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Home My WebLink AboutGrant Related - BOCC (002)GRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT: BOCC REQUEST SUBMITTED BY: Karrl@ Stockton CONTACT PERSON ATTENDING ROUNDTABLE: K81"I'I@ Stockton CONFIDENTIAL INFORMATION: ❑YES *NO DATE: 1 0/25/2024 PHONE: 2937 huaml I Kimilasav 11 a I i F.A11 Wil g g ul ❑Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ®ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related []County Code El Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders *Grants — Fed/State/County ❑ Leases ❑ MOA / MOU El Minutes ❑Ordinances El Out of State Travel El Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution El Recommendation ❑Professional Serv/Consultant ❑Support Letter ❑Surplus Req. ❑Tax Levies []Thank You's ❑Tax Title Property ❑WSLCB Reimbursement request from Port District #4 Coulee City on the American Rescue Plan Act (ARPA) in the amount of $100,000. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO *1 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: I I - �,v 2--L-f APPROVE: DENIED ABSTAIN D2: D3: --�� DEFERRED OR CONTINUED TO: WITHDRAWN: 4/23/24 TOTAL ENERGY MANAGEMENT, INC. HVAC •ELECTRICAL •CONTROLS 2521 Stevens Drive Richland, WA 99354 (509) 946-4500 +Fax 946-9383 TOTALEM1210N TOTALEM081QC Bided To: Leone & Keeble, Inc 108 W Boone Ave Spokane WA 99201 Customer Purchase Carder#: Customer Contract/Job#: 23115437 Contract Invoice Invoice#: 67223 Date: 06/20/2024 Project: Coulee City Medical Clinic and Library 218 W. Main St. Coulee City WA 99115 TEM Job #:22505 Description Amount Progress Billing# 1 Notes: Invoice due upon receipt. A service charge of 1.5% per month or a $5.00 minimum rebilling charge on all amounts over 30 days. Thank you for your prompt payment! Nan -Taxable Amount: Taxable Amount: Less Retainage Sales Tax: Amount Due 55,5 1 0.00 55,510.00 0.00 2,775.50 52,734.50 2ei 61 b ,-* / I . APPLICATION AND CERTIFICATION FOR PAYMENT A11 DOCI]MENTG702 PACE ONE OF a a TO OWNER: Grant County Pon District No A PP.O.Tf T- Coulee Cirf Medical Clinic & Library APPLICATION NG 311 Distribution to: 'IS W Main Street 219 W Main Street Coulee City, WA 99115 Coul= City, WA 99115 OWNER ARCHITEC i PE1UOD TO: 06i30:'24CONTRACTOR FROM CONTRACTOR- VIA A1,CHITECT Lceru & Kecble. Inc Lcotburrow Wetch Architcc! , P S. 108 W Boone Ave 201 W Yakima Ave: Spolexie, WA 99201 Yakima. V-'A 9S902 PR IF-C't' NOS 23-1154 CoINTRACT FOR- CONTRAcIr DA'I E: 0310hn4 CONTRACTOWS APPLICATION FOR PAYMENT Thr undersig&i.•d Ccr!tractm to the best of the Contmclar's knDwledga, Applicalion is matdc for payment, as shown below, in conntetion with the Contract inforrratioa and "-1 cf the Work covered by tints Applicaton for Payment has been Continuation Sheet, AIA Document G703, is attached compl:ted is accordance Nvith the Contras,, Documents, that all amounts have bctr: paid by 4k„�� R tl:e Contra or for Work for which pmvious Certificates for Payment were issued and O ;,.�•"•••,,. ,t1 `PoR payments recei ed froth the Owner, and that current payment sho,.,rn cerein is now due �� •'��} ',�` � ��, ;��.� �s� : A. I CONTRACTSUM 9 I.9$fi.570.00 �» "e O ARY 2 Net change by Charge Orders S 13,525 00 CIONTRACTOR Leone: r� Keeble, N - t� w � i ��wwrr $ ;t CON RACT SU'M TO DATE ;Lure 1 � 2? S � 2,005.tt)95 0fl � "� ;Ct °' C `"• 8 TOTAL COMPLETED & S7t3RED TO 5 63S. t i 8 62 Q DATE: (Column G on G70"s 7: 3 l By Date: 2112 �'+, � �g�s,. ,� `ear' 5 RL-717AINAG=: : vker 4 Vz of Cornplctcd W(rik S 0 :ail State or wasltinprt County of Spokane (Column D E an G703) Strbscriwe Sworn to tare met 3rd day of July 2024 %of Stored M:Iterial S Notaq flub[ ft<o.umn F on G703) Mvf r rttrrrt > rtzlnr 14 Total Reiainage (Lines a + 5b or Total in Column I of G703) 5 0 0sI ARCHrrECT'S CERTIFICATE. FOR PAYMENT h TOTAL FARNF-D I.F—SS RETAINAGE S 639.11862 In aecardarlcc with the Contract Documents, based on on-iiie observations and the data WASHINGTON STATE SALES TAX coraptising the application, the Architect certifcs to the Owner that to the beet of the g 2% S 52.325 73 Arehitec:. s knowledge, information and belief the Wor'ic bars progressed as indicated. 