HomeMy WebLinkAboutWTR2703344_9CECCIiNTI
January 23, 2008
Andrew Weygandt
City of Renton PBPW - Water Utilities
Renton City Hall - 5th Floor
1055 South Grady Way
Renton, WA 98057
RE: #658 — Benson Road Waterline Relocation
Dear Andrew:
RECEIVED
BAN 2 5
CITY OF RENTON
UTILITY SYSTEMS
Please find enclosed the Monthly EEO Reports for the following months of
CECCANTI, INC.
11 /07
12/07
MERIWETHER LEACHMAN ASSOCIATES
11 /07
12/07
APPLY A LINE
11/10/07—12/07/07
Should you have any questions, please contact me at (253)537-2990 extension 25.
Sincerely,
Ceccanti, Inc.
Kristie Rojas
Project Administrator
CECCANTI INC GENERAL CONSTRUCTION 4110 BROONDALf RD. E. TACOMA WA 0844012531537.2900 FAX 12531537-0943
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 01
TACOMA, WA 98446
From period end date: 12/01/07 To period end date: 12/31/07
Job number: 658 RENTON WATER LINE RELOCAT
Hispanic White
EEO Class / Work Class Sex Total
Work hours of employment
Black Asian
Pacific
Islander
American
Indian
Other(2 or
more)
Minority
%
Female
%
Total #
Employees
Total #
Minority
M
50.5
2.5
48.0
0.0
0.0
0.0
0.0
0.0
5.0%
0.0%
2
1
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
FLAGGER
M
27.5
0.0
27.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
3
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
FLAGGER
M
5.0
0.0
5.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
1
0
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Subtotal:
M
32.5
0.0
32.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
4
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
LABORER
M
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0%
100.0%
0
0
JOURNEYMAN
F
16.5
0.0
16.5
0.0
0.0
0.0
0.0
0.0
1
0
LABORER
M
19.5
0.0
0.0
19.5
0.0
0.0
0.0
0.0
100.0%
0.0%
1
1
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Subtotal:
M
19.5
0.0
0.0
19.5
0.0
0.0
0.0
0.0
54.2%
45.8%
1
1
F
16.5
0.0
16.5
0.0
0.0
0.0
0.0
0.0
1
0
OPERATOR
M
53.5
0.0
53.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
5
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
TRUCK DRIVER
M
63.0
0.0
0.0
0.0
0.0
0.0
63.0
0.0
100.0%
0.0%
1
1
APPRENTICE
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Journeyman total:
M
81.0
0.0
81.0
0.0
0.0
0.0
0.0
0.0
0.0%
16.9%
8
0
F
16.5
0.0
16.5
0.0
0.0
0.0
0.0
0.0
1
0
Apprentice total:
M
63.0
0.0
0.0
0.0
0.0
0.0
63.0
0.0
100.0%
0.0%
1
1
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Trainee total:
M
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
0
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
No work class total:
M
75.0
2.5
53.0
19.5
0.0
0.0
0.0
0.0
29.3%
0.0%
4
2
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Job total:
M
219.0
2.5
134.0
19.5
0.0
0.0
63.0
0.0
36.1 %
7.0%
13
3
F
16.5
0.0
16.5
0.0
0.0
0.0
0.0
0.0
1
0
Printed by KMP as of 01123108 5: 02: 52PM Page l
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 01
TACOMA, WA 98446
From period end date: 12/01/07 To period end date: 12/31/07
Job number: 658 RENTON WATER LINE RELOCAT
Hispanic White
EEO Class / Work Class Sex Total
Work hours of employment
Black Asian Pacific
Islander
i�4
Title: Telephone:
Signature
American Other(2 or Minority Female Total # Total #
Indian more) % % Employees Minority
,Iii -:
DAte Signed
Printed by KMP as of 01123108 5: 02: 52PM
CECCANTI, INC.
