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Home My WebLink AboutSubcontractor Approval Packets - 12/8/2016 Washington State Department of Transportation `° Request t® Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ( DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton,Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Sea-Tac Sweeping Service 601 735 583 91-1735273 Address Telephone Number 26305 79`x'Ave. So. 253-854-9717 City State Zip Code Estimated Starting Date Kent WA 98032 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *If no Federal Employer 1 D.Number, Use Owner's Social Security Number Item No. Partial Item.Description Amount A6 X SWEEPING SERVICESNAC TRUCK $7,000 1, o oa 1 understand and will insure that the subcontractor will Prime tractor Signature Date comply fully with the plans and specifications under which this work is being performed. 7// Department of Transportation Use Only Percent of Total Contract DBE Status Verification This Request '5 L % Previous Requests 1`b•S Sublet to Date 19. D"S Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Foran 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 IIIIII VIII VIII VIII VIII IIII IIIIII VIII VIII IIII IIIIII IIII IIIIII VIII IIII I II III VIII IIII I II III VIII VIII III IIII IIII *03854 703.2-Subcontractor Approval Packets 1210812016* Washington State Contrac and Subcontractor or e® Department of Transportation Lower Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004 STPUL 1113(003) Duvall AVe E Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the`Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company SeaTac Sweeping Signature Date Title Contractor Certification To be completed and signed by the contractor 1. ® A written agreement has been executed between my firm and the above subcontractor. 2• ❑ A written agreement has been executed between (the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled'Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON Materials Signature Date Title Mark Eichelberger, Project Manager DOT Form 420-004 EF Revised 0312008 x ar,c, 1 ux z. Home Espanol Contact Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing kiWashington State Department of Labor & Industries SEA-TAC SWEEPING SERVICE Owner or tradesperson 26305 79TH AVE S KENT,WA 98032 Principals 4-9717` VINSON,ALFRED,MEMBER • KING County Doing business as SEA-TAC SWEEPING SERVICE WA UBI No. Business type 601 735 583 Corporation Parent company AL VINSON INC License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. .......................................................... Meets current requirements. License specialties GENERAL License no. SEATASS919KN Effective—expiration 05/15/2009—05/15/2017 Bond American Contractors Indem CO $12,000.00 Bond account no. 100276107 Received by L&I Effective date 05/26/2015 05/15/2015 Expiration date Until Canceled Bond history Insurance ....................... Union Insurance Company $1,000,000.00 Policy no. CPA2880043 Received by L&I Effective date 06/06/2016 06/01/2016 Expiration date 06/01/2017 ............ ... ....... .. ... ... . ...... .... ..... .... ...... ................. . Union Insurance Company $1,000,000.00 Policy no. CWP2880043 Received by L&I Effective date 06/01/2016 06/01/2016 � ., 11 1 •r r.-. , •, nr 7 nr n A — 1 0.'G G Vl G Expiration date 06/0112017 Insurance history Savings ................... No savings accounts during the previous 6 year period. Lawsuits against the bond or savings ........................................................................................ No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ................................ No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations ........................................... No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 919,336-00 ......................... Doing business as SEA TAC SWEEPING Estimated workers reported Quarter 1 of Year 2016"11 to 20 Workers" L&I account representative T5/BREANN OLSEN(360)902-480210-Email:OLSA235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. I. , . n — , .-.r Ir r,,--. A A (v^I • XT (0 STATE OF WASHINGTON OFFICE OF MINORITY AND WOMEN'S BUSINESS ENTERPRISES 1110 Capitol Way South, Suite 150 • PO Box 41160 • Olympia, WA 98504-1160 (360) 664-9750 • Toll free 1-866-208-1064 • Fax(360) 586-7079 As Of 7/+6/2016 1:31:44 PM Contact Information Business Name AL VINSON INC Doing Business As Name SEA TAC SWEEPING SERVICE Contact Name Alfred Vinson - Description of Work PARKING LOT SWEEPING, STREET SWEEPING, PRESSURE WASHING, DUST CONTROL, SANDING Street 26305 79TH AVE S City, State, Zip Kent, WA, 98032 County King County Phone 2538549717 Fax 2538547244 E-mail info@seatacsweeping.com Website - -- - UBI Number 601735583 Owners Information Primary Owner ALFRED VINSON Other Owner(s) Certification Information State Federal Certification Type MBE DBE/SBE Certification Number M3M0015063 D3M0015063---_ ----� --------- — -- _-- --- NAILS codes for UCP USE ONLY to determine size standard NAICS Codes (Primary is specified in bold) .488490 -Street cleaning service 561790- Parking lot cleaning (e.g.; power sweeping, washing) services 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 Intent ID: Affidavit ID: Status: Approved On Date: 7/7/2016 773281 7/14/2016 Company Details Company Name: SEA-TAC SWEEPING SERVICE Address: 26305 79TH AVE S KENT, WA, 98032 Contractor Registration No. SEATASS919KN WA UBI Number 601735583 Phone Number 253-854-9717th Industrial Insurance Account ID 91933600 Email Address seatacsweeping@seatacsweeping.com Filed By Vinson, Alfred Prime Contractor Company Name . ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200ta Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303tp l�ttr.o•//fnrMaoo snftnt /�rii/tzorra�nn�m/Tri1-an�Tlo�ni�o ��„� �/�n/�ni� Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $17363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105313327 Intent Details Expected project start date: (AAM-DD-YYYY) 7/8/2016 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 Time and materials this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 1 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF l�tt+�o•//fnrtr000 •irn rtnr/lni/i rn r'olnnlr»r /TrtortTlotoilo nory 7MAP)1)14 WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Power Equipment Operators Brooms $53.57 4 Public Notes o Show/Hide Existing Notes No note exists N+'�'v[ci•��T^r�'rG c+[� [i�.] !tA[)�IH1�[S1.]rtPl/1/1 V1111/Tn 1'nn�TlAi'ni1C� .]C�Y1V �i�1) n 1 A Washington State Department of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON Materials 91-1272258 C/N CAG 16-004 STPUL 1113(003) Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Bilbrey Construction, LLC 603 002 155 27-2189277 Address Telephone Number 361 Roy Road SW 253-569-1621 City State Zip Code Estimated Starting Date Pacific WA 198047 8/10/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *lfno Federal Employer 1.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A22 X Hired Hauling(remove asphalt) $2500 I understand and will insure that the subcontractor will Prim o tra t r Signature Date comply fully with the plansand specifications under which this work is being performed. Department o0ransportation Use Only Percent of Total Contract DBE Status Verification This Request % Previous Requests % Sublet to Date 0/0 Project Engineer Date Approved-Region Construction Engineer Date F1 Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region Canary' Revised 1.1/2009 IIIIII IIIIII IIIIII IIIIIIIII III IIII IIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIII IIIIIIIIIIIIIII l *03854 703.2-Subcontractor Approval Packets i 9inRnni F* ULCILO r%VUIC INUIIfUC! 7 CAG 16-004 STPUL 1113(003) SU Subcontractor or Lower TW Subcontractor Con tr To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the-subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates: I certify the above statement to be true and correct. GompanY1 � cin s�I�c J'd©� LLr, Signature Date c5F;`1 / b �1 Title Contractor Certification To be completed and signed by the contractor 1. Z A written-agreement has been executed between my firm and the above subcontractor. 2. ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the.speciai provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the.above statements under Contractor Certification to,be true and correct. Company ICOI aterials Signature V Date , Title Mark Eichelberger DOT Form 420-604 EF Revised 03/2008 ra�c i ul � 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 Intent ID: Affidavit ID: Status: Approved On Date: 8/17/2016 783189 8/25/2016 Company Details Company Name: Bilbrey Construction Address: 361 Roy Rd. SW Pacific, WA, 98047-2133 Contractor Registration No. WA UBI Number 603002155 Phone Number 253-569-1621C5� Industrial Insurance Account ID 55935200 Email Address z.bilbrey@hotmail.com Filed By Bilbrey, Zachary Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200�p Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303,& 1 RSV L V1 J U ` Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105373897 Intent Details Expected project start date: (MM-DD-YYYY) 8/1/2016 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 Time and materials this 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 No work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 1 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF rage -1 Ul WA UBI Number 601006854 .Journey Level Wages Public Notes o Show/Hide Existing, Notes No note exists --"-''"-'•-•'•'�• vtatc r�VU[C ItlU11NC! CAG 16-004 STPUL 1113(003) Subcontractor or Lowey TW Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this.subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company B d ftp Y Signature J Date —/ Title Contlract®P Certification To be completed and signed by the.contractor 1. M A-written agreement has been executed between my firm and the above subcontractor. 2. ❑ A written agreement.has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision'entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. certify the ab.oVer statements under Contractor Certification to.be true and correct. Company ICO aterials Signature �� Date Title Mark Eichelberger DOT Form.420-do4 EF Revised.03/2008. rAMN. -' Washington State Department of Transportation Request t® Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE !l Prime Contractor Federal Employer I.D.Number* State Contract Number ICON Materials 91-1272258 CIN CAG 16-004 STPUL 1113 003 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Fork to: Subcontractor or Lower Tier Subcontractor r6O2237 fied Business Identifier(UBI) Federal Employer I.D.Number* Rockin A&J 437 20-2075374 Address Telephone Number 4223 162°d Ave E 253-826-2353 City State JZip Code Estimated Starting Date Sumner WA 98391 7/26/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Jfno Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount C01 X Hired Hauling(remove asphalt) $1,000 I understand and will insure that the subcontractor will Pr' e' ontractor Signature Date comply fully with the plans and specifications under which this work is being performed. Departm nt of Transportation Use Only ` Percent of Total Contract DBE Status Verification This Request % Previous Requests Sublet to Date % Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 IIIIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII `03854 703.2-Subcontractor Approval Packets 12/08/2016` Contract-or and Subcontractor or i [Deparb9224 09` nspos"ftHon L®16' ei Tier S@@bQiontrac'I-or Ce-ilificaVon for Faders@-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) FCA ct Number �Federal-Aid Number G 16--004 State Route Number STPUL 1113(003) contractor or Lower Tier Subcontractor signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special FProvision entitled"Required Federal-Aid Provisions",the`Required Contract Provisions ederal-Aid Construction Contracts(FHVVA 9273)",and the minimum wage rates. I certify the above tatement to be true and correct. Company U l k-i n C �- Signature Date ( lam Title Contractor Certification To be completed and signed by the contractor 9• !