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Home My WebLink AboutGrant Related - BOCC (005)f . 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 aY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kat'I"I@ Stockton CONFIDENTIAL INFORMATION: ❑YES 8 NO DATE:12/31 /2024 PHONE:2937 11 All ❑Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related El County Code El Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders ® Grants — Fed/State/County ❑ Leases ❑ MOA / MOU ❑ Minutes ❑ Ordinances ❑ Out of State Travel ❑ Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution ❑ Recommendation ❑ Professional Serv/Consultant ❑ Support Letter ❑ Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB Reimbursement request from Port District NoA Coulee City on the Strategic Infrastructure Program (SIP) 2023-05 in the amount of $93,244.80 for expenses in November and December 2024. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO R N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: -ZS"- DEFERRED OR CONTINUED TO: APPROVE: DENIED ABSTAIN D 1: D2: D3: 4/23/24 WITHDRAWN: GRANT COUNTY STRATEGIC LNTRASTR, UCTURE A OWN PROJECT CERTIFICATION i This form must be signed and returned, with an invoice., for the approved funding, i before reimbursement can be 41pproved by Grant County, SIP Project Proposal Number: 2023-05 SIP Funding Recipient: Grant !County Port District #4, Coulee SIP Project Description: New Coulee City Medical Clinic City L the undersigned, do hereby cedify -under ppalyopemnrj,hr• als have been ftu-nished, the services rendere(L and/or, the labor perfonned as described in the project proposal for the above -referenced SO Project and that I am ^11 auth14%ilmed authenticate and certify to this claim. I also certify that this claim of just and due and is an unpaid obligation againstGrant County. Further, according to the SIP Project Funding Policies, I attest that at the next audit of my entity. this project -shall be called to the attention of the Washington State Auditor's Office and an emphasis audit Will be requested: to assure that these fads were expended toward the project and according to the intent of the proposal. Signature Pfinted Name Date Signed .ranted Title Completed, signed original certifiteatioh and invoice are to be mailed to: Grant Administrative SpeclaUst, PO:: Box 37, Ephrata, WA 98823 ATTACHNE.NT 4 GENERALFUND GRANT COUNTY PORT DISTRICT #4 VOU HER LEST P. O. 80X 537 Y DATE:� � COULEE CITY., WA 9gA"5 � �� °, WARRANTS: ON I, 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 15 A JUST, DUE AND UNPAID OBLIGATION AGAINST GRANTCOUNTY PORT DISTRICT #4 AND THAT I Aid AUTHORIZED TO AUTHENTICATE .AND CERTIFY SAID CLAIM. SIGNED44 =r WARRANT NO I4 �' _ � �.J(/]�(i. �slwYwr�� YF � 1T Vim✓. APPROVED. AUDITOR PORT DISTRICT COMMISSIONERS ram}•• i All Amonk Q!4 Plumbingg Servic o7s, LLC I roO63 Stratford Rd NE Wot'*k 0 Invoice r/ M• esLake, Wt! WM8HMMf t f 1„ti �� 1yS .". `` �ti� f`lli:� 'j{txY`vMi4axim..a..e.da,Nacrk.d4..,sn•.rtuat,}a. r+...:�4.a.r.M,.i,��L TelFly . aiHie59uMyl.AM+nXwt�: ,;�:}aina+eicYt 1.9�t wty�yp�f�aidNo:�k�aK1.:Ms4ha>:.