The URL can be used to link to this page

Home My WebLink AboutGrant Related - BOCC (004)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 suBnnirTED BY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kal"1'12 Stockton CONFIDENTIAL INFORMATION: ❑YES ® NO DATE:1 /31 /2025 PHONE:2937 Due 00--io, _; I ; i 11:; IMM ❑Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑ Computer Related ❑ County Code ❑ 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 Rego ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB ��iiii� ��r��///�5��!y�%��✓/i/��'��1 �?�� i� �' � �" � � ��' � i /�'��//��!�//��%��/� �: �� -ems ��' ' " Reimbursement request from Grant County Port District No.4, Coulee City on the Strategic Infrastructure Program (SIP) 2023-05 in the amount of $263,455.12. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO R N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO W N/A DATE OF ACTION: �'�� oDEFERRED OR CONTINUED TO: APPROVE: DENIED ABSTAIN D1: D2: D3: � �u WITHDRAWN: 4/23/24 GRANT COUNTY STRATEGIC INFRASTRUCTURE PROGRAM PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding,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 Clinic L the undersigned, do hereby certify under penalty of perjury, that the materials have been ftimished, the services rendered, and/or the labor performed as described in the project proposal for the above -referenced SIP Project and that I am authmized 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, 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 funds were expended toward the project and according to the intent of the proposal. Sianatare Printed Name C - Date Signed Title Printed Title MA6� Completed, signed original certification and invoice are to be mailed to: Grant Administrative Specialist, PO Box 37, Ephrata, WA 98823 ATTACHMENT 4 GENERAL FUND GRANT COUNTY PORT DISTRICT #4 P. D. BOX 537 COULEE CITY, WA 99115 DATE: C51 Ila VCHER LIST WARRAN ow T Ts WO 1f0LA 141-7Z —IS7( ,. )jr ve0000 op 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 IS A JUST, DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. SIGNE f� 01 A WARRANT NO, APPROVED: 'AUDITO-R PORT DISTRICT COMMISSIONERS 1.3 GENERAL FUND GRANT COUNTY PORT DISTRICT #4 P. 0. BOX 537 COULEE CITYF WA 99115 lw-ora-� I VOUCHER LIST DATE: I v, ,,,.,,WARRANTS: I . THAT THE MATERIALS HAVE BEEN FURNISHED., THE SERVICES RENDERED OR THE , THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY. LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST GRANT COUNTY PORT DISTRICT #4 AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY SAID CLAIM. E WARRANT NO. APPROVED: AUDITOR .... ........ .. ........ . PORT DISTRICT COMMISSIONERS 3.24 Ply Grant County Port District 01120126 Check Detail January I - 20, 2025 Type W _w Num yDate Name Item Account Paid Amount Check 4167 01/19/2025 moss Public Affairs... Cash Account 514.40 - Pro►fessiona...-1,333.67 TOTAL-1,333.87 Check 4168 01/19/2026 Centurylink Cash Account 538.40 - Utilities-85.54Z TOTAL -85.54 Check 4169 01/19/2025 Ief1lA Public Ports A... Cash Account 514.40 - Dues/Mem... -75.00 TOTAL -75.00 Check 4170 01/19/2025 u S Bank Cash Account 514.30 - Office Supp...-229.63 New Construction-1,899.58 r+► TOTAL -2 129.2'1 Check 4171 01119/2026 Axe Fire & Security Cash Account 7Miscellaneous Expe...--453.18 f New Construction -1, 899.58 �- TOTAL -21,352.76 Check 4172 0111912025 Leone & Keeble, Inc. Cash Account Capital Projects-257,106.84 -- TOTAL-257,106. 84 Check 4174 01 /20/2025 Consolidated disp... Cash Account 538.40 - Utilities -13.02 TOTAL -13.02 Page 2 ......... ...... 3:24 PM Grant County Port District #4 01120126 Check Detail January 1 - 20, 2025 Type Num Date Name Item Account Paid Amount Check 4160 01/19/2025 Travis Liening Cash Account 513.10 - Commissio... -161-00 TOTAL -161.00 Check 4161 0111912025 McDonald, Howard Cash Account 513.10 - Commissio... -161-00loo/ TOTAL -161.00 Check 4162 01/19/2026 Joy Beardsley Cash Account 513.10 - Commissio... -161.00. TOTAL -161.00 Check 4163 01/19/2026 Chris Erickson Cash Account 514.30 - Office Supp... -5.39 514.10 - Port Secret... 400.00 TOTAL -405.39 Check 4164 01/1912025 ShirleyRae Maes Cash Account Property Management -250.00 TOTAL -250.00 Check 4165 01119/2025 Town of Coulee City Cash Account 538-40 - Utilities -138-66 V/00 TOTAL -138.66 Check 4166 01/19/2025 Grant County PUD Cash Account 538.40 - Utilities -222.40 TOTAL -222.40 Page 1 .. ............ .. . ...... - - ----- ....... 3:24 PM Grant County Port District #4 01120/26 Check Detail January I - 201,2025 Type glum Date Name Item Account Paid Amount Check 4175 01/2012025 WA Public Ports A... Cash Account 514.40 - Dues]Mem--- -300.00 TOTAL . -300-00 Check 4176 01/2012025 ACID School TOTAL Check 4177 01120/2025 Gray & Osborne, Inc. TOTAL Cash Account 514-40 - Advertising/... -50.00/ -50.00 Cash Account 514-40 - Professiona... 