❑ A written agreement has been executed between my firm and the above subcontractor. 2. ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled'Required Federal-Aid Provisions"are included in the agreement for (9)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON Materials Signature Date Title Mark Eichelberger DOT rorm 4e0-004 EF Revised 0312008 � Washington State �'!/ Department.of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor El DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title). Request Number City of Renton,Duvall Ave NE Pavement.Preservation Project Approval-is Requested to-Sublet the:Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Mulier Construction, LLC 1603391521 46-5366609 Address Telephone Number P.O Box 1169 425-210-9994 City State Zip Code Estimated Starting Date Maple Valley WA 98038-2037 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *If no Federal Employer LD.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A23 Planing Bituminous Pavement $26,528.68 A22 .Planing Bituminous Pavement. $20,400.00 9 lits/Jto I understand and will insure that the subcontractor will Prime a .or Signature Date comply filly with the plans and specifications underr which this work is being performed. Department of Tra sportation Use'Only Percent of Total Contract DBE Stattt VWfifiekion This Request �J•ti�f Previous Requests % Sublet to Date' Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Form 421.0M-EF 'Distribution: White(Original)—'Region Canary(Copy)—Project Engineer Pink(Com-Contracfor Revised 11/2009 1111 11HI 111111111111111111111111111111111111111111111111111111111111111111111111 IN '03854 703.2-Subcontractor Approval Packets AMA, Washington state Corib ctor and Subcontractor or �® DeParr nt of Transportation Lower Tier Subcontractor Certification for Federal-Aid projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number 'Federal-Aid Number CAU 16-004 State Route Number ._. . r STPUL 11 13(003) Duvall AVe E Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company Mulier Construction, Inc. Signature ry Date — Title Contractor Certification To be completed and signed by the contractor 1• A written agreement has been executed between my firm and the above subcontractor. 2. U A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. "�- ---- - --- - All documents required by the special provision entitled'Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON aterials Signature Date Title Mark Eichelberger, Project Manager DOT Form 420-004 EF Revised 03!2008 Page 1 of 2 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Usages Paid Project Detail - Project Dashboard Document 9/19/2016 Intent 774581 Affidavit 666279 Affidavit Approved on Received Date Id Id Status 9/22/2016 Your Company Information Name Mulier Construction LLC Address 25481 SE 275th PL MAPLE VALLEY,WA,98038 WA UBI no. 603391521 Contractor Registration no. MULIECL864JQ Industrial Insurance Account Id 31532900 Email Address accountingCmulierconstruction.com Filed By Accounting,Mulier Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact:' Flora Lee Awarding agency contact phone number: 485-430-7303 Project Details Project name Duvall Ave NE Pavement Preservation Project County where work was performed King City where work was performed Renton Job site address/directions: Prime contractor name ICON MATERIALS Prime contractor registration no. ICONM**982CF Contract no. CAG-16-004 Prime contractor Phone Number 206-575-3200 Prime contractor Intent form Id# for this 771206 project Dollar"amount of your contract: $ 42,,110.24 https:Hfortress.wa.gov/lni/wagelook4p/AffidavitDetails.aspx 10/10/2016 _ . r Page 2 of 2 Bid due date 6/7/2016 Contract award date 6/20/2016 Intent filed date 7/13/2016 Job start date:MM-DD-YYYY 8/8/2016 Date work completed:MM-DD-YYYY 9/1/2016 Project Completion Did your subcontractors perform all work on No this project? Did your company hire any subcontractors? No 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)? Company Owner Information How many owner/operators performed work 0 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 # # Workers Flours King Power Equipment Roto-mill, Roto-grinder 39.57 18.60 2 108.00 Operators` t Apprentice Wages Public Notes nShow/Hide Existing Notes No note exists https:Hfortress.wa.gov/lni/w,qgelookup/AffidavitDetails.aspx 10/10/2016 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 Project Detail - Proiect Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 7/13/2016 774581 7/19/2016 Company Details Company Name: Mulier Construction LLC Address: 25481 SE 275th PL MAPLE VALLEY, WA, 98038 Contractor Registration No. MULIECL864JQ WA UBI Number 603391521 Phone Number 425-210-9994@ Industrial Insurance Account ID 31532900 Email Address jen@mulierconstruction.com Filed By Despain, Jennifer Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number. 601006854 Phone Number 206=575-3200.x] Project Information Awarding Agency RENTON, CITY OF .1055 S GRADY WAY RENTON, WA - 98055. Awarding:Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303tp .. �'I-hro•��fns-h•noo ciao rtni ��ri�iznrro�nn�nir�Rr4or4Tlo4n.�c, .,�;..., �i�ninnic Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105321337 Intent Details Expected project start date: (MM-DD-YYYY) 7/25/2016 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 $46,928.68 this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Power Equipment Operators Roto-mill, Roto-grinder $37.84 $18.60 2 Public Notes o Show/Hide Existing, Notes No note exists L,44r.o•// rt•voo �so n�� /�rii/ci n ro��m/Tn4orf notni�o nor�v '7 0 1)1A AtOkk CWashington State AP Department of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer T.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title), Request Number Cit ,of Renton,Duvall Ave NE Pavement Preservation Project Approval is_Requested to-Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor TUnified 13usiness Identifier(UBI) Federal Employer I.D.Number* Northwest Trak,Inc. 602 140 049 91-2146780 Address Telephone Number PO Box 1915 253-862-4102 City State Zip Code Estimated Starting Date Milton WA 9835.4 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *If no Federal Employer LA Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A44 Modified Type 6 Extruded Curb $586.20 A45 Precast Dual.Face Slope Mountable Curb $4,051.50 A46 RPM Type I $6,277.34 A47 RPM Type II $1,599.00 A55 Paint Line $2,244.09 A56 Painted Crosshatching Marking 8 Jnch $6.00 A57 Plastic Traffic Arrow $1,222.00. A58 Plastic Stop Line $-71,8.20 A59 Temp Pavement Marking Paint, only if.required $2,779:20 C13 Modified Type 6 Extruded Curb $12,8$2.20 C14 Painted Curb $1,326.00 C15 Curbed Guide Post $5,928.00 3",549.73 • `7�t5"/fes I understand and will insure that-the subcontractor will Prime Contractor Signature. Date comply fully with the plans and specifications under which this work is being performed 7: t Department of Transportation Use Only Percent of Total Contract DBE Status Verification This Request . Z' % Previous Requests Z.4.Cps' %,, Sublet to.Date. Project Engineer Date Approved-Region,Construction Engineer Date ❑ Approved (When Required) DOT Form 421 012-EF Distribution: White(Original)=Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 • Ali *II II II I I I I II I I II II II I I I I I I I III II(I I I I II I III II 03854 703.2-'Subcontractor Approval Packets l 12/08/2016* ---- - — m .� Conti ;tor and Subcontractor or II hMngtan State e® Depsavitnt of Transportation Lower Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on'all Federal-Aid projects) Contract Number Federal-Aid Number TDuuval]AWE Route Number CAG 16-00.4 STPUL 1113(0.03) Subcontractor or Lower Tier Subcontractor To be signed by.proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions- Federal-Aid Construction Contracts{FHWA 1273)",and the minimum wage rates. 1 certify the above statement to be true and Correct. Company Northwest Traffic, Inc. Signature Date ^ Title � 7i(�C`•�fl` - Contractor Certification i To be completed and signed by the contractor i 1. ® A written agreement has been executed between my,firm and the above subcontractor. f 2. ❑ A written agreement has been executed betweek ' hl subcontractor) and the above lower tier subcontractor. I All documents required by the special provision entitled"Requird:federal-Aid Provisions'are included in the agreement for (1)or(2)marked above. certify 1he above statements under Contractor Certification io be t,ua and correct. company ICON Materials it Signature ti Date Title Mark Eichelberger,ProjectManager I, DOT Form 420.004 EF ( ` Revised`0 12008 1�: 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 7/8/2016 773413 7/14/2016 Company Details Company Name: NORTHWEST TRAFFIC INC Address: PO BOX 1915 MILTON, WA, 98354 Contractor Registration No. NORTHWT994PJ WA UBI Number 602140049 Phone Number 253-862-4102%R Industrial Insurance Account ID 01669500 Email Address office@nwtraffic.net Filed By Lang, Alisa Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200ta Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055. Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-73030 11+r�o•//fnrlrcoo zro rtnt /gni/inrrn�nn�m/Trlcarinatni�c ��„� �/�1) 1)14 Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105314372 Intent Details Expected project start date: (MM-DD-YYYY) 9/1/2016 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 $39,599.73 this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF �1-tr[o•//fnrfraoo[[1/] (TA[)��Yll�[Sly]/T��A![Vllll/111'L]Y1�1 '0�/]l�C /]CY1V ��ni�n�� WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Traffic Control Stripers Journey Level $43.73 1 King Traffic Control Stripers Journey Level $40.82 $2.91 1 Public Notes o Show/Hide Existinp, Notes No note exists �itr+o•//fnr4r000 �irn rrn�r/�r.i/z rn rro�nn�m/TntnrtTlcf ni�o ��,,,. '71) 0 1 A BUSlness Lice'' _ Qty•or, ' .