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En
<br /> II r City of Everett
<br /> E V E R E T T Construction Management
<br /> WASHINGTON
<br /> Affidavit of Amounts Paid DBE Participants
<br /> Contractor: Interwest Construction Inc Date:
<br /> 10/21/21
<br /> Address: 609 N. Hill Blvd City: Burlington State: WA Zip Code: 98233
<br /> Project Title: Grand Avenue Park Bridge Project Work Order#: 3588
<br /> Federal Aid Project Number(if Federally Funded) STPUL-0420 (022)
<br /> Contract Bid Price: DBE Condition of Award:
<br /> $ 13,789,439 $2,255,219.00
<br /> DBE Participant Ethnic Contract Bid Item Amount Paid Participants
<br /> Name and Address Code Type No.(s) (Including retainage held)
<br /> Belarde Company I ? I S I A1,A176,A187,A189,A191,A192,A193,A195, $250,541.84
<br /> Industry Erectors it I S A95,B7 ) $123,435.90
<br /> Electric West ? I S I Al,A162,A163,A164,A165,A166,A167,A169,A170,B19,B20,B21,B22+CO'S $1,053,508.13
<br /> Meko S A89,A90,A194,B2,83 $ 48,339.06
<br /> Out West Landscape and Irrigation S I Al,A103-A151 $252,839.26
<br /> Puget Sound Steel 1 M A92,A97,B5,B6 $235,542.41
<br /> Penny Lee Trucking I ? I S I A9,A14,A22,A25,A26,A28,A87,A88 $ 58,916.08
<br /> 1 Alliance Geomatics ° S I A3 $ 70,203.50
<br /> Western Industries S I .A92 A97,B5,BE $169,314.80
<br /> Metro Painting ? I S I A1,A153,A154,A155,A156,A158 $388,642.53
<br /> Ethnic Code: Contract Type: Total DBE Participation Achieved
<br /> B=Black I=American Indian and S=Subcontractor
<br /> H=Hispanic Alaskan Native M=Material Supplier $2,650,833.51
<br /> A=Asian American • 0=Other JV=Joint Venture
<br /> Affidavit
<br /> I,the undersigned, do hereby certify that in connection with all work on the project for which this statement is submitted,
<br /> each DBE participant contracted by me has been paid the amounts shown for bid items, or portions thereof, listed.
<br /> .__.
<br /> .``''`ire KaYOo �'
<br /> $ a•.•,-•tON F•; (•' Title Vice President
<br /> TA N' t/
<br /> ..i..j
<br /> � Np Ry
<br /> - _._ Subscribed and sworn before me this: 21n day of October , 2021 ;
<br /> c� N ftBLIC 4
<br /> tf•-:: Seal '`�;.ej__ y_ `
<br /> �•• ss. ,,A a_-__ i lefiC'i Notary Public in and for the State of Washington
<br /> i, - • i'. '
<br /> ,,'s• OA•riVA;�,esiding at Bellingham
<br /> THIS FORM IS REQUIRED WITH THE FINAL ESTIMATE
<br /> FROM THE PRIME CONTRACTOR ON ALL PROJECTS
<br />
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