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Contract - Sublet agreements
WashingtonStateDepartmentofTransportationRequesttoSubletWork(ProgramCertification-Checkallthatapply)DisadvantagedBusiness(DBE)VeteranOwnedBusiness(VBE)WomanOwnedBusiness(WBE)ElFederalSmallBusiness(FSBE)StateSmallBusiness(SBE)MinorityOwnedBusiness(MBE)PrimeContractorStatewideVendorNumberStateContractNumberWestCoastSignal,lncProjectTitleRequestNumberStreetLightFoundationReplacements1ApprovalisRequestedtoSublettheFollowingDescribedWorkto:flLowerTierSubcontractorSubcontractorUnifiedBusinessIdentifier(UBI)StatewideVendorNumberorLowerTierSubcontract/SubcontractNameFederalEmployerID.Number..578-089-188VentilationPowerCleaning-AddressTelephoneNumber3914LeeryWayNW(206)634-2750CityStateZipCodeEstimatedStartingDateSeattleWA98107-TBDIfLowerTierSubcontractorNameofCorrespondingSub.FedIDorVendor#ofRequesttoSublet#ofCorrespondingSubCorrespondingSubItemNo.PartialorItemDescriptionWorkDescription(ifpartial)AmountComplete1Partial#1Sunset/MonroeAveVacuumforremovalofoldbase/dignew$1,500.002Partial#24thSt/JeffersonAveNEVacuumforremovalofoldbase/dignew$1,500.003Partial#3RainierAve/RentonAveExtVacuumforremovalofoldbase/dignew$1500.004Partial#4RainierAve/7thStVacuumforremovalofoldbase/dignew$1,500.005Partial#5NTrafficIslandSunsetBdlHardieAveVacuumforremovalofoldbase/dignew$1500.006Partial#6ParkAve/2ndStVacuumforremovalofoldbase/dignew$1500.00Total$9000.00IunderstandandwillensurethatthesubcontractorrimContractorReresentativeandTitleDate1217/2020Departrn.eritofTranspol’tationUselyPercentofTotalContractElProgramCertificationVerificationElDebarred/RegistrationVeritication(LNI)ThisRequest%Comments:PreviousRequestsSublettoDate%sectEngineerorDesigneeDateDOTForm421-012Revised09/2019SaveElectronically-DoNotPrint WashingtonStateDepartmentofTransportationRequesttoSubletWork(ProgramCertification-Checkallthatapply)ElDisadvantagedBusiness(DBE)VeteranOwnedBusiness(VBE)WomanOwnedBusiness(WBE)FederalSmallBusiness(FSBE)UStateSmall8usiness(SBE)MinorityOwnedBusiness(MAE)PrimeContractorStatewideVendorNumberStateContractNumberWestCoastSignal,Inc.ProjectTitleRequestNumberStreetLightFoundationReplacements2ApprovalisRequestedtoSublettheFollowingDescribedWorkto:LowerTierSubcontractor[7]SubcontractorUnifiedBusinessIdentifier(UBI)StatewideVendorNumberorLowerTierSubcontractlSubcontractNameFederalEmployerID.Number,601-173-9,0WestwaterConstructionCompany-AddressTelephoneNumberPCBox59237(425)277-3137CityStateZipCodeEstimatedStartingDateRentonWA98058TBDIfLowerTierSubcontractor,NameofCorrespondingSub.FedIDorVendor#ofRequesttoSublet#ofCorrespondingSubCorrespondingSubPartialor.ItemNo.ItemDescriptionWorkDescription(ifpartial)AmountComplete3Partial#3RainierAve/RentonAveExtConcreteReplacementPanels$3,000.OD4Partial#4RainierAve/7thStConcreteReplacementPanels$3,000.006Partial#6ParkAvel2ndStConcreteReplacementPanels$3,000.00Total$9,000.00IunderstandandwillensurethatthesubcontractorNontractorRepresentativeandTitleDatepandspecificationsVCc4-12/7/2020Departmen’f&fTranspoi4ationUseOnlyPercentofTotalContractElProgramCertificationVerificationElDebarred/RegistrationVerification(LNI)ThisRequest%Comments:PreviousRequestsSublettoDate%ProjectEngineerorDesigneeDateN(Approved•DOTForm421-012SaveElectronically-DoNotPrintRevised09/2019