unit Unit Price Total Estimated Cost of Item I Concrete Removal 1 LS $19,396.44 $ 19,396.44 New Pay Items Total: $ 19,396.44 DELETE EXISTING PAY ITEM(S) per 1-09.5 ❑� Notapplicable Page 1 5ch Bid Item No Item Description Qty Unit Unit Price Cost of Item No. I $ Delete Existing Pay Items Total: $ INCREASE/DECREASE TO EXISTING PAY ITEM(S) :1] Notappiicabie Sch No. Bid Item No. Item Description Qty Unit Unit Price Cost of Item $ $ Increase / Decrease to Existing Pay Items Total: $ *TOTAL ESTIMATED COST OF CHANGE ORDER: [` $19,396.44Y� * Total of the Cost of Item Columns IV. WORKING DAYS Original Contract: 90 Due This Change Order: 0 Previous Total: 0 Explanation/lustification for Additional Working Days: This work is being performed off the critical path, and no additional working days are being added. *TOTAL WORKING DAYS: 90 * This Change Order + Previous Total Digitally signed by Sean Flint �/��,2024 Sean Flint DN:C=US,.",CN Sean Flint Capital Projects Manager: D,,,:2,Inc.", Flint Date: Date:2024.07.22 14:31:09.07'00' Sean Flint (KBA, Inc) Construction Engineering 9 9 Supervisor: Date: 7/22/24 for Jason Barry Construction Manager: Date: 7/22/24 Eric Connor Page 2 DAILY REPORT OF FORCE ACCOUNT WORKED _ e CONTRACTOR ICON Materials DATE 5/13/2024 SUBCONTRACTOR PAY EST# Project No.:20-3015 84th Ave S(EVH)Preservation 212th to 196th BID ITEM# Federal Aid No.:STBGUL-1073(006) FA# 03 DESCRIPTION OF WORK Concrete was encountered below HMA in 8"milling area and had to be PERFORMED:removed to prepare for PCCP. Contractor FA# LABOR WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT Knelleken,Matthew General Foreman/Equipment Operator 8.00 $ 110.29 $ 144.10 $882.32 Eichelberger,Anthony Foreman/Equipment Operator Grp to 8.00 $ 99.26 $ 131.22 $794.08 Winchester,Erik Equipment Operator Grp 2 6.00 $ 9T32 $ 128.37 $583.92 Washington,Taurean Equipment Operator Grp 2 6.00 $ 97.32 $ 128.37 $583.92 _ $ - $ - $0.00 LABOR SUBTOTAL $2,844.24 29%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $824.83 Per WSDOT Spec 1-09.6,add an additional2%for Contractor Sick Leave $56.88 TOTAL LABOR $3,725.96 EQUIPMENT EQUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE STDBY HRS I STDBY RATE AMOUNT CAT 308 Crawler Mounted Hydraulic Excz 308 8 $ 76.90 $ 26.42 $615.20 CAT CB4.0 Tandem Vibratory Compactor CB4.0 4 $ 108.74 $ 38.99 $434.96 FORD SUPER DUTY F-350 Lt Duty Truck 4X2 GAS(2022) 8 $ 42.79 $ 7.32 $342.32 Wirtgen W120F Craw.Mid.Hydraulic Exc W120F 4 $ 518.77 4.00 $ 153.79 $2,690.24 Freightliner Single Axle Dump Truck 2019 $ 69.38 8.00 $ 16.33 $130.64 $ - $ - $0.00 EQUIPMENT SUBTOTAL $4,213.36 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $884.81 TOTAL EQUIPMENT $5,098.17 MATERIALS and/or SERVICES VENDOR&INVOICE# MATERIAL SUB TOTAL TAX AMOUNT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MATERIALS SUBTOTAL INCLUDING TAX $0.00 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $0.00 TOTAL MATERIALS $0.00 SUBCONTRACTOR INVOICED WORK VENDOR&INVOICE# WORK DESCRIPTION AMOUNT $0.00 $0.00 SUBCONTRACTOR INV SUBTOTAL $0.00 Tax on Material(if applicable) $0.00 TOTAL SUBCONTRACTOR INV WORK $0.00 AMOUNT PRIME Subtotal of Labor,Equipment,&Material Work $8,824.12 SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcontractor Invoiced Work $0.00 Markups on work performed by Subcontractor:up to$25,000=12%,$25,000-$100,000=10%Greater than$100,000=7% 0 Subcontractor Mark-up $0.00 TOTAL COST $8,824.12 ElIf checked,this work is in dispute.By signing this form,parties are agreeing to the time and effort needed to accomplish the task. Entitlement to be determined at a later date. Owner's Representative Contractor's Representative Form Date 11/2023 Washington State Department of Transportation Daily Report of Force Account Worked Contract Number Date Item Number Item Name 20-3015/STBGUL-1073(006) 5/13/2024 Prime Contractor Subcontractor/Lower Tier Subcontractor Icon Materials Line/Station Group Basis of Material Acceptance RAM Number -849+50 to 850+90, SB lanes Description of Work Performed: Concrete was encountered below HMA in 8"milling area and had to be removed to prepare for PCCP Time Worked Record Workers and/or Equipment Occupation of Workers or Hours Worked Equipment Hours Working Equipment Size Reg. O.T. Reg. Stdby 1 Matt Knelleken Operator Superintendent 8 2 Anthony Eichelberger Operator Foreman 8 3 Erik Winchester Operator 6 4 Taurean Washington Operator 6 5 6 7 500335 Chevrolet 2500 tool truck 8 8 240892 John Deere loader/box scraper 8 9 CAT 308 Excavator 8 10 510534 Freightliner single axle dump 8 11 645258 CAT CB4.0 roller 4 12 690173 Wirtgen W 120 Fi asphalt mill 4 4 13 14 15 16 17 18 19 20 -J Calculated By Date Checked By Date Total Ledger Entry Number Entered By Date Entry Verified Date Inspector Contractor's Representative Title Sean Flint Matt Knelleken Operator Superintendent DOT Form 422-008A Revised 09/2020 DAILY REPORT OF FORCE ACCOUNT WORKED r CONTRACTOR ICON Materials DATE 5/16/2024 SUBCONTRACTOR PAY EST# Project No.:20-3015 84th Ave S(EVH)Preservation 212th to 196th BID ITEM# Federal Aid No.:STBGUL-1073(006) FA# 04 DESCRIPTION OF WORK Load out and dispose of concrete removed below asphalt on 5/13. PERFORMED: Contractor FA# LABOR WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT Washington,Taurean Equipment Operator Grp 2 5.00 $ 97.32 $ 128.37 $486.60 Sturdivan,Donald Truck Driver Grp 1 5.00 $ 87.88 $ 141.05 $439.40 $ - $ - $0.00 $ $ $0.00 $ $ $0.00 LABOR SUBTOTAL $926.00 29%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $268.54 Per WSDOT Spec 1-09.6,add an additional 2%for Contractor Sick Leave $18.52 TOTAL LABOR $1,213.06 EQUIPMENT EQUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE STDBY HRS STDBY RATE AMOUNT CAT 308 Crawler Mounted Hydraulic Exca 308 5 $ 76.90 $ 26.42 $384.50 Peterbilt 385 Solo Dump Trck 2020 5 $ 63.90 $ 9.63 $319.50 $ Is $0.00 EQUIPMENT SUBTOTAL $704.00 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $147.84 TOTAL EQUIPMENT1 $851.84 MATERIALS and/or SERVICES VENDOR&INVOICE# MATERIAL SUB TOTAL TAX AMOUNT 8768 Renton Recyclers,Concrete Dump Fees $705.60 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 MATERIALS SUBTOTAL INCLUDING TAX $705.60 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $148.18 TOTAL MATERIALS $853.78 SUBCONTRACTOR INVOICED WORK VENDOR&INVOICE# WORK DESCRIPTION AMOUNT $0.00 $0.00 SUBCONTRACTOR INV SUBTOTAL $0.00 Tax on