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HomeMy WebLinkAboutCAG-20-065 - Duvall - Subcontractor Legacy Tapping 12114123,3:28 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: 1163708 Status: Approved on 11/21/2022 11/21/2022 1207537 Company Details - Name LEGACY TAPPING INC Address 17832 87th Ave SE SNOHOMISH,WA,98296 WA UBI no. 604359046 Contractor Registration no. LEGACTI826R8 Industrial Insurance Account Id Not Applicable OMWBE Certifications as of 1/27/2022 No active certifications existed when Intent was submitted Email Address legacytapping®gmail.corn Filed By Gibbs, Erin Prime Contractor Prime contractor name REED TRUCKING &t EXCAVATING INC about:blank 1/3 12/14/23,3:28 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: $ 19,575.00 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: Project Details County where work was performed King _ abgut blank 2/3 " 12/14/2`3,3:28 PM about:blank City where work was performed Renton Prime contractor Intent form Id# for this project 1170257 Intent filed date 1/27/2022 Job start date:MM-DD-YYYY 4/29/2022 Date work completed:MM-DD-YYYY 10/7/2022 Project Completion Did your company hire any subcontractors? No Did your company have employees perform work on this No project? Did you use apprentice employees on this project? No Company Owner Information How many owner/operators performed work on the 1 project that own 30% or more of the company? First Name Last Name Trade Erin Gasparovich Plumbers Ft Pipefitters Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages Apprentice Wages Public Notes o Show/Hide Existing Notes No note exists about:blank 3/3 5 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: 11/21/2022 1207537 1163708 11/21/2022 Company Details Name LEGACY TAPPING INC Address 17832 87th Ave SE SNOHOMISH,WA,98296 WA UBI no. 604359046 Contractor Registration no. LEGACTI826R8 Industrial Insurance Account Id Not Applicable OMWBE Certifications as of 1/27/2022 No active certifications existed when Intent was submitted Email Address legacytapping@gmail.com Filed By Gibbs, Erin Prime Contractor Prime contractor name REED TRUCKING Et EXCAVATING INC Prime contractor registration no. REEDTEI016JW Prime contractor Phone Number 253-841-4837 Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA- 98055 Awarding agency contact: Flora Lee Awarding agency contact phone 425-430-7303 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 contract: $ 19,575.00 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: Project Details County where work was performed King City where work was performed Renton Prime contractor Intent form Id# for 1170257 this project Intent filed date 1/27/2022 Job start date:MM-DD-YYYY 4/29/2022 Date work completed:MM-DD-YYYY 10/7/2022 Project Completion Did your company hire any No subcontractors? Did your company have employees No perform work on this project? Did you use apprentice employees on No this project? * M Company Owner Information How many owner/operators performed 1 work on the project that own 30% or more of the company? First Name Last Name Trade Erin Gasparovich Plumbers Et Pipefitters Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages Apprentice Wages Public Notes o Show/Hide Existing Notes No note exists State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Statement of Intent to Pay Prevailing Wage Project Detail - Project Dashboard Document Received Intent ID: Affidavit ID: Status: Approved On Date: 1/27/2022 1207537 1/27/2022 Company Details Company Name: LEGACY TAPPING INC Address: 17832 87th Ave SE SNOHOMISH, WA, 98296 Contractor Registration No. LEGACTI826R8 WA UBI Number 604359046 Phone Number 206-396-7578 Industrial Insurance Account ID OMWBE Certifications as of 1/27/2022 No active certifications existed when Intent was submitted Email.Address. legacytapping®gmail.corn Filed By Erin Gibbs Prime Contractor Company Name REED TRUCKING 6t 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 Et EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Payment Details Check Number: Transaction Id: 108494209 Intent Details Expected project start date: (MM/DD/YYYY) 2/1/2022 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is Time and materials this a time and materials estimate? Does your company intend to hire ANY No subcontractors? Will your company have employees perform No work on this project? No Do you intend to use any apprentices? (Apprentices are considered employees.) How many owner/operators performing work on 1 the project own 30% or more of the company? First Name Last Name Trade Erin Gasparovich Plumbers Et Pipefitters journey Level Wages Public Notes o Show/Hide Existing Notes No note exists r Certified Payroll Report Department of Labor and t'''"TF C Prime Contractor ❑ Project Name County Project or Contract# Industries �4::: . `'E r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ,,+1i; - <�w= Subcontractor iiiii= •�l:g EJ PO Box 44540 '' S oy� Project Address Olympia WA 98504-4540 H� '""y Final Week of (360) 902-5335 