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Home My WebLink AboutCAG-20-065 - Duvall - Subcontractor Puget Construction Services 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: 3/18/2022 1219134 4/12/2022 Company Details Company Name: Puget Construction Srvcs Inc Address: 1609 Central Ave S, Unit 20 KENT, WA, 98032 Contractor Registration No. PUGETCS869BW WA UBI Number 603356329 Phone Number 253-856-2572 Industrial Insurance Account ID 28130100 OMWBE Certifications as of 3/18/2022 No active certifications existed when Intent was submitted Email Address cyndie@pcsjac.com Filed By Aimee Badure Prime Contractor Company Name REED TRUCKING a EXCAVATING INC Contractor Registration No. REEDTEI016JW WA UBI Number 601915034 Phone Number 253-841-4837 Project Information Awarding Agency RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding Agency Contact Flora Lee 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: 108581413 Intent Details Expected project start date: (MM/DD/YYYY) 3/24/2022 In what county (or counties) will the work be King performed? In what city (or nearest city) will the work be Renton performed? What is the estimated contract amount? OR is Time and materials this a time and materials estimate? Does your company intend to hire ANY No subcontractors? Will your company have employees perform Yes work on this project? No S Do you intend to use any apprentices? (Apprentices are considered employees.) How many owner/operators performing work on 0 the project own 30% or more of the company? Journey Level Wages 1 • County Trade Occupation Wage Fringe # Workers King Power Equipment Operators Motor Patrol Graders $73.49 $0.00 1 King Inspection/Cleaning/Sealing Tv Truck Operator $20.45 $0.00 1 Of Sewer Et Water Systems By Remote Control King Inspection/Cleaning/Sealing Head Operator $30.00 $0.00 1 Of Sewer it Water Systems By Remote Control Public Notes o Show/Hide Existing Notes No note exists State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Affidavit of Wages Paid Project Detail - Project Dashboard Document Received Date: Intent Id: Affidavit Id: 1269709 Status: Approved on 12/13/2023 1219134 12/18/2023 Company Details Name Puget Construction Srvcs Inc Address 1609 Central Ave S, Unit 20 KENT,WA,98032 WA UBI no. 603356329 Contractor Registration no. PUGETCS869BW Industrial Insurance Account Id 28130100 OMWBE Certifications as of 3/18/2022 No active certifications existed when Intent was submitted Email Address aimee®pcsjac.com Filed By Badure, Aimee Prime Contractor Prime contractor name REED TRUCKING Et EXCAVATING INC Prime contractor registration no. REEDTEI016JW Prime contractor Phone Number 253-841-4837 Project Information Awarding agency: RENTON, CITY OF 1055 S GRADY WAY RENTON, WA - 98055 Awarding agency contact: Flora Lee Awarding agency contact phone number: 425-430-7303 Contract no. CAG-20-065 Project name Duvall Avenue NE Project Description This project includes but is not limited to: excavation; grading; removal of pavement; plaining pavement; paving with asphalt, curb and gutter; drainage; illumination; HAWK restoration; and other work. Dollar amount of your contract: $ 24,046.11 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: 109728720 Project Details County where work was performed King City where work was performed Renton Prime contractor Intent form Id#for this 1170257 project Intent filed date 3/18/2022 Job start date:MM-DD-YYYY 3/24/2022 Date work completed:MM-DD-YYYY 12/13/2023 Project Completion Did your company hire any subcontractors? No Did your company have employees perform Yes work on this project? Did you use apprentice employees on this No project? Company Owner Information How many owner/operators performed work on 0 the project that own 30% or more of the company? No company owner added. Affidavit Subcontractor(s) No subcontractor is selected for this affidavit. Journeylevel Wages County Trade Occupation Wages Fringes # # Workers Hours 1%1115 IY I I .A,. a ,a.-., V.VV 1 ZJ•✓V • Operators King Inspection/Cleaning Tv Truck Operator 20.45 0.00 1 24.00 /Sealing Of Sewer Et Water Systems By Remote Control King Inspection/Cleaning Head Operator 30.00 0.00 1 7.50 /Sealing Of Sewer Et Water Systems By Remote Control Apprentice Wages Public Notes El Show/Hide Existing Notes No note exists Certified Payroll Report Department of Labor and t,,,..TF Project Name County Project or Contract# ?..1, hili Prime Contractor ❑ Industries 4 ':•. ;;. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -. e;. `- ii'= Subcontractor ►� :'° Project Address PO Box 44540 ',;: ' - °'. j Olympia WA 98504-4540 """ Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON, CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/21/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name fIC3 O~ o Mon Tue Wed Thu Fri Sat Sun Gross Amount Total and And — a� E 5/15 5/16 5/17 5/18 5/19 5/20 5/21 Total Rate Earned/Gross Hourly Net Wages m E FL' Hours of Pay "Usual FICA Withholding Other a) r 0 Payroll Benefits" Tax Soc Sec#of Employee Address cC O �33 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 Aimee Badure Office Manager 5/19/2023 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: Duvall Avenue NE 5/15/2023 5/21/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (F?-Qny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ding Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Aimee Badure Office Manager Aimee Badure MB 5/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and F,STArf Project Name County Project or Contract# c?:._. ••i_i::�� Prime Contractor ❑ Industries 4;r _ ,_� Prevailing Wage Program i . :=a Duvall Avenue NE King CAG-20-065 E;:� ••:p^ Subcontractor IZI PO Box 44540 ''.�;f.� Project Address Olympia WA 98504-4540 f '"�" Final Week of (360)902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/14/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name cc ~O o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a) E 5/8 5/9 5/10 5/11 5/12 5/13 5/14 Total Rate Earned/Gross Hourly Net Wages to E Hours of Pay "Usual FICA Withholding Other Payroll Benefits" Tax Soc Sec#of Employee Address co 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 Aimee Badure Office Manager 5/19/2023 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: Duvall Avenue NE 5/8/2023 5/14/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of-the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (MI_Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Aimee Badure Office Manager Aimee Badure MB 5/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and T.�TF Project Name County Project or Contract# ?:a= =f::.. Prime Contractor ❑ Industries ; 1i� ===y. `':. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <i~;: ''. =i ,,... •::� Subcontractor PO Box 44540 i-�,Y v Project Address Olympia WA 98504-4540 �r`^"°' Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone FOr the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/7/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name c9 O~ o Mon'Tue Wed Thu Fri Sat Sun Total F 5/1 5/2 5/3 5/4 5/5 5/6 5/7 Total Rate Gross AmountHourly and And Earned/Gross Net Wages _ Hours of Pay "Usual Usual FICA Withholding Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" Tax a 1. Power Equipment RG 0.00 0.00 5.00 0.00 0.00 0.00 0.00 5.00 $73.49 $367.45 Ni Operators Matt Carmack Motor Patrol Graders 16711 259th Ave $110.2 $367.45/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $367.45 $0.00/hr $28.11 $44.10 $295.24 Buckley,WA- _ •• 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9$ $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 5/9/2023 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: Duvall Avenue NE 5/1/2023 5/7/2023 T _ _ "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.Matt Carmack Power Equipment Operators Motor Patrol Graders $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for-workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. `'any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ding Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure office manager aimee badure MB 5/9/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �F,STATf, Project Name County Project or Contract# ;;' ' "!;i'y Prime Contractor ❑ IndustriesWage Program = ei=.. .6.1. Duvall Avenue NE King CAG-20-065 Prevailing 9 9 -$i:;, i Subcontractor El PO Box 44540 ".yy�. 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 4/30/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name a 8 9- Mon Tue Wed Thu Fri Sat Sun Gross Amount Total and And c Eci) 4/24 4/25 4/26 4/27 4/28 4/29 4/30 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m w B Payroll Benefits" Tax cc O 'o Hours Worked Each Day J J 1. Power Equipment RG 0.00 0.00 0.00 0.00 2.75 0.00 0.00 2.75 $73.49 $202.10 Operators Matt Carmack Ni Motor Patrol Graders 16711 259th Ave $110.2 $202.10/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $202.10 $0.00/hr $15.46 $24.25 $162.39 Buckley,WA- _ �* 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.98 $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 5/9/2023 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: Duvall Avenue NE 4/24/2023 4/30/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Matt Carmack 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. -vny 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 aimee badure office manager aimee badure MB 5/9/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and t T,�TF. Project Name County Project or Contract# ,?fi_• __°- Prime Contractor ❑ Industries %, =1; _ __ Y PrevailingWage Program < i�=,_ ;;�=ia= Duvall Avenue NE King CAG-20-065 g g ,:,, •:f;• Subcontractor El PO Box 44540 ''.y'••=' Project Address Olympia WA 98504-4540 �� '"hN' 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 4/23/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name E o O~ Mon Tue Wed Thu Fri Sat Sun Gross Amount Total and And a) E 4/17 4/18 4/19 4/20 4/21 4/22 4/23 Total Rate Hourly f0 E Hours of Pay Earned/Gross "Usual Withholding Net Wages r a, Payroll FICA Other Soc Sec#of Employee Address ct O o Hours Worked Each Day Benefits" Tax 0 J J 1. Power Equipment RG 0.00 0.00 6.00 0.00 0.00 0.00 0.00 6.00 $73.49 $440.94 Operators Matt Carmack / Motor Patrol Graders 16711 259th Ave $110.2 $440.94/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $440.94 $0.00/hr $33.73 $52.91 $354.30 Buckley,WA- _ •• 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186'9 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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 4/26/2023 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: niivall Avenue NE 4/17/2023 4/23/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Matt Carmack 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. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and `ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure Amended Reason filed no work performed in error,had_to revise Notes filed no work performed in error,had to revise r MB 5/1/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side ifir Certified Payroll Report Department of Labor and t.sl.arf Project Name County Project or Contract# Industries ;� .P 4 +y_ Prime Contractor ❑ Prevailing Wage Program = s'ii. .,"? Duvall Avenue NE King CAG-20-065 PO Box 44540 Ili ,' 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/16/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name & o a Mon Tue Wed Thu Fri Sat Sun Total a> Gross Amount and And a) E 4/10 4/11 4/12 4/13 4/14 4/15 4/16 Total Rate Earned/Gross Hourly Net Wages co E i Hours of Pay "Usual FICA Withholding Other rn r a, Payroll Benefits" Tax Soc Sec#of Employee Address cC O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure office manager 4/18/2023 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: Duvall Avenue NE 4/10/2023 4/16/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side ,sr 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. (51.4ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and t:iing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure office manager aimee badure MB 4/20/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �F 9TAT4, Project Name County Project or Contract# c.. •,.!t � Prime Contractor ❑ Industries "' "''; Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <hi. Subcontractor PO Box 44540 s. a,; ••w? Project Address Olympia WA 98504-4540 y� ``-py 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 4/9/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name 0 ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And a) E 4/3 4/4 4/5 4/6 4/7 4/8 4/9 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address a) a' a Payroll Benefits" Tax ce O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure office manager 4/7/2023 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""vall Avenue NE 4/3/2023 4/9/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ~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 aimee badure office manager aimee badure MB 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and aF,S,A�F Project Name County Project or Contract# A 1.._< «: , Prime Contractor ❑ Industries °-"•- "`4 Duvall Avenue NE King GAG-20-065 PrevailingWage Program 4=i:i;• a:`•fr= 9 9 ,;,;;;: ••i='z Subcontractor Z PO Box 44540 " .,' ,,v, Project Address Olympia WA 98504-4540 y` '"fly, 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 4/2/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name C9 ~ o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a) E 3/27 3/28 3/29 3/30 3/31 4/1 4/2 Total Rate Earned/Gross Hourly Net Wages j E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a y Benefits" Tax cC O o Hours Worked Each Day ci No Employees performed work 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 aimee badure office manager 4/7/2023 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: ni.vall Avenue NE 3/27/2023 4/2/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or-indirectly from the full wages earned. (5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and wing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure office manager aimee badure MB 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��srAr£o Project Name County Project or Contract# Industries a Prime Contractor ❑ %:. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <'°'.. "= Subcontractor El PO Box 44540 tea- ' Project Address Olympia WA 98504-4540 y� '""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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 3/26/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name (3 O~ o Mon Tue Wed Thu Fri Sat Sun Total u, Gross Amount and And m E 3/20 3/21 3/22 3/23 3/24 3/25 3/26 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address o > a Payroll Benefits" Tax o_ O 3 Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Puget Construction Services 3/28/2023 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: Duvall Avenue NE 3/20/2023 3/26/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (5)_nny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'ing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, Sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Puget Construction Services , aimee badure rr MB 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and F,STArf, Project Name County Project or Contract# . s'= ':_:., Prime Contractor ❑ Industries s !::_, = 4. :.y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program =`.". n== Subcontractor El PO Box 44540 4, :".y y. Project Address Olympia WA 98504-4540 y� "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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 3/19/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p I Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And a� E 3/13 3/14 3/15 3/16 3/17 3/18 3/19 Total Rate Earned/Gross Hourly Net Wages rn E Hours of Pay pa roll "Usual FICA Withholding Other f a) Pay Benefits" Tax Soc Sec#of Employee Address cc O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure office manager 3/22/2023 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: Duvall Avenue NE 3/13/2023 3/19/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (c\Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ring 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 4/7/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �E ST�rF. Project Name County Project or Contract# Industries ::::" `= ''4 Prime Contractor ❑ Prevailing Wage Program �;_: T Duvall Avenue NE King CAG-20-065 aim. Subcontractor ►� PO Box 44540 '?..• w Project Address Olympia WA 98504-4540 ` 1N89 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 3/12/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name a ~O 9- Mon Tue Wed Thu Fri Sat Sun Total IX m Gross Amount and And a� E 3/6 3/7 3/8 3/9 3/10 3/11 3/12 Total Rate Earned/Gross Hourly Net Wages Hours of Pay payroll "Usual FICA Withholding Other Soc Sec#of Employee Address a) -0 Benefits" Tax W O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 3/13/2023 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: Duvall Avenue NE 3/6/2023 3/12/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F)Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side • The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been.or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. "-15)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and "raining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 3/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and E �TATf Project Name County Project or Contract# ,+ • _::f Prime Contractor ❑ Industries ; a.' Duvall Avenue NE King CAG 20 065 PrevailingWage Program j'l: "'_ 9 9 � ,:,, Subcontractor PO Box 44540 ,ir. w� Project Address Olympia WA 98504-4540 y4 '8e9 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 3/5/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name c9 ~ o Mon Tue Wed Thu Fri Sat Sun Total cG O a) Gross Amount and And E 2/27 2/28 3/1 3/2 3/3 3/4 3/5 Total Rate Earned/Gross Hourly Net Wages j E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address cC O o Hours Worked Each Day y Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 3/9/2023 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: Duvall Avenue NE 2/27/2023 3/5/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3j The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. '-(5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and irraining 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 3/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side w Certified Payroll Report Department of Labor and �f �TAT< Project Name County Project or Contract# . tit.:°f Prime Contractor ❑ Industries 4....> •....s C-igl;y Duvall Avenue NE King CAG-20-065 Prevailing Wage Program „;an - •IN Subcontractor El ::ugt: =i PO Box 44540 i- 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 2/26/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions r Work Classification Name & o ° Mon Tue Wed Thu Fri Sat Sun Total N Gross Amount and And F 2/20 2/21 2/22 2/23 2/24 2/25 2/26 Totl Rate Hourly Hours of PayEarned/Gross "Usual Withholding Net Wages f a Payroll FICA Tax Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 3/2/2023 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: Duvall Avenue NE 2/20/2023 2/26/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F)Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Th5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and raining Council. Falsification of any of the above statements is a violation of,RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 3/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and $sTA=F: Project Name County Project or Contract# ,s? _::_°� Prime Contractor ❑ :�Industries •;___ _=f , Duvall Avenue NE King CAG-20-065 PrevailingWage Program -j ='i•s 9 9 ,�.. ... .;,� Subcontractor PO Box 44540 °'�_`•� y° Project Address Olympia WA 98504-4540 y` '"�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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 2/19/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions P Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And a) E 2/13 2/14 2/15 2/16 2/17 2/18 2/19 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address - w Payroll Benefits" Tax o_ O 'o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 2/21/2023 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 2/13/2023 2/19/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'F'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'lning 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 2/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and STATF Project Name County Project or Contract# p +•,!:• Prime Contractor ❑ Industries ,, _:, -7iii:4 . iiii: Duvall Avenue NE King CAG-20-065 PrevailingWage Program <iiii:. • }_' 9 9 wi;i,;. ,,,;. Subcontractor El PO Box 44540 '� v' 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 2/12/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name & 8 9- Mon Tue Wed Thu Fri Sat Sun Gross Amount Total and And a) E 2/6 2/7 2/8 2/9 2/10 2/11 2/12 Total Rate Hourly @ E Earned/Gross "UsualWithholdingNet Wages a) Payroll of Pay Payroll FICA Other Soc Sec#of Employee Address ce 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 aimee badure Office Manager 2/21/2023 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: nirvall Avenue NE 2/6/2023 2/12/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. -g`.,f1/4ny 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 aimee badure Office Manager aimee badure MB 2/23/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and a�STATF.