HomeMy WebLinkAboutCAG2024-292 - Change Order - #3 - SCI Infrastructure - S 218th St - 98th Ave S (94th Pl S - S 216th St) Stage #1 - 1/14/25 Agreement Routing Form
40 N'17K �•r For Approvals,Signatures and Records Management
E�T This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms.
WASHINGTON (Print on pink or cherry colored paper)
Originator: Department:
C. Frame PW Engineering
Date Sent: Date Required:
> 1/15/2025 N/A
O
aAuthorized to Sign: Date of Council Approval:
Q El Director or Designee ❑ Mayor 6/11/2024
Budget Account Number: Grant? 0 Yes ❑No
R90110.64110.120
Budget? 0 Yes ❑No Type: Federal
Vendor Name: Category:
SCI Infrastructure Contract
Vendor Number: Sub-Category:
C 33999 Change Order#3
O
Project Name: S 218th St - 98th Ave S (94th PI S-S 216th St) Stage #1
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CProject Details:Extra work for identifying location of Lumen conduit and for contractor installing storm drain
with Lumen conduit in conflict with pipe.This work includes FA No. 07 and FA No. 14
C
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£ Agreement Amount: $8,549.35 Basis for Selection of Contractor: Bid
O
aStart Date: N/A Termination Date: 211 Working Days
Q
Local Business? ❑Yes ❑ No*
*Ifineets requirements per KCC3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace.
Notice required prior to disclosure? Contract Number:
[]Yes El No CAG2024-292
Date Received by City Attorney: Comments:
C
3
3 0
a,
•� i
N
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C
p� Date Routed to the Mayor's Office:
IIA
Date Routed to the City Clerk's Office: 1/15/25
Visit Documents.KentWA.gov to obtain copies of all agreements
•
KENT
W A 5 H I N G T O N
CHANGE ORDER NO. 3
NAME OF CONTRACTOR: SCI Infrastructure LLC. ("Contractor")
CONTRACT NAME & PROJECT NUMBER: S 218th St-98th Ave S 94th PI S-S 216th St
ORIGINAL CONTRACT DATE: June 11, 2024
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:
Extra work for identifying location of Lumen conduit and for contractor
installing storm drain with Lumen conduit in conflict with pipe. This work
includes FA No. 07 and FA No. 14.
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, $6,059,881.82
(including applicable alternates and
WSST)
Net Change by Previous Change Orders $511,100.76
(inch applicable WSST)
Current Contract Amount $6,570,982.58
(incl. Previous Change Orders)
Current Change Order $8,549.35
Applicable WSST Tax on this Change $0.00
Order
Revised Contract Sum $6,579,531.93
Original Time for Completion 200 working days
(insert date)
Revised Time for Completion under 209 working days
prior Change Orders
(insert date)
CHANGE ORDER - 1 OF 3
Days Required (t) under Minor Change 00 working days
Orders
Days Required (f) for this Change Order 02 working days
Revised Time for Completion 211 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:
❑�girally signed by Chad Bieren
By By: Chad Bieren" zozs.oi.iaia:iszs-osoo
sign tune) (signature)
P nt ame: s dL Print Name: Chad Bieren, P.E.
is Its Public Works Director
(title) (title)
DATE: DATE:
EC
CHANGE ORDER- 2 OF 3
ATTEST: APPROVED AS TO FORM:
(applicable If Mayor's signature required)
Kent City Clerk Kent Law Department
C[tn this field,you may enter the electronic Blepath where the contract has been saved]
CHANGE ORDER - 3 OF 3
File No.200.2
CHANGE ORDER WORKSHEET NO. 03
KENT Construction Engineering Division - Public Works
Project: S 218th St/ 98th Ave S from 94th PI S to S Project No: 17-3010
Project Engineer: Abdulnaser Almaroof Fed-Aid No: 9917(045)
Capital Projects Sean Flint KBA Inc. Contractor: SCI InfrastrL1cture LLC
Date: 12/6/2024
I. Proposed Change
Extra work for identifying location of Lumen conduit and for contractor installing storm drain with Lumen
conduit in conflict with pipe. This work includes FA No. 07 and FA No. 14.
