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Home My WebLink AboutWTR2703531_3CITY OF RENTON - PUBLIC WORKS DEPARTMENT UTILITY SYSTEMS 430-7200 City Hall, 1055 S Grady Way, Renton, WA 98057 Contractor: KC Equipment, LLC Address: 4550 49th Avenue NE City Seattle State: WA Zip: 98105 Contract Number Project Name Statement Number CAG 11-030 LAKE WASHINGTON N. STORM & WATER SYSTEM IMPROVEMENT PROJECT Number of workina days charaed to vour contract for the week endina Mav 6. 2011 Date Day Weather Condition Working Days Unworkable Day Caused by Weather or Weather Conditions 5/2 Monday Rain and Clouds. high 40s 1 5/3 Tuesday Cloudy. low 50s 1 5/4 Wednesday Drizzle. low 50s 1 5/5 Thursday Rain, low 50s 1 5/6 Friday Rain, low 50s 1 Days this week..__ .. ... ...._........................ Days previously reported ....... ... - ...-- .................... Total days to date ..................................................... 5 0 5 CURRENT STATUS Working Days Specified In Contract ................................. ' Approved Extension of Time.. ........................................ Total Authorized Time of Contract ................................... Less Working Days Charges ............................................ —Working Days Remaining .-........................................ 0 80 5 75 `Show only extensions approved by letter from Headquarters "Use negative totals to show overrun in time Summary of Week's Activities: The Notice To Proceed was issued on April 27, 2011 for the first work day to be May 2, 2011. Contractor called and specified staging area was set with Vulcan and a private agreement was placed with Vulcan for stockpiling/staging on their site. Erosion control and grubbing done during the week along with surveying. See Inspector's Reports for more detailed information on activities. Steve Lee, Project Manager Note. The contractor will be allowed 10 days from date of this report in which to protest in writing the correctness of this statement, otherwise it shall be deemed to have been accepted as correct. wk-1/DWC/ CITY OF RENTON - PUBLIC WORKS DEPARTMENT UTILITY SYSTEMS 430-7200 City Hall, 1055 S Grady Way, Renton, WA 98057 Contractor: KC Equipment, LLC Address: 4550 49" Avenue NE City: Seattle State: WA Zip: 98105 Contract Number Project Name Statement Number CAG 11-030 LAKE WASHINGTON N. STORM & WATER 2 SYSTEM IMPROVEMENT PROJECT Number of workina days charaed to vour contract for the week endina Mav 27. 2011 Date Day Weather Condition Working Days Unworkable Day Caused by Weather or Weather Conditions 5/23 Monday Rain and Clouds, low 50s 1 5/24 Tuesday Cloudy, low 50s 1 5/25 Wednesday Drizzle, low 50s 1 5/26 Thursday Rain, low 50s 1 5/27 Friday Rain, low 50s 1 Daysthis week.......................................................... Days previously reported ............................................ Total days to date ...................................................... 5 0 5 CURRENT STATUS Working Days Specified In Contract ................................. * Approved Extension of Time .......................................... Total Authorized Time of Contract ................................... W N :1 Previous Reported Working Days Remaining ............... 75 (on May 6) Less Working Days Charges ............................................ 5 + (10 from May 9 — May 20) —Working Days Remaining ............................................. 60 `Show only extensions approved by letter from Headquarters "Use negative totals to show overrun in time Summary of Week's Activities: PSE power pole was held during installation of CB #5. Moving towards CB #6. Contractor working 4 days a week and 10 hr days. Fridays are counted as working days. During May loth to May 13th the City survey and cadd information was found as `wrong' and the additional CB #11, 12 and 13 work needed to be redone. Contractor may request one or two extra working day if needed later in addition to the approved Change Order #1. See Inspector's Reports for more detailed information on activities. Steve Lee, Project Manager Note: The contractor will be allowed 10 days from date of this report in which to protest in writing the correctness of this statement, otherwise it shall be deemed to have been accepted as correct. wk-1/DWC/ CITY OF RENTON - PUBLIC WORKS DEPARTMENT UTILITY SYSTEMS 430-7200 City Hall, 1055 S Grady Way, Renton, WA 98057 Contractor KC Equipment, LLC Address: 4550 49th Avenue NE City Seattle State: WA Zip: 98105 Contract Number Project Name Statement Number CAG 11-030 LAKE WASHINGTON N. STORM & WATER 3 SYSTEM IMPROVEMENT PROJECT Number of workina days charaed to vour contract for the week endina June 10. 2011 Date Day Weather Condition Working Days Unworkable Day Caused by Weather or Weather Conditions 6/6 Monday Clouds, 54 deg 1 6/7 Tuesday Cloudy. low 50s to mid 50s 1 6/8 Wednesday Drizzle/Cloudy. mid 40s to mid 50s 1 6/9 Thursday Partly Cloudy. mid 40s to low 50s 1 6/10 Friday Cloudy. mid 40s to low 50s 1 Daysthis week.......................................................... Days previously reported ............................................ Total days to date ...................................................... 5 0 5 CURRENT STATUS Working Days Specified In Contract ................................. Approved Extension of Time .......................................... Total Authorized Time of Contract ................................... Previous Reported Working Days Remaining ............... Less Working Days Charges ............................................ "`Working Days Remaining ..................................... :11 0 80 60 (on May 27) 5 + (4 from May 30 — Jun 3) 51 "Show only extensions approved by letter from Headquarters "Use negative totals to show overrun in time Summary of Week's Activities: 12-inch cpep from bioswale to CB#2 placed. Trenchline from CB #6 and CB #7 cleared and grubbed. Unidentified 24-inch concrete pipe was revealed. Contractor lost 1 working day due to revealed 24-inch. No utilities claimed the pipe. June 2nd McDowell Pile King drove piles. Additional piles were found under some spread footings. CPEP pipe installed between CB #7 and CB #6. Slowdown at Station 22+30 at the proposed watermain crossing work. See Inspector's Reports for more detailed information on activities. ' ZA�� 4--- Steve Lee, Project Manager Note: The contractor will be allowed 10 days from date of this report in which to protest in writing the correctness of this statement,. otherwise it shall be deemed to have been accepted as correct. wk-1/DWC/ Contractor: Address City: CITY OF RENTON - PUBLIC WORKS DEPARTMENT UTILITY SYSTEMS 430-7200 City Hall, 1055 S Grady Way, Renton, WA 98057 KC Equipment, LLC 4550 49th Avenue NE Seattle State: WA Zip: 98105 Contract Number Project Name Statement Number CAG 11-030 LAKE WASHINGTON N. STORM & WATER 4 SYSTEM IMPROVEMENT PROJECT Number of workina days charaed to vour contract for the week endina June 17. 2011 Date Day Weather Condition Working Days Unworkable Day Caused by Weather or Weather Conditions 6/13 Monday Partly Cloudy, 63 deg 1 6/14 Tuesday Cloudy, low 50s to mid 60s 1 6/15 Wednesday Drizzle/Cloudy, mid 40s to mid 50s 1 6/16 Thursday Partly Cloudy, mid 40s to 67 deg 1 6/17 Friday Cloudy. mid 40s to low 50s 1 Daysthis week.......................................................... Days previously reported ............................................ Total days to date. ....- --.................................... 5 0 5 CURRENT STATUS Working Days Specified In Contract ................................. 80 * Approved Extension of Time .......................................... 0 Total Authorized Time of Contract ................................... 80 Previous Reported Working Days Remaining ............... 51 (on June 10) Less Working Days Charges ............................................ 5 **Working Days Remaining ............................................. 46 *Show only extensions approved by letter from Headquarters **Use negative totals to show overrun in time Summary of Week's Activities: 24-inch RCP between CB #7 to CB #8 was completed on 6/15. CB#8 MH construction started. Construction of RCP slow due to soft soils and dewatering in the trench. See Inspector's Reports for more detailed information on activities. Steve e , Project Manager Note: The contractor will be allowed 10 days from date of this report in which to protest in writing the correctness of this statement,. otherwise it shall be deemed to have been accepted as correct. wk-1 /DWC/ CITY OF RENTON - PUBLIC WORKS DEPARTMENT UTILITY SYSTEMS 430-7200 City Hall, 1055 S Grady Way, Renton, WA 98057 Contractor: KC Equipment, LLC Address: 4550 49t' Avenue NE City: Seattle State: WA Zip: 98105 Contract Number Project Name Statement Number CAG 11-030 LAKE WASHINGTON N. STORM & WATER 5 SYSTEM IMPROVEMENT PROJECT Number of workino days charoed to vour contract for the week endina June 24. 2011 Date Day Weather Condition Working Days Unworkable Day Caused by Weather or Weather Conditions 6/20 Monday Partly Cloudy, 54 — 69 deg 1 6/21 Tuesday Cloudy, low 50s to mid 60s 1 6/22 Wednesday Drizzle/Cloudy, mid 40s to mid 50s 1 6/23 Thursday Partly Cloudy, mid 40s to 67 deg 1 6/24 Friday Cloudy, mid 40s to low 50s 1 Daysthis week.......................................................... Days previously reported ............................................ Total days to date ...................................................... 5 0 5 CURRENT STATUS Working Days Specified In Contract. ................................ * Approved Extension of Time .......................................... Total Authorized Time of Contract ................................... Previous Reported Working Days Remaining ............... Less Working Days Charges ............................................ —Working Days Remaining ............................................. 0 80 46 (on June 17) 5 41 *Show only extensions approved by letter from Headquarters **Use negative totals to show overrun in time Summary of Week's Activities: 24-inch RCP between CB #7 to CB #8 was completed on 6/15. CB#8 MH construction started. Construction of RCP slow due to soft soils and dewatering in the trench. See Inspector's Reports for more detailed information on activities. S ve Lee, Project Manager Note: The contractor will be allowed 10 days from date of this report in which to protest in writing the correctness of this statement, otherwise it shall be deemed to have been accepted as correct. wk-1 /DWC/ Lake Washington Blvd North Storm & Water Systems Improvement Project Pre Construction Meeting Agenda DATE: April 28, 2011 (Thurs) TIME: 1:30 PM to 4:00 PM LOCATION: CITY OF RENTON, ROOM 511 MEETING AGENDA The following agenda topics are to be discussed: I. Introductions II. Project Review for Storm, Water, Sidewalk & Irrigation III. Sub -contractors - 4bra °��v�r• 1 IV. Various Plans �� Id C41- a. Traffic Control Plan b. Temporary Water Pollution / Erosion Control Plan c. Bypass Pumping Plan d. Cleaning & Sweeping Plan e. Stormwater Pollution Prevention Plan f. Spill Prevention, Control & Countermeasures Plan g. Easements and right-of-entrys V. Material sources for the project a. Water b. Storm c. Landscaping/Irrigation VI. Payment a. Tickets b. Inspection c. Submittal of testing materials (i.e. concrete) d. Progress estimates / procedures for payment VII. Change Order Process VIII. Hours of Work IX. Project Schedule Lake Washington Blvd North Storm & Water Systems Improvement Project Pre Construction Meeting Agenda DATE: April 28, 2011 (Thurs) TIME: 1:30 PM to 4:00 PM LOCATION: CITY OF RENTON, ROOM 511 MEETING AGENDA The following agenda topics are to be discussed: I. Introductions II. Project Review for Storm, Water, Sidewalk & Irrigation III. Sub -contractors IV. Various Plans a. Traffic Control Plan b. Temporary Water Pollution / Erosion Control Plan c. Bypass Pumping Plan d. Cleaning & Sweeping Plan e. Stormwater Pollution Prevention Plan f. Spill Prevention, Control & Countermeasures Plan g. Easements and right-of-entrys V. Material sources for the project a. Water b. Storm c. Landscaping/Irrigation VI. Payment a. Tickets b. Inspection c. Submittal of testing materials (i.e. concrete) d. Progress estimates / procedures for payment VII. Change Order Process VIII. Hours of Work IX. Project Schedule DAILY INSPECTION DIARY REPORT DAY: DATE: 5 /Z. /11 WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: O TEMP. MAX OF MIN4{':�) OF PRECIPITATION:c WORK ACCOMPLISHED TODAY: � A) c i l$ t?xx r-S v M. • 1 1 �r•� r n. , - -L-- CONTRACTOR SIGNATURE INSP TOR SIGNATURE DATE: C7 l f DAILY INSPECTION DIARY REPORT DAY:_ � �v� DATE: 5 7�5 /I) WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER:'p,+1 (24d TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TO AY: CONTRACTOR SIGNATURE NSPEC R IGNATURE DATE: L DAILY INSPECTION DIARY ` REPORT DAY: DATE: / /< WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: .,ti. ('. `=_✓mil CONTRACTOR SIGNATURE L INSPEVTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY.• DATE:.) /J`• l�l WORK PERIODe(- j/p.m. to a.m./p.m. WEATHER: G't c TEMP. MAX OF MIN OF PRECIPITATION:-S,r�/��"� WORK ACCOMPLISHE TODAY: J� � �'�L�'/h As✓t✓ 6� �l1 ��,,p��r LC �.�/rL[i l�c� L L A �r�r � ,� l�4-lacs�- G✓ � re CONTRACTOR SIGNATURE I SPECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY: .� DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. N[A'. °F MIN °F PRECIPITATION:y� WORK ACCOMPLISHED TODAY: Lrml I I -` AMa La �a 4 CONTRACTOR SIGNATURE �INSCTOR SIGNATURE DATE: is" ANSM ls-w x DAILY INSPECTION DIARY REPORT 4� DAY:, DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: [+ TEMP. MA)O-`-,,-' OF MIN OF PRECIPITATION:�� WORK ACCOMPLISHED TODAY: GAS-e,rt ,zsttu r f/.�f 3T17C-�3Cw�C�L U a2gaarz:;r2_ 'Tff��N✓.�2A�.?��L ["�srr� 7�./[�Ls�J �.Ot/G✓�f� �.�'C'�is�-fY.b /i%id4�� Cj r�+,�/�� x t"�(rJ:�i i✓ O f i�� i . C�--St,/�Z�C� �E-� f�/.s-r e+3'� CONTRACTOR SIGNATURE INS CTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: DATE: Z7 /%A7 /1/ WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX4,r-7�,04 OF MIN OF PRECIPITATION: A&.Ale— WORK ACCOMPLISHED TODAY: �� /yin �.¢e_,.� �� As� �!-� ? sGUeP n-, �.•��S 7 --7 7 2 7�� Cyr �s-/��' „��"G,�✓x�7c j� �r �� iil'� �zc.