HomeMy WebLinkAbout000158 Original ContractProject PK -11 -011
City of Port Angeles
Public Works Utilities Dept.
Operations Office
1703 South B Street
Port Angeles WA 98362
Tel: 360 417 -4541
Fax: 360 452 -4972
Contract Title: Columbaria Casting Construction
LIMITED PUBLIC WORKS PROCESS
Request for Quotation
Z Contract
Project Number: PK -11 -011
City of Port Angeles
Record #000158 ni,
THIS CONTRACT is entered into the date last below written between the CITY OF PORT ANGELES, WASHINGTON
"CITY AND Ouirina Monuments "CONTRACTOR I
1. WORK BY CONTRACTOR
The Contractor shall perform the work as described in Attachment "A" (Attachment "A" may include Contractor's
Proposal, Scope of Work, Statement of Work, Plans, Specifications, and any other related Contract Documents)
which is attached hereto and by this reference is incorporated herein.
2. TERM OF CONTRACT
All work under this Contract is to be completed as indicated (check one):
All work under this Contract is to be completed by this date:
All work under this Contract is to be completed 70 days from the Notice to Proceed. No work is
to be performed prior to written Notice to Proceed by the City.
The performance period under this Contract commences calendar days after contract
award and ends calendar days after contract award.
3. PAYMENT
A. The City shall pay the Contractor for the work performed under this contract (check one):
Time and material, not to exceed:
Time and actual expenses incurred, not to exceed:
Unit prices set forth in the Contractor's bid or quote, not to exceed:
Firm Fixed Price set forth in Contractor bid or quote in the amount of: 37.723.20
The Contractor shall do all work and furnish all tools,; materials, and equipment, in accordance
with and as described in the Attachment "A
The Contractor shall provide and bear the expense of all equipment, work and labor of any sort
whatsoever that may be required for the transfer of materials and for constructing and completing
the work provided for in this contract and every part thereof; except as are mentioned in the
specifications to be furnished by the City of Port
B. The Contractor shall maintain time and expense records, which may be requested by the City. The contractor
shall submit invoices to the City for payment for work performed. All invoices must reference the City's contract
number. Invoices shall be in a format acceptable to the City.
C. The City shall pay all invoices from the Contractor by mailing a City warrant within 30 days of receipt of a
properly completed invoice.
D. All records and accounts pertaining to this Contract are to be kept available for inspections by representatives
of the City for a period of three (3) years after final payment. Copies shall be made available to the City upon
request.
Page 1 Rev. 04/25/2011
E. If during the course of the Contract, the work rendered does not meet the requirements set forth in the
Contract, the Contractor shall correct or modify the requi fed work to comply with the requirements of this
Contract. The City shall have the right to withhold payment for such work until it meets the requirements of the
Contract Documents.
4. RESPONSIBILITY OF CONTRACTOR
A. Safety. Contractor shall take all necessary precautions for the safety of employees on the work site and shall
comply with all applicable provisions of federal, state and local regulations, ordinances and codes. Contractor
shall erect and properly maintain, at all times, as required by the conditions and progress of the work, all
necessary safeguards for the protection of workers and the public and shall post danger signs warning against
known or unusual hazards.
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B. Correction of Defects. Contractor shall be responsible for correcting all defects in workmanship and /or
materials discovered within one year after acceptance of this work. When corrections of defects are made,
Contractor shall be responsible for correcting all defects in workmanship and /or materials in the corrected work
for one year after acceptance of the corrections by the City. The Contractor shall start work to remedy such
defects within seven (7) days of mailing notice of discovery thereof by City and shall complete such work within a
reasonable time. In emergencies where damage may result from delay or where loss of service may result, such
corrections may be made by the City, in which case the cost shall be borne by the Contractor. In the event the
Contractor does not accomplish corrections at the time specified, the work will be otherwise accomplished and
the cost of same shall be paid by the Contractor. I
C. Warranty. Contractor shall be liable for any costs, losses, expenses or damages including consequential
damages suffered by the City resulting from defects in the Contractors work including, but not limited to, cost of
materials and labor expended by the City in making emergency repairs and cost of engineering, inspection and
supervision by the City. The Contractor shall hold the City harmless from any and all claims which may be made
against the City as a result of any defective work and the Contractor shall defend any such claims at its own
expense. Where materials or procedures are not specified in the Contract Document, the City will rely on the
professional judgment of the Contractor to make appropriate selections.
