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Home My WebLink About*Other - Central ServicesFORM STATE OF WASHINGTON 3T8rg 19-11) ( ° - INVOICE VOUCHER (Rev. 5/91) ''• `� AGENCY USE ONLY AGENCY N0. LOCATION CODE P.R. OR AUTH. N0. AGENCY NAME Washington State Department of Agriculture Fairs Program PO Box 42560 Olympia, WA 98504-2560 VENDOR OR CLAIMANT (Warrant is to be payable to) Grant County (Grant County Fair) Attn: County Treasurer PO Box 37 Ephrata, WA 98823 INSTRUCTIONS TO VENDOR OR CLAIMANT. Submit this form to claim payment for materials, merchandise or services. Show complete detail for each item, Vendor's Certificate: I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, national origin, handicap, religion, or Vietnam er abled veterans status. BY (SIA IN INK)' County Commissioner, District 3 (Chair) 9/24/2024 FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For reporting Personal Services Contract Payments to I.R.S. I RECEIVED BY DATE RECEIVED DATE I DESCRIPTION UNIT FOR AGENCY QUANTITY PRICE AMOUNT USE INTERAGENCY AGREEMENT NO. K5051 Capital Improvement Grant — Safety Li htin ; illuminating1 Vendor areas, patron eating areas, ADA pathways, Livestock area and public pathways. Promoting better Access to Fair activities. Total Due PREPARED BY TELEPHONE NUMBER DATE AGENCY APPROVAL Tom Gaines 509-754-6085 9/19/2024 DOC. DATE PMT DUE DATE CURRENT DOC. NO. REF DOC. VENDOR NUMBER VENDOR MESSAGE 2426-40 REF TRANS M MASTER INDEX SUB SUB ORG WORKCLASS COUNTY CITY/TOWN DOC CODE O FUND APPN PROGRAM SUB BUDGET PROJECT SUB PROJ SLIF_INDEX INDEX QBJnRAErT INDEX ALLOC Mos PROJ PHAS UNIT 05 7 D00 64465 ACCOUNTING APPROVAL FOR PAYMENT DATE 145,000.00 $145,000.00 DATE UBI NUMBER AMOUNT INVOICE NUMBER WARRANT TOTAL I WARRANT NUMBER CERTIFIED PROJECT COMPLETION REPORT Agreement Number: K5051 Washington State Department of Agriculture FAIRS PROGRAM CAPITAL PROJECT GRANT 1. Grantee 2. Fair Facility Grant County Grant County Fair PO Box 37 3953 Airway Drive NE Ephrata,, WA 98823 Moses Lake, WA 98837 3. Grantee Representative 4. WSDA Representative Tom Gaines, Central Services Director Anne Norman, Fairs Program Administrator Phone: 509-237-2920 Phone: (360) 902-2043 tgainesegrantcountvwa.gov fairs2agr.wa.gov 5. Grant Amount 6. Grant Start Date 7. Grant End Date $145,000.00 Upon Final Signature May 31, 2025 8. Biennium: 9. Project Completion Date 2023-2025 7/15/2024 10. Tax ID # 11. Statewide Vendor # 12. UBI # 916001319 2426-40 132001884 A. Statement of project completion: The County has accepted this project as complete. We have filed a notice of completion and have only retainage left to be invoiced. B. Before and after photographs: Photographs are included in this certified project completion report. YesO No❑ C. Statement of actual dollar amounts spent and that all costs have been accounted for: Enter a statement of actual dollar amounts spent, from all funding sources, in completing the capital project. This includes the value of in - kind services performed. $280, 882. 88 D. Project receipts: Copies of receipts associated with this capital project are attached. Yes❑x No❑ E. Contractor affidavit of paying prevailing wage: Enter a statement that any contractors hired to work on your project paid prevailing wage and attach a copy of the contractor's 'Affidavit of Wages Paid. " Attached F. Recognition of community benefits: Enter a statement that explains how the Grantee meets the community benefits as provided in Section 5 of the Agreement. This lighting project by all accounts touches to an extent each of the items in section five. This project provided better visibility to ADA accessible areas, fair exhibits and facilities, for all patrons, we are primarily an agricultural fair, and it certainly supported local groups and programs that promote the welfare of farming and people. G. Final invoice voucher: A final invoice voucher is included with this certified project completion report. YesN No❑ We received and attached two vouchers through KCDA for this project, we have only retainage to complete. I affirm and guarantee that the above representations are true and accurate, Signature Date Public Wore. Projects Awarding Agency: GRANT COUNTY Project: Grant County Fairgrounds Phase 4 Project Overview Project name Grant County Fairgrounds Phase 4 Job site 3953 Airway Drive NE Moses Lake, WA 98837 Description Materials & labor to install sports lighting Notice of