Jansen Inc. 12/9/2021 - Laserfiche WebLink

City of Everett E V E R E T T Construction Management WASHINGTON Affidavit of Amounts Paid DBE Participants Contractor: Jansen Inc. Date: 4/5/21 Address: 1215 W Holly Street City: Bellingham State: WA Zip Code: 98225 Project Title: Everett Downtown Streetscape Improvement Project Work Order#: Rucker Ave (Pacific Ave to Everett Ave & Hoyt Ave (Pacific Ave to Wall St) PW3640/UP3648/PW3553 Federal Aid Project Number (if Federally Funded) N/A Contract Bid Price: DBE Condition of Award: $9,577,841.02 $0.00 DBE Participant Ethnic Contract Bid Item Amount Paid Participants Name and Address Code Type No.(s) (Including retainage held) I His Hands Lawn Care &Services 0 S A7, $331,193.44 P.O. Box 3750 A38toA41, Silverdale, WA 98383 A44toA57, C48toC51, C54toC65, C67toC71 OMA Construction 0 S A15toA17, $743,536.81 22412 SE 2315' St A20,A43, Maple Valley, WA 98038 B4,B6,C17, C18,C22, C23,C53,D3, D4,D5,E5 Ethnic Code: Contract Type: Total DBE Participation Achieved B= Black 1=American Indian and S=Subcontractor H=Hispanic Alaskan Native M=Material Supplier $1,074,730.25 A=Asian American 0=Other JV=Joint Venture Affidavit I, the undersigned, do hereby certify that in connection with all work on the project for which this statement is submitted, each DBE participant contracted by me has $een paid the amounts shown for bid items, or portions thereof, listed. t1 r. _ ^ I \�t\\\NN""11 11 t t ! v\s10PHFR U// Title Grant Jansen; President V•r`,•IsesioFI'a, i ji ture (n " 199939 y 5ubgribed and sworn before me this: 5th day of April , 2021 ; —1 SNota'ia, c, y 14 ?9-22 = Notary Public in and for the State of Washington III,wAS. 'residing at: Bellingham Washington THIS FORM IS REQUIRED WITH THE FINAL ESTIMATE FROM THE PRIME CONTRACTOR ON ALL PROJECTS