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HomeMy WebLinkAboutCAG-20-065 - Duvall - Subcontractor Lakeridge / 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 Intent Id: Affidavit Id: Status: Approved on Date: 4/25/2023 1171808 1204911 5/17/2023 Company Details Name LAKERIDGE PAVING CO L L C Address PO BOX 8500 COVINGTON,WA,98042 WA UBI no. 601592135 Contractor Registration no. LAKERPC050JM Industrial Insurance Account Id 28825603 OMWBE Certifications as of 8/24/2021 No active certifications existed when Intent was submitted Email Address Heidyb®lakepav com Filed By Brothers, Heidy Prime Contractor Prime contractor name REED TRUCKING a 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 a 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: $ 757,705.65 Bid due date 6/22/2021 Contract award date 7/21/2021 Job site address/directions: Hiring Contractor Company Name REED TRUCKING a EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 109290522 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 8/24/2021 Job start date:MM-DD-YYYY 5/2/2022 Date work completed:MM-DD-YYYY 3/29/2023 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 0 work on 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 King Laborers Raker-Asphalt 54.01 0.00 15 387.50 King Power Roller, Plant Mix Or 72.28 0.00 7 280.50 Equipment Multi-lift Materials Operators King Truck Drivers Other Trucks 64.55 0.00 10 59.63 King Truck Drivers Asphalt Mix To 16 Yards 63.71 0.00 10 398.50 King Laborers General Laborer 52.39 0.00 1 37.00 King Power Spreader, Topsider a 73.49 0.00 10 352.50 Equipment Screedman Operators King Power Mechanics,All (leadmen 74.22 0.00 1 8.00 Equipment - $0.50 Per Hour Over Operators Mechanic) King Power Shovel, Excavator, 74.22 0.00 1 7.00 Equipment Backhoes: Over 50 Operators Metric Tons To 90 Metric Tons King Power Roto-mill, Roto-grinder 72.84 0.00 1 7.00 Equipment Operators King Power Gradechecker/Stakeman 69.12 0.00 1 8.00 Equipment Operators Apprentice Wages Public Notes o Show/Hide Existing Notes -- On 4/25/2023:-- Truck Driver/ Other Truck is used for Low Bed Heavy Trailer Truck Drivers. They mobilize the equipment to the job site. General Laborers -Assist the Foreman, Operators and Crew on projects. They use brooms, shovels and buckets. They do anything from filling the water coolers to sweeping up at a job site, whatever is needed to assist the crew. • 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 Intent Id: Affidavit Id: Status: Approved on Date: 12/7/2022 1171808 1167621 12/28/2022 Company Details Name LAKERIDGE PAVING CO L L C Address PO BOX 8500 COVINGTON,WA,98042 WA UBI no. 601592135 Contractor Registration no. LAKERPC050JM Industrial Insurance Account Id 28825603 OMWBE Certifications as of No active certifications existed when Intent was 8/24/2021 submitted Email Address Heidyb@lakepay.com Filed By Brothers, Heidy Prime Contractor Prime contractor name REED TRUCKING Et EXCAVATING INC Prime contractor registration REEDTEI016JW no. Prime contractor Phone 253-841-4837 Number Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: Flora Lee Awarding agency contact 425-430-7303 phone number: 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 $ 757,705.65 contract: Bid due date 6/22/2021 Contract award date 7/21/2021 Job site address/directions: Hiring Contractor Company Name REED TRUCKING It EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 109055047 Project Details County where work was King performed City where work was Renton performed Prime contractor Intent form 1170257 Id#for this project Intent filed date 8/24/2021 Job start date:MM-DD-YYYY 5/2/2022 Date work completed:MM-DD- 11/9/2022 YYYY Project Completion Did your company hire any No subcontractors? Did your company have Yes employees perform work on this project? Did you use apprentice No employees on this project? 1 R Company Owner Information How many owner/operators 0 performed work on 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 King Laborers Raker-Asphalt 54.01 0.00 15 362.00 King Power Equipment Roller, Plant Mix Or 72.28 0.00 7 262.50 Operators Multi-lift Materials King Truck Drivers Other Trucks 64.55 0.00 10 50.88 King Truck Drivers Asphalt Mix To 16 63.71 0.00 10 393.00 Yards King Laborers General Laborer 52.39 0.00 1 37.00 King Power Equipment Spreader, Topsider Et 73.49 0.00 9 325.00 Operators Screedman King Power Equipment Mechanics, All 74.22 0.00 1 8.00 Operators (leadmen - $0.50 Per Hour Over Mechanic) Apprentice Wages Public Notes o Show/Hide Existing Notes -- On 12/7/2022:-- Truck Driver/ Other Truck is used for Low Bed Heavy Trailer Truck Drivers. They mobilize the equipment to the job site. General Laborers - Assist the Foreman, Operators and Crew on projects. They use brooms, shovels and buckets. They do anything from filling the water coolers to sweeping up at a job site, whatever is needed to assist the crew. 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: 8/24/2021 1171808 8/30/2021 Company Details Company Name: LAKERIDGE PAVING CO L L C Address: . PO BOX 8500 COVINGTON,.WA, 98042 Contractor Registration No.. LAKERPC050JM WA UBI Number 601592135 Phone Number 253-631-829.0 Industrial Insurance Account ID 28825603 OMWBE Certifications as of 8/24/2021 No active certifications existed when Intent was submitted Email Address Heidyb@lakepav com - Filed By . . . Heidy Brothers Prime Contractor Company Name REED TRUCKING &t 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 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 &t EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 108241168 Intent Details Expected project start date: (MM/DD/YYYY) 9/15/2021 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 $706,900.00 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? Do you intend to.use any apprentices? No (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 # 8 8 Workers King Truck Drivers Other Trucks $64.55 $0.00 1 King Truck Drivers Asphalt Mix To 16 Yards $63.71 $0.00 1 King Truck Drivers Asphalt Mix Over 16 Yards $64.55 $0.00 1 King Power Equipment Operators Spreader, Topsider Et $73.49. $0.00 1 Screedman King Power Equipment Operators Roller, Plant Mix Or Multi-lift $72.28 $0.00 1 Materials King Laborers Raker-Asphalt $54.01 $0.00 1 King Laborers General Laborer $52.39 $0.00 1 King Flaggers Journey Level $44.40 $0.00 1 Public Notes Show/Hide Existing Notes -- On 8/24/2021:-- Truck Driver /Other Truck is used for Low Bed Heavy Trailer Truck Drivers. They mobilize the equipment to the job site. General Laborers -Assist the Foreman, Operators and.Crew on projects. They use brooms, shovels and buckets. They do anything from filling the water coolers to sweeping up at a job site, whatever is needed to assist the crew. 12/1d123,3:27 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: 1167621 Status: Approved on 12/28/2022 12/7/2022 1171808 Company Details Name LAKERIDGE PAVING CO L L C Address PO BOX 8500 COVI NGTON,WA,98042 WA UBI no. 601592135 Contractor Registration no. LAKERPC050JM Industrial Insurance Account Id 28825603 OMWBE Certifications as of 8/24/2021 No active certifications existed when Intent was submitted Email Address Heidyb@lakepay.com Filed By Brothers, Heidy Prime Contractor Prime'contractor name REED TRUCKING Et EXCAVATING INC about:blank 1/4 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: $ 757,705.65 Bid due date 6/22/2021 Contract award date 7/21/2021 Job site address/directions: Hiring Contractor Company Name REED TRUCKING Ft EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 109055047 Project Details County where work was performed King about:blank 2/4 12/14 23,3:27 PM about:blank City where work was performed Renton Prime contractor Intent form Id# for this project 1170257 Intent filed date 8/24/2021 Job start date:MM-DD-YYYY 5/2/2022 Date work completed:MM-DD-YYYY 11/9/2022 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 Raker -Asphalt 54.01 0.00 15 362.00 King Power Equipment Operators Roller, Plant Mix Or Multi-lift 72.28 0.00 7 262.50 Materials King Truck Drivers Other Trucks 64.55 0.00 10 50.88 King Truck Drivers Asphalt Mix To 16 Yards 63.71 0.00 10 393.00 King Laborers General Laborer 52.39 0.00 1 37.00 about:blank 3/4 12/14/23,3:27 PM about:blank King Power Equipment Operators Spreader, Topsider Et Screedman 73.49 0.00 9 325.00 King Power Equipment Operators Mechanics,All (leadmen - $0.50 74.22 0.00 1 8.00 Per Hour Over Mechanic) Apprentice Wages Public Notes o Show/Hide Existing Notes. -- On 12/7/2022:-- Truck Driver / Other Truck is used for Low'Bed Heavy Trailer Truck Drivers.. They mobilize the equipment to the job site. General Laborers-Assist the Foreman, Operators and :Crew on projects. They use. brooms, shovels and buckets. They do anything from filling the water coolers.to sweeping.up at a job.site, whatever is needed to assist the crew. —' about:blank 4/4 12/141E3,3:22 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: 1204911 Status: Approved on 5/17/2023 4/25/2023 1171808 Company Details Name LAKERIDGE PAVING CO L L C Address PO BOX 8500 COVINGTON,WA,98042 WA UBI no. 601592135 Contractor Registration no. LAKERPC050JM Industrial Insurance Account Id 28825603 OMWBE Certifications as of 8/24/2021 No active certifications existed when Intent was submitted Email Address Heidyb@lakepay.com Filed By Brothers, Heidy Prime Contractor Prime contractor name REED TRUCKING &t EXCAVATING INC about:blank 1/4 12/14/23,3:22 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: $ 757,705.65 Bid due date 6/22/2021 Contract award date 7/21/2021 Job site address/directions: Hiring Contractor Company Name REED TRUCKING a EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 109290522 Project Details County where work was performed King .about:blank 2/4 12/14/23,3:22 PM about:blank City where work was performed Renton Prime contractor Intent form Id# for this project 1170257 Intent filed date 8/24/2021 Job start date:MM-DD-YYYY 5/2/2022 Date work completed:MM-DD-YYYY 3/29/2023 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 Raker -Asphalt 54.01 0.00 15 387.50 King Power Equipment Operators Roller, Plant Mix Or Multi-lift 72.28 0.00 7 280.50 Materials King Truck Drivers Other Trucks 64.55 0.00 10 59.63 King Truck Drivers Asphalt Mix To 16 Yards 63.71 0.00 10 398.50 King Laborers General Laborer 52.39 0.00 1 37.00 about:blank 3/4 12/14/23,3:22 PM about:blank King Power Equipment Operators Spreader, Topsider a Screedman 73.49 0.00 10 352.50 King Power Equipment Operators • Mechanics,All (leadmen - $0.50 74.22 0.00 1 8.00 Per Hour Over Mechanic) King Power Equipment Operators Shovel, Excavator, Backhoes: 74.22 0.00 1 7.00 Over 50 Metric Tons To 90 Metric Tons _ King Power Equipment Operators Roto-mill, Roto-grinder 72.84 0.00 1 7.00 King Power Equipment Operators Gradechecker/Stakeman 69.12 0.00 1 8.00 Apprentice Wages Public Notes o Show/Hide Existing Notes -- On 4/25/2023:-- Truck Driver / Other Truck is used for Low Bed Heavy Trailer Truck Drivers: They mobilize the equipment.to the job site. General Laborers -Assist the Foreman, Operators and Crew on projects. They use brooms, shovels and buckets. They do anything from filling the water coolers to sweeping up at a job site, whatever is needed to assist the crew. .abo!t:blank 4/4 12114/33,3:05 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: 1233530 Status: Approved on 8/24/2023 8/17/2023 1171808 Company Details Name LAKERIDGE PAVING CO L L C Address PO BOX 8500 COVINGTON,WA,98042 WA UBI no. 601592135 Contractor Registration no. LAKERPC050JM Industrial Insurance Account Id 28825603 OMWBE Certifications as of 8/24/2021 No active certifications existed when Intent was submitted Email Address Heidyb@lakepay.com Filed By Brothers, Heidy Prime Contractor Prime contractor name REED TRUCKING Et EXCAVATING INC about:blank 1/4 12/14/23,3:05 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: $ 706,900.00 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: 109509301 Project Details County where work was performed King aboiR"olank 2/4 12/14/23,3:05 PM about:blank City where work was performed Renton Prime contractor Intent form Id# for this project 1170257 Intent filed date 8/24/2021 Job start date:MM-DD-YYYY 5/2/2022 Date work completed:MM-DD-YYYY 7/21/2023 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 Power Equipment Operators Roller, Plant Mix Or Multi-lift 72.28 0.00 7 280.50 Materials King Truck Drivers Other Trucks 64.55 0.00 10 59.63 King Truck Drivers Asphalt Mix To 16 Yards 63.71 0.00 11 405.00 King Laborers Raker -Asphalt 54.01 0.00 18 406.50 King Laborers General Laborer 52.39 0.00 1 37.00 about:blank 3/4 12/14/23,3:05 PM about:blank King Power Equipment Operators Spreader, Topsider it Screedman 73.49 0.00 10 352.50 King Power Equipment Operators Mechanics, All (leadmen - $0.50 74.22 0.00 1 8.00 Per Hour Over Mechanic) King Power Equipment Operators Shovel, Excavator, Backhoes: 74.22 0.00 1 7.00 Over 50 Metric Tons To 90 Metric Tons King Power Equipment Operators Roto-mill, Roto-grinder 72.84 0.00 1 7.00 King Power Equipment Operators Gradechecker/Stakeman 69.12 0.00 1 8.00 Apprentice Wages Public Notes El Show/Hide Existing Notes -- On 8/17/2023:-- Truck Driver / Other Truck is used for Low Bed Heavy Trailer Truck Drivers. They mobilize the equipment to the job site. General Laborers -Assist the Foreman, Operators and Crew on projects. They use brooms, shovels and buckets. They do anything from filling the water coolers to sweeping up at a job site, whatever is needed to assist the crew. about:i5lank 4/4 Certified Payroll Report STATs Project Name County Project or Contract# Department of Labor and ,S+!;:,. .,,,... Prime Contractor ❑ Industries i Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <::, "A Subcontractor ® Project Address PO Box 44540 :"k oy"= Olympia WA 98504-4540 y` 188�a Final Week of (360) 902-5335 Payroll El Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 4/1/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions i- Work Classification Name p o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount Hourl And a) E 3/26 3/27 3/28 3/29 3/30 3/31 4/1 Total Rate Earned/Gross g y Withholding Net Wages and c`v E ) Hours of Pay "Usual FICA Other a) Payroll Benefits Tax Soc Sec#of Employee Address a) a) = "Hours Worked Each Day IX O o a 1. J NItaxes:$12.18 Power Equipment RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $69.12 $552.96 r Operators Virginia Basher �J O Gradechecker/Stakeman 15308 116th St E $103.6 $552.96/ (King) Puyallup,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,016.016.72 $0.00/hr $77.78 $67.97 $858.79 98374 $138.2 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4 $0.00 taxes:$27.43, 2. Truck Drivers RG 0.00 0.00 0.00 2.34 0.00 0.00 0.00 2.34 $64.55 $151.05 $11.41, Other Trucks WILLIAM