Payroll 0 Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 11/4/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions o Work Classification Name c� Sat Sun MonTue Wed Thu Fri Total Lt o a, 10/2 10/3 10/3 Gross Amount and And a> E 9 0 1 11/1 11/2 11/3 11/4 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a�'i > - Benefits" Tax ce O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date ERIN GASPAROVICH Owner 11/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/29/2022 11/4/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. yif-'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and hing 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 12/1/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �4.,TATf fi Project Name County Project or Contract# Industries ,Ii Prime Contractor ❑ 4 ig m.y a:; Duvall Avenue NE King CAG-20-065 PrevailingWage Program :°' :. =ai,is 9 9 ,,:::,,. •iiiz Subcontractor PO Box 44540 "pi:ar �v" 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 10/28/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions ~ Sat Sun Mon Tue Wed Thu Fri Work Classification Name C9 Total ct o d 10/2 10/2 10/2 10/2 10/2 10/2 10/2 Gross Amount �, E Total Rate Hourly and And 2 3 4 5 6 7 8 Earned/Gross Net Wages E a Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address 0 a) Payroll Benefits" Tax Ct 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 ERIN GASPAROVICH Owner 10/28/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 10/22/2022 10/28/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ! ?.4ny 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 mac sure,o� Project Name County Project or Contract# Industries a ,,; .y Prime Contractor ❑ �;,,, y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4°..,. _• = Subcontractor �� PO Box 44540 a ,.`�. '.e. Project Address Olympia WA 98504-4540 y` '-"�n° Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 10/21/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions o Sat Sun Mon Tue Wed Thu Fri Work Classification Name C� Total cC 2 a) 10/1 10/1 10/1 10/1 10/1 10/2 10/2 Gross Amount a) E Total Rate Hourly and And E i 5 6 7 8 9 0 1 Hours of PayEarned/Gross ^Usual Withholding Net Wages o� f a> Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address a) > n tr 0 o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date ERIN GASPAROVICH Owner 10/27/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: n..vall Avenue NE 10/15/2022 10/21/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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 - ERIN GASPAROVICH Owner ERIN GASPAROVICH • 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 �t,ST�TF. Project Name County Project or Contract# A,..;. litc9 y Prime Contractor ❑ Industries '' Duvall Avenue NE King CAG-20-065 PrevailingWage Program <"` "`_ 9 9 .;, Subcontractor PO Box 44540 "�il'� 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 10/14/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions Work Classification Name c9 15 o Sat Sun Mon Tue Wed Thu Fri Total i o a> 10/1 10/1 10/1 10/1 10/1 Gross Amount and And a) E 10/8 10/9 Total Rate Hourly t E 0 1 2 3 4 Hours of Pay Earned/Gross Usual Withholding Net Wages Soc Sec#of Employee Address a) z Payroll Benefits" FICA TaxCD Other r O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date ERIN GASPAROVICH Owner 10/27/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: ^ vall Avenue NE 10/8/2022 10/14/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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 I Vining 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 11/8/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Departmentf ing Program and Industries �'•+ra OWNER ONLY CERTIFIED PAYROLL REPORT Prevailing Wage Progtam �`'`�l�"'4. °�� PO Box 44540 ` � �' ViliiOlympia WA 98504-4540 14.1' 360 902-5335 �' ''AO Prime ContractorProject Name County (360) t a El Contract# Duvall Avenue NE King CAG-20-065 ElProject Address City State Subcontractor Awarding Agency Name Phone Company Name RENTON,CITY OF Phone (425)430-7303 LEGACY TAPPING INC (206)396-7578 Address City State Zip Address City State Zip 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 For Week Ending: t D I -(7 (2-2-- Final Payroll?El Owner Name %of Ownership Trade Classification Total Hours 'er(n 65p"rt J h loncra rikl-A‘OinLS i Ore) 5 The party signing below AFFIRMS that all information contained in this Certified Payroll Report,including any addenda,is correct and complete. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Today's Date Printed name of party signing this report Title 1 Q 111 2,1- Cy-in L ikiptro lv to © 1Ai Nix-- Signature f:;2,......_,L.N.. MB 10/11/22 F700-065-000 certified payroll report 05-09 Certified Payroll Report Department of Labor and aQst�r`•o Project Name County Project or Contract# Prime Contractor ❑ Industries &:!Pgt n Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ' SubcontractorIX PO Box 44540 '' 18 '' 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 9/30/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions R.