^.'�ta�1f'J�+r `i::"}'r:1i i:ecY `. '` •-a'id egcwi� j/lys� 0 CON r OWK ..+� i L i � +04tJ.3sxawlK .. ��+M:OM•M�d44.�w'" . oe iu kA �+ a _,255 ram ....��.� *�.+.o-,n•��ev.,,arsee•.+sec.wr�w,r.�«.x:�+f�wa;.a.�x,.�+.,..<.� �•av�c...r..., -' .. .. �d'.Til.'l.tleJlal.2•tiMek'.'-wW:aFy,±A+y,+}RtN.y�a . aaqj { �n$$ >�!•++H.^.[xs e✓+t..;. »n1•.- _ FQ4ab�aTcY%tit Ja. %>•.�i'b9sti�63':9V�rlK'_. ARRIVAL TIME MErM A Yrt imp Irrx 11 � ---- - .� ._ti✓'" _. __.•--••-"'�...�.r ..r. � �.�••.�.•vr+•-i.w ... s+•-s sr►r�a•�.af `u�f tiiv�y!►4T�6i �rt �.tl �♦ Na te }}�Je '�.tr� #k+ ��.�� tr�rt�.'S°�;-ahi.i+�:i �► �t`��`ww:d s1 -invoice CONSULTING ENGINEERS Grant County Port District No. 4 December 02, 2024 P.O. Box 537 Project No: 20840.00 Coulee City, WA 99115 Invoice No: Project 20840.00 Coulee City Medical Clinic Professional Services from November 03, 2024 to November 30,_2024 Professional Personnel Houm Reba-- P. Manager Meskimen, Michael 4.00 203-98 815.92 Totals 4.00 815.92 Total Labor 816,92 Billing Limits Current Prior To"Date Total Billings 816.92 269,506.02 270,321.94 Limit 294,000.00 Remaining 23,678.06 Total this Invoice- 815Z,9&/ 1130 Rainier Avenue S., Sutte 300 Seattle, Washington 96144 (206)264-08W Fax (206)263-3206 9:33 AM 12/13/24 Grant County Port District #4 Check Detail December I - 13,2024 Type Num Date Name Item Account 615.40 - Legal Ads TOTAL Check 4163 1211312024 Banks Lake Brow Cash Account 514.40 - Advertising/.,. TOTAL Check 4164 12M3/2024 Centurylink Cash Account 538.40 - Utilities TOTAL Check 4156 1211312024 JRCC Cash Account 546.40 - Repairs Mis. TOTAL Check 4166 12113/2024 All American Plum... Cash Account Capital Projects TOTAL Check 4157 12/1312024 u S Bank Cash Account 514.30 - Office Supp... TOTAL Paid Amount -349.00 -349-00 -175.00 -175.00 -85,54 -85.64 -19,521 .65 -19,521-65 -11942.85 -11942.85 -115.92 -115.92 Check 4158 12/1312024 Gray & Osborne, Inc. Cash Account 514.40 - Professiona.,.. -815.92 TOTAL -815.92 Check 4169 12/13/2024 Leone & Keeble, Inc. Cash Account Page 2 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 4 TO OWNER� Grant County Port District No 4 PROJECT Coulee City Medical Clinic & Library APPLICATION NO 7 Distribudon to, 2 18 W Matn Street 2 18 W Main Street Coulee City, WA 99115 Coulee C4, WA 99115 OWNER _JARCH TEX 1- PEIUOD TO,- 10131/24 :JCOWMACTOP. FROM CONTRACTOR,- VIA ARCHITECT, Leone & Feeble. Inc. Loofburrow Wetch Architects, P S 108 W Boone Ave 2.01 W. Yakima Ave Spokane, WA 99201 'Yakima, WA 98902 PROJECT NOS- 23-1154 CONTRACT FOR: CONTRACT DATE, 03/06/24 PAGES CONTRACTOWS APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contwoes knowledge. Application is made for payment, as shown below, in connection with the ContracL information and belief the Work covered by this Application for Payment Etas been Continuation Sheet, AIA Document G703,, is attached completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work ror which Certificates for Payment issued %1ri,J111181 previous were