medical:e ins: 11.4, (King) CARLSON $516.94/ 21447 Piessner Rd OT 0.00 0.00 0.00 0.16 0.00 0.00 0.00 0.16 $96.82 $15.49 $2,128.55 $0.00/hr $161.96 $344.96 401(k):$50.00 $1,521.52 Yelm,WA-98597 $129.1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 $0.00 taxes:$27.43, uck Drivers RG 0.00 0.00 0.00 5.50 0.00 0.00 0.00 5.50 $63.71 $350.41 $11.41, Asphalt Mix To 16 Yards WILLIAM medical:e ins:$11.27,1. (King) CARLSON $516.94/ 21447 Piessner Rd OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $95.57 $0.00 $2,128.55 $0.00/hr $161.96 $344.96 401(k):$50.00 $1,521.52 _= Yelm,WA-98597 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 taxes:$25.66, 4. Power Equipment RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $72.28 $578.24 medical:$11.41, Operators life ins:$1.16, Materials 25434 144th PI OT 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 2 $54.21 Roller, Plant Mix Or Multi-lift COREY GURSLEY $108.4 $632.45/ $0 00/hr $150.32 $301.66 garn:$154.29 $1,331.95 $1,976.45 (King) Kent,WA-98042 $144.5 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6 $0.00 ' - - taxes:$31.44, 5. Truck Drivers JEFFREY RG 0.00 0.00 1.88 0.00 0.00 0.00 0.00 1.88 $64.55 $121.35 JACKSON $559.19/ $0.00/hr $157.00 $302.67 medical:$11.41 $1,561.17 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Sid( Other Trucks 5836 A St $2,063.69 (King) Tacoma,WA- OT 0.00 0.00 0.12 0.00 0.00 0.00 0.00 0.12 $96.82 $11.62 98408 - $129.1 * - - ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 $0.00 6. Truck Drivers RG 0.00 0.00 6.12 0.00 0.00 0.00 0.00 6.12 $63.71 $389.91 taxes:$31.44, Asphalt Mix To 16 Yards JEFFREY medical:$11.41 (King) JACKSON $559.19/ 5836 A St OT 0.00 0.00 0.38 0.00 0.00 0.00 0.00 0.38 $95.57 $36.32 $2 063.69 $0.00/hr $157.00 $302.67 $1,561.17 * _ _ ** Tacoma,WA- 98408 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127'4 $0.00 2 7. Laborers RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $54.01 $432.08 taxes: l:$11 , Raker-Asphalt BENJAMIN medical:$11.41 (King) JOHNSON OT 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 $81.02 $40.51 $472.59/ $0.00/hr $97.24 $130.82 $1,024.34 * ** 28915 20th Ave S $1,282.59 Roy,WA-98580 $108.0 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 _aborers RG 0.00 0.00 7.16 0.00 0.00 0.00 0.00 7.16 $54.01 $386.71 taxes: , Raker-Asphalt BRIAN NEWELL medical:l:$11.$11.41 (King) 501 McKenzie Ave OT 0.00 0.00 1.34 0.00 0.00 0.00 0.00 1.34 $81.02 $108.57 $495.28/ $0.00/hr $119.72 $145.18 $1,277.17 * ** SW $1,576.35 Yelm,WA-98597 $108.0 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2J $0..00 9. Power Equipment RG 0.00 0.00 7.00 0.00 0.00 0.00 0.00 7.00 $74.22 $519.54 taxes:$15.72, Operators J medical:$78.40, Shovel, Excavator, Backhoes: garn:$340.83 James Quimby $111.3 Over 50 Metric Tons To 90 103 Skyline Dr OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $519.54/ Metric Tons y $1,195.54 $0.00/hr $85.47 $97.86 $577.26 Elma,WA-98541 (King) DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $14'4 $0.00 10. Power Equipment RG 0.00 0.00 7.00 0.00 0.00 0.00 0.00 7.00 $72.84 $509.88 taxes:$18.90, Operators 401(k):$62.50, NICKOLAS REITER Roto-mill,Roto-grinder 22512 45th Ave aflac:$33.49,life OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $109.2 $0.00 $509.88/ $0.00/hr $94.98 $188.62 ins:$3.10 $906.42 (King) Spanaway,WA- 6 $1,308.01 98387 $145.6 * '* DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 11. Truck Drivers RG 0.00 0.00 2.67 0.00 0.00 0.00 0.00 2.67 $64.55 $172.35 taxes:$23.33, Other Trucks SCOTT RIGTRUP 401(k):$374.46 (King) 19412 207th Street $325.32/ * ** Ct E OT 0.00 0.00 1.58 0.00 0.00 0.00 0.00 1.58 $96.82 $152.98 $1 872.32 $0.00/hr $143.23 $68.90 $1,262.40 Orting,WA-98360 $129.1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 $0.00 12. Laborers RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $54.01 $432.08 taxes:$20.48 Raker-Asphalt Samuelu Samaga (King) 11222 18th Ave S $472.59/ APT#305 OT 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 $81.02 $40.51 $1385.10 $0.00/hr $105.97 $155.89 $1,102.76 Tacoma,WA- 98444 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 2 08'0 $0.00 13. Power Equipment TUVALE SAMAGA taxes:$22.51, Operators 12209 106th Ave Ct RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $73.49 $587.92 $643.04/ $0.00/hr $142.77 $261.76 medical:$47.21 $1,439.30 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Sid( ' 1 Spreader,Topsider& E I $110.2 $1,913.55 Screedman Puyallup,WA- OT 0.00 0.00 0.50 0.00 0.00 0.00 0.00 1 0.50 3 $55.12 (King) 98374 ......... DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186'9 $0.00 14. Power Equipment RG 0.00 0.00 7.24 0.00 0.00 0.00 0.00 7.24 $73.49 $532.07 taxes: , Operators medical:l:$11.$11.41 JACOB Spreader,Topsider& SCHNEIDER $110 2 $781.19/ Screedman 1508 Taylor St OT 0.00 0.00 2.26 0.00 0.00 0.00 0.00 2.26 3 ' $249.12 $1 828 69 $0.00/hr $139.02 $260.97 $1,393.94 (King) Milton,WA-98354 ......... DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 a6.9 $0.00 15. Power Equipment taxes:$31.63, RG 0.00 0.00 7.24 0.00 0.00 0.00 0.00 7.24 $73.49 $532.07 Operators medical:$11.41, JOSHEPH SMITH hsa:$50.00 Spreader,Topsider& 39611 62nd Ave $110 2 $781.19/ Screedman OT 0.00 0.00 2.26 0.00 0.00 0.00 0.00 2.26 $249.12 $0.00/hr $193.78 $296.00 $2,011.70 Eatonville,WA- 3 $2,594.52 (King) 98328 $146.9 / 1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 ......... 16. Power Equipment RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $72.28 $578.24 taxes: , Operators medical:l:$11.$11.41, Caleb Wakefield arn: Roller, Plant Mix Or Multi-lift 1446 Main St $108 4 $740 87/ g $105.00 Materials Buckley,WA- OT 0.00 J 0.00 1.50 0.00 0.00 0.00 0.00 1.50 2 ' $162.63 $2 212 87 $0.00/hr $168.41 $299.04 $1,600.65 (King) 98321 i . ....... DT 0.00I0.00 0.00 0.00 0.00 0.00 0.00 0.00 $164'5 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Makenna O'Farrell Operations 4/28/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/26/2023 4/1/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Virginia Basher Power Equipment Operators Gradechecker/Stakeman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) • 2.WILLIAM CARLSON Truck Drivers er Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.WILLIAM CARLSON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • �� 4.COREY GURSLEY Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 5.JEFFREY JACKSON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 `s gyp) 6.JEFFREY JACKSON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.BENJAMIN JOHNSON Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.BRIAN NEWELL Laborers er-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 9.James Quimby Power Equipment Operators Shovel, Excavator,Backhoes: Over 50 Metric Tons To 90 Metric $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Tons (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 10.NICKOLAS REITER Power Equipment Operators Roto-mill, Roto-grinder $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 11.SCOTT RIGTRUP Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) ' Samuelu Samaga Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 13.TUVALE SAMAGA Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 14.JACOB SCHNEIDER Power Equipment Operators �-,79ader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 15.JOSHEPH SMITH Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 16.Caleb Wakefield Power Equipment Operators Roller, Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (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` 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 Makenna O'Farrell Operations Makenna O'Farrell Amended Reason change pierce to king on Jeff jackson 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 ���STnrsa� Project Name County Project or Contract# Industries 4.:M ".,,;,,� Prime Contractor ❑ °Iii:' zt , Duvall Avenue NE King CAG-20-065 Prevailing Wage Program „"r '°i,ix Subcontractor PO Box 44540 siiw,r•.�0-, Project Address Olympia WA 98504-4540 y'`mu Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 3/25/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name a ~o o Sun Mon Tue Wed Thu Fri Sat Total and And E 3/19 3/20 3/21 3/22 3/23 3/24 3/25 Total Rate Hourly Gross Amount a� E I= 1 Hours of Pay Earned/Gross "Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address CD o 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/19/2023 3/25/2023 "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 Makenna O'Farrell Operations Makenna O'Farrell 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 wsrnrF.� Project Name County Project or Contract# .,.... Prime Contractor ❑ Industries "„r Duvall Avenue NE King CAG-20-065 PrevailingWage Program 3:: {a:=if= 9 9 ';il�< Subcontractor I� PO Box 44540 �y�ar aoy 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 3/18/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And m E 3/12 3/13 3/14 3/15 3/16 3/17 3/18 Total Rate Hourly Hours of Pay Earned/Gross "Usual Withholding Net Wages Soc Sec#of Employee Address a> a Payroll Benefits" FICA Tax Other IX 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: niivall Avenue NE 3/12/2023 3/18/2023 "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 Makenna O'Farrell Operations Makenna O'Farrell ( 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 �F STATS� Project Name County Project or Contract# Industries 4:;; 4 Prime Contractor ❑ Prevailing Wage Program jiii;V s Duvall Avenue NE King CAG-20-065 a=.:R ' ,.Q.- Subcontractor PO Box 44540 "y',` aoy" Project Address Olympia WA 98504-4540 ` 188� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 3/11/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions R Work Classification Name cc ~O - Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And `" a, E 3/5 3/6 3/7 3/8 3/9 3/10 3/11 Total Rate Hourly `° E i= Hours of Pay Earned/Gross "Usual Withholding Net Wages f a, Payroll FICA Other Soc Sec#of Employee Address CD ix 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 3/5/2023 3/11/2023 "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 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 Makenna O'Farrell Operations Makenna O'Farrell 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 f,s'rArk Project Name County Project or Contract# ?:.. q.q Prime Contractor ❑ Industries �.a:: ili4 �ii: y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program FijiEf ' `''z Subcontractor 0PO Box 44540 '.y:dit, a°y� Project Address Olympia WA 98504-4540 ` teB" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 3/4/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total and And a� Gross Amount Hourly f4 Earned/Gross Net Hours of Pay Payroll "Usual FICA Withholding Other Wages Soc Sec#of Employee Address ct 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: nuvall Avenue NE 2/26/2023 3/4/2023 "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 Makenna O'Farrell Operations Makenna O'Farrell 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, F Project Name County Project or Contract# Industries 411k:11111 =94, Prime Contractor ❑ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program :i . :::. Subcontractor PO Box 44540 ' ,°�' oy Project Address Olympia WA 98504-4540 ` '&ey 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 2/25/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions 1: Work Classification Name c7 ~O o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount au E 2/19 2/20 2/21 2/22 2/23 2/24 2/25 Total RateHourly and And m A t E Hours of Pay Earned/Gross "Usual Withholding Net Wages cu Soc Sec#of Employee Address 0 o Hours Worked Each Day Payroll Benefits" FICA Tax Other cc 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 2/19/2023 2/25/2023 "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 aing 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 Makenna O'Farrell Operations Makenna O'Farrell 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 �F,.STAN, Project Name County Project or Contract# Industries &,;i; ,,,, Prime Contractor ❑ �+r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <j =i, =if} Subcontractor ►z PO Box 44540 i;ii.]r Jy. Project Address Olympia WA 98504-4540 y` teB�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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 2/18/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name t9 ~O o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And �" au E 2/12 2/13 2/14 2/15 2/16 2/17 2/18 Total Rate Earned/Gross es Hourly Net Wages m r m Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address (13 cr 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: nuvall Avenue NE 2/12/2023 2/18/2023 "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 T ;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 Makenna O'Farrell Operations Makenna O'Farrell 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, T�Tf: Project Name County Project or Contract# p ,?:.:_ __ Prime Contractor ❑ Industries :�.; ==.s �;_. Duvall Avenue NE King CAG 20 065 Prevailing Wage Program gall;; ,iHT Subcontractor PO Box 44540 °''k7 - `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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 2/11/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name c7 ~O -9- Sun Mon Tue Wed Thu Fri Sat Total m Gross Amount and And a) E 2/5 2/6 2/7 2/8 2/9 2/10 2/11 Total Rate Earned/Gross Hourly Net Wages co E H Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address aa> a Payroll Benefits" Tax 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 2/5/2023 2/11/2023 "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" `yiing 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 Makenna O'Farrell Operations Makenna O'Farrell 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 �I,s'rnrg� Project Name County Project or Contract# Industries =�:::: y Prime Contractor ❑ Prevailing Wage Program %Ali 10,., Duvall Avenue NE King GAG-20-065 ,,, ,,, r Subcontractor El PO Box 44540 '';T, 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 2/4/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name ct ~o o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And @T Hours of Pay Earned/Gross "Usual Withholding Net Wages FICA Other Soc Sec#of Employee Address ce O sp o Hours Worked Each Day Benefits'E a) Payroll " 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 1/29/2023 2/4/2023 "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 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 Makenna O'Farrell Operations Makenna O'Farrell 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, T�rF Project Name County Project or Contract# ,.?.3� :s .F Prime Contractor ❑ Industries , ' ";,;4- Duvall Avenue NE King CAG-20-065 Prevailing Wage Program j 1: {:_;:; � u' �,�„�, :�y Subcontractor PO Box 44540 , v Project Address Olympia WA 98504-4540 �` ""y�� 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 1/28/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions P Work Classification Name & 8 o Sun Mon Tue Wed Thu Fri Sat Gross Amount Total and And a) E 1/22 1/23 1/24 1/25 1/26 1/27 1/28 Total Rate Hourly f0 E i _ Hours of PayEarned/Gross "Usual WithholdingNet Wages r a, Payroll FICA Other Soc Sec#of Employee Address Ix 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 1/22/2023 1/28/2023 "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. • (2j 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 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 . Makenria O'Farrell Operations Makenna O'Farrell 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.