- Work Classification Name C7 ~O o Sat Sun Mon Tue Wed Thu Fri Total 0 Gross Amount and And a> E 9/24 9/25 9/26 9/27 9/28 9/29 9/30 Total Rate Earned/Gross Hourly Net Wages j E is Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" Tax a i No Employees performed work 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 ERIN GASPAROVICH Owner 10/4/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 9/24/2022 9/30/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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. ' 'z,ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ping Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature ERIN GASPAROVICH Owner ERIN GASPAROVICH :MB 1016/22:: 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# Prime Contractor ❑ Industries J sTer Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -'"` ' ',i1 Subcontractor XI PO Box 44540 �"a' 6., Project Address Olympia WA 98504-4540 ''` 788J 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 9/23/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions p Work Classification Name C7 ~o o Sat Sun Mon Tue Wed Thu Fri Total o m Gross Amount and And E 9/17 9/18 9/19 9/20 9/21 9/22 9/23 Total Rate Hourly E i Hours of Pay Earned/Gross "Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address cn 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 ERIN GASPAROVICH Owner 10/4/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: niwvall Avenue NE 9/17/2022 9/23/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. '-',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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB :1I0t6Z2-2 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ?art;G Project Name County Project or Contract# at, 4• ,- Prime Contractor ❑ Industries ..ii !IL*. 3.iii - .,Yithr„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program iiiii, ,'dill: Subcontractor ❑x PO Box 44540 "y , �,y°' Project Address Olympia WA 98504-4540 y� 'N"" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 9/16/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions Work Classification Name (5 ~O 9- Sat Sun Mon Tue Wed Thu Fri Total tY a) Gross Amount and And E 9/10 9/11 9/12 9/13 9/14 9/15 9/16 Total Rate Earned/Gross Hourly Net Wages E a) - - — — Hours of Pay Payroll "Usual FICA Withholding Other CL Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" a 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 ERIN GASPAROVICH Owner 9/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: n,wall Avenue NE 9/10/2022 9/16/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ic),,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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 ti7.1ri Project Name County Project or Contract# p ,,,:11,i +E °F Prime Contractor ❑ Industries v:3i? 4 f. �•;;;i :_i.r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ill* ,,4s,h; Subcontractor ❑x PO Box 44540 ��ti Project Address Olympia WA 98504-4540 er '""� ' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 9/9/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions Work Classification Name c� ~o —CI Sat Sun Mon Tue Wed Thu Fri Total � a) Gross Amount and And E 9/3 9/4 9/5 9/6 9/7 9/8 9/9 Total Rate Earned/Gross Hourly Net Wages Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address fY O o Hours Worked Each Day 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 ERIN GASPAROVICH Owner 9/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: niwvall Avenue NE 9/3/2022 9/9/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. "`,Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'Ming 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 ;,nrE; Project Name County Project or Contract# ��':`•'�': °" Prime Contractor ❑ Industries ,;,;'• ;;,` Duvall Avenue NE King CAG 20 065 Prevailing Wage Program ;� l �;` ;�lllit � Subcontractor � PO Box 44540 d•esp,y, w'c) Project Address Olympia WA 98504-4540 '""u Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 9/2/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions f^ _ Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total a> Gross Amount and And a� E 8/27 8/28 8/29 8/30 8/31 9/1 9/2 Total Rate Earned/Gross Hourly Net Wages Ef 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 ERIN GASPAROVICH Owner 9/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: wall Avenue NE 8/27/2022 9/2/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' `-^,ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature ERIN GASPAROVICH Owner ERIN GASPAROVICH 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# .,:zs';'. i, °F Prime Contractor ❑ Industries iF`• ` 4 Duvall Avenue NE King CAG-20-065 �ii ,'- ,i t :'i Prevailing Wage Program ;I!lit+ ' i Subcontractor PO Box 44540 ", `:. Any' Project Address Olympia WA 98504-4540 ;rig Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 8/26/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions ill- Work Classification Name C9 ~• O o Sat Sun Mon Tue Wed Thu Fri Total a� Gross Amount and And a� 8/20 8/21 8/22 8/23 8/24 8/25 8/26 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address c > s 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 ERIN GASPAROVICH Owner 9/7/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 8/20/2022 8/26/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: • (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. R,ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,;ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 9/7/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 1 Certified Payroll Report Department of Labor and �a�sli.tfp�� Prime Contractor ❑ Project Name County Project or Contract# Industries io :ii: Duvall Avenue NE King CAG 20 065 ii Prevailing Wage Program =iiiii, ti311 Subcontractor X PO Box 44540 4i" y�. Project Address Olympia WA 98504-4540 yy t8�°`� Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON, CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 8/19/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions p Work Classification Name c9 ~O o Sat Sun Mon Tue Wed Thu Fri Total 1 m Gross Amount E 8/13 8/14 8/15 8/16 8/17 8/18 8/19 Total Rate Hourly and And `m E i= Hours of PayEarned/Gross °Usual Withholding Net Wages m N Payroll FICA Tax Other Soc Sec#of Employee Address a - Benefits" 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 ERIN GASPAROVICH Owner 8/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: ntrvall Avenue NE 8/13/2022 8/19/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 .,surf,o Project Name County Project or Contract# .�. Prime Contractor ❑ Industries 4.s:: .,i�. �.... :::.r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program VOLit, ,i iii Subcontractor [RI PO Box 44540 ;4;,i". , yn Project Address Olympia WA 98504-4540 y` 'd""ao Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 8/12/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions Work Classification Name c7 ~O o Sat Sun Mon Tue Wed Thu Fri Total (i) Gross Amount and And E 8/6 8/7 8/8 8/9 8/10 8/11 8/12 Total Rate Earned/Gross Hourly Net Wages j E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address 0 Benefits" Tax 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 ERIN GASPAROVICH Owner 8/19/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 8/6/2022 8/12/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (,c`-.1,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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries sv:'4. OWNER ONLY CERTIFIED PAYROLL REPORT Prevailing Wage Program ..!! +li:4.` PO Box 44540 Aui.. �aiit" Contract# Ilw• "qr I Project Name County Olympia WA 98504-4540 �•!t=.� v (360)902-5335 "'lit raHu a" Prime Contractor El Duvall Avenue NE King CAG-20-065 Project Address City State Subcontractor Awarding Agency Name Phone Company Name Phone RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Address City State Zip Address City State Zip 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 For Week Ending: O ) 5- /2'o22_ Final Payroll?n Owner Name %of Ownership Trade Classification Total Hours evin 6 I J IO 0(r/ OWN'Aa 9 i Fr-401 5Q The party signing below AFFIRMS that all information contained in this Certified Payroll Report,including any addenda, is correct and complete. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Today's Date Printed name of party signing this report Title / 8,i LA(1 r) tos p-vdo Lk) okAi Signature i ._ Lit........_____ MB 8/10/22 F700-065-000 certified payroll report 05-09 Certified Payroll Report Department of Labor and ArF, Project Name County Project or Contract# t"t�}t'+t 'F Prime Contractor ❑ Industries t!: lu•• :!r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program W I111t,� oill,�= Subcontractor ❑x PO Box 44540 .y� ;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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 7/29/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions p Work Classification Name C7 ~ 9- Sat Sun Mon Tue Wed Thu Fri Total (1 O a) Gross Amount and And m E 7/23 7/24 7/25 7/26 7/27 7/28 7/29 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m 0 Cl) Payroll Benefits" Tax O o Hours Worked Each Day 1 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 ERIN GASPAROVICH Owner 8/5/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 7/23/2022 7/29/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !g'<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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 8/10/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and reri. Project Name County Project or Contract# :`i'!f iR.,')F Prime Contractor ❑ Industries !1! -`!!! '> Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ��31l11,. +III Subcontractor 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 7/22/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions p Work Classification Name c7 ~• O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And