2,549.12 *00* -2,549.12 Page 3 AXE FIRE & SECURITY Prevared For Shirley Rae Maes Coulee City Estimate DWe. Estftate Number 12/18/2024 0000249 ..Ax-e Fire & Securiby (509) 423-5764 630 V611ey Mail Pkvvy #364 East Weoatchee, WA 98802 Rate. at. Lin e To t I y C'Ommerdal Lever Look- NextTouch- Touchscreen $699.00 4 $2,796.00 Wal fbb628n-zw3-rh-626 +Coulee City Labor (installation, Programming, Training) $100.00' 6 $600.00 +Coulee city Travel Charge $125.00 $125-00 +Coulee civ Subtotal U21.00 0)ouleeCity (7.9'�278.16 "-smate Total (US $3,799, 16 N o t s New exterior door locks for clinic and library that integrate with the alarm system. Half down due at acceptance, balance due upon completion C Cu 07- q 7W Invoice CONSULTING ENGMIEEKS Grant County Port District No. 4 P.O. Box 537 Coulee City, WA 99115 December 31, 2024 Project No: 20840.00 Invoice No: 26 Project 20840.00 Coulee City Medical Clinic Professional Services from December I , 2024 to December 312024 Professional Personnel .... ....... . Hours— --Rate- .-Arnount- P. Manager Meskimen, Michael 8.00 203.98 1;631.84 Civil Engr. Guzman, Zara 5.50 152.16 838.88 Totals 13.50 21468,72 Total Labor 2$468..72 Reimbursable Expenses Mileage Billing Limits Total Billings Limit Remaining Total Reimbursables 80.40 1.0 times 80-40 80.40 Current Prior To -Date 21549.12 270,321.94 272,871.06 294lOOO.00 21,128.94 Total this Invoice $25549,12 1134 RaInler Avenue S., Suite 300 Seattle, Washington 98144 (206)284-0860 Fax(206)283-3206 0 CERTIFICATION FOR PAYMENT 11IA221-:UWNTCt702 TO 411MER. 0=1 Counly Pctt Muict No 4 P'ROJEM. G ra City dvLadW Chr-ic & i.:*Iyrdty+ APPLICATION NO, r? 215 W. Wiq Strcet 21 a W Milo Saul to Cvft fray, V/A 90115 CeWle My, WA 40115 Ft OM CONMCTOR: VIA ARCHITECT, PEMODTO t2f31t24 CC1NMA OR Leone & keeble, Inc 103 W. Bwntr Ave LOOK MW W7 OtCh Arcdatc4a, P S 201 ill YSilM Ave Sp04=1 M01 Y€kti k WA 98902 PROJ=NOS 23.1154 CONTifiCa Riii:�.t CONTRACTORS F °S. pAyfiEff"rile Application is mzde for � '.�` � Q5 Shan v+ ivt�ir ird CQ1iii£Cx{!!i3 tt}i a r `9rhlTw't. Ccntra r c `i-� 311�3t t{i e£1;'�rc -� .dr�Mii'��ttstt��t�c, ` ' ` ti `F40, � � WOO � � � � Ct�+'llist r i MCI, Air�i i curt t , is � d. i ' st- OdiYRS}1rXthe WOO cw;cmd r y this A plIk" R IDA f6i PqiacAt �i a t=Cn i y con��in dxez�rc W*t.* with aw �:uutDoe.= Lit dd i rrsaunt� err �y � .d�� W ' , � , v mac} tfu aT f"t� Work for tiv?ri�i prcW ow Caifc forp'aymedtt %Vert isdrd W4 �� d � � &I gsymm:r. rccezv i frosrz ii:» U�vS3tr, ar;tl tire# cur�cat Pbymant shown itcrcin Is rosy flue � �' : �' BU6 "a 2. Not cb3n, by !Cbwp Otdtrl S t� i1S3..ttU ��' �D� 3, CONTRACT StJ1� TO DATE (large 1 y 2? S 2.i3J.4��,t?tt CfliaiTR�sCI eetade.dn» z ,e 4. T0;4"AL CaP.�.P M- W &S'i0;MD 0 S DATE {+Cul►drsxrd �a fii}3} 2.i3i7,ab�.5s r„� �� ;48141 on 5 RETAINAGE; By: :�-,,...: D2W t, n u ,...,_„�'eofComptcd Work S tl.0t3 c";, r�tp � + Fort ?Q3� Stof,Kaga t o#' S�n y tYety am w.wr.ww..... Ia) �S .St{ii �r::.i.�ifi�i,% y!�ryp ri: �_ i (t.` t111Z1tW.4d, Tob d Ratain3se (Lints Sa 4-Sb per uY E.'biiSMsfa .. " 3r t ; ',. That in Gs7uzun i of 703) S 7 �TAL EAPa1 REiAIMA�E S to 00 ARCJ�I3EC"�'3' + 37d=ita , E #3 1 a4 Ei i' N S AnOSS , I1`r�i'T!'�S S'!`AT£ S Ea'C' X 2.13ti.Z��. SS In a, c�rdancc with am Ctintrrcr C}sud�nms, �:an~sitc Obsetwatiu-ns ttte S 8, S PRME QUS C t IP-C'ATES VOR PAYMEW S 1 4.G71.10 �tE1i &-2 t3tC-IPPL:Ctx 10a. tho i�,tl:�ilY�dC1 1t$ to ih; &,y ov, ttt the bW. of Lsc Archheaft k=vkda-,% iuiardz n d; t bdift-#'ihr ftrkbs ptv0=M = Indtwe , C1.Sdtlt? tV'C J�AYd�riEla'i' AEIE 1; 2 7101. fit? 67.593 95 td.— grUrr of th* Work is in uccw� Wilh d� Cor4 .1 Docunr.-M, and tip L^� , r ctor 13$AL:Ai1C8'1'4M15H,1MUD1NG1MTA7HAGE is tu�Jed to plyrtmt of tl a AM -CUNT CF..Ct,'i'IF W. (Ltpe 3 Im Lip* G) 122945 ,, �� r�,.C3Ls"N'rCERi'd�}�i� S 3` �` ir CI�.�tP+iGE �iRUER �iJtt�h1Az21'r �JI'd'It�NS {3E#�{ FC3'dCJidS Tod! c4� ePp In ravIattsnwglTs i3s�lsr_c Yogi g raved This McWh TOT L$ Stl tii3 $1trt.T�r8Q3 D -�i3 516:�-G3 I iC� Nrj#:S by elm t)rC�r SIad,86��3 (ff6actt 9tsraoax+ ffttrs�p�rri cergr ,dt,{ rsfradn rh»�rr;a:.rsr �iltiarl {trilid s;lf f��rrr,es rrrr tips t1 ?; 'r aart orr.J cz i rrxxtrrstdra .der t!<w ,�r+ , r a ar? ro rareprm with tax rtt cen ct ARairMCr sy: —0115-14 'Mis Ct rtifrcaEC dS r-04 ntgOtt&r, Tkz4 AMOUN r CE?'