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HomeMy WebLinkAboutWWP273624 (2)Form Approveo STATEMENT OF COMPLIANCE 202160 OMB No. 1215-0149 Expires Jun 30, 1997 Pabi!c reporting ouroen !or this couection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, qathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 22 1 13/05/10 1 13/05/10 I, Jill Noble Payroll Administrator do hereby state (Name of s,gnarory party) ( I a:e) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC r ontractor or subcontractor, on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 28th day of (Bu„d,ng or work) April 201 3 and ending the 4th day of May 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K. Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates Tor laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract; that the classifications set torth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and I raining, United States Department of Labor, or it no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (G) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above reterenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5. REMARKS 6 NAME (Last. First. Middle Initial) 7. TITLE 8. SIGNATURE Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or ri inal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R5707371 WESTWKLY Aegion Corporation 5/8/2013 13:39:25 Certified Payroll Register Page - 77 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 5/4/2013 17988 EDISON AVE RENTON - WA G/L Period Number 2 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat ....... Regular ............. Overtime ...... Other Total Job ........... Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount L-----------NO WORK PERFORMED---------- PUBLIC WORKS DEPARTMENT city of D Q��(a O� M E M O R A N D U M DATE: July 30, 2013 TO: Natalie Wissbrod, Finance Accounting Assistant FROM: John Hobson, Wastewater Engineering, x7279 y( SUBJECT: CAG 12-106, Sanitary Sewer Rehabilitation 2012 and Lake Washington Blvd Pipe Rehabilitation, Insituform Technologies, Inc. Please process the enclosed final pay estimate for this project. The project was accepted by City Council at its regular meeting on July 22, 2013. The following documents are enclosed: • Copy of the Agenda Bill for Council acceptance of project and final pay estimate • Notice of Completion of Public Works Contract • Original of final pay estimate • Affidavits of Prevailing Wages Paid • Statements of Intent to Pay Prevailing Wage Thank you very much for your help. Enclosures H:\File Sys\WWP - WasteWater\WWP-27-3624 Sanitary Sewer Rehabilitation 2012\Pay Estimates\Finance notice for final payment Sanitary Sewer Rehabilitation 2012.doc\JDHtp PLANNING/BUILDING/PUBLIC WORKS DEPARTMENT UtiY �� Renton City Hall 1055 South Grady Way, Renton, WA 98055 UTILITY SYSTEMS DIVISION 425.430 7234 Fax: 425.430.7241 ❑ TRANSPORTATION SYSTEMS DIVISION 425.430-7321 Fax: 425.430.7376 To: / is, u o�r� ` ��,,,�„Lx,e-- ,t—,717, DATE: -,-],'v /Z -z JOB No. RLZn %1.v7c"Z.oF'E A/m/zss� �2n STD / RE:►�.�rsp C,4 WE ARE SENDING YOU ❑ ATTACHED ❑ SHOP DRAWING ❑ PRINTS ❑ COPY OF LETTER ❑ ❑ Under Separate Cover via the following items: ❑ REPRODUCABLE PLANS ❑ SPECIFICATIONS ❑ ORIGINALS COPIES DATE NUMBER DESCRIPTION / REMARKS MESSAGE: These are transmitted as checked below: ❑ FOR SIGNATURE APPROVAL ❑ APPROVED AS SUBMITTED ❑ RESUBMIT COPIES FOR APPROVAL ❑ FOR YOUR USE ❑ APPROVED AS NOTED ❑ SUBMIT COPIES FOR DISTRIBUTION ❑ AS REQUESTED ❑ RETURNED FOR CORRECTIONS ❑ RETURN CORRECTED PRINTS ❑ FOR REVIEW AND COMMENT ❑ ❑ PRINTS RETURNED AFTER LOAN TO US Copies to: From: IF ENCLOSURES ARE NOT AS NOTED, PLEASE NOTIFY US AT ONCE. PBPW5001 09/99 bh F-WRINT1 _ c�MMS SWIM AGENDA BILLTITLE,�&nj` PREPARED BY: 7 Dk v\ V4&bSor Extension: ?a - 9 DEADLINE/DATE ACTION �11511 GREGG'S SIGNATURE TRANSMIT TO CLERK VIA Electronic Agenda Bill Process � S l COUNCIL MEETING DATE Referred to Committee -7 laa COMMITTEE MEETING DATE COMMITTEE 7 ` as i Time: Place: COUNCIL MEETING REPORTED OUT USA\17\Misc Form s\AB-Schedule\tp CITY OF RENTON COUNCIL AGENDA BILL Al #: Submitting Data: Public Works For Agenda of: Dept/Div/Board.. Utility Systems Division/ July 22, 2013 Wastewater Utility Agenda Status Staff Contact...... John Hobson, x7279 Consent .............. X Public Hearinkce Subject: Final Pay Estimate CAG 12-106 Sanitary Sewer Rehabilitation 2012 and Lake Corresponde Ordinance........� Washington Blvd Pipe Rehabilitation �.... Resolution....AiITIAContractor: Insituform Technologies, Inc. Old Business.Exhibits: New Busines Final Pay Estimate Study Sessio Notice Of Completion of Public Works Contract Information......... . Recommended Action: Approvals: Council Concur Legal Dept......... (_ Finance Dept...... X Other ............... Fiscal Impact: Expenditure Required... $30,365.11 (Final Pay Est.) Transfer/Amendment....... Amount Budgeted....... $35,000 Revenue Generated......... Total Project Budget $1;160,05-7�1>>��iCity Share Total Project.. SUMMARY OF ACTION: The project was awarded on August 20, 2012. Construction began on December 17, 2012, and was completed on March 29, 2013. The original contract amount was $247,327.03 ($211,960.03 for the sewer rehabilitation and $35,367.00 for the surface water rehabilitation) and the final amount is $389,125.19 ($228,697.04 sewer and $160,428.15 surface water), an increase of $141,798.16 or 57 percent. The cost increase for the sewer rehabilitation portion was the result of additional costs for the contractor to perform night work in order to eliminate temporary sewer disruptions to -the Renton Technical College during classes. The cost increase for the surface water r abihtation portion was due to the structural failure of one culvert prior to e replaced by traditional excavation methods, and adding an lining, whichUtothe additional cuing contract. The final costwas within the amount budgeted for each portion of th The project budget amount for the Sanitary Sewer Rehabilitation 2012 and Lake Washington Blvd Pipe Rehabilitation project is $800,000 (2012/2013 Wastewater Utility) and $360,057 y (2012/2013 Surface Water Utility). The amounts budgeted for each portion of this project are enough to cover the construction, engineering, and staff costs for each portion of this project. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate, in the amount of $30,365.11, and release the retainage in the amount of $18,464.19 after 60 days, subject to the receipt of all required authorizations. 11, H:\File Sys\WWP - WasteWater\WWP-27-3624 Sanitary Sewer Rehabilitation 2012\Pay Estimates\Agenda Bill Final Pay San Swr Rehab 2012 & Lk Wash Blvd Pipe Rehab.doc\JDHtp CITY OF RENTON COUNCIL AGENDA BILL Al #: Submitting Data: Public Works For Agenda of: Dept/Div/Board.. Utility Systems Division/ July 22, 2013 Wastewater Utility Agenda Status Staff Contact...... John Hobson, x7279 Consent .............. X Public Hearing.. Subject: Final Pay Estimate CAG 12-106 Correspondence.. Sanitary Sewer Rehabilitation 2012 and Lake Ordinance ............. Washington Blvd. Pipe Rehabilitation Resolution............ Contractor: Insituform Technologies, Inc. Old Business........ New Business....... Exhibits: Final Pay Estimate Study Sessions...... Notice Of Completion of Public Works Contract Information......... Recommended Action: Approvals: Council Concur Legal Dept......... Finance Dept...... X Other ............... Fiscal Impact: Expenditure Required... $30,365.11 (Final Pay Est.) Transfer/Amendment....... Amount Budgeted....... $35,000 Revenue Generated......... Total Project Budget $1,169,907 City Share Total Project.. SUMMARY OF ACTION: The project was awarded on August 20, 2012. Construction began on December 17, 2012, and was completed on March 29, 2013. The original contract amount was $247,327.03 ($211,960.03 for the sewer rehabilitation and $35,367.00 for the surface water rehabilitation) and the final amount is $389,125.19 ($228,697.04 sewer and $160,428.15 surface water), an increase of $141,798.16 or 57%. The cost increase for the sewer rehabilitation portion was the result of additional costs for the contractor to perform night work in order to eliminate temporary sewer disruptions to the Renton Technical College during classes. The cost increase for the surface water rehabilitation portion was due to the structural failure of one culvert prior to lining, which required it be replaced by traditional excavation methods, and adding an additional culvert to the lining contract. The final cost was within the amount budgeted for each portion of the project. The project budget amount for the Sanitary Sewer Rehabilitation 2012 and Lake Washington Blvd. Pipe Rehabilitation project is $800,000 (2012/2013 Wastewater Utility) and $369,907 (2012/2013 Surface Water Utility). The amounts budgeted for each portion of this project are enough to cover the construction, engineering, and staff costs for each portion of this project. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate, in the amount of $30,365.11, and release the retainage in the amount of $18,464.19 after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WWP - Waste Water\WWP-27-3624 Sanitary Sewer Rehabilitation 2012\Pay Estimates\Agenda Bill Final Pay San Swr Rehab 2012 & Lk Wash Blvd Pipe Rehab.doc\JDHtp TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: Insituform Technologies, Inc. CONTRACT NO. CAG-12-106 PO# 18/0001828 ESTIMATE NO. 4 (Final) PROJECT: Sanitary Sewer Rehabilitation 2012 and Lake Washington Blvd Pipe Rehabilitation 1. CONTRACTOR EARNINGS THIS ESTIMATE $27,892.61 2. SALES TAX (ONLY ON SCHED A ITEMS) @ 9.50% $2,472.50 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $30,365.11 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $324,321.72 5. ' EARNINGS DUE CONTRACTOR THIS ESTIMATE $26,497.98 6. SUBTOTAL - CONTRACTOR PAYMENTS 7. RETAINAGE ON PREVIOUS EARNINGS $17,069.56 8. " RETAINAGE ON EARNINGS THIS ESTIMATE $1,394.63 9. SUBTOTAL - RETAINAGE 10. SALES TAX PREVIOUSLY PAID $17,368.80 11. SALES TAX DUE THIS ESTIMATE $2,472.50 12. SUBTOTAL - SALES TAX . $350,819.70 $18,464.19 $19,841.30 (95% x LINE 1) *' (RETAINAGE: 5%) GRAND TOTAL: $389,125.19 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 426.465488.018.594.35.63.000 $27,197.49 # 4 (Final) 427.475015.018.594.31.63.783 U650155010.0783 $1,772.99 # 4 (Final) RETAINED AMOUNT (Line 8): ACCOUNT # 426.465488.018.594.35.63.000 427.475015.018.594.31.63.783 $28,970.48 $1,301.32 # 4 (Final) U650151010.0783 $93.32 # 4 (Final) $1, 394.63 TOTAL THIS ESTIMATE: $30,365.11 CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION 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 THE CITY OF RENTON. AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID IM / J� Signed: i Printed On: 07/11/2013 City of Renton Public Works Department Page 1 Printed On: 07/11/2013 City of Renton Public Works Department Page 1 Sanitary Sewer Rehabilitation 2012 and Lake Washington Project: Blvd Pipe Rehabilitation Contract Number: CAG-12-106 _Contractor:_Insiluform Technologies, Inc. Pay -Estimate 4-(Final)-Closing Date: _06/14/2013 Item Description Unit Est. Unit Previous Previous This This Total Total No. Quantity Price Quantity Amount Quantity Amount Quantity Amour Schedule A A01 Mobilization & Demobilization Schedule A Lump Sum 1 $7,315.00 A02 Traffic Control Schedule A Lump Sum 1 $6,000.00 A03 Pre -Installation Cleaning and Inspection Schedule A Linear Foot 5455 $1.70 A04 Excessive Leak Repair for Cured in Place Pipe Each 2 $500.00 A05 Furnish & Install8" Cured In Place Pipe Linear Foot 4111 $23.70 A06 Furnish & Install 10" Cured In Place Pipe Linear Foot 546 $36.40 Furnish & Install 8' Cured In Place Pipe in Limited Access A07 Areas Linear Foot 798 $23.40 A08 Reinstate Side Sewer Laterals Each 46 $85.00 A09 Post Installation Inspection Schedule A Linear Foot 5455 $0.80 Remove and Replace Concrete Channeling in Existing A10 Manhole Each 5 $900.00 All Sewer Manhole Rehabilitation Each 11 $1,930.00 Al2 CO #1 - Additional TV Inspection for Dye Testing Lump Sum 1 $998.25 A13 CO #2 - Additional Costs to install 6' CIPP Lump Sum 1 $9,289.48 CO #3 - Additional Vertical Feet and Diameter for MH A14 Rehab Lump Sum 1 S1,892.71 CO #3 - Additional Labor and Materials for MH 5317-197 A15 Rehab Lump Sum 1 $2,161.60 A16 CO #3 - Extra City Required Flagging Lump Sum 1 S2,134.10 A17 CO #3 - Extra Mobilization for Night Work Lump Sum 1 S8,192.80 Subtotal Schedule A 9.5 % Sales Tax Total Schedule A Schedule B B01 Mobilization & Demobilization Schedule B B02 Traffic Control Schedule B B03 Trench Shoring and Excavation Safety Systems B04 Minor Reconstruction of Culvert No. 2 Outlet B05 Pre -Installation Cleaning and Inspection Schedule B B06 Furnish & Install 12' Cured In Place Pipe Lump Sum 1 $7,315.00 Lump Sum 1 $5,300.00 Lump Sum 1 S475.00 Lump Sum 1 $4,000.00 Linear Foot 150 $2.00 Linear Foot 92 S103.00 0.80 $5,852.00 1.00 $6,000.00 3862.00 S6,565.40 0.00 $0.00 3791.00 S89,846.70 546.00 $19,874.40 798.00 $18,673.20 0.00 S0.00 0.00 $0.00 5.00 S4,500.00 11.00 $21,230.00 1.00 $998.25 1.00 S9,289.48 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 $182,829.43 $17,368.80 $200,198.23 0.80 $5,852.00 1.00 $5,300.00 1.00 $475.00 1.00 $4,000.00 141.50 $283.00 34.00 $3,502.00 0.20 $1,463.00 1.00 $0.00 1.00 1273.00 $2,164.10 5135.00 $0.00 0.00 $0.00 3791.00 $0.00 546.00 $0.00 798.00 46.00 $3,910.00 46.00 5135.00 $4,108.00 5135.00 $0.00 5.00 $0.00 11.00 $0.00 1.00 $0.00 1.00 1.00 $1.892.71 1.00 1.00 $2,161.60 1.00 1.00 $2,134.10 1.00 1.00 $8,192.80 1.00 $26,026.31 $2,472.50 $28,498.81 0.20 $1,463.00 1.00 $0.00 1.00 $0.00 1.00 $0.00 1.00 $0.00 141.50 S0.00 34.00 $7,315.00 S6,000.00 $8,729.50 $0.00 $89.846.70 $19,874.40 $18,673.20 $3.910.00 S4,108.00 54,500.00 $21,230.00 $998.25 $9,289.48 $1,892.71 $2,161.60 $2,134.10 S8,192.80 $208,855.74 $19,841.30 S228,697.04 $7,315.00 S5,300.00 $475.00 $4,000.00 $283.00 S3,502.00 Printed On: 07/11/2013 City of Renton Public Works Department Page 2 Sanitary Sewer Rehabilitation 2012 and Lake Washington Project_Blv_d_Pipe Rehabilitation Contract Number: CAG-12-106 Contractor: Insitutorm Technologies, Inc. Pay Estimate - 4 (Final)- - Closing Date:— -- 06/14/2013— - - Item Description Unit Est. Unit Previous Previous This This Total Total 807 Furnish & Install 18' Cured In Place Pipe Linear Foot 58 S137.00 58.00 S7,946.00 $0.00 58.00 $7,946.00 608 Post Installation Inspection Schedule B Linear Foot 150 $3.70 34.00 $125.80 109.00 $403.30 143.00 $529.10 B09 CO #1 - Replace failed 12' culvert Lump Sum 1 S54,374.69 1.00 $54.374.69 $0.00 1.00 S54,374.69 B10 CO #2 - Clean & CCTV 24' culvert Lump Sum 1 S165.00 1.00 $165.00 $0.00 1.00 $165.00 Bit CO #2 - Furnish & Install 24' Cured in Place Pipe Lump Sum 1 S36,055.86 1.00 $36,055.86 $0.00 1.00 $36,055.86 CO #2 - Asphalt Road Restoration for 12' culvert B12 replacement Lump Sum 1 $40,482.50 1.00 $40,482.50 $0.00 1.00 S40,482.50 Subtotal Schedule B $158,561.85 $1,866.30 S160,428.15 Total Schedule A (Incl. tax) & Shedule B $358,760.08 $30,365.11 S389,125.19 qW -1413 F sArq O i�f �y� tR89 a� NOTICE OF COMPLETION OF PUBLIC WORKS -CONTRACT - Contractor's UBI Number: 601880220 Date: 07/11/2013 Name & Address of Public Agency City of Renton 1055 South Grady Way Renton, WA 98057 UBI Number: 177000094 Assigned to: Date Assigned: Use Notice is herebv given relative to the completion of contract or project described below Project Name Contract Number Job Order Contracting Sanitary Sewer Rehabilitation 2012 & Lake Washington Blvd Pipe Red CAG-12-106 ❑ Yes El No Description of Work Done/Include Jobsite Address(es) Rehabilitate 5,135 linear feet of 8" & 6" concrete sewer main using Cured -in -Place Pipe. Multiple sewers were lined in Edmonds Ave NE, NE 7th Pl, NE 7th St, NE 8th St, Pierce Ave NE, Kirkland Ave NE, Bronson Way NE, Grandey Way NE, S 3rd St, Shattuck Ave S, and Talbot Rd S. Rehabilitate 216 feet of 18" & 12" storm culverts in Lake Washington Blvd and Taylor Ave NW. Federally funded road transportation project? ❑ Yes ❑� No Contractor's Name I Telephone Number Affidavit ID* Insituform Technologies, Inc. 303-791-7199 459046 Contractor Address 17988 Edison Ave., Chesterfield, MO 63005 If Retainage is Bonded, List Surety's Name (or attach a copy) N/A Surety Agent's Address Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted August 20, 2012 December 17, 2012 March 29, 2013 July 22, 2013 Contract Amount $ Additions ( +) $ Reductions (-) $ Sub -Total $ Amount of Sales Tax Paid at 9.500% 228,937.80 140,346.09 369,283.89 Liquidated Damages $ 0.00 Amount Disbursed $ 370,661.00 Amount Retained $ 18,464.19 (If various rates apply, please send a breakdown) $ 19,841.30 TOTAL $ 389,125.19 NOTE: These two totals must be equal Please List all Subcontractors and Sub -tiers Below: TOTAL $ 389,125.19 Subcontractor's Name: UBI Number: (Required) Affidavit ID* C-More Pipe Services Co 601854387 443496 Green Earthworks Const Inc 602576777 445228 W M Dickson Co 278045472 433711 Advanced Government Svcs Inc 602304323 447388 Asphalt Patch Systems 601290396 440616 Stripe Rite Inc 601048084 447211 National Concrete Cutting Inc 600195813 457028 Gary Reed & Sons Inc 602164346 458643 F215-038-000 07-2012 REV 31 0020e (07/06/12) Continued on page 2 Please List all Subcontractors and Sub -tiers Below: Subcontractor's Name: UBI Number: (Required) Affidavit ID* Doolittle Construction LLC 602351934 457673 Petersen Brothers Inc 600072474 456859 Comments: . Contact Name: Title: Email Address: Phone Number: tote: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. , 40 PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. lffidavit lD* - Provide known ones at this time. No LNI release will be granted until all affidavits are completed. submitting Form: Please submit the completed form to all three agencies below. For a faster response, please submit by e-mail. Washington State Department of Revenue Public Works Section PO Box 47474 Olympia WA98504-7474 (360) 725-7588 FAX (360) 664-4159 PWC@dor.wa.gov Washington State s Department of Labor and Industries Contract Release PO Box 44274 Olympia, WA 98504-4272 (360) 902-5772 FAX (360) 902-6897 ContractRelease@lni.wa.gov .dlw-- Washington State Employment Security Department < Registration, Inquiry, Standards & Coordination Unit PO Box 9046 Olympia WA 98507-9046 (360) 902-9450 Fax (360) 902-9287 For tax assistance or to request this document in an alternate format, visit http://dor.wa.gov or call 1-800-647-7706. Teletype (TTY) users may call (360) 705-6718. F215-038-000 07-2012 REV 31 0020e (07/06/12) Insituform Technologies, LLC. Change Order Request No. 1 Project: City of Renton, WA Additional Working Days Required: 10 Description: Extras Job No. 202160 Date: 16.13.13 Description UM Package TM Rate Amount $0.00 Subcontractor Total $0.00 Description Labor Package Rate Amount $0.00 $0.00 Labor Total $0.00 Description UNIT Quantity Price Amount Molecular Additional VF and Diam VF 8 211.24 $1,689.92 Molecular MH 5317-197 Additional L & M EA 1 1930 $1,930.00 TCS Extra Flagging LS 1 1905.45 $1,905.45 ITL Extra Mob per new nightwork notice EA 1 7315 $7,315.00 email form John $0.00 $0.00 $0.00 Materials Subtotal $12,840.37 Sales Tax % 0 $0.00 Materials Total $12,840.37 EQUIPMENT, LABOR, MATERIALS -TOTAL $12,840.37 MARKUP Percent 0 $0.00 0 $0.00 0 $0.00 SUBTOTAL $12,840.37 ITL MU 12 $1,540.84 0 $0.00 TOTAL AMOUNT ( Lump Sum) $14,381.21 Page 1 of 1 _ RE: MH 5317197 at the corner of bronson way and windsor way -Insituform John D. Hobson - - - - - ` to: 'Richard Gann' 03/27/2013 02:59 PM Hide Details From: "John D. Hobson" <Jhobson@Rentonwa.gov> To: 'Richard Gann' <RGann@insituform.com>, History: This message has been replied to. Have them fix it. Thanks. From: Richard Gann [maiIto: RGann(&insituform.com] Sent: Wednesday, March 27, 2013 2:40 PM To: John D. Hobson Subject: MH 5317197 at the corner of bronson way and windsor way - Insituform John, An FYI - Molecular has been out prepping the manholes and coming into changes in plan depths and diameters, they are using extra material and labor to complete the prep. All but one manhole has been brick in really bad shape. They are out at the above mentioned brick manhole prepping it for rehab. The bottom just above the south side of the top of the pipe coming in is in really bad shape, bricks are all rotten. Molecular can go ahead and repair this due to its location with extra material & labor. They are saying roughly twice the price to fix this one. If it was in the road they are recommending replacement, but because its where its at, they say they can fix it. Let me know what you want them to do. Thanks, Richard Gann Project Manager Pacific Region Insituform Technologies Cell-503.956.2406 This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the named addressee you should not disseminate, distribute, retain, or copy this e-mail or any attachments. If you have received this email in error please delete and notify the sender. file:///C:/Users/rgann/AppData/Local/Temp/notesC7AO56/—web8857.htm 6/13/2013 BASE QTY EA Plan VF -- Actual VF Base Price — - - — 11 $ 1,930.00 100.5 108.5 $ 21,230.00 CHANGE MH REHAB $/ft $ 211.24 Additional VF 8 Subtotal $ 1,689.95 Extra $ 1,930.00 MH $ 3,619.95 -- - - -- Molecular; Inc-. - - - -- - - - 247 Schutt Road, Castle Rock, WA 98611 Ph 360-274-4125 Fax 360-274-6736 Molecularinc 1 @msn.com CCB # 121211 - MOLECI*015NT April 9, 2013 Renton manhole sizes and depths: Plan depth Actual depth and diameter 5309225 11' 13' 5309227 11' 12' 5309203 6' 6' 5309398 9' 9' 54" 5039399 11' 11' 54" 5309400 11' 12' 54" 5309401 9' 12' 54" 5309402 9' 10' 54" 5317194 4.5' 4.5' 5317195 10.5' 10.5' 5317197 8.5' 8.5' Total 100.5' 108.5' Extra $1818.18 due to severe corrosion and extra epoxy and cement to structurally rehab manhole 5317-197 TOTAL Total $ 24,868.20 Page 1 of 1 Night Work John D. Hobson to: Richard Gann (rgann@insituform.com) 02/28/2013 07:48 AM Hide Details From: "John D. Hobson" <Jhobson@Rentonwa.gov> To: "Richard Gann (rgann@insituform.com)" <rgann@insituform.com>, History: This message has been replied to and forwarded. Richard, I've just been informed that our new policy for noise variances for night work requires a two week notice to residents prior to the start of construction. This means that our night work cannot proceed prior to Thursday, March 14. All day work can proceed as planned or as you may modify the schedule. I assume there will be a remobilization cost for alteration to the schedule. Let me know what we need to do to alter the schedule. Thanks. John 9ffobson Wastewater Utility City of Renton 425-430-7279 file:///C:/TJsers/rgann/AppData/Local/Temp/notesC7AO56/—web l469.htm 4/3/2013 TRAFFIC —CONTROL SERVICES P.O. Box 52665 Bellevue, WA 98015 425-658-3655 Bill To INSITUFORM TECHNOLOGY AN AEGION COMPANY ATTN: ACCT. REC./JILL NOBLE 17988 EDISON AVENUE ST. LOUIS, MO. 63005 Invoke. Date Invoice # 3/8/2013 7081 4L TRAFFIC CONTROL SERVICES P.O. Box 52665 Bellevue, WA 98015 425-658-3655 Bill To INSITUFORM TECHNOLOGY AN AEGION COMPANY. ATTN: ACCT REC.'JILL NOBLE 17988 EDISON AVENUE ST LOUIS, MO. 63005 Invoice Date Invoice # 4,412013 7184 1� I P.O. No. I Terms I Project I Net 30 I Quantity I Description I Rate I Amount I ic> , CN -- 13 Prevailing Wage Flagging/Setup Services, Standard Rate Lieu/Tay.�2 MoA I TSa'1 Mat 47.75 —62" >K 10 Prevailing Wage Flagging/Setup Services, Overtime Rate iN C ., Jr- 2- 71.62 716.20 3 EQUIPMENT TRUCK - PER DAY 9000 270.00 20 SIGN W'STAND - PER DAY 5.00 100.00 40 28" CONES - PER DAY 0.45 1800 1 LIGHT TOWER W/ GENERATOR - PER DAY 200.00 20000 3 MOBILIZATION CHARGE 22.00 6600 Job Dates: 3/27 & 3/28/13 Job Address: Kirkland Ave, Lind & Taylor Renton Job # 202160 Flaggers- Johnson, Siler, Tyler Sales Tax 0 00% 0.00 Total T-Sr--9w1J5- 1.370..'ZU Green Earthworks Construction, Inc. 5001 So Tyler St Tacoma, WA 98409 253.606.8787 fax 253.220.2621 Bill To Insituform Technologies, Inc 17988 Edison Ave Chesterfield, MO 63005 Sanitary Sc"er Rehabilitation 2012 and Lake Washington Blvd Pipe Rehabilitation Renton, NVA Invoice Date Invoice # 4/5/2013 10147 Job Number Insituform-127-04042013 Date Quantity Description Rate Amount 4/3/2013 1 Stiping of N. Lake Washington Blvd. from Culvert 4,017.39 4.017.39T #2 Replacement. Includes Traffic Control Subtotal $4,017.39 Insituform PM Corey George � I Sales Tax (0.0%) $0.00 Total $4,017.39 www.GreenEarthworks.com " DAILY TIM-� CARD TRAFFIC CONTROL SERVICES A Professional Flogging Service P.0 Box 52665 . Bellevue. WA 98015-2665 (425) 658-3655. 1 (800) 766-5272 PLEISEPRLSSHARD __ }mr one mukn;q j rnpres CITY STATE IN OUT IN TOTAL HRS TOTAL HRS (LUNCH) (LUNCH) OUT REGULAR OVERTIME MINIMUM •�.,�.