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MAM TO:
INDUSTRIAL STATISTICIAN
Department of Labor & Industrieo
Employa'"t Standards Section
G .. ral Administration Building
Olympia, WA 08504-0631
(206) 753-4019
Statement of
INTENT TC PAY
PREVAILING WAGES
(public Works Contract)
Contract/BPW Number ----
Date Bid Was Due 6/10/86
Contract Awarding Public Agency Date Contract Awarded 10/6/86
City of Renton DEW County in Which Work Performed King
Address 200 Mill Avg- SO- Prime Contractor Coral Conatrictlin Co -
Your Contractor's Registration Certificate No. CO-13A-L"- -71-1114-
Phone 906/?'45-2611 Do You intend To Use Subcontractors? Yes EX No E)
In compliance with RCW 39-12.040 1, the undersigned, being a duly authorized representative of
Coral Construction Company, P.O. Box 347, Wilsonville, OR 97070
( � - Sb—�) (Add—)
do hereby certify that the foliowing rates of hourly wage and hourly fringe benefits will be paid to all
laborers, workers and mechanics employed by me upon the public works project described above and that
no laborer, worker or mechanic will be paid less than the "prevailing rate of wage" as determined by the
Industrial Statistician of the Department of Labor and Industries.
PLEASE NOTF_ If apprentices are to be used they must be registered with the State Ap-
prenticeship Council within 60 days of hiring or they must be paid prevailing journeyman
wages for the time preceding the date of registration.
CRAFT ESTIMATED NUMBER RATE OF RATE OF HOURLY
OF WORKERS HOURLY PAY -RINGE BENEFITS
Operator I=. GR IV
Operator GR IV
Laborers GR ill
NOTE: Attach Additional Sheets as Needed.
Subscribed and sworn to before me
this 13th day of October
19 86
Notary FLbUc in and for the State of "O."Wom, —lid-
'ng in 16"—Dgugbi?�
1 17.63 4,21
1 17.13 4.21
4 14.96 3.43
C4�10NST
- I I �._ J(� 'y pe Pres.
r�y (71U.) ,
For L & I Use Only
APPROVED
Department of Labor & Industries
Industrial Statistician
By: nPT 2 7 1986 1
BEFORE FINAL SETTLEMENT can be made on z. any public works project,'ig� prime contractor and each
and every subcontractor must submit form LI-700-7 (F700-007-000) "Affidavit of Wages Paid" to the officer
charged with the disbursement of public funds. FACH AFFIDAVIT OF WAGES PAID MUST BE CERTI-
FIED BY THE INDUSTRIAL STATISTICIAN OF THE DEPARTMENT OF LABOR AND INDUS-
TRIES BEFORE IT IS SUBMITTED TO SAID OFFICER.
PROGRESS PAYMENTS: Each voucher claim submitted to an owner by a contractor for payment on a
project estimate shall state that prevailing wages have been paid in accordance with the prefiled statement
or statements of intent to pay prevailing wages on file with the public agency.
COMPLETE AND MAIL ENTIRE SET FOR APPROVAL TO:
Employment Standards Section, Department of Labor and Industries, IN
Olympia, Washington 98504-0631
CONTRACTORS, DISTRIBUTE APPROVED STATEMENTS AS FOLLOWS: Al,
1P NK COPY) ORIGINAL CONTRACT —AWARDING AGENCY
,;TEN COPY) DUPLICATE —INDUSTRIAL STATISTICIAN (Retained by Department)
(BLUE COPY) TRIPLICATE —PRIME CONTRACTOR
(YELLOW COPY) QUADRUPLICATE—SUBCONTRAC MR
P., 0 QX 3
L_