.TIFMD 15 payabie only to W Cantor t�r�rstxi tscr»tri Issttas`�,e, pa�enr d3!'1� Y�Ct�►t3u'�t: flf jl2yitlCfdi are �'iib�u pre04= to any ri&#; of t'ite ti 0wr or, C011UW10r tr4W N1 Cortroj Aw a-Mls�rr �ttn • APPU ATION ANO ��tTIFICK d N FUR r 102 Wfffftt� � • 01692 THE 1A5 GAN trdSTJ � �F.d�t�r��x�. users May attain vaudaft mtt �Trt3t$pi �y eo�t a itg a rcmp led �Ctl ?turst i 4 • Ca3ti�et33icr� of 1Io~;3t: mra �,tt�rt:'4*4 rMM the J.;-C st�7�«,s i3E4�t YGRK A1lE,, P,l:b�t,, Y$ {fifi�GTOtd, COO" City Medical Clinic & Library APPLICAT(ON, FOR PAYM.E' NT Coulee Cifyo WA 99115 Period IM 1/20,74 job "21) Architect Uoofburrmy Watch Awjdt"' P S H. -- ------ -- TOTAL Via W:Wr VALUE CONTRCT WVIPLeTE COWLETrz VRSVIOUS ONUTNO VAL Nis Orr aweral Condi"As B&O and Jrisumncz 339,122-00 339*122.00 100 335,730.78 3,391. 4 Bond 18*04. 00 18,054,00 100 ;'17,87a,46 5 Final Documentation 14,349,00 27,299.00 13,6nss too 1.05 6 Pumh List Compliation 23om 28,696.00 100 7,174SO 11,52200 6,45705 7174S 7,17460 28'6!-v6:00 28j6%.00 100 21 522.00 7,17400 9 DIVISION 2 - SITE WORK S'S00.00 615woo 100 6150000 10 Selettive Site Demolidon I I DIVISION 3 - CONCRM 3A7 W 3,5198700 100 3,587 DD 12 CIP Concrete Anchors 13 CIP Concirge- aUjIding 4,53500 4,53500 too 4,53500 14 CIP Conerej%- - Sidovpqjks 91.127-00 5,634,00 91,12700 5,634 OD 100 100 5,63400 IS CIP C0110,010 - Trwsfomwr ?ad 16 Post, &,- P"ej SlAvage Conmte 1168900 1*639-00 100 17 GTOUL Steel Column Base 658-00 746,00 658.00 746,DO 100 65800 IS DIVISION WrALS 100 74600 19 Suvotiml Steel Framing 20 Nfoto�t Ludders 1, 41600 1,416.00 100 1,41,600 10 DIVISION 6 - CARPENTRY 608820 0 6,88200 100 6,88200 22 Rough Carpentry 23 CasevIvork Blocking & Baekine 163,344.00 163,344-00 100 24 kougb Hardwi�re 13,52-a-00 2,442W 13,52200 2,442.00 100 2,442 00 25 Hoisting I Craniqg 26 Interior Finish comartuy 2,000 w 21.10DO 00 100 2,00,00 27 91MX0X7-THM1VtALAW0,%101Vt1RV- PROTECT_101y 48�217 ao 48,2170 100 A8,21700 29 Thetm al Lts-ulatior, 29 &-dour Qude Rigid laswation 27,82500 27,82500 .100 30 ThaMoplz�c Single Fly k1trnbrane Roofing 77400 56,45500 77400 56.455 tv 1011 100 77400 31Siding 32 lkwf Aautmries 35t000 00 35'.00000 1 00 33 Joint Sentants 50000 1,12200 -%000 1'] n 00 100 100 34 DIVISION 8 - DOOR$ AND GLAZING 3$ MI Doolt 36 wood hirer 017,35-1) to 100 47,359 Q0 37 VjAy) 1XIindo%vs 2,71000 2,71000 100 2,68.2,96 2710 39 Door PlWware fie/ol'-wrig 6,58300 22,�79 00 0,583 tic! 221,37900 100 1.00 6,58300 23,' 155 21 22,119 40 DIVISIONq - FIXISt S,03700 5,03700 100 5,03704 4'l Gypsunj Board 42 Ceilov 100 FloarrikiC:3lcu 43 ing t9,480 00 19,480.00 100 19p480 00 44 Painting 3),66200, 31,156200 100 -31,66200 45 DIVISION 10 - ACCESSUR11;$ 27,665.0o 27,665 Do 100 46 ftnal 8ignVa 47 IVWI & Doorproftocaj 8,499 co �,49500 9,49900 48 Toilct, Bath Launft Acce�sar�cj 190'M 796.00 19000 796W 100 i0o 190 0a • 49 ViPreµc,�[�*tect{ion Srjctial6qS 50 179 Cq) 77900 too 77900 51 Book Return 82300 1,446,00 82.3 -00 1.44600 100 100 823.00 52 DIVISION 12- FURNISHINGS 1,44600 53 Window Treattwwrits 54 C "s Nvork 51000.00, 510000 i0i1 5,00000 -55 DIVISION 22 - PLUMBING 65,43600 65,43860 10D 56 Urld"ab Flu mblogLabor 57 Undemlab Plumbing hiatterials 20,M0O 20.0m 00 100 000 58 Rough fit Plumbing Labor l6r600.00 20,000-00 16,000-00 --'j-0j0C-0 co 100 Ito 16,00000 20.0000 59 Rough In Plutribing materials 60 Trim Out Plumbing Labor 45,000 qro 45A000 00 100 .45,00000 61 Tdin Out PlumbirigNtaterials 9,753oo 1.5,000.00 9,753 00 1.5,00000 100 100 9,75300 62 Pipe (Mulation 63 Adinin Jobite Labor 8,000.00 8,00000 100 8,00000 64 Commissioning 7,0 0000 7,WO.00 I 0D 7.00000 ,65 Punch List Completion 3,099-00 3"099.00 3,099 W 3,0�,00 100 IDD 3,099-OD 66 Final VocumenWion 67 Office Owthead 1 ,540.00 1,549-OD 100 68 Equipmept Rwal 3'moo 3-00(0 Im 69 tk'new I Twt % W---' 2170040 ? 2,70000 100 2,700,00 I - -- S7 SS Leona& KeaWa, In*. WM Boons Spokane, WA0201 Phone: (509) 327-4451 FOX', (505)) 326,9200 Page I of 3 Coulee +City MI�ei3 01 Chnir. & Librat�, `�►1',N ,1CA'CtC3 PCB P 4 I f�T z t COulee City, VIA 99115 ftricid 12/3112024 a IL - Archita& Looroarmw w.-teb Arah:jccts, p S .. .: . .. Mb'+I�% E_ft7y�t^IK� 1't+9'7i.�..y4'Fi VA1fq` y u 19. _ f QAity: t oitx. p+tirqr��w,y+�ia COMMACT 1201 ]PLETE CCNPLETE mVias CONTRACT y y^yp� vg,r y fN, 70 lli1 G/I!sd g 71 5t.,brriittals / Mobilistttiim 72 1�rrricuce Elt''s 1,720.00 1,72a.� 1� ; i,72G.01I 71 Procurm ftkaged Rm 23;900.00 '3,9000ti 1 2,900 t1�0 A. 74 t'cvcnrc Fxlrau Fans 24,40000 00 2k�,� 0 100 24,400.00 75 1'meure Duct Heat; rs '16 i,000.0i3 900 2,0flt3: 2,900. } 1D 100 . } 000.00 � n Procure Split system 77 Praatrre R�oafl�Sctfds ry �,�#5€1. 2,450 Oq 200 2,9110 0{3 2,�50.1iC1 w 78 Procure QRUs 1w0.00 I?ti C£l it�'3 13U.i� i 79 I�abricQed & Procured Duciti�vk 3,250,00 21,5 .00 3,250 SIG 21,5000 It 100 : 3,25t? t10 �t,50t3 � TM 80 Inataltutian c►Ts.i ckWorl: & Equipment SI Rel'rigetatiort Piping 63,2,60.00 63,260.00 100 4i1 �3,�uD.tii1 � $ Duct instrletion 83 2,500,00 7,000 0i1 2,500 Ct4 7,000 00 1�s0 100 2�5�iQ 00, 7,0m,00 w. Loy: Voltage wieiris I Contxols I�!Equipment 84 AC Startup 3,000 00 3,000 00 �i$ Tca� ALtjus#irzn, 8� i3alattCiylg a 4,000.00 :l,t? o C}9 100 85 Pin0l00aumontntiort 2,4°�30•€��J 2.