�LL� ,�I�,=' CONTRACTOR SIGNATURE INSPVCTOR SIGNATURE DATE: ,5 4 DAILY INSPECTION DIARY REPORT 4� DAY: DATE: Z7/l% /l WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER TEMP. MAX °F MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: -777t.w �i r-�:y ..s Ifs a � ✓'� .—1 Cs,✓ n l:;� %;cG- -,n/y CONTRACTOR SIGNATURE INSPECTORYSIGNATURE DATE: �%j� DAILY INSPECTION DIARY REPORT DAY:� DATE: // / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: . G- TEMP. MAX�°F MINOF PRECIPITATION: C WORK ACCOMPLI ED TODAY: 44& AN oL- F i , 0 t CONTRACTOR SIGNATURE INSPE OR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: -& I I ' /'7"-DATE: WEATHER: c TEMP. MAX WORK ACCOMPLISHED TODAY: C.5,z- L f) L Kyl ie- �c-- WORK PERIOD:jTt\ a.m./]& to OF MIN OF PRECIPITATION: - a.m./p.m. J I-411 n " l o CONTRACTOR SIGNATURE INSPNKOk SIGNATURE REPORT 4� DATE: v A I w hd DAILY INSPECTION DIARY ' REPORT DAY: DATE: / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: Z TEMP. MAX °F MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE ECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY:i a DATE: 01 WORK PERIOD: a.m./p.m. to WEATHER:ml, TEMP. MAX °F MIN ��°F PRECIPITATION: WORK ACCOMPLISHED TODAY: 1 r Aw ' _ '� • .� i.� A ✓ -� mil/ It � ' � ,f� L� a.m./p.m. CONTRACTOR SIGNATURE v INSPECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY: l DATE: / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER:=ram' TEMP. MAX ,°F MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: he c.l<-VAl,e,ry,z� t ` 0 pry "-0L � �Q r �i ! �t 4/� S o\ L1(tc �P TY+-.V' v�!`yw�r.TD 4, CONTRACTOR SIGNATURE INSPE SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY: DATE: 1121L WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: ( TEMP. MAX(:�7°F MIlRJ(!�? OF PRECIPITATION: WORK ACCOMPLISHED TODAY: ` ✓1 �'17L►�2 �►.r Tr � , �� ✓� D:i'1 f.�xJ� � ��i � ��) J 6�11 /�� Lei CONTRACTOR SIGNATURE C4t �IN�ECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT # DAY: DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER e/ TEMP. MAX46 _°F MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: JIV .r /v7, / •7 z !l CONTRACTOR SIGNATURE INSPEU'TOR SIGNATURE DATE: DAILY INSPECTION DIARY , DAY: /� DATE: / %liJ WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: REPORT A4- 7,11 a� �� 3tcic,//� !l s�:►Z� Fib SS'/.�4 �� u�rg T� „Ar2c�c��o rl.7fr� �c�?.�C� ��• o S'iC�f Y t� .,d�fL� v, r CONTRACTOR SIGNATURE NSPE OR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT �6 DAY: DATE:IS -t&/lr WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX G Cam— MIN OF PRECIPITATION: 1-10,Alr�r WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE TOR SIGNATURE DATE: Za DAILY INSPECTION DIARY DAY: "COX10/% DATE Jai- /WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: Q�. T TEMP. OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: ,e-1 / .! %� 9 r'C/ REPORT �1 All 7w �/�..b i.S��JS s �5'�f9.�. r � 7�r�-'TIU.J r- � �r �� ✓�'du.,�n �IJL.� Ad so r _ : V."A / r - PS A. CONTRACTOR SIGNATURE C4 �aI`NOPT�ORSI�GNATU3RE DATE: DAILY INSPECTION DIARY _ REPORT DAY: DATE: �2`1/l / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: EMP. MAX ( °F MIN r -Z__.�F PRECIPITATION: �D/✓� WORK ACCOMPLISHED TODAY: tom- �->• te.� /tS�'f3 it/(��_ C�.b ,i�L �LI ye,L�cA wJ � 5 ��}.7✓C.r 1/ S ��J �-'S � /�/6-� CONTRACTOR SIGNATURE INSPEITOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY: DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAj_°F MIN OF PRECIPITATION: WORK ACCOMPL HED TODAY: M CONTRACTOR SIGNATURE INSP C OR SIGNATURE DATE: in s DAILY INSPECTION DIARY DAY: DATE t5 12,1,11j WORK PERIOD: a.m./p.m. to WEATHER: 61ME.-e Cs TEMP. MAX S 5 OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE "PS ,S/117 a.m./p.m. I SPECTOR SIGNATURE REPORT DATE: DAY: WEATHER: DAILY INSPECTION DIARY DATE: ,4/ //1 WORK PERIOD: a.m./p.m. to a.m./p.m. REPORT TEMP. MAX OF MIN 416 OF PRECIPITATION./-- se �� L./';11 WORK ACCOMPLI HED TODAY: 40 , k CONTRACTOR SIGNATURE '1145tECTOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: DATE: �p / /� ( WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX��-F MIN OF PRECIPITATION: WORK ACCOMPLIS D TODAY: REPORT Zd '7� 1/ (� ip� c1/� �ic!`'t>,S t�J, G'B7vD�_.�-P ?�,�_ C��►'ty71r�� tom` i �c.., i"7�3 t'1../1/J �✓ %7 U�� " �� .yi t�O �'f.' ^ice � /��'., CONTRACTOR SIGNATURE U;5 �IN�CTORSIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: DATE: 6- WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX67 °F MIN 4 IB °F PRECIPITATION: WORK ACCOMPLISHED ODAY: Mir ?ifs (S-C-v 779Wv,'r _ e5TrU k 4Sy,- A14y �a Svc . i2� ro��r�'%r Vim` Z C J,4 5 CONTRACTOR SIGNATURE ECTOR SIGNAT DATE: DAILY INSPECTION DIARY REPORT DAY: DATE: /3 // / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: v/, TEMP. MAX � ` OF MIN _! ) OF PRECIPITATION: WORK ACCOMPLISHED TOD Y: kC, � apu ..o ✓r►�1-.+`� �a�y,n sa.+�1 ' CONTRACTOR SIGNATURE INSP CTOR SIGNATURE DATE: 2 r DAY: �>✓f WEATHER: er"jeiA DAILY INSPECTION DIARY REPORT DATE: 4 /� // / WORK PERIOD: a.m./p.m. to a.m./p.m. TEMP. MAX OF MIN ,54 OF PRECIPITATION: WORK ACCOMPLIS ED TODAY: CONTRACTOR SIGNATURE y INSMCTOR SIGNA DATE: Cp �p DAILY INSPECTION DIARY REPORT DAY � DATE: / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MI2V7-� OF PRECIPITATION: WORK ACCOMPLI HED TODAY: ! �Dv�+•[�� %�i*�-s4cJn ► d'7;r4-ck.�.cxb ) �r��.�_ ' C� 7 j cJLy�r 1. A,f3c T' 11F o L a.4oAM_ CONTRACTOR SIGNATURE 7. M a xN�l i Z SPECTOR SIGNATURE — DATE: .(0 1i11/ DAILY INSPECTION DIARY REPORT DAY: DATE:/ES /jl WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX:S°F MIN OF PRECIPITATION:jf2NQ,0,gr,_5 WORK ACCOMPLISHED ODAY: IKQ T12�rr .ti►. v van �, 1 � �"_ �— T_�.,� r� ��' n--t.i,�.�+1 Qc.:�c17c�.�" w7 is' ` O RVA CONTRACTOR SIGNATURE INSPECftft SIGNATURE DATE: wi I DAILY INSPECTION DIARY DAY: QAq DATE: 6, / /1 WORK PERIOD: a.m./p.m. to WEATHER: TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLI ED T AY: a.m./p.m. CONTRACTOR SIGNATURE —IN-SPEtJol SIGNATURE REPORT 4� DATE: DAY: DATE: WEATHER: TEMP. WORK ACCOMPLI HED T DAY: ROW DAILY INSPECTION DIARY // WORK PERIOD: a.m./p.m. to a.m./p.m. REPORT 4� MAX(°F MIN °F PRECIPITATION:I,�t CONTRACTOR SIGNATURE (4��INSPtt�RIGNATURE DATE: DAILY INSPECTION DIARY DAY: DATE: /� / WORK PERIOD: WEATHER: TEMP. MAX °F MIN X2,e_°F WORK ACCOMPLIS D TODAY: CONTRACTOR SIGNATURE a.m./p.m. to PRECIPITATION: fj a.m./p.m. INSF(ECTOR SIGNATURE REPORT DATE: DAILY INSPECTION DIARY REPORT DAY: ,(/ DATE:(z-1 / // WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MI499> °F PRECIPITATION: 77k�sl � WORK ACCOMPLISH D TODAY: CONTRACTOR SIGNATURE - `7/GC -1! f ✓ % 4 INW,ECTOR SI DATE: DAILY INSPECTION DIARY REPORT DAY`: DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHE! TEMP. MAX °F MIN °F PRECIPITATION: WORK ACCOMPLISHED TO AY: CONTRACTOR SIGNATURE IMPMIOR SIGNATURE DATE: lw DAY: i DATE: WEATHER:' Cv EMP. WORK ACCOMPLI ED TOD Y: DAILY INSPECTION DIARY 6112,0/ f ( WORK PERIOD: a.m./p.m. to MAX OF MIN OF PRECIPITATION: a.m./p.m. REPORT DATE: DAILY INSPECTION DIARY DAY DATE: % / WORK PERIOD: WEATHER: TEMP. MAX °F MIN °F WORK ACCOMPLISHED TODAY: REPORT a.m./p.m. to a.m./p.m. PRECIPITATION:Djt/�� --I Ftom= /°tee was sVr9k— Pi :Ae-.c'(�,- 7 4 /',P 1, p %.— 37_ "-s., r CONTRACTOR SIGNATURE INSP TOR SIGNATURE DATE: DAILY INSPECTION DIARY // DAY: L"( Aoo DATE: lO ZZ/% ( WEATHER: �,f� TEMP. MAX ,°F WORK ACCOMPLISHED TODAY: j WORK MIN PERIOD: a.m./p.m. to °F PRECIPITATION: *T— REPORT �� a.m./p.m. CONTRACTOR SIGNATURE ECTOW SIGNATURE DATE: f.. . DAY: 4 O-% WEATHER:�,(Q,G�� i DAILY INSPECTION DIARY DATE: 2, /F,/ It WORK PERIOD: a.m./p.m. to TEMP. MAX OF MIN �.b °F PRECIPITATION: WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE a.m./p.m. INSPEC'UR SIGNATURE REPORT DATE: DAILY INSPECTION DIARY DAY 1k DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER:e ?A$7- TEMP. MAX OF MINC�°F PRECIPITATION: WORK ACCOMPLISHED TODAY: _1/ CONTRACTOR SIGNATURE INVECTOR SIGNATURE REPORT DATE: DAY: DATE: WEATHER: <)) TEMP. WORK ACCOMPLIS ED TOD Y: DAILY INSPECTION DIARY /f WORK PERIOD: a.m./p.m. to MAX (,:-�_°F MIN°F PRECIPITATION: L„tQ,;Z> C-rMgzv--, a.m./p.m. VICE �� . o�,�-,,� �.�.� 1y✓. /� mi n CONTRACTOR SIGNATURE SIGNATURE REPORT DATE: DAILY INSPECTION DIARY 6 REPORT DAY:' - DATE: / 7/z WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: `' TEMP. MAX Aaf--�)°F MIN --5�LOF PRECIPITATION: WORK ACCOMPLISHE TODAY: �: 3 � �2 CONTRACTOR SIGNATURE INSPECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY: DATE: /� / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: :fit TEMP. MAX I'J °F MIN OF PRECIPITATION: WORK ACCOMPLISH D TODAY: DATE:/I-Zlj DAILY INSPECTION DIARY REPORT �l DAY: DATE: �/ WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX°F MIN°F PRECIPITATION: ,c/L WORK ACCOMPLIS D TODAY: r CONTRACTOR SIGNATURE INSPEC OR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: Aj DATE: g / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX- OF MIN OF PRECIPITATION:, WORK ACCOMPLISH D TODAY: (0"A CONTRACTOR SIGNATURE INSP OR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY'. DATE:' // / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER:{ TEMP. MAX OF MIN OF PRECIPITATION:9}Q��i2 WORK ACCOMPLISHED TODAY: www— e�E� )`ill i _ CONTRACTOR SIGNATURE INSPE R SIGNATURE DATE: DAILY INSPECTION DIARY DAY: 0 6 %-1 DATE: -( /Ia /1,, WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: -L TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TOD Y: FEW Mu a M 11- 1``1'tA yr ►C, CONTRACTOR SIGNATURE 90 t ■ -= r� u1 INSPEC R SIGNATURE REPORT cu'.. DATE: i i i DAILY INSPECTION DIARY ✓ REPORT DAY: 99 DATE: / / Il WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: C TEMP. MAX�± OF MIN OF PRECIPITATION: WORK ACCOMPLISH D TODAY: -+ . /1 vvtr�v = --�; LA t'15D l-2 1 ` -U-)-, e ) i2Qlvy� ti r2�'-��J �'� [s�T�T�l-sl-zScZ»'L- -d-�� 'mil �'�L Z_ � i �#-� ��✓�4-C _ (t'cx2 Al --V ] ,-1-- - tfi cam., cam`' t , 5 -r � ADE �i gAti r� CONTRACTOR SIGNATURE INSP UTOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: DATE: / / % WORK PERIOD: a.m./p.m. to WEATHER: C; TEMP. MAX Z_-,°F MIN °F PRECIPITATION: WORK ACCOMPLISHED TODAY: F1� a.m./p.m. PillL` i s - =�G , Ut.a. REPORT 4� DATE: W� DAY: WEATHER: DAILY INSPECTION DIARY DATE: of /x WORK PERIOD: a.m./p.m. to TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHJD TODAY: (,U �� ri 7 TLLhq�zc CONTRACTOR SIGNATURE a.m./p.m. SIGNATURE REPORT DATE: DAILY INSPECTION DIARY REPORT DAY: C:*40 DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MIN 5& OF PRECIPITATION: WORK ACCOMPLISHED TODAY: P-P-1 c: e; d z SA �� RAN - �_��`� •?'rf' � t 'Z , t � � i /� J4? S': �9 % �Cr'✓ ��/'L Zi� ~/-� CONTRACTOR SIGNATURE INSPFTTOR SIGNATURE DATE: DAY: r WEATHER: DAILY INSPECTION DIARY REPORT DATE:,0 /,2,1, /11 WORK PERIOD: a.m./p.m. to a.m. /p .m. TEMP. MAX 7_°F MIN OF PRECIPITATION: WORK ACCOMPLISH D TODAY: Q- T c� �14r /��'�� i� �?��-3.9y✓ i/5.rf1 � ��s.��►h�� TC�� s � CONTRACTOR SIGNATURE ECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4f DAY: '� "' DATE:W /2;-7/"WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX °F MIN �51 °F PRECIPITATION: Z-A4 WORK ACCOMPLISH D TODAY: ZAN CONTRACTOR SIGNATURE ECTOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: / DATE: / WORK PERIOD: WEATHER: TEMP. MAX OF MINCdZ= F WORK ACCOMPLISHED TODAY: a.m./p.m. to a.m./p.m. PRECIPITATION: REPORT ire ,4ai�0 LC4 7% 7-7� IZVQ % 6q4 ------- CONTRACTOR SIGNATURE INSPEVOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY:�c DATE: ,CT %2 / / WORK PERIOD: WEATHER: TEMP. MAX °F MIN 6 2 WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE a.m./p.m. to PRECIPITATION: SPECTOR SI a.m./p.m. REPORT DATE: DAILY INSPECTION DIARY REPORT DAY: ,� DATE:/Q / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MIN OF PRECIPITATION:],is WORK ACCOMPLISHED TODAY: II i CONTRACTOR SIGNATURE ECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT 4� DAY: DATE: /l/ WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: I TEMP. MAX �OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TOD Y: ell C-4-- ✓ LIB%/C7< CONTRACTOR SIGNATURE INSP OR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT �l DAY: DATE:06fiff-,-3/11 WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. TEMP. MAX Z°F MIN �°F PRECIPITATION: �✓ �r WORK ACCOMPLISHED TODAY: l-�/f %ramp r f-ygc - L—.-�-� ��LSi% r rY�� LSt� ("�'r»-TI•%L.�S ZiQ'Gl.✓� A2, Zza!�,2 TTiii / CONTRACTOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: DATE: Q� / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER:Zf TEMP. MAX ��% OF MIN_°F PRECIPITATION: WORK ACCOMPL HED ODAY: T- a CONTRACTOR SIGNATURE Al SIGNATURE REPORT 4� DATE: DAILY INSPECTION DIARY DAY: rl DATE: / WORK PERIOD: a.m./p.m. to WEATHER: t.; TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLIS ED TODAY: MAJ ./ V. ,!>1 i/ / cif G CONTRACTOR SIGNATURE a.m./p.m. 4*109TIII REPORT DATE: 0 ) I( DAILY INSPECTION DIARY DAY: DATE: t / WORK PERIOD: a.m./p.m. to WEATHER: TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLIS D TODAY: MA a.m./p.m. REPORT rs, Ml CONTRACTOR SIGNATURE SIGN DATE: onulownsimunnumlow DAILY INSPECTION DIARY REPORT 4� DAY:4.2 ✓ DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER. TEMP. MAX OF MIN OF PRECIPITATION: / WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE QZAI 4PECTOR SIGNATURE DATE: Isis' Susan= ■ ■ i i ■ DAILY INSPECTION DIARY y REPORT # DAY: tj DATE: `//�(�i / f 1 WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: A, aa. TEMP. MAX OF MIN;58 OF PRECIPITATION: WORK ACCOMPLISHED TODAY: ./, Gc1 /,-5 -.: 5 � �iw i G- --,rz— �� J � /, -'aa �L" C1�i��Z� Q Y✓�'�"O %�/f %4 i N L / .(/� /i(.%� �'Llr�i�C% �-/ .� �s»a5 F u SrLA-s-zo L a5 CONTRACTOR SIGNATURE '--'rNSPECTM SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: ji DATE: WORK PERIOD: WEATHER:C�2� TEMP. MAXL�-L°F MIN °F WORK ACCOMPLISHED TODAY: a.m./p.m. to a.m./p.m. PRECIPITATION: IJIOA16:% 2,-CS «0'i//�� PW16,'- l � C CONTRACTOR SIGNATURE AINSFECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: ' DATE: /%1 /j WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER TEMP. MAX&-7 °F MIN 5 r'F PRECIPITATION: WORK ACCOMPLIS ED TODAY: CONTRACTOR SIGNATURE SIGNATURE DATE: DAILY INSPECTION DIARY / DAY:/ fje DATE:�j /% WORK PERIOD: REPORT 4� a.m./p.m. to a.m./p.m. WEATHER: /� TEMP. MAX OF MIN �°F PRECIPITATION: WORK ACCOMPLI HED T AY: .,�� `?D✓r , rYlc��f/ �— ��;,,�r�- Al± 4-1 S 6� TIC ,� .