8 LESS PREVIOUS CERTIFICA'1 CS FOR PAYNtEENT S 2$.i2&3 73 the quzlity 01ilhc Work is 'a accordance -adth the Contract Documents, and the Conti -actor 9 £;IJRRFtvT PAYMENT DUE S 405,16062 is � itled tea pay rent of the Af�'f#�UNT CERTIFIED 10 BALANCE TO FINISH. INCLUDING RETAINAGE � r_ s 4JOS7 �&0 _ �✓t� (Lire 3 less !inc 6 ) S 1.366 976 ..S AMOUNT CERTEMIEJ CHANGE ORDER SUMMARY kD, Dr,MON5 DEDUCTIONS (fiiuch aVanurion if amount czrttf ed difJern from the amount ufrpiied. Inioui u1J ll rres an this . tr,ptrcrawn and €fr ti 4'0r2trnu�hwn Shtei that are cit.:nged to cc)nform with the amount cerafteri j ARCHi'17EC s r This Ccr;i ccate is rot negotiable "Tint: AMOUNT CERTIFIED is payable only to the Contractor named herein T-"=ncc, pay meat and aces -stare: of payment are without pt%�judi:c toany rights of the Owner or Cortiactor under this Contract Total changts approvcl in pircviousnionffis by Owner SU GO S0 00 Total approved this Month S35.425 tKi S 1 &90%) 00 TOTALS S35 425 j0 $16.900 00 DIET CHANGES by Change Order S'; 8.525 1010 AA DOCUMENT G702 APPUCATION AND CERTIFtCATION FOR PF.YI4ENT 1992 EDITION - A`A 01992 THE AMERICAN INSTITUTE OF ARCHFT=: T S. 1735 NE YQRK AVE., N.W.: WASHINGTON. D-C 2CC106-5292 Users may obtain validation of this document by raquesttttg a completed AIA Document D401 - Cartificatictrt of Document' Authanticrty from tho Llcsnsoq" ci , '�"N 4c 'j5 S 41'3 APPLICATION FOR pmMEwz Coulee City Medical Clinic & Lm=' Coulee City, WA 99115 job it 21-1154 CONTRACT �TMNAS TOTAL ITEM DESCRIPTION' CONTRACT C VALUE 71 Submittals I Mobilization 75 Procure Duct Heaters 1-70.00 77 Procure Roof Hoods 81 Refrigeration Piping 2*500.00 73o00,001 82 Duct insulation 83 Low Voltage Wiring I Controls 3,00HO 00 86 Fin -at Documentation 1,720,00 L4 40-00 87 Punch List Completion go Electrical Permits & Mobilization 91 primary Services -Material 4,260.,00 6,,550,00 92 primary Services -Labor 8.580.00 94 Branch Conduit & Wire - Labor 23,40000 96 Feeder Conduit & Wire - Labor 2,S50-00 5,33000 97 Exterior Lighting -Material too Panels & Disconnects - Labor Ilk510,00 11,50000 102 Trim - Labor 2,2480 107 Final Documentation 'List 4,496.00 108 Punch Completion 4,496,00 log Commissioning III Bring Site to Subgrade 25,709-00 113 Building Slab Prop 9,59500 117 Fine Grade Continuous Footings 118 Fine Grade SOO 123900 121 Asphalt Paving 36,020-00 126 Site Utilities water Systems - Labor 2,22600 1,112-00 127 Site Utilities Sanitary Sewer - Materials 128 Site Utilities Sanitary Sewer - Labor .0,406,00 129 Site Utilities Stom Drainage t Swale, - Materials 3,17200 130 Site Utilities Storm Drainage / SNvalc -Labor 14,405.OD 131 TOTAL ..ENT vxuE omPLsTE COMPLETE enF-VIooS Pariou 6o0o024 Architect Lo°m=*wvVeteb Architects, 'o Estimate No. - 3 TO DATE ESTIMATES 860-Oo 50 ' 319ono m» 24,400.00 zoo 1,00000 xm �moon xm 2,450m0 um \ - - - - ~ - ' - - - ' - - 2,27500 - - - - - - - - mo - 411-60-00 um - *�u�o r` - +,29oo 50 - 5,85000 25 - 900.00 yo - 1,425'0 ' - - ' - - - - - - - :m - - ' - - - - _ - - - - _ - - - - - - - - CURRENT oomzsxcT ESTI BALANCE /~ 23),900.00 2000.00 00 ]2,450 JOO 12000 3,2500 211500,00 63,260-00 2,500.00 7,000-00 _ -00000 - 000-00 - - ,00 _- - ,_0 ~ _-00 - _ __ 00 2,27500 4,26000 1,42500 v2=, - __0 0 - 55,lwoo - 00 ._-- _ __. 00 - .-_0-00 - 32,90000 - __ 11000 _ -__ - ___ _ o,2*uo - 4,496,0\ 25,70*0 nm 25,7090 - 18,413/0 - mo ' m�yu* ' - 3��* - - 579o0 ' - xm - 578.00 - 1/239u - xm - - - - 1,239"" - - 675,0 - nm - *75u0 a1164uo `on 3,6+ xm - 9z2600 100 8,226.00' 1,112o0 mo //ux" - 5,406.0 - nm - 5,406.0 - - ' - - - - ~ 10,30700 LeonemKeemmInc. Joov« Boone Spokane, WA 99201 Page of Coulee City Medical Clinic & Librmy APPLICATION FOR PAYMENT Period 6/30/2024 rmilee City- WA 99115•Architect Loofburrow Wetch Architects, P S r% ---a, Job A 23-1154 ............ CHANGE ORDER ITEMS ITEM DESCRIPTION NO- - ----- - TOTAL CONTRACT VALUE TOTAL COWLETE TO DATE PERCENT COWL= VALUE PREVIOUS ESTIMATES t511Ma1C NO, VALUE CURRENT ESTIMIATE VALUE CONTRACT BALANCE I CHANGE ORDERS 2 CHANGE ORDER #1 3 Substantial Completion Date - No Cost 4 CHANGE ORDER #2 5 PIUA Credit for S1 Altermte Bid (16,900.00) (16.900.00) 6 PR ",12 Knox Box - No Cost 1,212-00 7 PR llr7 Plan Review & Permit Fees 1.21200 5,21600 8 PR 10 Added Toilet Accessories 5,216,00 9 CHANGE ORDER #3 10 COP 45R Credit Cow Tongues -No Cost - I I COP 116 Sewer Line Connection Changes 5,49500 5X495,00 100 5,495.00 12 COP 98 Flooring Change 4,344,00 - - 4,344.00 2,622.00 13 COP 910 Blind Revisions 2,622.00 1,928,00 14 COP #12 Thru-Wall i►Iailbox Upgrade 15 COP NUR Sink & Casework Addition at Library 1,928,00 4,365.00 - 2,182.50 50 • - 2,18150 2,182.50 16 COP # 14 Furred WaUsfor Plumbing 546.00 546.00 too 546.00 - 17 CCD,,mrl Unsuitable Soils 9,697.00 9,697.00 100 9,697,00 19 20 21 22 23 24 25 CHMGE ORDERTOTAL 183525.00 i.SW5070,00 17,920.50 6720,198.12 263,063-33' 17,,926.50 356.5434.79 604 50 1,360.371 SK ORIGINNAL C0N*M;kCT'r0'rAL BILL IN (!'r0TiXL_i 2,00.5,095,00 63&11$,62 32% 263.663.33 - "I ---- 374,455-29 Leone & Keeble, Inc. 108 W. Boone Spokane, WA 99201 Page 3 of 3 Phone; (509) 327-4451 Fax: (509) 325-9200 APPLICATION AND CERTIFICATE FOR PAYMENT Coulee City Medical Clinic & Library Coulee City, WA 99115 Job # 2.3-1154 Period 6/3012024 Architect: Loofburrow Wetch A Estimate No. 5R SUBTOTAL C D E F H SCHEDULED i/ALUE PREWOUS APPLICATIONS CURRENT APPLICATION TOTAL TO DATE BALANCE TO FINISH 1 1,9861570.00 $ 263,663.33 $ 356534.79 $ 620,198.12$ 1,366,371.88 CO TOTAL $ 18.,525.00 $ - $ 17,1920.50 $ 17,920.50 $ 604.50 At SUBTOTAL $ 21005;095.00 $ 263,663.33 $ 374,455.29 $ 638.,118.62 $ 1.,366,r976.38 SALES TAX 8.2% $ 164,,417.79 $ 2:1..620.39 $ 30.305-33 $ 52,325.73 $ 112,092.06 TOTAL CONTRACT $ 2,169,512.79 $ 285..283.72 $ 405.,160.62 $ 690,444.35 $ 1..479,068.44 RETAINAGE 0% $ - 285,283.72 $ 405,.160.62 $ - $ 690,444.35 $ 285,283.73 405,160.62 TOTAL LESS RETAINAGE PREVIOUS PAYMENTS DUE THIS ESTIMATE UNPAID BALANCE I $ 1,r479,068.441 The undersigned Contractor certifies that to the best of his knowledge, information and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents., that all amounts have been paid by him for Work for which previous Certificate of Payments were issued and payments received from the Owner, and that current payment shown herein is now due. 713124,1:22 PM Public Works Dashboard HILL TOP CRAFTSMEN LLC Intents (1) "14-27349 $1431344-00 - Approved 6/il/2024 JOE'S EXCAVATION INC Intents -1759 $151,618.00 Approved 3/26/2024 141 i---- Certified Payroll Reports (6) LESLIE & CAMPBELL INC Intents (i) qg6io 856,455.00 Approved 4/3/2024 i SKAUG BROTHERS INC Intents (1) • Approved 5/24/2024 1428983 $313,662.00 SPECTRUM COATINGS TNC Intents (1) 14Approved 7/1/2024 - - 942 52 -$27,665.00 t STORHAUG ENGINEERING, INC. Intents (1) '---1439666 12,000.00 - Approved 6/21/2024 Certified Payroll Reports (I3 STRIPE RITE INC Intents (1) 14 15(3- )g-3 Time and Materials - APPrOVed 4/8/2024 TOTAL ENGY MIGT & I4V.4,C SERV INC Intents (1) 14199 U $172,000.0o - Approved 4/17/2024 Subcontractors (2) INSULATION SPECIALISTS INC Intents Approved 4/17/2024 1-d")(,'3.o6 $6,434-00 - RILEY ENGINEERING INC Intents tij 20606 $2,275.00 14 Approved 4/18/2024 WHITE DIAMOND CONCRETE LLC Intents (1) A i---1422042 $81,127-55pproved 4/24/2024 Certified Payroll Reports (9) Subcontractors (2) AMERICAN ROCK PRODUCTS Intents (1) Materials •A ),7 Time and Matei Approved 5/21/2024 t---1422- Certified Payroll Reports (8) CHAMPION CONCRETE PUMPING INC Intents (:L) 1425,46o Time and Materials • Approved 5/13/2024 Certified Payroll, Reports (7) I Help us improve https:lfsecure.ini.wa.gov/pwia/Dashboard.aspx?accepted=true#proiect/1114575 2/3 APPLICATION FOR PAYMENT