� .;�� SHOW TIME TOTAL HERE HOURS lOB ORDER NUMBER / NAME IMPORTANT FOR CLIENT. By exeCLbor of rhts form clieri ce 4Les mat hours shown are correct, work wos done sofrsfoctorty. and tot teen, ogress to me rerms and condlnors on the reverse srcoe of this form COMPANY N4hK -- e 1 SI �Gf C YLlli1 JOB LOC N / -_ MILEAGE /rrr-I CITY - t Aetn FLAGGING PART(yERM I--- `— DAILY TIME CARD TRAFFIC CONTROL SERVICL. A Professional Flagging Service %/ P 0 Box 52665 • Bellevue, WA 98015-2665 F� (425) 746-1060 9 1 (800) 766-5272 PLEASE PRW HARD ) rw are nurkir;g j Fs , D ^ - - SETUP 7RUCK ("—C11111 L �c Y ' IN OUT IN out TOTAL HRS TOTAL HRS (LUNCHI (LUNCH) REGULAR OVERTIME MINIMUM >c „K„•„ lip ,a SHOW TIME TOTAL ' HERE HOURS DERNUMBER JOBOR��v V 960- V X AU'HORf DS:GNATUW - IMPORTANT FOR CLIENT: By executor, of this four client certrnes mot hours shown ore correct. work wos Clone sortsfoctonly: ono shot Arent agrees to the terrtY, and Conditions on Ple reverse sde of this form j�i(l t r-- HEADQUARTERS - Ave- lewi AGGING PARTNFR(S) —1- MUWLZP.TKM ••••• ••• - /� NKJWULATIUN / NOPArAG -- --� - BARRELS-- BARRICADES - ---- -- - I CONES---- - -.._ - r _ BA—RRICADE� CONES _ ARROW BOARDS __--... VMS/TMA --- �-� -- ARROW BOARDS --- -- - OTHER - -- — \NERATOR W/LIGHT / 1HFR --- GENERATOR 4yf/ T X i X YC'J ID cl(--NGT WF HFpC. _-.-..,__.. — V OGR SGNATURE HERF Y m: I X X -fl n 0 W Z a oT ;( D > noz �c zl m r z T; c-- 0 - \ �i � 1.)3 1 n f n�DT^I p m T _T Z o' pPPQ N r-d t�►. R z v C`nn� �(.71 �) of n� Da '-,- 0 0 n z c O r-1 ° w 8�� r L I3H a�J J NNE DAILY TIME CARD TRAFFIC CONTROL SERVICES A ProfessrorxN Floggzrg Senate P O Box 52665 • Bellevue, WA 98015-2665 (425) W-3656. 1 1800) 766-5272 PGFASEPRMflARO h rx,, tN TCwurn noruEn iW:N� Q1RrClq OUT KOO" OV9111 SNOW TI HERE X AU 4 -WNRE X wry IMPORTANT FOR CLIENT &I OWUII� f INC—J cW"- I apt tlotyT d— b! C--, w4 rX8 my -W slaty, 0,0 "0' ~1 Cols to "41-- —.,r —fh—LwaRye,— X WEr i; Tuii 47E-------- DO NOT WRITE BELOW THIS LINE. 7--- Fot TCS Office us* only I FILE COPY DAILY TIME CARD .1 liviE %-p%LX" TRAFFIC CONTROL SERVICES TRAFFIC CONTROL SERVICES A Proteosomil Flogqng Sefvce P 0 Box 52665 - Bellevue WA 98015 2665 A Profesponov FloggdV Sewca P 0 Box 52665 - Bellevue, WA 98015-2665 (425) 746-1060 - 1 (800) 766 5272 (425) 746-1060 - 1 (800) 766-5272 XWE PRM H.4RD PIAMPRWHARD L ik i I A IN (Zh) OUT 10TAl HR3 MIAL M ra;4"R R w IN mi OU: iI UNC H) Zi UNC� TOMIL"n TOTAL Hii, INGULAR OVEMM 14 f OANIPAUM vm�llmf � � 11 P.o w T*A1 1101AL 1 IME ' T A10HORIZED SGNAYAd IMPORTANT FOR CLIENT. IMPORTAN7"CLIENT: r�n 010� C" CO-C' V"k V,05 0� MWOCIOny. Ono ctont cjpd to clom 00", k� I 1�.M form t-� ca-d � — " �w we 019. k", 4 -K) AkA-AADaWtCR5 'or 7 A F 0!:z WIPWNI�UST EOUIPMmm j--00UATcw CAW — 1COP45 W = w, ok'ur* Z DO NOT WRITE BELOW THIS UNE. DO NOT WRITE BELOW THIS LINE For TCS Office use only. For TICS Office use only. C�� PA� 11w FILE COPY FILE COPY ` LJtvlLI i llvlr, l.ti1111 TRAFFIC CONTROL SERVICES A Professional Flagging Service P O Box 52665 • Bellevue, WA 98015-2665 (425) 746-1060 • 1 (800) 766-6272 PISMSE PRESS HARD )vu are mukrng5 copies D DATE SET UP TRUCK STATE C1 L C�^Cl� IN I OUT I IN OUT I TOTAL MW TOTAL HRS (LUNCH) (LUNCH) REGULAR OVERTIME MINIMUM SHOW TIME IL4.,^, TO AL HERE_ HOURS --� — JOB ORDER NUMBER JOB NA — X AUTHORIZED SIGNATURE IMPORTANT FOR CLIENT: By exocut,on of this form, chant cert6es thol hours shown are correct, work was done sattsfoctofay, ana that chant agrees to the terms and con()irons on the reverse we of the form q K D X @'BO c R o p j Z a o T 90 z r c 3 a m 0 Z o� r m$< Kom 33c a3 n n R �m o� iJt�1L1 1, 11V11: L C11\iJ TRAFFIC CONTROL SERVICES A Professtonol Flogging Service PO Box 52665 . Bellevue, WA 98015-2665 (495)7dtS-IW. 1 (Ann)7AA-..,777 X AUTHORZED SIGNATURE - -- --_-- IMPORTANT FOR CLIENT: By execution of tars form, ckent cearres thor hours shown are correct. work was done sotatactonly. and that cient agrees to the terms and cand-tions on the reverse side a! this form i OMPANY N E I AREA FiEA06UAR1ETt5 — � MIEAGE tam " ING PARTNERS) —-'—"---- - - ---- EtARRELS �L-� RADIOS BARRICADES - CONES -TOTHER i GENERATOR W/LIGHT yp, SIGNATURE HERE O �f aODT N x r�� V N 0 0' 0 .60 �m o z ►� s a� 80 "> tTi c i �om ui N ' 0 TTTm777 N % N da n m y DAILY TIME CARD TRAFFIC CONTROL SERVICES A Pro!esaonal Flogging Service P O. Box 52665 • "tovue. WA 98015-2665 (425) 658-3655. 1 (800) 766-SR72 PLELSE PRESS HoW Ia en mnkugt S rtlarer Y1N tc'_y OJr h T0IAL MR! TOM/M3 N (LtDK'M a WYH) YEGUTAR OVERTIME NEB DAILY TIME CARD TRAFFIC CONTROL SERVICES A Polessrona FloWng Service P O Box 52665 • BeYevue. WA 98015-2665 (425) 746-1060 • 1 (800) 766-5272 PLFa.iE PRESS' ly II>vr an nak ,{I t rufn) CUT IN OUT TUTAN . E)TALME i 0.UNCHi (tV{rq EEGUTAt i OVBflIMI ++IOW TMIE your NHtE X _ X IMPORTANT FOR CLIENT: ermac.nmanara,r wgrrcertmtirrUr qq IMPORTANT FOR CLIENT: By..earcn i"tam.cw•fcewn v + trap a var ae c-t r k v anr. SOWMI" arp Rapt C9arr• OVOp b 1 RVIIa rtwn OM e V rYe l �rt ..m oma fen1O y[xxv. oW tpr yisn, Ogee •e t'ru fan Ma Ca%1iCY6On Ire rP.4'M Yfv U,np tdm +ne rpm, arc corraMau ar fro ro+kw W a rta Iv, NAME aL1 Y11 - AREAiiA - R_--- B Iocica+ u - � cE w lA<:E - - CrIv NGR/MRINER[Si - =-FlkiNERIS)/ �� jrI f-• —30 l r _ DO NOT WRITE BELOW THIS LINE For TCS Office use only 1FILE COPY t. - -- cam- IT --- �E�rtnror�F `Ql'Q 7CiNA111IA DER! DO NOT WRITE BELOW THIS LINE. For TCS Office use or*y. -1 f ('� s " FILE COPY _ PLANNING/BUILDING/PUBLIC WORKS DEPARTMENT Renton City Hall 1055 South Grady Way, Renton, WA 98055' 7 ® UTILITY SYSTEMS DIVISION 425.430 7234 Fax: 425.430.7241 ❑ TRANSPORTATION SYSTEMS DIVISION 425-430-7321 Fax: 425-430.7376 TO: ,� _ „i,/ DATE: IVAy /3 JOB No. RE: NA",1 .sGv �Ti=is�i)? 2�'Lriol? ZED/� A % .ram i.PG A, .SaJ/f2F: / WE ARE SENDING YOU ❑ ATTACHED ❑ SHOP DRAWING ❑ PRINTS ❑ COPY OF LETTER ❑ ❑ Under Separate Cover via the following items: ❑ REPRODUCABLE PLANS ❑ SPECIFICATIONS ❑ ORIGINALS COPIES DATE NUMBER DESCRIPTION / REMARKS MESSAGE: These are transmitted as checked below: ❑ FOR SIGNATURE APPROVAL ❑ ❑ FOR YOUR USE ❑ ❑ AS REQUESTED ❑ ❑ FOR REVIEW AND COMMENT ❑ Copies to: APPROVED AS SUBMITTED APPROVED AS NOTED RETURNED FOR CORRECTIONS From: ❑ ❑ ❑ ❑ RESUBMIT COPIES FOR APPROVAL SUBMIT COPIES FOR DISTRIBUTION RETURN CORRECTED PRINTS PRINTS RETURNED AFTER LOAN TO US IF ENCLOSURES ARE NOT AS NOTED, PLEASE NOTIFY US AT ONCE. PBPW5001 09/99 bh (6) insituform From ► Insituform Technologies, LLC Denise Carroll 17988 Edison Chesterfield, MO 63005 To ► 10(n Yfobson Wastewater Utility City of Renton 425-430-7279 LETTER OF TRANSMITTAL Our Telephone ► 636-530-8064 or 800-325-1159 FAX ► 636-530-8701 dcarroll@insituform .com Date No. 5/7/2013 Job Number ► Attention No - Reference ► Change order No. 2 WE ARE SENDING TO YOU THE FOLLOWING: x Attached. ❑ Plan(s). ❑ Videotape(s). ❑ Shop Drawing(s). ❑ Change Order(s). ❑ Project Report(s). ❑ Copy of Letter. ❑ Inspection Report(s). ❑ Bid Documents ❑ Prints. ® Contract(s). ❑ Following Items Under Separate Cover Via ❑ Other — NO. OF COPIES DATE NO. OF VOLUMES DESCRIPTION 2 1 Signed change orders REMARKS ► Please returned executed change order to me at the above address. Call me if you need any additional information or have any question at 800-325-1159. Thank you and we look forward to working with you on this project. Delivered By ► Received By No. Date ► Date ► Copy To ► Signed By ► 06/12/00 DOC ID: COR/FRM-DTM-01 EFF. DATE: 07/01/00 APPROVAL: CO. MGMT. REP. ON FILE PLANNING/BUILDING/PUBLIC WORKS DEPARTMENT Renton City Hall 1055 South Grady Way, Renton, WA 98055' / 7 0 UTILITY SYSTEMS DIVISION 425.430 7234 Fax: 425.430.7241 ❑ TRANSPORTATION SYSTEMS DIVISION 425.430-7321 Fax: 425-430.7376 TO: �AJS�TcIFOIti✓/�c�A iI./r DATE: r�r�4 ��j zpj3 JOB No. �1c2 o A4.r�IJ0�7" A�ap-� Suite / RE: WE ARE SENDING YOU ❑ ATTACHED ❑ SHOP DRAWING ❑ PRINTS ❑ COPY OF LETTER ❑ ❑ Under Separate Cover via the following items: ❑ REPRODUCABLE PLANS ❑ SPECIFICATIONS ❑ ORIGINALS COPIES DATE NUMBER DESCRIPTION / REMARKS ��2 �..�.� Ctrs o,c /�"➢vTD�./s �A.✓iTA�2�i S�✓�7z �1a.4l3it�irLlTin� Z!J/Z �n L.ud/t�� �•� LHin�c-rs+../ /1 MESSAGE: These are transmitted as checked below: ❑ FOR SIGNATURE APPROVAL ❑ APPROVED AS SUBMITTED ❑ RESUBMIT COPIES FOR APPROVAL ❑ FOR YOUR USE ❑ APPROVED AS NOTED ❑ SUBMIT COPIES FOR DISTRIBUTION ❑ AS REQUESTED ❑ RETURNED FOR CORRECTIONS ❑ RETURN CORRECTED PRINTS ❑ FOR REVIEW AND COMMENT ❑ ❑ PRINTS RETURNED AFTER LOAN TO US Copies to: From: IF ENCLOSURES ARE NOT AS NOTED. PLEASE NOTIFY US AT ONCE. PBPW5001 09/99 bh ELECTRONIC FUNDS TRANSFER DEPOSIT AUTHORIZATION AGREEMENT City of Renton, Alln: Casaundra Commodore, Accounts Payable, 1055 South Grady tPay, Rental, Washington 98057, 425.130.6918 Agreement instructions: 1. Fill in the COMPANY NAME as it appears on the company's accounts payable check. Provide the company ADDRESS and PHONE NUMBER. 2. Provide the company FEDERAL TAX ID NUMBER. 3. Provide your company's City of Renton VENDOR NUMBER. This number is noted on checks from the City of Renton. Or, call 425.430.6919 or 430.6930 for the vendor number. 4. Provide the checking account name(s) that are on your company's BANK ACCOUNT. Write the account name(s) exactly as it / they appear(s) on your bank account statement. 5. Provide the checking account BANK NAME, the bank's customer service 800 PHONE NUMBER, your BRANCH NAME, and the BRANCH PHONE NUMBER. 6. Provide the account's bank ROUTING NUMBER and checking ACCOUNT NUMBER. These numbers are at the bottom of each check. Provide a voided check for verification. 7. Fill in the authorized person(s) name(s) on the statement below, which statement gives the City of Renton the authority to make EFT direct deposits to the subject bank account. 8. Have the authorized person(s) provide their SIGNATURE and DATE below. Also provide the PRINTED NAME of the authorized person(s), and their TITLE. 9. RETURN this original, fully completed and signed EFT Deposit Authorization Agreement, along with a voided check (as noted in item 6), to Casaundra Commodore at the address shown above. 10. The payment remittance will be sent by email only. There will be no paper payment remittance sent by mail. Company Name Jy\s;y1FDrrn _ rQ ch v o l of i eS L-L G Address: 1-7 Qj 0 son 1\1 e . Phone # (956 - s3 O - $ 6 S7 Federal Tax ID # 13 3 O S Z I C °y Vendor # 03`736, p Name(s) on Bank Account ( A s 1 tv 4 e- rti Te C w o 1 o q ie's Second Name, if applicable 111rite name(s) exactly as it 'they appear on the bank account. Bank Name U tt Co SS 800 Phone # /- 6 o 0 - Z 3 .-I/ j Branch Name Branch Phone # Checking Account Routing # 3 b 10 S4 % Provide email address for payment remittance (see item 10 above) Account # Z S'z. o$ 3 7 -7 SS 0,CCfiS reCe;vC,bl�_Cz—(,%si-fvfotrn.Ct i Important reminder: You must attach avoided check from your checking account. Tliis is required for vel-ificatioti of the accuracy of your account information. All bank account information is kept confidential! I / we, and hereby give to the City of Renton the authority to make EFT direct deposits to the bank account described above. I / we understand that if this EFT agregment is to be changed or canceled in any way that I / we must provide 30- day advance written notice to the City -of Renton at the above address. Z- Authorized Signature ! �l';"i,''�,1 ={ .� ( tJ /'�,�.y� Date �— Printed Name \<'1Q./h t1A \(p to 1 Title Ce f res idkevi+ -TreaSv rem Authorized Signature Printed Name Title Date DC/F1S/EFTAuthFomi/bh 10/01/2008 Request for Change Order lnsituform Date: 02.13.13 Tec1 n.olop#es; Ire Client Job Description City of Renton, WA Furnish & Install 15" CIPP for Storm Sewer 2012 Sewer Rehab. on Taylor Place Job Number 202160 Project City of Renton 2012 Sewer Rehab Project TM Description Quantity Price'Rate Amount One CIPP Install Day EQUIP Daily Equipment 1.00 DY $ 5,000.00 $ 5,000.00 EQUIP Add1 Safety Equip. & Training 1.00 LS $ 7,500.00 $ 7,500.00 LABOR Avg. Labor (6 man crew x 15 hour day) 90.00 HRS $ 58.00 $ 5,220.00 LABOR Lodging + Per Diem (6 employees) 1.00 DY $ 810.00 $ 810.00 SUB Traffic Control 1.00 DY $1,500.00 $ 1,500.00 MATER. Liner: 15" x 9mm (thickness per design calcs) 85.00 LF $ 18.43 $ 1,566.55 66 ft length of culvert 11 ft depth upstream SDMH 5 ft installation equipment 3 ft extra length MATER. Liner Shipping - 1 /2 Freight Trip Charge 1.00 LS $ 6,000.00 $ 6,000.00 SUB Grout End of Pipe w Drain Holes 1.00 LS $ 2,450.00 $ 2,450.00 20% Markup on Total 1.00 LS $ 6,009.31 "Grout Sampling & Testing Not Included "CIPP Sampling & Testing Included Total $ 36,055.86 Change Order Accepted By. �K Date: 3 4 or J, P(� u.Uinv . Insituf+vrm technologies, InG Client City of Renton, WA 2012 Sewer Rehab. Job Number 202160 Request for Change Order 3 Date: 02.04.13 Job Description CCTV 15" to 24" Storm Line Project City of Renton 2012 Sewer Rehab Project TM Description Quantity Price/Rate Amount Clean and Televise 24" Storm Culvert @ Taylor Ln 66.00 LF $2.50 $165.00 Final Field Length: 66 ft Final Cost Will Be Based On Actual Footage Total S 165.00 Change Order Accepted By: �Ylx' Date: -- 7-ZZ:i:3 (9) Insituform Client City of Renton, WA 2012 Sewer Rehab. Job Number 202160 I echnologies, Inc. Request for Change Order Date: 02.04.13 Job Description Lines under bid item A07: 8" CIPP (limited access) are acutally 6" in diameter. This CO will cover difference in cost. Project City of Renton 2012 Sewer Rehab Project TM Description Quantity Price/Rate Amount One Additional Install Day EQUIP Daily Equipment 1.00 LS $3,500.00 $3,500.00 LABOR Labor (6 man crew x 10 hour day) 60.00 HRS $58.00 $3,480.00 LABOR Lodging + Per Diem (6 employees) 1.00 LS $810.00 $810.00 MAT Difference In Liner Price 798 LF $ (0.81) ($646.38) 6" Liner Cost/Ft : $6.29 8" Liner Cost/Ft : $7.10 EQUIP Shipping Charge for 6" Robot 1.00 LS $250.00 $250.00 Labor Markup (29%) 1.00 LS $1,244.10 Material & Equipment Markup (21%) 1.00 LS $651.76 Total $ 9.289.48 Change Order Accepted By: Date: 2-C/ Insituform Technologies, Ins Client City of Renton, WA 2012 Sewer Rehab. Job Number 202160 Request for Change Order 2 Date: 01.14.13 Job Description Dye Testing on Kirkland Ave. Project City of Renton 2012 Sewer Rehab Project TM Description Quantity Price/Rate Amount Dye Testing for Kirkland Ave 10% Insituform Markup on Subcontractor Work 1.00 LS 1.00 LS $907.50 $90.75 $907.50 $90.75 Total $ 998.25 Change Order Accepted By: . ( �/— Date: Z-7 - Zo/3 C-More Pipe Services Co. PO Box 69 Rickreall, OR 97371 Phone/Fax: 503-623-1319 TO Bernie Camacho Insituform Technologies, Inc. 8620 Antelope North Rd. #1 Antelope, CA 95843 INVOICE INVOICE # 12-1094 DATE: JANUARY 9, 2013 Approved for payment -Bernie Camacho 1/9/13 JOB PAYMENT TERMS DUE DATE #1094 - City of Renton Due on receipt 2/3/2013 PO #2616626 QTY I DESCRIPTION 1 Mobilization/Demobilization of TV Van Et Cleaner Truck (Pre - Clean) 522 Labor Et Equipment to Clean/TV 6" pipe 342.5 Labor It Equipment TV 6" pipe 3731 Labor Et Equipment to Clean/TV 8" pipe 780 Labor Et Equipment to Clean/TV 8" pipe - limited access 540 Labor Et Equipment TV 10" pipe 282 Labor Et Equipment Clean 10" pipe 47 Labor Et Equipment to Clean/TV 12" pipe 57 Labor Et Equipment to Clean/TV 18" pipe 5.5 Labor Et Equipment to Dye Test " Change Order Item -- Make all checks payable to C-More Pipe Services THANK YOU FOR YOUR BUSINESS! UNIT PRICE LINE TOTAL , $165/hr $907.50 SUBTOTAL $11,686.00 SALES TAX NA TOTAL $ 11,686.00 (C) 1FRff t Ff+ WT" .ti t. /iu_ City of Renton - Sanitary Sewer Rehab. 2012 & Lake Washington Blvd Pipe Rehab C.O.#1 Cb6-1Z-io(p CHANGE ORDER ITEMS TOTAL Culvert No. 2 Change Order Work $ 65,246.72 Cost of Lost 12" CIPP Liner ($11.51 X 66 FT) $ 759.66 (52 FT Culvert Length + 6 FT MH Depth a 5 FT Equipment + 3 FT Extra) Insituform FE Labor (3 Hours x $103.00) $ 412.00 GEC Billing In 2012 Total Amount per GEC Billing Material $ 6,916.92 Labor $ 7,042.02 Equip. $ 16,948.43 Subcontractor $ 19,231.95 Insituform Markup (10%) $ 4,235.37 �) t/ 2012 TOTAL $ 54,374.69 GEC Billing In 2013 Total Amount per GEC Billing Material $ 1,001,78 Labor S 3,758.22 Equip. S 2,726.21 Subcontractor S 1,860.60 Insituform Markup (10%) S 765.56 2013 TOTAL S 10,112 37 6" CIPP Lines (RCO #1) $ 9,289.48 lS� Dye Testing Kirland Ave (RCO #2) $ 998.25 .S CCTV 15" to 24" Storm Line (RCO #3) $ 165.00 v TOTAL $ 75,699.45 �p4S&'T,1P-VWwi MAf2-KL 11- 'S VIo 0FTWaQ. S.1a"'-' -'R-AC-rb12 S C6Xet'"j EAIZI?IWr,(Z�CS� i3%►Sic CoS-r' SE' A r•rAcN2A C-AL-c-,7LA vj.,4 �11�i. M� To7AL L-,?Ilp S''m r4 TLJ,,p WAS Av .� � ►.�� 3`f C. 1'r v c 1 .✓ Ckswc.E ba-�o2 fJ� . I (W OR-w- c. P&Iro tni Z0 z> V -Fill S L'.),nop S.. r., li Ta►•1 Vl-.f Aii-erveD QY Cr.--r o P il-�-.L C)cr,F';-' AE>. Z ` I Cto m o ►: ` \ �TLS Lamp Su.� (�M VAAS A1''Rt7�t�b �y C't-�'� �+_ �rl 4— ���Z l�� •r+i Sri 2v4 ® T, s Lx,v —<,n 1 Tw)n W A-s / fl4:;v---Yo C-Lrr r dial Ct0146,l�-7 c—Q (\�• 2 Htsituform 7i'rltt2ulnrnGe`! s h brt. City of Renton - Sanitary Sewer Rehab. 2012 & Lake Washington Blvd Pipe Rehab C.O.k 1 - Remove & Replace Culvert No. 2 Data Summaries Summary of Costs for Culvert No. 2 Change Order in 2012 Daily Breakdown Row labels_ _Sum of To_bl Cost _ Sum of GECs Billing Aker Markup - -_ 12/26/2012 _ _$_ _ 19,1_20.41 _$ _ _ _ _-- 22,814.7_1 Euipment $ 10,95S.77 $ 13,256.48 Labor $ 1,477.08 $ 1,905.43 Materials $ 1,909.04 $ 2,187.73 Subcont. <251, $ 4,879.52 $ 5,465.06 12/27/2012 $ 11,612.19 _$ _13_631.7_6 Euipment $ 1,392.32 $ 1,684.71 Labor 5 1,943.20 $ 2,384.19 Materials 5 2.073.41 5 2,508.83 Subcont. <251K $ 6,298.26 $ 7,054.05 12/22/2012 $ 11,621.14 $ 13,692.95 Euipment _ $ 1,658.89 $ _-_2,007.24 Labor $ 2,133.65 $ 2,752.41 Materials $ 1,835.01 $ 2,220.36 Subcont. <25r $ 54993.60 $ _ _ 6,712.83 Grand Total $ 42,353.74 $ 50,139.32 Summary of Costs for Culvert No. 2 Change Order in 2012 Breakdown by Markup Cost Type Row labels Sum of Total Cost Sum of GEC's Billing After Markup Euipment $ ----- 43 12/26/2012 $ 10,955.77 5 13,256.48 12/27/2012 5 1,392.32 $ 1,684.71 12/23/2012 $ 1.659.88 $ 2,007.24 Labor $ $ _. 12/26/2012 _5,458.93 $ 1,477.08 $ __7,042.02 1,905.43 12/27/2012 $ 1,948.20 $ 2,384.18 12/28/2012 $ 2,133.6S $ 2,752.41 Materials_ $ 5,716.46 $ 6,916.92 12/26/2012 _ _ _ $ 1,903.04 $ _ _ 2,187.73 12/27/2012 $ 2,07341 $ 2,508.83 12/28/2012 $ 1,835ol 5 2,220.36 Sub-1. <2SK $ 17,171.39 $ 19,231.95 12/26/2012 $ 4,679.52 $ 5,465.06 12/27/2012 $ 6,298.26 $ 7,054.05 _ 12/28/2012 $ 5,993.60 $ 6,712.1 Grand Total _ $� 42,353.74 $ 50,139.32 Summary of Costs for Culvert No. 2 Change Order in 2013 Daily Breakdown Ro_w labels _ __Sum of Total can _Sum of GEC__! Billing ANer M_ arkup_ _ $ 2,230.75 $ _ _ _ _1/15/2013 Materials $ _ _ _ _ _ _ 569.50 $ _ _2,549.70 689.10 Subcont. QSa $ 1,661.25 $ 1,860.60 1/16/2013 $ $ 4,499.71 _ Euipment _ 5 _3,603.07 1,854.22 $ 2,243.61 Labor $ 1,624.95 5 2.096.19 Materials $ 123.90 $ 149.92 1/24/2013 $ 1,010.63 $ _ _ 1,274.39 Euipment $ 231.91 $ 280.61 Labor 5 644.20 $ 831.02 Materials $ 134.52 $ 162.77 2/1/2013 $ 821.15 $ 1,033.02 Euipment $ 166.95 $ 202.00 labor $ 644.20 S 831`02 Grand Total $ _ 7,655.59 $ _ 9,346.82 Summary of Costs for Culvert No. 2 Change Order in 2013 Breakdown by Markup Cost Type Ro_w labels_ Sum of Total_Can Sum o/GEC's Billing Aker Markup_ --Euipment --$__ 2,253.07 $ -_ _ - -� _ 2,726.21 1/16/2013 $ 1,654.22 $ 2,243.61 1/24/2013 $ 231.91 $ 290.61 2/l/2013 5 166.95 $ 202.00 Labor_ $ 2,913.35 $ 3,7S8.22 1/16/2013 _. $ .__..___ _ _ .. 1,624.95 $ 2,096.19 1/24/2013 $ 644.20 $ 831.02 2/l/2013 5 644.20 $ 831.02 Materials $ 827.92 $__ 1,001.78 _ 1/15/2013 5 _ _ _ _ _ _ 569.50 5 _ 689.10 1/16/2013 S 123.90 $ 149.92 1/24/2013 $ 134.52 $ 162.77 cont. <25K 1,661.25 $ 1,860.60 _Sub 1/15/2013 _$ $ 1,661.25 $ 1,860.60 _. al ___ Grand Tot .. . $ __.__ ___ 7,fi55.59 Insituform 7(rchn,)bkrit"I;- ( :ail: hw City of Renton - Sanitary Sewer Rehab. 2012 & Lake Washington Blvd Pipe Rehab C.O.# 1 - Remove & Replace Culvert No. 2 Data Summaries Insituform Markup for 2012 Total Bare Cost to Date Summary Row Labels Sum of Total Cost _ "'21/2"1' $ , 11,111.71 .127/2012 $ 1.392.32 12/28/2012 $ 1,65818 labor _ $ _ 5,458.93 12/26/2012 5 1.477.08 12/27/2012 5 1, 141.11 12/28/2012 $ 2,133.65 5,716.46 _Materials_ __$_ 11,21/1111 _ $ 1,101.14 12/27/2012 $ 2,073.41 12/28/2012 $ 1,835.01 Q Subcont. SK $ 17,171.38 12/26/2012 $ 4,879.52 12/27/2012 $ 6,293.26 12/28/2012 $ 5,993.60 Grand Total $ 42,353.74 Markup% > WX $ 4,235.37 Insituform Markup for 2013 Total Bare Cost to Date Summary Roar labels _ Sum of_ Tm_al Cost Eulpment $ _ 2,211.01 1/16/2013 $ 1,954.22 1/24/2013 $ 231.91 2/1/2013 $ 166.95 Labor $ 2,913.35 1/16/2013 - $ 1,624.95 1/24/2013 $ 644.20 2/1/2013 $ 644.20 M_aterlals $ 1/15/2013 __827.92_ $ 569.50 1/16/2013 $ 123.90 1/24/2013 $ 134.52 Subcont <25K $ 1,661.25 1/15/2013 $ 1,661.25 Grand Total _ $ 7,6s5,59 Markup% � 101G $ 765.56 o I•, ! +o.ejc S..7aI lx , ml ml° I ,S hls, i �i�l�• " �e!x xl x�alxix x � � � r x � x'e x xi xixx!x �j�i�{�•x x,�elx x x!x 'x x'.xj� x� �Ix,x x x x x xlxx,xjx: x 8�. . I I EI E'EI I IEI€! I€ I"i i. i IE I ` Ii Ic18 I' f Ip EI 1 EI'jI EI ci EI. I. ! i �l n n 8 $,8 n! 8 xj8 SI n I 1 I n 818 !�� , I I I hj h,h�h,�l=jhi 11nfl1 ,.Ia a j a a a a I a a a m a m•9�„ C, CI 1 IC C C'CICi C' 'C !C'Ci I C SIC C C, CI SIC CICC �. C! 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6.90 6.77 8.19 9.07 9.47 10.07 12.68 13.72 14.BB 16.14 17.33 19.30 20.74 21.53 22.39 23.45 24.45 25.46 26.76 27.93 29.03 29.82 30.68 31.59 32.55 33.50 34.44 35.50 36.51 37.60 38.96 40.03 40.92 42.07 43.38 7.00 7.48 7.53 8.98 9.85 10.51 11.51 13.83 14.94 16.32 17.77 19.16 21.46 23.13 24.15 25.21 26.28 27.40 28.70 30.01 31.05 32.11 33.23 34.25 35.44 36.56 37.80 38.94 40.17 41.30 42.53 44.08 45.31 46.44 47.71 49.26 50.15 51.36 52.26 53.62 55.07 56.39 7.46 8.04 8.73 9.67 10.06 11.08 11.20 12.46 13.68 1205.13.28 15.03 12.96 14.49 16.02 15.19 16.77 18.90 16.56 18.43 20.14 18.14 20.04 21.92 19.68 21.75 23.71 21.26 23.43 25.40 23.83 26.20 28.84 25.60 28.06 31.01 26.79 29.32 32.62 27.86 30.64 33.98 29.12 32.08 35.38 30.29 33.54 36.73 31.81 34.95 36.36 33.25 36.42 39.99 34.43 37.56 41.28 35.61 39.36 43.05 36.87 41.04 44.77 38.21 42.85 46.53 39.48 44.04 48.02 40.81 45.20 49.49 42.12 46.47 50.91 43.48 47.70 52.39 44.76 48.86 53.88 46.11 50.11 55.34 47.47 52.04 57.45 49.20 53.84 59.44 50.65 55.48 61.18 51.88 56.90 62.93 53.41 58.52 54.68 54.76 60.34 66.69 56.12 61.54 68.05 57.36 62.90 69.39 58.47 64.09 70.74 60.02 65.70 72.56 61.47 67.26 74.29 62.97 68.86 76.06 67.29 73.53 81.04 68.36 74.75 82.62 70.08 76.59 84.46 71.38 78.02 86.03 72.77 79.55 87.60 78.03 85.00 93.52 80.84 87.92 96.50 83.57 90.86 99.51 88.86 95.67 ##### 96.69 102.82 ##### 99.22 104.94 ##### ##### 107.01 ##### ##### 143.00 ##### ##### 115.94 ##### ##### 118.93 ##### 16.15 17.30 18.74 20.36 21.17 23.36 22.78 25.08 24.72 27.01 26.75 28.97 28.76 30.91 30.88 33.30 32.99 35.65 34.43 37.46 36.08 39.08 37.82 40.76 39.55 42.45 41.35 44.48 43.08 46.52 44.55 48.20 46.33 50.04 48.12 51.87 49.89 53.62 51.52 55.48 53.17 57.29 54.89 59.16 56.56 61.01 5817 62.86 5187 64.71 62.07 66.98 64.21 69.16 66.07 70.99 67.86 72.86 69.71 74.75 71.91 77.00 73.52 78.72 75.13 80." 