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Home My WebLink About- PROJECT CLOSEOUT CHECKLIST with Intent-Affidavit sheet example X Retainage Bond Date Sent/ Completed 1/25/2023 1/31/2023 * 2/14/2023 5/22/2023 * 2/14/2023 * 4/25/2023 * Contractor COMPLETE Contractor COMPLETE 2/16/2023 * Date Received 12 3 4 5 Verify with Engineering Manager that Project and PO can be closed. Send email to Anna Cruz to close after verification. Project is ready for archive. Make copies of the documents for file, originals to be sent to Contracts Administrator MMIf we are holding the retainage bond then a Retainage Release form should be filled out copies of releases attached and sent to Accounts Payable for release. Originals should be sent to Shannon for file. If we have a retainage bond from the contractor then a release letter has to be sent to the insurance company and the original packet with a copy of the letter should be sent to Shannon. In case of contracts under $35,000. No retainage is held and no payment bond is required. A release of compensation will still be returned by the Contractor and the original should be sent to Shannon for her project file. PROJECT CLOSEOUT CHECKLISTBasic Information Project Name: Prevailing Wages Description Department of Revenue Certificate of Payment of State Excise Taxes by Public Works Contractor/ for Projects over $35,000 COB Holding Retainage FHWA Project/Payment Bond COB Project # When all documents (in red) have been received- Contractor's Name: Retainage Status Substantial Completion Date: Employment Security Acceptance Notices All Subcontractors Acceptance of Compensation & Release of All Claims Dates Responsible Party Project Manager Project Manager Revenue L & I 45 Days from published NOC Releases from State Agencies Documentation Required Project Manager\ Contractor Notice of completion of Public Works contract (sent to agencies listed below) Affidavits of Wages Paid Affidavit of Publication Notice of Completion (Received from Kitsap Sun)/ Only on projects of $35,000 or more. Claimant Amount Final Acceptance Letter (to Contractor) Project Manager Statements of Intent to pay Prevailing Wages All Subcontractors Other Kitsap Lake Elementary Safe Routes to Schools 315004 Active Construction, Inc. 6/25/2021 Department of Labor and Industries Employer Liability certificate/for projects over $35,000 4/2/2023 SALES TAX RULES RULE 170RULE 171 Employment Security Department Certificate of Payment of Contribution, Penalties & Interest on Public Works Contract /For projects of $20,000 and above Claims and Liens Against the Retainage and Payment Bond Type of Action* Streets owned by a municipal corporation, political subdivision of State, or the USA Storm or Combined sewer systems included as part of a street drainage system. Power lines when part of roadway Use tax is included in unit price. Sales tax is not stated separately in contract or on payment requests. Streets owned by State of WA. (ie within State ROW) Water Mains Sanitary sewers and sewage disposal systems that are not within or part of a street drainage system. Power lines when not part of roadway lighting system. Sales Tax is separately stated in contract and on payment requests Retainage of 5% is based on total payment request. 5% retainage is based on gross payment request (before sales tax). Contractor is paid: 95% of payment reauest plus 100 % of sales tax due on payment request **Retainage is not withheld if contractor has obtained a Release of Retention Bond or it is a FHWA project in which it is illegal to withold Retainage or obtain a retainage bond. If no retainage bond then a payment bond must be in the file. Final Acceptance Date: 1/25/2023 PO# 20508 Contract # 6118 ________________________________________________________________________________ Public Works & Utilities │ 345 6TH Street, Suite 100 Bremerton, WA 98337 * Phone (360) 473-5920 * Fax (360) 473-2330 Working for and with our residents to establish Bremerton as Puget Sound’s most beautiful and livable waterfront city! January 25, 2023 David Ceccanti President Active Construction Inc. P.O. Box 430 Puyallup, WA 98371 Subject: Kitsap Lake Elementary Safe Routes to Schools Project Federal Aid No. SRTS-6590(002), Bremerton No. 315004 Final Acceptance Dear Mr. Ceccanti: To completely close-out the Kitsap Lake Elementary Safe Routes to Schools Project Federal Aid No. SRTS-6590(002), Bremerton Project # 