Period 6/30/2024 Coulee City Medical Clinic & Library .Architect: Loofburrow Wetch Architects, P S Coulee City, WA 99115 Btimnlc No, 3 Job r"r _23-1154 - - -- - ------ CONTRACT ITEMS TOTAL TOTAL PERC-ENT COMPLETE PREVIOUS VALUL VALUE CURRENT VALUE CONTRACT ITEM DESCRIPTION CONTRACT COMPLETE VALUE TO DATE ESTIMATES EST NATF- BALANCE-__... NO I GENERAL REQUIREMENTS 339,12100 1082519.04 32 44,095.86 64,43318 230,60196 2 General Conditions 181054.00 51777-28 32 2,347.02 3,430,26 12.,276,72 3 B&O and Insurance 27,299,00 27,298.00 100 27,298.09 4 Bond 5 Final Documentation 14,34900 - - - 14,349.00 28,696.00 I 6 Punch List Completion 29,696.00 28.00 696, 7 Commissioning 28.696M 61500,00 i., 6,500.00 -0 100 - 6,500,00 - 8 Permit Allowance 9 DIVtSI0N 2 - SITE WORK to Selective Site Demolition 3,587,00 3,58700 100 3,587-00 I I DIVISION 3 - CONCRETE 4.535,00 4,535,00 too 3,628,00 90700 12 CIP Concrete Anchors 13 CIP Concrete - Buildingop 91 1,27.00 91,127.00 100 68,345.25 22,781,75 5,634.00 14 CIP Concrete - Sidewalks 5.634,00 - •- 1,689-00 15 CIP Concrete - Transformer Pau 1,689,00 658.00 16 Post & Panel Signage Concrete 658,00 746.00 17 Grout Steel Column Base 74600 18 DIVISION 5 - METALS 1,0416.00 19 Structural Stcel Framing 1,416�00 6,882,00 20 Metal Ladders 6,882.00 21 DIVISION 6 - CARPENTRY 163,344 130,67520 80 130,675,20 32,668.80 22 Rough Carpentry 23 casework- Blocking & Badking �00 13,522,00 6.761.00 50 6,761,00 t41831 6,761 ,00 610,50 24 Rough Hardware 2,44200 2 00000 1,831,50 S 2,000,00 75 100 .50 2,00000 - 25 Hoisting / Craning 48,2'17-00 26 interior Finish Carpentry 48,,217 00 - - 21 DIVISION 7 - THERMAL AND INMOISI-uRE pROTECTION 27,825.00 28 Thermal Insulation 27,825-00 77400 174,00 100 77400 1 29 Below Grade Rigid Insulation 56,455.001 3o 'I-hermoplastic Single Ply Mcmbmne Roofing 56AS500 - - 35,000.00 31 Siding 35,00000 500,00 32 Roof Accessories 500.00 1,122,00 33 Joint Sealants 1,122.00 34 DIVISION 8 - DOORS AND GLAZING 47,35900 35 HM Doors & Frames 47,35900 2,710,00 36 Wood Doors 2,71000 6,583.00 37 Vinyl Windows 6, 5 930 0 0 22,379.00 38 Door Hardware 22,379:00 5,037.00 39 Glazing 5,03700 40 DIVISION 9 - F'INNISHES 58,970-00 41 Gypsum Board 59,970 00 - 19,480,00 42 Acoustical Ceiling 19,.480.00 - 31,662.00 43 Flooring 31,66200 - 27,66500 44 Painting 27,66500 - 45 DIVISION 10 -ACCESSORIES 8,49900 46 Panel Signage 8,499.00 190�00 47 Wail & Door Protection 19000 79600 48 Toilet, Bath & Laundry Accessories 79600 - 779.00 49 Fire Protection SPCcialties 77900 - 82300 50 Knox Boxes 823-00 - 1,446,00 51 Book Return 144600 , - 1 52 DIVISION 12 - FURISISHINGS 5,00000 53 Window Treatments 5,00000 - 65,48600 54 Casework 65,486�00 - - - 55 DIVISION 22 -PLUMBING 20,00000 20,000,00 100 20,000-00 56 Understab Plumbing Labor 57 Underslab FlumbJng walcriats 16;,OnO.00 16.00000 100 50 16,00000 - - 10,000.00 10,000,00 58 Rough In Plumbing L2bor 20,000-00 45,00000 10,000-00 36,000-00 80 9,000,00 27,00000 9,000.00 59 Rough In Plumbing Materials9,753.00 - 9,75100 60 Trim Out Plumbing Labor - - 15,00000 61 Trim out Plumbing Materials 15,000,00 - 800000 62 Pipe Insulation 8,000.00 7,00000 - 231100-00 30 - 1,400.00 70000 4,90000 63 Adinin Jobsite Labor - 3,099.00 64 Commissioning 3,099,00 - 3,09900 65 Punch List Completion 1,549-00 - 1,549.00 66 final Documentation ,9-00 3,000-00 900.00 30 600,00 300.00 2vto0.00 67 Office Overhead 68 Equipment Rental 2,70000 1,080,00 40 5400 540.00 1,62D.00 467.40 69 General licins t C&O Tim 77900 1.390.0313,00 31160 475,776,021 40 155 8U 27 J5. 15.09 211.1,?60........... 914,256.39 s suirrout. 6lti6INNAI. CON Leone & feeble, Inc. 108 W. Boone Spokane, WA 99201 Page I of 3 Phone: (609) 327-451 Far (509) 325-9200 TOTAL ENERGY mANAGEMENT, IHc. HVAC - ELECTRICAL - CONTROLS 2521 Stevens Drive Richland. WA 99354 (509) 946-4500 -Fax 946-9383 TOTALEM12I0N TOTALEM081QC Billed To: Leone & feeble, Inc 108 W Boone Ave Spokane WA 99201 Customer Purchase Order#: Customer Contract/Job#: 23115487 Invoice#: 67445 Date: 08/20/2024 Project: Coulee City Medical Clinic and Library 218 W. Main St. Coulee City WA 99115 TEM Job #:22605 Description Amount Progress Billing# 3 Notes: P - If - - - - � - - - �_ 't A uxtrc- t�i;_Uiiy /iservice charge of 1.5% per month or a $5.00 minimum rebilling charge on all amounts over 30 days. Thank you for your prompt payment! 