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Home My WebLink AboutCAG-20-065 - Duvall - Subcontractor Concrete Services Certified Payroll Report Department of Labor and ��STATf.� Project Name County Project or Contract# �.... s•". Prime Contractor E Industries 4..::: �:;: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program °° "`= Subcontractor PO Box 44540 i;4•• o%, Project Address Olympia WA 98504-4540 y` `aa"a Final Week of (360) 902-5335 Payroll Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 1/29/2023 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions i= Work Classification Name 0 O~ o Mon Tue Wed Thu Fri Sat Sun Gross Amount Total and And a� E 1/23 1/24 1/25 1/26 1/27 1/28 1/29 Total Rate Earned/Gross Hourly Net f0 E Hours of Pay "Usual WithholdingWages f a) Payroll FICA Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side f Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 1/30/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: all Avenue NE 1/23/2023 1/29/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. F)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 1/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �� yTA,F. Project Name County Project or Contract# f _1i.�, Prime Contractor ❑ Industries �•>>�- ii 4 •.iiii't Duvall Avenue NE King CAG-20-065 Prevailing Wage Program .t{". i';i= Subcontractor �rf • s�i PO Box 44540 ";y°�' �w Project Address Olympia WA 98504-4540 ` 'bP" Final Week of (360) 902-5335 Payroll E Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 1/22/2023 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total a> Gross Amount and And a� E 1/16 1/17 1/18 1/19 1/20 1/21 1/22 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address IX O o Hours Worked Each Day Payroll Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 1/24/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 1/16/2023 1/22/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 7' ` Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ...Dining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force _PayrollAdmin. Kristin Force • MB 1/24/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and a$sTATh•G Project Name County Project or Contract# Industries 4.. f. Prime Contractor ❑ �:::: r, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program °" _= Subcontractor PO Box 44540 ,.'b .yr Project Address Olympia WA 98504-4540 y` te8"a� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 1/15/2023 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name c9 ~Om Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And a� E 1/9 1/10 1/11 1/12 1/13 1/14 1/15 Total Rate Earned/Gross Hourly Net Wages j E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address fcu ct o Hours Worked Each Day Payroll Benefits" Tax a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report ' Title Date Kristin Force Payroll Admin. 1/24/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 1/9/2023 1/15/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side _ „r The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker:laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. --Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 1/24/23 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and F, ?A, Project Name County Project or Contract# ,c�_,_, = t,°- Prime Contractor ❑ Industries a°Hi i_i:y . Prevailing Wage Program , .. iiT Duvall Avenue NE King CAG-20-065 =,itv Subcontractor ►_� PO Box 44540 4"4. �^ Project Address Olympia WA 98504-4540 y� `eB�e Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 1/8/2023 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name c O~ Mon Tue Wed Thu Fri Sat Sun Gross Amount Total and And m E 1/2 1/3 1/4 1/5 1/6 1/7 1/8 Total Rate Earned/Gross Hourly Net Wages Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address o o Hours Worked Each Day Payroll Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 1/24/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 1/2/2023 1/8/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and .ruining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force 'MB 1/24/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �� STA,..kt. Project Name County Project or Contract# Industries �i;: 4 Prime Contractor ❑ I::::` Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <°°° x — ,•... Subcontractor ►� PO Box 44540 t ;::� o•y�r Project Address Olympia WA 98504-4540 y` te�y a Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 1/1/2023 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name ~ C� ~ Mon Tue Wed Thu Fri Sat eC o a) 12/2 12/2 12/2 12/2 12/3 12/3 Sun Gross Amount Total and And a) E 1/1 Total Rate Hourly m E i 6 7 8 9 0 1 Hours of Pay Earned/Gross "Usual Withholding Net Wages Soc Sec#of Employee Address a) B Payroll Benefits" FICA Tax Other w O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 1/4/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: n''vall Avenue NE 12/26/2022 1/1/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ."`Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and lining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 1/10/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 4,STATF Project Name County Project or Contract# Industries Prevailing Wage Program 4�;;; Q Prime Contractor ❑ o,:::' Iiii.t. Subcontractor Duvall Avenue NE King CAG-20-065 "''x PO Box 44540 �!!:4, '"y< J Proect Address Olympia WA 98504-4540 y` `"ey` Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 12/25/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions o Mon Tue Wed Thu Fri Sat Sun Work Classification Name c7 Total ct o a> 12/1 12/2 12/2 12/2 12/2 12/2 12/2 Gross Amount a> E Total Rate Hourly and And m E i 9 0 1 2 3 4 5 Hours of Pay Earned/Gross °Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address , a) E Payroll Benefits" Tax ix O Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 1/4/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: n"wall Avenue NE 12/19/2022 12/25/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. `,,Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 1/10/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and a�ST�TF_� Project Name County Project or Contract# zpviii:4 L° Prime Contractor ❑ Industries o4.; . Duvall Avenue NE KingCAG 20 065 Prevailing Wage Program '= Subcontractor ® PO Box 44540 oyez Project Address Olympia WA 98504-4540 y� 'e8"a Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 12/18/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name C� p Total w o a) 12/1 12/1 12/1 12/1 12/1 12/1 12/1 Gross Amount cu E Total Rate Hourly and And @ E i 2 3 4 5 6 7 8 Hours of PayEarned/Gross "Hourly Withholding Net Wages m r a, Payroll Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address N Ce O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 12/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: 'yell Avenue NE 12/12/2022 12/18/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'a`.Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and lining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 12/22/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �$s'rert Project Name County Project or Contract# Industries ...; o Prime Contractor ❑ c.:::• Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 7 Subcontractor 0PO Box 44540 �`�1' . Project Address Olympia WA 98504-4540 �` `889 a Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 12/11/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions ~ Sat Sun Work Classification Name c9 o Mon Tue Wed Thu Fri Total cG o a) 12/1 12/1 Gross Amount a, E 12/5 12/6 12/7 12/8 12/9 Total Rate Hourly and And Earned/Gross Net Wages m E 0 1 Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m a) a Payroll Benefits" Tax o_ 0 o Hours Worked Each Day o No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 12/15/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 12/5/2022 12/11/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, otherthan those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 12/15/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,?ti„''m Prime Contractor IIIProject Name County Project or Contract# Industries Hi, "'f Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 41::”, °= Subcontractor ►5 PO Box 44540 ;:�r ..yam Project Address Olympia WA 98504-4540 y` t8�y�� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 12/4/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions ~ Mon Tue Wed Work Classification Name C7 ° Thu Fri Sat Sun Total ct o a) 11/2 11/2 11/3 Gross Amount and And 'aia, E 8 9 0 12/1 12/2 12/3 12/4 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address f Payroll Benefits" Tax O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 12/15/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: all Avenue NE 11/28/2022 12/4/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side - The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' `_Pny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 12/15/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and a�STA,F; Project Name County Project or Contract# ,.' : « °� Prime Contractor ❑ Industries ^»> 1!,y , ;ii; , Duvall Avenue NE King CAG-20-065 Prevailing Wage Program . %. +Iifiz=' Subcontractor i 1 Ifl z El PO Box 44540 ,?y,�` Gov Project Address Olympia WA 98504-4540 ` '"�" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 11/27/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name a � o Mon Tue Wed Thu Fri Sat Sun Total cc 2- N 11/2 11/2 11/2 11/2 11/2 11/2 11/2 Gross Amount a, E Total Rate Hourly and And m E i= 1 2 3 4 5 6 7 Hours of PayEarned/Gross ^Usual Withholding Net Wages rn f Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address g a) n Hours Worked Each Day No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 11/30/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: flu Avenue NE 11/21/2022 11/27/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly.wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'c`.!