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Home My WebLink AboutWTR2703638_5T0: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: Rodarte Construction, Inc CONTRACT NO. # CAG-13-044 PO#18/0001862 ESTIMATE NO. 2 PROJECT: President Park Water Main Replacement Project 1. CONTRACTOR EARNINGS THIS ESTIMATE $217,995.22 2 SALES TAX @ 9.50% $20,709.55 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $238.704.77 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $72,665.48 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $207,095.46 6. SUBTOTAL - CONTRACTOR PAYMENTS $279,760.94 7. RETAINAGE ON PREVIOUS EARNINGS $3,824.50 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE $10,899.76 9. SUBTOTAL - RETAINAGE $14,724.26 10. SALES TAX PREVIOUSLY PAID $7,266.55 11. SALES TAX DUE THIS ESTIMATE $20,709.55 12. SUBTOTAL - SALES TAX $27,976.09 * (95% x LINE 1) ** (RETAINAGE: 5%) GRAND TOTAL: $322,461.29 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455170.018.594 34.63.000 # 2 RETAINED AMOUNT (Line 8): *ACCOUNT # 6621292082 # 2 * Escrow Number, Wells Fargo Bank, N.A. - Tacoma Business Banking TOTAL THIS ESTIMATE: CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHOR ZED TO AUTHENTTCAT AND CERTIFY TO SAID CLAIM Signed: i 4 _ JJ (0 7,011, $227,805.01 $10,899.76 $238,704.77 �M J„ly io/ 20i3 Printed On: O710912013 City of Renton Public Works Department Page 1 Printed On: 07/09/2013 Project President Park Water Main Replacement Project Contractor: Rodarte Construction. Inc. Item Description No. City of Renton Public Works Department Contract Number. CAG-13-0" Pay Estimate 2 Closing Dale: 07/09/2013 Unit Est. Unit Previous Previous This Quantity Price Quantity Amount Quantity Page 1 This Total Total Amount Quantity Amount 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $34,000.00 50.00 0.75 $25,SD0.00 0.75 $25,500.00 002. Traffic Control Lump Sum 1 $25,000.00 $0.00 0.20 55,000.00 0.20 $5,000.00 003. Trench Excavation Safety Systems Lump Sum 1 $500.00 $0.00 1.00 $500.00 1.00 $500.00 0D4. Construction Surveying and Staking Lump Sum 1 $5,0D0.D0 $0.00 1.00 $5,000.00 1.00 $5.000.00 As -Built Surveying for Progress Payments and Final As- 005. Buills Lump Sum 1 $800.00 $0.00 $0.00 0.00 $0.00 006. Temporary Erosion and Sedimentation Control Lump Sum 1 $1.200.00 $0.00 $0.00 0.00 $0.00 007. Site Specific Potholing Each 20 $250.00 50.00 10.00 $2.500.00 10.00 $2,5D0.00 Furnish and Install 8' Cl 52 DI Water Pipe & Filings w/ 008. Polywrap Lineal Foot 4210 $61.00 1253.93 $76,489.98 2255.07 $137,559.02 3509.00 $214,049.00 009. Furnish and Install 8' Gale Valve Assembly Each 28 $1,000.00 $0.00 19.00 $19,000.00 19.00 $19,000.00 010. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 30 $300.00 $0.00 1.50 $450.00 1.50 $450.DD 011. Furnish and Install Fire Hydrant Assembly Each 5 $4,200.00 $0.00 2.00 $9,400.00 2.00 $8.400.00 012. Furnish & Install 1' Water Service Connection Each 69 $1.200.00 $0.00 4.00 $4,800.00 4.00 $4,800.00 013. Furnish & Install 2' Water Service Connection Each 1 $3,800.00 $0.00 $0.00 0.00 $0.00 014. Connection to Existing Water Main Each 8 $2,500.00 $0.00 $0.00 0.00 $0.00 015, Cut, Cap, and Block Existing Water Main Each 1 $1,000.00 SD.00 $0.00 0.00 $0.00 Removal and Replacement of Unsuitable Foundation 016, Material Ton 150 $32.00 $0.00 $0.00 0.00 $0.00 017. Select Imported Trench Backfill Ton 1100 $12.00 $0.00 $0.D0 0.00 $0.00 Crushed Surfacing Top Course, Crushed Rock Backfill, 018. Crushed Rock for Shoulder Restoration Ton 1150 $20.00 $0.00 88.06 $1.761.20 88.06 $1,761.20 019, 2' Temporary Cold Mix Asphalt Trench Patching Ton 360 $100.00 $0.00 75,25 $7,525.00 75.25 $7,525.00 020. H.M.A. Class h' PG 64-22 for Roadway Reconstruction Ton 720 $115.00 $0.00 $0.00 0.00 $0.00 021. Removal and Replacement of Concrete Curb and Gutler Lineal Foot 250 $26.00 $0.00 $0 D0 0.00 $0.00 022. Concrete Driveway and/or Sidewalk Restoration Square -Yard 100 $42.00 $0.00 $0.00 0.00 50.00 023. Property & Landscape Restoration Lump Sum 1 $6,50020 $0.00 $0 00 0.00 $0.00 Subtotal $76,489.98 $217,995.22 $294,485.20 9.5% Sales Tax $7.266.55 $20,709.55 $27,976.09 TT Total $83,756.53 $238,704.77 $322,461.29 �M 3„iy /O, LG i3 70°�zan TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: Rodarte Construction, Inc. CONTRACT NO. # CAG-13-044 PO#18/0001862 ESTIMATE NO. 3 PROJECT: President Park Water Main Replacement Project 1. CONTRACTOR EARNINGS THIS ESTIMATE $142,627.40 2. SALES TAX @ 9.50% $13,549.60 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $156,177.00 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $279,760.94 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $135,496.03 6. SUBTOTAL - CONTRACTOR PAYMENTS $415,256.97 7. RETAINAGE ON PREVIOUS EARNINGS $14,724.26 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE $7,131.37 9. SUBTOTAL - RETAINAGE $21,855.63 10. SALES TAX PREVIOUSLY PAID $27,976.09 11. SALES TAX DUE THIS ESTIMATE $13,549.60 12. SUBTOTAL - SALES TAX $41,525.70 * (95% x LINE 1) *' (RETAINAGE: 5%) GRAND TOTAL: $478,638.30 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455170,018.594.34.63.000 # 3 $149,045.63 RETAINED AMOUNT (Line 8): *ACCOUNT # 6621292082 # 3 $7,131.37 * Escrow Number, Wells Fargo Bank, N.A. - Tacoma Business Banking TOTAL THIS ESTIMATE: $156,177.00 CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF Q Z PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DES CRIS HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID /A/�� OBLIGATION AGAINST THE CITY OF RE�:TON, AND THAT l AM 7 AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID CLAIM Signed: / Printed On: 08/09/2013 City of Renton Public Works Department Page 1 Printed On: 08/09/2013 City of Renton Public Works Department Page 1 Project President Park Water Main Replacement Project Contractor. Rodarte Construction, Inc. Rem Description No. Pay Estimate 3 Unit Est link Quantity _ Price 001. Mobl6zabon, Demobilization, Site Preparation & Clean-up Lump Sum 1 002 Traffic Control Lump Sum 1 003. Trench Excavation Safety Systems Lump Sum 1 004. Construction Surveying and Staking Lump Sum 1 As -Built Surveying for Progress Payments and Final As- 005. Builts Lump Sum 1 006. Temporary Erosion and Sedimentation Control Lump Sum 1 007. Site Specific Potholing Each 20 Furnish and install 8' Cl 52 01 Water Pipe & Fittings vd 000. Polywrap Lineal Foot 4210 009, Furnish and Install 8' Gate Valve Assembly Each 28 010. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 30 011. Fumish and Install Fire Hydrant Assembly Each 5 012. Furnish 8 Install 1" Water Service Connection Each 69 013. Furnish & Install 2' Water Service Connection Each 1 014. Connection to Existing Water Main Each 8 015. Cut, Cap, and Block Existing Water Main Each 1 Removal and Replacement of Unsuitable Foundation 016. Material Ton 150 017. Select Imported Trench Backfill Ton 1100 Crushed Surfacing Top Course, Crushed Rock Backfill, 018. Crushed Rock for Shoulder Restoration Ton 1150 019. 2" Temporary Cold Mix Asphalt Trench Patching Ton 360 020. H.MA. Class %" PG 64-22 for Roadway Reconstruction Ton 720 021. Removal and Replacement of Concrete Curb and Gutler Lineal Foot 250 022, Concrete Driveway and/or Sidewalk Restorat on Square -Yard 100 023. Property 8 Landscape Restoration Lump Sum 1 Subtotal 9.5% Sales Tax TT Total $34.000.00 $25,000.00 $500.00 55,000.00 $800.00 $1.200.00 $250.00 $61.00 $1,000.00 $300.00 $4,200.00 $1,200.00 $3,800.00 $2.500.00 $1,000.00 $32.00 $12.00 j $20.00 $100.00 $115.00 $20.00 $42.00 i $6.500.00 Contract Number, CAG-13-044 Closing Date: 08/092013 Previous Previous This Quantity Amount Quantity 0.75 $25,500.00 020 $5.000.00 1.00 $500.00 1.00 55,000.00 0.00 $0.00 0.00 $0.00 10.00 $2.500.00 3509.00 $214,049.00 19.00 $191000.00 1.50 $450.00 2.00 $8,400.00 4.00 $4,800.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 88.06 $1.76120 75.25 $7,525.00 0.00 $0.00 0.00 $0.00 0.00 50.00 0.00 30.00 $294.485.20 $27.976.09 $322,461.29 This Total Total Amount Quantity Amour 0.00 $0.00 0,75 $25,500.00 0.07 $1,750.00 027 $6,750.D0 0.00 $0.00 1.00 5500.00 0.00 $0.00 1.00 $5,000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 2.00 $500.00 12.00 $3,000.00 701.00 542,761.00 4210,00 $256,810.D0 2.00 $2.000.00 21.00 $21.000.00 2.50 $750.00 4.00 $1,200.00 1.25 $5.250.00 3.25 $13.650.00 65.00 $78,000.00 69.00 $82.800.00 1.00 $3,800.00 1.00 $3,800.00 1.00 $2.500.00 1.00 $2,500.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 81.00 $972.00 81.00 $972.00 60.67 $1,213,40 148.73 $2,974.60 31.31 $3,131.00 106.56 $10,556.00 0.00 $0 00 0.00 $0.00 coo $0 00 0.00 50.00 0 0^ 50 00 0.00 $0.00 0.00 $0.00 0.00 $0.00 $142,627.40 $13,549.60 $156,177.00 $437.112.60 $41,525.70 $478,638.30 12t'A Au ) `t, 2.013 9191/3 TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: Rodarte Construction, Inc. CONTRACT NO. # CAG-13-044 PO#18/0001862 ESTIMATE NO. 4 PROJECT: President Park Water Main Replacement Project 1. CONTRACTOR EARNINGS THIS ESTIMATE $226,411.80 2. SALES TAX @ 9.50% $21,509.12 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $247,920.92 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $415,256.97 5. EARNINGS DUE CONTRACTOR THIS ESTIMATE $215,091.21 6. SUBTOTAL - CONTRACTOR PAYMENTS $630,348.18 7. RETAINAGE ON PREVIOUS EARNINGS $21,855.63 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE $11,320.59 9. SUBTOTAL - RETAINAGE $33,176.22 10. SALES TAX PREVIOUSLY PAID $41,525.70 11. SALES TAX DUE THIS ESTIMATE $21,509.12 12. SUBTOTAL - SALES TAX $63,034.82 " (95% x LINE 1) " (RETAINAGE: 5%) GRAND TOTAL: $726,559.22 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455170.018.594.34.63.000 # 4 $236,600.33 RETAINED AMOUNT (Line 8): *ACCOUNT # 6621292082 # 4 $11,320.59 Escrow Number, Wells Fargo Bank, N.A. - Tacoma Business Banking TOTAL THIS ESTIMATE CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHORIZED TO AUTHENTICAT AND CERTIFY TO SAID CLAIM �' / Signed: Ci:t �'►ISYtil,t/ 5 / $247, 920.92 r Printed On: 09/09/2013 City of Renton Public Works Department Page 1 Printed On: 09/09/2013 City of Renton Public Works Department Page 1 Project President Park Water Main Replacement Project Contractor. Rodarte Construction, Inc. Item Description Contract Number: CAG-13-044 Pay Estimate 4 Closing Date: 09/042013 Unit Est Unit Previous Previous This Quantity Price Quantity Amount Quantity 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 002. Traffic Control Lump Sum 1 003. Trench Excavation Safety Systems Lump Sum 1 004. Construction Surveying and Staking Lump Sum 1 As -Built Surveying for Progress Payments and Final As- 005. Bulls Lump Sum 1 006. Temporary Erosion and Sedimentation Control Lump Sum 1 007. Site Specific Potholing Each 20 Furnish and Install 8" Cl 52 DI Water Pipe & Fittings w/ 008. Polywrap Lineal Foot 4210 009. Furnish and Install 8" Gate Valve Assembly Each 28 010. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 30 011. Furnish and Install Fire Hydrant Assembly Each 5 012. Furnish & Install 1" Water Service Connection Each 69 013. Furnish & Install 2" Water Service Connection Each 1 014. Connection to Existing Water Main Each 8 015. Cut, Cap, and Block Existing Water Main Each 1 Removal and Replacement of Unsuitable Foundation 016. Material Ton 150 017. Select Imported Trench Backfill Ton 1100 Crushed Surfacing Top Course, Crushed Rock Backfill, 018. Crushed Rock for Shoulder Restoration Ton 1150 019. 2" Temporary Cold Mix Asphalt Trench Patching Ton 360 020. H.M.A. Class %" PG 64-22 for Roadway Reconstruction Ton 720 021. Removal and Replacement of Concrete Curb and Gutter Lineal Fool 250 022. Concrete Driveway and/or Sidewalk Restoration Square -Yard 100 023. Property & Landscape Restoration Lump Sum 1 Subtotal 9.5 % Sales Tax TT Total $34,000.00 $25,000.00 $500.00 $5,000.00 $800.00 $1,200.00 $250.00 $61.00 $1,000.00 $300.00 $4,200.00 $1,200.00 $3,800.00 $2,500.00 $1,000.00 $32.00 $12.00 $20.00 $100.00 $115 00 $20.00 $42.00 $6,500.00 This Total Total Amount 0.75 $25.500.00 0.25 $8,500.00 1.00 $34,000.00 0.27 $6,750.00 0.73 $18,250.00 1.00 $25.000.00 1.00 $500.00 0.00 $0.00 1.00 $500.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 1.00 $1,200.00 1.00 $1,200.00 12.00 $3,000.00 8.00 $2,000.00 20.00 $5,000.00 4210.00 $256,810.00 0.00 $0.00 4210.00 $256,810.00 21.00 $21,000.00 7.00 $7,000.00 28.00 $28,000.00 4.00 $1.200.00 26.00 $7,800.00 30.00 $9,000.00 3.25 $13,650.00 3.75 $15,750.00 7.00 $29,400.00 69.00 $82,800.00 1.00 $1,200.00 70.00 $84,000.00 1.00 $3,800.00 0.00 $0.00 1.00 $3,800.00 1.00 $2,500.00 7.00 $17,500.00 8.00 $20,000.00 0.00 $0.00 1,00 $1,000.00 1.00 $1,000.00 0.00 $0.00 81.00 $2,592.00 81.00 $2,592.00 81.00 $972.00 0.00 $0.00 81.00 $972.00 148.73 $2,974.60 965.75 $19,315.00 1114.48 $22,289.60 106.56 $10,656.00 32.82 $3,282.00 139.38 $13,938.00 0.00 $0.00 955.12 $109.838.80 955.12 $109.838.80 0.00 $0.00 188.00 $3,760.00 188.00 $3.760.00 0.00 $0.00 22.00 $924.00 22.00 $924 00 0.00 $0.00 1.00 $6,500.00 1.00 $6,500.00 $437,112.60 $226,411.80 $663,524.40 $41,525.70 $21,509.12 $63,034.82 $478,638.30 $247,920.92 $726,559.22 AGENDA BILL SCHED AGENDA BILL TITLE PREPARED BY: ICI Extension: DEADLINE/DATE ACTION �S/ GREGG'S SIGNATURE 4 .3 P l TRANSMIT TO CLERK VIA Electronic Agenda Bill Process COUNCIL MEETING DATE Referred Committee COMMITTEE MEETING DATE COMMITTEE Time: Place: COUNCIL MEETING REPORTED OUT USA\17\Misc Form s\AB-Sched u le\tp 14 CITY OF RENTON COUNCIL AGENDA BILL Al #: Submitting Data: Public Works For Agenda of: Dept/Div/Board.. Utility Systems/Water Utility April 7, 2014 Agenda Status Staff Contact....... Andrew Weygandt, x7208 Consent ................ X Public Hearing...... Subject: Final Pay Estimate — CAG-13-044 (WTR-27-3638) Correspondence... President Park Water Main Replacement Project Ordinance............ Resolution............ Old Business......... New Business....... Exhibits: Pay Estimate #5 (Final) Study Sessions...... Notice of Completion of Public Works Contract Information.......... Recommended Action: Approvals: Council Concur Legal Dept.......... Finance Dept...... X Fiscal Impact: Expenditure Required... $8,139.35 (final pay est. only) Transfer/Amendment....... Amount Budgeted........ $8,200.00 (final pay est. only) Revenue Generated......... Total Project Budget..... $1,000,000 (Acct.425/455170) City Share Total Project.... 100% SUMMARY OF ACTION: On April 15, 2013, Council awarded the construction contract to Rodarte Construction, Inc. Construction started on May 28, 2013, and the project was completed on September 30, 2013. The original contract amount was $733,003.95 and the final contract amount is $734,698.57. The increase in contract amount of $1,694.62 was due to additional pavement restoration beyond the amount shown on the original engineering drawings. The project was completed on schedule and within the amount budgeted. The final pay estimate and project closeout was delayed until the contractor submitted as -built drawings. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate in the amount of $8,139.35, and release the retainage bond after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WTR - Drinking Water Utility\WTR-27 - Water Project Files\W7R-27-3638 President Park Main Replacement\Construction Contract\WTR-27-3638_agenda-bill-final-payment.doc\AWtp TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: Rodarte Construction, Inc. CONTRACT NO. # CAG-13-044 PO#18/0001862 ESTIMATE NO. 5 (Final) PROJECT: President Park Water Main Replacement Project 1. 2. 3. CONTRACTOR EARNINGS THIS ESTIMATE SALES TAX @ 9.50% TOTAL CONTRACT AMOUNT THIS ESTIMATE $7,433.20 $706.15 $8,139.35 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $630,348.18 5. EARNINGS DUE CONTRACTOR THIS ESTIMATE $7,061.54 6. SUBTOTAL - CONTRACTOR PAYMENTS $637,409.72 7. RETAINAGE ON PREVIOUS EARNINGS $33,176.22 8. *` RETAINAGE ON EARNINGS THIS ESTIMATE $371.66 9. SUBTOTAL - RETAINAGE $33,547.88 10. SALES TAX PREVIOUSLY PAID $63,034.82 11. SALES TAX DUE THIS ESTIMATE $706.15 12. SUBTOTAL - SALES TAX $63,740.97 (95% x LINE 1) `* (RETAINAGE: 5%) GRAND TOTAL: $734,698.57 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455170.018.594.34.63.000 # 5 $7,767.69 RETAINED AMOUNT (Line 8): *ACCOUNT # 6621292082 # 5 $371.66 * Escrow Number, Wells Fargo Bank, N.A. - Tacoma Business Banking TOTAL THIS ESTIMATE: $8,139.35 CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHORIZED TO AUTHENTICATEA�CERT�TO SA/%ID��C,,L_,,AIIM / Signed: �9�6 41J v4ham 75 , 1 y' IIA Ck ( JA .2 0 Printed On: 03/20/2014 City of Renton Public Works Department Page 1 Printed On: 03/20/2014 City of Renton Public Works Department Page 1 Project: President Park Water Main Replacement Project Contractor: Rodarte Construction, Inc. Item Description No. Contract Number: CAG-13-044 Pay Estimate 5 (Final) Closing Date: 03/25/2014 Unit Est. Unit Previous Previous This Quantity Price Quantity_ Amount Quantity 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $34,000.00 002. Traffic Control Lump Sum 1 - $25,000.00 003. Trench Excavation Safety Systems Lump Sum 1 $500.00 004. Construction Surveying and Staking Lump Sum 1 $5,000.00 As -Built Surveying for Progress Payments and Final As- 005. Builts Lump Sum 1 $800.00 006. Temporary Erosion and Sedimentation Control Lump Sum 1 $1,200.00 007. Site Specific Potholing Each 20 $250.00 Furnish and Install 8" Cl 52 DI Water Pipe & Fittings w/ 008. Polywrap Lineal Foot 4210 $61.00 009. Furnish and Install 8" Gate Valve Assembly Each 28 $1,000.00 010* Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 30 $300.00 011. Furnish and Install Fire Hydrant Assembly Each 5 $4,200.00 012. Furnish & Install 1" Water Service Connection Each 69 $1,200.00 013. Furnish & Install2" Water Service Connection Each 1 $3,800.00 014. Connection to Existing Water Main Each 8 $2,500.00 015. Cut, Cap, and Block Existing Water Main Each 1 $1,000.00 Removal and Replacement of Unsuitable Foundation 016, Material Ton 150 $32.00 017. Select Imported Trench Backfill Ton 1100 $12.00 Crushed Surfacing Top Course, Crushed Rock Backfill, 018. Crushed Rock for Shoulder Restoration Ton 1150 $20.00 019. 2" Temporary Cold Mix Asphalt Trench Patching Ton 360 $100.00 020. H.M.A. Class Yi" PG 64-22 for Roadway Reconstruction Ton 720 $115.00 021. Removal and Replacement of Concrete Curb and Gutter Lineal Foot 250 $20.00 022. Concrete Driveway and/or Sidewalk Restoration Square -Yard 100 $42.00 023. Property & Landscape Restoration Lump Sum 1 $6,500.00 Subtotal 9.5 % Sales Tax TT Total This Total Total 1.00 $34.000.00 0.00 $0.00 1.00 $34,000.00 1.00 $25.000.00 0.00 $0,00 1.00 $25,000.00 1.00 $500.00 0.00 $0.00 1.00 $500.