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HomeMy WebLinkAboutCAG-20-065 - Duvall - Subcontractor Evergreen Sawcutting e .. State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 4/15/2022 1225970 5/6/2022 Company Details Company Name: EVERGREEN CONCRETE CUTTING INC Address: PO Box 1751 SUMNER, WA, 98390 Contractor Registration No. EVERGCC945CP WA UBI Number 601605667 Phone Number 253-826-7644 Industrial Insurance Account ID 88984400 OMWBE Certifications as of 4/15/2022 No active certifications existed when Intent was submitted Email Address Jen®EvergreenConcreteCutting.corn Filed By Jennifer Wolfe Prime Contractor Company Name REED TRUCKING a EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Phone Number 253-841-4837 Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee w a Awarding Agency Contact Phone Number 425-430-7303 Contract Number CAG-20-065 Project Name Duvall Avenue NE Project Description This project includes but is not limited to: excavation; grading; removal of pavement; plaining pavement; paving with asphalt, curb and gutter; drainage; illumination; HAWK signal; sidewalk; walls; adjustments to utility frames, grates, and covers; property restoration; and other work. Contract Amount $5,218,171.95 Contract Type Description Bid-Build (Traditional) Bid due date 6/22/2021 Award Date 7/21/2021 Project Site Address or Directions Hiring Contractor Company Name REED TRUCKING Et EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 108630114 Intent Details Expected project start date: (MM/DD/YYYY) 4/11/2022 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is Time and materials this a time and materials estimate? Does your company intend to hire ANY No subcontractors? Will your company have employees perform Yes work on this project? No Do you intend to use any apprentices? (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Journey Level Wages County Trade Occupation Wage Fringe # Workers King Laborers Concrete Saw Operator/Core $42.29 $13.33 1 Driller Public Notes o Show/Hide Existing Notes No note exists State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 • Affidavit of Wages Paid Project Detail - Project Dashboard Document Received Date: Intent Id: Affidavit Id: 1259618 Status: Approved on 11/9/2023 1225970 11/9/2023 Company Details Name EVERGREEN CONCRETE CUTTING INC Address PO Box 1751 SUMNER,WA,98390 WA UBI no. 601605667 Contractor Registration no. EVERGCC945CP Industrial Insurance Account Id 88984400 OMWBE Certifications as of 4/15/2022 No active certifications existed when Intent was submitted Email Address kori@evergreenconcretecutting.com Filed By Spencer, Kori Prime Contractor Prime contractor name REED TRUCKING Et EXCAVATING INC Prime contractor registration no. REEDTEI016JW Prime contractor Phone Number 253-841-4837 Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: Flora Lee Awarding agency contact phone number: 425-430-7303 Contract no. CAG-20-065 Project name Duvall Avenue NE Project Description This project includes but is not limited to: excavation; grading; removal of pavement; plaining pavement; paving with asphalt, curb and gutter; drainage; illumination; HAWK restoration; and other work. Dollar amount of your contract: $ 12,050.10 Bid due date 6/22/2021 Contract award date 7/21/2021 Job site address/directions: Hiring Contractor Company Name REED TRUCKING Et EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 109670318 Project Details County where work was performed King City where work was performed Renton Prime contractor Intent form Id#for this 1170257 project Intent filed date 4/15/2022 Job start date:MM-DD-YYYY 4/25/2022 Date work completed:MM-DD-YYYY 12/6/2022 Project Completion Did your company hire any subcontractors? No Did your company have employees perform Yes work on this project? Did you use apprentice employees on this No project? Company Owner Information How many owner/operators performed work on 0 the project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation Wages Fringes # # Workers Hours Operator/Core Driller w • King Laborers Concrete Saw 46.90 13.94 '2 13.18 Operator/Core Driller King Laborers Concrete Saw 43.90 13.94 2 24.00 Operator/Core Driller Apprentice Wages Public Notes El Show/Hide Existing Notes No note exists 12/14/23,3:02 PM about:blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Project Detail - Project Dashboard Document Received Date: Intent Id: Affidavit Id: 1259618 Status: Approved on 11/9/2023 11/9/2023 1225970 Company Details Name EVERGREEN CONCRETE CUTTING INC Address PO Box 1751 SUMNER,WA,98390 WA UBI no. 601605667 Contractor Registration no. EVERGCC945CP Industrial Insurance Account Id 88984400 OMWBE Certifications as of 4/15/2022 No active certifications existed when Intent was submitted Email Address kori@evergreenconcretecutting.com Filed By Spencer, Kori Prime Contractor Prime contractor name REED TRUCKING Et EXCAVATING INC about:blank 1/4 12/14/23,3:02 PM about:blank Prime contractor registration no. REEDTEI016JW Prime contractor Phone Number 253-841-4837 Project Information • Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: Flora Lee Awarding agency contact phone number: 425-430-7303 Contract no. CAG-20-065 Project name Duvall Avenue NE Project Description This project includes but is not limited to: excavation; grading; removal of pavement; plaining pavement; paving with asphalt, curb and gutter; drainage; illumination; HAWK signal; sidewalk; walls; adjustments to utility frames, grates, and covers; property restoration; and other work. Dollar amount of your contract: $ 12,050.10 Bid due date 6/22/2021 Contract award date 7/21/2021 Job site address/directions: Hiring Contractor Company Name REED TRUCKING Et EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 109670318 Project Details County where work was performed King about:blank 2/4 12/14/2.3,3:02 PM -about:blank City where work was performed Renton Prime contractor Intent form Id# for this project 1170257 Intent filed date 4/15/2022 Job start date:MM-DD-YYYY 4/25/2022 Date work completed:MM-DD-YYYY 12/6/2022 Project Completion Did your company hire any subcontractors? No Did your company have employees perform work on this Yes project? - Did you use apprentice employees on this project? No Company Owner Information How many owner/operators performed work on the 0 project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation Wages Fringes Workers # Hours King Laborers Concrete Saw Operator/Core 42.29 13.33 2 10.50 Driller King Laborers Concrete Saw Operator/Core 46.90 13.94 2 13.18 Driller King Laborers Concrete Saw Operator/Core 43.90 13.94 2 24.00 Driller about:blank 3/4 12/14/23,3:02 PM about:blank Apprentice Wages Public Notes El Show/Hide Existing Notes No note exists " 'aboutblank 4/4 Certified Payroll Report Department of Labor and a6 ST�TF:o Project Name County Project or Contract# Industries 4::::. 4 Prime Contractor ❑ �..: Duvall Avenue NE King CAG-20-065 PrevailingWage Program a"'' ::s: 9 9 � .:: Subcontractor PO Box 44540 °,p-A' o,) Project Address Olympia WA 98504-4540 y` 188a Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/28/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name a o o Sat Sun Mon Tue Wed Thu Fri Total o a) Gross Amount and And a> E 7/22 7/23 7/24 7/25 7/26 7/27 7/28 Total Rate Earned/Gross Hourly Net Wages ra E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a) m y Benefits" Tax ce 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 Jennifer Wolfe Certified Payroll Specialist 7/31/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/22/2023 7/28/2023 "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. 5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'raining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 8/2/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and aF•STATg� Project Name County Project or Contract# Industries ,I=lif Prime Contractor ❑ PrevailingWage Program ; !=::. tt s Duvall Avenue NE King CAG-20-065 g g tai, --ir Subcontractor PO Box 44540 "f',,�;• , a`y� Project Address Olympia WA 98504-4540 ` '"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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/21/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions 1---- Work Classification Name & ~ 9- Sat Sun Mon Tue Wed Thu Fri Total rt O a) Gross Amount and And a� E 7/15 7/16 7/17 7/18 7/19 7/20 7/21 Total Rate Earned/Gross Hourly Net Wages 6 Hours of Pay y "Usual FICA Wit Taxding Other g Soc Sec#of Employee Address ce 0 o Hours Worked Each Day Payroll Benefits" 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 Jennifer Wolfe Certified Payroll Specialist 7/24/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/15/2023 7/21/2023 "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. '5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and i'raining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe • MB 8/2/23 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�sT,T �, Project Name County Project or Contract# Industries s Prime Contractor ❑ Duvall Avenue NE King CAG-20-065 PrevailingWage Program ''''_ 9 9 ,,,,�. ��::,g Subcontractor NI PO Box 44540 6 ;„�r ", Project Address Olympia WA 98504-4540 y` '��0 a� 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/14/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name & ~ o Sat Sun Mon Tue Wed Thu Fri Total O • a, Gross Amount and And au E 7/8 7/9 7/10 7/11 7/12 7/13 7/14 Total Rate Earned/Gross Hourly Net Wages E 0 Hours of Pay Usual FICA Withholding Other Soc Sec#of Employee Address Tax O o Hours Worked Each Day Payroll Benefits" 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 Jennifer Wolfe Certified Payroll Specialist 7/17/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/8/2023 7/14/2023 "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. 