Material(if applicable) $0.00 TOTAL SUBCONTRACTOR INV WORK $0.00 AMOUNT PRIME Subtotal of Labor,Equipment,&Material Work $2,918.68 SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcontractor Invoiced Work $0.00 Markups on work performed by Subcontractor:up to$25,000=12%,$25,0004100,000=10%Greater than$100,000=7% 0% Subcontractor Mark-up $0.00 TOTAL COST $2,918.68 ElIf checked,this work is in dispute.By signing this form,parties are agreeing to the time and effort needed to accomplish the task. Entitlement to be determined at a later date. Owner's Representative Contractor's Representative Form Date 11/2023 � Washington State �I/ Department of Transportation Daily Report of Force Account Worked Contract Number Date Item Number Item Name 20-3015/STBGUL-1073(006) 5/16/24 Prime Contractor Subcontractor/Lower Tier Subcontractor Icon Materials Line/Station JBasis of Material Acceptance RAM Number Group Description of work Performed: Load out and dispose of concrete removed below asphalt on 5/13 Time Worked Record Workers and/or Equipment Occupation of Workers or Hours Worked Equipment Hours Working Equipment Size Reg. O.T. Reg. Stdby 1 Taurean Washington Operator 5 2 Donald Sturdivan Truck Driver 5 3 51-0597 Peterbilt dump truck 5 4 Cat 308 Excavator 5 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Calculated By Date Checked By Date Total Sean Flint 7/9/2024 Ledger Entry Number Entered By Date Entry Verified Date Inspector Contractor's Representative Title Pascal Cayambarantama Tyler Townsend Project Manager DOT Form 422-008A Revised 09/2020 Ca w2� E►a Renton Concrete Recyclers LLC aC M 22121 17th Ave SE STE 117 Bothell,WA 98021 425-481-9101 INVOICE 8768 ,T��tABILiTY t'��4 PAGE 1 DATE 5/16/2024 ACCOUNT NO. 445 TERMS Net 30 Days SOLD TO ICON MATERIALS PDX BOX 3366 SPOKANE, WA 99220 Fee Tax Ticket Date P.O. Product Qty Rate Amount Amount Amount Total 25029 5/16/2024 523319 Concrete Haulback 2'and Smaller 48.00 14.00 672.00 33.60 0.00 705.60 Subtotal 48.00 CY 672.00 33.60 0.00 705.60 Invoice Total 48.00 672.00 33.60 0.00 705.60 Total Invoice ----- > 705.60 DAILY REPORT OF FORCE ACCOUNT WORKED CONTRACTOR ICON Materials DATE 5/23/2024 SUBCONTRACTOR PAY EST# Project No.:20-3015 84th Ave S(EVH)Preservation 212th to 196th BID ITEM# Federal Aid No.:STBGUL-1073(006) FA# 05 DESCRIPTION OF WORK Core drilling was performed to map extent of concrete below HMA in PCCP PERFORMED:area on NB 84th S of 212th. Contractor FA# LABOR WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT Eichelberger,Anthony Foreman/Equipment Operator Grp 1A 5.00 $ 99.26 $ 131.22 $496.30 Stoppard,Nicholas Laborer Grp 3 5.00 $ 70.62 $ 97.93 $353.10 $ - $ - $0.00 - $ - $ - $0.00 - $ - $ - $0.00 LABOR SUBTOTAL $849.40 29%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $246.33 Per WSDOT Spec 1-09.6,add an additional 2%for Contractor Sick Leave $16.99 TOTAL LABOR $1,112.72 EQUIPMENT EQUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE STDBY HRS STDBY RATE AMOUNT GMC/CHEW 2500 On-Highway Light Du 2500(2022) 5 $ 22.96 $ 2.03 $114.80 - $ - $ - $0.00 $ - $ - $0.00 EQUIPMENT SUBTOTAL $114.80 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $24.11 TOTAL EQUIPMENT1 $138.91 MATERIALS