a> E 7/16 7/17 7/18 7/19 7/20 7/21 7/22 Total Rate Earned/Gross Hourly Net Wages • r a, Payroll • E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address O Benefits" Tax oHours 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 ERIN GASPAROVICH Owner 7/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: vall Avenue NE 7/16/2022 7/22/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 1 `,Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and r 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 ' tir";E R Project Name County Project or Contract# Industries i(l, f Prime Contractor ❑ Duvall Avenue NE King CAG 20 065 Prevailing Wage Program ;hill;' ,+ill(^; Subcontractor PO Box 44540 °';p": , '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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 7/15/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions H-- Work Classification Name CD ~O o Sat Sun Mon Tue Wed Thu Fri Total a> Gross Amount and And o E 7/9 7/10 7/11 7/12 7/13 7/14 7/15 Total Rate Earned/Gross Hourly Net Wages m E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address a) - Payroll Benefits" Tax 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 ERIN GASPAROVICH Owner 7/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: ^.wall Avenue NE 7/9/2022 7/15/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ;any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,,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 ERIN GASPAROVICH Owner ERIN GASPAROVICH . 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 +rE Project Name County Project or Contract# .�``'1. 4"., Prime Contractor ❑ Industries ;,:i`• j,,;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program wilih, ,+i;I��`= SubcontractorIX PO Box 44540 '; y° Project Address Olympia WA 98504-4540 y� '"""ao Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 7/8/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions P- Work Classification Name C9 ~O 9- Sat Sun Mon Tue Wed Thu Fri Total tY a> Gross Amount and And a� E 7/2 7/3 7/4 7/5 7/6 7/7 7/8 Total Rate Earned/Gross Hourly Net Wages Hours of Pay Payroll "Usual FICA Withholding 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 ERIN GASPAROVICH Owner 7/22/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: ^ wall Avenue NE 7/2/2022 7/8/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH • 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 ntE. Project Name County Project or Contract# ,A ^ ii``(ix Prime Contractor D Industries _,'}' Duvall Avenue NE King CAG-20-065 Prevailing Wage Program iiiii, ;tiiiij Subcontractor X PO Box 44540 "' i`. , '''‘I'''41-' 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 7/1/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions p Work Classification Name C7 8 o Sat Sun Mon Tue Wed Thu Fri Total - a) Gross Amount and And o 6/25 6/26 6/27 6/28 6/29 6/30 7/1 Total Rate Hourly `m E Hours of Pa Earned/Gross "Usual Withholdin Net Wages w. y Payroll FICA 9 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 ERIN GASPAROVICH Owner 7/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: •vall Avenue NE 6/25/2022 7/1/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 7/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,��rF Project Name County Project or Contract# ;:'`"��' »•'f'F Prime Contractor ❑ Industries i'• '�=f =i - , __!; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program �jiiii• ,'i€€i; Subcontractor XI PO Box 44540 ''�_�'� v� Project Address 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 6/24/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions Work Classification Name E5 ~O 9- Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 6/18 6/19 6/20 6/21 6/22 6/23 6/24 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address O o Hours Worked Each Day y Benefits" Tax a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date ERIN GASPAROVICH Owner 7/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: n,wall Avenue NE 6/18/2022 6/24/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. -_, .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 ERIN GASPAROVICH Owner ERIN GASPAROVICH MB 7/6/22 • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �� sled Project Name County Project or Contract# Industries •_1, ";i ° Prime Contractor ❑ ;z• z y, : _.