5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and raining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe • MB 8/2/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and !...51: r*.q. A Project Name County Project or Contract# IndustriesPrime Contractor O T Duvall Avenue NE King CAG-20-065 PrevailingWage Program t` 9 9 ,, .;;r• Subcontractor NI PO Box 44540 ,,,�•�. v' Project Address Olympia WA 98504-4540 y` '"g� '� 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/7/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions r Work Classification Name c9 b o Sat Sun Mon Tue Wed Thu Fri Total ix O • cu Gross Amount and And a) E 7/1 7/2 7/3 7/4 7/5 7/6 7/7 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address c Payroll 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 Jennifer Wolfe Certified Payroll Administrator 7/12/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/1/2023 7/7/2023 "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. 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe MB 8/2/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and aF,ST"TF 0 Prime Contractor ❑ Industries Project Name County Project or Contract# 4::: o;;;; � Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4€ i - " ,,,;� ,,i Subcontractor ® Project Address PO Box 44540 % Olympia WA 98504-4540 y`' '"S9��v Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/30/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions IL- Work Classification Name c9 b o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount a) E 6/24 6/25 6/26 6/27 6/28 6/29 6/30 Total Rate Hourly and And Earned/Gross WithholdingNet Wages m E m Hours of Pay y "Usual FICA Tax Other Soc Sec#of Employee Address m > Payroll Benefits" IX 0 c) 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 Jennifer Wolfe Certified Payroll Administrator 7/7/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/24/2023 6/30/2023 "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. i)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'raining 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe MB 8/2/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �FT^r Prime Contractor ❑ Project Name County Project or Contract# Industries s Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4 ;,.. . '= Subcontractor PO Box 44540 T ;„� wcy,_ Project Address Olympia WA 98504-4540 y` '�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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/23/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F= Work Classification Name & ~O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And a) E 6/17 6/18 6/19 6/20 6/21 6/22 6/23 Total Rate Earned/Gross Hourly Net Wages m r Hours of Pay Payroll Usual FICA Withholding Other Soc Sec#of Employee Address ax CD o o Hours Worked Each Day Benefits" 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 Jennifer Wolfe Certified Payroll Administrator 6/29/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/17/2023 6/23/2023 "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 .4 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 'raining 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe MB 8/2/23 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,STATgO Prime Contractor ❑ Project Name County Project or Contract# Industries 4: 4. :r;• � Duvall Avenue NE King CAG-20-065 PrevailingWage Program `_ 9 9 .;;z Subcontractor NI PO Box 44540 �' v° Project Address Olympia WA 98504-4540 y` 'yes ao Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/16/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F Work Classification Name a ~ ° Sat Sun Mon Tue Wed Thu Fri Total cC O a, Gross Amount and And a) E 6/10 6/11 6/12 6/13 6/14 6/15 6/16 Total Rate Earned/Gross Hourly Net Wages co E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address d y Benefits" Tax cc 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 Jennifer Wolfe Certified Payroll Administrator 6/22/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/10/2023 6/16/2023 "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. -"'5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and _.,'raining 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe MB 8/2/23 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�aTerF.o Project Name County Project or Contract# Industries x Prime Contractor ❑ 0.,,. �, Duvall Avenue NE King CAG-20-065 a:E.. Prevailing Wage Program ;`.$ Subcontractor El PO Box 44540 ,..4, ,� Project Address Olympia WA 98504-4540 y` 188s 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/9/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c7 ~O o Sat Sun Mon.Tue Wed Thu Fri Total m E 6/3 6/4 6/5 6/6 6/7 6/8 6/9 Total Rate Earned/Gross Hourly and Andco E Gross Amount Net Wages 'E __ Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address ct o o Hours Worked Each Day Benefits" 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 Jennifer Wolfe Certified Payroll Specialist 6/13/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/3/2023 6/9/2023 "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. ,5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ' ,.[-raining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe • MB 8/2/23 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'91,• 'f,� Project Name County Project or Contract# Industries . ,,, Prime Contractor ❑ s- ,_.!...it. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ='nf ' ,: 0. Subcontractor El PO Box 44540 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/2/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name ( ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 5/27 5/28 5/29 5/30 5/31 6/1 6/2 Total Rate Hourly Net Wages Earned/Gross Withholding g m E Hours of Pay Payroll "Usual FICA Other Soc Sec#of Employee Address C z 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 Jennifer Wolfe Certified Payroll Specialist 6/5/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/27/2023 6/2/2023 "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. ( ' tt ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,iing 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 6/6/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side -.... Certified Payroll Report Department of Labor and �t,=,.arf Project Name County Project or Contract# Industries Prime Contractor ❑ `==t.r.Ai v Duvall Avenue NE King CAG-20-065 Prevailing Wage Program i=, �� ,14114 Subcontractor PO Box 44540 'y'• r 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/26/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name 0 O~ o Sat Sun Mon Tue Wed Thu Fri Total a> Gross Amount and And m E 5/20 5/21 5/22 5/23 5/24 5/25 5/26 Total Rate Earned/Gross Hourly Net Wages j fE Hours of Pay Payroll "Usual FICA Withholding Other a) 0 y Benefits" Tax Soc Sec#of Employee Address cr 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 Jennifer Wolfe Certified Payroll Specialist 5/30/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/20/2023 5/26/2023 "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. °iy 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 6/6/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �. STATF Project Name County Project or Contract# Industries ..pri••_s��•,. Prime Contractor E 11• 1::.y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program �!i=i- ,4'=: Subcontractor PO Box 44540 ' '4 Project Address .? .� oy- 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/19/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name a p a Sat Sun Mon Tue Wed Thu Fri Gross Amount Total E 5/13 5/14 5/15 5/16 5/17 5/18 5/19 Total Rate Hourly Net Wages and And Earned/Gross Withholdin g m E Hours of Pay Payroll "Usual FICA Tax g Other r m Benefits" Soc Sec#of Employee Address 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 Now— 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 Jennifer Wolfe Certified Payroll Specialist 5/23/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/13/2023 5/19/2023 "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. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ding 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 5/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and F,..„?AT, Project Name County Project or Contract# Industries _� :t,r•ti,ft:'y Prime Contractor ❑ Prevailing Wage Program Fisd,. ,:;?;_ Duvall Avenue NE King CAG-20-065 PO Box 44540 ?s -' Subcontractor ® Project Address yy'� a"y Olympia WA 98504-4540 ,i 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/12/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name C9 ~O o Sat Sun Mon Tue Wed Thu Fri Total at Gross Amount and And E 5/6 5/7 5/8 5/9 5/10 5/11 5/12 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m a) Payroll Benefits" Tax o! 