HomeMy WebLinkAboutU16005901_Bill of Sale & Cost Data.pdfTYPE OF DOCUMENT:
GRANTOR(S):
GRANTEE:
NAME OF PROJECT:
ADDRESS OF PROJECT:
PROJECT FILE NUMBERS:
LEGAL DESCRIPTION:
PERSONAL PROPERTY DESCRIPTION:
Reference Number(s) of Documents assigned or released:
Additional reference #’s on page _____ of document
By By
Its Its
See Attached Exhibit B of this Document
By this conveyance, Grantor will warrant and defend the sale hereby made unto the Grantee against all
and every person or persons, whomsoever, lawfully claiming or to claim the same. This conveyance shall
bind the heirs, executors, administrators and assigns forever.
IN WITNESS WHEREOF, said Grantor(s) has caused this instrument to be executed this ________ day of
_______________________ 20 _____ .
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton, WA 98057
BILL OF SALE
Please make no mark in the margin space - Reserved for County Auditor's Use Only
Bill of Sale
PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY,
The Grantor, as named above, for, and in consideration of mutual benefits, hereby grants, bargains, sells
and delivers to the Grantee, as named above, the following described personal property as described in
Exhibit B of this document.
a Municipal Corporation
City of Renton, a Municipal Corporation
ABBREVIATED LEGAL
DESCRIPTION:
VALLEY MEDICAL CENTER BSP AS MODIFIED BY 1ST
AMENDMENT TO VALLEY MEDICAL CENTER NORTH CAMPUS
BSP VOL. 279 OF PLATS, PAGE 086-089
ASSESSOR TAX PARCEL I.D. NUMBERS: 885767-0060
Valley Medical Center parking garage
400 South 43rd Street
LUA16-000938, U16-005901, PLR-3937
See Attached Exhibit A of this Document
Page 1 of 4
INDIVIDUAL FORM OF ACKNOWLEDGEMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that ___________________
__________________________________________ signed this instrument and
acknowledged it to be his/her/their free and volumtary act for the uses and purposes
mentioned in this instrument.
Notary Public in and for the State of Washington
Notary (Print): ___________________________________________________
My appointment expires: __________________________________________
Dated: _________________________________________________________
REPRESENTATIVE FORM OF ACKNOWLEDGEMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that ___________________
__________________________________________ signed this instrument, on
oath stated that he/she/they was/were authorized to execute the instrument
and acknowledge it as the ______________________________ and
__________________________ of _______________________ to be free and
voluntary act of such party/parties for the uses and purposes mentioned in the
instrument.
Notary Public in and for the State of Washington
Notary (Print): ___________________________________________________
My appointment expires: __________________________________________
Dated: _________________________________________________________
CORPORATE FORM OF ACKNOWLEDGEMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING )
On this ____ day of ____________ , 20 _____ , before me personally appeared
_______________________________________________ to me known
to be _____________________________________ of the corporation that
executed the within instrument, and acknowledge the said instrument to be the free
and voluntary act and deed of said corporation, for the uses and purposes therin
mentioned, and each on oath stated that he/she was authorized to execute said
instrument and that the seal affixed is the corporate seal of said corporation.
Notary Public in and for the State of Washington
Notary (Print): ___________________________________________________
My appointment expires: __________________________________________
Dated: _________________________________________________________
BILL OF SALE
Page 2 of 4
VALLEY MEDICAL CENTER BSP AS MODIFIED BY 1ST AMENDMENT TO VALLEY MEDICAL CENTER NORTH CAMPUS BSP
VOL. 279 OF PLATS, PAGE 086-089
BILL OF SALE
EXHIBIT A
Legal Description
Project File Number: LUA16-000938, U16-005901, PLR-3937
Page 3 of 4
WTR - 3937
WWP - 3937
SWP - 3937
TRO - N/A
TED - 3937
PROJECT NAME:
CONSTRUCTION PERMIT NO.
PROJECT FILE NUMBER:
ROADWAY, STREET LIGHTS AND SIGNALS
DESCRIPTION QTY UNIT TOTAL COST
Curb and Gutter 20 L.F.250.00$
Sidewalk 31 S.Y.1,178.00$
Asphalt Concrete Pavement in Right of Way 325 S.Y.5,325.00$
Subtotal 6,753.00$
Sales Tax 675.30$
Grand Total Roadway, Street Lights and Signals 7,428.30$
WATER SYSTEM IMPROVEMENTS
QTY UNIT SIZE TYPE TOTAL COST
70 L.F.6"DI Water Main Pipe and Fittings 3,920.00$
754 L.F.12"DI Water Main Pipe and Fittings 60,320.00$
1 EA.4"Gate Valve Assembly 500.00$
4 EA.6"Gate Valve Assembly 2,800.00$
6 EA.12"Gate Valve Assembly 7,200.00$
4 EA.6"Fire Hydrant Assembly 16,000.00$
Subtotal 90,740.00$
Sales Tax 9,074.00$
Grand Total Water System Improvements 99,814.00$
Per the request of the City of Renton the following information is furnished concerning final costs for
improvements installed and turned over to the City for the referenced project.
ITEM
(City Staff Use Only)
EXHIBIT "B"
Contributary Assets
City Project Numbers:
Valley Medical Center parking garage
16-005901
16-000938
Return Address:
City Clerk’s Office
City of Renton
1055 South Grady Way
Renton, WA 98057
Page 4 of 4