HomeMy WebLinkAboutCAG2022-248 - Other - Department of Labor and Industries Notice of Completion - L.W. Sundstrom, Inc - Salt Air Vista Park Renovations - 6/15/24 Department Use Only
4= NOTICE OF COMPLETION OF
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.yf PUBLIC WORKS CONTRACT Assigned to: Date Assigned:
Date 03/06/2024 Form Version Original Revision Reason
Awarding Agency Information Prime Contractor Information
Name KENT, CITY OF UBI 173000002 Name L W SUNDSTROM INC UBI 601984136
Address 220 -4TH AVE S KENT,WA-98032-5895 Address PO BOX 893 RAVENSDALE,WA-98051
Email Address kjennings@kentwa.gov Email Address carriesundstrom@comcast.net
Contact Name KateLynn Phone 253-856-5114 Contact Name L W Phone 425-413-8158
Jennings SUNDSTROM INC
Project Information
Project Name Salt Air Vista Park Renovations Contract# Affidavit ID 1238348
Jobsite Address 24615 26th PI South, Kent, WA
Date Awarded Date Work Commenced 06/01/2022 Date Work Completed Date Work Accepted
05/19/2022 06/15/2023 03/05/2024
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 Remove and Replace existing play equipment, Drainage improvements, Landscaping
and Irrigation, remove and replace drinking fountain, add site furnishings, remove and replace concrete sidewalks
DOR Tax Information
*Right-click on the total field and select Update Field to auto-calculate.
Contract Amount $449,950.00 Liquidated Damages $ 0.00
Additions (+) $ 0.00 Amount Disbursed $495,394.95
Reductions (-) $ 0.00 Amount Retained $ 0.00
Sub-Total* $449,950.00 Other $ 0.00
Sales Tax Amount $45,444.95 Sales Tax Rate If multiple rates,attach a list. 10.10%
TOTAL* $495,394.95 TOTAL* $495,394.95
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 A00�4 Washington State Department of A9 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@LN I.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*
COAST TO COAST CONCRETE 601760910 1177563
DENALI WATER SOLUTIONS LLC 603583612 1197812
IVARY ENTERPRISES INC. 602255686 1215629
RALPH'S CONCRETE PUMPING 578085430 1279530
ROCKY MOUNTAIN DISTRIBUTORS 603474353 1206011