87,726.20 Non -Taxable Amount: 87,726.20 Taxable Amount: 0.00 Less Retainage 4,386.31 Sales Tax: 0.00 Amount Due 830339.89 2��mh.-�z 9/11/24, 1:30 PM $ .... 14532s6 40,000-00 - Approved 8/5/2024 Certified Payroll Reports (2) TOTAL ENGY MGT & FIVAC SERV INC Intents (1) $172,000.00 - Approved 4/17/2024 -,---14399 0 Certified Payroll Reports (io) Subcontractors (2) INSUIATION SPECIALISTS INC Intents (IL) 14203o6 $6 3434-00 •Approved 4/17/2024 Certified Payroll Reports (4) RILEY ENGINEERING INC Intents (1) 14206o6 $2,275.00 - Approved 4/18/2024 WHITE DIAMOND CONCRETE LLC Intents (3-) Approved 4/24/2024 --1420042 $81,127.55 Certified Payroll Reports (18) Subcontractors (2) AMERICAN ROCK PRODUCTS Intents (1) 1 .-.14227 97 Time and Materials •Approved 5/2/2024 Certified Payroll Reports (iS) C11"IPION CONCRETE PUIVIPLNG INC Intents 142546o Time and Materials •Approved 5/13/2024 Certified Payroll Reports (1 Public Works Dashboard Help us improve : https:/1secu re. In i.wa.gov/pvAa/Dash boa rd.aspx?accepted=true"rqject1 1114575 3/4 ... . ......... APPUCATION,AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PASS ONE Of 4 PAGE$ TO OWNER: c1rant County Pon District No 4 mojwm, coulee city medical clinic & Library APPLICATION NO: 5 Dishibution to: 21 a W main street 218 W Main smer !OWNER Coulee City, WA 99115 Coulee City, WA 99115 JARCHM-CT PERIOD TO' 08131/24FACTOR FROU CONTRACTOR VIA ARCHITECT. Leone &, Keeble, Inc, 1,00iburrow Wetch Architects, P S 108 W Boone Arc. 201 W Yakima Avc Spokane, WA 99201 Yakima, WA 99902 PROJECT NOS 23.1154 CONTRACTFOR CONTRACT QATE* 0346124 OR ' I -se CONTRACTOW S APPLICATION FOR PAYMENT Appitcaiion is made for payment, as shown briow, in connection with the Contract Continuation Sheet, ATA Document 0703, is attached I CONTMC7 SUM 2 Net change by Change Orders 3 CONTRACr SUM TO DATE, (Line I * 2) 4 TOTAL ComPLETED & STORED TO DATE (Column 0 OTV G703) 5 RBTAINAOE,• I% of Completed Work $ (Column D + S on G703) b %of Storcd Material (Coliumn F an G703.) Total Retatnage (Lines Sa + 5b or Total in Column I of G71033), 6 T01'AL EARNED LESS I ,IrTAINAGE 7 WASHINGTON STATE SALES TAX 920/0 8 LESS pREVIOUS CERT(FICATF.S FOR PAYMENT 9, CUMNTPAYMENTME 10. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ .9 Eq:. .570 D P -)6.50300 �!i S 2,013.073-00 S 12% 157 00 000 744,91600 0.00 _101988 97 956.24029 4 1 � �,OO 3 �58 CHANGE ORDER SUZyWARY ADDITION$-,- D mucrioNs T*W changes approved -inprevious months by Ovinitr $43,40300 $16,9 0.00 9 TVA apEoved th IS MOntb so 00 TOTALS $43.40100 S10".90000 NET CHANCES by Change Order $26,503.00 The undersigned Contractor certifies that to the best of the Contractoes kaawlcdge, inforina-tion and belief The Work covered by this Application for Payracni has been completed In accordance with the Contraci Documents, that all amounts have been paid by the Contractor for Work for which proiOus Certificates for Payment %yore Issued and payments received from the Owacr, and that 'Current payment Shown hereto is now due COUMACTOR Leone & Xeeble, hic, BY' Datc State of Washington County Counof Spokane "'y Subscribed and 5 Ora to be rue this Ith day of Notary Pubttz. hunt' 15, 2025 My conimissicia 0. irk. LYN ej; IE 040 4D 0141 Imm am §= AM 40 op (. too RJP BUD op _0 amp, AW 4% % Septetnb:r 2024 9111/2024 Akcmimcrs cEwincATE FOR PAYMENT In accordance with the Contract Documents, based mi on -site observations and the dalul ,comprising the application,, the ArchiteCt certifies M the Owner that to the best of the Architect's knowltdgo, '111f9imtion and b0iletthe WWI( has Progressed as indicated, the quality of the Work is in accordanc wilb the oDnttact Documents. and the Contractor is entitled to payment of the AMOU74T CERTIFIED AMOUNT CERTIFIED 0 �'z®rmar"rag-__ I f,41jacl, ex 'pjanf4jjpn I a n11101 all Isur $ n this f'on, ou�jt curtyieddiffersfrom the ampunt pplied. I f eo 0 jq Apphoollou and ondia Confinuallon $11091 Haut are chaftg8d 40 COOOPM W11h IlseaM Uj C(,,rjjj*q4f19 ARairmcn. 