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HomeMy WebLinkAboutWWP273627 (10) MAINTENANCE SERVICES DIVISION PUBLIC WORKS DEPARTMENT REQUEST FOR SERVICES I i Department/Division/Section requesting work from the Public Works Maintenance Services Division: Z5 s w r. Name of party requesting work, (please print) Contact number: x - r - Today's date: All work requests must be authorized by someone having budget authority and shall provide complete budget line item numbers and includes all project and sub-object numbers where applicable. Please be sure all information on this form is complete and accurate. Work cannot commence nor can parts be ordered until the information is complete and verified. Depending on the size of the project we attempt to get three price quotes. We will charge your budget for all parts, materials, labor and equipment costs associated with this project. 1. Project name: �i5 y %�� L.i�r �Jit:,�-.✓ �c��'��fsaz�i..�-cs: �, ae?= /'61AI" X2cu:c,.r,n•A.4 Work to be performed by section of the Maintenance Services Division. Project address: ILI, Budget line item number: 'r'Z(r�: 'S4f3S o/S.S44�SG3.�<<Project#:_ke1�/P�Z7 31oZ7 Approximate start date: If.5_,<i f� ? Authorizing signature: 4�'l ite below t Return original to: Vanessa Poorman City of Renton, Maintenance Services Division, Public Works 3555 NE 2"d Street Renton, WA 98056 (425) 430-7445 Estimated Cost: Actual Cost: Our Work Order#: Start Date: Budget Number to reimburse: Labor: Parts: Equipment: Approved by Maintenance Services Director: Date: Mike Stenhouse Q:/PublicWorks/Forms/RequestForService updated 8/16/2011 RECEIVED APR 8 2014 Ikpanmcm of I alx+rand lndu>tne +,.,,:, CERTIFIED PAYROLL REPORT Pn-(ailingN age l'rogram CITY OF RENTON "D Hox 44 s40 Prow Name Count, I'KWU(W('utaroM ()lympia WA 11304-4340 i4 ' Prime(ontraclnr 5 13601902.533s ❑ 027 Ripley I am N,Renton,WA 9Rp56 King WWP-27 3678 UTILITY SYSTEMS ® INoj 7 Wdre.. city %tale subcontractor 5027 Riplc%Lane N Renton WA Auarding Apenv Namc Pthoc (ontpany Namc Ptkxw For the aecl ending: Cite of Renton 425430-7279 DESIGNED GROUNDWATER SERVICES_LLC 253-"2-7330 Month I* Year Address Cm Static LIP+4 Addrcm Cin Slate LIP-4 311514 1055 SGRADY WAY Renton WA 98055 PO BOX 366 PUYALLUP WA 99371 and Date Ikducwm \1'nrAl'las.ification Name a tun 1.h,n lue (('ed rhu Fn Sat ratal and and c Rate lkwh SocSockofIntployec Addre,% i'0 nu ai, „ fq� ( (rt,n. lmount M'sual %hithAd- \II 'Iltwrs N orked Each Da} lioun Pa) F ankJ_J BcnefKs' it(A tng I ax t tthcr 1. OWtter Operator Ds(Id Ftw% (tl ow am , 1'(2H,n366 r-._ am t 0004)0-8164 Puyallup.WA98371 R(i a+ 2m om 2.Wellpoint Laborer (iARr'H IORS OT am om 3303 F Hay DR N%% woe s v t + s 000-00.9853 Gil Hart w.WA Q3335 R(i ,.• w- 3 am om s om + R(i oat, om 4. ul I om ow R(i nisi am �� (1T aw Om 1 5 t R(i i am M OW f t R(i Um am 7. OT .- 1 oat s om s om I� R(i ow em 8 OT _ om om am s am sow R(i am om am Ol om 9. 0.10 I s om s ------- R(; -- --- — am om - - 10. OT om am -r om t aw s 0— We am om F700.0654=certified pa)toll report 054)9 brink.ee Benefits Aivrihuthpir and Nignorure(errirrrrriun urr Reverw.fide l hpannum of Lahor andmin InJmtri�y AFFIRMATION Prevailing Wage I'now_ram 110{Lis 44540 o1pnpia WA 985(W-4540 Todav*s Date Printed name of pany signing this report Title 04/03/2014 Jamie Mitchell Office Manager 'fhe party signing this reprttt pays or supervises the (Name of contrrcwr or subcontractor) payment ofthe persons employed by: DESIGNED GROUNDWATER SERVICES LI-C Project Name: For the week staning: For the week ending: Mistv Cove Lifl Station Replacement 1 03/09/14 03/15/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourh•Pension (B)Hourh•Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program (A*It+C+D+F.) 1.Owner Operator $ 0.00 2.Wellpoint Laborer $ 0.00 3. $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract:and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans.funds or programs for the benefit of such employees. (•I) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible.have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name of party signing this report Title Jamie Mitchell Office Manager F700-065-000 cenitied payroll report backer 05-09 DevailienWageProgra lniiustries ��tA.� CERTIFIED PAYROLL REPORT Prevailing Wage Program ." �, 0 PO Box 44540 = Project Name County Project or Contract# Olympia WA 98504-45411 jhl. {�� Prime Contractor , (360)902-5335 ��� ❑ 50_7 Ripley Lane N. Renton, WA 98056 King W�VI'-27 3678 - - ® Project Address laity State -- Subcontractor 5027 Ripley Lane N Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425430-7279 ( DESIGNED GROUNDWATER SERVICES LLC 253-682-7330 Month Day Year Address City State %I11+4 Address 01% Suite %IN4 3/22/14 1055 S GRADY WAY Renton WA 98055 ( PO 130X 366 pUYALLUP WA 98371 Dav and Date Inductions \Vork Classification Name Sun Mon Tuc Wed Thu_ Fri Sal - fowl and and Rate Hourly SOc weir Of l]it,Plgyre Address Y _vrNii vrnr uix•u vr,n+ +rnn, v:ui�I .v,.ru •I,ulal of Gross Amount '-Usual Wilhold- VI�I Hours Worked Bach Day Ilours Pay Earned Benefits" FICA ingTa.e Other WAGES I. Owner Operator David Fors cI I ( �I I n° orrI s ° o'O Box 366 „1 s 0 a) 000-00-8164 1 Pub al lop•\1'r\98371 RG '0) I ( ( s 00 1 I °"' --- r l 1 2. Wellpoint Laborer CiARY 11.FORS I I ( I I oar I oar 3303 1:Bay DR NW -- — ff --— - 1 - -- 551 08 s 000 $42_) s)r 00 S4;o S 471 a 000-00 9853 Gie Ilarbor.WA 98335 R(.i ( I 5U! I sm ( I 1 1300 I .12.36 «r os I i 3. Wellpoint Laborer_I I'\'I.I R R. IIIJU1 o00 I oa) 8211 59thAVH E -- -- -- f sms_ s ocw )sits oroo ea s•10327 000-00 6492 I PUYALLUP.WA 98371 RG I I .r00 I srxt i I I I f200 2.36 ,S? 4. 01, I o m at 0 1 --1— - - I -- - - ----) — I 000 s oa, s oa RG I i 000 I 000 -_l 15. I-- — I 10001---1 uro f 000 I s °,t0 s oa) RG I 1 I I °�, I °0 6. (�I 000 oar s no° 5 000 1tCi ► i 1 1 I I °°° I I °r� Orb s oa) S ,)e.) RG - i ---I ow 11 0(U 8 I L I 1 OW rr>o 000 spa s oap RG I I I I 000 1 9 I (3 I I I -! - 000 I I 0 00 ' - ' 0 00 s it oo s o co 10. I I I I I I 000 I 1000 ON s o(A) —� -- - s 000 RG i 1:71N1-065-000 certified Payroll report 0S-09 Empluree Benefits Divrihutimi and Siknuture Certificulimi uu Reverse Side xor Ikpailing a f a ro and Indu,lnc, AFFIRMATION PreNa�ling Nagc program 110 Ihi.x 44540 Olympia IAA 9R5044540 Today's Date Printed name of pan) signing this report Title 04/03/2014 Jamie Mitchell Office Manager The party signing this report pays or supervises the (Name of contractor or sut►contractor) payment of the persons cmpluNed by DESIGNED GROUNDWA TER SERVICES LLC I Project Name: F or the week starting: or the week ending: Misty Cove Lift Station Replacement 03/16/14 03/22/14 "USUAL BENEFITS"DISTRIBUTION (Please report in "per hour" terms) — - Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (11)Houry. Medical (t ) Ilourh Vacalion (D) Hourly Holiday(% +B+( +n+E) Apprentice Program 1. Owner Operator $ 0.00 2.Wellpoint Laborer $ 0.00 3.Wellpoint Laborer $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 fhe party signing below AFFIRMS the following: l 11 All information contained in this Certified Payroll Report. including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned.and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of am or the above statements is a %iolation of MAN' 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Si _ Jamie Mitchell Office Manager 1 7(10-00-004)certified payroll report hacker 0" Depann)eni ul'I.atx)rand Industries ,.T,r< /Z ivop— CERTIFIED PAYROLL REPORT Pre%ailing Wage Program PO Box 44540 Project Name Count% PriWol of Contracts' Olympia%'A 98504-4540 �,, a Prime Contractor ❑ 5027 Ripley Lane N. Renton, WA 98056 King WWP-27-3678 (360)902-5335 ® Project Address City State 1,5 Subcontractor 5027 Ripley Lane N Renton WA _ - Awarding Agency Name Phow Company Name Phone For the%seek ending: Cit) of Renton 425430-7279 DESIGNED GROUNDWATER SERVICES LLC 253-682-7330 Month lay Year Address Cm State /IP-4 Address City Suae ZIP+4 3/29/14 1055 S GRADY WAY Renton WA 98055 PO BOX 366 PUYALLUP WA 98371 Day and Date Deductions Work Classification Name v Sun Mon Iue Wed Thu Fri Sat Teat and and r Z Rate Ftaurly Soc Seca of F.mplayee Address %'� n i� i. pie 4�,_,u ,MIA vw1+ Taal of Gross Amount •Usual Withold- NET Ilour%Worked Each Ord} { Hours Pay Lamed Benefits- FICA ingTax Other WAGES 1 111 uw o00 q.., f 000 f 000 R(i n00 000 7 Of 1101) 000 U iwi f 000 S• 4123 RG U 00 '� is b 4.00 . 3. OI 000 000 RG 000 1 ait 000 4. — OT 000 000 _--- 000 f 0fn f ow RG i 0o l oo 5 OT u uu 000 . --— 000 f 000 f U 00 R(i 000 1100 O"f 1 1 000 000 6. 0m s 00o $ Uoo R(i o 0o 000 7 — - OT Ono 000 O UU f o(a RG 000 U 00 8 (yT 000 . 000 o(.) s nm RG 0 00 OM 9. --— OT 000 000 0 00 s ow) s RG 000 u 00 10. Of 000 F 000 i oar s 0w f U .. RG npi 000 1:7(N)-065-(N)0 certified payroll report 05-09 Be•nefih /)i►frihulion and•5' nulure•(e•rq ica iun on Re•)•crse.Vide Ikpanment of l.atxx and Industries Provailing Wage Program AFFIRMATION 110 Rox 44540 Olympia WA 985044540 Todm's[rate - Printed name of party signing this report Fol itle04/03/2014 Jamie Mitchell ffice Manager I he party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: DESIGNED GROUNDWATER SERVICES LLC Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 03/23/14 03/29/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour" terms) Total Hourly I (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B) Hourh Medical (C) Hourly Vacation (D)Hourly Holiday apprentice Program (%+ R+( +D+ E) l. $ 0.00 2. $ 0.00 3. $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (11 All information contained in this Certified Payroll Report, including any addenda, is correct and complete. 12) The wage rates for workers. laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract.and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker. laborer or mechanic. 13) The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions,other than those which are legally permissible.have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of am of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report fitly — - - — Signature Jamie Mitchell Office Manager �I,l 1 LL( 1 7(x)-065-0(N)certified payroll report backer (15-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.9 For Week Endin :April 5,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions INet Wages Name,Address and No.of Work S M T I W I Th I F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 30 31 1 2 1 3 1 4 5 Hours of Pay Earned Sod Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 9.00 2.75 31.75 52.69' 1,672.91 (24.26) Bremerton,WA 98312 Operator (103.72) (141.00) (16.55) (212.50) (498.03) 1,174.88 XXX-XX-7696 Lead O *Employee benefits hourly value=$2.31 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 9.00 29.00 50.66' 1,469.14 (21.31) Lake Stevens,WA 98258 Operator XXX-XX-1921 O *Employee (91.08) (76.00) (15.51) (39.00) (242.90) 1,226.24 'Em to ee benefits.. ourly value=$2.34 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 9.00 29.00 44.46 1,289.34 (18.70) Maple Valley,W 98038 (79.94) (129.00) (15.51) (243.15) 1,046.19 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement ;that during the payroll period QX -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 30th day of March 2014,and ending the 5th day paid,as indicated on the payroll,an amount not less than the sum of the of April , 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig at e (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS rKathySalazar,Office Mana er e; 2- 1[wilful falsification of any of the above statements may subj¢ct the contracto r sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the ractor to civil or criminal prosecution. See section 1001 oe Title 18 and Seaton 231 above referenced payroll,payment of fringe benefits as listed in the contract have been le 31 of the United States Code. Department of Labor Report Period: 03/09/2014 to 03/15/2014 Payroll#: 1-FINAL Company: Armadillo Boring, Inc. Project: GHC-Renton P.O. Box 12219 Swr: Salem OR 97309-0219 Renton WA Employee No o Work Total Rate Gross Fed State Net Payroll Information Dep Classification S M T W T F S Hours of Pay Amount FICA Tax Tax SDI Other Total Wage Check# 03/09 03/10 03111 03/12 03/13 03/14 03/15 Straight Jacob D 4 Pwr Eq O D XXX-XX-1475 O 2.00 2.50 1.60 5.50 61.50 338.25 34715 Meridian Rd S 4.50 8.00 8.00 8.00 28.50 41.00 1,168.50 Lebanon OR 97355 Total Payroll for Employee: 2.010.32 226.62 153.79 139.00 212.03 73i.44 278.88 0000 Lewis RobertA 4 Pwr Equip D XXX-XX-7898 O 3.50 2.00 2.50 8.00 61.50 492.00 244 SE 6th Ave S 2.00 8.00 8,00 1.50 19.50 41.00 799.50 Albany OR 97321 Total Payroll for Employee: 2,176.85 381.09 774.79 0000 166.52 179.00 48.18 1,402.06 Malcolm Thomas P 1 Gen Lab D XXX-XX`7228 0 2.00 2:50 4.50 44.54 200.43 750 SE 32rid Ave. S 5.50 8.00 8.00 1.50 23.00 29.69 682 B7 Hillsboro OR 97123 Total Payroll for Employee: 1.435.93 249.49 465.80 6205 109.85 106.00 0.46 970.13 Stevens Adam J Gen Lab D XXX-XX-6572 O 3.50 2.00 2.50 1.00 9.00 44.54 400.86 4521 Farrell Ave NE S 2.00 8.00 8.00 8.00 26.00 29.69 771.94 Salem OR 97301 Total Payroll for Employee: 1,667.50 326.37 127.57 131.00 0.55 585.49 082.01 0000 Page 1 Department of Labor Report Period: 03/09/2014 to 03/15/2014 Continued... Employee No o Work Total Rate Gross Fed State Net Payroll Information Dep Classification S M T W T F S Hours of Pay Amount FICA Tax Tax SDI Other Total Wage Check# 03/09 03/10 03/11 03/12 03113 03114 03/1'5 Total For All Employees: D O 7.00 8.00 10.00 2.00 27.00 1,431.54 S 14.00 32.00 32.00 19.00 97.00 3,422.81 Total Payroll for All Employees: 7,290.60 1,183.57 2,557.52 557.73 555.00 261.22 4,733.08 Page 2 Date 0311612014 I,Derrinda Howe, Office Manager b)WHERE FRINGE BENEFITS ARE PAID IN CASH _ (Name Of Signatory•Party) (Title) ❑ Each laborer or mechanic listed In the above referenced payroll has been paid, do hereby state: as indicated on the payroli,.an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed (1)That I pay or supervise the payment of the persons employed by in the contract,except as noted in Section 4(c)below. Armadillo Boring,Inc. on the (Contractor-or Subcontractor) GHC-Renton ;that during the payroll period of 0310912014 to 0311.512014 c) EXCEPTIONS (Building or Work) all persons employed on said project have been paid the full weekly wages earned,that Exception(Craft) Explanation no rebates have been or will be made either directly or Indirectly to or on behalf of said Armadillo Boring,Inc. from the full (Contractor or Subcontractor) 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 L"abor 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: FICA(Social Security), Medicare,.Federal Income Taxes,State Income Taxes, State Disability(SDI),Court Ordered'WageAftachments,401K Plans (2)That any payrolls otherwise under this contract required to be submitted for the. Remarks: above period are correct,an6complete;that the wage rates for laborers or mechanics Benefits paid Hourly:. AGC Trust 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 i ea en Life iCHoliday vacation pp each laborer or mechanic conform with the work he performed. "Employee Pension Ins Ins Ins Leave Wages Wages Program (3)That any apprentices employed in the above period are duly registered in a bona Tide I Straight,J-OP 0.l)0 9.83 0.24 0.62 0.Q0 0.58 0.83 0.50 apprenticeship program registered.with a state apprenticeship agency recognized by the Lewis,R-OP 0.00 9.90 0:24 0.02 0.00 0.55 0.79 0.50, Bureau of Apprenticeship and Training,United States Department of Labor,or if no such I Malcolm,T-Lab 0.00 10.90 1.00 0.10 0:00. 0.00 0.06 0.00 recognized agency exists in a state,are registered with the Bureau of Apprenticeship Stevens,A=Lab 0.00 10.90 1.00 D.10 0.00 OAO 0.00 0.00 and Training;United States Department of Labor. Name and Title 3Sigature (4)That: Office Mg Derrinda Howe, fa)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS r G( ®/ in addition to the basic hourly wage rates paid to each laborer or mechanic listed in THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATE TS AY the above referenced payroll,payments of fringe benefits.as listed in the contract SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL have been or will be made to the appropriate programs for the benefit of such PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE employees, except as noted in Section 4(c)below. 31 OF THE UNITED STATES CODE. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.7 For Week Endin :March 22,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th I F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 16 17 18 19 20 1 21 22 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 10.00 40.00 53.31' 2,132.41 (30.92) Bremerton,WA 98312 Operator (132.21) (219.00) (19.11) (212.50) (613.74) 1,518.67 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.69 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 5.50 10.00 10.00 35.50 51.09- 1,813.70 (26.30) Lake Stevens,WA 98258 Operator (112.45) (12&00) (19.11) (39.00) (324.86) 1,488.84 XXX-XX-1921 01 Employe benefits ourly value=$1.91 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 5.50 10.00 10.00 1.00 36.50 44.46 1,622.79 (23.53) Maple Valley,W 98038 (100.61) (179.00) (19.65) (322.79) 1,300.00 XXX-XX-4901 O S O Date or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement -1 that during the payroll period QX -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 16th day of March 2014,and ending the 22nd day paid,as indicated on the payroll,an amount not less than the sum of the of March 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Si a Wre f (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS Kath Salazar,Office Mana er !/ The wilful falsification of any of the above statements may sub' ct the contractor- r sub --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 o Title 18 and Se on 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. ' CASCADE DRILLING,LP Pay Period Date: 03/02/14 Certified Payroll Report Comract s: P.O.BOX 1184 Week Erdm9 03/02/14 Job No 103141081 WOODINVILLE,WA 98072 Payroll No: 1 Jab Name: Misty Cove Lift Station R 425 527-9800 a Exemptions MOB Check Totals SociatSecu* MON TUE WED THU FRI SAT SUN Employee Work Class 24 25 26 27 28 01 02 Total Rate Grose Pay DeductionsTotals CERUTI,KYLE E. Ex:-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 Fed WtH 94.02 Gross 749.00 5717 LERCH RD "-3060 S 7.00 8.75 9.50 0.00 0.00 0.00 0.00 25.25 14.00 353.50 FICA 6: s 150,30 LABORER spWH � Local W/H 0.00 Add-0ro 20.00 0.74 SNOHOMISH,WA,98290 Other Job Pay lktomp/Shc 0.00 EE QHDHP 12.50 Not Pay 577.96 401It % 7.49 Check It 310522 EE Dental 0.50 EE Vision 0.25 Taal Job cross 353.50 GOSE,DAVID J. Ex:S-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed WtH 284.94 Gross 1,525.01 9905 1ST ST NE ••-2075 S 7.00 8.75 9.50 0.00 0.00 0.00 0.00 25.25 25.00 631.25 FICA 114.89 Taxes 399.83 DRILLER State W/H 0'00 Deducts 23.25 LAKE STEVENS,WA,98258 Local W1H 0.00 Add,Ons 0.00 Other Job Pay vi=nptSdi 0.00 EEQHDHP 12.50 Net Pay 11101.93 HEALTH SAV 10.00 Check C. 310523 EE Dental 0.50 EE Vision 0.25 Total Job Groan 631.25 OCHELTREE,AARON J. Ex:-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed YWH 184.76 Gross 1,151.75 113 SHORT ST UNIT A "-3048 S 7.00 8.75 9.50 0.00 0.00 0.00 0.00 25.25 17.00 429.25 FICA 84•23 Taxes 268.99 LABORER State W/H 0'00 Deducts 50.69 SNOHOMISH,WA,98290 Local WM 0.00 Add-Ons 0.00 Other Job Pay VWotnptSdi 0'00 Net EE+C QHDHP 37.50 Pay 832.07 EE+C Denta 12.09 Cam`a: E64350 EE+C Visio 1.10 Tom Job Gross 429.25 P.ff1 Statement of Compliance Date MARCH 7,2014 cnn+ra t%umhes I RANAE KUICH,PAYROLL MANAGER do hereby state (1)That 1 Pay or lipervise the payment of the persons employed by CASCADE DRILLING,LP on the Misty Cove Lift Station R.that during the payroll period commencing on the 24 day of FEBRUARY,2014 and ending the 2 day of MARCH,2014,all Ixrsons employed on said project have bem paid the full weekly wages earned,that no rebates have been or will be made either directly of indirectly to or on behalf of said CASCADE DRILLING,LP Cram 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.Pan 3(29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Star 949 63 Star 109,72 Stat 967,76 Star.357.40 U S.C.3145).and described below' Federal Withholding,State Withholding,Stale Disability 1 v_) That any payrolls otherwise under this connact required to he whm+ned for the above period arc correct and complete, that the wage rates for laborers or mechanics contan."therein arc nor less than the applicable wage rates contained to am wage determination incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the wort he performed (3)That any apprentices employed in the above period art duly refussesed in a bona fide apprenticeship program repstaed with■State•ppenticeshsp agency recognized by the Bureau of Apprenuceship and Training I rsited States Department of l.abor,or if no wch recognized agent}costs in a State, are registered with the Bureau of Apprenticeship and Training United States Department of Lahr toy That (a)WHERE FRP.V(JE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAhIS I X) In addition to the basic hourly wage tares pod to each laborer or mechan ic listed in the above referenced payroll pavments of fringe benefits as lived in the contract have been or will he made to appropriate programs for the benefit of such employ cs,racept as soled in Section Ne)below (b)WHERE FRINGE BENEFITS ARE PAID W CASH (X Each labceer ee mechanic listed in the abort referenced payroll has been paid as indicated on the p-11,an amount not less than the sum of the applicable basic hourly wage rase plus the amoum of the rega red in nge bend is as It ned in the conna t,mcept as noted in Seeuue 4(c)below (c)EXCEPTIONS EXCEPTION(Craft) ENPLANATION FRINGES PAID IN CASH LESS COMPANY PAID MEDICAL,DENTAL, LIFE REMARKS NAME AND TrrLE SIGN 'RE RANAE WICK PAYROLL MANAGER The willful fal stf cation ttf airy of the above statements may subject the conascmr a subcontractor io civil or criminal prosecution See Secesnt 1001 of T tlt it and Stectim 231 of Tide 31 of the United Sores Code /SnIY f Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction.Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.8 For Week Endin :March 29,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Day and Date Gross Deductions Net Wages Name.Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 23 24 25 26 27 28 29 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 10.00 40.00 53.17' 2.126.81 (30.84) Bremerton,WA 98312 Operator (131.86) (218.00) (20.99) (212.50) (614.19) 1,512.62 XXX-XX-7696 Lead O 'Em to ee benefits hour) value=$1.83 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 7.50 10.00 10.00 10.00 37.50 51.19' 1,919.63 (27.83) Lake Stevens.WA 98258 Operator (119.02) (144.00) (20.05) (39.00) (349.90) 1,569.73 XXX-XX-1921 1 O *Employee benefits ourly value=$1.81 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 7.50 10.00 10.00 10.00 1.00 38,50 44.46 1,711.71 (24.82) Maple Valley,W 98038 (106.13) (192.00) (20.59) (343.54) 1,368.17 XXX-XX-4901 O S O RECEIVED APR 2 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I.Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement ,that during the payroll period �X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 23rd day of March 2014,and ending the 29th day paid,as indicated on the payroll,an amount not less than the sum of the of March , 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Signa re (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar.Office Manager The wilful falsification of any of the above statements may subject the contract or sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and S&ction 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program --- PO Box 44540 Prime Contractor i Project Name County Projed or Contracts Otympia,WA 98504-4540 D018509-Gary Harper-Misty Cove Lit KING WWP-27-3678 (360)902-5335 Pro ct Address State ZIP+4 Subcontractor X` !e City Misty Cove Lit Station Replac ment Renton WA Awardin9Ageney Name phdte Company Name Phone For the week ending: City of Renton (425)430-7279 f Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 03 / 09 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street _ Tukwila WA 98168 - -_ Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly 41ry�� Soc Seal)of Employee Address Code Hours of Gross Amount 'Usual FICA ing Tax Otter NET 03/03 03/04 03/06 03/06 03/07 03/08 03109 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 I Pag 1 OF 1 Department n' a`'b"r'��°"'°"' AFFIRMATION P,e.ailir,g wage Prottran, P01tk,x W40 01vmpis w A 995044W Palle 1 of 1 Today's Date Printed name of part} signing this report Title 03/25/14 Wendy ConwayPayroll Administrator _ The party signing this report pays or supervises the (Name of contractor or subcontraciorl payment of the persons employed by: Bravo Environmental NW,Inc. Project None: For the week starting: For the week ending: DO Harper-Misty Cove Lift 03/03/14 03(09/14 "USUAL BFNFFITS^DISTRIBUTION (Pkase report in"per hour"ternss) feted Hourly (E)Approved NNork Classification "Uses[Benefits" (A)h lid hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Prtogran IA+aaC.'n'E 1. 3. 4 S G. 7. 9. 9. 10. I he party signing below At iFIKMS the following- lip All information contained in this Certified Payroll Report,including any addenda.is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform w ith the actual work performed by such worker.laborer or mechanic (3) The payments of usual benefits as listed above haze been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (`t) All pe wtit,cinpIvycd Vn the abo*c-nrfctcnc d ptujtxt(b)have Nxiii paid die full weekly wages carved.and no rebates have been or will be wade citlicn directly Or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are lepally permissible.have been made by any person either directly or indirectly from the ful I wages eamed 011 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of anc of the above statements is a violation of RC%% 19.12.050 subject to prosecution,sanctions, and penalties. -- ——- -- esigning - _ -- _— r Print or type nam of party this report Siptahm WellyG9M= PayrQ11 AdEninistrator r7OO-O65-OW certified payroll report backer 05-09 Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program _ - _ _ PO Box 44540 Prime Contractor Project Name Courtly Project or ConUsdt Olympia.WA 98504-4540 D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 (360)902-5335 Subcontractor (�X Project Address City State 21P+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week endk9: City of Renton (425)430-7279 Bravo Environmental NW Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 03 / 16 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions _ DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withnold- Soc Sec*of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 03/10 03/11 03/12 03/13 03/14 03/15 03/16 pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 1 Pag 1 OF 1 Departarient"t Latwx rL and""'"t"" AFFIRMATION I'resailittg Wage Pn�nm PO Box 44540 Olympia WA 98504.4540 Page 1 of 1 Today's Date Printed name of party signing ibis report Title 03/25/14 Wendy ConwayPayroll Administrator The party signing this report pays or supervises the (Name of contm-tor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project Name: - For the week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 03/10/14 03/16/14 "I1SUAL BFNFFITS^DISTRIBUTION (Please report in"per hour"term) Total Houriy I (E)Approved Work ClaWfkatiea "Usual Benefits" (A) llourly Pension (B)Hourly Ntedical (C)Hourly Vacation (D)Hourly Holiday Apprentice Progrrm 1- 2. -- -- 3. 4 S. G. 7. R. 9. 10. I he party signing below At VIKMS the following: t 1 t All information contained to this Certified Payroll Report. including an) addenda,is correct and complete. 12) The wage rates for workers.laborers or mechanics as rerwrted above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker.taborer or mechanic. (3) The payments of usual benefits as listed above have been or will be trade to appropriate approved plans.funds or programs for the benefit of such employees. (4) All persuus ertrployed un the abuvc-referrtrccd prujtxt(a)have been paid dtc full weekly wagt-s carried,and no rebates hate been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are Ieeal h permissible.have been made by any person either directly or indirectly from the ful I wages earned 00 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Counc i 1. Falsification of and of the above statements is a violation of RC'%V 39.12.050 subject to prosecution.sanctions. and penalties. Print or name of party signing this report f itle Signature Mob Comm I Payroll Administrator 1-700.065.000 certified payroll report backer 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction.Inc 14831 223rd St SE,Snohomish..WA 98296-3989 Payroll No.6 For Week Endin : March 15,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No WWP-27-3678 Da and Date Gross Deductions Net Wages Name.Address and No.of Work S M T W Th I F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 9 10 11 1 12 13 1 14 15 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 9.50 6.00 10.00 4.50 40.00 53.40` 2.136.00 (33.90) Bremerton,WA 98312 Operator (144.97) (271_00) (22,72) (212.50) (685.09) 1,653.16 XXX-XX-7696 (Lead) O 2.50 2.50 80.90` 1 202.25 *Employee benefits hourly value=$1.60 Justin Michaud 2410.11" 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 5.00 10.00 3.00 28.00 51.48` 1,441.44 (34.95) Lake Stevens,WA 98258 Operator (149.43) (232.00) (21.91) (39.00) (477.29) 1,932.82 XXX-XX-1921 01 1 1.00 1 3.50 1 4.50 77.98` 350.91 Em to ee benefits ourly value=$1.52, "Justin worked 12 hours on another job Richard McKenney,Jr. 1593.17" 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 7.50 27.50 44,46 1,222.65 (23.10) Maple Valley,W 98038 (98.78) (174.00) (17.91) (313 79) 1,279.38 XXX-XX-4901 O "Richard worked 8.5 hours on another ob S O RECEIVED MAR 19 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement :that during the payroll period ❑X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 9th day of March 2014,and ending the 15th day paid,as indicated on the payroll,an amount not less than the sum of the of March 1 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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. © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (Remarks (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 State Department of Labor. (4)That: Name and Title Sign to f (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar.Office Mana er /,/I Z C'//�i �! The wilful falsification of any of the above statements may subje the contractor or b- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution See section 1001 or itle 18 and Sectio' 31 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. hor Department Wage Pro and Industries , CERTIFIED PAYROLL REPORT Prc%ailing�1age Program o PO Box 44540 - Project Name County — Protect or Contract# Olympia WA 98504-4540 Prime Contractor 1 5 (`3601902-5335 i4« 5027 Ripley lane N. Kenton, WA t80"6 King WWP-27-3678 ` Subcontractor ® Project Address City Sate ` 5027 Ripley Lane N Renton WA Awarding Agenc) Name Phone Company Ntme Phone For the week ending_ City of Renton 425430-7279 DESIGNED GROUNDWATER SERVICES LLC 253-682-7330 Mo1ah Day Year Address C w, State ZIP-4 Address City State ZIP►4 3/I/14 1055 S GRADY WAY Renton WA 98055 PO BOX 366 PUYALLUP WA 98371 1--- T -- Day and Date -- — - -- Ikductions Work Classification I Namc D Sun Mon ILe Wed 1-hu Fri Sat Total and I and T T--i Rafe Ilourh Soc Sec#of Employee Address °C 11.