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HomeMy WebLinkAboutWWP273831i) AB - 1784 Transportation Systems Division requested approval of Addendum 03-16 to lease agreement LAG-13-005 with Landing Gear Works, LLC, for an increase of 2,020 sq. ft. of office space and 1,474 sq- ft. of storage space in the 295 E Perimeter Rd. building, for a net revenue increase of $9,175.06 per year. Refer to Transportation (Aviation) Committee. j) AB - 1785 Transportation Systems Division submitted 10C-01-54 (Formerly CAG-13-149, WO #54.15), Airport Pressure Reducing Valve Installation, with Forma Construction Company; and requested acceptance of the project and approval of the final pay estimate in the amount of $13,085.92. Council Concur. k) AB -1783 Utility Systems Division submitted CAG-15 149, Cascade Interceptor Rehabilitation Phase 11, with Insituform Technologies, LLC; and requested acceptance of the project and release of the retainage in the amount of $66,077 02 after 60 days, subject to the receipt of all required authorizations Council Concur. 1) AB - 1787 Utility Systems Division recommended adoption of the 2016 King County Surface Water Design Manual with City amendments Refer to Planning & Development Committee. MOVED BY CORMAN, SECONDED BY PAVONE, COUNCIL CONCUR TO APPROVE THE CONSENT AGENDA, AS PRESENTED, CARRIED UNFINISHED BUSINESS a) Committee of the Whole: Council President Corman stated that consensus appeared to be reached regarding the adoption of legislation regarding source of income discrimination MOVED BY CORMAN, SECONDED BY MCIRVIN, COUNCIL ADOPT THE EMERGENCY VERSION OF THE SOURCE OF INCOME DISCRIMINATION ORDINANCE DRAFTED BY THE CITY ATTORNEY AS AMENDED TO ONLY INCLUDE SECTION 8 HOUSING CHOICE VOUCHERS.' Council discussion ensued regarding the other forms of income included in the ordinance such as social security disability and pensions, child support payments, and unemployment benefits among others. It was determined that only Section 8 Housing Choice Vouchers be included in the emergency ordinance *ROLL CALL: ALL AYES. MOTION CARRIED. MOVED BY PRINCE, SECONDED BY CORMAN, COUNCIL REFER THE DISCUSSION ON OTHER SOURCES OF INCOME DISCRIMINATION TO THE ADMINISTRATION TO BE PRESENTED AT A FUTURE COMMITTEE OF THE WHOLE MEETING. CARRIED. ADDED LEGISLATION Ordinance for first reoding and advancement to second and final reoding: a) Ordinance No. 5828: An ordinance was read amending Title VI (Police Regulations) of the Renton Municipal Code, by adopting a new Chapter 6-32, entitled Fair Housing Regulations, temporarily prohibiting property owners and property managers from discriminating against tenants or potential tenants on the basis of participation in a Section 8 Housing Choice Program, establishing penalties and an appeal process, and declaring an emergency and immediate need for this ordinance to take effect upon passage. November 7, 2016 REGULAR COUNCIL MEETING MINUTES CITY COUNCIL REGULAR MEETING — November 7, 2016 SUBJECT/TITLE: Project Acceptance: Cascade Interceptor Rehabilitation Phase II CAG-15-149 RECOMMENDED ACTION: Council Concur DEPARTMENT: PW/Utility Systems Division STAFF CONTACT: John Hobson EXT.: 7279 The original contract amount was $752,904.32 and the final amount is $761,624.61, an increase of $8,720.29. The minor cost increase was due to additional time and materials to rehabilitate the project's 20 manholes that had larger diameters than the plans and specifications indicated. SUMMARY OF ACTION: The project was awarded on August 10, 2015. Construction began on July 18, 2016, and was completed on October 5, 2016. This rehabilitation project utilized Cured -in -Place Pipe (CIPP) technology. Insituform Technologies, LLC was the company awarded the contract. The next vacancy in their construction schedule was December 2015. To accomplish the work, Soos Creek Water and Sewer District would be required to reroute some of their sewage flows to a different interceptor. However, the other interceptor does not have the capacity to accept the additional sewage flows and the stormwater infiltration that occurs during the winter months. Therefore, the start of construction was rescheduled for summer 2016 to take advantage of the dry weather. Eighty percent of the sewage that flows through the Cascade Interceptor comes from Soos Creek Water and Sewer District. As part of an interlocal agreement, Soos Creek Water and Sewer District will reimburse the City of Renton for 80% of the construction costs ($609,299.69). A. Notice of Completion of Public Works Contract Accept the project and release the retainage in the amount of $66,077.02 after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WWP - WasteWater\WWP-27-03831 Cascade Interceptor Rehabilitation Phase II\Pay Estimates\agenda bill Central Renton Interceptor Reline & Upsize.docx\JDHtp SF, SCATf7 r, Original �El Revised # 't rNtl9 a, NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Date: Contractor's UBI Number: 601880220 Name & Mailing Address of Public Agency Department Use Only City of Renton Assigned to: 1055 S Gradv Wav Renton, WA 98057 Date Assigned: UBI Number: 177000094 Notice is lrerebt' Qiven relative to the completion of contract or project described below Project Name Contract Number Job Order Contracting Cascade Interceptor Rehabilitation Phase II Cag-15-149 ❑ Yes V No Description of Work Done/Include Jobsite Address(es) Cured -in -Place Pipe (CIPP) of approximately 605 ft of 14" diameter, 265 ft of 18" diameter, 962 ft of 21" diameter and 2,935 ft of 24" diameter concrete sewer mains and rehabilitation of 20 concrete manholes in the Tiffany Park neighborhood of Renton, Washington �{ Federally funded transportation project? El Yes S No (if yes, provide Contract Bond Statement below) Contractor's Name E-mail Address Affidavit 1D* Insituform Technologies, LLC Ipsoles470@insituform.com 1671645 Contractor Address Telephone # 17988 Edison Ave, Chesterfield, MO 63005 1636-530-8000 If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. ❑ Retainage Bond ❑ Contract/Payment bond (valid for federall} funded transportation projects) Name: I Bond Number: Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted August 10, 2015 July 18, 2016 October 5, 2016 Were Subcontracters used on this project? If so, please complete Addendum A. Wyes ❑ No Affidavit ID* - No L&I release will be granted until all affidavits are listed. Contract Amount Additions ( + ) Reductions (- ) Sub -Total Sales Tax Rate 9.5 (If various rates apply, please send a breakdown) Sales Tax Amount 687,583.85 7.963.74 $ 695,547.59 66077.02 TOTAL S 761,624.61 :vv t c: i nese two totals must ae Liquidated Damages $ Amount Disbursed $ 726,847.22 Amount Retained $ 34,777.39 TOTAL $ 761,624.61 Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Submitting Form: Please submit the completed form by email to all three agencies below. Contact Name: Natalie Wissbrod Title: Accounting Assistant Email Address: nwissbrod@rentonwa.gov Phone Number: 425-430-6919 to Department of Revenue Washington State mEmployment are Dgrxvn o} p � Security Public Works Section Department Labor & Industries Registration, In ui TRO(360) 704-5650 Contract Release Standards 8 Coordination PWC@dor.wa.gov (855) 545-8163, option # 4 Unit ContractRelease@LNI.WA. GOV (360) 902-9450 REV 31 0020e (10/26/15) F215-038-00010-2014 publicworks@esd.wa.gov Addendum A: Please List all Subcontractors and Sub -tiers Belo%i This addendum can be submitted in other formats. Provide knox%n affidavits at this time. No L&I release i%ill he granted until all affidavits are listed. Subcontractor's Name: UBI Number: (Required) Affida%it HY Advanced Government Services. Inc 602304323 672039 Maverick Pump Services 603265774 671826 C-More Pipe Services Co 601854387 674291 For tax assistance or to request this document in an alternate format, please call 1-800-647-7706. Teletype (TTY) users may use the Washington Relay Service by calling 711. REV 31 0020e Addendum (10/26/15) F215-038-000 10-2014 DATE: I `� ✓,__Z -I �. l `p COUNCILCITY 'R MEETING —November1 SUBJECT/TITLE: Project Acceptance: Cascade Interceptor Rehabilitation Phase II CAG-15-149 RECOMMENDED ACTION: Council Concur DEPARTMENT: PW/Utility Systems Division STAFF CONTACT: John Hobson EXT.: 7279 SUMMARY:FISCAL IMPACT The original contract amount was $752,904.32 and the final amount is $761,624.61, an increase of $8,720.29. The minor cost increase was due to additional time and materials to rehabilitate the project's 20 manholes that had larger diameters than the plans and specifications indicated. SUMMARY OF ACTION: The project was awarded on August 10, 2015. Construction began on July 18, 2016, and was completed on October 5, 2016. This rehabilitation project utilized Cured -in -Place Pipe (CIPP) technology. Insituform Technologies, LLC was the company awarded the contract. The next vacancy in their construction schedule was December 2015. To accomplish the work, Soos Creek Water and Sewer District would be required to reroute some of their sewage flows to a different interceptor. However, the other interceptor does not have the capacity to accept the additional sewage flows and the stormwater infiltration that occurs during the winter months. Therefore, the start of construction was rescheduled for summer 2016 to take advantage of the dry weather. Eighty percent of the sewage that flows through the Cascade Interceptor comes from Soos Creek Water and Sewer District. As part of an interlocal agreement, Soos Creek Water and Sewer District will reimburse the City of Renton for 80% of the construction costs ($609,299.69). A. Notice of Completion of Public Works Contract Accept the project and release the retainage in the amount of $66,077.02 after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WWP - WasteWater\WWP-27-03831 Cascade Interceptor Rehabilitation Phase II\Pay Estimates\agenda bill Central Renton Interceptor Reline & Upsize.docx\JDHtp t ITA LYI Original S Y; ❑ Revised # ?hl 1*69 a` NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Date: Contractor's UBI Number: 601880220 Name & Mailing Address of Public Agency Department Use Only City of Renton Assigned to: 1055 S Gradv Wav Renton, WA 98057 Date Assigned: UBI Number: 177000094 Notice is hereby eiven relative to the comnletion of contract or nroiect described below Project Name Contract Number Job Order Contracting Cascade Interceptor Rehabilitation Phase II Cag-15-149 ❑ Yes V No Description of Work Done/Include Jobsite Address(es) Cured -in -Place Pipe (CIPP) of approximately 605 ft of 14" diameter, 265 ft of 18" diameter, 962 ft of 21" diameter and 2,935 ft of 24" diameter concrete sewer mains and rehabilitation of 20 concrete manholes in the Tiffany Park neighborhood of Renton, Washington Federally funded transportation project? ❑ Yes SK No (if yes, provide Contract Bond Statement below) Contractor's Name E-mail Address Affidavit ID* Insituform Technologies, LLC ipsoles470@insituform.com 1676375 Contractor Address Telephone ## 17988 Edison Ave, Chesterfield, MO 63005 636-530-8000 If Retainage is not withheld, please select one of the following and List Surety's Name & Bond Number. ❑ Retainage Bond ❑ Contract/Payment bond (valid for federally funded transportation projects) Name: I Bond Number: Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted August 10, 2015 July 18, 2016 October 5, 2016 Were Subcontracters used on this project? If so, please complete Addendum A. Yes ❑ No Affidavit ID* - No L&I release will be granted until all affidavits are listed. Contract Amount Additions ( + ) Reductions (- ) Sub -Total Sales Tax Rate 9.5 (If various rates apply, please send a breakdown) Sales Tax Amount TOTAL $ 687,583.85 $ 7,963.74 $ 695, 547.59 $ 66077.02 $ 761.624.61 jvviC: ttrese two totats must ne Liquidated Damages $ Amount Disbursed $ 726,847.22 Amount Retained $ 34,777.39 TOTAL $ 761,624.61 Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Submitting Form: Please submit the completed form by email to all three agencies below. Contact Name: Natalie wissbrod Email Address: nwissbrod@rentonwa.gov Department of Revenue Washington staw DeparMwnt of CPublic Works Section Labor & Industries (360) 704-5650 Contract Release PWC@dor.wa.gov (855) 545-8163, option # 4 ContractRelease@LNI. WA.GOV Title: Accounting Assistant Phone Number: 425-430-6919 Employment Security Departrnent Registration, Inquiry, Standards & Coordination Unit (360)902-9450 publicworks@esd.wa.gov REV 31 0020e (10/26/15) F215-038-000 10-2014 Addendum A: Please List all Subcontractors and Sub -tiers Belo" This addendum can be submitted in other formats. Provide kno,.Nn affidavits at this time. No LSI release %gill be granted until all affidavits are listed. Subcontractor's Name: UBI Number: (Required) Affidavit lDx Advanced Government Services, Inc 602304323 672039 Maverick Pump Services 603265774 671826 C-More Pipe Services Co. 601854387 674291 For tax assistance or to request this document in an alternate format. please call 1-800-647-7706. Teletype (TTY) users may use the Washington Relay Service by calling 711. REV 31 0020e Addendum (10/26/15) F215-038-000 10-2014 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Project Detail -.Project Dashboard Document 10/26/2016 Intent 724502 Affidavit 676375 Affidavit Approved Received Date Id Id Status on 10/27/2016 Your Company Information Name Address WA UBI no. Contractor Registration no. Industrial Insurance Account Id Email Address Fi led By Project Information Awarding agency: Awarding agency contact: Awarding agency contact phone number: Project Details Project name INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD,MO,63005 601880220 INSITTL883CW fiili:L7�il psoles470@insituform.com Soles,Paul RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 John Hobson 425-430-7279 Cascade Interceptor Rehabilitation Phse II County where work was performed King City where work was performed Renton Job site address/directions: Prime contractor name INSITUFORM TECHNOLOGIES LLC Prime contractor registration no. INSIT-FL883CW Contract no. CAG-15-149 Prime contractor Phone Number 636-530-8000 Prime contractor Intent form Id# for this project 724502 Dollar amount of your contract: $ 761,624.61 Bid due date 8/4/2015 Contract award date 9/4/2015 Intent filed date 10/5/2015 Job start date:MM-DD-YYYY 10/26/2015 Date work completed:MM-DD-YYYY 8/20/2016 Project Completion Did your subcontractors perform all work on this No project? Did your company hire any subcontractors? Yes Did your company have employees perform work Yes on this project? Did this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, did this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Company Owner Information How many owner/operators performed work on 0 the project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) Company Name UBI License# C-MORE PIPE SERVICES CO 601854387 CMOREPS023CZ ADVANCED GOVERNMENT SVCS INC 602304323 ADVANGS9720Z MAVERICK PUMP SERVICES LLC 603265774 MAVERPS8781-5 Journeylevel Wages County Trade Occupation Wages King Laborers - Pipe Layer Underground Sewer Et Water Apprentice Wages Public Notes o Show/Hide Existing Notes No note exists 43.46 Fringes Workers Hours 5 945.50 A. State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Project Detail - Project Dashboard Document 10/18/2016 Intent 738011 Affidavit 674291 Affidavit Approved on Received Date Id Id Status 10/19/2016 Your Company Information Name C-MORE PIPE SERVICES CO Address 9350 RICKREALL RD RICKREALL,OR,97371 WA UBI no. 601854387 Contractor Registration no. CMOREPS023CZ Industrial Insurance Account Id Email Address brenda@cmorepipe.com Filed By McCoy,Viola Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: John Hobson Awarding agency contact phone number: 425-430-7279 Project Details Project name Cascade Interceptor Rehabilitation Phse 11 County where work was performed King City where work was performed Renton Job site address/directions: Prime contractor name INSITUFORM TECHNOLOGIES LLC Prime contractor registration no. INSITTL883CW Contract no. CAG-15-149 Prime contractor Phone Number 636-530-8000 Prime contractor Intent form Id# for this project 724502 Dollar amount of your contract: $ 90,836.77 Bid due date 8/4/2015 Contract award date 9/4/2015 Intent filed date 12/ 16/2015 Job start date:MM-DD-YYYY 1 /11 /2016 Date work completed: MM-DD-YYYY 9/16/2016 Project Completion Did your subcontractors perform all work on this project? No Did your company hire any subcontractors? No Did your company have employees perform work on this Yes project? Did this project utilize American Recovery and Reinvestment Act No (ARRA) funds? Specifically, did this project utilize any weatherization or No energy efficiency upgrade funds (ARRA or otherwise)? Company Owner Information How many owner/operators performed work on the project that 0 own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation Wages King Inspection/Cleaning/Sealing Cleaner 31.45 Of Sewer Et Water Systems Operator, By Remote Control Foamer Operator King Inspection/Cleaning/Sealing Tv Truck 20.45 Of Sewer Et Water Systems Operator By Remote Control King Inspection/Cleaning/Sealing Head Operator 24.91 Of Sewer Et Water Systems By Remote Control King Inspection/Cleaning/Seating Technician 19.33 Of Sewer Et Water Systems By Remote Control Apprentice Wages Public Notes o Show/Hide Existing Notes No note exists Fringes Workers Hours 1 23.00 1 23.00 1 213.75 1 213.75 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Project Detail - Project Dashboard Document 10/7/2016 Intent 774926 Affidavit 671826 Affidavit Approved Received Date Id Id Status on 10/7/2016 Your Company Information Name MAVERICK PUMP SERVICES LLC Address 9791 TITAN PARK CIRCLE LITTLETON, CO, 80125 WA UBI no. 603265774 Contractor Registration no. MAVERPS8781-5 Industrial Insurance Account Id 26344100 Email Address beckiCmavpump.com Fi led By Moessner, Becki Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: John Hobson Awarding agency contact phone number: 425-430-7279 Project Details Project name Cascade Interceptor Rehabilitation Phse II County where work was performed King City where work was performed Renton Job site address/directions: Prime contractor name INSITUFORM TECHNOLOGIES LLC Prime contractor registration no. INSITTL883CW Contract no. CAG-15-149 Prime contractor Phone Number 636-530-8000 Prime contractor Intent form Id# for this project 724502 Dollar amount of your contract: $ 169,000.00 Bid due date 8/4/2015 Contract award date 9/4/2015 Intent filed date 7/14/2016 Job start date:MM-DD-YYYY 7/21 /2016 Date work completed:MM-DD-YYYY 8/31 /2016 Project Completion Did your subcontractors perform all work on this No project? Did your company hire any subcontractors? No Did your company have employees perform work on Yes this project? Did this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, did this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Company Owner Information How many owner/operators performed work on the 0 project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation Wages King Laborers - General Laborer 32.37 Underground Ft Topman Sewer Et Water Apprentice Wages Public Notes c Show/Hide Existing Notes No note exists Fringes # # Workers Hours 10.30 3 495.25 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Project Detail -.Project Dashboard Document 10/7/2016 Intent 782210 Affidavit 672039 Affidavit Approved Received Date Id Id Status on 10/10/2016 Your Company Information Name Address WA UBI no. Contractor Registration no. ADVANCED GOVERNMENT SVCS INC 8644 PACIFIC AVE TACOMA, W A, 98444 602304323 ADVANGS972OZ Industrial Insurance Account Id 07045100 Email Address shearring@advancedgovernmentservicesinc.com Filed By HEARRING,Suzanne Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: John Hobson Awarding agency contact phone 425-430-7279 number: Project Details Project name Cascade Interceptor Rehabilitation Phse 11 County where work was King performed City where work was performed Renton Job site address/directions: Prime contractor name INSITUFORM TECHNOLOGIES LLC Prime contractor registration no. INSITTL883CW Contract no. CAG-15-149 Prime contractor Phone Number 636-530-8000 Prime contractor Intent form Id# 724502 for this project Dollar amount of your contract: $ 6,145.50 Bid due date 8/4/2015 Contract award date 9/4/2015 Intent filed date 8/15/2016 Job start date:MM-DD-YYYY 8/9/2016 Date work completed:MM-DD- 9/8/2016 YYYY Project Completion Did your subcontractors perform No all work on this project? Did your company hire any No subcontractors? Did your company have Yes employees perform work on this project? Did this project utilize American No Recovery and Reinvestment Act (ARRA) funds? Specifically, did this project No utilize any weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Company Owner Information How many owner/operators performed work on the project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) E No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation King Flaggers Journey Level Apprentice Wages Public Notes - Show/Hide Existing Notes No note exists Wages Fringes Workers Hours 25.17 11.00 2 96.25 WN2016 . r about:blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Project Detail - Project Dashboard Document Received Date: 12/16/2015 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Fi led By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency about blank Intent ID: Affidavit ID: Status: Approved On 738011 12/18/2015 C-MORE PIPE SERVICES CO 9350 RICKREALL RD RICKREALL, OR, 97371 CMOREPS023CZ 601854387 503-623-1319 brenda@cmorepipe.com McCoy, Viola INSITUFORM TECHNOLOGIES LLC INSITTL883CW 601880220 636-530-8000 RENTON, CITY OF 1 /3 8r'312016" about.blank 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: John Hobson 425-430-7279 CAG-15-149 Cascade Interceptor Rehabilitation Phse 11 $752, 904.32 8/4/2015 9/4/2015 105047511 Intent Details Expected project start date: (MM-DD-YYYY) 1 /11 /2016 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $90,836.77 a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY No subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? about blank 2/3 8,73/201E . aboAblank Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages INSITUFORM TECHNOLOGIES LLC INSITTL883CW 601880220 County Trade Occupation Wage Fringe Workers King Inspection/Cleaning/Sealing Of Cleaner Operator, Foamer $31.49 1 Sewer Et Water Systems By Operator Remote Control King Inspection/Cleaning/Sealing Of Tv Truck Operator $20.45 1 Sewer Et Water Systems By Remote Control King Inspection/Cleaning/Seating Of Head Operator $24.91 1 Sewer Et Water Systems By Remote Control King Inspection/Cleaning/Sealing Of Technician $19.33 1 Sewer Et Water Systems By Remote Control Public Notes - Show/Hide Existing Notes No note exists about:blank 313 K'2016,s about:blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Project Detail - Project Dashboard Document Received Date: 7/14/2016 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Filed By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency about:blank Intent ID: Affidavit ID: Status: Approved On 774926 7/21/2016 MAVERICK PUMP SERVICES LLC 9791 TITAN PARK CIRCLE LITTLETON, CO, 80125 MAVERPS8781-5 603265774 303-981-8349 26344100 becki@mavpump.com Moessner, Becki INSITUFORM TECHNOLOGIES LLC INSITTL883CW 601880220 636-530-8000 RENTON, CITY OF 1/3 §/2,�016 about: bl ank 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: John Hobson 425-430-7279 CAG-15-149 Cascade Interceptor Rehabilitation Phse 11 $752,904.32 8/4/2015 9/4/2015 105323518 Intent Details Expected project start date: (MM-DD-YYYY) 7/18/2016 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $169,000.00 a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY No subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes on this project? about: bl ank 2J3 TW-,'2016. r about:blank Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages INSITUFORM TECHNOLOGIES LLC INSITTL883CW 601880220 County Trade Occupation King Laborers - Underground Sewer General Laborer Ft Topman iL Water Public Notes - Show/Hide Existing Notes No note exists Wage Fringe Workers $32.37 $10.30 3 about:blank 3/3 -, It State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Project Detail - Project Dashboard Document Received Date: 8/15/2016 Company Details Company Name: Ad d re ss: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Fi led By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Intent ID: Affidavit ID: 672039 Status: Approved On 782210 8/22/2016 ADVANCED GOVERNMENT SVCS INC 8644 PACIFIC AVE TACOMA, WA, 98444 ADVANGS972OZ 602304323 253-531-9782 07045100 shearring@advancedgovernmentservicesinc.com HEARRING, Suzanne INSITUFORM TECHNOLOGIES LLC INSITTL883CW 601880220 636-530-8000 Awarding Agency Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 John Hobson 425-430-7279 CAG-15-149 Cascade Interceptor Rehabilitation Phse 11 $752, 904.32 8/4/2015 9/4/2015 105368692 Intent Details Expected project start date: (MM-DD-YYYY) 8/9/2016 In what county (or counties) will the work King be performed? In what city (or nearest city) will the work Renton be performed? What is the estimated contract amount? OR Time and materials is this a time and materials estimate? Will this project utilize American Recovery No and Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY No subcontractors? Does your company intend to hire No subcontractors to perform ALL work? Will your company have employees perform Yes work on this project? Do you intend to use any apprentices? (Apprentices are considered employees.) How many owner/operators performing work on the project own 30% or more of the company? Hiring Contractor Company Name Contractor Registration No. WA UBI Number Journey Level Wages County Trade King Flaggers King Laborers Public Notes - Show/Hide Existing- Notes No note exists M X INSITUFORM TECHNOLOGIES LLC INS ITTL883C W 601880220 Occupation Journey Level Traffic Control Supervisor Wage Fringe Workers $25.17 $11.00 1 $27.68 $11.00 1 8/23/2016 aboAblank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Project Detail - Project Dashboard Document Received Date: 10/5/2015 Company Details Company Name: Address: Contractor Registration No. WA UBI Number Phone Number Industrial Insurance Account ID Email Address Filed By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Intent ID: Affidavit ID: Status: Approved On 724502 10/13/2015 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD, MO, 63005 INSITTL883CW 601880220 636-530-8000 88268501 psoles470@insituform.com Soles, Paul INSITUFORM TECHNOLOGIES LLC INSITTL883CW 601880220 636-530-8000 about, bl ank 113 8/23/2016 Awarding Agency Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Contract Amount Bid due date Award Date Project Site Address or Directions Payment Details Check Number: Transaction Id: Intent Details aboLftlank RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 John Hobson 425-430-7279 CAG-15-149 Cascade Interceptor Rehabilitation Phse 11 $7521904. 32 8/4/2015 9/4/2015 104953250 Expected project start date: (MM-DD-YYYY) 10/26/2015 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is this $752,904.32 a time and materials estimate? Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? Does your company intend to hire ANY Yes subcontractors? Does your company intend to hire subcontractors No to perform ALL work? Will your company have employees perform work Yes about blank 2/3 8/2.3/2016 aboulliank on this project? Do you intend to use any apprentices? (Apprentices No are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Journey Level Wages County Trade Occupation King Laborers - Underground Sewer Pipe Layer 8 Water Public Notes - Show/Hide Existinp, Notes No note exists Wage Fringe Wo rkers $43.46 5 abm t:bl ank 313 G.More Pipe Services PO Box 69 Rickreall. OR 97371 Phone/Fax: 503-623-1319 Insituform Technologies 19165 SW 1 19th Ave. Tualatin, OR 97062 Attn: Jerry Zimmerman INVOICE INVOICE #: 16-1434MH DATE: September 9, 2016 Job Date of Service Due Date # 1434 — City of Renton 8/8/16 — 9/1 /16 10/9%16 Qty. Description Unit Price Total 1 Mobilization/Demobilization of Manhole Rehab Truck/Trailer $2,000 Trip $2.000.00 7 Labor & Equipment to Spray Seal Interior of MH with 1/2" Cementitious Mortar for 11-20' MH Depth $3,838/Ea. $26.866.00 5 Labor & Equipment to Spray Seal Interior of MH with 11Y Cementitious Mortar for 21-30' MH Depth $5.0701/ 1Ea. $30,420.00 Payments shall be made within 30 days following the date of the invoice. A late charge of 1 12 percent per month will be assessed on unpaid balances over 60 days. Subtotal $59.286.00 Sales Tax NA Total $59,286.00 Make all checks payable to C-More Pipe Services THANK YOU FOR YOUR BUSINESS! C-,.IMo.#•e Pipe Services PO Box 69 Rickreall, OR 97371 Phone/Fax: 503-623-1319 Insituform Technologies 19165 SW 119`' Ave. Tualatin. OR 97062 Attn: Jerry Zimmerman INVOICE INVOICE #: 16-1434MH-1 DATE: September 22. 2016 Job Date of Service Due Date # 1434 — City of Renton 88 16 — 9 1 16 10 9'16 Ot . Description Unit Price Total 4 Labor & Equipment to Spray Seal Interior of MH with 112' Cementitious Mortar for 0-10' MH Depth $2,216'Ea. $8.864.00 3 Labor & Equipment to Spray Seal Interior of MH with 112" Cementitious Mortar for 11-20' MH Depth $3,838/Ea. $11.514.00 1 Labor & Equipment to Spray Seal Interior of MH with 11i' Cementitious Mortar for 21-30' MH Depth $5.070%Ea. $5.070.00 Payments shall be made within 30 days following the date of the invoice. A late charge of 1 ,z percent per month will be assessed on unpaid balances over 60 days. Subtotal $25.448.00 Sales Tax NA Total $25,448.00 Make all checks payable to C-More Pipe Services THANK YOU FOR YOUR BUSINESS! Clore Pipe Services PO Box 69 Rickreall. OR 97371 Phone/Fax: 503-623-1319 Insituform Technologies 19165 SW 1191h Ave. Tualatin. OR 97062 Attn: Jerry Zimmerman INVOICE INVOICE #: 16-1434MH-CO DATE: September 9. 2016 Job Date of Service Due Date # 1434 — City of Renton 88 16 — 9 1 16 10 9 16 Ot . Description Unit Price Total 25 Material Costs — AV100 Grout $18.50'Gal $462.50 20 Material Costs — Strong Plug $10.50/Gal $105.00 1 Water Meter Rental Fees LS $76.50 Payments shall be made within 30 days following the date of the invoice. A late charge of 1 1,2 percent per month will be assessed on unpaid balances over 60 days. Subtotal $644.00 Sales Tax NA Total $644.00 Make all checks payable to C-More Pipe Services THANK YOU FOR YOUR BUSINESS! C-,More Pipe Services PO Box 69 Rickreall, OR 97371 Phone; Fax: 503-623-1319 Insituform Technologies 19165 SW 1 19`' Ave. Tualatin, OR 97062 Attn: Jerry Zimmerman INVOICE INVOICE #: 16-1434MH-COl DATE: September 22, 2016 Job Date of Service Due Date # 1434 — City of Renton 8'8 16 — 9'1'16 101916 of . Description Unit Price Total 35 Material Costs — AV100 Grout $18.50/Gal $647.50 16 Material Costs — Strong Plug $10.50/Gal $168.00 Payments shall be made within 30 days following the date of the invoice. A late charge of 1 ' 2 percent per month will be assessed on unpaid balances over 60 days Subtotal $815.50 Sales Tax NA Total $815.50 Make all checks payable to C-More Pipe Services THANK YOU FOR YOUR BUSINESS! Job #: NM l f C-More Pipe Manhole Inspection Report Report # : I CLIENT:y. s .''� w�c rm CITY: MH NO: 2 ` �f j MH LOCATION:DEPTH: DIAMETER: mr471, DATE INSPECTED: I - I I t:' COMPLETED: POST INSPECT: MH TYPE: STORM/ EWER + X PRE -CAST —BRICK WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE: (LO EDIUM/HIGH WEATHER: CLEAWRA �RCASTIGAS METER READING: CONDPTION OF MANHOLE: KEY CODES LID & FRAME: POOR FAIR GOOD, ^LEAKING (Y/N) SS = STRONG SEAL CS = CHEMICAL SEAL ORB LlCONE/FLAT TOP: ►VIP = MORTAR PATCH CRA —POOR _FAIR GOOD, LEAKING (Y/Adf = PIN HOLE T RISER: __POOR FAIR —GOOD, _LEAKING 1) -PICK HOLE = LADDFjR STEP '�•�'I 3 BENCH: —POOR FAIR _ GOOD, _LEAKING `S/N) CHANNEL: —POOR FAIR _ GOOD, _LEAKING (YIN) STEPS: # —POOR I( FAIR GOOD, —LEAKING (YIN) PIPE INVERT IN: SIZE4,L, I (TOP TO BOTTOM) PIPE INVERT OUT: SIZEI MH LID COVER: 2-HOLE 16 HOLE OTHER k, , p Pre -Inspection Notes: T!, . A. ✓ a w1r Repair/Rehab Notes: SUPPLIES USED: AA' - W-' — tQ 2AI -^ TRAFFIC CONTROL NEEDED: Yes No If yes —see back Street Mark North (N) with arrow line kcAK f Down Stream t I F SING RISER RAIN GUARD: RIESR BENCH H Updated 4/16 PO Box 69, RickreaU, OR 9 73 71 * (503) 623-1319 Offke/Fax Job #: MH 113q th,1� C-More Pipe Manhole Inspection Report Report # : CLIENT: L+Ls+++. CITY: �ov� L✓ MH NO: 2 77 MH LOCATION: `% + r,L,j �.K I.w'( DEPTH: 7L 4V DIAMETER: [ DATE INSPECTED: `�" 1 COMPLETED: �' / �� POST INSPECT: MH TYPE: STORM/ EWER ) PRE -CAST _`BRICK _ WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE: LOW/Nr(1�D�U1�/HIGH WEATHER: CI,F,AR/RAIN/OVE_Ci4T GAS METER READING: CONDTTION OF MANHOLE: LID & FRAME: _POOR _FAIR _ GOOD, _LEAKING (Y/N) CORBEL/CONE/FLAT TOP: _POOR _FAIR _ GOOD, _LEAKING (YIN) RISER: _POOR _FAIR — GOOD, _LEAKING (Y/N) BENCH: POOR FAIR GOOD, LEAKING (YIN) CHANNEL: POOR FAIR GOOD, LEAKING (YIN) STEPS: #A— _POOR _FAIR _ GOOD, _LEAKING (YIN) PIPE INVERT IN: SIZE 21 1 1 1 (TOP TO BOTTOM) PIPE INVERT OUT: SIZE A MH LID COVER: 2-HOLE 16 HOLE OTHER J. I�• Repair/Rehab Notes: x SUPPLIES USED: S— Z Cr + a, , "4�aj S""Street TRAFFIC CONTROL NEEDED: Yes No Mark North (N) If yea —gee back with arrow line STRONG SEAL Sf CCHEMICAL SEAL M MORTA PATCH ^= CRA \\ PPIN LPPIC HO E Ii AT1r1FR TRP R SER .4 RBEL RAIN GUARD: RISER CHAN BENCH Updated 4/ 16 PO Box 69, RickreaI4 OR 97371 * (503) 623-1319 Office/Fax A Job #: MH C-More Pipe Manhole Inspection Report Report # : CLIENT: j �- CITY:. �� ✓I. c.S 3 LOCATION: 1 'dG q k; 0,-J L S DEPTH: A DIAMETER: 37 2— MH NO: 3r - DATE INSPECTED: V _ I O `- I (o COMPLETED: '6 — / &/ POST INSPECT: MH TYPE: STORM EWER PRE -CAST —BRICK WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK ­--t WATER TABLE: LOW i Eb U /HIGH WEATHER: CLEAR/RAI — /OVERCAST M JRJUA MG: 2� Y CONDITION OF MANHOLE: SS = S DES BONGS L �1 LID & FRAME: POOR �IR _ GOOD, —LEAKING (Y" — CS = C JEMICAL SEAL MP = ORTAR TCH �r CORBEL CO /FLAT TOP: R AIR GOOD, (YA ^^^^^ C — _ —LEAKING PH = P N HOLE RISER: — AlR &/N) PK = F. CK I IOL _/POOR _GOOD, —LEAKING LS = L DDER S EP BENCH: `POOR _FAIR GOOD, —LEAKING (Yfxd -� CHANNEL: -- POOR /FAIR_ GOOD, _LEAKING (Y/K STEPS: #_' V —POOR )CFAIR — GOOD, —LEAKING (Y/N) PIPE INVERT IN: SIZE 2� lZ (TOP TO BOTTOM) ; PIPE INVERT OUT: SIZE 24 1 MH LID COVER: 2-HOLE 16 HOLE Repair/Rehab Notes: SUPPLIES USED: `2 -'ems TRAFFIC CONTROL NEEDED: Yes No If yes —wee back r Street Mark North (N) with arrow line RAIN GUARD: _,7 2 tv v o 4 RISER BENCH 7 `J tt i Down Stream Updated 4/ ] 6 PO Box 69, Rickreak OR 9 73 71 - (503) 623-1319 Office/Fax L S C) C-More Pipe Manhole Inspection Report Rcp rt#H 1 3y Pt CLn CITY:. MH NO: 2Tj_ MH LOCATION: L 0DEPTH: 11 1 DIAMETER: ;S DATE INSPECTED: - l l — C & COMPLETED: POST INSPECT: MH TYPE: STOR S WUi� X PRE -CAST BRICK WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE: LOW/MERI&/`HIGH WEATHER: 16LEARJ1WN/OVERCAST GAS METER READING: .Z. C% [' CONDTTION OF MANHOLE: LID & FRAME: POOR AIR GOOD, // (N/N) KEY CODES SS = STRONG SEAL — — _LEAKING CS = CHEMICAL SEAL CORBEL/CONE/FLAT TOP: MP = MORTAR PATCH POOR /FAIR GOOD, (,YtN) I = CRACK _LEAKING PH = PIN HOLE RISER: POOR -FAIR GOOD, (�Y/N) PK = PICK HOLE — — _LEAKING =LADDF-WSTEP`j BENCH: _POOR _FAIR — GOOD, _LEAKING (Y11N) S 3 6, CHANNEL: `FAIR GOOD, (Y[Yd v'ty t- ? Z •• _POOR FAIR — —LEAKING i RING RISER STEPS: # ; ti _POOR — GOOD, —LEAKING (Y/N) I +- PIPE INVERT IN: SIZE 2����II(TOP TO BOTTOM) PIPE INVERT OUT: SIZE 2 41 MH LID COVER: 2-HOLE 16 HOLE OTHER 1 SUPPLIES USED: 2-10 TRAFFIC CONTROL NEEDED: Yes No If yes —see back Street Mark North (N) with arrow line x RAIN / GUARD: 4 -- RISER 2 y1-1—' I BENCH k Down Stream Updated 4/ 16 PO Box 69, RickreaI4 OR 9 73 71 * (503) 623-1319 Of Ice/Fax Job #: MH m i4 C-More Pipe Manhole Inspection Report Report CLIENT: TVn4 �*J"' CITY:- ke-A 'F44.- =t MH NO: 2,1 MH LOCATION: S:^ S t e�-446(- AV DDEPTH: DIAMETER: 7 DATE INSPECTED: COMPLETED: t r (6 - G POST INSPECT: MH TYPE: STORM EW PRE -CAST BRICK WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK J WATER TABLE: LOW . EDI iHIGH WEATHER: CLEAR/RA /OVERCAS GAS METER READING: CONDITION OF MANHOLE: KEY CODES SS = STRONG SEAL LID & FRAME: POOR —FAIR _ GOOD, _LEAKING (Y/N) CS = CHEMICAL SEAL CORBEL/CONE/FLAT TOP: MP = MORTAR PATCH nnnnn — GOOD, (Y/N) _POOR _FAIR — _LEAKING P = PIN HOLE RISER: POOR ' FAIR — — — GOOD, _LEAKING (Y/N) P = PICK HOLE L = LADDE EP BENCH: POOR _FAIR _ GOOD, _LEAKING (Y/N) CHANNEL: _POOR _FAIR _>,/G60D, _LEAKING (Y/N) STEPS: # —POOR FAIR GOOD, _LEAKING (Y/N) RING RISER�— PIPE INVERT IN: SIZE I I (TOP TO BOTTOM) PIPE INVERT OUT: SIZE 24 � MH LID COVER: 2-HOLE 16 HOLE __>!!�_OTHER_t� Pre -Inspection Notes: Repair/Rehab Notes: x SUPPLIES USED: TRAFFIC CONTROL NEEDED: Yes No uy"ee back Street Mark North (N) with arrow line Updated 4/ 16 PO Box 69, R1Ckrea14 OR 9 73 71 * (503) 623-1319 Ofj°Ice/Fax RAIN _ � f `—•----�-. GUARD: RISER L \ BENCH 5 `5 Down Strea G ~✓ L �z Job #: MH C-More Ripe Manhole Inspection Report Report # : IV-, CLIENT: �_ yy�, c ,+�+ CITY:• _ MH NO: MH LOCATION: DEPTH: r1 k DIAMETER:'`_ DATE INSPECTED: qS _ 12-16 COMPLETED: ` 2- POST INSPECT: MH TYPE: STOR S E X PRE -CAST __ BRICK _ WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE: LOW EDIU ~ IGII WEATHER. EA IN/OVERCAST GAS METER READING: 201 CONDITION OF MANHOLE - LID & FRAME: _POOR FAIR GOOD, _LEAKING (Y/N) CORBEL/CONE L�TO/FAIR _ GOOD, _LEAKING Id) RISER: POOR _.FAIR —GOOD, _LEAKING W N) BENCH: __POOR FAIR _ GOOD, _LEAKING Vl1) CHANNEL: _POOR `FAIR GOOD, _LEAKING (yx STEPS: #-I�- _POOR /FAIR _ GOOD, _LEAKING (YIN) PIPE INVERT IN: S17,E 241 1 1 1 (TOP TO BOTTOM) PIPE INVERT OUT: SIZE 22 A MH LID COVER: 2-HOLE 16 HOLE _MOTHER f J,,c 4: Repair/Rehab Notes: x KEY CODES SS = STRONG SEAL CS - CHEMICAL SEAL = MORTAR PATCH PI6F = NOLE PICK =LVIDtIR S Ey '3�7 �� T, L? RI 0 ) CO BEL RAIN f� r� � � GUARD: lei off FA 'dg MA SUPPLIES USED: � % S42 1 \ 0;'S4'' /1ZS- Zf� ct R4 V Street TRAFFIC CONTROL NEEDED: Yes No Mark North (N) C If yes —see back with arrow line Down Stream Updated 4i 16 PO Box 69, Rkkreall, OR 97371 * (503) 623-1319 Ofjice/Fax 4 RISER BENCH Job #: MH I SYY IIIi C-More Pipe Manhole Inspection Report Report # : -7 CLIENT: :Zv y r'-m CITY: "w" 4," MH NO: Z ly 3 MH LOCATION: g �r I 4 �F,- +tit / 4wy �C DEPTH: DIAMETER: ? DATE INSPECTED: 9 -/ 7-16 COMPLETED: POST INSPECT: MH TYPE: STORM/ E '1C PRE -CAST _ BRICK WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE: LOW/) HIGH WEATHER CL A AIN/OVERCAST GAS METER READING: Z�0, jn CONDITION OF MANHOLE: CODE STRO L LID & FRAME: POOR FAIR — __ GOOD, _LEAKING (Y/N) CH I 1=CRA AL SEAL MORT R PATCH QC�ORRBECON AT TO K _P OR AIR __GOOD, _LEAKING (YIN) PH - PIN H LE RISER: POOR V( AIR GOOD, (Y/N) P -PICK I OLE — _LEAKING LS LADD R STEP BENCH: —POOR Y'FAIR _ GOOD, _I•EAKING (Y/N) CHANNEL: _POOR _ kgA1R _ GOOD, _LEAKING (Y/N) RING RISER STEPS: # —POOR ) AIR — GOOD, _LEAKING (Y/N) PIPE INVERT IN: SIZE jq $ (TOP TO BOTTOM) CORBE PIPE INVERT OUT: SIZE 2k ♦ MH LID COVER: 2-HOLE j r,, 16 HOLE O'I'HER\-A Repair/Rehab Notes: � L SUPPLIES USEED:L ; p Street TRAFFIC CONTROL NEEDED: Yes No Mark North (N) If yes —see back with arrow line Updated 4/16 PO Box 69, Rickreall, OR 9 73 71 * (503) 623-1319 Office/Fax A 'j VW CHANNEL Down Stream RAIN GUAI IS Job #: MH I`q 3-4 i l C-Afore Pipe Manhole Inspection Report Report #: � CLIENT: L +1 j c� r onn CITY:. _ ems t ►n j r �. MH NO;6 2S )_ MH LOCATION: DEPTH: ' Z 7 _DIAMETER:_ z,_ DATE INSPECTED: COMPLETED: POST INSPECT: MH TYPE: STO EW�� XPRE-CAST ___ BRICK WET -WELL STORM CONE _ POUR -IN -PLACE CINDERBLOCK WATER TABLE: LOV EDIU 1/HIGH WEATHER: �LEARI IN/OVERCAST GAS METER READING: CONDITION OF MANHOLE: KEY CODES LID & FRAME: POOR FAIR— GOOD, _LEAKING (Y/N) SS = STRONG SEAL CS = CHEMICAL SEAL CORBE CONE LAT TOP: —POOR _FAIR _ GOOD, _LEAKING (YIN) RISER: POOR FAIR GOOD, LEAKING (Y/N) ` BENCH: _POOR _ FAIR GOOD, -- -LEAKING (YIN) CHANNEL: _POOR —FAIR GOOD, _LEAKING (Y/N) STEPS: # -7 POOR FAIR GOOD, LEAKING (Y/N) PIPE INVERT IN: SIZE1O.61--6 1�j I 1__ (TOP TO BOTTOM) PIPE INVERT OUT: SIZE MH LID COVER: 2-HOLE 1C16 HOLE OTHER Pre-Imnertinn Note -a! y n- e1,+Jw.w x ✓,e d•j cQh//S//k� �,L L'1 v1 i raw w�+a✓ Q 'ti!'#f Ali .(Si.o►.�C'f'{ �li �' Repair/Rehab Notes: k t P,Ae ✓ !ti'� Wit. l� tl _ ' r �c.t Ewa SUPPLIES USED: l l J Street TRAFFIC CONTROL NEEDED: Yes No Mark North (N) If yes —see back with arrow line g3 IS Down Stream Updated 4/ 16 PO Box 69, Rtckreall; OR 97371 * (503) 623-1319 OJj`icdFax fi Job #: MR /Y-r*A C bore Pipe Manhole Inspection Report I report 9 : �I CLIENT: 5 CITY; - l tom: t. ; t L ✓'L MM NO: 21 3Q_ MI-1 LOCATION: (k, �• ,�- n :Q� � .1 MH DFffH: FT LIN DIAMETER: DATE INSPECTED: Z `3 I COMPLETED: `i POST INSPECT: IAY:Id. TY PE S FOR EWE _ PRE -CAST _ BRICK WET -WELL __ STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE: &Z-WTUDIUMAUGH WEATHER: C EA AIN/OVERCAS'T GAS METER READING: ' CONDITION OF MANHOLE: LID & FRAME: POOR _FAIR X GOOD, _LEAKING (Y/idf CORBEL: --POOR )CFAIR —GOOD, _LEAKING (Y/Di�r- [USER: _POOR FAIR _ GOOD, _LEAKING OYN) BENCH: _POOR YFAIR _ GOOD, LEAKING MI) CHANNEL: POOR FAIR VOOD, LEAKING (YfXr STEPS: #�_ ___-POOR AIR ^ GOOD, _LEAKING (Y/N) PIPE INVERT IN: SIZE a�, 1 9'>l (TOP TO BOTTOM) PIPE INVERT OUT: SIZE 9*1 MII LID COVER: 2-HOLE 16 HOLE V OTHER DROP: Al Li --INSIDE, SIZE JVAOUTSIDE, SIZE RAIN GUARD: RECOMMENDED _)t NONE NOTESIRECOMIIENDATIONS (see back for additional information) Al it Qi v B S. rew� te'k:4 4I } ��' ~ Y Ei��►s otwi;f TRAFFIC CONTROL NEEDED: Y N Street HEY CODES SS = STRONG SEAL CS = CHEMICAL SEAL MP = MORTAR PATCH PIN I PICK STEP RING RISER /0l4 X I I ! �"R R 11 "g q VIEW LOCATION: Mark North A with arrow line Z GMore Pipe Service, 9350 R&kreaU Rd, RickreW4 OR 97371 * (503) 623-1319 0ffkeJFav 4 -- BENCH f Job #: MR !-/A C bare Pipe Manhole Inspection Report Report CLrEraT: Y,`I jt _ - — CITY: 0-0-,,4 P1 11IN NO: Z MIi LOCATION: W l i ig ( C , MH DEPTH: _LL FT jIN DIAMETER: DATE INSPECTED: � u / COMPLETED: __ POST INSPECT: _ ,"AH T'I!PE: STO ER K PRE -CAST _ BRICK WET -WELL STORM CONE POUR -IN -PLACE CINDERBLOCK WATER TABLE:/�ONEDIUM/HIGH WEATHER:OV RCAS ME CLEAR/RAI GAS TER REA-DING: CONDITION OF MANHOLE: KEY CODES LID & FRAME: _POOR _FAIR /GOOD, _LEAKING SS = STRONG SEAL CORBEL: NPOOR _FAIR _ GOOD, LEAKING (Y/VI RISER: _POOR FAIR GOOD, _LEAKING6NN) BENCH: Y POOR _FAIR _ GOOD, _LFAKING (VN) CHANNEL: _POOR FAIR _ GOOD, ___LEAKING (Yxf STEPS: # f t3 _POOR FAIR _ GOOD, ,LEAKING (YlXf PIPE INVERT IN: SIZE Zvi 11I_—_j1__ (TOP TO BOTTOM) PIPE INVERT OUT: SIZE 7-1-11 MH LED COVER: 2-HOLE 16 HOLE OTHER LIE DROP: � INSIDE, SIZE IVAOUTSIDE, SIZE RAIN GUARD: RECOMMENDED NONE NOTEWRECOMMENDATIONS (see back for additional information) i 3 5."�- 5 - At 5.2 c TRAFFIC CONTROL NEEDED: Yes Q :.00ATION: Street Mark North (N) with arrow line CS = CHEMICAL SEAL CMvre Plpe Service, 9350 RkkeeaU Rd, Mckreal4 OR 9 73 71 * (503) 623-1319 Office/Fax Job #: M11 N.Pi C-More .,ft* Manhole hupecdon report I Report ff : _� L _ CLIENT: CITY• IyIH NO: 2-'614 MII LOCATION: _ I (, Qc-) 1H DEPTH: FT IN DIAMETER: LATE INSPECTED: COMPLETED:3 r i POST INSPECT: -- - IvHI TYPE: STORM/ EVI+ PRE -CAST BRICK WET -WELL STORM CONE POUR-IN-PLACECINDERBLOCK WATER TABLE: (IOWNED1UM/HIGH WEATHER CLEA CONDITION OF MANHOLE: LID & FRAME: _POOR _FFAIR — GOOD, _LEAKING (YIN) C BEL: j C-Or"--POOR n FAIR ^ GOOD, _LEAKING ) 0 RISER: _POOR V FAIR _ GOOD, _LEAKING1) BENCH: -POOR '_FAIR , GOOD, _LEAKING (Y/N) CHANNEL: Y __POOR 'FAIR GOOD, __LEAKING (YIN) STEPS: # _POOR _FAI,,R _ GOOD, _LEAKING (YIN) PIPE INVERT IN: SIZE ?L-f I f I I (TOP TO BOTTOM) PIPE INVERT OUT: SIZE 2,q MH LID COVER: 2-HOLE DROP: IVA INSIDE, SIZE 16HOLE OTHER_ _t_/1. tl AloUTSIDE, SIZE RAIN GUARD: RECOMMENDED NONE NOTES/RECOM-MENDATIONS (see back for additional Information) TRAFFIC CONTROL NEEDED: Ye Ni Street — LOCATION: Itobc Mark North (M J with arrow line iv C-More Pipe Service, 9350 Ricky eall RiL, Rkkre4g OR 9 73 71 * (503) 623-1319 Offlce/Fax = STRO G SEAL = CHEM CAL SEAL = MOR" R PATCH ' = CRA K = PIN H E = PICK H LE = LADDE STEP -7 RING RISER -f BENCH I Job #: MH /y 3 j C-More .ire Manhole Inspection Report Report CLI�+'NT: .`� , w� CrrX: �04'Ji o- GV k- — ---- Ipy1CH NO: 27 CC MH LOCATION: +�0 t 7:jE.X JL, 51 DEPTH: MH 21 FT 2- IN DIAMETER: 7 2 DATE INSPECTED: I �? COMPLETED: _ G/ , �_ , POST INSPECT: — '& %74P TStPE: STORM/EWER RE -CAST _ BRICK WET -WELL STORM CONE _ POUR -IN -PLACE CINDERBLOCK p NVATER TABLE OW EDIUM/HIGH WEATHER: CLEAR/ IR =VERCAST GAS METER READING: CONDITION OF MANHOLE: KEY CODES LID &. FRAME: _POOR FAIR >C GOOD, _LEAKING (Y/N) SS = STRONG SEAL CS = CH EAL CORBELi-5 VPOOR .-.__FAIR -_ __ GOOD, _LEAKING 6?N) P = MORT PAC I = CR RISER: x POOR _FAIR _GOOD, _LEAKING i'/N) P = PIN HO P = PICK H E BENCH: POOR _FAIR _ GOOD, _LEAKING CON) L = LADDE STEP CHANNEL: _POOR 'y FAIR ` GOOD, _LEAKING (Y N)RING RISER STEPS: # I _ _POOR �C FAIR _ GOOD, _LEAKING &N) T1' SA INVERT IN: SIZE Zf ll1-5 'b ("TOP TO BOTTOM) PIPE INVERT OUT: SIZE 2-41_ MH LID COVER: 2-HOLE 16 HOLE OTHER DROP: INSIDE, SIZE OUTSIDE, SIZE I I SS RAIN GUARD: RECOMMENDED -eZ NONE l�c'.?J.+.� �nJ•r.5 �a� c'�,�i � /" v'� yv1Ot.-,'t..IrGC <kf*-d eL.L ii�Sa�iXl t.,LC'G . 4n.-.-fi, ,, ,',, s bdv- o +-v-6 - ;11 6"j` A IA S Z tk TI�xAO+�q x,,Y Ate- S FFIC cONTR L NEEDED: Yea i o7 Street LOCATION: p ( '3 Mark North (N) 1bC� -ha2.� N4L9 with arrow line 2 4 C-Md�e Plpe Service, 93SO Rkkreafl P.d, Rkkreak OR 97371 * (503) 623-13I9 Oj, eelFax -75 RBEL S 5 --� SS HANTIT�L 2 BENCH 9� INSITUFORM TECHNOLOGIES 19165 SW 119th St. lnsituform- Tualatin, OR 97062 Please Remit Payment to: Insituform Technologies, Inc. Box 674060 BEVA Compass 4400 AMON CARTER BLVD Ste 110 FT Worth, TX 76155 Noteif you are overnighting a check via fedex or ups - ITI has a physical address for the check to go. MONTHLY / WEEKLY REVENUE PRODUCTION REPORT JOB Name: Renton. Wa_Cascade Interceptor Project Manager: Roberto Rizo JOB Number 202221 Superintendent #1: David Stambaugh Att John D. Hobston Field Engineer Jerry Zimmerman Previous Production Production This Month tad DHcrtptldn Est -at" _ -.- Unit ar -- ►rice Rer Unll Contract ►rk. or F. bet.uw __„_ R...... Prpdue.d 1 M bihz.hon 1 x/ LS $ 16.850.00 0.80 $ 13.48000 TrARic l'alnol 1.�10 LS $ 5.430.00 0.90 $ 4,867.00 3 Pre-N+IallatxlO Cltani and Inspection i.'BJ.,x) LF S 13.873.60 4781.00 f 17.67360 4 In mll 14" CEPP 605,on LF S 29.645.00 545.00 $ 26.705.00 5 InslAl118"CEPP 265.00 LF f 41.340.00 23t1.00 S 37.128,00 6 hnta1121"CIPP 979.00 1.F S 100.93700 gel 00 S 90.743,00 7 In.ull 24"C1PP -1 lxt Lk S 404,29625 2641.00 S 363.797.75 8 R-utc Suk Scorer Tap,: 00 EA S 140.00 200 $ 140.00 9 Post hi'mlhnon Ilss i-i 4 "`:I Ixl LF S 2.392.00 000 S 10 Sewn kiH R h b 0' 10 10' 1 tx1 1.11 S 7.5e0.00 000 $ 11 Sewn MH Rehab I1'to 29 I11.Ix1 F:5 S 3S,e00.D0 Co S 12 Sewn hIH Rdmb 21' to 30' Deep Iq F a S 29.400.00 - Insitutorm Work Totals I s 667,583.85 S 550.754.35 Chanoe Orden -- Work Done by Insltulorm PAGE: 1 DATE: ESTIMATE #: 1 INVOICE #: 1 JOB #: 202221 BILLING PERIOD: 7/25/2016 to &25=16 FEDERAL10: 13-3032158 DAY INDINO : Is Job Complete 7: NO Pay Est 21 Job To Date Ins[sll.d %c8=1I of Rwanw rroducw 0uanla Total 16.850.00 100% I S 5,430.00 100% 47UGo S 1387360 100% %2. 10 I S 99o96.3C 1 911% 1 m co 6 00 i9.100.00 - . Chanj a Orders Plus Allowable Mark U .- Work Done by Sub Contractors: C01 MH Rehab Coel De/eronc. D b 10 DOW 4 EA $ 37557 S 1.302.2e 0.0 I S 4.0 $ 111121 4.0 S 1,102,21 111% CO2 MH R.rup Cnt Dxlr.r1t. 17'b20' Deep 10 EA S 30186 S 7.Ot8.60 0.0 $ 10.0 S 7.Of e.60 10.0 S 3.018.60 100% CO3 MH R.hall Cost DOveoce 21'to 30'Deep 6 EA $ 198. 90 S 1,19340 0.0 s 6,0 s 1, 193.40 6.0 $ 1.19340 100% 204 M.lerul Cost t LS s 1.70762 S 1 707.62 0.0 S 1.0 S 1 707.62 t.0 S 10707.62 100-1. COS AdoNOMI Mooflual- For Un.apeclw Material Overage 1 LS $ 2.340 W 2.34U.00 0.0 S 1.0 s 2 340 00 t.0 f 2,340.00 100 Chan - Sub Contractor Total. S 9.761.e0 f S 2 761.90 f .,let.. 100 % Total Eutaw ►ravlou. Period Toilet 4rr1.d Cunt P.rbd Toah flamed To Dan Total of roved Work S 597.3a5.75 $ 550.754.35 S 144,850.70 S 095605.05 1 100% AMOUNT DUE s ,a.$5070 CURRENT ESTIMATE Job Status Comments: Sample reports are In route and will be delivered via postal mail no later than Wednesday, September 28, 2016. Final video report and media package are to be delivered via FedEx on Friday September 23 2016, Sub -Contractor Work Comments: Insituform Project Management Approval by: '.001141111"TAijdFr Progress Payment Approval by: tobMo J. R1zo Ham. 503.486,6274 Tim. 20150910 Date INSITUFORM TECHNOLOGIES 19165 SW 119th St V 1,nit�m, Tualatin OR 97062 I Please Remit Payment to: Insituform Technologies, Inc. Box 674060 BEVA Compass 4400 AMON CARTER BLVD Ste 110 FT Worth, TX 76155 Note, If you are overnighhng a check via fedex or ups - ITI has a physical address for the check to go. MONTHLY / WEEKLY REVENUE PRODUCTION REPORT JOB Name: Renton, Wa_Cascade Interceptor Project Manager Roberto Rizo JOB Number: 202221 Superintendent 01 David Stambaugh Att John D. Hobson Field Engineer Jerry Zimmerman Previous Production Production This Month 61tl Description Estimated 1.unitol Price Per Unit Contract Pnce No. of Inslalteo Revenue Protlucetl S 1. luaatl_'1"CIPP 9'9,00 LE f 10D,837.00 962.10 S 99,096.30 luwdl 24"CUT 2,935,00 LE S 404.296,25 :935.00 b 404,296.25 8 Reuulare Side Sewer Taps2 0U EA f 140.00 200 140A0 9 post Installation Im ctiou 4'84.00 LF' S 2.392.00 4767 10 S 2,793.55 10 +ewer MH Rehab 0' to 10' 400 FA S 7.580 DO s P_ S 7,S80.00 11 Sewer MH Rehab 1I'to 20' 10.00 EA f 35,800,00 36.800.00 1' Sewer MH Rdtab 2I' to 10'Deep 6 00 E.a S 2940000 o DC _ 29 400 00 S 687 PAGE: 1 DATE: ESTIMATE #: 3 - Final INVOICE #: 1 JOB #: 202221 BILLING PERIOD: v2sr20teto8.25r2016 FEDERAL ID: 13-3032158 DAY ENDIND : W297016 Is Job Complete 7: YES Pay Eat at Job To Date Inatelietl _ .._ Revenue Prodtl uce 'e Compl of _ 962.10 1 $ 99.096 30 98% 2935.00 $ 404,296.25 10D% 2.00 $ 140.00 100% 4767,10 f 2,39355 100% 4.00 $ 7,58000 t00% 10A0 S 35,8D0.00 10D% 6,00 $ 2/40/017 110% $ 685.76s.69 t6ox Change Orders Plus Allowable ark Up - Work Dons b Sub Contractors: C7i '.IF Remo Cost DMannca __ 976190 S 9.76190 M00 S 9,761.90 - 9761.90 0% Chen es • Sub contractor Totals f 9.761.90 f $ 9,761.90 S 9.761.90 1 100% Total Earned Pre us Period Total Earned Current Period Totni Earned To Date Total of Approved Work S 691.345.75 $ 682.415.69 1 1 1 1 S 13.131.90 $ 695.547.59 100% AMOUNT DUE CURRENT ESTIMATE f 13.131.80 Job Status Comments Sample reports are in route and will be delivered via postal mail no later than Wednesday. September 28 2016. Final video report and media package are to be delivered via FedEx on Friday, September 23. 2016. Sub -Contractor Work Comments: Insituform Project Management Approval by: �Z& Fi6berr!57 Rtzo 503.486 6274 20150910 Progress Payment Approval by: None. Tilde Dab Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reponing burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and revievnng the collection of mfonnation. Send comments regarding this burden estimate or any other aspect of this collection of informationincluding suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 eHerson Davis Highway, Suite 1204. Anington. VA 22202-4302and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER YROLL PAYMENT DATE (YYMMDD) F 3. CONTRACT NUMBER 4 DATE (YYMMDD) 52 16/09/30 1 16/09/30 I, Stephanie Forrest Payroll Specialist do hereby state IName of signatory party) (Tree) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II Conbacto orsubccniractarl on the CAG-15-149 , that during the payroll period commencing on the 18 day of (Bu(Jding or work) September 201 6 and ending the 24 day of September 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat 108, 72 Stat 967, 76 Stat 357, 40 U.S.0 276c), and described below Federal, Fica, State and Local tax. 401K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the age rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8 SIGNATURE - Forrest, Forrest, Stephanie Payroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal 0Cution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 9/29/2016 7:34:18 Certified Payroll Register Page - 33 Pay Period Ending Date 9/24/2016 INSITUFORM TECHNOLOGIES LLC Pro ect and Location 202221 Period Number 5 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24' CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular . . ..... ....... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for tins collection of information is estimated to average 15 minutes per response, including the time for revie inng instructions, searching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of informationincluding suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204, Arlington. VA 22202-4302and to the Office of Management and Budget, Paperwork Reduction Protect (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDD) 53 16/10/07 1 16/10/07 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 ; that during the payroll period commencing on the 25 day of (Building or work) September 201 6 and ending the 1 day of October 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Connector a subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat. 967, 76 Stat. 357: 40 U.S.C. 276c). and described below: Federal. Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH W1-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 8. NAME (Last. First, Middle Initial) TITLE 8 SIG NATUR Forrest, Stephanie T Payroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Protect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail ....... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount — NO WORK PERFORMED-------J 10/5/2016 7:39:41 Page - 33 Pay Period Ending Date 10/1/2016 Period Number 1 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. Including suggestions for reducing this burden. to Department of Defense Washington Headquarters Services Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Sure 1204. Arington. VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Protect (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. PAYROLL NUMBER r7AYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE;YYMMDD 51 16/09/23 1 16/09/23 I. Stephanie Forrest Payroll Specialist do hereby state (Na— of signatory party -if- (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contactor a subcontractor, on the CAG-15-149 that during the payroll period commencing on the 11 day of (8uildmg or work) September 201 6 and ending the 17 day of September 201 6 all persons employed on said protect have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat. 108 72 Stat 967 76 Stat 357, 40 U.S.C. 276c), and described below. Federal. Fica. State and Local tax 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle Initial) TITLE 8 SIGN UR Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or trim( rosecutr See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU I-VNM ot/ i, MAN y5 (tzu) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro11'ect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 9/22/2016 7:36:03 Page - 41 Pay Period Ending Date 9/17/2016 Period Number 4 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount I [ NO WORK PERFORMED _ l V ^ ,4 y. . Form QSS-347 CERTIFIED PAYROLL Page 1 of I Contractor: Insituforrn Technologies LLC Subcontractor: I/ Advanced Government Services Inc 8644 Pacific Ave Tacoma, WA 98444-6471 Project or Contract No: CAG-15-149 Cascade Interc Cost Acct. or Other No: CAG-15-149 Cascade Interc Tax ID No: 20-0053479 Payroll No: 5 For Week Ending: 09/10/2016 Project and Insituform Technologies LLC.2O2221 Cascade Interceptor PI2-Renton Location: Renton Name. Address, and Social Security Number of Employee # Ex Work Classification/ Apprentice Rate OT or ST Day and Date Total Hours Rate of Pay Fringe Ben. Gross Amount Weekly Deduction Totals Net Wages 09104 09,05 09,06 0907 0908 09,09 09/10 FICA State Other Total Ded. Su Mo Tu We T, Fr Sa Plan 5 Week With- Holding Local Tax Tax Check No. Hours Worked Each Day Cash $ Class Ded. Michael M Johnson xxx-xx-0541 Journeyman Flagger O 0 0 0 0 0 0 0 0 000 77 00 74261, 000 8 15 4896 693 69 S 0 0 O 0 C 25 17 000 176 19 84 CO 000 -100 00 21530 Myron D Trov`er xxx-xx.4619 0 Journeyman Fiagger O - 0 0 0 ., 0 _ 0 0 00 62 50 906 24 69 33 0 00 21 79 126 12 78C 1: S 0 0 7 5 0 0 7 5 25 17 0 00 ' 88 78 35 00 coo 000 21534 0 S O S 0 S O S 0 S 0 S wA& Date 09/16/2016 I. L Fredrick (Name of Signatory Party) PR/AR Manager (Title) do hereby state (1) That I pay or supervise the payment of the persons employed by Advanced Government Services Inc on the project Insituform Technologies LLC:202221 Cas that during the payroll period commencing on the 04 day of September 2016 and ending the 10 day of September 2016 all persons employed on said protect 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 Government Services Inc from the tContractor or Subcontractor) full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as defined in Regulations Part 3 (29 CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act. as amended (48 Stat 948, 63 Stat 108 72 Stat 967 76 Stat 357 40 U S C 276c), and described below Aflac/Colornal Life Court Ordered Garn/Support Wa Workers Comp (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor or if no such recognized agency exists in a State are registered with the Bureau of Apprenticeship and Training. United States Department of Labor i4) That ia1 WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to the appropriate programs for the benefit of such employees. except as noted in Section 4(c) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. except as noted in Section 4(c) below (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS The prevailing wages have been paid in accordance with the pre -filed Statement of Intent to Pay Prevailing Wages on file with the public agency (RCW 39 12 070) S11 00 fringe. per hour worked is deposited to 'The Contractors Plan Administrators" for "Qualified Medical Insurance and/or 401K Retirement Plan" NAME AND TITLE L Fredrick PR/AR Manager SIGNATURE /i THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE Form OSS-348 Monthly Employment Utilization Report U.S. Department of Labor Employment Standards Administration - Office of Federal Contract Compliance Programs This report is required by Executive Order 11246, Sec 203 Failure to report can result in contracts being cancelled terminated or suspended in whole or in part and the conlractoi may be oeclared ineligible for further Government contracts of federally assisted construction contracts 1. Covered Area (SMSA or EA) 2 Employers LD No. 20-0053479 0M8 No. 1215-01633 3 Current Goals Minority 6.5 Female 6.9 4 Reporting Period From 08/01/2016 To 08/31/2016 Name and Location of Contractor Advanced Government Services Inc 8644 Pacific Ave Tacoma, WA 98444-6471 Project and Location Insituform Technologies LLC:202221 Cascade Interceptor PH2-Renton Renton Federal Funding Agency 5 CONSTRUCTION TRADE Classifications 6 TOTAL FEDERAL & NON-FEDERAL CONSTRUCTION WORK HOURS s Total Number of Employees to Total Number of Minority Employees 6a Total All Employees By Trade 6b Black (Not of Hispanic Origin) 6c Hispanic 6d Asian or Pacific Islander 6e American Indian or Nalive American 7 A4uionty Percentage 8 Female Percentage M F M I F M F M F M F M F M F Flagger Journey Worker 40.5 41.25 205 0 0 0 0 0 0 0 25,08% 50.46% 2 2 1 0 Apprentice 0 0 0 0 0 0 0 0 0 0 0 0 - 0 0 Trainee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sub -Total 81.75 20.5 0 0 0 4 1 Journey Worker Apprentice Trainee Sub -Total Journey Worker Apprentice Trainee Sub -Total Journey Worker Apprentice Trainee Sub -Total Journey Worker Apprentice Trainee Sub -Total Total Journey Worker 40.5 41 25 20.5 0 0 0 0 0 0 0 25.08% 50.460"o 2 2 1 0 Total Apprentice o 0 0 0 0 0 0 0 0 0 0 0 0 0 Total Trainee 0 0 0 b 0 0 0 0 0 C 0 0 0 0 Grand Total 81.75 20.5 0 0 0 4 1 11. Company Official's Signature and Title 12. Telephone Number Q (Include area code) rtt- /j f - t 13. Date Signed I Page 531-9782 j 1 of 1 Form CC-257 BUREAU OF LABOR AND INDUSTRIES WAGE AND HOUR DIVISION PRIME CONTRACTOR ❑ SUBCONTRACTOR 29 PAYROLL NO. � PAYROLLICERTIFIED STATEMENT FORM WH-38 FOR USE IN COMPLYING WITH ORS 279C.845' FINAL PAYROLL ❑ Business Name (OBA): ' _&10ve_ pLpe—, serv," ,e C73. Phone: CCB Registration Number: Pro ect Name: [,( p Project Number: Type of Work: Street Address: , _5�? Mailing Address 0 P30 x �'�}I Project Location: Project County: Date Pay Period Began: lcp Date Pay Period Ended: 4 THIS SECTION FOR PRIME CONTRACTORS ONLY THIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name: ( ) Date Contract Specifications First Advertised for Bid: Contract Amount: Subcontract Amount: Prime Contractor Business Name (DBA): _S Prime Contractor Phone: ( ) A✓t Prime Contractor's CCB Registration Number. Date You Be an Work on the Project: 1 2 3 DAY AND DATE 4 5 6 7 8 9 1( 0) 11 NAME, ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION (INCLUDE GROUP p AND APPRENTICESHIP STEP IF APPLICABLE) 5 '� r VV r 1 TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGES TO EMPLOYEE GROSS AMOUNT EARNED (see directions) ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID HOURLY FRINGE BENEFITS PAID TO BENEFIT PARTY, PLAN, FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM ^ t i� HOURS WORKED EACH DAY r�E U1S n�+nmtxdtit. i �d t�xY- OT j •5 2 1 W ��. �� 1012.22 ST 3 `� $ `� 3� �I u� GYz- Iecl�n;cto °T 5 1 5 2. (o ,Ca 1-74 ST $ 55 OT ST OT ST OT ST 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of both the state PWR law and the federal Davis -Bacon Act. VVH-38(Rev. 06114) THIS FORM CONTINUED ON REVERSE CERTIFIED STATEMENT Date: 2Z T � 6t�i��il J r Ivl I, rr`���.{.Q.F�t{YE��v J{0 LjOfXa=��S In addition to completing sections (1) - (3), if your project is subject to the federal Davis -Bacon Act requirements, complete the following section as well: (NAME OF SIGNATORY PARTY) (TITLE) do hereby state: (1) That I pay or supervise the payment of1he persons employed by: lK -no rare Pt4&, E-Z"Is C6 (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (C011r-T%TO SUBC TRAC,��f� �R SURETY) on the �� .P.�ntlP/1. ►U?�tN.�hat during the payroll period (B ILDIN OR WORK) commencing on the day of . i� O , and ending the10 day ��'rn (MONTH) (YEAR) f oall persons employed on said project have been paid the (b) WHERE FRINGE BENEFITS ARE PAID IN CASH (MON ) (YEAR) full weekly wages earned, that no rebates have been g�will be made either directly or indirectly to or on behalf of said C—{YlUlrf' 1 ixe SC✓V'LPS_ (CONTRACTOR, SUBC NTRACTOR OR SURETY) from the full weekly wages earned by any person, and that no deductions have been ❑ - Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 652.610, and as defined in Regulations, Part (c) EXCEPTIONS: 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 EXCEPTION (CRAFT) EXPLANATION 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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the REMARKS: 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. NAME AND TITLE SIGNATURE I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE: 1 p ►re{Zc{yZ 0�� �IJLG{,°iy�r4(VP 11)(;,5 THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 (NAME AND TITLE) e-A jb OF THE UNITED STATES CODE. (GNAT R AND DATE FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOV/BOLT. BUREAU OF LABOR AND INDUSTRIES WAGE AND HOUR DMSION PRIME CONTRACTOR ❑ SUBCONTRACTOR PAYROLL NO. ri PAYROLUCERTIFIED STATEMENT FORM WH-38 FOR USE IN COMPLYING WITH ORS 279C.845' FINAL PAYROLL - Business Name (DBA): ' _ fYLr Y-e— PLPe-- se-i v," % Phone: (� ?�) (dZ3 -l3 Lu CCB Registration Number. l Z_'I t= X?CD Project Name: G ( Project Number: Type of Work: % Street Address: ?�_q� '- Mailing Address: Project Location: Project County: Date Pay Period Began: r Date Pay Period Ended: --) THIS SECTION FOR PRIME CONTRACTORS ONLY THIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name: Phone: ( ) Date Contract Specifications First Advertised for Bid: Contract Amount: Subcontract Amount: Prime Contractor Business Name (DBA): ��c �( �l Prime Contractor Phone: ( ) Prime Contractor's CCB Registration Number: Date You Began Work on the Pro ect. 1 2 3 DATE 4 5 6 7 8 9 10 11 NAME, ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION (INCLUDE GROUP # AND APPRENTICESHIP STEP IF APPLICABLE( !�"1 — I VDAAY `^AN,D Y ' r S TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGES TO EMPLOYEE GROSS AMOUNT EARNED (see directions) ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID HOURLY FRINGE BENEFITS PAID TO BENEFIT PARTY, PLAN, FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM �,, I I� HOURS WORKED EACH DAY �eia OT � Z 3 C%u�b OT I i5 -2— 3 f ST OT ST OT ST OT I ST 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of both the state PWR law and the federal Davis -Bacon Act. WH-38 (Rev. 06114) THIS FORM CONTINUED ON REVERSE Date: cAlZ3lI�0 I I, ,'�9'�ttLt tit �C q . jl,f` ctn {Ycx � P Cpe '� cyis (NAME OF SIGNATORY PARTY) (TITLE) do hereby state: (1) That I pay or supervise the payment ofthe p rsons employed by: J)A �r ONT TOR, SUBC, TRACTOR OR SURETY) on the P till�.� �pPJA� , that during the payroll period (BUILDING OR WORK commencing commencing on the day oftl� and ending the L-1 day (MO TH) (YEAR) all persons employed on said project have been paid the (MONTH) (YEAR) full weekly wages earned, that no rebates have been will be made either directly or indirectly to or on behalf of said (2--i"we j. ,zt° �C'+'✓+GPI (CONTRACTOR, SUBC NTRACTOR OR SURETY) from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 652.610, and 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 J, � t ; bS" (C��� (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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a state, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE 13fe_vt,:�Q Mc�CaN . kcc n~ yet : } VP GAS (NAME AND TITLE) 1 -f-A ac e , �r '7tit - q 12Zc ► �0 TU TATEME In addition to completing sections (1) - (3), if your project is subject to the federal Davis -Bacon Act requirements, complete the following section as well: (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below- (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ - Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS: EXCEPTION (CRAFT) EXPLANATION REMARKS: NAME AND TITLE SIGNATURE THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOVIBOLI. NCH-38 (Rev. Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information 6 estimated to average 16 minutes per response including the time for reviewing instructions searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports 1215 Jefferson Davis Highway Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Protect 0215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 4. PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDDi r 3 CONTRACT NUMBER 4 DATE iYYMMDD 45 16/08/12 16/08/12 Stephanie Forrest Payroll Specialist do hereby state (Name of signatory parry) 17 rtlei (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor; on the CAG-15-149 that during the payroll period commencing on the 31 day of (Building or work) July 201 6 and ending the 6 day of August 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or Indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (48 Stat 948, 63 Stat 108. 72 Stat 967, 76 Stat 357. 40 U.S.C. 276c). and described below: Federal. Fica. State and Local tax. 401K. Loan re -payment. Insurance. garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last First Middle Initial) TITLE 8 SIGNATURE Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnmi osecutr See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU t-UKM D/y, MHK y5 (t:u) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro ect and Location 202221 RATON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 8/10/2016 12:13:32 Page - 38 Pay Period Ending Date 8/6/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ......... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO S S M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-5785 White Shane M Ayers SA 8/6/2016 12.00 65.190 9.00 21.00 1,564.56 Payment Number:04927276 1575 Fircrest Ct SE Pipelayer 12.00 9.00 21.00 1,564.56 Gross Pay 3,595.47 Salem OR 97306 OR Departmen 326.67 United States FED W/H Tax 689.05 FICA W/H 223.54 Medicare W/H 52.28 Garnish % 575.98 Total Deduct 1,867.52 Net Pay 1,727.95 Hrs This Chk 65.00 Subtotal for Payment Number:04927276 12.00 9.00 21.00 1,564.56 Shane M Ayers 12.00 9.00 21.00 1,564.56 MO S S 1 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer XXX-XX-0002 White Adam Eugene Clary SA 8/6/2016 12.00 65.190 1768 Pine Street Pipelayer 12.00 Silverton OR 97381 United States Subtotal for Payment Number:04927281 12.00 Adam Eugene Clary 12.00 default 9.00 21.00 1,564.56 Payment Number:04927281 9.00 21.00 1,564.56 Gross Pay 3,501.94 OR Departmen 316.42 FED W/H Tax 812.71 FICA W/H 217.12 Medicare W/H 50.78 Chd Sup $/% 98.08 Total Deduct 1,495,11 Net Pay 2,006.83 Hrs This Chk 61.00 9.00 21.00 1,564.56 9.00 21.00 1,564.56 R07371 Aegion Corporation 8/10/2016 12:13:32 Certified Payroll Register Page - 39 Pay Period Ending Date 8/6/2016 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 2 17988 EDISON AVE RNTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADL1 NT1 RC24"EPTOR-PHASE II WA St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO S S 1 M 007 1971 For HSU 1971 Accrual XXX-XX-0687 White Brian Mitchell Hille SA 8/6/2016 3150 SW 108th Ave Pipelayer Beaverton OR 97005 United States Subtotal for Payment Number: 04927285 Brian Mitchell Hille MO M M M 008 1971 For HBU 1971 Accrual XXX-XX-8053 White Brennon Christopher Pratt SA 8/6/2016 1634 SE Jonathan Avenue Pipelayer Dallas OR 97338 United States Subtotal for Payment Number:04927269 Brannon Christopher Pratt PIPL Pipelayer default 12.00 65.190 9.00 21.00 1,564.56 Payment Number:04927285 12.00 9.00 21.00 1,564.56 Gross Pay 3,605.88 OR Departmen 327.49 FED W/H Tax 844.03 FICA W/H 224.06 Medicare W/H 52.40 Total Deduct 1,447.98 Net Pay 2,157.90 Hrs This Chk 63.00 12.00 9.00 21.00 1,564.56 12.00 9.00 21.00 1,564.56 PIPL Pipelayer default 12.00 65.190 9.00 21.00 1,564.56 Payment Number:04927289 12.00 9.00 21.00 1,564.56 Gross Pay 3,495.78 OR Deparlmen 286.83 FED W/H Tax 682.50 FICA W/H 216.74 Medicare W/H 50.69 Total Deduct 1,236.76 Net Pay 2,259.02 Hrs This Chk 61.00 12.00 9.00 21.00 1, 564.56 12.00 9.00 21.00 1,564.56 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Project and Location 202221 RENTON - WA- CAG-15-149 CASCA11NTt21 RCEPT DI`_OR-PHASE II WA 8/10/2016 12:13 32 Page - 40 Pay Period Ending Date 8/6/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular ....... I ...... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount RENTON - WA- CAG-15-149 48.00 36.00 84.00 6,258.24 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 15 minutes per response Including the time for reviewing instructionssearching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES, RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDDI 50 F16/09/16 1 16/09/16 Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) , Tire, (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor, on the CAG-15-149 that during the payroll period commencing on the 4 day of (Building or w010 September 201 6 and ending the 10 day of September 201 6 all persons employed on said project have been paid the full weekly wages earned. that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages eamed by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948. 63 Stat. 108, 72 Stat. 967. 76 Stat. 357, 40 U. S. C. 276c), and described below. Federal. Fica. State and Local tax. 401 K, Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last First Middle Initial) TIT-E 8 SIGNATUR Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnmtina ro ti See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU FUKM d/9. MAK 9b (E(i) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 9/15/2016 7:3934 Page - 39 Pay Period Ending Date 9/10/2016 Period Number 3 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED — Form QSS-347 CERTIFIED PAYROLL Page 1 of 1 Contractor: ❑ Insituform Technoloqies LLC Subcontractor: IV71 Advanced Government Services Inc 8644 Pacific Ave Tacoma, WA 98444-6471 Project or Contract No: CAG-15-149 Cascade Interc Cost Acct. or Other No: CAG-15-149 Cascade Interc Tax ID No: 20-0053479 Payroll No: 4 For Week Ending: 09/03/2016 Project and Insituform Technologies LLC:202221 Cascade Interceptor PI2-Renton Location: Renton Name, Address, and Social Security Number of Employee # Ex Work Classification/ Apprentice Rate OT or ST Day and Date Total Hours Rate of Pay Fringe Ben. Gross Amount We ly Deduction Totals Net Wages 9 08/28 08/29 08/30 08/31 09/01 09/02 09/03 FICA State Other Total Ded. Su Mo Tu I we I Th Fr Sa Plan $ Week With- Holding Local Tax Tax Check No. Hours Worked Each Day Cash $ Class Ded. No Work Performed. O s 0 s 0 S 0 S �S 0 0 s 0 S 0 S Date 09/09/2016 I, L Fredrick PR/AR Manager (Name of Signatory Party) (Title) do hereby state: (1) That I pay or supervise the payment of the persons employed by Advanced Government Services Inc on the project Insituform Technologies LLC:202221 Cas that during the payroll period commencing on the 28 day of August 2016 and ending the 03 day of September 2016 , 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 Government Services Inc from the (Contractor or Subcontractor) full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat. 108, 72 Stat 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Aflac/Colonial Life Court Ordered Garn/Support Wa Workers Comp (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to the appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS The prevailing wages have been paid in accordance with the pre -filed Statement of Intent to Pay Prevailing Wages on file with the public agency. (RCW 39.12.070) $11.00 fringe, per hour worked, is deposited to "The Contractors Plan Administrators" for "Qualified Medical Insurance and/or 401 K Retirement Plan". NAME AND TITLE L Fredrick PR/AR Manager SIGNATURE / THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Form OSS-348 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting oumen for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions. searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense Washington Headquarters Services. Directorate for Information Operations and Reports 1215 deflerson Davis Highway Suite 12D4, Arlington VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 'i PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD) F 3 CONTRACT NUMBER � DATE YYMPdDD 49 16/09/09 16/09/09 Stephanie Forrest Payroll Specialist do hereby state (Name of signatory partyi (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor, on the CAG-15-149 i that during the payroll penod commencing on the 28 day of !Building or work) August 201 6 and ending the 3 day of September 201 6 all persons employed or, said project have been paid the fuli weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat 108, 72 Stat 967. 76 Stat. 357: 40 U.S C. 276c). and described below Federal, Fica, State and Local tax, 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last First Middle Initial) TITLE 8 SIGN U`)-.N\ Forrest, Stephanie Payroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cri final o ecu See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code UU I-UKM bl/ j. MAK Vb (Eu) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount [ ------NO WORK PERFORMED -- ;t 9/B/2016 7:43:06 Page - 39 Pay Period Ending Date 9/3/2016 Period Number 2 f z,5Lz L ( BUREAU OF LABOR AND INDUSTRIES PAYROLLICERTIFIED STATEMENT FORM WH-38 WAGE AND HOUR DIVISION c FOR USE IN COMPLYING WITH ORS 279C.845- PRIME CONTRACTOR ❑ SUBCONTRACTOR PAYROLL NO. J FINAL PAYROLL \ Business Name (DBA): ''_� _•� tMOV-e- ptq� -)� SeW, c -, % . : C• Phone: ( ,) 4'Z-�i"I� l�� CCB Registration Number. (Z" 0qL-) Project Name Dt QWVA Project Number: TypeofWok Street Address: 3 ; �a�L ?c . Mailing Address: P c,Z1vect-LE, Or'— { ��.� Project Location: Project County: Date Pay Period Began: Date Pay Period Ended: THIS SECTION FOR PRIME CONTRACTORS ONLY ITHIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name: Phone: ( ) Date Contract Specifications First Advertised for Bid: Contract Amount: Subcontract Amount: Prime Contractor Business Name (DBA) Z(�l5[�yt 1M TeG�n . Prime Contractor Phone: ( ) Prime Contractor's CCB Registration Number: Date You Began Work on the Pro ect: 1 2 3 DAY AND DATE 4 5 6 7 8 9 10 11 NAME, ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION (INCLUDE GROUP # AND APPRENTICESHIP STEP IF APPLICABLE) m rj� V V �,' (YZ C j TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGESTO EMPLOYEE GROSS AMOUNT EARNED (see directions) ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID BENEFITS TSRPA DE TO BENEFIT PARTY, PLAN, FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM Z' HOURS WORKED EACH DAY V_aAA— T`r� 1.bi2_ A,"l'D✓ OT X„�'�-; ST b iu `rc� ty OT STJA OT ST OT ST OT ST 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of both the state PWR law and the federal Davis -Bacon Act. WH-38 (Rev. 08114) THIS FORM CONTINUED ON REVERSE for CERTIFIED STATEMENT Date: [rd ( ("::' In addition to completing sections (1) - (3), if your project is subject to the federal rz. LL� I L I: Xti'� �t �'I L`� ✓tf - � [l rt [4'c�>ti:; Vic) C�i'.r�`�'i U`YLS Davis -Bacon Act requirements, complete the following section as well: , (NAME OF SIGNATORY PARTY) (TITLE) (4) That: do hereby state: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR (1) That I pay or sue the payment of the persons employed by: T-myrif E42c� C6 PROGRAMS ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit (CONTRACTOR, SUBCONTRACTOR OR SURETY) on the ; that during the payroll period (BUILDING OR WORK) commencing on the day of ` and ending the = r day of such employees, except as noted in Section 4(c) below. (MONTH) (YEAR) of all persons employed on said project have been paid the (b) WHERE FRINGE BENEFITS ARE PAID IN CASH (MONTH) (YEAR) full weekly wages earned, that no rebates have been will be made either directly or indirectly to or on behalf of said C-VYl(afU' 1 LiIE-SC'ry'Lxs ❑ - 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 (CONTRACTOR, SUBCONTRACTOR OR SURETY) basic hourly wage rate plus the amount of the required fringe benefits as listed from the full weekly wages earned by any person, and that no deductions have been in the contract, except as noted in Section 4(c) below. made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 652.610, and as defined in Regulations, Part (c) EXCEPTIONS: 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 EXCEPTION (CRAFT) EXPLANATION described below. _ �-- V / 1 i I `c t,�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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the REMARKS: 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. NAME AND TITLE SIGNATURE I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE. \'`D f� t� Ntt: — kzzlgf Yc'�U v J THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 ( ME AND TITLE) OF THE UNITED STATES CODE. S NATU AND DATE FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOV/BOLT. wrt-:sss (rtev. UW14) 0.9Z7_l BUREAU OF LABOR AND INDUSTRIES WAGE AND HOUR DIVISION PRIME CONTRACTOR ❑ SUBCONTRACTOR 29 PAYROLL NO. PAYROLUCERTIFIED STATEMENT FORM WH-38 FOR USE IN COMPLYING WITH ORS 279C.845' FINAL PAYROLL ❑ Business Name (DBA): _.�1DY'eG P�rG `��►'�/�c e�� U. Phone: (' ) U=Z,?j-11icl CCB Registration Number: 12 C>e{C? Project Name: Ci( Pro ect Number: T e of Work: Street Address: _� Mailing Address:C c �t'ctL[, ►= Project Location: Project County: Date Pay Period Be an: Date Pay Period Ended: THIS SECTIONTOR PRIME CONTRACTORS ONLY THIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name ( ) Date Contract Specifications First Advertised for Bid: Contract Amount: Subcontract Amount Prime Contractor Business Name (DBA):c� Prime Contractor Phone: ( ) w1 Prime Contractor's CCB Registration Number. Date You Began Work on the Pro ect: 1 2 3 DAY AND DATE 4 5 6 7 8 9 10 11 NAME , ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION (INCLUDE GROUP 0 AND APPRENTICESHIP STEP IF APPLICABLE) n�} M T- (/ � V 4 i 1 (� i C� •..� TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGESTO EMPLOYEE GROSS AMOUNT EARNED (see directions) ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID HOURLY FRINGE BENEFITS PAID TO BENEFIT PARTY, PLAN. FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM , Q - 1 10 1 ` IZ I `3 HOURS WORKED EACH DAY T-e t�avmo,� ct a�'a OT 2 .5 S.S j 7, 3? "lto.o= 15� ST to to �D to �v Fri rk GXJ-LG 1 c1qy1I'Ciaj,_ OT ,Z 5 '1 29, �s ? 