+00 00 1 2,4�ti (��{ h 87 Punch Lisa Completion 1,720 04 3,440.0 1720 40 3r4�$I! ftU 100 XOiI 1,720.t?i7 3,4400 88 Commiusionirig 84 DIVISION2b - ELECTRICAL 3, 000 3,44010 100 3,440.00 ,. 90 Zlectxital 1'mlits & Mobilization 91 Primary services-- D401criat 2,275 0t3 2 5 #1 !0 92 PrimarySaryiceS - Labor hJ � 6,1550 00 �,,,75 �0000 61550:W �}�0 6,55000 93 1I'ranch Conduit & Fire - A.lateda! 94 Branch Conduit & Wire - I.sbat` 8,$84 00 g,5$0 00 3i?�f $,5$p a ; n$ Feeder Conduit & �fEta - g1to6�l �3;�+30 . 0/{7 23t4i10 C{3 3,3r0?. iii�i 143 23,4fl0. " „ 9'6 Fc;dcr Conduiat & NYjM - Labor �7 ]~�-tcrrQr Lich f irri� - ;�{lafar"rnj ,Ri7[i 7100 ry1,80�{0� �}tJQ .. 7 Extaior Lighting - L °o'!i 99 Pane -Is & Disconnects - Msteriaj 5,330 00 5,330 00 100 10D 5,33t1;9£1 5,020.00i I00 Panels &Disctii3txects-Labor 1.01 Trim •- Material t�Fi'+�SA i71.7.r'%�i 11r51000 Sii3.Ui.i Il,�51t�00 l�lt7 1.w ':J,ifi7. •w 102 Tarn - Laborsno 00 2,80000 100 2.800.00 - 103 Lisht Fixtures - 41'aterial 11,500 00 11 ,5�,G0 300 `;1,5QJ:f?G l p4 Lt t Fi+ turns Labor 32,900 3",,900 0o 1.00 3�'„ 30 t r 105 CommlData-vateri$ p00 2S f .5 i? .60 � • ..5,110, 100 r i251.11D.t}tI p , 1Cib Cot�rn�1� M Labor 5, 33 00 7,S0t� t30 5,900 00 3',5t�.�,► 100 100 5XI par 7 i10 .: �• 107 1"inai Documentation .103 Punch List Ccimplitiori 2,248 CIO 21248 00 100 a500 2,249.0 •' g 09 Commissioning 49 4,tS .00 ►1��*96 � t (� 4 ,�96..Q0 ` 110 DIVISION 31- CARTt�� ORK 4,496 00 4,496 00 100 4,�#9fi. t71# w I l I X3rin5 Site to Sttb racie 112 Foundation ,!Swwatiun & Back -fill 10,30` 00 10,307.Q0 too 10,307 00 113 guif4ing3iac# 1'ne 25"709.00 .25 j709 00 11.110 -Z,709 0 114 Sideftlk Prop i8, 13 t30 gg t8x is 00 100 .18,413 00 �. 1 t S "erenchi+ns for Eic. ctr cal ,II��//yy �, .7.rLSi� y4 { �y 7 SOS.00 �y 100 %S95.,00 '4 m 116 Pre for Conorde 0 Asphalt Sideugllcs f t�avin8 5,�7c1 � 45,962 00 5,��t1 Gt� �5�962 k?0 10tt lt?0 �}� � �.1� N 117 Flrct Cltatle Cottttrtit+atss faUtirig, 118 fine, Grade SCG 57800 578,00 10 57900 } 13 DIVISION 32 - SITE -WORK 11239.00 1,239 GO its 120 Vapor €larder Under SOG 1Z1 Asphalt Fad � 7 , . 2.21100 100 2,212 00 , 122 1'aviirr�ent, rkinff 3d,t120 i 3r,32t} 00 100 3Cx�b20 r30 123 DIVJS10t� 33 - U-TILIT1 7,37000 7►3TO G4 It3tI 7,3Z13 � . 1.224 Utiiilic s (Trenching)67a 125 Site Lrtilitics Water SysteM » hiateriai 4}0 i5?5 � t00 too 67S f3�i 126 Site Utilities ' ator Systcr -Tabor 3, 41. u 8,22e tv" 3,641 G 8,22£.00 I 100 3,64100 1.27 site Utilities Sanit Sewer- matexia#t 1,I12:GG l,i I2 001001,1 Sf225: I200 r 129 Site UdlitirS Sanitary Setwr - Labor 129' Site Utitrtics �atorm 1'�rairsii,gt: t alviste -il�latwis �ri 5 ,406 5,406.00 100 5x 6.tlfl • : .. 130 Site Utilities Storm Drai>:aptelSvraie - teb,a: 3,17200 14 405 00 3,172.00 iGrti 3.17200 l 3 k 14,405 00 100 : } 4AGS 00 T`fwrafsy�y *i j�+.y +iy(�.�f i■� +r#,a=YY! ,t�}� M Leone & !'feeble, Inm 108 W. Soom Spokane, AA 99201 a i r! 3 1 Phone: (509) 3274461 Pnx; (609) 326-9200 F i . .rt. Coulee City Medical Clinic Literary APPLICATION FOR PAYMENT F c F Coulee City, ix1A 9t31 i5 Period 1,�./3ltw'D2�S job A10hi#ebf: 1*01trrrm Y104 E Arcltlsom P.S. CT .. w��«r.'jN•pxu/..Nyw�,+1 �y ` 4•ra��liiaf i�I �f,O.RV�Xifxv7 . V'?�,:� y;. �d 7..� �da,'�� +R"w ?.?• 7iT �.''�}+.A2�. $ 'l»v� 6:.� 7 �Sii.$�'' �<r'kk.•��.fv�•,-3,:';... - f _ _ .. t 2 'C"Af�i{'+�G;E ORDER r0111 ��j^' 9�t �ft� 3 SSubsiant#.al CO1pie'tiOn Date " ND COSt 4 CHANGE ORDER in �yn v V Ctdrt for %ilwt1?«1Lo 6 PR 421 Knox Box .- No Cost �16,at}fi ODj tilts} Wj too16,9tID 7 pit 07 PW Review & Pe'z" Mit FG4�3 + ! } pp �•.y �j Added 4 I' tf' �TTi i7L 1 Q33�.RAccessories Toilet - � � l "-)12. 00 � 1,212�.OQ 100 too r 1,212 Of.) �. 9 CHANGE >t 1WER 113 5,216.00 5,21600 100 5,216, 00 I 10 COP VSR Credit Cow -Tongues -Wo Cost 1 I COP P6 Sawor Line Corrnee oo Changers 12 COP 98 Flooringthange 5,435,00 5,49500 ,1Q0 100' 5,495Y00 � L 13 CAP i 0 H1;nRevisions 4,344•00 2,622.00 4.34400 .2,622 00 100 l o � 2,622 00 4,344 Qo 14 COP Alt Thru-Nall Mailbox U ale nip is COP 0.1311 Sint. & Cumork Addition tit Library+ ixe 00 17328 00 100 96400 j 964 OD > t 16 COP 014 Furmd Walls rot Plumbing 4,365.00 54�i:0{t 4,36S.00 546:� 100 1�0 40365 oA . 