� } i. �- 1055 southGrady Way, �Rentan,lNA 98057(425)4306851 Fax(425)-43M983-. - L iceise�:#; BL,030966 . Expiry#lot Date: -1.0/31/2016 - Issued Date: 10/19/2015 NORTHWEST TRAFFt'.MC PO BOX 1915 Milton,.VilA 98354_19:15. oetpc ttcense and.Pr�st nr Fus!»rssJncaliodtsted below, BUSINESS LICENSE �� ° � eity0 Ant-of-061 of.ckty 4 NON-TRANSFERABLE : . License I3L 031396 Expiration Date: '10/31/2016 NAILS Code: 238990' r NORTHWEST TRAFFI 'I G 622 WValiey Hwy E Edg6wood; WA.98372-9709 Majror Adminlsira0ve 5 $Administrator Lieensea'has applied for a-city of Rentin;business license in accordance with Renton-Municipal Code(the Code),Title V Business, f Chapter 5 Business License.The Licensee agrees-to comply-with all requirements of the Code;as Well as state laws and 3 regulations applicable to the busmess:ac6vity licensed. 3 t Post this!_icsrise at the-0hace of business. p' .Thls;lit ense does not allow;licensee tt�:operate a permanent-physical loaaUon in.Renton. 9056 S Gredjr Way ,Rerrton WA 98057 6,696 -(42r3)-430-6983-- A,? licensing@rentoiiwa a wog Washington State Department of Transportation Request t® Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Totem Electric of Tacoma, Inc. 1278043550 91-0758480 Address Telephone Number PO Box 1093 253-383-5022 City State Zip Code Estimated Starting Date Tacoma WA 98401 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Ifno Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A6 X Mobilization $3,612.00 A52 Apply Non-Skid to Utility Cover $929.00 A53 Adjust Junction Box $710.00 B9 Solar Radar Speed Feedback Sign $16,476.00 B10 Junction Box Type 1 $1,096.00 B 11 Breakers $568.00 B12 Conduit Pipe 2 Inch $16,224.00 3�10� T/IS/t4 I understand and will insure that the subdontractor will Prime ntractor Signature. Date comply fully with the plans and specifications under which this work is being performed. l > Department of Transportati n Use Only Percent of Total Contract DBE Status Verification This Request 2, 4 Previous Requests ?_5 •3(11 % Sublet to Date 31 . 2(. % Project Engineer Date Approved Region Construction Engineer Date ❑ Approved (When Required) DOT Fonn 421-012 EF Distribution:. White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIII 03854 703.2-Subcontractor Approval Packets 12/08/2016* 'dft Washingt®n statim Contractor and Subcontractor or ® ®eisartment of Transportation Lower Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid.Number State Route Number CAG 16-004 STPUL 1113(003) Duvall AVe E Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company Totem Electric of Tacoma, Inc. Signature Date 71171/,9 Title Pro, a Contractor Certification To be completed and signed by the contractor 1. ® A written agreement has been executed between my firm and the above subcontractor. 2. ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled"Required Federal-Aid Provisions'are included in the agreement for (1)or(2)marked above, I certify the above statements under Contractor Certification to be true and correct. Company ICON aterials Signature Date Title Mark Eichelberger, Project-Manager DOT Form 420-004 EF Revised 03/2006 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 Intent ID: Affidavit ID: Status: Approved On Date: 7/13/2016 774429 7/19/2016 Company Details Company Name: TOTEM ELECTRIC OF TACOMA INC Address: PO BOX 1093 TACOMA, WA, 98401 Contractor Registration No. TOTEMET315BS WA UBI Number 278043550 Phone Number 253-383-5022t.@ Industrial Insurance Account ID 22994300 Email Address marks@totemelectric.com Filed By Stephens, Mark Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200�.a Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303tF 1 4+ro•//Fnrlw000 irn rrn�r/�rii/c:rnnnlnn� r /Tn4onlTla4ni�c nary '7 P)nio< Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105320505 Intent Details Expected project start date: (MM-DD-YYYY) 7/25/2016 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 $39,615.00 this 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 Yes work on this project? Do you intend to use any apprentices? Yes (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF l,ff--Ufn,,f---- -- '7P) P)n1 A ,k WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Electricians - Inside Journey Level $45.77 $19.95 2 King Laborers General Laborer - $34.42 $10.89 1 King Power Equipment Operators Shovel , Excavator, Backhoe, $39.12 $18.60 1 Tractors Under 15 Metric Tons. Public Notes o Show/Hide Existing Notes No note exists 1,44- •��TAYM`�[•[ [[l.] rt![[1�IYlt�[Sl.]RDIAAV11Y1�IYl�PH�'I.,G+'.11lC[ ��„� �i�ni�ni� - Washington State Ar Department of Transportation . Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer T.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number ' City of Renton,Duvall Ave NE Pavement Preservation Project Approval is .Requested to.-Sublet the.Following Described Mork to : Subcontractor or Lower Tier.Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Cascade Utility Adjusting,LLC. 603 407 046 47=3124314 Address Telephone Number 2505 185 'Ave:E 206-595-4572 City State 'Zip Code Estimated Starting Date Lake Tapps WA 9091 07J18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Yno Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item:Description Amount A28 Adjust Manholes $14,355.00 A29 Adjust Catch Basins $770.00 A31 Adjust Water Valves $5,130.00 A48 Adjust Monuments $855.00 2t, t t 0•a0 -7/K/LLP I understand and will insure that the,subcontractorwill Prime n actor, 'gnature Date comply fully with the plans.and specifications under.which this work is beingperformed.. Department of Transportation Use Only Percent of Total Contract DBE--Status Verification- This erificationThis Request Previous Requests 2't•CtD Sublet to Date 0/0 Project Engineer Date Approved-Region.Construction Engineer Date ❑ Approved (When Required) DOT Fonn 421-011 EF Distribution:"White,(Original)'-Region Canary(Copy):=Project Engineer Pink(Copy)—.Contractor Revised 11/2009 d Illlllllllllllllllllllllllllllllll�lllllllllllllllllllllllllllllllllulllllllllllllllllllllllllllllllllllllllllllllllll i 03854 703.2-Subcontractor Approval Packets i 12108/2016` i Coati :tcr and Subcontractor or TIWashington State Lower Fier Subcontractor AO Department of Transporta6an Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004 I STPUL 111-)(003) Duvall AVe E Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor or towor tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWF,1273)`,and the minimum wage rates. I certify the above statement to be true and correct. company Cascade Utility Adjusting,LLC Signature Cate — d Title6eY Contractor Certification To be completed and signed by the contractor 1. Z Awritten agreement has been executed between my firm and the above subcontractor. 2. ❑ Awritten agreement has been executed between(the subcontractor) and the above lower Fier subcontractor, Air documents requlred by the special provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON terials -- Signature . — - -- — — --------- Date Title :Mark Eichelberger,Project Manager DOT Form 42C-C,04 EF Revised 0312DDB i a�� i vi ..i 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 7/14/2016 774860 8/8/2016 Company Details Company Name: CASCADE UTILITY ADJUSTING LLC Address: 2505 185th AVE E BONNEY LAKE, WA, 98391 Contractor Registration No. CASCAUA860RK WA UBI Number 603407046 Phone Number 206-595-4572`0 Industrial Insurance Account ID 03898503 Email Address Linda@grahambookkeepingandtaxservice.com Filed By Mann, Kenneth Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200t® Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303tp i ,, iir n •i i it .r • nin inn � Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105323154 Intent Details Expected project start date: (MM-DD-YYYY) 7/15/2016 In what county (or counties) will the work King be performed? In what city (or nearest city) will the work Renton be performed? What is the estimated contract amount? OR $21,110.00 is this a time and materials estimate? Will this project utilize American Recovery No and 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 No subcontractors to perform ALL work? Will your company have employees perform Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing 1 work on the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS i u s v✓ v i✓ Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Laborers General Laborer $34.42 $10.89 3 Public Notes o Show/Hide Existing Notes -- On 8/5/2016:-- RE: CORRECTION NOTICE A) Describe whole project - Overlay Asphalt Over Existing Road Surface on Duvall Avenue NE, Renton, WA. B) Raise and lower utilities (manholes, water valves, gas valves, catch basins, utility vaults, etc.) as needed. C) The General Laborers use no tools, equipment, or vehicles. .. ... n i , , T .r .•, n in inns� Page 1 of 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 Project Detail - .Project Dashboard Document Received Date: Intent ID: Affidavit ID: Status: Approved On 7/14/2016 774860 8/8/2016 Company Details Company Name: CASCADE UTILITY ADJUSTING LLC Address: 2505 185th AVE E BONNEY LAKE, WA, 98391 Contractor Registration No. CASCAUA860RK WA UPI Number 603407046 Phone Number 206-595-4572 Industrial Insurance Account ID 03898503. Email Address Linda@grahambookkeepingandtaxservice.com Filed By Mann, Kenneth Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575.3200 Project Information Awarding Agency 'RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303 Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058:30 Bid due date 6/7/2016 https://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 8/10/2016 Page 2 of 3 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105323154 Intent Details Expected project start date: (MM-DD-YYYY) 7/15/2016 In what county (or counties) will the work be performed? King. In what city (or nearest city) will the work be performed? Renton What is the estimated contract amount? OR,is this a time $21,110.00 and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any weatherization No or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY subcontractors? No Does your company intend to hire subcontractors to No perform ALL work? Will your company have employees perform work on this Yes project? Do you intend to use any apprentices? (Apprentices are No considered employees.) How many owner/operators performing work on the 1 project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Laborers 'General Laborer $34.42 $10.89 3 Public Notes inShow/Hide Existing Notes. https://fortress.wa.gov/lni/Wagelookup/IntentDetails.aspx 8/10/2016 Page 3 of 3 -- On 8/5/2016:-- RE: CORRECTION NOTICE A) Describe whole project - Overlay Asphalt Over Existing Road Surface on Duvall Avenue NE, Renton, WA. B) Raise and lower utilities (manholes, water valves, gas valves, catch basins, utility vaults, etc.) as needed. C) The General Laborers use no tools, equipment, or vehicles. https://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 8/10%2016 Business License : c ylol � (} 1065 South Grady Way Renton, WA 98057 (425)430-6851 Fax(425)430-6983 License#: BL.040333 Expiration Date: 07/31/2017 issued Date: 06/27/2015 Cascade Utility Adjusting LLC PO Box 1946 Sumner, WA 98390-0420 cr.