►3 r:� c �c�T�C, _ CONTRACTOR SIGNATURE INSPECT SIGNATURE DATE: DAILY INSPECTION DIARY QQ REPORTS DAY: DATE:CJ / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: ,� TEMP. MAX 7,3 OF MIN OF PRECIPITATION: , wAt, WORK ACCOMPLISHED TODAY: /� �A.�„o/l�I�.Z/� ��7 �r'3� �—'�•j 1'Z /r' � ,yl'�rJt/ /cam L,- 5 .Q > / z "c�N�t/�7i%�� Gt/i 1> ,✓.% .�-2i�.c��7�y mil/!>>d �s�,/,fL�� -1 CONTRACTOR SIGNATURE INSPE R SIGN DATE: DAILY INSPECTION DIARY REPORT DAY: (/ DATE: �j / �/� WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAi7q" OF MIN 5 Z---F PRECIPITATION: WORK ACCOMPLISHED TODAY: c lA?5e-162sj rn&-)-rr- CONTRACTOR SIGNATURE 0 DATE: IN NA WEATHER: WORK ACCOMPLIS DAILY INSPECTION DIARY DATE: 1�!5/ / // WORK PERIOD: a.m./p.m. to �K• l 6�w . a/�9Aj::»j, a.m./p.m. MAX OF MIN �°F PRECIPITATION:C�/� ZQ � 1 i C- ' As� J l i— �"' a/.Y7 (cam y �� O .�"• j- 7 ST- C.,c-7C-ice CONTRACTOR SIGNATURE INSPttTOR SIGNATURE REPORT DATE: DAILY INSPECTION DIARY REPORT # DATE: l� WORK PERIOD: a.m./p.m. to a.m./p.m. TEMP. MAX OF MIN 61,,,.°F PRECIPITATION: �� • WORK ACCOMPLISH TODAY: CONTRACTOR SIGNATURE 7.� 7ag 2 Ag gf PECWR`"SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: - DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER / TEMP. MAX OF MIN-2L°F PRECIPITATION:�C/C�/U� WORK ACCOMPLIS ED TODAY: s1/lwmwl t r' �s . ` � arc _ v;40w DAILY INSPECTION DIARY � REPORT �6 DAY: DATE: WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: [i lege— TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: 1n.4 ✓`d ) N �v r_ i �"T� i7a l S Ldg V,-,4tX-Y DATE: DA Y:4 WEATHER: DAILY INSPECTION DIARY DATE : / WORK PERIOD: a.m./p.m. to a.m./p.m. TEMP. MAX WORK ACCOMPLISHED TODAY: OF MIN OF PRECIPITATION: REPORT 4� �, (�� v�T ✓1• �� VL�2nI !r t t 1 � d✓ -� � ; v O r��,/3 n/ Lahcx—, al : a4 R-A c—, Zp �y,c �� C.�J�-�1�� 1✓�Tc�� +�1 � 1" Y�on1 s�+e �ic� / 2 'bill 4, M, A, � � Qc..�� in-2 14 c'TIAZQle-- CONTRACTOR SIGNATURE INS TOR SIG DATE: DAILY INSPECTION DIARY REPORT DAY: DATE.0 N/I/ WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX A_°F MIN OF PRECIPITATION: X42� WORK ACCOMPLISHID TODAY: Tff/J'c s r ,c CONTRACTOR SIGNATURE DATE: pi-summussnan Run a DAILY INSPECTION DIARY DAY: � DATE: Jy/ WORK PERIOD: WEATHER: TEMP. MAX J OF MIN OF WORK ACCOMPLIS ED TODAY: CONTRACTOR SIGNATURE REPORT # a.m./p.m. to a.m./p.m. PRECIPITATION:k NS CTOR SIGNATURE DATE: �7'T0 iTM _7ZTt _ Tf DAY: DATE: WEATHER: awtj C n TEMP. WORK ACCOMPLISHED TODY: DAILY INSPECTION DIARY /-3j/ WORK PERIOD: a.m./p.m. to a.m./p.m. MAX 4LZ °F MIN (.i�r °F PRECIPITATION: A" A •4 REPORT 4i DATE: DAILY INSPECTION DIARY REPORT 4� DAY: DATE: / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAXe�OF MINI�°F PRECIPITATION: WORK ACCOMPLISHED TODAY: y �1 �t/ r CONTRACTOR SIGNATURE INSPE�y SIGNATURE DATE: ter DAILY INSPECTION DIARY REPORT DAY: 14 A n DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MIN 6Z .F PRECIPITATION:A)(,71e' WORK ACCOMPLISHED TODAY: ra 1'4c*— s Will - ma i CONTRACTOR SIGNATURE 3l *w- . •v-':b C. c• INSPEWOR SIGNATURE DATE: DAILY INSPECTION DIARY / REPORT DAY• DATE: / / ( WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX --F MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: FAR r CONTRACTOR SIGNATURE l rA �ei lCZ�"--'r-TNSPEcfOR SIGNATURE DATE: DAILY INSPECTION DIARY 4�' '-' DAY:' DATE: F 56 WORK PERIOD: WEATHER: TEMP. MAX °F MIN 7 z�.°F WORK ACCOMPLISHED TODAY: i CONTRACTOR SIGNATURE a.m./p.m. to PRECIPITATION: a.m./p.m. INSPICTOR SIGNATURE REPORT 4� DATE: DAILY INSPECTION DIARY REPORT 4� DAY: ¢ DATE: / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: C' / TEMP. MA63 OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE IGNWfTURE DATE: DAILY INSPECTION DIARY DATE: �/ /l WORK PERIOD: a.m./p.m. to TEMP. MAX OF MINOF PRECIPITATION: WORK ACCOMPLISHED TODAY: CONTRACTOR SIGNATURE REPORT a.m./p.m. ! m W MAN y- SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: DATE: / / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAXCi=J OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: ., CA .e l- - CONTRACTOR SIGNATURE —'CWSPA3tTORSIGNATURE DATE: DAILY INSPECTION DIARY 0 DAY: DATE: / / WORK PERIOD: a.m./p.m. to WEATHER: TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: a.m./p.m. REPORT # �' � ��i / rice► ♦ IN: ..L _ l llijg /';5�y1G/Yl a c ry ELP�6 w%: 40 7� J-`� ✓L� r /jR �./� J? �� ADD s��o- 2b 1- 3 5 r -t�T1a 27f� ?A MA-6 CONTRACTOR SIGNATURE I SPECTOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: ! ,-6f9,4L4 DATE: Cl j 5 /1( WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER L'i TEMP. MAX OF MIN �)Z OF PRECIPITATION: WORK ACCOMPLISHED TODAY: L- 6C ll ��C. f 14 At Z.4442 Cl- Pr �%� l'oh. �nza-� 7zJ✓c! `iN.�i�il �� fLZ7�—.�-f �'Y!� 9?-, 5'+ Y►r-� J`7 4-7-*2 L' Sys- / j-±'iD CONTRACTOR SIGNATURE I SPEC R SIGNATURE REPORT DATE: DAILY INSPECTION DIARY REPORT DAY: 1 DATE: /� /)l WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: 0-404Ct6j— TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: ", i� c� 4 0 Y CONTRACTOR SIGNATURE INSPFf/fOR SI DATE: DAILY INSPECTION DIARY REPORT DAY. l DATE: /Z WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX OF MI PRECIPITATION: WORK ACCOMPLISHED TODAY: Lam/ 46 ,�,✓�-� e.v,►9�' CONTRACTOR SIGNATURE R SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAYS DATE: �. /% WORK PERIOD: a.m./p.m. to a.m./p.m. W4 WEATHER: 4/gr—TEMP. MAX(_°F MIN°F PRECIPITATION: WORK ACCOMPLISHED TODAY: r- � f� .: Ala' ../ _- �' •L3 CONTRACTOR SIGNATURE SP OR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: DATE: / WEATHER: TEMP. MAX % F WORK ACCOMPLI ED TODAY: T� REPORT 4� WORK PERIOD: a.m./p.m, to a.m./p.m. MIN CC) °F PRECIPITATION:Z41 k-1— �� 4 DATE: DAILY INSPECTION DIARY DAY: DATE: 3/ WORK PERIOD: a.m./p.m. to WEATHER: TEMP. MAX OF MIN OF PRECIPITATION: WORK ACCOMPLISHED TODAY: L1/ 06 -5fM v* bzijcqA 4L ��r CONTRACTOR SIGNATURE a.m./p.m. REPORT DATE: w wassnannuassw DAILY INSPECTION DIARY REPORT DAY: DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. i6 WEATHER: TEMP. MAX OF MIN °F PRECIPITATION: WORK ACCOMPLI HED TODAY: CONTRACTOR SIGNATURE SPECVJr SIGNATURE DATE: DAILY INSPECTION DIARY REPORT a DAY: Z DATE: 1� /Z [-7 / l WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: ef I c TEMP. MAX& C- F MIN '�'5 I OF PRECIPITATIONS WORK ACCOMPLIS D TODAY: psi ga=�-r- ��•. 1 � �/ !U o L7F+/// L 714 e L&ZisA= C i 1--/ r4 C A ; CONTRACTOR SIGNATURE CTOR SIGNATURE U716-0 DAILY INSPECTION DIARY r REPORT DAY:;' / DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER:�ZrI fi(t4 TEMP. MAX &6 OF MIN S!j_°F PRECIPITATION: WORK ACCOMPLISHED T DAY: .C__tZZj 4 4/4flff7t, CONTRACTOR SIGNATURE I I IN CTOR SIGNATURE DATE: DAILY INSPECTION DIARY DAY: DATE: /� WORK PERIOD: WEATHER: TEMP. MAX OF MIN OF WORK ACCOMPLISH D TODAY: a.m./p.m. to a.m./p.m. PRECIPITATION: � l Al lAv- CONTRACTOR SIGNATURE NSP OR SIGNATURE REPORT # DATE: DAILY INSPECTION DIARY REPORT DAY: j%�r�}dj�l�/ DATE: �& / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX C I°F MIN�C4 °F PRECIPITATION: WORK ACCOMPLISH D TODAY: t CONTRACTOR SIGNATURE T PECTOR SIGNATURE DATE: DAILY INSPECTION DIARY REPORT DAY: DATE: / WORK PERIOD: a.m./p.m. to a.m./p.m. WEATHER: TEMP. MAX(,—k OF MIN OF PRECIPITATION: WORK ACCOMPLISH TODAY: 14 TI _ �. 1 � �.n _ _ � � .. .. , "� w ,� � � _.. . . it _. • , n• r_ • .. c'�-f� i�t \ � R n� CONTRACTOR SIGNATURE INSP OR SIGNATURE DATE: Del nt of Labor and Industries , q7. J Prevailing Wage Program `� e. 4. CERTIFIED PAYROLL ROORT M tsox 4434U Project Name County Project or Contract# Olympia WA 985044540 W aw Prime Contractor ® Lk Wa Blvd N Storm & Water King SWP-27-3531 (360) 902-5335 Project Address City State Subcontractor 4350 Lk Wa Blvd North Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425430-7205 KC Equipment LLC 206-399-3687 Month Day Year Address City State ZIP+4 Address City State ZIP+4 5/7/I1 1055 S Grady Way Renton WA 98055 4550 49" Ave NE Seattle WA 98105 Day and Date Deductions Work Classification Name v ti Sun Mon Tue Wed Thu Fri Sat Total and and Rate Hourly Soc Sec# of Employee Address x Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Pwr Equip O rtr Vem Miller 1201 Yelm Ave, #276 OT 0.00 0.00 1996.00 $ 0.00 $112.78 $384.98 $174.39 $1,323.85 534-74-5475 Yelm, WA 98587 RG 9,00 9.00 9.00 8.00 9.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave OT 0.00 0.00 1304.64 S 0.00 $71.08 $136.86 $9.75 $1,086.95 539-11-4824 Tacoma, WA 98406 RG 8.00 8.00 8.00 8.00 32.00 40.77 1304.64 3. Pipe Layer John Berge 24018 164th Ave SE OT 0.00 0.00 1630.80 S 0.00 92.14 305.30 12.64 $1,220.72 537-76-9880 Kent, WA 98042 RG 9.00 8.00 8.00 9.00 8.00 40.00 40.77 1630.80 4. Pipe Layer John Haag 12621 12th Ave S OT 0.00 0.00 917.33 S 0.00 $51.83 $59 33 $7.11 $ 799,06 536-76-4394 Seattle, WA 98168 RG 8.00 8.00 6s0 22.50 40.77 917.33 5 OT 0.00 0.00 0.00 5 0 s o.00 RG 0.00 0.00 6. OT o.00 0.00 0.00 $ s 0,00 RG 0.00 0.00 7 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 8. OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 0.00 $ 0.0o $ 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep0 of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 985044540 AFFIRM*ION Today's Date Printed name of party signing this report Title 6/23/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For eek ending: Lk Wa Blvd North Storm & Water Improvements 5/1/2011 5/7/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+F,) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager f 4 F700-065-000 certified payroll report backer 05-09 Del at of Labor and Industries *��t 1n -,� Prevailing Wage Program </ CERTIFIED PAYROLL R%ORT YV 13OX 4434U Project Name County Project or Contract# W:X� Olympia WA 98504-4540 : Prime Contractor ® Lk Wa Blvd N Storm & Water King SWP-27-3531 (360) 902-5335 Project Address City State Subcontractor ❑ 4350 Lk Wa Blvd North Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425-430-7205 KC Equipment LLC 206-399-3687 Month Day Year Address City State ZIP+4 Address City State ZIP+4 5/14/11 1055 S Grady Way Renton WA 98055 4550 49`h Ave NE Seattle WA 98105 Day and Date Deductions Work Classification Name u � Sun Mon Tue Wed Thu Fri Sat Total and and e ' t Rate Hourly 1 1 1 1 1 Soc Sec# of Employee Address 04 Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 OT o W 00) 1996.00 S 000 $112.77 $384.97 $174.39 $1,323,97 534-74-5475 Yelm, WA 98587 RG 8.00 9.00 &00 8.00 8.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave OT 000 0,00 1630.80 S 0.W $94.77 $182,49 $13.01 $1,340.53 539-11-4824 Tacoma, WA 98406 RG 8.00 Soo 8.00 8.00 8.00 40.00 40.77 1630,80 3. Pipe Layer John Berge 24018 164th Ave SE OT 000 0,00 163080 $ 0.0U 92.14 305.29 12.64 $1,220.73 537-76-9880 Kent, WA 98042 RG 8.00 8 W 800 800 8 W 40.00 40.77 1630.80 4. OT 0.00 0.W 000 $ 000 s o.00 RG o.W 0.00 5. OT 0.00 0.00 0.00 S O.W S 000 RG 0.00 oat 6. OT o.W 0.00 non $ 0.00 $ 0.00 RG non 0.00 7. OT oW o.W 0.00 $ 0,00 $ o. W RG 0,00 000 8. OT 000 000 0.00 s 0.00 $ o W RG 000 0.00 9. OT 000 0.00 000 $ o.00 $ 0.00 RG n on o. W 10. OT 0.00 o.W oW $ 000 $ 0,00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 EnWloyee Benefits Distribution and Signature Certification on Reverse Side Dept of Labor and Industries Prevanmg Wage Program AFFIRN&ION PO Box 445 oil ' 40 T a Date Printed name of party signing this report Title 6/23/2011 Brett Franceschina General Manager The Wy signingffl report pays or supervises the (Name of contractor or subcontractor) payment of the ons employed by: KC Eauioment LLC Project Name: For the week starting: For the week Lk Wa Blvd North Storm & Water Improvements 5/8/2011 5/14/20l 1 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program l . Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 x. $ 0.00 9. $ 0.00 10. $ 0.00 fhe 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. Print or type name of party signing this report Brett Franceschina Title General Manager Signature F700-065-000 certified payroll report backer 05-09 )epar Irevai ing oft at, i) and Industries lA,.. CERTIFIED PAYROLL ORT �t'`' e 'revailing W; ogram �: 4. 'O Box 4454 rroject Name County Projec r Contract# )lympia WA 98504-4540 "�y� ;aw u1r Prime Contractor ® Lk Wa Blvd N Storm & Water King SWP-27-3531 360)902-5335 a _ Subcontractor Project Address City State 4350 Lk Wa Blvd North Renton WA Awarding Agency Name Phone Company Name Phone 'or the week ending: City of Renton 425-430-7205 KC Equipment LLC 206-399-3687 month Day Year Address City State ZIP+4 Address City State ZIP+4 5/21/11 1055 S Grady Way Renton WA 98055 4550 49" Ave NE Seattle WA 98105 Day and Date Deductions Work Classification and Soc Sec# of Employee Name and Address h 9L x Sun Mon Tue Wed Thu Fri Sat Total Rate of Gross Amount Total Hourly "Usual NET Withold- L Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax WAGES Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 000 1996.00 $ 0.00 $112 78 $384.98 $174.39 $1,323.85 534-74-5475 RG 8.00 8.00 8.00 8.00 8.00 40.00 49.90 1996.00 '. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.80 $ 0.00 $92.14 $185 11 $1264 $1,340.91 539-11-4824 RG 8.00 8.00 8.00 8.00 8.00 40.00 40.77 1630.80 I. Pipe Layer John Berge 24018 164th Ave SE Kent, WA 98042 OT o.00 0.00 1630,80 $ 000 92 14 305 30 12.64 $1,220 72 537-76-9880 RG 8.00 8.00 8.00 8.00 8.00 40.00 40.77 1630.80 i. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 1825.20 $ 0.00 $103. 13 $25149 $68 16 $1,402,42 399-66-7182 RG 8.00 8.00 8.00 800 8.00 40.00 45.63 1825.20 i OT 0.00 0.00 0,00 $ 000 $ 0.00 RG 0.00 0.00 OT 0.00 0.00 0.00 $ 000 $ 0.00 RG 0.00 0.00 1 OT 0.00 0.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 �. OT 0.00 0.00 000 $ 0.00 $ 000 RG 0.00 000 I OT 0.00 o.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 0. OT 0.00 0.00 0.00 $ 000 $ 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side repartment ofa a i - - Industries AFFIRM TION revailing Wag. am O Box 44540 Ilympia WA 98504-4540 oday's Date Printed name of party signing this report Title 6/23/2011 Brett Franceschina General Manager 'he party signing this report pays or supervises the (Name of contractor or subcontractor) ayment of the persons employed by: KC Equipment LLC 'roject Name: For the week starting: For thew IpWding- IWa Blvd North Storm & Water Improvements 5/15/201 1 5/21/201 1 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ..Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 �. $ 0.00 $ 0.00 ;. $ 0.00 �. $ 0.00 0. $ 0.00 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 39.12.0-0 subject to prosecution, sanctions, and penalties. 'rint or type name of party signing this report Title Irett Franceschina General Manager Signature 0-065-000 certified payroll report backer 05-09 Del it of Labor and Industries s ATe F Prevailing Wage Program y. G � CERTIFIED PAYROLL RRORT ry nox H:)qv a Olympia WA 98504-4540 '" Prime Contractor (360) 902-5335 �Hl „ a° ® Subcontractor ❑ Project Name County Project or Contract# Lk Wa Blvd N Storm &Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 5/28/11 Address City State ZIP+4 1.055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49u' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address E �3 t i DU and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.rx1 0.00 1996.00 S 0 0 $112.77 $384.97 $174.39 $1,323,87 534-74-5475 RG MOO 10.00 10.00 10.00 40.00 49.90 1996,00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA98406 OT 0.00 0,00 1630.80 $ 0.1ro $92.14 $185.10 $12.64 $1,340.92 539-11-4824 RG 10.00 10,00 1000 10.00 40.00 40,77 1630.80 3. Pipe Layer John Berge 24018 164`" Ave SE Kent, WA 98042 OT 0.00 Ono 1630 SU $ 000 92.14 305.29 12.64 $1,220.73 537-76-9880 RG 10,00 10.00 10,00 10.00 40.00 40.77 1630,80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI53538 OT 0.00 0.00 1825.20 $ 0,00 $103,12 $251,49 $69.16 $1.402.43 399-66-7182 RG 10.00 1000 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.0u 271.44 $ 000 $15,34 $19.07 $2.53 S234.50 535-82-7473 RG 8.00 8.00 33.93 271.44 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 271.44 $ 0 00 $15.34 $0 nn $2.53 S 25357 534-70-6101 RG 8.00 8,00 33,93 27 1. 44 7 OT 000 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0,00 8. OT 0,00 000 0.00 S 0.00 $ 0.00 RG 0,00 0,00 9 OT 0.00 0.00 o.00 $ 0.00 $ 0.00 RG 0.00 0.00 10 OT 0.00 0.00 a.00 $ 000 $ 000 RG 0.. ]-�0.00 F700-065-000 certified payroll report 05-09 Emp/ovee Benefits Distribution and Signature Certification on Reverse Side Depi of Labor and Industries Prevaumg Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIION Today' Printed name of party signing this report Title 6/23/2011 Brett Franceschina I General Manager Thepy#ty signing this rc ays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 5/22/2011 5/28/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) llourlY lloliday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.13ump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Fit,tt,wc�� .c�t.t4 STALI Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del ❑t of Labor and Industries Prevailing Wage Program 41h CERTIFIED PAYROLL R-FORT rV nox'i'+74U wl Ol to WA 98504-4540 Ympi r, Prime Contractor ® (360) 902-5335 ` "'° a� Subcontractor ❑ -- - -- Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 6/4/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address ��, � 1104 Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 $ 0.00 $117,00 $405.94 $174.71 $1,298.35 534-74-5475 RG 10.00 10,00 10,00 10.00 40.00 49-90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.90 $ 0.00 $95.60 $200.40 $12.96 $1,321.94 539-1 1-4824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.90 3. Pipe Layer John Berge 24018 1644 Ave SE Kent, WA 98042 OT 0.00 0.00 1630.80 $ 0.00 95.60 320.59 12.96 $1,201.65 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 182520 $ 0.00 $106.99 $268.61 $12.96 $1,436.64 399-66-7182 RG 10 00 10.00 10.00 10.00 40.00 45.63 1825.20 5. OT 0.00 0.00 000 $ 0.00 $ 0.00 RG 0.00 0,00 6 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 7 OT 0.00 0.00 0.00 $ o.00 $ 0,00 RG o.00 0.00 8. OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 9 OT o.00 0.00 0.00 $ 0,00 $ om RG 0.00 0.00 10. OT 0.00 0.00 0.00 $ 0 00 s 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevawng Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIfON Today's Date Printed name of party signing this report Title 6/23/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 5/29,12011 1 6/4/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Der it of Labor and Industries Prevailing Wage Program K*11S ATF s CERTIFIED PAYROLL ROORT ry nux "J-+U - ;- Olympia WA 98504-4540 "' �� Prime Contractor ® (360) 902-5335 d 'ems a Subcontractor1:1 Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 6/11/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49`h Ave NE Seattle WA 98105 Work Classification and Soc See# of Employee Name and Address a Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yehn Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 $ 0.00 $112,78 $384.98 $174.39 $1,323, 85 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630,80 $ OAK) $92 14 $185.11 $12.64 $1,340.91 539-11-4824 RG 10.00 10,00 10.00 10.00 40.00 40.77 1630.80 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 0.00 000 1630,80 S 0.00 92.14 305.30 12.64 $1.220.72 537-76-9880 RG 10,00 10.00 10,00 10.00 40.00 40,77 10080 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 1825 20 $ 0.00 $103.13 $251.49 $12,64 $1,457,94 399-66-7182 RG 10.00 10.00 10,00 10.00 40.00 45.63 1825.20 5. Pwr Equip Cirtr Aaron Kooley 12301 118"' Ave SE Rainier, WA 98576 OT 0.00 0.00 1996M S 0.00 S112.78 $384.98 $12.64 S1,485.60 531-72-2811 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 6 OT 0.00 0.00 0.00 s 0.00 $ 0.00 RG 0,00 0.00 7 OT 0.00 0.00 0.00 $ 000 $ 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 s 0.00 $ 000 RG 0.00 0.00 9 OT 0.00 0.00 a.00 $ 0.00 s 0.00 RG 0.00 0.00 10. OT 0,00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIION Today's Date Printed name of party signing this report Title 6/23/2011 Brett Franceschina General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 6/5/2011 6/11/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Pwr Equip Oprtr $ 0.00 6. $ 0.00 7. $ 0.00 K. $ 0.00 9. $ 0.00 M. $ 0.00 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. Print or type name of party signing this report Brett Franceschina General Manager Signature F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries Prevailing Wage Program 4k... q. CERTIFIED PAYROLL R%ORT ry aux • iLty Olympia WA 98504-4540 "' � 'rH L Prime Contractor ® (360) 902-5335 ` 15�' Subcontractor Project Name County Project or Contract# Lk Wit Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 6/11/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49a' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address S to °G Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 2.00 2.00 74.85 149.70 2145.70 S 0.00 $117.00 S405.93 S174.71 S1,448.06 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 2.00 2,00 61.16 122.32 1753.12 $ 0.00 $95.59 S200.39 $12.96 $1,444.18 539-11-4824 RG 10.00 10.00 10.00 10,00 40.00 40.77 1630.80 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 2.00 2.00 61.16 122.32 1753.12 $ 0.00 95.59 320.58 12.96 $1,323.99 537-76-9880 RG 10.00 10.00 10.00 10,00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 2.00 2.00 68.45 136.90 1962.10 S 0.00 $106.99 S269.60 $12.96 $1,573.55 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Pwr Equip O rtr Aaron Kooley 12301 118" Ave SE Rainier, WA98576 OT 0.00 0.00 1497.00 S 0,00 S84.58 $254.06 $9.48 $1,149 88 531-72-2811 RG 10A0 10.00 10.00 30.00 49.90 1497,00 6 OT 0.00 0.00 0.00 $ 0.00 S 000 RG 0.00 0.00 7 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG o.00 0.00 S OT o.00 0.00 0 ro1 $ 0.00 $ 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 S 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 o.00 $ 0.00 S 000 RG o.o0 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRNMTION Today's Date Printed name of party signing this report Title 6/23/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 6/5/2011 1 6/11/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A + B + C + D+ E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Iloliday (E) Approved Apprentice Program 1. Pwr Equip oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Pwr Equip Oprtr $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager _Ae� F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries g Prevailing Wage Program o�% CERTIFIED PAYROLL ROORT YU Box 44540 Ol m la WA 98504-4540 Y P a9 7.eo ° Prime Contractor (360)902-5335 ® Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm &Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 6/25/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49 h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address S x Day and Date Sun Mon Toe Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned TOE Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 s 0.00 $112.77 $394.97 $174.39 $1.323.87 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 99406 OT 0.00 0.00 1630.80 S 0.00 $92 14 $185.10 $12.64 $1,340.92 539-11-4824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA98042 OT 0.00 0.00 1630.80 s 0.00 92.14 305.29 12.64 $1,220.73 537-76-9880 RG 10.00 1000 10.00 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 0.00 0.00 1825.20 $ 0.00 $103.12 $251.49 $12.64 $1,457.95 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Pwr Equip O rtr Aaron Kooley 12301 118s' Ave SE Rainier, WA 98576 OT 0.00 0.00 199600 s 0.00 $112.77 $384.97 $12.64 $1.485.62 531-72-2811 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 6 OT 0.00 0.00 0.00 $ 0,00 S 0.00 RG 0,00 0.00 7 OT o.00 0.00 111/(1 $ (), 00 S 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 s 0.00 S 0.00 RG o.0o 0.00 9 OT o.o0 0.00 0.00 s 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 0.00 s o.00 s 0.00 RG 0 ou 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRAION Today's Date Printed name of party signing this report Title 6/24/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 6/19/2011 6/25/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Pwr Equip Oprtr $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager G F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries ,,F. F Prevailing Wage Program - 4. CERTIFIED PAYROLL R%ORT rV "ox •wZ)4v Olympia WA 98504-4540 ;' Prime Contractor ® (360) 902-5335 .., '� Subcontractor ❑ Project Name County Project or Contract# Lk Wa Blvd N Storm & Water Kin SWP-27-3531 g Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 7/2/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 491h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address a x Dgy and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES :FICA]ing Withold- Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vem Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 3.00 3.00 6.00 74.85 449.10 2445.10 S 0.00 $125.46 S447.85 $175.34 $1,696.45 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 3.00 3.00 6.00 61.16 366.96 1997.76 S 0.00 S102.51 $230.99 $13.39 $1,650.68 539-11-4824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 3. Pipe Layer John Berge 1-4018 164" Ave SE Kent, WA 98042 OT 3.00 3.00 6.00 61,16 366.96 1997.76 $ 0.W 102.51 354.02 13.59 $1,527.64 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53539 OT 3.00 3.00 6,00 68.45 410.70 2235.90 S 0.00 $126.33 S235.77 $14.54 $1,959.26 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Pwr Equip O rtr Aaron Kooley 12301 118'" Ave SE Rainier, WA 98576 OT 3.00 3.00 6.00 74.83 449.10 2445.10 S 0.00 $125.46 $447.85 $13.59 $1,858.20 531-72-2811 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 6. OT 0.00 0.00 0.00 0.00 S 0.00 S 0.00 RG 0.00 7 OT 0.00 0.00 0.00 S 0.00 $ 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 10. OT 0.00 0.00 0.00 $ 0.00 $ 0,00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 I:niploYe e Benefits Distribution and Signature Certification on Reverse .Side Dep of Labor and Industries Prevawng Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMOFIOIV Today's Date Printed name of party signing this report Title 7/17/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 6/26/2011 1 7/2/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Pwr Equip Oprtr $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries 1�`E, Prevailing Wage Program � 4. CERTIFIED PAYROLL REPORT ry nux Olympia WA 98504-4540 - Prime Contractor ® (360)902-5335 �.r1 n 4 Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 7/9/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49 h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address v 94 QU and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 $ 0.00 $125,46 $447,95 $175.34 $1,247.35 534-74-5475 RG 10.00 10,00 10.00 10.00 40,00 49,90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.90 S 0.00 $102.51 $230.97 $13.59 $1,283.73 539-114824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.90 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 0.00 0.00 1630,80 $ 0.00 102.51 354.02 13.59 $1,160.68 537-76-9880 RG 1000 10.00 10.00 10.00 40.00 40.77 1630.90 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 399-66-7182 RG 0.00 0.00 5. Pwr Equip O rtr Aaron Kooley 12301 1180' Ave SE Rainier, WA 98576 OT 0.00 0.00 1996.00 S 0.00 $125.46 $447.85 $13.39 $1,409.10 531-72-2811 RG 10.00 10.00 10,00 10.00 40.00 49.90 19%.00 6 OT 0.00 0.00 0.0o s 0.00 s 0.00 RG 0.00 0.00 7 OT 0.00 0.00 0,00 $ 0.00 S 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 $ 0.00 s o.00 RG - 0.00 0.00 9 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 o.00 $ 0.00 $ o.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 F.n7ptoyee Benefits Distribution and Signature Certification on Reverse Side Depi of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 985044540 AFFIRMATION Today's Date Printed name of party signing this report Title 6/24/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/3,12011 1 7/9/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 S0.00 $0.00 $0.00 5.Pwr Equip Oprtr $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager -&JAn F700-065-000 certified payroll report backer 05-09 Del,_ ----at of Labor and Industries 6sr�r a P.o<,:1:<,.. Wo.... Pmm�-gym _�d►�'. CERTIFIED PAYROLL RfPPORT PO Box 44540 a to WA 98504-4540 0� Olympia sq Prime Contractor ® (360)902-5335 Subcontractor El - Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 7/16/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49 h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address �9 b, 94 Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other 1 1 1 Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yehn Ave, #276 Yelm, WA 98587 OT 0.00 0.00 0.00 $ 000 S 0.00 534-74-5475 RG 0.00 0.