D. Nondiscrimination /Affirmative Action. Contractor agrees not to discriminate against any employee or applicant
for employment or any other persons in the performance of this Contract because of race, creed, color, national
origin, marital status, sex, age or handicap, or other circumstances as may be defined by federal, state or local
law or ordinance, except for a bona fide occupational qualification. Contractor agrees to post in conspicuous
places, available to employees and applicants for employment, notices to be provided by Contractor setting forth
the provisions of the nondiscrimination clause.
E. Employment. Any and all employees of the Contractor, while engaged in the performance of any work or
services required by the Contractor under this Contract, shall be considered employees of the Contractor only and
not of the City. Any and all claims that may arise under the Workers Compensation Act on behalf of said
employees, while so engaged, and all claims made by a third party as consequence of any negligent act or
omission on the part of the Contractor's employees, while so engaged on any of the work or services provided or
rendered herein, shall not be the obligation of the City.
5. COMPLIANCE WITH LAWS
The Contractor shall comply with all federal, state and local laws and regulations applicable to the work done
under this Contract. Any violation of the provisions of this paragraph shall be considered a violation of a material
provision of this Contract and shall be grounds for cancellation, termination or suspension of the Contract by the
City, in whole or in part, and may result in ineligibility for further work for the City.
6. TERMINATION OF CONTRACT
A. This Contract shall terminate upon satisfactory completion of the work described in Attachment "A" and final
payment by the City.
B. The City may terminate the Contract and take possession of the premises and all materials thereon and finish
the work by whatever methods it may deem expedient, by giving 10 days written notice to the
Project PK -11 -011 Page 2
Rev. 04/25/2011
Contractor, upon the occurrence of any one or more of the events hereafter specified.
1. The Contractor makes a general assignment for the benefit of its creditors.
2. A receiver is appointed as a result of the insolvency of the Contractor.
3. The Contractor persistently or repeatedly refuses or fails to complete the work required herein.
4. Contractor fails to make prompt payment to subcontractors for material or labor.
5. Contractor persistently disregards federal, state or local regulations and ordinances.
6. Contractor persistently disregards instructions of the Contract Administrator, or otherwise
substantially violates the terms of this Contract.
7. The City determines that sufficient operating funds are not available to fund completion of the work
contracted for.
C. In the event this Contract is terminated by the City, Contractor shall not be entitled to receive any further
amounts due under this Contract until the work specified in Attachment "A" is satisfactorily completed, as
scheduled, up to the date of termination. At such time, if the unpaid balance of the amount to be paid under this
Contract exceeds the expense incurred by the City in finishing the work, and all damages sustained by the City or
which may be sustained by reason of such refusal, neglect, failure or discontinuance of employment, such excess
shall be paid by the City to the Contractor. If the City's expense and damages exceed the unpaid balance,
Contractor and his surety shall be jointly and severally liable therefore to the City and shall pay such difference to
the City. Such expense and damages shall include all legal costs incurred by the City to protect the rights and
interests of the City under the Contract, provided such legal costs shall be reasonable.
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7. OWNERSHIP OF DOCUMENTS
A. On payment to the Contractor by the City of all compensation due under this Contract, all finished or
unfinished documents and material prepared by the Contractor with funds paid by the City under this
Contract shall become the property of the City and shall be forwarded to the City upon its request.
B. Any records, reports, information, data or other documents or materials given to or prepared or assembled by
the Contractor under this Contract will be kept confidential and shall not be made available to any individual or
organization by the Contractor without prior written approval of the City or by court order.
8. CLAIMS
Any claim against the City for damages, expenses, costs f or extras arising out of the performance of this
Contract must be made in writing to the City within thirty days after the discovery of such damage, expense or
loss, and in no event later than the time of approval by the City for final payment. Contractor, upon making
application for final payment, shall be deemed to have waived its right to claim for any other damages for which
application has not been made, unless such claim for final payment includes notice of additional claim and fully
describes such claim.
9. GENERAL ADMINISTRATION AND MANAGEMENT
The Director of the Public Works and Utilities Department or his /her designee shall have primary responsibility for
the City under this Contract and shall oversee and approve all work to be performed, coordinate communications,
and review and approve all invoices, under this Contract.