�rf_ Project Name County Project or Contract# t •• Prime Contractor ❑ Industries $.ni al.y ',;•?:?:r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program `,iu„a ;,:EDfr Subcontractor PO Box 44540 1,1:1= ^`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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 1/21/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 p o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And 1/15 1/16 1/171/18 1/19 1/20 1/21 Total Rate Hourly Hours of Pay Earned/Gross "Usual Withholding Net Wages Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" FICA Other 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: all Avenue NE 1/15/2023 1/21/2023 "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 T' ,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 Makenna O'Farrell Operations Makenna O'Farrell 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 ,TATF Project Name County Project or Contract# ��;`:+_ ,E,i°,.y Prime Contractor ❑ Industries ... Prevailing Wage Program ., 's: {;iiijz Duvall Avenue NE King CAG-20-065 91iii 11, Subcontractor El PO Box 44540 '' w 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 1/14/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 ~O Sun Mon Tue Wed Thu Fri Sat Total a> Gross Amount and And m E 1/8 1/9 1/10 1/11 1/12 1/13 1/14 Total Rate Earned/Gross Hourly Net Wages m E i= 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: all Avenue NE 1/8/2023 1/14/2023 "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 f. 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 T 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 Makenna O'Farrell Operations Makenna O'Farrell 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 tea,STATFo� Project Name County Project or Contract# Industries :,, 4 Prime Contractor ❑ r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program `jlliii, +'•{I} Subcontractor PO Box 44540 ".k,, 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 1/7/2023 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And �" E 1/1 1/2 1/3 1/4 1/5 1/6 1/7 Total Rate Hourly Earned/Gross Net Wages m 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ^••••all Avenue NE 1/1/2023 1/7/2023 "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 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. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and iiing 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 Makenna O'Farrell Operations Makenna O'Farrell 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 ;T.aTt, Project Name County Project or Contract# Industries ,�" '`'4 .- Prime Contractor ❑ .:� „le,. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program �ili <{ Subcontractor ►z� " i }'_ Project Address PO Box 44540 ';;;i �,v 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 12/31/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name -6 � o Sun Mon Tue Wed Thu Fri Sat Total ct o a) 12/2 12/2 12/2 12/2 12/2 12/3 12/3 Gross Amount and And a) E iz: 5 6 7 8 9 0 1 Total Rate Earned/Gross Hourly Net Wages m E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a) > To Benefits" Tax w O o' Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: nii"all Avenue NE 12/25/2022 12/31/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 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 sling 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 Makenna O'Farrell Operations Makenna O'Farrell 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 �F,,T.a,F Project Name County Project or Contract# ..i� ;./ Prime Contractor ❑ Industries 4 ,1 ' PrevailingWage Program `J To; Duvall Avenue NE King CAG-20-065 g g �lii, ,"Efi Subcontractor PO Box 44540 "y". - Project Address Olympia WA 98504-4540 f�� `"h' Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 12/24/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name o Sun Mon Tue Wed Thu Fri Sat Total o a) 12/1 12/1 12/2 12/2 12/2 12/2 12/2 Gross Amount and And B E 8 g 0 1 2 3 4 Total Rate Earned/Gross "Hourly g Net Wages a) Hours of Pay Payroll Usual FICA Withholding Other Soc Sec#of Employee Address m a) - Benefits" Tax o: G 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 Makenna O'Farrell Operations 4/21/2023 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: —all Avenue NE 12/18/2022 12/24/2022 "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. (5)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 Makenna O'Farrell Operations Makenna O'Farrell 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 Project Name County Project or Contract# Industries 4.,,;, :5,, Prime Contractor ❑ ••: r Duvall Avenue NE King CAG-20-065 PrevailingWage Program 41::: ::_ 9 9 3 ,,,� Subcontractor El PO Box 44540 :.,• 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 12/17/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name c� p o Sun Mon Tue Wed Thu Fri Sat Total ct o w 12/1 12/1 12/1 12/1 12/1 12/1 12/1 Gross Amount y £ Total Rate Hourly and And 1 2 3 4 5 6 7 Earned/Gross Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m > Payroll Benefits" Tax I 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 Makenna O'Farrell Operations 12/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 12/11/2022 12/17/2022 "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. ��..Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and wining 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 Makenna O'Farrell Operations Makenna O'Farrell 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 4dsTereo Project Name County Project or Contract# Industries q 4 Prime Contractor ❑ o,.;;• Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Subcontractor El PO Box 44540 " Project Address Olympia WA 98504-4540 y"• zbay 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 12/10/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name c9 n o Sun Mon Tue Wed Thu Fri Sat Total ct O m 12/1 Gross Amount a� E 12/412/5 12/612/7 12/812/9 Total Rate Hourly and And Earned/Gross Net Wages CO E 0 Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address 0 a - 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 Makenna O'Farrell Operations 12/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: veil Avenue NE 12/4/2022 12/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' `,Askny 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 Makenna O'Farrell Operations Makenna O'Farrell • i t 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 �I,srArF.� Project Name County Project or Contract# Industries Prime Contractor ❑ o:;:; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program °' ,z Subcontractor PO Box 44540 �:: .y� Project Address Olympia WA 98504-4540 �` �e8g 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 12/3/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name o Sun Mon Tue Wed Thu Fri Sat Total ct 2- a) 11/2 11/2 11/2 11/3 Gross Amount and And m Eiz 7 8 9 0 12/1 12/2 12/3 Total Rate Earned/Gross Hourly Net Wages a) Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a) a)> a Benefits" Tax o_ 0 g 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 Makenna O'Farrell Operations 12/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ^wall Avenue NE 11/27/2022 12/3/2022 "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. f ';Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ' pining 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 Makenna O'Farrell Operations Makenna O'Farrell MB 12/22/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side I . Certified Payroll Report Department of Labor and ��,srerk Project Name County Project or Contract# Industries ; 4 Prime Contractor ❑ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program "' Subcontractor El PO Box 44540f'. , oy� 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 11/26/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name c7 � o Sun Mon Tue Wed Thu Fri Sat Total o ce w 11/2 11/2 11/2 11/2 11/2 11/2 11/2 Total Rate Gross Amount and And E 0 1 2 3 4 5 6 Earned/Gross Hourly mNet Wages Hours of Pay Payroll "Usual FICA Withholding Other 9 Soc Sec#of Employee Address a) > a Benefits" Tax W O 0 Hours Worked Each Day No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Makenna O'Farrell Operations 12/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 11/20/2022 11/26/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side f •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. 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 Makenna O'Farrell Operations Makenna O'Farrell MB 12/22/22 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 sTnre Project Name County Project or Contract# ��:��•�=:�,;°.� Prime Contractor ❑ Industries o: it 4 ` Duvall Avenue NE King CAG-20-065 Prevailing Wage Program a;'-', ' Rs Subcontractor El PO Box 44540 '`"`1,47 , Project Address tes �o' Olympia WA 98504-4540 Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 11/19/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 , Day and Date Deductions rg Work Classification Name o S /1 11/1 11/1 11/a 11/1 11/1 11/1 Gross Amount Total Total Rate Hourl and And a, E E 3 4 5 6 7 8 9 Earned/Gross y Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m > -0 Payroll Benefits" Tax o: O o 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 Makenna O'Farrell Operations 12/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: . For the week ending: Duvall Avenue NE 11/13/2022 11/19/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 1 ',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 Makenna O'Farrell Operations Makenna O'Farrell MB 12/22/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side ti - Certified Payroll Report Department of Labor and .,1,17. Project Name County Project or Contract# Industries ?..1:, .,`.1:- `i.'s, Prime Contractor ❑ `t • ',In r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ;j"I,� a1 �� ,ll� Subcontractor PO Box 44540 J.�,': w`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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 11/12/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions ~ Thu Fri Sat Work Classification Name c7 0 Sun Mon Tue Wed Total IX o a) 11/1 11/1 11/1 Gross Amount and And a) E 11/6 11/7 11/8 11/9 0 1 2 Total Rate Earned/Gross Hourly Net Wages Eco Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address c > Benefits" f 0 'o Hours Worked Each Day 0 1. Power Equipment RG 0.00 0.00 0.00 4.31 0.00 0.00 10.00 4.31 $72.28 $311.53 taxes: , Operatorsmedical:l:$21$218.21, Dan Garl aflac:$26.67, Roller, Plant Mix Or Multi-lift 17223 SE 373rd $108.4 $603.18/ Materials Street OT 0.00 0.00 0.00 2.69 0.00 0.00 0.00 2.69 2 $291.65 $3 288 07 $0.00/hr $233.63 $445.74 401(k):$50.00 $2,285.06 (King) Auburn,WA-98092 4.5 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $141 $7° 2. Power Equipment RG 0.00 0.00 0.00 4.33 0.00 0.00 0.00 4.33 $73.49 $318.21 taxes: l: , Operators SPENCER J medical:$11.41 Spreader,Topsider& GIBBONS $1142 $557.41 / -edman 5711 183rd Ave E OT 0.00 0.00 0.00 2.17 0.00 0.00 0.00 2.17 $23 .20 $2 240.69 $0.00/hr $170.54 $362.12 $1,677.53 I) Lake Tapps,WA- * x* 98391 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.98 $0.00 3. Power Equipment RG 0.00 0.00 0.00 4.31 0.00 0.00 0.00 4.31 $73.49 $316.74 taxes:$29.63, Operators medical:$11.41, Spreader,Topsider& TYLER JACOBSON $110.2 $613.26/ 401(k):$321.09 Screedman 505 S 150th St OT 0.00 0.00 0.00 2.69 0.00 0.00 0.00 2.69 3 $296.52 $3,210.85 $0.00/hr $244.76 $557.59 $2,046.37 (King) Burien,WA-98148 - DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 8'9 $0.00 4. Power Equipment RG 0.00 0.00 0.00 4.33 0.00 0.00 0.00 4.33 $72.28 $312.97 taxes:$23.12, Operators medical:l:$47.$47.21 BRIAN KREGNESS Roller, Plant Mix Or Multi-lift 24215 117th St E $108.4 $548.24/ Materials Buckley,WA- OT 0.00 0.00 0.00 2.17 0.00 0.00 0.00 2.17 2 $235.27 $2 505.27 $0.00/hr $188.04 $417.03 $1,829.87 (King) 98321 $144.5 DT 0.00 0.00 0.00 10.00 0.00 0.00 0.00 0.00 6 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 5. Laborers RG 0.00 0.00 0.00 4.31 0.00 0.00 0.00 4.31 $52.39 $225.80 TAXES:$27.01, General Laborer medical:$11.41 (King) DANIEL MUNOZ $437.21 / 618 SW 129th St OT 0.00 0.00 0.00 2.69 0.00 0.00 0.00 2.69 $78.59 $211.41 $2 615.36 $0.00/hr $199.20 $452.04 $1,925.70 * «*«*** Burien,WA-98146 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $184'7 $0.00 6. Laborers RG 0.00 0.00 0.00 4.31 0.00 0.00 0.00 4.31 $54.01 $232.78 taxes:$25.37 Raker-Asphalt (King) CALEB ORTEGA $450.73/ 2803 289th St S OT 0.00 0.00 0.00 2.69 0.00 0.00 0.00 2.69 $81.02 $217.94 $2 326.74 $0.00/hr $177.99 $385.51 $1,737.87 Roy,WA-98580 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128'0 $0.00 7. Power Equipment RG 0.00 0.00 0.00 4.31 0.00 0.00 0.00 4.31 $73.49 $316.74 taxes:$25.86, Operators medical:l:$11.$11.41, Spreader,Topsider& TREVOR OWENS $110 2 $613.26/ 401(k):$52.35 edman 26703 Bristol Ct OT 0.00 0.00 0.00 2.69 0.00 0.00 0.00 2.69 3 ' $296.52 $2,617.58 $0.00/hr $199.37 $479.71 $1,848.88 3) Kent,WA-98032 * ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9 $0.00 8. Power Equipment RG 0.00 0.00 0.00 4.92 0.00 0.00 0.00 4.92 $73.49 $361.57 taxes:$23.52, Operators medical:$47.21, Spreader,Topsider& CHRIS PEDERSEN $110.2 $701.08/ long term care: Screedman 1536 Index Ave Ne OT 0.00 0.00 0.00 3.08 0.00 0.00 0.00 3.08 3 $339.51 $2,925.41 $0.00/hr $219.25 $554.63 $12.19,gam: $1,983.23 (King) Renton,WA-98056 $85.38 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186'9 $0.00 9. Truck Drivers RG 0.00 0.00 0.00 3.12 0.00 0.00 0.00 3.12 $63.71 $198.78 taxes:$14.19, Asphalt Mix To 16 Yards KENNETH SHARP aflac:$29.43,life (King) 20412 93rd St E $235.09/ ins:$22.53, Bonney Lake,WA- OT 0.00 0.00 0.00 0.38 0.00 0.00 0.00 0.38 $95.57 $36.32 $1,514.80 $0.00/hr $113.63 $193.46 401(k):$75.74 $1,065.82 .**-...... 