and received from the Owner, and That current shown herein is now due 40� _L Y11 payments payment V I CONTRACT SUM S 1.986,570 00 2, Net change by Chango Orders S 3, CONTRACT SUM TO BATE (;Line 1* 2) S 106.36000 2tU92,93D 00 CONTRAC7TOR & Keeble., Inc A10TAW 4n: 4 TOTAL COMPLETED & STORED TO S 1,992,586 70 SO PUBUC DATE (Column G on G703) BY Date- 11/4/2024 dP vy WO 5 RETAINAGE: or, INC NO 'V�d A - a 0 % ofCompleted Work S 000 (Column D + E on G703) b % of Stored Material S State *r' Washington County of Spokane SubseriW an MOM to Lvfora me this 41h day of Novernbcr2024 Notary Public, Cop _441' (Column F on 0703) N, it -)5 mvCOMMISS1011 20.7.5 W = 5 202 Total Retainage (Unes 5a + 5b or Total in Column I of G703) 000 ARCHITECrS CERTIFICATE FOR PAYMENT 6 TOTAL EARNED LESS RETAINAGE 1,892,0586,70 In accordance with the Contract Documents. based on on -site observations and the data 7 WASHINGTON STATE SALES TAX comprising the apprication, the Architect certifies to the Owner that to -the best of the 155.192 11 Architect's knowledge, information and beliefthe Work has progressed as indicated, 8 LESS PREVIOUS CERTIFICATES FOR, PAYMENT 1 0637,569 79 ibe quality of the Work is in accordance with the Contract Docurnents, and the Contractor 9 CURRENT PAYMENT DUE S 410,20902 is entitled to payment of the AMOUNT CERTIFIED 10, BALANCE TO FINISH, INCLUDING RETAINAGE (Erne 3 less Line 6) S 200.34330 AMOUNT CERTIFIED CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS S Total changes approved in erevious months by Owner 0 S43A03 00 0 $16,90000 Total approved this Month $79,85700 $000 DO] TOTALS $I 23�.260 00 $16,90000 NET CHANGES byChramorder S106,360.00 (.4 11ach explanation ifamount certified diffe,*sfrom The amount applied. Itiff talafifigures on this Application 4fnd 0 the CominuallonSheet then are changed to conform wah the amount cernfied) ARCHITECT. By, Date - This Cerfificate is not negotiable The AMOLW CER71FIED is payable only to the Contractor named herein issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract, AIA D3MMENTMM2 - 7PPLEAMON AND CERTIPIMMN FZ5R'PAYMENT 1992 EDITION - ADZ : 01M2 THE AfAERZAM MMUTE OF ARCHOMS, T736 NEW YORK - AVE,. - N.W., WASHINGTON, DC 20006-5292 mom Users may obtain validation of this document by requesting a completed AIA Document =I - Certifleatton of DocurnenrS Authenticity from the Licensee. Foli PAYMENT Coulee City Medical Clinic & Library Coulee City,�VA 99115 Period Period 10/3112024 Job 0 -13- 1154 Architect: LooftrTmv Wetch Architects, P S ---------- --o UNNIA -CTrrr.,% I S EM TOTAL -PERC lo;NT VAIJ it Estimate No 'VALE"E 7 VALUE DESCRIP110N, NO CONTRACT COMPLETE COMN PLETE pRLvIOUS CURRENT CONTRACT I GERA NEL REQUIREIMENTS VALVE TO DATE, ESTI&IATES Ii.S! I'l N.1 AT 1, 13ALANCE 2 General Conditions 3 Bond and Insurance 339,122 00 305,20980 90 256,003.20 49,206.60 33,91220 4 B 18,05400 1,6,7,48-60 90 13,62896 2,61964 1,80540 5 Final Documentafion 217,208,00 27,29800 100 27,298-00 - 6 Punch List Completion 14,349 00 28 14,34900 7 Commissioning 469600 28,696 00 22,696 