\ny apprentices-employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 12/1/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �t,3TATA, Project Name County Project or Contract# ^�i3}'•.«;if y Prime Contractor ❑ Industries `.ri;. . , :;, V Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Fi'qr.- ,=ssi A 33iii, > Eci z Subcontractor El PO Box 44540 "',� y� Project Address Olympia WA 98504-4540 y� '"ey°� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 11/20/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name C7 Total 1 2 a> 11/1 11/1 11/1 11/1 11/1 11/1 11/2 Gross Amount E Total Rate Hourly Earned/Gross Net Wages and And E 4 5 6 7 8 9 0 Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address aa) T. - y Benefits" Tax O 'o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 11/29/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 11/14/2022 11/20/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Laing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 12/1/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and F,s Si AT, Project Name County Project or Contract# ? �•= __,°., Prime Contractor ❑ Industries %;i=' AO. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 11_...,. ,..; '{ Subcontractor ❑x PO Box 44540 °� ` ,� Project Address Olympia WA 98504-4540 y` 'b�y a� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 11/13/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name c9 F o Mon Tue Wed Thu Fri Sat Sun Total cc o a) 11/1 11/1 11/1 11/1 Gross Amount and And @ E 11/7 11/8 11/9 0 1 2 3 Total Rate Earned/Gross Hourly Net Wages c Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address Benefits" Tax CC O 'o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 11/17/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 11/7/2022 11/13/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly . (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or:will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. • (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report •Title Signature Kristin Force Payroll Admin. Kristin Force MB 11/21/22 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and F, %ATF Project Name County Project or Contract# Industries 4 ;?" ' `_;", Prime Contractor ❑ ili:; �i,y, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4ljilji, `etj�? Subcontractor ❑x PO Box 44540 s'? v� Project Address Olympia WA 98504-4540 Hy '"Ny'� Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 11/6/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions o Mon Work Classification Name 9 Tue Wed Thu Fri Sat Sun Total ct 20 10/3 Gross Amount and And 1 11/1 11/2 11/3 11/4 11/5 11/6 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address CCi 9 y Benefits" Tax rX O 0 Hours Worked Each Day No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 11/14/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/31/2022 11/6/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. .(5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 11/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �inrh. Project Name County Project or Contract# Industries ,�;;;�'"``t4.o. Prime Contractor LI Prevailing Wage Program �ii€,. x Duvall Avenue NE King CAG-20-065 Subcontractor N PO Box 44540 i�- ., Project Address Olympia WA 98504-4540 y` `""y''.1° Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 10/30/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions a Mon Tue Wed Thu Fri Sat Sun Work Classification Name c� Total i o a> 10/2 10/2 10/2 10/2 10/2 10/2 10/3 Gross Amount a, E Total Rate Hourly and And E 4 5 6 7 8 9 0 Hours of PayEarned/Gross ^Usual Withholding Net Wages 'Ea, Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address a) a) O Hours Worked Each Day a 1. Laborers Medicare:$26.47 RG 7.00 0.00 0.00 0.00 0.00 0.00 0.00 7.00 $52.39 $366.73 Cement Finisher Tender Daniel Becerra (King) Palacios $366.73/ 11048 SE 270th St OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $1,851.73 $0.00/hr $113.15 $151.00 $1,561.11 * ** Kent,WA-98030 $104.7 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 2. Cement Masons Medicare:$29.99 RG 7.00 0.00 0.00 0.00 0.00 0.00 0.00 7.00 $64.34 $450.38 Curb&Gutter,Sidewalks Jeffrey Brooks (King) 6209 Bock Ave $450.38/ Sumner,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2,068.02 $0.00/hr $128.21 $261.00 $1,648.82 * ** 98390 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 3. Laborers Medicare:$24.66 RG 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 $52.39 $314.34 Cement Finisher Tender Eutiquio Jimenez (King) 8120 34th Ave S $314.34/ Apt#30 OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $1,700.34 $0.00/hr $105.42 $52.00 $1,518.26 Lakewood,WA- 98499 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1084;7 $0.(�0 4. Cement Masons J J Medicare:$34.30 Curb&Gutter,Sidewalks German Moran RG 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 $64.34 $386.04 J (King) Bracamontes $386.04/ 22831 92nd Ave S OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 388.04 $0.00/hr $146.66 $129.00 $2,078.08 * _ _ •* #P103 Kent,WA-98031 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 8.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 5. Cement Masons i RG 7.50 0.00 0.00 0.00 0.00 0.00 0.00 7.50 $64.34 $482.55 Medicare:$42.75 Curb&Gutter,Sidewalks Rogello Velazco (King) 2564 S Meridian Apt $482.55/ B OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 975.30 $0.00/hr $182.81 $320.00 $2,429.74 ***.****** Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries • Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 11/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC • employed by: Project Name: For the week starting: For the week ending: Avenue NE 10/24/2022 10/30/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F • 1.Daniel Becerra Palacios _ Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Jeffrey Brooks agent Masons - b&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Eutiquio Jimenez Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 _ I (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.German Moran Bracamontes Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Rogelio Velazco Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side a_ ti.J The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made.either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. r 'F`-"ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Wing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force NIB 11/8/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and srerg Project Name County Project or Contract# 0,:.. Prime Contractor ❑ Industries •a. ��` :: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Subcontractor IN PO Box 44540 '?` Project Address Olympia WA 98504-4540 t;`ei s Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 10/23/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions C� ~ ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name Total ce 2- a) 10/1 10/1 10/1 10/2 10/2 10/2 10/2 Gross Amount m E Total Rate Hourly and And m E R. 7 8 9 0 1 2 3 Hours of PayEarned/Gross °Usual Withholding Net Wages rn f ro Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address > il 0 o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 10/31/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: ^ vall Avenue NE 10/17/2022 10/23/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ! ' Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ping Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 11/2122 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �,srerQa Project Name County Project or Contract#::: A Prime Contractor ❑ Industries a, ' c ;:•� Duvall Avenue NE King CAG 20 065 Prevailing Wage Program -''! Subcontractor IM PO Box 44540 4.:;::iit -, Project Address Olympia WA 98504-4540 `1e89 as Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 10/16/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name C� Total cK o e 10/1 10/1 10/1 10/1 10/1 10/1 10/1 Gross Amount a, E Total Rate Hourly and And ( E E. 0 1 2 3 4 5 6 Hours of Pay Earned/Gross ^Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address c > - Payroll Benefits" Tax O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 10/31/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/10/2022 10/16/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved • (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf oflthe above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those_which are legally permissible, have been made by any person either directly or indirectly from the full wages earned.. Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship-and 'ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 1112122 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and srnrR� Project Name County Project or Contract# Industries :1' 4. Prime Contractor ❑ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program �;-;;;, "`= Subcontractor IZ �'. ov Project Address PO Box 44540 eye i889 goy" Olympia WA 98504-4540 Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 10/9/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name t? o 9-0 Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And m E 10/3 10/4 10/5 10/6 10/7 10/8.10/9 Total Rate Earned/Gross Hourly Net Wages 5 E i= Hours of Pay Payroll "usual FICA Withholding Other Soc Sec#of Employee Address o > y Benefits" Tax c O o Hours Worked Each Day 0 J J 1. Cement Masons RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$32.55 Curb&Gutter,Sidewalks Edgar Ivan Garcia J (King) Jimenez $514.72/ 1946 S Hosmer St OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 271 72 $0.00/hr $139.19 $400.00 $1,699.98 Tacoma,WA- 98405 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $18'6 $0.00 8 2. Cement Masons Medicare:$38.52 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Adrian Guizar (King) 7220 116th St E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $514.72! $0.00/hr $164.69 $295.00 $2,185.01 * ** Puyallup,WA- $2,683.22 98373 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 3. Laborers Medicare:$19.00 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Cement Finisher Tender Alexis Guizar (King) Montoya $419.12/ 7220 116th St E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $1,310.12 $0.00/hr $81.23 $149.00 $1,060.89 Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $18 04'7 $0.00 4. Cement Masons Medicare:$39.85 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Hugo Hernandez (King) 508 165th St Ct E $514.72/ #109 OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 748 72 $0.00/hr $170.42 $481.00 $2,057.45 Spanaway,WA- 98387 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 5. Cement Masons German Moran Medicare:$38.40 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Bracamontes $514.72/ $0.00/hr $164.19 $197.00 $2,271.13 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks 22831 92nd Ave S $2,670.72 (King) #P103 OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 Kent,WA-98031 $128.6 ***-**-**** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 6. Cement Masons Gonzalo Moran RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$33.33 Curb&Gutter,Sidewalks Lepe (King) 18909 76th Ave Ct $514.72/ E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 334.72 $0.00/hr $142.55 $169.00 $1,989.84 ********* Puyallup,WA- $128.6 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 7. Laborers RG 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 $52.39 $314.34 Medicare:$21.70 Cement Finisher Tender Issaic Padilla -- (King) 19314 75th St E $314.34/ Bonney Lake,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $1,496.09 $0.00/hr $92.76 $190.00 $1,191.63 **«****** 98391 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $104.78 $0.00 8. Cement Masons RG 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 $64.34 $386.04 Medicare:$27.76 Curb&Gutter,Sidewalks (King) Isaac Wilson $386.04/ 12529 Morris Rd SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2,154.04 $0.00/hr $118.72 $162.00 $1,845.56 **.*.**** Yelm,WA-98597 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries • Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 10/13/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/3/2022 10/9/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Edgar Ivan Garcia Jimenez Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) _ 2.Adrian Guizar Cement Masons I Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) _ 3.Alexis Guizar Montoya Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Hugo Hernandez Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.German Moran Bracamontes Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 6.Gonzalo Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Issaic Padilla Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.Isaac Wilson Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • . The party signing below AFFIRMS the following: (1)All information contained in this-Certified Payroll Report,including any addenda, is correct.and complete. (2)The wage rates for workers, laborers or'mechanics as reported above are not less than the applicable wage rates contained n any wage determination related to the contract; and'the classifications as reported above for eachworker, laborer or mechanicconformwith the actual work performed by•such worker,.laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate.approved plans,funds,or programs for the benefitof such employees. (4)-All persons employed on the above-referenced project(S)have been paid the full weekly wages earned, and'no rebates,have been or will be'made either directly'or indirectly-to or on behalf of the above-named contractor or.-subcontractor from the weekly wages earned by any-person. No deductions,,other than.those which are-legally permissible, have been made by any person either directly or indirectly from the full wages earned. \,(5)Any apprentices employed in the above.period,are duly registered in a bona,fide apprenticeship'program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the-above statements is a violation of RCW 39:12:050 subject'to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB40/1'7122' • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �,erarf Project Name County Project or Contract# ?:_> sir . Prime Contractor ❑ Industries i `:i.y PrevailingWage Program � _ Duvall Avenue NE King CAG-20-065 g g 7nlii: ,:ai`r,= Subcontractor El ": Project Address PO Box 44540 "�;�• oti Olympia WA 98504-4540 ,le°'' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 10/2/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name a ~O 9- Mon Tue Wed Thu Fri Sat Sun Total G� a> Gross Amount and And E 9/26 9/27 9/28 9/29 9/30 10/1 10/2 Total Rate Earned/Gross Hourly Net Wages `m E i= _ Hours of Pay "Usual Withholding f a� - Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address a o Hours Worked Each Day 0 NI .11. Cement Masons RG 0.00 0.00 0.00 0.00 3.00 0.00 0.00 3.00 $64.34 $193.02 Medicare:$24.12 Curb&Gutter,Sidewalks Edgar Ivan Garcia (King) Jimenez $193.02/ 1946 S Hosmer St OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $1,690.30 $0.00/hr $103.14 $263.00 $1,300.04 Tacoma,WA- 98405 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 2. Cement Masons Medicare:$34.12 RG 0.00 0.00 0.00 0.00 3.00 0.00 0.00 3.00 $64.34 $193.02 Curb&Gutter,Sidewalks Adrian Guizar (King) 7220 116th St E $193.02/ Puyallup,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 380.30 $0.00/hr $145.92 $232.00 $1,968.26 98373 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 10/10/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/26/2022 10/2/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Edgar Ivan Garcia Jimenez Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Adrian Guizar Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. • (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force • MB 10/1'1/22 F700-065-000 certified payroll report 05-09 • Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,A srr9� Prime Contractor ❑ Project Name County Project or Contract# Industries 4:::: �; Is;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program t:r... =: gcz Subcontractor _� PO Box 44540 o"" Project Address Olympia WA 98504-4540 y` '�6� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 9/25/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions R.- Work Classification Name c9 ~O 2- Mon Tue Wed Thu Fri Sat Sun Total EY a> Gross Amount and And E 9/19 9/20 9/21 9/22 9/23 9/24 9/25 Total Rate Earned/Gross Hourly Net Wages `m f R. Hours of Pay Payroll Net FICA Withholding Other Soc Sec#of Employee Address a, Benefits" Tax 1 O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 10/10/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/19/2022 9/25/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 10/11/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and $•:l5,nrt "� Prime Contractor ElProject Name County Project or Contract# Industries '„r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <_: ,i.iti== st �, r iU: Subcontractor � PO Box 44540 ''�" y° Project Address Olympia WA 98504-4540 y` '"""�� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 9/18/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name C7 O~ Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a) E 9/12 9/13 9/14 9/15 9/16 9/17 9/18 Total Rate Earned/Gross Hourly Net Wages E i- Hours of Pay "Usual FICA Withholding Other a) LE0 Payroll Benefits" Tax Soc Sec#of Employee Address O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 9/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 9/12/2022 9/18/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. \.Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ;fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force M B 9/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and SlnrF. Project Name County Project or Contract# �`'.`,1,,,i,_10, Prime Contractor ❑ Industries .:!f. :;; �;, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -aii=i:,_ ,iiifs Willi„ iil,. Subcontractor X PO Box 44540 ''y'" y° Project Address Olympia WA 98504-4540 y` '�"",• ,o Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 9/11/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name C7 ~O 9- Mon Tue Wed Thu Fri Sat Sun Total CC a) Gross Amount and And m E 9/5 9/6 9/7 9/8 9/9 9/10 9/11 Total Rate Earned/Gross Hourly Net Wages .E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m m - Benefits" Tax r O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 9/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: n,wall Avenue NE 9/5/2022 9/11/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' 'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 9/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 91+r/ Project Name County Project or Contract# Industries :.s ={ i,i 4 Prime Contractor ❑ Hi'- -',:1:!;� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program t. sJtjIr,- Oil 1 Subcontractor ❑x PO Box 44540 4':,!