II. Reason and Background for Change
FA 07: The Lumen conduit run on S 218th St between 95th PI S and 96th PI S (Sta 60+00 to 64+00) was
installed 7-8' south of approved location, placing it in direct conflict with the new storm drain system. SCI
was required to perform additional potholing to ascertain the extent of conflict on 10/3/2024. FA 14: On
10/24/2024, SCI was significantly delayed during installation of the new storm pipe due to Lumen conduit
located within the trench excavation, requiring the suspension of Lumen conduit and alternative shoring
Imethods-
III. Method of Payment
NEW PAY ITEMS
Sch. Item Description Total Est. Unit Unit Price
No oty Total Estimated Cost of Item
IV Lumen Interference 1 FA $8,549.35 $ 8,549.35
$0.00 $
$0.00 $ -
$0.00 $
$a.OD $
New Pay Items Total: $ 8,549.35
DELETE EXISTING PAY ITEMS) per 1-09.5 w Nota kable
Sch
N Bid Item No. Item Description Qty Unit Unit Price Cost of Item
$
Delete Existing Pay Items Total: $
INCREASE/DECREASE TO EXISTING PAY ITEM(S)
Sch I Bid Item No. Item Description Qty Unit Unit Price Cost of Item
No. f
0 $0.00 $
Increase / Decrease to Existing Pay Items Total: $ -
*TOTAL ESTIMATED COST OF CHANGE ORDER: $8,549.35
Page 1
*Total of the Cost of Item Columns
IV. WORKING DAYS
Original Contract: 200 Due This Change Order:, 2 Previous Total:, 209
Explanation/Justification for Additional Working Days:
SCI was delayed during the extra work noted on this Change Order. Lumen's contractor was also onsite moving
misplaced conduit at two locations, delaying SCI's movement of hault trucks and equipment through work zone.
*TOTAL WORKING DAYS: 211
*This Change Order+ Previous Total
Sean Flint
Capital Projects Manager: ° r``= `�,_`:;;,'E� Date:
an Flint KBA, Inc)
Construction Engineering Date: iZ Z6 �
] on Barry
Construction Manager: Date: ZC,
c Connor
Page 2
DAILY REPORT OF FORCE ACCOUNT WORKED
CONTRACTOR SCI Infrastructure LLC DATE 10/24/2024
SUBCONTRACTOR PAY EST#
Project No.: 17-3010
ITEM# 1355
Federal Aid No.:IHIPUL-CRRSAASTBGUL-HLP-9917(045)
Time impact on 18"Storm Drain installation due to Lumen conduit FAN 014
DESCRIPTION OF WORK interference from—63+40 to 64+00.Lumen conduit was in conflict vertically
PERFORMED:and horizontally with storm line and had to be suspended during drain pipe Contractor
linstallation. FA#
LABOR
WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT
Elmendorf,Shane (Pipe Layerrrailor 300 $ 7348 $ 9708 $220 44
McClellan,Dallas IEquipment Operator Grp 2 300 $ 99.50 S 129.14 $298 50
Liles,Lucas 'Equipment Operator Grp 2 300 $ 99.50 $ 129.14 $298 50
Clark,Ryan Equipment Operator Grp 2 300 S 9950 $ 129.14 $298 50
Jackson,Elijah (General Laborer-Appr60%ISIep1 300 $ 50.40 $ 6422 $15120
Liles,Pal Operator Foreman 3 00 S 104.68 $ 13652 $314 04
Roning.Paul-TT 'Truck Driver-Dump Trk&Trailer 3 00 $ 90.28 S 116.48 $270 84
Brown,Kenneth-TT 'Truck Driver-Dump Trk&Trailer 300 $ 9028 $ 11648 $270.84
Jackson,Harold 'Truck Driver-Dump Trk&Trailer 300 $ 9028 S 11648 $270 84
LABOR SUBTOTAL $2.393.70
29%OVERHEAD AND PROFIT,BONDI NG,INSURANC£AND TAX $694.17
Per WSDOTSpec 1-09.6,add an additional 2%for Conlractor Sick Leave $47.87