10. HOLD HARMLESS
A. The Contractor shall protect, defend, indemnify and save harmless the City, its officers, employees and agents
from any and all costs, claims, judgments or awards of damages, arising out of or in any way resulting from the
negligent acts or omissions of the Contractor. The Contractor agrees that its obligations under this subparagraph
extend to any claim, demand, and /or cause of action brought by, or on behalf of, any of its employees or agents.
For this purpose, the Contractor, by mutual negotiation, hereby waives, as respects the City only, any immunity
that would otherwise be available against such claims under the industrial insurance provision of Title 51 RCW. In
the event the City obtains any judgment or award, and /or incurs any cost arising therefrom including attorneys'
fees to enforce the provisions of this article, all such fees, expenses, and costs shall be recoverable form the
Contractor.
Project PK -11 -011
Page 3 Rev. 04/25/2011
B. The City shall protect, defend, indemnify and save harrnless the Contractor, its officers, employees and agents
from any and all costs, claims, judgments or awards of damages, arising out of or in any way resulting from the
negligent acts or omissions of the City. The City agrees that its obligations under this subparagraph extend to any
claim, demand, and /or cause of action brought by, or on behalf of, any of its employees or agents. For this
purpose, the City, by mutual negotiation, hereby waives, as respects the Contractor only, any immunity that
would otherwise be available against such claims under the industrial insurance provision of Title 51 RCW. In the
event the Contractor obtains any judgment or award, and /or incurs any cost arising therefrom including
attorneys' fees to enforce the provisions of this article, all such fees, expenses, and costs shall be recoverable
from the City.
11. INSURANCE
The Contractor shall maintain insurance as set forth in Attachment B.
12. PREVAILING WAGE
This Contract is subject to the requirements of Chapter 39.12 RCW, and as it may be amended, relating to
prevailing wages. On Public Works projects, funded in part or in whole with Federal funds, Federal wages laws
and regulations shall also be applicable. NO WORKER, LABORER OR MECHANIC EMPLOYED IN THE
PERFORMANCE OF ANY PART OF THIS CONTRACT SHALL BE PAID LESS THAN THE PREVAILING RATE OF WAGE
as determined by the Industrial Statistician of the Department of Labor and Industries for the State of
Washington. The schedule of prevailing wage rates for this Contract is made a part of this contract as though
fully set forth herein.
Prior to making any payment under this Contract, the City must receive an approved copy of the "Statement of
Intent to Pay Prevailing Wages on Public Works Contracts" from the Department of Labor and Industries.
It is the Contractor's responsibility to obtain and file the "Statement of Intent to pay Prevailing Wage The
Contractor shall be responsible for all filing fees. Each invoice shall include a signed statement that prevailing
wages have been paid by the Contractor and all subcontractors. Following the final acceptance of services
rendered, Contractor shall submit an "Affidavit of Wages 'Paid".
For a contract award or an on -call contract work order urLer $2,500, and in accordance with RCW 39.12.040(2),
the contractor or subcontractor is authorized to submit al combined Statement Of Intent To Pay Prevailing Wages
Affidavit Of Wages directly to the City of Port Angeles at final invoicing. Submission shall be made on the form
developed by the Washington State Department of Labor and Industries and available from the City of Port
Angeles Public Works and Utilities Department.
In case any dispute arises as to what are the prevailing rates of wages for a specific trade, craft or occupation
and such dispute cannot be adjusted by the parties in interest, including labor and management representatives,
the matter shall be referred for arbitration to the Director of the Department of Labor and Industries, and his
decision shall be final, conclusive, and binding on all parties involved in the dispute.
13. INTERPRETATION AND VENUE
This Contract shall be interpreted and construed in accordance with the laws of the State of Washington. The
venue of any litigation between the parties regarding this Contract shall be Clallam County, Washington.
14. BRANDS OR EQUAL
When a special "brand or equal" is named it shall be construed solely for the purpose of indicating the standards
of quality, performance, or use desired. Brands of equal quality, performance, and use shall be considered,
provided Contractor specifies the brand and model and submits descriptive literature when available. Any bid
containing a brand which is not of equal quality, performance, or use specified must be represented as an
alternate and not as an equal, and failure to do so shall be sufficient reason to disregard the bid.