=:,14 2:.1, 2.14 2 , :^a l4 41 Total of Gross AmaaN -usual NtithoW- NET 1. Ifours Worked Each DaN Hours Earned Benefits FICA m "fax tither WAGES -L_ins - - I. Well point Laborer GARY ll.FORS OT 2S0 too '_co a00 6360 so952 3303 F Bay DR NW -- - 15211,56 S $11693 S17600 $1672 S1.21291 000-00-9853 Gig I(arbor,WA 98335 RG too 940 a 1 24 00 4246 101904 STEVEN A.FRY OT 2S0 300 4.a0 950 6369 60506 2. Well point Laborer 11012 CANYONRD E STE.8 PM8 135 162410 S 000 $114_4 S101 oo i $17 50 s1.314 36 000-00-9605 PUYALLUP.WA 99373 RG B0o B.eo too 2400 4246 101904 int Laborer TYLER B.PUGH OT 250 100 400 250 1200 6360 %42B 3. Well 8211 591h AVF F. _-_ _ __— _____ __ --.._ 212300 B 000 16240 43100 2299 SI.4/661 000-00-6492 PUYALLUP,WA98371 RG too 300 too Boo 3200 4246 1354t2 4.Owner Operator IMvid Fors OT 100 ►00 000 PO Box 366 - -- 000 S 000 000-00-8164 Puyallup,WA 98371 RG •oo Boo 000 5 OT 000 000 - --- 000 It 000 It 000 RG 0.00 0 00 6. OT 000 000 S OW) S 000 RG 0.00 0 00 i 7 OT 000 000 - -- 000 t 000 S 000 RG 000 000 i 8. OT - 000 000 000 It 000 S 000 RG 000 000 9. OT 0.a0 000 i -- - - - - - 000 s oao s oao RG 0.0o 000 �10. OT — - - 000 000 000 s 000 s 000 RG oao oao 1:700-0654W certified pa}roll report 05-09 L•inple)ee Hen fil5 DAtrihulinn and.Signature('erliTculion on Re verw.Vide I epartmcnt of I atkv and IndustriesAFFIRMATION Pedalling Wage Program Olympia WA 995044540 Today's Date Printed name of party signing this report Title 03/13/2014 Jamie Mitchell Office Manager The party signing this report pays or cupen ices the (Name of contractor or subcontractor) payment of the persons employed by: DESIGNED GROUNDWATER SERVICES LLC Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 1 02/23/14 03/01/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) - Total Hourly — (E)Approved Work Classification "Usual Benefits" (A) Ilourly Pension (13)Hourl% Medical (C) Hourly Vacation (D) lluurh Holiday Apprentice ProgramA+g+C+1)+ F:) 1. Wellpoint l.aborcr $ 0.00 ?.Wellpoint Laborcr $ 0.00 i.Wellpoint Laborer $ 0.00 4.0w ner Operator $ 0.00 _i. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing belo%% AFFIRMS the following: 11) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers. laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract:and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) T-he payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benclit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned.and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions,other than those which are legally lxrmissible, have been made by any person either directh or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered w ith the Washington State Apprenticeship and l raining Council. Falsification of any of the above statements is a s iolation of 1 CNV 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title S ore Jamie Mitchell Office Manager ( �, d F700-065-000certified payroll report backer 05-09 Department of Labor and Industries �6sr�re CERTIFIED PAYROLL REPORT 11re�'ailing Wage Program o q. _ PO Box 44540 5 = Project Name County Project or Contract# Olympia WA 98504-4540 a �° Prime Contractor � 5027 Ripley Lane N,Renton, WA 98056 King W WP-27-3678 (360)902-5335 ® Projcel Address City State Subcontractor 5027 RiLley Lane N Renton WA Awarding Agency Name Phone Company Namc Phone For the week ending_ City of Renton 425430-7279 DESIGNED GROUNDWA•rER SERVICES LLC 253-682-7330 Month Day Year Address City Slate ZIN-4 Address City State ZII' 3/8/14 1055 S GRADY WAY Renton WA 98055 PO BOX 366 PUYALLUP WA 983+471 Day and Date Deductions Work Classification Name = ( Sun \4on 'I'uc R'cd Thu Fri S—a—t-- 'Dotal attd and b �� Rate Hourly Soc See#of Flnplo)'ee Address '� ,mu vvu u,n, ss,, tan !.n, ,,a a total of Gross Amount Usual N ithold- NE 1• Hours Worked Each Day Ifours Pay Earned Benefits" FICA inaTax Other WAGES I David Fors uI' I I f_'�� I 000 I. Owner Operator I'O Box 366 0,00 $ o 00 ,_ I s o ao 000-00-8164 I'uyaflup,WA<)R371 RG I I I i.o° I too I 0.00 t� 2. 101 I I ! ! I 000 I o.o0 000 s 000 s 000 RG I--j-- I I 000 I 000 3. 0.1• l 000 I 000 l 000 s 00, S.162.44) I RG -- I f l 000 000 1 1 1 1 1 11 11 1 000 °°° 1 s °d RCi 5. OI I I I Irf j I °00 000 I I I o,°0 0(it) $ 000 s 000 RG I I (i. I OI I I I I I I I rem I I o,a, 000 S 000 S ow RG 7. I rRl0.00 I 000C (— I I I I 000 I I o.00 0.00s °00 s o00 8. I 01 I I ! ( 0.00 I I °00 0 00 s 000 s 000 RG f I I I 000 I °� 9• hRG� ! I 0° 0 0o s o 0o s o.rp I I I I I 000 I o00 l l I I I__ I I I °W �I Io. °� s °oa S 000 I:700-065-000 certified payroll report 05-09 Einplovee Benefits Distribution and Signature Certification on Reverse Side tkpailing 1V of Labor and Industries prevailing vailing agr Program PO[lox 44540 Olympia WA 985044540 today"s Date Printed name of party signing this repon l'itle 03/13/2014 Jamie Mitchell Office Manager The part signing this report pays or supervises the (Name of contractor or subcontractor) payment bf the persons employed by: DESIGNED GROUNDWATER SERVICES LLC Project Name: For the week starting: For the week ending: Mistv Cove Lift Station Replacement 1 03/02/14 03/08/14 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour" terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D)Hourly Holiday Apprentice Program (A 11 C+D+E) I. Owner Operator $ 0.00 2. $ 0.00 3. $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (I) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been-or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions,other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and braining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Prim or type name of party signing this repon Title Signatu Jamie Mitchell Office Manager 17700-065-000 certified P . report ort backer 05-09 tJ Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction, Inc. 14831 223rd St SE.Snohomish,WA 98296-3989 Payroll No.2 For Week Endin : February 15,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 9 10 11 12 13 14 15 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 8.00 9.00 10.00 10.00 3.00 40.00 53.31* 2,132.40 (30.92) Bremerton,WA98312 Operator (132.21) (219.00 (16.36) (212.50) (610.99) 1,521.41 XXX-XX-7696 Lead O 1 *Employee benefits hourly value=$1.69 Justin Michaud r1770.14** 2.41'* 10215 Lundeen Pkwy#C7 M-9 Equipment S 8.00 8.50 6.00 10.00 3.00 35.50 51.31* 21.51 (29,76) Lake Stevens,WA 98258 Operator (127.25) (163.00) (16.36) (39.00 (375.37) 1,677.04 XXX-XX-1921 O 'Em Io ee benefits hour) value=51.69, "Justin worked 4.5 hours on another job Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 8.00 8.50 5.00 5.00 400 30.50 44.46 1,356.03 (25.67) Maple Valley,W 98038 (109.75) (205.00) (16.36) (356,78) 1.413.36 XXX-XX-4901 O "Richard worked 9.5 hours on another job S O RECEIVED FEB 19 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Ringhill Booster Pump Station Modifications that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 9th day of February 2014,and ending the 15th day paid,as indicated on the payroll,an amount not less than the sum of the of February . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract.that the classifications set forth therein for each laborer or mechanic conform with the work he performed Remarks (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 State Department of Labor. (4)That: Name and Title Signnaatt e (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager �onZ ,:b- IThe wilful falsification of any of the above statements may su ' ct the❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Se4gi6n 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. r Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No. 1 Initial For Week Endin :February 8,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 2 3 4 5 6 7 8 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance I Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 1637.12" 3604 Madrona St M-6 Equipment S 6.50 5.00 11.50 52.81 607.32 (23.74) Bremerton,WA 98312 Operator (101.50) (135.00) (13.23) 31.51 (212.50) (454.46)1 1,182.66 XXX-XX-7696 Lead O *Employee benefits hourly value=$2.19, "Andrew worked 19.5 hours on another job Justin Michaud 1972.74" 10215 Lundeen Pkwy#C7 M-9 Equipment S 9.00 9.00 51.24' 461.16 (28.61) Lake Stevens,WA 98258 Operator (122.31) (152.00) (16.19) (39.00) 1 (358.11) 1,614.63 XXX-XX-1921 O 'Em to ee benefits ourly value=$1.76, "Justin worked 29.5 hours on another job Richard McKenney,Jr. 1441.91" 27427 220th PI SE M-2 Pipelayer S 9.00 5.00 1 14.00 44.46 622.44 Maple Valley,W 98038 (89.40) (152.00) (14.20) 1 (276.51) 1,165.40 XXX-XX-4901 O 1 "Richard worked 18.5 hours on another'ob S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Ringhill Booster Pump Station Modifications that during the payroll period �X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 2nd day of February 2014,and ending the 8th day paid,as indicated on the payroll.an amount not less than the sum of the of February 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig/natatufe (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subject the contractor pr,sub- ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sect+oh 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. V . U.S. Department of Labor PAYROLL Wage and Hour Division awHo (For Contractor's Optional Use;See Instructions at www,dol.gov/whd/forms/wh347instr.htm) U.S.Wagr and 11our Dnision Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev.Dec.2008 NAME OF CONTRACTOR m OR SUBCONTRACTOR ADDRESS PO Box 33 Kalama,WA 98625 OMB No.: 1235-0008 Downing Diversified,LLC Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 1 02/15/2014 Gary Harper Construction,City of Renton Misty Cove Lift Station,City of Renton (1) (2) (3) (4)DAY AND DATE 15) 11, 17) (9) (8) z N x $ M T W TH F S DEDUCTIONS NET ZO N NAME AND INDIVIDUAL IDENTIFYING NUMBER _`a GROSS WITH- WAGES (e.g.,LAST FOUR DIGITS OF SOCIAL SECURITY WORK `o I I TOTAL I RATE AMOUNT HOLDING ss Mcdlcare TOTAL PAID NUMBER)OF WORKER i="_ CLASSIFICATION HOURS WORKED EACH DAY HOURSA OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Logan Kallwick,3215 HDD Operator o 401 4.00 575.68 7,0441.72 $482.41 $138.56 $32.40 530.23 y61?flit S 14A 5o 4S 2 SS �l�1 J J) Patrick Cantrell,2712 HDD Locator o K 4.00 S76.47 S1.042.00 S363.72 S139.80 IS32.69 S19433 $730.54 5 yip 5[p 14.0 5097 1,61 43� $1,222.87 � 1 $78(1.86 Gil Camacho,6318 Laborer o 1.50 S61.98 $153.08 $104.11 $24.35 $17.59 $299.13 y s �x� 165( 41.32 0.37 $898.31 s 5 RECENED 0 S EB 2 7 2014 0 OF ENTQ s UTI ITY SYSTEN S While completion of Form WH-347 is rm Optional,it is mandatary for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the infoation collection contained in 29 C.F.R.§§3.3.5.5(a),The Copeland Act (40 US.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to'furnish weekly a statement with respect to the wages paid each employee during the preceding week.' U.S.Department of Labor(DOL)regulations at 29 C.F.R.§5.5(aX3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for o.financing the cc str„ction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.DOL and federal contracting agencies receiving this information review the information to determine that employcos have receNed legally required wages and fringe benefits. Public Burden Statement We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.If you have any comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Departme nt of Labor,Room S3502,200 Constitution Avenue,N.W. Washington,D.C.20210 (over) Date 02/19/2014 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Jaimie Hulsizer Controller ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Downing Diversified, LLC on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Misty Cove Lift Station,City of Renton that during the payroll period commencing on the (Building or Work) 9 day of February 2014 , and ending the 15 day of February 2014 all persons employed on s aid project have been paid t he full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Downing Diversified, LLC from the full (Contractor or Subcontractor) weekly wages earned by any person and t hat no deduc tions have been m ade either directly or indirec tly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Start.108,72 Stat.967,76 Stat.357.40 U.S.C.§3145),and described below: Vacation/Holiday Fringe Package H&W Fringe Package REMARKS (2)That any payrolls otherwise under this contract required t o be s ubmitted 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 det ermination incorporated int o t he c ontract;t hat t he classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)T hat any apprent ices em ployed in t he abov a period are duly registered in a bona fide apprenticeship program regis tered w ith a St ate apprent iceship 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 NAME AND TITLE SIGNATURE m Jaime Hulsizer,Controller in addition to the basic hourly wage rates paid to each laboreror mechanic listed in the above referenced payroll. payments of fringe benefits as listed In the contract THE WILLFUL FALSIFICATION O F ANY O F T HE ABO VE ST ATEMENTS M AY SUBJ ECT T HE CO NTRACTOR O R have been or will be made to appropria to progra ms for the bene fit of Such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE employees,except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.3 For Week Endin :February 22,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T I W I Th I F I S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 16 17 18 1 191 20 21 22 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 1403.58" 3604 Madrona St M-6 Equipment S 8.00 5.25 6.00 19.25 52.47' 1,010.05 (20.35) Bremerton,WA 98312 Operator (87.02) (100.00) (11.36) (212.50) (431.23)1 972.35 XXX-XX-7696 Lead O 1 *Employee benefits hourly value=$2.53,"Andrew worked 7.5 hours on another job Justin Michaud 1371.89" 10215 Lundeen Pkwy#C7 M-9 Equipment S 8.00 5.25 13.25 50.68' 671.51 (19.89) Lake Stevens,WA 98258 Operator (85.05) (61.00) (9.57) 1 (39.00 (214.51) 1,157.38 XXX-XX-1921 O 'Em to ee benefits ourly value=$2.32, "Justin worked 16 hours on another job Richard McKenney,Jr. 849.34" 27427 220th PI SE M-2 Pipelayer S 8.00 3.75 11.75 44.46 522.41 Maple Valley,W 98038 (52.65) (63.00) (8.53) (136.49) 712.85 XXX-XX-4901 O "Richard worked 7.5 hours on another job S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I. Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc. on the Ringhill Booster Pump Station Modifications ;that during the payroll period ❑X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 16th day of February 2014,and ending the 22nd day paid,as indicated on the payroll,an amount not less than the sum of the of February . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sign re (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may s6bject the contra(Or or sub - ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and ection 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.4 For Week Endin : March 1,2014 Project&Location: Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Day and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 23 24 25 26 27 28 1 1 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 800 8,00 8.00 8,00 8.00 40.00 53.31' 2,132.40 (30.92) Bremerton,WA 98312 Operator (132.21) (219,00) (20,13) (212,50) (614.76) 1.517.64 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.69 Justin Michaud 1840.32" 10215 Lundeen Pkwy#C7 M-9 Equipment S 9.00 10.50 9.00 28.50 51.12' 1,456.92 (26.68) Lake Stevens,WA 98258 Operator (114.10) (132.00) (13.59) 1 (39.00) (325.37) 1,514.95 XXX-XX-1921 O 1 1 1 1 *Employee benefits ourly value=$1.88, "Justin worked 7.50 hours on another job Richard McKenney,Jr. 1307.66" 27427 220th PI SE M-2 Pipelayer S 1 50 10.00 8.00 19.50 44A6 866.97 (18,96) Maple Valley,W 98038 (81.08) (122.00) (14.24) (236.28) 1.071,38 XXX-XX-4901 O "Richard worked 10.0 hours on another job S O - RECEIVED MAR 0 5 2014 CITY OF RENTON UTILITY SYSTEMS Date or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the _Ringhill Booster Pump Station Modifications :that during the payroll period �X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 23rd day of February 2014,and ending the 1 st day paid,as indicated on the payroll,an amount not less than the sum of the of March . 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Signatuu e�" (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subje the contractor or - --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and SectiqV231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.5 For Week Endin : March 8,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No. WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 2 1 3 4 5 6 7 8 Hours of Pay Earned Soc Sec Ta)c Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 1 11.50 10.00 10,00 8.50 1 40.00 53.31' 2,132.40 (30.92) Bremerton,WA 98312 Operator (132.21) (219.00) (21_39) (212.50) (616.02) 1,516.38 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.69 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 11.50 10.00 10.00 8.50 40.00 51.31 2,052.40 (29,76) Lake Stevens,WA 98258 Operator (127.25) (163.00) (21.39) (39.00) (380 40) 1.672,00 XXX-XX-1921 O *Employee benefits ourly value=$1.69 Richard McKenney.Jr. 27427 220th PI SE M-2 Pipelayer S 11.50 10.00 10.001 8.50 1 1 40.00 44.46 1,778.40 (25.79) Maple Valley,W 98038 (110.26) (207.00) (21.39) (364,44) 1.413.96 XXX-XX-4901 101 S O RECEIVED MAR 17 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement :that during the payroll period �X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 2nd day of March 2014,and ending the 8th day paid,as indicated on the payroll,an amount not less than the sum of the of March . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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. © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Si n uree.J�//,/ (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above stat ments may su ect the contractor sub- ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 6r Title 18 and SeC qn 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. �' Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 PHrna Contractor I Project Name County Project or Contract# Olympia,WA 98504-4540 DO18509-Ga -MistyCove Lift KING WWP-27-3678 (360)902-5335 ` ry Harper-- — 1` gubcocor ,X] Project Address City State ZIP+4 �! Misty Cove Lift Station Replac ment Renton WA - I(Awa�rdmgAgency Name Phone Company Name ��— Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 02 / 23 / 2014 111055 S Grady Way Renton WA 98D55 6437 out 144th Street Tukwila WA 98168 ------ — — - Deductions DAY AND DATE Work Classification Name T Total and and Earn MON TUE WEG f THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 02/17 02/18 02/19 02/20 02/21 02/22102/23 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY 1. O razor Northinglon.Clayton J PW 5.75 5.75 47.98 275.94 275.9420.47 56.7 11] 186.9 (mil 5104 240th Place OTHER DETAIL. Dad. Amt. .9842 Mount Lake Terrace.WA 98C DENT 1.3 L&I 1.5 MED 5.9 UNION 1.8 F700-065-000 certified payroll report 05-09 1 Pag 1 OF 1 RECEIVED MAR 17 2014 CITY OF RENTON UTILITY SYSTEMS ncparunent of Lttxr and lndu.tries A FFI RMAT[ON Prevailing Wage Program PO Box 44540 Olympia WA 985(H4540 Page 1 of 1 Today's Date Printed name of party signing this report Title 03/07/14 Wendy ConwayPayroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project dome: For the week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 02/17/14 02/23/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour-terms) Total Hourly pp Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program l*a+C+D}E 1. Operator S 9 689' . D S 2. 3. 4. 5. 6. 7. 8. 9. 10. I he patty signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All perswis employed un(Ile abu*c-tefetcmxd ptujw(s)have bcerl paid die full weekly wageb camtd,and btu rebates have beet►or will be made cidwr dirmily-it indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the ful I wages carried (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name of party signing this report title -_ - -— - Signature - — - - - Wgndy Conway Payroll Administrator 1'700-065-000 ccrtiftcd payroll report backer 05-09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 --- ----------- ------- ---_----------------- Olympia,WA 98504 4540 Prime Contractor (Project Name County Project or Contract# Olympia, ia,W 35 {� r D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor iXl Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 03 / 02 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE — ------- Work Classification Name Total and and Earn MON TUE WED••THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 02/24 02/25 0?l26 02/27 02/28 03/01 03/02 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Page 1 OF 1 DipG1ftment of Libor and'ndu tri`.i AFFIRMATION Prreailmg Wage Prot rn PO Box 44540 Olympia WA 985044540 Page 1 of 1 Today.5 Date Pnntrd name of party signing this report Title 03/07/14 1 Wendy ConwayPayroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. Project Name: For the week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 02/24/14 03/02/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (8)Hourly Medical (CI Hourly Vacation (D)Hourly Holiday Apprentice Program (AaBaC4D+C) 1. 2. 3. 4. 5. G. 7. 8. 9. 10. Fhc parry signing below Ah F'IKMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not lass than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All petwns employed un the above-referenced pt U)e:t(s)have beert paid cite full weekly wW4gea earned,uud(to rebate)have btxn or will ba made either direealy-it indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the ful I wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. -- ---------- ---- - --- - --- _. . -. - .- -------- - -- - -- -- - - Print or type name of party signing this report Title Signature r70O-065-000 certified payroll report backer 05.09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction, Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No. 10 For Week Endin :April 12,2014 Project&Location: Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No. of Work S M T W Th I F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 6 7 8 9 10 1 11 1 12 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 1 6.00 3.50 8.00 10.00 10.00 37.50 53.17' 2,126.80" (30.84) Bremerton,WA98312 Operator (131.86) (218.00) (21.39) (212,50) (614.59) 1,512.21 XXX-XX-7696 Lead O *Employee benefits hourly value=S1.83 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 6.00 10.00 10.00 9.00 35.00 51.04' 1,786.40 (25.90) Lake Stevens,WA 98258 Operator (110.76) (124.00) (18.71) (39.00) (318.37) 1,468.03 XXX-XX-1921 O *Employe benefits ourly value=$1.96 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10,00 9,001 29,00 44,46 1,289.34 (18.69) Maple Valley,W 98038 (79.93) (129.00) (15.51 (243.13) 1,046.21 XXX-XX-4901 O S - O employee requested check early,paid for 40 hours,2.5 hours overpaid. Will be adjusted next week RECENED APR 16 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction. Inc.on the Misty Cave Lift Station Replacement that during the payroll period �X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 6th day of April 2014,and ending the 12th day paid,as indicated on the payroll,an amount not less than the sum of the of April . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sin ' re . (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may su ect the contract or sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 oY Title 18 and SqAion 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 / Pro Name P or Conn Olympia.WA 98504-4540 7l P►IrM Contractor )ec� COUrNy Project Olympia 902WA D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor X Pro)ect Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. _ (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 03 1 23 12014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tuk%mla _ WA 98168 - -- Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- Soc Seals of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 03/17 03116 03/19 03/20 03/21 03/22 03/23 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY_ ' No Work Performed F700-065-WO certified payroll report 05-09 Pag 1 OF 1 Dcpartnicnt ut latxu and kwiuwic.. Prcradtng Wage Pntgiam AFFIRMATION PO Box 44540 Olympia WA 985W4540 Page 1 of 1 Today's Date I Printed name of party signing this report Title 04/W14 Wendy Cormmy Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payrncnt of tie persons employed hy: Bravo Environmental NW,Inc. Project Name: --`—— -- For the wroek stoning: For the week ending: — D018509-Gary Harper-Misty Cove lift 03/17/14 03/23/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"term) Ttstal Hourly (E)Approved " Work Classification Usul Benefits" (A)Hourly Pension (8)Hourly Medical (C)Hourh Vacation (D)Hourly Holiday Apprentice Program A+B•('+D•EI 1. ') 4 5 G. 7. R. 9. t0. I he patty signing below At FIRM1IS the following: 1 I) All information contained in this Certified Payroll Report,including any addenda.is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related w the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual bencftts as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees (4) All Mbutia cutploycd on dtr p[ujtxt(1.)Irdvc b%mi paid(lie full weekly wagcb camcd,and ttu rebates ItAkc beer;or will be madc cidwi dltmily of indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages carried by any person No deductions,other than those which arc legally permissible,have been made by any person either directly or indirectly from the ful I wages earned 0) Any apprentices employed in the alx*we period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is s violation of R(*%% .39.12.050 subject to prosecution,sanctions, and penalties. Print or type tAme of party sign ins this reportI it Ic S' Wendy Conway _ �Administrator 1-700-065-000 certified payroll report backer 05-09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor Project Name County Project or Contracts# Olympia.WA 98504-4540 (360)902-5335 D018509 Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor X� Project Address City State ZIP-4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 03 1 30 1 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 — Deductions — DAY AND DATE Work Classification Name Total and and Earn MONJ TUEJWCDJ THU I FRI SAT I SUN Total Rate Hourly Withhold- Soc Seats of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 03/24 1 03/25 1 03/26 03/27 03/28 03/29 03130 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065 000 certified payroll report 05-09 Pag 1 OF 1 Kir Pm ailment Uf a I'm 7otl ItKlultrle> AFFIRMATION Prrtatlmg wage Prugranl PO lk,x 44540 Olm, pta U'A "_SM-4540 Page 1 of 1 Today%Date Printed narrie of party signing this report 04/08/14 Wendy Corwmy Payroll Adrninistrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project N'tirm For the Meek starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 03/24/14 03/30/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"term) I otal Hourly - E) proved Work Classification "I'cual Benefits" (A) lfourty Pension (B)Hourly Medical (C)flour[% \acatioa (D)Hourl% Holid ( Ap a> AppE)Ape Program 1�•H �C�n•rl 2. 3. 1. 4 C 0. 7. R. 9. i0. I he party ;tgning below At-FIKNIN the tollowfng (1) All information contained in this Certified Payroll Report,including any addetxla,is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported atx)ve are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reposed above for each worker,laborer or mechanic conform with the actual Mork performed by such worker,taborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All p witib cmploycd on dtc atwve-rcfrrrttcrtl prvject(b)Iwvc b1.Yn paid tic full Mt:ckly wJgus carded,add 1K1 tebute%have been or will to nwdc cilltcr dimity or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by at»,person No deductions,other than those which arc Iettaliv permissible,have been made by any person either directly or indirectly from thr ful I wages rimed (S) Any apprentices employed in the above period are duly registered in a bona fide apprennctNhip program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Print or type name of party signing this report l Titic Signature — Wendy Conway I Payroll Administrator __-______ 1.700-065-000 certified payroll report backer 05-09 CERTIFIED_:PAYROLL �y� �' , Replacement Week Ending: Awarding Agency: Subcontractor c Prime Contractor �� _ 2/16/2014 RENTON, CITY OF Hours worked Each Day- Subcontractor Name: Cadman Inc Company Address: PO BOX 9 PR#1 1055SGRADY WAY RENTON,WA-98055 10 11 12 13 14 15 �16 Company Phone: 425-867-1234 Job Title Pay Rate Mon Tue wed Thu Fri Sat Sun TOTALS lr t lUSUSALB_Mf Gross Earnings Taxes Deductions Net Wages I Hrcek, Matthew_S Pre-Mix Reg a.os 4.08 107.92 6116696 Concrete 26.45 OT 0.00 0.00 Driver 4.08 21.46 _ -v 995.84 178.33� 250.66 566.85 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 ^ITS. Pre-Mix Reg 0.00 0.00 Concrete OT T:R 0.00 0.00 - - - - Driver = 0.00 ' Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 - Driver ti ... 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver _ 0.00 T' I Pre-Mix Reg 0.00 0.00 j Concrete OT 0.00 0.00 Driver 0.00 =r _f Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 - -i- I t Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 i Pre-Mix Rey 0.00 0.00 Concrete OT k++ 0.00 0.00 Driver 0.00 Pre-Mix Reg �� d.00 CADMAN INC CERTIFIED PROJECT PAYROLL CONTRACT#WWP-27-3678 RENTON,CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Lift Station Repl GARY CERTIFIED PROJECT PAYROLL CONTRACT RACT# PERCONST #WWP-273678 "ce" ` u L°"" °a Uu AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 4/7/14 Taylor Thomas Payroll Specialist The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Cadman Inc Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 2/10/2014 2/16/2014 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A) Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program (A+B+C+D+E) 1 . $ 0.00 $ 0.00 $ 0.00 4. $ 0.00 $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanetions,,And penalties. Print or type name of party signing this report Title Signatur / Taylor Thomas Payroll Specialist F700-065-000 certified payroll report backer 05-09 HEIDELF RG t-',f .i•...,° Cadman, Inc. Suite 100 7554 185th Avenue NE PO Box 97038 Redmond,WA 98073-9738 425.867.1234 r:.425.861.4046 www.cadman.com PR # 2 NO WORK PERFORMED CADMAN INC does hereby certify that no persons were employed on and no work was performed for Gary Harper Construction on the Misty Cove Lift Station Replacement job, during the period of February 1 7th, 2014 through February 23rd, 2014. Signed: Title: Payroll Specialist R �GERTIFIED. PAYROLL_. -' _ ;.. >>� eplacement Week Ending: Awarding Agency: J Subcontractor I o Prime Contractor 2/30/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address: PO BOX 9 PR#3 1055 S GRADY WAY RENTON,WA-98055 241 251 261 271 281 11 2 Company Phone: 425-867-1234 Job Title Pay Rate noon Tue Wed rhu Fri sat sun TOTALS T-i USUSAL B-fu Gross Earnings Taxes Deductions Net Wages !Owens, Kevin D Pre-Mix Reg 1.75 1.75 45.41 6118579 Concrete 25.95 OT 0.00 0.00 __ -- - Driver 1.75 21.96 _:T 1362.1 j 241.79J 319.89 800.42( Tait, Michael B Pre-Mix Reg 1.80 1.80 48.51 6119993 Concrete 26.95 OT 0.00 0.00 Driver 1.80 20.96 F 1524.19, 282.91I 424.671 816.61; Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 - - ----------- -- - - - - Driver 0.00 ' Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.007 Pre-Mix Regi I I I I 1 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 I PR Pre-Mix Reg 0.00 0.00. Concrete OT 0.00 0.00 - - ------ - - r - - ------ - - - Driver Win. . 