and/or SERVICES VENDOR&INVOICE# MATERIAL SUB TOTAL TAX AMOUNT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MATERIALS SUBTOTAL INCLUDING TAX $0.00 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $0.00 TOTAL MATERIALS $0.00 SUBCONTRACTOR INVOICED WORK VENDOR&INVOICE# WORK DESCRIPTION AMOUNT $0.00 $0.00 SUBCONTRACTOR INV SUBTOTAL $0.00 Tax on Material(if applicable) $0.00 TOTAL SUBCONTRACTOR INV WORK $0.00 AMOUNT PRIME Subtotal of Labor,Equipment,&Material Work $1,251.63 i SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcontractor Invoiced Work $0.00 Markups on work performed by Subcontractor:up to$25,000=12%,$25,0004100,000=10%Greater than$100,000=7% 0% Subcontractor Mark-up $0.00 TOTAL COST $1,251.63 ❑ If checked,this work is in dispute.By signing this form,parties are agreeing to the time and effort needed to accomplish the task. Entitlement to be determined at a later date. Owner's Representative Contractor's Representative Form Date 11/2023 Admbk Washington State w/ Department of Transportation Daily Report of Force Account Worked Contract Number Date Item Number Item Name 20-3015/STBGUL-1073(006) 5/16/24 Prime Contractor Subcontractor/Lower Tier Subcontractor Icon Materials Line/Station Group Basis of Material Acceptance RAM Number Description of Work Performed: Load out and dispose of concrete removed below asphalt on 5/13 Time Worked Record Workers and/or Equipment Occupation of Workers or Hours Worked Equipment Hours Working Equipment Size Reg. O.T. Reg. Stdby 1 Taurean Washington Operator 5 2 Donald Sturdivan Truck Driver 5 3 51-0597 Peterbilt dump truck 5 4 Cat 308 Excavator 5 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Calculated By Date Checked By Date Total Sean Flint 7/9/2024 Ledger Entry Number Entered By Date Entry Verified Date Inspector Contractor's Representative Title Pascal Cayambarantama Tyler Townsend Project Manager DOT Form 422-008A Revised 09/2020 DAILY REPORT OF FORCE ACCOUNT WORKED A CONTRACTOR ICON Materials DATE 6/4/2024 SUBCONTRACTOR PAY EST# Project No.:20-3015 84th Ave S(EVH)Preservation 212th to 196th BID ITEM# Federal Aid No.:STBGUL-1073(006) FA# 6 DESCRIPTION OF WORK Remove concrete below HMA from NB 84th @ 212th and haul offsite for PERFORMED:disposal Contractor FA# LABOR WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT Eichelberger,Anthony Foreman/Equipment Operator Grp 1A 5.00 $ 99.26 $ 131.22 $49&30 Winchester,Erik Equipment Operator Grp 2 2.00 $ 97.32 $ 128.37 $194.64 Champlin,Bryan Equipment Operator Grp 2 2.00 $ 97.32 $ 128.37 $194.64 Schoonover,Jesse Equipment Operator Grp 2 2.00 $ 97.32 $ 128.37 $194.64 Bobbitt,Brian Truck Driver Grp 1 4.00 $ 87.88 $ 141.05 $351.52 Littrell,Shawn Truck Driver Grp 1 1 4.00 1$ 87.88 1 0.0 1$ 141.05 $351.52 O'Neal,Lamont Truck Driver Grp 1 4.00 1$ 87.88 1$ 141.05 $351.52 LABOR SUBTOTAL $2,134.78 29%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $619.09 Per WSDOT Spec 1-09.6,add an additional2%for Contractor Sick Leave $42,70 TOTAL LABOR $2,796.57 EQUIPMENT EQUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE STDBY HRS STDBY RATE AMOUNT CAT 308 Crawler Mounted Hydraulic ExcE 308 5 $ 76.90 $ 26.42 $384.50 GMC/CHEVY 2500 On-Highway