2D LOD,-6 lUe ST 10 11p t0 ,Z5 1,40 tq •33 OT ST OT ST OT ST 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of both the state PWR law and the federal Davis -Bacon Act. VIM-38 (Rev. W14) THIS FORM CONTINUED ON REVERSE Date: (NAME OF SIGNATORY PARTY) (TITLE) do hereby state: (1) That I pay or supervise the payment of the pgrsons employed to (COj4T_RACTOR, S 5CO TRACTOR OR SURETY) l on the P 113, r that during the payroll period (BUILDING OR WORK) commencing on the �_ day of7Di (L, and ending the day (MONT ) (YEAR) of all persons employed on said project have been paid the (MONT (YEAR) full weekly wages earned, that no rebates have been QLwill be I made either directly or indirectly to or on behalf of said C—{'Ylt � L'Qf See—y+CPS (CONTRACTOR, SUBCONTRACTOR OR SURETY) from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 652.610, and 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 EAL (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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a state, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE: 1,R vet't AND t MELE) O L t`1 AND DATE In addition to completing sections (1) - (3), if your project is subject to the federal Davis -Bacon Act requirements, complete the following section as well: (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ - Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS: EXCEPTION (CRAFT) EXPLANATION REMARKS: NAME AND TITLE SIGNATURE THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOV/BOLT. WH-38 (Rev. 06/14) Z13ZZL( BUREAU OF LABOR AND INDUSTRIES WAGE AND HOUR DIVISION PRIME CONTRACTOR ❑ SUBCONTRACTOR PAYROLL NO. l PAYROLUCERTIFIED STATEMENT FORM WH-38 FOR USE IN COMPLYING WITH ORS 279C.845' FINAL PAYROLL ❑ Business Name (DBA): ' _r1-'Wye. Pi4Z Phone: CCB Registration Number: (ZZ040 Project Name:' . , fU j Project Number: Type of Work: Street Address: n�. Mailing Address. X (`� Project Location: Project County: Date Pay Period Began: IP Date Pay Period Ended: THIS SECTION FOR PRIME CONTRACTORS ONLY THIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name: Phone: ( ) Date Contract Specifications First Advertised for Bid: Contract Amount_ Subcontract Amount: Prime Contractor Business Name (DBA): __- Prime Contractor Phone: ( BLS ) wt Prime Contractor's CCB Registration Number: Date You Began Work on the Pro ect: 1 2 3 DAY AND DATE 4 5 6 7 8 9 10 11 NAME, ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION [INCLUDE GROUP # AND APPRENTICESHIP STEP IF APPLICABLE) S � 1 n'� y r ` �. ,� TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGESTO EMPLOYEE GROSS AMOUNT EARNED (see directions) ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID HOURLY FRINGE BENEFITS PAID TO BENEFIT PARTY, PLAN, FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM { (.l 8 HOURS WORKED EACH DAY k1��V`i�V S OT 2 . �! i 3 11 .1S q 31 ST Z 5t .24 A IA34 CGzle 4o l n1 OT Z_ 2—q •Ci7 � 1 Z b 22 • I I ST OT ST OT ST OT ST 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of both the state PWR law and the federal Davis -Bacon Act. wH-38(Rev. 06114) THIS FORM CONTINUED ON REVERSE CERTIFIED STATEMENT Date: In addition to completing sections (1) - (3), if your project is subject to the federal C�CNyy�� II Aaki / Davis -Bacon Act requirements, complete the following section as well: (NAME OF SIGNATORY PARTY) (TITLE) (4) That: do hereby state: (1) That I pay or supervise the payment of the pgfsons employed by: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit 0ITRACTiaR, SU CO TRAC OR SURETY) on the A A that during the payroll period UILD G OR WORK commencing on the _LL-r_ day of zuao_ and ending theme day of such employees, except as noted in Section 4(c) below. (MONT ) (YEAR) Of 2 0 (0, all persons employed on said project have been paid the (b) WHERE FRINGE BENEFITS ARE PAID IN CASH (MONT ) (YEAR) full weekly wages earned, that no rebates have been g,Lwill be made either directly or indirectly to or on behalf of said C—h'1 *e, 1or-, SC'Y✓-(pS (CONTRACTOR, SUBCONTRACTOR OR SURETY) ❑ - Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed from the full weekly wages earned by any person, and that no deductions have been in the contract, except as noted in Section 4(c) below. made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 652.610, and as defined in Regulations, Part (c) EXCEPTIONS: 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 EXCEPTION (CRAFT) EXPLANATION described below: PW 7 Svc► T (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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the REMARKS: 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. NAME AND TITLE SIGNATURE I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE: 1,4ctb — A ta- 6-e,0 VP ""YLS THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 (NAME AND TITLE) OF THE UNITED STATES CODE. S NATU ND DATE FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOV/BOLT. wH-36 (Rev. 06/14) 20 2Z z a BUREAU OF LABOR AND INDUSTRIES WAGE AND HOUR DIVISION PRIME CONTRACTOR ❑ SUBCONTRACTOR ES PAYROLL NO. 6 PAYROLLICERTIFIED STATEMENT FORM WH-38 FOR USE IN COMPLYING WITH ORS 279C,845" FINAL PAYROLL ❑ Business Name(DBA): _r'V1iJvPc��z Se'.h/�c.e"� ..C:. Phone (�3-1�) CCB Registration Number. IZ_-70q ? Project Name: )(tit k Project Number. T e of Work: Lc_ Street Address: 3_ d; �c:� �x C>< t Mailing Address: U 13 ( Project Location: Project County: Date Pay Period Began: YL( Date Pay Period Ended: THIS SECTION FOR PRIME CONTRACTORS ONLY THIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name: Phone: ( ) Date Contract Specifications First Advertised for Bid: Contract Amount: Subcontract Amount: Prime Contractor Business Name (DBA):—lSli-t,riT✓Vt.��`PG(,l ttJ e S Prime Contractor Phone: ( ) v Prime Contractor's CCB Registration Number: Date You Began Work on the Pro ect: 1 Z 3 DAY AND DATE 4 5 6 7 8 9 10 11 NAME, ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION (INCLUDE GROUP # AND APPRENTICESHIP STEP IF APPLICABLE( �� 1 1 n. V `r IP..1 TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGESTO EMPLOYEE GROSS AMOUNT EARNED (see tlirectltlnsI ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID -��7�P` HOURLY FRINGE BENEFITS PAID TO BENEFIT PARTY, PLAN, FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM ( / _ ��' i .^ -� HOURS WORKED EACH DAY �M Mona L7p� Pu LYlV OT (ol.g3 ST T rr tJI.�J OT //Oz/ OT ST OT ST OT ST 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of bath the state PWR law and the federal Davis -Bacon Act. WH-38 (Rev. W14) THIS FORM CONTINUED ON REVERSE Date: � [A ( ( co "5-",&t MeC -Po-*'��L (NAME OF SIGNATORY PARTY) do hereby state: (1) That I pay or supervise the payment of the CERTIFIED STATEMENT In addition to completing sections (1) - (3), if your project is subject to the federal Davis -Bacon Act requirements, complete the following section as well: v' i� C`� L'r>•S (TITLI=) (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR sons employed by. PROGRAMS '- ( ONT�`CTOR, SUBCONTRACTOR OR SURETY) on the [ �ln�%Lr�tt S fit i�h that during the payroll period UILDING OR WORK) commencing on the __ day of and ending the 1J day '(MONT ) (YEAR) of Wit all persons employed on said project have been paid the (MO TH) (Y full weekly wages earned, that no rebates have been;;_will be made either directly or indirectly to or on behalf of said iL—P Lye— WLc)", s ►'_y-u—S. (CONTRACTOR, SUBCONTRACTOR OR SURETY) from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 552.610, and 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:n� (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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a state, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE (NAME AND TITLE) (SIGN RE A ATE) ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ - Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS: EXCEPTION (CRAFT) EXPLANATION REMARKS: NAME AND TITLE SIGNATURE THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOV/BOLI. WH-38 (Rev. 06/14) ?z- U.S. Department of Labor PAYROLL iND, Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh3471nstr.htm) U.S. W;rtie and Hour l)ieiaun 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 9791 Titan Park Circle ! OMB No.: 1235-0006 Maverick Pump Services, LLC Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION i PROJECT OR CONTRACT NO. 7 - final 09/03/2016 Cascade Interceptor Rehabilitation Phase II CAG-15-149 Renton, WA (1) - NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g.. LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER OF WORKER (2) o F 0 i ry i i � (3) WORK CLASSIFICATION (4) DAY AND DATE (5) TOTAL HOURS I (6) RATE OF PAY (7) GROSS AMOUNT EARNED 18) DEDUCTIONS (9) NET WAGES PAID FOR WEEK o w[K/2N kn„n Tuc WA Thu Fri Sat N o 8/29 8130 8,31 9/I 9/2 9/3 FICA WITH- HOLDING TAX mtdirvc OTHER TOTAL DEDUCTIONS HOURS WORKED EACH DAY Miguel Mata 1701 Garden Oaks Dr, Irving, TX 75061 xXx-xx-2276 3 Laborer Sewer & Water General Laborer o 100 4.00 sin 200 00 000 000 ] g.0( bG, lad'�!i $141.57 $250.43 $33.11 $425.11 1CI �L+ s 0.00 a,on 8.e0 sw 0ua ow0a, 24.0( 33.65 10.30 Miguel Mijares 1914 Dory Lane Irving, TX 75061 xxx-xx-0216 p Laborer Sewer & Water General Laborer o toe 4.00 3.00 200 000 0.00 0.00 18_0( ''-IY_ -] 7' $ 3ry $141.57 S174.49 $33.11 S349.17 s 0.00 11.00 a.w wu uoe 0 0.w 24.0 33.65 1030 0 s 0 6 0 T.- Reg - 33.65 + fringe 10.30 = $43.95 OT - $60.78 DOT - $77.60 0 s 0 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'Yurrish weekly a statement with respect to the wages paid each employee dunng 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 pro)ect, 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 then the proper Davis -Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the Information to datermine that employees have received legally required wages and fringe benefits. Public Burden Statement We estimate that is will lake an average of 55 minutes to complete this collection, including time for reviewing Instructions, searching exlsfing 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 i3 '41 (over) Date 9/6/16 Becki Moessner office manager (Name of Signatory Party) (Title) do hereby state: (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC on the (Contractor or Subcontractor) Renton Cascade Interceptor Rehab Phase II , that during the payroll period commencing on the (Building or Work) 28th day of August 2016 , and ending the 3rd day of September 2016 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 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 loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below- (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS NAME AND TITLE SI UR Becki Moessner office manager THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SU JECT THE NTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol-goviwhd/forms/wh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Air aWND U.S. Wage and Hour t)11%4aicm Rev. Dec. 2008 NAME OF CONTRACTOR Q OR SUBCONTRACTOR ® ADDRESS 9791 Titan Park Circle OMB No.: 1235-0008 Maverick Pump Services, LLC Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 4 - revised 09/03/2016 Trimble Road Trunk Santa Clara, CA 190794 (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) (B) DEDUCTIONS 0 Sun rtua I Tuc I Wut Thu Fri Saltjo NAME AND INDIVIDUAL IDENTIFYING NUMBER a o o GROSS NET WAGES WITH- (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY I WORK � tv2x o xn9 s/JU s!JI 9/1 9/2 9/3 TOTAL RATE AMOUNT HOLDING mcdicarc TOTAL PAID HOURS WORKED EACH DAY NUMBER OF WORKER i 3 CLASSIFICATION HOURS OF PAY EARNED H r lu FICA TAX OTHER DEDUCTIONS FOR WEEK Carlos Mata Laborer Group 1 0 ,za, 400 400 400 nao u,0o 0m 34,0( 2512 W 4th Irving, TX 75060 0 J� $277.07 $4R6.17 $G4.80 $828A4 l� xxx-xx-1100 s o 0o s oo s 0o s oo 1,.. x oo o o0 38.0( 29.29 22.20 Miguel Mata Laborer Group 1 0 0.0o 0.00 0.00 0.00 000 0.00 ono $66.14 1701 Garden Oaks Dr, Irving, TX 75061 3 s 0.00 0.U0 0.00 rI o 0.00 e00 0.00 29.29 22.20 xxx-xx-2276 Carlos Miguel Davila Laborer Group 1 0 cot, 400 4.u0 400 400 000 0oo 28.0 u h•Iu 29 2802 N Pioneer Rd #130. Irving 75061 0 ' $237.45 $477.36 $55.53 $770.34 s 0.0n x.00 8.00 e.0o Boo 1.00 0.00 35.0( 29.29 22.20 xxx-xx-0121 Ever Ruiz Laborer Group 1 0 000 0.00 0.00 0.00 000 ago Ono $66.14 $308.94 1701 Garden Oaks Dr, Irving, TX 75061 0 $19.15 $21.52 $4.47 $45.14 $263.80 s 0,00 Don 0.0o 000 ew ono 0o0 6.00 29,29 22.20 xxx-xx-6845 0 TT 0 s Basic - 29.29. Fringe - $22.20 0 Total Hourly - $51.49 OT - $66.14 DOT - $80.78 s 0 s While completion of Form WH-347 is optional, it is mandatory for covered contractors and subconlractors 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 projecl, accompanied by a signed "Statement of Compkance" 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 instructionssearching 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 om .y i (over) Date 9/6/ 16 Becki Moessner office manager (Name of Signatory Party) (Title) do hereby state. (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC on the (Contractor or Subcontractor) Trimble Road Trunk that during the payroll period commencing on the (Building or Work) 28th day of Auguest 2016 and ending the 3rd day of September 2016 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 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: loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS reU-e� �19 !cc nclU-cue 12- NAME AND TITLE Becki Moessner office manager I ATU E THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CQ4TRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 1 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Pubk reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget Paperwork Reduction Project (1215-0149) Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER YROLL PAYMENT DATE (YYMMDD) F 3 CONTRACT NUMBER 4 DATE (YYMMDD) 47 16/08/26 1 16/08/26 I. Stephanie Forrest Payroll Specialist do hereby state (Name of signatory parry) %F tie; (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG 15-149 , that during the payroll period commencing on the 14 day of (Buildrng or work) August 201 6 and ending the 20 day of August 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax. 401 K. Loan re -payment.. Insurance. garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SIGNATURE Forrest, Stephanie TPayroll Specialist I ) 1) The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimindl r e io See Section 1007 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro act and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18.21,24" CIPP WA 8/25/2016 7:39:47 Page - 42 Pay Period Ending Date 8/20/2016 Period Number 4 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ..... I . Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO S S M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-5785 White Shane M Ayers MO 8/15/2016 8.00 41.890 4.00 65.190 12.00 595.88 Payment Number:04929200 1575 Fircrest Ct SE TU 8/16/2016 8.00 41.890 2.00 65.190 10.00 465.50 Gross Pay 4,901.26 Salem OR 97306 WE 8/17/2016 1.00 1.00 86.92 OR Departmen 456.01 United States WE 8/17/2016 8.00 41.890 4.00 65.190 12.00 595.88 FED W/H Tax 1,084.31 TH 8/18/2016 2.00 2.00 173.84 FICA W/H 304.54 TH 8/18/2016 8.00 41.890 4.00 65.190 12.00 595.88 Medicare W/H 71.23 FIR 8/19/2016 2.00 2.00 173.84 Net Pay 2,985.17 FIR 8/19/2016 8.00 41.890 4.00 65.190 12.00 595.88 Hrs This Chk 83.00 SA 8/20/2016 8.00 8.00 695.36 SA 8/20/2016 12.00 65.190 12.00 782.28 Subtotal for Payment Number:04929200 40.00 30.00 13.00 83.00 4.761.26 Shane M Ayers 40.00 30.00 13.00 83.00 4,761.26 MO S S 1 M 006 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-0002 White Adam Eugene Clary MO 8/15/2016 8.00 42.000 4.00 65.190 12.00 596.76 Payment Number:04929204 1768 Pine Street TU 8/16/2016 8.00 42.000 2.00 65.190 10.00 466.38 Gross Pay 4,905.66 Silverton OR 97381 WE 8/17/2016 1.00 1.00 86.92 OR Departmen 455.38 United States WE 8/17/2016 8.00 42.000 4.00 65.190 12.00 596,76 FED W/H Tax 1,262.14 TH 6/18/2016 2.00 2.00 173.84 FICA W/H 304.15 TH 8/16/2016 8.00 42.000 4.00 65.190 12.00 596.76 Medicare W/H 71.13 FIR 8/19/2016 2.00 2.00 173.84 Chd Sup $/% 98.08 FIR 8/19/2016 8.00 42.000 4.00 65.190 12.00 596.76 Net Pay 2,714.78 SA 8/20/2016 8.00 8.00 695.36 Hrs. This Chk 83.00 SA 8/20/2016 12.00 65.190 12.00 782.28 Subtotal for Payment Number:04929204 40.00 30.00 13.00 83.00 4,765,66 Adam Eugene Clary 40.00 30.00 13.00 83.00 4,765.66 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RETON - WA- CAG-15-149 4784'x 14 18,21 24" CIPP CASCADL INTERCEPTOR -PHASE II WA 8/25/2016 7:39:47 Page - 43 Pay Period Ending Date 8/20/2016 Period Number 4 St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO M M 5 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-3029 Black or African Ame Thomas Juan Dunn MO 8/15/2016 8.00 37.380 4.00 65.190 12.00 559.80 Payment Number:04929208 P.O. Box 52 TU 8/16/2016 8.00 37,380 2.00 65.190 10.00 429.42 Gross Pay 4,680.86 Smartville CA 95977 WE 8/17/2016 1.00 1.00 86.92 CA Departmen 355.23 United States WE 8/17/2016 8.00 37.380 4.00 65.190 12.00 559.80 CA -SDI 41.34 TH 8/18/2016 2.00 2.00 173.84 FED W/H Tax 1,024.97 TH 8/18/2016 8.00 37.380 4.00 65.190 12.00 559.80 FICA W/H 284.82 FR 8/19/2016 2.00 2.00 173.84 Medicare W/H 66.61 FR 8/19/2016 8.00 37.380 4.00 65.190 12.00 559.80 MEDICAL 80.31 SA 8/20/2016 8.00 8.00 695.36 DENTAL 5.99 SA 8/20/2016 12.00 65.190 12.00 782.28 VISION .69 Pipelayer 40.00 30.00 13.00 83.00 4,580.86 OP SP LIFE 1.83 Net Pay 2,819.07 Hrs This Chk 83.00 Subtotal for Payment Number:04929208 40.00 30.00 13.00 83.00 4,580.86 Thomas Juan Dunn 40.00 30.00 13.00 83.00 4,580.86 MO S S 1 M 007 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-0687 White Brian Mitchell Hills MO 8/15/2016 8.00 42.080 4.00 65.190 12.00 597.40 Payment Number:04929209 3150 SW 108th Ave TU 8/16/2016 8.00 42.080 2.00 65.190 10.00 467.02 Gross Pay 3,411.22 Beaverton OR 97005 WE 8/17/2016 1.00 1.00 86.92 OR Departmen 308.49 United States WE 8/17/2016 8.00 42.080 4.00 65.190 12.00 597.40 FED W/H Tax 790.29 TH 8/18/2016 2.00 2.00 173.84 FICA W/H 212.16 TH 8/18/2016 8.00 42.080 4.00 65.190 12.00 597.40 Medicare W/H 49.62 FR 8/19/2016 2.00 2.00 173.84 Total Deduct 1,360.56 FR 8/19/2016 8.00 42.080 4.00 65.190 12.00 597.40 Net Pay 2,050.66 Pipelayer 40.00 18.00 5.00 63.00 3,291.22 Hrs This Chk 63.00 Subtotal for Payment Number:04929209 40.00 18.00 5.00 63.00 3,291.22 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASC1 NTI=RCEPT ADI`OR-PHASE II WA 8/25/2016 7.39:47 Page - 44 Pay Period Ending Date 8/20/2016 Period Number 4 St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ..... I . Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Brian Mitchell Hille 40.00 18.00 5.00 63.00 3,291.22 MO M M M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-8053 White Brennon Christopher Pratt MO 8/15/2016 8.00 42.160 4.00 65.190 12.00 598.04 Payment Number:04929215 1634 SE Jonathan Avenue TU B/16/2016 8.00 42.160 2.00 65.190 10.00 467.66 Gross Pay 4,912.06 Dallas OR 97338 WE 8/17/2016 1.00 1.00 86.92 OR Departmen 416.54 United Stales WE 8/17/2016 8.00 42.160 4.00 65.190 12.00 598.04 FED W/H Tax 1,093.89 TH 8/18/2016 2.00 2.00 173.84 FICA W/H 304.55 TH 8/18/2016 8.00 42.160 4.00 65.190 12.00 598.04 Medicare W/H 71.23 FR 8/1912016 2.00 2.00 173.84 Total Deduct 1,886.21 FR 8/19/2016 8.00 42.160 4.00 65.190 12.00 598.04 Net Pay 3,025.85 SA 8/20/2016 8.00 8.00 695.36 Hrs This Chk 83.00 SA 8/20/2016 12.00 65.190 12.00 782.28 Subtotal for Payment Numbev 04929215 40.00 30.00 13.00 83.00 4,772.06 Brennon Christopher Pratt 40.00 30.00 13.00 83.00 4,772.06 RENTON - WA- CAG-15-149 200.00 138.00 57.00 395.00 22,171.06 U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. aNNO Hi Rev. Dec. 200A NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS 9791 Titan Park Circle OMB No.: 1235-000E Maverick Pump Services, LLC Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 5 08/20/2016 Cascade Interceptor Rehabilitation Phase II Renton, WA C AG-15-149 (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) Sun M.. Tuc wc Thu Fri Sat g o r v, I DEDUCTIONS NAME AND INDIVIDUAL IDENTIFYING NUMBER a O GROSS NET WAGES WITH- e. LAST FOUR DIGITS OF SOCIAL SECURITY ( 9•• `S � WORK 0 o ri/la Srl, fi/le 8'17 tlrl i R/19 8i20 TOTAL RATE AMOUNT HOLDING mcdwc TOTAL PAID HOURS WORKED EACH DAY NUMBER OF WORKER 9 CLASSIFICATION HOUR OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Miguel Mata Laborer o 0.00 000 000 000 noo nor, low 10.0( $60.78 $607.80 1701 Garden Oaks Or, Irving, TX 75061 3 Sewer & Water $37.68 $0.00 $8.81 $40.49 $561.31 xxx-xx-2276 General Laborer s nno 0.00 000 ear o.uu or,. a- 33,65 10.30 Miguel Mijares Laborer 0 'Di, om 000 Orin 000 am uro 1914 Dory Lane Irving, TX 75061 0 Sewer & Water $156.07 $285.50 $36.50 S250.00 S728.07 s u00 sm 600 moo eW moo 0.00 35.0 33.65 10,30 xxx-xx-0216 General Laborer 0 s 0 s 0 s 0 s Reg - 33.65 + fringe 10.30 = $43.95 0 OT - $60.78 s DOT - $77.60 0 T-F 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 'Yurnish 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)(6) 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) Date 8/22/2016 1. Becki Moessner office manager (Name of Signatory Party) do hereby state: (Title) (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC on the (Contractor or Subcontractor) Renton Cascade Interceptor Rehab Phase II , that during the payroll period commencing on the (Building or Work) 14th cby of August 2016 and ending the 20th day of August 2016 all persons employed on said pro)ect 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 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. 96T, 76 Stat. 357. 40 U.S.0 § 3145). and described below loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS NAME AND TITLE SI UR Becki Moessner office manager THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMEN S MAY BJEC THE CONTR TOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AN ECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. U.S. Department of Labor Wage and Hour Division PAYROLL (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. 4NNO Rev. Dec. 2008 NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS 9791 Titan Park Circle OMB No.: 1235-0008 Maverick Pump Services, LLC Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING 4 08/13/2016 PROJECT AND LOCATION Cascade Interceptor Rehabilitation Phase II Renton, WA PROJECT OR CONTRACT NO. CAG-15-149 (1) NAME AND INDIVIDUAL IDENTIFYING NUMBER e. LAST FOUR DIGITS OF SOCIAL SECURITY ( 9.• NUMBER OF WORKER (2) 2. 62 o g a O sE i � � (3) WORK CLASSIFICATION (4) DAY AND DATE (5) TOTAL HOURSI (6) RATE OF PAY (7) GROSS AMOUNT EARNED (8) DEDUCTIONS (9) NET WAGES PAID FOR WEEK 1� w Sun re Mun I Tuc I Wcd I The Fri Sal o � 8/7 o 8B 8/9 8'IU 8/i l K, 12 8/13 FICA WITH- HOLDING TAX mcdicurc OTHER TOTAL DEDUCTIONS HOURS WORKED EACH DAY Carlos Mata 2512 W 4th Irving, TX 75060 xxx-xx-1100 0 Laborer Sewer & Water General Laborer 0 000 $60.78 s 6ca 33.65 10.30 Miguel Mijares 1914 Dory Lane Irving, TX 75061 xxx-xx-0216 0 Laborer Sewer & Water General Laborer o 000 2.rxl 300 oae Dal nor 126o 17.0( $60.78 $2,483.61 $153.9X $280.46 $36.01 $250.00 $720.45 $1,763.16 a 000 tw sui 1100 33.(1l 33.65 103u 0 0 s 0 s 0 s Reg - 33.65 + fringe 10.30 = $43.95 OT - $60.78 DOT - $77.60 0 11 s s 7T —T 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(s). The Copeland Act (40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to'Yurnish 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) Date 8/15/2016 Becki Moessner (Name of Signatory Party) do hereby state office manager (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC (Contractor or Subcontractor) Renton Cascade Interceptor Rehab Phase II (Title) on the that during the payroll period commencing on the (Building or Work) 7th clay of August 2016 , and ending the 13th day of August 2016 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 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: loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS NAME AND TITLE Becki Moessner office manager s U THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATt6rNTS MAY SUB CT THE C TRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 1 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. u FormOSS-347 CERTIFIED PAYROLL Page 1 of 1 Contractor: Insttuform Technologies LLC Subcontractor: V Advanced Government Services Inc 8644 Pacific Ave Tacoma- WA 98444-6471 Project or Contract No: CAG-15-149 Cascade Interc Cost Acct. or Other No: CAG-15-149 Cascade Interc Tax ID No: 20-0053479 Payroll No: 2 For Week Ending: 08/20/2016 Project and Insituform Technologies LLCi202221 Cascade Interceptor PH2-Renton Location: Renton Name, Address, and Social Security Number of Employee # Ex Work Classification/ Apprentice Rate RT - OT ST Day and Date Total Hours Rate of Pay Fringe Ben. Gross Amount Weekly Deduction Totals Net Wages 08%14 08%15 08 16 1 08'17 08118 1 0819 O8120 FICA State Other Total Ded. Su fro Tu We rn Fr Sa Plan S Week With- Holding Local Tax Tax Check No. Hours Worked Each Day Cash S Class Ded. Brandy N Eaves -Stone xxx-xx-4937 0 Journeyman Flagger RT 0 0 0 0 0 0 C 1 000 38 50 t 054 28 80 55 D:r 18 35 251 OC OT 0 0 0 0 0 0 0 0 000 000 17619 15'- a TO 00 213Ct ST 35 0 0 0 0 0 0 35 5034 James E Gilbert xxx-xx-9554 Journeyman Flagger RT 0 0 0 0 0 0 7 0 000 3850 1283 39 98 1? 4- 697 48 585 91 OT o 0 0 0 0 0 0 0 000 000 176 19 131 OJ 56 84 ST 3 5 0 0 0 D o 0 3 5 50 34 RT OT ST RT OT ST j i RT OT ST RT OT ST RT OT ST RT OT ST Date 08126/2016 L Fredrick PR/AR Manager (Name of Signatory Party) (Title) do hereby state (1) That I pay or supervise the payment of the persons employed by Advanced Government Services Inc on the project Insituform Technologies LLC:202221 Cas that during the payroll period commencing on the 14 day of August 2016 and ending the 20 day of August 2016 . 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 Government Services Inc from the (Contractor or Subcontractor) full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as defined in Regulations. Part 3 t29 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 Aflac/Colonial Life Court Ordered Garn/Support Wa Workers Comp (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to the appropriate programs for the benefit of such employees except as noted in Section 4(c) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed in the above referenced payroll has been paid. as indicated on the payroll. an amount not less than the sum of the applicable bask 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 The prevailing wages have been paid in accordance with the pre -filed Statement of Intent to Pay Prevailing Wages on file with the public agency (RCW 39 12 070) S11 00 fringe per hour worked is deposited to "The Contractors Plan Administrators" for "Qualified Medical Insurance and/or 401 K Retirement Plan" NAME AND TITLE L Fredrick PR/AR Manager SIGNATURE THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE Form OSS-348 Form Approved STATEMENT OF COMPLIANCE 202221 Orate No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions. searching existing data sources. gathering and maintaining the data heeded, and Completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway, Suite 1204, Arlington. VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 48 1 16/09/02 1 16/09/02 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) (Trtle) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or Subcontractor) on the CAG-15-149 that during the payroll period commencing on the 21 day of (Building or work) August 201 6 and ending the 27 day of August 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 35T, 40 U.S. C. 276c), and described below: Federal, Fitts, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6 NAME (Last, First, Middle Initial) TITLE 8. SIGNATURE,/ Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnm I e ti See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED If R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro''ect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 8/31/2016 1150:00 Page - 40 Pay Period Ending Date 812712016 Period Number 1 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO S S M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-5785 White Shane M Ayers SU 8/21/2016 6.00 6.00 521.52 Payment Number: 04930856 1575 Fircrest Ct SE Pipelayer 6.00 6.00 521.52 Gross Pay 2,463.60 Salem OR 97306 OR Departmen 204.96 United States FED W/H Tax 370.87 FICA W/H 153.09 Medicare W/H 35.80 Net Pay 1,698.88 Hrs This Chk 39.50 Subtotal for Payment Number:04930856 6.00 6.O0 521.52 Shane M Ayers 6.00 6.00 521.52 MO S S 1 M 008 1971 For HBU 1971 Accrual XXX-XX-0002 White Adam Eugene Clary SU 8/21/2016 1768 Pine Street Pipelayer Silverton OR 97381 United States PIPL Pipelayer default 6.00 6.00 521.52 Payment Number:04930860 6.00 6.00 521.52 Gross Pay 2,465.80 OR Departmen 194.26 FED W/H Tax 497.24 FICA W/H 147.26 Medicare W/H 34.44 Chd Sup $/% 98.08 Other order$ 311.55 MEDICAL 88.88 DENTAL 5.46 VISION .74 OP EE LIFE 2.54 OP CH LIFE .69 Short Term D 4.81 Net Pay 1,079.85 Hrs This Chk 39.50 M R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register ProJ'ecI and Location 202221 RENTON - WA- CAG-15-149 4784'x 14 18.21 24" CIPP CASCADt INTtRCEPTOR-PHASE II WA 8/31 /2016 13.50:00 Page - 41 Pay Period Ending Date 8/27/2016 Period Number 1 St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Subtotal for Payment Number:04930860 6.00 6.00 521.52 Adam Eugene Clary 6.00 6.00 521.52 MO M M 5 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer XXX-XX-3029 Black or African Ame Thomas Juan Dunn SU 8/21/2016 P.O. Box 52 Pipelayer Smartville CA 95977 United States Subtotal for Payment Number: 04930863 Thomas Juan Dunn MO M M XXX-XX-8053 White Brennon Christopher Pratt 1634 SE Jonathan Avenue Dallas OR 97338 F United States M 008 1971 For HBU 1971 Accrual SU 8/21/2016 Installation Technician TECH Installation Technic default 6.00 6.00 521.52 Payment Number: 04930863 6.00 6.00 521.52 Gross Pay 2,373.40 CA Departmen 119.18 CA -SDI 20.58 FED W/H Tax 402.85 FICA W/H 141.75 Medicare W/H 33.15 MEDICAL 80.31 DENTAL 5.99 VISION .69 OP SP LIFE 1.83 Net Pay 1,567.07 Hrs This Chk 39.50 6.00 6.00 521.52 6.00 6.00 521.52 default 6.00 6.00 6.00 6.00 521.52 Payment Number:04930868 521.52 Gross Pay 2,469.00 OR Departmen 194.41 FED W/H Tax 413.50 FICA W/H 153.08 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register ProJ'ect and Location 202221 RE TON - WA-CAG-15-149 CASCA1 TREPT DI=N�COR-PHASE II WA St SMS SDep FMS FDep Sex EEO Union .................... Craft.................... Step.................