98391 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127'4 $0.00 10. Truck Drivers taxes:$26.88, Asphalt Mix To 16 Yards RG 0.00 0.00 0.00 2.98 0.00 0.00 0.00 2.98 $63.71 $189.86 medical:$47.21, p BRETT WALDRON (King) Po Box 8611 $512.32/ aflac:$7.20 Covington,WA- OT 0.00 0.00 0.00 1.77 0.00 0.00 0.00 1.77 $95.57 $169.16 $2 852.63 $0.00/hr $214.06 $498.67 $2,058.61 ***-**«*** 98042 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 11. Truck Drivers taxes:$26.88, RG 0.00 0.00 0.00 1.25 0.00 0.00 0.00 1.25 $64.55 $80.69 medical:$47.21, Other Trucks BRETT WALDRON (King) Po Box 8611 $512.32/ aflac:$7.20 Covington,WA- OT 0.00 0.00 0.00 0.75 0.00 0.00 0.00 0.75 $96.82 $72.62 $2 852.63 $0.00/hr $214.06 $498.67 $2,058.61 98042 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $129.10 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side ti r 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 Makenna O'Farrell Operations 12/5/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: rylall Avenue NE 11/6/2022 11/12/2022 "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 1.Dan Garl Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) ' ,SPENCER GIBBONS jNer Equipment Operators spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.TYLER JACOBSON Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.BRIAN KREGNESS Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 5.DANIEL MUNOZ Laborers General Laborer $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 rig) 6.CALEB ORTEGA Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.TREVOR OWENS Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.CHRIS PEDERSEN "wer Equipment Operators reader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 9.KENNETH SHARP Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 10.BRETT WALDRON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 11.BRETT WALDRON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 !king) i - 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 Makenna O'Farrell Operations Makenna O'Farrell Amended Reason Change to final payroll 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 �t,SKATE Project Name County Project or Contract# .. �, Prime Contractor ❑ Industries "i,•;. ',,i Duvall Avenue NE King CAG-20-065 PrevailingWage Program <_:':i! yafiii=9 9 Subcontractor ''„"i' i) Project Address PO Box 44540 °:y4 a°Y� j 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 11/5/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions a Sun Mon Work Classification Name c Tue Wed Thu Fri Sat Total 10/3 10/3 Gross Amount a, Eci' 11/1 11/2 11/3 11/4 11/5 Total Rate Hourly and And Ei= Q 1 Hours of Pay Earned/Gross "Usual FICA Withholding Other Net Wages a .-Ea) Payroll Benefits" Tax Soc Sec#of Employee Address a) > 1 O o Hours Worked Each Day a 1. Truck Drivers taxes:$26.71, RG 0.00 0.00 0.00 0.00 5.95 0.00 0.00 5.95 $63.71 $379.07 medical:$11.41, Asphalt Mix To 16 Yards WILLIAM (King) CARLSON $775.09/ 401(k):$50.00, 900 29th St SE OT 0.00 0.00 0.00 0.00 2.05 0.00 0.00 2.05 $95.57 $195.92 $2 923 07 $0.00/hr $222.74 $553.59 life ins:$11.27 $2,047.35 'i Auburn,WA-98002 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 2. Truck Drivers taxes:$26.71, RG 0.00 0.00 0.00 0.00 2.05 0.00 0.00 2.05 $64.55 $132.33 Other Trucks WILLIAM medical:$11.41, (King) CARLSON $775.09/ 401(k):$50.00, 900 29th St SE OT 0.00 0.00 0.00 0.00 0.70 0.00 0.00 0.70 $96.82 $67.77 $2 923 07 $0.00/hr $222.74 $553.59 life ins:$11.27 $2,047.35 Auburn,WA-98002 $129.1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 $0.00 3. Power Equipment taxes:$19.14, RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $72.28 $578.24 Operators 401(k):$50.00, Dan Garl aflac:$26.67, Roller, Plant Mix Or Multi-lift 17223 SE 373rd $108.4 $740.87/ Materials Street OT 0.00 0.00 0.00 0.00 1.50 0.00 0.00 1.50 2 $162.63 $2 449 87 $0.00/hr $169.50 $261.34 medical:$218.21 $1,705.01 (King) Auburn,WA-98092 $144.5 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6 $0.00 4. Power Equipment taxes:$23.44, RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $72.28 $578.24 Operators SPENCER medical:$11.41 Roller, Plant Mix Or Multi-lift GIBBONS $108.4 $578.24/ Materials 5711 183rd Ave E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 $0.00/hr $191.65 $428.36 $1,861.80 (King) Lake Tapps,WA- $2,516.66 98391 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 6 44.5 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 5. Power Equipment taxes:$22.71, RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $73.49 $587.92 Operators medical:$11.41, TYLER JACOBSON 401(k): 261.79 Spreader,Topsider& 2514A S 302nd PI $110 2 $ Screedman OT 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 $110.23 $698.15/ $0.00/hr $199.39 $429.51 $1,693.08 Federal Way,WA- 3 $2,617.89 (King) 98003 $146.9 ****«**** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 6. Laborers RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $54.01 $432.08 taxes:$20.79, Raker-Asphalt medical:$11.41 (King) DANIEL MUNOZ $513.10/ 618 SW 129th St OT 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 $81.02 $81.02 $2 181.52 $0.00/hr $166.02 $347.92 $1,635.38 ****«**** Burien,WA-98146 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $108.0 $010 7. Power Equipment RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $749 $587.92 taxes:$21.66, Operators Tony Newell J medical:$11.41 nreader,Topsider& 26431 233rd Ave. $110.2 :edman SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $587.92/ $0.00/hr $188.68 $419.06 $2,477.91 $1,837.10 _ g) Maple Valley,WA - * ** 98038 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9$ $0.00 8. Laborers RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $54.01 $432.08 taxes:$23.53 Raker-Asphalt (King) CALEB ORTEGA $513.10/ 2803 289th St S OT 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 $81.02 $81.02 $2 395.19 $0.00/hr $183.24 $401.94 $1,786.48 Roy,WA-98580 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1t�8.0 $0.00 9. Laborers RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $54.01 $432.08 taxes:$24.04, Raker-Asphalt 401(k):$50.98, (King) TREVOR OWENS $513.10/ medical:$11.41 26703 Bristol Ct OT 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 $81.02 $81.02 $2 548.91 $0.00/hr $194.12 $463.55 $1,804.81 * _ _ ** Kent,WA-98032 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128'0 $0.00 10. Truck Drivers RG 0.00 0.00 0.00 0.00 6.50 0.00 0.00 6.50 $63.71 $414.12 taxes:$32.59 Asphalt Mix To 16 Yards Tony Patricelli (King) 35631 13th Ave SW $414.12/ Federal Way,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $95.57 $0.00 $2 799 42 $0.00/hr $214.15 $460.50 $2,092.18 ****«**** 98023 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12'4 $0.00 11. Power Equipment taxes:$28.82, Operators RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $73.49 $587.92 medical:$47.21, Spreader,Topsider& CHRIS PEDERSEN $110.2 $698.15/ long term:$12.19, Screedman 1536 Index Ave Ne OT 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 3 $110.23 $3,448.48 $0.00/hr $259.26 $691.49 gam:$85.38 $2,324.13 (King) Renton,WA-98056 * ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 a6'9 $0.00 12. Truck Drivers medical:$47.21, RG 0.00 0.00 0.00 0.00 6.70 0.00 0.00 6.70 $63.71 $426.86 Asphalt Mix To 16 Yards BRETT WALDRON aflac:$7.20, (King) Po Box 8611 $630.48/ taxes:$27.66 * ** Covington,WA- OT 0.00 0.00 0.00 0.00 1.05 0.00 0.00 1.05 $95.57 $100.35 $3,268.37 $0.00/hr $245.87 $598.45 $2,341.98 98042 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side ti r. 13. Truck Drivers medical:$47.21, RG 0.00 0.00 0.00 0.00 1.30 0.00 0.00 1.30 $64.55 $83.92 aflac:$7.20, Other Trucks BRETT WALDRON (King) Po Box 8611 $630.48/ taxes:$27.66 Covington,WA- OT 0.00 0.00 0.00 0.00 0.20 0.00 0.00 0.20 $96.82 $19.36 $3,268.37 $0.00/hr $245.87 $598.45 $2,341.98 ..";*"*"` 98042 • DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $129.1 $0.00 14. Truck Drivers taxes:$33.37 RG 0.00 0.00 0.00 0.00 6.50 0.00 0.00 6.50 $63.71 $414.12 Asphalt Mix To 16 Yards (King) JASON WHITE $414.12/ 2819 R PI SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $95.57 $0.00 $2 831.69 $0.00/hr $216.63 $371.45 $2,210.24 .******** Auburn,WA-98002 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Makenna O'Farrell Operations 11/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ni!vall Avenue NE 10/30/2022 11/5/2022 "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.WILLIAM CARLSON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.WILLIAM CARLSON Truck Drivers ,her Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.Dan Garl Power Equipment Operators Roller, Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.SPENCER GIBBONS Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 5.TYLER JACOBSON Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (ing) 6.DANIEL MUNOZ Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.Tony Newell Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.CALEB ORTEGA - '-borers Aker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 9.TREVOR OWENS Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 10.Tony Patricelli Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 11.CHRIS PEDERSEN Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) BRETT WALDRON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 13.BRETT WALDRON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 14.JASON WHITE Truck Drivers iphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'g`,Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 Makenna O'Farrell Operations Makenna O'Farrell Amended Reason Work was done week ending 11/5/22 M B 11/22/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side A. Certified Payroll Report Department of Labor and �� ST�rF'�,� Project Name County Project or Contract# Industries a,;: lizi. Prime Contractor ❑ �.... r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program d:::::. "`x Subcontractor El Pro PO Box 44540 ", i':�` (, Project Address Olympia WA 98504-4540 y` `"ey Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 10/29/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions a Sun Mon Tue Wed Thu Fri Sat Work Classification Name 0 Total 2- a) 10/2 10/2 10/2 10/2 10/2 10/2 10/2 Gross Amount a, E Total Rate Hourly and And `m E 3 4 5 6 7 8 9 Hours of Pay Earned/Gross °Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address CD f --0o Payroll Benefits" Tax CK 0 o Hours Worked Each Day a 1. Power Equipment $1,156.4 taxes:$18.74, Operators RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $72.28 8 medical:$11.41 Roller, Plant Mix Or Multi-lift RAY BALDERSON $1,915.42 PO BOX 98761 OT 0.00 0.00 0.00 0.00 3.00 4.00 0.00 7.00 $108.4 $758.94 Materials Lakewood,WA- 2 / $0.00/hr $188.57 $458.39 $1,799.31 (King) 98496 • $2,476.42 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 6 44'S $0.00 2. Truck Drivers RG 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $64.55 $0.00 taxes:$25.88, Other Trucks WILLIAM medical:l:$11.$11.41, (King) CARLSON $970.91 / life ins:$11.27, 21447 Piessner Rd OT 0.00 0.00 0.00 0.00 0.00 0.00 2.50 2.50 $96.82 $242.05 $2 889 28 $0.00/hr $220.16 $545.48 401(k):$50.00 $2,025.08 Yelm,WA-98597 $129.1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 $0.00 3. Truck Drivers RG 0.00 0.00 0.00 0.00 0.00 6.37 0.00 6.37 $63.71 $405.83 taxes:$25.88, Asphalt Mix To 16 Yards WILLIAM medical:$11.41, (King) CARLSON $970.91 / life ins:$11.27, 21447 Piessner Rd OT 0.00 0.00 0.00 0.00 0.00 3.38 0.00 3.38 $95.57 $323.03 $2 889 28 $0.00/hr $220.16 $545.48 401(k):$50.00 $2,025.08 Yelm,WA-98597 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 , $ 70 4. Power Equipment taxes:$20.28, RG 0.00 0.00 0.00 0.00 4.00 2.40 0.00 6.40 $74.22 $475.p1 Operators aflac:$51.45, Mechanics,All(leadmen- MIKE COLLINS $11, Q J medical:$47.21, $0.50 Per Hour Over 7212 194th Ave E OT 0.00 0.00 0.00 0.00 1.00 0.60 0.00 1.60 3 $178.13 $653.14/ life ins:$13.55, Mechanic) Bonney Lake,WA- $2,825.64 $0.00/hr $210.65 $422.17 401(k):$565.13 $1,495.20 Kin 98391 (King) DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1�8.4 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 5. Power Equipment $1,156.4 taxes:$24.71, Operators RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $72.28 p 8 aflac:$26.67, Dan Garl Roller, Plant Mix Or Multi-lift '$2,078.05 medical:$218.21, Materials 17223 SE 373rd OT 0.00 0.00 0.00 0.00 3.50 5.00 0.00 8.50 $108.4 $921.57 ' / $0.00/hr $254.27 $505.06 401(k):$50.00 (King) Street 2 $3,557.71 Auburn,WA-98092 $144.5 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6 $0.00 6. Power Equipment $1,175.8 1 taxes:$31.15, Operators RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $73.49 4 medical:$11.41 Spreader,Topsider& Spencer Gibbons $110.2 '$1,947.45 Screedman 1809 H Street SE OT 0.00 0.00 0.00 0.00 3.00 4.00 0.00 7.00 3 $771.61 / $0.00/hr $311.65 $857.66 $2,873.29 (King) Auburn,WA-98002 $4,085.16 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9 $0.00 7. Power Equipment $1,175.8 taxes:$33.60, Operators RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $73.49 4 401(k):$448.36, c' ader,Topsider& TYLER JACOBSON $2,167.91 medical:$11.41 edman 505 S 150th St OT 0.00 0.00 0.00 0.00 4.00 5.00 0.00 9.00 $1 3'2 $992.07 / $0.00/hr $342.13 $894.60 $2,753.47 J) Burien,WA-98148 $4,483.57 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9 $0.00 8. Power Equipment $1,156.4 taxes:$24.34, Operators RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $72.28 8 medica;:$47.21 BRIAN KREGNESS Roller, Plant Mix Or Multi-lift 24215 117th St E $108 4 $1,915.42 Materials Buckley,WA- OT 0.00 0.00 0.00 0.00 3.00 4.00 0.00 7.00 2 ' $758.94 / $0.00/hr $241.91 $586.02 $2,309.93 (King) 98321 $3,209.41 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $144.5,/ $0`.0P 9. Truck Drivers V v taxes:$24.29, Asphalt Mix To 16 Yards RG 0.00 0.00 0.00 0.00 6.86 6.33 0.00 13.19 $61 $840,33 J 401(k):$145.42, p MARK MORROW J(King) 6915 227th St E J $1,347.81 life ins:$34.97 Spanaway,WA- OT 0.00 0.00 0.00 0.00 2.14 3.17 0.00 5.31 $95.57 $507.48 / $0.00/hr $222.50 $510.05 $1,971.15 - - * 98387 $2,908.38 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 I 10. Truck Drivers RG 0.00 0.00 0.00 0.00 0.00 6.32 0.00 6.32 $63.71 $402.65 taxes: , Asphalt Mix To 16 Yards AUSTIN MUNDELL medical:l:$47.$47.21 tieing) 20328 87th Ave E $515.42/ �� Spanaway,WA- OT 0.00 0.00 0.00 0.00 0.00 1.18 0.00 1.18 $95.57 $112.77 $1 412.72 $0.00/hr $104.46 $165.56 $1,081.59 ir*Ir98387 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 11. Laborers RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $52.39 $838.24 taxes:$29.07, General Laborer medical:l:$11.