76.66 82.18 78.74 84.36 80.81 86.56 82.88 88.71 86.49 92.58 88.17 94.38 90.19 96.52 91.87 98.32 93.52 ##### 99.66 MO 102.77 N##lt# 105.90 ##### 110.92 ##### 118.54 ##### 120.83 ##### 123.13 ##### 127.73 ##### 129.96 132.27 #11### 26.99 29.22 31.48 33.75 36.11 38All 40.21 41.95 43.72 45.49 47.69 49.89 51.76 53.52 55.28 57.04 59.07 61.09 63.17 65.18 67.22 69.25 71.60 73.87 75.82 77.80 79.78 82.10 83.93 85.77 87.62 89.91 92.21 94.51 98.67 100.56 102.81 104.73 106.65 113.31 116.65 120.00 125.26 133.17 135.70 138.23 143.30 145.83 148.36 29.51 32.15 34.13 36.09 38.59 41.07 42.98 44.89 46.90 48.95 51.20 53.45 55.39 57.41 59.42 61.46 63.40 65.32 67.29 69.29 71.24 73.17 75.66 78.17 80.46 82.50 84.67 87.21 89.15 91.09 93.11 95.53 97.96 100.35 104.06 105.98 108.24 110.18 172. to 118.61 122.17 125.74 131.23 139.38 142.14 144.90 150.42 153.18 156.01 38.27 40.60 42.88 45.14 47.57 40.90 43.37 45.58 48.37 50.69 43.54 46.14 48.48 51.63 S3.75 45.58 48.32 50.97 53.70 56.23 58.28 60.24 4Z65 50.57 53.09 56.19 58.99 61.28 63.65 49.80 52.90 55.81 58.77 61.75 64.36 67.07 51.94 55.22 58.32 61.36 64.45 67.52 70.51 54.32 57.69 60.95 64.33 67.34 70.55 73.72 56.72 60.17 63.56 67.04 70.26 73.58 76.88 58.79 62.33 6534 69.34 72.83 76.35 79.78 60.91 64.49 68.02 71.84 75.44 79.10 82.66 63.03 66.66 70A9 74.34 78.07 81.83 85.62 65.16 68.81 72.36 76.81 80.77 84.65 $8.50 67.33 71.14 74.82 79.35 83.34 87.48 91.48 69.46 73.41 77.24 81.80 85.90 90.40 94.51 71.67 75.74 79.79 84.28 88.49 93.28 97.54 73.76 78.03 82.24 86.75 91.13 96.12 ##### 75.94 80.32 84.69 89.23 93.72 99.05 ###N# 78.11 82.63 87.16 91.76 96.26 ##### O"If 80.55 85.27 89.93 94.63 99.28 ##### ##### 82.93 87.86 92.64 98.91 103.94 NN### #t7### 84.99 90.14 95.07 101.03 105.85 ##### "It" 87.07 92.39 97.48 102.89 107.55 kit### ##N## 89.14 94.67 99.90 104.96 110.24 ##### ##### 91.56 97.30 102.67 107.88 113.22 ##### ##### 93.64 99.73 105.09 110.44 116.21 ##### ##### 95.74 102.16 107.44 112.98 119.22 ##### ##### 97.81 104.59 109.78 115.51 122.28 ##### ##### 100.36 107.47 112.59 118.53 125.76 ##### ##### 102.90 110.36 115.41 121.61 129.19 ##### #9### 105.43 113.22 118.19 124.59 132.64 ##### ##### 109.57 117.32 122.80 129.42 137.86 ##### ##### 111.88 119.52 125.37 132.15 140.27 ##### ##### 114.51 122.03 128.36 135.21 143.00 ##### 0#0 116.79 124.17 130.93 137.99 145.48 ##N## ##### 119.01 126.30 133.52 140.71 147.88 #9#4# ##### 125.68 133.21 140.65 148.05 158.15 ##### ##### 129.42 137.07 144.64 162.21 162.45 ##### ##### 133.12 140.92 148.65 156.44 166.69 ####fl ##### 138.76 146.73 154.59 162.51 172.87 ##### ##### 147.08 155.16 163.17 171.24 181.72 ##### N#### 149.99 158.23 166.38 174.58 184.75 ##### ##1t## 152.91 161.30 169.64 177.93 187.73 ##### ""It 158.73 167.41 176.06 183.74 193.27 A#### ##### 161.65 170.46 179.25 187.09 196.26 ##WM N#### 164.56 173.53 182.44 190.41 199.25 ##### ##### 73.54 76.51 79.46 82.33 85.27 $8.18 76.89 79.93 83.01 $6.10 89.18 92.23 80.17 83.41 86.65 89.87 93.07 96.20 83.19 86.62 89.99 93.26 96.60 99.92 86.19 89.78 93.26 96.76 100.23 103.70 89.30 93.02 96.66 100.28 103.89 107.51 92.32 96.16 100.06 103.94 107.63 111.30 95.51 99.48 103.45 107.43 111.23 114.97 98.62 102.77 106.87 110.98 114.87 118.85 101.83 106.05 110.34 114.58 118.79 123.07 104.93 109.37 113.73 118.14 122.37 126.67 108.13 112.62 117.19 121.65 126.11 130.49 111.24 115.96 120.56 125.21 129.65 134.44 114.34 119.06 124.19 128.99 133.75 138.45 117.26 122.18 127.77 132.69 137.52 142.41 119.96 124.99 130.97 136.02 141.03 146.06 122.59 127.71 134.24 139.41 144.56 149.71 125.30 130.54 137.52 142.80 148.10 153.37 128.27 133.64 141.05 146.55 151.95 157.33 131.69 137.20 144.43 149.98 155.50 161.09 135.01 140.66 147.79 153.46 159A 4 164.B4 138.43 144.23 151.07 156.97 162.75 168.55 142.24 148.25 154.88 160.85 166. B3 172.76 146.10 152.20 158.71 164.80 170.92 176.98 149.89 156.20 162.43 168.73 175.00 181.17 155.67 162.22 168.74 175.18 181.67 188.15 159.04 165.71 172.33 178.96 185.59 192.24 162.66 169.50 176.31 183.10 189.89 196.64 166.02 173.01 179.95 166.88 193.81 200.72 169.32 176A41 183.53 190.61 197.66 204.73 17Z62 184.96 192.34 199.67 206.72 214.27 182.41 189.90 197.36 204.87 211.84 219.78 187.14 194.83 202.45 210.03 216.96 225.33 193.87 201.64 209.46 217.19 224.02 232.81 203.16 211.15 219.05 226.99 233.67 242.92 207.15 215.21 223.31 231.40 238.45 247.57 211.07 219.34 227.59 235.76 243.25 252.24 217.75 226.25 234.72 243.19 251.14 260.02 221.75 230.38 238.99 247.59 255.87 264.70 225.68 234.44 243.20 251.93 260.66 269.35 114.73 118.68 122.71 126.97 130.86 133.68 138.60 143.62 147.48 151.22 154.86 158.62 162.73 166.61 170.48 174.37 178.73 183.09 187.41 194.62 198.82 203.39 207.61 211.76 221.47 227A2 232.78 240.37 250.59 255.43 260.27 268.37 273.21 278.05 118.16 122.39 126.58 130.94 135.06 139.28 143.57 148.78 152 62 156.33 159.97 163.89 168.08 172.09 176.12 180.14 184.61 189.10 193.56 201.00 205.34 210.05 214.40 218.77 228.79 234.57 240.36 248.10 256.46 263.45 268.43 276.75 281.74 286.74 146.83 153.85 157.70 161.48 165.08 169.14 173,43 177.58 181.72 185.88 190.48 195.18 199.76 207.41 211 92 216.77 221.27 225.77 236.01 241.96 247.87 255.76 266.26 271.39 276.58 285.14 290.27 295.40 Green Earthworks Construction, Inc. 5001 So Tyler St Tacoma, WA 98409 253.606.8787 fax 253.220.2621 Bill To Insituform Technologies, Inc 17988 Edison Ave Chesterfield, MO 63005 City of Renton/l nsitu form Culvert #2 Replacement Invoice Date Invoice # 1 /2/2013 10105 Job Number Insituform-125-111412 Date Quantity Description Rate Amount 1/16/2013 1 Emergency project, culvert #2 replacement. work from 12/26 to 01/15/13 56,145.40 56,145.40T Subtotal $56,145.40 Attention:Bernie-Insituform PM Sales Tax (0.0%) $0.00 Total $56,145.40 www.GreenEarthworks.com /, Advanced Government Services, Inc 8644 Pacific Avenue Tacoma, WA 98444-6471 (253) 531=9782 Office (253) 531-9784 Fax Bill To Green Earthworks Construction Inc 5001 S Tyler ST Tacoma, WA 99409-1908 Invoice Date Invoice # 1/4/2013 5889 P.O. No. Terms Project 12/23-12/29 Net 30 Lake WA Blvrd Sewer Reha... Description Rate Amount Quantity 49.50 1,311.75 26.5 Flagging at Prevailing Rate per hour - TCS - (12/26,12/27, & 12/28) 48.00 1,032.00 21.5 Flagging and OTCL at Prevailing Rate per hour - (12/26,12/27, & 12/28) 125 00 375.00 3 Misc Sign Usage - Class B Signs, Crashworthy Stands, Cones, Sandbags, Sidewalk Closed/Detour Signs & Barricade Stands, Business Open Signs and Stands, No Park Signs - Per Week Day 125.00 375.00 3 Traffic Control Vehicle usage rate per day 250.00 250.00 1 Mobilization (LS) Thank you for your business. I Total $3,343.75 Ticket # Date i;:. r G^E.CN w &irental Scrvlces 5001 S. TYLER ST., TACOMA, WA 98409 PHONE:253-534-8202 FAX:253-220-2621 Customer Named . ; Site Contact Phone# Site Address City State - Zip Payment: S/B v Check # Cash Credit Card # Mailing Address City State Zip Exp. TECH LABOR TRUCK # START TIME ON SITE TIME OFF SITE TIME DISPOSAL IN ew. DISPOSAL Description of Work Performed Hr Unit Total Price Amount Additional work needed O Yes O No Drawing/Additional work info Sub -Total Tax % Total Terms: Net 10 days 1 1/2 % Per month delinquency charge on past due accounts Personal Guarantee By my signature below I have accepted personal liability for all amounts due GEC NW Environmental Services and promise to make the payments as agreed: WHEN WORK IS COMPLETE. I fully understand that in the event that payments are not made as agreed, that I have assumed personal liability for all unpaid amounts including all collection fees, all attorney fees, plus all costs incurred to pursue under law all amounts due GEC NW Environmental Services. Customer. Signature: Date: National Concrete Cutting Inc. 7716 Pacific Hwy. E. Milton, WA 98354-9635 Voice: (800) 551-0511 Fax: (253) 736-6777 To, GREEN EARTHWORKS CONSTRUCTION INC 5001 S. TYLER . TACOMA, WA 98409 rID —1 GREEN EARTHWORKS Ncc Operator r WHITE I Quantity I Item Check/Credit Memo No: Customer PO JASON Shipping Method Job Site Description SLAB SAWING: DECEMBER 26TH 65'X 6" A/C OVER 6" C/C 12" TOTAL DEPTH INVOICE. Invoice Number: 19420 Invoice Date: Dec 31, 2012 Page: Payment Terms Net 30 Days Ship Date Due Data 12/26/12 1�3 13 unit Price u 420.00 1 Subtotal 420.00 Sales Tax "I nn Total invoice Amount 420.00 P-a-y-ment/Credll Applied 420 TOTAL .00 Puget Sound 6nsly P.O. BOX 73399 rs Bucket WA9 PUYALLUP, WA 8373 A Division of Northwest Cascade, Inc. (253)848-2371 (800) 444-2371 Please visit www.honeybucket.com and take a moment to fill out our customer satisfaction survey Oregon I SW Washington Inland Empire P.O. 12923 P.O. BOX 3431 Salem, OR 97309 Post Falls, ID 83877 (503)581-7223 (208)687-0138 (800)966-2371 (888)810-8100 GREEN EARTHWORKS CONSTRUCTION 5001 S Tyler St Tacoma WA 98409-1908 Service: MONTHLY STANDARD UNIT RENTAL From 12/11/12 To 01/10/13 HB DELIVERY CHARGE FUEL SURCHARGE FOR 1 UNITS Amount Exempt from Sales Tax: 155.50 Amount Subject to Sales Tax: 0.00 Account No.: 123393 INVOICE PLEASE PAY FROM THIS INVOICE Terms: Net 10th Prox. Delinquency Charge -1 % per month Invoice: 1-592572 Order No.: 0853139 Account No.: 123393 Invoice Date: 12/11/12 Due Date: 01/10/13 P. O. #: Job #: RENTON Location: GREEN EARTHWORKS CONSTRUCTION LAKE WASHINGTON BLVD N 8 + N 36TH ST RENTON, WA # R10022 # DELIVERY # SURCHARGE Subtotal: Tax: Total 91.50 60.00 4.00 155.50 0.00 155.50 A NOTIFY DEALER IMMEDIATELY IF EQUIPMENT DOES NOT FUNCTION PROPERLY OR NO REFUND OR ALLOWANCES WILL BE MA �a CUSTOMER AGREES NOT TO ALTER OR REPAIR ANY OF THE RENTED EQUIPMENT. "V $ CUSTOMER WARRANTS THAT HE HAS THE KNOWLEDGE AND ABILITY TO OPERATE THE RENTED EQUIPMENT. THIS EQUIPMENT MUST BE RETURNED CLEAN OR A CHARGE WILL BE MADETOR CLEANING. &9TTi9f9R t f1A`LS MONDAY - FRIDAY 6:30AM - 5:00PM 24/7 EMERGENCY SERVICE SAT 8:OOAM - S:OOPM CLOSED SUNDAY *** *** CUSTOMER IS RESPONSIBLE FOR REFUELING AND TIRE DAMAGES DRIVER > NEW REMIT ADDRESS: DATE-- > PO BOX 6978 TIME > TACOMA WA 98417 ==Contract Number Customer ID____________________________________________________ 01-172842-04 110392 FINAL - ORIGINAL INVOICE O1/04/13 GREEN EARTHWORKS GREEN EARTHWORKS 5001 SO TYLER ST 5001 SO TYLER ST TACOMA WA 98409 TACOMA WA 98409 253-225-1106 ------------------------------------ __ ------------------ From: WED 12/26/12 0236P Thru: FRI 01/O4/13 0111P =Item No====Qty=Description=====------=====Rate Info=====___=====Unit==Extended 2500-2516 1 HIWAY, SWEEPER, RIDING, 81JJ CR 560.00 560.00 01-8007 29748-007 LAYMOR TOW Serial number: 297487-007 Rates: 140.00/d 560.O0/w 16O0.00/28d Meter: 2.0 Returned -out WED201/02/1/HOUR5P 40.0=free 1.750 0.00 2500-2517 1 BROOM WEAR PER INCH 0.00/d CR 0.60.00 0.00/20.00 0.00 Rtes --Receipts Summar------ summary ------- ------ Date Su Method Ref/PO - Amount GENERAL RENTAL 560.00 01/04/13 04 Charge 613.20 53.20 2717SLSTAX >>>>>Amt Due this Invoice: 613.20 Total Unpaid this Contract: 613.20 Total I. THE UNDERSIGNED PARTNER RENTER, SPECIFICALLY ACKNOWLEDGE THAT I HAVE RECEIVED AND UNDERSTAND THE INSTRUCTIONS REGARDING THE USE AND OPERATION OF THE RENTED EQUIPMENT. 1 HAVE READ THE TERMS AND CONDITIONS ON THE BACK HEREOF AND AGREE TO THEM AS A PART OF THIS CONTRACT THE SAME AS IF IT WERE PRINTED ABOVE MY SIGNATURE. THE FRONT AND BACK OF THIS CONTRACT COMPRISE THE ENTIRE AGREEMENT AFFECTING THIS ORDER AND NO OTHER AGREEMENTS OR UNDERSTANDINGS OF ANY NATURE CONCERNING SAME HAS BEEN MADE OR ENTERED INTO. I AUTHORIZE YOU TO CHARGE MY ACCOUNT ON ANY INSTRUMENT AS MAY BE NECESSARY TO ACCURATELY REFLECT MY JUST INDEBTEDNESS TO YOU. I HAVE BEEN ADVISED THAT, UNDER THE LAW (RCW 9A.56.096) FAILURE TO PROMPTLY RETURN THE RENTED PROPERTY OR PAY ALL RENTAL CHARGES MAY RESULT IN CRIMINAL PROSECUTION. I AGREE THAT JURISDICTION AND VENUE FOR ANY CIVIL LAWSUIT SHALL BE IN TACOMA, PIERCE COUNTY, WASHINGTON. 613.20 f --RETURNED-EQUIPMENT BY FRI 01/04/13 0111P V THIS IS YOUR CONIRACI; PLEASE READ B07H SIDES. IF I AM OTHER THAN THEAC CUSTOMER NAMED ABOVE, I CERTIFY THAT I AMA BONA FIDE AGENT OF CUST( ANDASSUME ALL RESPONSIBILITY FOR CUSTOMER AS PROVIDED IN THIS AGREEI Pq Sales Agent: Date: Customer: Contract: I ALEXX BACON 01/O4 GREEN EARTHWORKS 01-172842-04 FERGUSON Water zvorlcs 24025 SNOHOMISH-WOODINVILLE RD WOODINVILLE, WA 98072-8787 Please contact with Questions: 253-538-8275 00007057 01 MB 0.404 01 TR 030 FRIDDA01 000000 GREEN EARTHWORKS CONST INC 5001 SOUTH TYLER STREET TACOMA, WA 98409 INVOICE NUMBER CUSTOMER PAGE 0364322 43012 1 PLEASE REFER TO INVOICE NUMBER WHEN MAKING PAYMENT AND REMIT TO: FEI - SEATTLE WW #1539 PO BOX 847411 DALLAS, TX 75284-7411 HIP TO: COUNTER PICK UP 2042 SOUTH 112TH ST TACOMA, WA 98444-0000 SFIIP SELL TAX CODE CUSTOMER ORDER NUMBER SALESMAN JOB NAME INVOICE DATE BAiC;1 WHSE. WHSE. IRENTON 10 3156 3156 WAE RENTON MLH 12/21/12 43292 ORDERED SHIPPED ITEM NUMBER DESCRIPTION UNIT PRICE UM AMOUNT 1 1 R1861838 *CVR* FLPI INV MARK PAINT WTR 5.540 EA 5.5 1 1 N1277AG 12 SANDED M/HOLE ADPT 170.320 EA 170.3 52 52 A126500131B 12X13 N12 COR W/TITE HDPE PIPE BE 8.000 FT 416.0 2 2 ETR5101650 50 LB BAG SPD CRETE RED LINE *Z 30.790 EA 61.5 INVOICE SUB -TOTAL 653.4 TERMS: NET 10TH PROX ORIGINAL INVOICE TOTAL DUE ... 653.44 All accounts are due and payable per the invoiced terns. All Mist due amounts are subject to a service charge at the maximum rate allowed uy Stale law I)= WARRAN rY PROVISIONS. SEE REVERSE SIDE A cusis of collection including attorney lees it incurred Freight temis are FOB our dock unless otherwise specified above. invoice No. xno^mn Date 12m6o012 Order No. F006041 A* CF,,����UINC. Shipper ID 8O1�O0 (3EOS TMET|C PRODUCTS Order Type Fife Sales Order Customer ID Gnesso AopWest, Inc- uvo.oa.name for w.vveeommmeovn.Inc. 8851S.E.7G1hDrive, Portland, OR8730G5o3'771'611S80V'n7n'5115(fux)503'77141G1 pAos 1 GREEN EARTHWORKS CONSTRUCTION 5001 South Tyleratree 530009101 1/00 Straw Wattles, e^x10' (ES08.51UPRP-24 53000000 5.00 Poly Sand Bags, 14^x26' 070000050 10.00 5'MemlT'p9msQman. (.95|b/ft) 580000015 3.00 8c|.Drain Bag ' Standard 17o'oa'e EXIVIT Freight Exempt Please pay from this invoice Statements hyrequest only Thank you for your business GREEN EARTHWORKS CONSTRUCTION 34em.mAoSONur saCH1 1.00 0.00 15.000 0.00 15.000 EACH 5.00 uoo umm o/m 1.50 EACH 10.00 0.00 3.150 0.03 31.500 Sales Total 153.00 Shipping u*andlino 0.00 Misc. Charges 0.00 Tax Total 14.38 167.38 Less Paid Amount 0.00 BAKERS %0"Y R 3020 Old Ranch Parkway, Suite 220 Seal Beach, CA 90740 (562)430-6262 Job Site: GREEN EARTHWORKS CONSTRUCTION N 36TH ST & LAKE WASHINGTON BLVD RENTON, WA 98404 C#: 253-606-8787 J#: 253-606-8787 Customer #: 13599 GREEN EARTHWORKS CONSTRUCTION ATTN: ACCOUNTS PAYABLE 3419 N MADISON ST TACOMA, WA 98404 Remit to: PAGE: 1 BAKERCORP PO Box 843596 LOS ANGELES, CA 90084-3596 R E N T A L I N V O I C E Invoice #.:. 1394534-001 Invoice date 1/07/13 Terms....... Net 30 Job Loc..... N 36TH ST & LAKE WASHINGTON, Job No...... 6 - GREEN EARTHWORKS P.O. #...... RENTON Ordered By.. JAYSON Reference #. Quote....... Reservation. 506636 Qty Description Min Day Week 4-Week Amount 1 TANK 6500 GAL TD POLY WATER ONLY 29.00 29.00 203.00 812.00 232.00 P7033W Billed 8 days from 12/26/12 thru 1/02/13 1 PUMP 2" ELE SUBMERS 1HP 1PH 25.00 25.00 76.00 227.00 101.00 PUEL02314 81212110004 With floats Billed 8 days from 12/26/12 thru 1/02/13 6 HOSE 2"X50' DISCHARGE QD 6.00 6.00 18.00 54.00 144.00 7023212 Billed 8 days from 12/26/12 thru 1/02/13, 1 HOSE 2"X20' SUCTION M/F CAMLOCK 6.00 6.00 18.00 54.00 24.00 7031212 Billed 8 days from 12/26/12 thru 1/02/13 SALES ITEMS: Qty Description unit Price 2 DELIVER 1 POLY TANK HR 100.000 200.00 *{ 9972110 1 FUEL SURCHARGE AT 20.000 20.00 * 9999921 2 PICK UP 1 POLY TANK HR 100.000 200.00 * 9972120 1 FUEL SURCHARGE AT 20.000. 20.00 * 9999921 continued... Your Local Branch is: SEATTLE - BAKERCORP 9715 24TH PLACE W.. EVERETT, WA 98204 PHN# 425-347-8811 FAX# 425-347-0369 BakerCorp wishes you a Happy New Year. Thank you for your business. Please visit us on the internet at http://www.BakerCorp.com/Invoice.asp for more information about your invoice. BKRTP-100 REV. 4/07 .1 BAKER;r . "; Li 3020 Old Ranch Parkway, Suite 220 Seal Beach, CA 90740 (562)430-6262 Job Site: GREEN EARTHWORKS CONSTRUCTION N 36TH ST & LAKE WASHINGTON BLVD RENTON, WA 98404 C#: 253-606-6787 J#: 253-606-8787 Customer #: 13599 GREEN EARTHWORKS CONSTRUCTION ATTN: ACCOUNTS PAYABLE 3419 N MADISON ST TACOMA, WA 98404 Qty Description SALES ITEMS: Qty Description Remit to: PAGE: 2 BAKERCORP PO Box 843596 LOS ANGELES, CA 90084-3596 R E N T A L I N V O I C E Invoice #... 1394534-001 Invoice date 1/07/13 Terms....... Net 30 Job Loc..... N 36TH ST & LAKE WASHINGTON, Job No...... 6 - GREEN EARTHWORKS P.O. #...... RENTON Ordered By.. JAYSON Reference #. Quote....... Reservation. 506636 Min Day Week 4-week Unit Price Sub -total: State 6.5000%: County 3.0000t: Total: Tax charged on lines with an * Tax Rate: 9.5000t $89.40 Amount 941.00 61.17 28.23 1,030.40 Your Local Branch is: BakerCorp wishes you a Happy New Year. SEATTLE - BAKERCORP Thank you for your business. 9715 24TH PLACE W.. EVERETT, WA 98204 Please visit us on the internet at PHN# 425-347-8811 http://www.BakerCorp.com/Invoice.asp FAX# 425-347-0369 for more information about your invoice. 6KRTP-100 REV. 4/07 rn.1/1 l Dickson TO: Grccn Earthworks Construction, Inc. REMIT TO: Wm. Dickson Co. Attn: Sean 3315 South Pine Simi 5001 South Tyler Street TOcom0VA 984p9-5793 Tacoma, WA 99409 1253)472-4489 PROJECT: Storm Repair / City of Renton .1013 SITE,: N. 36th & Lake Washington Blvd, Renton INVOICE: 480116 wUr,JOB N 12032 DATE: 12/31/12 iTEkl NO. DESCRIPTION.:.. QTY,... PRICK';'. L «'Olil %.: TOTAL T&M per attached worksheets 1 12/26/12 - Mobilization of Equipment to proicct site 1 T&NI 960.27 100% 960.27 2 12/27/12 - Replace 12-Inch Storm Line I T&M 4,055.76 100"% 4,055.76 3 12/29/12 - Replace 12-Inch Storm Line I T&M 2,948.31 100% 2.948.31 4 12/31/12 - Demobilizationbf t,quipmcnt Iirom site I T&M 802.79 100% 802.79 TOTAL EARNED 8,767.13 LESS PREVIOUSLY BILLED 0,00 SUB -TOTAL THIS INVOICE 8,767.13 PLUS W.S.S.T. (1725) 0.0% Wholesale _OAO TOTAL AMOUNT INCLUDING TAX 8,767.13 pngn I of I ji, k� TIME AND MATERIALS IE ET zvyuff vi Wodc Description: MOBILIZATION OF EQUIPMENT TO PROJECT SITE LABOR COSTS: ;p HOURS RATE TOTAL NAME, CLASSIFICATION REGULAR OVERTIME REGULAR FOVERTIME COS-1, DAVID KNEELAND TEAMSTER 6.00 54,231 325.39 ------- --- TOTAL LABOR COST LABOR MARKUP 12% GRAND TOTAL LABOR 3257 39.05 77364M . EQUIPMEWCOSTS HOURS RATE TOTAL DESCRIPTION UNIT NO, REGULAR STANDBY REGULAR STANDBY COST KENWORTH LOWBOY TRACTOR K-1 6.00 $ 75.96 $ 455.16 LOWBOY TRAILER T9004 6.00 20.88 --- — $ 125.28 TOTAL EQUIPMENT EQUIPMENT MARKUP 0% GRAND TOTAL EQUIPMENT $ 58044 tt RENTAI*tOAS TOTAL DESCRIPTION QTY UNITS UNIT PRICE COST PERMIT INVOICER001817816 LS 14.00 $ 4.00 I TOTAL MATERIALS & RENTALS MATERIALS & RENT. MARKUP 10% GRAND TOTAL MATERIALS & RENTALS 14.00 1.40 417B' CONT CT TOTAL DESCRIPTION QUANTITY UNITS UNITS UNIT PRICE COST - TOTAL SUBCONTRACTOR SUBCONTRACTOR MARKUP 0% GRAND TOTAL SUBCONTRACTOR TOTAL EQUIPMENT, MATERIAL, & SUBCONTRACTS 0% B&O TAX, BONDING, AND INSURANCE TOTAL 960.27 960.27 WHo MCKS©M Ifla— 8105 Wm. Dickson Company Daily Foreman's Report 8915 SoutH Puy STREET • TACWdp, WA. 98409 • Pw Z63412d489 Job Name: 676r, Rbilrod Job # 17.,P5L Date: /2-2L-Zo/L M T©TH F SA SN Foreman: ���c��aes, Start: ?: 3o Finish: q,oa Weather: RAW - Employee Name WIVID Equipment Description WIVID & Rental Trucks Description of Work Performed Today: (Note Location, Station, MH#, CY's, Etc.../Job Events/Sketch If Nec. p t A--e> q4I O Supplier/Subcontractor Pack. Slip No. SupplieriSubcontractor Pack. Slip No. I Confined Space Entry: ❑ YES ❑ NO IF YES, ATTACH PERMIT FORM WITH FOREMAN'S REPORT Ground Type: ❑ Clay ❑ Sand ❑ Gravel ❑ Till ❑ Hard Pan �-7 Peat ❑ Rock Soil Classification: Type ❑ A ❑ B ❑ C Test Used: ❑ Manual ❑ Visual ❑ Both Ground Condition: ❑ Wet ❑ Caving ❑ Stands Bottom Condition: ❑ Firm ❑ Soft ❑ Boiling ❑ Unsuitable Used: ❑ Pumps ❑ Wells ❑ Plates ❑ Open Cut ❑ Box ❑ Other Utility Breaks: (Description) (Owner) Located? Yes No Yes No Yes No Yes No Owner/Inspector/Subs/Other Onsite Today: Name Description of Work Performed Extra Work or Changed Conditions: (Description) EWO # IAcclaenvinclaenvsaretyiL;omments: WM. Dickson Co. 1' „ 3315 South Pine St. `� Tacoma, WA 98409-5793 �\ (253) 472-4489 FAX (253) 472-4521 \ Dale: t) (.. f No: Tmok No: I Truck Charges: Trailer No.: f U'��f� Driver Charges: Tnrck Rate: Sub Total: TruckHours: "Add Charges: Driver Hours: 7 Total Charges: Customer: V I ` Bllling Address: Job Location: Jab Number: Stan: slop: G'J ``� Lunch: Downtime: - Reason: Material From To No. Loads Hours Fuel: I Oil: I Total Mlles: I Tolal Mlles Off Highway: Remarks: Drivers Signature: �. /� Aulhodzed Co. Rep. Signature: Signature of this truck Invoice will be considered your notice of our Intent to lien this protect, If necessary. Interest at 1% per month will be charged on all past due accounts. Charges due by the tenth of the month following date of this billing. MultiPermitPritTt Orden Confirmation Receipt Order No: 776884 Authorization Code: 06884G Cart No: 714246 Permit Company Vehicle PormitType Fee Amount Stall Date End Date 0018178-1-6.. DICCO .. 8-94-34C._ ..'e-1Over-w-e-lgM. -.T. rac,i Ov—er_sl .4.. I12--6-- 2- — -28-.2012. Total Fee Amount: $14.00 6v� Page 1 of I littps:Hsecul-e3 .wsdot, wa.gov/ConunercialVehicle/Peiinits/Cotnnlon/MultiPei•mitPrintRec... 12/26/2012 m, Dtcksonl;o. . t 4 1 TIME AND MATERIALS WURKSHEET PROJECT: GEC --STORM REPAIR--N.36TH & LAKE WASH. BLVD. Project No: 12032 Date: 12-27-2012 OWNER; CITY OF RE, NTON - Work Description: REPLACE 124N STORM LINE EWO#02 lABiaR COSTS , HOURS I RATE TOTAL NAME CLASSIFICATION REGULAR I OVERTIME REGULAR I OVERTIME COST STEVE MUDGE FOREMAN - 8.00 60.76 486.08 JOHN MAYERL OPERATOR 8. 00 57.92 _ SEAN MORGAN PIPELAYER 800 47 G _ 463.36 381.52 TOTAL LABOR COST LABOR MARKUP o 1,. 96 12/0 159159.72 GRAND TOTAL LABOR EQU.'wNTCOSTS HOURS RATE TOTAL DESCRIPTION UNIT NO. REGULAR STANDBY REGULAR I STANDBY COST KOMATSU PC 228 EXCAVATOR EX1010 8.00 $ 101.53 _ $ 812.24 CAT 414 BACKHOE BH4000 8,00 _ $ 35.97 _ $ 287.76 NPKC4C HOE PAC BH4000H 8.00 $ 6.26 $ 50.08 FORD 450-1-TON PIPE TRUCK _ IT-6 8.00 $ 25.43 $ 203.44 FOREMAN PICKUP PU801 l _ 8.00 _ $ 16,48 $ 131.84 ATLAS COPCO 35KW GEN SE_ T 8.00 $ 23.79 $ 190.32 ---- HYDRAULIC SHORING JACKS - - - 8.00 0,52 $ 4.IG 4-IN. ELECTRIC PUMP - 8.00 6.25 $ 50.00 TOTAL EQUIPMENT $ 1,729.84 EQUIPMENT MARKUP 0% $ -- GRAND TOTAL EQUIPMENT 1;729.84 MATERIALS & RENTAL .:� TOTAL DESCRIPTION QTY UNITS UNIT PRICE COST RENTAL BOX INVOICE#IR74160 - 1 LS $ 759.31 $ 759.31 -- - _-.. $ TOTAL MATERIALS & RENTALS $ 759.31 MATERIALS & RENT. MARKUP 10% $ 75.93 GRAND 'TOTAL MATERIALS & RENTALS 835,24 SUBCONTRACTOR' TOTAL DESCRIPTION QUANTITY UNITS UNIT PRICE COST TOTAL SUBCONTRACTOR SUBCONTRACTOR MARKUP 0% GRAND TOTAL SUBCONTRACTOR TOTAL EQUIPMENT, MATERIAL, & SUBCONTRACTS 4,055.76 0% B&O TAX, BONDING, AND INSURANCE `--- TOTAL WH. MC KSON cc 8103 )ki- Wm. Di kson Company Daily Foreman's Report 3315SouMpg$T EEf •Tkmgwk986•Par,253d12d489 Job Name: 66G — 96VF0Ai Job # 12.o32. Date: 'kL Z7,rZeZM T W ( F)F SA SN -- Foreman: cSTG3jc Al, laI-S Start: T& Finish: VAS Weather:SNoWeZg Employee Name • ' ���� WIVID Equipment PIVAMMS wMb & Rental Trucks Description of Work Performed Today: (Note Location, Station, MH#, CY's, Etc.../Job Events/Sketch If Nec. w/5 R45L1ffW, Gv eNT` TR�►GGiL Cam B c. v!3 , Se: B �,a•5S �J �iCl57 �� /?.4v L '- Gnu 6uiFif�2. z�TD l/ �i7 AceasSiAv�' /Z GbA 5 C0--QC 7; 4PwM. A&AQ Call -t7t- A16W /Z D 17 ^~ � o b _fQ r S>'D L S ci o A4-sr &A' 57444 a .j7 ,� t'. Per �u n e !zd acev e Pow 5/*7 Supplier/Subcontractor Pack. Slip No. Supplier/Subcontractor Pack. Slip No. M, Sol 9 59 Z � I I I Confined Space Entry: ❑ YES NO IF YES, ATTACH PERMIT FORM WITH FOREMAN'S REPORT Ground Type: - Clay ❑ Sand ❑ Gravel ❑ Till ❑ Hard Pan L Peat ❑ Rock Soil Classification: Type ❑ A ❑ B W C Test Used: Manual Visual ❑ Both Ground Condition: X Wet - Caving ❑ Stands Bottom Condition: ❑ Finn Soft ❑ Boiling ❑ Unsuitable Used: 91 Pumps ❑ Wells Plates ❑ Open Cut ❑ Box ❑ Other Utility Breaks: (Description) (Owner) Located? Yes No Yes No Yes No Yes No Owner/Inspector/Subs/Other Onsite Today: Name Description of Work Performed G9 rc5 Extra Work or Changed Conditions: (Description) EWO # MJ—At3ov w is erxmA 6Rze.) cv K Accide t/Incident/Safety/Comments: Wm Dlck�onCo. TIME AND MATERIALS WORKSILE,ET PROJECT: GEC --STORM REPAIR--N.36TH & LAKE WASH. BLVD. OWNER: CITY OF I2ENTON Project No: 12032 Date: 12-28-2012 Worlt Description: REPLACE 12-IN STORM LINT; EWO # 03 LABORCOSTS HOURS, RATE TOTAL NAME CLASSIFICATION REGULAR OVERTIME REGULAR OVERTIME COST STEVE MUDGE FOREMAN 4,00 JOHN MAYERL _ OPERATOR - - 60.76 _ 243.04 8.00 57.92 iEAN MOiGAN PIPELAYER 8 00 463.36 TOTAL LABOR COST LABOR MARKUP GRAND TOTAL LABOR ,EQUIPMENT COSTS DESCRIPTION UNIT NO. KOMATSU PC 228 EXCAVATOR CAT 414 BACKHOE NPKC4.0 HOE PAC FORD 450-I-TON PIPE TRUCK FOREMAN PICKUP ATLAS COPCO 35KW GEN SET EX1010 BH4000 BH4000H IT-6 PU8011 HYDRAULIC SHORING JACKS 4-IN. ELECTRIC PUMP TOTAL EQUIPMENT EQUIPMENT MARKUP GRAND TOTAL EQUIPMENT DESCRIPTION _ 47.69 381.52 1,087.92 12"�° 130.55 �: 1218:47: HOURS RATE TOTAL REGULAR STANDBY REGULAR STANDBY COST 8.00 $ 101.53 $ 812.24 8.00 _ .... _ $ 35.97 $ 267.76 8.00 $ 6.26 - $ 50.08 _- 8.00 $ 203.44 $ 16.48 $ 131.84 $ 23.79 $ 190.32 8.00 8.00 8.00 0.52 $ 4.16 8.00 6.25 $ 50.00 $ - $ 1,729.84 0% $ .... TOTAL MATERIALS & RENTALS MATERIALS & RENT. MARKUP 10% GRAND TOTAL MATERIALS & RENTALS ,: S,UBCONTL'9CTOR DESCRIPTION TOTALSUBCONTRACTOR SUBCONTRACTOR MARKUP GRAND TOTAL SUBCONTRACTOR •OTAL EQUIPMENT, MATERIAL, & SUBCONTRACTS 0% B&O TAX, BONDING, AND INSURANCE TOTAL 0% Wm. Dickson Company Daily Foreman's Report 3315SoupPIOrm•TA omkW6 OG-PH.Zb'3dW9 Job Name: 6IFe— ,-t?4OVI L l Job # Date: Dfe— n2erL M T W TH f SA SN Foreman: _`5qx;jjF: JjlQ QS=2 Start: 7'sjp Finish: 1%CD Weather:; ooAw . • �0�—�� • RentalDescription Description of Work Performed Today: (Note Location, Station, MH#, CY's, Etc.../Job Events/Sketch IV S r� ?t L!J deo s Rco6Aar Z' SJ A,v - A, P/120697-r 6v bvT Arm D [..A 7-.3 OL GL A AOW 17M' w- Gc� �JS v i D � C6n�,✓C bJ / �� ST74LL.�i'� �.r 55 .