13y: /htv Date*. This Certificate is not negotiable, The AMOUNT CERTIFIED is payable onlyio th%-. Contractor named herein issuance. payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract, I-ilp'll "U4p4jlvi"Ug a Uza W_ 0 , .. .. . . .. .— — - . -- - — . - . — . - - - - Users may obtalft Validation of this dOCU6194t by fORILIOSIM9 a completed AIA Document MI - -Carofication of Vocumeaft Authenticity from the Lie 000. APPLICATION FOR PAYNIENT Coulee City Medical Clipir, & Library Period 8/311202.4 Coulee City, W'A" 99115 Ax6itect: Looiburrow Watch Architects, P S Job 01. 213- 1154 F. CONITRACI-Tr 11TI-M TOTAL TOTAL PERCENT ' VALUE VALUE VALUE 0 li-S. C ',V,$ 1 �T ION, CONTRACT COMPLETE COMPLETE PREVIOUS CURRENT CONTRACT �xOr VALUE TO DiVrr-, I MATE- , S ESTIMATE I GENERAL REQUIREMENTS 2 General Conditions 339, I22.00 213,646-96 63 149,213.6S 64,433.18 125,47114 3 B&O and Insurance 18,0400 11,374.02 63 7,94336 3743016 6�679;99 4 Eload 21,29800 27;298,.00 too 1) 27,2quo - 5 Final Documerdation 14,349,00 14,,349,00 6 Punch List CompIction 28,696.00 25,696,00 7 Commissioning 28,696-00 28,696,00 9 Pennit Allowaa= 6,500.00 6)500,00 100 6,500.NN114 9 DIVISION 2 - SITE WORK 10 Selective Site Demolition 3,587 OD 3,587.00 100 3,5&7109 I I DrVISION 3 - CONCRETE 12 CIP Concrete Anchors 4,535,00 4,535.00 100 4,535�00 13 CIP Concrete - Building 91,12700 91,127,00 100 91,1277M 14 CIP Concrete - Sidewalks 5,63400 4,50720 so 238170 1,690,20 1,126.80 IS CIP Concrete - Transformer Pad 1,689.00 1,689tOO 100 1,689-00 # 16 Post& Panel Signage Concrete 658,00 - 658.00 17 Grout Steel Column Base 746.00 74600 100 10 746,00 19 DIVISION 5 - METALS 19 Structural Steel Framing 1,416.00 1,416.00 too 1,416,00 20 Metal Ladders 6,832.00 3,441,00 50 A 3,441,00 3,441,00 2) 1 DIVISION 6 - CARPENTRY 22 Rough Carpentry 163,34-4.00 163,344.00 100 163,344.00 - - 23 Case%vorh Blocking & Backing 13,52.2-00 136522,00 100 1,20-691.90 1;352.020 24 Rough Hardvywe 2,442.00 2,442 00 100 2,197.80 244.20 25 Hoisting i Craning '?000--00 2'000m too 2,000,00 - 26 Interior Finish Carpentry 48,217.00 - 48 3b 217.,00 27 DIVISION 7 - THERMAL AND MOISTURE PROTECTION" 28 Thermal, Insulation 27,925.-00 13,912.50 so 5,565.00 8,34750 13,912.50 2.9 Below Grade Rigid Insulation 77400 774,00 too 774,00 3G Thermoplastic Single Ply Membrane Roofing S6,455,0 36,455 (* too 45,164,00 11 ,2'9 I.00 31 Siding 35,000.00 35,000-00 100 - 35,000.00 32 Roof Accessories 500:00 500-00 100 5000 33 Joint Sealants 1,12200 56100- 50 56100 561.001 34 DIVISION 3 - DOORSAND GLAZING 35 HILT Doors & Frames 47,339-00 33,519.25 75 35,$19.23 11,83935 36 NVood Doors 2,710.,00 - 2,710 00 37 Vinyl Windows 6,583400 6,583,00 too 6A10O 3 *3 8 Door Hardware 4 37900 22,379-00 39 Glazing 5,037.00 3,022.20- 60 3,022.20 2,014.80 40 DIVISION 9 - FINISHES 41 Gypsum Board 58,970,00 17,691.00 3{? 7,666.10 10,02490 41,279,00 42 Acoustical Ceiling 19,480,00 1%480.00 43 Flooring 31,662-00 31,66100 44 Painting 27.,665.00 1,383.25 5 ;.4 11383-25 262291.75 45 DIVISION 10 - ACCESSORIES 46 Paml Signage 8,49900 7,64910 90 7,649.10 $49,90 47 Wall A Door Protection 190,00 95.00 so 95;00 9500 48 Toilet, Bath & Laundry Accessories 796-00 398.00 50 y 398.00 39a.00 49 Fire Protectiorn Specialties 779-00 399.50 50 389,$0 389,50 50 Knox Boxes V-3,00 923,00 100 576,10 24690 51 Book Reau-n 1,446,00 *4 1,44600 52 DIVISION 12- FURNISHINGS 53 Window Treatments 5,00000 5,000.00 54 Casework 65,486,00 32,743 00 so 321743.00 32,74300 55 DIVISION 22 - PLUMBING 56 Underslab Plunibing Labor 20,000.00 20,000-00 too 20,000;00 57 Undarslab Plumbing Materials 16,000-00 16,000.00 LOG 16,000.00 58 Rough In Plumbing Labor 20,000.00 17,000,00 95 17,00Q-00 41 3,000,00 59 Rough In Numbing Materials 45,00000 42.750,00 95 42,750,00 2,250.00 60 Trim Out Plumbing Labor 9,753-00 - 9,753.00 61 Trim Out Plumbing MaterWs 15,000,00 12.750.00 83 12,750.00 2.250.00 62 Pipe Insulation 8,000,00 - - - 3100000 63 Admin Jobsite Labor 7,00000 3,500,00 50 3,50000 3,500.00 64 Commissionins 3,099.00 A - - 3,099.00 I" 65 Pttuch List Completion. 