15. INSPECTION AND REJECTION
All goods, services, work, or materials purchased herein are subject to inspection and to approval by the City. Any
rejection of goods, services, work, or materials resulting because of nonconformity to the terms and specifications
of this order, whether held by the City or returned, will be at Contractor's risk and expense.
Project PK- 1 1 -0 1 1 Page 4
Rev. 04/25/2011
16. SUBLETTING OR ASSIGNING OF CONTRACTS
Neither the City nor the Contractor shall assign, transfer, for encumber any rights, duties or interest accruing from
this Contract without the express prior written consent of the other.
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17. INDEPENDENT CONTRACTOR
The Contractor is and shall be at all times during the term of this Contract an independent contractor and not
an employee of the City.
18. EXTENT OF CONTRACT /MODIFICATION
This Contract, together with the attachments and /or addenda, represents the entire and integrated Contract
between the parties hereto and supersedes all prior negotiations, representations, or agreements, either written
or oral. This contract may be amended, modified or added to only by written instrument properly signed by both
parties hereto.
19. SUBCONTRACTOR RESPONSIBILITY
A. The Contractor shall include the language of this section in each of its first tier subcontracts, and shall require
each of its subcontractors to include substantially the same language of this section in each of their subcontracts,
adjusting only as necessary the terms used for the contracting parties. The requirements of this section apply to
all subcontractors regardless of tier.
B. At the time of subcontract execution, the Contractor shall verify that each of its first tier subcontractors meets
the following bidder responsibility criteria:
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At the time of subcontract bid submittal, have a certificate of registration in compliance with chapter
18.27 RCW; 1
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Have a current state unified business identifier number;
If applicable, have:
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Industrial insurance coverage for the subcontractor's employees working in Washington as required
in Title 51 RCW;
An employment security department number as required in Tile 50 RCW; and
A state excise tax registration number as required in Tile 82 RCW;
An electrical contractor license, if required by Chapter 19.28 RCW;
An elevator contract license, if required by Chapter 70.87 RCW.
Not be disqualified from bidding on any public works contract under RCW 39.06.010 or 39.12.065(3).
Project PK -11 -011
Page 5 Rev. 04/25/2011
IN WITNESS WHEREOF, the parties have executed this Contract as of JUJU- o 2011.
QUIRING MONUMENTS
By:
Project PK -11 -011
Printed Name: 44.0 A 3
Title: /vl/k/2 C- Sc 'v /i
Address: C� 6a 7 P'vyL -4 I
City: S a-t?1 l to 3 Z29(
Tax ID S 9166
Phone Number: �r 3212
CITY OF PORT ANGELES
B
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Printed Name:
Title: (T1 A.CO 2�11i►
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Purchase Order
Page 6 Rev. 04/25/2011
City of Port Angeles
Operations Office
Public Works and Utilities Department
360 -417 -4541
The contractor shall do all work and furnish all tools, materials, and equipment in order to accomplish the project
described below. Unless otherwise provided for in the Statement of Work, the Contractor will be responsible for
obtaining and paying for any and all permits required for this work.
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Description of Project: The Parks Maintenance and Recreation Divisions are partnering to have two
new additional sets of Columbaria Castings built next to the original Columbarium at Ocean View
Cemetery. The specifications for the new Columbaria are that they are to match the existing
Columbarium in color and material type. It is understand that the colors may not be exact and the
Contractor is to work with City staff (Points of Contact) to make sure that the closest match possible.
The Contractor shall provide examples of the shutters, sandstone caps, and rosettes to Point of Contact
so that they can review and select what samples to use. Cindy Kochanek will be the Point of Contact on
this portion of the project.
Location: Ocean View Cemetery 3127 West 18 Street, Port Angeles, WA 98363
Site Point of Contacts: Cindy Kochanek, Administrative Specialist II at 360 417 -4550
Corey Delikat, Park Superintendent at 360 417 -4566
Work Hours: The contractor shall work from 8:00AM to 4:00PM, Monday through Friday. Work outside of these
hours may be requested and approval is at the discretion of the Site Point of Contacts Listed above. The
Contractor shall notify Site Point of Contacts listed above three (3) days prior to commencing work.
Work Requirements:
1.) The Contractor shall be responsible for any and all permits required for this project.
2.) All utility locates shall be the responsibility of the Contractor.