0.00 Pre-Mix Regi I I I I 1 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 1 Pre-Mix Reg 0.00 0.00 f Concrete OT 0.00 0.00 - --------------- - - Driver 0.00 1 i I _ Pre-Mix Reg 0.00 0.00 Concrete OT F++ 0.00 0.00 Driver --LL 0.00 F. Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT . ,-F - 0.00 0.00 _�------ Driver _ 0.00 -,, - - -- - --, ,71 i Pre-Mix Reg 0.001 0.00 CADMAN INC CERTIFIED PROJECT PAYROLL CONTRACT#WWP-27-3678 RENTON,CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Lift Station Repl CERTIFIED PROJECT PAYROLL CONTRACT#WWP-273678 "`nail ` U r ° '°°' ` AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 4n114 Taylor Thomas Payroll Specialist The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Cadman Inc Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 2/24/2014 3/2/2014 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour" terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program A+B+C+D+E) l . $ 0.00 $ 0.00 3. $ 0.00 4. $ 0.00 $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature r Taylor Thomas Payroll Specialist F700-065-000 certified payroll report backer 05-09 jCERTIFIED_PAYROLL Replacement 4 Week Ending: Awarding Agency: 1 J Subcontractor c P me Contragor 3/9/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address: PO BOX 9 PR#4 1055SGRADY WAY RENTON,WA-98055 , 31 41 51 61 71 81 9 Company Phone: 425-867-1234 Job Title Pay Rate Mon Tue Wed Thu Fri Sat Sun TOTALS T-1U5U5ALB-fa, Gross Earnings Taxes Deductions Net Wages Back, Chad A Pre-Mix Reg 1 10.2510.25 6.61 6113815 Concrete 26.45 JOT 0.00 0.00 _ _ __ Driver 0.25 21.46 1424.881 208.3bj 527.641 688.89j Brothers, Kenny B Pre-Mix Reg 1.n 1.50 2.67 71.96 8379748 Concrete 26.95 OT 0.00 0.00 Driver 2.67 20.96 - '--1404.25T 258.06, 90.15 1056.04 Carter, Steven D Pre-Mix Regi 1.55 1.63 4.701 1 1 7.88 212.37 6114594 Concrete 26.95 OT 0.00 0.00 - _ __ --_-`-- Driver 7.88 20.96 1377.291-- 201.11 -377.33( 798.851 !Dorman,James C Pre-Mix Regj 1 3.671 1 1 1 3.67 104.85 6115378 Concrete 28.57 OT 0.00 0.00 _ --- ---- - -. --- - ------- -- - Driver 3.67 19.34 j 1533.61( 294.13 j 12 1227.08 j Grosso, Brett J Pre-Mix Reg 1.50 1.50 36.98 ' 8541354 Concrete 24.65 OT 0.00 0.00 ------ Driver - 1.50 23.26 s f} 1106.11 220.13, 107.84 778.131 Olson, Christopher J_ Pre-Mix Reg 5.421 1 5.42 154.85 6118499 Concrete 28.57 OT 0.00 0.00 Driver 5.42 19.34 1311.25 232.75 182.54 895.96 :Tait,Jonathan S Pre-Mix Regi I 1 1 4.001 4.00 107.80 6119977 Concrete 26.95 OT 0.00 0.00 - Driver 4.00 20.96 1336.111 245.33r 250.08 840.7! Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 ry- T Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 -�+.+ 111 1 1 .1 . Driver 0.00 _ - -------- ( ---- j t _'. Pre-Mix Regi I I I I 1 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 dt_ z Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 F 7- Pre-Mix Reg 0.00 0.00 CADMAN INC JECT PAYROLL CONTRACT#WWP-27-3678 CERTIFIED PRENTON,CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Lift Station Repl GARY CERTIFIED PROJECT PAYROLL CONTRACT RACT# PERCONST #WWP-27-3678 lll11C111 U1 LAWI r IIIUUJl11C�Prev AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Date Printed name of party signing this report Title 4/7/14 7Taylor Thomas Payroll Specialist The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Cadman Inc Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 3/3/2014 3/9/2014 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C) Hourly Vacation (D) Hourly Holiday Apprentice Program (A+B+C+D+E) l. $ 0.00 ?. $ 0.00 3. $ 0.00 4. $ 0.00 $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Print or type name of party signing this report Title Signature e Taylor Thomas Payroll Specialist F700-065-000 certified payroll report backer 05-09 C�DM�IV HRbFI RD � r Cadman, Inc. Suite 100 7554 185"Avenue NE PO Box 97038 Redmond,WA 98073-9738 425.867.1234 fax 425.861.4046 www.cadman.com PR # 5 NO WORK PERFORMED CADMAN INC does hereby certify that no persons were employed on and no work was performed for Gary Harper Construction on the Misty Cove Lift Station Replacement job, during the period of March 1 Ot", 2014 through March 1 6t", 2014. Signed: T� -ter'^ Title: Payroll Specialist • i - CERTIFIED PAYROLL C_.T.- eplacement week Ending: Awarding Agency: SubcontractoTrIn,,..nl- Udy s or 3/23/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address: PO BOX 9 PR#6 1055 S GRADY WAY RENTON,WA-98055 171 181 191 201 21 22 23 Company Phone: 425-867-1234 Sob Title Pay Rate M6n Tue Wed Thu Fri Sat Sun TOTALS T-1USUs B-f. Gross Earninqs Taxes Deductions Net Wages I Back, Chad A Pre-Mix Reg 1.73 1 1 1.73 45.76 i -^ 6113815 Concrete 26.45 OT 0.00 0.00 _ ----------- Driver 1.73 21.46 r7, - 1377.181 197.841 515.96 663.38 [Carter, Steven D Pre-Mix Reg 2.901 1 1 1 2.90 78.16 6114594 Concrete 26.95 OT 0.00 0.00 --- --- Driver 2.90 20.96 1495.44! 226.79' -T- 384.95 883.71 1,--Clausnitzer, Richard A Pre-Mix Reg s.5s 3.59 102.57 -- -- 6114893 Concrete 28.57 OT 0.00 0.00 Driver 3.59 19.34 F ; 1501.84 380.85 12.581 1108.41 Pre-Mix Reg 0.00 0.00 Concrete OTH-+ 0.00 0.00 Driver 0.00 r Pre-Mix Reg 0.00 0.00 - Concrete OT 0.00 0.00 Driver 0.00 ------�-- ----- -i - - - Pre-Mix Reg 0.00 0.00 - Concrete OT 0.00 0.00 Driver 0.00 :.s _ Pre-Mix Reg 0.00 0.00 -- Concrete OTF++ 0.00 0.00 - Driver 0.00 - -- _ Pre-Mix Regi 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 _ Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 E I Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 ------- --- Driver 0.00 �- - -----r----- - ;- -------i--- -- -� - -- eg 0.00 0.00 Pre-Mix R CADMAN INC PAYROLL CONTRACT#WWP-27-3678 CERTIFIED PROJECT RENTON,CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Lift Station Repl G CERTIFIED PROJECT PAYROLL CONTRACT PERCONST CONTRACT#WWP-273678 veva11CI11 U/LQUUI a U uU C� AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 4/7/14 Taylor Thomas Payroll Specialist The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Cadman Inc Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 3/17/2014 3/23/2014 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour"terms) l Total Hourly (E)Approved Work Classification "Usual Benefits" (A) Houriv Pension (13) Houriv Medical (C)Hourly Vacation (D) Hourly Holiday Apprentice Program (A+B+C+D+E) PP ro g l. $ 0.00 $ 0.00 $ 0.00 4. $ 0.00 $ 0.00 6. $ 0.00 7. $ 0.00 S. $ 0.00 '). $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs,for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to pros cution, sanctions, a-d penalties. Print or type name of party signing this report Title Si atur Taylor Thomas Payroll Specialist F700-065-000 certified payroll report backer 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction, Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No. 11 For Week Ending Aril 19,2014 Project&Location:Misty Cove Lift Station Replacement,Renton.WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name.Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 13 14 1 15 16 17 18 19 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 3.50 10.00 10.00 9.00 32.50 52.74` 1,71405 (24.85) Bremerton.WA 98312 Operator (106.27) (147.00) (16.06) (212.50) (506.68) 1.207.37 XXX-XX-7696 Lead O *Employee benefits hourly value=$2.26 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 6.50 10.00 10.00 9.00 35.50 51.09' 1,813.70 (26.30) Lake Stevens,WA 98258 Operator (112.45) (128.00) (17.67) (39.00) (323.42) 1,490.28 XXX-XX-1921 1 O 1 1 1 1 *Employee benefits ourly value=$1.91 Richard McKenney,Jr. 27427 220th PI SE M 22 Pipelayer S 5.50 6.50 10.00 4.00 26.00 44.46 1,155,96 (16.76) Maple Valley,W 98038 (71.67) (109 00) (12.97) (210.40) 945.56 XXX-XX-4901 O S O RECEIVED APR 2 3 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4©below. I,Kathy Salazar,Office Manager.do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction. Inc.on the Misty Cove Lift Station Replacement ;that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 13th day of April 2014,and ending the 19th day paid,as indicated on the payroll,an amount not less than the sum of the of April , 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Siigna1ure�f �j� (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Mana er K lL,( �'r _/ �l s The wilful falsification of any of the above statements may subject the contractor or sub- ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor r1 Project Name County Project or Contract# Olympia.WA 98504-4540 (360)902-5335 1 D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor OX Project Address city State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 04 / 06 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount 'Usual FICA ing Tax Other. NET 03/31 04/01 04/02 04/03 04/04 04/05 04106 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY 1. No Work Performed F700-065-000 certified payroll report 05-09 Pag 1 OF 1 LAbor lkornm„c�m tPruS� "'`"`' AFFIRMATION Prlm W g Wage Program Olympia WA 985044540 Page 1 of 1 Today's Date Printed none of party signing this report rifle 04/18/14 Wendy Conway Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment ofthe pem. ns employed by: Bravo Environmental NW,Inc. Psujcct`arne: For the week::tarring: For the week ending: D018509-Gary Harper-Misty Cove Lift 0313l/14 04/06114 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) I atal Hourly (E)Approved Wark Classification -Usual Benefits" (A)Hourly Pension (B)Houriv Medical (C)Hourly Vacation (D)Hourly Holiday t pprrntletr Prosratn 1� rt .c.n-t1 I. 2. 3. - 4. 5. 6. 7. 8. 9. 10. I he patty signing trelow Af f IRS S the following: 11) All information contained in this Certified Payroll Rgwn,including any addenda,is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported abo,6e for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All perbum employed on the above-rcferemcd pruject(s)have been paid the full weekly wages ranted,and iiv rebates have beer)or will be utade either directly ur indirectly to or on behalf of the above-mined contractor or subcontractor from the weekly wages earned by anv person.No deductions,other than those which are legally permissible,have heen made by any person either directly or indirectly from the ful l wages earned 151 Any apprentices employed in the above period are duly registered in a bona fide apprcroticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of ans. of the above statements is a violation of 12('N 19.12.050 cuhject to prosecution,sanctions, and penalties. wPrint or"name ofptrty signing this report Title Slgnaturc UU Jt , Wendy C-4l1way o1LAd-mmjattatQr �. 1 i' 1'700-065-M)ccrttticd payroll report backer 05 119 Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Prime Contractor I 1 Project Name County Project or Contract# Olympia.WA 98504-4540 (360)902-5335 D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 ty�b Subcontractor Cl Project Address City State ZIP+4 yy Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 04 / 13 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourty Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 04107 04/08 04/09 04/10 04/11 04/12 04/13 pay Eamed Benefits' WAGES HOURS WORKED EACH DAY ' IVo Work Performed F700-065-000 certified payroll report 05-09 Pagel 1 OF 1 Pmaili gWf` Pro'n`I'n''" `" AFFIRMATION Pm ailing wage Pn�gram PO Box"540 Olwnpis WA 995044540 Page 1 of 1 Tofay's Date Printed narne of party signing this report Title 04/18/14 Wendy ConwayPayroll Administrator The patty signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. Project Name: For the weak starting: For the week ending: DO18509-Gary Harper-Misty Cove Lift 04/07/14 04/13/14 -- ----- "USUAL BFNFFITS"DISTRIBUTION (Please report in"per hour"terms) - I otal liourty (E)-vppro%ed Nork Classification I ^1 %ual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D) Hourly lloliday Apprentice PruKram tv .a•c+o�cf 3. I. 4 S. 6. 9. 10. I he parry signing below Af hIKIN1J the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All petsUns employed Uri the abut e-rcfcrcoc%;i pioject(i)have bCCtr paid IIIC full weekly wagcn.Corned,and ou tubales Itave beeu or will be made citltet directly Ur indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions.other than tho,c w hich are lceal h permissible,have been made by any person either directly or indirectly from the till I wage-earned 00 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of an} of the above statements is a violation of RC%% 19.12.051)subject to prosecution, sanctions, and penalties. Print or type name ofp:rrtt .inning ihureport I file �itn.mu Wendy Conway strator_ - f700-0654W certified payroll rcpon backer 05 09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No. 12 For Week Endin :April 26.2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S I M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 20 21 22 23 24 1 25 1 26 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 10.00 40.00 53.55' 2.182.53 (31,65) Bremerton,WA 98312 Operator (135.32) (232.00) (21,18) (212,50) (632,65) 1,549.88 XXX-XX-7696 (Lead) 01 0.50 0.50 81.05' *Employee benefits hourly value=$1,45 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 1 10.00 10.00 10.00 10.00 40.00 51.66' 2,105.4.8 (30.53) Lake Stevens,WA 98258 Operator (130.54) (171.00) (21.18) (39 00) (392.25) 1,713.23 XXX-XX-1921 O 0.50 1 1 0.50 78.16' *Employee benefits ourly value=$1.34 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 1 10.00 10.001 2.00 10.00 32.00 4446 1.422.72 (20.63) Maple Valley,W 98038 (88.21) (149.00) (17.02) (274.86) 1,147.86 XXX-XX-4901 O ro Fr RECEIVED APR 2 9 2014 CITY OF RENTpN UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager.do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction. Inc.on the Misty Cove Lift Station Replacement that during the payroll period ❑X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 20th day of April 2014,and ending the 26th day paid,as indicated on the payroll,an amount not less than the sum of the of April , 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig a re 7 (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager r`'' r - The wilful falsification of any of the above statements may su ject the contract or sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sp6tion 231 above referenced payroll,payment of fnnge benefits as listed in the contract have been or title 31 of the United States Code. 4/24/2014 STATEMENT OF COMPLIANCE I, ELLY MCINTYRE,OFFICE MANAGER do hereby state: (I)That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 13th of APR'14,and ending the 19th day of APR'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3 (29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE, OFFICE MANAGER 424/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1313 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE: NM- CEAIPT/SSA WORK CLASS PAY PERIOD DATE: 19-Apr 2014 SUN MON TUES WED Tim FRI SAT TOT GROSS FICA I.&I TOT DED 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr FIRS PAY FWF) UNION WK.GROSS NET PAY TIIOXIAS,DAVID L. 14433 20TI I DR.NW SSNe.......3645 0 0 0 1) 0 0 0 0 0 0.00 134.33 9.24 579.40 MARYSVILLE,WA 99271 tLEC./m s 0 0 0 0 10 0 0 10 429.10 220.00 215.83 0.00 1756.00 354.33 225.07 1176.60 I IANSON.GORDON 11 16901 21ST Ave SE SSNn.........5915 0 0 0 0 0 0 0 0 0 0.00 129.66 9.24 554.59 non ICU WA 9H012 CLEC.nR S 0 0 0 0 8 8 0 16 677.92 314.00 101.69 0.00 1694.80 443.66 110.93 1140.21 DORIIAI1.LON PO nox 51160 SSNP..........3H96 0 0 0 0 0 0 0 0 0 0.00 136.14 9.24 525.31 WENATCIIM WA98H07 ELEC./31% S 0 0 0 0 3 8 8 19 815.29 191.00 188.93 0.00 1779.76 327.14 198.17 1254.45 RECEIVED 4/29/2014 MAY 0 7 Z014 ADVANCED POWER LI.0 CERTIFIED PAYROLL REPORT CITY OF RENTON 1013 NlJM6ER: 1319 UTILITY SYSTEMS NAME: MISTY COVE LIFT STATION REPLACEMENT EAIPLOYrr NEXCENIPT/SSO wD1u:cLAss PAY PERIOD DATE: 26-Apr 2014 SUN MON TUES WED T1IUR FRI SAT TOT GIZOSS FICA L&I TOT DED 20-Apr 21-Apr 22-Apr 23-Apr 24-Apr 25-Apr 26-Apr I-IRS PAY FWI-I UNION WR.GROSS NET PAY 7110MAS,DAVID L 1.1433 26111 DIL NW SSNJI ....3643 o 0 0 0 0 0 0 0 0 0.00 131.99 8.89 572.83 MARYSVILLE,WA 99271 ELEccaR s 0 0 0 0 8.5 0 0 8.5 3(A.74 212.00 219.95 0.00 1725.30 343.99 228.84 1152.47 HANSON,GORDON P 16901 21ST Aye Sr SSNH...... ..5915 0 0 0 0 0 0 0 0 0 0.00 97.24 0,93 398.44 BOTHELL WA 99012 ta.rc nR s 0 0 0 0 6 0 0 6 254.22 208.00 76.27 0.00 1271.10 305.24 83.20 882.66 4/29R014 STATEMENT OF COMPLIANCE 1,ELLY MCINTYRE,OFFICE MANAGER do hereby state: (1)Thnt I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 20th oFAPR'14,and ending the 20th day of APR'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3 (29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in die above period are duly registered in a bona ride apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE_BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 1N CASH () Ench laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll an each 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,except as noted in section 4 (c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE yY� ELLY MCINTYRE,OFFICE MANAGER U.S. Department of Labor PAYROLL awHo Wage and Hour Division For Contractor's h i h hd/l d Use;Optional See Instructions at www.dol.gov/whd/forms/wh347instr.htm)P r g ) U.S.Rragc aril Hour I)i%isicm Persons a,,e nor required to respond to the c0sction of information unless it dispiays a currently valid OMB control number. Rev. Dec.2008 NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS 30316 MOUNTAIN HWY E GRAHAM WA 98338 OMB No.: 1235-0008 TACOMA PUMP&DRILLING CO INC Expires: 01/31/2015 PAYROLL N0. �� - FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO- 1 04/13/2014 MISTY COVE LIFT STATION 5027 RIPLEY LANE N,RENTON WA 98056 WWP-27-3678 I1) +•2) (3) (4)DAY AND DATE (51 (6) (7: (9) z N DEDUCTIONS o y M T W I'H F S S NET NAME AND INDIVIDUAL IDENTIFYING NUMBER ?5 a GROSS WITH- WAGES (e.g. LAST FOUR:AGrfS OF SOCIAL SECURITY o %ry WORK o 1 8 1 9 1 10 1 )1 12 13 TOTA.LI RATE AMOUNT HOLDING TOTAL PAID NUMBER)OF WORKER Z3 CLASSIFICATION HOURS WORKED EACH DAY HOURSI OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK BRIAN BESST OILER 0 $27 00 S63.00 298502 113TH AVE E,GRAHAfvl WA S4.82 $0.00 S4.82 S58.18 #2074 0 s sa r co 3.50 3-oo MARK WIESE DRILLER o S41.72 S97''4 PO BOX 1428.GRAHAM WA 0 $7.45 $0.00 S7.45 S89.89 #0703 s asc L,rc 3,50 27.31 s 0 s 0 s 0 s c S 0 s V�hile completion.of Form WH-347 s optional it is mandatory for covered ronractors and sutco^racto•s pefornng wore on Fecei finenced or ass.sled cOfritru.Uon contracts to resperd to the information collection conta nod in 29 C.F.R.§§3.3.5.5(a).The Copeland AU ;40 U.S.C.§3145)contractors and subcontractors per`.omirg work on Federally finarceo or assisted corsirud,on contracts:o"?urri9h weeklya statement with respect to the wages paid each employee during Viepreceding week." U.S.Deoartmert 0f LaCot(DOL)regulators at 29 C.F.R.§5.5(a)(3)(ii)require contractors to sunrr:weekly a copy o`Al payrolls to M Federal agene,•co.:.rarAing for or franciig Cx const:union Project,a=,xnied Cy a sigred"Statement of Coroliance'irdi at rig that the payro;ls are cored arc compiete and that ear,Wo:rer or mechanic has been paid not'.ess than the proper Davis-Bacon Prevailing wage rate's the wore perfo med.DOL anc federal contracting agencies receiving tnis information review the information to date-mine that emotoyees have received legally requtrad wages any fro^ge Penets. Public Burden Statement V'la estimate that is will take an average of 55 minutes t0 Complele Luis Colledi0n,vxdLding time for reviewing instructions.searcrirg exirorg data sources gatnenrg and ma nta n rig the data needed,any completing and reviawing the cdlecilor.of,n'ormation ff;ou have arty comments•egardng these astmales or a^y o,her aspect of this collection,irduding suggesticrs for reducing this burden send them to the Adr,ris:rator.Wago and Hour O v,s on,U.S.Deparmert of la0or,Room S3502,200 Cerstitulien Avenue,N.W. Washington.C.C.2021C (ova) Date• 5/01/2014 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ANDREA SODON BOOKKEEPER (Name of Signatory Party) (Title) ❑ — 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 do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as fisted in the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS TACOMA PUMP&DRILLING CO INC on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION MISTY COVE LIFT STATION ;that during the payroll period commencing on the (Building or Work) 7 day of APRIL 2014 , and ending the 12 day of APRIL 2014 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 TACOMA PUMP&DRILLING CO INC from the full (Contractor or Subcontractor) 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 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Start.108,.72 Stat 967;76 Start.357;40 U.S.C.§3145),and described belovr. REMARKS: (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 he performed. (3)That any apprentices employed in the above period are duty 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 NAME AND TITLE SIGNATURE ANDREA SODON © — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in BOOKKEEPERL41 177 the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATE PETS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted In section 4(c)below. 31 OF THE UNITED STATES CODE Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.13 For Week Endin :May 3,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M I T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 27 28 1 29 30 1 2 3 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 8.00 10.00 38.00 53.46- 2,031.48 (29.45) Bremerton,WA 98312 Operator (125.95) (195.00) (18.60) (212.50) (581.50) 1,449.98 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.54 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 10.00 10.00 40.00 51.64- 2,065.60 (29.95) Lake Stevens,WA 98258 Operator (128.07) (165.00) (19.58) (39.00) (381.60) 1,684.00 XXX-XX-1921 O *Employe benefits ourly value=$1.36 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 8.00 8.00 36.00 44.46 1,600.56 (23.21) Maple Valley,W 98038 (99.24) (175.00) (17.62) (315.07) 1,285.49 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period ❑X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 27th day of April 2014,and ending the 3rd day paid,as indicated on the payroll,an amount not less than the sum of the of May , 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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 Stall.948,63 Stat. 108.72 Stat.967, 76 Stat.357;40 U.S.C.276c),and described below: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sign tur (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS.. FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subject the contractor of sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sec4ori 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Prime Contractor Project Name Courtly Project or Contract# Olympia,WA 98504-4540 (360)902-5335 D018509 Gary Harper-Misty Cove Lift _ KING - WWP-27-3578 - !/1 Subcontractor Xj Project Address City State ZIP+4 �vJ Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending City of Renton _ _ (425)430-7279 Bravo Environmental NW,Inc. _ _ (425)424-9000 Month Day Year Address City State ZIP+4 Address City Slate ZIP+4 04 / 27 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name _ _ Total and and ` Earn► MON TUE VYED,THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec*of Employee Address 1 Code Hours of Gross Amount "Usual FICA ing Tax Other NET 04MI I W22 04/23(0424 W/25 04/28 04/27 Pay Earned Benefits" WAGES L HOURS WORKED EACH DAY_ ' I No Work Performed F700-065-000 certified payroll report 0509 I I Page ag 1 OF 1 r m { o n n m < m 'A m -q _� C z M 0 °`wi °'Laburand l"durics P �ailing Raga Program AFFIRMATION PO Box 44540 Olympia WA 985044540 Page 1 of 1 Today's Date Printed name of party signing this report Title 05/06/14 WerxJy Cormay Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. Projoct Nome: For the week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 04/21/14 04/27/14 "USUAL.BENEFITS-DISTRIBUTION (Please report in"per hour"terms) 'rota]Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program A+3+C*D-E) I. 2. 3. 4. 5. G. 7. 8. 9. 10. fhe patty signing below AF F'IKMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All per uns employed un dic abuvC-rcferem;cd ptuject(s)have bcctt paid die full weekly wages camcd.and ttu rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the ful I wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name of party signing thi report ---j-Titic Signature vYV�1v I'7WO65-000 certihcd payroll report backer 05-09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box Olympia.WA 445409a5O4 4540 Prime Contractor i Project Name County Project or Contract# (360)902-5335 ;DO18509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor )( I Project Address City State ZIP+4 Al Misty Cove Lift Station Replac ment _ Renton WA ' Awarding Agency Name Phone Company Name z� r Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 -------- -----------..--------- Month Day Year Address City State ZIP+4 Address City State ZIP+4 04 / 20 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE ----"- -_---- Work Classification Name Total and and Earn TUE WED(THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 04/14 04/15 04/16 04/17 04/18 04/19 04/20 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' FNo Work Performed F700-WS-000 certified payroll report 05-09 1 Pagl 1 OF 1 Department of tabor and Induwic, Prevailing Wage Program AFFIRMATION Po Box�t4san Ohmpia WA 985044540 Page 1 of 1 Today's Date Printed name of party signing this report Title 05/06/14 Wendy Conwav Pa roll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. Project Manx' For the week starting: For the week ending: D018509 Gary Harper-Misty Cove Lift 04/14/14 04/20/14 µUSUAL.BENEFITS"DISTRIBUTION (Please report in"per hour"terms) -total Hourly Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourt Medical (E)Approved i 4-a+C+D a E Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentke Program 1. 2. 3. 4. 5. G. 7. 8. 9. 10. I'he party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda.is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker•laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plaits.funds or programs for the benefit of such employees. (4) All persons rrnpluyed oil(Ire above-referetn:ed prujcct(s)have beeii paid die full weekly wages cut tied.and nu rebateb have beeli or will br made eidwi-directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions.other than those which are legally permissible•have been made by any person either directly or indirectly from the ful I wages earned. (1) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. - ----- —...-..--- - -- -- -- - ---- ------ -- - - -- Print or type name of party signing this report --------—Title Signature w �in�w f70O.065-000 certified payroll report backer 05-09. Department ufl.abnr and Industries , CERTIFIED PAYROLL REPORT Prevailing Wage Program " s. I'O Box 44540 _ Olympia WA 98304-4340 o ❑ h"""t ':'" County - — —Pro)rct or CnmractN --- hb0)902-53�5 Prime Contractor <,•� *° 11f11 ♦ C._o_v_ 1..�•l'�S' 1 - I [l''.11�-Z1-3(o77 P.-.—. VA res.N " Subcontractor ! pZ wly 6%%a— Agen A Name Phone Cutnpany Me Fur the week nuking: n- - 4�•S �f 3 0 17. to C.u1 5�-54cm s LL C, 2S 3•to 0 6•`j9 le Mon Day Year. Addr ss City ---St is %IP+4 Add, City Stale %IPt4 la W - �[$vl 3'1 a 7 u •Z _ atom a - W Pt ` 841) L Day and Dale lkducuans Work Classification Nan>r I ' Sun Mon Tue Wed Tlw Fri Sat - and and �� tool Soc Secg of Employee Address 'O �� v'--�t Rate Hourl) o _ Total ut' Gros Amount -Usual Wrahlrotd .z'4 NFI- - _ _ Hours Worked F.ach Uny Hours Pa• Earned �Hcrxfns- FICA -rak Tax _ (11Mr WAG" IWO8 'T- fkve z. 63 e'er 7LtiJ Gh-a,r� o I .va a as �E,z;` ;oll M+!tndlbtl 5�1 L — - 3`. 272A-f1 Va*,5 OT ow 0w 441-7 roto Nve r- 4 �� M r4rC 77"JPLO OT 1 O Lo y Ceo S S - — Taco W ftC qj b S, 35 I YVIkrC vaA -S OT 000 �y p Z bJ •L4 j4s RG -- — 000 r o 00 t u 00 000 o0s G. - OT - voo ON I i oau s ow s o00 RG o00 000 T O'E ano coo aao f o.0a f Om RG 000 ow S. LIT 000 000 000 S OW f OW RG 000 000 9, 07• Ow 000 — -- --� RG ODD000 1 000 t 000 ow =10. OT ot• 000 — — e,0 sow I -- s 000 �--- RG om ow ' 1-700-065-OOU certified payroll report 05-09 Empla•ee Benefits Distrvbuuon and Signature Cerfirwntiarr on Reverse Side Ucpannmm of t.atim and Industries Prevailing Wage Program PU Box Ol Ctyrnprnpa WA WA 9$5114-454U AFFIRMATION Todays Datc Printed name of party signing this report -�-l 1'ttle fhe party signing this report pays or superniscs the (Name of contractor or subcontractor) payment of the persons employed by: Project Name: the vrek statlina: For the'Z riding: "USUAL BENEFITS"DISTRIBUTION (Please report in`•per hour"terms) Total Hourly Work Classification "Usual Benefits" (A)Hourly Pension (B) Hourly Medical ,. t Approved roved IA+g+C+u+ti (�')hourly Vacation (ll) Ilrwrly Ilulidav ( )' I p Apprentice Program 1. $ 0.00 2. $ 0.00 $ 0.00 4• $ 0.00 s $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above arc not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-refcre:nced prcjcct(s)have been paid the full weekly wages earned,and no rebates have been or will be made eitherdirectly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name�of1pl +arty signing this repot i IV�LIY C V. =th f7 �J.�YLQ \� ti t natuic / F700-065-000 certified payroll report backer 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.14 For Week Endin :May 10,2014 Project 8 Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Day and Date Gross Deductions Net Wages Name,Address and No.of Work SIMI TIWIThl F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 4 1 5 1 6 7 1 8 1 9 10 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 8.50 38.50 53.48' 2,058.98 (29.86) Bremerton,WA 98312 Operator (127.66) (201.00) (18.84) (212.50) (589.86) 1,469.12 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.52 Justin Michaud 1959.66" 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 10.00 30.00 51.57' 1,547.10 (28.41) Lake Stevens,WA 98258 Operator (121.49) (150.00) (18.60) (39.00) (357.50) 1,602.16 XXX-XX-1921 1 O 1 1 *Employee benefits ourly value=$1.43, "Justin worked 8 hours on another'ob. Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 10.00 2.00 32.00 44.46 1,422.72 (20.63) Maple Valley,W 98038 (88.21) (149.00) (15.66) (273.50) 1,149.22 XXX-XX-4901 O S O - Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I.Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc. on the Misty Cove Lift Station Replacement that during the payroll period Q--- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 4th day of May 2014,and ending the 10th day paid,as indicated on the payroll,an amount not less than the sum of the of May . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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. © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sigplavire, / (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may s bject the contraeor or sub- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No. 15 For Week Endin :May 17,2014 Project&Location: Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name.Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 11 12 13 14 15 16 17 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 8.00 38.00 53.46' 2,031.48 (29.46) Bremerton,WA 98312 Operator (125.95) (195.00) (18.60) (212.50 (581 51) 1,449.97 XXX-XX-7696 Lead O *Employee benefits hourly value=$1 54 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 10.00 8.00 38.00 51.57' 1,959.66 (28.42) Lake Stevens,WA 98258 Operator (121.50) (150.00) (18.60) (39.00) (357.52) 1,602.14 XXX-XX-1921 O 1 1 1 1 *Employee benefits ourly value=$1.43 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 10.00 8.00 38.00 44.46 1,689.48 (24.50) Maple Valley,W 98038 (104.74) (189,00) (18.60) (336 84) 1,352.64 XXX-XX-4901 O S lot I I—T-1 C n _i < O n ( T t-z M < im Z o < m O 4F- U) Z v Date or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement ,that during the payroll period ❑X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 11th day of May 2014,and ending the 17th day paid,as indicated on the payroll,an amount not less than the sum of the of May , 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig re (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may, ubject the contra or sub- ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and ction 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. u Prevailing ent a t aoor ra tnaustrtes STAT CERTIFIED PAYROLL REPORT ��E e o0 Prevailing Wage Program �, 4. PO Box 44540 � � • Project -Olympia WA 98504-4540 ,Name County Project or Contract# rya iEa9 °y Prime Contractor ❑ Misty Cove Lift Station Replacement King W WP-27-3678 (360) 02-5335 - j I Subcontractor ® Project Address City State Renton Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425-430-7279 .,Miles Sand&Gravel Company-(Gary Harper) 253-833-3705 Month Day Year _Address City State ZIP+4 Address City State ZIP+4 4/26/14 1055 S Grady Way Renton WA 98055 -400 Valley Ave NE Puyallup WA 98372 Day and Date Deductions Work Classification Name Sun Mon Tue Wed Thu Fri Sat Total and and Rate Hourly Soc Sec#of Employee Address > ,nnii, 1/2VM1 ,/22111 1 4123n, 1 1121n1 1 125111 416111 Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Transit Mixer-All Josephy Umanskiy OT 0.00 50.07 0.00 11132 SE 304"'PI 86.12 $ 9.85 $ 86.12 000-00-1273 Auburn,WA 98092 RG 2.58 2.58 33 38 86.12 2 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 3 OT 0.00 50.07 000 0.00 $ 9.85 $ 0.00 RG 0.00 33 38 0.00 4 OT 0.00 50.07 0.00 o.00 s 9.85 s 0.00 RG 0.00 33.38 0.00 5 OT o.o0 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 6 OT 0.00 50.07 0.00 0.0o s 9.85 $ 0.00 RG 0.00 3338 0.00 7 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 8 OT o.o0 50.07 0.00 0.00 s 9.85 $ 0.00 RG 0.00 33.38 0.00 9 OT 0.00 50.07 o.00 0.00 $ 9.85 $ 0.00 RG o.o0 33.38 0.00 10 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 3338 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Ppar"cin 01 Laour ailu 11mustrics AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 985044540 Today's Date TPrinted name of party signing this report Title 5/16/14 Marjean Davis Payroll/HR Mgr The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Miles Sand&Gravel Company -(Gary Harper) Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 4/20/14 4/26/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday (E) Approved (A+B+C+D+E) Apprentice Program 1. Transit Mixer-All $ 9.85 $3.34 $4.82 $0.99 $0.70 2. $ 9.85 $3.34 $4.82 $0.99 $0.70 3. $ 9.85 $3.34 $4.82 $0.99 $0.70 4. $ 9.85 $3.34 $4.82 $0.99 $0.70 5. $ 9.85 $3.34 $4.82 $0.99 $0.70 6. $ 9.85 $3.34 $4.82 $0.99 $0.70 7. $ 9.85 $3.34 $4.82 $0.99 $0.70 8. $ 9.85 $3.34 $4.82 $0.99 $0.70 9. $ 9.85 $3.34 $4.82 $0.99 $0.70 10. $ 9.85 $3.34 $4.82 $0.99 $0.70 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signatur Marjean Davis Payroll/HR Mgr F700-065-000 certified payroll report backer 05-09 vep of t aoor tnaustrtes STATE CERTIFIED PAYROLL REPORT Prevailingailing Wage Program �"� . PO Box 44540 Olympia WA 98504-4540 Project Name County Project or Contract# y Prime Contractor (360)902-5335 H�i6�a° Misty Cove Lift Station Replacement King W WP-27-3678 Subcontractor ® Project Address City State Renton Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425-430-7279 Miles Sand&Gravel Company-(Gary Harper) 253-833-3705 Month Day Year Address City State ZIP+4 Address City State ZIP+4 5/3/14 1055 S Grady Way Renton WA 98055 400 Valley Ave NE Puyallup WA 98372 Day and Date Deductions Work Classification Name 2 r Sun Mon Tue Wed Thu Fri Sat Total and and Rate Hourly Soc Sec#of Employee Address o x Ono/, ,/2W14 4/29/14 4/30114 5/1/14 5/2/l4 5/3/U Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA in-Tax Other WAGES 1. Transit Mixer-All Max Babb OT 0.00 50.07 0.00 956 McKiley Rd E 65.76 $ 9.85 $65.76 000-00-8350 Tacoma,WA 98404 RG 1.97 1.97 33.38 65.76 2 Joseph Umanskiy OT 0.75 0.75 50.07 3z55 11132 SE 304°i PI 62.59 s 9.85 $62.59 000-00-1273 Aburn,WA 98092 RG o.75 0.75 33.38 25.04 3 OT 0.00 50.07 0.00 0.00 s 9.85 $ 0.00 RG 0.00 33.38 0.00 4 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 5 OT o.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 6 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 7 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 8 OT 000 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 9 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 000 33.38 0.00 10 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side DUY uevaili g Ul a Pro a 1RUU5lrIG5 AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 5/16/14 Marjean Davis Payroll/HR Mgr The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Miles Sand&Gravel Company -(Gary Harper) Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 4/27/14 5/3/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour'terms) Total Hourly Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D) Hourly Holiday ( Approved (A+B+C+D+E Apprentice Program 1. Transit Mixer-All $ 9.85 $3.34 $4.82 $0.99 $0.70 2. $ 9.85 $3.34 $4.82 $0.99 $0.70 $ 9.85 $3.34 $4.82 $0.99 $0.70 4. $ 9.85 $3.34 $4.82 $0.99 $0.70 5. $ 9.85 $3.34 $4.82 $0.99 $0.70 6. $ 9.85 $3.34 $4.82 $0.99 $0.70 7. $ 9.85 $3.34 $4.82 $0.99 $0.70 8. $ 9.85 $3.34 $4.82 $0.99 $0.70 9. $ 9.85 $3.34 $4.82 $0.94 1 $0.70 10. $ 9.85 $3.34 $4.82 $0.99 $0.70 The party signing below AFFU MS the following: (1) All information contained in this Certified Payroll Report,including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Print or type name of party signing this report Title Signature Marjean Davis Payroll/HR Mgr F700-065-000 certified payroll report backer 05-09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor n Project Name Olympia,WA 98504-4540 I I County Project or Contract# (360)902-5335 ❑ I D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor X Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City Stale ZIP+4 05 / 04 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code TUE WED THU FRI Hours of Gross Amount "Usual FICA ing Tax Other NET 04/28 04/29 04/30 05/01 05/02 05/03 OS/04 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Pagel1 OF 1 w' °c aiot w " AFFIRMATION Prr.ailinit aE�c Pmruparn Po Box 44540 01 mpia N A 9245(M 4.54n Page 1 of 1 Today's Dare Printed name of party bugling this report Title 05/21/14 Wendy ConwayPavroll Administrator The party signing this report pays or supervises the (Name of contractor or subcuntractorl payment of the persons employed by: Bravo Environmental NW.Inc. Projwl Name: For the aroek starting: For the week cndinE: D018509-Gary Harper-Misty Cove Lift 04128/14 05/04/14 "USUAL BENEFITS"DISTRIBUTION (Pleas report in"per boor"term) - Total Hourly (E)A roved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly 1ledleal (C)Hourly Vaation ID) llourly Holiday A+a•C*�-1.1 Apprentice NnrKram I. 1 3. 4 4 G. 7. R. 9. 10. I he party signing below•At F IKMS the followmg7 it) All information contained in this Certified Payroll Rqwrt, inriuding am addenda,is correct and complete. (_') The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rate%contained in any wage determination related to the contract;and the classifications as reported abote for each worker,laborer or mechanic conform with the actual work performed by such worker-laborer or mechanic. (31 The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persulr)employed on the abo%c-tCfc:cm:cd ptojrct(a)INVC bVell bald 111C full weekly WdgL-b carried,and flu rcbntt:s have been or will tx made eidter dirmily or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible.have been made by any person either directly or indirectly from the ful I wages earned (s) An} apprentices employed in the above period are duly registered in a bona fide apprenticeship program register d with the Washington State Apprenticeship and Training Council. Falsification of any of the ahov a statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or 4TK nanw of 0rm .igmng this report I«Ic signature 1 rJYLI,� PayrollAdmini;mW1 1'700-065-M certified payroll report backer 05-09 vl� Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor F1 Project Name Olympia,WA 98504-4540 I Count' Project or Contract# (360)902-5335 1 D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor X❑ I Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 05 / 11 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 05/05 05/06 05/07105/08 05/09 O5/10 OS/11 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Page 1 OF 1 �a Ik'%allin m,it I Plo and Induant. AFFIRMATION Pi c�a d mE\1age Pmgnm PC)Nov 44'40 Ohnµ+im H A 48SW 540 Page 1 of 1 Today's Date Printed name of parry signing this report Title 08/21/14 Wenity Convoy Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project Name: �ff,05/05114 he week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 05/11/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) total Hourly I (K)Approved Work Classification -Usual Benefits" (A)Hourly Pension (B) Hourh Medical (C)Hourly Vacation (D)Hourly Holiday Apprtntka ProKram �.u+c.o•c I. 3. S G. 7. R. 9. 10. I he party signing below AF FIRMS the tollowing: i t) All information contained in this Certified Payroll Report.including any addenda,is correct and complete. t?) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reposed above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. ta) All persuts employed un the above-refercmW lrrujc ct(>)have beret laid the full m eckly wages canted.and im rebdim have Wen or will bC RIMIC Getter diF=Ily ur indirectly to or on behalf of the above-named contractor or subcontractor from the weekiv wages earned by any person.No deductions,other than those which are legal ly permissible,have been made by any peruin either directly or indirectly froth the ful I wages earned (S) Any apprentices employed in the above period are duly registered in a bona fide apprenticeNhip program registered with the Washington State Apprenticeship and Training Council. Falsification of an% of the above statements is a violation of RCN' 39.12.050 subject to prosecution,sanctions, and penalties. Print or type nanx of party igtunlz thi,rq*wt 1 itic — Signature vY J Wendy Qmboy Administrator )-700-065-OW certified pa>roll report backer 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.16 For Week Endin :May 24,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W ITh F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 18 19 20 21 1 22 1 23 24 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 9.00 39.00 53.50' 2,086.50 (30.25) Bremerton,WA 98312 Operator (129.36) (208.00) (19.44) (212.50) (599.55) 1,486.95 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.50 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 10.00 9.00 39.00 51.61' 2,012.79 (29.18) Lake Stevens,WA 98258 Operator (124.80) (158.00) (19.44 (39.00) (370.42) 1,642.37 XXX-XX-1921 O 1 1 *Employee benefits ourly value=$1.39 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 10.00 8.50 38.50 44.46 1,711.71 (24.82) Maple Valley,W 98038 (106.13) (192.00) (19.25) (342.20) 1,369.51 XXX-XX-4901 O S O 1 _ Date: or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4©below. I, Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement ;that during the payroll period ❑X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 18th day of May 2014,and ending the 24th day paid,as indicated on the payroll,an amount not less than the sum of the of May 1 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract.except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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 Stall.948.63 Stat. 108,72 Stat. 967 76 Stat.357;40 U.S.C.276c),and described below: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Siggature (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS Kath Salazar,Office Manager The wilful falsification of any of the above statements may su ject the contractor or sub- ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 br Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. PAYROLL SUPPLEMENTARY SHEET NO WORK PERFORMED SUBCONTRACTOR: ADVANCED POWER, LLC PAYROLL # 3 I HEREBY CERTIFY THAT NO EMPLOYEE WORKED ON THE CONSTRUCTION OF PROJECT L DURING THE PERIOD FROM THEo OF , 201 THROUGH �a OF 201,. DATE: o 4/0 SIGNATURE: TITLE: ^� -�� 5/22/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT }I, JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE NEXCEMPTISSN woRK cLAss PAY PERIOD DATE: 17-May 2014 SUN MON TUGS WED THUR FRI SAT TOT GROSS FICA L&I TOT DED II-May 12-May 13-May 14-May 15-Mny 16-May 17-May I-IRS PAY FWI•I UNION WK.GROSS NET PAY FRINGES STEPI[ENS,JOSE1311 W 166203RD PL NE SSNN.........6993 0 0 0 0 0 0 0 0 0 0.00 127.16 8.77 707.58 SHORELINE WA 9N155 E•LECAli s 0 0 0 0 0 8 0 8 374.96 287.00 284.65 0.00 1662.26 414.16 293.42 954.68 DORRAl1,LON PO BOX 5D60 SSNN..........306 0 0 0 0 0 0 0 0 0 0.00 133.73 9.24 536.69 WENATCHEc WA 99807 ELECAR s 0 0 0 0 0 8 0 8 374.96 186.00 207.72 0.00 17,18.08 319.73 216.96 1211.39 5722/2014 STATEMENT OF COMPLIANCE 1,ELLY MCINTYRE,OFFICE MANAGER do hereby state: (])That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the I I th of MAY'l4,and ending the l7th day of MAY'l4 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona ride apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X) 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 correct 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 each 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,except as noted,in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER 4376720 170 OMB No. 0607-0153: Approval Expires 05/31/2016 FORM C-700(SL) In any correspondence pertaining to this report, (6 18 2013) refer to the control number shown below. U.S. DEPARTMENT OF COMMERCE Economic and Statistics Administration U.S.CENSUS BUREAU CONSTRUCTION DATE SV S WGT TC NEWTC ST NEWAA STATUS PROJECT REPORT 201312 821 18. 91 76 1317 53 3 1 STATE AND LOCAL GOVERNMENTS IMPORTANT 4376720 1 0501424 L3 Please refer to the Reporting Instructions on the back of the form. CITY OF RENTON UTILITY SERVICES DUE DATE: MAR 19, 2014 ATTN JOHN HOBSON PROJECT MGR isU.S.Census Bureau WASTEWATER UTILITY ENGINEER 1201 East 10th Street 1055 S GRADY WAY - 5TH FLR Jeffersonville, IN 47132-0001 RENTON WA 98057 1-800-845-8245 www.census.gov/econhelp/cprs Use your unique User ID and original password. FAX (425) 430-7241 PHONE (425) 430-7279 User ID: 0501424 Password: Rmn#14## (Please correct any error in name and address including ZIP Code, telephone and fax number) PROJECT IDENTIFICATION I SQUARE FEET The construction project described below is associated with your 7. Based on exterior dimensions, how many square organization according to published sources. Please correct any errors or feet of enclosed floor area (including basements) fill in any blanks in items 1 and 2. If necessary,make your corrections in will be created by this project? item 10,Remarks,or use a separate sheet. IF YOU HAVE ANY QUESTIONS CONCERNING THIS FORM, PLEASE CALL 1-800-845-8246. Exclude nonbuilding projects 1. PROJECT DESCRIPTION and existing floor space Square feet MISTY COVE LIFT STATION REPLACEMENT that is being remodeled. CAG13178 If none, enter "0." RECEIVED MONTHLY CONSTRUCTION CAG1317 8 PROGRESS REPORT 2. PROJECT LOCATION 5021 RIPLEY LN N MAR 10 2014 ' • Continue with item 8 if project has started;otherwise, RENTON WA skip to section F. CITY OF RENTON . Report the value of construction put in place each month. UTILITY SYSTEMS Include only those construction costs defined in item 5c. DO NOT include costs reported in item 6. 7o, OWNERSHIP AND START DATE • Report costs in the month in which work was done E OF OWNERSHIP- Mark (X) one box. (including any monthly retainage being withheld from contractors) rather than in the month in which s project ❑State Government or Agency payment was made. vately-owned OR Owned by: El Federal Government or Agency • When project is completed,enter month and year in item 9. ❑L�c._I Gcvc nm.c..I or Agcrcy a I AIONTY.LY VALUE^.r CCNST^ D INLwT:.ITEM^.N :wT hr 1 4. START DATE OF CONSTRUCTION Month and year of actual PLACE ON PROJECT DESCRIBE When did actual construction work on the or expected start date Value of construction put you estimate it will Month and year in place during month site start, or when do Y report period as defined in item 5c start? Enter month and year. FEB 2014 (Thousands of dollars) COST ESTIMATES (a) (b) INCLUDE •Site preparation and outside construction such as sidewalks FEB 2014 and roadways $ Z7 4 ,000.00 • Mechanical and electrical installations which are integral parts of the structure,such as elevators, heating equipment, etc. $ '000.00 EXCLUDE • Land and pre-existing structures . Architectural, engineering, and owner's overhead and $ '000.00 miscellaneous costs-See item 6 . Furniture,furnishings,and other movable equipment • Contingency funds $ '000.00 FOR HEAVY NONBUILDING PROJECTS $ '000.00 SEE SPECIAL INSTRUCTIONS ON BACK $ '000.00 NOTE: If project is on a"cost plus"basis,enter your best estimate of the final cost. 5a.CONTRACT CONSTRUCTION COST Construction costs $ '000.00 (Amounts to be paid to contractors and (Thousands of dollars) subcontractors) 821 $ '000.00 $ ,000.00 5b.OWNER SUPPLIED MATERIALS AND LABOR $ '000.00 (Construction materials supplied by owner and the value of work done by project owner's own construction employees assigned to the project.) $ '000.00 $ 000.00 5c.TOTAL CONSTRUCTION COST (Sum of 5a + 5b) $ 821 '000.00 $ 000.00 6. ARCHITECTURAL, ENGINEERING, AND MISCELLANEOUS $ 000.00 COSTS-If book figures are not available, reasonable estimates are acceptable. INCLUDE •All fees for architectural and engineering services. If contractor was authorized to"design and construct"this project,such cost $ '000.00 should be included in item 5a. • Cost of design work by owner's staff If construction is complete except for some minor work . Project owner's overhead and office costs or retainage(up to 3 percent of item 50,you may stop reporting on this project by entering the completion date . Fees and other miscellaneous costs allocated in item 9 and indicating any remarks in item 10. on owner's books to this project EXCLUDE • Cost of movable machiner d Architectural,engineering, y an and miscellaneous costs 9. COMPLETION DATE Month and year equipment, land,and furniture and (Thousands of dollars) of completion furnishings Enter date when all . All interest to be paid directly by construction is State or local governments $ 156 ,000.00 1 actually completed NOTE:Be sure to complete section F on the back of the form. REPORTING INSTRUCTIONS FOR STATE AND LOCAL CONSTRUCTION PROJECTS ►Section A-PROJECT IDENTIFICATION Item 5a-Estimate the total amount to be paid to Correct any information in items 1 and 2 if necessary. construction contractors by the project owner for work done on this project. For the project described in item 1 to be government owned, it must be State or local government owned during Item 5b-Estimate the total cost of labor by the owner's construction and involve the erection of a new structure(s)or construction employees working on the project, including improvements to an existing structure(s) as defined below. supervisory personnel assigned to the project. Include the total cost of all construction materials supplied by the For the project described in item 1 to be privately owned, it owner, including those the owner expects to supply to the must be privately owned during construction and involve the contractor for installation in this project. erection of a new structure(s) or improvements to an existing structure(s) as defined below. Item 5c-Sum of values reported in items 5a and 5b. This is the value to be reported in item 8, monthly value If the project is only maintenance and repairs, please note so of construction put in place. in item 10, Remarks, complete item 11, and return the form. Item 6-Estimate the total amount of fees which the project owner has paid or will pay to architectural and ►Section B-OWNERSHIP AND START DATE engineering firms for work on this project.Also estimate Item 3-As noted, "ownership"for purposes of this survey, the total cost of all other construction items which the depends on the owner during the construction phase. project owner will allocate on his books to this project. Check the appropriate box. Include the project owner's overhead and office costs, the cost of design work by the owner's staff, and other Item 4-The start date is defined as the date that actual miscellaneous construction fees and costs allocated on construction work first began on the project described in the owner's books. DO NOT include the cost of movable item 1. If the project is to start at some future date, please machinery and equipment, land, and furniture and enter the date, complete item 11, and return the form. furnishings. If book figures are not available, reasonable estimates are acceptable. ►Section C-COST ESTIMATES "Construction,"for purposes of this survey, is defined as the ► Section E-MONTHLY CONSTRUCTION building of and/or improvements to fixed structures. PROGRESS REPORT This INCLUDES: a Item 8-Report the monthly value of construction put in . New structures, additions, alterations, conversions, place for the costs associated with item 5c.These costs expansions, rebuilding, reconstruction, renovations, include: rehabilitations and major replacements (such as the complete replacement of a roof or heating system). a. Work done by contractors and/or subcontractors, including any retainage being withheld until the work is b. Mechanical and electrical installations-Plumbing, complete. heating, electrical work, elevators, escalators, central b. The cost of any materials installed which were provided air-conditioning, and other similar building services. by the owner. c. Outside construction-Clearing and grading of c. The work done by the project owner's own construction undeveloped land and the fixed, auxiliary structures emplovees, including supervisory personnel assigned which the project owner builds within the property lines. to this project. Also, roadways, bridges, parking lots, utility connections, outdoor lighting, pools, athletic fields, piers,wharves and Initially, report monthly values from the start month to docks, and all similar auxiliary facilities. the most current month shown in item 8.Then each month, when the form is returned to you, report for the month shown and any revisions which you might have. When entering monthly data, be sure to report the costs FOR HEAVY NONBUILDING PROJECTS in the month in which the work was done rather than in the month in which payment was made. In addition to a, b, and c, construction INCLUDES: If the contractor's bills are for periods other than monthly, d. Fixed works, such as power plants, dams, highways, estimate a monthly amount. In each month where there is bridges, reservoirs and sewer and water facilities. no construction, enter a zero. e. Machinery and equipment which are integral parts of Item 9- If construction is complete except for some structures.Also fixed, largely site-fabricated equipment minor work or retainage (up to 3 percent of item 5c), you such as storage tanks. may stop reporting on this project by indicating in item 10, Remarks, and entering the completion date in item 9. f. The following types of equipment: boilers,towers and fixtures. EXCLUDE: Movable machinery and equipment which ► Section F-PERSON TO CONTACT REGARDING are not integral parts of structures.Also,for power THIS REPORT generation plants,exclude primary power producing machinery such as generators, reactors, and steam Item 11 -Enter the name,title, address,telephone and engines. fax number of the person who can answer questions about this report. 10. REMARKS sVIW-V/Try ay • PERSON TO CONTACT REGARDING THIS REPORT- Please print or type 11 a. Name b.Title c.Telephone Area code Number Extension d.Organization e. Address f.Fax Area code Number -ORM C-700(SD 16 18-2013) Department Labor and Industries a day �' CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Project Name County Project or ContradN Olympia WA 98504-4540 Prime Contractor ElMisty Cove Lift Station Replacement King WWP-27-3678 (360)902-5335 Project Address City State Subcontractor ® 5027 Ripley Ln N Renton WA Awarding Agency Name - .Phone Company Name ---- Phone For the week ending: City of Renton _ 425430-7279 WCCL Systems LLC 253-W-4964 Month Day Year Address City State ZIP+4 Address City State Z1P+4 05/032014 1055 S Grady Way Renton WA 98055 3407 N 24a'Street Tacoma Wa 98406 Work Classification Name b Day and Date Deductions Sun_ Mon Tue Wed Thu Fri Sat Total and and Rate Hourly Soc Sec#of Employee Address a Total of Gross Amount "usual Withold- NET Hours Worked Each Day Hours Pay Eamed Benefits" FICA ing Tax Other WAGES 1 OT 0.00 s 0.00 2. OT o.W 000 o W s °. RECEIVED � s °.o, RG o.00 0.00 3. OT 0.00 _ °.00 UN 0 2 2014 o.ao s 0.00 s 0.00 RG ow 0.00 4• °T 000 °° 0.0 s 0.00 UTILITY SY TEM s o0o RG 0.00 0.00 5. O'T 0.00 0.00 i 0.00 s 0.00 s 000 I RG 0.00 0.00 6. OT 0.00 0.00 0.00 s 0.00 s 0.00 RG 0.00 0.00 7 OT 0.00 0.00 0.00 s 0.00 $ o oa RG 0.00 0.00 8. OT 0.00 0.00 0.00 s 0.00 s o.00 RG 0.00 0.00 9. OT 0m 0.00 0,00 s 0.00 s 0.00 RG 0.00 0.00 10. OT 0,00 0.00 --F0.00 s 0.00 s 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and.Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program AFFIRMATION PO Box 44540 Olympia WA 98504-4540 Today's Date Printed name of party signing this report Title 05/28/2014 Gina Gepke Administrative Asst The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: WCCL Systems LLC Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 04/27/2014 05/03/2014 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly Work Classification "Usual Benefits" (A)HourlyPension (E)Approved (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday A+B+C+D+E Apprentice Program 1 $ 0.00 2• $ 0.00 3• $ 0.00 4• $ 0.00 5• $ 0.00 6. $ 0.00 7• $ 0.00 8. $ 0.00 9• $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name of party signing this report Title Signature 91 Gina Gepke Administrative Asst 7� ILA— F700-065-000 certified payroll report backer 05-09 Department of Labor and Industries a RTIFIED PAYROLL REPORT Prevailing Wage ProgramPO Box 44540 Project Name County Project or Contract# Olympia WA 98504-4540 Prime Contractor Misty Cove Lift Station Replacement King WWP-27-3678 (360)902-5335 Ci State Project Address ty Subcontractor ® 5027 Ripley Ln N Renton WA Awarding Agency Name Phone Company Name Phone For the week ending:___ City of Renton 425-430-7279 WCCL Systems LLC 253-606-4964 Month Day Year Address City State ZIP+4 I Address City State ZIP+4 5110/14 1055 S Grady Wy Renton WA 98055 3407 N 24th Tacoma WA 98406 Day and Date Deductions Work Classification Name ta Sun Mon Tue Wed Thu Fri Sat Total and and Rate Hourly Soc Sec#of Employee Address 0 w os a o7 os a, io Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours pay Earned Benefits" FICA ing Tax Other WAGES Ladislao Amaral OT 0.00 o.00 1. General Laborer 16308 7th Ave Ct E 375.21 s 0.00 a23.70 $0.00 $6.04 $340.47 528-6- Spanaway,WA 98387 RG 7.00 z.00 9.00 41.69 375.21 Frank Valdes OT 0.00 0.00 2.General Laborer 9617 10th Ave E 375.21 s 0.00 s28.70 s41.00 S6.04 s299.47 402-7 Tacoma,WA 98445 RG zoo 2.00 9.00 41.69 375.21 OT 0.00 0.00 3. 0.00 $ 0.00 s o.00 RG 0.00 0.00 OT 0.00 0.00 4. 0.00 s 0.00 s 0,00 RG 0.00 0.00 OT 0.00 0.00 5. 0.0) $ 0.00 s 0.00 RG 0.00 0.00 OT 0.00 0.00 6 0.00 s 0.00 s 0.00 RG 0.00 o.a0 OT 0.00 0.00 7 0.0o s 0.00 s o.00 RG 0.00 0.00 OT 0.00 0.00 g. 0.00 s 0.00 $ 0.00 RG 0.00 0.00 OT 0.00 0.00 9. 0.00 $ 0.00 s 0.00 RG 0.00 0.00 OT 0.00 0.00 0. 0.00 s 0.00 s 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 05/28/14 Gina Gepke Administrative Asst The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: WCCL Systems LLC Project Name: For the week starting: For the week ending: Misty Cove Lift Station 05/04/14 05/10/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program A+B+C+D+E 1. General Laborer $ 0.00 2.General Laborer $ 0.00 3. $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda,is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name of party signing this report Title Sign Turwy, Gina Gepke Administrative AssistantklOk -1 F700-065-000 certified payroll report backer 05-09 U.S. Department of Labor PAYROLL (For Contractor's Optional Use; See Instructions, Form W11-347 Inst.) Employment Standards Administration t'eGons arr not,couired to d,e collection of inf'o,ma(ion an1e.+5 it di5phvs a cunvml.•.:did 01013 cem,nl numbs,. Wage and Hour Division NAME OF.,CONTRACTOR:;•o " OR SUBCONTRACTOR :� r a , ;:_.. .� .,.- 4- 'ADDRESS----- _ - Y = - z.