TOTAL LABOR 13.135.74
EQUIPMENT
EQUIPMENT TYPE EQUIPMENT SIZE REG HRS REG RATE N30
STDBY RATE AMOUNT
200-157 CAT Excavator 320E 3 $ 130.92 $ 4040 $392 76
200-164 Komatsu PC138USLC-11 3 $ 10995 $ 3668 $329 85
110-151 CAT Loader Composite -938M 3 $ 70.77 $ 2057 $212 31
325-115 Misc.On-Highway Flatbed Truck 4x2 20KGVW DSL 3 $ 41.583 589 S124.74
335-157 GMCICHEVY On-Highway Light 1500(200-299 hp) 3 S 26.29 $ 1 93 $78 87
300-082 Dump Truck&Pup Composite .NIA 0 $ 96.83S 1631 $40 93
305-068 Tractor&Side Dump Composite NIA 0 $ 69.95 3.00 $ 12 116 $36.18
305-069 Tractor&Side Dump Composite NIA 0 5 69.95 3.00 $ 1206 $36,18
$ is $000
EQUIPMENT SUBTOTAL $1,259 82
21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $264.56
TOTAL EQUIPMENT $1,524,38
MATERIALS andfcr SERVICES
VENDOR&INVOICE# MATERIAL SUB TOTAL TAX AMOUNT
$000 $000
$000 $000
$000 $000
MATERIALS SUBTOTAL INCLUDING TAX $0 00
21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $000
TOTAL MATERIALS $0.00
SLBCONTRACTOR INVOICED WORT[
VENDOR&INVOICE# WORK DESCRIPTION AMOUNT
$000
$000
SUBCONTRACTOR INV SUBTOTAL $000
Tax an Material(if applicable) $000
TOTAL SUBCONTRACTOR INV WORN S0.00
AMOUNT
PRIME Subtotal of Labor,Equipment,&Material Work $4,660 12
SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcontractor Invoiced Work $000
Markups on work performed by Subcontractor up to$50.000=12%,$50,000-$200,000=10%Greater than$200,000=7% 12%
Subcontractor Markup $000
TOTAL COST $4,660.12
f�I
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 he determined at a later date.
Owrlvr's Represerrtarive CorrtracmYs Ruproserrtathre
Form Date 912024
DAILY REPORT OF CONTRACTOR'S WORK
Project: S 218TH ST/98TH AVE S from 94th PL S to S 216TH ST Project No.: 17-3010
Prime Contractor: SCI Infrastructure Date of Work: 10/24/2024
Subcontractor: Fed Aid No: HLP-9917(045)
Description of Work Time impact on 18"Storm Drain installation due to Lumen conduit interference from—63+40 to
&Reference 64+00. Lumen conduit was in conflict vertically and horizontally with storm line and had to be
Documents(RFI, suspended during drain pipe installation.
Field Memo,Bid Item,
etc.)
RECORDTIME
WORKERS AND/OR OCCUPATION OF WORKERS OR HOURS WORKED EQUIPMENT HRS
EQUIPMENT NUMBER EQUIPMENT SIZE
REG. T OT REG. STDBY
Shane Elmendorf Pipe Layer 3
Dallas McClellan Operator 3 _
Lucas Liles Operator 3
Ryan Clark Operator 3
Patrick Liles Operator Foreman 3
200-157 320 Excavator 3
200-164 138 Excavator 3
110-151 930 Loader 3
325-115 1 Ton Tool Truck 3
335-157 1/2 ton foreman truck 3
Paul Roning Teamster 3
Ken Brown Teamster 3
Harold Jackson Teamster 3
300-068 Side Dump 3
300-069 Side Dump 3
300-082 Dump Truck and Trailer 3
Eliiah Jackson Laborer Apprentice 3
MATERIALS/SERVICE
QUANTITY/MATERIALS/SERVICE DESCRIPTION
Comments:
Sean Flint Patrick Liles
Inspector(printed name) Contractors Representative(printed name)
Inspector Signature Date Contractors Representative Signature Date
By signing this form, parties are agreeing to the time, materials, and equipment needed to accomplish this task.
Entitlement to be determined at a later date.