00 8 Permit Allo%Nance 6,50000 6.50000 too 6,50000 23,69600 9 DIVISION 2 - SITE WORK 10 Selective Site Demolition 3,587.00 3,58700 100 3,58700 I I DIVISION 3 - CONCRETE 12 CIP Concrete Anchors 4.53500 4,33500 too 4,53500 13 CIP Concrete - Building 91,12700 91,12700 100 91,127 00 14 Cl P Concrete - Sidewalks 5,63400 5,63400 100 4,507 20 1,12680 15 CIP Concrete - Transformer Pad 1 l689 00 1,63900 100 1,69900 rt 16 Post & Panel Si�nage Concrete 65800 6$800 100 658,00 17 Grout Steel Column Base 74600 74600 too 74600 18 DIV(SION 5 - METALS 19 Structural Steel Framing 1141600 1,41600 too 1,41500 20 Metal Ladders 21 DIVISION 6 - CARPENTRY 6,88200 6,88200 100 3,441 00 3,44100 22 Roug ,h Carpentry 163,34400 163,34400 too 163,134400 23 Casework Blocking & Backing 13,522.00 13,522.00 too 13,522.00 24 Rough Hardware 2,44200 2,44200 100 2,44100 25 Hoisting I Craning 2,00000 2'000 00 100 2,00000 26 Interior Finish Carpentry 27 DIVISION 7 - THERMAL AND MOISTURE PROTECTION 48,21700 45,80615 95 45,8.0615 -2,410. 85 28 Thermal Insulation 27,823 00 27,825 00 100 27,82500 29 Below Onde Rigid frisufation 77400 77400 100 774 W 30 Thermoplastic Sinrje Ply Membrane Roofing 56,45500 56,,45500 100 56,45500 31 Siding 35NO 00 35)00000 100 35,000.00 32 Roof Accessories $0000 50000 100 50000 33 Joint Sealants 1,12200 1,12200 100 1,00980 11220 34 DIVISIONS - DOORS AND GLAZING 35 MI Doors & Frames 47,35900 47,35900 too 35,51925 11,83975 36 Wood Doors 37 Vinyl Windows 2W71000 2,574 50 95 2,57450 13550 3E Door Hardware 6,58300 22,37900 6,58300 21,26005 100 95 6,58300 .1 21,26005 39 Glazing 5,03700 5,03700 100 3.02220 Z,014 80 1,118-95 40 DIVISION 9 - FINTS14ES 41 Gypsurn Board S8,970 00 58,97000 100 58,97000 42 Acoustical Ceiling 43 Flooring '19,480 00 19,48000 100 15,58400 306 00 44 Painting 3 14 '6 6"' - 00 27,66$00 12,66480 27,66500 40 100 W 27,665 00 1204 80 - 18,997 20 45 DIVISION 10 - ACCESSORIES 46 Panel Signage 47 Wail &- Door Protection 8,49900 8,49900 100 7,64910 849,90 48 Toilet, Bath & Laundry Accessories 19-0 00 79600 19000 71640 100 90 9$00 39800 9500 31840 49 Fire Protection Specialties 77900 77900 100 389.50 38950 7960 50 Knox Boxes 32300 82300 100 82300 51 Book. Return 52 DIVISION 17. - FURNISHtNGS 1,44600 1,44600 100 1,446 00 53 Window "treatments 5,00000 5,00000 too sk000 00 54 Casework 55 DIVISION 22 - PLUMBING 65,0600 65,48600 100 49,11450 16,371 50 56 Underslab Plumbing Labor 20,00000 20'000.00 too 70,00000 57 Underslab Plumbing Materials 16,00000 16,00000 100 16,00000 58 Rough In Plumbing Labor 20,00000 20,00000 1W 20,00000 59 Rough Irt Plumbing Materials 45,W0 00 45,00000 100 45,00000 60 Trim Out Plumbing Labor 9,75300 61 Trim Out Plumbing Materials 1.5.00000 15,00000 100 12,75000 - 2.,250 00 9,75300, 62 Pipe Insulation 63 Admin Jobsite Labor 8,00000 8,000.00 100 3,00000 64 Commissioning 7,00000 3,09900 6,65000 - 95 41200,00 2,45000 35000 65 Punch List Completion 3,09000 J, U99 UU 66 Final Documentation 1,54900 3,09900 6*7 Office Overhead 68 Equipment Rental 3X0 00 1180000 60 1,80000 1,1"'754900 .0000 6') General herv4 I B&.0 Tax 2,700 W 1,89000 46740 70 60 1,89000 46740 $10.00 SUBTOTAL OP,(GrNAL CONTRACT' -- 90.03 00 1.239,660 70 ow- - 11 194.39059 311 60 1 ti0-172 30 Leone & Keeble, Inc. 108 W. Boone Spokane, WA 99201 Phone: (609) 327-4451 Fax: (609) 325-9200 Page 1 of 3 APPLICATION FOR PAYMENT Coulee City Medical Clinic & Libraty Coulee City, WA 99115 Period 10131/2024 23-1154 Architect'. Looffiurrow Watch Architects, P S Esilmate No 7 C0114TRACT Cr��1i 117. 