7 CCU? unwiWe Sails IS Cl€DANCE ORDER 04 9,637.00 9,69700 100 546111y 9,69700 19 COP t; U'R# 16 Broken Saddles 20 PR. 017 Stud Wall Revisions 7,789.00 7,789.00 100 7,7�9,;3Q ti 21 CHANGE GRDER WS 189 fiii} lR�.tlti l(30 189•AO �� p 2' COP 413 Data Conduits in Clecvicaf 'l mnch .23 COP 04 Exteriors Siding CIarifc:611,t%S&Dot+ails 1,4I47 00 1,04700 100 1,047 OD 24 COP #15 Added & Adjusters DoorC�anfshurgtion 3,151.,00 5,77700 3,151.00 5,77700 100 I00 3,15100 2$ CQl' 8 ElectriceJ Li&dng , Powar/Srwem. e P1arr Ugrgrad� for Library $1203 p0 8.208,00 100 5,77700 R,209 00 F ?t'x COP A 19 F-t�,.trccat 1.it;;: *]' Pimycr.-Systems tees PlAn Upgrade ror Clinic 27 COP 0 Key Pads at. Front & 090k, Mors.. 3,62100 3,62100 100 3,62100 ,, � y 29 COP t#22 Domestic Liszt Water Heater Recire Pump Eiectficat Power i,39.3 �30 3,254i1t3 1,39300 3,254 ,00 100 100 1,393.0{} 3,254 �. �':• �. � 00 30 CCD l#2 Sideveaik Repitseemot Final 31 COP #11R. COTIduits & Pullbvms for Puftire Site Fovter Requirements 100 11;2�6 �{I 32 COP #21i1 Additional fEC� at Currie & Libzmy 7 W21 18 Do 1,682 t#0 7,22 �,tltl i,�82.Oi3 I00 100 71218.00 .` 33 COP #23 Whty Glazing in E,,.1e1it,r I)OW92 t}0 2S t30 IO!? T 2 - s 34 COP 924 Love Val ra e Nvjrmg tit Libnvy 35 COP 926 PZTe Afarin of 3 4edleal Slop ifs COP 830 ,gem v1, &.Replace Sidev all; in Row Sfil' 10,086.00 3 L,756.i�3 10,086 00 t 2, 75f 00 100 100 10,086 00 12,75E oo !a e 37 COP 151 Uplvada Trut�'ugh %11 R+saalbog 1,024 00 512 00 so , is 38 CHANGE OP4VER #7 � i 2 p0 $12 �t� 1 39 COP 1:25 Haaxlrail at l+ai dicai Step 40 COP 027 6 inch Metal Lenery for Address . Nlo Cost 2, 732.00 21732,00 100 2,59S.�dt} 13& �iUU 41 COP 9.28 PLAM Wall SufteWeat Wall Restroom. 1r16 918-00 913,00 100 91800 42 COP 929 80ut.h Entry Canopies Enter Light Revisions - No Cost y 43 COP P32 ;forth Pari;tng sot Unsuitable Saris Removal 44 COP !#33 Provide Crushed Root mace & Werbialde Tmatimex t 4;520 04 , �,52Q.t� l iiD 4,52000 Y% x i 45 COP 934 Revise Egam & Troat meat Room Sinks M into CW1 11,003.00 11,003 00 100 46 COP '3S PVC F'encislR F=rt Property Litre 47 19,335 00 14,335C 100 19 335 ; t •� TS s t. 49 50 A pLKfr C ORDER TOTAL w ,� . . i.SpPP•M�iRlit ]I1L+Tins-+.'� ... j} l �.. }��(,y ,/ayy •+} �' �+ j� �� ," :. ,.. .. ., .: .... A«�' .... .. ,. � - �Y ��:�'� uvM >...��SP 'f'�%��' -`F if' �i:'1k• �q3'. �e$�.W a+ iik�,'+. '�� V � xi-A+S' t- i. j i S A is 4 ... ... .. .. .... .... ... .. .. • ..,r .m ...... �.. ...". w.. -..r• .«..r..,...... .....r r.r ....�«•«..y-r..�+...,..rn.,.....,........w..,,w. ..-w........r.i: ....,-�»•Y•. +«r. .... n,.�-.- S 1 9 S I i Leone 1%able, Inc, 100 W,- Boone Spokane, WA 99201 Phone: (609) 227-4461 Fes: (609) 3325-920 Page 3of3 ' F t S i. S APPLICATION AND CERTIFICATE FOR PAYMENT Coulee City Medical Clinic & Library Coulee City, WA 99115 Job # 23-1154 SUBTOTAL �CO TOTAL ISUBTOTAL LES TM TOTALCONTRACT_ RETAINAGE TOTAL LESS RETAINAGE PREVIOUS PAYMENTS qovaftftftnwwo� DUE' !S ESTIMATE UNPAID BALANCE C D SCHEDULED tAPPLICATIONS PRMOUS 1,986.,70.00 1.*959o575.85 86-8.0-0 $ 108,061.40 21131,428,00 2,067,0737.25 $ 174,777,92 $ 169,554.45 21306a2l5.92 4237,291.70 $ % $ 21237,,291.70 -Period 12/31/2024 Architcot; Ledbun-ow Wetch A Estimate No. 9 E F H. JARMT TOTAL Wpm A BALANCE UCATION TO DATE ; . ............ TO FINIS 26,176.70 $ 1,985 852.515 717 ' AS .36,294.60 $ 144,356.00 512.00 62,471,30 $ 2$130,208.�-5 $ 1,229AS 5,122.65 $ 174,677A0 $ 100,81 67,593,95 $ 2,304,885.65 jtj30.26 67,593-95 2,304,885.�S 2o237,291.10, 7 6.1 11330.26 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 Cermcate of Pay'ments were issued and payments received from the Owner,, and that current payment shown herein Is now due. APPUCATiON AND CERTIFICATION FOR PAYMENT I AUDOCMEW6702 PAM OW OF TO OWNER Gwd County Pori DisUkt No. 4 PILOIC-CT*CoukoCity MtdkWClinic &b-brdty APPLICATION NO a WwibWonw. 218W Wastmet Coulet City, WA 09115 218W Main $Uttl. Coulee City, WA 99115 OWNER ARCHIIECI PERIOD TO 1 11=4 CONMCTOR FROM CONTRACTOR VIAARCHITECT. Lc= & Kccblc, Inc. L*Wburmw Wcotch ArcWtotm, P S t08 W Boone Ave 2ol w Yakm6 Ave Spokane, WA 99201 Yakima, WA 09902 PROJECT NOS, 23-1154 CONMCTFort. CQNMCT,DATE, 03106 4 CONTRACTOR'S APPUCATION FOR PAYMENT 1 Tm urzasigncd conuutor centrits than to ih-. best of th-. coanugoes kwwwgt, x Application is inadr. for payment. as shown bdow, in connWim with ft COW= u4mim od bdidthe Wolk covered by ft APPrwatioa for Payrntal h" been jA wick thc Con= Docu=4 ft all vacunts have been paid by Continuation Sheet AIA Dmument 0703, is aftched cmplcmd ==&= kt, �"e�{r' As ft CWM=W for Wock for Wbith pzvoz Cw&=Iu for Pq=Tt carteimw and remycd from ft Owng, and dWcumnt p)imnt shown herein is now d= %%7 PRY11=4 MOB TY I CONTRACT sum S 1.996.57d 00 P UBLic 2 Net thftgc by ChRAIA OrdeM S' 144,96800 ok & Keeblk Ine C*NMJI�kct 71% NZ 3 CONTRACT SUIMTO DATE (Line It 2) S 2.131.4.3000 44.1w. Al 4 TOTAL COWLEM 4: STOREDTO DWv. 12WO24 0 DATE (Column 0 on 0703) et RobeM Ro $ RETAINAGE