� Project Name County Project or Contract# :. s;i Prime Contractor IDIndustries ;,, y o ;; :,� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <_.°°;:. '..:: Subcontractor PO Box 44540 �,Fii lei 'v°z Project Address Olympia WA 98504-4540 y� 1Hey F Final Week of (360) 902-5335 Payroll III Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 2/5/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name c9 ~O o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a> E 1/30 1/31 2/1 2/2 2/3 2/4 2/5 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other a> r 0 Payroll Benefits" Tax Soc Sec#of Employee Address cL 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 Aimee Badure Office Manager 2/9/2023 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: "' van Avenue NE 1/30/2023 2/5/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !F'_Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ;ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Aimee Badure Office Manager , Aimee Badure MB 2/15/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �F,s'TAt�, Project Name County Project or Contract# ;,?;:3 ,,,y Prime Contractor ❑ IndustriesWage Program -i::: :::,: Duvall Avenue NE King CAG-20-065 Prevailing 9 g ,..;.., Subcontractor EM PO Box 44540 °'�",' w° Project Address Olympia WA 98504-4540 y` '�8"a Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 1/29/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name & O~ o Mon Tue Wed Thu Fri Sat Sun Total r a) Gross Amount and And E 1/23 1/24 1/25 1/26 1/27 1/28 1/29 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other r a) Payroll Benefits" Tax Soc Sec#of Employee Address ce O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 1/31/2023 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: ^•rvall Avenue NE 1/23/2023 1/29/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. t4Any 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 aimee badure Office Manager aimee badure MB 2/1/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��I,sTA b:o� Project Name County Project or Contract# ^+.:: 4 Prime Contractor ❑ IndustriesWage Program �_iiii x Duvall Avenue NE King CAG-20-065 Prevailing 9 g ,� Subcontractor PO Box 44540 ".;;"•41' ay. Project Address Olympia WA 98504-4540 y� they 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 1/22/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name c9 b o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a) E 1/16 1/17 1/18 1/19 1/20 1/21 1/22 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay "Usual FICA Withholding Other at f a) Payroll Benefits" Tax Soc Sec#of Employee Address CL 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 aimee badure Office Manager 1/24/2023 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: wall Avenue NE 1/16/2023 1/22/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. !=`,,,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 aimee badure Office Manager aimee badure MB 1/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �w sTATR Project Name County Project or Contract# Industries ii:. Prime Contractor El oAii Duvall Avenue NE King CAG-20-065 PrevailingWage Program �:::: 9 9 Subcontractor IN PO Box 44540 `7",4' oy�� Project Address Olympia WA 98504-4540 y` '&88 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 1/15/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 I Day and Date Deductions p Work Classification Name Cc ~ -c Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And E 1/9 1/10 1/11 1/12 1/13 1/14 1/15 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay "Usual FICA Withholding Other o') f a) Payroll Benefits" Tax Soc Sec#of Employee Address cC O o Hours Worked Each Day of No Employees performed work 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 Aimee badure Office Manager 1/17/2023 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: rvalI Avenue NE 1/9/2023 1/15/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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«N Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and iining 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 1/30/23' F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��F STATF,�n Project Name County Project or Contract# Industries 4 ,; ,;;.y Prime Contractor ❑ ;;,; ii;, Duvall Avenue NE KingCAG-20-065 Prevailing Wage Program i,_ : ,r Subcontractor N PO Box 44540 i';,;.4, ,.yam Project Address Olympia WA 98504-4540 y` 'bey"� 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 1/8/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name cc ~O o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And cu E 1/2 1/3 1/4 1/5 1/6 1/7 1/8 Total Rate Earned/Gross Hourly Net Wages ct E Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address f o Hours Worked Each Day PayrollBenefits" Tax cC 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 Aimee badure Office Manager 1/17/2023 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: ^wall Avenue NE 1/2/2023 1/8/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'c`;lAny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and dining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Aimee badure _ Office Manager Aimee badure MB 1/30/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side J Certified Payroll Report Department of Labor and F,9TATF Project Name County Project or Contract# ••? Prime Contractor ❑ Industries ,::Y Duvall Avenue NE King CAG-20-065 PrevailingWage Program <`: :: ___ 9 9 ••1 j Subcontractor PO Box 44540 y.,, cv Project Address Olympia WA 98504-4540 ` 'BBB 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 1/1/2023 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions 1 ~ Mon Tue Wed Thu Fri Sat Work Classification Name C� Sun Total cr a> 12/2 12/2 12/2 12/2 12/3 12/3 Gross Amount and And E 6 7 8 9 0 1 1/1 Total Rate Earned/Gross Hourly Net Wages a E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m it) ra Benefits' Tax er O 8Hours Worked Each Day a 1 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 aimee badure Office Manager 1/5/2023 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: "-veil Avenue NE 12/26/2022 1/1/2023 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. '\Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 1/10/23 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and av srnrt Project Name County Project or Contract# Industries a 4 Prime Contractor ❑ o,::, i Duvall Avenue NE King CAG-20-065 Prevailing Wage Program • != Subcontractor PO Box 44540 4.::•�' ov° Project Address Olympia WA 98504-4540 y� 'Key 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 12/25/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name ( p o Mon Tue Wed Thu Fri Sat Sun Total ce o a, 12/1 12/2 12/2 12/2 12/2 12/2 12/2 Gross Amount E Total Rate Hourly and And m a,E 9 0 1 2 3 4 5 Hours of PayEarned/Gross "Usual Withholding Net Wages rn r w Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address a, m rx O Hours Worked Each Day No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 12/29/2022 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-vall Avenue NE 12/19/2022 12/25/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. • (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,: ),Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 aimee badure Office Manager aimee badure MB 1/10/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 19. Prime Contractor ❑ Project Name County Project or Contract# Industries ,t Duvall Avenue NE King CAG-20-065 PrevailingWa a Pro ram < ••, 9 9 .,, Subcontractor El PO Box 44540 ` ;H`�r a�y� Project Address Olympia WA 98504-4540 1etl" 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 12/18/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name 0 I- o Mon Tue Wed Thu Fri Sat Sun Total cc o a) 12/1 12/1 12/1 12/1 12/1 12/1 12/1 Gross Amount m E Total Rate Hourly and And E 2 3 4 5 6 7 8 Hours of PayEarned/Gross 'Usual Withholding Net Wages r a, Payroll FICA Tax Other Soc Sec#of Employee Address cr > a Benefits" (20 8 Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 12/20/2022 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: ni ivall Avenue NE 12/12/2022 12/18/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers,.laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (RI,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 aimee badure Office Manager aimee badure MB 12/22/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �.sTATA. Project Name County Project or Contract# Industries 4:;;:. 4 Prime Contractor ❑ Q;;: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program • i Subcontractor El PO Box 44540 k."aii civ Project Address Olympia WA 98504-4540 y� 'ba"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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 12/11/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name c 0~ ° Mon Tue Wed Thu Fri Sat Sun Total a� 12/1 12/1 Gross Amount a� E 12/5 12/612/7 12/8 12/9 Total Rate Hourly and And 4 E 0 1 Hours of Pay Earned/Gross °Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address - CD a Payroll Benefits" Tax W O o Hours Worked Each Day o No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 12/13/2022 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: nuvall Avenue NE 12/5/2022 12/11/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,:c'.UAny 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 Aimee Badure Office Manager Aimee Badure MB 12/15/22. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and a�BT i Project Name County Project or Contract# Industries :i;: 4 Prime Contractor ❑ o... t, Duvall Avenue NE King CAG-20-065 PrevailingWage Program .::: 9 9 ;�• Subcontractor PO Box 44540 "„�" oy� Project Address Olympia WA 98504-4540 y` �e8a 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 12/4/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions ~ Mon Tue Wed Work Classification Name c9 Thu Fri Sat Sun Total cc o a) 11/2 11/2 11/3 Gross Amount and And E 8 9 0 12/1 12/2 12/3 12/4 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address aa) a n Payroll Benefits" Tax O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 12/13/2022 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."all Avenue NE 11/28/2022 12/4/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 1.,r The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. j,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 Aimee Badure Office Manager Aimee Badure MB 12/15/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and at,,T.";',i Prime Contractor ❑ Project Name County Project or Contract# Industries .; q _.,;'',,;;: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -,+,��i•, =.tsEit= Subcontractor . . `I'= Project Address PO Box 44540 "''�u` .w' 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 11/27/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name C� p Total fx 2- ap 11/2 11/2 11/2 11/2 11/2 11/2 11/2 Gross Amount and And Total Rate Hourly Earned/Gross Net Wages c`o E f= 1 2 3 4 5 6 7 Hours of Pay "Usual FICA Withholding Other g Soc Sec#of Employee Address aa) > Payroll Benefits" Tax CK 0 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 aimee badure Office Manager 11/29/2022 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: nuvall Avenue NE 11/21/2022 11/27/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates,have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 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 aimee badure Office Manager aimee badure MB 12/1/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��t :JA „� Project Name County Project or Contract# Industries 4,,, VI 4, Prime Contractor ❑ o••••, 's:i. , Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <Iiii•- .;iIiim Subcontractor N PO Box 44540 �' 14 •cr Project Address Olympia WA 98504-4540 y` `""y Final Week of (360) 902-5335 Payroll D Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 11/20/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name c7 Total ct 2- a) 11/1 11/1 11/1 11/1 11/1 11/1 11/2 Gross Amount a, E Total Rate "Hourly and And 4 5 6 7 8 9 0 Earned/Gross Net Wages g r Hours of Pay Payroll Usual FICA Withholding Other Soc Sec#of Employee Address m a) 25 Benefits" Tax 18 2, 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 aimee badure Office Manager 11/29/2022 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: Duvall Avenue NE 11/14/2022 11/20/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: - (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ='.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 aimee badure Office Manager aimee badure MB 12/1/22 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 gT�r�� Project Name County Project or Contract# 4.a. Prime Contractor ❑ Industries o,ii' ,I;;: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4'•" ::i3�= itrr Subcontractor PO Box 44540 d�:,'� `�v 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 11/13/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name aF' o Mon Tue Wed Thu Fri Sat Sun Total S ap 11/1 11/1 11/1 11/1 Gross Amount and And m E 11/7 11/8 11/9 0 1 2 3 Total Rate Earned/Gross Hourly Net Wages Hours of Pay Usual FICA Withholding Other Soc Sec#of Employee Address a) Payroll Benefits" Tax O gHours Worked Each Day rn No Employees performed work 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 aimee badure Office Manager 11/15/2022 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: Duvall Avenue NE 11/7/2022 11/13/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. '(5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 11/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,AT, Project Name County Project or Contract# ,;. i • :?,, Prime Contractor ❑ Industries t Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 'I'•`•3ilii• .! 'i? Subcontractor "��: 't` Project Address PO Box 44540 v j Olympia WA 98504-4540 yH� 1ek" 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 11/6/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions o Mon Work Classification Name c� Tue Wed Thu Fri Sat Sun Total cc O N 10/3 Gross Amount and And a E 1 11/1 11/2 11/3 11/4 11/5 11/6 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address 0 n y Benefits" Tax ci) 0 o Hours Worked Each Day 0 J J 1. Power Equipment RG 0.00 0.00 0.00 0.00 4.50 0.00 0.00 4.50 $73.49 $330.71 Operators Myrin Short J Motor Patrol Graders 9408 1st Ave NE $110.2 $330.71 / (King) Seattle,WA- OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $330.71 $0.00/hr $25.30 $39.69 $265.72 98115- $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 11/10/2022 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: Duvall Avenue NE 10/31/2022 11/6/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Myrin Short 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. +5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and (raining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 11/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,STATt Project Name County Project or Contract# 07: Prime Contractor ❑ Industries Dili s e•:: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program - Subcontractor III PO Box 44540 ":', , ' Project Address Olympia WA 98504-4540 �`1B�� 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 10/30/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions o Mon Tue Wed Thu Fri Sat Sun Work Classification Name c7 Total CI a> 10/2 10/2 10/2 10/2 10/2 10/2 10/3 Gross Amount Total Rate Hourly Earned/Gross Net Wages and And m E 4 5 6 7 8 9 0 Hours of Pay "Usual FICA Withholding Other g Soc Sec#of Employee Address m a) Payroll sa Benefits" Tax fy 0 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 aimee badure Office Manager 11/2/2022 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: nuuvall Avenue NE 10/24/2022 10/30/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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 Bing 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 11/2/22 F700-065-000 certified payroll report 05-09 - Employee Benefits Distribution and Signature Certification on Reverse Side • Certified Payroll Report Department of Labor and grer�o Project Name County Project or Contract# .e.. Prime Contractor ❑ Industries & ; '�'`' Duvall Avenue NE King CAG-20-065 Prevailing Wage Program a Subcontractor El PO Box 44540 ....::::Aar Project Address Olympia WA 98504-4540 `"��, Final Week of (360) 902-5335 Payroll El Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 10/23/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions ~ Mon Tue Wed Thu Fri Sat Sun Work Classification Name C9 1- o Total oG oa 10/1 10/1 10/1 10/2 10/2 10/2 10/2 Gross Amount m E Total Rate Hourly and And 7 8 9 0 1 2 3 Earned/Gross Net Wages E a Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address ci > Benefits" Et O o Hours Worked Each Day 0 J NI1' RG 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.50 $37.00 $18.50 Inspection/Cleaning/Sealing J Of Sewer&Water Systems Michael Babcock By Remote Control 30754 229th PI SE OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $55.50 $0.00 $18.50/ Tv Truck Operator Black Diamond,WA $18.50 $0.00/hr $1.42 $2.22 $14.86 (King) -98010 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $74.00 $0.00 2. RG 0.00 0.00 0.00 0.00 1.50 0.00 0.00 1.50 $30.00 $45.00 Inspection/Cleaning/Sealing of Rawer&Water Systems Jesse Miller :emote Control 21520 185th Ave OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $45.00 $0.00 $45.00/ $0.00/hr $3.44 $5.40 $36.16 . ad Operator SE . $45.00 (King) Renton,WA-98058 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $60.00 $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 10/28/2022 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: nuvall Avenue NE 10/17/2022 10/23/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 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) lesse Miller 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) 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 aimee badure Office Manager aimee badure MB 11.12/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,sret.& Project Name County Project or Contract# O... A Prime Contractor ❑ Industries r :!." �. ;, Duvall Avenue NE King CAG-20-065 PrevailingWage Program a 9 9 Subcontractor ❑x PO Box 44540 `40, Project Address Olympia WA 98504-4540 �'� 'ees 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 10/16/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions o Mon Tue Wed Thu Fri Sat Sun Work Classification Name c7 Total ct a> 10/1 10/1 10/1 10/1 10/1 10/1 10/1 Gross Amount a, E Total Rate Hourly and Andct E i= 0 1 2 3 4 5 6 Hours of Pay Earned/Gross Usual FICA Withholding Other Net Wages Soc Sec#of Employee Address a) > —ten Payroll Benefits" Tax Et 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 aimee badure Office Manager 10/28/2022 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: Duvall Avenue NE 10/10/2022 10/16/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or.- indirectly to or on behalf 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 lning 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 NIB 11/2/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �... °c.ware_ Project Name County Project or Contract# 4 . :,i.F• Prime Contractor ❑ Industries ai:: :;;: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ..,a...• PO Box 44540 f, iii oy Subcontractor ® j 4. Pro ect Address Olympia WA 98504-4540 y` MO 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 10/9/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions F-- , Work Classification Name & o Mon Tue Wed Thu Fri Sat Sun Total O a> Gross Amount and And E a> E 10/3 10/4 10/5 10/6 10/7 10/8 10/9 Total Rate Earned/Gross Hourly Net Wages Hours of Pay "Usual Withholding - a> Payroll FICA Other Soc Sec#of Employee Address cn 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 aimee badure Office Manager 10/12/2022 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: Duvall Avenue NE 10/3/2022 10/9/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this.Certified Payroll Report, including any.addenda, is correct and complete. (2)The wage rates for Workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)•All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, otherthan those which are.legally permissible, have been made by any person,either directly or indirectly from the full wages earned. (5)Any apprentices employed in the above period are duly registered in.a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 10/17/22: F700-065-000 certified payroll report 05-09 Employee Benefits.Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and Project Name County Project or Contract# � ':: °° °F Prime Contractor ❑ Industries 4 �._. :� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program - Subcontractor N t°' ; Project Address PO Box 44540 yyc �86U''oyo 1 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 10/2/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions F= Work Classification Name c9 0 o Mon Tue Wed Thu Fri Sat Sun Total ▪ a� Gross Amount and And w E 9/26 9/27 9/28 9/29 9/30 10/1 10/2 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address 0 a y Benefits" Tax ✓ O o Hours Worked Each Day 0 1. Power Equipment RG 0.00 0.00 0.00 0.00 2.25 0.00 0.00 2.25 $73.49 $165.35 Operators Matt Carmack Motor Patrol Graders 16711 259th Ave $110.2 $165.35/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $165.35 $0.00/hr $12.65 $19.84 $132.86 Buckley,WA- _ _ R. 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $186.9 $0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side 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 10/12/2022 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: Duvall Avenue NE 9/26/2022 10/2/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F 1.Matt Carmack 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 correctand 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 mde either directly rir indirectly to or on behalf of the above-named contractor orsubcontractor from the weekly wages earned by any person. No deductions, otherthan.those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. , ,(5)Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program'registered with the Washington State Apprenticeship.and Training Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB°1 Q/17/22 F700-065-000 certified payroll report 05-09 Employee Benefits.Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor andF s �; Project Name County Project or Contract# .: °� Prime Contractor ❑ Industries 4::r «<f :__, sis;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <;: , I.4 �.,iiil. jll': Subcontractor XI PO Box 44540 a ,:: 1°4. Project Address Olympia WA 98504-4540 yy 1e"a 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 9/25/2022 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 ~• O o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And E 9/19 9/20 9/21 9/22 9/23 9/24 9/25 Total Rate Earned/Gross Hourly Net Wages • E i= Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address • o o Hours Worked Each Day PayrollBenefits" 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 aimee badure Office Manager 9/30/2022 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: Duvall Avenue NE 9/19/2022 9/25/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and dning 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 10/4/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side . & Certified Payroll Report Department of Labor and Ci ,lI' \ ,s?�f Project Name County Project or Contract# Prime Contractor ❑ Industries « Duvall Avenue NE King CAG-20-065 Prevailing Wage Program + ��• ^ N Subcontractor XI PO Box 44540Project 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 9/18/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions E. Work Classification Name C7 ~O - Mon Tue Wed Thu Fri Sat Sun Total cC G At and AndE rossmoun 9/12 9/13 9/14 9/15 9/16 9/17 9/18 Total Rate y Hourl Earned/Gross Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address 0 > Benefits' Tax I O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 9/22/2022 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-vall Avenue NE 9/12/2022 9/18/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ( 'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 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 tiT�rf' Project Name County Project or Contract# �`'.`., �:"� Prime Contractor ❑ Industries _. _=f. =====i •==!:r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program Guiiih ,,r:;Ei'� Subcontractor PO Box 44540 .:'__ , ,y° Project Address Olympia WA 98504-4540 ti� '""�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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 9/11/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 it Day and Date Deductions Work Classification Name C7 ~O o Mon Tue Wed Thu Fri Sat Sun Total cC a> Gross Amount and And E 9/5 9/6 9/7 9/8 9/9 9/10 9/11 Total Rate Earned/Gross Hourly Net Wages E i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address fo 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 aimee badure Office Manager 9/13/2022 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: Duvall Avenue NE 9/5/2022 9/11/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side c s_ The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and wing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure 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 t,51ATf:� Project Name County Project or Contract# Industries •stiff., "•g ,F Prime Contractor ❑ ;i? - :=:r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program gilliib e 1P4 Subcontractor NI PO Box 44540 ''.:-i, w'C 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 9/4/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions FL- Work Classification Name c7 ~O o Mon Tue Wed Thu Fri Sat Sun Total iY m Gross Amount and And o E 8/29 8/30 8/31 9/1 9/2 9/3 9/4 Total Rate Earned/Gross Hourly Net Wages E R Hours of Pay Payroll Net FICA Withholding Other Soc Sec#of Employee Address C > - Benefits" Tax O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 9/7/2022 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 ,vall Avenue NE 8/29/2022 9/4/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. rr" ALny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ring 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 a fi MB 9/8/22 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•S;1An, Prime Contractor ❑ Project Name County Project or Contract# ..I, •'t,�.�� Industries ..i?i'" lL ,,:. .. •, i�:i;r Duvall Avenue NE King CAG 20 065 Prevailing Wage Program l;3ij,, ,,ii€i1 Subcontractor X PO Box 44540 """,j( ,° Project Address Olympia WA 98504-4540 y` 'kii°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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 8/28/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name & ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Total Rate Hourly and And `m E i= Hours of Pay Earned/Gross "Usual FICA Withholding Other Net Wages 6 a Payroll Benefits" Tax Soc Sec#of Employee Address c2 o 8 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 aimee badure Office Manager 8/30/2022 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: '' -'all Avenue NE 8/22/2022 8/28/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. \Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'rung 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 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 • slpw", Prime Contractor ❑ Project Name County Project or Contract# Industries i'!" "i`f. CAG-20-065 �a,,,, __!.1;, Duvall Avenue NE King Prevailing Wage Program ;I'I ':i{'!x Subcontractor LX7 '4 ,` Project Address PO Box 44540 Q:�N:�y a`�� 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 8/21/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name c� ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And m E 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Total Rate Earned/Gross Hourly Net Wages e E i Hours of Pay pa roll "Usual FICA Withholding Other Soc Sec#of Employee Address c > - y Benefits" Tax r O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 8/22/2022 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. mall Avenue NE 8/15/2022 8/21/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side J • The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. '5` ^,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 Aimee Badure Office Manager Aimee Badure _ E J 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 ti ,A Fr Project Name County Project or Contract# ��,_ '� Prime Contractor ❑ Industries at' 'i .¢. 3,i�; - ;�3ir Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ';_' +il1i►r Subcontractor •I�ii=, Project Address PO Box 44540 = : a w�,y. 1 Olympia WA 98504-4540 y` '�q" Final Week of (360) 902-5335 Payroll Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 8/14/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name c7 8 o Mon Tue Wed Thu Fri Sat Sun Total tY O m Gross Amount and And a) E 8/8 8/9 8/10 8/11 8/12 8/13 8/14 Total Rate Earned/Gross Hourly Net Wages 03 E i Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address > n Payroll Benefits" Tax CD CK 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 aimee badure Office Manager 8/17/2022 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: Duvall Avenue NE 8/8/2022 8/14/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ',5 .Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ring 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 9/6/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side _ 10- Certified Payroll Report Department of Labor and ,urE Project Name County Project or Contract# "t' "�� °F Prime Contractor ❑ Industries "l �. �'::;- - ,;;_::;�� Duvall Avenue NE King CAG-20-065 Prevailing Wage Program I<`'i ' '.iii Subcontractor PO Box 44540 '';t.'. • w`,y" Project Address Olympia WA 98504-4540 y� '""" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 8/7/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name & ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And E 8/1 8/2 8/3 8/4 8/5 8/6 8/7 Total Rate Hourly Earned/Gross WithholdingNet Wages 3 E Hours of Pay Payroll Net 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 Aimee Badure Office Manager 8/11/2022 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: '' all Avenue NE 8/1/2022 8/7/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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`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 Aimee Badure Office Manager Aimee Badure R i MB 8/15/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �,srnrf Project Name County Project or Contract# ��;�}n " Prime Contractor ❑ Industries - f Duvall Avenue NE King CAG-20-065 Prevailing Wage Program :ill; '" Subcontractor PO Box 44540 "�" - �' � k„ Final Week of Project Address �' ` Olympia WA 98504-4540 = (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 7/31/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions lc- Work Classification Name C7 ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And E 7/25 7/26 7/27 7/28 7/29 7/30 7/31 Total Rate Earned/Gross Hourly Net Wages `c E � Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m m - Payroll Benefits" Tax O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 8/1/2022 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: vall Avenue NE 7/25/2022 7/31/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side M • 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 i 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 Aimee Badure Office Manager Aimee Badure 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 C" , AT,, Project Name County Project or Contract# 1 tPrime Contractor ❑ IndUStrleS0 eDuvall Avenue NE King CAG-20-065 - _ rPrevailing Wage Program ' .