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 0.00 $0.00 1,00 $800.00 1.00 $800.00 1.00 $1,200.00 0.00 $0.00 1.00 $1,200.00 20.00 $5,000.00 0.00 $0.00 2000. $5,000.00 4210.00 $256,810.00 0.00 $0.00 4210.00 $256,810.00 28.00 $28,000.00 0.00 $0.00 28.00 $28,000.00 30.00 $9,000.00 0.00 $0.00 30.00 $9.000.00 7.00 $29,400.00 000 $0.00 7.00 $29,400.00 70,00 $84.000.00 0.00 $0.00 70.00 $84,000.00 1.00 $3.800,00 0.00 $0.00 1.00 $3.800.00 8.00 $20,000.00 0,00 $0.00 8.00 $20,000.00 1.00 $1,000.00 0,00 $0.00 1.00 $1,000.00 81.00 $2,592.00 0.00 $0.00 81,00 $2,592.00 81.00 $972.00 0.00 $0.00 81.00 $972.00 1114.48 $22,289.60 0.00 $0.00 1114.48 $22,289.60 139.38 $13,938.00 0.00 $0.00 139.38 $13,938.00 955.12 $109,838.80 57.68 $6,633.20 1012.80 $116,472.00 188.00 $3,760.00 0,00 $0.00 188.00 $3,760.00 22.00 $924.00 0.00 $0.00 22.00 $924,00 1.00 $6,500.00 0.00 $0.00 1.00 $6,500.00 $663,524.40 $7,433.20 $670,957.60 $63,034.82 $706.15 $63,740.97 $726,559.22 $8,139.35 $734.698.57 %/� (A q,r-LA o , 2-019 ST ATt, s. f � ly. H� tew9a` NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Name & Address of Public A2encv I City of Renton 1055 S. Grady Way Renton, WA 98057 UBI Number: 177000094 Contractor's UBI Number: 600264803 Date: 03/25/2014 Assigned to: Date Assigned: Use Notice is hereby given relative to the completion of contract or project described below Project Name Contract Number Job Order Contracting President Park Water Main Replacement Project CAG-13-044 ❑ Yes ❑x No Description of Work Done/Include Jobsite Address(es) Installation of 4,200 linear feet of 8-inch diameter ductile iron water pipe, fittings, valves, and fire hydrants for the City of Renton's President Park neighborhood in the vicinity of Olympia Ave NE and NE 12th Street. Federally funded road transportation project? ❑ Yes V No Contractor's Name Telephone Number Affidavit ID* Rodarte Construction, Inc. 1(253) 939-0532 Contractor Address 17 E. Valley Way E Auburn, WA 98092-5531 If Retainage is Bonded, List Surety's Name (or attach a copy) Surety Agent's Address Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted April 15, 2013 May 28, 2013 September 27, 2013 September 30, 2013 Contract Amount $ 669,410.00 Additions ( +) $ 1,547.60 Reductions (-) $ Sub -Total $ 670,957.60 Amount of Sales Tax Paid at 9.5 (if various rates apply, please send a breakdown) $ 63,740.97 TOTAL $ 734,698.57 NOTE: These two totals must be equal Please List all Subcontractors and Sub -tiers Below: Liquidated Damages $ Amount Disbursed $ Amount Retained $ 701,150.69 33,547.88 TOTAL $ 734,698.57 Subcontractor's Name: UBI Number: (Required) Affidavit ID* Ground Up Road Construction, Inc. 602790246 Corliss Resources, Inc. 602237779 Lloyd Enterprises, Inc. 171004642 F215-038-000 07-2012 REV 31 0020e (07/06/12) Continued on page 2 Please •List all Subcontractors and Sub -tiers Below: Subcontractor's Name: IUBI Number: (Required) lAffidavit ID* I Comments Contact Name: Natalie Wissbrod Title: Accounting Assistant Email Address: nissbrod@rentonwa.gov Phone Number: 425-430-6919 Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Affidavit ID* - Provide known ones at this time. No LNI release will be granted until all affidavits are completed. Submitting Form: Please submit the completed form to all three agencies below. For a faster response, please submit by e-mail. Washington State A& Department of Revenue Public Works Section PO Box 47474 Olympia WA 98504-7474 (360)725-7588 FAX (360) 664-4159 PWC@dor.wa.gov Washington State ( Department of Labor and Industries ♦ Contract Release PO Box 44274 Olympia, WA 98504-4272 (360)902-5772 FAX (360) 902-6897 ContractRelease@lni.wa.gov MWashington State Employment Security Department Registration, Inquiry, Standards & Coordination Unit PO Box 9046 Olympia WA 98507-9046 (360)902-9450 Fax (360) 902-9287 publicworks@esd.wa.gov For tax assistance or to request this document in an alternate format, visit http://dor.wa.gov or call 1-800-647-7706. Teletype (M) users may call (360) 705-6718. F215-038-000 07-2012 REV 31 0020e (07/06/12) CITY OF RENTON COUNCIL AGENDA BILL Al #: Submitting Data: Public Works For Agenda of: Dept/Div/Board.. Utility Systems/Water Utility April 7, 2014 Staff Contact....... Andrew Weygandt, x7208 Agenda Status Consent ................ X Subject: Public Hearing...... Final Pay Estimate — CAG-13-044 (WTR-27-3638) Correspondence._. President Park Water Main Replacement Project Ordinance........... Resolution... DATE: Old Business .... N E 'NI -A Exhibits: New Busine + Pay Estimate #5 (Final) Study Sessioi is.. Notice of Completion of Public Works Contract Information.... Recommended Action: Approvals: Council Concur Legal Dept.......... Finance Deot...... X Fiscal Impact: Expenditure Required... $8,139.35 (final pay est. only) Transfer/Amendment....... Amount Budgeted........ $8,200.00 (final pay est. only) Revenue Generated......... Total Project Budget..... $1,000,000 (Acct.425/455170) City Share Total Project.... 100% SUMMARY OF ACTION: On April 15, 2013, Council awarded the construction contract to Rodarte Construction, Inc. Construction started on May 28, 2013, and the project was completed on September 30, 2013. The original contract amount was $733,003.95 and the final contract amount is $734,698.57. The increase in contract amount of $1,694.62 was due to additional pavement restoration beyond the amount shown on the original engineering drawings. The project was completed on schedule and within the amount budgeted. The final pay estimate and project closeout was delayed until the contractor submitted as -built drawings. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate in the amount of $8,139.35, and release the retainage bond after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WTR - Drinking Water Utility\WTR-27 - Water Project Files\WTR-27-3638 President Park Main Replacement\Construction Contract\WTR-27-3638_agenda-bill-final-payment.doc\AWtp G abouttlank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Document 3/24/2014 Intent 568969 Affidavit 505237 Affidavit Approved Received Date Id Id Status on 3/25/2014 Your Company Information Name Address Contractor Registration no. Industrial Insurance Account Id Email Address Filed By Project Information Awarding agency: Awarding agency contact: Awarding agency contact phone number: Project Details Project name County where work was performed RODARTE CONSTRUCTION INC 17 EAST VALLEY HWY E AUBURN, W A, 98092 600264803 RODARI*225D9 38860100 aprit@rodarteconstruction.com Rodarte,April RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Andrew Weygandt 425-430-7208 President Park Water Main Replacement Project Ki ng aboutblank 114 4/2/14 about: blank City where work was performed Renton 0 Job site address/directions: Prime contractor name Prime contractor registration no Contract no. Prime contractor Phone Number Prime contractor Intent form Id# for this project Dollar amount of your contract: Bid due date Contract award date Intent filed date Job start date:MM-DD-YYYY Date work completed: MM-DD-YYYY Project Completion Monroe Ave NE and Olympia Ave NE and Pierce Ave NE from NE 11th PL to NE 10th PL RODARTE CONSTRUCTION INC RODARI*225D9 CAG-13-044 253-939-0532 568969 $ 733,003.95 4/9/2013 4/15/2013 5/10/2013 5/20/2013 10/24/2013 Did your subcontractors perform all work No on this project? Did your company hire any subcontractors? Yes Did your company have employees perform Yes work on this project? Did this project utilize American Recovery No and Reinvestment Act (ARRA) funds? Specifically, did this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Is the prime contract at a cost of over one No million dollars ($1,000,000)? Company Owner Information How many owner/operators performed 0 work on the project that own 30% or more of the company? 2/4 4/2/14 aboutblank i No company owner added. Affidavit Subcontractor(s) Company Name UBI License# CORLISS RESOURCES INC 602237779 CORLIR1880JZ LLOYD ENTERPRISES, INC 171004642 LLOYDI.238QB GROUND UP ROAD CONST INC 602790246 GROUNUR929CR Journeylevel Wages # # County Trade Occupation Wages Fringes Workers Hours King Flaggers Journey Level 32.86 1.75 5 342.50 King Laborers - General Laborer 39.08 1.75 8 857.50 Underground Et Topman Sewer Et Water King Laborers - Pipe Layer 39.84 1.75 1 240.00 Underground Sewer Et Water King Power Loaders, Plant 49.65 1.75 2 122.00 Equipment Feed Operators - Underground Sewer Et Water King Power Roller, Other 46.87 1.75 1 18.00 Equipment Than Plant Mix Operators - Underground Sewer Et Water King Power Shovel, 49.65 1.75 6 894.50 Equipment Excavator, Operators- Backhoes, Underground Tractors: 15 To Sewer Et Water 30 Metric Tons King Truck Drivers Dump Truck Et 46.16 1.75 6 147.00 Trailer King Truck Drivers Dump Truck (W. 45.32 1.75 5 73.25 WA -Joint Council 28) abouttlank 3/4 4/2/14 Apprentice Wages abouttlank Public Notes r=E Show/Hide Existing Notes No note exists about: blank 4/4 about: blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: 5/10/2013 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Fi led By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact Intent ID: Affidavit ID: Status: Approved On 568969 5/15/2013 RODARTE CONSTRUCTION INC 17 EAST VALLEY HW Y E AUBURN, WA, 98092 RODARI*225D9 600264803 253-939-0532 388,601-00 apri[@rodarteconstruction.com Rodarte, April RODARTE CONSTRUCTION INC RODARI*225D9 600264803 253-939-0532 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Andrew Weygandt 1/3 3I20114 about: blank Awarding Agency Contact Phone Number 425-430- 7208 Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: Intent Details CAG-13-044 President Park Water Main Replacement Project $733,003.95 4/9/2013 4/15/2013 Monroe Ave NE and Olympia Ave NE and Pierce Ave NE from NE 11th PL to NE 10th PL 103918864 Expected project start date: (MM-DD-YYYY) 5/20/2013 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $733,003.95 a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY Yes subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? about: blank 2/3 3120/14 abouttlank Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Journey Level Wages County Trade Occupation Wage Fringe # Wo rkers King King King King King King King King King Flaggers Journey Level $32.86 $1.75 4 Laborers - Underground Sewer General Laborer Et Topman $39.08 $1.75 2 Et Water Laborers - Underground Sewer Pipe Layer $39.84 $1.75 Et Water Power Equipment