a- 0 it ofCampIWA Work S 000 i sude Cr Waftnpn Counvy of Spoks= (Cotumn b + E an 670) SubsmW am sz 61h day of" December 01.5. b % ofStortd Mal S I lazpu (Column F on 0703) MyC0M?ni4s$' =PM. 20*V Total Retainage (Lines 51L + 5b of ToW in Column 1 *fG703) S 0,00 ARCHITECTS CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS MAINAGE 5 2,067,73725 In a=td=e with The Canurmt D=umnts, bxttd on o"tte ob=rvoons and the Haifa 7 WASHINGTON STATE SALES TAX I cwaptWn the applitzlion. the Arcbjl= =!ft to ft Ow= 110 to the b= of ft 8.2% S 16935445 Mbimeft kwwledM Inibmation W Wief the Work has proWessed as indkotd. S LP -SS PREVIOUS CERIMCAM FOR PAYMENT' S &047.778 81 the quality of the work is in a=rd=e with ftCont= Docuinmts.avd the Coaftmr 9 CURRENTPAYMEWDUE S 180.512 99 jsenIijW to pzMcm of ft AMOUNT CERTIFIED 10 BALANCE 70 FINISH. INCLUDING PErAINAGE I I f�qo 1 eq63.70075 I E AM01.C-. CMMEORDMUONRY ADDITIONS DEougnoNs Total clumges approved in 9mvious months by Qwner $12326000 SI6,90000 Total ;pproyal this Month S38.50300, S000: TOTALS S161.769001 $16.90000 NET CHARGES byChingc0ift $144.96900 (.411.9=b Cq*n011vn if amosmi certified differsfrom the amatint opplsed. Initial all fir on Mw Apphomw cad anthe Contmull are chogato ear with meomow certified. Al'ag" By Dale v 7b* CERTIFIED is payable only to be C=ngwramed herein ksuva wA psyme =ptz= of pa vnent ate vntboul I prejW= W any nghts orthe 0W= or 7tZenor under ths Contmt. T AIA DOCUMENT GM - APPUCATIONANS CER-nPAYMENT'ON FOR PAYMENT' iMEOMON AIA WMTHE - ALSRICAN WsTnufa 3F AREPTF-cTs. 1735 NEW YZ9R= N.W., MASHIN0014, DO 20008-5292 Usem may oblAn volldstIon WIMS doWment by requesting a coMplated AIA D"umant D401 -CaMcationatDocument' Aothengdty from the Lkenavo. Coulee City Medical Clinic & Library Coulee City, WA 99115 =Nf %010 1 GENERAL REQUIRE'SIENTS, 2 General Conditions 3 B&O and Insurance 4 Bond 5 Final Documentation 6 Punch Gist Completion 7 Commissioning 8 Permit Allowance 9 DIVISION 2 -SITE WORK to Selective Site Demolition I I DIVISION 3- CONCRETE 12 CIP Concrete Anchom 13 CIF Concrete - Building 14 CIP Concrete- Sidewalks 15 CIP Concrete - Transrormer Pad 16 post & Panel Signage Concrete 17 Grout Steel Columv, BaSe 18 DIVISIONS - METALS 19 Structural Steel Framing ,)o Metal Ladders 21 DIVISION 6- CARPENTRY 22 Rough Carpentry 23 Ces%vork Blocking & Backing, 24 Rough Hardware 25 Hoisting/Craning 26 Interior finish Carpentry 27 DIVISION 7 - THERMAL AND MOISTURE PROTECTION 28 Thermal Insulation 29 Below Grade. Rigid insulation zo Thermoplastic Sin-41c, Ply Membrane Roofing 31 Siding 32 RaDfAccessolies 33 Joint Sealants 34 DIVISION a -BOORS AND GLAZING 35 HM Doors & Frames 36 Wood Doors 37 Vinyl Windows 39 Door Hardware 39 Glazing 40 DIVISION 9 - FINISHES 41 Gypsum Board 42 Acoustical Ceiling 43 Flooring 44 Painting 45 DIVISION 10 -ACCESSORIES 46 Panel Signage 47 Wall & Door Pootection 48 Toilet. Bath & Laundry Accessories 49 Fire Protection Specidtics So Knox Boxes 51 Book Return 52 DIVISlow 12 - FURNISHINGS 53 Window Treatments 54 Casework 55 DIVISION 22 - PLUMBING 56 Underslab Plumbing Labor 57 Underslab Plumbing Materials 58 hough In Plumbing Labor 59 Rough In Plumbing Materials 60 Ttim, Out Plumbing Labor 61 Trim Out Plumbing Mutcrials 62 Pilic insulation 63 Admin Job!ite Labor 64 Commissioning 65 Punch List Completion 66 Final Documentation 67 Office Overhead 68 Equipment. Rental AQ rtpnt-ral Itemsf EMO Tax Leone& Keeble, Inc, joBW. Boone Spokane. WA 99201 Phone: (509) 327-4451 Fax: (509) 325-9200 LICAMON FOR PAYNENr Period ArchitccL ----------- )TAL TOTAL PERCENT VALUT VALUE TRACT COWLETE CONE' LETS PREVIOUS CURRENT 11/30/2024 Loolburrviv Wdds MWIWIX, P S VALUE CONTRACT BALANICE 339.1" 00 335,73078 g9 305,20960 30,52098 19,05400 171197346 99 16,248 60 1,62486 27,298.00 27,298 00 103 27,298-00 - 14,34900 7,17450 "zo 7,17450 28,69600 21,52200 75 21,52200 28,69600 21,5--a 00 75 21,52200 6.50000 b,50a 00 too 6,50000 - 3,58700 3,587 00 too 3,58700 4.53500 4,53S 00 100 4.53500 91,12700 91,12700 100 91,12700 5,63400 5.63400 100 5,63400 1,68900 1,68900 100 1,68900 65800 65800 100 65800 74600 74600 100 74600 • 1.41600 1,41600 1400 1141600 6.98203 6.88200 100 6,8$200 163,34400 163,34400 100 163,344 OD 13,122 00 13,52.700 100 13,52200 2,44200 2.44200 100 44200 2,00000 2,00000 100 2,0W 00 - 48,21700 49,21700 100 45,S06 15 2,41085 27,82500 27.S25 00 too 27,825-00 77400 77400 100 77400 56,45500 56,455 00 100 56.45500 35,M0 00 35.000 00 100 35,00000 50000 500 00 100 500 OD 1,122 00 1.12200 103 47,35900 too 47,35900 2.71000 2,'682-90 99 U74 50 10940 6,58300 6,59300 100 6,593 OD - 22,37900 n7'155 21 99 21,26005 895 16 5,03700 5,03700 100 5,03700 • 58,97000 58,970 OQ 100 58,970 