1 of 1 P-17(Rev.2023 March)
Daily Cost Record
2821 SOUTH 154th ST SEATTLE,WA 98188 • (206)242-0633 • FAX:(206)242-0792 3 C ®f 63
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Project 5 T Job# 01L-foT Date ��_ —a"Lf Weather a •�►eqT. Ll•�q�
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Sub-Total
Labor Taxes&Fringe Benefits
Travel Time
Labor Markup
Total Labor Costs
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Total Equipment Costs
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Sales Tax.(if applicable)
Material Markup
Total Material Costs
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Sub-Total
Bond Insurance Taxes
A-4 JI-I Miscellaneous Costs
Conlfeclor's Representative Sub-Total
Overhead
Subcontractor's Representative
.kr OwnersRep esentelive Sub-Total
Sales Tax
No. Sheet of TOTAL
DAILY REPORT OF FORCE ACCOUNT WORKED
4
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Ar CONTRACTOR SCI Infrastructure LLC DATE 10/3/2024
SUBCONTRACTOR PAY EST#
Project No.: 17-3010
ITEM# 1355
Federal Aid No.: HIPUL-CRRSAA-STBGUL-HLP-9917(045)
DESCRIPTION OF WORK Extra potholing performed on Lumen conduit line relocated in conflict with FA# 007
PERFORMED:storm drain and PSE power systems(-8'S of designed relocation area)on St
ntractor
side of 218th between 95th PI S and 96th PI S. FA#
LABOR
WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT
Liles,Pat Operator Foreman 200 $ 10468 $ 136-52 $209 36
$ _ $ _ $0 00
$ $ $0 00
$ $ $0 00
$ $ $0 00
LABOR SUBTOTAL $209 36
29%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $60 71
Per WSDOT Spec 1-09 6,add an additional 2%for Contractor Sick Leave $419
TOTAL LABOR $274,26
EQUIPMENT
EQUIPMENTTYPE EQUIPMENTSIZE REG HRS REG RATE STDBY HRS STDBY RATE AMOUNT
335-157 GMC/CHEVY On-Highway Light C 1500(200-299 hp) 2 $ 2629 $ 193 $52.58
$ $ _ $0.00
$ $ $0.00
EQUIPMENT SUBTOTAL $52.58
21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $11.04
TOTAL EEU-IPMENTI S63.62
MATERIALS andlor SERVICES
VENDOR&INVOICE# MATERIAL SUB TOTAL TAX AMOUNT
Northern Environmental#79145 Extra potholing for Lumen conduit placed in conflict with storm drain s $2,935 00 $0 00 $2,935 00
Total invoice is$4060-$1125 for BI 1315 potholes=$2935 $0.00 $0.00
$0 00 $0.00
MATERIALS SUBTOTAL INCLUDING TAX $2.935.00
21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $616 35
TOTAL MATERIALS $3,551.35
SUBCONTRACTORINVOICED 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 SD.00
AMOUNT
PRIME Subtotal of Labor,Equipment,&Material Work $3,889 23
SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcontractor Invoiced Work $0 00
Markups on work performed by Subcontractor:up to$50,000=12%,$50,000-$200,000=10%Greater than$200,000=7% 12%
Subcontractor Mark-up $0 00
TOTAL COST $3,889.23
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 Represerifative Contractor's Rooms enrartve
Form Date 912024
DAILY REPORT OF CONTRACTOR'S WORK
No
A91"'
Project: S 218TH ST/98TH AVE S from 94th PL S to S 216TH ST Project No.: 17-3010
Prime Contractor. SCI Infrastructure Date of Work: 10/24/2024
Subcontractor: Fed Aid No: HLP-9917(045)
Description of Work Time impact on 18"Storm Drain installation due to Lumen conduit interference from-63+40 to 64+00.
&Reference Lumen conduit was in conflict vertically and horizontally with storm line and had to be suspended during
Documents(RFI, drain pipe installation.
Field Memo,Bid Item,
etc.)
RECORDTIME
WORKERS AND/OR OCCUPATION OF WORKERS OR HOURS WORKED EQUIPMENT HRS
EQUIPMENT NUMBER EQUIPMENT SIZE
REG. OT REG. STDBY
Shane Elmendorf Pipe Laver 3
Dallas McClellan Operator 3
Lucas Liles Operator 3
Ryan Clark Operator 3
Patrick Liles Operator Foreman 3
200-157 320 Excavator 3
200-164 138 Excavator 3
110-151 930 Loader 3
325-115 1 Ton Tool Truck 3
335-157 1/2 ton foreman truck 3
Paul Roninq Teamster 3
Ken Brown Teamster 3
Harold Jackson Teamster 3
300-068 Side Dump 3
300-069 Side Dump 3
300-082 Dump Truck and Trailer 3
Eliiah Jackson Laborer Apprentice 3
MATERIALS/SERVICE
QUANTITY/MATERIALS/SERVICE DESCRIPTION
Comments:
Sean Flint
Patrick Liles
Inspector(printed e) Contractors Representative(printed name)
1 pector Sign re I Date Contractor's Representative Signature Date
By signing this form, parties are agreeing to the time, materials, and equipment needed to accomplish this task.