Operators- Loaders, Plant Feed $49.65 $1.75 Underground Sewer Et Water Power Equipment Operators- Roller, Other Than Plant Mix $46.87 $1.75 Underground Sewer Et Water Power Equipment Operators- Shovel , Excavator, Backhoe, $49.23 $1.75 Underground Sewer Et Water Tractors Under 15 Metric Tons. Power Equipment Operators- Shovel, Excavator, Backhoes, $49.65 $1.75 Underground Sewer Et Water Tractors: 15 To 30 Metric Tons Truck Drivers Dump Truck Et Trailer $46.16 $1.75 Truck Drivers Dump Truck (W. WA -Joint $45.32 $1.75 Council 28) Public Notes -. Show/Hide Existing Notes No note exists 2 2 2 2 2 4 4 about: blank 3/3 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: 8/23/2013 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Fi led By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact Intent ID: Affidavit ID: Status: Approved On 589625 8/27/2013 GROUND UP ROAD CONST INC PO BOX 1690 MILTON, WA, 98354 GROUNUR929CR 602790246 253-677-5594 915, 605-05 susan@grndup.com Stultz, Susan RODARTE CONSTRUCTION INC RODARI*225D9 600264803 253-939-0532 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Andrew Weygandt 3/20114 about blank Awarding Agency Contact Phone Number 425-430-7208 Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: Intent Details CAG-13-044 President Park Water Main Replacement Project $733,003.95 4/9/2013 4/15/2013 Monroe Ave NE and Olympia Ave NE and Pierce Ave NE from NE 11th PL to NE 10th PL 104041993 Expected project start date: (MM-DD-YYYY) 8/22/2013 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this Time and materials a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY No subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? about.blank 2,3 3/20'14 about: blank Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages RODARTE CONSTRUCTION INC RODARI*225D9 600264803 County Trade Occupation King Power Equipment Operators Roto-mill, Roto-grinder Public Notes Show/Hide Existi No note exists Notes Wage Fringe # Workers $46.88 $4.52 2 about:blank 313 312014 about blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: 9/6/2013 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Fi led By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact about blank Intent ID: Affidavit ID: 502889 Status: Approved On 592182 9/11/2013 CORLISS RESOURCES INC 16805 64TH ST E SUMNER, WA, 98390 602237779 253-845-6983 041,114-07 cbettamy@cortissresources.com Bellamy, Candice RODARTE CONSTRUCTION INC RODARI*225D9 600264803 253-939-0532 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Andrew Weygandt V3 3/20/ 14 about:blank r Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: 425-430-7208 CAG-13-044 President Park Water Main Replacement Project $733, 003.95 4/9/2013 4/15/2013 Monroe Ave NE and Olympia Ave NE and Pierce Ave NE from NE 11th PL to NE 10th PL 104057227 Intent Details Expected project start date: (MM-DD-YYYY) 8/19/2013 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this Time and materials a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY No subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? about: blank 3/20 14 about:blank Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages County Trade King Truck Drivers Public Notes - Show/Hide Existing Notes No note exists RODARTE CONSTRUCTION INC RODARI*225D9 600264803 Occupation Wage Fringe # Workers Transit Mixer $35.55 $7.68 10 about: blank 3/ 3 3/20114 ahouthlank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: 9/16/2013 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Filed By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact about: blank Intent ID: Affidavit ID: Status: Approved On 593862 9/18/2013 LLOYD ENTERPRISES, INC PO BOX 3889 FEDERAL WAY, WA, 98063 LLOYDI*238QB 171004642 253-874-6692 256,406-00 LUANND@LLOYDENTERPRISESINC. COM DAVIS, LUANN RODARTE CONSTRUCTION INC RODARI*225D9 600264803 253-939-0532 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Andrew W eygandt 1/3 3/20/ 14 about:blank Awarding Agency Contact Phone Number 425-430-7208 Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: Intent Details CAG-13-044 President Park Water Main Replacement Project $733,003.95 4/9/2013 4/15/2013 Monroe Ave NE and Olympia Ave NE and Pierce Ave NE from NE 11th PL to NE 10th PL 104067583 Expected project start date: (MM-DD-YYYY) 6/28/2013 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be RENTON performed? What is the estimated contract amount? OR is this Time and materials a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY No subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? about: blank 2/3 3/20/14 abouttlank Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name RODARTE CONSTRUCTION INC Contractor Registration No. RODARI*225D9 WA UBI Number 600264803 Journey Level Wages County Trade King Laborers King Laborers King Power Equipment Operators King Power Equipment Operators King Truck Drivers King Truck Drivers Occupation General Laborer Raker - Asphalt Roller, Other Than Plant Mix Roller, Plant Mix Or Multi -lift Materials Dump Truck (W. WA -Joint Council28) Dump Truck Et Trailer # Wage Fringe Wo rkers $35.32 $5.51 2 $36.60 $5.51 1 $42.44 $6.18 1 $44.80 $6.18 1 $41.49 $5.58 2 $42.33 $5.58 1 Public Notes Show/Hide Existing Notes -- On 9/16/2013:-- The general laborer will be manually digging and spreading materials with hand shovels. LEI#263613 abouttlank 3/3 3/20/14 .14 about blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Document 3/7/2014 Intent 592182 Affidavit 502889 Affidavit Approved Received Date Id Id Status on 3/10/2014 Your Company Information Name Address 02%VI'-] Contractor Registration no. Industrial Insurance Account Id Email Address Filed By Project Information Awarding agency: CORLISS RESOURCES INC 16805 64TH ST E SUMNER,WA,98390 602237779 041,114-07 cbellamy@cortissresources.com Bellamy,Candice RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: Andrew Weygandt Awarding agency contact phone number: 425-430-7208 Project Details Project name County where work was performed President Park Water Main Replacement Project King about. blank 1/3 3/20/14 about: bIank City where work was performed Renton Job site address/directions: Monroe Ave NE and Olympia Ave NE and Pierce Ave NE from NE 11th PL to NE 10th PL Prime contractor name RODARTE CONSTRUCTION INC Prime contractor registration no. RODARI*225D9 Contract no. CAG-13-044 Prime contractor Phone Number 253-939-0532 Prime contractor Intent form Id# for this 568969 project Dollar amount of your contract: $ 3,689.84 Bid due date 4/9/2013 Contract award date 4/15/2013 Intent filed date 9/6/2013 Job start date:MM-DD-YYYY 8/19/2013 Date work completed:MM-DD-YYYY 9/3/2013 Project Completion Did your subcontractors perform all work No on this project? Did your company hire any No subcontractors? Did your company have employees Yes perform work on this project? Did this project utilize American No Recovery and Reinvestment Act (ARRA) funds? Specifically, did this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Is the prime contract at a cost of over No one million dollars ($1,000,000)? Company Owner Information How many owner/operators performed 0 about: blank 2/3 3/20/14 -1 abouttlank work on the project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation Wages Fringes King Truck Drivers Transit Mixer 35.55 7.68 Apprentice Wages Public Notes - Show/Hide Existing Notes No note exists Workers Hours 2 5.75 about: blank 3/3 r Escrow Number: LVI ' - t I .� { l ,1) IJ1 Agency: _ City of Renton Contract Number: CAG-13-044 Project Name: President Park Water Main Replacement Project RETAINED FUNDS ESCROW AGREEMENT TO: Wells FarRo Bank. N.A. Tacoma Business Banking Attn: Marsha Bums, Vice President Phone: 253-593-5422 1210 Pacific Ave., 3rd Floor Tacoma, WA 98402 The undersigned, Rodarte Construction, Inc. , hereinafter referred to as the Contractor, has directed the City of Renton , hereinafter referred to as the City, to deliver to you its checks, which shall be payable to you and the Contractor jointly. Such checks are to be held and disposed of by you in accordance with the following instructions and upon the terms and conditions hereinafter set forth. INSTRUCTIONS The City shall deliver to you from time to time checks payable jointly to you and the Contractor. You are hereby authorized by the Contractor to endorse in the Contractor's name any such check so that you may receive the proceeds thereof and invest the same. The power of endorsement hereby granted to you by the Contractor shall be deemed a power coupled with an interest and shall be irrevocable during the term of this escrow. Although you may be a payee named in such checks as shall be delivered to you, your duties and responsibilities with respect to the same shall be only those duties and responsibilities which a depository bank would have pursuant to Article 4 of the Uniform Commercial Code of the State of Washington for an item deposited with it for collection as of the date such check shall be delivered to you. The proceeds from collections shall be used by you to purchase, as directed by the City, bonds or other securities chosen by the City on behalf of the Contractor and approved by you. For the purpose of each such purchase, you may follow the last written direction received by you from the City, provided such direction otherwise conforms with the restrictions on investments recited herein. Attached Addendum A is a list of such bonds, or other securities approved by the City. No further approval is necessary if any of these bonds or securities is selected by the City. Other bonds or securities, except stocks, may be selected by the City, subject to express