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA98406 OT 0.00 0.00 0.00 S 0.00 S 0.00 539-11-4824 RG 000 0.00 3. Pipe Layer John Berge 24018 164t° Ave SE Kent, WA 98042 OT 000 0.00 0.00 $ 0.00 $ 0.00 537-76-9880 RG 0.00 0.00 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 0.00 $ 0.00 S 0.00 399-66-7182 RG 0.00 0.00 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 339.30 S 000 $19.17 $25.85 $258.60 S 3568 535-82-7473 RG 10.00 10.00 33.93 339.30 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 339.30 S 0.00 $19.17 $0.00 $258.60 S 61.53 534-70-6101 RG 10.00 10.00 33.93 33930 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0,00 0.00 0.00 $ 0.00 $ 0.00 531-72-2811 RG 0.00 0.00 8. OT 000 0.00 0.00 S 0.00 $ 0.00 RG 0.00 0.00 9. OT 0.00 0.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 10. OT 0.00 0.00 0.00 S 0.00 $ 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 8/18/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/10/2011 1 7/16/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hoar" terms) Work Classification Total Hourly "Usual Benefits" (A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) dourly Holiday (rApproved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.171agger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Brett Franceschina I General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries s STnre Prevailing Wage Program CERTIFIED PAYROLL R%ORT rU BOX 44341) � = � Olympia WA 985044540 4q .. Prime Contractor (360) 902-5335 I '' ® Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm &Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Address City State ZIP+4 4550 49'h Ave NE Seattle WA 98105 Month Day Year 7/16/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Work Classification and Soc Sec# of Employee Name and Address '� 1� x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vem Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1846.30 S 0.00 $108.55 $364 02 $173.44 S1,200.29 534-74-5475 RG 10.00 10.00 7.00 10.00 37.00 49.90 1846.30 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1508.49 $ 0.00 S88.69 $174 96 $11.69 S1,233.15 539-1 1-4824 RG 10.00 10.00 7.00 10.00 37.00 40.77 1508.49 3. Pipe Layer John Berge 24018 164h Ave SE Kent, WA 98042 OT 0.00 0.00 1508.49 $ 0.00 98.68 290.01 11.69 $1,118.11 537-76-9880 RG 10.00 10.00 7.00 10.00 37.00 40.77 1509.49 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 0.00 0.00 100396 S 0.00 $79.92 S162.37 $6.95 S 754.62 399-66-7182 RG 0.00 5.00 zoo 10.00 22.00 45.63 1003.86 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 135J2 $ 0.00 $40.73 $95.64 $1.26 $- 1.91 535-82-7473 RG 4.00 4.00 33.93 135.72 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 135.72 $ 0.00 S40.74 $72.57 S1.26 S 21.15 534-70-6101 RG 4.00 4.00 33.93 135.72 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.00 0.00 1846.30 $ 0.00 $108.54 $364.02 S11.69 $1,362 05 531-72-2811 RG 10.00 10.00 zoo 10.00 37.00 49.90 1946.30 8 OT 0.00 0.00 o.00 $ 0.00 $ 0 00 RG o.00 11,711, 9 OT 0.00 0.00 0.00 $ 0.00 S 0.00 RG o.al 0.00 10. OT 0.00 0.00 0,00 s 0.00 s o.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 F.mpkgee Benefits Distribution and Signature Certification on Reverse Side Dep . of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMRTION Today's Date Printed name of party signing this report Title 8/2/2011 Brett Franceschina General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/10/2011 1 7/16/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" (A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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 anv of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries Prevailing Wage Program CERTIFIED PAYROLL R%ORT ru nux -wj to Olympia WA 98504-4540 "+ Ympi i Prime Contractor ® (360) 902-5335 �9 Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 7/16/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 491" Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address 3 b x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1846.30 $ 0.00 $109.55 $364.02 $173.44 $1.200.29 534-74-5475 RG 10.00 10.00 7.00 10.00 37.00 49.90 1846.30 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1508.49 $ 0.00 $88.69 $174.96 $11.69 $1,233.15 539-11-4824 RG 10.00 10.00 7.00 10.00 37.00 40.77 1508.49 3. Pipe Layer John Berge 24018 164t6 Ave SE Kent, WA 98042 OT 0.00 0.00 1508.49 S 0.00 88.68 290.01 11.69 $1,118.11 537-76-9880 RG 10.00 10.00 7.00 10.00 37.00 40.77 1508.49 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 1003.96 S 0.00 579.92 $162.37 $6.95 $ 754.62 399-66-7182 RG 0.00 5.00 7.00 10.00 22.00 45.63 1003.86 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 135.72 S 0.00 540.73 595.64 $1.26 $- 1.91 535-82-7473 RG 4.00 4.00 33.93 133.72 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 135,72 $ 0.00 540.74 $72.57 $1.26 5 21 1 534-70-6101 RG 4.00 4.00 33.93 135.72 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA98576 OT 0.00 0.00 1846.30 $ 0.00 $108.54 $364.02 $11.69 $1,362.05 531-72-2811 RG 10.00 10.00 7.00 10.00 37.00 49.90 1946.30 8 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 0.00 S 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 8/2/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/10/2011 1 7/16/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" (A + B + C + D + E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries c B?Are Prevailing Wage Program 41 CERTIFIED PAYROLL R�PORT TrO nox 44J4U Olympia WA 98504-4540 Ymp Prime Contractor ® (360)902-5335 IF Subcontractor Project Name County Project or Contract# Lk Wit Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 7/23/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address E ' . Z 94 Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount"Usual Earned Total Hourly Benefits" Deductions NET WAGES FICA Withold- inp Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0,00 0.00 1996.00 $ n.00 S108.54 $364.02 $176.15 $1,347.29 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.80 $ 0.00 $88.68 $174.97 $14.40 S1,352.75 539-11-4824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.90 3. Pipe Layer John Berge 24018164thAve SE Kent, WA 98042 OT 0.00 0.00 1630.80 $ 0.00 8869 290.01 14.40 $1,237.70 537-76-9880 RG 10.00 10.00 10.00 land 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 0.00 0.00 1825.20 S 0.00 $79.92 $162.37 $14.40 $1,569.51 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 1306.31 S ROO S4074 S95.64 $13.86 S1,156.07 535-82-7473 RG 10.00 8.50 10.00 10.00 38,50 33.93 1306.31 6. Flagger Lrry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.0o 1306.31 $ 0.00 $40.73 $72.58 $13.86 $1,179.14 534-70-6101 RG 10.00 8.50 10.00 10.00 38.50 33.93 1306.31 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.00 0.00 1996.00 S 0.00 $109.55 $364.02 $14.40 $1,509.03 531-72-281 1 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 8. OT o.00 0.00 0.00 s 0.00 s 0.00 RG 0.00 0.00 9. OT o.00 0.00 0.00 $ 0.00 S 0.00 RG 0.00 0.00 10 OT 0.a 0.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Der t of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 8/2/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/17/2011 1 7/23/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+F.) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager .. - - ti F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industrics t _, Prevailing Wage Program 4'`� a . xTF `f CERTIFIED PAYROLL REPORT rU mx 4454U Olympia WA 98504-4540 f1 �s> Prime Contractor ® (360) 902-5335 3P1 Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 7/23/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49a' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address u °� Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT o.00 0.00 1996.00 S 0.00 $108.54 $364.02 $176.15 $1,347.29 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA98406 OT 0.00 0.00 1630.80 $ 0.00 $88.68 $174.97 $14.40 $1,352.75 539-11-4824 RG 1000 10.00 10.00 10.00 40.00 40.77 1630.80 3. Pipe Layer John Berge 24018 1646 Ave SE Kent, WA 98042 OT 0.00 0,00 1630.80 $ 0.00 88.69 290.01 14.40 $1,237.70 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40,77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 0.00 0.00 1825.20 S 0.00 $79.92 S162.37 $14.40 $1,568.51 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 1306.31 $ 0.00 $40.74 $95.64 $13.96 $1,156.07 535-82-7473 RG 10.00 8.50 10.00 10.00 38.50 33.93 1306.31 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 1306.31 S 0.00 $40.73 S72.58 S13.86 $1,179.14 534-70-6101 RG 10.00 8.50 10.00 10.00 39.50 33.93 1306.31 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA98576 OT 0.00 0.00 1996.00 $ 0.00 $108.55 $364.02 $14.40 $1,309.03 531-72-2811 RG MOO 10.00 10.00 10.00 40.00 49.90 1996.00 8 OT 0.00 0.00 0.00 $ 0.00 s 0.1x1 RG 0.00 0.00 9 OT 0.00 0.00 o.00 S 0.00 000 RG 0.00 0.00 10. OT 0.00 0.00 0.0o S 0.00 s 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Depi of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMtION Today's Date Printed name of party signing this report Title 8/2/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/17/2011 7/23/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) l lourh I lolida (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager . 1-- F700-065-000 certified payroll report backer 05-09 De; nt of Labor and Industries Ra� Prevailing Wage Program CERTIFIED PAYROLL REPORT rU tsox 44J4U Project Name County Project or Contract# Olympia WA 98504-4540 Prime Contractor wov, ® Lk Wa Blvd N Storm & Water King SWP-27-3531 (360) 902-5335 Project Address City State Subcontractor 4350 Lk Wa Blvd North Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425-430-7205 KC Equipment LLC 206-399-3687 Month Day Year Address City State ZIP+4 Address City State ZIP+4 7/30/11 1055 S Grady Way Renton WA 98055 4550 49a' Ave NE Seattle WA 98105 Day and Date Deductions Work Classification Name v IN Sun Mon Tue Wed Thu Fri Sat Total and and "� � Rate Hourly Soc Sec# of Employee Address x Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 OT 2.50 1.00 3.50 74.85 261.98 2257.98 S 0.00 $I 16.65 S404.19 S176.32 S1,560.82 534-74-5475 Yelm, WA 98587 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave OT 2.5o 1.00 3.50 61.16 214.06 1844.86 S 0.00 $83.79 $161.97 $512.77 $1,086.33 539-11-4824 Tacoma, WA 98406 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 3, Pipe Layer John Berge 24018 164m Ave SE OT 2.50 1.00 3.50 61.16 214.06 1844.96 S 0.00 95.30 319.31 14.57 $1,415.68 537-76-9880 Kent, WA 98042 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 4, Dump Trk Driver William Miner 402 Glenview Court OT 2.50 1.00 3.50 68.45 239.59 2064.79 S 0.00 5106.67 S267.18 $14. 57 $1,616.36 399-66-7182 Fort Atkinson, WI 53538 RG 10.00 10.00 10.00 10,00 40.00 45.63 1525.20 5. Flagger Rita Damas PO Box 1403 OT 1.00 1.00 50.90 50.90 1408.10 $ 0.00 $75 24 $248.32 $14.03 $1,070.51 535-82-7473 McKenna, WA 98558 RG 10.00 10.00 10.00 10.00 40.00 33.93 1357,20 6. Flagger Larry Skeels 951 S. Sprague Ave OT 1.00 1.00 50.90 50.90 1409.10 S 0.00 $75.24 $212.74 $14.03 $1,106.09 534-70-6101 Tacoma, WA 98405 RG 10.00 10.00 10.00 10.00 40.00 33.93 1357.20 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE OT 2.50 1.00 3.50 74.85 261.98 2257.98 S 0.00 $116.65 $404.19 $14.57 $1,722.57 531-72-2811 Rainier, WA 98576 RG 10.00 10.00 10.00 10.00 40.00 49.90 199G.00 8. Pipe Layer John Haag 12621 12°i Ave S OT 0.00 0.00 672.71 $ 0.00 $39.01 $5.94 $ 628.76 536-76-4394 Seattle, WA 98168 RG 10.00 6.50 16.50 40.77 672.71 9. OT 0.00 0.00 0.00 $ 0.00 S 0.00 RG 0.00 9.00 10. OT 0.00 0.00 0.00 $ 0.00 S 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep : of Labor and industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFI RM#TiON Today's Date Printed name of party signing this report Title 8/17/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/24 1 7/30/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.171agger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8.Pipe Layer $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries \�.-11-11./'.� Prevailing Wage Program /� CERTIFIED PAYROLL REPORT rV 25ox 4474V = Olympia WA 98504-4540 "' J Ympi r� Prime Contractor ® (360) 902-5335 ` '��" � Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 8/6/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49a' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address S a Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other I I I Hours Worked Each Day 1. Pwr Equip O rtr Vem Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1871.25 $ 0.00 S116.65 $404.19 $176.33 $1,174.08 534-74-5475 RG 7.50 10.00 10.00 10.00 37.50 49.90 1871.25 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1121.18 $ 0.00 $83.79 $161.97 $512.78 $ 362.64 539-11-4824 RG 7.50 10.00 10.00 27.50 40.77 1121.18 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 0.00 0.00 1528.88 S 0,00 95.31 319.32 14.58 $1,099.67 537-76-9880 RG 750 10.00 10.00 10.00 37.50 40.77 1528.88 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 0.00 0.00 1711.13 $ 0.00 $106.67 $26718 $14.58 $1,322.70 399-66-7182 RG 7.50 10.00 10.00 10.00 37.50 45.63 1711.13 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 1255.41 $ 0.00 $75 25 $248 33 $14.04 $ 917.79 535-82-7473 RG 7.00 10.00 10.00 10.00 37.00 33,93 1255.41 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 1255.41 $ 000 $75.25 $212.75 S14.04 $ 953.37 534-70-6101 RG 7.00 10.00 10.00 10.00 37.00 33.93 1255.41 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.00 0.00 1871.25 $ 0.00 $116.65 $404.19 $14.58 $1,335.83 531-72-2811 RG 7.50 10.00 10.00 10.00 37.50 49.90 1971.25 8. OT 0.00 0.00 0.00 $ 0.00 s o.oa RG 0.00 0.00 9 OT 0.00 0,00 0.00 $ 0.00 s o.ao RG 0.00 0.0o 10. OT 0.00 0.00 0.00 s 0.00 s 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep_ ____: of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 I.7 Today's Date Printed name of party signing this report Title 8/17/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 7/31/2011 1 8/6/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" (A+B+C+D+E (A) Hourly Pension (B) llourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program I . Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 1 o. $ (00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager r_y F700-065-000 certified payroll report backer 05-09 Del.____nt of Labor and Industries ,� Prevailing Wage Program 2� CERTIFIED PAYROLL REPORT ry nox 44:)4v z 2' Olympia WA 98504-4540 "�H aw Prime Contractor ® (360) 902-5335 ` �8� Subcontractor ❑ Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 8/13/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49a' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address a x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- inR Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.50 0.50 74.85 37.43 2033.43 S 0.00 S113.84 S390.22 $176.24 S1,353.13 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA98406 OT 0.50 0.50 61.16 30.58 1539.07 S 0.00 $89.55 $177.26 $13.95 $1,258.31 539-11-4824 RG 10.00 10.00 zoo 10.00 37.00 40.77 1508.49 3. Pipe Layer John Berge 24018 164' Ave SE Kent, WA 98042 OT 0.50 0.50 61.16 30.58 1661.38 $ 0.00 93.01 309.12 364.49 $ 894.76 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.50 0.50 68.46 34.23 1859.43 $ 0.00 $91 20 $198.74 $12 69 $1,556.80 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1925.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.50 0.50 50.90 25.45 1382.65 $ 0.00 $7740 $257.97 $14.49 $1,032-99 535-82-7473 RG 10.00 10.00 10.00 10.00 40.00 33.93 1357.20 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.50 0.50 50.90 25.45 1382.65 $ 0.00 $7740 $222.29 $14.49 $1,068.47 534-70-6101 RG 10.00 10.00 10.00 10.00 40.00 33.93 1357,20 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.50 0.50 74.95 37.43 2033.43 $ 0.00 $109 61 $369 26 $13.95 $1,340,61 531-72-2811 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 8 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 S 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 o.00 s 0.00 $ o.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep C of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRN,n rION Today's Date 9/7/2011 Printed name of party signing this report Brett Franceschina Title I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: Lk Wa Blvd North Storm & Water Improvements For the week starting: 8/7/2011 For the week ending: 8/13/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager C. F700-065-000 certified payroll report backer 05-09 Departs 'Labor and Industries PrevailL.s -age Program 411k4, CERTIFIED PAYROLL REART PV box 4434U Olympia WA 98504-4540 rrH� J a' Prime Contractor ® (360) 902-5335 "` Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 M ay Yea 8/13/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49`h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address 7 x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET I WAGES FICA Withold- ing Tax Other 7-7 Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.30 0.50 74.85 37.43 2033.43 S 0.00 $113.84 $390,22 $176.24 $1.353.13 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA98406 OT 0.50 0,50 61.16 30.58 1539.07 $ 0.00 $89.55 $177.26 $13.95 $1,258.31 539-11-4824 RG 10.00 10.00 7.00 10.00 37.00 40.77 1508.49 3. Pipe Layer John Berge 24018 1641" Ave SE Kent, WA 98042 OT 0.50 0.50 61.16 30.58 1661.39 $ 0.00 93.01 309.12 364.49 $ 894.76 537-76-9880 RG 10.00 l0.00 MOO 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 0.50 0.50 68.46 34.23 1859.43 $ 0.00 $91.20 $198.74 $12.69 S1.556.80 399-66-7182 RG 10.00 MOO 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.50 0.50 50.90 25.45 1382.65 s ROO $7740 $25787 $14.49 $1.032.89 535-82-7473 RG 10.00 MOO 10.00 10.00 40.00 33.93 1357.20 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.50 0.50 50.90 25.45 1382.65 S D n0 $77.40 $222.29 $14.49 $1,068.47 534-70-6101 RG 10.00 10.00 10.00 10.00 40.00 33.93 13512o 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.50 0.50 74.95 37.43 2033.43 $ 0.00 $109.61 $369.26 $13.95 $1,34061 531-72-2811 RG l0.00 10.00 10.00 10.00 40.00 49.90 1996.00 8. OT 0.00 0.00 0.00 s 0.00 $ aun RG 0.00 0.00 9. OT 000 0.00 0.00 $ 0.00 $ a0u RG 0.00 0.00 10. OT 0.00 0.00 0.00 $ 0.00 $ 0.00 �RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Departmt abor and Industries Prevailine .. _e_ Program PO Box 44540 Olympia WA 98504-4540 AFFIRMAWN Today's Date Printed name of party signing this report Title 9/7/2011 Brett Franceschina General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For week ending: Lk Wa Blvd North Storm & Water Improvements 8/7/2011 8/13/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries o Prevailing Wage Program CERTIFIED PAYROLL 1R1U.J1'ORT rV nox 44J4U '� Olympia WA 98504-4540 Prime Contractor ® (360)902-5335 �'° Subcontractor ❑ Project Name County Projector Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 8/20/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49`h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address 8 x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. PWr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 $ 0.00 $113.83 $390,21 $176.23 $1,315.73 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA98406 OT 0.00 0.00 1630.80 $ 0.00 $99.55 $177.26 $13.94 $1,350.05 539-11-4824 RG 10.00 10.00 10.00 1000 40.00 40.77 1630.90 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 0.00 0.00 1630.80 S 0.0093.00 309.48 364.48 $8G3.84 537-76-9880 RG Moo Moo 10.00 10.00 40.00 40.77 1630.90 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT o.00 0.00 1368.90 $ 0.00 $91.20 $198.73 $12.69 $1,066.29 399-66-7182 RG 10.00 10.00 10.00 30.00 45.63 1369.90 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 1357.20 S 0.00 577.40 5257.86 514.48 51,007.46 535-82-7473 RG 10.00 10.00 10.00 10.00 40.00 33.93 1357.20 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 1357.20 $ 0.00 577.40 $222.29 $14.48 $1,043.03 534-70-6101 RG Moo 10.00 10.00 10.00 40.00 33.93 1357.20 7. Pwr Equip O rtr Aaron Kooley 12301 1 l8th Ave SE Rainier, WA 98576 OT 0.00 0.00 1946,30 S 0.00 $109 60 $369.26 13.94 $1,35350 531-72-281 1 RG 10.00 10.00 zoo 10.00 37.00 49.90 1846.30 8 OT 000 0.00 0.00 S 0.00 $ 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 10. OT 0.00 0.00 0.00 $ 0.00 S 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 9/7/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 8/14/2011 8/20/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" (A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.171agger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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 projects) 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 RC'W 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report I Title Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries Prevailing Wage Program Ors. CERTIFIED PAYROLL APORT rV Box 4454U -' Olympia WA 98504-4540 "1 J, Y►npi wy Prime Contractor ® (360) 902-5335 ` ,.;„, "�� Subcontractor ❑ Project Name CountyProject or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA Company Name Phone KC Equipment LLC 206-399-3687 For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Month Day Year 8/27/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vem Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 $ 0.00 $112.77 $384.98 $176.15 $1,322.10 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.80 $ 0.00 $92.14 $185.11 $14.40 $1,339.15 539-11-4824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.90 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 0.00 0.00 1630.80 $ 0.00 92.14 305.30 14.40 $1,218,96 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 1825.20 $ 0.00 $103,13 $251.49 $14.40 $1,456.18 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 1357.20 $ 0.00 $7668 $226.48 $14.39 $1,039.65 535-82-7473 RG 10.011 10.00 10.00 10.00 40.00 33.93 1357.20 6. Flagger Lary Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 1357.20 $ 0.00 $76.68 $17905 $14.39 $1,087.08 534-70-6101 RG 10.00 10.00 10.00 10.00 40.00 33.93 1357.20 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.00 0.00 1996.00 $ 0.00 $112.77 $384 98 $14.40 $1,483.85 531-72-2811 RG 10.00 10.00 10.00 Moo 40.00 49.90 1996.00 8 OT 0.00 0.00 0.00 $ 0.00 $ 000 RG o.00 0.00 9. OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 10 OT 0.1K1 O. W 0.00 $ 0.00 $ 0,00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Depi_....____ of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 8/2/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 8/21/2011 1 8/27/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A + B + C + D + E) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. PNvr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager ._61, F700-065-000 certified payroll report backer 05-09 Del nt of Labor and Industries Prevail:.. W.- P-M CERTIFIED PAYROLL REPORT PO Box 44540 "4'1 Olympia WA 98504-4540 Prime Contractor ® (360) 902-5335 Subcontractor ❑ Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 9/3/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49 h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address d to x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.00 0.00 1996.00 $ 0.00 S112.77 S384.97 s176.14 $1,322.12 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.80 $ 0.W $92.14 $185, 10 $14.39 $1,339.17 539-1 1-4824 RG 10.00 10.00 10.00 MOO 40.00 40.77 1630.80 3. Pipe Layer John Berge 24018 164"Ave SE Kent, WA 98042 OT 0.00 0.00 1630.80 $ 0,00 92.14 305.29 14.39 $1,218.98 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.80 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 1925.20 S 0.00 $103.12 $251.49 $14.39 $1,456.20 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 678.60 $ 0.00 $38.34 $113,24 $7.20 $ 519.82 535-82-7473 RG 10.00 10.00 20.00 33.93 678.60 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 678.60 S 0.00 S38.34 $99.52 $7.20 S 543 54 534-70-6101 RG 10.00 10.00 20.00 33.93 679.60 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.00 0.00 1996.00 S 0(u) $11277 $38497 $14.39 $1,483.87 531-72-2811 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 8. OT 0.00 0.00 0.00 $ 0.00 S 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0.00 0.00 10 OT 0.00 0.00 0,00 S 0.00 $ 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Dep. of Labor and industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMA' n O N Today's Date Printed name of party signing this report Title 8/2/2011 Brett Franceschina General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 8/28/2011 1 9/3/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" (A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) IIourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina I General Manager rtic�� F700-065-000 certified payroll report backer 05-09 D gent of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 (360)902-5335 "0`g "ra CERTIFIED PAYROLL SPORT 0 Project Name County Project or Contract# �e� Prime Contractor ® Lk Wa Blvd N Storm & Water King SWP-27-3531 Subcontractor Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name KC Equipment LLC Month Day Year 9/10/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City 4550 49 h Ave NE Seattle Work Classification and Sue Sec# of Employee Name and Address v to 9 � a Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" FICA Hours Worked Each Day 1. Pwr Equip O rtr Vern Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 2.00 1.00 3.00 74.85 224.55 2220.55 $ 0.00 $119.12 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT I.Oo 1.00 61.16 61.16 1284.26 $ 0.00 $82.35 539-11-4824 RG 10.00 10.00 10.00 30.00 40.77 1223.10 3. Pipe Layer John Berge 24018 164" Ave SE Kent, WA 98042 OT 2.00 2.00 61.16 122.32 1345.42 $ 0.00 94.08 537-76-9880 RG 10,00 10.00 10.00 30.00 40.77 1223.10 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, W153538 OT 2.00 1.00 3.00 69.45 205.35 2030.55 S 0.00 $108.92 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 2.00 1.00 3.00 50.90 152.70 1170,60 $ 000 $61.82 535-82-7473 RG 10.00 10.00 10.00 30.00 33.93 1017,90 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 2.00 2.00 50.90 101.80 780.40 $ 0.00 s50.80 534-70-6101 RG 10.00 10.00 20.00 33.93 678.60 7. Pwr Equip O rtr Aaron Kooley 12301 1 l8th Ave SE Rainier, WA 98576 OT 1 1.00 74.85 74.85 1322.35 S 0.00 $65.55 531-72-2811 RG 5.00 10.00 10.00 25.00 49.90 1247.50 8 OT 0.00 0.0o 000 $ 0.00 RG 0.00 0.00 9. � N 11 F.0.00 OT 0.00 0.00 S 0.00 RG 0.00 0.00 10. OF RENTON EMS OT 0.00 0.00iY o.00 s o.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Phone 206-399-3687 State ZIP+4 WA 98105 Withold- NET ine Tax I Other I WAGI S416.41 1 $182.93 1 $1,502.09 $158.13 1 $12.77 1 $1030.99 7.69.62 1 12.95 1 $ 978.77 $277.16 1 $14.93 1 S1,629.54 S188.94 1 $11.33 1 $908.51 $104.59 1 $9.33 1 $ 615.66 $169.85 1 $8.28 I $1,078.67 Employee Benefits Distribution and Signature Certification on Reverse Side S 0.00 DE nt of labor and Industries Prevamng Wage Program PO Box 44540 Olympia WA 985044540 AFFIRATIOIY Today's Date Printed name of party signing this report Title 10/28/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 9/4/201 l 1 9/10/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program l . Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 s(1.00 $0.00 $0.00 5.171agger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager �c- F700-065-000 certified payroll report backer 05-09 DE ent of Labor and Industries t ,,A,.E• Pr g Wage Program CERTIFIED PAYROLL DEPORT ry "ox 44J4v Olympia WA 98504-4540 j 4ses Prime Contractor ® (360)902-5335 Subcontractor Project Name County Projector Contract# Lk Wa Blvd N Storm &Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 9/17/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49a` Ave NE Seattle WA 98105 Work Classification and Soc See# of Employee Name and Address S ta _ '�o b x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Vem Miller 1201 Yelm Ave, #276 Yelm, WA 98587 OT 0.01 0.00 1996.00 S 0.00 S119. 12 $416.42 $182.94 $1,277.52 534-74-5475 RG 10.00 10.00 10.00 10.00 40.00 49.90 1996.00 2. Pipe Layer Kevin Kooley 2208 North Union Ave Tacoma, WA 98406 OT 0.00 0.00 1630.80 S ow S82 3> $158.15 $12.79 $1,377.52 539-11-4824 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.90 3. Pipe Layer John Berge 24018164°Ave SE Kent, WA 98042 OT 0.00 0.00 1630,90 $ 0.00 94.09 269.63 12.96 $1.2G41 537-76-9880 RG 10.00 10.00 10.00 10.00 40.00 40.77 1630.90 4. Dump Trk Driver William Miner 402 Glenview Court Fort Atkinson, WI 53538 OT 0.00 0.00 1925. 