Light Out 2500(2022) 5 $ 22.96 $ 2.03 $114.80 Peterbilt 385 Solo Dump Trck 2020 4 $ 63.90 $ 9.63 $255.60 Peterbilt 385 Solo Dump Trck 2020 4 $ 63.90 $ 9.63 $255,60 Peterbilt 385 Solo Dump Trck 2020 4 $ 63.90 $ 9.63 $255.60 EQUIPMENT SUBTOTALI $1,266.10 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $265.88 TOTAL E UIPMENTI $1,531.98 MATERIALS and/or SERVICES VENDOR&INVOICE# MATERIAL SUB TOTAL I TAX AMOUNT 9165 Renton Recyclers,Concrete Dump Fee 1 $1,713.601 $0.00 $1,713.60 $0.00 $0.00 $0.00 $0.00 MATERIALS SUBTOTAL INCLUDING TAX $1,713.60 21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $359.86 TOTAL MATERIALS $2,073.46 SUBCONTRACTOR INVOICED WORK VENDOR&INVOICE# WORK DESCRIPTION AMOUNT $0.00 $0.00 SUBCONTRACTOR INV SUBTOTAL $0.00 Tax on Material(if applicable) $0.00 TOTAL SUBCONTRACTOR INV WORK $0.00 AMOUNT PRIME Subtotal of Labor,Equipment,&Material Work $6,402.01 SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcontractor Invoiced Work $0.00 Markups on work performed by Subcontractor:up to$25,000=12%,$25,0004100,000=10%Greater than$100,000=7% 0 Subcontractor Mark-up $0.00 TOTAL COST $6,402.01 If checked,this work is in dispute.By signing this form,parties are agreeing to the time and effort needed to accomplish the task. Entitlement to be determined at a later date. Owner's Representative Contractor's Representative Form Date 11/2023 AdMk Washington State W/ Department of Transportation Daily Report of Force Account Worked Contract Number Date Item Number Item Name 20-3015/STBGUL-1073(006) 5/16/24 Prime Contractor Subcontractor/Lower Tier Subcontractor Icon Materials Line/Station Group Basis of Material Acceptance RAM Number Description of work Performed: Load out and dispose of concrete removed below asphalt on 5/13 Time Worked Record Workers and/or Equipment Occupation of Workers or Hours Worked Equipment Hours Working Equipment Size Reg. O.T. Reg. Stdby 1 Taurean Washington Operator 5 2 Donald Sturdivan Truck Driver 5 3 51-0597 Peterbilt dump truck 5 4 Cat 308 Excavator 5 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Calculated By Date Checked By Date Total Sean Flint 7/9/2024 Ledger Entry Number Entered By Date Entry Verified Date Inspector Contractor's Representative Title Pascal Cayambarantama Tyler Townsend Project Manager DOT Form 422-008A Revised 09/2020 ,IN Ca , Renton Concrete Recyclers LLC aC 22121 17th Ave SE STE 117 Bothell, WA 98021 X 425-481-9101 INVOICE 9165 reA'CURILIVI G��4 PAGE 1 DATE 6/4/2024 ACCOUNT NO. 445 TERMS Net 30 Days SOLD TO ICON MATERIALS PDX BOX 3366 SPOKANE, WA 99220 Fee Tax Ticket Date P.O. Product Qty Rate Amount Amount Amount Total 26073 6/4/2024 523319 Concrete Haulback 2'-4' 36.00 16.50 594.00 29.70 0.00 623.70 26091 6/4/2024 523319 Concrete Haulback 2'and Smaller 12.00 14.00 168.00 8.40 0.00 176.40 26091 6/4/2024 523319 Concrete Haulback 2'-4' 12.00 16.50 198.00 9.90 0.00 207.90 26097 6/4/2024 523319 Concrete Haulback 2'and Smaller 24.00 14.00 336.00 16.80 0.00 352.80 26099 6/4/2024 523319 Concrete Haulback 2'and Smaller 24.00 14.00 336.00 16.80 0.00 352.80 Subtotal 108.00 CY 1,632.00 81.60 0.00 1,713.60 Invoice Total 108.00 1,632.00 81.60 0.00 1,713.60 Total Invoice ----- > 1,713.60 I