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 Jennifer Wolfe Certified Payroll Specialist 5/16/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/6/2023 5/12/2023 "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. (s)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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 5/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �, �.,rF, Project Name County Project or Contract# Industries �? _- Prime Contractor ❑ Prevailing Wage Program = tts, ail= _ Duvall Avenue NE King CAG 20-065 pis,: 19.:— Subcontractor ►_� PO Box 44540 'i.,9•If ,�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: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/5/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name & o 9- Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And L.. a) E 4/29 4/30 5/1 5/2 5/3 5/4 5/5 Total Rate Earned/Gross Hourly Net Wages co E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m a) y Benefits" Tax O 0 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 Jennifer Wolfe Certified Payroll Specialist 5/9/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 4/29/2023 5/5/2023 "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 '( '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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 5/30/23 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and f,,,,TAT F Project Name County Project or Contract# &+.:._•�_ «:°= Prime Contractor ❑ Industries °�:. y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program `iHili , s€ �� Al Subcontractor ZI PO Box 44540 ""' Project Address Olympia WA 98504-4540 y-4 '""`',v Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 4/28/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name c9 p GISat Sun Mon Tue Wed Thu Fri Total 5 w Gross Amount and And m E 4/22 4/23 4/24 4/25 4/26 4/27 4/28 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address > y Benefits" Tax o 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 Jennifer Wolfe Certified Payroll Specialist 5/1/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 4/22/2023 4/28/2023 "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. ( N Qny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ding 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 5/9/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ai,STATso Project Name County Project or Contract# Industries 4;::, y Prime Contractor ❑ 4i:i Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -,9IIi, ,z Subcontractor IZI PO Box 44540 '•?ll'., ov° Project Address Olympia WA 98504-4540 "Py 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 4/21/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions i= _ Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And a� E 4/15 4/16 4/17 4/18 4/19 4/20 4/21 Total Rate Hourly Earned/Gross Net Wages 14 f a Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address O o Hours Worked Each DayII 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 Jennifer Wolfe Certified Payroll Specialist 4/24/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 4/15/2023 4/21/2023 "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. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and )ing 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 5/1/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and t ,,,TAT,‘ Prime Contractor ❑ Project Name County Project or Contract# Industries ± ""=(-y Prevailing Wage Program ii;. ,fia Duvall Avenue NE King CAG-20-065 �,E ,,ii Subcontractor El PO Box 44540 '.y�,_ Project Address Olympia WA 98504-4540 ` ;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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 4/14/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name (— ~O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And a) E 4/8 4/9 4/10 4/11 4/12 4/13 4/14 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address - m 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 Jennifer Wolfe Certified Payroll Specialist 4/17/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 4/8/2023 4/14/2023 "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. u '°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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 4/20/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and \\t,.TAif Project Name County Project or Contract# Industries et s Prime Contractor ❑ Prevailing Wage Program i u s€ Duvall Avenue NE King CAG-20-065 s t Subcontractor PO Box 44540 y, v Project Address Olympia WA 98504-4540 J ^"`'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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 4/7/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F= Work Classification Name CI 9-a) Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And d E 4/1 4/2 4/3 4/4 4/5 4/6 4/7 Total Rate Earned/Gross Hourly Net Wages 1 f is Hours of Pay Payroll "Usual FICA Withholding Tax Ing Other Soc Sec#of Employee Address a) a) a Benefits" 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 Jennifer Wolfe Certified Payroll Specialist 4/10/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 4/1/2023 4/7/2023 "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. -vh'<ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and lung 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 4/20/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��=,j?A«=.F Project Name County Project or Contract# Industries Prime Contractor ❑ :, -:::s. ` :r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program i '__, : gz Subcontractor ►� PO Box 44540 ' yi.,�r' ,,,v Project Address Olympia WA 98504-4540 nP_ ^ Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 3/31/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F= Work Classification Name c7 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And au E 3/25 3/26 3/27 3/28 3/29 3/30 3/31 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Pa roll "Usual FICA Withholding Other Soc Sec#of Employee Address CD > a y Benefits" Tax o' O 8 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 Jennifer Wolfe Certified Payroll Specialist 4/3/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/25/2023 3/31/2023 "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. (5N-�.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. t, 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �t,,TA TA Project Name County Project or Contract# 1pi Prime Contractor ❑ Industries iii! " ;: Duvall Avenue NE King CAG-20-065 PrevailingWage Program -`Rl 9 9 Ii,#. '-' Subcontractor — PO PO Box 44540 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 3/24/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name c9 ~ oa, Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And a) E 3/18 3/19 3/20 3/21 3/22 3/23 3/24 Total Rate Hourly E Hours of Pay Earned/Gross "Usual FICA g Other Net Wages Withholding Soc Sec#of Employee Address - > Payroll Benefits" Tax iy 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 Jennifer Wolfe Certified Payroll Specialist 3/27/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/18/2023 3/24/2023 "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. (73^,iy apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Acing 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and :. ,,ATF, Project Name County Project or Contract# ?:i___•1«;:.F Prime Contractor Industries ,,.S!! 1=..4 El_ :ii:y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ,1 . ;Ail Subcontractor IN: I `"4, Project Address PO Box 44540 "� v j Olympia WA 98504-4540 y, `nR"' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 3/17/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name c9 O~ o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And a� E 3/11 3/12 3/13 3/14 3/15 3/16 3/17 Total Rate Earned/Gross Hourly Net Wages r is Hours of Pay Payroll "Usual FICA Tax Withholding Other Soc Sec#of Employee Address m a) a 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 Jennifer Wolfe Certified Payroll Specialist 3/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/11/2023 3/17/2023 "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. (75` ^,iy apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ing 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and �4,STATF'U Prime Contractor ❑ Project Name County Project or Contract# Industries 4:ii` 4. ,. � Duvall Avenue NE King CAG-20-065 PrevailingWage Program 4"' "" 9 9 ...s Subcontractor PO Box 44540 "',,:°•Ar' v Project Address Olympia WA 98504-4540 H` 1A8�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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 3/10/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name 0 ~o o Sat Sun Mon Tue Wed Thu Fri Total -"I"",_ m Gross Amount and And a) E 3/4 3/5 3/6 3/7 3/8 3/9 3/10 Total Rate Earned/Gross Hourly Net Wages 3 E r Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a) - y Benefits" Tax cc 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 Jennifer Wolfe Certified Payroll Specialist 3/13/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/4/2023 3/10/2023 "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. ",5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and (raining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 3/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �ai..fT,.TE_{,� Prime Contractor ❑ Project Name County Project or Contract# Industries 4:::: +• °::::, Duvall Avenue NE King CAG 20 065 PrevailingWage Program ::::. "`_ 9 9 .::4 Subcontractor ►. PO Box 44540 `4,4„.4,, v� Project Address Olympia WA 98504-4540 y`e 188B aO Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 3/3/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H Work Classification Name cc o oa, Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And w E 2/25 2/26 2/27 2/28 3/1 3/2 3/3 Total Rate Earned/Gross Hourly Net Wages 3 E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a�i > a y 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 Jennifer Wolfe Certified Payroll Specialist 3/7/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 2/25/2023 3/3/2023 "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 I • 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)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and raining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 3/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 65T"'" Prime Contractor ❑ Project Name County Project or Contract# Industries PrevailingWage Program t ,,, Duvall Avenue NE King CAG 20 065 9 9 -'• Subcontractor LE PO Box 44540 4'„...