* yn Project Address Olympia WA 98504-4540 y` 'N"" c Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 9/4/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name c& ~o o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And m E 8/29 8/30 8/31 9/1 9/2 9/3 9/4 Total Rate Earned/Gross Hourly Net Wages rn E i- Hours of Pay Payroll roll "Usual FICA Withholding Other ° Tax ' Benefits" Soc Sec#of Employee Address CC O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 9/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: .vall Avenue NE 8/29/2022 9/4/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F ) No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to-the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. fg-'<<4ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Jining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force • MB 9/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,,r�. Project Name County Project or Contract# ,..z it '.►,(i, Prime Contractor ❑ Industries - :II ,:: 4 �:ie:;. ::�� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program iiii,; ; IIj` Subcontractor IN PO Box 44540 ';i- ., ,-,, Project Address Olympia WA 98504-4540 H� '" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON, CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 8/28/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name e ~ o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And m E 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Total Rate Earned/Gross Hourly Net Wages 8 Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address c > - y Benefits" Tax r O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 9/1/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 8/22/2022 8/28/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force - 1 MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and >>�rF. Project Name County Project or Contract# ,�a ,;•• °•= Prime Contractor ❑ Industries - _ i_=f• �•;; =•=.:r Duvall Avenue NE King CAG-20-065 PrevailingWage Program �=i °__ 9 9 ,�,;i13; •lil:� Subcontractor � PO Box 44540 °;;rI' I` 1y' Project Address Olympia WA 98504-4540 y� '8___ a Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 8/21/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 p Day and Date Deductions Work Classification Name c9 ~, o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And E 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Total Rate Earned/Gross Hourly Net Wages `m E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address o CK o Hours Worked Each Day Payroll Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 9/1/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: ^,wall Avenue NE 8/15/2022 8/21/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,.fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 3,�rF Project Name County Project or Contract# -* '�l•°� Prime Contractor ❑ Industries F`• '�" Duvall Avenue NE King CAG-20-065 a siuC• ,.j.•ea3.r Prevailing Wage Program i;ilj t= ::il < Subcontractor LX PO Box 44540 ' ;.• a`y'• Project Address Olympia WA 98504-4540 ` ' �� ' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: I RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 8/14/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name (3 ~O 9- Mon Tue Wed Thu Fri Sat Sun Total cG a) Gross Amount and And E 8/8 8/9 8/10 8/11 8/12 8/13 8/14 Total Rate Earned/Gross Hourly Net Wages E i= _ Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address > Payroll Benefits" Tax O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 8/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: -tall Avenue NE 8/8/2022 8/14/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: • (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'q\kAny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �, �;F Project Name County Project or Contract# ,•.:t� ��•7tF Prime Contractor ❑ Industries = Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <;liiil; rj�t` Subcontractor PO Box 44540 a' ,:: °y Project Address Olympia WA 98504-4540 y` '®g� Final Week of (360) 902-5335 Payroll Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 8/7/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name C7 O g E..), Mon Tue Wed Thu Fri Sat Sun Total eC cu Gross Amount and . And e E 8/1 8/2 8/3 8/4 8/5 8/6 8/7 Total Rate Earned/Gross Hourly Net Wages a E I= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m > 4 y Benefits" Tax i2 O o Hours Worked Each Day 0 1. Cement Masons Medicare:$39.98 RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Adrian Guizar (King) 7220 116th St E OT 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.50 $96.51 $48.26 $56298/ $0.00/hr $170.97 $316.00 $2,257.51 Puyallup,WA- $2,784.46 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $18.6 $0.00 2. Laborers Medicare:$22.18 RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Cement Finisher Tender Adrian Guizar (King) Montoya $458.42/ 7220 116th St E OT 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.50 $78.59 $39.30 $1,529.91 $0.00/hr $94.86 S234.00 $1,178.87 _ _ ** Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $104.7 $0.00 3. Laborers RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Medicare:$20.94 Cement Finisher Tender Alexis Guizar J (King) Montoya J J $458.42/ 7220 116th St E OT 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.50 $78.59 $39.30 $1,444.28 $0.00/hr $89.55 $179.00 $1,154.79 •,_«>..x Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $104.7 $0.00 4. Cement Masons Medicare:$42.06 RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Sergio Guzman (King) 2012 E 63rd St OT 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 $611.23/ $0.00/hr $179.83 $360.00 $2,345.44 Tacoma,WA- $2,927.33 *1 ..,.** 98404 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 5. Cement Masons Gerardo Moran Medicare:$40.39 RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 24620 Russell Road $611.23/ $0.00/hr $172.72 $335.00 $2,273.12 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks Apt C-306 $2,821.23 (King) Kent,WA-98032 OT 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$.6 $0.00 6. Cement Masons RG 8.00 8.00 0.00 0.00 0.00 0.00 0.00 16.00 $64.34 $1,029.4 Medicare:$42.33 Curb&Gutter,Sidewalks Abraham Moran 4 (King) Lepe $1,222.46 1918 SW 351st St OT 0.00 2.00 0.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 / $0.00/hr $180.99 $490.00 $2,241.24 Federal Way,WA- $2,954.56 98023 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$8.6 $0.00 7. Cement Masons RG 8.00 8.00 0.00 0.00 0.00 0.00 0.00 16.00 $64.34 $1,029.4 Medicare:$36.92 Curb&Gutter,Sidewalks Jorge Velasco 4 (King) Guzman $1,222.46 8012 147th St E OT 0.00 2.00 0.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 / $0.00/hr $157.90 $236.00 $2,142.74 * _ _ ** Puyallup,WA- $2,573.56 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$8.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side . Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 8/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: _, ,all Avenue NE 8/1/2022 8/7/2022 • "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Adrian Guizar Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Adrian Guizar Montoya )borers -ment Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Alexis Guizar Montoya Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Sergio Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Gerardo Moran Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) Abraham Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Jorge Velasco Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (RN Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ping Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and sae.,;?,";,..�� Prime Contractor Ill Project Name County Project or Contract# Industries 4::=.= !