20 S 0.00 $108.92 $277,16 $14.94 S1,424. 18 399-66-7182 RG 10.00 10.00 10.00 10.00 40.00 45.63 1825.20 5. Flagger Rita Damas PO Box 1403 McKenna, WA 98558 OT 0.00 0.00 1017. 90 $ n 00 S6113 S188.95 $11.34 S 755.78 535-82-7473 RG 10,00 10,00 10.00 30.00 33.93 1017.90 6. Flagger Larry Skeels 951 S. Sprague Ave Tacoma, WA 98405 OT 0.00 0.00 1017 ni S S50.81 S104.60 S9.36 $853.13 534-70-6101 RG 10.00 10.00 10.00 30.00 33.93 1017.90 7. Pwr Equip O rtr Aaron Kooley 12301 118th Ave SE Rainier, WA 98576 OT 0.00 0.00 998.00 $ 0.00 $63.55 S169.85 $8.28 $754 32 531-72-2811 RG 10.00 10.00 20.00 49.90 9".00 8 OT o.00 0.00 0.00 s 0.00 $ 000 RG 0.00 0.00 9 OT 0.00 0.00 000 $ 000 $ O.IN1 RG 0.00 0.00 10. OT 0.00 0.00 0.00 S 0.00 $ 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Lampioyee Benefits Distribution and Signature Certification on Reverse Side De it of Labor and Industries Pn Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRATI ON Today's Date Printed name of party signing this report Title 10/28/2011 Brett Franceschina General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week startTFor the week endi ng: ing: Lk Wa Blvd North Storm & Water Improvements 9/11/%l I 9/17/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Dump Trk Driver $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Flagger $ 0.00 7.Pwr Equip Oprtr $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 +f Dr -nt of Labor and Industries R ` erB� Pr-. __.__g Wage Program � $ 0 CERTIFIED PAYROLL AORT PO BOX 44540 Ympi s j Prime Contractor ® Olympia WA 98504-4540 �W.N.-o-i (360)902-5335 Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 9/24/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49th Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address b- .t o °C Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT a 00 74.85 olro 199600 $ ()!H) $11453 $433.55 $14.39 $1,43353 532-08-0836 RG 6.00 850 10.00 900 7.50 40.00 49.90 1996.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 61.16 0.00 1345.41 $ o.00 $85.52 $293,78 $13.13 $ 952')8 612-38-9553 RG 8,50 10.00 8.00 6.50 33.00 40.77 1345.41 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA98372 OT 0.00 61.16 1100 1630.80 $ 0.()0 93.58 329.70 14.39 $1,193,13 535-13-5988 RG 600 850 10,00 goo 7,50 4000 4077 1630.80 4. Flagger Robert Linder 7126 208th ST SW Edmonds, WA 98206 OT 0,00 50.91 0.0o 458 06 $ 0.00 $25,88 S40.25 $344.96 $ 47.07 531-76-1176 RG 5.50 8.00 13.50 33.93 458.06 5. OT 0.00 11 0.00 11 (8) $ 0.00 S (1.00 RG 0.00 0.00 6 OT 0.00 0.00 0 (91 s 0 (N) $ 0.00 RG 0.00 0.00 7. OT 0.00 0 00 0.(8) $ 0,00 S 0.(X) RG 0.00 0.00 8 OT 0.00 0.00 000 $ 0,00 S 0.00 RG 000 0.00 9. OT 0.00 000 0,00 s 0.00 $ o.00 RG 0 00 0.00 10. OT 0.00 0.00 000 $ 0.00 s 000 RG 0,00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side IN it of Labor and Industries Pn Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRATION Today's Date Printed name of party signing this report Title 10/28/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 9/18/2011 1 9/24/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+F. (A) Hourly Pension (11) 1lourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 DI ent of Labor and Industric s n,.. Pr g Wage Program ^` CERTIFIED PAYROLL &ORT ry nun 44-1yv - = Olympia WA 98504-4540 "1 2 Ympi ;, Prime Contractor ® (360) 902-5335 t W. Subcontractor ❑ Project Name County Projector Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 10/1/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49a' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address ° Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 1.50 1.00 2.50 74.95 187.13 2058,38 s 0.00 $114.54 s433.56 $14.40 $1,495.88 532-08-0836 RG 8.00 9.50 10.00 10.00 37.50 49.90 1971,25 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 1.50 Loo 2.50 61.16 152.90 1681.78 $ 0.00 $85.32 $293.78 S13.14 s1,289. 34 612-38-9553 RG 9.00 9.50 10.00 10.00 37.50 40.77 1528.88 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 1.50 1.00 2,50 61.16 152.90 1681.78 $ 0.00 93.55 329.70 14.40 $1,244.10 535-13-5988 RG 8.00 9.50 10.00 10.00 37.50 40.77 1528.88 4 OT 0.00 0.00 0 00 s 0.00 s 0.00 RG 000 0.00 5. OT 0,00 0.00 000 s 0.00 s 000 RG 0.00 0.00 6 OT 0.00 0.00 0.00 s 0.00 s 0,00 RG 0.00 0.00 7. OT 0.00 0.00 00o s 0.00 S u uu RG 0.00 0.00 8 OT 0.00 0.00 0.00 $ 0.00 $ 000 RG n no 0.00 9 OT 0.00 0.00 0.00 s 0.00 s 0.00 RG 0.00 0.0o 1 OT 0.00 0.00 n 00 s 0.00 s 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits DistribufioN « nd Siq ordure Cerfi/icufina on Reverse .Side De nt of Labor and Industries Pn Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRM. __ _TION Today's Date Printed name of party signing this report Title 10/28/2011 Brett Franceschina General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 9/25/2011 10/1/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+ B+ C+ D+ E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holida y (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe I:ayer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4. $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager --);�,� F700-065-000 certified payroll report backer 05-09 )apartment of Labor and Industries 'revailing I 'rogram ^�� SiATE.G 0 9 i CERTIFIED PAYROLL PORT Ympi Prime Contractor ® )1 DV i WA 98504-4540�V-11B 360) 902-5335 y'`' Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA ,or the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 donth Day Year 10/8/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49th Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name ando Address Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 1.00 1.00 74.85 74.85 2070.85 $ 0.00 $114.88 $435 30 $14 57 $1,506.10 532-08-0836 RG 8.00 10.00 9.50 10.00 2.50 40.00 49.90 1996.00 '. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA98166 OT 0.00 61.16 0.00 1590.03 $ 0.00 $90.98 $31799 $1421 $1,166.95 612-38-9553 RG 6.00 10.00 9.50 10.00 3.50 39.00 4077 1590.03 i. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA98372 OT 0.00 61.16 0.00 1630.80 $ 0.00 92.14 323 08 1439 S1,201.19 535-13-5988 RG 6.00 10.00 9.50 10.00 4.50 40.00 4077 1630.90 1. Flagger Jon Russell PO Box 2671 Everett, WA98213 OT 0.00 0.00 797.36 $ 000 $45 05 S80 59 $478 46 $ 193.26 535-80-1918 RG 600 7.00 8.50 2.00 23.50 33.93 797.36 �. Flagger Mikal Bailey 6203 S 118th PL Seattle, WA 98178 OT 0.00 0.00 797.36 $ 0.00 $45 05 $37 57 S540 54 S 174.20 532-74-4764 RG 6.00 7.00 8.50 2.00 23.30 33-93 797.36 OT 0.00 0.00 0.00 $ 0.00 $ 000 RG 0.00 0.00 r OT 0.00 0.00 0.00 $ o.00 $ 000 RG 0.00 0.00 OT 0.00 0.00 000 s 0.00 $ 0.00 RG 0.00 0.00 1 OT 0.00 0.00 0.00 s 0.00 $ 0.00 RG 0.00 0.00 0 OT 0.00 0.00 0.00 s 0.00 $ 000 RG - 0.00 000 F700-065-000 certified payroll report 05-09 Empligee Benefits Distribution and .Signature Certification on Reverse Side lepartment of Labor and Industries revailing Wa gram O Box 44541 8ympia WA -4540 oday's Date Printed name of party signing this report 10/28/2011 Brett Franceschina be party signing this report pays or supervises the (Name of contractor or subcontractor) ayment of the persons employed by: KC Equipment LLC Title General AFFIR*TION 'ro ect Name: For the week starting: For the week : endin J g g .k Wa Blvd North Storm & Water Improvements 1 10/2/2011 1 10/8/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A + B + C + D + E) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ..Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 .Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 •.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ;.Flagger $ 0.00 �. $ 0.00 $ 0.00 $ 0.00 �. $ 0.00 0. $ 0.00 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. Tint or type name of party signing this report Title Signature Irett Franceschina General Manager r 0-065-000 certified payroll report backer 05-09 DI ent of Labor and Industries Pt.. szaig Wage Program odk CERTIFIED PAYROLL IWORT ru nox w+t)wU Olympia WA 98504-4540 v T Prime Contractor Z (360)902-5335 W. Subcontractor ❑ Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA Company Name Phone KC Equipment LLC 206-399-3687 Address City State ZIP+4 4550 490' Ave NE Seattle WA 98105 For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Month Day Year 10/15/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Work Classification and Soc Sec# of Em to ee P Y Name and Address to 3 � a Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ine Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 0.00 74.85 0.00 1996.00 S U W $114.99 $435.30 S14.58 S1,431.23 532-08-0836 RG 6.50 8.00 - 8.50 9.50 7.50 40.00 49.90 1996.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 61.16 0.00 1630.90 S o.0o $90.98 $317.99 S14.22 $1,207.60 612-38-9553 RG 6.50 9.00 8.50 950 7.50 -- 40.00 40.77 1630.80 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0.00 61.16 0.00 1630.80 S 0.UU �r 14 323.09 14.40 $1,201.17 535-13-5988 RG 6.50 8.00 8.50 950 7.50 40.00 40.77 1630.90 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT 0.00 1 0.00 220.55 $ 0.00 $12.46 $22.29 $132.34 S 5345 535-80-1918 RG 6.50 6.50 33.93 220.53 5. Flagger Mikal Bailey 6203 S I I8th PL Seattle, WA 98178 OT 0.00 0.00 101.79 S 010 $5.74 S4 AU $69.00 S 22.24 532-74-4764 RG 3.00 3.00 33.93 101.79 6 OT 0.00 0.00 U,00 S O.W S IL(HI RG 0.00 0.00 7 OT 0.00 0.00 O.W S 0.W $ 0.U0 RG 0.00 0. W 8 OT 0.00 0.00 0.lNI 5 ll00 $ 000 RG 0.00 0.00 9 OT 0.00 0.00 0.00 S 000 $ 000 RG 0.00 0.00 10. OT 0.00 0.00 0.00 S 0.00 $ ono RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side De nt of Labor and Industries Pn Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRATION Today's Date Printed name of party signing this report Title 10/28/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 10/9/2011 1 10/15/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program l . Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Dt -nt of Labor and Industries 4.1-h Prevamng Wage Program CERTIFIED PAYROLL IWORT V UVA YYJYV Olympia WA 98504-4540 PrimeContractor W.- (360)902-5335Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA Company Name Phone KC Equipment LLC 206-399-3687 For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Month Day Year 10/22/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 491h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address _;a 'go a x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- inR Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 2.50 2.50 74.95 187.13 2183.13 $ 000 $11906 S451,02 S14.84 $1,599.21 532-08-0836 RG 10.00 9.50 8.00 8.00 5.50 40.00 49.90 19%.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 61.16 0.00 1630.80 S 0.00 $92 14 $323.08 $14.39 S1,2U I.19 612-38-9553 RG 10.00 8.50 8.00 8.00 5,50 40.00 40.77 1630.80 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT o.00 61.16 0.00 1630.80 $ 0.00 92 14 323.08 14.39 51,201.19 535-13-5988 RG 10.00 8.50 8.00 8.00 5.50 40.00 40.77 1630. 00 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT 0.00 0.00 1 983.97 S 0.00 $43. 13 $89.61 $8.10 $ 843. 13 535-80-1918 RG 9.50 7.00 6.50 7.00 29.00 33.93 983.97 5. Flagger Mikal Bailey 6203 S 118th PL Seattle, WA 98178 OT 0.00 0.00 93308 S 0 (8) $41 21 $63 17 $232.74 $ 595 96 532-744764 RG 9.50 7.00 5.00 7.00 27.50 33.93 933.08 6. OT 0.00 0.00 0.00 S 00) S 0.00 RG 0.00 0.00 7 OT 0.00 0.00 0.00 $ 0. ) $ 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 S 0.00 s 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.(N) $ 0.00 S 0.00 RG 0.00 o.a1 10. OT 0.00 0.00 000 $ o.00 S 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side De at of Labor and Industries Prevaning Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRATION Today's Date Printed name of party signing this report Title 10/28/2011 1 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 10/16/2011 1 10/22/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A + B + C + D + E) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6. $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager F AL R- *F/I-&L' 1.1C" F700-065-000 certified payroll report backer 05-09 DI ent of Labor and Industries 6 s ary Pr.,-.,..g Wage Program CERTIFIED PAYROLL &ORT ry nox ww-1wv Olympia WA 98504-4540 y1 Prime Contractor ® (360)902-5335 Suhcoutractor _ ❑ Awarding Agency Name Phone For the week ending: City of Renton 425430-7205 Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton _ WA Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 10/29/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49 h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address d a e ' �' b Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 0.00 74.85 0.00 199600 $ Ono $118.07 S45102 S14.95 $1,41206 532-08-0836 RG 8 0o goo 9 50 950 600 40.00 49. )0 1996.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 61.16 0.00 163080 $ 0.00 $92 14 S323.09 $14.40 $1,201,17 612-38-9553 RG 8.00 Roo 8.50 9.50 6.00 40.00 40.77 1630.80 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0.00 61.16 0.«I 1630.90 S 0.00 92.14 323.09 14.40 $1,201.17 535-13-5988 RG 8.00 8.00 8.00 9.50 6.50 40.00 4077 163080 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT 0 no 0.00 542.88 $ 0.00 S43 14 $8961 S8.10 $ 402.03 535-80-1918 RG 7.00 9.00 16.00 33.93 542.88 5. Flagger Mikal Bailey 6203 S 118th PL Seattle, WA 98178 OT 0.00 0.00 525.92 S Ono $41 22 $63.18 $232.74 S 18878 532-744764 RG 6.50 9.00 15.50 33.93 52592 6. Pipe Layer Arturo Magana 2360 62n4 Ave E Apt D Fife, WA 98424 OT Ono 0.00 1630.80 $ 0.00 $92, 14 S152-12 S14.40 S1.372.14 456-95-2995 RG 900 8.00 9.00 950 650 40.00 40.77 1630,80 7 OT 000 n no 0.On S 0.00 $ 0.00 RG 0,00 0.00 8 OT 0.00 0.00 0.00 $ 0.00 s 0.00 RG 0.00 0.00 9. OT 0.00 0.00 0.00 $ 0.00 $ 0.00 RG 0,00 0.00 10 OT 0.00 0.00 0.00 $ Ono $ 0.00 RG 0.00 00o F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side De it of Labor and Industries Pry._.._ _ Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRATION Today's Date Printed name of party signing this report Title 10/28/201 l Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 10/22 1 10/29/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.0U $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 6.Pipe i,ayer $ 0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report --TTitle Signature Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Department of Labor and Industries ea �Ta CERTIFIED PAYROLL REPORT Prevailing Wage Program '`� A PO Box 44540 Olympia WA 98504-4540 � e� Project Name County Project or ContracU► r91 ie� a„ti Prime Contractor ® Lk Wa Blvd N Storm & Water King SWP-27-3531 (360)902-5335 Subcontractor Project Address City State 4350 Lk Wa Blvd North Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425430-7205 KC Equipment LLC 206-399-3687 Month Day Year Address City State ZIP+4 Address City State ZIP+4 11/5/11 1055 S Grady Way Renton WA 98055 4550 49`h Ave NE Seattle WA 98105 Day and Date Deductions Work Classification Name Sun Mon Tue Wed Thu Fri Sat Total E and and Rate Hourly Soc Sec# of Employee Address Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT O.00 74.85 0.00 199600 S o (lo $1 12 77 $424 82 S 1439 $1,444.02 532-08-0836 RG 8.