3,099-00 1 3,099,001 66 Final Documentation 1,549:00 - 1$549-00 67 Office Overhead 3,000-00 1,500.00 30 1,500.00 1,500.00 68 Equipment Rental 2,700,00 1,620.00 60 1,620.00 1,080-00 69 Goneral 77900 46T.40 f`) 4-67.410 311 a64 4) Leone & Keeble, Inc. 108 W, Boone Spokane, WA 99201 Phorw (509) 327."51 Fax, (609) 325-9200 Page 1 of 3 Coulee City Medical Clinic & Library Coulee City, WA 99115 Job 9 23-1154 (" XA TRACT MZIMS DESCWTLION IVISIGN 23 - HVAC 71 Submittals / Mobilization r. 72 Procure ERV's 73 Proctre Packaged RTUtg 74 Procure Exhaust Fans 75 Procuro Duot Heaters 76 Procure Split System 77 Procure Roof Hoods 7S Procure OWS 79 Fabricated & Procured Ductwork 80 Installation of Duch-vork & Equipment 81 Refrigeration Piping 82 Duct Insulation 83 Low Voltage Wiring / Controls 84 HVAC Equipment Startup 85 Test; Adjusting & Balancing i 86 Final Doturnentation 87 Ptwc:h List Completion 88 Commissioning 89 DIVISION 26 - ELECTRICAL 90 Electrical Permits & Mobilization 91 Primary Services - Material 92 Primary Services - Labor 93 Branch Conduit & Wire - Material 94 Branch Conduit & Wire - Labor 95 Feeder Conduit & Wire - Material 96 Feeder, Conduit & Nkfire - Labor -97 Exterior Lighting - Material 98 Exterior Lighting - Labor 99 Panels & Disconnects - Material 100 Panels & Disconnects - Labor 101 Trim - Material 102 Trim - Labor 103 Light Fixtures - Material 104 Light Fixtures - Labor 105 Comm/Data - Material 106 ComnVData - Labor 107 Final Documentation 108 Punch List Completion 109 Commissioning 110 DIVISION 31 - EARTWORK Ill Bring Site to Subgrade 112 fbundadon Excavation & BadM 113 Building Slab Prep 114 Sidewalk Prep 115 Trenching for Electrical 116 Prep for, Concrete & Asphalt Sidewalks I Paving 117 Fine Grade Continuous Footings 118 Fine arlade SOG 119 DIVISION 32 - SITEWORK t20 Vapor Barrier Under SOG 121 Asphalt PaAng. t22 Pavement Marhings 123 DIVISION 33 - UTILITIES 124 Utilities (Trenching) 125 Site Utilities Water Systems - Nfaterial 17-6 Site Utilities "Niter Systems - Labor 127 Site Utilities Sanitary SCV;Cr - N'13terialS 128 Site Utilities Sanitary Sewer - Labor 129 Site Utilities Storm Drainage / Swale. - Nfatcrials 130 Site Utilities Storm Drainage / Swale - Labor 131 TOTAL ORIGNAL CONT.RRACT Leone & Keeble, Inc. 108 W. Boone Spokane, WA 99201 Phone, (509) 327-4451 Fax: (509) 325-92.00 APPLICATION FOR PAYMENT Period 8131/20224 Architect: Looiburtow Watch Architects, P S AL PERCENT VALUE VALUE V t CONTRACT COWLETE COMPLETE PREVIOUS CURRENT CONTRACT V A f i. t G; TO DATE ESTIMATES EITINfATE 1,720-00 1,720,00 too 96000 960,00 23,900.00 23,900.00 100 23,900.00 24,406,GO 24,400A 100 24,400,00 1,00D.00 1,000,00 100 1,000,00 2,900.00 2f9WOO too 2,900,00 2,4$0.00 2,450,00 too 2,450.00 120.00 (20,00 too 120.00 3,25000 st. - - 11 3,250.00 21)500-00 20,4275,00 95 1,075--00 19,350,00 1,075.0D 63,260,00 60,097,00 95 3,163,00 56,934.00 3,163.00 2,500.00 2,500,00 too 0 2'500.40 7,000.00 7,000.00 100 7,000,00 3,000,00 2,550,00 95 x 2,55000 450.00 4,000,00 00. - - 4,000,00 2,400,aO V 2,400�-.00 1,720,00 11720,00 3,440�00 3,440.00 3,440.00 3,440,00 2127500 2,215,00 100 7,275.00 4,260.00 4,260.00 100 4,260.Q0 61550 00 5,24tD.00 so 4,912,50 r qn 3277l' %F 1,31Q:00 9,590-00 6,44-5.00 75 4,2WOD 2.145,00 2,145.00 23,400,00 22;230,00 95 5'850�00 16"80'.00 1,170.00 1,800,00 1,440.00 so 014t1.0O 540.00 360,00 21850:.00 2,280,00 so 1,425,00 855-.00 570,0011 5'-J30-00 - - - -A 5,1250.00 5,62000 - A: P,620.00 55,70000 