1 TOTAL IOTA L PEP-CFNIT VALUE VALI! C- VALUE 1% 0 Esc R.1 PT 10 No CONTRACT COMPLETE CONMPLE'rt PRF.VIOUS CURRENT CONTRACT 70 DIVISION 23. t1Vt%C VALUE 110 0.1VrE egimxr!Ls E, STI &J, ATE 8C -' LI /V..\ 71 Submittals I Mobilization 1,720.00 1,7' 20,00 100 1,72000 72 Procure ERVs 223,900,00 23,90000 100 23190000 73 Procure Packaged KTUs 24,40000 24,400 00 100 24,400,00 74 Procure Exhaust Fans 11,00000 1,000,00 too 1,00000 75 Procure Duct Heaters 2,900 00 2,90000 100 2%90000 76 Procure Split System 2145000 2,450.00 100 2,45000 77 Procure Roof Hoods 12000 120.00 100 1,2000 78 Procure ORD's 3,250.,00 3,250,00 100 3,250.00 79 Fabricated & Procured Ductwork 21,50000 21,500;00 too 20,42500 1,07500 80 Installation ofOuctwork& Equipment 631.11160.00 60,097 OD 0$ 60,07 00 - 3,16300 81 Refrigeration Piping 150000 2,500'00 100 2,50000 8.2 Duct Insulation 7,00000 7,00000 too 7,000.00 93 Low Voltage Wiring I Controls 3,000 00 2,85000 95 2,550.00 30000 150,.00 84 HVAC Equipment Startup 4,00000 3,00000 7S 3,00000 1,00000 85 Test, Adjusting & Balancing 2,40000 86 Final Documentation 1,72000 2,40000 87 Punch List Completion 3,44000 M a 1,72000 3,440-00 88 Commissioning 3,44000 3,440.00 89 DIVISION 26 - EL ECTRfCAL 90 Electrical Permits & Mobilization 2,27500 411?5 00 100 2,27500 91 Primary Services - Material 4,26000 4,26000 100 4,26000 92 Primary Services - Labor 6,550.,00 -6,55000 100 6,55000 93 Branch Conduit & Wire - Material 81580 00 8,58000 100 6,43500 2,14500 94 Branch Conduit & Wire - Labor 23,40000 23,40000 too 22,23000 1,17000 95 Feeder Conduit & Wire - Material 1,80000 1,80000 100 1,e140,00 36000 96 Feeder Conduit & Wire - Labor 2,S5000 2,85000 too 2,28000 57000 97 Exterior Lighting - Material 5,330.00 5,33000 100 3,464, 50 1,865.50 98 Exterior Uighting - Labor 5,620,00 5,62000 too 3,372 00 2124800 99 Panels & Disconnects - Material 55,700 00 55,70000 100 53,47200 2?228 00 100 Panels & Disconnects - Labor 11,51000 111-51000 lob 9,20800 2,30200 101 Trim - Material 2,80000 21660.00 95 1,82000 $4000 14000 102 Trim - Labor 103 Light Fixtures - Material 11,S0000 32,90000 10,46500 32,900 00 91 too 24,61500 10,46500 8,22500 1*035 00 104 Light Fixtures - Labor 25,11000 22,59900 90 )0,59020 2,00880 2,511.00 103 Comm./Data - i'vlatcrial 5,90000 5,900.00 106 Comm/Data - Labor 7,50000 A 4r 7,50000 107 Final Documentation 2,24800 108 Punch List Completion 4,49600 2,2248 00 109 Commissioning 4,49600 4149600 110 DIVISION 31 - EARTHWORK 4,49600 III Bring Site to Subgrade 10,30700 10,30700 100 10130700 H2 Foundation Excavation & Backfil 1 25,70900 25,70900 100 25,70900 113 Building