OD 19,48000 19,48000 too 19,49000 - 31.66200 31.66200 too 12,66480 18,99720 27,66500 27,66500 100 273 66500 8.49900 8119900 100 9,49900 19000 190DO 100 19000 79500 79600 100 71640 7960 77900 77900 100 77900 - 1 82300 K3 00 100 823 00 1,44600 1,446 00 100 1,44600 5 , 00o0o 5,00000 100 5,00D 00 65,8600 65,,48600 too 65,48600 # 20.000 OD 20,00000 too 20.W0 00 - 16,00000 16,00000 100 16,00000 20,00000 20,000 00 100 20,00000 45,03000 45.000, 00 100 45,00000 9,75300 9275300 100 9,75300 15,00000 15,00000 too 15,00000 8,00300 8.00000 100 8,00000 7,00000 7,00000 100 6.65000 35000 3,09900 3309900 100 - 3,099 00 3,09900 3,099,00 100 3jG99 00 11549 co - - 3,00000 33000 W I 01D 1,80000 110000 ';1000 ft 2.70000 2,70000 100 1,89000 77900 77900 too 467-40 1;239-66tt 70 121478 15 3,391:22 18054 7,17450 7,17400 7,174001 2710 *223 79 Paget of 3 A.-PPLICA110NI FOR PAYKEINT Coulee City Medical Clinic & Library Period 11/3012024 Coulee City, WA 99115 Architect: Loofbuffc%v Wetch Architcers, P S Job 4 23- t 154 "I'll'' Estimate No. 111 11 1; 11 1.3 8 11 all 11 ftr 1, M CONTRACT ITEMS �t�i'AL'IrrCT 1 2 1 1 11 :211:1 TOTAL PERCENT Com-pt-sm ColNIPLET-C ;q� VALUL- PREVIOUS 12c Ing; LALUE VAUE CURRENT V C ON.TTL%.CT Tiz�?kim I DESCRaPTION NO ArALUE TO DATE MINIATES E-51'IMAIT, 1:iALANCI:- 70 DIWSION 23- HVAC 71 Submittals I Mobilization 1,72000 1 P720 00 100 1,72000 72 Frocurc ERY's 23,90000 23,90000 400 23,90000 73 Procure Packaged RTUs 24,40000 24,40000 100 24,40000 74 Procure Exhaust Fans 1.00000 1.00000 lao 1,00000 75 Procure Duct Heaters 2$90000 2,90000 100 2,90000 76 Procure Split System 2,45000 2,45000 100 2,45000 77 Procure Rooft4cods 12000 12000 too 12000 78 Procure GRVs 3.25000 3.25000 100 3,25000 79 Fabricated & Procured Duckwork- 21,50000 21,50000 100 21,50000 80 Installation of Ductwork & Equipment 63?60 00 63,2a0 Op 100 60.09700 3,16300 91 Reffiguradon Piping 7,500,00 2,50000 100 2,50000 82 Duct insulation 7,00000 7,00000 100 7.00000 - 83 Low Voltage Wiring I Controls 3"000 00 3,00000 100 2.85000 15000 84 HVAC Equipment Startup 4,000 00 IA tteco 00 too 3.00000 1,00000 85 Test.. Adjusting & Balancing 2,40000 12,40000 too 2,40000 86 Final Documentation 1,72000 1,72000 100 1,72000 97 Punch Gist Completion 3,44-000 3,44000 100 3,44000 88 Commissioning 3,44000 3,440 00 100 3,44000 89 DIVISION 26 - ELECTRICAL 90 Electrical Perniks & Mobilizadon 2,27500 2,27500 100 1275 00 91 Primary Services - Material 4,260 OD 4,26000 too 4,260 00 92 Primary Services - Labor 6,55000 6,55000 too 6,55000 93 Branch Conduit & Wire - Niaterial 8.58000 8.58000 100 8,58000 94 Branch Conduit & Wire -Labor 23,400 00 23,40000 100 23,40000 95 Feeder Conduit & %re -INtaterial 1,80000 1,80000 100 t,GGO 00 96 Feeder Co,-Idui,. & Wire - Labor 2995000 185000 -5: 100 "850 00 2 W Extcrior Lighting -;Material 5,330 OD 330 00 100 5,330 00 98 Exterior Lighting - Labor 5,62000 5,62000 10 5.62000 99 Panels & Disconnects - Material 55,700.00 55,700 00 100 55,70000 100 Panels & Disconnects - Labor 11.5100.0 11,51000 100 11,51000 - 101 Trim - Material 2,80000 180000 100 2066000 14000 102 Trim - Labor 11,50000 11,50000 iO4 10.46500 1,03500 103 Light Fixtures - hiatcrial 32.,90000 32,90000 100 32,90000 - 104 Light Fixtures - Labor 25,11000 25,11000 100 22,59900 2,51100 105 Comm/Data. - Material 5.90000 5,90000 100 5,90000 106 Comm/Data - Labor 7,50000 7*50000 100 7,500 GO 107 Final Documentation 2,248 00 2,24800 100 2,24800 108 Punch List Completion 4,49600 4,49600 100 4,49600 109 Commissioning 4.496 OD 4,49600 100 - 4,49600 110 DIVISION 31 - EARTHWORK III Bring Site to Subgrade 10,30700 10,30700 100 10,30700 112 Foundation Excavation & Backfill 25,700.00 25,709 00 100 25,70900 113 Building Slab Prep 18,41300 13,41300 too 18,41300 114 Sidewalk Prep 939500 9..'-9500 100 9,59500 115 Trenching for Electrical 3,67000 5,67000 100 5,67000 116 Prep for Concrete & Asphalt Sidewalks I Paving 45,96200 45,96200 Wo 45,96200 • 117 Fine Grade Continuous FooltinP 57800 578 00 100 578 00 113 Fine Grade SOG 1'.23900 1,239.00 100 1,2,3900 119 DIVISION 32 - SITENVORK 120 Vapor Barrier Under SOG 2121200 2,1271200 100 2,2112 00 121 Asphalt Paving 36,02000 3b.02000 1011 36,02000 122 Pavement Markings 7.37000 7,37000 100 7,37000 123 DIVISION 33 - UTILITIES 124 Utilities (Trenching) 67500 67500 too 61500 125 Site Utilities Water Systems - Nlarcrial 3.64100 3.64100 100 3,641 GD 126 Site Utilities Water Systems - Labor 9,22600 8,226 CO 1600 3,226 127 Site UtilitiesSanitary Sewer - Nlaturizls 1 1,11200 1,11200 100 1.11200 128 Site Utilities SanhM Sewer - Labor 5,40600 5 - 40600 i0o 5,40600 129 Site Utilities Storm Drainage/ Swale - ilaterials 3.172 00 3"1720* 100 3,17200 130 Site Utilities Storm Drainage