315004, please ensure that you have supplied final copies of approved “Affidavit of Prevailing Wages Paid” for your firm and for each firm that provided work and materials for the contract. In accordance with the definition of terms in the Contract Documents, the City acknowledges the following key dates: Notice of Award May 11, 2020 Notice to Proceed June 3, 2020 Substantial Completion June 25, 2021 Physical Completion September 28, 2022 I have attached the Final Acceptance and Release of all claims document. Please execute with notary and return at your soonest opportunity. Sincerely, Shane Weber, P.E. Engineering Manager Cc: Ned Lever, City Engineer, City of Bremerton Cathy Bonsell, Project Assistant, City of Bremerton Chris Roberts, Project Manager , ACI Project File Shane Weber Digitally signed by Shane Weber DN: C=US, E=Shane.Weber@ci.bremerton.wa.us, O=City of Bremerton, OU=Engineering, CN=Shane Weber Reason: I am the author of this document Date: 2023.01.25 15:38:45-08'00' Order Confirmation Not an Invoice Account Number:288797 Customer Name:City Of Bremerton Customer Address: City Of Bremerton 345 6 Th Street Suite 100 Bremerton WA 98337 Contact Name:Angela Hoover Contact Phone:3604735323 Contact Email:angela.hoover@ci.bremerton.wa.us PO Number:#6118 Completion Date:02/14/2023 Order Number:8461483 Prepayment Amount: $ 0.00 Column Count:1.0000 Line Count:1.0000 Height in Inches:0.0000 Print Product #Insertions Start - End Category BKS kitsapsun.com 1 02/16/2023 - 02/16/2023 Govt Public Notices BKS Kitsap Sun 1 02/16/2023 - 02/16/2023 Govt Public Notices Total Order Confirmation $11.08 1/2 Ad Preview 2/2 Kitsap Sun PART OF THE USA TODAY NETWORK PO Box 52173, Phoenix, AZ. 85072-2173 PROOF OF PUBLICATION Angela Hoover City Of Bremerton 345 6 Th Street Suite 100 Bremerton WA 98337 STATE OF WISCONSIN, COUNTY OF BROWN. I, being first duly sworn on oath, deposes and says: That I am now, and at all times embraced in the publication herein mentioned was the principal clerk of the printers and publishers of KITSAP SUN; that said newspaper has been approved as a legal newspaper by the order of the Superior Court of the County of Kitsap, in which County it is published and is now and has been for more than 6 months prior to the date of the publication hereinafter referred to, published in the English language continually as a daily newspaper in Bremerton, Kitsap County, Washington, a weekly newspaper in Kitsap County, Washington and is now and during all of the said time, was printed in an office maintained in the aforesaid place of publication of said newspaper; that the following is a true text of an advertisement as it was published in regular issues (and not in supplement form) of said newspaper on the following date(s), to wit: And on 02/16/2023 NOTICE OF COMPLETION Notice of Completion has been issued Active Construc- tion, Inc., for City Contract No. 6118 for the Kitsap Lake Elementary Safe Routes to Schools Project. Any parties having a claim for material, labor or damages related to th is Contract have forty five (45) days from the date of first publication of this notice to file a claim. Angela Hoover, City Clerk City of Bremerton 345 6th Street, #100 Bremerton, Washington 98337 8461483 2/16/23 such newspaper was regularly distributed to its subscribers during all of said period. Subscribed and su ir.:::23 Legal Cl My commision expires Publication Cost: $11.08 Order No: Customer No: 8461483 288797 # of Copies: 1 PO#: #6118 Completion THIS IS NOT AN INVOICE! Please do 110/ use this form for payment remittance. S H E L LY H O RA -1 Notary Public t State of Wisconsin t, • , T~. tr. ~ ....,_ - .. ~;.~--e,;;• ,..~':'""'-'"lr.l'!Jt-Y.-·•T'•··.•...,.., ·-..--~ .•·;- Page 1 of 1 Department Use Only NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Assigned to:Date Assigned: Date 02/15/2023 Form Version Revised# 1 Revision Reason DOR Requested Sales Tax be reflected in both the comments and contract accounting sections of NOC. Awarding Agency Information Prime Contractor Information Name BREMERTON, CITY OF UBI 181002539 Name ACTIVE CONSTRUCTION INC UBI 273001533 Address 345 6th Street Suite 100 Bremerton,WA-98337 Address PO BOX 430 PUYALLUP,WA-98371 Email Address cathy.bonsell@ci.bremerton.wa.us Email Address amandas@activeconstruction.com Contact Name Cathy Bonsell Phone 360-473-5717 Contact Name ACTIVE CONSTRUCTION INC Phone 253-248-1091 Project Information Project