*. ,::::; - ,•':IL Duvall Avenue NE King CAG-20-065 Prevailing Wage Program yiiii: ,tu,jlt` Subcontractor PO Box 44540 °' :' y�. Project Address Olympia WA 98504-4540 isso'� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 7/31/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions H Work Classification Name C7 ~O G. Mon Tue Wed Thu Fri Sat Sun Total II a) Gross Amount and And a) E 7/25 7/26 7/27 7/28 7/29 7/30 7/31 Total Rate Earned/Gross Hourly Net Wages al▪ E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address c > -°'fl y Benefits" Tax ▪ O o Hours Worked Each Day ci 1. Cement Masons J ` Medicare:$39.73 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 J Curb&Gutter,Sidewalks Adrian Guizar (King) 7220 116th St E OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96 51 $611.23/ $0.00/hr $169.89 $313.00 $2,244.36 Puyallup,WA- $2,766.98 ***«*«*** 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$8.6 $0.00 2. Laborers Medicare:$21.05 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Cement Finisher Tender Adrian Guizar (King) Montoya $497.71 / 7220 116th St E OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $78.59 $78.59 $1,451.84 $0.00/hr $90.01 $217.00 $1,123.78 ***«***** Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $184'7 $0.00 3. Laborers Medicare:$16.23 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Cement Finisher Tender Alexis Guizar Kin Montoya (King) 7220 116th St E OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $78.59 $78.59 $1,118.71 9 ' $0.00/hr $69.36 $107.00 $926.12 ********* Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 8 04'7 $0.00 4. Cement Masons Medicare:$36.47 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Sergio Guzman (King) 2012 E 63rd St $611.23/ Tacoma,WA- OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 $2 542.23 $0.00/hr $155.96 $275.00 $2,074.80 **•«*«*�• 98404 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128.68 $0.00 5. Cement Masons Gerardo Moran Medicare:$26.42 RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 24620 Russell Road $611.23/ $0.00/hr $112.94 $151.00 $1,566.87 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks Apt C-306 $1,857.23 (King) Kent,WA-98032 OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 *****-**** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$.6 $0.00 ' 6. Cement Masons RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$33.62 Curb&Gutter,Sidewalks Abraham Moran (King) Lepe $611.23/ 1918 SW 351st St OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 $2 353.73 $0.00/hr $143.73 $349.00 $1,827.38 * *•***� Federal Way,WA- 98023 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 7. Cement Masons Gonzalo Moran RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$33.91 Curb&Gutter,Sidewalks Lepe (King) 18909 76th Ave Ct OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 $611.231 $0.00/hr $145.01 $173.00 $2,022.31 E $2,374.23 Puyallup,WA- $128.6 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 Jement Masons RG 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$37.04 Curb&Gutter,Sidewalks Ruben Velazco (King) 3429 55th Ave NE $611.23/ Tacoma,WA- OT 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 $96.51 $96.51 $2 676.23 $0.00/hr $158.34 $254.00 $2,226.85 ********* 98422 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$8.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program- PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 8/3/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: nvall Avenue NE 7/25/2022 7/31/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Adrian Guizar Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Adrian Guizar Montoya .borers `ment Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 I f (King) 3.Alexis Guizar Montoya Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Sergio Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Gerardo Moran Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 _(King) 'Abraham Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Gonzalo Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.Ruben Velazco Cement Masons irb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ()Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and i,s,;erf Project Name County Project or Contract# +.... `•i,.'F. Prime Contractor Industries ...::: f o.... r,R Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4."' :.- Subcontractor ❑X PO Box 44540 t"''',,r 'y°} Project Address Olympia WA 98504-45401 1eB°'t'.° Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 7/24/2022 1055 S GRADY WAY RENTON, WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And a) E 7/18 7/19 7/20 7/21 7/22 7/23 7/24 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m > Payroll Benefits" Tax (Y O o Hours Worked Each Day 0 1. Cement Masons 4 J Medicare:$38.89 RG 0.00 0.00 0.00 0.00 3.00 0.00 0.00 3.00 $64.34 $193.02 J Curb&Gutter,Sidewalks Sergio Guzman (King) 2012E 63rd St $193.02/ Tacoma,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 708 84 $0.00/hr $166.28 $312.00 $2,191.67 ***** **** 98404 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 2. Cement Masons Medicare:$37.82 RG 0.00 1.50 0.00 0.00 0.00 0.00 0.00 1.50 $64.34 $96.51 Curb&Gutter,Sidewalks Abraham Moran e (King) Lepe SW 351st St OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $29643186 $0.00/hr $161.72 $417.00 $2,027.32 * _ _ ** Federal Way,WA- 98023 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 3. Laborers Medicare:$30.79 RG 0.00 1.50 0.00 0.00 3.00 0.00 0.00 4.50 $52.39 $235.76 Cement Finisher Tender Juan Manuel Sales (King) Ponce $235.76/ 210 37th St SE Trlr OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $2 123.20 $0.00/hr $131.64 $225.00 $1,735.77 **** **** 20 Auburn,WA-98002 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 84.7 $0.00 4. Cement Masons Medicare:$42.40 RG 0.00 1.50 0.00 0.00 3.00 0.00 0.00 4.50 $64.34 $289.53 Curb&Gutter,Sidewalks Jorge Velasco (King) Guzman $289.53/ 8012 147th St E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 951.53 $0.00/hr $181.34 $315.00 $2,412.79 ********* Puyallup,WA- 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $18'6 $0.00 8 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries • Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 7/28/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Avenue NE 7/18/2022 7/24/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F • 1.Sergio Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 - $0.00 (King) 2.Abraham Moran Lepe -ment Masons rb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Juan Manuel Salas Ponce Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Jorge Velasco Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. .c`Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 8/2/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and `�tiarF.t Prime Contractor ❑ Project Name County Project or Contract# Industries ` ''`•• -1-.. -F. �;i�t� __ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program filii. .. 3t'tx Subcontractor PO Box 44540 ,:::il• ,iy< Project Address Olympia WA 98504-4540 ` `��"a�� Final Week of (360)902-5335 Payroll El Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 7/17/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions 1.-- Work Classification Name c7 0 9--a, Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And N E 7/11 7/12 7/13 7/14 7/15 7/16 7/17 Total Rate Hourly Earned/Gross Net Wages E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address o ce o Hours Worked Each Day Payroll Benefits" Tax 0 1. Laborers RG 6.00 0.00 8.00 0.00 0.00 0.00 0.00 14.00 $52.39 $733.46 Medicare:$34.54 Cement Finisher Tender Luis Alvarez Villa (King) 12910 SE 240th St OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $78.59 $157.18 $890.64/ $0.00/hr $147.67 $376.00 $1,850.32 ********* Apt 1-04 $2,408.53 Kent,WA-98031 $104.7 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 2. Laborers Medicare:$30.82 RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Cement Finisher Tender Daniel Becerra (King) Palacios $576.30/ * ** 11048 SE 270th St OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $78.59 $157.18 $2 152.66 $0.00/hr $131.81 $190.00 $1,800.03 Kent,WA-98030 $104.7 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 3. Cement Masons Medicare:$41.74 RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Miguel Diaz (King) Cornelio $707.74! 16308 B St E#61 OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $2 878 58 $0.00/hr $178.47 $474.00 $2.184.37 ********* Tacoma,WA- 98445 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$28.6 $0.00 4. Cement Masons Medicare:$42.88 RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Sergio Guzman (King) 2012 E 63rd St OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00; 2.00 $96.51 $193.02 $ ,983. /67$2983. $0.00/hr $183.33 $372.00 $2,385.46 ********* Tacoma,WA- 98404 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 5. Cement Masons Abraham Moran RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$44.82 Lepe $707.74/ $0.00/hr $191.65 $531.00 $2,359.17 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks 1918 SW 351st St $3,126.64 (King) Federal Way,WA- OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 98023 $128.6 * - - ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 6. Laborers 4 4 Medicare:$26.23 RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 J Cement Finisher Tender Issaic Padilla (King) 19314 75th St E $576.30/ Bonney Lake,WA- OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $78.59 $157.18 $1 808 80 $0.00/hr $112.14 $259.00 $1,411.43 ********* 98391 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$4.7 $0.00 7. Cement Masons RG 0.00 0.00 7.00 0.00 0.00 0.00 0.00 7.00 $64.34 $450.38 Medicare:$42.61 Curb&Gutter,Sidewalks Jorge Velasco (King) Guzman $450.38/ 8012 147th St E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 964.87 $0.00/hr $182.16 $317.00 $2,423.10 * _ **** Puyallup,WA- 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 cement Masons RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$43.75 Curb&Gutter,Sidewalks Rogelio Velazco (King) 2564 S Meridian Apt $707.74/ B OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $3,043.93 $0.00/hr $187.06 $334.00 $2,479.12 * _ _ ** Puyallup,WA- 98373 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 9. Cement Masons RG 6.00 0.00 8.00 0.00 0.00 0.00 0.00 14.00 $64.34 $900.76 Medicare:$39.91 Curb&Gutter,Sidewalks (King) Isaac Wilson $1,093.78 12529 Morris Rd SE OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 / $0.00/hr $170.66 $319.00 $2,462.21 * ****** Yelm,WA-98597 $2,991.78 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 7/26/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: ".wall Avenue NE 7/11/2022 7/17/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F • 1.Luis Alvarez Villa Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Daniel