• ,,;,hi r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <OF ,+tgllr Subcontractor IZ PO Box 44540 4. '�/ ° Project Address cs'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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 6/17/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 _ Day and Date Deductions ~ ——,, Work Classification Name E5 O~ o Sat Sun Mon Tue Wed Thu Fri Total eC Gross Amount and And E 6/11 6/12 6/13 6/14 6/15 6/16 6/17 Total Rate Hourly Earned/Gross Net Wages `m E a Hours of Pay Payroll Net FICA Withholding Other Soc Sec#of Employee Address CC 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 ERIN GASPAROVICH Owner 6/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: •vail Avenue NE 6/11/2022 6/17/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any'person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ' ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 f,sr�ra� Project Name County Project or Contract# ��'. :_ 'T °F Prime Contractor ❑ Industries __' _=f. �:;:; - V;; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program A;___ ;•tx ,F li3ii: 3ii r Subcontractor PO Box 44540 ''•"" Project Address Olympia WA 98504 4540 Yy�`8kti'Jy Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 6/10/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions i p Work Classification Name C7 ~O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And E 6/4 6/5 6/6 6/7 6/8 6/9 6/10 Total Rate Hourly E i= Hours of PayEarned/Gross "Usual WithholdingNet Wages -, r 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 ERIN GASPAROVICH Owner 6/21/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: /all Avenue NE 6/4/2022 6/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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. 1ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and .ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 ��;,;,';�< Prime Contractor ❑ Project Name County Project or Contract# Industries ;z', "3 r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program l' +�' f= Subcontractor ,iil , , ,,', Project Address PO Box 44540 v Olympia WA 98504-4540 y` t8"° Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 6/3/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions Work Classification Name C.9- ~O o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And m E 5/28 5/29 5/30 5/31 6/1 6/2 6/3 Total Rate Earned/Gross Hourly Net Wages Hours of Pay "Usual FICA Withholding Other a, 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 ERIN GASPAROVICH Owner 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: Duvall Avenue NE 5/28/2022 6/3/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. `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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 TAr, Project Name County Project or Contract# ,<�*`'i;•t,I.''' Prime Contractor ❑ Industries iii !ii..4, Hi:- ;API Duvall Avenue NE King CAG-20-065 Prevailing Wage Program s�IRlt; i 4110 Subcontractor i PO Box 44540 � 9 Project Address Olympia WA 98504-4540 �� '" ",is.,,,, Final Week of (360) 902-5335 Payroll ❑ (Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 5/27/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions p Work Classification Name c9 8o Sat Sun Mon Tue Wed Thu Fri Total a) Gross Amount and And a) E 5/21 5/22 5/23 5/24 5/25 5/26 5/27 Total Rate f °' Earned/Gross Hourlyy Net Wages Cr) E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a Benefits" Tax IX o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date ERIN GASPAROVICH Owner 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: n'vall Avenue NE 5/21/2022 5/27/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 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 ERIN GASPAROVICH Owner ERIN GASPAROVICH 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 t.:i ntF„ Project Name County Project or Contract# Industries , :� Prime Contractor ❑ I=,;:- .:;: r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program .jiiiV +�l!;,y Subcontractor X PO Box 44540 ''.y,E•, , �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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 6/5/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions P Work Classification Name C7 0 Mon Tue Wed Thu Fri Sat Sun Total cc a a� Gross Amount and And , E 5/30 5/31 6/1 6/2 6/3 6/4 6/5 Total Rate Earned/Gross Hourly Net Wages E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a O o Hours Worked Each Day Benefits" Tax Ni J 1. RG 0.00 0.00 0.00 0.00 7.50 0.00 0.00 7.50 $35.00 $262.50 Inspection/Cleaning/Sealing Of Sewer&Water Systems Michael Babcock Ni By Remote Control 30754 229th PI SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $78.59 $0.00 $262.50/ $0.00/hr $20.08 $31.50 $210.92 Tv Truck Operator Black Diamond,WA $262.50 (King) -98010 $104.7 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 2. RG 0.00 0.00 0.00 0.00 7.50 0.00 0.00 7.50 $24.91 $186.83 Inspection/Cleaning/Sealing Of Sewer&Water Systems Landon Stockton By Remote Control 128 1st Ave N OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $37.37 $0.00 $186.83/ $0.00/hr $14.29 $22.42 $150.12 d Operator Algona,WA-98001 $186.83 3) DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $49.82 $0.00 3. Power Equipment RG 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 $73.49 $587.92 Operators Ryan Willard Motor Patrol Graders 26003 137th St Ct E $110.2 $753.27/ (King) Buckley,WA- OT 0.00 0.00 0.00 0.00 1.50 0.00 0.00 1.50 3 $165.35 $753.27 $0.00/hr $57.63 $90.39 $605.25 98321 $146.9 - DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 6/6/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons Puget