Completion Status NOC Not Filed Certificate of Release Not Released Affidavit 1329156 Document Received Date: 7-15-2024 Intent Id: 1423357 Afidavit Id: 1329156 Affidavit Status: Approved on 7-15-2024 Contract no. 4143804 / CSD2403fg Attn: Tom Gaines Project cost $259,596.00 Award Date 4-2-2024 Bid Date 8-24-2023 Contract Type Bid -Build (Traditional) Awarding Agency Contact Thomas Kim, 425-251-8115X143 Apprentice Utilization Required No Change OMWBE Utilization Required No Change Prime Contractor Name MUSCO SPORTS LIGHTING LLC Phone number 641-673-0411 WA UBI Number Contractor License no. 602o91682 MUSCOSL992JB Federally Funded Project No Change Close 0 Contractor Details (Prime Contractor) Name MUSCO SPORTS LIGHTING LLC Address PO BOX 808 OSKALOOSA, IA, 52577 WA UBI no. 602091682 Contractor Registration no. MUSCOSL992JB ------- --- --------- Industrial Insurance Account Id - ----------- ------ --- -------------------- - ---------- 92434503 Email Address prevailing.wage@musco.com Filed By Stout, Amy OMWBE Certifications as of 4-29-2024 No active certifications exist for this business. ove ProjecLIofbrznadoo Awarding agency GRANT COUNTY Awarding agency contact Thomas Kim Awarding Agency Project name Grant County Fairgrounds Phase 4 County where work was performed Grant City where work was performed Moses Lake Project Site Address or Directions 3953 Airway Drive NE Moses Lake, WA 98837 Project Description Materials & labor to install sports lighting Prime contractor name MUSCO SPORTS LIGHTING LLC Prime contractor registration no. Contract no. 4143804 CSD2403fg Attn: Tom Gaines Contract Type Bid -Build (Traditional) Is apprentice utilization required? No Is OMWBE utilization required? No Prime contractor phone number 641 -673-0411 Prime contractor intent id 1423357 Original contract amount Bid due date -24-2023 Contract award date 4-2-2024 intent filed date 4-29-2024 Job start date 6-20-2024 Date work completed 7-2-2024 Project Completion Affidavit ----- Company Name UBI License# _----- _�__________ Journey Level Wages No employee wages are selected for this affidavit Apprentice Wages Noapprentices have been selected for this affidavit ove Public Notes There are no public notes. A Access @ Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington, otricia( Stat.e Goven-nmerit. Website Help usimprove KCDA Purchasing Cooperative P.O. Box 5550 Kew, WA 98064-5 550 1425-251.8115 ]BI'll To: GRANT COUNTY + PO BOX 37 EPHRATA, WA 98823 USA INVOICE NVOICE 300793433 Invoice 'Date Page 06/28/2024 09:22:18 1 of I ORDER NUMBER 2127481 CUSTOM R PO NUMBER 1?0# CSD2403fg Attn: Tom Gaines "DIRECT SHIPWNT** Ship To: GRANT COUNTY FAIROROUNDS 3953 AIRWAY DR NE MOSES LAKE, WA 98837 USA Customer ID4. 100046 Ordered By: Tom Gaines Ca.rrler: Tracking #: 4143804 MUSCO LIGHTING 1 D 00000 LOT 0.0 0.00 0.00 RETAINAGE HILL BACK/PAY 13ACK 0 NSMUSCO-406 LOT 2051,315.80 205.1315.80 205,315.80 MUSCO PROJECTS 0 NSPERF EACH 2,361,00 2,361.00 2x361,00 PF,RFORMANCE BOND Total Lines: 3 TOTAL COST: 197,292.96 SUB -TOTAL: 207,676,80 Grant County -Unincorporated: 17X9.50 RETAINAGE: -10,383.84 AMOUNTDUE: 214,322.46 Budget Code.SummW Budget Code: Lines: 3 L.Ine Tax:1 7,029.50 Sub Total., 197,292.96 Total.-214,322-46 * * *REPRINT* * * KCDA Purchasing Cooperative P.O. Box 5550 Kent, WA 98064-5550 1425-251-8115 Hill To: CTRANTCOUNTY+ PO BOX 37 EPHRATA, WA 98823 USA Customer ID: 100046 OrderlatePick nekes` No 04/02/2024 13:22:10 3666955 Quanddes Ordered l Shipped I Renwintng INVOICE INVOICE 300789912 Invoice Date - Page 06/06/2024 08:42152 1 Of2 ORDER NUMBER 2127481 CUSTOMER P0 NUMDER�"� di I %aft oi-wivoig nun: iom uaines "DIRECT SHIPMENT** Ship Tog GRANT COUNTY FAIRGROUNDS 3953 AIRWAY DR NE MOSES LAKE, WA 98837 USA Ordered By: Tom Gaines Primary Salesrep Name Net DueDate fakerm Paul McMakin 07/18/2024 THOMAS pricing KCDA Item ID UOU unit fteaded Unit cost pre, Price Budget Code Item Description Carrier; %'-- - - ---- M. Tracking 4143 804 MUSCO LIGHTING 0 1 D 00000 LOT 0.0 0.00 Or Ott RETAINAGE BILL BACK/PAY BACK 0 1 D NSMUSCO-406 LOT 0.0 205,315.80 0.00' MUSCO PROJECTS 0 NSMUSC0406 LOT 51,919.20 511,919.20 51,919.20 MUSCO PROJECTS Order Line Notes: )BILLING MATERIALS FOR PHASE 4 OF THE FAIRGROUNDS 0 1 D NSPERF EACH 0.0 2s361-00 0,00 PERFORMANCE BOND ToW Lines: 4 TOTAL COST.* 49 323.24 SUB -TOTAL, 510919.20 Grant County-Unincorporojed: 4s257.37 4v ;j ad A RETAINAGE, "2P595.96 AMOUNTDUE.o 53,o580#61 00 *IMPP LNT*