Slab Prep 18,413,00 18,41300 100 18,41300 114 Sidewalk Ptcp 9,59500 9,59500 100 9,59500 115 Trenching f6r Electrical 5,67000 5,67000 100 5,67000 116 Prep flor Concrete & Asphalt Sidewalks Paving 45,96200 45,96200 100 41,365,80 4.596.20 117 Fine Grade Continuous Footings 57800 57800 too 578.00 - 118 Fine Grade SOG 1,23900 1,23900 100 1,23900 119 DIVISION 32 - Sff EWORK 120 Vapor Barrier Under SOO 2,212 00 2,21200 too 2,21.2 00 121 Asphalt Paving 36,020 00 36,02000 too - 36,02000 122 Pavement Markings 7,37000 7,37000 too 7,37000 123 DIVISION 33 - UTILITIES 124 Utilities (Trenching) 67500 67500 100 67500 125 Site Utilities Water Systems - Material 3,641.00 3fi41 00 too 3,641,00 A t26 Site Utilities Water Systems -Labor 8,22&00 8,22600 100 8,22600 127 Site Utilities Sanitary Sewer - Materials 1,11200 1,11200 100 1,111200 128 Site Utilities Sanitary Sewer - Labor 5,406,00 5,40600 100 5,40600 129 Si to Utilities Storm Drainage I Swale - Materials 3,17200 3J72 00 100 3,17200 130 Site Utilities Storm Drainage / Swale - Labor 14,40500 14,40500 ion 14140500 131 ----- ---- - T- TOTAL OkWINAL CON 'TRACT Leone & Keeble, Inc. 108 W. Boone Spokane, WA 99201 Phone-, (509) 3274451 Fax: (509) 325-9200 Page 2 of 3 Coulee City Medical Clinic & Library Coulee City, WA 99115 ............ APPLICATION FOP. PAYMENT Period Architect: .10/31/2024 Lodburrow Wvtcli Architccts, P S 7 CHANGE ORDER trims TOTAL TOTAL 1 ZZ PERCENT VALClE VALUE VALUE FrEN.1 DESCRJPT*N CONTRACT COMPLETE COWLETE PREVIOUS CURRENT CONTRACT NO VALUE TO QA1t A I CIIANGE ORDIERS 2 CHANGE ORDER #1 3 Substantial Completion Date - No Cost 4 CHANGE ORDER 412 5 PRT'r I Credit for S I Alternate Bid (16,90000) (16,90000) 100 (16,90000) 6 PR #2 Knox Box - No Cost 7 PR 97 Plan Review & Permit Fees, 1,21200 1,21200 100 1,21200 8 PR IM19 Added'roilet Accessories 5,21600 5,216.00 100 5,21600 9 CHANGE ORDER 93 10 COP 9511 Credit Cow Tongues - No Cost - I I COP 46 Sewer Line Connection Changes 5,49500 5,49500 100 5,49500 12 COP 98 Flooring Change 4,34400 4,344 00 13 COP 910 Blind Revisions 2,61.2,00 2,62200 100 2,611200 14 COP #12 Thra-Wall Mailbox Upgrade 1,92800 96400 so 96400 96400 15 COP PI 311 Sink & Casevmrk Addition at Library 4,36500 4,365400 100 4,365-00 16 COP #14 Furred Walls for Plumbing 54600 546,00 100 $46,00 17 CCD ""I Unsuitable Soils 9,69700 9,69700 too 9169700 18 CILANGE ORDER 94 19 COPP I /PR9 16 Broken Saddles 7,78900 7,789 00 too 7,79900 20 PR r'rl 7 Stud Wall Revisions 18900 18900 100 18900 21 CHANGE ORDER 0.5 2 COP N3 Data Conduits in Electrical Trench 1,04700 1,04700 100 - 1,04700 23 COP 94 Exteriors Siding Clarifications & Details 3,15100 3,15100 100 3,15100 24 COP 015 Added & Adjusted Door Can figuration V177 00 5,77700 100 R 5,77700 25 COP #1 8 Electrical Lighting, Power/Systems Flan Upgrade ror LCbrary 8,20800 8,20800 100 8120800 26 COP 919 Electrical Lighting, Power/Systems Plan Upgrade for Clinic 3,62100 3,62100 100 3XI 00 27 COP 9.20 Key Pads at Front& Back Doors 1,39300 1,39300 100 1,39300 28 COP 922 Domestic Hot Wrater 14eater & Recire Pump