Becerra Palacios ' -aborers )ment Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Miguel Diaz Cornelio Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Sergio Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Abraham Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) Issaic Padilla Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Jorge Velasco Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.Rogelio Velazco Cement Masons r'urb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 9.Isaac Wilson Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side L �.r The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments.of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' t\ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and dining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 8/2/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,`";! Prime Contractor ❑ 'Project Name County Project or Contract# Industries -,„!RV. ;,,,;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program illh}- +lig Subcontractor El PO Box 44540 '' z2, . ; Project Address Olympia WA 98504-4540 I'' :,YK„ Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 7/10/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name C7 o Mon Tue Wed Thu Fri Sat Sun Total O a) Gross Amount and And m E 7/4 7/5 7/6 7/7 7/8 7/9 7/10 Total Rate Earned/Gross Hourly Net Wages `m E i Hours of Pay Net FICA Withholding Other PayrollTax Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" rD No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 7/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/4/2022 7/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been.or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. / =Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and :fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force . MB 8/2/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and,Signature Certification on Reverse Side . Certified Payroll Report Department of Labor and Project Name County Project or Contract# Industries 4, 4 Prime Contractor ❑ o_:: CAG-20-065 �: � �, ;;� Duvall Avenue NE King Prevailing Wage Program {�I=1. ,1; = Subcontractor l PO Box 44540 , y� Project Address Olympia WA 98504-4540 � �e80�� Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year " Awarding Agency Address Address City State Zip+4 7/3/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name c3 ~o o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And a) E 6/27 6/28 6/29 6/30 7/1 7/2 7/3 Total Rate Earned/Gross Hourly Net Wages 03 E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address cs > .—n y Benefits" Tax i o o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 7/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/27/2022 7/3/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. fr-' ,1ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 7/11/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,,,;1.+r, Project Name County Project or Contract# Industries tt�"''i. " Prime Contractor El it -, tli;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ll1li,- ,; �r PO Box 44540 ,,y .,,- Subcontractor Project Address Olympia WA 98504-4540 H, """ Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 6/26/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name 5 ~O o Mon Tue Wed Thu Fri Sat Sun Total a> Gross Amount and And E 6/20 6/21 6/22 6/23 6/24 6/25 6/26 Total Rate Earned/Gross Hourly Net Wages .E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a-,al > - Benefits" Tax O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Sidi Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 6/30/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Ara ll Avenue NE 6/20/2022 6/26/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Sid( The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. . Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and `. lining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force • MB 7/5/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 5, :nrf o Project Name County Project or Contract# f s:= =.'\f Prime Contractor ❑ Industries ,::: ,,,•.' Duvall Avenue NE King CAG-20-065 Prevailing Wage Program tji3i iii:p., Subcontractor PO Box 44540 °".., f.�. Project Address yy aCY Olympia WA 98504-4540 ` ''""� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 6/19/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions P Work Classification Name c9 O 8 o Mon Tue Wed Thu Fri Sat Sun Total cc a, Gross Amount and And iD E 6/13 6/14 6/15 6/16 6/17 6/18 6/19 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a) a)IE -a Benefits" Tax O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 6/30/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: avall Avenue NE 6/13/2022 6/19/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or • indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. .'c),.Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and lining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 7/5/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and l^r Project Name County Project or Contract# Industries ;, :it 'it,°'y Prime Contractor ❑ iIi.- -,.;lit;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program !HIV,' ell;: Subcontractor ❑x PO Box 44540 ',SO Project Address Olympia WA 98504-4540 Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 6/12/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions F- Work Classification Name E7 ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And E 6/6 6/7 6/8 6/9 6/10 6/11 6/12 Total Rate Earned/Gross Hourly Net Wages *-Ea Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address 0 Benefits" O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 6/16/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: ^ all Avenue NE 6/6/2022 6/12/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. "ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force L MB 6/17/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��ssAr`,o� Project Name County Project or Contract# Industries �,;; ,;; Prime Contractor ❑ �: • - lit Duvall Avenue NE King CAG-20-065 Prevailing Wage Program igiir { Subcontractor N PO Box 44540 ,�� y Project Address Olympia WA 98504-4540 -,t less�� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address - Address City State Zip+4 6/5/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 1 Day and Date ' Deductions jr: Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And a> E 5/30 5/31 6/1 6/2 6/3 6/4 6/5 Total Rateta Earned/Gross Hourly Net Wages E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address O -a Benefits" Worked Each Day Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: !vall Avenue NE 5/30/2022 6/5/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. kg\Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 6/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and f,i, �,rF` Prime Contractor ❑ Project Name County Project or Contract# Industries =AE" A�`.F Duvall Avenue NE King CAG-20-065 j�i�:�. xFj.'tif I Prevailing Wage Program W R,` ii ,r PO Box 44540 : .. Subcontractor LRJ ^""' Project Address Olympia WA 98504-4540 y� ,r"� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 5/29/2022 1055 S GRADY WAY RENTON,WA-98055 16423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions P Work Classification Name & ~O o Mon Tue Wed Thu Fri Sat Sun Total cL a) Gross Amount a, E 5/23 5/24 5/25 5/26 5/27 5/28 5/29 Total Rate Hourly and And Earned/Gross Net Wages E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address CU 12 O o Hours Worked Each Day y Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/23/2022 5/29/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. r'.,,Nny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 6/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and �,� �?+i««; Project Name County Project or Contract# Industries ,,:=ff' ti: ¢ Prime Contractor ❑ :_;. __.: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program iiii +:;1 x Subcontractor EZ aii se: ' `; 'l Project Address PO Box 44540 ';� '. ,y J Olympia WA 98504-4540 y� 18"� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 5/22/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions Work Classification Name C7 ~ Mon Tue Wed Thu Fri Sat Sun Total O o a> Gross Amount a, E 5/16 5/17 5/18 5/19 5/20 5/21 5/22 Total Rate Hourly and And E Hours of Pay Earned/Gross "Usual Withholding Net Wages •- 0 Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: n,,vall Avenue NE 5/16/2022 5/22/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)-The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. c',!\ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature- Kristin Force Payroll Admin. Kristin Force MB 6/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 41„ST"r _9. Prime Contractor ElProject Name County Project or Contract# Industries :: _ ., ::•r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <a, . ii ,_ y3litti ,_��. Subcontractor PO Box 44540 °:;°`'� K,�,: Project Address Olympia WA 98504-4540 'NI 'bay ' Final Week of (360) 902-5335 Payroll ❑ • Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 5/15/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name c7 ~O G Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And a� E 5/9 5/10 5/11 5/12 5/13 5/14 5/15 Total Rate Earned/Gross Hourly Net Wages • r Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address • m Benefits" Tax • O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 5/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: 'veil Avenue NE 5/9/2022 5/15/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ping Council. Falsification of any of,the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 5/20/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �, ..-, Project Name County Project or Contract# ��IE }_l Prime Contractor ❑ Industries c..:f. �.=,t m n�;'� Duvall Avenue NE King CAG-20-065 aei°' Prevailing Wage Program i -- ,'" Subcontractor NI PO Box 44540 °'�._•� y Project Address Olympia WA 98504-4540 y` '�d°�c Final Week of (360) 902-5335 Payroll LI Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 5/8/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions P Work Classification Name C7 ~O o Mon Tue Wed Thu Fri Sat Sun Total , Gross Amount and And a� E 5/2 5/3 5/4 5/5 5/6 5/7 5/8 Total Rate Earned/Gross Hourly Net Wages r Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address o O o Hours Worked Each Day Benefits" Tax a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 5/16/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: /all Avenue NE 5/2/2022 5/8/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !a\ Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,rning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force • MB 5/20/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �,A,F. Project Name County Project or Contract# p igl;'•"[;t-4 Prime Contractor ❑ Industries .x. ,111:1. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -Ai, _ ,,=ti=a`= PO Box 44540 ,,H. '"'-, Subcontractor ►_� ;.,',( �`, Project Address Olympia WA 98504-4540 ""y Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 5/1/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions p Work Classification Name C9 ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And CD E 4/25 4/26 4/27 4/28 4/29 4/30 5/1 Total Rate Earned/Gross Hourly Net Wages m E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m w Payroll Benefits" Tax O 3 Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 5/3/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: "-van Avenue NE 4/25/2022 5/1/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • The party signing below AFFIRMS the following: - (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 1.5'.1ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 5/3/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �,5��?�. Project Name County Project or Contract# Industries ^ .i� :?:1, Prime Contractor ❑ -IT -iih Duvall Avenue NE King CAG-20-065 Prevailing Wage Program AIpli. "<ii i= �.'333i!} r ;��^, Subcontractor PO Box 44540 ''.y," . �y. Project Address Olympia WA 98504-4540 �` ` "y Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 4/24/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions i= Work Classification Name ( ~O E Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And E 4/18 4/19 4/20 4/21 4/22 4/23 4/24 Total Rate Hourly Hours of Pay Earned/Gross "Usual Withholding Net Wages f m Payroll FICA Other Soc Sec#of Employee Address cD 0 o Hours Worked Each Day Benefits" Tax a 1. Laborers RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Medicare:$31.65 Cement Finisher Tender Luis Alvarez Villa (King) 12910 SE 240th St OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $78.59 $157.18 $576.30/ $0.00/hr $135.32 $332.00 $1,710.33 Apt 1-04 $2,209.30 Kent,WA-98031 $104.7 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 2. Laborers RG 3.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 $52.39 $157.17 Medicare:$20.28 Cement Finisher Tender (King) Matthew Balko $157.17/ 1106 11th Ave S OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $1,425.42 $0.00/hr $86.72 $169.00 $1,149.42 Milton,WA-98354 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$4/.7 $0.00 s. cement Masons `/ " Medicare:$39.60 Curb&Gutter,Sidewalks RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 / Adrian Guizar J J V (King) 7220 116th St E $707.74/ IF*�} Puyallup,WA- OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $2 757.74 $0.00/hr $169.32 $311.00 $2,237.82 98373 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 4. Cement Masons RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$37.27 Curb&Gutter,Sidewalks Sergio Guzman (King) 2012 E 63rd St OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $707.74/ $0.00/hr $159.33 $287.00 $2,113.14 Tacoma,WA- $2,596.74 98404 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 5. Cement Masons Abraham Moran RG 0.00 6.00 8.00 3.00 0.00 0.00 0.00 17.00 $64.34 $1,093.7 Medicare:$40.23 Lepe 8 $1,286.80 $0.00/hr $172.04 $453.00 $2,145.04 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks 1918 SW 351st St / (King) Federal Way,WA- OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $2,810.31 98023 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 6. Laborers Medicare:$22.95 Cement Finisher Tender Juan Manuel Salas RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Kin Ponce (King) 210 37th St SE Trlr OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $78.59 $157.18 $�582.64 $0.00/hr $98.13 $142.00 $1,319.56 * ** 20 Auburn,WA-98002 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1084.7 $0.00 7. Cement Masons RG 0.00 6.00 8.00 3.00 0.00 0.00 0.00 17.00 $64.34 $1,093.7 Medicare: $41.96 Curb&Gutter,Sidewalks Jorge Velasco 8 (King) Guzman $1,286.80 8012 147th St E OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 / $0.00/hr $179.42 $308.00 $2,391.18 * _ _ ** Puyallup,WA- $2,920.56 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$8.6 $0.00 :ement Masons Medicare:$39.08 RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Ruben Velazco (King) 3429 55th Ave NE $707.74/ Tacoma,WA- OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $2 817.74 $0.00/hr $167.11 $284.00 $2,327.55 * '* 98422 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 5/3/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: _ For the week starting: For the week ending: ✓all Avenue NE 4/18/2022 4/24/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Luis Alvarez Villa Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Matthew Balko ',borers -ment Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Adrian Guizar Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Sergio Guzman Cement Masons - Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Abraham Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) Juan Manuel Salas Ponce Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Jorge Velasco Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.Ruben Velazco Cement Masons ^r>>rb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ening Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 5/3/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��:.Ss�?'G Project Name County Project or Contract# 4 Prime Contractor CIIndustries § _ Fk„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program al.{ Subcontractor PO Box 44540 Project Address Olympia WA 98504-4540 141 1N39 ae Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 4/17/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions H Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And m E E 4/11 4/12 4/13 4/14 4/15 4/16 4/17 Total Rate Hourly Earned/Gross Net Wages = _ Hours of Pay Payroll "Usual FICA Withholdingf a) Other Soc Sec#of Employee Address > Benefits" Tax c O o Hours Worked Each Day 0 1. Laborers RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Medicare:$27.92 Cement Finisher Tender Luis Alvarez Villa (King) 12910 SE 240th St OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $78.59 $117.89 $537.01 / $0.00/hr $119.39 $278.00 $1,527.20 * *= Apt 1-04 $1,952.51 Kent,WA-98031 $104.7 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 2. Laborers Medicare:$17.77 RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Cement Finisher Tender Carlos Arreola (King) Colmenares $537.01 / 23 S 341st PI#A OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $78.59 $117.89 $1,225.51 $0.00/hr $75.98 $131.00 $1,000.76 Federal Way,WA- 98003 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $104.7 $0. 0 3. Cement Masons Roberto Medicare:$40.05 RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Curb&Gutter,Sidewalks Colmenares (King) Contreras $659.49/ 7812 57th St E Apt OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $96.51 $144.77 $2 798 00 $0.00/hr $171.28 $317.00 $2,269.67 _ _ ** B13 Puyallup,WA- DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128.6 $0.00 98371 8 4. Cement Masons RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$29.99 Curb&Gutter,Sidewalks Ruben Colmenares (King) 11224 Pacific Ave S $659.49/ Apt#3 OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $96.51 $144.77 $2 094 99 $0.00/hr $128.22 $131.00 $1,805.78 _ _ ** Tacoma,WA- 98444 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128.6 $0.00 5. Cement Masons Abraham Moran RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$39.77 Lepe $659.49/ $0.00/hr $170.02 $445.00 $2,123.04 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks 1918 SW 351st St $2,777.83 (King) Federal Way,WA OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $96.51 $144.77 98023 "• DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 6. Laborers RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $52.39 $419.12 Medicare:$19.36 Cement Finisher Tender Juan Manuel Salas (King) Ponce $537.01I 210 37th St SE Trlr OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $78.59 $117.89 $1 334.94 $0.00/hr $82.76 $112.00 $1,120.82 * _ _ •= 20 Auburn,WA-98002 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1084.7 $0.00 7. Cement Masons RG 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$44.37 Curb&Gutter,Sidewalks Jorge Velasco (King) Guzman $659.49/ 8012 147th St E OT 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1.50 $96.51 $144.77 $3,086.64 $0.00/hr $189.70 $343.00 $2,509.57 Puyallup,WA- 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1288.