19"-f95 00 35 19A95-00 36,205,00 111510,00 6,906100 60 6,906,00 4,604.00 2180000 - - 2,800,00 11,500.00 1 t)1500.00 R900-00 94225,00 25 8,225.00 24,675t00 25,110,00 12,555.00 12,555,00 12,555-00 5,90000 5,900,00 7,500,00 7,500.00 2,248.00 M,248,OD 4,496,00 4,496.00 4,496:00 4 4,496. OD 10,307-00 10,30700 25,70900 25,709,00 100 25,709,00 18,413.00 18,413 W 100 18,413,00 9,59500 9,595:00 100 9,595,00 5,670 DO 5,670.00. Too t,134,00 4,536-60 45,962,00 37,229,22 81 37,22.9,22 si-732 78 57&B0 579.00 100 578-00 1,23900 1,239,00 too 1,239-00 2,212.00 2,21100 100 2,212.00 36,02000 "o. 36,020.00 7,370.00 - w 7,370W 67500 675X0 100 675,00 3164100 3,6410(1 too 3,641 .00 8,226,00 SS226,00 too 9,226.00 1,11,200 1,112,00 100 1,112.00 5,406,00 5,406,00 too 5,406A 3,1727.00 3,17200 Ica 3t] 72.00 14,405.00 14,40500 $00 14,405.00 I'vo-OV-90 1,257,946 50 956.660.56 40 11 -285-94 Page 2 of 3 APPLICATION FOR PAYMENT Coulee City Medical. Clinic & Library Period 8/31/2024 Coulee C4, WA 99115 Architect-, Lodburrow Watch Architects, P S EstimateNa. CHANGE ORDER ITEMS TOTAL TOTAL PERCENT VALUE VALUE VA.LUB ITEM DESCRIPTION CONTRACT COMPLETE COMPLETE PREVIOUS CURUNT CONTRACT VALUE TO DATE ESTIMAT,ES ESTIMATE. BALANCE I CHANGEORDERS 2 C14AINGE, ORDER91 3 Substntial Completion Date -No Cost 4 CHANGE ORDER 92 5 PRO I Credit for S1 Alternate Bid (16,9M,00) (16,900m) 100 (16,900.00) 6 PP, 912 Knox Box - No Cost 7 PR 97 Plan Retiew & Permit Fees 1,212.00 1,212,00 100 1,212.00 a PR 99 Added Toilet Accessories 53216.00 9 CHANGE IDRDE R 03 10 COP 11t5R Crafft Cow -Tongues - No Cost I I COP Iffi Sewer Line Connection Changes 5;495 00 5,495.00 too 5,49500 12 COP fig flooring Change 4,344,00 r 4,344M 13 COP Itr 10 Blind Revisions 2,622.00 2,622.00 14 COP 912 ThruAVall Mai"Ibox Upgrade 1,928.00 1,928.00 15 COP 1113R Sink & Casework Addition at Library 4,365,00 2,182,50 50 2J82,50 2,18210 16 COP 414 Furred Walls for Plumbing 546.00 546.00 100 546.00 17 CCD #I Unsuitable Soils 9,697-100 9,697,00 100 9,697-00 IS MANGE O"Ek AW 19 COP 9 I1PR,4 16 Broken Saddles 7,739M 7,789.00 too 7,789.00 20 PR #17 Stud Wall Revisions 189,00 189.00 100 I39,00 21 23 24 25 26 27 28 -)q 3 1 CHANGE ORDEP, TOTAL 26;,SO3, 00 10121Y30 2711 10�50 (16,900:00) 16,292 56 ORUGMAL CONTRACT TOTAL 11 j.f)%,57t).0f.1 f 2_1 3 W. 6. 5 0 1611115H14, z-3-flo WLI,Mn TOT/,,Lg 1310 73 -V() 1:168JS-r. t7��'+s 8K31,771.06 3 .14 161H, Leon & Keeble, Inc. 108 K Boone Spoi(ane, WA 99201 Phone: (509) 327-4451 Fax: (509) 325-9200 Page 3 of 3 APPLICATION AND CERTIFICATE FOR PAYMENT Coulee City Medical Clinic & Library Coulee City, WA 99115 Job # 23-1154 Period 8/31/2024 Architect: Loofburrow Wetch A Estimate No. 5 SUBTOTAL 'D E F SCHEDULED VALUE PREVIOUS APPLICATION$ CURRENT APPUCATION TOTAL TO DATE BALANCE M FINISH 1,986,570.00, $ 856.,660.56 401,285.94 1,257,.946.50 $ 728,623.50 CO TOTAL 26,50.00 $ 2711110.510 6..900.00) 10,.210.50 16,292.50 SUBTOTAL 2,013,073.00 $ 883,771.06 $ 384,385.94 $ 1,268,157.00 $ 744,916.00 SALES TAX 8.2% 165..071.99 $ 72,469.23 $ 31,519.65 $ 103..988.87 61p083.11 TOTAL CONTRACT 2,o178.,144.99 956,240.29 415,905.59 $ 1p372..145.87 805,.999.11 RETAINAGE ova 956240.29 415,.905.59 $ $ $ 1p372,145-87 956j240.29 415,905.58 TOTAL LESS RETAINAGE PREVIOUS PAYMENTS 0' DUE THIS ESTIMATE 1UNPAID BALANCE 805;999.11 The undersigned Contractor certifies that to the best of his knowledge, information and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents., that all amounts have been paid by him for Work for which previous Certificate of Payments were issued and payments received from the Owner, and that current payment shown herein is now due. I 1c. .-vQ GRANT COUNTY PORT. DISTRICT. #4- GENERAL FUND.. . ....... ..... DATE: kc) P. O. BOX 537 COULEE CITY, WA 99115 WARRANTS: THE UNDERSIGNED., DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS MUST, DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. I WARRANT NO. — " APPROVED: AUDITOR ............ Ommis IONERS