«'r.;;of!:Uli.:osa:..ca!:oo!s._d&e!p.v. BUSINESS LICENSE 1 r�-�- < .t, �,; ; Out of City NON-TRANSFERABLE License #: BL.04.0333 Expiration Date: 07131/2017 CASCADE UTILITY ADJUSTING LLC NAICS Code: 237310 5522 Elaine Ave_ 5E Auburn, WA 98092-8398 i - i Mayor Adminhtrative s Admiru5lrwor Licensee has applied for a City of Renton business license in accordance with Renton Municipal Code(the Code),Title V Business, ` Chapter 5 Business License.The Licensee agrees to comply with all requirements of the Code,as well as state laws and regulationr applicable to the business activity licensed. s Post,this License at the place of business. This licence does not allow licensee to operate a permanant physical location In Renton. - - - 1055.S•Grady-Way;Renton WA 98057-(425)•430.6851•Fax•(425)430-6983-licensing@rentonwa,9ov --- Washington State 0(n, v7z P' Department of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Caliber Concrete Construction, Inc. 601 156 625 91-1433997 Address Telephone Number PO Box 1881 253-927-0707 City State Zip Code, Estimated Starting Date Milton WA 98354 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor - * (f no Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount B08 Cement Concrete Sidewalk $2,533.96 A42 Cement Concrete Traffic Curb/Gutter $18,213.12 A43 _ Cement Concrete Pedestrian Curb . $9,141.75 A49 Cement Concrete Sidewalk $13,059.64 A50 Cement Concrete Curb Ramp Type Perpendicular $12,448.86 A51 Cement Concrete Curb Ramp Type Parallel $22,822.91 B67 Cement Concrete Traffic Curb and Gutter $1,559.92 I understand and will insure that the subcontractor will Prime tracto Signature Date comply fully with the plans and specifications under which this work is being performed. , Department of Transportation Use Only Percent of Total Contract DBE Status Verification This Request g S % Previous Requests q •�S Sublet to Date 2`f•`1c� % Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF • Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 -- — ---- — --II- --- -- - -- II II II I I I I II I III IIII II II I III III I VIII I IIIIIIIII IIIIIIIIIIIIIIVIIIIIII II VIII II '03854 703.2-Subcontractor Approval Packets 12/08/2.016' ' COnt. -ctor and Subcontract®r or . DOPavbiwnt of TranspartaNan Lowell Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004 STPUL 1113(003) Duvall AVe E Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision-entitled'Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FNWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company Caliber Concrete Constructia Inc. 5ignbture �`�Y/_-r-=''� -�/ Date ride —1:ez Contractor Certi ecation To be completed and signed by the contractor 1. ® A Written agreement has been executed between my firm and the above subcontractor. 2. ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. . I certify the above statements under Contractor Certification to be true and correct. Company ICON Materials Signature — _ ! Date Title Mark Eichelberger,Project Manager DOT Form 420.004 EF Reyfsed 0312008 BUSINESS LICENSE ityof Out of!City NON-TRANSFERABLE License#: BL.024387' Expiration Date: 07/31/2017 CALIBER CONCRETE CONSTRUCTION NAICS Code: 23811.0 10514 8th St E Edgewood, WA 98372-1130 i Mayor Administrative S s Administrator Licensee has applied for a City of Renton business license in accordance with Renton Municipal Code(the Code),Title V Business, Chapter 5 Business License.The Licensee agrees to comply with all requirements of the Code,as well'as State laws and regulations applicable to the business activity licensed.. Post this License at the place'of business. This license does not allow licensee to operate a permanent physical-location in Renton. 1055 S Grady Way, Renton-WA 98057 (425)•430-6851 Fax(425)430-6983 .licensing@rentoriwa.gov:. - Page 1 of 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 Project Detail - .Project Dashboard Document Received Date: Intent ID: Affidavit ID: Status: Approved On 7/21/2016 776522 7/27/2016 Company Details Company Name: CALIBER CONCRETE CONST INC Address: PO BOX 1881 MILTON, WA, 9.8354 Contractor Registration,No. CALIBCC115CA WA UBI Number 601156625 Phone Number 253-927-0707 Industrial Insurance Account ID 54638901 Email Address kathy@caliberconcrete.com Filed By Johnson, Sue Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 2067-575-3200 Project Information Awarding Agency RENTON, CITY'OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-73.03 Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058:30 Bid due date 6/7/2016 https://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 8/2/2016 Page 2 of 3 `Award Date 6/20%2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105333618 Intent Details Expected project start date: (MM-DD-YYYY) 8/1/2016 In what county (or counties) will the work be performed? King In what city (or nearest city) will the work be performed? Renton What is the estimated contract amount?OR is,this a time $79,780.16 and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any weatherization No or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY'subcontractors? No Does your company intend to hire subcontractors to No perform ALL work? Will your company have employees perform work on this Yes project? Do you intend to use any apprentices? (Apprentices are Yes considered employees.) How many owner/operators performing work on the 0 project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 60100.6854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Cement Masons Journey Level $39.52 $16.04 -3 King Laborers Cement Finisher Tender $34.42 $10.89 2 Public (Votes https://fortress.wa.gov/lni/wagelookup/.IntentDeiails.aspx 8/2/2016 Page 3 of 3 inShow/Hide Existing, Notes No note exists https://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 8/2/2016 - - ------ --- BUSINESS LICENSE Annual Out of City a R ,, ' City o{ NON-TRANSF ,.r T —�;.. �.<.•.r_ c7 ERABLE ,f gid? '1• e' ?'�:�''<. Ucense# _ 'BL.024387 Expiration Date ;..:0713112016 NAlCS;Code 238110-- 10514 8th St E Edgewood, WA 98372 ��L r • Mayor `. AdminigratWS tI MM. Licenseeha's.applied-for a,City of Retitan business license in accordance wrth Renton Municipal Code(tt a Code);`tate.V Business; l Chapter s Business•License.The.Ltcensee agrees to eompiy with'alk requirements of the Code,as welt as'8tate laws:and- regulations applicable torthe.busideess a_ckfvity licensed. j Postthts lce Lns®atth®place of business; . Tots license does riot al(otni licensee tQ:operate a;permanent phystcal.location In Renton: M_ 4055 S Grady Way,Renton WA-:913057 (425}430-8851•fax(�28),430-6983 licen§fng@reotonwa,gov AdW Washington State Department of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor El DBE PES Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Fork to: Subcontractor or Lower Tier Subcontractor1603 Unified Business Identifier(UBI) Federal Employer I.D.Number* Able Industries, Inc. 542 604 47-5088545 Address Telephone Number PO Box 1658 253-266-1351 City State Zip Code Estimated'Starting Date Milton WA 98354 08/01/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *If no Federal Employer I D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount C01 X Hired Haul(remove asphalt) $3,000 I understand and will insure that the subcontractor will Primo ntractor Signatures D to comply fully with the plans and specifications under which >� this work is being performed. P7 Department ofGTransportation Use Only Percent of Total Contract DBE Status Verification This Request % Previous Requests Sublet to Date Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor----- Revised ontractor--__Revised 11/2009 _--- -- IIIIIIIIIIIIIIIIIIIIillllllllllllllllllllllllllllllllllllllllllll IIIIIIIIIII I IIIII IIII III '03854 703.2-Subcontractor Approval Packets iomunn1t;' ---- --- ---- GontractoF and Subcontractor or WMSi On Lower Tier Subcontractor= Certification for Federal Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004 STPUL 111.3(003) f Subcontractow or Lower Tier Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include-as part of the subcontract a special provision entitled'Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company LE: U15 Signaf ire Date k f l2ult-a Title Contractor CcMficaflan To be completed and signed by the contractor 1. MA A written agreement has been executed between my firm and the above subcontractor. z ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. Ali documents required by the special provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON hJaterials Signature _ Date r Title Mark Eichelberger DOT Form 420-004 EF Revised 0312009 Washington State Department of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON Materials 91-1272258 C/N CAG 16-004 STPUL 1113 003 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* RCD Trucking 602 965 306 27-1243701 Address Telephone Number 1302 Mowitch Dr. 253-677-7291 City State Zip Code Estimated.Starting Date Fox Island WA 98333 8/4/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Jfno Federal Employer I.D.Number, Use Chi ner's Social Security Number Item No. Partial Item Description Amount CO1 X Hired Hauling(remove asphalt) $2,000 1 understand and will insure that the subcontractor will Prime- actor Signature Date, comply filly with the plans and specifications under which this work is being pe)formed. Department of Transportation Use Only Percent of Total Contract DBE Status Verification This Request % Previous Requests °/a Sublet to Date % Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 9/2/2016 787049 9/12/2016 Company Details Company Name: R.C.D. Trucking LLC Address: 1302 Mowitch Dr Fox Island, WA, 98333 Contractor Registration No. WA UBI Number 602965306 Phone Number 253-677-7291tC� Industrial Insurance Account ID 18439001 Email Address rcdtrucking@comcast.net Filed By Desjardins, Ryan Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-32001,0 Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303,.a K ArGG Vl J Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105397546 Intent Details Expected project start date: (MM-DD-YYYY) 8/4/2016 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 Time and materials this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF r agv j ui j ` a WA UBI Number 601006854 ,Journey Level Wages County Trade Occupation Wage Fringe # Workers King Truck Drivers Dump Truck Ft Trailer $51.25 1 Public Notes R Show/Hide Existing Notes No note exists Page 1 of 2 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 Project Detail - Project Dashboard Document 9/28/2016 Intent 787049 Affidavit 669363 Affidavit Approved on Received Date Id Id Status 9/30/2016 Your Company Information Name R.C.D. Trucking LLC Address 1302 Mowitch Dr Fox Island,WA,98333 WA UBI no. 602965306 Contractor Registration no. Industrial Insurance Account Id 18439001 Email Address rcdtrucking@comcast:net Filed By Desjardins,Ryan Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: Flora Lee Awarding agency contact phone number: 485-430-7303 Project Details Project name Duvall Ave NE Pavement Preservation Project County where work was performed King City where work was performed Renton Job site address/directions: Prime contractor name ICON MATERIALS Prime contractor registration no. ICONM**982CF Contract no. CAG-16-004 Prime contractor Phone Number 206-575-3200 Prime contractor Intent form Id# for this 771206 project Dollar amount of your contract: $ 1,995.00 