Construction Srvcs Inc employed by: Project Name: For the week starting: For the week ending: n,wall Avenue NE 5/30/2022 6/5/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Michael Babcock Inspection/Cleaning/Sealing Of Sewer&Water Systems By Remote Control $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Tv Truck Operator (King) Landon Stockton ,pection/Cleaning/Sealing Of Sewer&Water Systems By Remote Control $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Head Operator (King) 3.Ryan Willard Power Equipment Operators Motor Patrol Graders $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. �� 4ny 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 aimee badure Office Manager aimee badure 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.+,f Project Name County Project or Contract# :a`a it+ `, Prime Contractor ❑ Industries _mkr, ;•lt; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program � ;i' ,_ PO Box 44540 `' ��� Subcontractor ® 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 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 5/20/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions H Work Classification Name 6' ~O o Sat Sun Mon Tue Wed Thu Fri Total G At and And E rossmoun 5/14 5/15 5/16 5/17 5/18 5/19 5/20 Total Rate Hourly Earned/Gross WithholdingNet Wages E Hours of Pay "Usual FICA Other Soc Sec#of Employee Address ix 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 Erin Gasparovich Owner 5/20/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: µ "...van Avenue NE 5/14/2022 5/20/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. F>,4ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Erin Gasparovich Owner Erin Gasparovich 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.5?�rF. Project Name County Project or Contract# c?.=3 • °F Prime Contractor ❑ Industries __ ... iy.- „rt,:i;„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program W�j i! fsl�'i Subcontractor IX PO Box 44540 '',;_- ��y Project Address Olympia WA 98504-4540 H' •`"""" • Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 5/13/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions P Work Classification Name C9 ~O o Sat Sun Mon Tue Wed Thu Fri Total cc , Gross Amount and And 5/7 5/8 5/9 5/10 5/11 5/12 5/13 Total Rate Hourly Hours of Pay Earned/Gross °Usual Withholding Net Wages f 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 Erin Gasparovich Owner 5/20/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: r +Fall Avenue NE 5/7/2022 5/13/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications.as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 Erin Gasparovich Owner Erin Gasparovich 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 sTnrE. Project Name County Project or Contract# ,�*1:3�,••_=�:°F Prime Contractor ❑ Industries =.:ai• �=s. = r Duvall Avenue NE King CAG-20-065 .a%oii. -..iI E n Prevailing Wage Program t :=,;• tiII Subcontractor PO Box 44540 °�y=,r Project Address Olympia WA 98504-4540 ' "' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Month Day Year Awarding Agency Address Address City State Zip+4 5/6/2022 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 Day and Date Deductions P Work Classification Name (7 8 o Sat Sun Mon Tue Wed Thu Fri Total Gross Amount and And E 4/30 5/1 5/2 5/3 5/4 5/5 5/6 Total Rate Hourly `a E i= Hours of Pa Earned/Gross "Usual Withholding Net Wages r w y 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 Erin Gasparovich Owner 5/20/2022 The party signing this report pays or (Name of contractor or subcontractor) supervises the payment of the persons LEGACY TAPPING INC employed by: Project Name: For the week starting: For the week ending: ',viva!'Avenue NE 4/30/2022 5/6/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. riny 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 Erin Gasparovich Owner Erin Gasparovich MB 5/24/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries ,,, W1,, t OWNER ONLY CERTIFIED PAYROLL REPORT Prevailing Wage Program •I i PO Box 44540 5/,a!,r4..'1.s , Olympia WA 98504-4540 r; 4�,''' El Project Name County Contractli " (360)902-5335 'f�1. 01 Prime ContractorDuvall Avenue NE King CAG-20-065 El Address City State Subcontractor Awarding Agency Name Phone Company Name Phone RENTON,CITY OF (425)430-7303 LEGACY TAPPING INC (206)396-7578 Address City State Zip Address City State Zip 1055 S GRADY WAY RENTON,WA-98055 17832 87th Ave SE SNOHOMISH WA 98296 For Week Ending: L. //1(1/ZZ Final Payroll?❑ Owner Name %of Ownership Trade Classification Total Hours Cv« icss rv-,Ch )WI)6 Fk.h\ fl5/r2ctiThflj L/ 4 The party signing below AFFIRMS that all information contained in this Certified Payroll Report, including any addenda, is correct and complete. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution,sanctions, and penalties. Today's Date Printed name of party signing this report Title Li hM k 1/2/ Ala 6Go j)G.rovt(..L- Dwn«-- Signature 01,......-''''\._______ _ MB 5/2/22 F700-065-000 certified payroll report 05-09