`•r;-' - _ :O\1t3:No I?15-0149" - `. _ - Johnston onstruction Company Inc. 4527 So'Orchard Street Tacoma WA 98466 _ L�pires 12-31=11 PAYROLL NO' : FOR WEEK ENDING - PROJECT btOCATION PROJECTOR CONTRACT NO 1 FINAL 7 5,14 14 Mlsty:;C:oye Lift,Station, 1�1R'P.2i,3G78 ' _. (t) (2) (3) (4)DAY OF WEEK (s) l61 (7) te) T F S M T I W le) DEDUCTIONS NO. g 9 10 12 IJ 14 W/HOLD RATE GROSS L&I DUES NET NAME,ADDRESS,b SOCIAL b WORK HOURS WORKED EACH DAY TOTAL OF PAY AMOUNT FICA WITHHOLD- OTHER TOTAL WAGES SECURITY NUMBER EXEMPT CLASSIFICATION HOURS EARNED Med.Aid ING TAX Vacation DEDUCT PAID FOR WEEK Lyle Renecker 7677 S T 664.47 78.86 W. 1021 Partrid-e Drive Olympia; WA 98502 0 Bricklayer ST 5.5 8 4 17.5 37.97 607.53 18.45 228.00 18.80 84.43 33.5 462.04 809.96 Roger McClure 0951 S 0 429.78 75.84 P.O. Box 2562 Gis Harbor. WA 98335 1 HodCarrier ST 5 8 13 33.06 793.44 17.74 196.00 20.76 44.40 38.85 393.59 929.63 Chris Moore 9554 S 462.80 64.01 825 Monterey Lane Fit-crest. WA 98466 1 Bricklayer 5 8 7 13 35.60 569.60 14.97 149.00 16.27 73.08 29.00 346.33 686.07 Clif Loper 2597 M 74.82 16429 Railway Rd. SE Yelm. WA 98597 0 HodCarrier 7 8 5.5 8 8 36.5 33.06 1206.69 17.49 1.39.00 20.48 43.80 38.33 333.92 872.77 ST We estimate that it will take and average of 56 minutes to complete this collection of information,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. If you have any comments regarding these estimates or any other aspect of this collection of information,including suggestions for reducing this burden,send them to the Administration,Wage and Hour Division,ESA,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W.,Washington D.C.20210 Form WI I-347,Revised Nov. 1998-FORNIERLY S01.I&t-PfAi(:HAS/_'T/flS 911?1(:71)'1-7?0,bf 7-Nf:SIJI'7'.DI'Ix)(7114b113:T'; Date Mav,28, 201.1 benefits as listed in the contract have liven or will be made to appropriate programs fur the benefit or such cmplo)'ces,etcept as noted I, Icd 1'.Olafson 'Treasurer in Section 4(c)below. (Name of Signatory Party) ('Tide) Du hereby state: (h)W11FRE FRINGE nENITITS ARE PAIN IN CASII (1) That I pay or supervise the payment of the persons enydoyed by Ct—Each laborer or mechanic listed in the above referenced payroll has Inhnsion Construction Comuany. Ills• on been paid,as indicated on the payroll,an amount not less than the sum of the the applicable basic hourly wage rate plus life amount of the required (Contractor or Subcontractor) fringe benefits as listed in the contract,irwept as noted in Section 4(c) below. Misty Cove Lift Station (Building or Work) (c)fiXClil''1'IONS that during,the payroll period commencing on the Sthdayof May 2014 and endingthc 14111 day of all persons employed on said project have been paid the full weekly wages earned,that nit rebates BRICKLAYERS 11A11CARKIIKS have been or will be made either directly or indirectly to or on behalf of said Johnston Construction Com iriy. Inc. from the full (Contractor or Subcontractor) 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 defintvl in Regulations,Puri 3(29 CHI Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Slat.948,93 Slat.108,72 Stut.967,7o Stat.357,40 U.S.C.276c),and described below: (2)That nny payrolls otherwise under this contract required ut le submittal for the above period fire correct and complete: that the wage rates for laborers or mechanics contained therein are not less than lite applicable wage rates contained in any wage determination incorporated into the contract: that file classifications set forth therein for each laborer or mechanic conform with the work he perforned. (3) 'That any apprentices employed in the.above period are duly registered in a bona fide apprenticeship program registered with a Stateapprenticeship agency recognized by the Bureau of Apprenticeship and'Training.United States Department of Labor,of if no such recognised agency e%isfs in a State,:u•c regiSdered N ith the Bureau of apprenliceshit,and Training,United States The willful falsificationiiut of and of,tile above slatenxnU map subject the contractor or Deltartmrnt of Labor. Subcontractor to civil or•criminal prosecution.See Seclion 101 of'fitle IS and Section 231 of title 31 of the United States code. (4)That: (al 1�'u1;Itl:F)tlst"r BI: EP NITS ARE PAID•TO APPM."';D PLANS.FUNDS,OR NAME,AND TI TLF SIGN41,•1 URE, 1 PItOC R��15 JC(I I'.0IaIS(111/T1•CaSl1TCr /2 � \Xo— in addition to the.basic hourly'wage rates paid to each lal ref or (�J��(/ mechanic listed in the above referenced payroll,payments of fringe —�/ Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish.WA 98296-3989 Payroll No. 17 For Week Endin : May 31,2014 Pro ect&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No,of Work SIMI TIWIThl F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 25 1 26 1 27 1 28 1 29 1 30 1 31 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 7.00 10.00 10.00 5,00 32.00 53.02* 1961.74** (28.45) Bremerton,WA 98312 Operator (121.63) (184.00) (19.00) (212.50) (565.58) 1,396,16 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.98, **Andrew worked 5 hours on another job Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 7.00 10.00 10.00 10.00 37.00 51.17* 1,893.29 (27.46) Lake Stevens.WA 98258 Operator (117.38) (140.00) (19.78) (39.00) (343.62) 1,549.67 XXX-XX-1921 O *Employee benefits hourly value=$1.83 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 7.00 10.00 10.00 7.00 34,00 44.46 1642.41** (23,81) Maple Valley,W 98038 (101.83) (182.00) (19.31) (326.95) 1,315.46 XXX-XX-4901 O **Richard worked 3 hours on another ob S O RECEIVED JUN 0 3 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement :that during the payroll period �X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 25th day of May 2014,and ending the 31 st day paid,as indicated on the payroll,an amount not less than the sum of the of May , 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned.that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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. © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Signature (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS rKath Salazar,Office Mana er wilful falsification of any of the above statements may subject the contractor Or ub- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the tractor to civil or criminal prosecution. See section 1001 or Title 18 and Sec0Q11 231 above referenced payroll,payment of fringe benefits as listed in the contract have been tle 31 of the United States Code. 5/30/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE HECCEh"SSH WORK CLASS PAY PERIOD DATE: 24-May 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA L&I TOT DED 18-May 19-May 20-May 21-May 22-May 23-May 24-May FIRS PAY FWI-I UNION WK.GROSS NET PAY HANSON.GORDONP 169DI 21ST Ave St SSNH.........5915 0 0 0 0 0 0 0 0 0 0.00 100.47 7.16 405.44 DO TELL WA 98012 r:LEC.IJR s 0 0 0 0 0 8 0 8 338.96 219.00 78.81 0.00 1313.47 319.47 85.97 908.03 DORRAI1.LON 110 UOX S060 SSN9..........3096 0 0 0 0 0 0 0 0 0 0.00 143.42 9.24 477.15 WENATCHEE,WA96907 ELEC.nR S 0 0 0 0 0 8 0 8 374.96 212.00 112.49 0.00 1874.80 355.42 121.73 1397.65 5/30/2014 STATEMENT OF COMPLIANCE 1,ELLY MCINTYRE,OFFICE MANAGER do hereby state: (1)That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 18th of MAY 94,and ending the 2H It day of MAY'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker,laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona ride apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c) EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER /�1U uepar Prevailing a t aoor ra maustnes sTATF CERTIFIED PAYROLL REPORT Prevailing Wage Program "� °�' o b ' 4. PO Box 44540 - y Olympia WA 98504-4540 p� y? Project Name County Project or Contract# y�7889 au Prime Contractor Misty Cove Lift Station Replacement King WWP-27-3678 (360)902-5335 ® Project Address City State Subcontractor Renton Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425-430-7279 Miles Sand&Gravel Company-(Gary Harper) 253-833-3705 Month Day Year Address City State ZIP+4 Address City State ZIP+4 5/10/14 1055 S Grady Way Renton WA 98055 400 Valley Ave NE Puyallup WA 98372 Day and Date Deductions Work Classification Name Sun Mon Toe Wed Thu Fri Sat Total and and 'u v Rate Hourly Soc Sec#of Employee Address o sun4 Sisn4 sic i4 snn4 5 i4 5�9�14 snon4 Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Transit Mixer-All Scott Ellis OT 0.00 %07 o.00 PO Box 264 74.10 $ 9.85 $ 74.10 000-00-5021 Buckley,WA 98321 RG 2.22 2.22 33.38 74.10 2 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 3. OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 4. OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 5. OT o.00 50.07 0.00 0.00 $ 9.85 s 0.00 RG 0.00 33.38 0.00 6. OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 O.oO 7 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 g OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 9. OT 0.00 5007 o.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 10. OT o.o0 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 F700-065-000 certified payroll report 05-09 Employee.Benefits Distribution and Signature Certification on Reverse Side UCparllllClll Ul LUDUr WU IIIUUBlrICS Prevailing Wage Program AFFIRMATION PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 5/27/14 Marjean Davis Payroll/HR Mgr The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Miles Sand&Gravel Company -(Gary Harper) Project Name: For the week starting: __TFor the week ending: Misty Cove Lift Station Replacement 5/4/14 5/10/14 "USUAL BENEFITS"DISTRIBUTION (Please report in "per hour"terms) Total Hourly Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C) Hourly Vacation (D)Hourly Holiday (E)Approved A+B+C+D+E) Apprentice Program 1. Transit Mixer-All $ 9.85 $3.34 $4.82 $0.99 $0.70 2. $ 9.85 $3.34 $4.82 $0.99 $0.70 3. $ 9.85 $3.34 $4.82 $0.99 $0.70 4. $ 9.85 $3.34 $4.82 $0.99 $0.70 5. $ 9.85 $3.34 $4.82 $0.99 $0.70 6. $ 9.85 $3.34 $4.82 $0.99 $0.70 7. $ 9.85 $3.34 $4.82 $0.99 $0.70 8. $ 9.85 $3.34 $4.82 $0.99 $0.70 9• $ 9.85 $3.34 $4.82 $0.99 $0.70 10. $ 9.85 $3.34 $4.82 $0.99 $0.70 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature Marjean Davis PayrolUHR Mgr /y , F700-065-000 certified payroll report backer 05-09 L)epar Prevailing or t aoor ano maustnes Esrare CERTIFIED PAYROLL REPORT Prevailing Wage Program �,"�' p4 PO Box 44540 Olympia WA 98504-4540 "r �2 Project Name County Project or Contract# �y1 I889 CVy Prime Contractor ❑ Mist Cove Lift Station Replacement Kin WWP-27-3678 (360)902-5335 y P g Subcontractor ® Project Address City State Awarding Agency Name Phone Company Name Renton Phone For the week ending: City of Renton 425-430-7279 Miles Sand&Gravel Company-(Gary Harper) 253-833-3705 Month Day Year Address City State ZIP+4 Address City State ZIP+4 5/17/14 1055 S Grady Way Renton WA 98055 400 Valley Ave NE Puyallup WA 98372 Day and Date Deductions and and Work Classification Name A Sun Mon Tue Wed Thu Fri Sat Total v Rate Hourly Soc Sec#of Employee Address O'C 5nina snzna >ii3n, snap, snsna 5nc1u 5inaa Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Transit Mixer-All Eric Stoll OT 0.00 50.07 0.00 243 Riggs Dr E 52.41 $ 9.85 $ 52.41 000-00-1511 Enumclaw,WA 98022 RG 1.57 1.57 33.38 52.41 2, OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 3. OT O.00 50.07 0.00 o.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 4. OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 5. OT o.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 6. OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG O.00 33.38 0.00 7. OT O.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG O.00 33.38 0.00 8. OT 0.00 50.07 0.00 0.00 $ 9.85 g OM RG 0.00 33.38 0.00 9. OT 0.00 50.07 0.00 0.00 $ 9.85 _ $ 0.00 RG 0.00 33.38 0.00 10. OT 0.00 %07 O.0o 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 F700-065-000 certified payroll report 05-09 - Employee Benefits Distribution and Signature Certification on Reverse Side UCparllllClll Ul L'dDUr UJIU IIIUUSLrIC3 AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Date Printed name of party signing this report Title 5/27/14 Marjean Davis Payroll!HR Mgr The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Miles Sand&Gravel Company -(Gary Harper) Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 5/11/14 5/17/14 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour"terms) Total Hourly Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday (E)Approved (A+B+C+D+E) Apprentice Program 1. Transit Mixer-All $ 9.85 $3.34 $4.82 $0.99 $0.70 2. $ 9.85 $3.34 $4.82 $0.99 $0.70 3. $ 9.85 $3.34 $4.82 $0.99 $0.70 4. $ 9.85 $3.34 $4.82 $0.99 $0.70 5. $ 9.85 $3.34 $4.82 $0.99 $0.70 6. $ 9.85 $3.34 $4.82 $0.99 $0.70 7. $ 9.85 $3.34 $4.82 $0.99 $0.70 8. $ 9.85 $3.34 $4.82 $0.99 $0.70 9. $ 9.85 $3.34 $4.82 $0.99 $0.70 10. $ 9.85 $3.34 $4.82 $0.99 $0.70 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature Marjean Davis Payroll/HR Mgr F700-065-000 certified payroll report backer 05-09 RECf IVED JUN 19 2014 CITY OF 'RENTON UTILITY SYSTEMS PAYROLL SUPPLEMENTARY SHEET NO WORK PERFORMED SUBCONTRACTOR: ADVANCED POWER, LLC PAYROLL # I HEREBY CERTIFY THAT NO EMPLOYEE,WORKED ON THE CONSTRUCTION OF PROJECT 1 1 COl DURING THE PERIOD FROM THE r-kD OF MQAJ , 20LJ�_THROUGH OF DATE: SIGNATURE: TITLE: M 6/12/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE NL"xmfpT/5SH Woes CLASS PAY PERIOD DATE: 7-Jun 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA L&1 TOT DED I-Jun 2-Jun 3-Jun 4-Jun 5-Jun 6-Jun 7-Jun HRS PAY FWH UNION WK.GROSS NET PAY EIANSON,CORDON P 1690I21ST Ave SE SSNP.........5915 0 0 0 0 0 0 0 0 0 0.00 57.37 3.69 192.06 DOTI HELL WA 9R012 ELL•c./nt s 0 0 0 0 0 8 0 8 374.96 86.00 45.00 0.00 749.92 143.37 48.69 557.86, DORMAN.LON PO DOS 5060 SSNB..........3896 0 0 0 0 0 0 0 0 0 0.00 123.42 8.31 187.11 WENATMEE,WA 988D7 ELEC.JJR s 0 0 0 0 0 8 0 8 374.96 166.00 189.38 0.00 1613.40 289.42 197.69 1126.29 6/12/2014 STATEMENT OF COMPLIANCE rf I,ELLY MCINTYRE,OFFICE MANAGER do hereby state: (I)That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the Ist ofJUN'14,and ending the 7th day ofJUN'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3 (29CFR 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: I (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 the laborers or mechanics contained therein are not less than die applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each worker, laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 13ENEFITS ARE PAID IN CASH () Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll an each 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,except as noted in section 4 (c)below. (c)EXCEPTIONS EXCEPTION (craft) EXPLANATION I I REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties NAME AND TITLE S]GNATURE ELLY MCINTYRE,OFFICE MANAGER Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. _ 14831 223rd St SE,Snohomish,WA_9.8296_3989 Payroll No.19 For Week Endin :June 14,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 8 1 9 1 10 11 1 12 1 13 14 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 10.00 8.00 10.00 9.00 37.00 53.02* 1,961.74 (28.45) Bremerton,WA 98312 Operator (121.63) (184.00) (19.78) (212.50) (566.36) 1,395.38 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.98 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 8.00 10.00 8.00 36.00 51.12* 1,840.32 (26.68) Lake Stevens,WA 98258 Operator (114.10) (132.00) (19.25) (39.00) (331.03) 1,509.29 XXX-XX-1921 O *Employee benefits oudy value=$1.88 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S Ft Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 8th day of June 2014,and ending the 14th day paid,as indicated on the payroll,an amount not less than the sum of the of June , 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work he performed Remarks (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 State Department of Labor. (4)That: Name and Title Si ure (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may s ject the contract r or sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and fiction 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 t Prime Contractor Project Name County PrOjIM or Contracts Olympia.WA 98504-4540 )1 F/ (360)902-5335 DO1850&Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor X Project Address city State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year (Address City State ZIP+4 Address City State ZIP+4 05 / 18 / 2014 1 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukvwla WA 98168 DAY AND DATE Deductions Work Classification Name Total and and Earn MON TUE WED1 THU FRI SAT SUN Total Rate Hourly Withhold- and Seca of Employee Address Code - Hours of Gross Amount "Usual FICA mg Tax Other NET 05/12 05/13 OS/14 05/15 05/18 05/17 05/t8 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY__ ' No Work Performed F700-065-000 certified payroll report 05-09 Paq 1 OF 1 C n _i r O z (ll n _M m _0 C m - i p �' Ill cn z 0 D %3ilig "tePntand ",rti" AFFIRMATION Prc,ailittg Wag Pnrlran, PU Bo%as s m ohrnpu WA 985at4W Page 1 of 1 Today's late Printed natne of party.igning this mport Title - -- -� 06I03114 Wendy C orrway Payroll Administrator The parry signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: _ Bravo Environmental NW.Inc. _ Project Name: T�!C e week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 5/12/14 05/18/14 "IJSUAI.BENEFITS"DISTRIBUTION (Please report in"per hour"terns) - .. Iolal IIourty (E)Appro%vd Work Classification -Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C1 Ilourly Vacation JD) hourly llolida,� Apprrmicr Program A+0+C+D-Fi 2. 3. 4. 5. 6. 7. 9. 9. 10. I he parry-agmng below.fit h IH CIS the following: 1 t All information contained in this Certified Payroll Report,including any addenda,is correct and complete. Q) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker.labo er or mechanic. (►► The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persuns employed un the above-refcrctKxd prujcct(s)leave been paid the full weekly wages earnwd.and ttu rebates Rase been ur will be owdc citlwr dirccd, or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions.other than those which arc Iceal h permissible,have been made by any pennon either directly or indirectly from the ful I wages earned (51 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprcnticcshtp Auld Training Counc il. Falsification of any of the above statements is a violation of WAN 19.12.050 subject to prosecution, sanctions, and penalties. Printatypenantteofnatty:igninc-hi.report Title r Signature C _ ____ I Payroll Administrator r700.0654)00 certified payroll report backer 05 09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor I I Project Name County Project or Contract# Olympia,WA 98504-4540 (360)902-5335 I D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor ❑X Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA -Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 05 / 25 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 05/19 05/20 05/21 05/22 05/23 05/24 05/25 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Pag 1 OF 1 Lljunment„t LAbor and InduWics AFFIRMATION Pic,jding wage Proyam 110 1iot 44540 1)1%mnia%A 993044W Page 1 of 1 Tuday's Date Printed name ofparty signing this report Title (]5=14 Wendy ConwayPayroll Administrator The patty signing this report pays or sup rviscs the (Name of contractor or subconlractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project Nam: For the Mock starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 06119/14 05/25/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) I alai Hourty (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Ntedksl (C)Hourly Vacadoe (D)Hourly Holiday Appremike Program A*3+C•o-E I. 4 S. (t. 7 x 9. 10. I he party signing below AF F7RMS the following: t I► All information contained in this Certified Payroll Report,including any addenda.is correct and complete. 0) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (3) The payments of usual benefits m listed above have been or will be made to appropriate approved plans.funds or programs for the benefit of such employees. (4) All perboub e11[ployt.'d un(tte abu%,c-rcfctcnecd Nto)ect(a)slave btxtl paid the full Meekly wages fc-Anwd.and IIU reb:atea Ita%e been or will be inade clttwT dirmily or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wastes earned by anti•person.No deductions.other than those which are legally permissible.have been made by any person either directly or indirectly from the tid I wages earned i c t Any apprentices employed in the-alxwve period are duly registered in a bona fide apprcnuccahtp program registered with the Washington State Apprenticeship mki Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Pnnt or htx name of party signing this report rifle Signature II — I w U Amx y Conway - f700-065-M)ccrtifrcd payroll rcportbacker 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831223rd_St_SE,_Snohomish,WA-98296-3989 Pa roll No.18 For Week Endin :June 7,2014 Project&Location:Mist Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678. Da and Date Gross Deductions Net Wages Name,Address and No.of Work SIMI TfWIThI F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 1 1 2 1 3 4 1 5 6 7 1 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Day I Andrew Evans 2126.80" 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 7.00 37.00 53.17' 1,967.29 (30.83) Bremerton,WA98312 Operator (131.86) (218.00) (20.91) (212.50) (614.10)1 1,512.70 XXX-XX-7696 Lead O *Employee benefits hourly value=$1.83, "Andrew worked 3 hours on another job Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 10.00 10.00 40.00 51.31 2,052.40 (29.76) Lake Stevens,WA 98258 Operator (127.25) (163.00) (21.39) (39.00) (380.40) 1,672.00 XXX-XX-1921 10 'Em to ee benefits ourly value=$1.69 Richard McKenney,Jr. 1775.79" 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 10.00 7.00 37.00 44.46 1,645.02 Maple Valley,W 98038 (110.10) (206.00) (20.91) (362.76) 1,413.03 XXX-XX-4901 O "Richard worked 3 hours on anotherjob S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I. Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement ;that during the payroll period �X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 1st day of June 2014,and ending the 7th day paid,as indicated on the payroll,an amount not less than the sum of the of June . 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed Remarks (3)That any apprentices employed in the above penod 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 State Department of Labor. (4)That: Name and Title Signature 4"WrIv/ (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subject the contractor sub- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Se on 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 ` Prime Contractor Project Name County Project or Contractit Olympia.WA 98504-4540 (360)902-5335 0018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 13ulown aetor a Project Address City State ZIP+4 Misty Cove Lift Station Replac menl Renton WA Awarding Agency Name Phony 1 Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City Sate ZIP+4 Address City State ZIP+4 06 1 01 1 2014 1055 S Grady Way Renton WA 9805s 6437 South 144th Street Tukwala WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MOpI TUE WED' THU FRI SAT ' SUN Total Rate Hourly Withhold- Address Other Soc Seat of Employee Address Code Hours of Gross Amount "Usual FICA T Oth NET 05@6 05127 06128 05129 05130 05/31 WO Pay Earned Benefits" WAGES HOURS WORKED EACH DAY No Work Performed- F700-065-000 certified payroll report 05-09 Pag 1 OF 1 CZ t- c ill < o z C) m m m � C m � 0 � atn, �r tanntn,t�aric, Pic%ai I m AFFIRMATION Pi c+ g N"aFK Prup'ant PO Ik+a 44540 01ympis WA 983044W Page 1 of 1 Today's Date Printed name of psny signing this report Title _- 06/17/14 Wencly Conway _ Payroll Administrator _ The party signing this report pays or+upervi-ws the (Name of contractor or subcontractor) payment of the persons employed by: _ Bravo Emrironmental NW.Inc. -- Prt jest Name: For the week starting For the week ending: D018509-Gary Harper-Misty Cove Lift 05/26114 06/01/14 "IISUAI.BFNF.FITS"DISTRIBUTION (Please report in"per hour"terms) Iotal llourly _ - (E)Approsed Work Classification l coal lienelitx" (A)Hourly Pension (81 1lourh Medical (C)Hourly Vacation (D) llourlc llolidr% Apprenticr Program (c a•c o-t.t I. 2. 1. 4, 5 G. 7. x. 9. 10. I he party signing below AF F IKhIS the following: (I) All information contained in this Cenifled Payroll ReTwn, including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as report d above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual Murk performed by such worker,laborer or mechanic (3) The payments of usual benefits as listed above have been or will be made to appropriate appro%cd plans.funds or programs for the benct'it of such employees. 14) All peiYi 1s clttltloytd Vtl ilw above-IcfereaLLd pto/ect(s)have bcctl pdid lie full Meekly wagcs caned.and tMt rrtwtcs Itd%c Itccu of will Ite made citlki ditcclls ul indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by atn person.No deductions,other than ihwse which are leualh pemiiscihle.hace tern made by any person either directly or indirectly from the till I wages earned Igl Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Woihington Stute Apprenticeship and Training Council. Falsification of an% of the above statements is a violation of RCN .19.12.050 subject to prosecution,sanctions, and penalties. Pnmort"Wnemeofparty signing th rcr~n Irtic S Payroll Administrator -- 1­700-065-000 certi13od payroll report backer 05-09 Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Prime Contractor El Project Name County Project or Contract# Olympia,WA 98504-4540 11 (360)902-5335 I/ D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 06 / 08 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED I THU I FRI I SAT I SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount Usual FICA ing Tax Other NET 06/02 06/03 06/04 06/05 06/06 06/07 1 06/OS Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Page 1 OF 1 Depannimt of tabor and!:Wustries AFFIRMATION Pmailing Rage Program PO[lox 44540 Olympia WA "MM 4W Page 1 of 1 Today's Date Printed name of pan)signing this report Title M17114 Wendy Conway Payroll Administrator The party signing Ibis report pays or supery ivy the (Native of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. - -"Oct vim: For the..ock starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 06/02/14 06/08114 "hS1 Al RENFFITS"DISTRIBUTION (Please report in"per hour"terms) Fetal HettApproved Nork Classificatiaa "Useal Besents" (.10 llourl,i Pension 4B) Ilourh Medical (C)Hourh Vitcation (D)Hourly Holiday Apprentice ice Program (A+a+C+D+E) I. 2. 3. 4. 5 G- 7. 9. 9. 10. I he pang signing below Al-F MINIS the lollou ing: l 1 t All information contained in this Certified Payroll Repon,including any addenda.is correct and complete. (2) The wage rates for workers.laborers or mechanics as repotted above are not less than the applicable wage rate+contained in any wage determination related to the contract;and the classiticatons as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker. laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All Mbcmt]employed UII tlK al>,ne-ICfCII'IICCd ptUj'tel(b)have bt=l paid Qte full%Lckly Wagub caltttll.and tto Icbatts ltasc bcen or Ntll tie 11614le citllcl dirccll% in indirectly to or on behalf of the above-named contractor or subcontractor from the woekiv wages earned by anv person.No deductions,other than"i%t which are Ieeal h, permissible,have been made by any person either directly or indirectly from the ful I wages eamed (51 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a %iolation of RC'N 39.12.050 subject to prosecution,sanctions, and penalties. ---------- - type name ofpany signing this re ton I Title — — Signature — Will*s`,WM Payrol Administrator f MQ`065-M cedified payroll-va baclter 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.20 For Week Endin :June 21,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 DaX and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 15 16 17 18 19 20 21 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S 7.00 8.00 3.00 18.00 52.91 952.38 (13.81) Bremerton,WA 98312 Operator (59.05) (33.00) (9.62) (212.50) (327.98) 624.40 XXX-XX-7696 Lead O *Employee benefits hourly value=$2.09 Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S 9.00 10.00 19.00 51.14` 971.66 (14.09) Lake Stevens,WA 98258 Operator (60.24) (13.00) (10.16) (39.00) (136.49) 835.17 XXX-XX-1921 O 1 1 1 1 *Employee benefits ourly value=$1.86 Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period OX --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 15th day of June 2014,and ending the 21 st day paid,as indicated on the payroll.an amount not less than the sum of the of June , 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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. © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig are�l1� ,J^, a, (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager !L The wilful falsification of any of the above statements may subjed the contractor ub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sect' 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. U.S. Department of Labor PAYROLL WHD Wage and Hour Division For Contractor's ht t h347i/hd/f/l d t ti t I S l U ti O onase;See Instructions a www.dol.gov/whd/forms/wh347instr.htm)p g ) U.S.Wage and Hour Division Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev.Dec.2008 NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS OMB NO.: 1235-0008 Lakeridge Paving Co. LLC PO BOX 8500 Covington WA 98042 1 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION Gary Harper Const PROJECT OR CONTRACT NO. Payroll #1 06/14/14 Renton, WA 13-404-W (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) � (e) z w in DEDUCTIONS S 0: oaroa oaioe oeno oam oenz aen3 Dan NET NAME AND INDIVIDUAL IDENTIFYING NUMBER �� O GROSS WAGES p= F Sun Mon Tue Wed Thu Fri Sat WITH- (e.g.,LAST FOUR DIGITS OF SOCIAL SECURITY ix- WORK O TOTAL RATE AMOUNT HOLDING SWI I L& I TOTAL PAID NUMBER OF WORKER 93 CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Ronald D o 187.61 o.o Ca rl sen 0 General Laborer 14.36 0.73 0.00 1.61 37.24 53.94 133.67 a.50 1726 S 4.50 41.69 0.0 187.61 William D 193.4 0.0 Cozad 0 General Laborer 27.42 38.55 0.00 4.28 75.11 145.36 213.10 a.5o 9875 S 4.50 42.99 O.0 358.46 Dan A o A4.2 0.0 Garl 0 Screedman 78.25 104.12 0.00 11.07 75.92 269.36 753.59 5265 S 5.50 5.50 53.49 0.0 Jeffrey 0 /294.2o.oHooper 3 Spreader, Topsi 78.26 72.09 0.00 11.07 213.25 374.67 648.28 5.505442 S 5.5053.49 O.0 Troy R 0 247.5 McCord 0 General Laborer 0.0 102.98 209.52 0.00 14.29 146.27 473.06 873.09 S 5.50 5.50 45.00 O.0 1346115 0 0 0 0 s 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.0 0.00 Mark E o 0.017 117.6 S z.so 2.50 Morrow 1 Dumpster 0-16 y 39.85 47.62 0.00 6.62 26.05 120.14 400.80 47.07 0.0 520.94 Johnathan 0 193.4 0.00 Moser 1 General Laborer 38.52 48.91 0.00 7.14 175.47 270.04 233.42 S a.so 4.50 42.99 0.0 503.46 While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a). The Copeland Act (40 U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week." U.S.Department of Labor(DOL)regulations at 29 C.F.R.§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing ttie collection of information. If you have any comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W. Washington,D.C.20210 (over) U.S. Department of Labor PAYROLL WHD Wage and Hour Division For Contractor's t/l t ti t I l U ti O onase; See Instructions a www.dol.gov/whd/forms/wh347instr.htm)p g ) U.S.Wage and Hour Division Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev.Dec.2008 NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS OMB NO.: 1235-0008 Lakeridge Paving Co. LLC PO BOX 8500 Covington WA 98042 Expires: 01/3 112 01 5 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION Gary Harper Const PROJECT OR CONTRACT NO. Payroll #1 06/14/14 Renton, WA 13-404-W (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) (8) i w DEDUCTIONS M 0e/08 06109 06/10 08111 OB/12 OB/t3 OB/1 NET J NAME AND INDIVIDUAL IDENTIFYING NUMBER u GROSS WAGES (e.g.,LAST FOUR DIGITS OF SOCIAL SECURITY sun Mon 7ue wee Thu F Set WITHPAID - NUMBER OF WORKER $96 CLASSIFICATION O HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TOTAL RATE AMOUNTH TAX G SWH L& I OTHER DEDUUCTIONS FOR WEEK Donald 0 235.35 0.0 Nesper 0 Dumpster 0-16 y 48.38 47.35 0.00 7.85 98.76 202.34 430.14 5.00 2822 S 5.00 47.07 0.0 632.48 Christopher N 0 236.4 o.o Pedersen 6 General Laborer 56.32 26.89 0.00 8.75 315.73 407.69 328.76 5.50 5315 S 5.50 42.99 0.0 736.45 Kenneth 0 211.82 0.00 0.0 Sharp 1 Dumpster 0-16 y 64.97 100.28 0.00 9.83 38.00 213.08 636.28 3223 s ' S0 4.50 47.07 0.0 849.36 Kenneth 0 0.0 47.9 Sharp 1 Lowbed-Heavy Tr 64.97 100.28 0.00 9.83 38.00 213.08 636.28 3223 g 1.00 1.00 47.91 0.0 849.36 Cory 0 193.4 S a.so 4.50 0.00 0.0 Shepard 1 General Laborer 33.74 39.53 0.00 7.50 0.00 80.77 360.19 42.99 0.0 440.96 James L o /236.60.0Watson 0 Roller Plant Mi 48.93 79.11 0.00 7.14 95.05 230.23 409.38 S 4.50 4.504681 52.58 0.0 Dylan o /566.61,_ S a.so 4.50 Wood 1 Roller Plant Mi 43.35 58.38 0.00 7.50 14.40 123.63 442.98 52.58 0.0 0 S J L T-1 I I While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a). The Copeland Act (40 U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to'Yumish weekly a statement with respect to the wages paid each employee during the preceding week." U.S.Department of Labor(DOL)regulations at 29 C.F.R.