�J dP/L neo /�Z5,xd. V G S MAjgm w Nf1G t. D t6 V &7&'C— Ale— A- - ,e 5 G . —19&&XeIL i iK- A—� s}v� v ArXZ LrI i Supplier/Subcontractor Pack. Slip No. Supplier/Subcontractor Pack. Slip No. Confined Space Entry: ❑ YES ❑ NO IF YES, ATTACH PERMIT FORM WITH FOREMAN'S REPORT Ground Type: ❑ Clay ❑ Sand ❑ Gravel ❑ Till ❑ Hard Pan ❑ Peat ❑Rock Soil Classification: Type ❑ A ❑ B ❑ C Test Used: ❑ Manual ❑ Visual ❑ Both Ground Condition: ❑ Wet ❑ Caving ❑ Stands Bottom Condition: ❑ Firm ❑ Soft ❑ Boiling ❑ Unsuitable Used: ❑ Pumps ❑ Wells ❑ Plates ❑ Open Cut ❑ Box ❑ Other Utility Breaks: (Description) (Owner) Located? Yes No Yes No Yes No I Yes No Owner/Inspector/Subs/Other Onsite Today: Name Description of Work Performed IG A-4— N p Extra Work or Changed Conditions: (Description) EWO # AU,dF uE- (.l lkL Is ft MA 1 vcclaenvinclaenvsaTerylL;omments: ik TIME. ANn MATRRiAi c wnortcurr. PROJECT: GEC --STORM REPAIR--N.36TH & LAKE WASH. BLVD. Project No: 12032 Date: 12-31-2012 OWNER: CITY OF RENTON EWO # 04 Work Description: DE --MOBILIZATION OF EQUIPMENT FROM PROJECT SITE IABOR:COSTS HOURS RATE TOTAL NAME CLASSIFICATION REGULAR OVERTIME REGULAR OVERTIME COST DAVID KNEELAND TEAMSTER ---5.00 54.23 271.15 TOTAL LABOR COST LABOR MARKUP 12% GRAND TOTAL LABOR 271.15 32.54 303 69. •BQUIP;MENT COSTS HOURS RATE TOTAL DESCRIPTION UNIT NO, REGULAR STANDBY REGULAR STANDBY COST KENWORTHLOWBOY TRACTOR K-I 5.00 $ 75.86 $ 379.30 LOW- BOY TRAILER T9004 5.00 - $ 20.88 $ 104.40 -- $ TOTAL EQUIPMENT EQUIPMENT MARKUP 0% GRAND TOTAL EQUIPMENT $ 483.70 $ - _ - 483;70 MATERIALS:& RENT.4L[COSTS :. TOTAL DESCRIPTION QTY UNITS UNIT PRICE COST PERMIT' INVOICE #001819178 1 LS $ 14.00 $ 14.00 TOTAL MATERIALS & RENTALS MATERIALS &RENT. MARKUP 10% GRAND TOTAL MATERIALS & RENTALS $ 14 00 :I 4 5UECONTl24CTOR - TOTAL ... DESCRIPTION QUANTITY UNITS I UNIT PRICE COST E:A TOTAL SUBCONTRACTOR SUBCONTRACTOR MARKUP 0% GRAND TOTAL SUBCONTRACTOR TOTAL EQUIPMENT, MATERIAL, & SUBCONTRACTS 0% B&O TAX, BONDING, AND INSURANCE TOTAL 802.79 �78�0279 Flo D�CKS0H COo \ 810 6 Wm. Dickson Company Daily Forema 3316 SouiH PNSw • Tkcog WA 93409 • PH. Y63d124439 Job Name: 45e—-12IeAff—OJ Job # Date: 2-3/,&Yz, W TH F SA SN Foreman: Start: 7A Finish: 1:co Weather: dAzAe•, m mum UMIMWA'= ���� Description of Work Performed Today: (Note Location, Station, MH#, CY's, Etc.../Job Events/Sketch If Nec. 15"�n. Supplier/Subcontractor Pack. Slip No. Supplier/Subcontractor Pack. Slip No. e.EwL iT. Confined Space Entry: ❑ YES ❑ NO IF YES, ATTACH PERMIT FORM WITH FOREMAN'S REPORT Ground Type: ❑ Clay ❑ Sand ❑ Gravel C Till ❑ Hard Pan ❑ Peat ❑ Rock Soil Classification: Type ❑ A ❑ B ❑ C Test Used: ❑ Manual ❑ Visual ❑ Both Ground Condition: ❑ Wet U Caving ❑ Stands Bottom Condition: ❑ Firm ❑ Soft ❑ Boiling ❑ Unsuitable Used: ❑ Pumps ❑ Wells ❑ Plates ❑ Open Cut ❑ Box ❑ Other Utili Breaks: (Description) (Owner) Located? Yes No Yes No Yes No Yes No Owner/Inspector/Subs/Other Onsite Today: Name Description of Work Performed Extra Work or Changed Conditions: (Description) EWO # lAccident/In cident/Safety/Comments: Date: �.�� -1 /���.. No: { 1 ill WM. Dickson Co. Truok No: Truck Charges: 3315 South Pine St. Trailer No.: '1 r r Driver Charges: Tacoma, WA 98409.5793 (253) 472-4489 FAX (253) 472-4521 Truck Rate: Sub Total: Truck Hours: *Add Charges: Driver Hours: Total Charges: Customer: k'-j; {"a •r ) it elt—IN ettling Address: Job Location: Job Number: start: (10'. �; ] sty 1 . ^r1 1 l uoeh• el.56t' n uMe. Material From To NO.Loads ^^Ls Hours 17 ruer: I Oil: Total Miles: I Total Mlles OH Highway Remarks: Drivers Signature: . �__ 9 —.1< I Authorized Co. Rep. Signature: Signafure`of this truck invoice will be considered your notice of our Intent to Ilan this project, if necessary. Interest at t % per month will be charged on all past due accounts. Charges due by the tenth of the month following date of this billing. g wM. Dickson CO. 3315 South Pine Si. Tacoma, WA 98409-5793 (253) 472-4489 FAX (253) 472-4521 vale: - Truck No:1�. _ ? Truck Charges: Trager No.: fa �yj . Dfl w Charges: Truck Rate: Sub Total: Truck Hours: Add Charges Driver Hours: s Total Charge i Customer. \k V\ ( r Billing Address: Job Location:` Job Number. J Material From To No_ Loads Hours Fuel: 10&1 I Total Miles I Total Miles Off Highway. Remarks: al Drivers Signature: Z-12 Authorized Co. Rep. Signature: - Signature of this truck invoice will be considered your notice of our intent to lien this "project, if necessary_ Interest at 1% per month will be charged on all past due accounts. Charges due by the tenth of the month following date of this billing. MultiPermitPrint Order Confirmation Receipt Order No: 777635 Authorization Code: 03548G Cart No: 715142 Permit Company Vehicle Permit Type Fee Amount Start Date End Date 001810178 WM DICKSON CO 894334C OvwsizelOvnrweighl Tcac 14.OD -12-31-2012 01-02-2013 Total Fee Amount: $14.00 Page 1 of 1 https:Hseciire3.wsdot,wa.gov/CominercialVehicle/Permits/CoiiiiiioidlvfultiPermitPriiitRec.,. 12/31 /2012 No MCKSON coo INVOICE 47999 Gw�1! Page 1 of 1 DATE 12/31 /12 GREEAR TERMS Net 30 Days Green Earthworks Construction 5001 South Tyler Street Tacoma, WA 98409 -----Material----- Fee Tax Ticket Date P.O. Order Loc Product Oty Rate Amount Amount Amount Total Export Material Purchased 1153763 12/20/12 AUBURN 1 Gravel Borrow 3.39 6.00 20.34 0.00 0.00 20.34 3.39 Ton $20.34 $0.00 $0.00 $20.34 Subtotal Group Totals 3.39 Ton $20.34 $0.00 $0.00 $20.34 Import Disposal Material 1153916 12/29/12 LK WASH. BLVD. RI 1 Dry Dirt 15.95 5.50 87.73 0.00 3.16 90.89 15.95 Ton $87.73 $0.00 $3.16 $90.89 Subtotal 1153854 12/26/12 renton 1 Clean Vactor Mud ($50 M 1.53 50.00 50.00 0.00 1.80 51.80 1153915 12/29/12 LK WASH. BLVD. RI 1 Clean Vactor Mud ($50 M 9.08 12.50 113.50 0.00 4.09 117.59 10.61 Ton $163.50 $0.00 $5.89 $169.39 Subtotal Group Totals 26.56 Ton $251.23 $0.00 $9.05 $260.28 29.95 Ton $271.57 $0.00 $9.05 $280.62 Invoice Total Total Invoice ----- > $280.62 7 ' I I 'ty ,M►. Carrier GREEAR Green Earthworks Constructic Vehicle 88 88 Customer GREEAR Green Earthworks Constructic Order Product 1400 Clean Vactor Mud ($50 Min) P.O. LK WASH. BLVD. RENTI Deliver Weighmaster JWS Ticket System Received Wo MCKSON Ca, Carrier GREEAR Green Earthworks Constructic Vehicle 88 88 Customer GREEAR Green Earthworks Constructic Order Product 1400 Clean Vactor Mud ($50 Min) P.O. LK WASH. BLVD, RENT( Deliver Weighmaster JWS Ticket System Received R Ticket 1153915 12/2 9/2 012 12 : 3 3 : 37 P M Location: 1 Waller Rd. Gravel Pit Qty Rate Amount Product 9.08 Ton 12.50 113.50 Freight 0.00 0.00 Tax REFUSE 4.09 Total 117.59 Pounds Tons Metric Gross 57800 28.90 * 26.22 Tare 39640 19.82 * 17.98 Net 18160 * 9.08 * 8.24 * Manual Weight Today Load: 1 Qty 9.08 R Ticket 1153915 12/29/2012 12:33:37PM Location: 1 Waller Rd. Gravel Pit Qty Rate Amount Product 9.08 Ton 12.50 113.50 Freight 0.00 0.00 Tax REFUSE 4.09 Total 117.59 Pounds Tons Metric Gross 57800 28.90 * 26.22 Tare 39640 * 19.82 * 17.98 * Net 18160 9.08 * 8.24 * Manual Weight Today Load: 1 Qty 9.08 Carrier GREEAR Green Earthworks Constructic Vehicle 1 Green Earthworks Vehicle Customer GREEAR Green Earthworks Constructic Order Product 1100 Dry Dirt P.O. RENTOD Deliver Weighmaster JWS Ticket System Received Carrier GREEAR Green Earthworks Constructic Vehicle 1 Green Earthworks Vehicle Customer GREEAR Green Earthworks Constructic Order Product 1100 Dry Dirt P.O. RENTOD Deliver Weighmaster JWS Ticket System Received R Ticket 1154163 1/7/2013 1:30:42PM Location: 1 Waller Rd. Gravel Pit Qty Rate Amount Product 4.49 Ton 5.50 24.70 Freight 0.00 0.00 Tax REFUSE 3.6000 0.89 Total 25.59 Pounds Tons Metric Gross 23960 11.98 10.87 Tare 14980 * 7.49 * 6.79 Net 8980 4.49 4.07 Predetermined Tare Today Load: 1 Qty 4.49 R Ticket 1154163 1 /7/2013 1: 30:42 P M Location: 1 Waller Rd. Gravel Pit Qty Rate Amount Product 4.49 Ton 5.50 24.70 Freight 0.00 0.00 Tax REFUSE 3.6000 0.89 Total 25.59 Pounds Tons Metric Gross 23960 11.98 10.87 Tare 14980 7.49 6.79 Net 8980 4.49 4.07 * Predetermined Tare Today Load: 1 Qty 4.49 Carrier GREEAR Green Earthworks Constructic Vehicle RENTAL RENTAL Customer GREEAR Green Earthworks Constructic Order Product 1100 Dry Dirt P.O. LK WASH. BLVD. RENTI Deliver Weighmaster JWS Ticket System Received WK MCKSON Ca,. Carrier GREEAR Green Earthworks Constructio Vehicle RENTAL RENTAL Customer GREEAR Green Earthworks Constructic Order Product 1100 Dry Dirt P.O. LK WASH. BLVD. RENT( Deliver Weighmaster JWS Ticket System Received R Ticket 1153916 12/29/2012 12:34:42PM Location: 1 Waller Rd. Gravel Pit Qty Rate Amount Product 15.95 Ton 5.50 87.73 Freight 0.00 0.00 Tax REFUSE 3.16 Total 90.89 Pounds Tons Metric Gross 59500 29.75 * 26.99 * Tare 27600 * 13.80 * 12.52 * Net 31900 * 15.95 * 14.47 * Manual Weight Today Load: 1 Qty 15.95 R Ticket 1153916 12/29/2012 12: 34:42 P M Location: 1 Waller Rd. Gravel Pit Qty Rate Amount Product 15.95 Ton 5.50 87.73 Freight 0.00 0.00 Tax REFUSE 3.16 Total 90.89 Pounds Tons Metric Gross 59500 * 29.75 * 26.99 * Tare 27600 13.80 * 12.52 * Net 31900 15.95 * 14.47 * Manual Weight Today Load; 1 Qty 15.95 Location- I Waller Rd. Gravel Pil Carrier GREEAR Green Earthworks Constr ti: QtY — Rate Amo—un uct Customer GREEAR Green Earthworks Cons 1 Freight 000 0.00 1F Pounds Po u Tons Metric Gross 490( Tare Net Net c18 401 ^L45 � � ,.Loads Todiv Received Qty - - — — ' � ---'—'— -- — 9? l{ •{l�: 1 �)•.) :.�•;rn:j +1J 4Y �, i'1 i%: (253) '111 -0.1 AJ „ :a�N rr.rLd,cf'.•. C:OIYt :a01-8 sat W M DICKSON COMPANY 3315 S PINE ST TACOMA WA 3: lq'VCD�2: (-- I--- r` l CUST#: 35598.0000 DEL DATE:12/27/12 253 472 4489 L# QTY DESCRIPTION CATALOG 1T 1 XYPEX PATCH N PLUG 20LB PAIL XYPPP20 DUE DATE: 01/26/13 SHIP RENTON TO: CUST PO:12032 TERMS: NET 30 DAYS QTY UNITS A 1 EA 12/27/12 12:16 011 S 1 P2311 DB 205 A 1 W 205 C 2 P 2 BID#: 35598.999 ;U;dblEl�:kh+ihN I UAY COAI:>7RUCTION PIODUCTS (COMAIENOFMFIJT BA'O MM(ES NO WARRENTIES PERTAINING (U RECOIAKIENDATIONS OR ADVICE GIVEN BY IT'S EMPLOYEES, NOR DOES COMMEIJCEMENT BAY WARRENT ,ICRCI-:ANIAL•ILIT Y O'1 FITNESS OF ANY PARTICULAR MATERIAL OR PRODUCT FOR 11AR(ICULAR USE, THE LIMIT OP COMMENCL'MENT BAYS LIABILITY IS THE REPLACEMENT OF ANY DEFECTIVE MATERIAL OR PRODUCT. RECEIVED BY: sifvw(URE .._....... PRINTED NAME _0 OF f�'rII�VGICENO.; IR741G0 ��DATE: 12/31/12 1 r� (f, BILLING TYPE: Partial 9426 8th Ave, South Seattle WA - 98108 Page: 1 Phone:866-695-5008 Fax: 206-763-4088 knrww.dpnicoll.com Customer No 12025 BILL TO: SHIP TO: WM Dickson Cc WM Dickson Co 3315 S Pine St N 36th and Lake Wa Blvd Tacoma, WA 98409 renton, WA 98056 CUST. JOB NO.: I JOBSITE PHONE NO.: 253-225-1106 JOBSITE CONTACT: Shawn OFFICE PHONE NO.: 253-472-4489 OFFICE CONTACT: Steve Nichols ORDER DATE: 12/26/12 PROJECT: DPN ORDER #: R022576 SALESPERSON: Ryan Jaffe S TERMS: NET30 items Rented Qty Part Description Date Out Delivery # Blil From Min Day Week 4 Week Total P.O. # Return # Bill To 1 3"x6'x14' Aluminum Double Wall 12/26/12 OT44898 12/26/12 385.71 128.57 385.71 1,157.12 385.71 Each Trench Shield wl Flat Bottom RT47846 12/28/12 4 Build -A -Box Ad)uslable 12/26/12 DT44898 12/26/12 10.77 3.59 10.77 32.32 43.09 Each Spreader 36"-60" RT47846 12/28/12 4 Aluminum Shield Build -A -Box 12/26/12 DT44898 12/26/12 2.56 0.85 2.66 7.69 10.25 Each Lifting Lug RT47846 12/28/12 8 Aluminum Shield Build -A -Box 12/26/12 DT44898 12/26112 D,00 0.00 0.00 0.00 0.00 Each Liftng Lug Pin 3/4"x 4-5/8" RT47846 12/28/12 Item_ s Sold ........... Qty Part Description W.O. # P.O. # Weight UOM Price Ext Price Continued... IL jr.4- Fllu' 9426 Sth Ave. South Seattle WA - 98108 Phone:956-695-5008 Fax:206-763-4088 www.dpnicoli.com Customer No 12025 BILL TO: WM Dickson Co 3315 S Pine St Tacoma, WA 98409 CUST. JOB NO.: JOBSITE CONTACT: Shawn OFFICE CONTACT: Steve Nichols PROJECT: SALESPERSON: Ryan Jaffe S II.11 ems Sold _._............ . I City Part Description 1 Deflvery Freight - DPN Truck Each 1 Return Freight - DPN Truck Each INVOICE NO.: IR74160 DATE: '12/31 /12 BILLING TYPE: Partial Page: 2 SHIP TO: WM Dickson Co N 36th and Lake Wa Blvd renton, WA 98056 JOBSITE PHONE NO.: 253-226-11OE OFFICE PHONE NO.: 253-472-448c, ORDER DATE: 12/26/12 DPN ORDER A R022576 TERMS: NET30 W.O. # P.O. g Weight UOM DT44898 RT47846 We show following additional equipment remaining on rent for this sales order Qty Part Description 1 4 Leg Chain Sling 318 x % GR-BO Each Leg Proof Loaded To Please remit to: D.P. Nicoll, Inc. M/S 52 PO Box 4100 Portland, OR 97208 Price Ext Price 125.00 126.00 EACH 125.00 125.00 EACH Subtotal: 689.05 Environmental Fee: 4.39 Tax: 65.87 Total: 759.31 Date P.O.# Delivery# Shipped DT44898 12/26/12 YI A UAW., I RAW v i Y;':' C.,V I f )LI'al_ jjl� 'P 1-fik f;jj1?o!j.-.j FIOLJ�W 01 1": 11! AM &M . 91 i, In w i ;j I isle wpmv, PIJ "Al 1'11�!Itlfs [P! 1, 11 Ip o I i. off; 11­. vomoul ARNM ONT! Widwo9wo loll 10, iYj W&WAq if WKIS) phi i WON WKINCTA, 101101, MUMV ARG 0i41-80 ViVI 64 Irx ANY 9426 8th Ave. South Seattle WA - 98108 Phone:866-695-5008 Fax:206-763-4088 www.dpnicoli.com Customer No 12025 BILL TO: WM Dickson Co 3315 S Pine St Tacoma, WA 98409 INVOICE NO.: IR74327 DATE: 01 /06/13 BILLING TYPE: Final Page: 1 SHIP TO: WM Dickson Co N 36th and Lake Wa Blvd renton, WA 98056 CUST. JOB NO.: JOBSITE PHONE NO.: 253-225-1106 JOBSITE CONTACT: Shawn OFFICE PHONE NO.: 253-472-4489 OFFICE CONTACT: Steve Nichols ORDER DATE: 12/26/12 PROJECT: DPN ORDER* R022576 SALESPERSON: Ryan Jaffe S TERMS: NET30 Items Rented - ----- Qty Part Description Date Out Delivery # Bill From Min Day Week 4 Week Total P.O. At Return # Bill To 1 4 Leg Chain Sling 318 x 16 12/26/12 DT44898 12/26112 25.10 8.37 25.10 75.29 25.09 Each GR-80 Each Leg Proof Loaded To RT47947 12/31/12 14200 Items Sold -- Qty Part Description W.O. # P.O. # Weight UOM Price Ext Price 1 Return - WIII Call RT47947 0.00 0.00 Each EACH Subtotal: 25.09 Environmental Fee: 0.25 Tax: 2.41 Total: 27.75 No additional equipment/services outstanding for this Rental Order. Please remit to: D.P. Nicoli, Inc. M/S 52 PO Box 4100 Portland, OR 97208 FromsUNITED RENTALS Tos253-220-2621 JAYSON W ST LOCATZ52 O United Rentals' 135 STON 3 SO 7135 8TH AyH SOUTH SnTTLB, NA 98108 800-UR-RENTS (800-877-3687) 206-767-3121 206-767-0265 PAS unitedTentals.com II II � I IIIIIII�IIII IIIIIIIIII IIIII�III�II II� 4J JAYSON W STEVENS -H LAKE WA BLVD N & N 36 ST x:1@2 0 RENTON, WA '98055 Office: 253-606-8787 Job: 253-606-8787 N JAYSON W STEVENS LAKE WA BLVD N & N 36 ST RENTON, WA 98055 m 0 U Msg#9172962.0.1 01/17/2013 1508 Page 2 of 2 RENTAL RETURN INVOICE # 108022139-001 Customer Number $# 1006812652 Invoice Date 1/15/13 Rental Out 12/26/12 12:00 PM Rental In 1/01/13 12:00 PM Job Location: LAKE WA BLVD N & N 36 ST, R Job Number . P.O. Number : RENTON Ordered By : JASON Written By URB52VD Salesperson : 1776 RENTAL ITEMS: t7ty EQuinment Description Minimum Day Week 4 Week Amount 2 944/9942 ROAD PLATE 8' % 101- 50.00 50.00 129.00 304.00 258.00 1 944/9946 ROAD PLATE 8' B 20' 91.00 61.00 187.00 399.00 187.00 1 944/9892 LIFTING TOOL , CROSSING PLATE 13.00 23.00 59.00 23.00 Rental Subtotal: 468.00 SALES/MISCELLANEOUS ITEMS: Oty Item Price Unit of Measure Extended Amt. 1 DELIVERY CHARGE 167.640 (EA) BACH 167.94 1 PICKUP CHARGE 167.640 (EA) EACH 167.64 DATE Type $ Fes# $QT$ TRANS TYPE $pOWT APPLIED 2/26/12 MASTERCARD -•6715 09115Z CHARGED 935.42 Sales/Rise Subtotal: 335.20 Agreement Subtotal: 803.28 Rental Protection: 65.52 Tax: 66.62 Total: 935.42 Deposit: 935.42 Balance paid: 935.42 COMMENTS/NOTES: .... .......... .... ..... ........ ......... ........... ..... ..... CONTACT: JASON CELLA: 253-606-8787 ... THIS INVOICE IS ISSUED SUBJECT TO THE TERMS AND CONDITIONS OF THE RENTAL AGREEMENT, WHICH ARE INCORPORATED HEREIN BY REFERENCE. A COPY OF THE RENTAL AGREEMENT IS AVAILABLE UPON REQUEST. Page: 1 --G RY REED & SONS L L C 13324 WALLER ROAD EAST TACOMA , WA• 98446 - 1826 Phone # Fax # 253-537-7309 253-537-7308 Bill To GREEN EARTHWORKS CONSTRUCTION, INC. 5001 SOUTH TYLER STREET TACOMA, WA. 98409 P.O. Number Item Code Description DUMP TRU... INVOICE # 3089 SOLO DUMP TRUCK DUMP TRU... INVOICE # 3090 SOLO DUMP TRUCK JEFF R-3 ... INVOICE # 3091 SOLO DUMP TRUCK DUMP TRU... INVOICE # 3092 SOLO DUMP TRUCK DUMP TRU... INVOICE # 3093 SOLO DUMP TRUCK JEFF R-3 ... INVOICE # 3094 SOLO DUMP TRUCK E MAIL - GREXCAVATING c,_rGMAIL.COM Invoice Date Invoice # 12/28/2012 2012-166 JOB JOB # 2012 LAKE WASHINGTON BLVD and NORTH 36th STREET CITY OF RENTON RENTON, WA Terms Due Date Project Due on receipt 1212812012 I CITY OF RENTON HOURS Rate Work Date Amount 6 115.00 12/27/2012 690.00 6.6 115.00 12/2712012 747.50 7 116.00 12/27/2012 805.00 6 115.00 12/28/2012 690.00 5 115.00 12/28/2012 575.00 8.5 115.00 12/28/2012 977.50 Subtotal $4,485.00 Total $4,486.00 Date: �C • d ��% No. 3089 Gary Reed & Sons LLC Truck No.: Chak is 13324 Wailer Road East Tacoma, WA 98446 GaryCell 253 405-2900 ( ) Joe Cell 405-28.59 Truck T e: Truck olo Trailer Transfer Other es: Driver charge: sub (253) Truck Rate: Total: Office (253) 537-7309 Jeff Cell (253) 405-2234 Additional Fax (253) 537-7308 Permit No. CC63096 Truck Hours: Driver Hours: Cha es: Total Char es: Billing Customer. E.— i oaf dress: Job 1 nr�finn 77 ` ILo I- 1 nn ` IG �. • 1/f 9 iL A n _ I f Z • a't. i� Start: a / P% Stop: ,a1�c1 3 �yV Lunch: h' Downtime: Reason: Material :- • From To No. Loads H U i S lY f— Fuel: 011: Total Miles: Total Miles Off -Hi hwa : -Remarks Drivers Signature: Author. Co Rep Signature.• PLEASE NOTE: ADDITIONAL TERMS AND CONDITIONS: THE TERMS AND CONDITIONS STATED ON THE REVERSE OF THIS INVOICE ARE A PART OF CARRIER'S AGREEMENT TO PROVIDE SERVICE. YOUR SIGNATURE ON THE F OF THIS INVOICE SIGNIFIES YOUR KNOWLEDGE, AND ACCEPTANCE, OF THE TERMS ON THE REVERSE. 0 Copyrighted FORMS 6 PROMOTIONS • 42S/48 Date: a G.. VF 7 '90 NO. 3 O 9 O k1gaiL Gary Reed & Sons LLC Truck No.: tNah Cha k es: 13324 Waller Road East GaryCell 253 405 2900poloTraller Driver ( ) Truck T e: Transfer Other Char e: Tacoma, WA 98446 Joe Cell (253) 405-2859 Truck Rate:otalOffice (253) 537-7309 Jeff Cell (253) 405-2234 Truck Hours: •Additional Fax (253) 537-7308 Permit No. CC63096 Char es: Driver Hours: Total Char es: Billing Customer. r �.. ar ) p h S r- c� Address: Job /f Job 1 —firm- G �. ►.1 r I - L 2 �.._ I A • I -i tFt r' 1 Start: i Stop: Lunch: / Downtime: ` F♦. VUrrlOer' Reason: Materials : _ .:.:.: : From' :. . No. Loads IV$ N . R s1 17 t r Fuel: Oil: Total Miles' Total Miles Off Highway Drivers Signature: 1 -v 1 OIL X3 d StKe Author. Co. Rep. Signature: PLEASE NOTE: ADDITIONAL TERMS AND CONDITI THE TERMS AND CONDITIONS STATED ON THE REVERSE OF THIS INVOICE ARE A PART OF CARRIER'S AGREEMENT TO I ERVIC &JR"S�.'.OR.IiT�1..�THOFTHIS INVOICE SIGNIFIES YOUR KNOWLEDGE, AND ACCEPTANCE, OF THE TERMS ON THE REVERSE. m CopyrigF Gary Reed & Sons LLC 13324 Waller Road East Gary Cell (253) 405-2900 Tacoma, WA 98446 Joe Cell (253) 405-2859. Office (253) 537-7309 Jeff Cell (253) 405-2234 4;0 Fax (253) 537-7308 Permit No. CC63096 Date: 19C . C" C40 1 ems% 1 NO. J V J 1 Truck No.: 3 Char es: Truck T e: oio Truck Trailer Transfer Other Driver Char e: Truck Rate: Total: Truck Hours: -Additional Char es: Driver Hours: �^ Total Char es: 1 Customer: / ►� 6r O/%c Billing Address: Job Location:- �a r•C� Or 5 n Job umber: 7 Start: /' ZD ^7S Stop: J: Do Lunch: 1 a- ice. Downtime: Reason: Material•' - -From To No. Loads a Pe" r'd / %L a �a is G :. Job Fuel: 011: Total Mlles: I Total Miles Off -Highway: -Remarks PLEASE NOTE: ADDITIONAL TERMS AND CONDITIONS: L.-THE TERMS AND CONDITI NS STATED ON THE REVERSE OF THIS INVOICE ARE A PART OF CARRIER'S AGREEMENT TO PROVIDE SER . YOUR SIGNATURE ON T OF THIS INVOICE SIGNIFIES YOUR KNOWLEDGE, AND ACCEPTANCE, OF THE TERMS ON THE REVERSE. ® Copyrighted X6�rT d-lf FF FORMS & PROMOTIONS - Date: N0. 30 t f Gary Reed & Sons LLC Truck No.: / Truck Char es: 13324 Waller Road East GaryCell 253 405-2900 Truck oriver ( ) Truck T e: Solo Trailer Transfer Other Char e: Tacoma, WA 98446 Joe Cell (253) 405-2859 Truck Rate: Office (253) 537-7309 Jeff Cell (253) 405-2234 Total: � Truck Hours: Additional Fax (253) 537-7308 Permit No. CC63096 Char es: J ,-- Billing G Customer. (-efy-, , Address: Job Job Location: L-dK� waSi�; _a !-i, , iZ (u.>f . al_ It w 1,,, IJ ?: +11 c• 1 /l 1 g� Start: 3D Sto : 2- . _36 Lunch: tj 0 - --- iVUI11UtlIC Downtime: Reason: Material . .. .. . .,From. To.. ... No. �r cr4- 's L14k— w 0'4% U S4"& Loads I L cm ft Fuel: Oil: Total Miles �1 Total Miles Off -Highway: +P •nemarus Authot. Co. Rep. Signature: PLEASE NOTE: AD AL TERMS AND CONDITIONS: THE TERMS AND CONDITIONS STATED ON THE REVERSE OF THIS INVOICE ARE A PART OF CARRIER'S AGREEMENT TO PROVIDE SERVICE. YOUR SIGNATURE ON THE OF THIS INVOICE SIGNIFIES YOUR KNOWLEDGE, AND ACCEPTANCE, OF THE TERMS ON THE REVERSE. m Copyrighted )C96=ye7r F . FORMS 6 PROMOTIONS 415/. t I Gary Reed & Sons LLC 13324 Waller Road East Gary Cell (253) 405-2900 Tacoma, WA 98446 Joe Cell (253) 405-2859 Office (253) 537-7309 Jeff Cell (253) 405-2234 Fax (253) 537-7308 Permit No. CC63096 Date: PG .r OJ NO. a U a J Truck No.: t ci Truck Char es: Truck Type: olo Truck Trailer Transfer Other Driver Char e: Truck Rate: Pi Sub Truck Hours: 11 •Additional Char es: Driver Hours: Total Char es: ;ustomer. Billing Address: ,UO f S 4 lob ) .ocabon: We- asl, in ., IJ �A .. Job Number: Aart: �` 3c7 Stop: Lunch: © Downtime: TReason: Material From To No. Loads Hours { v J V - �� 5b Fuel: Oil: Total Miles: Total Miles Off -Highway: -Remarks PLEASE NOTE: ADDITIONAL TERMS AND CONDITIONS: " 'HE TERMS AND CONDITIONS STATED ON THE REVERSE OF THIS INVOICE AREA PART OF CARRIER'S AGREEMENT TO PROVIDE SERVICE. YOUR SIGNATURE ON THE FACE )F THIS INVOICE SIGNIFIES YOUR KNOWLEDGE, AND ACCEPTANCE, OF THE TERMS ON THE REVERSE. 0copyrighted aLS/CNA7cRE FORMS b PROMOTIONS 475/145-9900 t Gary Reed & Sons LLC 13324 Waller Road East Gary Cell (253) 405-2900 Tacoma, WA 98446 Joe Cell (253) 405-2859 Office (253) 537.7309 Jeff Cell (253) 405-2234 Fax (253) 537-7308 Permit No. CC63096 fig, av1,3L a NO- 30 e- _(,.Y.c I Address: G a0) C�;ustomer. Billing ob�F+^^ � is 1L, J , i,, c L : 4 _ P �.. _) w) It; w L_La `l / YL C*L 67 . -L. Job tart: �` 3b Sto : S' �ID I Lunch: 10 a Downtime: Reason: Material. ' .,-,:From.. _ To .No. Loads Hours )) qbn b i ri- `,ab S�o., a- Fuel: IN: Oil: Total Miles: Total Miles Off -Highway: Drivers Signature: zz- I Author. Co. Rep. Signature; �t�( PLEASE NOTE: ADDITIONAL TERMS AND CONDITIONS: HE TERMS AND CONDITIONS STATED ON THE REVERSE OF THIS INVOICE AREA PART OF CARRIER'S AGREEMENT TO PROVIDE SERVICE. YOUR SIGNATURE ON THE FACE f THIS INVOICE SIGNIFIES YOUR KNOWLEDGE, AND ACCEPTANCE, OF THE TERMS ON THE REVERSE. 0Copyrighted J6K7./AYnRF FORMS& PROMOTIONS • 425p9609oo KANGLEY ROCK & RECYCLING ACCOUNTING: 9125 cFArrEF. WA 981NTH 08E SOUTH06) 762-2566 REV 04/2009 TRIO KANGLEY PIT (Plant # 021) 32500 S.E. Kent-Kangley Rd.,Ravensdale, WA 98051 • (360) 886-9269 BLACK RIVER QUARRY (Plant # 022) 510 Monster Road, Renton, WA 98055 • (425) 226-1000 ext. 3339 CEDAR SHORES (Plant # 020) — 21010 Cedar Grove Road S.E., DELIVERY TICKET ORDER Qr.i!'. CUSTOMER Caplf KANGLEY ROCK & RECYCLING ACCOUNTING: 9125 TENTH AVENUE SOUTH SEATTLE, WA 98108 - (206) 762-2566 A DIVISION OF GARY-MERLINO CONSTRUCTION COMPANY, INC KANGLEY PIT (Plant # 021) 32500 S.E. Kent-Kangley Rd., Ravensdale, WA 98051 - (360) 8815-9269 BLACK RIVER QUARRY (Plant # 022). 510 Monster Road, Renton, WA 98055 - (425) 226-1000 ext. 3339 CEDAR SHORES (Plant # 020) — 21010 Cedar Grove Road S,E., Maple Valley, WA 98038 - (425) 226-1000 ext. 3340 ...-.,.-DELIVERY TICKET SALES ORDER DESK MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE [CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) El CASH El CHECK # EICHARGE CARD # EXP. SPECIAL INSTRUCTIONS El VISA [I MASTERCARD 0 DISCOVER QUANTITY U.M. PRODUCT DESCRIPTION CODE DRIVER TRUCK NO. ORDERED BY DISPATCHER TAX CODE TIME DUE, S AND 'v1'.E-ES TO !'01.0 IARMLESS KANGLEY ROCK 8, RECYCLING, A DIWSION GR, - C-%APNY. ice,-`)R DAPvIAGETC) HIS PFFSO'NAL. - N -V RS V CUSTOMER SIGNATURE PRINT NAME DATE REV 04/2009 TRIO cum '71"QUER, COPY KANGLEY PIT (Plant# 021) DELIVERY TICKET KANGLEY Ravensdale, 886-9269 32500 S.E. Kent-Kangley Rd., �Wy�Ag5j_t_aQ) ------------- ROCK & RECYCLING BLACK RIVER QUARRY (Plant 2) ACCOUNTING: 9125 TENTH AVENUE SOUTH 510 Monster Road, Renton, WA 945 • (425) 226-1000 ext. 3339 FAX . . ..... SEATTLE, WA 98108 - (206)762-2566 CEDAR SHORES (Plant # 020) — 2701U-Uedgr Grove Rud ORDER DE.,-K 3 - A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. Maple Valley, WA 98038 (425) 226-1000 ext. 3340 MAP LOCATE I - — LEAVE PLANT ARRIVE LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. COLLECT ON DELIVERY (C.O.D.) JOB ADDRESS 0 CASH 0 CHECK # EICHARGE CARD # EXP. 0 VISA 0 MASTERCARD 0 DISCOVER SPECIAL INSTRUCTIONS DESCRIPTION•TOTAL TONS UNIT PRICE• DRIVER TRUCK NO. ORDERED BY •• DISPATCHER TAX CODE TIME DUE �.AQ E EST C) Ho LO HARMLESS i' ANCLEY R00,K PEC',"CL)MG., A DiVIS!0N 0' GAR,. i.FOR AN!%' DAN1AGE TO 'X!S FIFAL nfli -IrRSONAL PROPERTY T jS=D R�- DELIVERY 0, L!.,- AL-*VE. DETAII—S('N REVERSE. CUSTOMER SIGNATURE • PRINT NAME DATE REV 04/2009 TRIO CUSTOMER CUPY KANGLEY PIT (Plant# 021) DELIVERY TICKET KANGLEY 32500 S.E Kent-Kangley Rd., Ravensdale, WA 98051 - (360) 8813-9269 ROCK & RECYCLING BLACK RIVER QUARRY (Plant * 022) ACCOUNTING: 9125 TENTH AVENUE SOUTH 510 Monster Road, Renton, WA98055 •- (425)226-1000ext. 3339 1 x SEATTLE, WA 98108 - (206) 762-2566 CEDAR SHORES (Plant# 020) — 21010 Cedar Grove Road S.E., A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. Maple Valley, WA 98038 • (425) 226-1000 ext. 3340 i ORDPP, DESK MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO. ORDER NO: PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. I DELIVERY-fidmu NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) C] CASH El CHECK # E)CHARGE CARD # EXP. SPECIAL INSTRUCTIONS 0 VISA 0 MASTERCARD 0 DISCOVER QUANTITY U.M. DESCRIPTION TONS• DRIVER TRUCK j`40. ORDERED BY • DISPATCHER TAX CODE, TIME DUE • TO HOLD HANNILES$ AAMC-4_�.Y t OO.IC it P5tG3' ILE A DIVISION C'F P'...