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Subtotal for Payment Number:04930868 6.00 6.00 521.52 Brennon Christopher Pratt 6.00 6.00 521.52 RENTON - WA- CAG-15-149 24.00 24.00 2,086.08 8/31 /2016 13, 50.00 Page - 42 Pay Period Ending Date 8/27/2016 Period Number 1 ........ I . Check Detail .......... Description Amount Medicare W/H 35.80 Total Deduct 796.79 Net Pay 1,672.21 Hrs This Chk 39.50 U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. MHO JF U.S. Wales and Hour l)iviFlon Rev. Dec. 2008 NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS 9791 Titan Park Circle OMB No.: 1235-000E Maverick Pump Services, LLC Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO, FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 6 08/27/2016 Cascade Interceptor Rehabilitation Phase II AG-15-149 C Renton, WA (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) o H DEDUCTIONS Sun .Mug 7uc Wed Thu Fri Sat NAME AND INDIVIDUAL IDENTIFYING NUMBER F n o GROSS NET WAGES WITH (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY ry WORK r- o „/21 w22 8/23 V24 8/25 x^6 8/27 TOTAL RATE AMOUNT HOLDING medicare. TOTAL PAID HOURS WORKED EACH DAY NUMBER) OF WORKER i CLASSIFICATION HOURS OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Miguel Mata Laborer o r.,00 0.00 0.00 000 400 200 ,00u 22.0( moo.?j ��' $�p�' r v—► 1701 Garden Oaks Dr, Irving, TX 75061 3 Sewer & Water .187.26 $285.02 $43.80 $516.08 xxx-xx-2276 General Laborer s 0a, N.00 7.00 500 800 Srx, om 36.0( 33.65 10.30 Miguel Mijares Laborer o e.o0 e1x1 euo 0,„, 401) ux, I— 22.0( �, 3G2$.2'8 L -1 1914 Dory Lane Irving, TX 75061 0 Sewer & Water $187.26 $360.96 $43.79 $250.00 $842.01 6 o.u0 Nor) zoo sca N00 9W 6.w 36.0 33.65 W30 xxx-xx-0216 General Laborer 0 s 0 s 0 s 0I I sl I Reg - 33.65 + fringe 10.30 = $43.95 0 OT - $60.78 DOT - $77.60 s 0 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 dunng 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 Divislon, U.S. Department of Labor, Room 53502, 200 Constitution Avenue, N.W. Washington. D.C. 20210 (over) Date 8/29/2016 Becki Moessner (Name of Signatory Party) do hereby state. office manager (Title) (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC on the (Contractor or Subcontractor) Renton Cascade Interceptor Rehab Phase II ; that during the payroll period commencing on the (Building or Work) 21 st day of August 2016 and ending the 27th day of August 2016 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 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. loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor.. or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paidr as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS NAME AND TITLE 1 ATU E Becki Moessner office manager P2—� THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE MENTS MAYS JECT THE QNTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. FJ Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructionssearching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204. Arlington, VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (12150149) Washington. DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD) F 3. CONTRACT NUMBER 4 DATE (YYMMDD) 46 16/08/19 1 16/08/19 I. Stephanie Forrest Payroll Specialist do hereby state (Name of signatory patty) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcortracton on the CAG-15-149 , that during the payroll period commencing on the 7 day of (Building or, work) Auoust 201 6 ,and ending the 13 day of August 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or Will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor, or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S. C. 276C), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION i k 5 REMARKS 6. NAME (Last, First, Middle Initial) TITLE B. SIGNATUR Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or c i ro n- See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU t-UKM d(V, MAK 9b (L(i) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 8/17/2016 15:01:34 Page - 45 Pay Period Ending Date 8/13/2016 Period Number 3 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO S S M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-5785 White Shane M Ayers MO 8/8/2016 8.00 41.890 4.00 65.190 2.50 14.50 813.18 Payment Number:04928373 1575 Fircrest Ct SE TU 8/9/2016 8.00 41.890 4.00 65.190 1.00 13.00 682.80 Gross Pay 4,991.64 Salem OR 97306 WE 8/10/2016 8.00 41.890 4.00 65.190 12.00 595.88 OR Departmen 464.93 United States TH 8/11/2016 8.00 41.890 4.00 65.190 12.00 595.88 FED W/H Tax 1,114.06 FR 8/12/2016 8.00 41.890 2.00 65.190 10.00 465.50 FICA W/H 310.13 SA 8/13/2016 11.00 11.00 956.12 Medicare W/H 72.53 SA 8/13/2016 12.00 65.190 12.00 782.28 Garnish % 296.97 Pipelayer 40.00 30.00 14.50 84.50 4,891.64 Net Pay 2,733.02 Hrs This Chk 84.50 Subtotal for Payment Number:04928373 40.00 30.00 14.50 84.50 4,891.64 Shane M Ayers 40.00 30.00 14,50 84.50 4,891.64 MO S S 1 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-0002 White Adam Eugene Clary MO 8/8/2016 8.00 42.000 4.00 65.190 2.50 14.50 814.06 Payment Number:04928377 1768 Pine Street TU 8/9/2016 8.00 42.000 4.00 65.190 1.00 13.00 683.68 Gross Pay 4,996.04 Silverton OR 97381 WE 8/10/2016 8.00 42.000 4.00 65.190 12.00 596.76 OR Departmen 464.33 United States TH 8/11/2016 8.00 42.000 4.00 65.190 12.00 596.76 FED W/H Tax 1,291.97 FR 8/12/2016 8.00 42.000 2.00 65.190 10.00 466.38 FICA W/H 309.76 SA 8/13/2016 11.00 11.00 956.12 Medicare W/H 72.44 SA 8/13/2016 12.00 65.190 1200. 782.28 Chd Sup $/% 98.08 Pipelayer 40.00 30.00 14.50 84.50 4,896.04 Net Pay 2,759.46 Hrs This Chk 84.50 Subtotal for Payment Number:04928377 40.00 30.00 14.50 84.50 4,896.04 Adam Eugene Clary 40.00 30.00 14.50 84.50 4.896.04 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ecI and Location 202221 RE�TON - WA- CAG-15-149 4784'x 14 18,21 24" CIPP CASCADE` INTERCEPTOR -PHASE II WA 8/17/2016 15:01:34 Page - 46 Pay Period Ending Date 8/13/2016 Period Number 3 St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount MO M M 5 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-3029 Black or African Ame Thomas Juan Dunn MO 8/8/2016 8.00 37.380 4.00 65.190 2.50 14,50 777.10 Payment Number:04928380 P.O. Box 52 TU 8/9/2016 8.00 37.380 4.00 65.190 1.00 13.00 646.72 Gross Pay 4,711.24 Smartville CA 95977 WE 8/10/2016 8.00 37.380 4.00 65.190 12.00 559.80 CA Departmen 358.34 United States TH 8/11/2016 8.00 37.380 4.00 65.190 12.00 559.80 CA -SDI 41.62 FR 8/12/2016 8.00 37.380 2.00 65.190 10.00 429.42 FED W/H Tax 1,033.92 SA 8/13/2016 11.00 11.00 956.12 FICA W/H 286.71 SA 8/13/2016 12.00 65,190 12.00 782.28 Medicare W/H 67.06 Pipelayer 40.00 30.00 14.50 84.50 4,711.24 MEDICAL 80,31 DENTAL 5.99 VISION .69 OP SP LIFE 1.83 Total Deduct 1,876.47 Net Pay 2,834.77 Hrs This Chk 84.50 Subtotal for Payment Number04928380 40.00 Thomas Juan Dunn 40.00 MO S S 1 M 007 1971 For HBU 1971 Accrual XXX-XX-0687 White Brian Mitchell Hille MO 8/8/2016 8.00 42.080 3150 SW 108th Ave TU 8/9/2016 8.00 42,080 Beaverton OR 97005 WE 8/10/2016 8.00 42.080 United States TH 8/11/2016 8.00 42.080 FIR 8/12/2016 8.00 42.080 SA 8/13/2016 SA 8/13/2016 Pipelayer 40.00 30.00 14.50 84.50 4,711.24 30.00 14.50 84.50 4.711.24 PIPL Pipelayer default 4.00 65.190 2.50 14.50 814.70 Payment Number 04928381 4.00 65.190 1.00 13.00 684.32 Gross Pay 4,999.24 4.00 65.190 12.00 597.40 OR Departmen 465.69 4.00 65.190 12.00 597.40 FED W/H Tax 1,296.49 2.00 65.190 10.00 467.02 FICA W/H 310.60 11.00 11.00 956.12 Medicare W/H 72.64 12.00 65.190 12.00 782.28 Total Deduct 2.145.42 30.00 14.50 84.50 4,899.24 Net Pay 2,853.82 Hrs This Chk 84.50 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro1'ect and Location 202221 RENTON - WA- CAG-15-149 CASCA1 TREPT DLNtCOR-PHASE II WA St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Subtotal for Payment Number 04928381 40.00 30.00 14.50 84.50 4,899.24 Brian Mitchell Hille 40.00 30.00 14.50 84.50 4,899.24 MO M M XXX-XX-8053 White Brennon Christopher Pratt 1634 SE Jonathan Avenue Dallas OR 97338 United States M 008 1971 For HBU 1971 Accrual MO 8/8/2016 8.00 42.160 TU 8/9/2016 8.00 42.160 WE 8/10/2016 8.00 42.160 TH 8/11/2016 8.00 42.160 FIR 8/12/2016 8.00 42.160 SA 8/13/2016 SA 8/13/2016 Pipelayer 40.00 Subtotal for Payment Number:04928385 40.00 Brennon Christopher Pratt 40.00 8/17/2016 15 01:34 Page - 47 Pay Period Ending Date 8/13/2016 Period Number 3 PIPL Pipelayer default 4.00 65.190 2.50 14.50 815.34 Payment Number: 04928385 4.00 65.190 1.00 13.00 684.96 Gross Pay 5,002.44 4.00 65.190 12.00 598.04 OR Departmen 427.26 4.00 65.190 12.00 598.04 FED W/H Tax 1,123.72 2.00 65.190 10.00 467.66 FICA W/H 310.15 11.00 11.00 956.12 Medicare W/H 72.53 12.00 65.190 12.00 782.28 Total Deduct 1,933.66 30.00 14.50 84.50 4,902.44 Net Pay 3,068.78 Hrs This Chk 84.50 30.00 14.50 84.50 4,902.44 30.00 14.50 84.50 4,902.44 RENTON - WA- CAG-15-149 200.00 150.00 72.50 422.50 24,300.60 •4 U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dot.govlwhdlformslwh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. U.S. Wage auJ Hour Divi,ion Rev. Dec. 2008 NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS 9791 Titan Park Circle OMB No.: 1235-000E Maverick Pump Services, LLC Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 3 08/06/2016 Cascade Interceptor Rehabilitation Phase II Renton, WA CAG-15-149 (1) (2) (3) (4) DAY AND DATE (5) (6) (7) (9) (9) Sun Mvn Tuc w,d Thu Fri Sat I So 1� w DEDUCTIONS NAME AND INDIVIDUAL IDENTIFYING NUMBER d o . GROSS NET WAGES WITH- (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY SS WORK o 131 8/1 8/2 8/3 8/4 i/5 Ii/6 TOTAL RATE AMOUNT HOLDING mcllc rc TOTAL PAID HOURS WORKED EACH DAY NUMBER) OF WORKER i g CLASSIFICATION HOURS OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Carlos Mata Laborer o ow 2512 W 4th Irving, TX 75060 Sewer & Water s ow 33.65 10.30 xxx-xx-1100 0 General Laborer Miguel Mijares Laborer o orxi 150 aw orio otio eno rtoo 18.5( (00. 1845 .8' I7`9 8 1914 Dory Lane Irving, TX 75061 0 Sewer & Water �% 1 $114.44 $184.79 $26.77 $250.00 S576A0 1�• s o.w s.ou 6.50 o0o 000 o,00 ow 14.5 33,65 10,30 xxx-xx-0216 General Laborer 0 s 0 6 0 s 0 s Reg - 33.65 + fringe 10.30 = $43.95 a OT - $60.78 s DOT - $77.60 0 -11117 4Nvle completion of Form WH347 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 date 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) Date 8/8/2016 (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Becki Moessner office manager m — 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 Maverick Pump Services, LLC on the (Contractor or Subcontractor) EXCEPTION (CRAFT) EXPLANATION Renton Cascade Interceptor Rehab Phase 11 , that during the payroll period commencing on the (Building or Work) 30th clay of July 2016 , and ending the 6th day of August 2016 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 Maverick Pump Services, LLC 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 Stat. 357, 40 U.S.C. § 3145), and described below: loan repayment 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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS NAME AND TITLE SI NAT El Becki Moessner — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in office manager the above referenced payroll, payments of fringe benefits as listed In the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT E CONTRAC OR 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 TI LE 18 AND S TION 231 OF TITLE except as noted in section 4(c) below. OF THE UNITED STATES CODE. U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh3471nstr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. aWND U.S. Wage and Hour Dhision Rev Ikec 9nnA NAME OF CONTRACTOR OR SUBCONTRACTOR ® Maverick Pump Services, LLC ADDRESS 9791 Titan Park Circle Littleton, CO 80125 OMB No.: 1235-OOOE Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING 2 07/30/2016 PROJECT AND LOCATION Cascade Interceptor Rehabilitation Phase II Renton, WA PROJECT OR CONTRACT NO. CAG-15-149 (�) NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER OF WORKER (2) z a o i (3) WORK CLASSIFICATION IA O (4)DAY ANDDATE (5) TOTAL HOURSOF (6) RATE PAY (7) GROSS AMOUNT EARNED 2109 y .93 (6) DEDUCTIONS (8) NET WAGES PAID FOR WEEK sun Man Tuc wed Thu Fri Sat 7/24 723 726 7/27 7/28 7/29 7/30 FICA WITH- HOLDING TAX medicare OTHER TOTAL DEDUCTIONS HOURS WORKED EACH DAY Carlos Mata 2512 W 4th Irving, TX 75060 xxx-xx-1100 0 Laborer Sewer & Water General Laborer o 0.00 5.50 3.00 0.50 3.00 3.00 0.00 15.0( AA $167.09 $312.16 $39.08 $S 1 R.33 21-Ap, (A a 0.00 s.00 size s.00 sea e.0o 0.00 40.0( 33.65 10.30 Miguel Mijares 1914 Dory Lane Irving, TX 75061 xxx-xx-0216 0 Laborer Sewer & Water General Laborer o 0.00 7.00 4.00 0.50 4.00 3.00 3.2s 21,7- $172.29 $324.74 $40.29 $250.00 $787.32 19q 1.51 6 0.00 ail 8.00 zoo soo too 0.00 32,0 33.65 10 3l1 0 6 0 6 0 [4-1-1 0 a Reg - 33.65 + fringe 10.30 = $43.95 OT - $60.78 DOT - $77.60 0 a 0 a While completion of Form WH347 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 dung the preceding week." U.S. Department of Labor (DOL) regulations at 29 C.F.R. § 5.5(e)(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, Inducing time for reviewing instructions, searching existing data sources, gathering and maintaining the data neededand 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) Date 8/1/2016 Becki Moessner office manager (Name of Signatory Party) (Title) do hereby state. (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC on the (Contractor or Subcontractor) Renton Cascade Interceptor Rehab Phase 11 , that during the payroll period commencing on the (Building or Work) 24th day of July 2016 , and ending the 30th day of July 2016 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 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: loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS El - in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paid. as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS NAME AND TITLE S TU Becki Moessner office manager )wo Ux THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STAT91MIENTS MAY SUBJECT TH C TRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION, SEE SECTION 1001 OF TITLE 18.-AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. U.S. Department of Labor PAYROLL Wage and Hour Division 4NN0 (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm) L.S. Wage and Hour Dhiaun Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev. Dec. 200E NAME OF CONTRACTOR OR SUBCONTRACTOR ® Maverick Pump Services, LLC ADDRESS 9791 Titan Park Circle OMB No.: 1235-OOOE Littleton, CO 80125 Expires: 01/31/2015 PAYROLL NO. FOR WEEK ENDING 1 07/23/2016 PROJECT AND LOCATION Cascade Interceptor Rehabilitation Phase it Renton, WA PROJECT OR CONTRACT NO. CAG-15-149 (1) NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER OF WORKER (2) 2 � 0 u_ g O ia (3) WORK CLASSIFICATION 1� m o r o (4) DAY AND DATE (5) TOTAL HOURS (6) RATE OF PAY (7) GROSS AMOUNT EARNED DEDUCTIONS (9) NET WAGES PAID FOR WEEK Sun mve Tuc wcd Thu Fri Sat 7/17 7;1N 7/19 7l2U 7R1 74? 7�:3 FICA WITH- HOLDING TAX mcdicnrr OTHER TOTAL DEDUCTIONS HOURS WORKED EACH DAY Carlos Mata 2512 W 4th Irving, TX 75060 xxx-xx-1100 0 Laborer Sewer & Water General Laborer o 0.00 oso ergo uoo s,so sao tiro 22.5( w0 7' 1993. o5 $117.37 $ I91.87 $27.45 $336.69 �5J�0• s grog a.w grin o00 ,uo Nrq o.o0 11.0( 33.0 10.30 Miguel Mijares 1914 Dory Lane Irving, TX 75061 xxx-xx-0216 0 Laborer Sewer & Water General Laborer o Ito 1 aoa arxi eix, — err, inns 100 $60.78 $607.80 $37.68 $25.16 $8.81 $71.65 $536.15 IS 0- 0.00 000 0.00 0,00 0.00 0.00 33.65 1030 0 s 0 s 0 s 0 S Reg - 33.65 + fringe 10.30 = $43.95 OT - $60.78 DOT - $77.60 0 s 0 6 While completion of Form M-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'lumish 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 INS 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 0 (over) Date 7/25/16 Becki Moessner office manager (Name of Signatory Party) (Title) do hereby state: (1) That I pay or supervise the payment of the persons employed by Maverick Pump Services, LLC on the (Contractor or Subcontractor) Renton Cascade Interceptor Rehab Phase II that during the payroll period commencing on the (Building or Work) 17th clay of July 2016 , and ending the 23rd day of July 2016 all persons employed on said pro)ect 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 Maverick Pump Services, LLC (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 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. 96T 76 Stat. 357, 40 U.S.C. § 3145), and described below. loan repayment (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 duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH m — Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. except as noted in section 4(c) below. (c) EXCEPTIONS BUREAU OF LABOR AND INDUSTRIES WAGE AND HOUR DMSION PRIME CONTRACTOR ❑ SI IFlr.nNTDGCT(1D DQ PAYROLLICERTIFIED STATEMENT FORM WH-38 FOR USE IN COMPLYING WITH ORS 279C.845' ----- - —. Fr 1 RVLL nv. FINAL PAYROLL U Business Name (DBA): _.� Vj,j yt - P ��w, -:, �-, , Li'' Phone: (' '�) 4''L3-t?>i.e-1 CCB Registration Number: (ZZv?0 Project Name Or ae Project Number: Type of Work: Street Address: Project Location: Mailing Address. 7 + Project County: I � Yf'cLi) C)r,-z oj- Date Pay Period Began: Date Pay Period Ended: ? THIS SECTION FR PF1IME CONTRACTORS ONLY THIS SECTION FOR SUBCONTRACTORS ONLY Public Contracting Agency Name: Phone: ( ) Date Contract Specifications First Advertised for Bid: Contract Amount: 2 3 DAY AND DATE 4 Subcontract Amount Prime Contractor Business Name (DBA): Prime Contractor Phone: ( ) Prime Contractor's CCB Registration Number: Date You Be an Work on the Pro ect. 5 6 7 8 g �p 11 NAME , ADDRESS AND EMPLOYEE'S IDENTIFICATION NUMBER CLASSIFICATION (INCLUDE GROUP # AND APPRENTICESHIP STEP IF APPLICABLE) S �� ,r V t rl �j TOTAL HOURS HOURLY BASE RATE HOURLY FRINGE BENEFIT AMOUNTS PAID AS WAGES TO EMPLOYEE GROSS AMOUNT EARNED (see directions) ITEMIZED DEDUCTIONS FICA, FED, STATE, ETC. NET WAGES PAID BENEFITS TSURLY RIN DE TO BENEFIT PARTY, PLAN, FUND, OR PROGRAM NAME OF BENEFIT PARTY, PLAN, FUND, OR PROGRAM �y�. 41t HOURS WORKED EACH DAY UaAA- (�Ov�LP,�'t•Z.a.vto AWE ITI/j . DY•-- I V OT �5'la8 2'7.3'8 33o.5b -- ST 20. S�oN �wSi JtM A.LI.S, D E_ U tlnGLfST OT S OT ST OT ST OT ST IT I 'Although this form has not been officially approved by the U.S. Department of Labor, it is designed to meet the requirements of both the state PWR law and the federal Davis -Bacon Act. WH-38 (Rev. 06114) THIS FORM CONTINUED ON REVERSE Date: 1, ► t MCCi-M'ail &v�L (NAME OF SIGNATORY PARTY) do hereby state. (1) That I pay or supervise the payment of1he C -m cre Lye,_ CEK I IrIEU 5 I A I I=MLN I In addition to completing sections (1) - (3), if your project is subject to the federal Davis -Bacon Act requirements, complete the following section as well: u' i� Cpi',t�c�`�t L� (TITLE) (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS OR sons employed. by. PROGRAMS (CONTRACTOR, SUBCONTRACTOR OR SURETY) on the that during the payroll period (BUILDING R WORD � commencing on the day of and ending they day (MONTH)1 (YEAR) of. �. all persons employed on said project have been paid the (MONTH) (YEAR) full weekly wages earned, that no rebates have been,DLwill be made either directly or indirectly to or on behalf of said eiMl��" SC'r tf .Lp SSC'r �/ [yp S (CONTRACTOR, SUBCONTRACTOR OR SURETY) from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as specified in ORS 652.610, and 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: V X]1 1 . 5VJ_1 1 VU &I-1V _ (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 workers 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 conform with work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a state, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. I HAVE READ THIS CERTIFIED STATEMENT, KNOW THE CONTENTS THEREOF AND IT IS TRUE TO MY KNOWLEDGE: LAME AND TITLE) ❑ - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ - Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS: EXCEPTION EXCEPTION (CRAFT)EXPLANATION REMARKS: NAME AND TITLE SIGNATURE THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. FILE THIS FORM WITH THE PUBLIC AGENCY ASSOCIATED WITH THE PROJECT NOTE TO CONTRACTORS: YOU MUST ATTACH COPIES OF THIS FORM TO EACH OF YOUR PAYROLL SUBMISSIONS ON THIS PROJECT. INSTRUCTIONS AND ADDITIONAL FORMS ARE AVAILABLE ON OUR WEBSITE: WWW.OREGON.GOV/BOLI. WH-3s Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructionssearching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden. to Department of Defense Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway Suite 1204. Arington. VA 22202-4302 and to the Office of Management and Budget. Paperwon, Reduction Protect 11215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 44 1 16/08/05 16/08/05 Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) :Tine (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subrontraoror) on the CAG-15-149 that during the payroll period commencing on the 24 day of (Building or work) July 201 6 and ending the 30 day of July 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (46 Stat 948 63 Stat 108 72 Stat 967. 76 Stat 357. 40 U S.C. 276c), and described below: Federal. Fica, State and Local tax, 401K Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete:. that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION i 5 REMARKS` 6. NAME (Last First. Middle Initial) TITLE 8. SIGNP,tUPE , Forrest, Stephanie Payroll Specialist T � l(p The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or c n pros On. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DD FORM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II �A 4'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED_ 8/3/2016 8:34:14 Page - 37 Pay Period Ending Date 7/30/2016 Period Number 1 Vo Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructionssearching existing data sources. gathering and maintaining the data needed. and completing and revievng the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense Washington Headquarters Services . Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204. Arington VA 22202-4302 and to the Office of Management and Budget. Paperwork Reduction Protect 02150149� Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE !YYMMDDI 43 1 16/07/29 1 16/07/29 I. Stephanie Forrest Payroll Specialist do hereby state (Name o'srgnatory party, (TRlei (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractorl on the CAG-15-149 that during the payroll period commencing on the 17 day of (8m1dmg or work.) July 201 6 and ending the 23 day of July 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat 108, 72 Stat 967 76 Stat 357, 40 U. S. C 276c). and described below. Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last. First. Middle Initial) 77LE 8 SIGNATU Forrest, Stephanie TPayroll Specialist 10 The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cn pros ub6 . See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RETON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 7/27/2016 13:55:54 Page - 35 Pay Period Ending Date 7/23/2016 Period Number 5 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED 00 0,-4k Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER- 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDD) 41 1 16/07/15 1 16/07/15 I, Stephanie Forrest Payroll Specialist do hereby state (Na— of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contactor or subconbacror) on the CAG-15-149 that during the payroll period commencing on the 3 day of (Building o, work) July 201 6 and ending the 9 day of July 201 6 all persons employed on said project have been paid the full weekly wages earned. that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (contractor or subcontac" and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357. 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform With the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SIGN U Forrest, Stephanie TPayroll Specialist 1 12) The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crilbioal DAeC&Ill See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 7/15/2016 10:08:19 Page - 36 Pay Period Ending Date 7/9/2016 Period Number 3 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job I .. I ..... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -------- NO WORK PERFORMED ---------- J U Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructionssearching existmg data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for information Operations and Reports, 1215 Jefferson Davis Highway Suite 1204, Arlington VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Protect (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER, 1 PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD) F 3. CONTRACT NUMBER 4 DATE (YYMMDD) 42 16/07/22 1 16/07/22 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subconaacror) on the CAG-15-149 that during the payroll period commencing on the 10 day of (B.ddmg or works July 201 6 and ending the 16 day of July 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357. 40 U.S.C. 276c), and described below: Federal, Fica. State and Local tax. 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8 SIGNAT Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or c in l pr a n. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 Aegion Corporation 7/20/2016 13 22:37 Certified Payroll Register Page - 39 Pay Period Ending Date 7/16/2016 INSITUFORM TECHNOLOGIES LLC Pro''ect and Location 202221 Period Number 4 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II WA4'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED A a Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Protect (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 38 1 16/06/24 1 16/06/24 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) (Ttfe) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 12 day of (Building or work) June 201 6 ,and ending the 18 day of June 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this Contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the Contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) 7. TITLE 8. SIGNATUR Forrest, Stephanie Payroll Specialist I The willful falsification of any of the above statements may subject the contractor or subcontractor to civil o?crKtnavprosecutton. See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. 