https://fortress.wa.gov/lni/wagelookup/AffidavitDetails.aspx 10/10/2016 Page 2 of 2 Bid due date 6/7/2016 Contract award date 6/20/2016 Intent filed date. 9/2/2016 Job start date:MM-DD-YYYY 8/4/2016 Date work completed:MM-DD-YYYY 8/5/2016 Project Completion Did your subcontractors perform all work on No this project? Did your company hire any subcontractors? No 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)? Company Owner Information How many owner/operators performed work 0 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 # # Workers Hours << a King Truck Drivers Dump Truck £t Trailer51.25 1 14.25 Apprentice Wages Public Notes mShow/Hide Existing Notes No note exists littps://for.tress.wa.gov/liii/wagelookup/AffidavitDetail8."px 10/10/2016 3f k L) 17WWashington State Department of Transportation Request t® Sublet Work E Subcontractor ❑ Lower Tier Subcontractor IR DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Green City, Inc. 601 196 371 91-1459869 Address Telephone Number 2224 NE 31St St. 425-802-7081 Cit' State Zip Code Estimated Starting Date Renton, WA 98056 WA 98056 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Ifno Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A6 X Mobilization&Demobilization $4,500.00 C2 Topsoil Type a $14,960.00 C3 PS Summit Ash 2.5"Gal $8,400.00 C4 PS Kelsey Dogwood 1 Gal $2,500.00 C5 PS Mediterranean Pink Heath 1 Gal $10,500.00 C6 PS Daylily 1 Gal $1,940.00 C7 PS Variegated Maiden Grass 2 Gal $1,520.00 C8 PS Abbotswood Potentilla 2 Gal $5,740.00 C9 PS Dwarf English Laurel 1 Gal $6,000.00 C10 Bark or Wood Chip Mulch $1,380.00 C11 Landscaping-Tree Root Barrier $1,600.00 C 12 Irrigation system $15,000.00 X040 I understand and will insure that the subcontractor will Prime on actor Signature Date comply fully with the plans and specifications under which this work is being performed. /a Department of Transportation Use Only Percent of Total Contract DBE Status Verification This Request `f3 Previous Requests % Sublet to Date Project Engineer Date Approved-Region.Construction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 1112009 I II IIIIIIII IIIII III IN1111 IIIIIIIIIIIIIIIIIII IIIIIIIIIII IIIIIIIIIIIIVIIIIIIIIIIIIIIIIIIIIIIII *03854 703.2-Subcontractor Approval Packets 19lnsan1s* Washington State Contractor and Subcontractor or W/ Department of Transportation Lower Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid NumberState Route Number _ CAG 16-004 _ STPUL 1113(003) Duvall AVe E Subcontractor or Lower Tier Subcontractor Tobe signed by-proposed subcontractor-or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage.rates. I certify the above statement to be true and correct. Company Green City; Inc. Signature . ?_ ! —. Date Title. i'G -_- Contractor Certification To be completed and signed by the contractor 1. A written agreement:has been executed between my firm and the above subcontractor. 2. J- A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. _ All documents required by the special provision entitled"Required Federal-Aid Provisions"`are included in the agreement,for (1)or(2)marked above. 1 certify the above;statementsunder Contractor Certification to be true and correct. Company JCONb4aterials Signature Date Title Mark-Eichelberger,Project Manager DOT'FOrrr 420.00.4 EF` Revised:0312008 JL n.6,. 1 v i�. Home Espanol Contact Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries GREEN CITY INC Owner or tradesperson 2224 NE 31ST ST RENTON,WA 98056 Principals 425-228-6488`© FALANIKO,FRANK KING County FALANIKO, ROSE Doing business as GREEN CITY INC WA UBI No. Business type 601 196 371 Corporation Governing persons FRANK FALANIKO ROSE M FALANIKO; License Verify the contractor's active registration!license 1 certification(depending on trade)and any past violations. Construction Contractor Active. .......................................................... Meets current requirements. License specialties LANDSCAPING License no. GREENCI105B4 Effective—expiration 01/24/1990—08/24/2016 Bond ............ o No bnd accounts during the previous 6 year period. Insurance ....................... Liberty Northwest Ins Corp $1,000,000.00 Policy no. BKS54830596 Received by L&I Effective date 09/17/2015 09/19/2011 Expiration date 09/19/2016 Insurance history S.avin.gs ................. (in lieu of bond) $6,000.00 Received by L&I Effective date 02/26/2015 01/30/2015 Release date Impaired date N/A N/A Savings account ID 1260920 .._...._................_.._................._....... ..... _.............:.:.:...:................................ ........................................._....................................... .. ... !'-T TI'Yl ALT A 00 A ITT_ '7/L P)A1 L (in lieu of bond) $6,000.00 Received by L&I Effective date 09/20/2007 09/18/2007 Release date Impaired date N/A N/A Savings account ID 0055027742 ..................._....................................................................................................................................................,.................................................................................. (in lieu of bond) $6,000.00 Received by L&I Effective date 10/14/2002 10/10/2002 Release date Impaired date NIA 07/23/2007 Savings account ID 55027742 ..... .........................................................................._............................................................................................................................................... ......... Savings history Lawsuits against the bond or savings ........................................................................................ No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ............................... No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations ........................................... No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 454,329-01 ......................... Doing business as GREEN CITY INC Estimated workers reported Quarter 1 of Year 2016"4 to 6 Workers" L&I account representative TO/DALE MCMASTER(360)902-5617®-Email:MCMS235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. 1 n11171 o-T Tn—,r1nT1.Tn.TnT1 ncnn 0-0 A ITT— 7/4/7n1 AC `:?!lig'` ti STATE OF WASHINGTON OFFICE OF MINORITY AND WOMEN'S BUSINESS ENTERPRISES 1110 Capitol Way South,Suite 150 - PO Box 41160 - Olympia, WA 98504-1160 (360) 664-9750 -Toll free 1-866-208-1064 - Fax (360) 586-7079 As Of 7/6/2016 1:30:44 PM YA,.., -. - . .mak Contact Information Business Name Green City Inc Doing Business As Name Green City Inc Contact Name Frank Falaniko Description of Work Landscaping services: Planting, pruning and lawn maintenance; lawn sprinkler system installation; Irrigation design, planning, configurations and installation. Street 2224 NE 31st ST City, State, Zip Renton, WA, 98056 County King County Phone 4252286488 Fax 4252286488 E-mail andrewf@greencitywa.com Website _ . --- - - --- - ---- - - -- UBI Number 601196371 Owners Information Primary Owner FRANK FALANIKO Other Owner(s) Certification Information State Federal Certification Type MBE DBE/SBE Certification Number M4M0021336 D41VI0021336 NAILS codes for UCP USE ONLY to determine size standard NAICS Codes (Primary is specified in bold) ;561730 -Landscaping services (except planning) 237110- Irrigation project construction (except lawn) 238220 - Lawn sprinkler system installation rage 1 el 1 r 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 7/14/2016 774887 7/22/2016 Company Details Company Name: GREEN CITY INC Address: 2224 NE 31ST ST RENTON, WA, 98056 Contractor Registration No. GREENC1105134 WA UBI Number 601196371 Phone Number 425-228-648810 Industrial Insurance Account ID 45432901 Email Address and rewf@greencitywa.com Filed By Falaniko, Rose Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200*,0 Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-730310 Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $17363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105323278 Intent Details Expected project start date: (MM-DD-YYYY) 8/1/2016 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 $74,040.00 this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 1 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF rage -1 of WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Landscape Construction Irrigation Or Lawn Sprinkler $32.79 $0.00 3 Installers King Landscape Construction Landscape Equipment $32.79 $0.00 1 Operators Or Truck Drivers King Landscape Construction Landscaping or Planting $32.79 $0.00 3 Laborers Public Notes o Show/Hide Existing Notes -- On 7/14/2016:-- Installation of around 8-12" topsoil and 2-3" bark mulch in new median planter unit. Installation of in ground irrigation system approximately 12" below finish grade. Installation of trees and shrubs. All work shall be completed with small equipment included front load skid steers, mini excavators (class 35 or smaller), and hand tools. Purpose of project is to improve pedestrian safety and revitalize Duvall Ave. 4.. Business. - 1055 South Grady Way R n ',711A- 4 430-6351 F x 11425 _ Exb 13 Dat C11 =0 t Issued Dials.cic, -0 GREEN CITY INC 2224 N E 31 st St Renton, WA 98056-205:1 Detach License and Post at business location listed below. BUSINESS LICENSECity 0I oe" Annual -iia City.NON TRAfJSFERABLE -- '- ='-=—. � ---` • a i License#: BL.007222 Expiration Date: 01:131/2017 ! NAICS Code: 561730 GREEN.CITY' .NC � s GREEN CITY INC 2224 NE 31st`St Renton, WA 96056-2051 i Mayor Rdrriinistrative se es Administrator Licensee has applied for a City of Renton-business license In accordance with Renton Municipal Code(the Code),Title V Business, i Chapter 5,l3usiness License.The Licensee:agrees to.comply with all�equirements-of the:Code,es,weli as State laws and i regulations-appGcabie to the business activity.licensed. Post this License at the place.of business. -----•---- -- 14055 S.GradyWayi Rentrin 1WA 98057-(4 5)4 0-6$5�-Fax(425}430-698 :-licensing{�reritonwa gov- - -- ---j Washington State Department of Transportation Request to Sublet Work ® Subcontractor "C ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON Materials 91-1272258 C/N CAG 16-004 STPUL 1113 (003) Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* R& L Trucking and Construction, Inc. 600 550 088 91-1267859 Address Telephone Number 4802 Quincy Ave SE 253-735-2298 City State Zip Code Estimated Starting Date Auburn WA 98092 8/9/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *If no Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A22 X Hired Hauling(remove asphalt) $3,000 1 understand and will insure that the subcontractor willPrime ec 'a for Signature Date comply fully with the plans and specifications under which this work is being performed IDepartmecfR of T anspor`fation Use my Percent of Total Contract DBE Status Verification This Request % Previous Requests % Sublet to Date % Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT For,-n 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 II IIII I II I II II II IIII I I I�III III III II ul I III III II "03854 703.2-Subcontractor Approval Packets 12/08/2016' UkShk2t,on Mate Contractor and Subcontractor or Lower Tier Subcontractor Certr6dication for Federa9-Aid Pr OjeCuS (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004' STPUL 11 13(003J) Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractoror lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company R & L TRUCKING AND CONSTRUCTION, INC. Signature Date 8/16/2016 Title PRESIDENT Contractor Certification To be completed and signed by the contractor 1. X[I A written agreement has been executed between my firm and the above subcontractor. 2• ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON aterials Signature w ! Date Title Mark Eichel 'rger DOT Form 420-004 EF Revised 03/2008 1 ap, 1 Vl J 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 8/9/2016 780979 8/15/2016 Company Details Company Name: Able Industries INC Address: PO BOX 1658 Milton, WA, 98354 Contractor Registration No. WA UBI Number 603542604 Phone Number 253-266-1351�.a Industrial Insurance Account ID 60023800 Email Address Whitney@Ablelncwa.com Filed By Libadia, Whitney Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200t,O Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303�p .. ,.. , •i . , it .r .. •, nininnc 1 0. 4 L Vl J Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105360495 Intent Details Expected project start date: (MM-DD-YYYY) 8/1/2016 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 Time and materials this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe Workers I KingTruck Drivers Dump Truck Et Trailer $51.25 1 Public Notes o Show/Hide Existing Notes -- On 8/9/2016:-- ALL Fringe Benefits paid to driver directly w' 10 Washington State Department of Transportation Request to Sub8et Work ® Subcontractor ��`` ❑ Lower Tier Subcontractor ❑DBE Prime Contractor Federal Employer.I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton,Duvall Ave NE Pavement,Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Northwest Concrete Cutting 600 472 894 91-1260562 Address Telephone Number PO Box 5851 253-852-6231 City State Zip Code Estimated Starting Date Kent WA 98064-5851 07/25/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Lf no Federal Emplow LD.Number, Use Owner's Social Security Atumber Item No. Partial Item Description Amount A16 X Saw Cutting $840 A18 X Saw Cutting $840 B02 X Saw Cutting $160 B03 X Saw Cutting _ - ._._-. _.. _ .- $750 B04 X Saw Cutting $160 7-7 S U rundestand andivill insure that the subcontractorwill PrimeCoti't actor-Signature •, �' Date comply fully with the plans and specifications under which �� /� `/� this work is being performed ;/ /� �• r ,' {Ji - � ✓ ,."G Vii'f !,! /r' .�� Department of Transportation Use/Only Percent of Total Contract DBE Status Verification This Request Z % Previous Requests -� Sublet to Date 3 s•�1 % Project Engineer Date Approved-Region Construction Engineer Date Approved (When Required). ❑ DOT Form.427-0I2 EF Distribution White(Original)—Region Canary(Copy)—Projecit Engineer Pink(Copy)=Contractor Revised 1112009' c f� -,J coMQ t'7 �l25/1� 11IIII11I111111111111111�� *03854 703.2-Subcontractor Approval Packets 1?108/701 fi* Page 1 of 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 Project Detail - Project Dashboard Document Received Date: Intent ID: Affidavit ID: Status: Approved On 7/25/2016 777109 7/29%2016 Company Details Company Name: NORTHWEST CONCRETE CUTTING LLC Address: PO BOX 58.51 KENT, WA, 98064 Contractor Registration No: NORT-HCC84ODN WA UBI Number 603572428 Phone Number 253-852-6231 Industrial Insurance Account ID 47673503 Email Address nwwcl@comcast.net Filed By Conwell, Vincent Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM"982CF WA UBI Number 601006854 Phone Number 206-57573200 Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency-Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303 Contract Number CAG'-.16-004 Project NameDuvall Ave NE Pavement Preservation Project Contract Amount $1,163,058.30 Bid due date 6/7/2016 ittps://fortress.wa.gov/In/wagelookup/InteniDetails.aspx 8/2/2016 Page 2 of 3 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105337116 Intent Details Expected project start date: (MM-DD-YYYY) 7/26/2016 In what county (or counties) will the work be performed? King In what city (or nearest city) will the work be performed? Renton What is the estimated contract amount? OR is this a time Time and materials and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any weatherization No or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY subcontractors? No Does your company intend to hire subcontractors to No perform ALL work? Will your company have employees perform work on n this Yes project? Do you intend to use any apprentices? (Apprentices are No considered employees.) How many owner/operators performing work on the 1 project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Laborers Concrete Saw Operator/core Driller $44.76 1 Public Notes inShow/Hide Existing Notes https://fortress.wa.gov/lni/wagelookup/InteiitDetails.aspx 8/2/2016 IML Contractor and Subcontractor Or Lower Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all FederalrAid projects) State Contract Number Federal-Aid Number state f Route Number CAG-16-004 STPUL-110(003) ..Duvall A-ve NE S,,ibcontractor or Lower Tier Subcontractor Tobe signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled."Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)',and the minimum wage rates. I certify the above sLatemeht to be true and correct. Company Northwest Concrete Cutting. Signature Date Title Contractor Certification To be completed andsigned by the-contractor 1. A written agreement has been executed between my firm and the above subcontractor. 2. A written agreement has,been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled"Required Federal-Aid Provisions'are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON N4aterials Signature --.__-^._ Date Title Project Matiager MY Form 420-ON'EF ReVised.0312605 State of Washington Department of Labor& Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Payment Receipt %(ol r payment has been rroc-c-Sced and, v o a r Kill-, 1h as been subrnil Cly. Transaction 7/25/2016 Date Transaction Id 105337116 Project Name Duvall Ave NE Pavement Preservation Project Form Filed Intent Form Id 777109 Payment Type VISA ************2926 Amount Billed $40.00 ,4 d FD is o vC;1,5-5.51 y BUSINESS LICENSE Out of City NORTHWEST CONCRETE CUrT7, INN LLC NA=— m- 2L�110 t I ' i /-Ji 1*:C''liSO r~ Rt',1tan kkns-pro�3�f CCn`o) 4'=' vi �J�l!*lt ilCCl13C 'm I t`�itt.�.I�C A;Tr1t.3;yC��w%"�'J`j 44ti�1i 43 -4` Cy IY4FtiS R� Oft, " CS I!<#i :�L^ "h'� Li �It�.'Y+Y•,lC'-��Yic3�Qi7��t1 w'��+'�1J��f''`TA �"'�a�114�'�►��^d�. P041 NS Lltewsc at tto pfacc ri,tx,a1c►a". TANS s not ariaw lictloo 1,0 rte! e wr,Xmml phrsita1 tocallan it-. Rontom I 1t1S5 S s ar,'y1k_Pier:.rx7W A 7 (4,?, oda 4M25) :.3?+ r �agFnt4 � f Home Espanol Contact Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries Debarred Contractors List A debarred contractor may not bid on,or have a bid considered on,any public works contract.You can search and filter this list using the options presented below. Company Name:NW Concrete Cuttin WA UBI Number:600 472 894 License Number: Principal: RCW:All v From:MMlDDNYYY To:MMlDDNYYY Penalty Due: All v Wage Due: All v pply Filter Rese Download all debarment data0+ Show 25 v per page Showing 0 records Fi rstPreviousNextLast Company Name UBI License Principals Status RCW Debar Begins Debar Ends Penalty Due Wages Due There are no records that match your search criteria. Show F257V per page Showing 0 records Fi rstPreviousNextLast ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. rage 1 of 1 w STATE OF WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage August 25, 2016 WA UBI No. 603 572 428 L&I Account ID 476,735-03 Legal Business Name NORTHWEST CONCRETE CUTTING LLC Doing Business As NORTHWEST CONCRETE CUTTING LLC Workers' Comp Premium Status: Account is current. I Estimated Workers Reported Quarter 2 of Year 2016"4 to 6 (See Description Below) Workers" Account Representative T1 /TYRONE COLEMAN (360)902-48071 - Email: COTI235@lni.wa.gov Licensed Contractor? Yes License No. I NORTHCC84ODN License Expiration —__ ! 03/15/2018 I_ What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51 .12.050 and 51.16.190). rQ�'G 1 Ul G Home Espanol Contact Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries NORTHWEST CONCRETE CUTTING LLC Owner or tradesperson PO BOX 5851 Principals KENT,WA 98064 2-62 CONWELL,VINCENT RAYMOND,MANAGER KING County KING Doing business as NORTHWEST CONCRETE CUTTING LLC WA UBI No. Business type 603 572 428 Limited Liability Company Governing persons VINCENT CONWELL VINCENT RAYMOND CONWELL; License Verify the contractor's active registration!license/certification(depending on trade)and any past violations. Construction Contractor Active. .......................................................... Meets current requirements. License specialties CONCRETE License no. NORTHCC84ODN Effective—expiration 03/15/2016—03115/2018 Bond Western Surety Co $6,000.00 Bond account no. 62704335 Received by L&I Effective date 03/15/2016 03/10/2016 Expiration date Until Canceled I.nsuran.ce.. ................... Ohio Security Ins Co $1,000,000.00 Policy no. BKS52956614 Received by L&I Effective date 05/03/2016 05/17/2015 Expiration date 05/17/2017 S.aving.s ............ .. No savings accounts during the previous 6 year period. Lawsuits against the bond or savin.s las No wuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts Mo L&1 tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. rage L of L License Violations ................ No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 476,735-03 ........................ Doing business as NORTHWEST CONCRETE CUTTING LLC Estimated workers reported Quarter 2 of Year 2016"4 to 6 Workers" L&I account representative T1/TYRONE COLEMAN(360)902-4807�.a-Email:COTI235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. K u A�Lr 1 TSUBMITTAL REVIEW RESPONSE Duvall Ave NE Pavement Preservation Project City of Renton #CAG-16-004 Date Received:7/25/16 Submittal No.: 018 Submittal Description: Request to Sublet— Northwest Concrete Cutting Review Response Category(select one): ® No Exceptions Taken ❑ Exceptions Noted—See Below ❑ Submit Specified Item: ❑ Make Corrections Noted. No Resubmittal Required ❑ Revise and Resubmit, Per Engineer's Comments ❑ Rejected Review Comments: Review is only for general conformance with the information given in the contract documents. Contractor is responsible for conformance with all requirements of the Contract Documents including but not limited to the dimensions which shall be conformed and correlated at the job site fabrication processes and techniques of construction coordination of qork wit that of all others and satisfactory performance of all work. Reviewed by: Ken Ket Title: RE Date: 8/29/16 Page 1 of 1 Page 1 of 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 Project Detail - .Project Dashboard Document Received Date: Intent ID: Affidavit ID: Status: Approved On 7/25/2016 777109 7/29/2016 Company Details Company Name: NORTHWEST CONCRETE CUTTING LLC Address: PO BOX 5851 KENT, WA, 98064 Contractor Registration No. NORTHCC84ODN WA UBI Number 603572428 Phone Number 253-852-6231 Industrial Insurance Account ID 47673503 Email Address nwwc1 C comcast.net Filed By Conwell, Vincent Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206:575-3200 Project Information Awarding Agency RENT ON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303 Contract Number CAG-16-004 Project Name. Duvall Ave NE Pavement Preservation Project Contract Amount ' $1,363,058.30. Bid due date 6/7/2016 attps://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 8/2/2016 Page 2 of,3 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105337116 Intent Details Expected project start date: (MM-DD-YYYY) 7/26/2016 In what county (or counties) will the work be performed? King In what city ('or nearest city) will the work be performed? Renton What is the estimated contract amount? OR is this a time Time and materials and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any weatherization No or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY subcontractors? No Does your company intend to hire subcontractors to No perform ALL work? Will your company have employees perform work on n this Yes. project? Do you intend to use any apprentices? (Apprentices are No considered employees.) How many owner/operators performing work on the 1 project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey LeVel Wages County Trade Occupation Wage Fringe # Workers King Laborers Concrete Saw Operator/core Driller $44.76 1 Public Notes iaShow/Hide Existing.Notes https://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 8/2/2016 .. _ *L Washington State Department of Transportation Request to Sublet Work ® Subcontractor ❑ Lower Tier-Subcontractor IN DBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is'Requested to.Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* O'Bunco Engineering, International 1602045762 91-2048486 Address Telephone.Number 1042 West James St. Ste 20 425-451-7300 City StateZip Code Estimated Starting Date Kent WA 98032 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *If no.Federal Employer LD.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A2 SURVEY SERVICES $8,615.00 IS.vo 71 KIA—e I understand and will insure that the subcontractor will Prime Contractor Signature Date comply fully with;the plans and specifications under which this work is being performed „ Department of Tra sportation Use Only Percent of-Total Contract DBEStatus Verification This Request r V3 Previous Requests k-7.CIO % Sublet to Date •15.1-I %, Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved' (When Required) DOT Foran 421-012 EF Distribution: White(Original)=Region Canary(Copy)-Project Engineer Pink(Copy)-Contractor Revised 112009 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIII II �� 03854 703.2-Subcontractor Approval Packets Washington State Adft Contractor and Subcontractor or Department of Transportation Lower Tier Subcontractor Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor,on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004 STPUL 11 13(00j) Duvall AVe E Subcontractor or. Lower Tier Subcontractor To be signed by proposed subcontractor or lower tier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1.273)",and the minimum Wage'rates. certify the above statement to be true and correct. Company O'Bunco Engineering . Signatu Date Title Contractor Certification To be completed and signed by the contractor 1. ® A written agreement,has been executed between my firm and the above subcontractor. 2. ❑ A written agreement has been executed-between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct.. Company ICON Materials Signature. Date �� Title Mark Eiehelberger,Project Manager DOT Form 420-004 EF Revised 03/2008 1 6Lr,V 1 Vl 1 Home Espanol Contact Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries O BUNCO ENGINEERING INTERNATIONAL INC Owner or tradesperson PO BOX 1356 SAMUEL OBUNIKE KENT,WA 98035 Doing business as O BUNCO ENGINEERING INTERNATIO WA UBI No. 602 045 762 Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 968,060-01 ......................... _ Doing business as O BUNCO ENGINEERING INTERNATIO Estimated workers reported Quarter 1 of Year 2016"7 to 10 Workers" L&I account representative T5/BREANN OLSEN(360)902-48024@-Email:OLSA235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. i u5%, i vl i .k —}s x RATE OF WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage July 6, 2016 WA U IB No. 1602045762 L&I Account ID x.968,060-01 Legal Business Name O BUNCO ENGINEERING . I INTERNATIONAL INC Doing Business As O BUNCO ENGINEERING - L INTERNATIO Workers' Comp Premium Status: j Account is current. Estimated Workers Reported Quarter 1 of Year 2016"7 to 10 1 (See Description Below) +Workers" Account Representative T5/BREANN OLSEN f (360)902-4802%F- Email: { OLSA2350_Ini.wa.gov Licensed Contractor? No What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial.insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). a STATE OF WASHINGTON OFFICE OF MINORITY AND WOMEN'S BUSINESS ENTERPRISES 1110 Capitol Way South,Suite 150 • PO Box 41160 - Olympia,WA 98504-1160 (360) 664-9750 -Toll free 1-866-208-1064 - Fax(360) 586-7079 As Of 7/6/2016 1:28:26 PM Contact Information .Business Name O'Bunco Engineering Int'I, Inc. Doing Business As Name O'Bunco Engineering Contact Name SamuelObunike -,---- __. 'Description of Work CIVIL &GEOTECHNICAL ENGINEERING, ENVIRO/SITE REMEDIATION CONSULTING, .TRANSIT FACILITY DESIGN. LAND SURVEYING:GPS CONTROL, BOUNDARY& .CONST. LAYOUT/STAKING. CONTRUCTION MANAGEMENT:HWY/ST/BRIDGE, TRANSIT, UTILITIES, WATER/SEWER LINES & COMMERCIAL BLDG. Street PO Box 1356 City, State, Zip Kent, WA, 98035 County King County Phone 4254517300 1 .Fax 4254529192 E-mail sobunike@obuncoengineering.com Website `www.obuncoengineering.com UBI Number 602045762 Owners Information Primary Owner SAMUEL OBUNIKE Other Owner(s) ,Certification Information State Federal Certification Type __---MBE �------�-----�- ---`-�______ DBE/SBE-- -------- ____— Certification Number M3M0016030 D3M0016030 NAILS codes for UCP USE ONLY to determine size standard NAICS Codes (Primary is specified in bold) ;541330 - Engineering services 237310-Construction management, highway, road, street and bridge 541370-Surveying and mapping services (except geophysical) .541611 -Administrative management consulting services 1541611 -General management consulting services 1541620 - Environmental consulting services 41620-Site remediation consulting services 1 u�t. 1 vi ✓ I 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 7/12/2016 774097 7/18/2016 Company Details Company Name: O'Bunco Engineering Intl. Inc. Address: 1042 W James ST, Ste 201 Kent, WA, 98032 Contractor Registration No. WA UBI Number 602045762 Phone Number 425-451-7300t�-- Industrial Insurance Account ID 96806001 Email Address sobunike@obuncoengineering.com Filed By Obunike, Sam Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-32001, Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-73031; 1 .. //f` , /1 / _ 1_ _t_. /r._.__._.'T Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105318799 Intent Details Expected project start date: (MM-DD-YYYY) 7/18/2016 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 $8,615.00 this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers King Surveyors Construction Site Surveyor $39.54 $17.40 1 King Surveyors Chainman $38.07 $17.40 1 Public Notes E3 Show/Hide Existing Notes No note exists Washington State Department of Transportation Request to SuNat {if ork N Subcontractor El Lower Tier Subcontractor ElVVDBE Prime Contractor Federal Employer I.D.Number* State Contract Number ICON MATERIALS 91-1272258 CAG 16-004 STPUL 1113(003) Job Description(Title) Request Number City of Renton, Duvall Ave NE Pavement Preservation Project Approval is Requested to Sublet the Following Described Work to: Subcontractor or Lower Tier Subcontractor Unified Business Identifier(UBI) Federal Employer I.D.Number* Puget Construction Services 603 356 329 46-4287232 Address Telephone Number 253-856-2572 1609 Central Ave. So.Unit 20 City State Zip Code Estimated Starting Date Kent WA 98032 08/22/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *.If no Federal EmployerlD.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount CO1 X Hired Hauling(remove asphalt) $1,000 1 understand and will insure that the subcontractor will Prline. tr cto Signature �e Date comply f:dly with the plans and specifications under which � 7/14/16 this work is being performed. Department of T ansportation Use Only Percent of Total Contract DBE Status Verification This Request % Previous Requests % Sublet to Date % Project Engineer Date Approved-Region Construction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region Canary(Copy)—Project Engineer Pink(Copy)—Contractor Revised 11/2009 -- - II IIII I III Ililllll IIII I II IIIIIIII IIIIIIIIIIIII III IIIIIIIIIIII "03854 703.2-Subcontractor Approval Packets I 12/08/2016" - _ Washington Malts Contractor and Subcontractor or v7zW;--' Lower Tier Subcontractor ®epwtr�ent of`i�trasQam�m2ij®e� Certification for Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number Federal-Aid Number State Route Number CAG 16-004 1 STPUL 1113(003) Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor or lower Fier subcontractor The contract documents for this subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the`Required Contract Provisions Federal-Aid Construction Contracts(FHWA 1273)",and the minimum wage rates. I certify the above statement to be true and correct. Company Puget Construction Services, Inc Signature K� 6t)A24d Date 8/23/2016 Title Accounts Manager Contractor Certification To be completed and signed by the contractor 1. N A written agreement has been executed between my firm and the above subcontractor. 