I Swale - Labor 14,40500 14,40500 100 t4,405 00 131 132 *rfrrAl e%D1r.r4-"_'tt 1,9599.675 5 _1*792,558 70 167.11715 26.S19 IS Leone & Keeble. Inc. 108 W. Boone Spokane, WA 99201 Page 2 of 3 Phone: (509) 3274451 Fax: (509) 325-9200 APPLICATION FOR PAYMEW Coulee City Medical Clinic & Library Coulco City, WA 99115 lob U 21-11 $4 MANGE ORDER ITEMS rrEK Dr-,SCRJPTtON NO 'TOTAL CONTRACT VALUE TOTAL PERCE, 7 COMPLETE CO,',,IPLM TO DATE Period 1113012024 Architect: Loofburroiv Wetch Architects, P S VALUE VALUE VALUE PREVIOUS CURRENT CONTRACT ESTIMATES ESTIMATE I C11ANGE ORDERS 2 CHANGE ORDER #1 3 Substantial Completion Date - No Cost 4 CHANGE ORDER #2 .5 PR#1 Credit forSI AlternateBid (16,90000) (16,900,00) 100 (16,90000) 6 PR 92 Knox Box - No Cost 7 PR 97 Plan Review & Permit Fees t.212 00 1,21200 too 1,17-1200 8 PR 99 Added Toilet Accessories 5,21600 5.21600 too 5,21,600 9 CHANGE ORDER #3 to COP WSR Credit Cow -Tongues - No Cost I I COP W6 Sewer Line Connection Changes 5,49500 5,49500 100 5.49500 1 -2 COP 98 Flooring Change 4,34400 4334400 1 ) COP Prl 0 Blind Rovisiarns 2,62200 2,62200 100 2,62200 14 COP # 12 Thru-Wall Mailbox Upgrade 1.92800 96400 50 96400 96400 15 COP #I 3R Sink- & Casework Addition at Library 4,36500 4,36500 too 4,36500 16 COP 914 Furred Walls for Plumbing 54600 54600 JOG 54690 17 CCD #I Unsuitable Soils 1 9169700 9,69700 100 9069700 18 CHANGE ORDER 04 19 COP #1 1PR9 16 Broken Saddles 7,78900 7.78900 JOG 7,78900 20 PR 1) 17 Stud Wall Revisions 18900 18900 100 18900 21 CHANGE ORDER HS 22 COP 113 Data Conduits in Electrical Trench 1,04700 1,04700 100 1.04700 23 COP 04 Exteriors Siding Clarifications & Details 3,15100 3,15100 JOG 3,151 OD 24 COP At 5 Added & Adjum.-dDoor Configuration 5)77700 5$177700 100 5,77700 25 COP 1118 Electrical Lighting, PoNyer/Systetns Plan Upgrade for Libnuy a *708 00 812208 00 100 8,20800 26 COP 919 Electrical Lighting, PowerlSysterns Plan Upgrade ror Clinic 3,62100 3.62100 100 3,62100 27 COP,920 Key Pads at Front & Back Doots 1,39300 1,39300 100 J.393.00 28 COP 922 Domestic Not Water Heater & Recirt Pump Electrical PoiNer 3,25400 3P254 00 IGO 3125400 29 CHANGEORDERN6 30 CCD 42 Sidewalk Replacement final i . 11128600 11,28600 100 11,28600 31 COP 411 R. Conduits & Pullboxes for Future Site Power Requirements 7,218 00 7,.21800 100 7.21800 32 COP 021 R Additional FE-FEC's at Clinic & Library 1.68200 1.68200 too 1,6820 33 COP #23 Safety Glazing in Exterior Doors 91218 00 82800 100 92800 34 COP 024 Low Voltage Wirine. at Library 8052600 8,152600 10D 8,52600 35 COP $26 Fire Alarm al Medical Step 10,08600 10,08600 too 10,08600 36 COP 1130 Remove & Replace Sidewalk in Row W 12,75600 1 Z756 00 100 12,756.00 37 COP 031 Upgrade Through WalliMailbox. 1,02400 11024001 38 CHANGE ORDER 07 39 COP #25 Handrail at Medic it Step 2,73200 2.,59340 95 2,59540 13660 40 COP #027 6 Inch Metal Letters for Address - No Cost 41 COP 028 PLAN4 Wall Surface West WaIlRestroom 916 91800 91800 100 91800 42. COP 929 South Entry Canopies Entry U& Revisions - No Cost 43 COP 032 North Parking Lot Unsuitable: Soils Removal 4,52000 4.52000 100 4,520 OD 44 COP 0.33 Provide Crushed Rock Base & Herbicide Treatment 11.00300 11,003 00 45 COP #34 Revise Exam & Treatment Room Sinks - No Cost 46 COP 1135PVC Fencing East ftpanyLine 19,33500 19,33500 47 48 49 wuNGEORDER70TA1, 144.86800 108,06140 100,02800 9,03340 36,80660 ORIGINAL cowmAcrTo*rAL t 1.986570 00 1.959.67:5'85 7-15 Q7 V. i 1,727-559 70 1.99 58670 167.11715 -6.894 15 175.15055 63.7W *7 5 41.11t,XG70TALS 131,438 00 1067.717 Leone& Keeble, Inc, 103W. Scone Spokane, WA99201 Page 3 of 3 Phone: (S09) 327-4451 Far, (509) 326-0200 APPLICATION AND CERTIFICATE FOR PAYMENT Coulee City Medical Clinic & Library Coulee City, WA 99115 Job # 23-1154 Period 11/30/2024 Architect: Looffitirrow vetch A Estimate No. 8 SUBTOTAL C D E F H SCHEDULED VALUE PREVIOUS APPUCATIONS CURRENT APPLICATION TOTAL TO DATE BALANCE TO FINISH $ 1,986,570.00 $ 1,792,558.70 $ 167,117.15 $ 1,959,675.85 $ 26,894.15 CO TOTAL $ 144,86.8.00 100,1028,00. $ 8,1033.40 $ 108,061.40 $ 36..806.60 SUBTOTAL $ 2,131,438.00 $ 1,892,586-70 $ 175,150.55 $ 2,067,737.25 $ 63,700,75 AV SALESTAX 8.2% $ 174,777.92 $ 155,192.11 $ 14,362.35 $ 169,1554.45 $ 5,223.46 TOTAL CONTRACT $ 2,306,215.92 $ 2..047*778.81 $ 189,512.90 $ 2,237,291.70 $ 68,924.21 RETAINAGE 01yo $ Y $ 2,047,778.81 $ - 189,1512.90 $ $ I$ - 2;237o291.70 2,047,378.81 189,512.89 TOTAL LESS RETAINAGE PREVIOUS PAYMENTS DUE THIS ESTIMATE ,UNPAID BALANCE 68*1 The undersigned Contractor certifies that to the best of his knowledge., information and belief the work covered by this Application for Payment has been complet4d 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.