$11.41 (King) DANIEL MUNOZ $1,545.55 618 SW 129th St OT 0.00 0.00 0.00 0.00 4.00 5.00 0.00 9.00 $78.59 $707.31 / $0.00/hr $263.46 $656.15 $2,495.35 Burien,WA-98146 $3,455.44 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$4.7 $0.00 12. Power Equipment $1,175.8 taxes:$32.07, Operators Tony Newell RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $73.49 4 medical:$11.41 Spreader,Topsider& 26431 233rd Ave. $110.2 $2,057.68 Screedman SE OT 0.00 0.00 0.00 0.00 3.00 5.00 0.00 8.00 3 $881.84 / $0.00/hr $323.67 $907.96 $2,967.25 (King) Maple Valley,WA- $4,242.36 * ** 98038 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186.9 $0.00 ' F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side taxes 13. Truck Drivers RG 0.00 0.00 0.00 0.00 1.50 0.00 0.00 1.50 $64.55 $96.83 401 Other Trucks BRIAN O'FARRELL 401(kk):$225.00, (King) . 19603 228th Ave $96 83/ life ins:$53.34 SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.82 $0.00 $182710 $0.00/hr $139.78 $253.99 $1,137.69 ********* Maple Valley,WA- 98038 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10.1 $0.00 14. Laborers taxes:$28.13 RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $54.01 $864.16 Raker-Asphalt - (King) - Caleb Ortega $1,593.34 2803 289th St S OT 0.00 0.00 0.00 0.00 4.00 5.00 0.00 9.00 $81.02 $729.18 / $0.00/hr $253.78 $623.30 $2,412.29 ** * **** Roy,WA-98580 $3,317.50 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10 i $0.p0 15. Laborers `� V taxes:$31.11, RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $54.01 $864 16 J 4 Raker-Asphalt 01(k):$74.14, (King) TREVOR OWENS V $1,593.34 medical:$11.41 26703 Bristol Ct OT 0.00 0.00 0.00 0.00 4.00 5.00 0.00 9.00 $8 .02 $729.18 / $0.00/hr $282.73 $765.92 $2,541.92 ********* Kent,WA-98032 $3,707.23 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128.0 $0.00 16. Truck Drivers taxes:$32.90 RG 0.00 0.00 0.00 0.00 6.32 0.00 0.00 6.32 $63.71 $402.65 Asphalt Mix To 16 Yards Tony Patricelli (King) 35631 13th Ave SW $515.42/ Federal Way,WA- OT 0.00 0.00 0.00 0.00 1.18 0.00 0.00 1.18 $95.57 $112.77 $2 709.61 $0.00/hr $207.29 $438.94 $2,030.48 ***-****** 98023 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 17. Power Equipment $1,175.8 taxes:$34.23, Operators RG 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 $73.49 4 medical:$47.21, Spreader,Topsider& CHRIS PEDERSEN $110.2 $2,167.91 long term care: Screedman 1536 Index Ave Ne OT 0.00 0.00 0.00 0.00 4.00 5.00 0.00 9.00 3 ' $992.07 / $0.00/hr $353.40 $1,100.71 $12.19,garn: $3,045.80 (King) Renton,WA-98056 $4,678.92 $85.38 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186.9 $0.00 18. Truck Drivers taxes:$28.73, RG 0.00 0.00 0.00 0.00 6.74 7.33 0.00 14.07 $63.71 $896.40 aflac:$29.43, Asphalt Mix To 16 Yards KENNETH SHARP (King) 20412 93rd St E $1,367.56 401(k):$167.10, Bonney Lake,WA- OT 0.00 0.00 0.00 0.00 1.26 3.67 0.00 4.93 $95.57 $471.16 / $0.00/hr $253.41 $601.85 life ins:$22.53 $2,238.93 '* **** 98391 $3,341.98 $12 7.4 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 19. Truck Drivers RG 0.00 0.00 0.00 0.00' 1.07 0.62 0.00 1.69 $64.55 $109.09 taxes:$30.11, Other Trucks Pa 8611x 8611aflac:$7.20, (King) Po BoxWALDRON $2,452.16 medical:$47.21 Covington,WA- OT 0.00 0.00 0.00 0.00 2.82 4.62 0.00 7.44 $96.82 $720.34 / $0.00/hr $288.91 $762.56 - $2,695.00 **.**-**** 98042 $3,830.99 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10.1 $0.00 20. Truck Drivers taxes:$30.11, RG 0.00 0.00 0.00 0:00 6.93 7.38 0.00 14.31 $63.71 $911.69 aflac:$7.20, Asphalt Mix To 16 Yards BRETT WALDRON (King) Po Box 8611 $2,452.16 medical:$47.21 Covington,WA- OT 0.00 0.00 0.00 0.00 2.82 4.62 0.00 7.44 $95.57 $711.04 / $0.00/hr $288.91 $762.56 $2,695.00 98042 $3,830.99 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12.4 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 21. Truck Drivers taxes:$26.47. RG 0.00 0.00 0.00 0.00 0.00 6.43 0.00 6.43 $63.71 $409.66 Asphalt Mix To 16 Yards (King) JASON WHITE $774.73 I 2819 R PI SE OT 0.00 0.00 0.00 0.00 0.00 3.82 0.00 3.82 $95.57 $365.08 $0.00/hr $173.97 $248.79 $1,824.91 ********* Auburn,WA-98002 $2,274.14 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127'4 $0.00 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Makenna O'Farrell Operations 11/2/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ❑!wall Avenue NE 10/23/2022 -10/29/2022 "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.RAY BALDERSON Power Equipment Operators Roller, Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials • (King) WILLIAM CARLSON dick Drivers Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 • (King) 3.WILLIAM CARLSON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) c F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.MIKE COLLINS Power Equipment Operators Mechanics,All(leadmen-$0.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Per Hour Over Mechanic) (King) 5.Dan Garl Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials ng) - 6.Spencer Gibbons Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.TYLER JACOBSON Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8_BRIAN KREGNESS wer Equipment Operators _Jler,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 9.MARK MORROW Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 10.AUSTIN MUNDELL Truck Drivers- Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 11.DANIEL MUNOZ Laborers General Laborer $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) Tony Newell Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 13.BRIAN O'FARRELL Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 14.Caleb Ortega Laborers ,ker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 15.TREVOR OWENS Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 16.Tony Patricelli Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 17.CHRIS PEDERSEN Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00, $0.00 $0.00 $0.00 (King) ia.KENNETH SHARP Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 19.BRETT WALDRON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 20.BRETT WALDRON Truck Drivers phalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 21.JASON WHITE Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 • Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been.or will-be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !g'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 Makenna O'Farrell Operations Makenna O'Farrell 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 0.1 sTerr,•o Project Name County Project or Contract# Industries Prime Contractor ❑ �::_:. r„ Duvall Avenue NE King CAG-20-065 PrevailingWage Program ••• 9 9 Subcontractor PO Box 44540 4y AN ao;, Project Address Olympia WA 98504-4540 ` �8B" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 10/22/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions o Sun Mon Tue Wed Thu Fri Sat Work Classification Name (5 Total cC 9 CD 10/1 10/1 10/1 10/1 10/2 10/2 10/2 Gross Amount �, Total Rate Hourly and And Earned/Gross Net Wages j E 6 7 8 9 0 1 2 Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address aa) > Benefits" Tax tZ co .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 Heidy Brothers Office Manager 10/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ^•- all Avenue NE 10/16/2022 10/22/2022 "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. ",ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and sling 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 Heidy Brothers Office Manager Heidy Brothers 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 �� aTer�• � Project Name County Project or Contract# ..... Prime Contractor ❑ Industries ,� o; ••. `iii;�� Duvall Avenue NE King CAG 20 065 Prevailing Wage Program :,:,:. Subcontractor 71 PO Box 44540 �y aJy Project Address Olympia WA 98504-4540 � ies" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 10/15/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date I Deductions Work Classification Name c7 ~ o Sun Mon Tue Wed Thu Fri Sat Total a� 10/1 10/1 10/1 10/1 10/1 10/1 Gross Amount and And °' E 10/9 0 1 2 3 4 5 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address a .n 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 Heidy Brothers Office Manager 10/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ^gall Avenue NE 10/9/2022 10/15/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F)Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced.project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. :,Lny 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 Heidy Brothers Office Manager Heidy Brothers 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 sT�rR• Project Name County Project or Contract# .'k::• ��•OF. Prime Contractor ❑ Industries :• o:I:!,�. -- l •.:i i Duvall Avenue NE King CAG-20-065 Prevailing Wage Program a�...: Subcontractor ❑x 3• Project Address PO Box 44540 6.yy ,end a°v" 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 10/8/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date I Deductions p Work Classification Name c� o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount and And E 10/2 10/3 10/4 10/5 10/6 10/7 10/8 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address > - Payroll Benefits" Tax CD fY 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 Heidy Brothers Office Manager 10/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: "—all Avenue NE 10/2/2022 10/8/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F ) No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All,information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Jc ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and i 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 Heidy Brothers Office Manager Heidy Brothers MB 10/24/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side fit _ Certified Payroll Report Department of Labor and sTnr�• Project Name County Project or Contract# " ° Prime Contractor ❑ Industries Duvall Avenue NE King CAG 20 065 Prevailing Wage Program 1:4!;. "" Subcontractor PO Box 44540 Q :::� y�. Project Address Olympia WA 98504-4540 yy 188e`�Q` Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 10/1/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name (- ~O o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount and And a) E 9/25 9/26 9/27 9/28 9/29 9/30 10/1 Total Rate Earned/Gross Hourly Net Wages r Hours of Pay Payroll "Usual FICA Withholding Other 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 Heidy Brothers Office Manager 10/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/25/2022 10/1/2022 "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. t$' 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 Heidy Brothers Office Manager Heidy Brothers MB 10/24/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 16. Certified Payroll Report Department of Labor and �TnrF, Project Name County Project or Contract# .<$,:tI�'••�_�::°� Prime Contractor ❑ Industries 4 :: �=f. �_;_•_.•. =•=••r„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <;it:,, ,e:,.! Subcontractor NI PO Box 44540 °;k�" _ �,,,' 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 9/24/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total m Gross Amount and And E 9/18 9/19 9/20 9/21 9/22 9/23 9/24 Total Rate Earned/Gross Hourly Net Wages 3 E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address c a - 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 Heidy Brothers Office Manager 9/28/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ivall Avenue NE 9/18/2022 9/24/2022 "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. +c`.'kny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'r 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 Heidy Brothers Office Manager Heidy Brothers 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 11':0-, Project Name County Project or Contract# Industries Prime Contractor ❑ t�iir, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program I4 . '_= Subcontractor! 3: ll` Project Address IM PO Box 44540 °. ' ,,y j 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 9/17/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions IL- Work Classification Name C9 O~ 9— Sun Mon Tue Wed Thu Fri Sat Total a> Gross Amount and And E 9/11 9/12 9/13 9/14 9/15 9/16 9/17 Total Rate Earned/Gross Hourly Net Wages r Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m a - 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 Heidy Brothers Office Manager 9/28/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/11/2022 9/17/2022 "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. 14\.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 Heidy Brothers Office Manager Heidy Brothers 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 a, s„Arf;�. Prime Contractor ❑ Project Name County Project or Contract# Industries •`';:p F !; �c*'s .;;;: - . �;;;;• Duvall Avenue NE King CAG-20-065 Prevailing Wage Program lip,: ;i.111' Subcontractor N PO Box 44540 °,; ',� ,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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 9/10/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c2 ~O o Sun Mon Tue Wed Thu Fri Sat Total � Gross Amount and And E 9/4 9/5 9/6 9/7 9/8 9/9 9/10 Total Rate Earned/Gross Hourly Net Wages `m E i= Hours of Pay "Usual FICA Withholding Other �, Payroll Benefits" Tax 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 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 Heidy Brothers Office Manager 9/28/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/4/2022 9/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !�\Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 Heidy Brothers Office Manager Heidy Brothers MB 9/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side p Certified Payroll Report Department of Labor and rnr4 Project Name County Project or Contract# 4.?fit" It °F Prime Contractor ❑ Industries 11: J_n•.• ..A Duvall Avenue NE King CAG-20-065 Prevailing Wage Program f lih ;4411 Subcontractor Cx_- PO Box 44540 3'y=.': soy 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 9/3/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date i Deductions IL- Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total a� Gross Amount E 8/28 8/29 8/30 8/31 9/1 9/2 9/3 Total Rate Hourly " and And Earned/Gross Net Wages f a) Payroll E i= Hours of Pay Usual FICA Withholding Other Soc Sec#of Employee Address O Benefits" Tax -0Hours 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 Heidy Brothers Office Manager 9/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 8/28/2022 9/3/2022 "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. 's 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 Heidy Brothers Office Manager Heidy Brothers MB 9/7/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified ayro Report Department of Labor and �,. �;;,,";i.''F Prime Contractor ❑ Project Name County Project or Contract# Industries i;, `k �r�,. .=�:,.� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program All. ,'111114 Subcontractor Ni PO Box 44540 °;;y• - µ�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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 8/27/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 ~ o Sun Mon Tue Wed Thu Fri Sat Total cc O a) Gross Amount and And o E 8/21 8/22 8/23 8/24 8/25 8/26 8/27 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address 0 > - 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 Heidy Brothers Office Manager 9/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 8/21/2022 8/27/2022 "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. ' ',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 Heidy Brothers Office Manager Heidy Brothers 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 ,��rE. Project Name County Project or Contract# �' `'. Prime Contractor El Industries . ,ii,y_ ;q•• - ;.;:i.=i•r, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ?Al, sl�bryx Subcontractor NI PO Box 44540 ,;,:, , a��y Project Address Olympia WA 98504-4540 ` ,��� ' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 8/20/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions IL- Work Classification Name cc9 ~O o Sun Mon Tue Wed Thu Fri Sat Total a� Gross Amount and And a) E 8/14 8/15 8/16 8/17 8/18 8/19 8/20 Total Rate Earned/Gross Hourly Net Wages `m E i Hours of Pay "Usual FICA Withholding Other rn r a, Payroll Benefits" Tax Soc Sec#of Employee Address ff O o Hours Worked Each Day 0 1. Laborers RG 0.00 3.03 8.00 8.00 0.00 0.00 0.00 19.03 $54.01 $1,027.8 taxes:$25.50, Raker-Asphalt 1 long term care: (King) RYAN BAILEY $1,091.3 $2,119.15 $4.62 803 291st St E OT 0.00 2.47 5.50 5.50 0.00 0.00 0.00 13.47 $81.02 4 / $0.00/hr $219.61 $516.11 $2,109.67 Roy,WA-98580 _ $2,875.51 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12.0 $0.00 2. Power Equipment $1,156.4 taxes:$28.85, Operators RG 0.00 0.00 8.00 8.00 0.00 0.00 0.00 16.00 $72.28 8 medical:$11.41 RAY BALDERSON Roller, Plant Mix Or Multi-lift PO BOX 98761 $108.4 $2,132.26 Materials OT 0.00 0.00 4.50 4.50 0.00 0.00 0.00 9.00 $975.78 / $0.00/hr $279.41 $775.76 $2,568.42 Lakewood,WA- 2 (King) 98496 $3,663.85 ********* DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $16 5 $0.00 3. Truck Drivers J taxes:$35.60, RG 0.00 2.12 6.81 6.69 0.00 0.00 0.00 15.62 $63.71 $995.15 medical:$11.41, Asphalt Mix To 16 Yards WILLIAM (King) CARLSON .I f $2,387.33 401(k):$50.00, 21447 Piessner Rd OT 0.00 1.13 4.69 3.56 0.00 0.00 0.00 9.38 $95.57 $896.45 / $0.00/hr $338.24 $1,013.90 life ins:$11.27 $2,972.48 * ** Yelm,WA-98597 $4,432.90 $1274 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 . $0.00 4. Truck Drivers RG 0.00 1.64 1.19 1.31 0.00 0.00 0.00 4.14 $64.55 $267.24 taxes: , Other Trucks WILLIAM medical: $11.41, (King) CARLSON $2,387.33 401(k):$50.00, 21447 Piessner Rd OT 0.00 0.86 0.81 0.69 0.00 0.00 0.00 2.36 $96.82 $228.50 / $0.00/hr $338.24 $1,013.90 life ins:$11.27 $2,972.48 $4,432.90 Yelm,WA-98597 $191 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 ' $0.00 5. Power Equipment Dan Garl RG 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 $72.28 $1'734.7 taxes:$30.82, Operators 17223 SE 373rd 2 $3,144.18 $0.00/hr $305.70 $660.80 401(k):$50.00, $2,938.01 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Roller,Plant Mix Or Multi-lift Street $108.4 $1,409.4 / aflac:$26.67, Materials Auburn,WA-98092 OT 0.00 4.50 4.50 4.00 0.00 0.00 0.00 13.00 2 6 $4,230.21 medical:$218.21 (King) $144.5 * ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6 $0.00 6. Power Equipment $1,763.7 taxes:$37.30, Operators RG 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 $73.49 6 medical:$11.41 Spreader,Topsider& Spencer Gibbons $110.2 $1598.3 $3,362.10 Screedman 1809 H Street SE OT 0.00 5.50 4.50 4.50 0.00 0.00 0.00 14.50 34, / $0.00/hr $367.94 $1,109.39 $3,295.06 (King) Auburn,WA-98002 $4,821.10 ********* DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$.9 $0.00 7. Laborers taxes:$15.54, ANTHONY RG 0.00 3.03 0.00 0.00 0.00 0.00 0.00 3.03 $54.01 $163.65 medical:$198.77 Raker-Asphalt GRANDINETTI (King) 21804 Mountain $363.77/ ********* Hwy OT 0.00 2.47 0.00 0.00 0.00 0.00 0.00 2.47 $81.02 $200.12 $1 249 98 $0.00/hr $140.94 $89.07 $805.66 Spanaway,WA- $108.0 98387 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 8. Power Equipment RG 0.00 2.96 0.00 0.00 0.00 0.00 0.00 2.96 $72.28 $213.95 taxes:$23.02, Operators medical:$11.41, Roller,Plant Mix Or Multi-lift COREY GURSLEY $108.4 garn:$154.29,life Materials 25434 144th PI OT 0.00 2.04 0.00 0.00 0.00 0.00 0.00 2.04 2 $221.18 $435.13/$2 290.49 $0.00/hr $174.34 $393.92 ins:$1.16 $1,532.35 (King) Kent,WA-98042 * ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $16'5 $0.00 9. Truck Drivers RG 0.00 2.07 0.00 0.00 0.00 0.00 0.00 2.07 $64.55 $133.62 taxes: , Other Trucks JEFFREY medicall::$$11.11.41 (King) JACKSON $272.07/ 5836 A St OT 0.00 1.43 0.00 0.00 0.00 0.00 0.00 1.43 $96.82 $138.45 $2 279 27 $0.00/hr $173.50 $371.38 $1,694.06 ********* Tacoma,WA- 98408 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 29.1 $0.00 10. Power Equipment J $1,763 7 taxes:$41.35, Operators RG 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 $73.49 6 f 4 401(k):$548.09, Spreader,Topsider& TYLER JACOBSON $1104 $1,929 0 $3,692.79 medical:$11.41 Screedman 505 S 150th St OT 0.00 6.50 5.50 5.50 0.00 0.00 0.00 17.50 3 3 4 / $0.00/hr $418.42 $1,206.38 $3,255.29 tteir,g) Burien,WA-98148 $5,480.94 ****** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1$6.9 $0.00 *** 8.36 11. Laborers RG 0.00 2.96 0.00 0.00 0.00 0.00 0.00 2.96 $54.01 $159.87 taxes: l:$11., Raker-Asphalt BENJAMIN medical:$11.41 (King) JOHNSON OT 0.00 2.04 0.00 0.00 0.00 0.00 0.00 2.04 $81.02 $165.28 $325.15/ $0.00/hr $115.30 $196.74 $1,176.85 28915 20th Ave S $1,518.66 Roy,WA-98580 $108.0 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 12. Power Equipment $1,734.7 taxes:$37.12, Operators RG 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 $72.28 p 2 medical:$47.21, BRIAN KREGNESS Roller,Plant Mix Or Multi-lift 24215 117th St E $108.4 $1,572.0 $3,306.81 garn:$100.00 Materials Buckley,WA- OT 0.00 5.50 4.50 4.50 0.00 0.00 0.00 14.50 2 9 / $0.00/hr $368.78 $1,113.21 $3,201.51 (King) 98321 $4,867.83 * **** ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $16,5 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side l 13. Truck Drivers $1,378.6 taxes:$25.45,life RG 0.00 7.43 7.30 6.91 0.00 0.00 0.00 21.64 $63.71 8 ins:$34.97, Asphalt Mix To 16 Yards MARK MORROW (King) 6915 227th St E $1,085.6 $2,464.36 401(k):$158.93 Spanaway,WA- OT 0.00 5.57 3.20 2.59 0.00 0.00 0.00 11.36 $95.57 8 / $0.00/hr $243.16 $571.68 $2,144.46 leIrle jelr- ** 98387 $3,178.65 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127'4 $0.00 14. Truck Drivers .83, RG 0.00 3.50 0.00 0.00 0.00 0.00 0.00 3.50 $63.71 $222.99 medical:ed $ Asphalt Mix To 16 Yards AUSTIN MUNDELL $47.21 (King) 20328 87th Ave E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $95.57 $0.00 $222'99/ $0.00/hr $112.13 $187.62 $1,150.20 Spanaway,WA- $1,512.99 ********* 98387 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1�7'4 $0.00 15. Laborers ta .01, RG 0.00 2.96 0.00 0.00 0.00 0.00 0.00 2.96 $54.01 $159.87 medical:ed Raker-Asphalt BRIAN NEWELL $$111.1. 41 (King) 501 McKenzie Ave OT 0.00 2.04 0.00 0.00 0.00 0.00 0.00 2.04 $81.02 $165.28 $325.15/ $0.00/hr $132.01 $171.28 $1,402.46 SW $1,737.17 *****- *** Yelm,WA-98597 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $128'0 $0.00 16. Laborers taxes:$25.54 RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $54.01 $432.08 Raker-Asphalt (King) Caleb Ortega $958.71 / 2803 289th St S OT 0.00 6.50 0.00 0.00 0.00 0.00 0.00 6.50 $81.02 $526.63 $2 492 68 $0.00/hr $190.70 $425.34 $1,851.10 * * **** Roy,WA-98580 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 28'0 $0.00 17. Laborers RG 0.00 0.00 8.00 8.00 0.00 0.00 0.00 16.00 $54.01$ taxes:$37.11, .16 Raker-Asphalt medical:$11.41, (King) TREVOR OWENS 4 NI $3,038.35 401(k):$271.01 26703 Bristol Ct OT 0.00 0.00 5.50 5.50 0.00 0.00 0.00 11.00 $81.02 $891.22 / $0.00/hr $344.67 $965.92 $2,886.70 ********* Kent,WA-98032 $4,516.82 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12'0 $0.00 18. Power Equipment RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $72.28 $578.24 taxes:$37.11, Operators medical:l:$11.41, Roller,Plant Mix Or Multi-lift TREVOR OWENS $3,038.35 401(k):$271.01 =i:erials 26703 Bristol Ct OT 0.00 6.50 0.00 0.00 0.00 0.00 0.00 6-50 $108'4 $704.73 / $0.00/hr $344.67 $965.92 $2,886.70 ;g) Kent,WA-98032 $4,516.82 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $164'5 $0.00 19. Truck Drivers RG 0.00 2.91 6.04 6.40 0.00 0.00 0.00 15.35 $63.71 $977.95 taxes:$33.63 Asphalt Mix To 16 Yards Tony Patricelli (King) 35631 13th Ave SW $2,055.01 Federal Way,WA- OT 0.00 0.09 3.21 3.60 0.00 0.00 0.00 6.90 $95.57 $659.43 / $0.00/hr $244.88 $556.86 $2,365.58 **** -**** 98023 $3,200.95 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12'4 $0.00 20. Truck Drivers RG 0.00 0.00 1.96 1.60 0.00 0.00 0.00 3.56 $64.55 $229.80 taxes:$33.63 Other Trucks Tony Patricelli (King) 35631 13th Ave SW $2,055.01 Federal Way,WA- OT 0.00 0.00 1.04 0.90 0.00 0.00 0.00 1.94 $96.82 $187.83 / $0.00/hr $244.88 $556.86 $2,365.58 * - ** 98023 $3,200.95 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10.1 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 21. Power Equipment $1,763.7 taxes:$42.01, Operators RG 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 $73.49 6 medical:$47.21, Spreader,Topsider& CHRIS PEDERSEN $110.2 $1929.0 $3'692.79 garn:$85.38,long Screedman 1536 Index Ave Ne OT 0.00 6.50 5.50 5.50 0.00 0.00 0.00 17.50 33, / $0.00/hr $429.96 $1,451.04 term care:$12.19 $3,612.08 (King) Renton,WA-98056 $5,679.87 ********* DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9 $0.00 22. Truck Drivers RG 0.00 5.14 4.48 7.06 0.00 0.00 0.00 16.68 $63.71 $1,062.6 taxes:$27.13, Asphalt Mix To 16 Yards SCOTT RIGTRUP 8 401(k):$661.39 (King) 19412 207th Street $1,956.52 OT 0.00 3.86 2.52 0.44 0.00 0.00 0.00 6.82 $95.57 $651.79 $0.00/hr $252.98 $273.85 $2,091.59 Ct E ***** **** $3,306.94 Orting,WA-98360 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 23. Truck Drivers 3, RG 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $64.55 $0.00 taxes: $6 161.. 39 Other Trucks SCOTT RIGTRUP 401(k):$6 (King) 19412 207th Street $1,956.52 Ct E OT 2.50 0.00 0.00 0.00 0.00 0.00 0.00 2.50 $96.82 $242.05 / $0.00/hr $252.98 $273.85 $2,091.59 ********* $3,306.94 Orting,WA-98360 $129.1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 $0.00 - 24. Laborers taxes:$12.56 Raker-Asphalt Samuelu Samaga RG 0.00 2.96 0.00 0.00 0.00 0.00 0.00 2.96 $54.01 $159.87 (King) 11222 18th Ave S $325.15/ APT#305 OT 0.00 2.04 0.00 0.00 0.00 0.00 0.00 2.04 $81.02 $165.28 $1,112.14 $0.00/hr $85.08 $109.82 $904.68 _ _ ** Tacoma,WA- 98444 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $108.0 $0.00 25. Power Equipment RG 0.00 3.03 0.00 0.00 0.00 0.00 0.00 3.03 $73.49 $222.67 taxes:$14.77, Operators TUVALE SAMAGA medical:$94.42 Spreader,Topsider& 12209 106th Ave Ct $110 2 $494.94/ 'Screedman E OT 0.00 2.47 0.00 0.00 0.00 0.00 0.00 2.47 3 $272.27 $1,609.20 $0.00/hr $115.88 $198.40 $1,185.73 (King) Puyallup,WA- ********* 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 8.9 $0.00 26. Truck Drivers $1,323.8 taxes:$27.08, Asphalt Mix To 16 Yards RG 0.00 7.08 6.96 6.74 0.00 0.00 0.00 20.78 $63.71 9 aflac:$29.43, life KENNETH SHARP (King) 20412 93rd St E $2,157.26 ins:$22.53, Bonney Lake,WA- OT 0.00 4.42 3.04 1.26 0.00 0.00 0.00 8.72 $95.57 $833.37 / $0.00/hr $250.76 $593.95 401(k):$165.37 $2,218.22 ********* $3,307.34 98391 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2 $0.00 27. Power Equipment taxes:$18.36, RG 0.00 3.03 0.00 0.00 0.00 0.00 0.00 3.03 $73.49 $222.67 Operators medical:$11.41, JOSHEPH SMITH Spreader,Topsider& 39611 62nd Ave OT 0.00 2.47 0.00 0.00 0.00 0.00 0.00 2.47 $110.2 $272 27 $494.94/ hsa:$50.00 Screedman Eatonville,WA- 3 $2,340.49 $0.00/hr $174.34 $268.07 $1,818.31 (King) 98328 DT 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 $146.98 $0.00 28. Power Equipment taxes:$24.69, Operators RG 0.00 3.03 0.00 0.00 0.00 0.00 0.00 3.03 $72.28 $219.01 P medical:$11.41, Caleb Wakefield Roller,Plant Mix Or Multi-lift garn:$105.00 1446 Main St OT 0.00 2.47 0.00 0.00 0.00 0.00 0.00 2.47 $108.4 $267.80 $486.81 / Materials Buckley,WA- 2 $2 487.29 $0.00/hr $189.40 $382.85 $1,773.94 (King) 98321 " ***,.**** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $144.5 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side ,r 29. Truck Drivers $1,381.2 taxes:$35.02, RG 0.00 7.14 7.22 7.32 0.00 0.00 0.00 21.68 $63.71 3 medical:$47.21, Asphalt Mix To 16 Yards BRETT WALDRON (King) Po Box 8611 $1 249 1 $2,918.54 aflac:$7.20 Covington,WA- OT 0.00 5.36 4.28 3.43 0.00 0.00 0.00 13.07 $95.57 0 / $0.00/hr $332.43 $946.96 $3,031.20 98042 $4,400.02 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1�7'4 $0.00 30. Truck Drivers RG 0.00 0.86 0.78 0.68 0.00 0.00 0.00 2.32 $64.55 $149.76 taxes:$35.02, Other Trucks BRETT WALDRON medical:l:$47.$47.21, (King) Po Box 8611 $2,918.54 aflac:$7.20 Covington,WA- OT 0.00 0.64 0.47 0.32 0.00 0.00 0.00 1.43 $96.82 $138.45 / $0.00/hr $332.43 $946.96 $3,031.20 *****-**** $4,400.02 98042 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $129.1 $0.00 31. Truck Drivers taxes:$17.65 RG 0.00 6.75 0.00 5.00 0.00 0.00 0.00 11.75 $63.71 $748.59 Asphalt Mix To 16 Yards(King) JASON WHITE $1,130.87 2819 R PI SE OT 0.00 4.00 0.00 0.00 0.00 0.00 0.00 4.00 $95.57 $382.28 / $0.00/hr $142.07 $167.20 $1,530.19 I ********* Auburn,WA-98002 $1,857.11 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Heidy Brothers Office Manager 9/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 8/14/2022 8/20/2022 "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 1.RYAN BAILEY Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.RAY BALDERSON --,wer Equipment Operators )filer, Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 materials (King) 3.WILLIAM CARLSON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.WILLIAM CARLSON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.Dan Gar! Power Equipment Operators Roller, Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials ing) 6.Spencer Gibbons Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.ANTHONY GRANDINETTI Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.COREY GURSLEY D.