3.) Before commencing work, the Contractor shall safely secure work zone from the general public.
4.) The Contractor shall construct two (2) Columbaria Castings that match the existing
Columbarium. The two sets of Columbaria Castings shall be positioned alongside opposite ends
of the existing Columbarium. The City of Port Angeles personnel shall mark where Castings
shall be placed.
5.) Each Casting shall have sixty (60) niches, totaling 120 for both.
Specifications for Columbaria's Casting:
1. Each of the castings must be five (5) units high, 67 inches, and six (6) units long, 80 inches.
Diagram "A" below.
Project PK -11 -011
Page 7
1
ATTACHMENT "A"
WORK BY CONTRACTOR
Rev. 04/25/2011
2. Sandstone Caps shall have a three (3) inch o\ erhang from the shutters and the Sandstone Ends
Cap Bricks shall have an overhang of one (1) inch all the way around the units with a rock
pitched edge.
3. The niche units need to be back to back against each other. See Diagram "B
Specifications for Niche Columbaria's Shutter
1. Individual niches and shutters are required and the niche shall have a minimum opening of 9'A
x 9 'A and shall be 12 inches deep. They also must have a security shutter that can be sealed for
added security of the cremated remains.
2. The Shutter Dimensions shall be 12 "x12 "with the corners cut for rosette fastening (Angle cut of
45 degrees). Samples are available upon request.
3. Shutter colors shall be Sunset Red, or as approved by Point of Contact.
4. Existing rosettes are provided by Matthews Iiternational and Granite Bronze.
Specifications for Concrete Base:
1. Two concrete slabs shall be placed. One on each side of the existing Columbarium. Each slab
shall match the existing foundation and height of the original slab. The slab shall be 122" wide
and extend 50" of slab on each end of the new Pre -Cast Columbaria. This needs to be performed
on each end of the existing Columbarium.
2. Excavation and importing additional material may be required to make sure the height and grade
are level for the new Columbaria. The height of the new Columbaria's does not need to exactly
match the existing height of the original Columbarium; however, the new units shall sit flat and
level. Any questions can be directed to Point of Contact.
Project PK -11 -011
P age 8
Rev. 04/25/2011
67"
V
Sandstone Caps
Diagrams "A"
Project PK -11 -011
80"
Diagrams "C"
Concrete Slab Side View
Center Columbaria on Slab
I II
122"
Diagrams "B"
Diagram Showing Units
Back to Back.
Page 9 Rev. 04/25/2011
n are
Project PK -11 -011
Concrete Slab Front View
Center
50 'Inches
'Page 10 Rev. 04/25/2011
City of Port Angeles
Operations Office
Public Works and Utilities Department
360 -417 -4541
Insurance Requirements:
1. Minimum Scope of Insurance
The Contractor shall procure and maintain for the duration of the Contract, insurance against claims for injuries to
persons or damage to property which may arise from or in connection with the performance of the work
hereunder by the Contractor, their agents, representatives, employees or subcontractors. Failure by the
Contractor to maintain the insurance as required shall constitute a material breach of contract upon which the
City may, after giving five working days notice to the Contractor to correct the breach, immediately terminate the
Contract or at its discretion, procure or renew such insurance and pay any and all premiums in connection
therewith, with any sums so expended to be repaid to the City on demand, or at the sole discretion of the City,
off set against funds due the Contractor from the City.
The Contractor shall obtain insurance of the types described below:
ATTACHMENT B
INSURANCE
a. Automobile Liability insurance covering all owned, non owned, hired and leased vehicles. Coverage
shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing
equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability
coverage.
b. Commercial General Liability insurance shall, be written on ISO occurrence form CG 00 01 and shall
cover liability arising from premises, operations, stop gap liability, independent contractors, products
completed operations, personal injury and advertising injury, and liability assumed under an insured
contract. The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per
Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of
the Commercial General Liability insurance for liability arising from explosion, collapse or
underground property damage. The City shall be named as an insured under the Contractor's
Commercial General Liability insurance policy with respect to the work performed for the City using
ISO Additional Insured endorsement CG 20, 10 10 01 and Additional Insured Completed Operations
endorsement CG 20 37 10 01 or substitute endorsements providing equivalent coverage.
c. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of
Washington.