Entitlement to be determined at a later date.
1 of 1 P-17(Rev.2023 March)
Daily Cost Record
2621 SOUTH 164th ST • SEATTLE,WA 98188 (206)242-0633 • FAX:(206)242-0792 32060
Project !�- 0 %BT —1 W S Job# at'{ d-7-' Date ao A 9- , Weather c1►EW IR
Description(must be complete) T%No\ 1.+_'�o gy, g mo-r —r L 1
L 5T tA =x b0+1 1 20 O% 1
SFbCr.U+/Z, =LfN C,o c%.-M b4G-r
DETAIL COST RECORD CODE HOURS RATE EXTENSION
S.T. O.T. D.T. TOTAL
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Travel Time
Labor Markup
Total Labor Costs
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Total Equipment Costs
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Material Markup
Total Material Costs
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Sub-Total
Bond Insurance Taxes
- Miscellaneous Costs
Contractor's Representative Sub-Total
Overhead
Subcontractor's Representative
3 ig
wner's Representati a Sub-Total
Sales Tax
No. Sheet of TOTAL
Invoice
Northern
ENVIRONMENTAL Date Invoice#
www.northemenv.com
10/4/2024 79145
Bill To Ship To
SCI Infrastructure LLC Job#2407
2821 S 154th Street 21628 98th Ave S
Sea Tac,WA 98188 Kent,WA 9
Service Date Customer P.O.# Terms Sales Rep Northem W.O.#
10/3/24 Job#2407 Net 30 DAD 79539
Quantity Description Price Each Amount
Vactor truck and operator to hydro excavate for utilities as directed.
8 Vactor Truck&Operator-Prevailing Wage 295.00 2,360.00
4 Vactor Truck&Operator-Prevailing Wage Over Time 325.00 1,300.00
1 Hydro Excavation Waste-NW Cascade 400.00 400.00
Please remit payment to: Sales Tax (10.2%) $0.00
Northern Environmental,LLC
2661 N Pearl St#145
Tacoma,WA 98407 Total $4,060.00
Ph. 253-503-3096
Payments/Credits $0.00
Balance Due $4,060.00
Job Ticket and Safe-Start Checklist
DATE_ T WORFC ORDER# �_ TRUCK# _ . .
1Vortl�ern __ 1 T ..
FnI vlRO ENTAt OPERATOR LABORER
1
CUSTOMER: 2 1 fc JOB PHONE:
JOB ADDRESS: 29t
TRAVEL TO SITE ON-SITE DUMP OUT COMPLETED RETURN TO SHOP
START STOP IN OUT
QUANTITY JOB DESCRIPTION
r
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D� ❑ ON-SITE ❑ OFF-SITE LOCATI
Prior to starting work, this checklist must be completed, and all identified and 20terdra1 hazards mitigated.
Overhead hazards such as powerlines, and low clearances have been identified and mitigated J
Locate marks are current and visible.All underground utility hazards identified and mitigated
i Public and pedestrian hazards have been identified and mitigated. Including work area delineation and protection
Adjacent workers,heavy equipment, vehicles, and other stuck-by hazards have been identified and mitigated
Ambient noise hazards for workers and the public have been identified and mitigated
Trenching and excavation hazards have been identified and mitigated. Competent Person:
Confined Spaces have been evaluated and the proper entry documentation will be completed.
All necessary PPE is available and will be used. Dielectric gloves and boots: o will be worn ❑will not to be worn
All workers are knowledgeable and have been trained in the tasks they will be performing
The nearest hospital name and address.
• • • . CHECKLIST
Prior to leaving the fob, this checklist must be completed.
�:A post-trip walk around inspection of trucks and trailers has been completed.