--wer Equipment Operators filler,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 �,aterials (King) 9.JEFFREY JACKSON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 10.TYLER JACOBSON Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 11.BENJAMIN JOHNSON Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) BRIAN KREGNESS Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 13.MARK MORROW Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 14.AUSTIN MUNDELL ;, Track Drivers phalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 15.BRIAN NEWELL Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 16.Caleb Ortega Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 17.TREVOR OWENS Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) ia.TREVOR OWENS Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 • Materials (King) 19.Tony Patricelli Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 20.Tony Patricelli 'hoick Drivers .ier Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 21.CHRIS PEDERSEN Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 22.SCOTT RIGTRUP Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 23.SCOTT RIGTRUP Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 nc�ng) 24.Samuelu Samaga Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 25.TUVALE SAMAGA Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 26.KENNETH SHARP Truck Drivers phalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 27.JOSHEPH SMITH Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 28.Caleb Wakefield Power Equipment Operators Roller, Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 29.BRETT WALDRON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 'ng) 30.BRETT WALDRON Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 31.JASON WHITE Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) - F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. «\Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Heidy Brothers Office Manager Heidy Brothers 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 �� rAtt. Project Name County Project or Contract# � ;ii 4�:,°,�. Prime Contractor E Industries _�=y. �•i3i -�,�''_;;��„ Duvall Avenue NE King CAG-20-065 PrevailingWage Program < 1`•': ""_ g g ,s:3111. ''1!!'i Subcontractor NI PO Box 44540 °;�u"]r y° Project Address Olympia WA 98504-4540 y� '�""r� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 8/13/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name C7 ~O o Sun Mon Tue Wed Thu Fri Sat Total cc a> Gross Amount and And E 8/7 8/8 8/9 8/10 8/11 8/12 8/13 Total Rate Earned/Gross Hourly Net Wages j = Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address CD 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 Heidy Brothers Office Manager 9/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: n,—all Avenue NE 8/7/2022 8/13/2022 "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 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 Heidy Brothers Office Manager Heidy Brothers 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 �,,;,s:(ArF, Project Name County Project or Contract# .:.:.p °, Prime Contractor ❑ Industries :: fn 3;;:: =.r. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program •;PH' "IT,- Subcontractor L�J PO Box 44540 ';,,y,, c�,-, Project Address Olympia WA 98504-4540 ` '"Ha Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 8/6/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions H Work Classification Name 0 O~ o Sun Mon Tue Wed Thu Fri Sat Total cC Gross Amount and And j E 7/31 8/1 8/2 8/3 8/4 8/5 8/6 Total Rate Hourly `m E i Hours of Pay Earned/Gross "Usual Withholding Net Wages a) Payroll FICA Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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 Heidy Brothers Office Manager 9/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 7/31/2022 8/6/2022 "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. "Lny 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 Heidy Brothers Office Manager Heidy Brothers 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 ,t,sr�rE Project Name County Project or Contract# ,�;i.3,., .r:,,- Prime Contractor ❑ Industries ;ii; r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <ii°°s'H +:",= Subcontractor �,it:: tl` Project Address PO Box 44540 4,::" µJy 1 Olympia WA 98504-4540 yy '""" ' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON, CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 7/30/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name C5 ~O o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount and And m E 7/24 7/25 7/26 7/27 7/28 7/29 7/30 Total Rate Earned/Gross Hourly Net Wages j E ia) Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address > z y Benefits" Tax a' 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 Heidy Brothers office manager 8/2/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 7/24/2022 7/30/2022 "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. Eg`,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 Heidy Brothers office manager Heidy Brothers 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 1,ATi Project Name County Project or Contract# ��'`'4s _t ", Prime Contractor ❑ Industries :h, `IL s. �_,;_ - ,;:�==:Y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 1111ii,. ,�Eili'r Subcontractor LRJ PO Box 44540 '';'t'=; y,. Project Address Olympia WA 98504-4540 f� "� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 7/23/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount a, E 7/17 7/18 7/19 7/20 7/21 7/22 7/23 Total Rate Hourly and And Earned/Gross Net Wages .E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m > Q 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 Heidy Brothers office manager 8/2/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: veil Avenue NE 7/17/2022 7/23/2022 "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 ..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. lc),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 Heidy Brothers office manager Heidy Brothers 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 *,t `°�,r, Project Name County Project or Contract# Industries _,,l ,, .f Prime Contractor ❑ tip'- 9:.41 Duvall Avenue NE King CAG-20-065 Prevailing Wage Programs 11+ �ri��'� Subcontractors PO Box 44540 "':_�• , �,.2 Project Address Olympia WA 98504-4540 A' AC' `—""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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 7/16/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name (13 ~O o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount and And E 7/10 7/11 7/12 7/13 7/14 7/15 7/16 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other 4- a, Payroll Benefits" Tax Soc Sec#of Employee Address O o12 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 Heidy Brothers office manager 8/2/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 7/10/2022 7/16/2022 "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. 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 Heidy Brothers office manager Heidy Brothers , 1 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 *t ��E Project Name County Project or Contract# Industries ; t,I,F Prime Contractor ❑ ::, «i:r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ;i�iiii 'ilia- Subcontractor N PO Box 44540 4,,;b" , 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 7/9/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions IL- Work Classification Name c7 8 l Sun Mon Tue Wed Thu Fri Sat Total u, Gross Amount and And E 7/3 7/4 7/5 7/6 7/7 7/8 7/9 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay cu Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address 0 > 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 Heidy Brothers Office Manager 7/11/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ^•-tall Avenue NE 7/3/2022 7/9/2022 "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. 7"- 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 Heidy Brothers Office Manager Heidy Brothers MB 7/11/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and *f OVA 7: Project Name County Project or Contract# Industries _^,i;s.,==t. .. Prime Contractor ❑ =n;, ___:; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program .116 lif Subcontractor ® Project Address PO Box 44540 _ ,.y�j1`,' apY Olympia WA 98504-4540 ` ""d ' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 7/2/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions P Work Classification Name C� ~ o Sun Mon Tue Wed Thu Fri Sat Total a, Gross Amount and And a) E 6/26 6/27 6/28 6/29 6/30 7/1 7/2 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address C > y Benefits" Tax 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 Heidy Brothers Office Manager 7/11/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/26/2022 7/2/2022 "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. 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 Heidy Brothers Office Manager Heidy Brothers MB 7/11/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and gerf; Project Name County Project or Contract# �.::i =_:•F Prime Contractor ❑ Industries ° ' `;Y Duvall Avenue NE King CAG 20 065 Prevailing Wage Program 1.iiij;=t .� li M Subcontractor 0 PO Box 44540N.': ;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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 6/25/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name C7 ~O 9- Sun Mon Tue Wed Thu Fri Sat Total CC Gross Amount and And E 6/19 6/20 6/21 6/22 6/23 6/24 6/25 Total Rate Earned/Gross Hourly Net Wages .E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address CD 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 Heidy Brothers Office Manager 7/11/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: n,—all Avenue NE 6/19/2022 6/25/2022 "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. ,Ikny 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 Heidy Brothers Office Manager Heidy Brothers MB 7/11/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and t: Project Name County Project or Contract# •<`'''in^ei`'F Prime Contractor ❑ Industries :.:s:i ++ ••.•9i:4-, Duvall Avenue NE King CAG 20 065 Prevailing Wage Program I w4llie ;f f l i Subcontractor Lx PO Box 44540 `°'�H` w,,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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 6/18/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions I Work Classification Name C7 ~O o Sun Mon Tue Wed Thu Fri Sat Total a) Gross Amount and Andct E 6/12 6/13 6/14 6/15 6/16 6/17 6/18 Total Rate Earned/Gross Hourly " Net Wages .E a Hours of Pay Payroll Usual FICA Withholding Other Soc Sec#of Employee Address al Ct 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 Heidy Brothers Office manager 6/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: ivall Avenue NE 6/12/2022 6/18/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ! `Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 Heidy Brothers Office manager Heidy Brothers 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 ���:}s+erf.�� Project Name County Project or Contract# Industries Prime Contractor ❑ Ki t f. - , `iii;i Duvall Avenue NE King CAG-20-065 Prevailing Wage Program lib ,+:j(s':= Subcontractor ❑x PO Box 44540 ,',yf ,_, 6y� 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 6/11/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name C9 ~O o Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And E 6/5 6/6 6/7 6/8 6/9 6/10 6/11 Total Rate Earned/Gross Hourly Net Wages 1= a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address cK 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 Heidy Brothers Office manager 6/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 6/5/2022 6/11/2022 "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. "Vny-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 Heidy Brothers Office manager Heidy Brothers • 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 ,,1llti';� Prime Contractor ❑ Project Name County Project or Contract# ,.t Industries _a!# ' n_i - ,::i&L- Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ,.Ikr ,tA�Ili` Subcontractor n< 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 6/4/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date • Deductions Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total a� Gross Amount and And ` a> E 5/29 5/30 5/31 6/1 6/2 6/3 6/4 Total Rate Earned/Gross Hourly Net Wages m E i= Hours of Pay Net FICA Withholding Other �, Payroll Benefits" Tax 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 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 Heidy Brothers Office manager 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/29/2022 6/4/2022 "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 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. ,,qny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and o 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 Heidy Brothers Office manager Heidy Brothers MB 6/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �`{,,I Tl Project Name County Project or Contract# Industries .{G" ElPrime Contractor __:-r.;,.: r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program �<i;III 4; ;_ PO Box 44540 a.y;:� �y. Subcontractor ® Project Address Olympia WA 98504-4540 yy '&""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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 5/28/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total a� Gross Amount and And E 5/22 5/23 5/24 5/25 5/26 5/27 5/28 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address ill CC 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 Heidy Brothers Office manager 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons .LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/22/2022 5/28/2022 "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. kny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and i'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 Heidy Brothers Office manager Heidy Brothers MB 6/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and aF,�TArf,� Project Name County Project or Contract# �,.a, �::.F Prime Contractor ❑ Industries §iiii i f. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program I�.