§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. If you have any comments regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W. Washington,D.C.20210 (over) ate 06/18/14 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Heidy Brothers Contract Administrator ® — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll, an amount not less than the sum of the applicable Jo hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed 1 That I a or supervise the payment of the persons employed b in the contract, except as noted in section 4(c)below. O pay P P Y PY .akeridge Paving Co. LLC on the (c) EXCEPTIONS (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION iary Harper COnst that during the payroll period commencing on the (Building or Work) 08 day of June 2014 ,and ending the 14 day of June 2014 I persons employed on said project have been paid the full weekly wages earned that no rebates have ?en or will be made either directly or indirectly to or on behalf of said .akeridge Paving Co. LLC from the full (Contractor or Subcontractor) eekly wages earned by any person and that no deductions have been made either directly or indirectly )m the full wages earned by any person.other than permissible deductions as defined in Regulations,Part (29 C.F.R Subtitle A) issued by the Secretary of Labor under the Copeland Act as amended(48 Stat.948, 3 Start 108,72 Stat.967.76 Stat. 357,40 U.S.0 §3145),and described below. ledical Dental Vision 401 K Garnishments REMARKS' (2) That any payrolls otherwise under this contract required to be submitted for the above period are :orrect 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 ;lassifications set forth therein for each laborer or mechanic conform with the work he 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 hate,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 NAME AND TITLE SIGNATURE in addition to the basic hourly wage rates paid to each laborer or mechanic listed in Heidy Brothers Contract A � } the above referenced payroll. payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJE ONTRACTOR OR have been or will be made to appropriate programs for the benefit of such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1001 0 TI LE 18 AND SECTION 231 OF TITLE employees,except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE 6/17/2014 ADVANCED POWER LLC CERTIFIED PAYROLL.REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT [AIPLOYEE NEXCEAIPT/SSN WORK CLASS PAY PERIOD DATE: 14-Jun 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA LSI TOT DED 8-Jun 9-Jun 10-Jun 11-Jun 12-Jun 13-Jun 14-lun I•IRS PAY FWFI UNION WK.GROSS NET PAY HANSON,GORDON P 16901 21ST Ave Sr SSNN.........5915 0 0 0 0 0 0 0 0 0 0.00 82.46 5.31 312.45 130THELL WA 98012 ELGC./)R s 0 0 0 8 0 4 0 12 562.44 160.00 64.68 0.00 1078.01 242.46 69.99 765.56 DORRAlI,LON PO BOX 5060 SSNN..........3896 0 0 0 0 0 0 0 0 0 0.00 139.59 9.24 520.13 WENATCHE_E.WA 98907 EI.EC.uR s 0 0 0 8 0 0 0 8 374.96 199.00 172.30 0.00 1824.64 338.59 181.54 1304.51 6/17/2014 STATEMENT OF COMPLIANCE 1, ELLY MCINTYRE,OFFICE MANAGER do hereby state: (])That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 8th of JUN'14,and ending the 14th day of JUN'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act,as amended 48 Slat.948.63, Slat. 108,72 Slat. 967;76 Slat.357;40 U.S.C.276c,and described below: (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 the 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 worker, laborer or mechanic conform with the work performed by such worker,laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of the above statements is a violation ofRCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.21 For Week Ending:June 28,2014- No Work Performed Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F 5 Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 22 23 24 1 25 26 27 28 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens.WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O RECEIVED JUL 02 Z014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 22nd day of June 2014,and ending the 28th day paid,as indicated on the payroll,an amount not less than the sum of the of June . 2014.all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction. Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title 5A. rryy (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS KathySalazar.Office Manager �IWOs� The wilful falsification of any of the above statements may s4bject the contraqor or sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. J 6/26/2014 (IZ ADVANCED POWER LLC 1 CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION EMPLOYEE OEXCENUIT/SS4 WORK CWS PAY PERIOD DATE: 21-Jun 2014 SUN MON TUES WED TI-IUR FRJ SAT TOT GROSS FICA L&I TOT DED 15-Jun 16-Jun 17-Jun I8-Jun 19-Jun 20-Jun 21-Jun I•IRS PAY FWI-I UNION WK.GROSS NET PAY OORRAII,LON Po Box 5060 SSNP..........3896 0 0 0 0 0 0 0 0 0 0.00 139.79 9.24 518.18 WENATCIIEE•.WA 988D7 E•LL-C.11R s 0 4 8 8 0 0 0 20 937.40 200.00 169.15 0.00 1827.28 339.79 178.39 1309.10 6n_6nat4 STATEMENT OF COMPLIANCE *9 1,ELLY MCINTYRE,OFFICE MANAGER do hereby state: (])That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 15th ofJUN'14,and ending the 21 st day of JUN'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)lint any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT 1 /1 PO Box 44540 1 I Prime Contractor Projed Name County Projed or ConbucW Olympia,WA 98504-4540 (360)902-5335 D018509 Cary Harper-Misty Cove Lift _ KING _ 1NWP-27-3678 Subcontractor A Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Rertlon WA Away"Agency Plains - Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 06 / 15 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukv& WA 98168 Deductions - --- DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Raft HourlyWithhold- Soc Seca of Employee Address Code Hours of GrouAmart "Usual FICA ing Tax Other NET 08I09 06/10 06/11 OSM2 06113 06/14 06/15 pay Ealtlad Benefits" WAGES HOURS WORKED EACH DAY No Work Performed F700-065-000 certified payroll report 05-09 Pag 1 OF 1 D"xinent of t.aPur and Wu Inc AFFIRMATION Ptr,ail,ng Aage Propw, PO WX W40 04rMla W A 985(A4'40 Page t of 1 Todav's Date Printed name of part) suing this report Title 06rM14 Wendy ConwayPavrollAdministrator The parry signing this report pays or supervises the (Native of contractor or subcontractor) payment of the persons employed by. Bravo Environmental NW.Inc. _ Project Name: ror the wvck starting For the week ending: DOIM9-Gary Harper-Misty Cove Lift 06IM14 06115114 -- "USUAL BENEFITS"DISTRIBUTION (Please report in"per hoar"terms) total Hostrty (E)Approved work Classification ~l'cual Retaelfta" (A)Has Pension (B)Hourly Medical (C) our. Vacadoa 1U1 llourlc Holiday %pprenticr Program 1� B•C+DBE 1. 2. 1. d S. G. 7. R. 9. 10. I he party signing below At FIKMS the following: 41) All information contained in this Certified Payroll Report.including anv addenda,is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported aix)%c are not less than the applicable wage rates contained in any wage determination related to the contract,and the classifications as reported above for each worker,laborer tw mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed abode have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All per�,UttY etuploycd ou live 4bu%c-tcfe1c1K;cd pxujccl(D)have been)paid dic full weekly Nagcn,carried,and Ito lebates 1—been or will be utede eitlwl directly or indirectly to or on behalf of the above-mined contractor or subcontractor from the weekly wages earned by any person No deductions,other than those which arc le►tally permissible,have been made by any person either directly or indirectly from the ful I wages earned (51 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. , Pistil or type naflle ofpony signing this report I Inle Stgnattirc Paywfl Administrator r7(10-065-000 certified payroll report(sacks 05-09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor Project Name Courtly Project or CordrecW Otymp{a.WA 98504-4540 (360)902-5335 )00 D018509-Gary Harper-MistyCove Lill KING VWVP-27-3676 Subcontractor X❑ Project Address City Shla ZU44 Misty Cove Lift Station Replac ment Renton WA Awardng Agency Name Phone I Company Name Phorm For the week ending_ City of Renton (425)430.7279 Bravo Envirorunental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City Stab ZIP+4 06 / 22 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deducttiorns QAYAND DATE - Work Classification Name 1 Total and and Earn MON TUE WED THU I FRI SAT SUN Total Rate Hourly Wifftiolld. Soc Seats of Employee Address Code Hours of Gross Amount "Usual F ICA ing Tax Other NET 08I18 OB117 08/18 08J19 08J20 06/21 O6l22 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' No Work Performed - - F700-065-000 certfied payroll report 05-09 P 1 OF 1 Dcpartnisent or La&w and kWu.0 Ptrs 4.1 rni;1%ai c I'Miiram AFFIRMATION PC)llox 44540 Olyrttpia VI'A 985044540 Page t of 1 Today's Date Printed naake of party signing this report - 06WI4 i Wendy C Pd roI Administrator The party signing this report pays or supervises the (Narne of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc--- Project None; the week starting: For the week ending: D018509-Gary Harper-Misty Cove Lift 06/16/14 06/22/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour-terms) Thal Hourly - -- (E) Approved Work Classification "Usul Benefits" (A)Hourly Peasil" (B)Hoorty Medical (C)Hourl% &cation M Hourh Holiday Apprentice Program A+■+C+D+[ 1. 2. S G. 7 x. 9. 10. I he partm signing below At FIRMS the following (1) All infurniadon contained in this Certified Payroll Report.including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported abawe for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (31 The payirrmc ils of usual benefits as listed ahovc has c been or will be trade to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persutts employed uo the abuse-referettvxd prujml(s)bare been paid Qte full weekly wages canted,and ttu rebates have been or will bt:nwdc either dirmlly or indirectly to or on behalf of the above-earned contractor or subcontractor from the weekly wanes earned by anv person No deductions.other than those which are legal IN permissible,have been made by any person either directly or indirectly from the full wages earned (5) Any apprentices employed in the aboac period arc duly registered in a bona fide apprenticeship program registered w it the%Vushington State Apprentwc%hip and Training Council. Falsification of any of the above statements is a violation of WAN' 39.12.050 subject to prosecution,sanctions, and penalties. Pratt or type ruin of party signing this report Title Signature 1 Payroll Administrator _ f700-065-000 certified payroll report backer 05-09 J.S. Department of Labor PAYROLL WHD vage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) U S Wage and Hour Division Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number Rev Dec 2008 VAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS OMB NO.. 1235-0008 Lakeridge Paving Co. LLC PO BOX 8500 Covington WA 98042 Expires 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION Gary Harper COnst PROJECT OR CONTRACT NO Payroll #1 06/14/14 Renton, iAA 13-404-W (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) a z DEDUCTIONS osroe os�os Deno Dent Danz Dens Den NET NAME AND INDIVIDUAL IDENTIFYING NUMBER OF GROSS WAGES p=a H Sun Mon Tue Wed Thu Fn Sat WITH- (e g..LAST FOUR DIGITS OF SOCIAL SECURITY oF. WORK O TOTAL RATE AMOUNT HOLDING TOTAL PAID NUMBER OF WORKER Z3w CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TAX `SWH l' I OTHER DEDUCTIONS FOR WEEK Ronald D A.6a.oCarlSen 0 General Laborer 14.36 0.73 1.61 7.241726 41.69 0.0 Wi11iam 0 193.4 0.0 Cozad General Laborer 27.42 38.55 0.00 4.28 70.11 145.36 213.1C 9875 S 4.50 42.99 0.0 358.46 Dan A294.20o.oGarl 1 Screedman 78.25 104.12 0.00 11.07 )2 269.36 75?.59 5265S 5.5 53.49 0.0 Jeffrey „ 294.2 o.o Hooper Spreader, Tops_ 78.26 72.09 0.00 11.07 _. 5442 S 5.5053.49 0.0 1022.95 Troy 0 247.5 o.o McCord 3eneral Laborer 102.98 209.52 0.00 14.29 :46. - .4 _ S 5.50 45.00 0.0 1346.15 0 0 0.0 0 Q 0.00 0.00 0.00 0.00 0.00 0000 5 0.00 0.0 /0.00 Mark E o 117.6 Morrow i Dumpster 0-16 39.85 47.62 0.00 6.62 26.05 120.14 430.8- S 2.50 47.07 0.0 520 994 JOtlTlathan 0 /3.40.0 Moser 1 General Laborer 38.52 48.91 0.00 7.14 175.47 2.70.04 233.42 9760 512.99 0.0 . While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the intonation collection contained in 29 C F R§§3.3,5 5(a). The Copeland Act (40 U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week" U.S.Department of Labor(DOL)regulations at 29 C.F.R.§5.5(ax3Xn)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project.accompanied by a signed"Statement of Compliance"indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis_Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is will take an average of 55 minutes to e i Ilea i i e for reviewing instructions.searching existing data sources gathering and maintaining the data needed.and completing and reviewing the collection of information If you have any comments regarding these estimates or any other a of th ncl stions for reducing this burden.send them to the Administrator Wage and Hour Division.U S Department of Labor.Room S3502,200 Constitution Avenue,N.W. Washrgton,D.C.20210 11 (over) J.S. Department of Labor PAYROLL WHD vage and Hour Division (For Contractor's Optional Use;See Instructions at www.dol.gov/whd/forms/wh347instr.htm) U.S.Wage and Hour Division Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev.Dec.2008 4AME OF CONTRACTOR OR SUBCONTRACTOR ADDRESS OMB NO.: 1235-0008 Lakeridge Paving Co. LLC PO BOX 8500 Covington WA98042 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION Gary Harper Const PROJECT OR CONTRACT NO. Payroll #1 06/14/14 Renton, WA 13-404-W (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) (a) oz in DEDUCTIONS O6108..06". O6/11 O6/n.113 NET 10 NAME AND INDIVIDUAL IDENTIFYING NUMBER LLia OGROSS WAGES Sun MonI TOTAL RATE AMOUNT Tue Wed Th(e.g..LAST FOUR DIGITS OF SOCIAL SECURITY WITH- of3� WORK CLASSIFICATION o HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA HOLDING SWH L& I OTHER DEDUCTIONS FOR TOTAL (WEEK NUMBER OF WORKER Donald D 235.35 0.0 Nesper 0 Dumpster 0-16 y 48.38 47.35 0.00 7.85 98.76 202.34 430.14 s.oa 2822 S 5.00 47.07 0.0 632.48 Christopher N o 236.4 o.o Pedersen 6 General Laborer 56.32 26.89 0.00 8.75 315.73 407.69 328.76 s.sa 5315 S 5.50 42.99 0.0 736.45 Kenneth 0 211.82 o.00 o.o Sharp 1 Dumpster 0-16 y 64.97 100.28 0.00 9.83 38.00 213.08 636.28 3223 s 4.50 4.50 47.07 0.0 849.36 Kenneth D 47.9 0.0 Sharp 1 Lowbed-Heavy Tr 64.97 100.28 0.00 9.83 38.00 213.08 636.28 3223 g 1.00 1.00 47.91 0.0 849.36 Cory p 193.4 0.00 0.0 Shepard 1 General Laborer 33.74 39.53 0.00 7.50 0.00 80.77 360.19 S 4.so 4.50 325 42.99 0.0 440.96 James L o 236.6 0.0 Watson 0 Roller Plant Mi 48.93 79.11 0.00 7.14 95.05 230.23 409.38 S 4.50 4.50 468 52.58 0.0 639.61 Dylan 0 00 236.6 S 14-5. 4.5 Wood 1 Roller Plant Mi 43.35 58.38 0.00 7.50 14.40 123.63 442.98 52.58 0.0 566.61 O S While completion of Form WH-347 is optional,it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R.§§3.3,5.5(a). The Copeland Act (40 U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week." U.S.Department of Labor(DOL)regulations at 29 C.F.R.§5.5(a)(3)(ii)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance'indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. If you have any comnlenls regarding these estimates or any other aspect of this collection,including suggestions for reducing this burden,send them to the Administrator,Wage and Hour Division,U.S.Department of Labor,Room S3502,200 Constitution Avenue,N.W. Washington,D.C.20210 (over) ate 06/18/14 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Heidy Brothers Contract Administrator — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll, an amount not less than the sum of the applicable o hereby state. basic hourly wage rate plus the amount of the required fringe benefits as listed (1) That I pay or supervise the payment of the persons employed by in the contract,except as noted in section 4(c)below. 3keridge Paving Co. LLC on the (c) EXCEPTIONS (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION ary Harper Const that during the payroll period commencing on the (Building or Work) J8 day of June 2014 and ending the 14 day of June 2014 persons employed on said project have been paid the full weekly wages earned.that no rebates have en or will be made either directly or indirectly to or on behalf of said 3keridge Paving Co. LLC from the full (Contractor or Subcontractor) ekly wages earned by any person and that no deductions have been made either directly or indirectly m the full wages earned by any person.other than permissible deductions as defined in Regulations, Part 29 C F R Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended(48 Stat.948, Start 108,72 Stat 967,76 Stat 357.40 U S C §3145),and described below edical Dental Vision 401 K Garnishments REMARKS (2) That any payrolls otherwise under this contract required to be submitted for the above period are nrrect and complete:that the wage rates for laborers or mechanics contained therein are not less than the pplicable wage rates contained in any wage determination incorporated into the contract:that the assifications set forth therein for each laborer or mechanic conform with the work he performed (3)That any apprentices employed in the above period are duly registered in a bona fide pprenticeship program registered with a State apprenticeship agency recognized by the Bureau of pprenticeship and Training, United States Department of Labor,or if no such recognized agency exists in a tate,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 NAME AND TITLE SIGNATURE 1 — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in Heidy Brothers Contract A the above referenced payroll. payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY UBJ T THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1 1 OFYITLE 18 AND SECTION 231 OF TITLE employees.except as noted in section 4(c)below 31 OF THE UNITED STATES CODE 7/2/2014 RECEIVED ADVANCED POWER LLC JUL 0 8 2014 CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 CITY OF RENTON NAME: MISTY COVE LIFT STATION REPLACEMENT ►1TIL.ITY SYSTEMS r%IPLOYI:r drXMIPT/SSd WORK CLASS PAY PERIOD DATE: 28-Jun 2014 SUN MON TUES WED TI-IIJR FRI SAT TOT GROSS FICA L&I TOT DED 22-Jun 23-Jun 24-Jun 25-Jun 26-Jun 27-Jun 28-Jun IIRS PAY FWH UNION WK.GROSS NET PAY FRINGES DORRAI1.LON ro nox 506n SSNd.. _38% 0 0 0 0 0 0 0 0 0 0.00 142.20 9.24 190.82 WENATCI ICE.wA 08G7 MCC nR s 0 9 0 0 0 8 0 17 796.79 208.00 131.38 0.00 1858.96 350.20 140.62 1368.14 7/2/2014 STATEMENT OF COMPLIANCE O I,ELLY MCFNTYRE,OFFICE MANAGER do hereby state: (1)That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 22nd ofJUN'14,and ending the 28th ofJUN'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3 (29CFR 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: (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 the 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 worker, laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c) EXCEPTIONS EXCEPTION (craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER r%,^�, G j' 1 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.22 For Week Endin :July 5,2014- No Work Performed Project 8 Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No.of Work SIMI TfWIThI F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 29 30 1 1 1 2 1 3 4 5 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 29th day of June 2014,and ending the 5th day paid,as indicated on the payroll,an amount not less than the sum of the of July . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title S7Z71 re / (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may su iect the contractor ub- ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sectil; 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. 7/9/201 a STATEMENT OF COMPLIANCE ®Et�`"C JUL 16 2014 1, ELLY MCINTYRE, OFFICE MANAGER do hereby state: CITY OF RENTON (1)That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY CdILII'SYSTEMS STATION,that during the payroll period commencing on the 29th day ofJUN '14,and ending the 5lh day of JUL'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29CFR 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: (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 the 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 worker, laborer or mechanic conform with the work performed by such worker,laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in n bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS (X)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 correct 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 O Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll an each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE E-LLY MCINTYRE, OFFICE MANAGER -,Z 7/9/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT FNIPLOYEE HL•\CEAIPTJSSH WORK CLASS PAY PERIOD DATE: 5-Jul 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA LSI TOT DED 29-Jun 30-Jun I-Jul 2-Jul 3-Jul 4-Jul 5-Jul IiRS PAY FWI•I UNION WK.GROSS NET PAY FRINGES TI IOMAS,DAVID L. 14433 20T11 DR.NW SSNH.......3645 0 0 0 0 0 0 0 0 0 0.00 123.88 8.08 483.54 MARYSVILLE:,WA96271 ELEC.AR s 0 0 9 9 9 0 0 27 1265.49 190.00 161.58 0.00 1619.33 313.88 169.66 1135.79 STEM IENS,JOSEPI1 22110 53RD Ave W SSNO.........6993 0 0 0 0 0 0 0 0 0 0.00 64.55 4.16 233.65 MOUNTLAKE TERIaACE, ELEC.UR s 0 9 9 0 0 0 0 18 843.66 99.00 75.94 0.00 WA 98613 843.66 153.55 80.10 610.01 DORIIAI I,LON 110 BOC 5060 SSNH..........3896 D 0 0 0 0 0 0 0 0 0.00 113.941 7.39 370.91 WENATCHEE.wA 9881n ELEC.JJR s 0 10 9 9 0 0 0 28 1312.36 147.00 102.58 0.00 1489.28 260.94 109.97 1118.37 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.23 For Week Endin :July 12,2014-No Work Performed Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No.of Work S M I T I W I Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 1 6 7 1 8 9 1 10 1 11 12 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc on the Misty Cove Lift Station Replacement that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 61h day of July 2014,and ending the 12th day paid,as indicated on the payroll,an amount not less than the sum of the of July . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig a re (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS.FUNDS OR PROGRAMS KathySalazar,Office Manager Q Lim` The wilful falsification of any of the above statements may subj ct the contractor or b ❑--- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.24 For Week Ending:July 19,2014- No Work Performed Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W I Th I F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 13 14 15 16 1 17 1 18 19 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hout's Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton.WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 1 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O RECEIVED JUL 2 4 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period �X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 13th day of July 2014,and ending the 19th day paid,as indicated on the payroll.an amount not less than the sum of the of July . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned.that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Si$na re (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager �� `L ^ 11'111�'Z191 The wilful falsification of any of the above statements may su fect the contract r sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sidon 231 above referenced payroll,payment of fringe benefits as listed in the contract have been Jor title 31 of the United States Code. Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Prime Contractor i Projed Name— --— ------ County --------- Project of Contract# Olympia.WA 985044540 11_ !D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 (360)902-5335 ;� Subcontractor iJ Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA -- --- Awardrcug Agency Name — ------ —— Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 06 / 29 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 _ __Deductions DAY AND GATE Work Classification Name Total and and Earn MON I TUE WED THU FRI I SAT SUN Total Rate Hourly yyithrypld- Soc Sect of Employee Address Code Hours of Gross Amount 'Usual FICA ing Tax Other NET 06/23 06/24 06/25 06/26 06/27 06/28 06I29 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY _ ,.------- --------- ---- --- - No Work Performed - F700-M-000 certified payroll report 05-M I Pagj 1 OF 1 °cparu ° e PnW=i "'�``` AFFIRMATION Prevailing�.•agr PnKtnn, PO Floe 44540 Olympia WA 985044.140 Page 1 of 1 Today's Date Printed name of party signing this rupurt Tidr 07/16/14 Wendy Comvay Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by- Bravo Environmental NW.Inc. Project Nome: For the week starting: For the week ending: DOI8503-Gary Harper-Misty Cove lift 06/23/14 06129/14 "USUAL BENEFITS"DISTRIBUTION (Please report In"per hour"terms) Total Hourly (E)approved Rork Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Niedical (C)Houriy Vacation (D)Hourly Holiday Appreatke Program to+B+C+D+[ 1. 2. 3. 4. 5. 6. 7. 8. 9. l0. Fhe party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as retorted above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plant,funds or programs for the benefit of such employees. (4) All perauxis employed on due abo%c-faferciKxd project(h)have bean paid die full weekly%vagm cmwd,and tw rebaleb have been or will be inade tidier directly of indirectly to or on behalf of the above-earned contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible.have been made by any person either directly or indirectly from the full wages earned (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training.Council_ Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,an penalties. Print or type name of party signing this report Titic Signature( �, i f700-065.000 certified payroll report backer 034)9 1 Department of tabor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 _ ---- -- Olympia.WA 98504-4540 Prime Contractor Project Name--- County - — Project or Contrad0 (360)902-5335 ;D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 /(� Subcontractor !Project Address city State ZIP+4 Misty Cove Lift Station Replac ment Renton WA _— Awarding Agency Name -- -----""-Phone -- Company Name Phone For the`Week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 07 / 06 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE —" Work Classification Name Total and and Earn MONITUEIWEDITHUI FRI SAT SUN Total Rate Hourly wthhold- Soc Seth of Employee Address Code Hours of Gross Amount 'Usual FICA ing Tax Other NET O6/30 07/01 07/02 07/03 07/04 07/OS 07106 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 1 Pagl 1 OF 1 °`' "°`t rh"f and "" rn '°� AFFIRMATION Prrrailntg Wage�e PnrKta Po Box 44540 Olympia WA 995044540 Page 1 of 1 Today'Date Printed name of party signing this report Title 07/16/14 1 Wendy Conway Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. Project Name: For the week starting: For the week ending: D018509-Gary Harper-Misty Cove lift 06rM14 07IM14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per bour"terms) Total Hourly proved Ap Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice(E)E)ApProgram 1. 2. 3. 4. S. 6. 7. 8. 9. 10. fhe parry signing below AF'F71tIHS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons cutployed vit(lie above-rCfcrclKxd prufect(s)have been paid die full weekly wages earned.wid too rebateb have been or will be made either directly or indirectly to or on behalf of the above tamed contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship pro_wum registered with the Washington State Apprenticeship aril Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Print or type name of party signing this report TitleWendy Conway Payroll Administrator Signature, ` — �. l f700.0654M certified payroll report backer 05.09 i Department of Wage ogra Industries 69TATl CERTIFIED PAYROLL REPORT Prevailing Wage Program o °g PO Box 44540 - Olympia WA 98504�540 � Project Name County Project or Contract# ( ay1 eee a�1 Prime Contractor M ��J' S 1 k 16a �f ,1-7 -367 360)902-5335 I 1 T Subcontractor Project dress City State � wck Awarding Agency Name (� Phone Company Name Phone For the week ending: �'; p f tc�rt w [�C L-LC 53 34 q S l4 Month Day Year Address Ci State ZIP+4 nAddress City ! State ZIP+4 I© E Gtt�d %otm (Na (� ��7r SC 1-lS61k Wa E��lkM40 K., (N� � Day and Date Deductions Work Classification Name ° Sun Mon Tue Wed Thu Fri Sat Total and and Rate Hourly Soc Sec#of Employee Address x Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Eamed Benefits" FICA ing Tax Other WAGES 1. OT 0.00 000 0.00 s 0.00 s 0.00 RG 0.00 000 2 OT 0.00 000 000 $ 000 $ 0.00 RG 0.00 000 3. OT 0.00 000 _ 00o $ o0o RECEIVEDs aoo RG 0.00 000 4 Or A 1.4 0.00 000 JUL 0.00 s 0.00 $ 0.00 RG 01 000 000 CITY OF RE TON 5 OT 000 000 UTILITY SYSTEMS 0.00 $ 0.00 s 0.00 RG 000 0.00 6 OT 0.00 000 0.00 $ 0.00 s 0.00 RG 000 000 7. OT 000 000 0.00 $ 0.00 s 000 RG 000 000 8. OT 000 0.00 000 s 0.00 s 000 RG 000 000 9 OT 000 om 000 s 0.00 s o 00 RG 0.00 000 10 OT 000 000 000 s 0.00 s 000 RG 000 000 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries AFFIRMATION Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Date Printed nam of party signing this report Title Le The pfirty sighing this report pays or supervises the (Name f contractor or subcontractor) payment of the persons employed by: L_(,_ Project Name: , t si For the week starting: For the week ending: "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program A+B+C+D+E) 1. $ 0.00 2. $ 0.00 3. $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions, other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature F700-065-000 certified payroll report backer 05-09 7/24/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT Fa1PLOYGC NEXCGIPT/SSN WORK CLASS PAY PERIOD DATE: 12-Jul 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA L&I TOT DED 6-Jul 7-Jul 8-Jul 9-Jul 10-Jul II-Jul 12-Jul FIRS PAY FWI-I UNION WK-GROSS NET PAY FRINGES OORRA11.LON Po pox 5060 SSNN.........3896 0 0 0 0 0 0 0 0 0 0.00 136.55 9.24 557.31 WENATCHEE,WA 98807 ELEC.UR 5 0 0 2 0 0 0 0 2 93.74 192.00 219.52 0.00 1785.0.1 328.55 228.76 1227.73 7n_4n_014 STATEMENT OF COMPLIANCE I, ELLY MCINTYRE,OFFICE MANAGER do hereby state: (])That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 6th ofJUL'14,and ending the 12th ofJUL']4 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3 (29CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act,as amended 48 Stat.948.63,Stnt. 108,72 Stat.967;76 Stat.357;40 U.S.C.276c,and described below: (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 the laborers or mechanics contained therein are not less than the applicable wage rates contained in nny wage determination incorporated into the contract; that the classifications set forth therein for each worker, laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda,is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE G ELLY MCINTYRE,OFFICE MANAGER 7/24/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE NE.