2. Minimum Amounts of Insurance
The Contractor shall maintain the following insurance limits:
a. Automobile Liability insurance with a minimum combined single limit for bodily injury and property
damage of $1,000,000 per accident.
b. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each
occurrence, $2,000,000 general aggregate and a $2,000,000 products- completed operations
aggregate limit.
3. Other Insurance Provisions
The insurance policies are to contain, or be endo sed to contain, the following provisions for Automobile
Liability and Commercial General Liability insurance.
Project PK -11 -011
Page 11 Rev. 04/25/2011
a. The Contractor's insurance coverage shall be primary insurance as respect to the City. Any
insurance, self- insurance, or insurance pool coverage maintained by the City shall be in excess of the
Contractor's insurance and shall not contribute with it.
b. The Contractor's insurance shall not be cancelled or reduced as to coverage by either party, except
after forty-five (45) days prior written notice by certified mail, return receipt requested, has been
given to the City.
4. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VI.
5. Verification of Coverage
The Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements,
including but not necessarily limited to the additional insured endorsement, evidencing the Automobile
Liability and Commercial General Liability insurance of the Contractor before commencement of the work.
Before any exposure to loss may occur, the Contractor shall file with the City a copy of the Builders Risk
insurance policy that includes all applicable conditions, exclusions, definitions, terms and endorsements
related to this project.
6. Contractor's Insurance For Other Losses
7. Waiver of Subrogation
Project PK -11 -011
The Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools,
Contractor's employee owned tools, machinery, equipment, or motor vehicles owned or rented by the
Contractor, or the Contractor's agents, suppliers or contractors as well as to any temporary structures,
scaffolding and protective fences.
The Contractor and the City waive all rights against l each other, any of their Subcontractors, Subcontractors,
agents and employees, each of the other, for damages caused by fire or other perils to the extent covered by
Builders Risk insurance or other property insurance obtain pursuant to the Insurance Requirements Section of
this Contract or other property insurance applicable to the work. The policies shall provide such waivers by
endorsement or otherwise.
Page 12 Rev 04/25/2011
City of Port Angeles
Operations Office
Public Works and Utilities Department
360 -417 -4541
See attached listing:
1. Washington State Prevailing Wage Rates For Public Works Contracts Journey Level and Apprentices,
Clallam County, effective 04/25/2011.
2. To access applicable prevailing rate(s) of wages rates for the describe work by trade, use the following Labor
and Industries website link: htto:// www. lni. wa. 2ov/ Trade /WaseRates /default.asn
3. A copy of the applicable prevailing wage rates can be obtain by contacting Lucy Hanley at 360 417 -4541 or by
email, lhanlev cni citvofna.us. A hard copy is available for yiewing in person at 1703 South B Street, Port Angeles,
WA. 98363.
Project PK -11 -011
ATTACHMENT "C"
PREVAILING WAGE RATES
Page 13 Rev. 04/25/2011
City of Port Angeles
Operations Office
Public Works and Utilities Department
360- 417 -4541
Quote form submitted by vendor follows:
Project PK -11 -011 Page 14
ATTACHMENT "D"
QOUTE FORM
Rev 04/25/2011
f
The bidder hereby bids the following amounts for all work (including labor, equipment, time
and materials) required to perform the work in thelStatement of Work and this package.
1. Lump Sum
2. Sales Tax (8.4
3. Total Bid 7
5. The bidder hereby acknowledges that it has received Addenda No(s).
(Enter "N /A" if none were issued) to this Request for Quotation package.
6. The name of the bidder submitting this bid and its business phone number and address, to which
address all communications concerned with this bid and with the contract shall be sent, are listed
below. Any written notices required by the terms of an awarded contract shall be served or mailed to
the following address:
Contractor Information:
1. Company Name:
2. Address:
3. City, State, Zip Code:
4. Phone Number:
5. Contractor Registration Number:
6. UBI Number:
7. WA State Industrial Insurance Account Number:
8. WA State Employment Security Dept Number:
9. State Excise Tax Registration Number:
The bidder represents that it is qualified and possesses sufficient skills and the necessary capabilities
to perform the services set forth in this Contract.
Signed by
Title
Printed Name:
Date
Project: PK -11 -01 1
QUOTATION FORM
Columbaria Cast Construction
PK- 11!011
7 7
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MAit el f,,
S-k/(/
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P'ge 2 Rev 04/25/2011