`iiiIi, ,t.;;; Subcontractor PO Box 44540 °' ° Project Address Olympia WA 98504-4540 yy� '& "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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 5/21/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name cc ~O -raw Sun Mon Tue Wed Thu Fri Sat Total Gross Amount and And a) E 5/15 5/16 5/17 5/18 5/19 5/20 5/21 Total Rate a, Payroll Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address O o Benefits" Tax 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 Heidy Br Office Manager 5/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: rI wall Avenue NE 5/15/2022 5/21/2022 l ; "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. L` any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Heidy Br Office Manager Heidy Br • 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 � Project Name County Project or Contract# ? � t ,, Prime Contractor ❑ z Industries =_:. Nis.. •_r. tviii;, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program limit ,+:111'` Subcontractor IN PO Box 44540 °'p'1 ,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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 5/14/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions p Work Classification Name (— ~O o Sun Mon Tue Wed Thu Fri Sat Total iY Gross Amount and And E 5/8 5/9 5/10 5/11 5/12 5/13 5/14 Total Rate Hourly Earned/Gross Net Wages j E i= , Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address cC 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 Heidy Brothers Office manager • 5/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: nvvall Avenue NE 5/8/2022 5/14/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,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 Heidy Brothers Office manager Heidy Brothers 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 t,_TArf• Project Name County Project or Contract# ?..! Prime Contractor ❑ Industries _=GF f �':ii;.r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 11=11i ,;:=ilia Subcontractor PO Box 44540 '',;_,, 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 LAKERIDGE PAVING CO L L C (253)631-8290 Month Day Year Awarding Agency Address Address City State Zip+4 5/7/2022 1055 S GRADY WAY RENTON,WA-98055 PO BOX 8500 COVINGTON WA 98042 Day and Date Deductions P Work Classification Name c9 ~O o Sun Mon Tue Wed Thu Fri Sat Total a� Gross Amount and And o E 5/1 5/2 5/3 5/4 5/5 5/6 5/7 Total Rate Earned/Gross Hourly Net Wages ` = Hours of Pay Payroll "Usual FICA Withholdingf a) Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" Tax a 1. Laborers RG 0.00 6.15 0.00 0.00 0.00 0.00 0.00 6.15 $54.01 $332.16 taxes:$27.56, J Raker-Asphalt long term care: (King) RYAN BAILEY J J $1,838.27 $4.62 803 291st St E OT 0.00 3.85 0.00 0.00 0.00 0.00 0.00 3.85 $81.02 $311.93 / $0.00/hr $243.17 $590.00 $2,318.05 • _ _ •* Roy,WA-98580 _ - . $3,183.40 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $108 0 $0.00 2. Power Equipment RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $73.49 $587.92 taxes:$2 , Operators J long term care: Spreader,Topsider& RYAN BAILEY $110 J $1,838.27 $4.62 Screedman 803 291st St E OT 0.00 0.00 5.50 0.00 0.00 0.00 0.00 5.50 3 $606.27 / $0.00/hr $243.17 $590.00 $2,318.05 (King) Roy,WA-98580 $3,183.40 ......... DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186'9 $0.00 3. Truck Drivers J J taxes:$26.70, RG 0.00 0.00 6.29 0.00 0.00 0.00 0.00 6.29 $63.71 $400.74 medical:$11.41, Asphalt Mix To 16 Yards WILLIAM (King) CARLSON J J $588.05/ life ins:$11.27, x �* 21447 Piessner Rd OT 0.00 0.00 1.96 0.00 0.00 0.00 0.00 1.96 $95.57 $187.32 $2 939 83 $0.00/hr $224.02 $557.61 401(k):$50.00 $2,058.82 Yelm,WA-98597 $127.4 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 J $0v90 4. Laborers ANTHONY RG 0.00 6.15 8.00 0.00 0.00 0.00 0.00 14.15 $54.01 $764.24 taedcall$24.89, J medical: Raker-Asphalt GRANDINETTI :$198.77 98 (King) 21804 Mountain ,I J $1,521.78 Hwy OT 0.00 3.85 5.50 0.00 0.00 0.00 0.00 9.35 $81.02 $757.54 / $0.00/hr $278.98 $442.03 $1,827.04 Spanaway,WA $2,771.71 $1080 98387 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ' $0.00 5. Power Equipment COREY GURSLEY RG 0.00 6.33 8.00 0.00 0.00 0.00 0.00 14.33 $72.28 $1,035 7 J taxes:$31.27, Operators 25434 144th PI 7 J $1,867.35 $0.00/hr $303.42 $777.46 medical:$11.41, $2,819.91 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Roller,Plant Mix Or Multi-lift Kent,WA-98042 $108 4, J / life ins:$1.16, Materials OT 0.00 3.17 4.50 0.00 0.00 0.00 0.00 7.67 2 J $831.58 $4,098.92 garn:$154.29 (King) $144.5 ' DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 ***_**_**** J J 6. Laborers RG 0.00 6.33 8.00 0.00 0.00 0.00 0.00 14.33 $54.01 $773.96 taxes:$15.93, Raker-Asphalt Zackary Isbell J medical:$47.21, (King) 5322 N Highland St J J $1,395.39 garn:$187.84 APTA OT 0.00 3.17 4.50 0.00 0.00 0.00 0.00 7.67 $81.02 $621.42 / $0.00/hr $139.58 $266.54 $1,214.62 ********* Tacoma,WA- $1,871.72 98047 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $108.0 $0 000 7. Laborers RG 0.00 6.33 8.00 0.00 0.00 0.00 0.00 14.33 $54.01 $773.96 J taxes:$23.89, Raker-Asphalt BENJAMIN medical:$11.41 (King) JOHNSON J J $1,395.39 28915 20th Ave S OT 0.00 3.17 4.50 0.00 0.00 0.00 0.00 7.67 $81.02 $621.42 / $0.00/hr $199.26 $452.22 $1,929.32 ********* $2,616.10 i. - - Roy,WA-98580 $108.0 , 1 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 8. Laborers J taxes:$4.88, Raker As halt R J G 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $54.01 $432.08 J garn:$129.46, p Nick Michael medical:$11.41 (King) 212 Valley Ave 4 $594.12/ Sumner,WA- OT 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 $81.02 $162.04 $594.11 $0.00/hr $44.58 $37.14 $366.64 ********* 98390 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $108.0 $OV.�jO 9. Truck Drivers RG 0.00 0.00 7.33 0.00 0.00 0.00 0.00 7.33 $63.71 $466.99 taxes:$10.80,life Asphalt Mix To 16 Yards MARK MORROW ins:$34.97, (King) 6915 227th St E J J $892 94/ 401(k):$64.72 Spanaway,WA- OT 0.00 0.00 3.67 0.00 0.00 0.00 0.00 3.67 $95.57 $350.74 $1,294.42 $0.00/hr $99.02 $153.87 $931.04 ****.**** 98387 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 10. Truck Drivers RG 0.00 0.00 0.67 0.00 0.00 0.00 0.00 0.67 $64.55 $43.25 taxes:$10.80,life J Other Trucks MARK MORROW ins:$34.97, (King) 6915 227th St E J J $892 94/ 401(k):$64.72 Spanaway,WA- OT 0.00 0.00 0.33 0.00 0.00 0.00 0.00 0.33 $96.82 $31.95 $1,294.42 $0.00/hr $99.02 $153.87 $931.04 ***_**_**** 98387 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $129.1 $0.00 1,11. Truck Drivers RG 0.00 6.58 0.00 0.00 0.00 0.00 0.00 6.58 $63.71 $419.21 taxes:$14.13, J Asphalt Mix To 16 Yards KAILY MOSSER medical:$11.41, (King) 25213 103rd Ave E J J $822.20/ 401(k):$77.25 Graham,WA- OT 0.00 2.67 0.00 0.00 0.00 0.00 0.00 2.67 $95.57 $255.17 $1,544.95 $0.00/hr $117.31 $185.53 $1,139.32 ********* 98338 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.42 $0\0 12. Truck Drivers J taxes:$14.13, Other Trucks RG 0.00 1.42 0.00 0.00 0.00 0.00 0.00 1.42 $64.55 $91.66 medical:$11.41, KAILY MOSSER (King) 25213 103rd Ave E J J $822 20/ 401(k):$77.25 Graham,WA- OT 0.00 0.58 0.00 0.00 0.00 0.00 0.00 0.58 $96.82 $56.16 $1,544.95 $0.00/hr $117.31 $185.53 $1,139.32 ****.**** 98338 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $12J9.1 $0.00 13. Laborers DANIEL MUNOZ RG 0.00 0.00 4.44 0.00 0.00 0.00 0.00 4.44 $52.39 $232.61 J taxes:$24.48, 618 SW 129th St. $276.62/ $0.00/hr $167.10 $369.77 medical:$11.41 $1,875.41 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side General Laborer 'Burien,WA-98146 4 J $2,448.17 (King) OT 0.00 0.00 0.56 0.00 0.00 0.00 0.00 0.56 $78.59 $44.01 ********* DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10044.7 $0.00 14. Truck Drivers RG 0.00 0.00 2.50 0.00 0.00 0.00 0.00 2.50 $64.55 $161.38.1taxes:$17.32, Other Trucks BRIAN O'FARRELLJ 401(k):$225.00, (King) 19603 228th Ave $161.38/ life ins:$53.34 SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $96.82 $0.00 $1,827.11 $0.00/hr $139.77 $253.99 $1,137.69 ****__*__* Maple Valley,WA- . 98038 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $129.1 $0.00J 15. Truck Drivers RG 0.00 6.77 6.80 0.00 0.00 0.00 0.00 13.57 $6Jl $864.54 J taxes:$27.42 Asphalt Mix To 16 Yards Tony Patricelli - . J $1,168.46 (King) 35631 13th Ave SW OT 0.00 1.48 1.70 0.00 0.00 0.00 0.00 3.18 $95.57 $303.91 / $0.00/hr $180.05 $353.49 $1,792.61 Federal Way,WA- $2,353.57 __**�*__* 98023 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0.00 lb-. Laborers Laborers RG 0.00 6.33 8.00 0.00 0.00 0.00 0.00 14.33 $54. J 1 $773.96 taxes:$23.22, Raker-Asphalt losefo Samaga p medical:$11.41 (King) 11222 18th Ave S V J $1,395.39 APTH305 OT 0.00 3.1.7 4.50 0.00 0.00 0.00 0.00 7.67 $81.02 $621.42 / $0.00/hr $187.53 $376.95 $1,863.60 ********* Tacoma,WA- $2,462.71 98444 DT 0.00 0.00 0.00 _0.00 0.00 0.00 0.00 0.00 $12.0 $0�0 17. Laborers RG 0.00 6.33 8.00 0.00 0.00 0.00 0.00 14.33 $54.01 $773.96 J taxes:$23.49 Raker-Asphalt Samelu Samaga (King) 11222 18th Ave S J �J/ $1,395.39 APT#305 OT 0.00 3.17 4.50 0.00 0.00 0.00 0.00 7.67 $81.02 $621.42 / $0.00/hr $192.27 $430.33 $1,867.39 ___*_**_* Tacoma,WA- $2,513.48 98444 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10088.0 $0.00 18. Laborers RG 0.00 6.15 0.00 0.00 0.00 0.00 0.00 6.15 $54.01 $332.16 taxes:$33.90, Raker-Asphalt TUVALE SAMAGA J medical:$47.21 (King) 12209 106th Ave Ct J J $1,838.27 E OT 0.00 3.85 0.00 0.00 0.00 0.00 0.00 3.85 $81.02 $311.93 / $0.00/hr $263.85 $777.82 $3,151.43 Puyallup,WA- $4,274.21 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10088.0 $0.00 Power Equipment RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $73.49 $587.92 taxes:$33.90, Operators TUVALE SAMAGA J medical:$47.21 Spreader,Topsider& 12209 106th Ave Ct $110 J $1,838.27 Screedman E OT 0.00 0.00 5.50 0.00 0.00 0.00 0.00 5.50 3 $606.27 / $0.00/hr $263.85 $777.82 $3,151.43 (King) Puyallup,WA- $4,274.21 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1846.9 $0.00 ********* 20. Laborers RG 0.00 6.33 8.00 0.00 0.00 0.00 0.00 14.33 $54.01 $773.96 J taxes:$23.89, Raker-Asphalt JACOB medical:$11.41 (King) SCHNEIDER J J $1,395.39 1508 Taylor St OT 0.00 3.17 4.50 0.00 0.00 0.00 0.00 7.67 $81.02 $621.42 / $0.00/hr $199.17 $461.96 $1,918.59 ********* $2,615.02 Milton,WA-98354 $108.0 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 42 21. Truck Drivers KENNETH SHARP RG 0.00 0.00 7.04 0.00 0.00 0.00 0.00 7.04 $63.71 $448 J taxes:$22.52, 2 20412 93rd St E $826.98/ $0.00/hr $232.04 $538.18 aflac:$29.43,life $2,064.88 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Asphalt Mix To 16 Yards Bonney Lake,WA- V V $3,062.72 ins:$22.53, (King) 98391 OT 0.00 0.00 3.96 0.00 0.00 0.00 0.00 3.96 $95.57 $378.46 401(k):$153.14 * ** *** ' ** DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127'4 $0.00 22. Laborers J J taxes:$30.53, RG 0.00 5.93 0.00 0.00 0.00 0.00 0.00 5.93 $54.01 $320.28 4 medical:$11.41, Raker-Asphalt JOSHEPH SMITH ) I (King) 39611 62nd Ave �1 V $1,899.33 hsa:$50.00 Eatonville,WA- OT 0.00 4.07 0.00 0.00 0.00 0.00 0.00 4.07 $81.02 $329.75 / $0.00/hr $284.78 $587.30 $2,819.96 ****._**** 98328 $3,783.98 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $10J8.0 $0.0 23. Power Equipment RG 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 $73.49 $58792 taxes: l: , Operators / J medical:$11.41, JOSHEPH SMITH V $1,899.33 hsa:$50.00 Spreader,Topsider& 39611 62nd Ave $110 Screedman OT 0.00 0.00 6.00 0.00 0.00 0.00 0.00 6.00 $661.38 / $0.00/hr $284.78 $587.30 $2,819.96 (King) Eatonville,WA- 3 $3,783.98 . 98328 $146.9 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 ********* 24.e Power Equipment RG 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 $72.28 $578.24 taxes:$28.41, Operators J medical:$11.41, Roller,Plant Mix Or Multi-lift Caleb Wakefield J $1,818.64 garn:$105.00 1446 Main St $108.4 Materials Buckley,WA- OT 0.00 5.50 0.00 0.00 0.00 0.00 0.00 5.50 2�/ $596.31 / $0.00/hr $260.11 $604.67 $2,401.96 (King) 98321 $3,411.56 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $144.5 $0.00 25. Laborers J `� taxes:$28.41, RG 0.00 0.00 6.15 0.00 0.00 0.00 0.00 6.15 $54.01 $332.16 medical:$11.41, Raker-Asphalt Caleb Wakefield (King) 1446 Main St $1,818.64 garn:$105.00 Buckley,WA- OT 0.00 0.00 3.85 0.00 0.00 0.00 0.00 3.85 $81.02 $311.93 / $0.00/hr $260.11 $604.67 $2,401.96 ********* 98321 $3,411.56 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $108.0 $0 000 26. Truck Drivers RG 0.00 4.50 6.94 0.00 0.00 0.00 0.00 11.44 $63.71 $728.84 J taxes:$39.61 Asphalt Mix To 16 Yards (King) JASON WHITE J J $1,703.06 2819 R PI SE OT 0.00 2.25 4.56 0.00 0.00 0.00 0.00 6.81 $95.57 $650.83 / $0.00/hr $298.87 $611.67 $2,956.63 ********* Auburn,WA-98002 $3,906.78 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $127.4 $0`.q0 zi. Truck Drivers `/ `� taxes:$39.61 RG 0.00 1.67 1.06 0.00 0.00 0.00 0.00 2.73 $64.55 $176.22 Other Trucks (King) JASON WHITE J J $1,703.06 2819 R PI SE OT 0.00 0.83 0.69 0.00 0.00 0.00 0.00 1.52 $96.82 $147.17 / $0.00/hr $298.87 $611.67 $2,956.63 *****+*** Auburn,WA-98002 $3,906.78 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 29'1 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Heidy Brothers Office manager 5/24/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LAKERIDGE PAVING CO L L C employed by: Project Name: For the week starting: For the week ending: "°•mall Avenue NE 5/1/2022 5/7/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.RYAN BAILEY Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 • (King) 2.RYAN BAILEY "'5),wer Equipment Operators reader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 3.WILLIAM CARLSON Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 4.ANTHONY GRANDINETTI Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 5.COREY GURSLEY Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials • °ing) 6.Zackary Isbell Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 7.BENJAMIN JOHNSON Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 8.Nick Michael "'fforers Jker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 9.MARK MORROW Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 10.MARK MORROW Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 11.KAILY MOSSER Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ,LL (King) KAILY MOSSER Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 13.DANIEL MUNOZ Laborers General Laborer $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 14.BRIAN O'FARRELL Truck Drivers ler Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 15.Tony Patricelli Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 16.losefo Samaga Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 17.Samelu Samaga Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) u.TUVALE SAMAGA Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 19.TUVALE SAMAGA Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 20.JACOB SCHNEIDER Laborers -ker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 21.KENNETH SHARP Truck Drivers Asphalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 22.JOSHEPH SMITH Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 23.JOSHEPH SMITH Power Equipment Operators Spreader,Topsider&Screedman $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 rking) Z4.Caleb Wakefield Power Equipment Operators Roller,Plant Mix Or Multi-lift $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Materials (King) 25.Caleb Wakefield Laborers Raker-Asphalt $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 26.JASON WHITE Tick Drivers ohalt Mix To 16 Yards $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 27.JASON WHITE Truck Drivers Other Trucks $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. \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 Heidy Brothers Office manager Heidy Brothers MB 5/24/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side