+ I,�: �� SubcontractorPO Box 44540 vProject Address Olympia WA 98504-4540 � '� a, Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 7/24/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name C7 0 o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount and And a) E 7/18 7/19 7/20 7/21 7/22 7/23 7/24 Total Rate Earned/Gross Hourly Net Wages `m E F. Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address m a Q Payroll Benefits" Tax _ O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 7/29/2022 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: wall Avenue NE 7/18/2022 7/24/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side r - The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ining Council. • Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Aimee Badure Office Manager Aimee Badure } M B 8/2/22 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 ,',''`";e rr. Prime Contractor ❑ Project Name County Project or Contract# Industries = ..:, _ �. i�;;.- ---.,,,�i: Duvall Avenue NE King CAG-20-065 Prevailing Wage Program :liiih}J f111's Subcontractor ❑x PO Box 44540 ';ss,=. �`,,, Project Address Olympia WA 98504-4540 ;a"" Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 7/17/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions F= Work Classification Name c7 1 o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And E 7/11 7/12 7/13 7/14 7/15 7/16 7/17 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m - y Benefits" Tax O o Hours Worked Each Day 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 7/18/2022 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: vall Avenue NE 7/11/2022 7/17/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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. xf- Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and mining 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 8/2/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and t >r'i Project Name County Project or Contract# �:3"p•••i«.'�y Prime Contractor ❑ Industries _.;;i; _ ,,tl.„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -jillli' ,Iir Subcontractor ►z PO Box 44540 ';" y' Project Address Olympia WA 98504-4540 '` ^µ4 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 7/10/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name c� ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And a) E 7/4 7/5 7/6 7/7 7/8 7/9 7/10 Total Rate Earned/Gross Hourly Net Wages 03 E i Hours of Pay "Usual FICA Withholding Other m f a, Payroll Benefits" Tax Soc Sec#of Employee Address cc O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 7/11/2022 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: vall Avenue NE 7/4/2022 7/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ".Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and dining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature Aimee Badure Office Manager Aimee Badure MB 7/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,,F.sIArF. Project Name County Project or Contract# Industries < it• "'•`., Prime Contractor ❑ ':I f. �;s;;. -1i' ';, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program =� h,- if r Subcontractor 0 PO Box 44540 R'�;;,, yn• Project Address Olympia WA 98504-4540 y` '��a 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 7/3/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name c7 ~o o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And E 6/27 6/28 6/29 6/30 7/1 7/2 7/3 Total Rate Earned/Gross Hourly Net Wages .E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address O o Hours Worked Each Day Benefits" Tax 0 No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date Aimee Badure Office Manager 7/7/2022 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: fall Avenue NE 6/27/2022 7/3/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2).The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Qny 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 Aimee Badure Office Manager Aimee Badure I J ` l3 MB 7/11/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,f,5,�rf. Project Name County Project or Contract# .$11- °. Prime Contractor ❑ Industries ;•••:••, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program t.,i1. Subcontractor C PO Box 44540 ',,,p:i '` y� Project Address Olympia WA 98504-4540 y` 'a""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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 6/26/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name C. ~O o Mon Tue Wed Thu Fri Sat Sun Total a) Gross Amount E 6/20 6/21 6/22 6/23 6/24 6/25 6/26 Total Rate Hourly and And Earned/Gross Net Wages E i Hours of Pay "Usual FICA Withholding Other 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 aimee badure Office Manager 6/29/2022 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 6/20/2022 6/26/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse 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 aimee badure Office Manager aimee badure MB 7/5/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and s�.nrE Project Name County Project or Contract# �a, :f, •. Prime Contractor ❑ Industries =.!l "«y ==;r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program t '°li ;:4,, �• PI Subcontractor IX s�l PO Box 44540 ,: Project Address t' 0 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 6/19/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions P Work Classification Name C9 ~O o Mon Tue Wed Thu Fri Sat Sun Total CC Gross Amount and And E 6/13 6/14 6/15 6/16 6/17 6/18 6/19 Total Rate Earned/Gross Hourly Net Wages E i= Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address fY O o Hours Worked Each Day Benefits" Tax No Employees performed work 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 Aimee Badure Office Manager 6/20/2022 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: wall Avenue NE 6/13/2022 6/19/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. -"Lny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 'ruing 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 6/21/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ti i Project Name County Project or Contract# *;��•�a.I, Prime Contractor ElIndustries ,ttl ':L s, R,>;• a: r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program lilil}; ,'�l,ll`r Subcontractor 57( 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 6/12/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name (7 ~O o Mon Tue Wed' Thu Fri Sat Sun Total cC a> Gross Amount and And a> E 6/6 6/7 6/8 6/9 6/10 6/11 6/12 Total Rate Earned/Gross Hourly Net Wages c E 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 aimee badure Office Manager 6/14/2022 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: ^ all Avenue NE 6/6/2022 6/12/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. "ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 6/17/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ^��t•t;";�,,� Prime Contractor ❑ Project Name County Project or Contract# Industries di `h ‘.. Duvall Avenue NE King CAG-20-065 Prevailing Wage Program -AN ,,�O �ll ; Subcontractor PO Box 44540 ,: , ;; Project Address Olympia WA 98504-4540 Final Week of (360) 902-5335 Payroll Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 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 C9 ~O o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And 7 E 5/30 5/31 6/1 6/2 6/3 6/4 6/5 Total Rate Hourly Earned/Gross "UsualNet Wages a) Payroll of Pay Payroll FICA Withholding Other Soc Sec#of Employee Address ce o o Hours Worked Each Day Benefits" Tax J 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 J Of Sewer&Water Systems Michael Babcock 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 ig) 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 spection/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. ! \ Any apprentices employed in the above period are duly registered ih 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 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 r • - w _ Certified Payroll Report ' Department of Labor and ^�6srAri.:°F Prime Contractor ❑ Project Name County Project or Contract# Industries - 4 h 5 Duvall Avenue NE King CAG-20-065 PrevailingWage Program all ,=?If3 9 9 :°° ' Subcontractor El PO Box 44540 °'� ' aoY" Project Address Olympia WA 98504-4540 ` 'g89 ' 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 5/29/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions '- p Work Classification Name c. ~• o o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And a) E 5/23 5/24 5/25 5/26 5/27 5/28 5/29 Total Rate Earned/Gross Hourly Net Wages Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address Tax CD• O o Hours Worked Each Day Payroll Benefits" 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 aimee badure Office Manager 6/1/2022 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: Duvall Avenue NE 5/23/2022 5/29/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification i 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. 7 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 aimee badure Office Manager aimee badure r� ~ 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 ��,sure Project Name County Project or Contract# Prime Contractor ❑ Industries a ii i ��''t ith Duvall Avenue NE King CAG-20-065 o i.. U!: PrevailingWage Program ;iiii; 41ii:lS 9 9 ,�i;ij;� I„} Subcontractor PO Box 44540 °�ti1 ! /�oy�. 