(X) 8.00 8.00 8.00 8.00 4000 49.90 19961)o 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 000 61.16 0.00 1630180 S (ax) $92 14 $323.08 $14.39 $1,201 19 612-38-9553 RG 800 800 8.00 Soo 8.00 40.00 40.77 163090 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0.00 61.16 0 a) 1630.80 $ 0.00 92.14 323.08 1439 51,201 19 535-13-5988 RG 800 8.00 8 (8) 8 (w 8.00 40 00 40.77 1630.80 4. Flagger Jon Russell PO BOX 2671 Everett, WA 98213 OT 050 0.51) 50.90 25.45 1297 83 $ 000 $59.66 5161.61 SI 1.15 51,065.41 535-80-1918 RG zoo 7.50 7.00 8.00 8 (00 37.50 33.93 127238 5. Flagger Mika] Bailey 6203 S I I8th PL Seattle, WA 98178 OT 0.50 (00 50.90 25,45 129783 S 0 rx) $5679 $113 31 S10.61 $1,1 v 12 532-744764 RG 7.00 7.50 7.00 8.00l 800 37.50 33.93 1272.38 6. Pipe Layer Arturo Magana 2360 62"d Ave E Apt D Fife, WA 98424 OT 000 61.16 0.0O 1630.80 S 0.00 592.14 5152.12 $212.39 $1,174.15 456-95-2995 RG 8.00 8.00 9.00 8.00 8,00 40.00 40.77 16 R0 7. OT 000 0.00 O.011 $ 0.W $ (!W RG 0.00 600 8 OT 000 0.00 0 a) $ 0 (y) $ 000 k RG o.(x) 0.00 9. D 1 9 2011 OT 0.00 0.00 0,00 S O.INI S 0.00 C11YOFRENTON RG 0.00 0.00 UTi 10. L 1TY YST-n �J9 OT 0.00 0.00 O.(X) $ ().(1O S 000 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 12/15/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 10/30/2011 1 11 /5/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 6.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type time of party signing this report Title Signature Brett Franceschina. General Manager ---?) -P� F 700-065-000 certified payroll report backer 05-09 Department of Labor and Industries N Prevailing Wage Program CERTIFIED PAYROLL REPORT rU t sox 44J4U Olympia WA 98504-4540 r Prime Contractor ® (360) 902-5335 SubcontractorEl Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 11/12/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 490' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address s la ' � x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- inp Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 0.00 74.95 0.00 1996.00 $ 0.00 $112.77 $424 82 S14.40 $1,444.01 532-08-0836 RG 8.00 8.00 8.00 8.00 9.00 40.00 49.90 1996.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA98166 OT 0.00 61.16 0,00 1630.80 $ 0.00 $92.14 $323.09 $14.40 $1.201 17 612-38-9553 RG 8.00 9.00 8.00 8.00 8.00 40.00 40.77 1630.80 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0,00 61.16 0.00 1630.80 $ 0.00 92.14 32309 14.40 $1,201.17 535-13-5988 RG 8.00 8.00 8.00 &00 8.00 40.00 40.77 1630.90 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT 000 50.90 0.00 814.32 S 0.00 $59.67 S161.62 $11.16 $ 581.87 535-80-1918 RG 8.00 8.00 8.00 24.00 33.93 814.32 5. Flagger Mika] Bailey 6203SII8thPL Seattle, WA 98178 OT 0.00 50.90 0.00 712.53 S 0.00 $5680 $11332 $10.62 S531.79 532-74-4764 RG 8.00 3.00 9.00 21.00 33.93 712.53 6. Pipe Layer Arturo Magana 2360 62nd Ave E Apt D Fife, WA 98424 OT o.W 61.16 0.00 1630.80 $ 0,00 $92.14 $152.12 $212.40 $1,174.14 456-95-2995 RG 8.00 8.00 8.00 9.00 9.00 40.00 40.n 1630.80 7 OT 0. W 0.00 0.00 $ 0. W $ 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 $0.00 $ 000 RG o.W 0.00 9 OT 0.00 0.00 0.00 $0.00 $ 000 RG 0.00 0. W 10. OT 0.00 0.00 0.00 S 0.00 S 0.011 RG 0.00 o. W F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 12/15/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 11/6/2011 1 11/1.2/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.171agger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 6.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Title Signature Brett Franceschina General Manager __7014-_ F700-065-000 certified payroll report backer 05-09 Department of Labor and Industries 6 s1n'p Prevailing Wage Program u CERTIFIED PAYROLL REPORT ru box 44J4u j Olympia WA 98504-4540 w Prime Contractor (360) 902-5335 91 eaa �� ® Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm &Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 11/19/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 491h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address E �3 t i x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other I I I I I Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 0.00 74.85 0,00 19960 $ UIN7 $u 28 $n ss $1.44 S 175.00 532-08-0836 RG 4.00 4,00 49.90 199,60 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 6116 0.00 326.16 $ 0.u0 $1843 $24.54 $2.88 $ 280.31 612-38-9553 RG s.00 9.00 40.77 326.16 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0.0o 61.16 000 489.24 $ 0.0U 2764 4492 4.32 $ 412.36 535-13-5988 RG 8.00 400 12,00 40,77 469.24 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT 0.00 50.90 0.00 0.00 $ o 00 $ o.00 535-80-1918 RG 0,00 33.93 0.00 5. Flagger Mikal Bailey 6203 S I I8th PL Seattle, WA 98178 OT 0.00 50.90 0.00 0,00 $ 000 $ 0.00 532-74-4764 RG 0.00 33.93 0,00 6. Pipe Layer Arturo Magana 236062 nd Ave E Apt D Fife, WA 98424 OT 000 61.16 n,00 326. 16 $ 0,00 $1 s 43 $2.88 S 304.85 456-95-2995 RG 9.00 8.00 40.77 326 16 7 OT 0.00 0.00 0.00 S 0.00 S 0.00 RG 000 0.00 8 OT o.00 0.00 0.00 $ 0,00 $ 0.00 RG 000 0.00 9 OT 0.00 0.00 000 s o.0o s 0.00 RG 0.00 0.00 10 OT 0.00 0.00 0,00 $ 0 a1 $ 000 RG 0.00 oat F700-065-000 certified payroll report 05-09 Enrp/ulee BeneJits /)i.%trihutinrr �rnr/ .S'i,, nohrm Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 12/15/2011 1 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 11/13/2011 1 11/19/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 6.Pipe layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7. $ 0.00 x. $ 0.00 9. $ 0.00 10. $ 0.00 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 anN, of the above statements is a violation of RCW 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature Brett Franceschina General Manager '-It�A- F700-065-M certified payroll report backer 05-09 Department of Labor and Industries „ATE.G Prevailing Wage Program s CERTIFIED PAYROLL REPORT rV Box 4434U J Project Name County Project or Contract# Olympia WA 985044540 Prime Contractor h1,8� ® Lk Wa Blvd N Storm & Water King SWP-27-3531 (360) 902-5335 Project Address City State Subcontractor 4350 Lk Wa Blvd North Renton WA Awarding Agency Name Phone Company Name Phone For the week ending: City of Renton 425430-7205 KC Equipment LLC 206-399-3687 Month Day Year Address City State ZIP+4 Address City State ZIP+4 11/26/11 1055 S Grady Way Renton WA 98055 4550 49"' Ave NE Seattle WA 98105 Day and Date Deductions Work Classification Name Sun Mon Toe Wed Thu Fri Sat Total and and aaats gO Rate Hourly Soc Sec# of Employee Address a� Total of Gross Amount "Usual Withold- NET Hours Worked Each Day Hours Pay Earned Benefits" FICA ing Tax Other WAGES 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW OT 0.00 74.85 0.00 0.00 s 000 $ 0.00 532-08-0836 Burien, WA 98166 RG 0.00 49.90 0.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW OT 0.00 61.16 0.00 0.00 S 0.00 $ 0.00 612-38-9553 Burien, WA 98166 RG 0.00 40.77 0.00 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE OT o.00 61.16 0.00 0.00 S 0.00 s 0.00 535-13-5988 Puyallup, WA98372 RG 0.00 40.77 Roo 4. Flagger Jon Russell PO Box 2671 OT 0.00 50.90 0.00 0.00 S 0.00 s 0.00 535-80-1918 Everett, WA 98213 RG 0.00 33.93 0.00 5. Flagger Mikal Bailey 6203 S l I Sth PL OT 0.00 50.90 0.00 0.00 $ 0.00 s 0.00 532-74-4764 Seattle, WA 98178 RG 0.00 33.93 0.00 6. Pipe Layer Arturo Magana 2360 62nd Ave E Apt D OT 0.00 61.16 0.00 0.00 s 0.00 s 000 456-95-2995 Fife, WA 98424 RG 0.00 40.77 0.00 7 OT 0.00 0.00 0.00 S 0.00 $ U.lril RG 0.00 0.00 8 OT 0.00 0.00 0.00 S 0.00 S 0.00 RG 0.00 0.00 9. OT 0.00 0.00 0.00 s 0.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 0.00 s 0.00 s 0.00 RG 0.00 0.00 F700-065-000 certified payroll report 05-09 Emp/gyee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 12/15/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 11/20/2011 1 11/26/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) ,approved kpp►.entice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.171agger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 6.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 l o. $ 0.00 I'he 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. Print or type name of party signing this report I Title Brett Franceschina General Manager F700-065-000 certified payroll report backer 05-09 Department of Labor and Industries b SiApE Prevailing Wage Program pa CERTIFIED PAYROLL REPORT ry BOX 44:34u IT Olympia WA 98504-4540 Prime Contractor (360) 902-5335 ® Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm &Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425-430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 12/3/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 49 h Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address x Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 0.00 74.85 0.00 0.00 s 000 s 0.00 532-08-0836 RG 0.00 49.90 0.00 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 61.16 0.00 0.00 $ 000 $ 0.00 612-38-9553 RG 0.00 40.77 0.00 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0.00 61.16 0.00 0.w s 0.00 $ 0.00 535-13-5988 RG 0.00 40.77 0.00 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT 0.00 50.90 0.00 0.00 s 0.00 $ 0.00 535-80-1918 RG 0.00 33.93 0,00 5. Flagger Mikal Bailey 6203 S I I8th PL Seattle, WA 98178 OT 0.00 50.90 0.00 0W s 0.00 $ 000 532-744764 RG 0.00 33.93 0.00 6. Pipe La er Arturo Magana 2360 62"`' Ave E Apt D Fife, WA 98424 OT 0.00 61.16 0.00 0.00 $ 0.00 $ o o0 456-95-2995 RG 0.00 40.77 om 7 OT 0.00 0.00 0.00 s 0.00 $ 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 s 0.00 s 0.00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ o.00 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 ow s 000 s 000 RG o.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 12/15/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 11/27/2011 1 12/3/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 6.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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 eamed, 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. Print or type name of party signing this report Title Signature Brett Franceschina I General Manager F700-065-000 certified payroll report backer 05-09 Department of Labor and Industries Prevailing Wage Program 0,04: "" CERTIFIED PAYROLL REPORT ru nox w+:)4u Olympia WA 985044540 ,'` Prime Contractor ® (360) 902-5335 ti� "�° a� Subcontractor Project Name County Project or Contract# Lk Wa Blvd N Storm & Water King SWP-27-3531 Project Address City State 4350 Lk Wa Blvd North Renton WA For the week ending: Awarding Agency Name Phone City of Renton 425430-7205 Company Name Phone KC Equipment LLC 206-399-3687 Month Day Year 12/10/11 Address City State ZIP+4 1055 S Grady Way Renton WA 98055 Address City State ZIP+4 4550 490' Ave NE Seattle WA 98105 Work Classification and Soc Sec# of Employee Name and Address d '� � Day and Date Sun Mon Tue Wed Thu Fri Sat Total Hours Rate of Pay Gross Amount Earned Total Hourly "Usual Benefits" Deductions NET WAGES FICA Withold- ing Tax Other Hours Worked Each Day 1. Pwr Equip O rtr Adrian Lacasse 14426 4th Ave SW Burien, WA 98166 OT 0.00 74.85 0.00 274.45 $ 0.00 $15.50 S19.37 $1.98 $ 237.60 532-08-0836 RG 5.50 5.50 49.90 274.45 2. Pipe Layer Justin Kirkland 15645 Maplewild Ave SW Burien, WA 98166 OT 0.00 61.16 0.00 224.24 S 0.00 $12.67 $14.35 S1.98 S 195,24 612-38-9553 RG 5.50 5.50 40.77 224.24 3. Pipe Layer Johnathan Raymer 1024 4th Ave SE Puyallup, WA 98372 OT 0.00 61.16 0.00 224.24 $ 0.00 1267 14.35 1.99 $193.24 535-13-5988 RG 5 50 5.50 40.77 224.24 4. Flagger Jon Russell PO Box 2671 Everett, WA 98213 OT o.o0 50.90 0.00 0.00 s 0.00 S 0.00 535-80-1918 RG 0.00 33.93 0.00 5. Flagger Mika] Bailey 6203 S 118th PL Seattle, WA 98178 OT o.0o 30.90 0.00 0.0o s o.0o S 0.00 532-74-4764 RG 0.00 33,93 0.00 6. Pipe Layer Arturo Magana 2360 62od Ave E Apt D Fife, WA 98424 OT 0.00 61.16 0.00 224.24 $ 0.00 $12 67 $0. oo $1.98 $ 209.59 456-95-2995 RG .5 50 5.50 40.77 224.24 7 OT 0.00 0.00 0.00 s 0.011 $ 0.00 RG 0.00 0.00 8 OT 0.00 0.00 0.00 $ 0.00 $ 0 00 RG 0.00 0.00 9 OT 0.00 0.00 0.00 $ o.a1 $ 0.00 RG 0.00 0.00 10. OT 0.00 0.00 0.00 $ o.00 $ 0.00 RG o.00 0.00 F700-065-000 certified payroll report 05-09 Employee Benefits Distribution and Signature Certification on Reverse Side Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 AFFIRMATION Today's Date Printed name of party signing this report Title 12/15/2011 Brett Franceschina I General Manager The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: KC Equipment LLC Project Name: For the week starting: For the week ending: Lk Wa Blvd North Storm & Water Improvements 12/4/2011 1 12/10/2011 "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "usual Benefits" (A 1 11+C+1)+F.) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program 1. Pwr Equip Oprtr $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 2.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5.Flagger $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 6.Pipe Layer $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7. $ 0.00 8. $ 0.00 9. $ 0.00 10. $ 0.00 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. Print or type name of party signing this report Brett Franceschina Title General Manager F700-065-000 certified payroll report backer 05-09