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 4/25/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: f'^Nall Avenue NE 4/11/2022 4/17/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F)Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Luis Alvarez Villa Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Carlos Arreola Colmenares -/orers jment Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Roberto Colmenares Contreras Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Ruben Colmenares Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Abraham Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) Juan Manuel Salas Ponce Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Jorge Velasco Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer-or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. )A y apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side - Certified Payroll Report Department of Labor and ..m;s..:E F tom Project Name - County Project or Contract# Industries o� :: Prime Contractor ❑ �• s - ram ik , Duvall Avenue NE King CAG-20-065 Prevailing Wage Program iiif1. itli Subcontractor N PO Box 44540 yf me�045 Project Address Olympia WA 98504-4540Final Week of (360)902-5335 Payroll ❑ . Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 4/10/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions H Work Classification Name (7 c o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And m E 4/4 4/5 4/6 4/7 4/8 4/9 4/10 Total Rate Hourly Hours of Pay EamPea Gross "Usual FICA Withholding Other Net Wages roll Soc Sec#of Employee Address o da ce o Hours Worked Each Day y Benefits" Tax 0 1. Cement Masons RG 0.00 5.50 0.00 0.00 0.00 0.00 0.00 5.50 $64.34 $353.87 Medicare:$30.36 Curb&Gutter,Sidewalks Jorge Velasco (King) Guzman $353.87/ 8012 147th St E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 120 87 $0.00/hr $129.84 $161.00 $1,799.67 **_*_*.** Puyallup,WA- 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188'6 $0.00 2. Cement Masons RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$31.44 Curb&Gutter,Sidewalks Rogelio Velazco (King) 2564 S Meridian Apt $514.72/ B OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2,194 72 $0.00/hr $134.41 $169.00 $1,859.87 **_*=**** Puyallup,WA- p 98373 $128.6 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 $01 `3.-cement Masons RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 / Medicare:$31.67 Curb&Gutter,Sidewalks Ruben Velazco V (King) 3429 55th Ave NE $514.72/ Tacoma,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.51 $0.00 $2 306.72 $0.00/hr $135.44 $181.00 $1,958.61 ***.***** 98422 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$28'6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 4/14/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 4/4/2022 4/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly I (C) Hourly (D) Hourly (E)Approved (F)Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Jorge Velasco Guzman Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Rogelio Velazco (Rment Masons rb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Ruben Velazco Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side _ The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates,contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by.any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,11ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin. Kristin Force MB 4/26/22 F700-065-000 certified payroll report 05-09 .' Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��8s ?ti o� Project Name County Project or Contract# Industries ..: Prime Contractor ❑ �:,__,, _ , Duvall Avenue NE King CAG-20-065 Prevailing Wage Program .4;iai :iei= PO-Box 44540 V,P i , 4,f Subcontractor ® Project Address '.44 f �,o Olympia WA 98504-4540 Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 CONCRETE SERVICES INC (253)922-1444 Month Day Year Awarding Agency Address Address City State Zip+4 4/3/2022 1055 S GRADY WAY RENTON,WA-98055 6423 PACIFIC HWY E FIFE WA 98424 Day and Date Deductions F= Work Classification Name E7 F" o Mon Tue Wed Thu Fri Sat Sun Total rZ O m Gross Amount and And E 3/28 3/29 3/30 3/31 4/1 4/2 4/3 Total .Rate Hourly Earned/Gross Net Wages Hours of Pay "Usual FICA Withholding Other a) a) Payroll Benefits" Tax Soc Sec#of Employee Address ce o o Hours Worked Each Day 0 1. Laborers RG 8.00 0.00 8.00 0.00 0.00 0.00 0.00 16.00 $52. 9 $838 24 Medicare:$27.11 Cement Finisher Tender Luis Alvarez Villa J (King) 12910 SE 240th St OT 0.00 0.00 1.50 0.00 0.00 0.00 0.00 1.50 $78.59 $117.89 $956.13/ $0.00/hr $115.93 $267.00 $1,486.59 Apt 1-04 $1,896.63 " ''"`"*** Kent,WA-98031 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10J4.7 $0V.90 2. Cement Masons Roberto RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00. $64. 4 $51 72 Medicare:$21.03 Curb&Gutter,Sidewalks Colmenares ` J (King) Contreras �( $659.49/ 7812 57th St E Apt OT 0.00 0.00 1.50 0.00 0.00 0.00 0.00 1.50 $96.51 $144.77 $1,486.24/ $0.00/hr $89.95 $107.00 $1,268.26 ........* B13 Puyallup,WA- DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 8.6 $0j0 3. Cement Masons RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64. 4 $514.72 Medicare:$20.71 Curb&Gutter,Sidewalks Ruben Colmenares . J (King) 11224 Pacific Ave S . V $659.49/ Apt#3 OT 0.00 0.00 1.50 0.00 0.00 0.00 0.00 1.50 $96.51 $144.77 $1455.24 $0.00/hr $88.57 $54.00 $1,291.96 ********* Tacoma,WA- 98444 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12J8'6 $0. 0 4. Cement Masons RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64. 4 $514 72 Medicare:$35.94 Curb&Gutter,Sidewalks Sergio Guzman Vf (King) 2012 E 63rd St OT 0.00 0.00 1.50 0.00 0.00 0.00 0.00. 1.50 $96.51 $144.77 $659.49/ $0.00/hr $153.67 $267.00 $2,048.68 Tacoma,WA- $2,505.29 .....**.. 98404 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1281,6 so.QO 5. Cement Masons Armando Moran RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514.72 Medicare:$34.88 Bracamontes $562.98/ $0.00/hr $149.16 $399.00 $1,822.74 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Curb&Gutter,Sidewalks 3720 S 239th St v v $2,405.78 (King) Kent,WA-98032 OT 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 $96.51 $48.26 ********* DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128.6 $0 j 6. Cement Masons RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.34 $514. 2 Medicare:$36.93 Curb&Gutter,Sidewalks Abraham Moran Le (King) p J e $707.74! 1918 SW 351st St OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $2 581 79 $0.00/hr $157.88 $403.00 $1,983.98 ********* Federal Way,WA- 98023 DT 0.00 0.00 0.00 0.00 0.00. 0.00 0.00 0.00 $128 6 $0.Q0 Qi 7. Laborers RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $52.$9 $419E12 Medicare:$23.81 Cement Finisher Tender Issaic Padilla J J(King) 19314 75th St E OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $78.59 $157.18 $576.30! $0.00/hr $101.82 $222.00 $1,294.67 ********* Bonney Lake,WA- $1,642.30 98391 $104.7 - DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 �0 J, $O.Op __.�'ement Masons `1 J Medicare:$40.39 Curb&Gutter,Sidewalks Jorge Velasco RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.$4 $514.72 4. (King) Guzman J VI $707.741 8012 147th St E OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 •2.00 $96.51 $193.02 $2 811.79 $0.00/hr $172.67 $285.00 $2,313.73 ***_**_**** Puyallup,WA- 98375 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128''6 $0`90 9. Cement Masons `� `� Medicare:$37.51 Curb&Gutter,Sidewalks RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $64.04 $51472 (King) Isaac Wilson V/ J $707.74\/ / 12529 Morris Rd SE OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $96.51 $193.02 $2,825.99 $0.00/hr $160.38 $284.00 $2,344.10 ********* Yelm,WA-98597 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $188.6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries - Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Kristin Force Payroll Admin. 4/11/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons CONCRETE SERVICES INC employed by: Project Name: For the week starting: For the week ending: "wall Avenue NE 3/28/2022 4/3/2022 f 1 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Luis Alvarez Villa Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Roberto Colmenares ntreras ment Masons curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Ruben Colmenares Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.Sergio Guzman - Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Armando Moran Bracamontes Cement Masons $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Curb&Gutter,Sidewalks ng) 6.Abraham Moran Lepe Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Issaic Padilla Laborers Cement Finisher Tender $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.Jorge Velasco Guzman cement Masons rb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 9.Isaac Wilson Cement Masons Curb&Gutter,Sidewalks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !g'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,Wing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Kristin Force Payroll Admin.. Kristin Force MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side