10 R07371 Aegion Corporation 6/22/2016 14:14:28 Certified Payroll Register Page - 31 Pay Period Ending Date 6/18/2016 INSITUFORM TECHNOLOGIES LLC Prot1ect and Location 202221 Period Number 4 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED a Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for tins collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions. searching ewstmg data sources. gathering and maintaining the data needed and completing and reweaving the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports 1215 Jefferson Davis Highway, Suite 1204. Arington VA 22202-4302 and to the Office of Management and Budget. Paperwork Reduction Protect (1215-0149) Washington DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER PAYROLL PAYMENT DATE (YYMMDDi 3. CONTRACT NUMBER 4 DATE (YYMMDD) 40 16/07/08 1 16/07/08 Stephanie Forrest Payroll Specialist do hereby state (Name o'stgnarory party ,Td)e (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Con"crar or subcontractor on the CAG-15-149 that during the payroll period commencing on the 26 day of iButldmg o1 work) June 201 6 and ending the 2 day of July 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (contractor or subcontractoo and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948. 63 Stat 108 72 Stat 967. 76 Stat, 357. 40 U.S C 276c), and described below Federal, Fica. State and Local tax. 401K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 557 -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle Initial) TITLE 8 SIGN.ATU Forrest, Stephanie T Payroll Specialist � ­6 1 L/� The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or chmina%pios See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 7/6/2016 11:48:40 Page - 40 Pay Period Ending Date 7/2/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED-------- i. Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, mctutlmg the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense, Washington Headquarlers services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215.0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDD) 37 1 16/06/17 1 16/06/17 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory parry) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor; on the CAG-15-149 that during the payroll period commencing on the 5 day of (Building or work) June 201 6 and ending the 11 day of June 2016 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SIGNATURE ' Forrest, Stephanie T Payroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or c r e ion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. r R07371 Aegion Corporation 6/15/2016 13:31:04 Certified Payroll Register Page - 42 Pay Period Ending Date 6/11/2016 INSITUFORM TECHNOLOGIES LLC Pro act and Location 202221 Period Number 3 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED f Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response including the time for reviewing instructionssearching existing data sources gathering and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspen of this collection of informationincluding suggestions for reducing this burtlen. to Department of Defense Washington Headquarters services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204, Arlington VA 22202-4302 and 10 the Office of Management and Budget. Paperwork Reduction Protect 02150149) Washington DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. ,, PAYROLL NUMBER PAYROLL PAYMENT DATE !YYMMDD. T 3 CONTRACT NUMBER 4 DATE (YYMMDDi 39 16/07/01 16/07/01 Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) (Teel (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 19 day of (Building or work) June 201 6 and ending the 25 day of June 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948. 63 Stat. 108, 72 Stat. 967: 76 Stat. 357. 40 U.S.C. 276c). and described below Federal. Fica. State and Local tax, 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor. or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last. First, Middle Initial) -.'LE 8 SIGNATU Forrest, Stephanie TPayroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimi ecution See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code Liu rvftivi Ofti. IvItNM aD (tu) PREVIOUS EDITON MAY BE USED a R07371 Aegion Corporation 6/29/2016 13:05:09 Certified Payroll Register Page - 33 Pay Period Ending Date 6/25/2016 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 1 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21.24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ... I ... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED 1 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Sutle 1204, Arlington. VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (12150149) Washington. DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER- 1. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 36 1 16/06/10 1 16/06/10 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor Or subMnraGtor) on the CAG-15-149 , that during the payroll period commencing on the 29 day of (Building or work) May 201 6 and ending the 4 day of June 2016 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontrdCrori and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are 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 -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION s 5.REMARKS 6. NAME (Last. First, Middle Initial) 7. TITLE 8. SIGNATURE Forrest, Stephanie Payroll Specialist The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimin'2Lcution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU 1-UKM bf!:i, MAK !:l5 (L(3) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pr' J'ect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II WA4'x 14,18,21,24" CIPP 6/8/2016 13:44:23 Page - 49 Pay Period Ending Date 6/4/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail ......... . Name/Address _ Work Dale Hours Rate Hours Rate Hours Hours Amount Description Amount ----- NO WORK PERFORMED __-] ri Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions, searching existing data sources, gathering and maintaining the data neededand completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway, Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4. DATE (YYMMDD) 34 1 16/05/27 1 16/05/27 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory parry) (Tme) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 15 day of (Budding or work) May 201 6 and ending the 21 day of May 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor a, subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First. Middle Initial) TITLE 8. SIGNATURE Forrest, Stephanie Tpayroll Administrator i The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimmalpr6secution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 5/25/2016 13:41:40 Certified Payroll Register Page - 43 Pay Period Ending Date 5/21/2016 INSITUFORM TECHNOLOGIES LLC Project and Location 202221 Period Number 4 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4754'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding Nis burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204. Arlington. VA 22202-4302and to the Office of Management and Budget. Paperwork Reduction Protect (1215-0149) Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 35 1 16/06/03 1 16/06/03 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Tt)el (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or sabcontrdotorl on the CAG-15-149 that during the payroll period commencing on the 22 day of (Building or work) May 201 6 and ending the 28 day of May 201 6 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 Insitufonm Technologies, LLC from the full weekly wages earned by any person (Contactor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108. 72 Stat. 967: 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax. 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered With the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last, First, Middle Initial) 8. SIGNATURE 17TITLE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal ion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. - DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 Aegion Corporation 6/1/2016 15:33:58 Certified Payroll Register Page - 48 Pay Period Ending Date 5/28/2016 INSITUFORM TECHNOLOGIES LLC Prot1ect and Location 202221 Period Number 1 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II �A 4'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -- NO WORK PERFORMED ----- • Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewmg instructionssearching existing data sources. gathenng and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 22202-4302and to the Office of Management and Budget Paperwork Reduction Project (1215-0149) Washington DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDDI F 3 CONTRACT NUMBER 4 DATE (YYMMDD) 33 16/05/20 1 16/05/20 Stephanie Forrest Payroll Administrator do hereby state (Name or s,gnatory panyi (Title, (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 8 day of (Budding or work) May 201 6 and ending the 14 day of May 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or Indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor, and that no deductions have been made either directly or Indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat 108 72 Stat 967: 76 Stat, 357: 40 U.S C 276c). and described below. Federal. Fica State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below_ (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle Initial) TITLE 8. SIGNATURE Forrest, Stephanie Tpayroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU FURM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED i R07371 Aegion Corporation 5/18/2016 14:58:35 Certified Payroll Register Page - 43 Pay Period Ending Date 5/14/2016 INSITUFORM TECHNOLOGIES LLC Pro ect and Location 202221 Period Number 3 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ... I ... Regular .............. Overtime ...... Other Total Job .......... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount — NO WORK PERFORMED ---- 4 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information send comments regarding this burden estimate or any other aspect of this collection of mformatmnincluding suggestions for reducing this burden. to Department of Defense. Washington Headquarters services. Directorate for information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204. Arlington. VA 22202A302 and to the Office of Management and Budget, Paperwork Reduction Project 0215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDDj 3. CONTRACT NUMBER < DATE (YYMMDDi 32 1 16/05/13 116/05113 Stephanie Forrest Payroll Administrator do hereby state )Name of signatory party, ,Tbe (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor, on the CAG-15-149 that during the payroll period commencing on the 1 day of (Building or work) May 201 6 and ending the 7 day of May 201 6 all persons employed on said pro)ect have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person /Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (48 Stat. 948. 63 Stat. 108, 72 Stat 967. 76 Stat 357. 40 U.S.C. 276c), and described below: Federal. Fica. State and Local tax. 401 K Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training. United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS B NAME (Last, First. Middle Initial) - TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnYninal pro`secbfion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63006 St SMS SDep FMS FDep Sex Social Security No Ethnic Cat Name/Address Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RRTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4A84'x 14,18,21,24" CIPP 5/11/2016 13:11:15 Page - 46 Pay Period Ending Date 5/7/2016 Period Number 2 EEO Union ....................... Craft......................... Step......................... ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED--------- Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden forthls colleclion of information is estimated to average 16 minutes per response. including the time for reviewing instructions. searching existing data sources. gathering and maintaining the data needed and completing and reviewing the colleclion of information. Send comments regarding this burden estimate or any other aspect of this coliechon of informationincluding suggestions for reducing this burden to Department of Defense Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget Paperwork Reduction Project (12150149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDDj 3 CONTRACT NUMBER 4 DATE. iYYMMDD': 30 1 16/04/29 1 16104/29 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory parry) (iibe (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II iContractor or subcontractor on the CAG-15-149 that during the payroll period commencing on the 17 day of fBurldrng or work' April 201 6 and ending the 23 day of April 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Confracta or subcontractor and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as defined In Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (46 Stat 948. 63 Stat. 108, 72 Stat. 967: 76 Stat 357. 40 U.S C 276c). and described below: Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH XX Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First, Middle Initial TITLE 8 SIGNATU EForrest, Stephanie Tayroll Administrator I I � ) The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pro n. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code UU FUKM 6/9, MAR 95 (E (3) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro1'ect and Location 202221 RE4TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4764'x 14,18,21,24" CIPP WA 4/27/2016 12:29:20 Page - 47 Pay Period Ending Date 4/23/2016 Period Number 5 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ..... I . Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount F NO WORK PERFORMED ----- a Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 7215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of )nformation is estimated to average 16 minutes per response including the time for reviewing instructions. searching existing data sources. gathering and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway. Suite 1204. Arlington VA 22202-4302 and to the Office of Management and Budge: Paperwork Reduction Protect (1215-01491 Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER T7AYROLL PAYMENT DATE (YYMMDD� 3 CONTRACT NUMBER 4 DATE (YYMMDD) 31 16/05/06 1 16/05/06 1, Stephanie Forrest Payroll Administrator do hereby state (Name of Signatory party, Witte (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or sub —tractor) on the CAG-15-149 that during the payroll period commencing on the 24 day of (Budding or work' April 201 6 and ending the 30 day of April 201 6 all persons employed on said project have been paid the full weekly wages earned. that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act. as amended (46 Stat 948, 63 Stat. 108 72 Stat 967 76 Stat. 357: 40 U. S. C. 276c). and described below Federal, Fica. State and Local tax. 401K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First, Middle Initial) TITLE 8 SIGNATForrest, Stephanie Tayroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimin p , e ion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code UU rUKM Y9/y, MAK yb (t(3) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 5/4/2016 7 40 09 Certified Payroll Register Page - 46 Pay Period Ending Date 4/30/2016 INSITUFORM TECHNOLOGIES LLC Pro ect and Location 202221 Period Number 1 17988 EDISON AVE RMON - WA- CAG-15-149 CHESTERFIELD MO63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job .......... Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED s Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions searcfnng existing data sources. gathering and maintaining the data needed and completing and reviewing the couenion of information. Send comments regarding this burden estimate or any other aspect of this collection of informationincluding suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 22202-4302and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER c ; DATE YYMMDD. 28 16/04/16 16/04/15 I. Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) , Tiber (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 3 day of (Building or work) April 201 6 and ending the 9 day of April 201 6 all persons employed on said protect have been paid the full weekly wages earned. that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person fContractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948 63 Stat 108, 72 Stat. 967: 76 Stat 357, 40 U. S.C. 276c), and described below Federal. Fica, State and Local tax, 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete. that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor. or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) 7 TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal PFOSeo See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. Liu rvr-'rvl of V, IVI/AM yD (tv) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 4/13/2016 13:15:45 Certified Payroll Register Page - 44 Pay Period Ending Date 4/9/2016 INSITUFORM TECHNOLOGIES LLC Pro1'ect and Location 202221 Period Number 3 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II WA4'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job .... I ...... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount — NO WORK PERFORMED 1 a At Form Approved STATEMENT OF COMPLIANCE 202221 once No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructionssearching existing data sources. gathering and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden to Department of Defense Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204. Arington VA 22202-4302 and to the Office of Management and Budget. Paperwori, Reduction Project (1215-0149) Washington. DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD) r 3 CONTRACT NUMBER 4 DATE (YYMMDD 29 16/04/22 1 16/04/22 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) 7,1re. (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 10 day of (Building or work) April 201 6 and ending the 16 day of April 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat 108, 72 Stat 967. 76 Stat 357. 40 U.S.C. 276c), and described below Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last First, Middle Initial) i TITLE 6 SIGNAT+4RE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimina rosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU rUKM D/y, MAK y5 (ttzi) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 4/20/2016 14:36:03 Certified Payroll Register Page - 45 Pay Period Ending Date 4/16/2016 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 4 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 12150149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 27202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (12154149) Washington DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 26 1 16/04/01 1 16/04/01 I. Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Title' (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or submittractorl on the CAG-15-149 that during the payroll period commencing on the 20 day of (Budding or work) March 201 6 and ending the 26 day of March 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontracton and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948. 63 Stat. 108, 72 Star 967 76 Stat 357. 40 U.S.C. 276c). and described below' Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5. REMARKS 6 NAME (Last. First. Middle Initial) TITLE 8 SIGNATURE . Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pr6Seau1 cn. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UD FURM 879, MAR 95 (E(3) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 3/30/2016 13:47:42 Certified Payroll Register Page - 47 Pay Period Ending Date 3/26/2016 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 1 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II WA84'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED i Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 12150149 L Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate of any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204 Arlington VA 22202-4302. and to the Office of Management and Budget Paperwork Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES, RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER r7AYROLL PAYMENT DATE (YYMMDDi 3 CONTRACT NUMBER c DATE (YYMMDD) 27 16/04/08 116/04/08 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Title, (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 27 day of (Building or work) March 201 6 and ending the 2 day of April 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person !Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat 108, 72 Stat 967, 76 Stat 357. 40 U.S C. 276c). and described below: Federal, Fica. State and Local tax. 401 K, Loan re -payment. Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH XX -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle Initial) 7 TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU t-1 6/9, MAK Yb (El PREVIOUS EDITON MAY BE USED r R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RATON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 4/7/2016 7:41:07 Page - 45 Pay Period Ending Date 4/2/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount I NO WORK PERFORMED a Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington, DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYIvl 3. CONTRACT NUMBER 4. DATE (YYMMDD) 24 1 16/03/18 1 16/03/18 1, Stephanie Forrest Payroll Administrator do hereby state (Name or signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 ; that during the payroll period commencing on the 6 day of (Building or work) March 201 6 and ending the 12 day of March 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SIGNATUREForrest, Stephanie TpayrollAdministrator I � J The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminaLgposyution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE4TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II WA4'x 14,18,21,24" CIPP 3/16/2016 13 26:20 Page - 61 Pay Period Ending Date 3/12/2016 Period Number 3 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job I ........ Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -- NO WORK PERFORMED --------- a Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for tins collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions, searching existing data sources. gathenng and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect WINS collection of informationincluding suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway Suite 1204. Arlington VA 22202-4302. and to the Office of Management and Budget. Papenwon, Reduction Project (1215-01491 Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 25 1 16/03/25 1 16/03/25 1, Stephanie Forrest Payroll Administrator do hereby state (Name or signatory parfy, !Tire, (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade interceptor Rehab Phase II (contractor or subcontracrop on the CAG-15-149 that during the payroll period commencing on the 13 day of (Building or work) March 201 6 and ending the 19 day of March 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations, Pali 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (48 Stat 948, 63 Stat 108 72 Stat 967: 76 Stat 357; 40 U.S.C. 276c), and described below Federal. Fica. State and Local tax, 401 K, Loan re -payment, Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last �Irst Middle Initial) 7. TITLE 6 SIGNATURE __J/J Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal p ufio . See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 3/24/2016 7:48 04 Certified Payroll Register Page - 45 Pay Period Ending Date 3/19/2016 INSITUFORM TECHNOLOGIES LLC Project and Location 202221 Period Number 4 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED t 'P, Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 12150149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructionssearching exrstmg data sources gathering and maintaining the data needed, and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burtlen. to Department of Defense Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 222024302. and to the Office of Management and Budget. Paperwork Reduction Project (12150149) Washington DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD; 3 CONTRACT NUMBER 4 DATE (YYMMDD 22 1 16/03104 1 16/03/04 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory parry) iTne (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor on the CAG-15-149 that during the payroll period commencing on the 21 day of (Building or work) February 201 6 and ending the 27 day of February 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (48 Stat 948. 63 Stat. 108, 72 Stat 967. 76 Stat. 357. 40 U. S C 276c). and described below Federal. Fica. State and Local tax. 401K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete. that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract.. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last, First. Middle Initial) TITLE 8. SIGNATURE Forrest, Stephanie Tpayroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal p c ion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation Certified Payroll Register INSITUFORM TECHNOLOGIES LLC Pro'act and Location 202221 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED 4 3/2/2016 14:25:01 Page - 53 Pay Period Ending Date 2/27/2016 Period Number 1 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquaners services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway. Suite 1204, Arlington, VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Project (12150149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD) T 3. CONTRACT NUMBER 4. DATE (YYMMDD) 23 16/03/11 16/03/11 i. Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Trfre) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontactp on the CAG-15-149 that during the payroll period commencing on the 28 day of (BuONng or work) February 201 6 and ending the 5 day of March 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat. 967: 76 Stat. 357, 40 U.S.C. 276c). and described below Federal, Fica, State and Local tax, 401K, Loan re -payment Insurancegarnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8 SIGNATURE Forrest, Stephanie TpayrollAdministrator I NI The wilHul falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pr9secu See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. uu r vim or a, lvimr,. vu tw) h'KEVIUUS EUI IUN MAY BE USED a R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II WA4'x 14,18,21,24" CIPP 3/9/2016 1325,11 Page - 56 Pay Period Ending Date 3/5/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED I Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions searching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Adingion. VA =02-4302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 19 16/02/12 1 16/02/12 I Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party, (Title, (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor a subcontractor) on the CAG-15-149 that during the payroll period commencing on the 31 day of (Building or work) January 201 6 and ending the 6 day of February 2016 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor a subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 946. 63 Stat 106. 72 Stat 967: 76 Stat 357: 40 U S C 276c). and described below- Federal, Fica, State and Local tax, 401K. Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained In any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 2E-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle Initial) TITLE B. SIG Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or trim'IN,ecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 2/10/2016 12:46:07 Page - 52 Pay Period Ending Date 2/6/2016 Period Number 2 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ............. ........... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED - Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 12150149 Expires Jun 30 199- Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions. searching existing data sources. gathenng and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information_ including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington.. VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. ? PAYROLL NUMBER T7AYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE , YYMMDD 20 16/02/19 16/02/19 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) "fie (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or sobcom"cf r) on the CAG-15-149 that during the payroll period commencing on the 7 day of (Building or work.) February 201 6 and ending the 13 day of February 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined In Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat. 108 72 Stat 967: 76 Stat, 357: 40 U.S.C. 276c), and described below Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (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 i^ any wage deterrninabun incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First Middle Initial) TITLEForrest, 8 SIGNATURE Stephanie TP ayroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecut See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code UU 1-(-)KM bi`Y. MAN 9b (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 2/17/2016 13:26:25 Certified Payroll Register Page - 52 Pay Period Ending Date 2/13/2016 INSITUFORM TECHNOLOGIES LLC Pro11'ect and Location 202221 Period Number 3 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ..... I ..... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount — NO WORK PERFORMED N Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions searching existing tiara sources. gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any otner aspect of this collection of informationincluding suggestions for reducing this burden. to Department of Defense Washington Headquarters Services . Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204, Arlington, VA 22202-4302and to the Office of Management and Budget, Paperwork Reduction Project (1215-01491 Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER r7AYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER - DA?G " MMDD 21 16/02/26 16/02/26 I. Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) ci_ (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or suocontraorav on the CAG-15-149 that during the payroll period commencing on the 14 day of (Building or work) February 201 6 and ending the 20 day of February 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person fc-tractor or S'Dcont—for) and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (48 Stat. 948, 63 Stat 108 72 Stat, 967, 76 Stat 357, 40 U S.C. 276c), and described below: Federal. Fica, State and Local tax, 401K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the Contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last, First, Middle Initial) _ TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal p ion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code vt� rvnrvl or Z7. lvimr-, :Ij tw) F'KEVIOUS EDI TON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro and Location 202221 RTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 2/24/2016 12 37:21 Page - 55 Pay Period Ending Date 2/20/2016 Period Number 4 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ... I ....... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED_ 1 J Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 12150149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway. Suite 1204. Arington. VA 22202-4302. and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington. OC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDD) 1 17 1 16/01 /29 16/01 /29 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 17 day of (Bui)ding or work) January 201 6 and ending the 23 day of January 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal Fica State and Local tax 401K Loan re -payment. Insurance garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -in addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6 NAME (Last, First, Middle Initial) 7 TITLE 8. SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal c tion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 9b (L(3) PRLVIUU5 LUI IUN MHY Ct UJtU. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 REKTON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular. , . ........... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount L NO WORK PERFORMED - 1/27/2016 14.27 40 Page - 52 Pay Period Ending Date 1/23/2016 Period Number 4 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the lime for reviewing instructions searching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to Department of Defense Washington Headquarters Serves. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Protect (12150149) Washinqton. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES, RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD 3 CONTRACT NUMBER 4 DATE (YYMMDDi 18 1 16/02/06 16/02/05 I Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party, '11 = (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II fConba-fdr or subcontractor on the CAG-15-149 that during the payroll period commencing on the 24 clay of !Building or work' January 201 6 and ending the 30 day of January 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will De made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Star 948. 63 Stat 108, 72 Stat. 967: 76 Stat. 357, 40 U.S.0 276c), and described below. Federal Fica. State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and Complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates Contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic Conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle initial) TITLE 8. SIGNATURE Forrest, Stephanie TpayrollAdministrator The willful falsr icatton of any of the above statements may subject the contractor or subcontractor tc civil or cnmi o . See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. a R07371 Aegion Corporation 2/2/2016 11 15:38 Certified Payroll Register Page - 49 Pay Period Ending Date 1/30/2016 INSITUFORM TECHNOLOGIES LLC Project and Location 202221 Period Number 1 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE 11 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED • Ae ; M � X Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspen of this collection of information, including suggestions for reducing this burtlen. to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 22202-4302and to the Office of Management and Budget. Paperwork Reduction Protect (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDDI 3 CONTRACT NUMBER 4 DATE (YYMMDD: 16 1 16/01 /22 1 16101 /22 I, Stephanie Forrest Payroll Administrator do hereby state (Name of srgna(ory party) `me (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor on the CAG-15-149 that during the payroll period commencing on the 10 day of (Budding w work) January 201 6 and ending the 16 day of January 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcbntracton and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (48 Stat. 948. 63 Stat 108, 72 Stat 967, 76 Stat 357. 40 U.S C 276c), and described below. Federal. Fica, State and Local tax. 401 K, Loan re -payment. Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS B. NAME (Last. First. Middle Initial) _ TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal ton. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DID FORM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'act and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 1/21/2016 7:45:47 Page - 50 Pay Period Ending Date 1/16/2016 Period Number 3 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Pubhc reporting burden for this collection of information is estimated to average 16 minutes per response including the time for reviewing instructions searching existing cata sources. gathenng and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding this ourden estimate or any other aspect of this collection of informationincluding suggestions for reducing this burden. to Department of Defense Washington Headquarters Services. Directorate for Information Operations and Reports 1215 Jefferson Davis Highway. Suite 1204. Arlington VA 22202-4302. and to the Office of Manaaemem and Budget. Paperwork Reduction Project (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES, RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER- 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD: 3 CONTRACT NUMBER 4 DATE (YYMMDD) 15 1 16/01116 16/01/16 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (1,Hl (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor orsubcontractor, on the CAG-15-149 that during the payroll period commencing on the 3 day of (Building or work) January 201 6 and ending the 9 day of January 201 6 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or Indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967. 76 Stat. 357, 40 U.S.C. 276c), and described below Federal Fica. State and Local tax. 401 K Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed In the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll.. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last. First. Middle Initial) TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator T The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cumin scut n. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED v R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RATON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP W.4 St SMS SDep FMS FDep Sex EEO Union. . . .................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount — -- NO WORK PERFORMED 1/14/2016 9:17:06 Page - 54 Pay Period Ending Date 1/9/2016 Period Number 2 0 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions. searching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204. Arlington. VA 22202-4302and to the Office or Management and Budget Paperwork Reduction Protect (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER PAYROLL PAYMENT DATE (YYMMUDi 3 CONTRACT NUMBER 4 DATE !YYMMDD . 14 F 16/01/02 1 16/01/02 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) `e,e (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II Con acto asubcon aco l on the CAG-15-149 that during the payroll period commencing on the 27 day of (Budding or work, December 201 5 and ending the 2 day of January 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subconfractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948. 63 Stat 108. 72 Stat. 967 76 Stat 357, 40 U.S.C. 276c), and described below. Federal, Fica. State and Local tax, 401 K, Loan re -payment. Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor. or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training, United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below. I WHERE FRINGE BENEFITS ARE PAID IN CASH XX -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS B NAME (Last, First Middle Initial)- `ITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnmjnal o cu on See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DD FORM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 1/5/2016 12:47:26 Certified Payroll Register Page - 45 Pay Period Ending Date 1/2/2016 INSITUFORM TECHNOLOGIES LLC Protect and Location 202221 Period Number 1 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24' CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED I' CITY OF RENTON PRECONSTRUCTION MEETING Cascade Interceptor Rehabilitation Phase H WWP-27-3831 FIFTH FLOOR CONFERENCE ROOM-511-11:00 A.M. J anu41 1`F, GVIV City Project Manager: John Hobson Office: 425-430-7279 Fax: 425-430-7241 Email: jhobson@ rentonwa.gov City Inspector: Tom Main Mobile # 206-999-1833 Insituform Technologies, LLC Project Manager: Mark Werts Office: 916-729-2209 INTRODUCTIONS: SCHEDULE: • Estimated start date. • Contractor's proposed schedule and work plan • Standard work hours are weekdays, 7:00 AM to 5:00 PM. Depending on construction caused traffic disruptions. Work on Saturday by approval only and no work will be allowed on Sundays. Any changes to work hours shall have prior approval from the City of Renton. No work on Sundays or holidays. No equipment shall be started prior to 7:00 a.m. Work on Tiffany Park Elementary School grounds shall take place on non -school days only. • Holidays: Martin Luther King Jr. Birthday (Monday, January 18) • Progress Payments: Typically once a month. When we issue the notice to proceed, we will agree on the schedule. Quantities from inspection reports will take precedence. Cut off for quantities will typically be the Friday before our Finance Cutoff Day (see finance calendar). Submittals of quantities should be by the end of the day the Tuesday before our Finance Cutoff Day. This should give us opportunity to work out discrepancies. If they can not be worked out prior to our cutoff day, we will use inspection reports and work it out for the next pay estimate. Checks are typically mailed (or electronically transferred) 11 days after the Finance Cutoff Day. • Final acceptance shall be after review of the post -installation TV inspection. PRIVATE UTILITIES • A. PUGET SOUND ENERGY — POWER • B. PUGET SOUND ENERGY — GAS • C. QWEST TELEPHONE COMPANY • D. COMCAST CABLE, INC. • E. METRO • F. RENTON SCHOOL DISTRICT - TRANSPORTATION GENERAL: • Overtime takes special authorization. Pay schedule is $75 per hour for overtime. The City shall cover inspection overtime hours from 3:00 — 5:00 PM, Monday -Friday and all hours on weekends while working on School property. • Keep the streets clean. Truck washing and other measures, as approved, are required for the duration of the project. Provide whatever measures necessary for cleanup and dust control during the job and at night. All truck maneuvering and materials storage to be within the project area only. Right of way to remain unobstructed when possible. • Haul legal loads. • Keep a set of approved City construction drawings and construction documents on -site at all times. Contractors are advised to only use sets of drawings stamped and signed by the City of Renton for constructing utility and transportation improvements. • Notification of residents / property owners / School officials — start of work / during construction • Bypass pumping • Certified Payroll SPECIAL PROJECT CONSIDERATIONS: • Proposed staging areas? • Minimize construction vehicles on residential streets outside of the project area. • Traffic Control shall be per the approved plans. A. MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (M.U.T.C.D.) B. TRAFFIC CONTROL PLAN (RESPONSIBLE PERSON) C. FLAGMAN — CERTIFIED BY STATE D. PROJECT SIGNING (BEGINNING AND END) • SAFETY AND HEALTH REQUIREMENTS O.S.H.A./W.I.S.H.A. AND DESIGNATION OF SAFETY OFFICER. CONFINED SPACE ENTRY PROCEDURES. CITY INSPECTION • City inspection (Tom Main) All work to be inspected by City inspector during installation. The inspector or City's project manager shall be onsite during side sewer re-establishment H:\File Sys\WWP - WasteWater\WWP-27-03831 Cascade Interceptor Rehabilitation Phase II\Construction\Precon Agenda Cascade Interceptor Rehab Ph Il.doc Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing Instructions, searching existing data sources. gathering and maintaining the data needed r antl completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information operations and Reports, 1216 Jefferson Davis Highway, Suite 1204. Arlington, VA 22202-4302. and to the office of Management and Budget. Paperwork Reduction Protect (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 12 1 15/12/24 1 15/12/24 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Tile) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontracrwl on the CAG 15-149 , that during the payroll period commencing on the 13 day of (Building or work) December 201 5 and ending the 19 day of December 201 5 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 Insitufonn Technologies, LLC from the full weekly wages eamed by any person (Contracts or subcorl"clor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat 967, 76 Stat. 357: 40 U S. C. 276c), and described below. Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6 NAME (Last. First, Middle Initial) 7. TITLE 8. SIGNATU� Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal on. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITION MAY BE USED. R07371 Aegion Corporation 12/22/201510:07:22 Certified Payroll Register Page - 64 Pay Period Ending Date 12/19/2015 INSITUFORM TECHNOLOGIES LLC Pro ect and Location 202221 Period Number 4 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft...........,............. Step......................... Social Security No Ethnic Cat .... I .. Regular ....... ....... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED • ♦ .A"'' =orm Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this Collection of Information is estimated to average 16 minutes per responseincluding the time for reviewing instructions searching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of Information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense Washington Headquarters Services, Directorate for information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204, Arington, VA 222024302and to the Office of Management and Budget, Paperwork Reduction Protect (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD, F 3 CONTRACT NUMBER 4 DATE (YYMMDD) 13 15112/31 1 15/12/31 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party, ➢ties (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) or the CAG-15-149 that during the payroll period commencing on the 20 day of fauddmg or wpA' December 201 5 and ending the 26 day of December 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or 5ubcontracror) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat 108, 72 Stat 967, 76 Stat 357: 40 U.S.C. 276c), and described below' Federal. Fica. State and Local tax, 401K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete:. that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last First. Middle Initial) 7. TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator The wilHul falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosEc ion See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code UU rUKM 6(9, MAK 95 (LU) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE�TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 12/29/201512:58 24 Page - 57 Pay Period Ending Date 12/26/2015 Period Number 5 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular ....... ....... Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount — NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responser including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204. Arlington, VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Protect (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 11 15/12/18 1 15/12/18 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Conoerxor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 6 day of (Buliding or work) December 201 5 and ending the 12 day of December 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Confracror or submittradon and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S. C. 276c). and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or 0 no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last. First, Middle Initial) 7. TITLE 8 SIGNATURE Forrest, Stephanie Payroll Administrator �) The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal 11cution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro1'ect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 12/16/201514 07:23 Page - 59 Pay Period Ending Date 12/12/2015 Period Number 3 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail ......... . Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount -- NO WORK PERFORMED ------ Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of Information Is estimated to average 16 minutes per response. including the time for reviewing instructions searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway, Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget. Papenvmrk Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4 DATE (YYMMDD) 10 1 15/12/11 1 15/12/11 Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractor) on the CAG-15 149 . that during the payroll period commencing on the 29 day of ffl.admg or work) November 201 5 and ending the 5 day of December 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontracorl and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat, 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH W7-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS AL 6 NAME (Last, First, Middle Initial) 8 SIGNATU 17TITLE Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cllecution See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro act and Location 202221 REATON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount - NO WORK PERFORMED ---- 12/9/2015 12:15A9 Page - 58 Pay Period Ending Date 12/5/2015 Period Number 2 r OL Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway Suite 1204. Arlington. VA 22202-4302and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 9 1 15/12/04 1 15/12/04 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Tree) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 22 day of (Building or wank) November 201 5 and ending the 28 day of November 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357,- 40 U. S. C. 276c), and described below. Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH FTI-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SIGNATURE Forrest, Stephanie TpayrollAdministrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pro n. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU t-UKM tsfy, MAN y5 (LU) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 REATON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 12/2/2015 11:49:35 Page - 58 Pay Period Ending Date 11/2812015 Period Number 1 St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED J Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions. searching existing data sources. gathering and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway. Suite 1204. Arlington. VA 22202-4302. and to the Office of Management and Budget. Paperwork Reduction Protect (12150149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 8 F15/11/27 1 15/11127 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (77tie) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase 11 (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 15 day of (Building or work) November 201 5 and ending the 21 day of November 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967: 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS 71 -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SIGNATLI 2Forrest, Stephanie TpayrollAdministrator 1 ), The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal proses n. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO53005 St SMS SDep FMS FDep Sex Social Security No Ethnic Cat Name/Address Aegion Corporation Certified Payroll Register Prolict and Location 202221 RE TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4784'x 14,18,21,24" CIPP WA 11 /24/201511:41:32 Page - 70 Pay Period Ending Date 11/21/2015 Period Number 4 EEO Union ....................... Craft......................... Step......................... ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount L NO WORK PERFORMED j I I Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden forthis collection of information Is estimated to average 16 minutes Per response. including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed, and completing and renewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of informationincluding suggestions for reducing this burden, to Department of Defense Washington Headquarters Semces. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204 Arlington. VA 22202-4302 and to the Office of Management and Budget Paperwork Reduction Project (1215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER _T Dr;TE ;vvMMDD, 7 15/11/20 15/11/20 Stephanie Forrest Payroll Administrator do hereby stare (Name of signatory party) !Tbe, (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 8 day of IBuildmg or work) November 201 5 and ending the 14 day of November 201 5 all persons employed on said project have been paid the full weekly wages earned. that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontraotorn and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat, 967: 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal. Fica. State and Local tax. 401K. Loan re -payment. Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last, First, Middle Initial) 7 TITLE 8_ SIGNA Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or co s ution. See Section 1001 of Title 16 and Section 231 of Title 31 of the United States Code DD FORM 879. MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation Certified Payroll Register INSITUFORM TECHNOLOGIES LLC PrMct and Location 202221 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4A84'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED 11 /18/201513:50:34 Page - 73 Pay Period Ending Date 11/14/2016 Period Number 3 V Form Approved STATEMENT OF COMPLIANCE 202221 'OMB No 1215-0149 Excites Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources gathering and maintaining the data neededand completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection o' information. including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Serves. Directorate for information Operations and Reports 1215 Jeflerson Davis Highway Sune 1204 Adingtor. VA 22202-4302 and to the Office of Management and Budge! Paperwork Reduction Project 0215-0149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. ' PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD 3 CONTRACT NUMBER 4 DATE (YYMMDD) 6 15/11/13 15/11/13 I. Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party, , "be (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 1 day of i S,ddmg or work) November 201 5 and ending the 7 day of November 201 5 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcon7actop and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (46 Stat 948. 63 Stat, 108. 72 Stat 967. 76 Stat 357. 40 U S. C. 276c). and described below' Federal. Flca. State and Local tax. 401K. Loan re -payment. Insurance. garnishments NO WORK (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 Sat forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State. are registered with the Bureau of Apprenticeship and Training, United States Department of Labor (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last, First. Middle Initial) 7 TITLE 8. SIGNATURE Forrest, Stephanie Payroll Administrator )� The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimina cution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code, DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 11/10/201515.40,54 Certified Payroll Register Page - 78 Pay Period Ending Date 11/7/2015 INSITUFORM TECHNOLOGIES LLC ProJ''e�ct and Location 202221 Period Number 2 17988 EDISON AVE RATON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24' CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ........................ . Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED OL, corm Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed and completing and renewing me collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden, to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204 Adingtor VA. 27202-4302and to the Office of Management and Budoet. Paperwork Reduction Project (1215.0149) Washington DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER, 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE(YYMMDD) NUMBER 4 DATE (YYMMDD: 5 1 15/11 /06 F-CONTRACT 15111 /06 Stephanie Forrest Payroll Administrator do hereby state (Name dt srgnarory party, Tare (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II icontractor or suoconrrecron on the CAG-15-149 that during the payroll period commencing on the 25 day of /building or work) October 201 5 and ending the 31 day of October 201 5 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contracts, or subcontractor and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act, as amended (46 Stat 948. 63 Stat 108. 72 Stat 967. 76 Stat. 357. 40 U.S.C. 276c) and described below: Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor. or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH W7-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First. Middle Initial) TITLE 8 SIGNATURE Forrest, Stephanie Tpayroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cri os cution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879. MAR 95 (EG) PREVIOUS EDITION MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro''ect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA 11/4/2015 7:34:13 Page - 76 Pay Period Ending Date 10/31/2015 Period Number 1 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job .......... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount ---NO WORK PERFORMED ---- Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources. gatnenng and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of informationincluding suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway Suite 1204 Artmolon. VA 22202-4302 and to the Office of Management and Budge! Paperwork Reduction Project (12150149) Washington DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER AYROLL PAYMENT DATE (YYMMDD 3 CONTRACT NUMBER 4 DATE (YYMMDD) 3 F15/10123 1 15/10/23 Stephanie Forrest Payroll Administrator do hereby state (Nairn of signatory parry, (rite, (1) That I pay or supervise the payment of the persons employed by insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractor, on the CAG-15-149 that during the payroll period commencing on the 11 day of (Building or work, October 201 5 and ending the 17 day of October 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (contractor or subcontractor and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (48 Stat 948, 63 Stat 108. 72 Stat. 967, 76 Stat, 357: 40 U S C 276c), and described below Federal. Fica. State and LDcal tax, 401K. Loan re -payment. Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees. except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS B NAME (Last First Middle Initial) TITLE B SIGNATURt-�,V) Forrest, Stephanie Payroll Administrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal tion. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. UU F-UKM b/9, MAK 9b (EU) PREVIOUS EDITON MAY BE USED R07371 Aegion Corporation 10/21/201514.15:54 Certified Payroll Register Page - 81 Pay Period Ending Date 10/17/2015 INSITUFORM TECHNOLOGIES LLC Project and Location 202221 Period Number 4 17988 EDISON AVE RENTON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4A84'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED I .._ -A Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Sure 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (1215�0149) Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 4 1 15/10/30 1 15/10/30 I, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (7-M.) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contra or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 18 day of (Building or work) October 201 5 and ending the 24 day of October 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor Or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SI NAForrest, Stephanie TpayrollAdministrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or mi secution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 Aegion Corporation 10/28/201514:33:01 Certified Payroll Register Page - 77 Pay Period Ending Date 10/24/2015 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 5 17988 EDISON AVE RE - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24' CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED --- 1IK .1, Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30, 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per responseincluding the time for reviewing instructions, searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of thrs collection of information, including suggestions for reducing this burden, to Department of Defense. Washington Headquarters services , Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway, Sude 1204, Arlington, VA 22202-4302. and to the Office of Management and Budget, Paperwork Reduction Project (1215-0149) Washington. DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER- 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 2 15/10/16 1 15/10/16 1, Stephanie Forrest Payroll Administrator do hereby state (Name of signatory party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 4 day of (Building or work) October 201 5 and ending the 10 day of October 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subconbactor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6. NAME (Last, First, Middle Initial) TITLE 8. SK3NA Forrest, Stephanie TpayrollAdministrator The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or c y l prosecution. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro''ect and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASE11 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ..... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount ----- NO WORK PERFORMED --- — 10/15/2015 7:37:27 Page - 80 Pay Period Ending Date 10/10/2015 Period Number 3 I f. Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response including the time for reviewing instructions searching existing data sources. gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing this burden. to Department of Defense. Washington Headquarters Services Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway Suite 1204. Arington VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149i Washington DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE (YYMMDD) 1 15/10/09 1 15/10/09 Stephanie Forrest Payroll Administrator do hereby state (Name of sr9-1-y panyi j Tmel (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II /Contractor or subcontradorl on the CAG-15-149 that during the payroll period commencing on the 27 day of IBuddrng or wwk, September 201 5 and ending the 3 day of October 201 5 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contracra or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat 108 72 Stat 967. 76 Stat 357: 40 U.S C 276c), and described below: Federal, Fica, State and Local tax. 401 K. Loan re -payment, Insurance. garnishments (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH XX -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract. (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6. NAME (Last. First. Middle Initial) TITLE 8 SIGMA UREForrest, Stephanie Tpayroll Administrator The wiltful falsification of any of the above statements may subject the contractor or subcontractor to civil or cn alp cation. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Project and Location 202221 RENTON - WA- CAG-15-149 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24" CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Social Security No Ethnic Cat .. I .... Regular .............. Overtime ...... Other Name/Address Work Date Hours Rate Hours Rate Hours MO S S 8 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer XXX-XX4960 White Christopher,Charlie Blake FR 10/2/2015 5.00 38.000 1170 SW 170th Ave Pipelayer 5.00 #203 Beaverton OR 97003 United States MO S XXX-XX-0002 Adam E Clary 1768 Pine Street Silverton OR 97381 United States Subtotal for Payment Number:04874032 5.00 Christopher,Chadie Blake 5.00 S M 008 1971 For HBU 1971 Accrual PIPL Pipelayer White FIR 10/2/2015 5.00 38.300 Pipelayer 5.00 10/7/2015 14:12:49 Page - 86 Pay Period Ending Date 10/3/2015 Period Number 2 Step......................... Total Job ........... Check Detail .......... Hours Amount ---- Description Amount --- --- -- default 5.00 190.00 Payment Number: 04874032 5.00 190.00 Gross Pay 1,752.32 OR Departmen 91.69 FED W/H Tax 170.19 FICA W/H 107.44 Medicare W/H 25.13 MEDICAL 20.67 DENTAL 3.18 VISION .32 HTHFSA 4.81 401K EE Ded 87.62 Roth 87.62 Total Deduct 598.67 Net Pay 1,153.65 Hrs This Chk 45.00 5.00 190.00 5.00 190.00 default 5.00 191.50 Payment Number:04874007 5.00 191.50 Gross Pay 1,779.20 OR Departmen 137.05 FED W/H Tax 343.33 FICA W/H 107.52 Medicare W/H 25.14 Chd Sup $/% 98.08 MEDICAL 49.60 DENTAL 5.46 OP CH LIFE .84 R07371 Aegion Corporation 10/7/2015 14:12:49 Certified Payroll Register Page - 87 Pay Period Ending Date 10/3/2015 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 2 17988 EDISON AVE RE�TON - WA- CAG-15-149 CHESTERFIELD MO 63005 4784'x 14 18,21 24" CIPP CASCADI= INTERCEPTOR -PHASE II WA St SMS SDep FMS FDep Sex EEO Union .................... Craft .................... Step .................. Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount Short Term D 4.39 Total Deduct 771.41 Net Pay 1,007.79 Hrs This Chk 45.00 Subtotal for Payment Number:04874007 5.00 5.00 191.50 Adam E Clary 5.00 5.00 191.50 MO M M M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-2066 White Ryan Thomas Hagemann FIR 10/2/2015 5.00 36.550 5.00 182.75 Payment Number: 04874011 203 Faith Dr. Pipelayer 5.00 5.00 182.75 Gross Pay 1,723.27 Jefferson OR 97352 OR Departmen 114.90 United Slates FED W/H Tax 183.63 FICA W/H 97.84 Medicare W/H 22.88 MEDICAL 144.92 DENTAL 9.72 VISION 1.32 Total Deduct 575.21 Net Pay 1,148.06 Hrs This Chk 45.00 Subtotal for Payment Number: 04874011 5.00 5.00 182.75 Ryan Thomas Hagemann 5.00 5.00 182.75 MO M M 3 M 008 1971 For HBU 1971 Accrual PIPL Pipelayer default XXX-XX-9446 Two or More Races Brent E Robinett FR 10/2/2015 5.00 34.260 5.00 171.30 Payment Number:04874033 R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 St SMS SDep FMS FDep Sex Social Security No Ethnic Cat Name/Address 1271 Dorval Avenue NW Pipelayer Salem OR 97304 United States Aegion Corporation Certified Payroll Register Pro'ecI and Location 202221 RE�TON - WA- CAG-15-149 4784'x 14 18,21 24" CIPP CASCADI` INTERCEPTOR -PHASE II WA EEO Union .................... Craft.................... ....... Regular .............. Overtime ...... Work Date Hours Rate Hours Rate 5.00 10/7/2015 14:12:49 Page - 88 Pay Period Ending Date 10/3/2015 Period Number 2 Step.................. Other Total Job ........ Check Detail .......... Hours Hours Amount Description Amount 5.00 171.30 Gross Pay 2,098.59 OR Departmen 137.25 FED W/H Tax 231.18 FICA W/H 127.30 Medicare W/H 29.77 MEDICAL 44.05 DENTAL 9.72 VISION 1.32 OP EE LIFE 1.20 OP SP LIFE 2.22 OF CH LIFE .84 401K EE Ded 104.93 Short Term D 4.91 Total Deduct 694.69 Net Pay 1,403.90 Hrs This Chk 52.00 Subtotal for Payment Number:04874033 5.00 5,00 171.30 Brent E Robinett 5.00 5.00 171.30 RENTON - WA- CAG-15-149 20.00 20.00 735.55 ��► _ T// tat Request for Approval of Material Contract Number FA Number SR Date UAG- I 5-118(City of Renton No. WW9-27-03712) 11 2 201 Section / Title of Project County Central Renton Sewer Interceptor Reline & Upsize King Contractor Subcontractor Road Construction Northwest, Inc. This form shall be completed prior to submittal. If this form is not complete at time of submittal it may be returned for information that was omitted. For WSDOT Use Only For assistance in completing, see Instructions and Example RAM # 001-2 Bid Material or Name and Location of Fabricator, Specification PE/QPL Hdqtr. QPL Item No. Product/Type Manufacturer or Pit Number Reference Code Code 8 84" ID Sewer Manhole Shope Concrete Products Puyallup,WA 7-05 O Project Engineer Date State Materials Engineer Date Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 1. Acceptance Criteria: Acceptance based upon 'Satisfactory' Test Report for samples of materials to be incorporated into project. 2. Acceptance Criteria: Mfg. Cert. of Compliance for 'Acceptance' prior to use of material. 3. Acceptance Criteria: Catalog Cuts for'Acceptance' prior to use of material. Catalog Cut Approved 1"e. No 4. Acceptance Criteria: Submit Shop Drawings for'Approval' prior to fabrication of material. 5. Acceptance Criteria: Only 'Approved for Shipment', 'WSDOT Inspected' or'Fabrication Approved Decal' material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action 8. Source Approved. 9 Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution ❑ Contractor ❑ Region Operations Engineer ❑ Fabrication Inspection DOT Form 350-071 EF Revised 1212012 ❑ Region Materials ❑ State Materials Lab M/S 47365 State Materials Engineer Distribution ❑ General File ❑ Signing Inspection ❑ Other Central Renton Sewer Interceptor Reline & Upsize Contractor Responses Approval of Material: Bid Item 8- 84-inch Diam. Sewer Manhole 1. 84" Manhole shall be WSDOT B-15.60-01as submitted on Shope Concrete Products cut sheet. The Shope cover letter specifies the incorrect WSDOT spec (B-15.40-00). Please see attached Catalog Cut for Shope Contcete Products 84" Type 3 Precast Manhole. WSDOT Spec B-15.60-01 referenced in heading. Please disregard previously submitted cover letter. 2. Predl Systems Drawing No. 20.1 does not appear to be applicable to this project. Contractor shall note that a polypropylene wall liner is not required for this manhole. As an option, Contractor may provide Predl Systems polypropylene wall liner in lieu of Wasser MC-Aroshield coating for all interior concrete surfaces above the FRP base liner, provided there is no additional cost to the Owner. Drawing No. 20.1 is deleted from submittal package. No interior coating / liner will be used or provided on surfaces above the FRP base liner. Per review, this is an option that is not required and original polypropylene liner is not an acceptable option. 3. Predl Systems Drawing No. 89 includes a polypropylene wall liner above the FRP base liner. As previously indicated, a polypropylene wall liner is not required for this manhole. As an option, Contractor may provide Predl Systems polypropylene wall liner in lieu of Wasser MC-Aroshield coating for all interior concrete surfaces above the FRP base liner, provided there is no additional cost to the Owner. See response above stating that no interior coating / liner will be used on surfaces above the FRP base liner. Per review, this is an option that is not required and original polypropylene liner is not acceptable. 4. Contractor to verify skewed angles and invert elevations prior to fabrication of base liner as noted on Detaill , Drawing C-2. Submit revised shop drawing (Predl Systems Dwg No. 89) indicating field verified angles and invert elevations. Adjust manhole dimensions as appropriate. Skewed angles and invert elevations related to the FRP Base liner are approved per attached review. 84" Type 3 Precast Manhole WSDOT B-15.60-01 Flat Top Slab Reinforcing • #6 deformed rebar • Round opening Manhole Wall Reinforcing • Minimum 0.24 square inches / linear foot Base Reinforcing • © Separated base slab 0.39 square inches / linear foot in both directions Hole or Knock Out Dimensions ■ Maximum hole size is 72 inches ■ 12 inches of minimum distance between holes ■ 3 inch diameter lifting holes provided Conformity Standards • ASTM C478 - 97 Manhole ■ ASTM C443 rubber gasket joint ■ ASTM D - 4101 polypropylene steps and ladders • Washington State APWA / WSDOT Standard Options Available ■ Specialized coatings ■ Prechanneled base • Custom hatches • Kor-N-Seal boots Note: drawings not to scale manhole products Top Slab Plan View Sh Shope Enterprises, Inc. (253) 848-1551 1-800-422-7560 [Toll Free] I I 1618 East Main Avenue Fax Line 1 (253) 845-0292 www.shopeconcrete.com Concrete products Puyallup, WA 98372-3142 Fax Line 2 (253) 864-6172 AI k I State MH Base Liner Approval Only Request for Approval of Material Contract Number FA Number SR 7AG-15-11B(Cit) of Renton No. W1N'9-27-03712) Section I Title of Project County Central Renton Sewer Interceptor Reline & Upsize king Contractor Subcontractor Road Construction ?northwest, Inc. Date j W24,12015 This form shall be completed prior to submittal. If this form is not complete at time of For WSOOT Use Only submittal it may be returned for information that was omitted. y For assistance in completing, see Instructions and Example IRAM# Bid Material or Item No Product/Type Name and Location of Fabricator, Manufacturer or Pit Number Specification Reference PE/QPL Code Hdqtr /QPL Code 8 84" ID Sewer Manhole Predl Systems Burnaby, BC 7-05 Project Engineer j Date State Materials Engineer Date Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 1 Acceptance Criteria Acceptance based upon 'Satisfactory' Test Report for samples of materials to be incorporated into project 2 Acceptance Criteria Mfg. Cert of Compliance for 'Acceptance' prior to use of material. 3 Acceptance Criteria Cata'og Cuts for 'Acceptance'prior to use of material Catalog Cut Approved ❑ Yes ❑ No 4 Acceptance Criteria Submit Shop Dravnngs for'Approval' prior to fabrication of material. 5 Acceptance Criteria Oniy'Approved for Shipment'. WSDOT Inspected' or'Fabrication Approved Decal' material shall be used 6 Acceptance Criteria Submit Certificate of Materials Origin to Project Ergineer Office. 7 Acceptance Criteria Request Transmitted to State Materials Laboratory for Approval Action 8 Source Approved 9 Approval Withheld Submit samples for preliminary evaluation. 10 Approval Withheld 11 Miscellaneous Acceptance Criteria Remarks. A 7s ib2 r,.,c-- M C— IAA-!` S`•aV•%T.-,L rrVJ@G[ cnglneer wistrioutton ❑ Contractor ❑ Reg on Materials ❑ Region Operations Engineer ❑ State Materials Lab ❑ Fabrication Inspection M/S 47365 DOT Form 350-071 EF Revised 122012 State Materials Engineer Distribution ❑ General File ❑ Signing Inspection ❑ Other CENTRAL RENTON SEWER INTERCEPTOR RELINE & UPSIZE PROJECT SANITARY SEWER AS —BUILT SURVEY EXHIBIT FOR ROAD CONSTRUCTION NORTHWEST PACCAR / WSDOT EXISTING RIGHT OF WAY SSW RIM 3917 / CJI1R STR,.I — h 181.•E893 � / /SSW RN 12.32 E 1 3C3 53/ 11 / IE WEST 312T 04' PPE) CNTR STR.! / SSMH RY SS.K N 131 0745 CNTR CNNIl M05 SECTION INE �170.11' $$ E: 1,303.a057)`122,09' (CNTR STRC)STINGRIWAY S 10.147G N ill Wei E FAST 31.OB' (i/' P PE / 1 E EAST : 3139 (17 CANC.') E 1303.92953 4TH ST N ( X I.EawLY:3l. or(is- E) / 3 UAGVARw 1 M4G N41 / _ nle.sr U EXISTING RIGHT OF WAY /� _ / E •Y'T''/d2 y IE WEST :l1.77It7 CONC7) 7 E F: /' 3S `/ > U O Wco hh /N Y O' my C 2 Z � a' IE IELY: 33K (If PPE) mSSW RIM: 4332 O a� stRµ N $K7xN E 11/101372 GRAPHIC SCALE 20 0 20 40 RO 1 INCH = 40 FT. DETAIL OF PROPOSED SMH 1968 �^ .. SCALE: 1 NCH - 10 FEET W 4235 IE 31.4 E, 12' i IE 3t.2.2 W, 24' / E 31.7 S, 15 SSMH RIM CItfR SLR..' / N 1aL1e71s E +,393105.3e I.E. WEST. 312Y(N PPE) N: 1a1,1aa.06 / E. 1303.a02.05 CENTER OF PROPOSED SEWER MANHOLE SW 19aa,1 FOOT SOUTH OF COORDINATES LISTED ON SHEET G1 OF THE PROJECT CONSTRUCTION PINS N SS EL� EAST:31.N CONC7) l'OltLE (17 /LE SNLY: 31JR )15 PPE) GENERAL NOTES 1. THIS AS -BUILT SURVEY WAS CONDUCTED ON THE GROUND ON SEPTEMBER 11, 2015. 2. FIELD SURVEY CONDUCTED USING A SPECTRA S SECOND DIRECT READING ROBOTIC TOTAL STATION. PRECISION OF CONTROL TRAVERSE 15 AT A HIGHER LEVEL THAN MINIMUM STANDARDS REQUIRED BY WAC 332-130-090. METHOD OF FIELD SURVEY: TRAVERSE AND RADIAL SURVEY. 3. THE HORIZONTAL AND VERTICAL GROUND CONTROL UTILIZED FOR THIS SURVEY WAS PER PROJECT PLAN COORDINATES. 4. THE VERTICAL BENCHMARK USED FOR THIS ASBUILT SURVEY WAS A MAG NAIL FOUND IN A CONCRETE SEAM IN THE LOCATION SHOWN HEREON; HELD AN ELEVATION OF 41.09 UNITED STATES FEET. S. THE HORIZONTAL ACCURACY FOR THE CENTER OF EXISTING SANITARY MANHOLE POSITIONS 15 ASSUMED TO BE WITHIN PLUS OR MINUS THREE (3) INCHES. 2015-09-22 Form Approved STATEMENT OF COMPLIANCE 202221 OMB No 1215-0149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions searching existing data sources. gathering and maintaining the data needed. and completing and reviewing the collection of information Send comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burtlen. to Department of Defense, Washington Headquarters Services. Directorate for Information Operations and Reports 1215 Jefferson Davis Highway Suite 1204 Anmgton VA 22202-4302 and to the Office of Managemem and Budget Paperwork Reduction crolect (1215-01491 Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1 PAYROLL NUMBER 2 PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4 DATE YYMMDD. 56 Final 1 16/10/28 16/10/28 Stephanie Forrest Payroll Specialist do hereby state !Name of signatory party, -fie (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractoro subcontractor on the CAG-15-149 that during the payroll period commencing on the 16 day of (8u0drng or work', October 201 6 and ending the 22 day of October 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person lContnac7w or subcomrracfon and that no deductions have been made either directly or indirectly from the full wages earned by any person other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat 948, 63 Stat. 108, 72 Stall 967, 76 Stat. 357, 40 U.S.C. 276c). and described below' Federal. Fica. State and Local tax. 401 K. Loan re -payment. Insurance. garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work performed (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training. United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5 REMARKS 6 NAME (Last. First Middle Initial) TITLE 7ialist 8. SIGNATU Forrest, Stephanie Payroll Spec The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or trim al pr a uti See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code DID FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED R07371 INSITUFORM TECHNOLOGIES LLC 17988 EDISON AVE CHESTERFIELD MO 63005 Aegion Corporation Certified Payroll Register Pro'ect and Location 202221 RE �TON - WA- CAG-15-149 CASCADE INTERCEPTOR-PHASEII 4A84'x 14,18,21,24" CIPP 10/26/201614:19:04 Page - 39 Pay Period Ending Date 10/22/2016 Period Number 4 St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... CReck Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 12150149 Expires Jun 30. 1997 Public reporting burden for this collection of information is estimated to average 16 minutes per response. including the time for reviewing instructions, searching existing data sources, gathenng and maintaining the data needed. and completing and reviewing the Collection of information. Send Comments regarding this burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden to Department of Defense. Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204. Arlington. VA =02-4302. and to the Office of Management and Budget. Paperwork Reduction Project (1215-0149) Washington, DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER. 1. PAYROLL NUMBER 2. PAYROLL PAYMENT DATE (YYMMDD) 3 CONTRACT NUMBER 4. DATE (YYMMDD) 55 1 16/10/21 1 16/10/21 I, Stephanie Forrest Payroll Specialist do hereby state (Name of signatory pally) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contractor or subcontractor) on the CAG-15-149 that during the payroll period commencing on the 9 day of (auitdrrrg a• work) October 201 6 and ending the 15 day of October 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person (Contractor or subcontractor) and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948. 63 Stat. 108, 72 Stat. 967: 76 Stat 357, 40 U.S.C. 276c). and described below. Federal, Fica, State and Local tax, 401 K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH -Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS 6 NAME (Last, First, Middle Initial) TITLE 8 SIGNA Forrest, Stephanie TPayrollSpecialist � ) V ) The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or ina a tjon. See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. DD FORM 879, MAR 95 (EG) PREVIOUS EDITON MAY BE USED. R07371 Aegion Corporation 10/20/2016 7:53:25 Certified Payroll Register Page - 38 Pay Period Ending Date 10/15/2016 INSITUFORM TECHNOLOGIES LLC Pro act and Location 202221 Period Number 3 17988 EDISON AVE RATON - WA- CAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II WA4'x 14,18,21,24" CIPP St SMS SDep FMS FDep Sex EEO Union ....................... Craft ......................... Step ......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job I ........ Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED Form Approved STATEMENT OF COMPLIANCE 202221 OMB No. 1215-0149 Expires Jun 30 1997 Public reporting burden for this collection of Information is estimated to average 16 minutes per response. including the time for reviewing instructionssearching existing data sources. gathering and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Defense, Washington Headquarters services. Directorate for Information Operations and Reports. 1215 Jefferson Davis Highway. Suite 1204. Arlington, VA 222024302, and to the Office of Management and Budget. Paperwork Reduction Project (12150149) Washington. DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER- 1. PAYROLL NUMBER FAYROLL PAYMENT DATE (YYMMDD) 3. CONTRACT NUMBER 4. DATE (YYMMDD) 54 16/10/14 16/10/14 I. Stephanie Forrest Payroll Specialist do hereby state (Name of mgnatofY Party) (Title) (1) That I pay or supervise the payment of the persons employed by Insituform Technologies, LLC Cascade Interceptor Rehab Phase II (Contactor or subcontractor) on the CAG-16-149 that during the payroll period commencing on the 2 day of (Building or workl October 201 6 and ending the 8 day of October 201 6 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Insituform Technologies, LLC from the full weekly wages earned by any person fCor:ractor a- submnrracton and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Federal, Fica, State and Local tax, 401K, Loan re -payment, Insurance, garnishments NO WORK (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS -In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4 (C) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH W1-Each laborer or mechanic listed In the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, (C) EXCEPTIONS EXCEPTION (Craft) EXPLANATION 5.REMARKS B. NAME (Last, First, Middle Initial) TITLE 8. SIGNATUR Forrest, Stephanie TPayroll Specialist k IT The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnmina uti See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. uu rumivi of a, MHK y0 Itzu) PREVIOUS EDITON MAY BE USED. R07371 Aegion Corporation 10/13/2016 7:36:23 Certified Payroll Register Page - 34 Pay Period Ending Date 10/8/2016 INSITUFORM TECHNOLOGIES LLC Pro'ect and Location 202221 Period Number 2 17988 EDISON AVE RE�TON - WA- GAG-15-149 CHESTERFIELD MO 63005 CASCADE INTERCEPTOR -PHASE II 4784'x 14,18,21,24' CIPP WA St SMS SDep FMS FDep Sex EEO Union ....................... Craft......................... Step......................... Social Security No Ethnic Cat ....... Regular .............. Overtime ...... Other Total Job ........... Check Detail .......... Name/Address Work Date Hours Rate Hours Rate Hours Hours Amount Description Amount NO WORK PERFORMED