Electrical Power 3 *254 00 3,254.00 100 3,25400 29 C),LkNGE ORDER:96 30 CCD 92 Sidewalk Replacement Final 11,28600 11,28600 100 11,28600 31 COP 911 R. Conduit & Pullboxes for Future Site Power Requirement% 7,21800 7,21800 100 7,21800 11. COP 921 R Additional FE-FECs at Clinic & Library 1,68200 1,68200 100 1,68200 33 COP 11,23 Safety Glazng in Exterior'Doors 82800 82800 100 828,00 34 COP A"14 Low Voltage Wiring at Library 8%526,00 8,526.00 100 8,52600 35 COP 026 fire Alarm at Medical Step I V86 00 10,08600 100 10.,08600 36 COP #30 Remove & Replace Sidewalk in Row W 12,75600 12,75600 100 12,75600 37 COP f01 Upgrade Through Wall Mailbox 1*024 00 1402400 38 39 40 44 M. C H.NN Q E 0 R D 9 R TOT'r%L 106136000 100,0 noo ct'393 00 87,63500 03 00 MIGNAL CONI-ti%Ct TOTAL 1 .480-571) 00, I-7q!5iR-7() 1 461 (111 A t yt01 ASU" Arl i r6 t st I'l !)ill, Leone & Keeble, Inc, 108 X Boone Spokane, 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 10/31/2024 Architect; Loofburrow Wetch A Estimate No,, 7 SUBTOTAL C D E F H SCHEDULED VALUE PREVIPUS APPLILATIONS CURRENT APPLICATION TOTAL TO DATE BALANCE TO FINISH $ 1,986,570.00 $1,50110 '7 2.61 -$ 29148609 - j $ 1792,- 55870 0 $ 194;011.30 CO TOTAL $ 106o360.00 $ 12,363.00 $ 87,635.00 $ 100,028.00 $ 6332.00 SUBTOTAL $ 2,092,930.00 $ 151%465.61 $ 379,121.09 $ 1,892o586.70 $ 200,343-30 SALES TAX 8,2% $ 171,620.26 $ 124..104.18 $ 31,087.93 $ 155,192.11 $ 16,428.15 TOTAL CONTRACT $ 2;264,550.26 $ 1,637,569.79 $ 410,209.02 $ 2oO47,778.81 $ 216371.45 RETAINAGE 0% L637o51169.79 410,209-02 $ $ $ 21047o778.81 1,637,569.79 410o209.02 TOTAL LESS RETAINAGE PREVIOUS PAYMENTS DUE THIS ESTIMATE UNPAID BALANCE $ 216,771.45 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 accorda,nce with the Contract. Documents, that all amounts have been paid by him for Work for whicliprevious Certificate of Payments were issued and payments received from the Owner, and that current payment shown herein is now due. GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before reimbursement can be approved, by Grant County. SIP Project Proposal Number: 2023-05 SIP Funding Recipient: Grant County Port District #4, Coulee City SIP Project Description: New Coulee City Medical Clu'lic 1, the -undersigned, do hereby certify under penalty of perjury,, that the materials have been furnished, the services rendered, and/or the labor performed as described in. the project proposal for the above -referenced SIP Project and that T am to authenticate and certify to this claim. I also certify that this claim of $ just and due and is an unpaid obligation against Grant County. Further, according to the SIP Project Funding Policies.1 attest that at the next audit of my entity, this project shall be called to the attention of the Washington State Auditor's Office and an emphasis audit will be requested to assure that these funds were expended toward the project and according to the intent of the proposal. Signature Printed Name 66(0,61y Date Signed MLIYI-) Title nip P*�*-ted Title Completed, signed original certification