�; v° Project Address Olympia WA 98504-4540 y` '"BV ao Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 2/24/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c9 ~o o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And a� E 2/18 2/19 2/20 2/21 2/22 2/23 2/24 Total Rate Earned/Gross Hourly Net Wages z E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address re 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 Jennifer Wolfe Certified Payroll Specialist 2/27/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 2/18/2023 2/24/2023 "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. 15)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,Graining 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 3/23/23 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�STAr F:�� Project Name County Project or Contract# If ,.4 Prime Contractor ❑ IndustriesWage Program i!=.:. Duvall Avenue NE King CAG-20-065 Prevailing 9 9 ,,.i,;,;�.-_!;;.- Subcontractor IZI PO Box 44540 '',I,n a`.4) 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 2/17/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H Work Classification Name C9 ~O 9- Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And E 2/11 2/12 2/13 2/14 2/15 2/16 2/17 Total Rate Earned/Gross Hourly Net Wages E i= 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 Jennifer Wolfe Certified Payroll Specialist 2/20/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 2/11/2023 2/17/2023 "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. 41ny 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 2/23/23 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,STATF,� Project Name County Project or Contract# �• <<::., Prime Contractor ❑ Industries :: ':,,' Duvall Avenue NE King CAG-20-065 PrevailingWage Program 4` - sie3ix 9 9 ,�,,:;,,. .�;� Subcontractor PO Box 44540 3 , , Gov' Project Address Olympia WA 98504-4540 ` 'gay Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 2/10/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name a ~O G Sat Sun Mon Tue Wed Thu Fri Total m Gross Amount and And a) E 2/4 2/5 2/6 2/7 2/8 2/9 2/10 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address CD > a 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 Jennifer Wolfe Certified Payroll Specialist 2/13/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ✓all Avenue NE 2/4/2023 2/10/2023 "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. (NI 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 2/15/23 • 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-�T";'" Prime Contractor ❑ Project Name County Project or Contract# .�a f :.G Industries 4 i t Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ji• .`.`.°', Subcontractor i3 11 r Project Address PO Box 44540 �� -' v� Final Week of Olympia WA 98504-4540 H� '-"" (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 2/3/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total r w Gross Amount and And m E 1/28 1/29 1/30 1/31 2/1 2/2 2/3 Total Rate Earned/Gross Hourly Net Wages 3 E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address f 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 Jennifer Wolfe Certified Payroll Specialist 2/7/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: rl vall Avenue NE 1/28/2023 2/3/2023 "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 _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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 2/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �����.ATf. Project Name County Project or Contract# Industries jai,, ,;.y Prime Contractor ❑ ,: r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Firii. this Subcontractor IM ''i.. I�` Project Address PO Box 44540 "°"' Olympia WA 98504-4540 yf�` '""y^w Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 1/27/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c3 O~ -a Sat Sun Mon Tue Wed Thu Fri Total � Gross Amount and And a) E 1/21 1/22 1/23 1/24 1/25 1/26 1/27 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address > 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 Jennifer Wolfe Certified Payroll Specialist 1/30/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ^n^fall Avenue NE 1/21/2023 1/27/2023 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB.2/6/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �4 STA,F. Project Name County Project or Contract# �..,!_ i:i/ Prime Contractor ❑ Industries Lin! m:4. r, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program i+i'_ �iii=Y Subcontractor El PO Box 44540 ' '.u: aov" Project Address Olympia WA 98504-4540 ` `nay Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 1/20/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H Work Classification Name C7 ~O o Sat Sun Mon Tue Wed Thu Fri Total a� Gross Amount and And a) E 1/14 1/15 1/16 1/17 1/18 1/19 1/20 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address CD Cr o 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 Jennifer Wolfe Certified Payroll Specialist 1/24/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ^..'call Avenue NE 1/14/2023 1/20/2023 "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 k . 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. ,kny 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 sTnr& Project Name County Project or Contract# '�:•:"'«{:°.. Prime Contractor ❑ Industries `"`A Duvall Avenue NE KingCAG-20-065 Prevailing Wage Program a...”. ^ : Subcontractor PO Box 44540 °, ::, 60, Project Address yy' o. Olympia WA 98504-4540 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 1/13/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 H _ Day and Date I 1 Deductions ) Work Classification Name c9 p Pro Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And . E 1/7 1/8 1/9 1/10 1/11 1/12 1/13 Total Rate Earned/Gross Hourly Net Wages al ,.EE m Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address cs > a Benefits" Tax o! 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 Jennifer Wolfe Certified Payroll Specialist 1/16/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 1/7/2023 1/13/2023 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 1/17/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and sTnr@o Project Name County Project or Contract# 4.... ° __- Prime Contractor ❑ Industries o;;'', f:i;ia Duvall Avenue NE King CAG-20-065 iics Prevailing Wage Program l i `:::: Subcontractor ❑x PO Box 44540 0,y 40"' 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 L Month Day Year Awarding Agency Address Address City State Zip+4 1/6/2023 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions I Work Classification Name ap o Sat Sun Mon Tue Wed Thu Fri - Total ce o a) 12/3 Gross Amount and And m E 1 1/1 1/2 1/3 1/4 1/5 1/6 Total Rate Hours of Pay Earned/Gross Hourly "Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address c > a Payroll Benefits" Tax ft 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 Jennifer Wolfe Certified Payroll Specialist 1/10/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 12/31/2022 1/6/2023 "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 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 • Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 1/17/23 F700-065-000 certified payroll report 05-09 • Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and R��sTnTga� Project Name County Project or Contract# E. Prime Contractor ❑ Industries a::!: 1:,4. a1E3i• y a..;,r 1.=, ,�, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ;.,...! «. Subcontractor IZI PO Box 44540 may'1 goy" Project Address Olympia WA 98504-4540 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 12/30/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 r Day and Date Deductions Work Classification Name p o Sat Sun Mon Tue Wed Thu Fri Total ec 2. a> 12/2 12/2 12/2 12/2 12/2 12/2 12/3 Gross Amount a, E Total Rate Hourly and And E F 4 5 6 7 8 9 0 Hours of PayEarned/Gross °Usual Withholding Net Wages o� 'c a, Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address a� CD> n re 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 Jennifer Wolfe Certified Payroll Specialist 1/2/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ^""vall Avenue NE 12/24/2022 12/30/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe i, 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�,sTATA. Project Name County Project or Contract# .... Prime Contractor ❑ Industries a 4. �:::;• �, Duvall Avenue NE King CAG-20-065 PrevailingWage Program '"`_ 9 9 Subcontractor IZI PO Box 44540 y:� a°yam Project Address Olympia WA 98504-4540 ` 1eB� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 12/23/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name -5 p o Sat Sun Mon Tue Wed Thu Fri Total ct o a> 12/1 12/1 12/1 12/2 12/2 12/2 12/2 Gross Amount a) E Total Rate Hourly and And m E i 7 8 9 0 1 2 3 Hours of PayEarned/Gross °Usual Withholding Net Wages Soc Sec#of