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 5/22/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions 1 _ p Work Classification Name c7 I' o Mon Tue Wed Thu Fri Sat Sun Total and And m E EarnedGross 5/16 5/17 5/18 5/19 5/20 5/21 5/22 Total Rate Hourly Hours of Pay A/mounGrosst "Usual Withholding Net Wages rn :- a) Payroll Benefits" FICA Tax Other Soc Sec#of Employee Address _ O o Hours Worked Each Day a J J 1. Power Equipment RG 0.00 0.00 6.50 0.00 0.00 0.00 0.00 6.50 $73.49 $477.69 Operators Matt Carmack / Motor Patrol Graders 16711 259th Ave $110.2 $477.69/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $477 68 $0.00/hr $36.54 $57.32 $383.82 Buckley,WA- ********* 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $146.9$ $0.00 i 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 6/1/2022 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: Duvall Avenue NE 5/16/2022 5/22/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F ) 1.Matt Carmack 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. '=\:My 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 aimee badure Office Manager aimee badure r � 4- 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 ��,ST"rA�� Prime Contractor ❑ Project Name County Project or Contract# Industries k. 3 ; r� Duvall Avenue NE King CAG-20-065 PrevailingWage Program 4.: ,• 9 9 Subcontractor PO Box 44540 °;;,.,� 9yK Project Address Olympia WA 98504-4540 y� 'Ba"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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/15/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name C7 ~O o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a� E 5/9 5/10 5/11 5/12 5/13 5/14 5/15 Total Rate Earned/Gross Hourly Net Wages f i Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address cr 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 aimee badure Office Manager 5/18/2022 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: ^ ll Avenue NE 5/9/2022 5/15/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 1,c1 '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 aimee badure Office Manager aimee badure MB 5/20/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and , ;,1.-, Project Name County Project or Contract# 104 :., Prime Contractor E Industries - .era',=. , Duvall Avenue NE King CAG-20-065 Prevailing Wage Program a r.= Subcontractor PO Box 44540 -'.,-. Project Address Olympia WA 98504-4540 Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/8/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name & ~O o Mon Tue Wed Thu Fri Sat Sun Total Et a, Gross Amount and And E 5/2 5/3 5/4 5/5 5/6 5/7 5/8 Total Rate Earned/Gross Hourly Net Wages f Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address CD> 7. Benefits" Tax IY O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 5/9/2022 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: ,all Avenue NE 5/2/2022 5/8/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. ,..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 aimee badure Office Manager aimee badure MB 5/17/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,>.t•''";�,,� Prime Contractor ElProject Name County Project or Contract# Industries ..iii 14.. =•iiv --,,;;'lily, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program �JNlh ,+ltfl Subcontractor XI PO Box 44540 ': �' ,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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/1/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name C.7 ~O o Mon Tue Wed Thu Fri Sat Sun Total a> Gross Amount and And a E 4/25 4/26 4/27 4/28 4/29 4/30 5/1 Total Rate Earned/Gross Hourly Net Wages Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address m a Benefits" Tax O o Hours Worked Each Day a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 5/9/2022 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: Duvall Avenue NE 4/25/2022 5/1/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. r,,_',\ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ,fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 5/27/22 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,Simi; Project Name County Project or Contract# Industries .s .. „¢ Prime Contractor ❑ ` 1 r„ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 4'.... Subcontractor PO Box 44540 °;�i•,� y< Project Address Olympia WA 98504-4540 e� "a°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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/24/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name a 8 Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And a) E 4/18 4/19 4/20 4/21 4/22 4/23 4/24 Total Rate Hourly t0 E i= Hours of Pay Earned/Gross "Usual Withholding Net Wages a) Payroll FICA Other Soc Sec#of Employee Address cp 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 aimee badure Office Manager 4/26/2022 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: wall Avenue NE 4/18/2022 4/24/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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 ,aping 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 • M B.4/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and 8,.st�+.r.4: Project Name County Project or Contract# Industries ::3' •,, Prime Contractor ❑ '" Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ° x Subcontractor IX PO Box 44540 ".� 1` Project Address Olympia WA 98504-4540 y` 'a�ac Final Week of (360) 902-5335 Payroll ❑ Awarding Agency Name Phone Company Name Phone For the week ending: RENTON,CITY OF (425)430-7303 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/17/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p —__ Work Classification Name c9 ~O 9- Mon Tue Wed Thu Fri Sat Sun Total rx a, Gross Amount and And ZB a� E 4/11 4/12 4/13 4/14 4/15 4/16 4/17 Total Rate Earned/Gross Hourly Net Wages E Hours of Pay Payroll "Usual FICA Withholding Other Soc Sec#of Employee Address CD O ia 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 aimee badure Office Manager 4/26/2022 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: ^ iall Avenue NE 4/11/2022 4/17/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and ng Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 4/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ,,,. TArf Project Name County Project or Contract# Industries •. "''.,,-f, Prime Contractor ❑ i', _ Duvall Avenue NE King CAG-20-065 Prevailing Wage Program *t lt:' ,u4ijll`.= Subcontractor PO Box 44540 ,,til;�l / Project Address Olympia WA 98504-4540 '` 'Ngg 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/10/2022 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 ~O Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount ` and And E 4/4 4/5 4/6 4/7 4/8 4/9 4/10 Total Rate Earned/Gross Hourly Hours of Pay "Usual Withholding Net Wages m f a) Payroll FICA 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 aimee badure Office Manager 4/13/2022 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: wall Avenue NE 4/4/2022 4/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s)have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. «I.Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and 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 aimee badure Office Manager aimee badure MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��.;s?erF. � Project Name County Project or Contract# Industries ;,;f Prime Contractor ❑ ::_;;- ,lLt., Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <=114 �'3 Subcontractor Z t v PO Box 44540 1'il,;. 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/3/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions E= Work Classification Name c. ~o o Mon Tue Wed Thu Fri Sat Sun Total a� Gross Amount and And a� E 3/28 3/29 3/30 3/31 4/1 4/2 4/3 Total Rate Earned/Gross Hourly Net Wages E i- Hours of Pay "Usual FICA Withholding Other am r 0 Payroll Benefits" Tax Soc Sec#of Employee Address ce O Hours Worked Each Day a J J 1. RG 0.00 4.75 0.00 0.00 0.00 0.00 0.00 4.75 $30.00 $142.50 Inspection/Cleaning/Sealing Of Sewer&Water Systems Cody Willard V By Remote Control 5610 99th Ct E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $45.00 $0.00 $142.50/ $0.00/hr $10.90 $17.10 $114.50 Head Operator Puyallup,WA- $142.50 (King) 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $60.00 $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 4/13/2022 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: ^•wall Avenue NE 3/28/2022 4/3/2022 "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 1.Cody Willard Inspection/Cleaning/Sealing Of Sewer&Water Systems By Remote Control $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Head Operator (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 Wing Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and +‘ . Project Name County Project or Contract# a.. 'rf +E '' Prime Contractor ❑ Industries 4.::!: .s. 0: .,:1 r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program ?)i1' i lj 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 3/27/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions H Work Classification Name c7 ~O a Mon Tue Wed Thu Fri Sat Sun Total cc m Gross Amount and And a) E 3/21 3/22 3/23 3/24 3/25 3/26 3/27 Total Rate Hourly a, E i Hours of Pay Earned/Gross 'Usual Withholding Net Wages a) Payroll FICA Other Soc Sec#of Employee Address CD cc O o Hours Worked Each Day Benefits" Tax a J J 1. Power Equipment RG 0.00 0.00 0.00 7.00 0.00 0.00 0.00 7.00 $73.49 $514.43 Operators Matt Carmack Motor Patrol Graders 16711 259th Ave $110.2 $514.43/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $5,143.43 $0.00/hr $39.35 $61.73 $5,042.35 Buckley,WA- '••-'•-"`• 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $106.9 $V0 2. RG 0.00 0.00 0.00 7.25 0.00 0.00 0.00 7.25 $30.00 $217.50 Inspection/Cleaning/Sealing Of Sewer&Water Systems Cody Willard By Remote Control 5610 99th Ct E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $45.00 $0.00 $217.50/ Head Operator Puyallup,WA- $217.50 $0.00/hr $16.64 $26.10 $174.76 g) 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $60.00 $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 4/13/2022 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,.vall Avenue NE 3/21/2022 3/27/2022 "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 1.Matt Carmack Power Equipment Operators Motor Patrol Graders $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) 2.Cody Willard Dection/Cleaning/Sealing Of r✓er&Water Systems By note Control $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Head Operator (King) F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans,funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 'Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fling Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 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 aimee badure Office Manager aimee badure MB 5/20/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ��,{;erg..