written approval by you. Purchase of such bonds or other securities shall be in a form, Escrow Agreement for Retained Funds Page 1 of 4 i which shall allow you alone to reconvert such bonds or other securities into money, if you are required to do so by the City as provided in paragraph 4 of this escrow agreement. The investments selected by the City, and purchased by you must mature on or prior to the date set for the completion of the contract, including extensions thereof or thirty days following the final acceptance of said improvement of work. 2. You are not authorized to deliver to the Contractor all or any parts of the securities held by you pursuant to this agreement (or any monies derived from the sale of such securities, or the negotiation of the City's checks) except in accordance with written instructions from the City. The City shall inform you and keep you informed in writing of the name of the person or persons with authority to give you such written instructions. Compliance with such instructions shall relieve you of any further liability thereto. The estimated completion date on the contract underlying this Escrow Agreement is September 30, 2013 . Upon request by you, the City shall advise you in writing of any change in estimated completion date. If the estimated completion date is changed, you are authorized to reinvest the monies hereunder in accordance with the new estimated completion date. 3. In the event the City orders you to do so in writing, and withstanding any other provisions of this Agreement, you shall, within thirty-five (35) days of receipt of such order, reconvert into money the securities held by you pursuant to this agreement and return such money together with any other monies, including accrued interest on such securities, held by you hereunder, to the City. 4. The City agrees to pay you as compensation for your services any reasonable cost for set-up of this escrow agreement: No payment required Payment of all additional fees shall be the sole responsibility of the Contractor and shall not be deducted from any property placed with you pursuant to this agreement until and unless the City directs release to the Contractor of the securities and monies held hereunder whereupon you shall be granted a first lien upon such property released and shall be entitled to reimburse yourself from such property for the entire amount of your fees and any unanticipated amounts which might be owing as provided herein. In the event that you are made a party to any litigation with respect to the property held by you that you are inquired to render any services not provided for in these instructions, or the event that the condition of the escrow are not promptly fulfilled or that there is any assignment of interests of this escrow or any modification hereof, you shall be entitled to reasonable compensation for such extraordinary services from the Contractor and reimbursement from the Contractor for all costs and expenses, including attorney fees occasioned by such default, delay, controversy or litigation. Should you at any time and for any reason desire to be relieved of your obligations as escrow holder hereunder, you shall give written notice to the City and Contractor. The City and Contractor shall, within 20 days of the receipt of such notice jointly appoint a successor escrow holder and instruct you to deliver all securities and funds held hereunder to said successor. If you are notified of the appointment of the successor holder within 20 days, you may return the subject matter to the City and upon so doing, it absolves you from all further charges and obligations in connection with this escrow. Escrow Agreement for Retained Funds Page 2 of 4 r 6. This agreement shall not be binding until executed by the Contractor and City & accepted by you. 7. This instrument contains the entire agreement between you, the Contractor and the City with respect to this escrow and you are not a party to nor bound by any instrument or agreement other than this; you shall not be required to take notice of any default or any other matter, nor be bound by nor required to give notice or demand, nor required to take any action whatever except as herein expressly provided; you shall not be liable for any loss or damage not caused by your own negligence or willful misconduct. 8. The foregoing provisions shall be binding upon the assigns, successors, personal representatives and heirs of the parties hereto: The undersigned have read and hereby approve the instructions as given above governing the administration of this escrow and do hereby execute this agreement the Rodarte Construction Inc. (Contractor) 91-1016627 (Tax I.D. or Social Security Number) By: J JR Rodarte, President (Title) 17 East Valley j wy E (Address) Auburn, WA. 98092 (City, State, Zip) day of 2013. LIM (City) (Name and Title) Approved as to form: This above escrow instruction received and accepted thisday of , 2013. Wells Fargo Bank, N.A. 2 (Bank or.Tnrst Co an ) (Au orized Sign re) Escrow Agreement for Retained Funds Page 3 of 4 rr ESCROW AGREEMENT ADDENDUM A Investment deposits, including certificates of deposit, kti ith qualified public depositories are defined in Chapter 39.50 Revised Code of Washington. Certificates, notes, or bonds of the United States, or other obligations of the United Stations or its agencies, or of any corporation wholly owned by the government of the United States ( such as the Government National Mortgage Association.) Obligations of government -sponsored corporations which are eligible as collateral for advances to member banks as determined by the Board of Governors of the Federal Reserve System. ( These include but are not limited to Federal Home Loan Bank notes and bonds. Federal Farm Credit Bank, consolidated notes and bonds. Federal National Mortgage Association notes, debentures, and guaranteed certificates of Participation.) Bankers acceptances purchased on the secondary market. Escrow Agreement for Retained Funds Page 4 of 4 LAKESIDE INDUSTRIES, INC. i J r gc: I i u I t s Ta-rL —.—Hat. 'k'00 IRODUC, T MD I -QAj)- T 10 t/TODAY -21 V �),j Co.Nx. RL �R jj t .V\ 1, LA IIIII(JINMA %W HOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE LA K 1--%) 1 D I -* INI) k—STRI F.S, INC. ITE 0" KII Jq f F) I V JS I ON IL J, If I Nq f)ND LO(A) '1704f) L 7 I i \1 I WIN )JU I \1*1'i I XWI (61 It m V t L CONT. REG # LkKESI*274JD 0 OR. CCI3 V18542 HOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE } Li.,.;'i lJi"tf F; � i••[; "ilT<1'ifb f 1 GiJ 1 ritr rc .�r:�3 1.:I►'rfcl=f!trii Liti� T-Fa'r ca hies t. I L11) 1 1) ',ill•) 1 ); i�?,'r'!J rl (` rCONN'REG#1_;kI r ? IiOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE �):r �ii INDUSTRIES, I�.� . i I I Pli, .It It '-.I I ', FMPI.OYER ■ WA. ST. CONT. REG tt LAKESI'2'4JD ■ OR CCB :: ! HOT ASPHALT MATERIAL SAFELY DATA SHEE1 ON REVERSE KENT DIVISION WA 9804 T 4 o x Tru6e. r.L or Tave 2 72 3 0 1. h EPP!,, - 7471-' )00 12 3 41 Mg 37 llq tits.LY -. J.114LLlLy ny Company: 01 LLOYD ENTERPRISES, INC. Time:09:37 -------------------------------------------------------------------------------------- Customer Number: R0005 Telephone:(253)939-0532 Terms:10TH OF MO FDI RODARTE CONSTRUCTION INC Salesman : Tax Auth. 27 17 EAST VALLEY HWY E Credit Limit: 999,999 YTD Sales 408 Largest Bal: 138,586 YTD Pymnts: 0 AUBURN WA 98092 Date Of Bal.: 11/04/13 Last Pymnt: 12/23/13 Open Invoices: 11,928.59 On Account Amnt: 27.00(All Companies) Open Credits .00 Current Balance: 11,901.59 Open Invoice Date Job Number Gross Amount Payments Adjustments Balance -------------------------------------------------------------------------------------- O/A 12/23/13 .00 27.00 .00 27.00-(()) 173373 09/11/13 263613 94,291.41 82,124.27 2,547.58- 9,619.56 ifC�►G�tS 175195 11/14/13 267813 80.00 .00 .00 80.00 175205 11/13/13 MTP 0001 30.24 .00 .00 30.24 176235 01/14/14 MTP 0001 210.88 .00 .00 210.88 FCA02E 07/31/13 110.73 .00 .00 110.73 FCA02F 08/30/13 152.67 .00 .00 152.67 FCA030 09/30/13 44.31 .00 .00 44.31 FCA031 10/31/13 1,145.30 .00 .00 1,145.30 FCA032 11/30/13 240.89 .00 .00 240.89 FCA033 12/31/13 97.30 .00 .00 97.30 FCA034 01/31/14 97.30 .00 .00 97.30 FCA035 02/28/14 99.41 .00 .00 99.41 Current Over 30 Over 60 Over 90 Retention On Account 99.41 97.30 308.18 11,423.70 .00 27.00- (i) LAKESIDE INDUSTRIES, INC. KENT DIVISION 7icket #: RM39' 18808 SE 256th STRE Covj.ngton , WA 9t ate: 08/26/1� 253-631 ~� 3611 rJU[) 07 09 AM «** Silo 1 L d - -r-e--s-s-: 004343 D I 999 9P� Nme: Lloyd ,n Ic. P�RK A-I-ld)-d: P. 0. Box 3A89 NRAVE N� FIE", 109TH9 Federal Way, WA 980633A89 RENTON, WA Phone: 2538�46692 P00: Truck and Carrier Truck Weiahts ` U\l k ....Descript: 1 �] �D 105120 lb 39020 lb 66100 lb -- 52.56 Tn 19.51 Tn ' 33.05 Tn 47.68 Mg 17.70 Mg ' 29.98 Mg 0 lb -----Legal----' . ` 0 lb PRODUCT AND LOAD TOTALS Name: 1/2NMA 6422 33.05 Tn 43.01 Tn JMF#: 29.98 Mg 39.02 Mg Seal: 307 W.Ill aster: Rcv'd By: ~�r Load Total: 66100 -----'AN't{UAL MWA. uzC0Nt�6 41A, i��141b'w-bk.oB # 108542 �� LJ",ACOUAI'r&Rx`=O.". Q^==rV°",""u==rnw0=vCm*= LAKESIDE INDUSTRIES, INC. KENT DIVISION /'et #: �0�42� 18808 SE 256th STRE Covington Wr, Date: 08/26/1� ~ , | . 253-631 3611 a/ Y'i 09 24 *** Sio 1 _______________ ID: 004343 ID: _ ITEM 999999 Name: Lloyd Enterprises, Inc. Name: PARK Address: P. 0. Box 3839 Location MONROE AVE NE & NE 1011-1 P Federal Way, WA 980633889 RENTON, WA Phone: 25�8746692 PU#: _____ b�� _ __ _ Truck ID: L132T r= Mo Gross Tare. Met Descript: 1 i05320 lb 39020 lb 66300 lb �u" P�/ 52.66 Tn 19.51 Tn 3,:.15 Tn �-� 47.77 Mg 17.70 Mg 30.07 Mg 0 lb ---._----........................ -_-PR.0DwT.-ANQ0-L0AD-T.0TAL.S_................ ...... ......... -...................... ' ID: 127 ----.4/10PA0[ Name: 1/2HMA 6422 129.06 Tn 139.02 Tn JMF#: 117.08 Mg 126.12 Mg Seal: �07 W.Master:_ ...................... _................... ____ Rcv'd By:_ __ . _____ __ Load Total: 66300 mxs0nm'OPPORTUNITY EMPLOYER 6 WA. ozcoxTnEs# LAuESa~274Jo0OR. Coo# 1085* LAKESIDE INDUSTRIES,INC. VENT DIVISION Ticket #: 20852- �8808 SE 056�h SIRE Covingho�` , WA 9804 Date: 08/26/1�� 253-6131.... 3611 *** Silo 1 Loaduut *** ____ ID: 004343 Name: Lloyd Enterprises, Inc. Address: P. 0. Bmx 3889 Federal Way, WA 980633889 Phone: 2538746692 Truck and Carrier Information Truck IQ: L132T Descript: 1 ---, _ _,-------......... ... -...... ....... ......... ............... ......... II>: ITEM 999999 Name: PR[SlDEN� PARK ' Location MONRUE AVE NE & NE 10TH P KENTON, WA PO#: Truck Weights Gross Tare _ 105�20 lb 39020 lb 66000 lb 52.51 Tn 19.51 Tn 33.00 Tv-1 47'C� Mn 17.70 Mg 29.94 Mg Mpg noLegal---'- 0 lb 0UU IB: 127 IWTODAY II/TO DATE Name: 1/2HMA 6422 321.14 Tn 331.10 Tn JMF#: 291.33 Mg 300.3,7 Mg Seal: 307 W.Master: Rcv'd B �-�'__ _ . Load Total: 66000 ------��l��nj��ur�up�n�cn � x��sz��t�i��L��/�z�o� nu��o�mos�m LAKESIDE INDUSTRIES, INC. KENT DIVISION 18808 SE 256th STRE Covington , '')A 9804 Date: 08/26/1� 253-631-3611 Time: 12:13 P� Loadout *** ID: ` 004343 ID: IlEM 999999 Name: Lloyd Enterprises, �nc. Name: NT PARK ' Address: P. 0a Box 3889 Location MUNRDE AVE'NF & NE 1011-1 P Federal Way, WA 980633889 RENTON, WA ' Phone: 2538746692 ' PD#: __- ��[�_�l�fx�rm��t"1� -l[��@�� _......._ -. '[ruck IDo L1��T [�] � �� __ __ ___ '___04�rt_.__ Descript: l p� `|) 3g020 lb 66100 lb \n 19.51 Tn 33.05Tn 47.68 Mg 17.70 Mg 29.��8 Mg 0 lb .... .... ...... .... Legal-^ .... .... - 0`lb PRODUCT AND LOAD TOTALS ID: 127 ----��8�O��, '---'��l��']0�B[� Name: 1/2HMA 6422 224.99 Tn 234.95 Tn JMF#: 244.11 Mg 213.14 Mg Seal: 307 � � W.Master: d Load Total: ----musVrmopPORTuwo,-cmpmvFR MnA�srcnx�-nms#LAmRSj-274Jo-lff'o»z1rB #)08542 66100 HOT Amp*A/rMArpm/u/sAprrvnArun*FpromnrvFmnp INC. -----~'--^-INDUSTRIES, (l�)/ �u. .� .�ur= KENT DIVISION #: 298401 18808 SE 256th STm-, Covington , WA 9804 Date: 08/26/1� 253-631-3611 ' 7ime: 07:28 (-)IV *** 8ilo 1 ID: Name: Lloyd Ent' �nc.. Address: P. 0. Bo R, Q Federal |` U(/U Phone: 253874( Truck and Carrier Information Truck ID: L1W8t Descript: 1 ES KENTON, WA PO#: Truck Weiahts Gross Tare Halt 992lb 35680 lb 63540 lb 49.61 Tn 17.84 ln 31.77 Tn 45.M1 Mg 16.18 Mg 28.82 Mg 0 lb -----Legal----- 0 lb _PRODUCT AND LI 3/TO DATE Load Total: 63540 VAT. npPOnnMnrEMPLOYER N WK # 1085* U^'r°OMLI A''r"""'rM0'"` C"VC-k; k";r"eu�v-r ^M n=`P"nl-� LAKESIDE INDUSTRIES, INC. KENT DIVISION 1.860i:4 .:3€: ?5(:,J, 6w ':)t3o4 Da -{:Fa 08: %?;`.';::'s... (:.:31_... ;3E:,:1, :1 T':i.lr�c::• e :1.1. r. (��"? r'ctY CUSTOMER IWORMAT I ON ............ .... ...... . _ ................ ............,. 004::34:.3 c•- t�'ic:it:l i•i:�::»:: F�' i�)., %;t3ri ::3.':11�4 :� F ede-rixl. W-.-v, Wit �. _.._.. ijFp! i'iATION €''I(:)1.1N(:)(:: 1:)VL:. 1il::iaTi)h!y 6W) i::IO :: _Truck _.....................................................................................__ and Carrier Information .... _.......... , ........................ _ . T)CMg Weights_......._ .......... ...................._......: i �r� c.cc� 1��. :i: T} :: 1...1. t%)�il•i; � �rr�s� ri pt, :: I :1. M ` (�� '�17(,f0 I. L) .Tare 3.:.,t:,t:li:3 I la ..�...._..._.... UV�LStJ ►�� )•• i S:4 T 1'1 1. !„ 44 Tit .3i:.'.„ 04 ` 1--[ f:?:i I111A l.t:;„ :1.i:4 fYll:€, is?`::4,. i9"l' 1YIr:l 0 :1. 1:1 ........,........ I...eEA:l................_.. 0 :L L; _.........._......_,. ........ _._._.PRODUCT....AND....LOAD.. TOTALS............_ ... _...._._. _................ ._......._.. I: X} 1.,(.27 5/TODAY` ...... .................... ..__.......... 6/TO __.....__.. �_....__......__..__.... DATE N,.kme- 1/21-1110 161. 1,0 Tv) Tv) J'I1F*W: :146„ 1.5 Ivin :15r.":„ 18 Mg W. !Y€.-.I >-t e-v f:c:.'v'' d 1::4 l c;i:u:l l ca i;s:t:€. ;: (:,�4Q)�40 y •. AN EQUAL OPPORTUNITY EMPLOYER ■ WA. ST CONT. REG # L.AK SI.274JD ■ OR. CCB # 108542 HOT ASPHALT MATERIAL SAFFTY nATA SHFFT ON RFVFRSF LAKESIDE INDUSTRIES, INC. K.EMT DIVISION 208-q& :1.�5fJ08 S1:_ i�,:;G'!'.1'r F::: �;��v i.rz i;c31� ., W(a `it f=s l�: i:caw [:it3ri'r:;�':1.:: r 53....G:31 -13611. x x x ;:) :i.1. c) :I. L (w:ua (:xt't # )c x CUSTOMER INFORMATION _................._.._............_....._..............._.... _......... ...........__.._..........__.._.............. _.... _........ _....... _....... I�I��n�Fr I...1c)yci Way, Wfl 98r36,3:388`) INFORMATION ..... .._...... _ .._.... _._. . _.__._..._.............._...w-.m__............... ..... ... ...._......... .......... ..._.._............ I'Fil-�iJ:T)l:::I{r I::,f1Fil: I...�:�c zt:ic:)►� .:i::. (tVl: 1�IE:: & 1'li: I.i%13{I F•1 r ENI'01,1, WA _....Truck and Carrier. ,information Truck. Weights..._ ...... 4:..__......_......._......_...._._..._. ............................._......_..........-........._._......_.._........._...._ i'ru(:; k. T 1) :: 1-1. 0, 811; Gross Tare Met __...._..._..._._. .............-.._......_..,..._..._.....�.............. _... .... .._ 1Dc� )c 'r i l:> !; ; L i`�t,t=,ft :1. la :3;:fE,tSti) 1 . f:,::3` 8..0 11: ERncTr= MINL�DD A`:),. 813 '1 1.1 1.'7.. 1.14 -f n .:31... �:i9 �f•,..F 5.. 211 114 1.f ..:1.8 el 29. 0i? I*Icl 0 1. h ........ .._.... .... L ra tl al . ................. 0 1 b PRODUCT AND .. LOAD„_ TOTALS _......._....__..._......_...._...._....___..._..._..._.._....__...._............. ........ .......... ........ I DD : 1.27 8lTODAY 4/TO DATE Itl<amca s 1/21-111(l 64'r.ti.. f f :1Lr . `:3i:1 'Y'rl 266.. 94 '1'r) 1'IYI# 0 ; i::?::3,3. 113 Ill ;?42. 1...., Viol W.. rl<..%i-; I:F..''1' :........ ............_ ... P'c--v �, H 1?}l:................................ ..-......,. .....__.. L.(.)ad X (7tl."N , .. �.,............... .. .7 tCN EZUA PORTUNITY EMPLOYER ■ WA. ST. CONT. REG # LALKESI.2.4JD ■ OR. CCB # 108542 UAT ACDYAI T IIAATCDIAI CACCTV AATA CI.ICCT Akl DCVCDCC LAKESIDE INDUSTRIES, INC. KENT DIVISION T a.r f�.cat; # c'dSat 1.8808 #:;G.:: 2•`..i@: -Uh �;Ti;FW C(:)Vi.)')i1t;(:)rl , W(a 980/t •`l' i.m6: 0,3 w .:34 Ully ar**- CUSTOMER INFORMATION INFORMATION ........ ................. ........... ........ _.........._......__................_..........................__....._......._......._._...._....................... _._._........ _........_ ,............. �.ar:,.:3f,:i.:a 'f %111 91:`:?')�}`:) I�l�:�ri�F�,;; I...:1.rayil E::z){:ta•,-1,•e�i��,r>7 1:rtf�.. hlati7i•:�;; �:•.::<.�::'.:.I�1't' ,1��(�F41; ' '. �'�r.1 r1 .+°t:•ti r..l t:b%.' 1•<°.. 0., Dox 134,89 Iy(0F•iN0[:: CWE:: Ni . & HE. :1 0 41-4 P F(-.,der;A:1. WAY, WW'--)8 6,3.:38F+`::1 Ii'E::hal'f11�1., 44) Truck and, ..Carrier Information ........•........ .... ......... _............ .... ............ _...... ................. ....... T, v-u e f•f. :C T) 1.:.1. 08 ' . 1.7Ga Se -f` a. 1..) 1::: :1 LKI MR7 I ip - PCAl :: _....__ .. ......... _ . Truck Wei nht�::._........:.........:........._ ... ......... �...rnss..._.... _...... Tare .............. Net ........_.. 26. ir113 Tr) 1 P.. 10 I Yl T .) r":- e:..,.r .. F ::3 1"f i. 1. 0,. ?: 8 1'11:j E 4.. 4 Ili Ij 0 :1.1.) 0 JA-) ,f}RODUCT AND EGAD TOTALS 1:1) :: 127 I1/TODAY IPYTO DATE .._.._ ......_.__...� ._.........._............_..._ _ 3::P. 07 'T 1.1 ,"347.. 03 'T"n .3:1.4.8P ip1r.1 L,k:�A :I.. ::30 r '� r �., W. hl�A.:>i,e'('v -EQUf LOP VT .:iPLOYER ■ WA: ST'CONT. RFG ## LAKf:SI*274JD ■ OR. CCB # 108542 PHAI T MATFRIAl RAFFTV nATA RNFFT nN RFVFRCF 31860 0 L&K ESDDEINDUSTRIES, INC. � KENT DIVISION ��~ Ticket #: 2w4at 18808 SE 256th STR[ Covington Wo 9804 Date: 08/26/1,` _ 253-631-3611 ' me" m8:07 A� *** Siln 1 Lo d CUSTOMER INFORMATION ID: 004343 ��---------------- Name: �loyd E\�terprises, Inc. Name: + N[ PARK Address: P. 0. 8ox 3889 Lcfc"ation M(]MROE AYF NE & NE 10TH P ' Federal �ay, WA 980633889 ` ''� ' RENTON, WA Phone: 2538746692 .. Descript: 1 Gross Tare met 105220 ]b '430 +b 6218N lb 52.61 Tn 21. W. Tn 31.09 Tn 47,73 MQ. Mg 28.1.11 Mg 0 lb -----Leqal----- 0 lb Naoe: 1/21-iMA 6422 95.91 Tn 105.87 Tn Seal: 307 W.Master: '~ �� «� d-�� n�t Total: 62180 '-----AmeQuA�OpponrczwrrrMpLbt�um vucxzcnnzxrs�u��a^zr�onn�nn.cca��on�� (i) LAKESIDE INDUSTRIES, INC. ,65100 b?0 KENT DIVISION It. 2084& :l.t:)t:}08 ;:,C::. 'r:';��f,•t;l-) >'I�l-"1:: (:.ovi.iicli:t:»� ., WFa ':�1',t�)=t ))�aGi t<8/%.'.f:,/ {.; 251,:5 f..31..-3CiJ.:1. , . rE x x : J. L oacl as(: CUSTOMER INFORMATION .... ................................................................... __ ('1 )a1`):`1Y). 'F'.: l_ hl; mcro :: I...1c)yd I:i:rl ht•:� r Iy r:i.<y�:.,:,, :C rtc: Id�y.ntc::� � !='f�h:`yJ:Y) : �t T !'f`iF r , .._ .; :. flrlclP. N). Y:rc3x 38f3`) I ... r.>t::<:tt::i.tarf {*! ..)I::.- OVE ill:: t Idk:: :1.0TI-I 1'' Way, Wf"t ':�t:Y►)k:,:3:3F.1fJ`::i hF:::hI Tt;)I�i., Wfi ' ,.__ ,, Truck._,and...-Carrier. Infor'mat on _ ...-_. ..T.ruck....Wei'ghts_.::.`?.:.....:..... _... _.. ...................... ................ ..... Gross Tare;-., Net ``4P.:3f:, TY1 4?1. 5c? .1..1i.-'. :30.. 64 T ri 47'.50 111.1 P.). `':ir i'1 rl i:? f . `: b Ill la r':...ODIICT .AND LOAD TOTALO_...._........._......... b/TODAY 7/To „ DATE 1.9 1— ` 4 T y..i 111F It ;: :L'7�a .. 'L ::3 1•i ►� 1,813.1.6 MCI W. Mal :it,'ei ...._..._............. .-1--... cl I ... -... ........... _ ....... ...... ... ..-... L..(w.-t a AN EQUAL OPPORTUNITY ENIPL0IT-.R ■ WA. ST. CONT. REG # LAKESI.274JD ■ OR. CCB # 108542 HOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE LAKESIDE INDUSTRIES, --^ 7\� � ��-� L/ ~ KENT DIVISION #: uINkW. 