Employee Address a) - Payroll Benefits" FICA Tax Other ct 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 Jennifer Wolfe Certified Payroll Specialist 12/27/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 12/17/2022 12/23/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 sTers Project Name County Project or Contract# R : -�3::°.. Prime Contractor ❑ Industries 4.;a, King Duvall Avenue NE CAG-20-065 Prevailing Wage Program a iltt Subcontractor ❑x PO Box 44540 V t; �, Project Address Olympia WA 98504-4540 `ma 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year . Awarding Agency Address Address City State Zip+4 12/16/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 e Day and Date I Deductions Work Classification Name i? 1_ o Sat Sun Mon Tue Wed Thu Fri Total ce o a 12/1 12/1 12/1 12/1 12/1 12/1 12/1 Gross Amount Total Rate Hourly Earned/GrossNet Wages and And EF. 0 1 2 3 4 5 6 Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address m CD - y Benefits" Tax o: 0 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 Jennifer Wolfe Certified Payroll Specialist 12/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 12/10/2022 12/16/2022 "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 - ti 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. "`yAny 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 ��sTATF•� Project Name County Project or Contract# ,;_ ,i Prime Contractor ❑ IndustriesWage Program -2,::::. x Duvall Avenue NE King CAG-20-065 Prevailing 9 9 ;:. :;;�� Subcontractor ® Project Address PO Box 44540 , , ov j Olympia WA 98504-4540 y` 'atl"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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 12/9/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H Work Classification Name c9 ~O oa, Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And a� E 12/3 12/4 12/5 12/6 12/7 12/8 12/9 Total Rate Earned/Gross Hourly Net Wages 3 f w Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address ce O o Hours Worked Each Day Benefits" Tax O J • J 1. Laborers RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $43.90 $351.20 Medicare:$34.05, Concrete Saw Operator/Core Workers' Driller Blake Divelbiss I Compensation: (King) 17806 75th Ave E $351.20/ OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $65.85 $0.00 �J $20.62,Union Puyallup,WA- $2,347.65 $13.94/hr $145.55 $385.00 Dues:$7.50, $1,644.17 ;; 98375 Union Dues: DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $87.80 $0.00 $110.76 2. Laborers RG 0.00 0.00 1.00 8.00 0.00 0.00 0.00 9.00 $46.90 $422.10 Medicare:$30.95, Concrete Saw Operator/Core Union Dues: Driller Andrew Shadle $103.66, I) 574 Harrington Ave OT 0.00 0.00 0.00 0.50 0.00 0.00 0.00 0.50 $70.35 $35.18 $457.28/ Workers' NE $2,141.49 $13.94/hr $132.32 $374.00 Compensation: $1,465.88 *' Renton,WA-98056 $19.50,Disability DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $93.80 $0.00 Insurance:$15.18 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 Jennifer Wolfe Certified Payroll Administrator 12/15/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: "all Avenue NE 12/3/2022 12/9/2022 "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.Blake Divelbiss Laborers Concrete Saw Operator/Core $13.94 J $5.30 $7.55 $0.00 $0.00 $1.09 Driller (King) 7 Andrew Shadle Jorers .,,,ncrete Saw Operator/Core $13.94 $5.30 $7.55 $0.00 $0.00 $1.09 Driller (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. 'F 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe 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 �.sTArk� Project Name County Project or Contract# ,- Prime Contractor ❑ Industries 4 �:y Wage Program :�••• r Duvall Avenue NE King CAG 20 065 Prevailing g g a"'' " Subcontractor El PO Box 44540 ,' ',,�r '4;,) Project Address Olympia WA 98504-4540 y` 'd�"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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 12/2/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name o Sat Sun Mon Tue Wed Thu Fri Total o m 11/2 11/2 11/2 11/2 11/3 Gross Amount and And E E 6 7 8 9 0 12/1 12/2 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m Payroll Benefits" Tax cr O o' Hours Worked Each Day a Ni1. Laborers � Medicare:$23.10, RG 0.00 0.00 0.00 0.00 5.50 0.00 8.00 13.50 $43.90 $592.65 Workers' Concrete Saw Operator/Core / Driller Blake Divelbiss J Compensation: (King) 17806 75th Ave E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $65.85 $0.00 $592.65/ J $14.79, Union Puyallup,WA- $1,593.10 $13.94/hr $98.77 $211.00 Dues:$89.46, $1,148.48 "` 98375 Union Dues: DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $87.80 $0.00 $7.50 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 Jennifer Wolfe Certified Payroll Administrator 12/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: n"vall Avenue NE 11/26/2022 12/2/2022 "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. Blake Divelbiss Laborers Concrete Saw Operator/Core $13.94 J $5.30 $7.55 $0.00 $0.00 $1.09 Driller (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. '-',,kny 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe Amended Reason Hours worked on site. Notes Hours worked on site. ti MB 12/7/22 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and sTArfi Project Name County Project or Contract# -t' i.i_,.), Prime Contractor ❑ Industries . ,;:' y,,, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program w--. :si€i'z Subcontractor ❑x PO Box 44540 -,,,i v° Project Address Olympia WA 98504-4540 Hy '��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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 11/25/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions o Sat Sun Mon Tue Wed Thu' Fri Work Classification Name c7 Total ly o 0 11/1 11/2 11/2 11/2 11/2 11/2 11/2 Gross Amount a) E Total Rate Hourly and And m E 9 0 1 2 3 4 5 Hours of Pay Earned/Gross °Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address a) a) a Payroll Benefits" Tax cK 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 Jennifer Wolfe Certified Payroll Specialist 11/29/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: n..vall Avenue NE 11/19/2022 11/25/2022 "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 Jning 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 SrnTF� Project Name County Project or Contract# .\''I __(' Prime Contractor ❑ Industries = - ; E,= Duvall Avenue NE King CAG-20-065 Prevailing Wage Program f�iii=;._- iii l ,;;ii;ii, ,f� Subcontractor ❑x PO Box 44540 ';"' y� Project Address Olympia WA 98504-4540 y` ''"By° Final Week of (360) 902-5335 Payroll III Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 11/18/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions o Sat Sun Mon Tue Wed Thu Fri Work Classification Name c7 Total eL o a) 11/1 11/1 11/1 11/1 11/1 11/1 11/1 Gross Amount a, E Total Rate Hourly and And m E p 2 3 4 5 6 7 8 Hours of Pay Earned/Gross °Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address a) .n Payroll Benefits" Tax rI O 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 Jennifer Wolfe Certified Payroll Specialist 11/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: nii"all Avenue NE 11/12/2022 11/18/2022 "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. ,\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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 AI;',";� Prime Contractor ElProject Name County Project or Contract# Industries <ki i 4. Jail; "iiio; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program e=liiii, /'!iirj Subcontractor PO Box 44540 '�i �y Project Address Olympia WA 98504-4540 H� '"H"" 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 11/11/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions ~ Thu Fri Work Classification Name C7 ~O o Sat Sun Mon Tue Wed Total 11/1 11/1 Gross Amount and And a) Ea) 11/5 11/6 11/7 11/8 11/9 Total Rate Hourly Net Wa es 0 1 Earned/Gross Withholding g ,. E r Hours of Pay " Payroll Usual FICA Other Soc Sec#of Employee Address - y Benefits" Tax IY 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 Jennifer Wolfe Certified Payroll Specialist 11/15/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 11/5/2022 11/11/2022 "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. f 1;5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe • 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 STA, _ Project Name County Project or Contract# �:6," Prime Contractor ❑ Industries 4„t :l4. PrevailingWage Program <+_�:. ' a:x Duvall Avenue NE King CAG 20-065 g g Subcontractor PO Box 44540 o;;y.lr a' Project Address Olympia WA 98504-4540 `"B" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 11/4/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date I Deductions p o Sat Sun Mon Work Classification Name cTue Wed Thu Fri Total cC 2, au 10/2 10/3 10/3 Gross Amount and And E E 9 0 1 11/1 11/2 11/3 11/4 Total Rate Earned/Gross Hourly Net Wages co E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address 0 cp Payroll Benefits" Tax W 0 E 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 Jennifer Wolfe Certified Payroll Specialist 11/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/29/2022 11/4/2022 "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. ,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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 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 ST,r4 Project Name County Project or Contract# p ,c? ti0,, Prime Contractor ❑ Industries "•' ";y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program da`.,, ,g1!j Subcontractor ❑x PO Box 44540 4�ii= vn Project Address Olympia WA 98504-4540 y` �aea 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 10/28/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions ~ Sat Sun Mon Tue Wed Thu Fri Work Classification Name c� ~ Total cC o 0 10/2 10/2 10/2 10/2 10/2 10/2 10/2 Gross Amount Total Rate Hourly and And m E i= 2 3 4 5 6 7 8 Hours of Pay Earned/Gross °Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address Payroll Benefits" Tax Cr 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 Jennifer Wolfe Certified Payroll Specialist 11/1/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 10/22/2022 10/28/2022 "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. 