\CUSPT/Ssa woRK cLAss PAY PERIOD DATE: 19-Jul 2014 SUN MON TOES WED THUR FRI SAT TOT GROSS FICA L&I TOT DED 13-Jul 14-Jul 15-Jul 16-Jul 17-Jul 18-Jul 19-Jul HRS PAY FWI-I UNION WK.GROSS NET PAY FRINGES DOJU AII.LON PO Box s060 SSN4.......—.3896 0 0 0 0 0 0 0 0 0 0.00 136.16 9.24 562.21 WENATCI IEE.WA 98807 ELECAR s 0 0 0 4 0 0 0 4 187.49 191.00 225.81 0.00 1779.76 327.16 235.05 1217.55 7R4/Z014 STATEMENT OF COMPLIANCE 22 1,ELLY MCINTYRE,OFFICE MANAGER do hereby state: (])That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 13th of JUL'14,and ending the 19th of JUL'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3 (29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS (X)In addition to die basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll,payments of fringe benefits as listed in the correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of tie above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.25 For Week Endin :July 26,2014-No Work Performed Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 20 21 22 23 24 25 26 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period �X ---Each laborer or mechanic listed in the above referenced payroll has been commencing on the 20th day of July 2014,and ending the 26th day paid,as indicated on the payroll,an amount not less than the sum of the of July . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract.except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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 Slat.948,63 Slat. 108,72 Slat.967; 76 Stat.357,40 U.S.C.276c),and described below: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Si na uree,, (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Mana er The wilful falsification of any of the above statements may subject the contractor or sub- -- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 br Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Prime Contractor Project Name — -C U*- Project or CorttracW Olympia.WA 98504-4540 (360>902-5335 I DOt 8509-Gary Harper-Misty Cove Lift KING WWP-27-3678 8trbcon&ac1Io► ❑X Project Address city State ZIP+4 Misty Cove Lift Station Replac ment Ranbn WA Awarding Agency Na phone pany Name Phone Nam For the week ending City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 07 1 13 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 —---- --- - -- --- - -— Deductions _ DAY AND DATE Work Classification Name Total and and Earn MON 1rUE IWED 11iU FRI SAT SUN Total Rate Hourly yy� . Soc Sec$of Employee Address code Hours of Gross Amount Usual FICA W1p Tax Other NET 07107 0710e 07/09 07110 07111 07/12 07/13 pay Earned Benefits" WAGES HOURS WORKED EACH DAY 1 No Work Performed F700-065-000 certified payroll report 05-09 Pag 1 OF 1 Dcparunent of lahur and Indu.tric. Prc%atIing v►'agc Program AFFIRMATION PO Box 44540 Olympia WA 985044540 Page 1 of 1 Today's Date Printed nsrne of party sitmintr this report Title 07f30114 Wendy ConwayPayroll Administrator The patty signing this report pays or suporvi-es the (Name of contractor or subcontractor) payment of the persona employed by: Bravo Environmental NW.Inc- Project Nome: For the%vek starting For the week ending: D016509-Gary Harper-Misty Cove lift 07/07/14 07/13114 "USUAL BENF-FITS"DISTRIBUTION (Please report in"per hour"terms) Total Harty — — (E)Approved Work Classification "Usual Benefits" (A)Hourly Peesion (B)Hourly Medical (C)Hourh Vacation (D)Hourly lioliday AppreatGee Programto+a+C+D+ti 1. 2. 3. 4 $. G. 7. R. 9. 10, I he party signing below AM P IKMN the following: 1 I I All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any sage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All pet-bons ettipluyed on the abuvr-rrfrretaced ptujmt(s)have bit paid the full weekly wages eatatrd,aril sal tebditn'hdsr beers or will be made either directly or indirectly to or on behalf of the above-twined contractor or subcontractor from the weekly wages earned by any person.No deductions.other than those which arc legally permissible,have been trade by any person either directly or indirectly from the ful I wattes earned ISI Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCN'39.12.050 subject to prosecution,sanctions, And penalties. PrinIottyperrimeofpartysignank this report Trtic Signature i — ��( I � f700-065-000 certified payroll report backer 05-09 Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program PO Box 44540 Prime Contractor t l Project Name County Project or Contract# Olympia,WA 98504-4540 (360)902-5335 D018509-Gary Harper-Misty Cove Lift KING WP-27-3678 Subcontractor Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 07 / 20 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourty Withhold- Ad Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 07/14 07/15 07/16 07/17 07/18 07/19 0720 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-W5-000 certified payroll report 05-09 Page 1 OF 1 LAN "nmling a ePn)r°°'`"'°�"" AFFIRMATION Rr�a�l�ng µ'age Pn�gram K)[lox 44540 01ynpis%A 985044540 Page 1 of 1 Today's Date Printed name of party signing this report Title 07/30H 4 Wendy ConwayPa oN Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project Name: For the%rock starting: For the week ending: D018509-Gary Harper-Misty Cove Litt 07/14/14 07/20/14 USUAL BENEFITS"DISTRIBUTION (Please report in"per hear"terms) - -- Iotal Hourly (E)Approved Nork Classification "Usual BeneAb" (A1 Hourlv Peasioa (B)Hourh Medical (C)Hourly Vacation (D)Hourly Halliday 1ppreoticc Program to+a+C+D+[ 1. 2. -. 4 S G. 7. R. 9. 10. I he patty signing below Al•1,INNIS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported atxwve are not Iess than the applicable wage rates contained in any wage determination related to the contract,and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such%orker,laborer or mechanic. (3) The pa)mients of usual benefits as listed above have been or will be made to appropriate approved plans,funds or program,for the benefit of such employees. (4) All persunb employed uu the abuvc-referenced ptuject(a)have been paid lire full weakly wages rained,and 1tu icbatca have born or will be made either directly 01 indirectly to or on behalf of the above-narned contractor or subcontractor from the weekly wanes earned by any person.No deductions,other than those which arc legally permissible,have been made by any person either directly or indirectly from the full wage-earned 0;1 Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered%nth the Washington State Apprenticeship and Training Council. FaWRcatiow of any of the above statements is a violation of RCN' 39.12.050 subject to prosecution,sanctions, and penalties. Print or type name of party signing this repot Title Sigtattre ____-__ t Payroll Administratoi f700-065-000 certified payroll report backer 03-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.26 For Week Endin :August 2,2014-No Work Performed Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Du and Date Gross Deductions Net Wages Name,Address and No.of Work SIMI TjWjThj F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 27 28 1 29 30 1 31 1 2 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee. tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S - Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 1 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction. Inc.on the Misty Cove Lift Station Replacement ;that during the payroll period O-- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 27th day of July 2014,and ending the 2nd day paid,as indicated on the payroll,an amount not less than the sum of the of August , 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction.Inc.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, © EXCEPTIONS 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. EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits Justin Michaud Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Signat}rre (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subject the contra or sub- ❑-- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and S ion 231 above referenced payroll.payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries f.S,r£ CERTIFIED PAYROLL REPORT Prevailing Wage Program .'`t `.� PO Box 44540 = Project Name County Project or Contractr4 Olympia WA 98504-4540 ± y� Prime Contractor (360)902-5335 H1 fay�'° ❑ Misty Cove Lift Station Replacement ® Project Address City State Subcontractor 5027 Ripley Lane Renton Wa Awarding Agency Name Phone Company Name Phone For the week ending:_ Gary Harper_Construction Inc. 360 863-1955 Star Roofing&Construction Inc. 425 290-7827 Month Day Year Address City Stale ZIP+4 Address City State 7_IP+4 6/15/14 14831 223`d ST SE Snohomish wa 98296 16912 90'Ave SE Mill Creekk Wa 98012 Day and Date Deductions _ Work Classification Name Sun Mon Tue Wed Thu Fri Sat Total E_ and and 60 Rate hourly Soc Sec#of Employee Address a r '_ Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES Michael T Burrows 8432 45th OT 0.00 o.00 1. Sheet Metal � Drive NEMarysville,WA 763.07 s 0.00 360.62 $32 00 $183.99 $486 46 531-78-3453 98270 RG 6.00 5.00 11.00 69.37 76307 ! 2. Sheet Metal Robert A Becham 110 East OT 000 000 j Highland Drive,Arlington i040.55 s 0.00 s9413 $123 o0 s$23.17 537-76-2633 WA 98233 RG 8.00 7.00 15.0o 69.37 1040.55 3 OT 0.00 0 00 000 s 0.00 s 0.00 RG 0.00 000 q OT 0.00 0.00 0.00 s 0.00 s 000 RG 0.00 o co 5. OT 0.00 oco RG o.� ooa RENTN o.00 s 0.00 CITY Q $ o.a� � 6. OT 0.00 oco YSTE c - 0.00 s 0.0o $ 0.00 RG 000 0.00 7 OT 0.00 oco - - -- 0.00 $ 0.00 s 0.00 RG 0.00 000 8. OT 0.00 0.00 0.00 IS 0.00 s 0.00 RG 0.00 0.00 9. OT o.00 0.00 o.00 s 000 $ moo RG 0.00 000 10, OT 0.00 0.00 0 00 $ 0.00 � - = moo RG F700-065-000 certified payroll report 05-09 EnWloyee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program AFFIRMATION PO Box 44540 Olympia WA 98504-4540 Today's Date Printed name of party signing this report Title 08/05/2014 Sandra Pelan Secretary The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Star Roofing&Construction Inc. Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 1 06/01/201 06/06/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program A+B+C+D+E) 1. Sheet Metal $ 0.00 2.Sheet Metal $ 0.00 3. $ 0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, an nalties. Print or type name of party signing this report Title Signature Sandra Pelan Secretary f ljr"- .4 F700-065-000 certified payroll report backer 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.27 For Week Endin :August 9,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Da and Date Gross Deductions I Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 3 4 5 6 7 8 9 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 1377.78` 27427 220th PI SE M-2 Pipelayer S 2.00 1 2.00 44.46 88.92 (19.98) Maple Valley,W 98038 (85.42) (142.00) (15.20) (262.60) 1,115.18 XXX-XX-4901 O 'Richard worked 29.5 hours on other jobs S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement :that during the payroll period �X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 3rd day of August 2014,and ending the 9th day paid,as indicated on the payroll,an amount not less than the sum of the of August 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits Justin Michaud Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Sig tuje (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subje9ft the contractor or s b- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Sectign" 31 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction, Inc. 14831 223rd St SE,Snohomish,WA S8296-3989 Payroll No. 29 For Week Endin :August 23,2014 Project&Location:Misty Cove Lift Station Replacement, Renton,WA Contract No.:WWP-27-3678 Day and Date Gross Deductions Net Wages Name,Address and No. of Work S M I T I W I Th F S Total Rate Amount Medicare W/H L&I Total Paid Social Security Number Exemp- Classifications 17 18 1 19 1 20 1 21 22 23 Hours of Pay Earned Soc Sec Tax Emp Other Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 2044.35" 3604 Madrona St M-6 Equipment S 7,00 8.50 5.00 20.50 53.10` 1,088.55 (29.65) Bremerton,WA 98312 Operator (126.75) (197.00) (17.14) (214A (584.96) 1,459,39 XXX-XX-7696 (Lead) O *Employee benefits hourly value S1.90, "Andrew worked 18 hours on other projects Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 1227.94" 27427 220th PI SE M-2 Pipelayer S 2.00 4.00 6.00 44,46 266,76 (17.80) Maple Valley,W 98038 (76.14) (120.00) (13.99) (227.93) 1,000.01 XXX-XX-4901 O ."Richard worked 22 hours on other projects. i - - RECEIVED AUG 2 7 2014 CITY OF RENTON UTILITY SYSTEMS Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc.on the Misty Cove Lift Station Replacement that during the payroll period �X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 17th day of August 2014,and ending the 23rd day paid,as indicated on the payroll,an amount not less than the sum of the of August 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits Justin Michaud Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title A14ff11'1 ure (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS Kathy Salazar,Office Manager -5; ( /;��e The wilful falsification of any of the above stat ments may sub' ct the contractor o sub- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 Title 18 and Sec n 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor ec Pro t Name Olympia,WA 98504-4540 I County Protect or Contract# (360)902-5335 / D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 C Subcontractor X Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending City of Renton Bravo Environmental NW. Inc (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 08 / 10 / 2014 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 08/04 08/05 08/06 08/07 08/08 08/09 08/10 Pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed f--Y 9 F700-065-000 certified payroll report rt 05-09 Pa 1 OF P 1 Z U o1 > w } o LL co r oLLJ �- Cn cc � � Deliartment of tabor and Induaric. Pncailing Wage Program AFFIRMATION PO pot 44.W fNrmpia WA 9RS04-4tdn Page 1 of 1 Today's gate Printed name of party signing this repot - -- Title 08/27/14 _ Wen I Conway _ Payroll Administrator The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. Project Name: — -- - - For the week starting: For the week ending: D018509-Gary Harper-Misty Cove(sift 1 08104/14 1 08/10/14 -USUAL BENEFITS"DISTRIBU 110% (Please report in"per boar"terms) Total Hoarty Work Classification I It 1 %ppro%ed "Ussol Beneths" I �) lluurh Pension (B) llourh Medical (C)Hourh N acation (D)Hourh Holiday A+B+c+D+F Apprentice Program 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report.including any addenda.is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rdtes contained in any wage determination related to the contract:and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans.funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned.and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly%•ages earned by any person.No deductions.other than those which are legally permissible.have been made by any person either directly or indirectly from the full wages carried. (5) Any apprentices employed in the above period arc duly registered in a twna fide apprenticeship program registered with the Washingpon State Apprcrosceshtp and Training Council. Falsification of any of the above statements is a violation of RC%V 39.12.050 subject to prosecution. sanctions,and penalties. Print or type name party _signing _this n Signature VYmxW Conway. Payroll Administrator - U—- _. F7(X)4)65-(11K)certified pa�Tutl report hacker 05-09 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor Project Name County Project or Contract# Olympia.WA 98504-4540 ry Harper- y(360)902-5335 D018509-Gary H Mist Cove Lift KING WWP-27-3678 �lL�� 9 Subcontractor X Project Address City State ZIP+4 Misty Cove Lift Station Replac menl Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton Bravo Environmental NW. Inc (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 08 / 17 / 2014 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount "Usual FICA in9 Tax Other NET 08/11 08/12 08/13 08/14 08/15 08116 08/17 Pay Earned Benefits WAGES HOURS WORKED EACH DAY No Work Performed t OF 1 F700-065-000 certified payroll report 05-09 Paq Detmrtmrnt of tahty and Industric. flmn ailing wage PrtWam AFFIRMATION PC)nox"W M-in WA 9R.M1d-1WP Page 1 of 1 Today's Date Printed name of party signing this report - — Tilic 08/27/14 WendyConway I Payroll Administrator The patty signing this report pays or supervises the (Name of contractor or subcontractor) payment of the pcntons ymTloyod by: Bravo Environmental NW.Inc. Project Name -- — _ Fo_r lire week starting: For the week ending: DOI8509-Gary Harper-Misty Cove Lift 08/11/14 W17/14 "USUAL.BENEFITS"DISTRIBUTION (Please report in"per hour"terns) Total Hourly I1:1 :lppro�ed Work Classification Usual Benefits" (A)Hourly Pension (B)Hourly Medical IC7 HouHy vacation (D)Houri Holiday A+a+C D+E %pprentice Program 1. 2. 3. 4. 5. 6. 7. S. 9. 10. The patty signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda. is correct and complete. (_') The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract:and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (3) The paymentt%of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned.and no rebates have been or will he made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which arc legal I} permissible.have been made by any person either directly or indirectly from the full wages camcd. (5) Any apprentices employed in the above period arc duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. 71 -- n- -- - - - ---- - - -- =nway e name of pan-, signing this report ' Title tiignaturc _ -__ Payroll Administrator F7(1n-065-(KX1 certificd pa)T011 rermttt hacker 054W Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.30 For Week Endin :August 30,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 DaX and Date Gross Deductions Net Wages Name,Address and No.of Work S M T I W I Th I F S Total Rate Amount Medicare W/H L&I Total Paid Social Security Number Exemp- Classifications 24 25 26 1 27 1 28 1 29 30 Hours of Pay Earned Soc Sec Tax Emp Other Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 2124.80" 3604 Madrona St M-6 Equipment S 10.00 10.00 10.00 5.00 35.00 53.12' 1,859.20 (30.81) Bremerton,WA 98312 Operator 1 (131.74) (217.00) (16.26) (213.46) (609.27)1 1,515.53 XXX-XX-7696 Lead O *Employee benefits hourly value$1.88, "Andrew worked 5 hours on other projects Justin Michaud 2067.00" 10215 Lundeen Pkwy#C7 M-9 Equipment S 10.00 10.00 20.00 53.00 1,060.00 (29.97) Lake Stevens,WA 98258 Operator (128.15) (166.00) (15.92) (174.40) (514.44) 1,552.56 XXX-XX-1921 O "Justin worked 19 hours on other ro'ects Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S 10.00 10.00 7.50 5.00 32.50 44.46 1,444.95 (20.95) Maple Valley,W 98038 (89.58) (152.00) (13.11) (275.64) 1,169.31 XXX-XX-4901 O S O Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I. Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction, Inc on the Misty Cove Lift Station Replacement that during the payroll period �X -- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 24th day of August 2014,and ending the 30th day paid,as indicated on the payroll,an amount not less than the sum of the of August 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits Justin Michaud Waivered out of group benefits (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 determiniation incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed Remarks (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 State Department of Labor. (4)That: Name and Title Sign t " (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS KathySalazar,Office Manager � �� The wilful falsification of any of the above statements may subjqobt the contractor 0Y sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Section 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. i Department of Labor and Industries CERTIFIED PAYROLL REPORT Prevailing Wage Program _ PO Box 44540 PrIII Contractor l Projec►Name County Projatt or Contractit Olympia.WA 98504-4540 D018509-Gary H Misty Cove Lift KING WWP-27-3678 (360)902-5335 ry Harper H - //y, � � ProjectAd�ess C((y Stale 21P+4 Misty Cove Lilt Station Replac ment Renton 11YA Awarding Agency Name Phorte Company Name For Mee week ending: City of Renton (425)430-7279 Bravo Environmental NW,Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City Stale ZIP+4 07 / 27 / 2014 11 S Grady Way Renton WA 98055 6437 South t44th Street Tukwila WA 98168 _ Deductions DAY AND DATE Work Classification Name Total and Earn MON TUE WED THU FRI SAT SUN Total Rate Hourly Withhold- andSoc Sec*of Employee Address Code Hours of Gross Amount "Usual FICA mg Tax Other NET 07121 07122 0723 0724 0725 07126 0727 Pay Earned Benefits- WAGES HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Pag 1 OF 1 RE C'E',VED AU G 4` 0 2014 CITY -lF RENTON UTILITY ;,YSTEMS DcFertinest of lobar and lndu�tric. rm-arling Wage Prupun AFFIRMATION ro BOX"540 Olympia WA 995(M4W Page 1 of 1 Today's Date Printed rurne of party signing this report Title MI3114 Wendy Conway Payroll Administrator lbe parry signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW,Inc. _ Project\arse: For the week starting: For the week ending: D018509-Gary Harper-Misty Cove LiR 07/21/14 07/27/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour"terns) Total Hourly _ (E)Approved Work Classiticatiou "Usual BeoeOts" (A)Hourly Pension (B)Hourly Medical (C)HNrly Vacation (D) Hourl> llolidaN Apprentice PrvtKram 1. 2. 3. 4. 5. 6. 7. R. 9. 10. I he party signing below At VIKMS the following- 11) All information contained in this Certified Payroll Report,including any addenda,is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker,labtmr or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All perwlls cmploycd u11 lie a1wvC-rCfCfeln ell ptufctt(b)Itavc bccrl paid die full weekly wdgCs CdnWd,inn)110 rCbdtC9 have been or will be Ilt aide ciLlwT dimlly of indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned (S) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions,and penalties. Printor - - ----- --- - rype ttame of party signing this repott 1tt Ic Signature- -— - _ftaft Conway 1DI Ad-M-1m, Lrat2 -_ r7oo-oo-ow certifacd payroll report backcr 05-119 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor L I Project Name County Project or Contract# Olympia.WA 98504-4540 D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 (360)902-5335 1`.� .7 Subcontractor QX Project Address City State ZIP+4 Misty Cove Lift Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 08 / 03 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Earn MON I TUE WED I THU I FRI I SAT I SUN Total Rate Hourly Withhold- Soc Sect of Employee Address Code Hours of Gross Amount "Usual FICA ing Tax Other NET 07128 07/29 07/30 07/31 08/01 08/02 08l03 pay Earned Benefits" WAGES HOURS WORKED EACH DAY ' No Work Performed F700-WS-000 certified payroll report 05-09 1 Pag 1 OF 1 [kpantnent of LANx and lndu+trio. AFFIRMATION Proailing Wahw Pwgnm PO Mix 44540 Olympia WA 9851µ4540 Page 1 of 1 Today's Date Printed name of party signing this report - 08/13/14 werxly cortway Payroll Administrator _ The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc Project Name: For the vmck starting: For the week ending: DO18509-Gary Harper-Misty Cove Lift 07/28/14 08/03/14 "IISUAI.BENEFITS"DISTRIBUTION (Please report in"per hour"teran) Total Hourly (E)approved Work Classi/kation "Usual Be"llts" (A)Hourly Pension (B)Hourly Medical (C)Hourh V*cation (D) Nourlr Holiday Apprentice Prouram 1. 2. 3. 4. G. 7. 8. 9. 10. the party signing below AF FIK%IS the following (1) All information contained in this Certified Payroll Repots,including any addenda,is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract.and the classifications as mpor-ted above for each worker.laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic. (1) The payments of usual benefits as listed abocc ha►c been or will he made to appropriate approved plans.funds or programs for the benefit of such employees. (4) All persons employed on the abv%c-rcfercih:W ptujrct(s)have bran paid the full weekly wages catiwd.and no tebates ltase been or will be hate hither dirmily ur indirectly to or on behalf of the above-earned contractor or subcontractor from the weekly wages earned by any,person No deductions,other than those which arc legally permissible,have been made by any perutn either directly or indirectly frnm the ful I wages earned 0) Any apprentices employed in the alx vc period are duly registered in a bona tide apprenticeship program registered kith the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Print or type nameofprty usning ibis report I ]file Signature - - Molly Cann I Payroll Administrator_ _ J r7OO-O65-OW certified payroll report backer 05-09 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction,Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.28 For Week Endin :August 16,2014 No Work Performed Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Dax and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Reimb Child Emp Total Paid Social Security Number Exemp- Classifications 10 11 12 13 14 15 16 Hours of Pay Earned Soc Sec Tax Emp Mats Support Advance Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 3604 Madrona St M-6 Equipment S Bremerton,WA 98312 Operator XXX-XX-7696 Lead O Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 1 O S O - - Date: or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4©below. I,Kathy Salazar,Office Manager do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction. Inc.on the Misty Cove Lift Station Replacement that during the payroll period QX --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 10th day of August 2014,and ending the 16th day paid,as indicated on the payroll,an amount not less than the sum of the of August 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract,except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits Justin Michaud Waivered out of group benefits (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 determiniation incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Signa re (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS KathySalazar,Office Manager l ��/iC�� The wilful falsification of any of the above statements may subject the contracto r sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001 or Title 18 and Se ion 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Prime Contractor Project Name Olympia.WA 98504-4540 County Project or Contra (360)902-5335 n�/ D018509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor Xj Project Address City State ZIP+4 xf1` Misty Cove Litt Station Replac ment Renton WA Awarding Agency Name 1 r' Phone Company N �ame P For the week ending City of Renton (425)430-7279 Bravo Environmental NW.Inc. (425)424-9000 Month Day Year Address City State ZIP+4 Address City State ZIP+4 08 / 31 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 Deductions DAY AND DATE Work Classification Name Total and and Eam MON TUE WED THU I FRI I SAT SUN Total Rate Hourly Withhold- Soc Sec#of Employee Address Code Hours of Gross Amount 'Usual FICA ing Tax Other NET 08/25 08/26 08/27 08/28 08/29 08/30 08/31 Pay Earned Benefits" WAGES _ HOURS WORKED EACH DAY ' No Work Performed F700-065-000 certified payroll report 05-09 Pag 1 OF 1 RECEIVED SEP 11 2014 CITY OF RENTON UTILITY SYSTEMS Departinenr of iAtrwand Industricc Prevailing ware Prograrn AFFIRMATION PC)Box 44540 nlv"Via MA QR�lM-4t4� Page 1 of 1 Today's Date Printed name of party signing this mpod --- Title 09IM14 Wendy Cartway _ _ _ Pa rol Administrate The party signing rht,rgxin pays or strpenises the (Name of contractor or subttmtractor► payment of the peraons employed hy: Bravo Environmental NW.Inc- Psojeet Name _- - For the week stoning: F'rw the week ending: D018509-Gary Harper-Misty Cove Lill OW&14 08/31114 "IISUAI.BENEFITS"DISTR1811TION (Please report in"per hour"term) T — l alai Hourh' (E)Approved Work Classification -Usual Beaelils" (A)Heady Pension B)Hourly Medical (C)Hourly Vacation (D) llourl% Holida% troupe Pro rum A+n+C•D•[ ' PP K I. 2. 3. 4. S. 6. 7. R. 9 10. 1 he pan signing heluw AFFIRMS the follow mg 11) All information contairxd in this Certified Payroll Report,including any addenda.is corrLct and complete. (21 The wage rate-for workers,laborers or mechanics as reported above are not le-.than the applicable wage vales contained in any wage determination related to the contract and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker,laborer or mechanic (3) The payments of usual benefits as listed above have been or will be made to uppropriale approved plans,fiends or programs for the benefit of such employees. (4) All p crnuns rutpluycd un the dbuve-referenced ptujitm(s)have beets paid the full weekly wages canted,and ou relates have brew or will be outdo either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by anv person.No deductions.other than those which are legally permissible,have been made by any person either directly or indirectly from the till I wager earned. 