and invoice are to be mailed to: Grant Administrative Specialist, PO Box 37,E phrata, WA 98823 ATTACHMENT 4 9a58 AM 12/26/24 Grant County Port District #4 Check Detail November 1 - 26, 2024 Type Num Date Name Check 4134 11/1712024 Travis Liening TOTAL Check 4135 11117/2024 McDonald, Howard TOTAL Check 4136 11/17/2024 Joy Beardsley TOTAL Check 4137 11/1712024 Chris Erickson TOTAL Check 4138 11/17/2024 Town of Coulee City TOTAL Check 4139 11/17/2024 u S Bank TOTAL Check 4140 11/17/2024 Gray & Osborne, Inc. TOTAL Check 4141 1111712024 Boss Public Affairs... Item Account Cash Account 513.10 - Commissio... Cash Account 613.10 - Commissio... Cash Account 513.10 - Commissio... Cash Account 514.10 - Port Secret... Cash Account New Construction Cash Account 514.30 Office Supp... Cash Account 514.40 - Professiona... Cash Account Paid Amount -161.00 -161.00 -161.00 -161.00 -161.00 -161.00 -200.00 -200.00 -138.66 -138.66 -49.85 -49.85 -11126.61 t -1,126.61 Page 1 9:68 AM 12/26124 Grant lz-a-ftnt County Port District #4 Check Detail November I - 26, 2024 Type plum Date Name Item Account Paid Amount 514.40 - Professiona... -12128.97 TOTAL -11128.97 Check 4142 11/1712024 Centurylink Cash Account 538.40 - Utilities -85.54 TOTAL -85.54 Check 4143 11/17/2024 All American Plum... Cash Account Capital Projects -744.3 TOTAL -744,34 Check 4144 11117/2024 Leone & Keeble, Inc. Cash Account Capital Projects -2651423.92 TOTAL -2651423.92 Page 2 GENERAL FUND GRANT COUNTY PORT DISTRICT #4 P. O. BOX 537 COULEE CITY, WA 99115 VOQCHER LIST DATE: WARRANTS: iQU -�.4�� V-14 i' t V�R �V 8��RNI ED, THE SERVICES RE E THE [ THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HA I LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGAT-[O-N AGAINST GRANTCOUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. WARRANT NO. -ape, �. APPROVED: AUDITOR SIGNED BY:, PORT DISTRICT COMMISSIONERS im All American Plumbing Services, LLC 16063 Stratford Rd NE Moses Lake, Wa. 98837 Tel: (509)761-1195 A 13DAYWORK [3CONTMCT [3EXTFIA [3 OVERTIME El OTHER ARRIVAL TIME DEPARTURE TIME SG• 15N.■ ve 0 I 1 1%04 WWY vAwr%s I%wyv U Iw -7Q&UQIQ%'LVI Y ',%,It I IFIWLIVI I VI U lu MULIVU UUSr'nDe(J worK. x All A-2 LA -Ame Date, :—�?- ThaWYWI Q4* PrWed in USA by www.ptintk4lm.com * 8M370-5591 Grant County Port District No. 4 P.O. Box 637 Coulee City, WA 99115 t�r.�yr 4Sr C3sb�c�.�, I,�. ooN6ULtING ENG4NE#RS N ember 04, 2024 r P ect No: 20840.00 In, ire e No: 24 Project 20840-00 Coulee City Medical Clinic ^ A 0 to Novembe-r ZJ r of.$ 1 S 10 n a I.. a e I X:t kes f r 0 M Ct.O.! Wr .0.1 2 24 Professional Personnel Res. Engr. 3.00 Carlson, Chad P. Manager 3.00 Meskimen, Michael Totals 6.00 Total Labor Reimbursable Expenses Mileage Meals 0 Total ReImbursables Billing Limits Current Total Billings Limit Remaining --RWfb7—' - - AMWfif 46.41 439.23 W-98 611.94 ito5l.17 1,061.17 62.31 13.13 1.0 times 761" 76.44 Prior To -Date �,379.41 269,506-02 2941,000.00 24,493,98 Total this Invoic 1130 Rainier Avenue S., Suite 300 Seattle. Washington il" (206)284.0660 Fax (200) 283-3206