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe • MB 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 at.STArF. Project Name County Project or Contract# Industries y Iii "•;, y Prime Contractor ❑ .:;'. lity Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ,I!'•3ji. <s�'•il= Subcontractor"'•;}',t, 1; Project Address PO Box 44540 ''�''` �y° j Olympia WA 98504-4540 e� 'b-"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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 10/21/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions o Sat Sun Mon Tue Wed Thu Fri Work Classification Name C� Total cr o a> 10/1 10/1 10/1 10/1 10/1 10/2 10/2 Gross Amount a, E Total Rate Hourly and And E 5 6 7 8 9 0 1 Hours of PayEarned/Gross °Usual Withholding Net Wages f a, Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address a, > o_ 0 o Hours Worked Each Day 0 J Ni1. Laborers RG 0.00 0.00 0.00 0.00 0.00 2.50 0.00 2.50 $43.90 $109.75 Medicare:$14.86, Concrete Saw Operator/Core Workers' Driller ` Compensation: (King) RONALD LOWE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $65.85 $0.00 $109.75/ `r/ $10.93, Union 1128 33rd St SE - - $1,046.26 $13.94/hr $63.54 $105.00 Dues:$66.03, $753.68 _ _ _. Auburn,WA-98002 Disability DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $87.80 $0.00 Insurance:$32.22 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 Jennifer Wolfe Certified Payroll Administrator 10/27/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ^..vall Avenue NE 10/15/2022 10/21/2022 "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 1.RONALD LOWE Laborers Concrete Saw Operator/Core $13.94 J $5.30 $7.55 $0.00 $0.00 $1.09 Driller (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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe Amended Reason Hours worked on site. Notes Hours worked on site. MB 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 ��S..�T�op Project Name County Project or Contract# � Prime Contractor ❑ Industries & li' Duvall Avenue NE King CAG-20-065 km:.Prevailing Wage Program . ` Subcontractor PO Box 44540 °,k,.. 0., 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 10/14/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c7 ~ o Sat Sun Mon Tue Wed Thu Fri Total o 10/1 10/1 10/1 10/1 10/1 Gross Amount and And @ E 10/8 10/9 Total Rate Hourly 0 1 2 3 4 Hours of Pay Earned/Gross ^Usual Withholding Net Wages Soc Sec#of Employee Address a Payroll Benefits" FICA Tax Other l O 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 Jennifer Wolfe Certified Payroll Specialist 10/18/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: ' For the week ending: niwvall Avenue NE 10/8/2022 10/14/2022 "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 bu 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 Jennifer Wolfe. Certified Payroll Specialist Jennifer Wolfe MB 10/24/22, F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,,Si:A1'A Project Name County Project or Contract# ?.t+ .Ei 2.. Prime Contractor ❑ Industries . ii �'ii Prevailing Wage Program ,.- ,,1 r Duvall Avenue NE King CAG-20-065 PO Box 44540 ii ; ;: Subcontractor ►� Project Address Olympia WA 98504-4540 0� '^" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 10/7/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c9 0 Sat Sun Mon Tue Wed Thu Fri Total 9-a) Gross Amount and And a) E 10/1 10/2 10/3 10/4 10/5 10/6 10/7 Total Rate Earned!Gross Hourly Net Wages cE i Hours of Pay Payroll Net FICA Withholding . Other Soc Sec#of Employee Address 0 45> - y Benefits" Tax rr O 0 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 Jennifer Wolfe Certified Payroll Specialist 10/10/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/1/2022 10/7/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 a�.M Project Name County Project or Contract# �.... • ::;.� Prime Contractor ❑ Industries '.f �> Prevailing Wage Program `;s Duvall Avenue NE King cAG-20-065 PO Box 44540 sia,:: `� Subcontractor ® Project Address Olympia WA 98504-4540 y` '"e°`� Final Week of (360)902-5335 Payroll D Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 9/30/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F= Work Classification Name c9 0 9- Sat Sun Mon Tue Wed Thu Fri Total cC O a) Gross Amount and And a) E 9/24 9/25 9/26 9/27 9/28 9/29 9/30 Total Rate Earned/Gross Hourly Net Wages fCO E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address rr 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 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 Jennifer Wolfe Certified Payroll Specialist 10/4/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/24/2022 9/30/2022 "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 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. (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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 a4.STAPA Project Name County Project or Contract# ..:_. .ii F Prime Contractor ❑ Industries =.ii ..f. . ::::r„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4.iiili, ,;iiii'; Subcontractor ❑x PO Box 44540 di.: - �,y Project Address Olympia WA 98504-4540 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 9/23/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name 0 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 9/17 9/18 9/19 9/20 9/21 9/22 9/23 Total Rate Earned/Gross Hourly Net Wages `m f a Hours of Pay Payroll "Usual FICA Withholding 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 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 Jennifer Wolfe Certified Payroll Specialist 9/27/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ivall Avenue NE 9/17/2022 9/23/2022 "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. (c`;!kny 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 Project Name County Project or Contract# 4:.?..7_*), Prime Contractor ❑ Industries ,t:? ``� 4 Duvall Avenue NE King CAG-20-065 ,.... ,esxi Prevailing Wage Program 11IJ; 'I'iEI` Subcontractor L�7 PO Box 44540 °;� ` yn 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 9/16/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c7 ~O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And a.) E 9/10 9/11 9/12 9/13 9/14 9/15 9/16 Total Rate Earned/Gross Hourl•y Net Wages `m E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address > - Payroll Benefits" Tax FY 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 Jennifer Wolfe Certified Payroll Specialist 9/20/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: nnvall Avenue NE 9/10/2022 9/16/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 9/28122 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and 5yAr., Project Name County Project or Contract# 'star- ,t•°F Prime Contractor ❑ Industries 4.:! a:i- CAG 20 065 ,,' Duvall Avenue NE King Prevailing Wage Program slIlli: r+ij3'� Subcontractor ❑x PO Box 44540 °.;.: - ,v° Project Address Olympia WA 98504-4540 �` '"""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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 9/9/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions IL- Work Classification Name p o Sat Sun Mon Tue Wed Thu Fri Total m Gross Amount and And E 9/3 9/4 9/5 9/6 9/7 9/8 9/9 Total Rate Earned/Gross Hourly Net Wages r a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address - > - 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 Jennifer Wolfe Certified Payroll Specialist 9/12/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: n,.vall Avenue NE 9/3/2022 9/9/2022 "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 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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 .i,sinrE Project Name County Project or Contract# Industries 4 3. 'i(i.'