All loads, small equipment, devices, and tools have been properly secured
All tires have been inspected for damage, punctures, and proper inflation
The work area has been inspected for company property, unprotected hazards, and restored properly
Northern Environmental 7517 Portland Ave. E STE B Tacoma WA 98404 253-503-3096 support@northemenv.com
B.O.L. #
07ENAIDVINSHIPPING PAPER
RONMENTAL
E WAH000039211 flA� WO#
USDOT#2133996
253.503.3096
SHIPPER/CUSTOMER COXTACT NAME
ADORES PHONE /
CITY,STATE,ZIP
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CONSIGNEE/FACILITY �,l CONTACT NAME
A13DRFSS PHONE#
CITY,STATE,ZjP
Contalners Total
HM US DOT Description Qncluding Proper Shipping Name,Hazard Class,and 1D Number) UOM CHLOR pH
No. Type Quantity
A MATERIAL NOT REGULATED BY DOT
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Special Handling Instruction and Additional Information:
A)Profile#
SHIPPER'S CERTIFICATION:"I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,
packaged,marked ana labelled/placarded-and are in all respects in proper condition for transport according to applicable international and national governmental
regulat)ons."t also cattily that all times listed above are true and correct.
(SHIPPER)PRINT OR TYPE NAME SIGNATURE ' Mor,ni v YEAR
(CARRIER TRANSPORTER)PRINT OR TYPE NAME SIGNATURE ' MONTH DAY YEAR
(CONSIGNEEI;ACILITY)PRINT OR TYPE NAME SIGNATURE MONTH DAY YEAR
x x
DAILY REPORT OF FORCE ACCOUNT WORKED
CONTRACTOR SCI Infrastructure LLC DATE 10/25/2024
SUBCONTRACTOR PAY EST#
Protect No.:17-3010 ITEM# 1355
Federal Ald No.:HIPUL-CRRSAA-STBGUL-HLP-9917(045)
SCI excavated for Comcast contractor Cannon.Conduits were extended Out FA a 015
DESCRIPTION OF WORK of curb line using split duct and hose clamps.SCI tunneled below Comcast
PERFORMED:conduit taking care not to damage extended conduffs.Comcast box was re- Contractor
set over sweeps and as cknllled by SCI. FA#
LABOR
WORKER'S NAME WORKER'S OCCUPATION REG HRS REG RATE OT HRS OT RATE AMOUNT
Elmendorf,Shane Pipe Layer/Tallor 4-00 $ 73 48 S 9708 5293.92
McClellan,Dallas Equipment Operator Grp 2 4-00 $ 99.50 $ 12914 S39E 00
Liles,Lucas Equipment Opefatw Grp 2 4.00 S 99.50 S 12914 5317E 00
Clarx,Ryan F_qulpmOM Opermat Gtp 2 4.00 S 03 50 5 129.14 538d.00
Jackson,Elijah General Laborer-Appr 60%/Step 1 400 $ 50-40 S 6422 $201 60
Liles-Pat Operator Foreman 4 00 $ 104-88 S 13652 $418 72
Roning,Paul 'truck Dover-Dump Trk&Trailer 4.00 $ 90-28 $ 11648 $361 12
Brown,Kenneth 'rruck Driver-Dump Trk&Trailer 400 $ 90-28 $ 11648 $361 12
Jackson,Harold Truck Driver-Dump Trk&Trailer 4.00 $ 90.28 $ 11848 $361-12
S $ $0.00
LA90RSUBTOTAL $3,191-60
29%OVERHEAT]AND PROFIT.SONDING,IN5URANCE AND TAX $925 56
Par WEOOT Spat 1.09 S.add an adddienal 2%W Conlracida Sick Leave $63 83
TOTAL LABOR S4,1WAIII
EQUIPMENT
EQUIPMENT TYPE EOUIPMENT SIZE REGHRSj REG RATE STOGY HRS STUBy RATE-AMOUNT,
200-157 CAT Excavator :320E 4 15 13092 S 40.40 $523.88
200-164 Komatsu I-CI38USLC-11 4 $ 10995 S 3666 S439 80
110-151 CAT Loader Composde 938M 4 $ 7077 S 20-57 $263 08
325-115 Mlsc On-Highway Flatbed Truclu 4x2 20KGVW DEL 4 $ 41.58 S 5.89 $166 32
335.157 GMC1CHEVv On-Highway L%rI 1 1500(200-299 hp) 4 S 26 29 S 1.93 $105 16
300-082 DUmp Truck&PUP Composde IV/A 0 S 9683 4.00 $ 1631 $65 24
305-068 Treclar&Side Dump Composite IWA 0 S 6995 400 S 12.06 S48.24
305-069 Tractor&Side Dump Composite IWA 0 S 6995 4.00 S 12.06 $41124
$ IS SO 00
EQUIPMENT SUBTOTAL. $1,67976