°F Project Name County Project or Contract# Industries Prime Contractor ❑ ;•: i- r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program 111 ;nt1j j Subcontractor PO Box 44540 d,9:: , �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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 5/8/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions E= Work Classification Name C 8 9- Mon Tue Wed Thu Fri Sat Sun cu Gross Amount Total and And a� E 5/2 5/3 5/4 5/5 5/6 5/7 5/8 Total Rate Earned/Gross Hourly Net Wages • E• -E Hours of Pay Payroll "Usual FICA Withholding Other g Soc Sec#of Employee Address • a,eC 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 aimee badure Office Manager 5/9/2022 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: tall Avenue NE 5/2/2022 5/8/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person.No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 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 aimee badure Office Manager aimee badure MB 5/17/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and t,srerF Project Name County Project or Contract# i'IfII Prime Contractor ❑ Industries _.i;,. ,,,.;;i,, Duvall Avenue NE King CAG-20-065 Prevailing Wage Program `f (t +tilI Subcontractor CXJ PO Box 44540 :n . `yo 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 5/1/2022 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 ~O 9- Mon Tue Wed Thu Fri Sat Sun Total a> Gross Amount E 4/25 4/26 4/27 4/28 4/29 4/30 5/1 Total Rate Hourly and And E i= Hours of PayEarned/Gross 'Usual Withholding Net Wages a, Payroll FICA Tax Other Soc Sec#of Employee Address m m - Benefits" iz 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 aimee badure Office Manager 5/9/2022 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: Duvall Avenue NE 4/25/2022 5/1/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work on this project during this reporting period. • F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side - - The party signing below AFFIRMS the following: (1)All information contained in this Certified Payroll Report, including any addenda, is correct and complete. (2)The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage determination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3)The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4)All persons employed on the above-referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above-named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. 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 NIB 5/27/22 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;ar"T�� Prime Contractor ❑ Project Name County Project or Contract# Industries _=f PrevailingWage Program 4;;�:,; i=_° Duvall Avenue NE King CAG 20 065 9 9 �,�::_.. . ,i;`� Subcontractor PO Box 44540 ';, .. ( �0y 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/24/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions E= Work Classification Name c9 ~O G Mon Tue Wed Thu Fri Sat Sun Total cC and And Gross 4/18 4/19 4/20 4/21 4/22 4/23 4/24 Total Rate Amount Hourly Earned/Gross Net Wages m E Hours of Pay "Usual FICA Withholding Other g Soc Sec#of Employee Address CD CC o o Hours Worked Each Day Payroll Benefits" Tax a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 4/26/2022 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 4/18/2022 4/24/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E) Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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 aimee badure Office Manager aimee badure MB 4/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and ct., „ri ,, Prime Contractor ❑ Project Name County Project or Contract# Industries 4. is 4 ::_,�: i:��r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program <=i3i=_ fs = ,�:,3t, , 111•i Subcontractor SI 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/17/2022 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 ~ - Mon Tue Wed Thu Fri Sat Sun Total X O a) Gross Amount and And a) E 4/11 4/12 4/13 4/14 4/15 4/16 4/17 Total Rate EarnedHourly /Gross Net Wages `m E H Hours of Pay "Usual FICA Withholding Other Soc Sec#of Employee Address ce o oEl 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 aimee badure Office Manager 4/26/2022 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: ^ iall Avenue NE 4/11/2022 4/17/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly (A) Hourly (B) Hourly (C) Hourly (D) Hourly (E)Approved (F) Other "Usual Pension Medical Vacation Holiday Apprentice Benefits Benefits" Program (A+B+C+D+E+F No Employees performed work 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. Y« 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 aimee badure Office Manager aimee badure M B.4/28/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �N. ti,,r1 Project Name County Project or Contract# &.:te +''i - Prime Contractor ❑ Industries •'•'•'' "`r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program •.,.:::::.- �::? i` Subcontractor IN PO Box 44540 4:p: 1` �' Project Address 4'4Olympia 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 4/10/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S,Unit 20 KENT WA 98032 Day and Date Deductions p Work Classification Name c9 ~o o Mon Tue Wed Thu Fri Sat Sun Total GrossAmount and And `" E 4/4 4/5 4/6 4/7 4/8 4/9 4/10 Total RateHourly E i= Hours of Pay Earned/Gross "Usual Withholding Net Wages a) Payroll FICA Other Soc Sec#of Employee Address cr O o Hours Worked Each Day Benefits" Tax a No Employees performed work on this project during this reporting period. F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Affirmation Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Today's Printed name of party signing this report Title Date aimee badure Office Manager 4/13/2022 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: vall Avenue NE 4/4/2022 4/10/2022 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour"terms) Work Classification Total Hourly (A) Hourly (B) Hourly (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. icIM4ny 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 aimee badure Office Manager aimee badure MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �a..srere,�F Project Name County Project or Contract# f Prime Contractor ❑ IndustriesWage Program -ii's: ;..=.;s Duvall Avenue NE King CAG-20-065 Prevailing 9 g �..:..;:�. al!, Subcontractor ® Project Address PO Box 44540 ":� : ,y 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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 4/3/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 _ Day and Date Deductions Work Classification Name E7 ~O o Mon Tue Wed Thu Fri Sat Sun Total m Gross Amount and And `m E iE 3/28 3/29 3/30 3/31 4/1 4/2 4/3 Total Rate EarnedHourly !Gross Net Wages Hours of Pay Payroll "Usual Withholding f a) FICA Other Soc Sec#of Employee Address cc O o Hours Worked Each Day Benefits" Tax Nio J 1. RG 0.00 4.75 0.00 0.00 0.00 0.00 0.00 4.75 $30.00 $142.50 Inspection/Cleaning/Sealing I Of Sewer&Water Systems Cody Willard V By Remote Control 5610 99th Ct E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $45.00 $0.00 $142.50/ $0.00/hr $10.90 $17.10 $114.50 Head Operator Puyallup,WA- $142.50 (King) 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $60.00 $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 4/13/2022 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: veil Avenue NE 3/28/2022 4/3/2022 "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 1.Cody Willard Inspection/Cleaning/Sealing Of Sewer&Water Systems By Remote Control $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Head Operator (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. 15'_4ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and I ;ning Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Certified Payroll Report Department of Labor and �t,;Ar, Project Name County Project or Contract# Industries ^ . "•i;`f Prime Contractor ❑ .ir - s..s1:r Duvall Avenue NE King CAG-20-065 Prevailing Wage Program lit: fI="'i= PO Box 44540 W• :: -fir Subcontractor °•;;��•,� ,,y�. Project Address Olympia WA 98504-4540 y� �8d�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 Puget Construction Srvcs Inc (253)856-2572 Month Day Year Awarding Agency Address Address City State Zip+4 3/27/2022 1055 S GRADY WAY RENTON,WA-98055 1609 Central Ave S, Unit 20 KENT WA 98032 Day and Date Deductions Work Classification Name E ~O o Mon Tue Wed Thu Fri Sat Sun Total Gross Amount and And a> E 3/21 3/22 3/23 3/24 3/25 3/26 3/27 Total Rate Hourly m` E - Hours of Pay Earned/Gross "Usual Withholding Net Wages 'Ea, Payroll FICA Other Soc Sec#of Employee Address Ce O o Hours Worked Each Day Benefits" Tax ❑ J J 1. Power Equipment RG 0.00 0.00 0.00 7.00 0.00 0.00 0.00 7.00 $73.49 $514.43 Operators Matt Carmack Motor Patrol Graders 16711 259th Ave $110.2 $514.43/ (King) Court E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 $0.00 $5,143.43 $0.00/hr $39.35 $61.73 $5,042.35 Buckley,WA- ********* 98321 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $1 06'9 $O.Q0 2. RG 0.00 0.00 0.00 7.25 0.00 0.00 0.00 7.25 $30.00 $217.50 Inspection/Cleaning/Sealing / Of Sewer&Water Systems Cody Willard J By Remote Control 5610 99th Ct E OT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $45.00 $0.00 $217.50/ $0.00/hr $16.64 $26.10 $174.76 Head Operator Puyallup,WA- - $217.50 g) 98374 DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $60.00 $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 4/13/2022 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: ✓all Avenue NE 3/21/2022 3/27/2022 "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 1.Matt Carmack Power Equipment Operators Motor Patrol Graders $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (King) • 2.Cody Willard Dection/Cleaning/Sealing Of aver&Water Systems By note Control $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Head Operator (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. I c`stk,ny apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and fining Council. Falsification of any of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Printed name of party signing this report Title Signature aimee badure Office Manager aimee badure MB 4/26/22 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side