` Prime Contractor ❑ ::: • :.;;yp Duvall Avenue NE King CAG-20-065 Prevailing Wage Program iiiit4" ;��, Subcontractor PO Box 44540 4+; �k}y4, 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 9/2/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total ce m Gross Amount and And E 8/27 8/28 8/29 8/30 8/31 9/1 9/2 Total Rate Eamed/Gross Hourly Net Wages `m E H Hours of Pay "Usual FICA Withholding Other rn 0 Payroll Benefits" Tax Soc Sec#of Employee Address o tY 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 Jennifer Wolfe Certified Payroll Specialist 9/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: van Avenue NE 8/27/2022 9/2/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 9/7/22 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,i.Arw� Project Name County Project or Contract# . •:� ,.1.. Prime Contractor ❑ Industries all :`€!s. a,4,., - ,..::,.r„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program liiiilc ; �41fr Subcontractor CJ PO Box 44540 d''.. s. Project Address Olympia WA 98504-4540 �y� 'd"°a\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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 8/26/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F= Work Classification Name c7 ~O o Sat Sun Mon Tue Wed Thu Fri Total cc m Gross Amount and And u E 8/20 8/21 8/22 8/23 8/24 8/25 8/26 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address g > - y Benefits" Tax r 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 Jennifer Wolfe Certified Payroll Specialist 8/29/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ^. "all Avenue NE - 8/20/2022 8/26/2022 "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 L 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 ng 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side r z Certified Payroll Report Department of Labor and ay s Project Name County Project or Contract# Industries 04: a: Prime Contractor ❑ : � Duvall Avenue NE King CAG-20-065 Prevailing Wage Program - g Subcontractor Ox PO Box 44540 ' 4+' •;fi 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 8/19/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H Work Classification Name c 8~O oa) Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And a) 8/13 8/14 8/15 8/16 8/17 8/18 8/19 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address Tax ai ct o o Hours Worked Each Day Payroll Benefits" 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 Jennifer Wolfe Certified Payroll Specialist 8/23/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 8/13/2022 8/19/2022 "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 addend , 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. ( "Wny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and i, 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side l Certified Payroll Report Department of Labor and ��. I�}<„ Project Name County Project or Contract# Industries a,;d•W`' 4 Prime Contractor D l;,- ,,.,it r, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Illft' 'l1),,- Subcontractor PO Box 44540 ''y", Project Address Olympia WA 98504-4540 '�� ,deb"` Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 8/12/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name cD ~• O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And E 8/6 8/7 8/8 8/9 8/10 8/11 8/12 Total Rate Earned/Gross Hourly Net Wages E I= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address - CD Payroll Benefits" Tax o_ 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 Jennifer Wolfe Certified Payroll Specialist 8/16/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 8/6/2022 8/12/2022 "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 )ing 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 Prime Contractor ElProject Name County Project or Contract# Industries ;, '•i' Y, Duvall Avenue NE King CAG 20 065 -�i::•. :::: Prevailing Wage Program ,A.il„ ,,: ;._� Subcontractor N PO Box 44540 "p:41� .iy� Project Address Olympia WA 98504-4540 4.4 fNma ac Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 8/5/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions 1--- Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And a E 7/30 7/31 8/1 8/2 8/3 8/4 8/5 Total Rate Earned/Gross Hourl• y Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address Benefits" Tax fY O o Hours Worked Each Day a 1. Laborers RG 0.00 0.00 0.00 0.00 0.00 0.00 3.68 3.68 $46.90 $172.59 Medicare:$32.97, Concrete Saw Operator/Core Workers' Driller Compensation: (King) OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $70.35 $0.00 J $24.60,Union Kevin Kendall $172 59/ Dues:$127.66, ......... 8448 Katsuk Ln SE $2 281 92 $13.94/hr $140.96 $407.00 Disability $1,424.90 Tenino,WA-98589 Insurance:$8.45, DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $93.80 $0.00 Garnishment DSHS:$115.38 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 Jennifer Wolfe Certified Payroll Administrator 8/11/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: ^'-tall Avenue NE 7/30/2022 8/5/2022 "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 1. Kevin Kendall Laborers Concrete Saw Operator/Core $13.94 $5.30 $7.55 $0.00 $0.00 $1.09 Driller (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. tr`-'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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe 1 MB 8/15/22 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 gF-�F Project Name County Project or Contract# Industries 4 = =i s. Prime Contractor ❑ : - �''••:r„ Duvall Avenue NE King CAG-20-065 ..75:::`. '.iii: Prevailing Wage Program <:::;::. ...:Ir= Subcontractor PO Box 44540 Q'::::�` y Project Address Olympia WA 98504-4540 y� '�""aJ Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/29/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions F= Work Classification Name C7 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And 7/23 7/24 7/25 7/26 7/27 7/28 7/29 Total Rate Hourly Earned/Gross Net Wages f0 = Hours of Pay Payroll "Usual FICA Withholding Other g 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 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 Jennifer Wolfe Certified Payroll Specialist 8/2/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/23/2022 7/29/2022 "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. ' .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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 8/4/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �.;,,iArt Project Name County Project or Contract# Industries `�1O``'2f't ''` Prime Contractor Elid', t FNT.iicr, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 2; 111 rig Subcontractor PO Box 44540 ;yy..t. , 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/22/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name c� o o Sat Sun Mon Tue Wed Thu Fri Total a� Gross Amount E 7/16 7/17 7/18 7/19 7/20 7/21 7/22 Total Rate Hourly and And Earned/Gross Net Wages c) i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address acy' ai> - Benefits" Tax rI 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 Jennifer Wolfe Certified Payroll Specialist 7/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 7/16/2022 7/22/2022 "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. fr` 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 8/2/22 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. rs).gny 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 Jordie Admin Jordie 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 S�A?F Project Name County Project or Contract# kt:0 1;,•,. Prime Contractor E Industries •1iit ,���=y Prevailing Wage Program -::::.., • Duvall Avenue NE King CAG-20-065 11ii is Subcontractor �'3W `E i Project Address PO Box 44540 "' w" 1 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/8/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name c� ~O - Sat Sun Mon Tue Wed Thu Fri Total m Gross Amount and And cu E 7/2 7/3 7/4 7/5 7/6 7/7 7/8 Total Rate Earned/Gross Hourly Net Wages co E Hours of Pay "Usual FICA Withholding Other o„ 'Ea) Payroll Benefits" Tax Soc Sec#of Employee Address cr 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 J . 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 Jennifer Wolfe Certified Payroll Specialist 7/11/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: mall Avenue NE 7/2/2022 7/8/2022 "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 - '.d. 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 • ;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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 7/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and t ;.,»•F Project Name County Project or Contract# Industries `sL "', y Prime Contractor ❑ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Ali ' r'�i€.= Subcontractor IZI PO Box 44540 ' � �,n.,,;" Project Address Olympia WA 98504-4540 �` `b""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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 7/1/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name 0 o Sat Sun Mon Tue Wed Thu Fri Gross Amount Total and And E 6/25 6/26 6/27 6/28 6/29 6/30 7/1 Total Rate Earned/Gross Hourly Net Wages m Hours of Pay Pa roll "Usual FICA Withholding Other Soc Sec#of Employee Address o IX o Hours Worked Each Day y 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 Jennifer Wolfe Certified Payroll Specialist 7/5/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: 'f,vall Avenue NE 6/25/2022 7/1/2022 "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. ''.4ny 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 7/2.1/22 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�st rr,,�� Project Name County Project or Contract# Industries ,_,. Prime Contractor ❑ � ft . : _:.