18808 SE 256th STRE <�ovingt".' , WA 98W� uate: 08/26/1�� ' 253-631-J611 *** Silo 1 Loadout *** --'-----------'---------^-~'-' -' '-'-------'l-D-�---' ORMATION --'=====��------.................. -.' �' l7EM 999)9004343 Name: Lloyd Enterprise,*, Inc. Hame: T PARK Address: P. 0. Box 388� ' Locatinn MONR[E A�E NE & NE 10TH P �gderal Way'� WA 9806338 8:9 REN1,81"l, WA Phone: 2538746692 PO#: ][vv pp, Truck ID: 1-.94T Gross Tare met Descript: 1 105360 lb 43040 lb 62320 lb uu" 52.G0 ln 21.52 Tn 31.16 Tn L� ^~ 47.79 Mg 19.52 Mg 26'27 Mg 0 lb -----Legal----' 0 lb PRODUCT AND LOAD TOTALS Seal: 307 -� By: |nad Total: 62320 ot'AL OP � vn\src��n��- �midR'. 108542 woT Aqpwu/rUur=pm pu==rvn«raQu==rnmm=v=0p= ��SIO6l�DDS�RJ��1 --' INC. ^7�'��-��/l �l c�« (i) ` - KENT DIVISION Ticket #: 2086M 18808 SE 256th STRE Covington , WA 9804 Date: 08/27/1':; 253-631 5 A� *** Silo 2 LdMit CUSTOMER INFORMATIONFORMATION ------_---'-_-___-----_'--_----_-'__�--------- _--,_-' _---... ........ .... ...... -........................ __-- ID: 004343 ID: ' ITEM 999999 Name: Lloyd Enterprises, Inc. Name: I g��N}'PARK Address: P. 0. Box 3889 Location MONRG AVE HE & NE10TH p Federal Way, WA Rl*::_*N Phone: 2538746692 PO#: 07 ��_�� _ ��_�� _�� ....... Net____ Descript: | 96960 lb v*-'�60 lb 60100 l6 48.4&'s Tn v 18.43 Tn 30.05 Tn 43.98 Mg '' 16.72 Mg 27.26 Mg 0 lb ---'-Legal----- 0 lb PRODUCT, ��_�-�_�� _��....... ........ �_ ID: 127 9/TODAY 21/TO DATE Name: 1/2HMA 6422 286.94 Tw .97 Ti-) JMF#: 260.31 Mg,�/n �575.13 MQ Seal: 307 . W.Master:... .............. ___________ Rc 'd K Load Total: 60100 AxEQUAL OPPORTUNITY EMPLOYER 0 NNx.xr C REG c»Kaarz74JoNOR. cca# 108542 lAK-ESDDETNDO5TRIES' INC. //�y\ L/� J ~~ KENT DIVISION lu'".'. "' OW&P 18808 SE 256thSTKE Covinyton ' WA 9804 Date: 08/2711� 253-631-3611 �' � � ' ?�m� Time: 02:5� Pt *** Silo it CUSTOMER INFORMATION' II): 004343 ID: i ITEM 999999 Name: Lloyd Enterpriees, Inc. Name:^' - .[ PARK Address: P. Y9. Box 3889 Lmc�tion MONRUE AV� NE & NE 10lH P Fed�ral Way, WA 980633889 RENTUN, WA Phone PQ#: � ier Information - -----------.... ........... .... --.... Truck W iahts Truck ID: 1...126T Gross Tare Met Descript: 1 96980 lb 36860 lb 60120 lb 48.49 Tn 18.43 Tn 30.06 Tn 43.99 Mg 16.72 Mg 27.27 Mg ID: 1 Name: 1/2414A 6422 444.08 Tn JMF#: 402.86 Mg Seal: 307 W.Master: -......... -'xN-EQmALOPPORTUNITY EMPLOYER 0vmA: HOT ASPHALT MATERIAL SAI 1 Tn .68 M12 DATA SHEET xN REVERSE otal: 60120 LAKESIDE INDUSTRIES, INC. NENT DIVISION Ticket #: 28S63- 18808 SE 256th WA 9804 Date: 08/27/1� 253-631-3611 ` n^� ~ ime0240 p *** Silo 1- Loado �l*��Wl��Y�`��x : :P ID: 00�343 Name: Lloyd Enterprises, Inc. N PARK Address: P. 0. Box 3889 |ocati o I. NE & NE 10T1.1 P Federal Way, WA RE#TON, WA Phone: 2538746692 b��E=991 �~]y�J �� -- Truck I1): L941 DescripL: 1 PRODUCT AND LOAD TOTALS .............��?��-_-. ----8��-'_- 104780 lb 43020 lb 61760 lb 52.39 Tn 21.51 Tn 30.88 Tn 47.53 Mg 19.51 Mg 28.01 Mg 0 lh -----Legal----- 0 lb ID: 127 Name: 1�2HMA 6422 414.02 Tn 761.05 Tn JMF#: 375.59 Mg 690.41 Mg r~ Seal: 307 W.Master:_ Load Total: 61760 ovsmpco�nuN vwAsrro\znFo9L\xzSrz�4oioncca#1o8m LAKESIDE INDUSTRIES, INC. KENT DIVISION 1.1: 0,08 `3FF: t"-.': 6i h 1::'iTRl::: ( ov:L1-1ci �.. ,.. ,,., ',1�,r�: D a•te. 061-'c '711.;:i r 5,:3 F13I . .3f.', f..l. 5 V" I "`/ y :1. n1LCi : 1. t!) » :{.1. t �l•I ;e x tc �-3 :i. l (:) i. L.. a a cl o t.t t CUSTOMER .:INI~ORMATION . ._._ ........ .. ... .... ' FORMA 7IC3N N(%,434::3 __..................._..._ C3()» ................_.w�....._......_..-__..�._: ':)`:)"-)`�99 „1laille» Lloyd l...ttte{:�(I.)r i.`.,,os., L;tl w Idaim..').. !dI b�tl�M�l:fI:l � ` Add P.. 0., T.lox :3869 I._(a(it.a.c,tl 11tJh11� OI::. ()Vl::: {� F 8, 1-`1t 1.0 1-1 F� Truck and Carrier Information _...__._........__._....._......._._...__.............._.........._..._............_ _ �..............._......_.. Trt.tcl-:. ID.- 1...':4T ):)(4s(:-r a. pt -. :{. Truck _We.is9hts.._...........:..._ ..__.._....._... _._Gross.......... _......Tare...._........ _..._.._.M................ D ,,.1. 'T r) 31... 04 'T rt 0 cl, C-11 rl tt:1..._............._. 0 :1. b _. ___.._._........_......_. PRODUCT AND LOAD TOTALS _... __.._ . _._...._....__.................._.._..........._............_......._.........__.._.__......._.._..........__.._... _....... _.._....__.�... ID.-, 1.%?7 G/TODAY IS/TO DATE _.........._........ __.._.._ ....._..__ _ __..._... 1.92. 19 'Trt 539. 22. Tt't .flyll'44. FJ4,.3— lYly 4t1`) 1."7 I*!cl f>cr<:iI u ::307 W. p{aS>t;(r»...._..__. _ .... I.cv' (:! lE:;Y»_..._..............._...._..........__....._.._..........__.._..._..._ ..... L..(as�(I 'T(at:ta. AL PORTL'NI MPLOYER ■ TWA. ST. CUNT. REG # LAKESI.274JD ■ OR. CCB # 108542 HOT ASP ALT MATERIAL SAFETY DATA SHEET ON REVERSE t:,i.�yF)t:lL7 L�Q�8lDI�INDUSTRIES, . ---___ KENT DIVISION Ticket #: 2086a 18808 SE 256th STRE CovinQton WA 9804 Date: 08/27/1� 253-631-3611 Time: 12:20 P� 0/X) CUSTOMER INFORMATION 004343 ' Name: Lloyd Ent�rprises, Inc. Address: P. 0. Bov 3889 Federal Way, WA 980633889 Phone: 2:j��8746692 J FORMATION 999999 '/ REWTON, WA Truck and Carrier Information Truck Wei-qbts--, .. . .......... __ ruck ID: L941' Gross Tare Met Descript: 1 Ib 43W20 lb 62240 lb 21.51 Tn 31.12 Tn 28.23 Mg �� `-----Lega1----- 68 lb PRODUCT AND LOAD TOTALS ID: 127 N�ne: 1/21-111A 6422 318.06 Tn 665.09 Tn JMF#: 288.54 Mg 603.36 Mg � Seal: 307 W.Masterx � x Load Total: 62@40 - ��pLoY�n 9 vw(sz0 7OR. CCa#/08S42 LA8-E8DDEINDUSTRIES, INC. KENT DIVISION Ticket #: ROB54.1 18808 SE 256th SllR� Covington WA 98Q4 Date: 08/2�/1� , '07:25 AV *** Silo J. L d ��_�.��_� CUSTOMER INFORMATION -ORPIATION ID: 004343 ID: ' lTEM' 999g99 Hame: I loyd Enterprisee, Inc. Name: PARK, . Address: P. @. Box 3889 Location MO��OE AVE NE & NE 10TH P ' Federal Way, WA 980633889 14ENT01'4.jWA Phone: 2538746692 PQ#: ` ' Truck ID: L941' Desoript: 1 Dg MEN Truck Weiahts `Gross --Ta@��-.....met 10500� lb 43020 lb 61980 lb 52~50`Tn 21.51 Tn 30.99 Tn 47.63 Mg 19.51 Mg 28.11 Mg i&lb --~--Legal----- 0 lb PRODUCT AND LOAD TOTALS ID: 127 3/TODAY 15/TO DATE Name: 1/2HMA 6422 95.97 Tn 443.00 Tn 87.06 Mo 401.88 Mo SeaI: 307 W.�Master: By: Load Total: 61980 ~~---�� 0ns.ScCoWTXEG ftiAKES�2�mNOR. d�# 1u�m wn`��nwu/rMur=m/u/ purr:`vnurupmrp`nmurv=nn= INC.LAX-ESIDE INDUSTRIES, KENT DIVISION Ticket 44: ~61L:ml 18808SE 256th STRE Covington , \/� 980« Date: 08/��7/1� 253-63 CUSTOMER INFORMATION WOkMATION *** Silm 1 ad Name: LIoyd Addre�s: P. 0. Box 3889 Location MBNRQE AVE NE & NE 10TH P `Federal Way, WA 980633889 `'RENT8H, WA ^' Phone: 2538746692 PO#: ' Truck and Carrier Information `�� (A.- N' Truck ID: L108t ` Gr.��__� Tare No, Descript: 1 99740 1.b 35700 lb 64040 lb 4987 n 1.8Tv), �Tn OF42M905 g ' 0 lb -----L*,nal--=--0 lb ID: 127 Name: 1/2HMA 6 Tn PRODUCT AND LOAD TOTALS 730.17 Tn JMF#x Mg 662.40 Mg SeaI: 307 W.Master:W-P'PDXTUNFMn' N L(WER 0 WN. STCONIT. REG # LAKEST*274JD ff OR.'(,CB 108542 By: Lzna1 Total: 64040 LAKESIDE INDUSTRIES, INC. KENT DIVISION 00659 08/2.7".; 253-6 1-3 Sil.c) P. 06 CUSTOMER INFORMATION -&Uv:vlwflUN ................. . ...... .......... ITEM 999999 I lame. 1 1(-.), d Ento-f,prises, 3,11C. P. 0.. I'tox 3889 1-(:watiar) 110W01-- OVE. 1-41". & 1-tl'::: 104H F, Fed(-.-ry]. Way, WA 98063,3889 lq--Nl ON, WA 00 Truck and Carrier Information Truck- Weights.,__ .... .. ......... ................ Carrier_ ............ Information ........... I ... ............... - ................ . . ........ T-vu(:'P. 1D.- L-108t EMET [EMD Tare Net ("3600 1 b ull A lb (40 1 IJ I (,.-,5 r-t M 16. 19 111.1 28"65 -411 0 1-1) al 0 1 b 11) -. 127 307 W. mas-t;e-r. 8/TODAY 20/TO D ............ 256" fTE NL Y v I nad I I AI. ()TYPoRl't-'Ni'l-)'[-',NI131.OYER 0 WA, ST CONT. REG # LAKESI'2-4 ID N OR. C-CB # 108542 14nT ARS314AI T MATSMIAl QAPr-TV nATA RWr-I=T nN 01:v;:P-qr- (13t."(10 T.AJ{E3lDE INDUSTRIES, INC. � VENT DIVISILN4 0*49571 18808 SE 256th S[RE Covington e: 08/27/1": 253-�31-3611 /me: 09:53 AV . ` «�^ *** Silo 1 Loadout IB: 004343 ID . 'ITEM 999999 Name: Lloyd Enterprises,�Inc. Name: , PARK Address: P.' 0. Bmx3889 Locatio n~/ HVE NE Q NE 10TH P WA Deser�p�: 1 JNFO 307 W. vlastk�.fl / 1- rL� � Gros ' 45.25 Mg 16.l9 Mg 29.06 Mg 0 lb -----LeaI----- 0 lb OAP TOTALS 161.15 Tn 5G8.18 Tn 146.19 Mg 461.01 Mg _ Rcv'd Byx Load Total: 64060 EQUAL OPPORTUNITY EMPLOYEVIrVA. ozcowTnEo#uuoESrur4JD MOR. cca# 108542 LAKESIDE INDUSTRIES, INDU8TRIES, INC. NUENI DIVISION Ticket #: 18808 SE STRE C^vinQton , WA 9804 Date; 2153-631-3611 ' ' �� Time: 07:20 Or *** Silo 1 Loadout _----C:�='ORMAT:��-__---_--' 3z4-J-'�-D: ITEM 999999 -Name: Lloyd Entmrprise�, Inc. Name: PARK Address: P. 0. Box '��889 Locatic OE' Au6 NE & NE 1oTH P Federal Way, WA EMTON, WA Truck I1): 1 108t Gross Tare' 'Net Descript: 1 3��0 lh '35700 lb 64060 lb �n 17.85 Tn 32.03 Tn q 16.19 Mg 29.06 Mg -----Legal----- 0 lb W.Master: _ Load Total: 64060 LAKESIDE INDUSTRIES, INC. KENT DIVISION t.. , F:.()is z# :: 20 55: :€.t�8013 G1--, a:'.5f.-', f.�i'T'!ik l t7l�:l.t'tl "Lt:)t') , lJ(1 `:3(:'t7�, Z:•t:N. i:as: tsali'I/i:i 't:t;-1.�..-6 3:�.....361 �. ,.t i Y :1.R All CUSTOMER __._......_..._.._...._.INFO....R....M,...ATION ......_.__...............'......._J..O._.B_..__1r.N._F._.O_.R.....M._.A..._T._._I.,.O....N T........ ................_.....0......4.............._....--........._......_........_.._.............1_,......................._....._i_...3..`._}....}.. 1):03 �3 E `.'..}._'..._j...._-..._... -.. F::v) (--.-v )'ri.sel.,, Tvw .. ! I{ F.5:r1 M..14T-PflF4, Address:: 0., I:((ax :3889 IMC)NROE:: (.)V[.. HE HE:. 10 T I -I r) I.. (--; 3de"rta.l. Way,) W(a 9806 3.3f18`.J I;i..Iq T ()I%I, Wfa Truck and Carrier Information uck Weight ..... _......... ..._........,..,_.._........._..._....._.......w__............_.._.__............_.................._................. ......... '... Tare fit ....._ Dessc:'r i p-L W �. 4:;t�l ; 3`-t t3it) l t) " (:,i,::it�(1 J. I;) {:,`:)' )'1 :I..C.) •.:i�4 1 )l S,a.. i.',"r (1'1 4'7.. 