Name Kitsap Lake Elementary Safe Routes to Schools Project Contract # # 315004 Affidavit ID 1179017 Jobsite Address Harlow Drive, from Kitsap Way to Osprey Circle; Carr Boulevard, from Harlow Drive to Kitsap Lake Elementary School Main Entrance; Lyle Avenue, from Harlow Drive to Kitsap Lake Elementary School Bus Entrance. Date Awarded 05/11/2020 Date Work Commenced 06/04/2020 Date Work Completed 06/25/2021 Date Work Accepted 01/25/2023 Federally Funded Transportation Project If yes, attach Contract Bond Statement. Bond Waived? Retainage Waived?Subcontractors Used? If yes, complete Addendum A. Detailed Description of Work Completed Project will construct sidewalk from Kitsap Way to Carr Boulevard, including stormwater and roadway improvements. DOR Tax Information *Right-click on the total field and select Update Field to auto-calculate. Contract Amount $2,281,410.97 Liquidated Damages $ 0.00 Additions (+)$274,147.62 Amount Disbursed $2,558,423.58 Reductions (-)$ 8.04 Amount Retained $ 0.00 Sub-Total*$2,555,550.55 Other $ 0.00 Sales Tax Amount $2,873.03 Sales Tax Rate If multiple rates, attach a list. 9.00% TOTAL*$2,558,423.58 TOTAL*$2,558,423.58 These two totals must be equal. Apprentice Utilization Information Was Apprentice Utilization Required? If yes, complete this entire section. Engineer’s Estimate $ 0.00 Utilization % 3.43%Was a Good Faith Effort approved? Comments Sales Tax (9%) was only applicable on Schedule C-Water of the contract. Subtotal Schedule C $ 31,922.58; Sales Tax $ 2,873.03; Total paid Schedule C $ 34,795.61 The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM THE RETAINED FUNDS until receipt of all release certificates and affidavits. Submitting Form: Submit the completed form by email to all three agencies below. Addendum A: Please List all Subcontractors and Sub-tiers Below This addendum can be submitted in other formats. Provide known affidavits at this time. No L&I release will be granted until all affidavits are listed. Subcontractor’s Name:UBI Number: (Required)Affidavit ID* APPLY-A-LINE LLC 600553941 1071603 CAD OF PUGET SOUND 603058404 1047080 CASTANEDA LANDSCAPING 603373639 1110036 COEN & SONS SERVICES INC 602343356 1054532 DELMAR CONCRETE CTNG&CRNG LLC 603490906 989965 DOOLITTLE CONSTRUCTION LLC 602351934 979434 DRAIN-PRO INC 602740534 1054445 ECO STREET SERVICES, LLC. 604197016 1048251 G & G CORPORATION 601381635 1136285 INFORMED LAND SURVEY LLC 602487061 1051097 LC WELDING & FABRICATION LLC 603403584 1008450 MCCANN TRUCKING, LLC 604228787 991164 MILES SAND & GRAVEL COMPANY 171004760 1060074 MILES SAND & GRAVEL COMPANY 171004760 1184405 MILES SAND & GRAVEL COMPANY 171004760 1037716 OLYMPIC TRUCKING LLC 602099529 1047182 OLYMPIC TRUCKING LLC 602099529 947317 PR SYSTEMS LLC 601303110 988837 PR SYSTEMS LLC 601303110 1001857 ROCKING A & J 602237437 1004603 STRONG TRUCKING, INC. 601777166 994858 TONY LIND PAVING LLC 602813830 1010011 WESTSOUND LOGGING & EXVTN LLC 604459803 947149 WILSON CONCRETE CONST INC 602168956 1110345 Contract Release (855) 545-8163, option # 4 ContractRelease@LNI.WA.GOV Employment Security Department Registration, Inquiry, Standards & Coordination Unit (360) 890-3499 publicworks@esd.wa.gov February 14, 2023 ESD# 000321915000 UBI# 273001533000 ACTIVE CONSTRUCTION INC PO BOX 430 PUYALLUP,WA-98371 BREMERTON, CITY OF Employment Security Department hereby certifies those contributions, penalties and interest due from the above named contractor under the Employment Security Act have been paid in full or provided for with respect to the following public works contract: Description Kitsap Lake Elementary Safe Routes to Schools Project Contract number 315004 The Employment Security Department hereby certifies that it has no claim pursuant to RCW 50.24.130 against the public body named above for tax attributable to service performed for said public body by the above named contractor on the above described contract. The Employment Security Department releases its lien on the retained percentage which is provided by RCW 60.28.040 for contributions, penalties and interest due from said contractor. This certificate does not release said contractor from liability for additional contributions, penalties and interest which may be later determined to be due with respect to the above mentioned contract. If we may be of further assistance, please call (360) 890-3499 or email publicworks@esd.wa.gov EMPLOYMENT SECURITY DEPARTMENT