AG 00-068 - LAKEHAVEN UTILITY DISTRICTOF FEDERAL WAY LAW DEPARTMENT
,CT PREPARATION /DOCUMENT REVIEW /SIGNATURE ROUTING SLIP
1 . OR10ffiM I�b{IMPT ✓DIY.:
CITY ATTORNEY
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1 INA - \ ��� EXT:Q 3. DATE REQ. BY: 06
4. TYPE OF DOCUMENT REQUESTED (CHECK ONE):
❑ PROFEBBIONAL SERVICES AGREEMENT
❑ MAINTENANCE/LABOR AGREEMENT
❑ PUBLIC WORKS CONTRACT
❑ SMALL PUBLIC WORKS CONTRACT
(LESS THAN SXS,OODI
❑ PURCHASE AGREEMENT
(MATERIALS, ■UP►UES, EQUIPMENT)
❑ REAL ESTATE PURCHASE @ SALEB AGREEMENT
5. PROJECT NAME: '5 3 17- Is 1
❑ SECURITY DOCUMENT
(E.O., ADR[[M[NT f, P[RF /MAIM MOND; ASSIDNM[NT OI FUND[ IN LI[U Or 0OND)
❑ CONTRACTOR SELECTION DOCUMENT
RFB, RFP, RFQ)
❑ CONTRACT AMENDMENT AO #:
❑/////EE��-ASEMENTt; r
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�THER u I t- L- 0 it J c
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G. NAME OF CONTRAP �
TOR: LA s/ 1 A ✓�^� 71 L1lk E/, S J
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ADDRESS: I- �� 1 `L/� PHONE: —
TYPE OF PERSON OR ENTITY (CHECK ONE):
❑ INDIVIDUAL ❑ SOLE PROPRIETORBHIP STATE: TAX IO # /SS #:
❑ PARTNERSHIP ❑ CORPORATION -
SIGNATURE NAME:
TITLE:
0
7. SCOPE OF WORK: ATTACH EXHIBIT A - A COMPLETE AND DETAILED DESCRIPTION OF THE SERVICES OR SCOPE OF
WORK, INCLUDING COMPLETION DATES FOR EACH PHASE OF WORK AND LOCATION OF WORK.
S. TERM: COMMENCEMENT DATE:
COMPLETION DATE:
9. TOTAL COMPENSATION: $ (INCLUDES EXPENSES AND SALES TAX, IF ANY)
Or CALCULATED ON HOURLY LABOR ONAROC - ATTACH SCNEOULES Or EMPLOY[[/ TITLER AND HOURLY RATES)
REIMBURSABLE EXPENSES: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED? ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
10. SELECTION PROCESS USED (CHECK ONE):
❑ REQUEST FOR SIDS ❑ REQUEST FOR QUOTES ❑ ARCHITECT & ENGINEER LIST
❑ REQUEST FOR PROPOSALS ❑ REQUEST FOR QUALIFICATIONS ❑ SMALL WORKS ROSTER
1 1. Opj4TRACT `R_E'VIE INITIAL/DATE APPROVED
MiwULeL�ry L1 2Aov 0•v2• � � �'�
DIRECTORY �e
LAW (ALL CONTRACTS) Ale- �' L QMMI'✓ik (max
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1 2. CONTRACT SIGNATURE ROUTING INITIAL/DATE APPROVED
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COMMENTS
WHITE - ORIGINAL STAYS WITH CONTRACT CANARY - CLERK TD STAfr PINK - LAW DEPT. GOLDENROD - ORIGINATINO STn r L0492 (Rev 6/95)
BILL OF SALE FOR WATER FACILITIES
(S. 312TM STREET)
KNOW ALL MEN BY THESE PRESENTS: That the undersigned party of the first, part,
hereafter designated as "Vendor" for good and valuable considerationin the amount of Two Hundred
Forty One Thousand Six Hundred Ninety Four and 43/100 Dollars ($241,694.43) does by these
presents grant, bargain, sell and deliver unto LAKEHAVEN UTILITY DISTRICT of King County,
Washington, party of the second part, hereafter designated as "Vendee," the following described
Personal Property, to wit:
located on South 312th Street from South 23rd Avenue to SR99.
Construction Costs for Water Lines and Related Appurtenances $230,184.22
Construction Management 11,509.21
TOTAL $241,694.43
TO HAVE AND TO HOLD the same unto the Vendee, its successors and assigns forever.
The vendor, jointly and severally, and their respective successors and assigns, covenant and agree to
and with the Vendee, its successors and assigns, that the Vendor is the Owner of said personal
property, and has good right and authority to sell the same.
IN WITNESS WHEREOF, Vendor has hereunto set their hand this '-~ day of
¼ ,2000.
Public Works Director
STATE OF WASHINGTON )
) ss.
COUNTY OF KING )
On this day personally appeared before me, Cary M. Roe, to me known to be the Public Works
Director for the City of Federal Way, a Washington Municipal corporation that executed the foregoing
instrument, and acknowledged the said instrument to be the free and voluntary act of said corporation,
for the uses and purposes therein mentioned, and on oath stated that he/she was authorized to
execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation.
.-'_";2'11 '-'"', l
- "~~ i'~,.~ 5 ~Si nature
t ~ ~..~ ~ ~ Printed Name
~. ~, ~.~.~;Z ~ :' Notary Public in and for the State of Washington
My appointment expires:
ORIGINAL
EXHIBIT "A"
S 312th STREET IMPROVEMENT PROJECT
(FROM SR99 TO 23RD AVENUE SOUTH)
ESTtMA TED CONSTRUCT/ON AND CONSTRUCT/ON MANAGEMENT
COSTS/IVClUD/NG IAKEHA VEN UTILITY D/STR/CT WA TERMAIN
FINAL INVOICE
January 21, 2000
Total Watertnain
Project Portion
CONSTRUCTION
Streets Construction Costs
Watermain Estimate $211,956.00
(12.9% of total project estimate)
Sales Tax (8.6%) $18,228.22
Total Project Construction Management
(15% of construction $2,041,913)
Watermain Estimate for Construction $11,509.21
Management (5% of $230,184.22).
District to provide watermain inspector and
construction survey)
10% Construction Contingency
Total Estimated Project Costs
Total Watermain Portion $241,693.43
Less Invoice #1864 Paid 1/28/99 ($75,347.72)
FINAL PAYMENT DUE $166,345.71
Note: Costs represented are estimated only. Actual costs incurred will be used to
calculate final cost of Lakehaven Utility District's watermain portion for reimbursement
to the City.
k:\streets\projects\s312sr99\s3 ! 2 bill of sale final invoice.doc