-ON AL �..MM�7'HfJ6TION n )il 1V F(rl AN( Tij HIS REAL 0� RY OF i­n!AL3 S_ 1)11-UNILS ON P-CVER;. CUSTOMER SIGNATURE • PRINT NAME DATE REV 04/2009 TRIO OU81,063ER COPY oncrete: Injurious to eyes.Causes skin irdtabon.Contains Portland Cement. Read the following warning before using: Contact with wwith et, hhardened concrete, t ort n, cement a cement mixtures can cause fulNength trousers andsevere �tight4�ibums a eye protection Men waking wie darnage. Avoid � ese lee � skin'Wear waterproof gloves, a fitly-butoned, lag iatenals. If you have to stand in wet concrete, use waterproof boots that are light at the top and h gh enoig to keep concrete fran flowin.9 into them. finishing concrete, wear knee pads to protect knees. After contadwdh any of these materials, wash off Immediately with fresh, dean water. Indirecteontad trough clothing is as dangerous so promptly nose these materials from clothing. Seek immediate medical aftenton 6 you have persistent or severe 30,78128 isoomfortln rase of eye contact, flush with plenty of water for at least 15 minutes. Consult physic ian Irnn>eJiatey. KEEP out of reach of children! Qser o y + green to convey this warning to all persons who may use a come into contact with wet (unhardened) concrete, mortar, czrrherct a oerrherhl mBe6utes. o your health. Mewres ous & should be taken Qhandling this pnodi�LLL Hot aAsphalt tions of demits uisance from a gravel pfumes. Aroduct void brbe eathing •fumes. Also, Asphak may tcahse severe bumso control fugitive . Wear protective afety gear (bng sleeves, pants and gloves). if burned, Cod with water and see a physician. Vater added at customer's own risk Additional water added to concrete will Property Damage Inde heavy agdp &Release be educe its strength,Buyersagent agrees toaccept responsiibilityfor reduced strength The operator of to ou this piece Of re is oftheuoppi ontliattl�operaationoftlhis charged at postedtrucktimerates.lTruck gstandby ue towateradded abovedesign. machinery In the manner required to perform our contract with you may time dharged at posted truck time rates. lo cause damage to the premises a property. It is our wish to help Limited Warran The only liability of the seller for 4mved at job with inch slump. y that we can, but in order to do this, the is asking fly you n evenyway ° product defect is the return of the purchase price. In no Added gal water at, tourer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the vent shall the seller be liable for any direct indirect, ?� taken...'- seller of its contact with me, I the urxlersgrhed, hereby INDEMNIFY the incidental or consequential damages resulting from seller and its employees for any damage and for all claims to the premises, the use of the pproducts or arising out of breach of any Other additiorjs buildingutility pipelines a cables, telephone lines, driveway a other warranty. Allcfaimsfor damages orshortages must be , " made within 24 hours of delivery.We do not assume appurtenances, at . Received t responsibility for any damage beyond the curb line. Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from ;}. ;•• %;;i,: t';i i : i...':a any liability. ::, is-J'j" t i r . ; : � The addition of any extra products to our mixer may void any warranty "i 1 expressed or implied by the seller. The seller accepts no liability for any �,.e :a•. ; �- . ;. t : ; ;'. �' i;'1?-: personal Injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent _ hNGDELT.KT09D.4oB it !'# i (( -- --- i t _.. __.._ .-_. Arrive Plant r Leave Plant Arrive Job Sit Start Discharg Finish Discharge Leave Job Site t 1 I t li tl 1 E3 t t 1 Drivers' Comments Company/ Customer PO/ TICKETNO. Driver Co. Proj. No. Order No. Cust. No. Customer Job Phase Code y •.; . L :t .�.1 - ! s•' . + 1 1 - r..i is f ... Date• - r Delivery Address Customer I I a zone ._ ..I•, .r....i, .. Delivery Instructions Scale Time: .,,:t Unit Price Amount Load Oty Delivered Qty OrderQty ProductCode UOM Product Description _ - Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plant i Sales Tax Load Siza • • TOTAL DUE Truck Gross V Trailer Check # �MILES� SAND & GRAVEL COMPANY 400 VALLEY AVE NE • PUYALLUP, WA 98372-2516 • (253) 833-3705 www.MilesSandandGravel.com CONCRETE ORDERS CONCRETEORDERS SAND& GRAVEL ORDERS SAND& GRAVEL ORDERS ACCOUNTING & SALES Keg, Piece & Mo Cc. TMas m Lws & Mewn Ca King & Puce 0a TMnim, Lewis & Masan Co. (253) 833-3705 (253) 833-3700 (360) 491-7777 (253) 536-9100 (360) 491-7777 GREEN EARTHWORKS CONSTRUCTION 5001 S TYLER ST TACOMA, WA 98409 INVOICE CUSTOMER NO � DATEF±' ; INVOICE NO PAGE 017098 12/27/2012 851698 1 000021 LAKE WASHINGTON BLVD & 36TH NE 12/27 211-256595 13.43 TN PEA GRAVEL 12/27 211-256595 13.43 TN ENVIRONMENTAL COMPLIANC JOB TOTAL LINE RENTON 9.900 0.750 PRODUCT RECAP 13.43 1100 PEA GRAVEL 13.43 1700 ENVIRONMENTAL COMPLIANCE - AGG 132.96 10.07 143.03 143.03 PALMER COKING COALC0.UP �ij Ticlte't Number: 3�05C�2 Y+ Tate: 12/27/12 Timex.. 15:55 P.O. Box 10 / 31407 Hwy 169 ' Black Diamond, WA 98010 (3 0)886x (425) 2841 (425) 432-4700 432-3883 www.palmercc.com customer: 111111 CASH $45.50 100 GREETS EARTHWORK Price/Unit: 4. Tru.cr:: CASH DUMFTRUCK SALES Amount;$4S5.e7 i2 Job: CASH DUM " PQ Number: BACKHAUL - SLURRY Delivery: 365 Scale Sub-Tota].:. $465.91 GROSS: 54940 Lbs K Tax: 50.0Q TARE:....44900 Lbs S .-- ? $485.97 NET: 20040 Lbs i ._ Yards rf f Net � lons : 10. 02 Comments. RENTON driver Scale Legend 1 _ Sca 1 e 1 , C- 7; M Man Wt Weighed By g Stored Tare SUBJECT TO PCCS THE MONTH SUBJECT OEF NANCE CHARGEDUE By THE 'OF 1'�/o PER MONT'H.— TERMS: ALL PURRHES ' SUPPLIES. FOLLOWING RECEIPT MATERIALS LABOR, SERVICE ORF UNPAID SUMS RENTON."-PONCR,ETE RECYCLERA 22121, 7th'A�. ;$.E. SU4.0.0ii-Bothell, WA,98021.. Pit Sitei-: 500 Monster 111"li0;0' ;l'--.%W,Rp!itoiniq WA. Buiskni:ess 0jfi4&.&4.2t4..81. 9101 Scale. House: 206-772-2278 Ticket Date:— A d- 1— .1 -d Customer: Project Name/P.O. Number. Project Location (City, Stre Trucking Company: Scalleperson: Cash ❑ Account Truck# Time Material Gross Weight Tare Weight Net Tons/Yd3 Price_-, Material Size TERMS: NET 0 ar st se DAYS FROM END -OMI f �17:_ Finance Charge will nj!, A Ina Lit L 44. , �_Y Annuai Tinance charge of im NOTICE: It is specificall reed that this com pany shall not be in anyway responsible damage to c property resutingfrom deliveries beyond the curb line. 5% Environmental Fee Sales Tax T,,fal P DRIVER SIGNATUREIPRINTED NAME:A.I-A 1, i,-d dqV:C0 el, /0 uer RENTON. CON, CRETE RECYCLERt'!`.: 221211 17th Ave SX.'i'.'.Smite #117 Bothell, Wk-.46021 Pit Site::.500 Mbnster Roa`ii�`S' W Renton WA 1144sin,ess Office:,.425!.481-9101 Scale House:'206-772-2278 41A It I LIT" ..20191.0 D a t e: Customer: �Jf Project Narne/P.O. Number:- ;:A Project Location (City, Street *l!'O%�- A 'Scaleperso J Trucking Company: Cyvu V n: Cash Account-.,, Truck# Time Material v Gross Weight Tare Weight Net weight Net Tons/Yd' Price,_ Material Size 01 L� 7 7 WIWI' EffTallaDAY'STIR oe sesse n -a Da END dAE r cE"n , MONTH A Finance Charge will K21-1. nf 1 1 /10/ nor mnnfh Tnf=I Material t . rate .A, f Annuai Finance cnarge or w/o NOTICE: It is specifically a preed that this company shall not 0 be in anyway responsible or damage to customers property resuRin fromdeliveriesbeyond the curb line. 5% Environmental Fee Sales Tax I t Total DRIVER SIGNATURE/PRINTED NAME: �, ` I,-d dqb:Co Cl, LO U8r Ticket # Date I, c k. G.E.C. NW Vac & Environmental Services 5001 S. TYLER ST., TACOMA, WA 98409 PHONE:253-534-8202 FAX:253-220-2621 Customer Name- t. :. Site Contact Phone# Site Address;: City State Zip Payment: S/B Check # Cash Credit Card # Mailing Address City State Zip Exp. TECH LABOR TRUCK # START TIME ON SITE TIME OFF SITE TIME DISPOSAL IN CNJT+ DISPOSAL Description of Work Performed Hr Unit Total Price — Amount —^ — — — Additional work needed O Yes O No Drawing/Additional work info Sub -Total Tax % Total Terms: Net 10 days 1 1/2 % Per month delinquency charge on past due accounts Personal Guarantee By my signature below I have accepted personal liability for all amounts due GEC NW Environmental Services and promise to make the payments as agreed: WHEN WORK IS COMPLETE. I fully understand that in the event that payments are not made as agreed, that I have assumed personal liability for all unpaid amounts including all collection fees, all attorney fees, plus all costs incurred to pursue under law all amounts due GEC NW Environmental Services. Customer Signature: Date: Ticket # Date` G.E.0 "W Vac & Environmental Services 5001 S. TYLER ST., TACOMA, WA 98409 PHONE:253-534-8202 FAX:253-220-2621 Customer Name : Site Contact Phone# Site Address ; City State Zip Payment: S/B Check # Mailing Address Cash Credit Card # City State Zip Exp. TECH LABOR TRUCK # I START TIME ON SITE TIME OFF SITE TIME DISPOSAL IN OUT DISPOSAL ` t Description of Work Performed Hr Unit Total Price Amount ' -- ' ' --_--'�- - ---.. S �.i.....-ate• ----- Additional work needed O Yes - 0 No Drawing/Additional work info Sub -Total Tax % Total Terms: Net 10 days 1 1/2 % Per month delinquency charge on past due accounts Personal Guarantee By my signature below 1 have accepted personal liability for all amounts due GEC NW Environmental Services and promise to make the payments as agreed: WHEN WORK IS COMPLETE. I fully understand that in the event that payments are not made as agreed, that I have assumed personal liability for all unpaid amounts including all collection fees, all attorney fees, plus all costs incurred to pursue under law all amounts due GEC NW Environmental Services. Customer Signature: Date: KANGLEY KANGLEY PIT (Plant # 021) DELIVERY TICKET 32500 S.E. Kent-Kangley Rd., Ravensdale, WA 98051 • (360) 886-9269 1- — --- --- - - --- ROCK & RECYCLING :>:; oL.raTlNc rza; BLACK RIVER QUARRY (Plant # 022) _ ACCOUNTING: 9125 TENTH AVENUE SOUTH 510 Monster Road, Renton, WA 98055 • (425) 226-1000 ext. 3339 rAX SEATTLE, WA 98108 206 762-2566 SALES. `, ( ) CEDAR SHORES (Plant # 02D) — 21010 Cedar Grove Road S.E., ; A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. Maple Valley, WA 98038 • (425) 226-1000 ext. 3340 I ORDER DL611: 6?2F1 2'%6 '. (r)O MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO DELIVERY TICKET NO JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE I ; CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD El DISCOVER UNIT PRICE AMOUNT U.M. PRODUCT DESCRIPTION CODE DRIVER TRUCK NO. ORDERED BY • DISPATCHER TAX CODE TIME DUE 1 R'-LhraSE O!'v R RELEASES AND tGi= FES "O HOLD HARMLESS KANGLEY ROCLG a RCCYCUW.;3, A DIVISION O iiS1Rl'' ili;_ l:.lrk GONSTfiUCTl0�1 c'XMRANY, ICb :. FOR ANY DAMAGE ?'O HIS RL=AL OR PERSONAL PROPERTY �,.-,LSE%.-;'r DEL IVEQV OF ... r. DE.IAi_S ON REVERSE'. CUSTOMER SIGNATURE PRINT NAME DATE REV 04/2009 TRIO CUS OW0 COM( KANGI.EY ROCK & RECYCLING ACCOUNTING: 9125 TENTH AVENUE SOUTH SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. DELIVERY TICKET I SALES 8, ORDEP. DESK -4251 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO. ORDER NO, PROJECT PLANT # ---.._..--_....-._.__.... CUSTOMER NAME CUSTOMER P.O. JOB NO, i DELIV-- ER.Y _ TICKET NO. , i JOB ADDRESS -- — ---- - - - - COLLECT ON DELIVERY (C.O.D.) O CASH ❑ CHECK # ❑ CHARGE # SPECIAL INSTRUCTIONS CARDEXP. / ❑ VISA ❑ MASTERCARD ❑ DISCOVER QUANTITY U.M. •�DESCRIPTION •UNIT PRICE AMOUNT .. i� t'! , .. .'pi;•ti i .u'%:i,. `It. 'I� ... . DRIVER TRUCK NO. ORDERED BY • DISPATCHER TAX CODE TIME DUE i!;t^IVII_:?S :�ANfiiLL i0� E� Cat y4 C"CL.zlGi�, A jIVISION FOR ANY DAwi: G !S R 1' - F. irl v P • • �. a 1. Il. f i... ��-Ai.. �h N_ _ �I,i:L Pr-c6 ril�, �_•:�.L _ �. ��i.:':'i.I;'', :F• ...\.. d:,: i_I` �uD.GF:�11'7'`.1r-? li11L�-' "XII r-d:VtYSc. CUSTOMER SIGNATURE ��,�� 4 / �_�--_� • PRINT NAME DATE REV 04/2009 TRIO KANGLEY PIT (Plant # 021) 32500 S.E. Kent-Kangley Rd., Ravensdale, WA 98051 • (360) 886-9269 BLACK RIVER QUARRY (Plant # 022) 510 Monster Road, Renton, WA 98055 • (425) 226.1000 ext. 3339 CEDAR SHORES (Plant # 020) — 21010 Cedar Grove Road S.E., Maple Valley, WA 98038 • (425) 226-1000 ext. 3340 CUS 0 MAER COPY KANGLEY ROCK & RECYCLING ACCOUNTING: 9125 TENTH AVENUE SOUTH SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. DELIVERY TICKET FAX 1 j SALES R. ORDER DESK MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE i08 ARRIVE PLANT DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS - — -- ----- — COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE CARD # EXP. SPECIAL INSTRUCTIONS F; ❑ VISA [IMASTERCARD ❑DISCOVER PRODUCT •CODE • • TOTONSUNIT PRICE AMOUNT DRIVER TRUCK NO. ORDERED BY • DISPATCHER TAX CODE TIME DUE ; -:RE, L;G.4 _iFcE3`_ +. QLi) i IARi I -F3 NANrZLEY ROCK R,2'.',Y :i-MG, .A DIVISION :i!- . i•'1r:`' i:1 ,�i! ii V' -:�P -?L!C;'I iOfv i;lN.`iF?\i'J'. iPi� ;=Oi ;ANY D>� .1"' - l r Icy - r_o _ � '-�i�- T(. � - EAi. i)Fi E:,.>rlf\:.11. Pisi)i'EP,T'.' • • • • iiaii_S Doi FI .Vt:RSE. CUSTOMER SIGNATURE_ O r� -� • PRINT NAME DATE • REV 04/2009 TRIO KANGLEY PIT (Plant # 021) 32500 S.E. Kent-Kangley Rd., Ravensdale, WA 98051 • (360) 886-9269 BLACK RIVER QUARRY (Plant # 022) . 510 Monster Road, Renton, WA 98055 • (425) 226-1000 ext. 3339 CEDAR SHORES (Plant # 020) — 21010 Cedar Grove Road S.E., Maple Valley, WA 98038 • (425) 226-1000 ext. 3340 KANGLEY KANGLEY PIT (Plant# 021) 32500 S.E. Kent-Kangley Rd., Ravensdale, WA 98051 - (360) 886-9269 ROCK & RECYCLING BLACK RIVER QUARRY (Plant # 022) ACCOUNTING: 9125 TENTH AVENUE SOUTH 510 Monster Road, Renton, WA 98055 - (425) 226-1000 ext. 3339 DELIVERY TICKET 0­1 TTLE, Injurious to eyes.Causes 'skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, I..UJ I VIVICI"f xxhcrete, mortar, cemeritor cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with t. Wear waterproof gloves, a fullybuftor-ed, long -sleeve shirt, full-length trousers and tight -filling eye protection when working with these V 'have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. ,ete, wear knee pads to protect knees. After contact with any of these materials, wash off imrnediately with fresh, dean water. Indirect contact rh as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe - aisoorly tln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User N <' agrees to convey this warning to all persons who may use or came into contact with wet (unhardened) concrete, mortar, cement or cement mixtures, 8 ; 8 (0 Aggregates: Pmbnged inhalations of dust from a gravel product may be hazardous to your health. Measures to oontml fugitive dust should be taken when handltrg this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce Its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, isofthe opinion that the Operation Ofthis charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with Inch slump. � possibly cause damage to the premises or property. It is our wish to help ty g q Test cylinders You � �fi! that we can, but in order to do this, the operator is asking Limited l defect n the he only tliability of they seller for Added al water at customer request. y dens that sign this RELEASE. In consideration of the performance of the P purchase rice. In no taken seller of is contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct indirect, damage Other additions seller and its employees for any and for atdaimstothe premses, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the pproducts or arising out of breach of any bRyceivedX appurtenances, at: warranty. All craimsfor damages orshortages mustbe Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent WGl)ELTKIOg040 — - - Leave Plant Arrive Job Sit Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers' -'' ,4 ---- --- -------- Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKETNO. Customer Delivery Address Delivery Instructions oaa uty Delivered Qty OrderQty ProductCode made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. a aNii�+.i is Driver Co. Proj. No. Date .. ,._ . .. _ . Map Zone Scale Time: �,:,` •_.. r' Load Size Prod. No. Description Slump Type CC Use Haul Cd: Pit/RtaRt : Sales Tax TOTAI I'll m Tr ck,, ._ . Gross. We( ht Tare Weight Trailer Trailer , a SAND & GRAVEL COMPANY 400 VALLEY AVE NE • PUYALLUP, WA 98372-2516 • (253) 833-3705 www.MilesSandandGravel.com CONCRETE ORDERS CONCRETE ORDERS K% Pierce & IGtup Co. Thustan, tevm& Mason Co. (253) 833-3700 (360) 491-7777 SAND GRAVEL ORDERS SAND &GRAVEL ORDERS ACCOUNTING&SALES Kmg & Pieece Co. Thurston Lexis & Mason Co. (253) 833-3705 (253) 536-9100 (360) 491.7777 GREEN EARTHWORKS CONSTRUCTION 5001 S TYLER ST TACOMA, WA 98409 INVOICE CUSTOMER NOr DATE INVOICE NO PAQE 017098 12/28/2012 852067 1 000021 LAKE WASHINGTON BLVD & 36TH NE 12/28 211-256673 14.07 TN PEA GRAVEL 12/28 211-256673 14.07 TN ENVIRONMENTAL COMPLIANC JOB TOTAL LINE RENTON 9.900 139.29 0.750 10.55 149.84 PRODUCT RECAP 14.07 1100 PEA GRAVEL 14.07 1700 ENVIRONMENTAL COMPLIANCE - AGG 149.84 c.._... AL. 9d 1e7 r-nc 9SQ_03q_,'i 1.'11 KANGLEY KANGLEY PIT (Plant# 021) . DELIVERY TICKET 32500 S.E. Kent-Kangley Rd., Ravensdale, WA 98051 - (360).486-.9.269 C -1 0 u �--j TN Gi ROCK & RECYCLING BLACK RIVER QUARRY (Plant # 022) \ k 17' ACCOUNTING: 9125 TENTH AVENUE SOUTH 510 Monster Road, Renton, WA 98055 •- (425) 226-1000 ext. 33314 SEATTLE, WA 98108 - (206) 762-2566 CEDAR SHORES (Plant# 020) — 21010 Cedar Grove Road S.E., SALFS S, ORDER DESK 425)'226- A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY INC. Maple Valley, WA 98038 - (425) 226-1000 ext. 3340 MAP LOCATE LEAVE PLANT ARRIVE JOB LEAVE JOB ARRIVE PLANT DATE CUSTOMER NO. IORDER NO. PROJECT PLANT # ' CUSTOMER NAME CUSTOMER P.O. JOB NO. j DELIVERY TICKET NO. % JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) EICASH [I CHECK # 0 CHARGE CARD # EXP.SPECIAL INSTRUCTIONS E-1 VISA 0 MASTERCARD 0 DISCOVER DESCRIPTION TONS• DRIVER TRUCK NO. ORDERED BY • DISPATCHER TAX CODE TIME DUE y ;tIEM NW) OnINSTF"IR:; riON co"VFANYI .!""C.. FOR ANY EDAIMAGE TO HIS EEL OR PER SONAL P-RO.-PERTY CAUS-'-f) rX- WIATIEFJAL-" ;.-!.3 --ED DETAILS OiN RIFVERSE. CUSTOMER SIGNATURE PRINT NAME DATE REV 04/2009 TRIO :. Invoice No. 10161503 ;:;' ..... y Date 1!3l2013 Order No. F0060165 UESTINC. Shipper ID S0177772 G E Q S Y N T H E T I C PRODUCTS Order Type Fife Sales Order N Customer ID GRE350 ACF West, Inc. is a D.B.A. name for N.W. Geosynthetics, Inc. 8951 S.E. 76th Drive, Portland, OR 97206 503-771-5115 800-878-5115 (fax) 503-771-1161 PAGE 1 GREEN EARTHWORKS CONSTRUCTION 5001 South Tyler Street TACOMA, WA 98409 Shaun 253-225-1106 GREEN EARTHWORKS CONSTRUCTION N 36th Sttreet and Lake WA BLVD See direrctions below Renton, WA 98407 510000105 1.00 ROLL 1.00 0.00 45.000 0.00 45.000 North American Green S150, 6.67' x 108' 521011054 1.00 BOX 1.00 0.00 9.000 0.00 9.000 6" U-Shaped Staples (11 ga.), .100 ct.... _ - FREIGHT Freight Charge Notes: Take Exit 6 off of 1-405. Follow to lake WA BLVD tak right and you will see Green Earthworks. Please pay from this invoice Statements by request only Thank you for your business Sales Total Shipping & Handling Misc. Charges Tax Total Less Paid Amount 10.00 54.00 0.00 10.00 0.00 64.00 0.00 64.00 Z q QvrtU-� $i/tLt-S ot, co�y+ REIVTON CO.NCRE-T,,Ik. ECY ERS .BothelL , `` . ..it . cc c*i Pit Site: 500 Ntonster [Road..S',W. Renton;, WA Business ®ffce::425-481-9101.:. Scale House: 206: 772-2278 Date: Ticket # 2. 01919 Customer: Project Name/P.O.!Number:_''; Project location (City, Stre Trucking Company: vvi r "`' ? Scaleperson: f Cash �'" "`] Account - Truck# Time Material Gross Weight Tare Weight Met We TonsJYd3 Price MaterivaliSi" a TERMS: NET 30 DAYS FROM END OF MONTH, A Finance Charge will Ue gpDeZPSeU UPI dll FldSl UUC 4%;WJUnlb ill d Idle ut 1 uL7n per munln. a LUP at - �•-i-✓�� is Annual finance charge of 18% 5% Environmental Fee NOTICE: It is specifically a reed that this company shall not be in anyway responsible f9or damage to customers property Sales Tax resutl nng from deliveries beyond the curb line. Total DRIVER SIGNATUREIPRINTED NAME: 110 i r y`- C l,'d dgti:£0 el, LO uer -l'icket 4 Date — Customer Name NW 11� G.E. Vac & Environmental Scrvlces 5001 S. TYLER ST., TACOMA, WA 98409 PHONE:253-534-8202 FAX:253-220-2621 R Site Contact—_., Phone# ` Site Address City Payment: S/B Check # Cash Credit Card # State ._. Zip Mailing Address City State Zip Exp. TECH LABOR TRUCK # START TIME ON SITE TIME OFF SITE TIME DISPOSAL IN -OUT DISPOSAL Description of Work Performed Hr _Unit Total Price Amount 4 --- -� —� Additional work needed O Yes 04 Drawing/Additional work info Sub -Total Tax % Total Terms: Net 10 days 1 1/2 % Per month delinquency charge on past due accounts Personal Guarantee By my signature below I have accepted personal liability for all amounts due GEC NW Environmental Services and promise to make the payments as agreed: WHEN WORK IS COMPLETE. I fully understand that in the event that payments are not made as agreed, that I have assumed personal liability for all unpaid amounts including all collection fees, all attorney fees, plus all costs incurred to pursue under law all amounts due GEC NW Environmental Services. Customer Signature: Date: FERGUSON ENTERPRISES, INC®aW0lSELEYwmpany Waterworks k` E1 -• TAC"OMA 94 #315 f 042 SOUTH 112TR ST TAC'014A, WA 98444•-0000 "OURCE -- 330[:, PFCC Op :;HP :: N 6j ` r^ —� IA _ . - -AX! 253—ri — 909 S 'T U C K S A L, E, S h R La E R ORDER NO. REQUIRED DATE SHIP WHS. SELL WHS. 7 CUSTOMER NO CUSTOMER ALPHA CONTRACT I40. BID NO. ORDER DATE ORDERED BY INSTRUCTIONS VERRAT, GREEN EARTHRORKS CONST INC COUNTER PICK UP 5001 SOUTH TYLER STREET 2042SOUTH 112TH ST TACOMA, WA 98409 TAM -NA, WA 98 444-0000 SHIP VIA PR PTrK-.Ilr) PCS BAGS BOXES CRATES LENGTHS BUNDLES e — l WRITER QMB SALESMAN TAG P.O. N0. OML CONTACT DonnaT81114re'll BFirbpr VENDOR VENDOR P.O. NO. ROUTE NO. RUN N0. OEPAF ROUTE DESC. TOME. P.O. NO. JOB NAME e: r u ATTN: SHIP WT. SHIR TE f I r DELIVERED BY PAD Y • j� �1 CHECKED BY LINE ORDER OTY SHIP OTY ITEM CODE DESCRIPTION UNIT PRICE U/M • TOTAL P.O. NO. AISLE LO a. L -T :377 CUSTOMER'S �.�' //�,._tt , TERMS: SIGNATURE: ,/ DATE: RENTON CONCRETE RECYCLERS 22121 17th Ave S.E. Suite #117 Bothell, WA 98021 Pit Site: Soo Monster Road S.W. Renton, WA Business Office: 425-481-9101 Scale House: 206-772-2278 �t or* 6IABILYt"I Date: :F �.. ; '... Ticket # 202484 � - •• ,.� ' ' Customer: Project Name/P.O. Number., '�g Project Location (City, Stream;: Trucking Company = Scaleperson:- ; Cash [] Account Truck# Time f y •.. Material �..� Gross Weight .�4.. Tare Weight ` Nget1 TonslYd3 T� i 4 1 ; Price ., ` j�'.•'�: Materia sh= �� °l .ems' . �� TERMS: NET 30 DAYS FROM END QE M_ ONTH A Finance Charge will Total Material r ' De assessea on wi pa5l UUC al wwiw aL a law Vi Annual finance charge of 18% 5% Environmental Fee NOTICE: It is specifically a reed that this company shall not be in anyway responsible for damage to customers property Sales Tax t" resutlIng from deliveries beyond the curb line. 4 Total ` E DRIVER SIGNATUREIPRINTED NAME: National Concrete Cutting Inc. " � ai __ "ate 'r�=��:. p�-.. 7715 Pacific Hwy. E. Invoice Number: 19453 Milton, WA 98354-9635 Invoice Date: Jan 17, 2013 Page: 1 Voice: (800) 551-0511 Fax: (253) 735-6777 IDDISON CONSTRUCTION �tion Supply 6201 S ADAMS TAZ53) 474-07119 BATCH! 