011 Any apprentices employed in the shove period are duly registered in a bona fide apprenticeship program registered with the Washington Stone Apprenticeship and Training Council. Falsification of anv of the abo%c statements is a violation of R('%% 39.12.050 subject to prosecution,sanctions. and penalties. Print or type name of party signing this report Title Sipurturc L_ t'7004)654000 certified payroll report backer 0"9 Department of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL REPORT PO Box 44540 Olympia WA 98504-4540 1� I Prime Contractor Project Name County Project or Contract# (360)902-5335 /p DO18509-Gary Harper-Misty Cove Lift KING WWP-27-3678 Subcontractor X Project Address City State ZIP+4 Misty Cove lilt Station Replac ment Renton WA Awarding Agency Name Phone Company Name Phone For the week ending C of Renton _ City (425)430-7279 Bravo Environmental NW.Inc. (425)424-90pp Month Day Year Address City State ZIP+4 Address City State ZIP+4 08 1 24 / 2014 1055 S Grady Way Renton WA 98055 6437 South 144th Street Tukwila WA 98168 DAY AND DATE Deductions Work Classification Name Total and and Earn MON TUE WED THU I FRI SAT SUN Total Rate Hourly Withhold- Soc Sect of Employee Address Code - Hours of Gross Amount "Usual FICA ing Tax Other NET 08118 08/19 08120 08/21 08/22 08/23 08/24 Pay Earned Benefits' WAGES HOURS WORKED EACH DAY ' No Work Performed F 700-D65-000 certified payroll report 05-09 Pag 1 OF 1 i tkpin arIIbor. Ind"stncs AFFAFFIRMATIONPre.aiatlitig wage Program K)Hms 44540 tll.nyris N A 911IM"540 Page 1 of 1 Today's Date Printed name of pan),signing this report — - Title _ 09/09/14 Wendy Conway _ Payroll Administrator The party sitpting this report pays or supervises the_--� (Name of contractor or subcontractor) payment of the persons employed by: Bravo Environmental NW.Inc. _ Project\time: _ -- For the week starting For the week endinc -- -- D018509-Gary Harper-Misty Cove Lift 08/18/14 08/24/14 "USUAL BF.NF.FITS"DISTRIBUTION (Please report in"per hour"terms) I otal Hou rh Wort Classification "I'vual Benefit." (A)Hourly Pension (B)Houriv Medical (C)Houriv Vacation (D) Ilourh llnlida� 1F")'+,ppr°".i t v u c n e t 1pprrntice Program 1. 2. 3. 4. S. G. 7. R. 9. 10. I he Party signing helou %F h IIt MS the lollow ing (1) All information contained in this Certified Payroll Repon. including am addenda.is correct and complete. (2) The wage rates for workers.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract.and the classifications as reported above for each worker.laborer or mechanic conform with the actual work performed by such worker.laborer or mechanic (3) The payments of usual henefits as limed above have been or will be made to appropriate approved plans.funds or progmms for the benefit of such employees. (4) All petKuns cinpluycd un else above-rrfctcnvvd ptt jcct(s)have txcn paid the full weekly.%ages ranted,and tits tebalrs Wit:been in H ill be made:vitltrt dtrrcily of indirectly to or on behalf of the above-named contractor or subcontractor fmrn the weekly wages earned by anv person.No deductions,other than those which arc Icgaliv permissible,have been made by any person either directly or indirectly from the full wages earnest l5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the%Vachington State Apprenticeship and Training Council. Falsification of an- of the ahove statements is a v inlation of R('%%"39.12.0.M subject to prosecution.sanctions. and penalties. Print or type name of party signing this rrM.n Title SigrWurc Wendy Conway PaviolAdministrator _ - i f700-065-000 certiRed payroll rcporl backer 05-09 9/5/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE HENCG.IIITISSH WORK CLASS PAY PERIOD DATE: 23-Aug 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA L&I TOT DED 17-Aug I8-Aug 19-Aug 20-Aug 21-Aug 22-Aug 23-Aug I-IRS PAY FWH UNION WK.GROSS NET PAY FRINGES DOMN)1.LON PO I3ON 5060 SSNH..........3996 0 0 0 0 0 0 0 0 0 0.00 142.61 9.24 195.93 wENATCIIEE,WA 9RH07 ELECAll 5 0 0 6 0 5 0 0 11 515.57 209.00 125.08 0.00 1864.24 351.61 134.32 1378.31 9h/2014 STATEMENT OF COMPLIANCE J I, ELLY MCINTYRE,OFFICE MANAGER do hereby state: (I)That 1 pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 171h day of AUG'14,and ending the 23rd day of AUG'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations, Part 3(29CFR 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3) that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION (craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation ofRCW 39.12.050 subject to prosecution,sanctions,and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER PAYROLL SUPPLEMENTARY SHEET NO WORK PERFORMED SUBCONTRACTOR: ADVANCED POWER, LLC PAYROLL # 1 HEREBY CERTIFY THAT NO EMPLOYEE WORKED ON THE CONSTRUCTION OF PROJECT r/YL DURING THE PERIOD FROM THE 0?0-1!�C OF / , 20Lj/-THROUGH ar OF 2015�. DATE: aq 9 SIGNATURE: TITLE: //7/rYll��i4 Certified Payroll Name of Contractor X or Subcontractor Address Gary Harper Construction, Inc. 14831 223rd St SE,Snohomish,WA 98296-3989 Payroll No.31 FINAL For Week Endin :Au ust 30,2014 Project&Location:Misty Cove Lift Station Replacement,Renton,WA Contract No.:WWP-27-3678 Day and Date Gross Deductions Net Wages Name,Address and No.of Work S M T W Th F S Total Rate Amount Medicare W/H L&I Total Paid Social Security Number Exemp- Classifications 31 1 1 2 3 4 5 6 Hours of Pay Earned Soc Sec Tax Emp Other Deduct For Week of Employee tions Hours Worked Each Da Andrew Evans 2124.80** 3604 Madrona St M-6 Equipment S 2.00 2.00 53.12* 106.24 (30.81) Bremerton,WA 98312 Operator (131.73) (217.00) (15.33) (196.15) (591.02)1 1,533.78 XXX-XX-7696 (Lead) O *Em to ee benefits hourly value$1.88, **Andrew worked 38 hours on other projects Justin Michaud 10215 Lundeen Pkwy#C7 M-9 Equipment S Lake Stevens,WA 98258 Operator XXX-XX-1921 O Richard McKenney,Jr. 27427 220th PI SE M-2 Pipelayer S Maple Valley,W 98038 XXX-XX-4901 O S O - Date: or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4©below. I, Kathy Salazar,Office Manager,do hereby state: (b) (1)That I pay or supervise the payment of the persons employed by Gary Harper Construction. Inc.on the Misty Cove Lift Station Replacement ;that during the payroll period ❑X --- Each laborer or mechanic listed in the above referenced payroll has been commencing on the 31st day of August 2014,and ending the 6th day paid,as indicated on the payroll,an amount not less than the sum of the of September . 2014,all persons employed on said project have been paid the full weekly applicable basic hourly wage rate plus the amount of the required fringe wages eamed..that no rebates have been or will be made either directly or indirectly to or on behalf benefits as listed in the contract.except as noted in Section 4(c)below. of said Gary Harper Construction, Inc.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, © EXCEPTIONS 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: EXCEPTION CRAFT EXPLANATION Richard McKenney Waivered out of group benefits Justin Michaud Waivered out of group benefits (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 determiniation incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work he performed. Remarks (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 State Department of Labor. (4)That: Name and Title Si na ure (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS KathySalazar,Office Manager The wilful falsification of any of the above statements may subject the contract r or sub- --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the contractor to civil or criminal prosecution. See section 1001'or Title 18 and Action 231 above referenced payroll,payment of fringe benefits as listed in the contract have been or title 31 of the United States Code. mIL SAND AND GRAVEL COMPANY it s — 400 VALLEY AVE NE - PUYALLUP, WA 98372-2516 www.MilesSandandGravel.com - (253) 833-3705 CONCRETE - GRAVEL - CRUSHED ROCK - SAND RECEIVED SEP 18 2014 CITY OF RENTON UTILITY SYSTEMS NO WORK PERFORMED Miles Sand & Gravel Company, does hereby certify that no person were employed and no work was performed on the Gary Harper Construction Inc — Misty Cove Lift Station Replacement during the payroll period commencing on the 18 day of May, 2014 and ending the 23 day of August, 2014. Marjean Davis Payroll/HR Mgr CONCRETE ORDERS CONCRETE ORDERS SAND&GRAVEL ORDERS SAND&GRAVEL ORDERS ACCOUNTING&SALES King.Pierce&Kitsap Co. Thurston,Lewis&Mason Co. King&Pierce Co. Thurston,Lewis&Mason Co. (253)833-3705 (253)833-3700 (360)491-7777 (253)536-9100 (360)491-7777 Department of Labor and Industries STATe CERTIFIED PAYROLL REPORT Prevailing Wage Program ore °4 PO Box 44540 2 Project Name County Project or Contract# Olympia WA 98504-4540 `l 8H �y Prime Contractor o (360)902-5335 ryv a ❑ Misty Cove Lift Station Replacement King WWP-27-3678 Subcontractor ® Project Address City State Renton Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425-430-7279 Miles Sand&Gravel Company-(Gary Harper) 253-833-3705 Month Day Year Address City State ZIP+4 Address City State ZIP+4 8/30/14 1055 S Grady Way Renton WA 98055 400 Valley Ave NE Puyallup WA 98372 Dav and Date Deductions Work Classification Name G Sun Mon Tue Wed Thu Fri Sat Total and and v Rate Hourly Soc Sec#of Employee Address > 8a,na 8a5n, satin, 8/27/14 sasn, ./zW.4 W.14 Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Earned Benefits" FICA in-Tax Other WAGES l. Transit Mixer-All David Johansen OT 0.00 50.07 0.00 1615 57°Ave NE 79.11 $ 9.85 $ 79 11 000-00-8627 Tacoma,WA 98422 RG 2.37 2.37 33.38 79.11 2 OT 0.00 %07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 3 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 4 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 5 OT O.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 6 OT 0.00 50.07 0.00 o.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 7 OT o.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 8 OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 RG 0.00 33.38 0.00 9 OT 0.00 50.07 0.00 o.00 $ 9.85 $ 0.00 RG O.00 33.38 0.00 10. OT 0.00 50.07 0.00 0.00 $ 9.85 $ 0.00 rRG 0.00 33.38 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program AFFIRMATION PO Box 44540 Olympia WA 985044540 Today's Date Printed name of party signing this report Title 9/11/14 Marjean Davis Payroll/IIR Mgr The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Miles Sand&Gravel Company -(Gary Harper) Project Name: For the week starting: For the week ending: Misty Cove Lift Station Replacement 1 8/24/14 8/30/14 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour" terms) Total Hourly (E)Approved Work Classification "Usual Benefits" (A)Hourly Pension (B)Hourly Medical (C)Hourly Vacation (D)Hourly Holiday Apprentice Program (A+B+C+D+E) 1. Transit Mixer-All $ 9.85 $3.34 $4.82 $0.99 $0.70 2. $ 9.85 $3.34 $4.82 $0.99 $0.70 3. $ 9.85 $3.34 $4.82 $0.99 $0.70 4. $ 9.85 $3.34 $4.82 $0.99 $0.70 5. $ 9.85 $3.34 $4.82 $0.99 $0.70 6. $ 9.85 $3.34 $4.82 $0.99 $0.70 7. $ 9.85 $3.34 $4.82 $0.99 $0.70 8. $ 9.85 $3.34 $4.82 $0.99 $0.70 9. $ 9.85 $3.34 $4.82 $0.99 $0.70 10. $ 9.85 $3.34 $4.82 $0.99 $0.70 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report,including any addenda, is correct and complete. (2) The wage rates for workers,laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4) All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signatur Marjean Davis Payroll/HR Mgr ` F700-065-000 certified payroll report backer 05-09 �� MIL S�� �-1;gh SAND AND GRAVEL COMPANY 4111111111p, 400 VALLEY AVE NE • PUYALLUP, WA 98372-2516 www.MilesSandandGravel.com • (253) 833-3705 CONCRETE GRAVEL • CRUSHED ROCK • SAND NO WORK PERFORMED Miles Sand & Gravel Company, does hereby certify that no person were employed and no work was performed on the Gary Harper Construction Inc — Misty Cove Lift Station Replacement during the payroll period commencing on the 31 day of August, 2014 and ending the 6 day of September, 2014. G� Marjean Davis Payroll/HR Mgr CONCRETE ORDERS CONCRETE ORDERS SAND&GRAVEL ORDERS SAND&GRAVEL ORDERS ACCOUNTING&SALES King,Pierce&Kitsap Co. Thurston,Lewis&Mason Co. King&Pierce Co. Thurston,Lewis&Mason Co. (253)833-3705 (253)833-3700 (360)491-7777 (253)536-9100 (360)491-7777 9/11/2014 STATEMENT OF COMPLIANCE I, ELLY MCINTYRE,OFFICE MANAGER do hereby state: (1)That I pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 13th day of JUL'14,and ending the 19th day of JUL'14 all persons employed on said project have been paid the full weekly wages earned,that' reb7ttes have been or will be made either directly or indirectly to or on behalf of said ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by ny person,other than permissible deductions as defined in Regulations,Part 3 (29CFR Subtitle A),issued by the Secretary of Li bor 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: (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 the 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 worker,laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X)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 correct 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 each 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,except as noted in section 4(c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report,including any addenda, is correct. Falsification of any of the above statements is a violation ofRCW 39.12.050 subject to prosecution,sanctions, and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE, OFFICE MANAGER , 9/11/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE MEXCrl.1PT/SSN WORT:CLASS PAY PERIOD DATE: 19-Jul 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS FICA L&1 TOT DED 13-Jul 14-Jul 15-Jul 16-Jul 17-Jul 18-Jul 19-Jul I•IRS PAY FWI•I UNION WK.GROSS NET PAY FRINGES THOMAS,DAVID L. 1.1433 20TII OIL NW SSNa.......3645 o 0 0 0 0 0 0 0 0 0.00 77.27 5.08 287.43 MARYSVILLE,WA 98271 ELECJJR S 0 0 0 8 6 0 0 14 656.18 98.00 107.08 0.00 1010.02 175.27 112.16 722.59 DORRAII,LON PO ROx 5060 SSNH..........3R96 0 0 0 0 0 0 0 0 0 0.00 136.16 9.24 562.21 WENATCIIEE WA MW ELEC./lit S 0 0 0 4 0 0 0 4 187.48 191.00 225.81 0.00 1779.76 327.16 235.05 1217.55 PAYROLL SUPPLEMENTARY SHEET NO WORK PERFORMED SUBCONTRACTOR: ADVANCED POWER, LLC PAYROLL # L I HEREBY CERTIFY THAT NO EMPLOYEE WORKED ON THE CONSTRUCTION OF PROJECT DURING THE PERIOD FROM THE ! �OF , 20JL THROUGH �-OF 29��. DATE: -AT "Li- SIGNATURE: TITLE: 9/t 0/-014 STATEMENT OF COMPLIANCE I, ELLY MCINTYRE,OFFICE MANAGER do hereby state: (])That 1 pay or supervise the payment of the persons employed by ADVANCED POWER LLC on MISTY COVE LIFT STATION,that during the payroll period commencing on the 3lst day ofAUG'14,and ending the 6th day of AUG'14 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 ADVANCED POWER LLC from full weekly wages earned by any person and that no deductions have been made either directly or indirectly from full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3 (29CFR 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: (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 the 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 worker, laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3)that any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS OR PROGRAMS (X) 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 correct 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 1N CASH () Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll an each 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,except as noted in section 4 (c)below. (c)EXCEPTIONS EXCEPTION(craft) EXPLANATION REMARKS: All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. NAME AND TITLE SIGNATURE ELLY MCINTYRE,OFFICE MANAGER 9/10/2014 ADVANCED POWER LLC CERTIFIED PAYROLL REPORT JOB NUMBER: 1319 NAME: MISTY COVE LIFT STATION REPLACEMENT EMPLOYEE NE.NUMPTISSN WORK CLASS PAY PERIOD DATE: 6-Aug 2014 SUN MON TUES WED THUR FRI SAT TOT GROSS PICA L&I TOT DED 31-Jul ]-Aug 2-Aug 3-Aug 4-Aug 5-Aug 6-Aug HRS PAY FWH UNION WK.GROSS NET PAY FRINGES DORRAH,LOREN W 17505 51 ST ST SE SSNN........4314 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 DOTI TELL,WA 99012 OWNERJOPER S 0 0 0 0 0 4 0 4 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OWNERJOPERATOR CERTIFIED•PAYROLL Replacement Week Ending: Awarding Agency: d Subcontractor _Prime Com actor : t 6/8/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address.PO BOX 9 t PR#177055SGRAOY WAY RENTON,WA-98055 21 31 4 51 61 71 Company Phone: 425-867-1234 Job Title Pav Rate Mon Tue Wed Thu Fri Sat Sun TOTALS r«,wsuswn ten, Gross Eaminas T8X@S Deductions Net Wages k Mergenthaler, David R' Pre-Mix Reg o.50 0.50 14.29 ; 8349418 Concrete 2 8.5 7 OT 0.00 0.00 Driver 0.50 19.34 1 t 1479.01 281.77 85.58 1111.66 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 F++ Driver 0.00 r._. _. Pre-Mix Reg 0.00 0.00 F' Concrete OT �_H 0.00 0.00 Driver 0.00 d Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 x �. Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 -; Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 3 Driver 0.00 ,. a Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 t Driver 0.00 t -•- i ` Pre-Mix Reg 0.00 0.00 k Concrete OT 0.00 0.00 } Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.0100 . 00 Pre-Mix Reg 0.00 0.00 f Concrete OT 0.00 0.00 Driver 0.00 a Pre-Mix Reg 0.00 0.00 FINAL CADA1AN INC CONTRACT#WWP-27-3678 - CERTIFIED PROJECT PAYROLL RENTON.CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Lift Station Repl S CERTIFIED PROJECT PAYROLL GACT# PER CONST - CONTRACT WWP-27-3878 i �;,,J I MIC111 u1�aua auu uwWIuic,S ��j Y' A ���®� Pn:�-iiling Wage Program AFFIRMATION Y Y 110 13oc 44540 blynipia WA 985044540 �i ;i I od�y's Date Printed name of party signing this report Title i 9/23/14 TavlorThomas Payroll Specialist fhe'party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Cadman Inc Pm� ct Name: For the week starting: 1'or the week ending: I��listy Cove Lift Station Replacement 6/2/14 6/8/14 "USUAL BENEFITS"DISTRIBUTION (Please report in"per hour" terms) t Total Hourly (E)Approved Work Classification "Usual Benefits" (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday Apprentice Program I (A+B+C+1)+E) 0.00 0.00 $ 0.00 14. S 0.00 $ 0.00 16. $ 0.00 17.�( $ 0.00 (g, $ 0.00 0.00 0.00 } The party signing below AFFIRMS the following: All information contained in this Certified Payroll Report,including any addenda, is correct and complete. 1(2- The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the i ;� contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. t I (4)} All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or 7i indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally i permissible, have been made by any person either directly or indirectly from the full wages earned. 1 ! (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. i j Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecutio ,sanctions, and penalties. 4 t I'ruu or type name of party signing this report Title Signature Tavlor Thomas Payroll Specialist a I"•17001065-000 certified payroll report backer 05-09 1 11 • r i 1 CERTIFIED PAYROLL Replacement . Week Ending: Awarding Agency: f` J Subcontractor c Pnme CowmciT , 6J1/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address:PO BOX 9 f<< t PR#16 BOSS S GRAOY WAY RENTON,WA•86055 2-6-F-27-7281 291 301 311 11 Company Phone: 425-867-1234 k Job Title Pay Rate neon Tue wed Thu Fri sat sun TOTALS rttyusustie..n Gross Earnings Taxes Deductions Net Wages Rammler, Shawn A Pre-Mix Reg .1351 1 1 10.85 22.70 8319294 Concrete 26.70 OT 0.00 0.00 Driver 0.85 21.21 ~_ 1318.29 326.95 49.46 941.88 Pre-Mix Reg 0.00 0.00 I i Concrete OT 0.00 0.00 ! i Driver 0.00 I Prc-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 - Pre-Mix Reg 0.00 0.00 Concrete OTH-4 0.00 0.00 j Driver 0.00 Prc-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 x: t Pre-Mix Reg 0.00 0.00' t Concrete OT 0.00 0.00 Driver 0.00 i Pre-Mix Reg 0.00 . ,0.00 I Concrete OT 0.00 0.00 s Driver 0.00 .Y _ ? Pre-Mix Reg 0.00 0.00 i Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 t Concrete OT 0.00 0.00 k j Driver 0:00 I Pre-Mix Reg 0.00 0.00 k 1 Concrete OT 0.00 0.00 Driver r... 0.00 77 Pre-Mix Reg 0.00 0.00 G ; CADMAN INC CONTRACT#WWP-27-3678 CERTIFIED PROJECT PAYROLL RENTON.CITY OF ; Job Address5027 Ripley Lane N, Renton, WA 98056 Misty cove Lift Station Repl CERTIFIED PROJECT PAYROLL CONTRACT GRACT4HARPERCONST tlWWP•27.3678 f t t t i k ; -- i I�GIJ IUIICIII I}1 1.J1)lll Sllll IIIU U>l1 IC> AFFIRMATION1 Ltcvailinr\\'aac Program PO 0'ox 44540 Ilj•ntria WA 98504.4540 q T6tlii 's Date Printed name of party signing this report Title ;f 9/23/14 Taylor Thomas Payroll Specialist 'lhe party signing this report pays or supervises the (Name of contractor or subcontractor) I ayment.of the persons employed bv: Cadman Inc I ro4ect Name: For the week starting: For the week ending: t<�vlisiv Cove Lift Station Replacement 5/26/14 6/1/14 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour"terms) Total Hourly (E) Approved Work Classification "Usual Benefits" (A) Hourly Pension (B) Hourly Medical (C)Hourly Vacation (D)Hourly Holiday ApprcnticeProgram (A+B+C+D+E) 0.00 2: k $ 0.00 0.00 �}: $ 0.00 0.00 0.00 7. { $ 0.00 0.00 { $ 0.00 1101 $ 0.00 !The party signing below AFFIRMS the following: f {1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2); The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in anv wage determination related to the contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)' The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)"1 All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will be made either directly or { indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 1(.5).j Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and t Training Council. i { Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. 11166t or type name of party signing this report Title Signature lTa,'t]or Thomas Payroll Specialist .i 1:300-065-000 certified payroll report backer 05-09 I i 7 CERTIFIED PAYROLL Replacement Week Ending: Awarding Agency: ontractor c Pnme Controcrnr 4/20/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address:PO BOX 9 k I ' PR#10 1055 S GRADY WAY RENTON,WA•9W55 141 151 161 171 181 191 20 Company Phone: 425-867-1234 ]OI)Title Pav Rate Mon Tue Wed Thu Fri Sat Sun TOTALS towususnie Gross Earnings Taxes Deductions Net Wages ' Dorman,James C Pre-Mix Reg 1.25 1.25 35.71 6115378 Concrete 28.57 OT o.00 0.00 j Driver 1.25 19.34 y ., � 1350.95 264.16 9.89 1076.9 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 j Driver 0.00 4�4 1E Pre-Mix Reg 0.00 0.00 ! j Concrete OT 0.00 0.00 I. Driver 0.00 Pre-Mix Reg 0.00 0.00f E, j Concrete OT 0.00 0.00 Driver 0.00 - c f ` t Pre-Mix Reg 0.00 0.00 t Concrete OT 0.00 0.00 ! 3 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 h Prc-Mix Reg 0.00 0.00 E Concrete OT 0.00 0.00 0.00 r 1 Driver .. .. Pre-Mix Reg 0.00 0.00 1 Concrete OT 0.00 0.00 '` 1 Driver 0.00 k 1 Pre-Mix Reg a00 0.00 Concrete OT 0.00 0.00 j _ _Driver 0.00 ,.----._ Pre-Mix Reg 0 00 - 0.00' _ Concrete OT 0.00 0.00 t Driver 0.00 i �� ' b ' Pre-Mix Rea 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 1. t Pre-Mix Reg 0.00 0.00 CADMAN INCPAYROLL CONTRACT#WWP-27-3678 CERTIFIED PROJECT RE TON.CITY OF p # Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Ldt Station Repl G PERCONST CONTRACT CERTIFIED PROJECT PAYROLL CONTRACT tlWWP-273678 1� } e r r a 4 { UCp�ll IIIICIIL U1 LAIX11 Gl1U IIIU LL]IIIC] - 11TO ilin g Wage Program AFFIRMATION P0,13o1 44540 inl\?nlpia WA 99SNA5110 3 Jl #1 oiia�'s Date Printed name of party signing this report Title 9/23/14 Taylor Thomas Payroll Specialist ITha party signingthis report pays or supervises the (Name of contractor or subcontractor) 0 y)nent of the persons employed by: Cadman Inc Pro�cct Name: For the week starting: For the week ending: Misty Cove Lift Station Re lacement 4/14114 4/20/14 "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour" terms) ,1 Total Hourly (E)Approved Work Classification "Usual Benefits" (A) Hourly Pension (B)Hourly Medical (C) Hourly Vacation (D)Hourly Holiday Apprentice Program (A+B+C+D+E) 0.00 12.J $ 0.00 43.;J $ 0.00 14. ; $ 0.00 -J $ 0.00 6. $ 0.00 $ 0.00 $ $ 0.00 $ 0.00 The party signing below AFFIRMS the following: (I) All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (?)i The wa-e rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the (31,, contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker,1aborer or mechanic. The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. -. -W All-persons em to ed-on the-above-referenced roject s _have-been aid the full weeklywa es earned,and no rebates-have been or will be made either directly or P P )' P J O -P - - �- -- - — - - indirectly to or on behalf of the above-named contractor or subcontractor from the-weekly wages earned by any person:No deductions,-other than those which are-legally permissible,have been made by any person either directly or indirectly from the full wages earned. 1 (5;! Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. i Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. 3 Print or type name of party signing this report 'hide Signature Taylor Thomas Payroll Specialist i j700 065-000 certified payroll report hacker 05-09 1 t 1 ' 'CERTIFIED.PAYROLL - Replacement Week Ending: Awarding Agency: r subcontractor k P-Comrauo, 4/6/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address: PO BOX 9 PR#8 1055 S GRADY WAY RENTON;WA-98o55 311 11 21 31 41 5 6 Company Phone: 425-867-1234 Job Title Pay Rate Mon Tue Wed Thu Fri Sat Sun TOTALS T_usuvie�rcn Gross Earnings Taxes Deductions Net Wages Grosso, Brett J Pre-Mix Reg ^ 1-001 1 1 1 1 1.00 24.65 t 8541354 Concrete 24.65 OT 0.00 0.00 i Driver 1.00 23.26 1 ` ' 1405.85 318.19 106.16 981.5 i Pre-Mix Reg 0.00 0.00 FF i Concrete OT 0.00 0.00 P I Driver 0-00 5 Pre-Mix Reg 0.00 0.00 r i Concrete OT 0.00 0.00 i Driver 0.00 _ Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-MIN Reg 0.00 0.00 # + Concrete OT 0.00 0.00 Driver 0.00 s fi i Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 k t Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT QAO 0.00 Driver 0.00 x Pre-Mix Reg 0.00 0.00 Concrete OTH_j 0.00 0.00 1'._.__ Driver V "- 0.00 I I k Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 r j Driver- 0.00 __ Pre-Mix Reg _ _ - 0.00 0.00 - - - Concrete OT 0.00 0.00 Driver 0,00 Pre-Mix Reg 0.00 0.00 1 { Concrete OT 0.00 0.00 Driver r 0-00 ."4 Pre-Mix Reg 0.00 0.00 I' CADMAN INC PAYROLL CONTRACT#WWP-27-3678 CERTIFIED PROJECT REENTON,CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove Lift Station Rept GARYHARPERCONST CON CERTIFIED PROJECT PAYROLL I TRACT#WWP-27-3G78 � 1 F i i ie1111l1It ulu 11Uu]U IC] vailin Va_c Yroeram AFFIRMATION c.)lios 44540 lmipia WA 98504-4540 1 i1'odhy's Date Printed name of party signing this-report Title I '1 9/23/14 Taylor Thomas Payroll Specialist lnccjparty signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by- Cadman Inc Proji ct Name: For the week starting: For the week ending: 4is Cove Lift Station Replacement 3/31/14 4/l/14 i � S "USUAL BENEFITS" DISTRIBUTION (Please report in"per hour"terms) Total Hourly F., Approved Work Classification "Usual Benefits" (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday ( )I E (A+u+C+D+F) Apprentice Program $ 0.00 0.00 0.00 ;4. } $ 0.00 15. i $ 0.00 0.00 t7.. ? $ 0.00 0.00 19. i $ 0.00 l 0'� $ 0.00 f The party signing below AFFIRMS the following: 0)a All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)1 The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in anv wage determination related to the C contract-,and the classifications as reported above for each worker,laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. i The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. i I(-4 All persons employed on the above-referenced project(s)have been paid the full weekly wages earned,and no rebates have been or will-be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally ! permissible,have been made by any person either directly or indirectly from the full wages earned. ('S) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 1 Training Council. � 1 1 Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. 3 1 i CPrint or type name of party signing this report Title Signature "ravlor Thomas Payroll Specialist t i 1'100-,065-000 certified payroll report hacker 05-09 t CERTIFIED PAYROLL Replacement Week Ending: Awarding Agency: 't� Subcontractor o Pdme can raaor 3/30/2014 RENTON, CITY OF Hours Worked Each Day Subcontractor Name: Cadman Inc Company Address:PO BOX 9 PR#7 1055 S GRADY WAY RENTON.WA-98055 241 251 26177-F78-F-291 30 Company Phone: 425-867-1234 Job Title PaV Rate Mon Tue Wed Thu Fri Sat Sun TOTALS t�ususALeI�o Gross Earnings_Taxes Deductions Net Wages 1 Carter, Steven D Pre-Mix Reg 10.231 1 1 1 0.23 6.20 6114594 Concrete 26.95 OT 1 1 1,57 1 1 1 1.57 63.47 1 Driver 1.80 20.96 _..r.�,. 1439.12 214.55 381.05 843.52 Grosso, Brett J Prc-Mix Reg 1.o0 1.00 1 2.00 49.30 8541354 Concrete 24.65 OT 1 0.00 0.00 Driver 2.00 23.26 1161.41 238.2 108.68 814.53 Olson,Christopher J Pre-Mix Reg 4.001 1 1 14.00 105.80 i 6118499 Concrete 26.45 OT 0.00 0.00 1 Driver 4.00 21.46 V~- 1307.48 231.58 182.01 893.89 Rammler,Shawn A Pre-Mix Reg 4.23 4.23 106.60 , 8319294 Concrete 25.20 OT 0.00 0.00 Driver - 4.23 1190.48 285.23 51.61 853.64 Pre-Mix Reg 0.00 0.00 t Concrete OT 0.00 0.00 t Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 t Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT 0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 Concrete OT �_H0.00 0.00 Driver 0.00 Pre-Mix Reg 0.00 0.00 p Concrete OT 0.00 0.00 L ! Driver __ _ - 0:00 Pre-Mix Reg 0.00 0.00 # Concrete OTH_+ 0.00 0.00 I Driver 0.00 t t Pre-Mix Reg 0.00 0.00' t I Concrete OT 0.00 - 0.00 Driver ;. 0.00 _ :,! r Pre-Mix Reg 0.00 0.00 x CADMAN INC 1 CERTIFIED PROJECT PAYROLL CONTRACT#WWP-27-3678 RENTON,CITY OF Job Address5027 Ripley Lane N, Renton, WA 98056 Misty Cove L h Station Rapt G CERTIFIED PROJECT PAYROLL P; PERCONST k t CuNTRACTACT sWWP•273678 F t r fii r ? 1 i I 4 � ?I Pt ic\il1nl.tllllllg Wag a_LciIProgram rogram UIUII]II IlJ AFFIRMATION ln PU 13oz 44540 )(vi'llipii WA 9s504A540 iii Tbdity's Date Printed name of party signing this report ride 9/23/14 __7TavlorThomas Payroll Specialist IIfhrjparty signing this report pays or supervises the (Name of contractor or subcontractor) ppy nent of the persons employed by: Cadman Inc r the week ending: Project Name: For the week starting: Fo �m stv Cove Lift Station Replacement 3/24/2014 3/30/14 ' "USUAL BENEFITS- DISTRIBUTION (Please report in"per hour"terms) ff Total Hourly (E) Approved f Work Classification "Usual Benefits" (A) Hourly Pension (B)Hourly Medical (C) Hourly Vacation (U)Hourly Holiday Apprentice Program j (A+B+C+D+E) 0.00 0.00 $ 0.00 0.00 0.00 16.J $ 0.00 17. $ 0.00 18.y $ 0.00 19. j $ 0.00 10� $ 0.00 The party signing below AFFIRMS the following: k CI): All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (',2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the 1 ; ` contract;and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3j The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. j(4 All-persons employed-on the above=referenced-project(s)have-been paid the-full weekly-wages earned,and no rebates have been or will be made-either directly-or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions,other than those which are legally pennissible,have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signatur ftiylor Thomas Payroll Specialist 1001065-000 certified payroll report backer 05-09 � J Cadman, Inc. Suite 100 7554 185"'Avenue 1\'G PO Box 97038 Redmond,WA 98073-9738 425.867.1234 taz 425.861,4046 www.cadman.cann PR 9 9 NO WORK PERFORMED CADMAN INC does hereby certify that no persons were employed on and no work was performed for Gary Harper Construction on the Misty Cove Lift Station Replacement job, during the period of April,7th through April 13th, 2014. Signed: Title: Payroll Specialist arioa IFRGt'id.ti:.,Ir p r.• Cadman, Inc. Suitt 100 7554 185i°Avenue NE PO Box 97038 Redmond,WA 98073-9738 425.867.1234 cap 425.861.4046 www.cadman.com PR # 11 -15 NO WORK PERFORMED CADMAN INC does hereby certify that no persons were employed on and no work was performed for Gary Harper Construction on the Misty Cove Lift Station Replacement job, during the period of April 21 2014 through May 25th, 2014. Signed: Title: Payroll Specialist