2. ❑ A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor. All documents required by the special provision entitled'Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked above. I certify the above statements under Contractor Certification to be true and correct. Company ICON Materials Signature Date ,/{, Title Mark Eichelberger DOT Form 420-004 EF Revised 03/2008 rage 1 of 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 Intent ID: Affidavit ID: Status: Approved On Date: 8/24/2016 784775 9/1/2016 Company Details Company Name: Puget Construction Srvcs Inc Address: 1609 Central Ave S, Unit 20 KENT, WA, 98032 Contractor Registration No. PUGETCS869BW WA UBI Number 603356329 Phone Number 253-856-2572,.E Industrial Insurance Account ID 28130100 Email Address cyndie@pcsjac.com Filed By Fogli, Cyndie Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200tp Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303tn ra�c � ul � Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105383429 Intent Details Expected project start date: (MM-DD-YYYY) 8/18/2016 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 Time and materials this 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 Yes work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF rage -1 of WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe Workers I King Power Equipment Operators Motor Patrol Graders $56.94 $0.00 1 Public (Votes o Show/Hide Existing Notes No note exists .0 of � Washington State vf/ Department of Transportation Request to Sublet Work ® Subcontractor `7❑ Lower Tier Subcontractor DBE Prime Contractor Federal Employer LD.Number* State Contract Number ICON MATERIALS STPUL 1113(003) CAG 16-004 Job Description(Title) Request Number City of Renton;,Duvall Ave NE Pavement Preservation Project Approval-is Requested to'Sublet the Followiiug Described'Work to: Subcontractor or-Lo'w' er Tier Subcontractor Unified Business Identifier(.UBI) Federal Employer I.D.Number* Advanced Government Services,Inc. 602 304 323 20=0053479 Address Telephone Number 8644 Pacific Ave. 253-531-9782 `City State Zip Code. Estimated Starting.Date Tacoma WA 98444 07/18/2016 If Lower Tier Subcontractor,ID of Corresponding Subcontractor *Ifno Federal Employer I.D.Number, Use Owner's Social Security Number Item No. Partial Item Description Amount A6 X Mobilization $10,500 A7 Traffic Control Supervisor $28,000 A8 Flagging $12,000. A9 Flagging/Traffic control Supervisor $58,500 A10 Police Officer Traffic Control Services $2,000 All Arrow Board $4,000 Al2 PCM Board $12,000 A13 All Class B Project TC Signs,etc/Traffic Control Vehicle $13,000 A14 Class A Construction Signs $30,000 it no, oc>O I understand and will insure that the subcontractor will Pr on ac Signature Date comply fully with the plans and specifications under which this work is.beingperformed. /off Department of Transp 'tation Use Only' Percent of Total Contract DBE Status Verification This Request i2•y Previous Requests % Sublet to Date- (2• `(T % Project.Engneer Date Approved-Region Gonstntction Engineer Date ❑ Approved (When Required) DOT Form 421-012 EF Distribution: White(Original)—Region .Canary(Copy)—Project Engineer' .Pink(Copy)—Contractor Revised 11/2009 IIII Ilii I II II III Illu IIIIIIII II II IIIIIIII�IIIII IIII III IIIIIIIIIIIIIIIII IIII II ' -03854 703.2-Subcontractor Approval Packets � __1.2/08ow.6" - — ---- i Adlk Washington State VUF : Contractor and Subcontractor or Department of Transportation Lower Tier SGhContraCtOf _ . Certificatior for-Federal-Aid Projects (Required for each Subcontractor or Lower Tier Subcontractor on all Federal-Aid projects) Contract Number :��ederal-Aid Number State Route Number CAG 16-004 UL 1113(003) Duvall AVe.E Subcontractor or Lower Tier Subcontractor To be signed by proposed subcontractor:or lower tier,subcontractor The contract documents fort his subcontract include as part of the subcontract a special provision entitled"Required Federal-Aid Provisions",the"Required.Contract Provisions Federal-Aid Construction:Contracts,(FHWA 1273)",and the minimum wage rates. I-certify"the-above statement to be true and correct: company Advanced Government Services, Inc: Signature 17r! J ,�--•-•- _ .�_�.�., ._..v_.,_._- _. Date I� Title Contractor Cer-tificati;on To be completed and signed by the contractor 1• A written agreement has been executed between my firm and-the above subcontractor. 2. 0 A written agreement has been executed between(the subcontractor) and the above lower tier subcontractor: - — - - ---- Alt documents_required by`the special provision entitled"Required Federal-Aid Provisions"are included in the agreement for (1)or(2)marked abovez. I certify the above statements under Contractor Certification to be true and.correct. Company ICON Materials - Signature Date Title Mark Eichelberger,Project-Manager: f.� of Form 420.004 EF= Revised 03/2008 Home Espanol Contact Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries ADVANCED GOVERNMENT SVCS INC Owner or tradesperson 8644 PACIFIC AVE TACOMA,WA 98444 Principals 253-531-97829 HEARRING,SUZANNE MARIE,PRESIDENT PIERCE County . HEARRING,FRED,VICE PRESIDENT (End:01/19/2005) Doing business as ADVANCED GOVERNMENT SVCS INC WA UBI No. Business type 602 304 323 Corporation License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. .......................................................... Meets current requirements. License specialties GENERAL License no. ADVANGS9720Z Effective—expiration 09/09/2003—09/09/2017 Bond Contractors Bonding&Insurance Co $12,000.00 Bond account no. SJ7277 Received by L&I Effective date 09/14/2012 09/08/2012 Expiration date Until Canceled ............................................................................................................................................................................................................................................................... OLD REPUBLIC SURETY CO $12,000.00 Bond account no. YLI246192 Received by L&I Effective date 09/09/2003 09/08/2003 Expiration date Until Canceled Insurance Western National Assur Co $1,000,000.00 Policy no. CPPI02238105 Received by L&I Effective date 03/01/2016 03/20/2015 Expiration date 03/20/2017 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ................................ No L8<I tax debts are recorded for this contractor license during the previous 6 year period,but some debts. may be recorded by other agencies. License Violations ................ No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 070,451-00 Doing business as ADVANCED GOVERNMENT SERVICES Estimated workers reported Quarter 1 of Year 2016"21 to 30 Workers" L&I account representative T41 CASSANDRA SMITH(360)902-5632`d-Email:SMCA235@ini.wa.gov Workplace safety and health. Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 02/18/2011 No violations Inspection no. 314714858 Location 29805 Pacific Hwy S Federal Way,WA 98003 .............:................................................................................................................................................................................................................................................. ©Washington State Dept.of Labor&Industries:Use of this site is subject to the laws of the state of Washington. 1 0.�1J 1 Vl 1 ABOUT US CONTACT US Department of Worktng together to Espanol Revenue eWashingtons — r e Sue t search ) tDOING BUSINESS}REGISTER MY BUSINESS'LOOKUP BUSINESS INFORMATION Home ' Back to search results File&pay taxes If "Non-revenue"appears after Tax Registration Number,the account is not registered with the Department of Revenue. Doing business However,it may be registered with other agencies in the state. Business types Register my business Washington State Department-of Revenue My account 'State Business Records Database Detail Audits TAX_11EG75TRATION NO':6D2304323- :ACCOUNT OPENEDa71140003-_1.2_:00cODAf•1 Find taxes&rates UBI: 602304323` ACCOUNT CLOSED:OPEN* .ENTITY NAME: ADVANCE D.GOVERN f4 ENT-SERVICES-INC BUSINESS NAME: - Workshops&education MAILING•ADDRESS: BUSINESS'.LOCATION: Get a form Or publication .8644 PAC I06AVE; '8644_PACIFIC AVE; - YgCOf•IA;1NA'98444;6471 �-7ACOTIA;;WA�4644!I•-6471 Find a law or rule r - ENTITY TYPE,CORPORATION RESELLER PERMIT N0 A16'887817- PERFIIT Ef:FECTIVE: •1%1(2014:,- NAILS CODE:.561990 _-_ ..__ PERMIT EXPIRES: •12%31/2017^ NAICS DEFJYJITION-.ALL OTHeR. PORT ,SERVICES We need your help. FOR NON-COMMERCIAL USE ONLY Take a 30 sec survey 7/6/201611:41 Af•1 - r r a CONTACT US I ABOUT US I QUESTIONS&ANSWERS I PRINTER FRIENDLY I CAREERS o ® You Esp ftl I Py-6 I Iz Tagalog I rIM9 V,6t I;M.' AAS %V-h;ngtcn_ Your PliV y @2010 WASHINGTON STATE DEPARTMENTOF REVENUEAND ITS LICENSORS,ALL RIGHTS RESERVED. Votarregistmdon assistance(SECRETARY OF STATE) � ,. 11• 1 1• � 1 i n i 1.i r �, .•r li to n�i STATE OF WASHINGTON OFFICE OF MINORITY AND WOMEN'S BUSINESS ENTERPRISES 1110 Capitol Way South, Suite 150 • PO Box 41160 - Olympia, WA 98504-1160 (360) 664-9750 •Toll free 1-866-208-1064 • Fax(360) 586-7079 As Of 7/6/2016 1:29:45 PIVI Saw Contact Information Business Name 'Advanced Government Services Inc .Doing Business As Name Advanced Government Services Inc 'Contact Name Suzanne Hearring Description of Work Flagging/traffic control services including the installation of Class A Signs. Computer generated traffic plans, traffic control equipment and rental including: NCHRP 350 crash worthy signs and stands, arrow boards, trailer&trucks, PCM boards, light towers, traffic control vehicles with flashing beacon, pilot cars, and TMA. Wholesale/retail of safety apparel including gloves, safety glasses, hard hats, vests/jackets, raingear, & parkas. Street 8644 Pacific Avenue i City, State, Zip •Tacoma, WA, 98444 County Pierce County Phone 2535319782 Fax 2535319784 E-mail suzanne.ags@live.com_a-..—_._._._____.._________.____�_.__....._._______.__.._.__. Website www.advancedgovernmentservices.com ;UBI Number 602304323---___.--__^--_.� 'Owners Information ,Primary Owner Suzanne Hearring Other Owner(s) Certification Information State Federal Certification Type _ WBE DBE/SBE ;Certification Number — — _ W2F0019009 —�(— D2F0019009 — , i NAICS codes for UCP USE ONLY to determine size standard NAICS Codes (Primary is specified in bold) ,561990 -Flagging (i.e., traffic control)services .424320-Work clothing, men's and boys', merchant wholesalers 532120-Trailer rental or leasing 532310-General rental centers ;532490-Industrial truck rental or leasing .541330-Traffic engineering consulting services 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 Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 7/13/2016 774452 7/19/2016 Company Details Company Name: ADVANCED GOVERNMENT SVCS INC Address: 8644 PACIFIC AVE TACOMA, WA, 98444 Contractor Registration No. ADVANGS9720Z WA UBI Number 602304323 Phone Number 253-531-9782�p Industrial Insurance Account ID 07045100 Email Address shearring@advancedgovernmentservicesinc.com Filed By HEARRING, Suzanne Prime Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Phone Number 206-575-3200th Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee Awarding Agency Contact Phone Number 485-430-7303tF H"I'11o•//fnrhraao [i 1.] ITn1/gni/giro rta�nnLiir/Tn�an4Tln4ni�o ��„� /�n/int A r Contract Number CAG-16-004 Project Name Duvall Ave NE Pavement Preservation Project Contract Amount $1,363,058.30 Bid due date 6/7/2016 Award Date 6/20/2016 Project Site Address or Directions Payment Details Check Number: Transaction Id: 105320676 Intent Details Expected project start date: (MM-DD- 7/25/2016 YYYY) In what county (or counties) will the King work be performed? In what city (or nearest city) will the Renton work be performed? What is the estimated contract amount? Time and materials OR is this a time and materials estimate? Will this project utilize American No Recovery and 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 No subcontractors to perform ALL work? Will your company have employees Yes perform work on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing 0 work on the project own 30% or more of the company? �M0M014 V Hiring Contractor Company Name ICON MATERIALS Contractor Registration No. ICONM**982CF WA UBI Number 601006854 Journey Level Wages County Trade Occupation Wage Fringe # Workers EKing Flaggers Journey Level $26.26 $11.00 4 King Laborers Traffic Control Supervisor $28.84 $11.00 1 Public Notes o Show/Hide Existing Notes -- On 7/13/2016:-- Fringe includes Medical/Dental/Vision/Life and Pension benefits. �41-i�c••��ir4rcon c: o rr�c ��ri��ii»rYo��ir./Tv.4ov.4Tlo4n.l c. .,�,.,� - '7171)le)ni4