�,, Duvall Avenue NE King CAG-20-065 PrevailingWage Program <''- "_ 9 9 :;;� Subcontractor XI PO Box 44540 �',,y',�'` Project Address Olympia WA 98504-4540 ` �eB� 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/24/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H Work Classification Name c9 O o Sat Sun Mon Tue Wed Thu Fri Total a� Gross Amount and And E 6/18 6/19 6/20 6/21 6/22 6/23 6/24 Total Rate Earned/Gross Hourly Net Wages a E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a�'i > 9 y Benefits" Tax f 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 Jennifer Wolfe Certified Payroll Specialist 6/26/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 6/18/2022 6/24/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 `,t ,,xrF Project Name County Project or Contract# Industries �•4' ' Prime Contractor E tii � ::,, :3 Y` Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <; 'it Ail,�,jj,t, gl�-� Subcontractor N PO Box 44540 8�y''r �,v 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/17/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 I Day and Date Deductions Work Classification Name & ~o o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 6/11 6/12 6/13 6/14 6/15 6/16 6/17 Total Rate Earned/Gross Hourly Net Wages E _._ Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address 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 Jennifer Wolfe Certified Payroll Specialist 6/20/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/11/2022 6/17/2022 "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 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 '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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 6/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and rnrf Project Name County Project or Contract# Industries ;31}�u '!�i'`,- Prime Contractor ❑ -+h!s =!!•r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program j9llll;' ,QiIII Subcontractor PO Box 44540 '.k,, ,,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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 — Month Day Year Awarding Agency Address Address City State Zip+4 6/10/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions p Work Classification Name c7 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 6/4 6/5 6/6 6/7 6/8 6/9 6/10 Total Rate Earned/Gross Hourly Net Wages ( E Hours of Pay Payroll "Usual FICA Withholding Other 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 Jennifer Wolfe Certified Payroll Specialist 6/13/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/4/2022 6/10/2022 "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 K � 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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe 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 IAri Project Name County Project or Contract# Industries s ;' ''',", Prime Contractor ❑ ,Iii-P ,ig:6; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ,y, 6111!±: Subcontractor PO Box 44540 ''' PI 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 6/3/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions Work Classification Name a ~o o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And E 5/28 5/29 5/30 5/31 6/1 6/2 6/3 Total Rate Earned/Gross Hourly Net Wages E a Hours of Pay Payroll "Usual FICA Withholding holding Other Soc Sec#of Employee Address c 43> .fl 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 Jennifer Wolfe Certified Payroll Specialist 6/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: niivall Avenue NE 5/28/2022 6/3/2022 "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. 1,5',,4ny 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 6/7/22 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=,AT,;�, Project Name County Project or Contract# c?» f: , Prime Contractor ❑ Industries _ "' Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <;;ii; =aii?=1 Subcontractor PO Box 44540 4' ;.= r ,y Project Address Olympia WA 98504-4540 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/27/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions 1---- Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And N 5/21 5/22 5/23 5/24 5/25 5/26 5/27 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a 9 Benefits" 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 Jennifer Wolfe Certified Payroll Speciallist 5/31/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: r1uvall Avenue NE 5/21/2022 5/27/2022 "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. w�ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and l 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 Jennifer Wolfe Certified Payroll Speciallist Jennifer Wolfe M B 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 `. ' ir<,r Prime Contractor ❑ Project Name County Project or Contract# Industries x.`eat <, -tx' r',:.i', ,r. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 3., _ elf' Subcontractor PO Box 44540 "'. '_ 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/20/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions f= Work Classification Name & ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 5/14 5/15 5/16 5/17 5/18 5/19 5/20 Total Rate Hourly Earned/Gross Net Wages m E .E Hours of Pay Payroll Net FICA Withholding Other g Soc Sec#of Employee Address o II 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 Jennifer Wolfe Certified Payroll Specialist 5/23/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: 'vvall Avenue NE 5/14/2022 5/20/2022 "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 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 Jennifer Wolfe Certified Payroll Specialist Jennifer Wolfe MB 5/24/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and TA77 Project Name County Project or Contract# .ctI p i•ii.°F Prime Contractor ❑ Industries • _! a=...f 3• :' - : 9 .r,. Duvall Avenue NE King CAG-20-065 PrevailingWage Program <''' 9 9 ,, .;,� Subcontractor XI PO Box 44540 '���•� Jy°r Project Address Olympia WA 98504-4540 y� 'bad Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/13/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions IL' Work Classification Name 6 ~O o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 5/7 5/8 5/9 5/10 5/11 5/12 5/13 Total Rate Hourly E i Hours of Pay Earned/Gross "Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address fcc o Hours Worked Each Day Payroll Benefits" Tax 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 Jennifer Wolfe Certified Payroll Administrator 5/17/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: fall Avenue NE 5/7/2022 5/13/2022 "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. 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe 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 Prime Contractor ❑ Project Name County Project or Contract# Industries ;; ,' "f. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program .•.•I ,j,�n Subcontractor PO Box 44540 °•k,. ,T 55 Project Address Olympia WA 98504-4540 y� "�d 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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 5/6/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions - H Work Classification Name 3 ~• O - Sat Sun Mon Tue Wed Thu Fri Total - m Gross Amount and And a) E 4/30 5/1 5/2 5/3 5/4 5/5 5/6 Total Rate Earned/Gross Hourly Net Wages f m Hours of Pay Payroll "Usual FICA Withholding 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 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 Jennifer Wolfe Certified Payroll Administrator 5/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: nuvall Avenue NE 4/30/2022 5/6/2022 "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. ,'kny 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe Notes No Work MB 5/9/22 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?.,rf. Project Name County Project or Contract# Industries ;4k�£ , Prime Contractor ❑ -ice• n..'� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program :tit!, 0111 Subcontractor PO Box 44540 �; y Project Address Olympia WA 98504-4540 yy `e�"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 EVERGREEN CONCRETE CUTTING INC (253)826-7644 Month Day Year Awarding Agency Address Address City State Zip+4 4/29/2022 1055 S GRADY WAY RENTON,WA-98055 PO Box 1751 SUMNER WA 98390 Day and Date Deductions H _ Work Classification Name c9 ~O 9- Sat Sun Mon Tue Wed Thu Fri Total ft , Gross Amount and And a) E 4/23 4/24 4/25 4/26 4/27 4/28 4/29 Total Rate" y Earned/Gross Hourly Net Wages rn Benefits E Hours of Pay Payroll "Usual" Tax FICA Withholding Other Soc Sec#of Employee Address o o Hours Worked Each Day 0 1. Laborers Medicare:$24.85, RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $42.29 $338.32 Concrete Saw Operator/Core Workers' Driller Compensation: (King) OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $63.44 $0.00 J J $15.48,Union Kevin Kendall $338.32/ Dues:$80.33, «.... . . 4570 Avery Ln SE $1 722 39 $13.33/hr $106.26 $274.00 Disability $1,097.64 Lacey,WA-98503 Insurance:$8.45, DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $84.58 $0.00 Garnishment / DSHS:$115.38 2. Laborers Medicare:$33.71, RG 0.00 0.00 1.00 0.00 0.00 0.00 0.00 1.00 $42.29 $42.29 crete Saw Operator/Core Workers' er J J Compensation: (King) Michael Lopez OT 0.00 0.00 1.50 0.00 0.00 0.00 0.00 1.50 $63.44 $95.16 J J $24.06,Union 10215 10th Ave SW $137.45/ $13.33/hr $144.13 $399.00 Dues:$141.85, $1,431.85 Seattle,WA-98146 $2,324.60 Garnishment Traffic Violation: DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $84.58 $0.00 $150.00 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 Jennifer Wolfe Certified Payroll Administrator 5/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons EVERGREEN CONCRETE CUTTING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 4/23/2022 4/29/2022 "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 1.Kevin Kendall Laborers Concrete Saw Operator/Core $13.33 $5.04 $7.20 $0.00 $0.00 $1.09 Driller (King) 2.Michael Lopez borers _mcrete Saw Operator/Core $13.33 Ni $5.04 $7.20 $0.00 $0.00 $1.09 Driller (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 i Thing 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 Jennifer Wolfe Certified Payroll Administrator Jennifer Wolfe Notes INITIAL MB 5/9/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side