110 l''111 :1. 7 .r i.:3 l'1 ., 'its ;. 0 7 1 1 e1 0 1.F) ..... _..... ....:._ 0 :I.b PRODUCT AND LOAD TOTALS _........_..._.............................__.--....._..._........_._.._.._..._._....................,....�,..w_....._.___......_...._..._..............._._..._......_. J ? l 4/TODAY. 16/TO DATE ..._......................_....._._....,......._..._..._............... Name. 1./i?hilYl(1 (14i�c' :Lr".?� ].i:? 'Tt� ;i'76., 1 F) 'i)') J'1' F,#3 :1.:I.'r„ 1.4 Nq 431..96, Vlr_.l 307 V W.. �r 'I:F7'r ; _.., ..._. AN EQUAL OPPORTUNITY E\IPLOYER WA: S` . CONNT I"I<':REGG #-ZAKESI*274JD ■ OR. CCB # 108542 HOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE LAKESIDE INDUSTRIES, INC. KBNT DIVISION #: 18�*508 S[ 256i-,h SIRE- Covington , WA 9804 Date: 08/2//1. 253-631-.3611 � -� .�' ' Time: 06:35 AP *** Silo 1 Loadmut *** ..........--' -- ID: 004343 ^ ID: �' 263613 JOB - ` �MAT -TEM 999ON 999 Name: Lloyd Enterprises, Inc. Name: [NT PARK Address: P. 0. Box 13889 Locio �[ AVE NE & NE 107H P Federal Way, WA 980633889Jl/}H, WA' Phone: 2538746692 POP: \/ Truck and Carrier Information Truck 132T Descript: 1 -- --'---- ----- Gross Tare.'met 1.049410 lb 39080 lb 65900 lb 19.54 Tn 32.95 Tn 17.73 Mg 29.89 Mg ... ......... .... Legal----- 0 lb PRODUCT AND LOAD TOTALS ID: 127 Name: 1/2HMA 6422 32.95 Tn 379.98 Tn JMF#: 29.89 Mg 344.71 Mg Seal: 307 W.Master: Rcv'd B °^°' ~ Load Totalx 65900 -A, EOU'Ar w na.s�T1�NT.*nffi�#1,�QffSYW2��ji5miD�Iffta#1oa54z 011-1/ � ��D�DINDUSTRIES,INC. T� KENI DIVISION t 4: 18808 SE 256th STR::'. Covingtmn , WA 9804 i� Date: '^253-631-3611 '' - Time: Loadout *** CUSTOMER INFORMATION JOB INFORMATION 08/27�13 01:37 Py ID: A04343 ` ID: 263613 ITEM 999999 Name: Lloyd Enterpris�s, Inc. Name: PRESIDENT PARK Address: P.' 0. Box MUNROE AVE NE NE 1071-1 P Federal Way, WA 980633889 RENTON, WA ' Phone: 2538746692 PO#' Truck and Carrier Information Truck ID: L132T ` � `met Descript: 1 105200 lb 9080 lb 66120 lb 52.60'Tn 19.54 ln 33.06 Tv-1 47.72 Mg 17.73 Mg 29.99 Mg 0 lb -----Legal----- 0 lb ____ PRODUCT AND LOAD TOTALS ID: 127 Name: �/2HMA 6422 351.12 Tn 698.15 Tn JMF#: 318.53 Mg 633.35 Mg Seal: 307 W.Master: di-t' Total: 66120 -~--' AN w vo�srcnmTxem�'u�ue��er�onr�u�coa��oe4z INC.LAKESIDE INDUSTRIES, KENT DIVISION (icket #: ZOS-518� , ,218808 S256th 7/1� »** Silo 1 d CUSTOMER INFORMATION ___ ID: 004343 .D ITEM 999999 Name: Lloyd Enterprises, Inc. [PARK Ad�ress: P. 0~ Box 3889 Loc E AVE NE 8 NE 10TH P Federal Way, WA 980633889 RENTON, WA Phone: 2538746692 POW: Truck and Carrier � ��-��``��.�`�.��`�� ^�� Truck L132T � ___��___ �_�e��____ 1��____ � Des cript: 1 �4880 lb 39080 lb 65800 lb .141.44Tn' 19.54 7n 32.90 Tn �7.57 Mg 17.73 Mg 29.85 Mg 0 l6 -----Legal----- 0 lb ID: 127 7/TODAY 19/TO DATE Name: 1/2HMA 6422 225.09 Tn 572.12 Tn JMF#: 204.20 Mg 519.02 Mg Seal: 307 '------ W.Master: Load Totalx 65800 -----'7�� pLovsx 0 voA.rcCONT.iREG # '0'OR. CCB #/oo54z (9) [AfQES1DEINDUSTRIES, INC. ^ KENT DIVISION 18808 SE 256th STRE Covington00 -------COSTOMER INFORMATION----- ' ID: 804343 ID: ITEM. 999999 Name: Lloyd`EDterprises, Inc. Name: PARK Address: P. 0. Box 3889 Locati�n��NROE AVE HE & NE 101�1 P �ederal Way WA 98063389 RENTON, WA ` Phone: 2538746692 PO#Truck and Carrier Information Truck Weiahts Tare Not Descript: 1 99740 lh 35�40 lk 64000 lb 49.87 Tn 17.87 Tv) 32.00 Tn ~ 45. 29. 03 M§ � — 0 lb hf/U�zU��5 127 2/TODAY 28/TO DATE Seal: 307 W Master:WOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE [ota]: 64000 W. --'---*w cco# 108542 LAKESIDE INDUSTRIES, INC. L KE14T DIVISION _...._..._...__._.....__ CUSTC>R..I1Cltl'►AT I OM...._.._..._.......... ...... ..... 1�lranlc:�. 1.7.i:>p•i:i E_li�t;i:�r};ra.<.�t::��:>, 7��t::,, cklt:l f•E7ss.— Fi. 0..,- 1. ox ::3889 Way',, WO r?80("3;3889 "f :i. t:: t-:ra -. 0 �Q_'09100 i nzfa M()Wt AVE::' Ftf. hI T"i:Jh17 Wfi 00865! i! 8 11.? 8/I":t 06, . _': ri? t--AY 991.),399 1.0TII F:' Truck ant! Carrier Inftarma�i�..... __...__.. _ _. �.....T urrk_Weights_...... ........... _....Gross Tare met IJV�L�II 13C-"7 `:i�}.. �fi;' -T-11 '`). 5'.�7 T11 ;:ii,�. 90 fn DD 47.,:. 8 11rf 1.-7.. "f'%+ IVI11 2`:)., Fi`:', IYIi1 } - _......__......__ ................_.__.........._._PRODUCT. AND LOAD . TOTALS T I> : I/TODAY 27'/TO DATE .............._.............._._._....... _....._ _ _....__..._._......_.._.._ Flikine - 1. /tE.11 10 6422 32. 90 T vi 82 4.. i4:1. T"1.1 J"IYiF"f1: « 29 . f.."5 M11 747.. 51*3 !'Irl i fly W„ ilit'..-i t(=!'f' . _...... _......AN-SQUAL OPPORTU.Nl '-EMPLOYER 0 WA, ST. CGNT®;-RE"" G-## iAKE:Sl-27.4j.D 0 OR. GC-B � 1'({$5�4� T ol*,'a.l is 65800 HOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE LAKESIDE INDUSTRIES, INC. (i) E cl, ~ I 1=1 1=1 19 KENT DIVISION ! 20866� ^ 18�08 SE 256th STRE Covingto �at�: 08/28/13 Ti09:29 AM *** Silo 1 Loadmut »)�/�/�«"- -- ID: 004343 Name: Lloyd Enterprises, Inc". A6dresso 1:11" 0. Box3�B9 Federal Way, WA 980833889 Phone: 2538746692 Truck and Carrier Information _ Descript: 1 Gross Tare _ Net 52.56 Tn 33.01 Tn . 47.68 Mg 17.74 Mg ' 29�95 Mg 0 lb �----'egal--�-� 0 lb` AND LOAD TOTItlLS ID: 127 4/TODAY 3@/TO DATE Name: 1/2HMA 6422 128.97 Tn 920.08 Tn JMF#: 117.00 MQ ''834.68 Mg Seal: 3 14 7 W.Master:___��ro�� ^�oNz��#aK�/^�oM_�� Total: 66�20 unr^QPumr=",CO."/ *"==,V"","""==,°"O=.=OO= LAKESIDE INDUSTRIES, INC. L KENT DIVISION 1-t3t3�.6 Sr. 25f.-,'l;tt ��tFtl:-.: «� _, 253 6,31 :361.1. {'M'ik `,:i:i.:Lt7 'I 1 r•�.�rdr-�}�•� .p•.ti, _..........._. __........C-UST..:.._........_..-..IW RMATIOM..__._......:.:..._...._. 004 343 t•d:.�ntr.�: I...:ic)yci C:t'tt:r•.=�r�{:rri:;c:�t�, :Lrtc�,. (1cltlrc:ts;; a„ t!. 6,. Dox :3tll:s`a F, -yt: e- Wray, Wfi `�t� (•.,:i;:3�:)!�'`1 %':':i;38 "'W Truck and Carrier Information Trucl•e. I I) s, L-941' lice<_ c,ript;: 'I. D A'LQ ° 0B/2(3,' 1.;: I 1 : 01. t"tl'` .......SMATION _.W.._ . I...ctr.:�a'I~i.r.)tt htflFlkt.; . Ji NE:_ & FIE: 1.01+1 I"' WA Poft Trucf€ Weights Gross _Tare..... .... _.._ met..._ .._... t3�'rlt:st:) 1. L) 4,3060 1 b .390(120 1. b it "L . 04 .t t t i? 1.., 53 T 1-1 1. 9. 51. 1* 1.) 3'/. 23 11 g l it.1 1. . 7(3 lylla 0 :Li:) 'L.................•.. t1 J.I:) _.._._._..._ ......................._....._......_._.PRODUCT �AND..LOAD TOTALS ........ _........ _..---..-....------•-----------... 1 27 5/TODAY 31lTO DATIF I I�:t►It� a . 1. /;:4.1110 6422 148.48 1).-I : ;3`7 !:'i�) Royr 4HOT� L,34.70 r`Ir, t35,2.D W. I•I<�`�'%e- r ......._._.. ��< ..OE�IPLbYER'r WA;ST. C.OtiZ.R.EG # LAKF.SI'274JD.i..OR..CCB # 3'68542 ALT MATERIAL SAFETY DATA SHEET ON REVERSE 3`: 02L (i) LAKESIDE INDUSTRIES, INC. KEWT DIVISIOhi 2W66i (11:0", C OV:i.ti•ita l:d��°� y L3f-d `: t,i: Iia�°i; a� t�311.'f?tlr` 361. a. -w%� , 08- tl `30 Ells "V'. CUSTOMER INFORMATION _..._.. ............._._._..._......_.._....,..__..._......__-..........._..._........_...........,..._...._..._......._.....__.... _......._.._.._.__..__.._ JOB � = OkMAT�Qt?I ... _.._...._...__............... P?f" 361.-3 .. TEN .................. .... __...__._..._,.. 999999 Haim--) ; Lloyd I:;:i•i•t';e:a•r° la•r i. iie—�.>, 1:)« n., flax 13689 Nc3NRi:3E:: f1t11::.: Hr.:: Ht'.* :I.t%3"ti l U.' WAy., WA 9806 3:'31 &.-) I�:L:'hl'f'Ohly W04 ............ !Carrier_._Irtiforation......._........ _...................... _........_...._Truck.. Weight.........._..........._......_....._ ........... ....._..... `T''rlm:4: I' D a 1-94'T Grass. Tare' Net IA) 4 3i ("0 1b 62:I20 :I b 52. .., .J Y i t r:.. .. _,,:3 t 7"r ,c, .I. « CIF, 1' n ic7 a.ts-.....:..._.._.:i...�::�rl:a7....:....._......... 0 1.I:1 .• .PROD.UCT AND LOAD TOTALS D -_.__...3/TCIDAY 29/TO DATE UV �L- _._....._......_.... _.............. _.l DD {�lrasuca '1./21 {1''Ift C"Iti c.? `!3. `: 6 'T n 11117. 0-11, Tn W 1'1<�.G> t;t:a r ; ........__. QrnId'Ii 'ii VbA: 5T. CONT. REO._#..I �1ICS1*274)D.■ OR. Cc.,s # i'os2 T ra trti:t f:,c 1. c?i� HOT A PHALT MATERIAL SAFETY DATA SHFFT AN RFVFRRF LAKESIDE INDUSTRIES, ' �� ' uu v czuu�� Cr KENT DIVISION 18808 SE 256th STRE Covington WA 9804 Date: 253-631-3611 (?N��/' r^'^� '^}�- T,`��: 07:30 r'4vl w**CUSTOMER INFORMATION Silo 3 Loadout **� 1D: 004343 IBo 263613 ITEM 99999-9 Name: Lloyd �nterp��ses, Inc. Name: PRESI�ENT PARK ` ` Address: P. 0. Box 3889' Location MO4RUE AVE NE & HF.�' 10TR P ' Feder*J Way, WA 980633889 RENTON, WA PhonePO#: ' and Carrier Information_-_--,'-_'--'_'----�-----'___'-- Truck Weiahts ____-'_--'-_--------_-_-~^--_--'_--'----'---_-- Truck ID: L108 ' Gross Tare ` D�script: 1 56880 Ib 245|@ lb 32360 .b 28.44 Tn 12.26 Tn 16.18 Tn 25.80 Mg 11.12 Mg 14.68 Mg 0 lb ---'-Legal----- 0 lb PRODUCT P44D LOAD TOTALS U.Master: Load Total: �2360 -F IYAL ITC P�RTLNQTnY ENIPLOYER 0 WA. S�tINIT.DEG.4-I�KESI��74JD�bk,'*d--B # 108542 LAKESIDE INDUSTRIES, INC. T UFt W L5 D 1'GEI4T DIVISION # JM1;�;; u.'.x:.x. 5 i :!. o ::3 L..O�,:,kCf Oi.t1. {�#;a�aac:�r ;, 1_,1 a:;� ri l:: a•a t t�ar• #:r r a. t� �:a ��s � :C a'u:: ,. 0. FiOK 3889 p I W{:av, Wra 91.,W-,::3388. : F''#ac;+ac:};; Truck and .Carrier Information,.__.._.., .,__�.......w... _...._........ ._•............ __........... _ {'r uCA:. :[DU L.A.(%1L' 1)o sC, v i. t: t:, I Name 1•t:ion f*IClh1R{7E AVE:: hI#:;: & 1',IE 1.OT1"1 14 WA P O. _...._. _. _....... 7ru..... t •....... _.._...... . _... _. Gross_...... Tare ....... 44460 :L Lr Lp,,r.:0 {aa 1,0,01-3 .1.a..� ;?1:1.:L7 mg 1.1."07 11 0 N E!3 :#.b........_.........#_.,egal..... .... .... _.. 0 1.1:a " DCIO.T... iAN,D-LO'AD*.._TCITAdLS......_........_.............._._.._. . :#. c?"r' 2/TCII)AY 33/TO DATE :1'C'11- 0 ; / 11 ;i3::3.. 7 fi 1,11-1 876..:1. (:. ITIq ?�; e� <:t 1.: .:3 {) r W. r1,:k af;I�r — - } ca n I...t:iml Tc:rt;< :L s i:'o{iI(10 ANC AL OPPORTUNITY EMPLOYER ■ VA. ST. CONT REG # LAKESI.274JD ■ OR. CCB # 108542 HOT ASPHALT MATERIAL SAFETY DATA SHEET ON REVERSE