21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $352.75
TOTAL EQUIPMENT 52,032.51
MATERIALS andfor SERVICES
VENDOR&INVOICE# MATERIAL SUBTOTAL TAX AMOUNT
50.00 50.00
SO 00 $000
SO.00 So.00
MATERIALS SUBTOTAL INCLUDING TAX SO.00
21%OVERHEAD AND PROFIT,BONDING,INSURANCE AND TAX $0 00
TOTAL MATERIALS $0.00
SUBCONTRAC TOR INVOICED WORK
VENDOR&INVOICE# WORK DESCRIPTION AMOUNT
$0 00
$0.00
SUBCONTRACTOR INV SUBTOTAL SO.00
Tax an Material(if applicable) $0 00
TOTAL SUBCONTRACTOR INV WORK so.00
AMDUNT
PRIME Subtotal of Labor,Equipment,&Material Work S6,213.50
SUBCONTRACTOR Subtotal of Labor,Equipment,Material,&Subcen0ac1er Invoiced Work $0.00
Markups on work performed by Subcontractor:up to$50,000=12%,$50,000-3200.000=10%Greater than$200,000=7% 12%
Subcontractor Mark-up SO 00
TOTAL COST $6.213.50
�IIf checked,this workls In dispute,By signing this form,parties are agreeing to the Qme and effort
needed to accomplish the task.Entitlement to be determined at a later dale.
Ownor-s RepresunfwNvs Cerdracfafa Rapresenfa!ve
Form Dale 912024
Daily Cost Record
2821 SOUTH 1641h ST • SEATTLE,WA 98188 - (206)242-0633 • FAX:(206)242.0792 3 2 0!)6
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Description(must be complete)
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DETAIL COST RECORD CODE HOURS RATE EXTENSION
S.T. O.T. D.T. TOTAL
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Sub-Total
Labor Taxes&Fringe Benerils
Travel Time
Labor Markup
Total Labor Costs
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Total Equipment Costs
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Sales Tax(if applicable) -
Material Markup
Total Materlal Costs
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Sub-Total
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_Overhead
Subcontractor's Representative
Owner's Representative _Sub-Total _
Sales Tax_ _
No. Sheet of TOTAL
DAILY REPORT OF CONTRACTOR'S WORK
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Project: S 218TH ST/98TH AVE S from 94th PL S to S 216TH ST Project No.: 17-3010
prime Contractor: SCI Infrastructure Dato of Work: 10/25/2024
Subcontractor: Fed Aid No: HLP-9917(045)
Description of Work SCI excavated for Comcast contractor Cannon. Conduits were extended out of curb line using split
&Reference duct and hose clamps. SCI tunneled below Comcast conduit taking care not to damage extended
Documents(RFI, conduits. Comcast box was re-set over sweeps and backfilled by SCI.
Field Memo, Bid Item,
etc.)
TIME -D
WORKERS AND/OR OCCUPATION OF WORKERS OR HOURS WORKED EQUIPMENT HRS
EQUIPMENT NUMBER EQUIPMENT SIZE
REG. OT REG. STDBY
Shane Elmdorf Pipe Layer 4
Dallas McClellan Operator 4
Lucas Liles Operator 4
'Ryan Clark Operator 4
Eliiah Jackson Laborer 4
Patrick Liles _ Foreman 4
Paul Roning Teamster 4
Ken Brown Teamster 4
Harold Jackson Teamster 4
200-157 320 Excavator 4
200-164 138 Excavator 4 _
110-151 930 Excavator 4
325-115 1 Ton tool truck 4
335-157 1/2 ton foreman truck 4 _
300-068 Side dump truck 4
300-069 Side dump truck 4
300-082 Dump truck and trailer 4
MATERIALS SERVICE
QUANTITY I MATERIALS)SERVICE DESCRIPTION
Comments:
Sean Flint Patrick Liles
Inspector(printed name) Contractors Representative(pfintedname]
lnsimtorsignalum Date ContractoYs Reprwentstive Signature Date
By signing this form, parties are agreeing to the time, materials, and equipment needed to accomplish this task.
Entitlement to be determined at a later date.
1 of 1 P-17(Rev.2023 March)