056 S-A-L-79825885-A-F-T 938808559008 IF! BBB2 ;D TYPE: VISA 'R TYPE1. PURCHASE ATE: JAN 11) 2 13135/57 HWORKS Invoice Customer No.: 99999 Invoice No.: 268530 Ship To: CASH ACCOUNT TOTAL $123.90 ACCT: th*w*1417988 EKP: U/0 AP; B6775G NAME; SEAN HART T RAH. 163811777578883 TAR $8.08 CARDMEMBER ACKNOWLEDGES RECEIPT OF GOODS Via s F.O.B. Terms AHD/OR SERVICES IN THE AMOUNT OF THE TOTAL SHOWN BV Origin Prepaid HLIGANSTFOR CAROMEMBER'S AGREEMENT WITH THE ISSUER Order Date Sales Person Our Order Number THANKS FOR USING VISA 01/11/13 DAN Item Number Description Unit Price Amount CUSTOMER COPY :TPACK 10 OZ SIMPSON EPDXY 21.9500 43.90 80 80 R5E EPDXY REBAR #5 1.0000 80.00 19@2-OX2-0 Invoice subtotal 123.90 Invoice total 123.90 Less payments received 123.90 Net balance due 0.00 ALL RETURNS ARE SUBJECT TO A 15% RESTOCKING FEE Thank You Advanced Government Services, Inc Invoice 8644 Pacific Avenue Tacoma, WA 98444-6471 (253) 531-9782 Office (253) 531-9784 Fax Bill To Green Earthworks Construction Inc 5001 S Tyler ST Tacoma, WA 98409-1908 Date Invoice # 1/18/2013 5920 P.O. No. Terms Project 01/13-01/19 Net 30 Lake WA Bivrd Sewer Reha... Quantity Description Rate Amount 6.5 Flagging at Prevailing Rate per hour - TCS - 01115 49.50 321.75 5.5 Flagging and OTCL at Prevailing Rate per hour - 01/15 48.00 264.00 1 Misc Sign Usage - Class B Signs, Crashworthy Stands, Cones, Sandbags, Sidewalk 125.00 125.00 Closed/Detour Signs & Barricade Stands, Business Open Signs and Stands, No Park Signs- Per Week Day - 01/15 I Traffic Control Vehicle usage rate per day - 01115 125.00 125.00 1 Cone usage (QTY) 20 @ $ .50 each OR $10.00 per day 100.00 100.00 12/30 - 01/05 ( 7 ) discounted to weekly rental rate of $50.00 01/06 - 01/12 ( 7 ) discounted to weekly rental rate of $50.00 01/13 - 01/19 ( 7 ) 1/13, 01/14, crew worked w/full set 01/15, 01/16 - requested to keep ( 12 ) cones."No additional charge for daily rental over the $125/day for full set this week only. Beginning 01/20 coned rental will be charged @ $40.00/week until returned to AGS. Customer is responsible for lost, stolen, or damaged cones. Replacement cost will be charged @ $15.00 EA plus applicable sales tax Thank you for your business. Total $935.75 ADVANCED GOVERNMENT SERVICES, INC. EMPLOYEE TIME CARD 4 3 � 71Z d �U d� oW WU 00 d¢ �z WW Y� z0 FL as a0 O00 W W0 Z < Z� >0 Cc w¢ Fz x 30 d �0 IL OW LU 0 JaCC gz WW Y� z0 E0 8644 Pacific Ave, Tacoma, WA 98444 (253) 531-9782 - Fax (253) 531-9784 NAME LA OUR F SN ONLY WEEK ENDING SA D Y. XXX -XX- 7/ '� w DAILY TIME RECORD - Round to Nearest 15 min 0 0 DAY DATE START TIME .FINISH TIME LESS. LUNCH TOTAL HOURS REG OT :. SUN MON TUE WED THU FRI SAT CLIENT NAME (PLEASE PRINT) JOB# LOCATION V `2 Y1 certify that I have worked these hours and I will not accept < a regular or independently contracted position with any company 2 for which I worked as an AGS employee without prior written cc approval from AGS. I understand that.l must submit this time < card to AGS within four weeks of the last day worked in order 0 to be paid, and that falsification of hours is a criminal offense. I g ° " EMPLOYEE SIGNATURE NPLEASE NOTE: Signature indicates acceptance of terms and w conditions on the reverse side by an authorized agent of client. The undersigned certifies that the hours indicated were worked a by the above named employee. The services were performed satisfactorily and the expenses are correct. X CLIENT SIGNATURE TITLE ADVANCED GOVERNMENT SERVICES, INC. EMPLOYEE TIME CARD 43274 8644 Pacific Ave, Tacoma, WA 98444 (253) 531-9782 - Fax (253)EE 531-9784 NAME LAST. FOUR OF S N ONLY Wl;EK ENDING.S TUR-A XXX-XX- DAILY TIME RECORD - Round to Nearest 15 min 0 DAY DATE_. START TIME. FINISH TIME.. :LESS:. LUNCH :TOTAL HOURS: REG:. -OT SUN MON TUE i (1 -- WED THU FRI SAT CLr'jt NAME:(PLEASE PRINT) JOB# LOCATION U a Y1 certify that I have worked these hours and I will not accept < a regular or independently contracted position with any company wfor which I worked as an AGS employee without prior written ¢ approval from AGS. I understand that I must submit this time < card to AGS within four weeks of the last day worked in order 0 to be paid, and that falsification of hours is a criminal offense. X , r T EMPLOYEE SIGNATURE APLEASE NOTE: Signature indicates acceptance of terms and n conditions on the reverse side by an authorized agent of client. s The undersigned certifies that the hours indicated were worked y by the above named employee. The services were performed satisfactorily and the expenses are correct. X CLIENT SIGNATURE TITLE Green Earthworks 5001 So Tyler St Tacoma, WA 98409 253.606.8787 , fax 253.220.2621 Bill To Construction, Inc. Insituform Technologies, Inc Rocky Mountain Region 9654 Titan Court Littleton, CO 80125 Sanitary Sewer Rehabilitation 2012 and Lake Washington BLVD Pipe Rehabilitation, City of Renton, WA Project No. WWP-27-3624, Invoice Date Invoice # 1/25/2013 10123 Job Number Insituform-125-111412 Bey �ucke Puget Sound P.O. BOX 73399 PUYALLUP, WA 98373 A Division of Northwest Cascade, Inc. (848-2371 (800) 00) 444-2371 Please visit www.honeybucket.com and take a moment to fill out our customer satisfaction survey Oregon / SW Washington inland Empire P.O. 12923 P.O. BOX 3431 Salem, OR 97309 Post Falls, ID 83877 (503)681-7223 (208)687-0138 (800)966-2371 (888)810-8100 111111toll 111"111lfl"11111'1iJill 111111111'111111'I11111II11'11 GREEN EARTHWORKS CONSTRUCTION 5001 S Tyier St Tacoma WA 98409-1908 3 249 Service: MONTHLY STANDARD UNIT RENTAL, From 01/11/13 To 02/10/13 FUEL SURCHARGE FOR 1 UNITS Amount Exempt from Sales Tax: 95.50 Amount Subject to Sales Tax: 0.00 Account No.: 123393 INVOICE PLEASE PAY FROM THIS INVOICE Terms: Net 10th Prox. Delinquency Charge -1 % per month Invoice: 1-602214 Order No.: 0853139 Account No.: 123393 Invoice Date: 01/11/13 Due Date: 02/10/13 P. O. #: .lob #: RENTON Location: GREEN EARTHWORKS CONSTRUCTION LAKE WASHINGTON BLVD N & + N 36TH ST RENTON, WA # R10022 # SURCHARGE Subtotal: Tax: Total: 91.50 4.00 95.50 0.00 95.50 Concrete: Injurious to eyes.Causes skin irritation -Contains Portland Cement Read the following warning before using: Contact with wet, unhardened oonaete, mortar, cement or cement males can cause skin inflation, severe chemical bums or senora eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fu!ly-buttoned, fag -sleeve shirt fulkength trousers and tight -felting eye protection when waking with these materia . If yeu-havoc stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep cahaete from flowing into them. If fin�shing corhaete, wear knee pads to protect knees. Aftercastactwith any of these materials, wash of Immediately with fresh, dears wafer. indirect oentad through dothrg is as dangerous so promptly rinse these materials torn clothing. Seek invnediate rnu M a�i�EP out have Usor er 7 1) dscanfoRln rase of eye contact, flush with plenty of water for at least 15 minutes. Consul physidan ' �. 1338 j 9 7 3, agrees to convey this worming to all persons who may use a come into catfad with wet (unharderhedj concrete, mortar, cement a oemeni mixtures. Aggreqates: Prolonged nlhafatas of dust from a gravel piodud maY Your health Measures control fugitive dust should be taken when handling fhb prcdurt Hot Asuhalt emits nuisance lames. Avid txeathing fumes. Also, Asphalt may cane severe bums • Wear Protective safety gear (long sleeves, paNs and gloves}. If burned, cod with water and see a pthyssdan t r k Additional water added to concrete will Property Damage Indemnification & Release Water added at sus ome sown ns reduce its strength.Buyelsagentagreestoacceptresponsibil;tyforreducedstrength The operator of this piece of heavy eghihpment, in presenting this RE- Unloading &Standby Excess unloading will be due to water added shove design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby Arrived at job with inc4 slump. ED rrsadhnery in the manner required to perform our contract with you may possibly cause damage to the premises a property. It is our wish to help in everyway that we can, but in order to do this, the operator is asking time charged at posted truck time rates. Limited Warranty The oil liability of the seller for Y tY lie Test cylinders Added al water at%ome, request. Y you that you n the RELEASE. m consideration of the performance of the Y product defect isth return of the purchase price. In no event shall the seller be liable for any direct, indirect, taken Other additans ,\ seller of is contract with me, I the undersigned, hereby 1NDElu IFY the sells and lsemployeesfa any damage and for an dawns to the premises, budding, utility pipelines or cables, telephone lines, driveway or other incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims fadamagesorshortagesmustbe Received ' appurtenances, at made within 24 hours of delivery.We do not assume by X t� j Buyer's Agent, receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for airy personal injury incurred by you while addirig additional products to our mixer. _Signature of Owner or its Agent-_ _ Leave Plant Arrive Job Sit Stall Discharg Finish I Drivers' Comments Company/ Order No. Cust. No, Customer Job Customer CAqi-1 S,ALi=S--SEiQ T TI_-E Delivery Tnsiruchons Y. DeliyeredQty OrderQty Products and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Leave Job Site f Arrive I responsibility for any damage beyond the curb line. .r.E.o1\1 i+IraERIPLS 1115 S 0 U T 1.1 `:-S H 6EP)TTL.E. WA 98 NIS W fLl 6'•-' : 6 ( J 21 Customer POI Phase Code TICKETNO. Driver Co. Proj. No. tj r SIP, 53115931 OUTS &PE DR Delivery Address Map `h 1 Z� JAYSCIN STEVEN'S Sglel 1- Time: ode UOM Product Description Unit Price Amount rr MODIFIED CLASS B 81. 0 121.2-1. 2 5 01:-S -Ta..•r"3 NP'E T'-k : 1"Islink '14-5-Fait 3000 COD Total: FLIEL- CHG * . . C 2 1 34. 52 k 12 . 85 Loa�¢e Pod: No. " Desc •ption Slump Type CC Use Haul Cd. 2 Pit/Plant Sales Tax 531 $ '• ?fit ` 2 TOTAL DUE . Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # I f_, r SH yet a:� 12/26/2012 EQUIPMENT MOBILIZATION ITEM NO. ITEM DESCRIPTION DATE LABOR/EQUIPMENT UTILIZED ESTIMATED QUANTITY UNITOFMEASURE UNFFPRICECOST EXTENDED COST 1 PROJECT COORDINATION 12/19/2012 PROJECT MANAGER 4 HOUR S115.00 $460.00 2 PROJECT COORDINATION 12/20/2013 PROJECT MANAGER 5 HOUR $115.00 $575.00 3 ON -SITE MEETING W/SUBCONTRACTORS ' 12/21/2013 PROJECT MANAGER 8 HOUR $115.00 $920.00 FORD F-150 8 HOUR $21.49 $171.92 4 COORDINATION WITH SUBCONTRACTORS 12/21/2013 PROJECT MANAGER 4.5 HOUR $115.00 $517.50 5 PROCUREMENT OF JOB MATERIALS 17/21/2013 FOREMAN 6 HOUR $128.86 $773.16 FORD F-150 6.25 HOUR $21.49 $134.31 LABORER 6 HOUR $65.11 $390.66 FORD F-550 6 HOUR $25.50 $153.00 6 EQUIPMENT MOBILIZATION - YARD PREP 12/26/2013 FORD-F550 3 HOUR $25.50 $76.50 PI DUMP TRAILER 3 HOUR $19.65 $58.95 FORD F-150 3 HOUR $21.49 $64.47 FOREMAN 3 HOUR $128.86 $386.58 LABORER 3 HOUR $65.11 $195.33 EQUIPMENT OPERATOR 3.25 HOUR $78.90 $256.43 EQUIPMENT OPERATOR - EDUCTOR TRUCK 3.25 HOUR $B0.24 $260.78 VAC-CONL-SOOOEDUCTORTRUCK 3.25 HOUR $127.95 $415.84 7 PROJECT TRAVEL TIME 12/26/2013 THROUGH 12/28/2012 FOREMAN 9 HOUR $128.96 $1,159.74 EQUIPMENT OPERATOR 9 78.90 $71GA0 8 PROJECT COORDINATION 12/26/2013 PROJECT MANAGER 1 15.00 $115.00 9 PROJECT COORDINATION 12/27/2013 PROJECT MANAGER 2 15.00 $230.00 10 PROJECT COORDINATION 12/28/2013 PROJECT MANAGER 2 15.00 $230.00 11 PROJECT COORDINATION 1/3/2013 PROJECT MANAGER 1 15.00 $115400 12 PROJECT COORDINATION 1/4/2013 PROJECT MANAGER 1 MOUR$1-15wOO 115.00 $115.00 13 PROJECT COORDINATION 1/7/2013 PROJECT MANAGER 1 115.00 $115.00 14 PROJECT COORDINATION 1/9/2013 PROJECT MANAGER 2 115.00 $230.00 15 PROJECT COORDINATION 1/11/2013 PROJECT MANAGER 1.5 115.00 $172.50 15 PROJECT COORDINATION 1/14/2013 PROJECT MANAGER 2 115.00 $230.00 TOTAL $9,232.77 1/15/2013 EQUIPMENT MOBILIZATION ITEM NO. ITEM DESCRIPTION DATE LABOR/EQUIPMENT UTILIZED ESTIMATED QUANTITY UNIT OF MEASURE UNIT PRICE COST EXTENDED COST 1 EQUIPMENT MOBILIZATION - YARD PREP 1/15/2013 LABORER 2 HOUR $65.11 $130.22 2 PROJECT TRAVEL TIME 1/15/2013 FOREMAN 3 HOUR $128.86 $386.58 1/15/2013 EQUIPMENT OPERATOR 3 HOUR $78.90 $236.70 TOTAL $753.50 ®ate aa��® 00®�� oa��® oa�t�s� . TOTAL ROADWWAY RESTORATION. - - - $9,355.39" TOTAL COST CORl .$58,568.36 o,pu„ •, STATEMENT OF COMPLIANCE 202160 Form Approved MBNo. 1215-0149 ECxpires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, m ar including the time or reviewing instructions, seing existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFI ER. 1. PAYROLL NUM 2. 3. CONTRACT NUMBER 4. DATE 2 1 12/12/21 1 12/12/27 I, Jill Noble Payroll Administrator do hereby state (Name of signatory party (title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 9th day of (Budding or work December 201 2 and ending the 15th day of December 201 2 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classitications set torth therein for each laborer or mechanic conform with the work pertormed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or it no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required tringe benetits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5. REMARKS 6.(Last, First, Middle Initial 7. TITLE 8. SIGNATURE Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator /-S" The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal rosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. i DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. �� RECEIVED JAN 1 7 2013 CITY OF RENTOW UTILITY SYSTEMS Aegion Corporation 12/21/2012 9:49:00 R5707371 WESTWKLY Certified Payroll Register Page - 102 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 12/15/2012 17988 EDISON AVE RENTON - WA G/L Period Number 3 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat ... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours _Rate Hours Rate Hours Hours _Amount Description _ Amount MO M M M 008 1971 For HBU 1971 Accrual TECH LABORER default XXX-XX-6302 White Tyson L. Lacey MO 11/19/2012 4.00 16.000 4.00 64.00 Payment Number: 04710279 242 S 22ND STREET LINE 1 TU 11/20/2012 Gross Pay 640.00 COTTAGE GROVE OR 97424 WE 11/21/2012 OR Departmen 40.53 TH 11/22/2012 FED W/H Tax 55.90 FR 11/23/2012 FICA W/H 26.88 SA 11/24/2012 Medicare W/H 9.28 SU 11/25/2012 Total Deduct 132.59 MO 11/26/2012 Net Pay 507.41 TU 11/27/2012 Hrs This Chk 36.00 WE 11 /28/2012 TH 11/29/2012 FIR 11/30/2012 SA 12/1/2012 SU 12/2/2012 MO 12/3/2012 TU 12/4/2012 WE 12/5/2012 TH 12/6/2012 FIR 12/7/2012 SA 12/8/2012 SU 12/9/2012 MO 12/10/2012 TU 12/11/2012 WE 12/12/2012 TH 12/13/2012 FIR 12/14/2012 SA 12/15/2012 Subtotal for Payment Number: 04710279 4.00 4.00 64.00 Tyson L. Lacey 4.00 4.00 64.00 RENTON - WA 4.00 4.00 64.00 STATEMENT OF COMPLIANCE 202160 Form Approvec OMB No. 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. LL AY N DATE ( MMDD) 3 CONTRACT NUMBER 4 DATEM (YYM) 3 12/12/28 12/12/27 I, Jill Noble Payroll Administrator do hereby state (Name of signatory party Trfle (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 16th day of udding or work) December 201 2 and ending the 22nd day of December 201 2 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract; that the classifications set torth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or it no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 ((;) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) Jill Noble 636-530-8753 7. TITLE 8. I NAT� R jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pr ecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. Aegion Corporation 12/26/201214:47:50 R5707371 WESTWKLY Certified Payroll Register age - 95 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 12/22/2012 17988 EDISON AVE RENTON - WA G/L Period Number 4 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... nip,. 1AH i-, Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -----------NO WORK PERFORMED---------- STATEMENT OF COMPLIANCE 202160 Form Approved OMB No. 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office o1 Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING FFI ER. 1. PAYROLL NUMBE 2. PAYROLL PAYMENT DATr) 3. CONTRACTNUMBER 4. DATE (YYMMDD) 4 1 13/1/2004 1 13/1/2003 1, Jill Noble Payroll Administrator do hereby state (Name of signatory party ,1e (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor) on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 23rd day of (building or work) December 201 2 and ending the 29th day of December 201 2 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or Subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates Tor laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract; that the classitications set torth therein for each laborer or mechanic contorm with the work pertormed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benetits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5. REMARKS g. NAME (Last, First, MiddleInitial) 7. TITLE 8. Jill Noble 636-530-8753 ZZE jnoble@aegion.com Payroll Administrator �O The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or c�fiin I prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. �/ R5707371 WESTWKLY INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Project and Location 202160 RENTON - WA SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' v \ 1 /312013 8:00:31 Page - 84 Pay Period Ending Date 12/29/2012 G/L Period Number 1 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work -Date- Hours Rate Hours Rate Hours Hours Amount Description Amount -----------NO WORK PERFORMED---------- rage t or s State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: Intent ID: Affidavit ID: Status: Approved On 12/10/2012 547805 12/12/2012 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Filed By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount GREEN EARTHWORKS CONST INC 5001 SOUTH TYLER STREET TACOMA, WA, 98409 GREENEC944KB 602576777 253-606-8787 107,281-00 seanhart@greenearthworks.com Hart, Sean INSITUFORM TECHNOLOGIES INC INSITT102ONP 601880220 636-530-8020 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 John Hobson 425-430-7279 Sanitary Sewer Rehab 2012 Et Lake Washington Blvd Pipe Rehab $247, 327.03 https:Hfortress.wa.gov/1ni/wagelookup/IntentDetaiIs.aspx 02/ 1 1/2013 Page 2 of 3 Bid due date 8/14/2012 Award Date 8/23/2012 Project Site Address or Directions Payment Details Check Number: Transaction Id: 103754169 Intent Details Expected project start date: (MM-DD-YYYY) 11 /5/2012 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $8500.00 a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY Yes subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 2 the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages INSITUFORM TECHNOLOGIES INC INSITT1020NP 601880220 https:Hfortress.wa.gov/lni/wagelookup/IntentDetails.aspx 02/11/2013 Page 3 of 3 County Trade Occupation Wage Fringe # Workers King Laborers General Laborer $40.03 $0.00 2 l King Power Equipment Operators Shovel , Excavator, Backhoe, Tractors Under 15 Metric Tons. $49.48 $0.00 1 King Power Equipment Operators _ Motor Patrol Graders, Finishing $50.39�� $0.00 �1 — J Public Notes 0 Show/Hide Existing Notes No note exists https:Hfortress.wa.gov/1n1/wageIookup/IntentDetails.aspx 02/1 1/2013 rage i or s State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: Intent ID: Affidavit ID: Status: Approved On 12/5/2012 547366 12/10/2012 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Filed By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount C-MORE PIPE SERVICES CO 9350 RICKREALL RD RICKREALL, OR, 97371 CMOREPS023CZ 601854387 503-623-1319 farmermccoy@cmorepipe.com McCoy, Viola INSITUFORM TECHNOLOGIES INC INSITT1020NP 601880220 636-530-8020 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 John Hobson 425-430-7279 Sanitary Sewer Rehab 2012 Et Lake Washington Blvd Pipe Rehab $2471327.03 https:Hfortress.wa.gov/lni/wagelookup/IntentDetails.aspx 12/12/2012 rage 2 or s Bid due date 8/ 14/2012 Award Date 8/23/2012 Project Site Address or Directions Payment Details Check Number: Transaction Id: 103750143 Intent Details Expected project start date: (MM-DD-YYYY) 11 /7/2012 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $13,368.95 a time and materials estimate? Will this project utilize American Recovery and Reinvestment Act (ARRA) funds? Specifically, will this project utilize any weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY subcontractors? Does your company intend to hire subcontractors to perform ALL work? , Will your company have employees perform work on this project? Do you intend to use any apprentices? (Apprentices are considered employees.) How many owner/operators performing work on the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages No No No No Yes No 0 INSITUFORM TECHNOLOGIES INC INSITT102ONP 601880220 https:Hfortress.wa.gov/lni/wagelookup/IntentDetails.aspx 12/ 12/2012 rabc � ui � County Trade Occupation Wage Fringe # Workers King Inspection/Cleaning/Sealing Tv Truck Operator $20.45 $0.00 1 Of Sewer Et Water Systems By i Remote Control l King Inspection/Cleaning/Sealing Cleaner Operator, Foamer $31.49 $0.00 1 L—____— Of Sewer Et Water Systems By Remote Control Operator Public Notes c-i Show/Hide Existing Notes No note exists https://fortress.wa.gov/lni/wagelookup/IntentDetails.aspx 12/12/2012 Page 1 of 3 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Document Received Date: Intent ID: Affidavit ID: Status: Approved On 12/4/2012 546966 12/5/2012 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Filed By Ptime--Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount INSITUFORM TECHNOLOGIES INC 17988 EDISON AVE CHESTERFIELD, MO, 63005 INSITT102ONP 601880220 636-530-8020 882,695-01 kmorrow@insituform.com Morrow, Kristy INSITUFORM TECHNOLOGIES INC INSITT102ONP 601880220 636-530-8020 RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 John Hobson 425-430-7279 Sanitary Sewer Rehab 2012 Et Lake Washington Blvd Pipe Rehab $247, 327.03 https:Hfortress.wa.gov/lni/wagelookup/IntentDetails.aspx 12/12/2012 Yaae 2 of S Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: Intent Details 8/14/2012 8/23/2012 103747274 Expected project start date: (MM-DD-YYYY) 12/8/2013 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $247,327.03 a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY Yes subcontractors? Does -your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? Do you intend to use any apprentices? No (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Journey Level Wages County Trade Occupation Wage Fringe Workers 1 King Laborers - Underground Sewer 8 Water Pipe Layer $40.77 6 https://fortress.wa.gov/InUwagelookup/IntentDetails.aspx 12/12/2012 Yage .3 of S Public Notes 2 Show/Hide Existing Notes No note exists https:Hfortress.wa.gov/lni/wagelookup/IntentDetails.aspx 12/12/2012 STATEMENT OF COMPLIANCE 202160 Form Approved MB No. 1215.0149 EOxpires Jun 30 1997 Public reporting burden for this colleclion of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reduang this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING FFI ER. 1. PAYROLL NUMBE 2. PAYROLL PAYMENT) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 1 12/12/14 1 12/12/13 1, Jill Noble Payroll Administrator do hereby state (Name of signatory party) (title (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor) on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 2nd day of (Building or work) December 201 2 and ending the 8th day of December 201 2 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 91 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic contorm with the work pertormed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Departmenf of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®-Each laborer or mechanic listed In the above reterenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NA(Last, First, Middle Initial) Jill Noble 636-530-8753 7. TITLE 8. SIGNATURE �`' jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cr' inal pr ecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. 1 DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. _�� RECEIVED HC262012 CITY OF RENTON UTILITY SYSTEMS R5707371 WESTWKLY Aegion Corporation \ 12/13/2012 9:53:43 Certified Payroll Register Page - 99 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 12/8/2012 17988 EDISON AVE RENTON - WA G1L Period Number 2 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job .... I ...... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO M M 1 M 008 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-4594 White Douglas S. Inman SU 12/2/2012 Payment Number: 04708816 379 Alder Street MO 12/3/2012 Gross Pay 2,469.34 Falls City OR 97344 TU 12/4/2012 OR Departmen 188.80 WE 12/5/2012 FED W/H Tax 446.86 TH 12/6/2012 FICA W/H 101.94 FIR 12/7/2012 Medicare W/H 35.19 SA 12/8/2012 8.00 61.155 8.00 489.24 DentEmpSpWK 3.17 Laborer 8.00 8.00 489.24 VISIONWK .74 CorEmpSpWksm 51.73 Total Deduct 828.43 Net Pay 1,640.91 Hrs This Chk 48.50 Subtotal for Payment Number: 04708816 8.00 8.00 489.24 Douglas S. Inman 8.00 8.00 489.24 MO S S M 008 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-3261 White Gregory Dean Brown SU 12/2/2012 Payment Number: 04708809 8322 Squirrel Hill Rd SE MO 12/3/2012 Gross Pay 2,901.49 Salem OR 97306 TU 12/4/2012 OR Departmen 243.80 WE 12/5/2012 FED W/H Tax 642.84 TH 12/6/2012 FICA W/H 121.90 FIR 12/7/2012 Medicare W/H 42.08 SA 12/812012 8.00 61.155 8.00 489.24 401 k 116.06 Laborer 8.00 8.00 489.24 CoreEmpWK 6.17 DentEmpWK 1.58 Short Term D 3.77 Total Deduct 1,178.20 Net Pay 1,723.29 Hrs This Chk 66.00 Subtotal for Payment Number: 04708809 8.00 8.00 489.24 R5707371 WESTWKLY Aegion Corporation 12/13/2012 9:53:43 Certified Payroll Register Page - 100 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 12/8/2012 17988 EDISON AVE RENTON - WA GIL Period Number 2 CHESTERFIELD MO 63005 8"X4909'1 0"X546'1 2"X92'18"X58' SS REHAB 2012, LAKE WASHINGTON St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Gregory Dean Brown 8.00 8.00 489.24 MO S S 1 M 007 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-8659 Hispanic or Latino Raul Tavera SU 12/2/2012 Payment Number: 04708824 PO Box 344 Line 1 MO 12/3/2012 Gross Pay 2,894.74 MT Angel OR 97362 TU 12/4/2012 OR Departmen 213.70 WE 12/5/2012 FED W/H Tax 560.37 TH 12/6/2012 FICA W/H 119.89 FIR 12/7/2012 Medicare W/H 41.39 SA 12/8/2012 8.00 61.155 8.00 489.24 401 k 289.47 Laborer 8.00 8.00 489.24 DentEmpChWK 2.94 VISIONWK .79 CorEmpChWksm 45.47 Total Deduct 1,274.02 Net Pay 1,620.72 Hrs This Chk 63.50 Subtotal for Payment Number: 04708824 8.00 8.00 489.24 Raul Tavera 8.00 8.00 489.24 MO M M M 008 1971 For HBU 1971 Accrual LAB Laborer XXX-XX-6302 White Tyson L. Lacey SU 12/2/2012 PO Box 3750 MO 12/3/2012 Sun River OR 97707 TU 12/4/2012 WE 12/5/2012 TH 12/6/2012 FIR 12/7/2012 SA 12/8/2012 8.00 61.155 Laborer 8.00 default Payment Number: 00105164 Gross Pay 1,957.22 OR Departmen 150.76 FED W/H Tax 299.68 FICA W/H 82.54 Medicare W/H 28.50 8.00 489.24 Total Deduct 561.48 8.00 489.24 Net Pay 1,395.74 Hrs This Chk 42.00 Subtotal for Payment Number: 00105164 8.00 8.00 489.24 R5707371 WESTWKLY Aegion Corporation Certified Payroll Register INSITUFORM TECHNOLOGIES LLC Project and Location 202160 17988 EDISON AVE RENTON - WA CHESTERFIELD MO 63005 8"X4909'10"X546'12"X92'18"X58' SS REHAB 2012; LAKE WASHINGTON St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Tyson L. Lacey 8.00 8.00 489.24 MO M XXX-XX-5267 Jarrod R. Gregory 953 Charter PI NE Salem OR 97301 M M 008 1971 For HBU 1971 Accrual LAB Laborer White SU 12/2/2012 MO 12/3/2012 TU 12/4/2012 WE 12/5/2012 TH 12/6/2012 FR 12/7/2012 SA 12/8/2012 Laborer Subtotal for Payment Number: 04708813 Jarrod R. Gregory RENTON - WA 8.00 8.00 8.00 8.00 40.00 default 12/13/2012 9:53:43 Page - 101 Pay Period Ending Date 12/8/2012 G/L Period Number 2 ........... Check Detail .......... Description Amount Payment Number: 04708813 Gross Pay 2,725.94 OR Departmen 219.22 FED W/H Tax 489.85 FICA W/H 114.49 Medicare W/H 39.53 61.155 8.00 489.24 Total Deduct 863.09 - - - 8.00 - 489.24 Net Pay 1,862.85 Hrs This Chk 53.50 8.00 489.24 8.00 489.24 40.00 2,446.20 FRINGE BENEFIT STATEMENT TO BE SUBMITTED WITH FIRST CERTIFIED PAYROLL PROJECT TITLE: Sanitary Sewer Rehab 2012 and Lake Washington Blvd Pipe Rehab WORK ORDER#: CONTRACTOR LIC#: TODAY'S DATE: 8/1/12 TO: City of Renton Attn: Labor Compliance Officer ADDRESS: Attn: John Hobson 1055 South Grady Way Renton, WA 98057 PHONE/FAX: 425-430-7279 IN ORDER THAT THE PROPER FRINGE BENEFIT RATES CAN BE USED FOR CHECKING PAYROLLS OR APPLIED TO FORCE ACCOUNT WORK WHICH MAY BE DONE ON THE ABOVE CONTRACT, THE HOURLY RATES FOR FRINGE BENEFITS, SUBSISTENCE AND/OR TRAVEL ALLOWANCE PAYMENT (AS REQUIRED BY COLLECTIVE BARGANING AGREEMENTS) MADE FOR EMPLOYEES ON THE VARIOUS CLASSES OF WORK ARE TABULATED BELOW. CLASSIFICATION: Labor 4 EFFECTIVE DATE: 8/1/12 SUBSISTENCEIIRAVEL PAY $ HEALTH&WELFARE $ .32 - 4.49 PAID TO: Anthem Blue Cross Blue Shield P.O. Box 36550, Louisville, KY 40223-6550 PENSION $ .29-2.40 PAID TO: Prudential 280 Trumbull Street, Hartford, CT 06103 VACATION/HOLIDAY $ PAID TO: TRAINING/OTHER $ .64 PAID TO: CA Apprenticeship Counsel P.O. Box 420603. San Francisco, CA 94142 CLASSIFICATION: EFFECTIVE DATE: SUBSISTENCE/TRAVEL PAY $ HEALTH&WELFARE $ PAID TO: PENSION $ PAID TO: VACATION/HOLIDAY $ PAID TO: TRAINING/OTHER S PAID TO: CLASSIFICATION: EFFECTIVE DATE: SUBSISTENCE(TRAVEL PAY S HEALTH&WELFARE $ PAID TO: PENSION S PAID TO: VACATION/HOLIDAY $ PAID TO: TRAINING/OTHER $ ___ PAID TO: NAME OF CONTRACTOR: SIGNATURE/f=: Overtime - over 8 a day, 40 a week and Saturdays WA Doubletime - over 10 on weekdays and Saturdays, and on Sunday's and Holiday's Employee Name Class Base Vac & 401 k Total Base for DOH Vac Rate :Ins (sub) Hot Match Fringes Vac & Hol 3.00 2.78 0.00 34.99 22.11 5129.52 9/5/95 20 Beltran, Ricardo Lab Regular 40.77 Tech Overtime 1 61.161 0.00 61.16 165737 Db 81.54 _ , 0.00 81.54 Brechbiel, Scott _ Lab Regular 40.771 3.00 1.51 1.22 35.041 19.121 2905.63 8/i3/081 10 Laborer Overtime 61.16 1.83 59.32 1872935 Db 81.54 2.45 79.09 Brown, Gregory Lab Re ular�40.77 2.05 - 1.33 0.00 37.39 _-16.89 2567.58 10/19/09 10 Overtime 61.16 0.00 61.16 2053691 Db 81.54 0.00 81.54 24.691 _ 4740.86 9/20/04 Campos, Eulalio Lab Regular 40.771 2.22 2.51 _ 0.00 36.041 15 Overtime 61.16 0.00 61.16 1220785 Db 81.54 0.00 81.54 Diaz, Anthony e ular 41.77 2.22 5/18/06 15a TV Tech Overtime 62.66 2.51 60.15 1538275 Db 83.54 3.34 80.20 Garcia, Eze uiel B. Lab Re ular 40.771 5.52 2.83 1.63 30.79 27.85 5347.01 4/12/04 15 Overtime 61.16 2.45 58.71 222594 Db 81.54 1.29 3.26 78.28 Grego , Jarrod Lab Regular 40.77 0.00 39.48 16.00 2432.00 10/4/12 2 Overtime 61.16 0.00 61.16 3095631 _�.,--.-...-,._-�_-r_.,-T ;- Db -n-�...-fi,.-�,--.,,� 81.54 _..r,'_.;,.'�"`_^„'-_...-._.,-_. 0.00 m�^;� ..�---�,.,.----�-•- 81.54 ----,-�-,.�. .-----,��.�.. --r--s-; :;=mA- .��...--^r�^-sus^,«.,�.--� , .._-�-. Inman, Douglas Lab Re ular 40.77 0.00 1.78 0.00 38.99 17.50 3360.00 7/9/12 5 Overtime 61.16 0.00 61.16 1881559 Db 81.54 0.00 81.54 Lace meson Lab ____Regular 40.77 0.00 1.63 0.00 3;. 141 16.00 3072.00 8/29/12 4 Overtime 61.16 0.00 61.16 3070856 Db 81.54 3.49 0.00 81.54 , Potill o, Luis Lab Re ular 41.77 2.53 0.00 35.75 24.88 3781.76 10/24/05 Z.L� 15 Overtime 62.661 0.00 62.66 257931 Db 83.54 0.00 83.54 Rodriguez, Nelson Lab Re ular 40.77 6.14 2.47 0.00 32.16 24.25 3686.00 9/19/05 15 Overtime 61.16 0.00 61.16 180312 Db 81.54 0.00 81.54 -,.----�---- h T 202098, 202115, 202119, 202123, 202125, 202127, 202128, 202130, 202137, 202140, 202143, 202144, 202147, 202148, 202151, 202154, 202157, 202160 Overtime - over 8 a day, 40 a week and Saturdays WA Doubletime - over 10 on weekdays and Saturdays, and on Sunday's and Holiday's Simons, Bryan Lab Regular 40.77 2.05 1.54 0.00 37.18 19.48 2960.96 6/26/10 10 Overtime 61.16 0.00 61.16 1144031 Db 81.54 0.00 81.54 + $ � � lk ' •. 1. 3. Tavara, Raul Lab -.-- Regular 1 40.77 1 ,.'. 0.00 ,�� 40.77 - 6 20.00 .. `3040.001 _.L - ._.. 6/26/10 jai 10 - Overtime 61.16 0.001 61.16 2182178 Db 81.54 0.00 81.54 Zimmerman, Jer r yC Lab Regular 40.77 2.05 1.29I 0.00 37.43 16.40 2492.80 6/15/10 10 Tech Overtime 61.16 0.00 61.16 2177678 Db 81.54 0.00 81.54 202098, 202115, 202119, 202123, 202125, 202127, 202128, 202130, 202137, 202140, 202143, 202144, 202147, 202148, 202151, 202154, 202157, 202160 Overtime - over 8 a day, 40 a week and Saturdays WA Doubletime - over 10 on weekdays and Saturdays, and on Sunday's and Holiday's Colorado Crew..:. - 1� Ballard, Jules Lab Regular 40.77 2.95 1.92 0.00 35.90 24.39 3706.52 12/9/03 Overtime 61.16 0.00 61.16 1104979 Db 81.54 0.00 81.54 Dunn, Thomas 35.83 Lab Regular 40.77 3.64 1.30 0.00 16.51 2509.52 3/1/10 Overtime 61.16 0.00 61.16 2132841 Db 81.54 0.00 81.54I^ Flores, Alberto J Lab Regular 40.77 5.69 1.45 0.00 33.63 18.33 2786.16 9/20/10 Overtime 61.16 0.00 61.16 2219735 Db 81.54 0.00 81.54 Huber, Daniel - Lab Regular 40.77 4.90 1.58 0.00 34.29 20.05 3047.60 8/29/05 Overtime 61.16 0.00 61.16 1397441 Db 81.54 0.00 81.54 King, Marcus Lab Regular 40.77 1.36 0.00 39.41 17.25 2622.00 6/11/12 Overtime 61.16 0.00 61.16 3016649 Db 81.54 0.00 81.54 Stambaugh, David Lab Regular 40.77 5.25 1.56 0.00 33.96 19.82 3012.64 9/13/10 Overtime 61.16 0,00 61.16 1559797 Db 81.54 0.00 81.54 202098, 202115, 202119, 202123, 202125, 202127, 202128, 202130, 202137, 202140, 202143, 202144, 202147, 202148, 202151, 202154, 202157, 202160 STATEMENT OF COMPLIANCE 202160 Form Appmved OMB No. 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information !s estimated to average 1B minutes pei response, including u the lime ,or reviewing instructions, searching existing data source. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any oche aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highwav, Suite 1204, Arlington, VA 22202.4302. and to the Office of Management and Budget. Paperwork Reduction Project 0215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER, 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYN1MDD) 3. CONTRACT NUMBER 4 DATE f.YYMMDD) 16 1 13/03/29 1 13/03/28 I. Jill Noble Payroll Administrator do hereby state i Name of s!ynatay pally) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC '^ontractor pr s::f.cwtr; o': - on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 17th day of (Build,n.9 or work) March 201 3 and ending the 23rd day of March 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contiactororsu'bcOntractoi) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108. 72 Stat. 967. 76 Stat. 357; 40 U.S.C. 276c). and described below: Federal Fica, State and Local tax. 401 K, Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete. that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained to any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) 7. TITLE 8. SI URE Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator �y The willful falsification of any of the above Statements may suhject the contractor or subcontractor to civil or cri Yosecii—tion, See Section 1001 of Title IS and Section 231 of Title 31 of the United States Code. n DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. RECEIVED APR 15 2013 CITY OF RENTON UTILITY SYSTEMS ems+ R5707371 ',:'LrF_ST'Jv1<t.'Y INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 6,3005 Aegion Corporation Certifies! Payroli Register Project and Location 202160 RENTON -WA SS REHAB 2012: LAKE V,,ASHINGTON F,"X4909' 10" X54612"X92' 13"X 58 \�—D W8/201311:02:26 Page - 94 Pay Period Ending Date 3i23i203 G'L Period Number 5 St SMS SDep FMS FDep Sex EEO Union ....................... Craft .. ........ Ste? .......... I Social Security No Ethnic Cat Regular .............. Overtime ...... Ober Total .ob ........... Check Detail .... _ .... . Name/Address Work. Date Hours Rate Hours Rate Hours Hours Amount Description Amount --._.---NO V ORK PE:RFOR.MED------_--_ Fort?) Approved STATEMENT OF COMPLIANCE 202160 B No. 1215-0149 Ex ires Jun 3D, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the lime for reviewing instructions, searching e,aisting data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of tlris collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters SerJioas, Directorate for Infonration Operations and Reports. 1215 Jefferson Davis Highway, Suile 1204. Arlington. VA 22202.4302. and to the Office of Management and Budget. Paperwork. Reduction Project 0215-0149) Washington. DC 205W PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING C 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE iYYrvtMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD), 17 13/04/05 13/04/04 1, Jill Noble Payroll Administrator do hereby state j Name of ,c!gnatoly pa!t y) rTrtie ) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subconhector: on the Sanitary Sewer Rehab 2012 : that during the payroll period cornmencing on the 24th day of (BwbJrng or )rorh March 201 3 and ending the 30th day of March 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person ( ontractw or subconbnctor:l and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108. 72 Stat. 967: 76 Stat 357, 40 U.S.C. 276c). and described below: Federal Fica State and Local tax 401K Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or If no Stich recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ( -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less tX� than the stun of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last, First. Middle Initial) Jill Noble 636-530-8753 jnoble@aegion.com 7. TITLE Payroll Administrator 8. SNATURE �\ \ v The aviliful falsification of any of the above statements may subject the contractor or subcontractor to civil or cri tin prosecution. See Section 1001 of Title 18 and Section 231 of Tide 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. �� R5707371 WEST\AXLY Aegion Corporation \ 473/2013 7:44:26 Certified Payroll Register Page - 97 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3,30i2013 17988 EDISON AVE RENTON - VVA. GIL Period Number 1 CHESTERFIELD MO 63005 SS REHAB 2012: LAKE VVASHIN GTON 8"X4909' 10"X546' 12°X92' 1:8"X58' St SMS SDep FN'S FDep Sex EEO Union ....................... Craft ................. ....... Step ........................ . Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job ......... Check Detail ......... . Name/Address Work Date Hours Rate Hours Pate Hours Hours Amount Description Amount MO M 1 M 008 '1971 For HBU '1971 Accrual LAB Laborer default XXX-XX-4594 White Douglas S. Inman SU 312412013 Payment Number: 04725946 379 Alder Street MO 3.+25112013 Gross Pay 878.00 Falls City OR 97344 TU 3i262013 OR Departmen 47,12 WE 3•'27201,3 6.00 36.000 6.00 216.00 FED W(H'1'ax 120,83 TH 3/28;20133 8.00 36,000 .50 v1.155 8,50 318.58 FICA1A111-1 50.92 FIR 3129,12013 Medicare'XH 11.91 SA 3.'3012013 .... _ ._ _.... DentEmpSpVVK 4.65 Laborer 14.00 _. .50 14.50 534 8 y ' ISIONWY .74 CorEmpSpW1ksm 61.69 Total Deduct 298.06 Net Pay 579.94 His This Chk 27.50 Subtotal for Payment Number: 04725946 ---..._... -- --- 14.00 - -- ..-- .50 14.50 ........ .... -- - 53458 Douglas S. Inman 14.00 .50 14,50 534.58 MO S S M 008 1971 For FIBU 1971 Accrual LAB Laborer default XXX-XX-3261 Vvhite Gregory Dean Brawn SU 312412013 Payment Number: 04725935 8322 Squirrel: Hill Rd SE MO 3125 201g Gross Pay 1,219.13 Salem OR 97306 T U Y2&2013 OR Departmen 79.50 WE 327112013 7.50 35.240 7.50 264.30 FED VVIH Tax 184.17 TH 312812013 7.50 35.240 750 264,30 FICA W/H 75.2 FIR 32912013 2.00 35.240 2.00 70.48 Medicare W/H 17.60 SA 3r3012013 401k 121.91 Laborer 17.00 7.00 599.08 CoreEmpWK 10.13 DentEmpWK 2A7 Short Tenn D 3,77 Total Deduct 494.82 Net Pay 724.31 Firs This Chk 36.00 Subtotal for Payment Number: 04725935 17.00 17.00 599.08 Aegion Corporation 4i3/2013 7:44:26 R5707371 WESTdVKL'Y Certified Payroll Register Page - 98 INSfTUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3/302013 17988 EDISON AVE RENTON - WA G/L Period Number CHESTERFIELD MO 63005 8"X4909' 10" X546'12"X92` ,6" X58' SS REHAB 2012, LAKE WASHINGTON St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step ................. . Social Security No Ethnic Cat ...:. Reaular .............. Overtime ...... Other Total Job ........... Check Detail ......... . Name/Address `Mork Date Hours Rate Hours Rate Hours Hours Amount Description Amount Gregory Dean Brown 17.00 1..D0 599.08 MO S S M 007 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-5735 White Jerry C. Zimmerman SU 3:24/2013 Payment Number: 04725955 PO Box 568 Lone 1 MO 3/2512013 Gross Pay 1,038.31 Dallas OR 97338 TU 3/26/2013 OR Departmen 67.33 WE 3/27/2013 6.00 35.740 6.00 214.44 FEDVJIH Tax 140.32 TH 3/28/2013 7.50 35.740 7.50 268.05 FICA WiH 63.28 FIR 3/29!2013 Medicare W/H 14.80 SA 3/30/2013 --..- 40'1 k 103.83 Laborer 13.50 13.50 482.49 DenIEmpVVK 2.47 CorEmpVWsm 21.69 Short Term D 3.57 Total Deduct 417.29 Net Pay 621.02 Hrs This Chk 31.50 ........................ _ Subtotal for Payment Number: 04725956 13.50 Jerry C. Zimmerman 13.50 MO S S 1 M 007 1971 For HBU 1971 Accrual LAB Laborer XXX-XX-8659 Hispanic or Latino Raul Tavera SU 3/24/2013 PO Box 344 Line 1 MO 3125/2013 MT Angel OR 97362 TU 3/26/2013 WE 3/27!2013 6.00 34.370 TH 3/28/2013. 6.00 34.370 4.50 58.710 FIR 3/29/2013 SA 313012013 Laborer 12.00 4.50 13.50 482.49 13.50 482.49 default Payment Number: 04725953 Gross Pay 1,311.97 OR D partmen 79,09 6.00 206.22 FED VJr'H Tax 174.31 1D,50 470A2 Fi A VV,,H i'8.05 Medicare WiH 18.25 401k 13 1. 20 16.50 6 6.64 DentEmoCWAX 4.24 VISION MK .79 CorErr:eCh'Msm 54.40 Total Deduct 540.33 Net Pay 771.64 -1- Aegion Corporation 4/3/2013 7:44:26 R5707371 WEST'JVKLY Certified Payroll Register Page - 99 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3/30/2013 17988 EDISON AVE RENTON - VUA. G/L Period Number CHESTERFIELD MO63005 8"X4909'10"X546'12"X92'1a'X58' SS REHAB 2012: LAKE WASHING T ON St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat I .... Regular ....... ....... Overtime ...... Other Total Jab ....... Check Detail ......... . Name/Address `Mork Date Hours Rate Hours Rate Hours Hours Amount Description Amount Hrs his Chk 37.00 Subtotal for Payment Number: 04725953 12.00 4.50 ... ............... - 16.50 67r 64 Raul Tavera 12.00 4.50 16.50 676.64 MO PI M. M 008 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-5267 White Jarrod R. Gregory SU 312412013 Payment Number: 04725942 953 Charter PI NE MO 3/25..2013 Gross Pay 1,199.80 Salem OR 97301 TU 3/26/2013 OR Departmen 81.70 WE 3/27.12013 6M 39.510 6.00 237.06 FED V'd1H Tax 139.71 TH 3/28/2013 6.00 39.510 4.50 61.155 10.50 512.26 FICA W;l4 74.73 FIR 3/2912013 Medicare WiH 17.47 SA 3/30/2013 -- .. - . _......_.-... -- __........ - Total Deduct 313.61 Laborer 12,00 4.50 16.50 749.32 Net Pay 886.19 Hrs This Chk 33,00 Subtotal for Payment Number: 04725942 12.00 _... 4.50 - .......... 16.50 -- 749.32 ..-- -- Jarrod R. Gregory 12.00 4.50 16.50 749.32 RENTON -,NA - 68.50 -- 9.50 - - -._ __......... . - 78.00 --- -- _..... 3.042.'11 STATEMENT OF COMPLIANCE 202160 Form pproved OMB No. 1215-0149 1&pires Jun 30, 1997 Public reporting burden for this collection of information ,s estimated to avef3ge 1E minutes per response, including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway, Suite 1204. Arlington, VA 222024302, and to the Office of Management and Budget. Paperwork Reduction Project (121 W149) Washington. DC 20.103, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTIN R 1 AYR LL NUM R 2. PAYROLL PAYMENT DATE (YYMMU ) 3. CONTRACT NUMBER 4 DATE (YYMMU ) 14 1 13/03/14 13/03/15 I, Jill Noble Payroll Administrator do hereby state ir�.;mE•.^.f <r�OF.fOr !•�ariyJ .;ielE�t (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC ( Contractor or .subcontractor i on the Sanitary Sewer Rehab 2012 : that during the payroll period commencing on the 3rd day of ( u'dvig or work; March 201 3 and ending the 9th day of March 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Lontractol or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108. 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c.). and described below: Federal Fica State and Local tax 401 K Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of �—) fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of Such employees. except as noted In Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) 7. TITLE 8. SI NAT Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator LiLlce The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cri final pro. cation. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. RECEIVED MAR 2 7 2013 CITY OF RENTON UTILITY SYSTEMS R57107371 egon i Coiporaton Ai , 1 \A 1114/2P13 8:0 ,5:22 Certified Payroll Register Page - 95 INSITLIFORM TECHq,-_dLO-GlES LLC Project and Location 202160 may Period Ending Date 3 9/2 -' 0 13 1,HESTER7968 EDISON AVE RENTON -VVA G.;.- Period Number 3 CRELD MO 6,3005 SS REHAB 2012: LAKE WASHINGT ON F"X4909'10"X546 12"X92-:&'X5S' St SMS SDep FMS FDep Sex E E 0 Union ....... .... ....... Craft .. ...................... Step ......................... SOCIal Security No Ethnic Cat Reouiar. .......... . Overtime ... Other Total -0b Check Detail ... Name/Addr&ss, Work Date Hours Rate L i r s Rate Hours Hours Amouni Description Amount - ------- ...... - - --- ------ - MO M M 1 M 008 1971 For! IBU 1971 Accrual LAB Laborer defai.t XXX-XX-4594 White Douglas S. Inman SU .,3,2013 Payment Number: 04722656 379 Alder Street M,3 --"4!2013 8.00 36.000 150 c i. 155 9.50 3 '17 9. 7 3 Gross Pay 1,230.93 Falls City OR 97344 Tij 3512G13 8,00 36.000 3.50 A 1.155 11.50 5102.04 OR Departmer. .-.29 WE 3 1 6 �2,0 13 8,00 36.G00 1,00 61.t55 C, 00 349.16 FED Wffi Tax 3.80 1-1- 1 3,7!2013 F IC A IPJ1 H 72.8 FIR 3!812013 Medicare '1,1,,H 17.03 SA 31912l)13 DentEmpSpIvVK 4. (,5 Laborer 24,00 6.00 30.N 1,230.93 V I S 10 WAIK 1 74 sm o r E m p SWAIN 6 1. 8 Total Deduct, 406.21; Net Pay 824.72 His This Chk 3 0. 00 Subtotal for Payment Number: 04722656 24.00 6.131, 3G.00 11.230.93 Douglas S. Inman 24.013 6.co 1...00 2 3 0. 9 MC S S M 006 1971 For HBU 1971 Accrual LAB Laborer CrCfaUit XXX-X,X-3261 "Afilile Gregor. Dean Bio 1 y wri SU 3i312l)13 Payment Number 04722648 83'22 Squiirei H-1 Re SE MC; 3114,2013 ?":;o 35,240 2.50 59.010 10.50 429.45 3ross Pav 1,269.9' Salem OR Tlj 31�512013 5,50 35.240 5 u 193.82 OR Departmen 90.3 WE 3 6 1'20 13 8.00 35,240 .50 59.o10 0 ',V; 0.44 FED ,(V.,H Tax 214.36 TH 3 7 120) 13 5.00 35.240 5). ,0 176.20 F 1 C 1AP H 76,35 FR 318/2013 Medicare `AI/H 16.32 SA 319/20 13 401 k 110.8a Laborer :26.50 4.00 ... .. .. . ...... ... 30.50 1.169.91 CoreEmp'4X 10.13 DentEmpVVK 2.47 Short Term D 377 La:: Deduct 466.57 Net Pay 601.34 Hfs This Chk 30.50 Subtotal for Payment Number: 04-1,22648 30,50 1,169.91 4,00 26.50 R5707371 WEST'A1'LY Aegion Corporatist: 8:05 22 ,,.e:tified Payroll Register Page - 96 INSIT UFORM TECHNOLOGIESILLC Project and Location 2 02 16 0; -ray Period Ending Date 3191t2013 17968 =EDISON AVE PENTON - 'v%iA G/L Period Number 3 CHESTERFIELD IVIO 63.305 8"X4909"0"X546'12"X92'18"X58' SS REHAB 2012: LAKE WASH I NGTON St SMS SDe.p. FMS FDep Sex EEC Union .................... Craft .................... Step ......... .... ... Social Security No Ethnic Cat Regula. .......... Overtime ...... Other Total "o b Check Detail ......... Name/Address Work Date Hours Rate ........... Hours Rate Hours Hours Amount Descriptor. Amount Gregory Dean Brown 26.50 4.00; 30.50 1 6 9 . 91 MO S S PA 007 1971 For HSU 1971 -,.areal LAB L"'i"'crer defaut XXX-XX-5735 ,white Jerry C. Zirnmetman SU 3 13,': --T 1 Payment Number: 04722665 PO Box 568 Line I MO 3,14/2013 8.00 35.740 2.50 59.010 10.50 43145 Gross Pay 1.30 1.03 Dallas OR 97338 'U 3151201, 6.00 35.740 G. 01 0 214.44 OR Depaitmen 92.04 V,'E 316120013 8.00 35.740 1.50 59.010 9.50 374.44 FAD 'Al/H ',a x 218.99 TH 3 ! 7 12 0 13 5.00 35.740 E.. 00 178.70 FICA Wil-i 79.56 F R 318/20 13 Mcclicire Vv7H 1 M1 SA 3/9120 13 .01k 52,04 Laborer 27.00 4.00 3 1.00 1.2.01,03 Dej,t=mpIv%;K 2.47 C o r E n s! I 1 21.69 Short Term D 21. 5 7 pl To, Deduct 1 x 4ft.99 Net Pay 812,04 Hrs This Chk 31.00 Subtotal for Payment Number CC,47=;F5 27.00 ...... .... . ....... 4.00 31.00 1. 2 -01 . 0'3 Jerry C. Zimmerman 2 7. 0 4.0)0 31.00 1,20 (13 MO S S I m 307 1971 For IABLJ 1971 Accrual LAB Laborer defa0 XXX-XX-8659 spaniC or Latino Raul Tavera S U 3i3.2013 Payment Numbar: 04722662 PO Box 344 Line I NI 0 3/4/2013 8.00 34,370 4.00 58.710 12.00 509-10 'Gross Pay 1.68e.95 MT Angel OR 97362 TU 3f512013 8.00 34.370 4.50 58.710 12.50 539.16 OR Departmen 109,50 WE M12013 8.00 34.370 1.50 58.710 8.50 363,03 FE D "Al/ I i Tax 258.79 T H 3i71201 3 6.00 341.370 8.00 274.96 F'GA,,VH 101,33 F R 3 / 812 0, 13 I'VI e, d i c a r e '.N! H 22 3. 7 0 SA 3/9f;20113 101k 1158.70 L :borer 32,00 10.00 42.00 1,C86,95 D e r, t - m.L) C WA'K 4,24 V 1 S 1 0 N V,1K .79 Cor_PrnP(:;lh',/,Asn) 54.40 Total Deduct 721.45 Net Pay 965.50 R5707371 WESPIVKLY Aegion Coipora*ion 3114/2013 P:05,22 C -e.tified Payton Register Page 97 INS[T, UFORM TECHNOLOGIES LLC pr�iec' and Location 202160 Period Ending Date 319t201 33 1 7988 EDISON AVE RENTON - VVA G/L Period Numhel, 3 CHESTERFIELD MO 63005 ?"X49,09". 3"X546: 1 2"X92 1, 8"X5S' SS REHAD 2012: LAKE'AASHING-, ON St SMS SDe.,- HAS FDep Sex EEO Union .................... Craft ..... ...... ....... Step ............ Social SeCLIFAY NO Ethnic Cat ... . Regular. ...... Overtime . . Other Total job Check Deta;'I . . Name;.Address \,Ajork Date Hours, Rate Hours Rate Hours Hours Amoun' Description Amount Hirs This Chk 42.100 Sub!.Dtal for Payment Number: 04722f;62 32.00 10.0.0 42.00 Raul Taveioa 32.0 10.00 42,00 1.6&Z.95 MO MI it M 008 1971 For H B U 1911 Accrual LAB Lahore: default XXX-XX-5267 WNW je.rfod R. Gregory Si.! 3!3/2013 Payment Number: 04722653 . I I 953 Char,er 0: NE M 0 3/4/20) 13 8.00 39�510 4.00 61�i5s 12. 00 56 0 0 f_�ross Pay I 1,9.75.87 Salem OR 97301 TU 315/2013 8.00 39.510 450 6 1. 155 12.50 591.28 28 OR Departmen 151.30 'A,'E 316/20- 3 8.00 39.510 1.50 61.155 9.50 FED 'Alil­l Tax 299.59 li 3/7/2j'3 8,00 39.510 8.00 316.08 F: 4 CA VV,,H 123.03 F R 3i8/20'i 3 Medicare ',.!ViH 228,78 SA 3/9/20,. 3 To',@! Deduct 6 O,3. 2 0 Laborer 32,00 10.00 42.00 1, 8 5, 7 Net Pay 1,372.6.7 Hrs This Chk 42.00 ,Subtotal for Payment Number: 047226,53 32.00 10. 0 42 00 1,875.87 Janod R. Gregory 32.00 i0.00 42.00 1,875.87 R E N . 0 N - JA 141.50 34.00 175.50 7. 1. C, 4 � 9 STATEMENT OF COMPLIANCE 202160 Fort pproved MB No. 1215-0149 EOxpires Jun 30 1997 ublic reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204. Arlington, VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington, Dc 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING O I. PAYROLL NUMBER 2, PAYROLL PAYMENT DATE (YY D) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 15 1 13/03/22 1 13/03/21 I, Jill Noble Payroll Administrator do hereby state (Name of signatory party) (Title; (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor) on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 10th day of (Sud,L,mg or wcrki March 201 3 and ending the 16th day of March 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcoeuracton and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108. 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c). and described below: Federal Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State opprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: - (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sure of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5. REMARKS 6. NAME (Last, First, Middle Initial) 7. TITLE 8, I TURE Jill Noble 636-530-8753 _ jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements nlay subject the contractor or subcontractor to civil or cn f prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. �'_j � r,egion Corporaiian M13,R57077I 3-01421:15 Register Page- INSITI.JiFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3/16i20'13 '7966 EDISON AVE RENTON -)vVA ta?L Perod NUMLOr 4 CHESTERFIELD MO 63N5 SS REHAB 2012: LAKE "JJASHINGMN 8"X4909'10:'X546'12"X92"S'X56 St SIMS SIDep FMS I'Dep Sex EEO Unior .................... .... Craft ........................ Step .... ................. Social Security NO Ethnic Cat . I . . I . Regular .............. over -time . . ... Ogler Total Job I I ...... Check, Detail ..... NimeiAddress Work. Date Hours Rate -lours Rate Hours Icurs Amount Description Amount MO M. M, 1 M 008 1971 For' IBU 1971 Accrual AB L.abore- dcau XXX XX-4594 VV-hiie Douglas S. Inman S U 3'10F°2013 Payment Number: 04723507 379 Aldcr, Strect MO -4 1 13 8. 0 0 36.000 8.00 2,38.00 Gross Pay 972.000 Falls City OR 97344 TU 3 2;'-) -0 3 5.50 36,0013 5.50 198.00 OR Departmcn. 55.72 V'VE 3,31/2013 6,50 36.000 13.50 234.00 FED W.IH 'Tax 35.16 3 7 -00 36.000 7.00 252.00 F:,,A`,N.,,H 55.84 F R Medicare 'W/H 13.29 SA 3;` 6'22011 3 DentErr.oSpWK 4.65 Lahore?, 27 00 27.u0 97ZG0 VISIONWK Comm.," IKsm 61.54 otal Deduct 328.29 Net Pay ' ; 643.7, I His This Chk 27,00 Subtotal for Payment Number: 04723507 271.00 27.00 972.00 Douglas S. Inman 27.00 27.00 972.00 MC S S M 008 1971 For BU 1971 Accrual I LAB Labcre, default XXX-XX-3261 "IvIlite Gregory Dean Brown Sul 3111011201, 3 Payment Number 04723499 6322 Saturre! Hill Rd SE MC,, Y'l 1 i2013 TOO 35.240 7.00 246.68 Gross Pay 1,370.29 Salem OR 97306 TU 3111212013 6.50 35.240 6.50 229.06 OR Deoartmer. 99.02 vVE 3r, 31�2013 6.50 35.240 6.50 229.06 FED VVIH Tax 236.38 TI ; 1 H 3!1412-013 8.00 35.2.40 G.50 �9.010 14. 5 5F5.49 FICA 84.65 FR 3r1 5/20 13 Medicare 19.78 SA 3/16;2013 401k 54.81 Laborer 2 R.0, 0 ti.50 34.50 1,37029 CoreEmpWK 1 C.. 13 DentErnPVIX 2.47 Short Term D 3.77 -ital Deduct 5 12.91 Net Pay 857.38 Hrs This Chk 34.50 Subtotal for Payment Number 04723499 28.00 R5707371 ',A'F.ST'IJKI..Y Aeg'on Cot oration 3120/2013 14:2 1 Certified Payroll Register Page, - 84 INSITUFORM TECHNOLOGIES LLC Protect and Location 20216D Pay Period Ending Date 316.i2013 17988 EDISON AVE RENTON - WA GAL Period Number 4 HESTER FIF POO 630,05 8"X49)9'1OI'X543 12"X92 18"X�8' SS REHAB 2012: AKE 101,'�SHING-ON St SMS SID-ep FNAIS I'Dep Sex EEO Union .................... Craft ..... Step ........... SOCIal Security Nc Ethnic Cat -RegWar....... ....... OVC-rli-.e ...... Other Total ob Check, Detafl .......... NimeiAddress .... ....... .. Work Date Hours Rate Hours Rate Ho;lj.,s Hours Amount Desci.0on Av I)OUnt. Gregory Dean Brown 28.00 6.50 2, 4. 5 0 1.370.29 MO S S ki 007 1971 For H B U 1971 Accrual LAB Laborer derauqt XXX-XX-57'3g 'v%,hite Jerry C. Zirnrnerrnan S;;-:' 3/10/2013 Payment Number. 04723517 PO Box 568 Line 1 MO 3/11 /20 13 7,C10 35.740 010 25113 Gross. May 1.354.29 Dallas OR 97338 TU 3 ;' 2/2, 13 6.50 35.740 C.50 232.31 OR Decartmen 99.19 VVE 3/1, 3i2013 6.50 35.740 5 0 232.31 FED VVIH Tax 238.87 TH 3l1 4/20 13 8.010 35,740 6.50 59.010 14.50 669.49 FICA Willi 84.711 FR 3115/20 13 Medicare 19.81 SA 3/16!2013 40Ik 55.37 Laborer 28.00 6.50 34.50 1.38429 DentEmp',jVK 2,47 CorErnr,'Alksm 21.69 Short Term D 15 -1 Total Deduct 525.68 Net Pay 852.61 Hrs This Chk 34.50 Sub,otal for Payment Number: 04723517 .. . . . ......... . 23 00 6. 50 '3 4.50 1,38429 Jerry G. Zimmerman 28.00 6. r" 0 14.1, . --3 1,36429 M0 S S .1 IIA 007 1971 For HBU 1971 Accrual LAB Laborer delautt XXX-XX-3659 pantie or Latino Raul Tavera S U 3 i 10 1.1 2 01 13 Payment Number: 04723514 PO Box 344 Line I MO 3,11/2013 8.00 341. 3 0 3.50 53.710 11. CIO 480.45 Gross Pay 1,800.45 MT Angel OR 97362 TU 3/12/20 3 6.50 34.370 6.50 223,41 OR Departmen 118.69 VvT- 3/13120 7.00 -,4.370 700 240.59 FED ',NiH Tax 28432 TH 3i 14/2 0 3 8.00 34.370 3.50 53.710 50 7 74. 00 F lCA 'vV,H 103.37 FR 3 i 15/2 013 Medicare ',N/H 2 15. 134 SA 3/16!2013 401k 180.05 Laborer 29.50 12.00 41.50 1,718.45 D e n t.-E rn p C t ;VV K 4.24 VISIONVOK 79 C o r E rn p C WIA, s fn 54.40 Total Deduct 776.20 Nk Pay 1,024.25 STATEMENT OF COMPLIANCE 202160 Form Approved MB No, 1215-0149 EOxpires Jun 30, 1997 Public reporting b ur en for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway. Suite 1204, Arlington, VA 22202-4302. and to the Office of Management and Budget, Paperwork Reduction Project It215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING FYI ER. 1. PAYROLL NUM 2. PAYROLL M 4. DATE (YYMMDD) 5 1 13/01 /11 1 13/01 /11 1, Jill Noble Payroll Administrator do hereby state i(Name of signatory party rime (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor orsubcontractor) on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 30th day of (Building or work December 201 2 and ending the 5th day of January 201,J_ , all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967,- 76 Stat. 357,• 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated Into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or it no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6, NAME (Last, First, Middle Initial) Jill Noble 636-530-8753 7. TITLE 8. SIGNATURE jnoble@aegion.com Payroll Administrator L4:LL The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal rosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITION MAY BE USED. RECEIVED MAR 18 2013 CITY OF RENTON UTILITY SYSTEMS R5707371 WESTWKLY INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Project and Location 202160 RENTON - WA SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' 1 /10/2013 11:45:22 Page - 89 Pay Period Ending Date 1/5/2013 G/L Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -----------NO WORK PERFORMED---------- Form Approved STATEMENT OF COMPLIANCE 202160 MB No. 1215.0149 EOxpires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFI E . 1. PAYROLL NUMBE 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. ) 6 1 13/01 /18 1 13/01 /17 I, Jill Noble Payroll Administrator do hereby state (Name of signatory party rt e (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 6th day of i'Lludding or work January 201 3 and ending the 12th day of January 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967,• 76 Stat. 357,• 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5. REMARKS 6. NA Last, First, Middle Initial Jill Noble 636-530-8753 7. TITLE 8. UHIZ jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cri tna osecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITION MAY BE USED. r `� R5707371 WESTWKLY Aegion Corporation 1/16/2013 13:19:29 Certified Payroll Register Page - 97 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 1/12/2013 17988 EDISON AVE RENTON - WA G/L Period Number 3 CHESTERFIELD MO 63005 SS REHAB 2012' LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -----------NO WORK PERFORMED---------- Form Approved STATEMENT OF COMPLIANCE 202160 OMB No. 1215-0149 lExpires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget.. Paperwork Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3, NTRA T NUMBER 4 DATE (YYMMDD) 7 13/01 /25 13/01 /25 I, Jill Noble Payroll Administrator do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor) on the Sanitary Sewer Rehab 2012 ; that during the payroll period commencing on the 13th day of (Budding or work) January 201 3 and ending the 19th day of January 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal Fica, State and Local tax 401 K Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6 NAME (Last, First, Middle Initial) 7. TITLE 8. SIGNATURE Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor 70 civil or riminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R5707371 WESTWKLY Aegion Corporation / \ 1/24/2013 8:28:54 Certified Payroll Register ! \ Page - 157 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 1/19/2013 17988 EDISON AVE RENTON - WA G/L Period Number 4 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X 546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount ---------NO WORK PERFORMED-------- Form Approvea STATEMENT OF COMPLIANCE 202160 OMB No. 1215-0149 lExpires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222024302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING FFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3. C NTRACT NUMBER 4. DATE (YYMMDD) 8 13/02/01 13/01 /31 1. Jill Noble Payroll Administrator do hereby state (Name of signatory party) (title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or Subcontractor) on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 20th day of (Building or mork) Janus 201 3 and ending the 26th day of January 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357: 40 U.S.C. 276c). and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) 7. TITLE 8. SIGNATURE Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator _kA The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimio6f p Iecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R5707371 WESTWKLY Aegion Corporation 1/30/2013 15:02:39 Certified Payroll Register Page - 90 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 1/26/2013 17988 EDISON AVE RENTON - WA G/L Period Number 1 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909'1 0"X546'1 2"X92'18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form pproved STATEMENT OF COMPLIANCE 202160 MB No. 1215-0149 FOypiresJun 30. 1997 public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Higl away, Suite 12rM, Arlington, VA 222024302. and to the Office of Management and Budget. Paperwor* Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES, RETURN THE COMPLETED FORM TO THE CONTRACTING FFIC R 1 PAYROLL NUMBER g 2. PAYROLL PAYMENT DATE. iYYMRADD; 1 13/02/08 3. CONTRACT NUMBER 4. DATE (YYMIADD) 1 13/02/28 i. Jill Noble Payroll Administrator do hereby state (Name of signatory party) (1dA+7 (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 27th day of - (auifdrng or work) January 201 3 and ending the 2nd day of February 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person i i,;J,.i riCfJr- �,' S(ibCCri; CJ!JI'. and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108. 72 Stat. 967: 76 Stat. 357 40 U.S.C. 276c), and described below: Federal Fica State and Local tax 401K. Loan re -payment InSLtrance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (L) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH f--� Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less l Xx I than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS g. NAME (Last, First, Middle Initial) Jill Noble 636-530-8753 7. TITLE 8. ATURE , jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or unin rasecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITION MAY BE USED. �� R5707371 WESTWKLY Aegion Corporation ` 2;1412013 8:09:37 Certified Payroll Register Page - 96 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 2/2;2013 17988 EDISON AVE RENTON - WA G/L Period Number 2 CHESTERFIELD MO 63005 SS REHAB 2012, LAKE WASHINGTON 8"X4909' 10"X546'12"X92'18"X58' St SMS SDep FMlS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat .... I .. Regular ....... ....... Overtime ...... Other Total Jot) ........... Check, Detail .......... Name.rAddress Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -----NO WORK PERFORMED---- Form Approved STATEMENT OF COMPLIANCE 202160 OMB No. 1215-0149 lExpires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per res. onse, including the time for reviewing instructions, searching exisfing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments reuardmg this burden estimate or any other aspect of this collection of infoi mation. including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222024302, and to the Office of Management and Budget. Paperwork Reduction Project t1215-0149) Washington. DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES, RETURN THE COMPLETED FORM TO THE CONTRACTING FFIC R. 1 PAYROLL NUMBER PAYROLL PAYMENT DATE (YYMMDD;. i. CONTRACT NUMBER 4. DA rE (YYMFr1DD) 10 F. 13/02115 13/02/28 I Jill Noble Payroll Administrator do hereby state ova of signatoq c?rt,) i ;tiat (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Contras of or on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 3rd day of February 201 3 ,and ending the 9th day of February 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person lcantracto; Or subcc tracNr. and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967: 76 Stat. 357; 40 U S C. 276c), and described below Federal Fica State and Local tax 401 K. Loan re -payment InSLlranCe, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete. that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH (-1 Each laborer or mechanic listed In the above referenced payroll has been paid as Indicated on the payroll, an amount not less t Xx I than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed to the contract (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS G. NAME (Last, First, Middle Initial) Jill Noble 636-530-8753 7. TITLE 8. SI TURE jnoble@aegion.com Payroll Administrator A�( The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or min prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDiTON MAY BE USED. �� R5707371 WESTWKLY Aegion Corporation ` 2/14/2013 8:10:10 Certified Payroll Register Page - 90 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 2/9/2013 17988 EDISON AVE RENTON - WA G/L Period Number 3 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909'10"X546'12"X92' 18"X58' St SMS SDep FMS Map Sex EEO Union ........ Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Form Approved STATEMENT OF COMPLIANCE 202160 M1B No. 1215-0149 FOxpiies Jun 30, 1997 Public reporting burden for this eailectiun of inforrnation is estimated to average 16 minutes per, response, including the tuna for reviewing instructions. searching amistirg data sources, gathering and maintaining the data needed, and completing and reviewing the collection or information. Send comments regarding this burden estimate or any other aspect of this collection: of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222024302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-01491 Washington, DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OF I 1 PAYROLI- NUMB 'R 2. PAYROLL PAYME.NI' DATE. (YYMMDD; 3. CONTRA,'f NUMBER4. C)t TE (YYP:1Fat)C)) 11 1 13/02/22 13/02/28 I. Jill Noble Payroll Administrator do hereby state ,,Nanie Of s;GnatJ!y p.'fO , ..,.) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Con, actor or subcontractor) on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 10th day of BUYmog 01 wolf() February 201 3 and ending the 16th day of February 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person i c-on"f actor Or subrQntra Yw ) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat 108, 72 Stat. 967: 76 Stat. 357: 40 U.S.C. 276c), and described below: Federal Fica, State and Local tax, 401K. Loan re -payment. Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or If no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required tnnge benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last First, Middle Initial) 7. TITLE 8 SIG RE Jill Noble 636-530-8753 / jnoble@aegion.com Payroll Administrator The willful falsification of any of the ahove statements may subject ttte contractor or sr.ibcr;nt.,<lctor to civil or crif teal pro cution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. � —� R5707371 WESTWKLY Aegion Corporation \\ 2/20/2013 13:24:20 Certified Payroll Register Page - 93 INSITUFORM TECHNOLOGIES LL.0 Project and Location 202160 Pay Period Ending Date 2./16/2013 17988 EDISON AVE RENTON - %rJA ilL Period Number 4 CHESTERFIELD MO 63005 SS REHAB 2012; LAKE WASHINGTON 8"X4909' 10"X546'12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic. Cat ....... Regular .............. Overtime ...... Other Total Job .......... Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -----NO WORK PERFORMED---- STATEMENT OF COMPLIANCE 202160 orm .pproved MB No. 1215-0149 Expires Jun 30, 1997 ubiic rer orting bnrdon for this co lection of infofination is estir iated to average 16 mu -. Life s per response, inrluding the bwe for reviewing instruction. searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments rewarding this buidwi estimate ei any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149i Washington, DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DArE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDD) 12 13/03/01 13/02/28 I. Jill Noble Payroll Administrator do hereby state (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC r c>,,,tractor or Subcontractor) on the Sanitary Sewer Rehab 2012 that during the payroll period commencing on the 17th day of ;Building or worih J February 201 3 and ending the 23rd day of February 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108. 72 Stat. 967 76 Stat. 357 40 U.S.C. 276c), and described below: Federal. Fica, State and Local tax; 401K, Loan re -payment. Insurance, garnishments NO HOURS WORKED (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract. that the classifications set torth therein for each laborer or mechanic conform with the work performed. (3 i That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS 0 In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum at the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First. Middle Initial) 7. TITLE 8. SI Jill Noble 636-530-8753 LU jnoble@aegion.com Payroll Administrator The wailful falsification of any of the above statements may subject the contractor or subcontractor to civil or ,rirninal Pt secution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DD FORM 879, MAR 95 (EG) PREVIOUS EDiTrO' N MAY BE USED. �� R5707371 WESTWKLY Aegion Corporation 2i28/2013 7:46:51 Certified Payroll Register Page - 85 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 2.-23;2013 17988 EDISON AVE RENTON - WA G/L Period Number 1 CHESTERFIELD MO 63005 SS REHAB 2012, LP.KE WASHING T ON 8"X4909' 10"X546'12"X92'18'X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat ....... Repuiar .............. Overtime ...... Other Total Job ...... I ... Check, Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -------NO WORK PERFORMED-------- orrn Approved STATEMENT OF COMPLIANCE 202160 MB No. 1215-0149 FOxpires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE OFFICER. 1 90WANALK 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 13 1 13/03/08 1 13/03/08 I, Jill Noble Payroll Administrator do hereby state (N.me of signatory party) (Tit'Ej (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC (Contractor or subcontractor) on the Sanitary Sewer Rehab 2012 : that during the payroll period commencing on the 24th day of t uddin9 or wodc) February 201 3 and ending the 2nd day of March 201 3 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or.subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108. 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c). and described below: Federal Fica, State and Local tax 401 K, Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ®Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5-REMARKS 6. NAME (Last, First, Middle Initial) 7. TITLE 8. SIG U Jill Noble 636-530-8753 jnoble@aegion.com Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or urinal osecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. Aegion Corporation 3/812013 9:12:04 R5707371 VVEST'✓VKLY \ Certified Payroll Register Page - 90 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3/2/2013 17988 EDISON AVE RENTON -WA G/L Period Number 2 CHESTERFIELD MO 63005 SS REHAB 2012: LAKE WASHINGTON 8"X4909' 10"X546' 12"X92' 18"X58' St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ..... Regular .............. Overtime ...... Other Total Job .......... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO S S 2 M 008 1771 For HBU 1771 Accrual LAB Laborer default XXX-XX-4810 Hispanic or Latino Rudolfo Hernandez SU 2i2412013 Payment Number: 04721776 5593 S. Biloxi 'Way MO 2125i2013 Gross Pay 3,340.38 Aurora CO 80016 TU 2126!2013 CO Departmen 142.00 WE 2,27/2013 1,50 34.840 1.50 52.26 FED W/H Tax 728.72 TH 2%28r2013 8,00 34.840 2,00 61.155 2.00 12.00 564.11 FICA W//H 2O1.84 FR 3%1/2013 8.00 34.840 2.00 61.155 1.50 11.50 523.34 Medicare W.1H 47.21 SA 3%2/2013 . .... 6.00 61.155 6.00 366.93 CoreFamV'JK 83.12 Laborer 17.50 10.00 3.50 31.00 1,506.64 DentFamWK 7.55 VISION'v%/K 1.44 Depl-ifeOpt3W 3.38 Supl-ife WK 6.24 Total Deduct 1,223.50 Net Pay 2,11G.88 Hrs This Chk 65.50 Subtotal for Payment Number: 04721776 17.50 3.50 31.00 1,506.64 10.00 Rudolfo Hernandez 17.50 i0.00 3.50 31.00 1,506.64 MO M M 1 M 008 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-4594 While Douglas S. Inman SU 2!24i2013 Payment Number: 04721750 379 Alder Street MO 2:25i2D13 Gross Pay 1,864.33 Falls City OR 97 344 TU 212612013 OR Departmen 132.39 VV'E 2i27i2013 1.50 36.000 1.50 54.00 FED W/H Tax 286.96 TH 2i28/2013 8.00 36.000 4.00 61.155 12.00 532.62 FICA 1 41-1 112.14 FR 3/1/2013 Medicare W/H 26.23 SA 312i2013 DentEmpSpWK 4.65 Laborer 9.50 4.00 13.50 586.62 'vIS10NVVIC 74 CorEmpSpWksm 611.89 Total Deduct 625.00 Net Pay 1,239.33 Hrs This Chk 48.50 R5707371 tiRJESTWKLY Aegion Corporation 31812013 9:12:04 Certified Payroll Register Page - 91 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3l2;2013 17988 EDISON AVE RENTON -WA G;L Period Number 2 CHESTERFIELD MO 63005 8"X49091 0"X546' 12"X92' 18"X58` SS REHAB 2012: LAKE WASHINGTON St SMS SDep FMS FDep Sex EEO Union :.................... Craft .................... Step ................. . Social Security No Ethnic Cat ..... I . Regular. . ............ Overtime ...... Other Total Job ......... Check Detail ......... . NamerAddress Work Date Hours Rate ....... _...._.... Hours Rate Hours _...... _.._........ _ _._ ...... Hours Amount Description Amount .._.._._- _..._ ..__..- Subtotal for Payment Number: 04721750 9.50 4.00 ..._.._ 131.50 _ .. .. 5863.62 ..__.._._......._. Douglas S. Inman. 9.50 4.00 13.50 586 62 MO S S M 008 1971 For HBU 1971 Accrual LA. Laborer default XXX-XX-3261 W7ite Gregory Dean Brown SU 2!24 2013 Payment Number: 04721741 8322 Squirrel Hill Rd SE MO 2125'2013 Gross Pay 2,598.76 Sa?em OR 97306 TU 2/26:2013 OR Departmen 207.50 Va'E 2127.2013 1.50 35,240 1.50 52.86 FED WiH Tax 556.45 TH 21281201,', 8.00 35.240 6.00 59.010 14.00 635.98 FICA WrH 160.84 FIR 3t11;2013 8.00 35.240 5.00 59.010 13.00 576.97 Medicare Lh9H 37.62 SA 3/2;2013 7.00 59.010 7.00 413.07 401k 103.95 Laborer 17.50 18.00 35.50 1.678.88 CoreEmp',NK 10.13 DentEmpW'K 2.47 Short Terri D 3.77 Total Deduct 1,082.73 Net Pay 1,516.03 Hrs This Ch.k 55.50 Subtotal for Payment Number: 04721741 17.50 .......... --- 18.00 _ _ .... --- - 35.50 ............._... 1.676.88 --1,6118.88 Gregory Dean Brown 11.50 18.00 35.50 MO S S M 007 1971 For HBU 1971 Accrual LAB Laborer de`:.auit XXX-XX-5735 u1 Hite Jerry C. Zimmerman SU 2l2412013 Payment Number: 04721762 PO Box 568 Line 1 MO 2125.`2013 Gross Pay 2,615.51 Dallas OR 97338 TU 2126.12013 OR Departmen 207.91 WE 2/27,12013 1.50 35.740 1.50 53.61 FED W;H Tax 557.75 TH 2i26..2013 6.00 35.740 6.00 59.010 14.00 639.98 FICA W'H 161.17 FIR 3/1 f2013 8.00 35.740 5.00 59.010 13.00 580.97 Medicare W;H 37.69 SA 3/2.20'13 7.00 ........_ 59.010 _.. 7.00 _ 413.07 __. 401k 104.62 Laborer 17.50 18.00 35.50 1,687.63 DentEmpWK 2.47 CorEmp'dvksm 21.69 Short Term D 3.57 Total Deduct 1,095.87 R5707371 WESTWKLY Aegion Corporation 3i8!2013 9:12:04 Certified Payroll Register Page - 92 INSITUFORM TECHNOLOGIES LLC Project and Location 202160 Pay Period Ending Date 3/2i2013 17988 EDISON AVE RENTON - WA. G!L Period Number 2 CHESTERFIELD MO 63005 9 8"X4909'10"X546'12"X..2' 18'X58' SS REHAB 2012, LAKE WASHINGTON St SMS SDep FMS FDep Sex EEO Union ................ ... Craft . .................. Step ................. . Social Security No Ethnic Cat ..... Regular ....... ....... Overtime ...... Other Total Job Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Net Pay 1,518.64 Hrs This Chk 55.50 Subtotal for Payment Number: 04721762 17.50 18.00 Jerry C. Zimmerman 17.50 8.00 35.50 1,687.63 35.50 1.687.63 MO M M M 006 1971 For HBU 1971 Accrual LAB Laborer default XXX-XX-5267 White Jarrod R. Gregory SU 2/24,12013 Payment Number: 04721746 953 Charter P:' NE MO 2/25/2013 Gross Pay 2,258.89 Salem OR 97301 TU 2/26 2013 OR Departmen 177.14 VVE 2/27/2013 1.50 39.510 1.50 59.27 FED VV/H -I ax 369.98 TH 2/28!2013 8,00 39.510 4.00 61.155 12.00 560.70 FICA VV!H 140.48 FR 3/1'2013 Medicare +:1r'/H 32.85 SA 312!2013 5.50 61.155 ___.-.... 5.50 _. ._._.....____...__- - ..........___.._._......._____ 336.35 Total Deduct 720.45 Laborer ___..._......... _.... 9.50 9.50 19.0" 956.32 Net Pay 1,538.44 Hrs This Chk. 44.00 Subtotal for Payment Number: 04721746 9.50 - 9.50 -- 19.00 --- 956.32 Jarrod R. Gregory 9.50 9.50 19.00 956.32 -- RENTON - VVA ........ --.... - 71.50 59.50 3.50 134.50 6.416.09