Monthly Employment Utilization Report
1I.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 01
TACOMA, WA 98446
From period end date: 11/01/07 To period end date: 11/30/07
Job number: 658 RENTON WATER LINE RELOCAT
EEO Class / Work Class
Sex
Total
Hispanic
White
M
58.5
7.0
51.5
NO WORK CLASS
F
0.0
0.0
0.0
APPRENTICE OPERATOR
M
191.0
0.0
0.0
APPRENTICE
F
0.0
0.0
0.0
FLAGGER
M
231.5
0.0
213.5
JOURNEYMAN
F
17.0
0.0
17.0
FLAGGER
M
109.5
0.0
109.5
NO WORK CLASS
F
60.5
0.0
0.0
Subtotal:
M
341.0
0.0
323.0
F
77.5
0.0
17.0
FORMAN
M
195.5
0.0
195.5
JOURNEYMAN
F
0.0
0.0
0.0
LABORER
M
358.0
14.0
344.0
JOURNEYMAN
F
60.0
0.0
60.0
LABORER
M
23.5
0.0
0.0
NO WORK CLASS
F
0.0
0.0
0.0
Subtotal:
M
381.5
14.0
344.0
F
60.0
0.0
60.0
OPERATOR
M
395.0
0.0
395.0
JOURNEYMAN
F
0.0
0.0
0.0
SHOP MAINTENANCE
M
19.5
0.0
19.5
NO WORK CLASS
F
0.0
0.0
0.0
TRUCK DRIVER
M
167.5
158.5
9.0
JOURNEYMAN
F
0.0
0.0
0.0
TRUCK DRIVER
M
62.5
0.0
0.0
APPRENTICE
F
0.0
0.0
0.0
Subtotal:
M
230.0
158.5
9.0
F
0.0
0.0
0.0
Journeyman total:
M
1,347.5
172.5
1,157.0
F
77.0
0.0
77.0
Work hours of employment
Black
Asian
Pacific
Islander
0.0
0.0
0.0
0.0
0.0
0.0
0.0
191.0
0.0
0.0
0.0
0.0
18.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
�n
60.5
18.0
60.5
0.0
0.0
0.0
0.0
23.5
0.0
23.5
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
18.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
American
Indian
Other(2 or
more)
Minority
%
Female
%
0.0
0.0
12.0%
0.0%
0.0
0.0
0.0
0.0
100.0%
0.0%
0.0
0.0
0.0
0.0
7.2%
6.8%
0.0
0.0
0.0
0.0
35.6%
35.6%
0.0
0.0
0.0
0.0
18.8%
18.5%
0.0
0.0
0.0
0.0
0.0%
0.0%
0.0
0.0
0.0
0.0
3.3%
14.4%
0.0
0.0
0.0
0.0
100.0%
0.0°/a
0.0
0.0
0.0
0.0
8.5%
13.60/c
0.0
0.0
0.0
0.0
0.0%
0.0%
0.0
0.0
0.0
0.0
0.0%
0.0%
0.0
0.0
0.0
0.0
94.6%
0.00/(
0.0
0.0
62.5
0.0
100.0%
0.00/(
0.0
0.0
62.5
0.0
96.1 %
0.00/(
0.0
0.0
0.0
0.0
13.4%
5.4°/<
0.0
0.0
Total #
Employees
3
0
1
0
7
1
1
1
8
2
2
0
4
1
1
0
5
1
6
0
1
0
2
0
1
0
3
0
21
2
Total #
Minority
1
0
1
0
2
0
0
1
2
1
0
0
1
0
1
0
2
0
0
0
0
0
1
0
1
0
2
0
4
0
Printed by KMP as of 01123108 5: 03:29PM Page 1
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 01
TACOMA, WA 98446
From period end date: 11/01/07 To period end date: 11/30/07
Job number: 658 RENTON WATER LINE RELOCAT
EEO Class / Work Class Sex Total
Apprentice total:
M
253.5
F
0.0
Trainee total:
M
0.0
F
0.0
No work class total:
M
211.0
F
60.5
Job total:
M
1,812.0
F
137.5
Title
Hispanic
White
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
7.0
180.5
0.0
0.0
179.5
1,337.5
0.0
77.0
Work hours of employment
Black
Asian
Pacific
Islander
0.0
191.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
23.5
0.0
0.0
60.5
0.0
0.0
41.5
191.0
0.0
60.5
0.0
0.0
Telephone:
Signature
American
Other(2 or
Minority
Female
Total #
Total #
Indian
more)
%
%
Employees
Minority
62.5
0.0
100.0%
0.0%
2
2
0.0
0.0
0
0
0.0
0.0
0.0%
0.0%
0
0
0.0
0.0
0
0
0.0
0.0
33.5%
22.3%
6
2
0.0
0.0
1
1
62.5
0.0
27.4%
7.1 %
29
8
0.0
0.0
3
1
I, ) -,-� Z) O�7
8
Date igned
Printed by KMP as of 01123108 5: 03:29PM Page 2
Monthly Employment Utilization Report U.S. Department of Labor
Employment Standards Administration
Office of Federal Contract ComDllance Programs
This report is required by Executive Order 11246, Sec. 203. Failure to report can result in contracts
being cancelled, terminated or suspended in whole or in part and the contractor may be declared
ineligible for further Government contracts of federally assisted construction contracts.
1. Covered Area (SMSA or EA)
Benson Road
Water Line Relocation
Renton, WA
2. Employers I.D. No.
91-0832021
OMB No. 1215-01633
Expires: 12/13/92
3. Current Goals
Minority
Female
4. Reporting Period
From 12-01-07
To 12-31-07
Name and Location of Contractor
Meriwether Leachman Assoc., Inc.
11800 NE 160th Street, Bothell, WA 98011
Federal
Funding
Agency
5.
CONSTRUCTION
TRADE
Classifications
6. TOTAL FEDERAL
& NON-FEDERAL
CONSTRUCTION
WORK HOURS
9.
Total
Number of
Employees
10.
Total Number of
Minority Employees
6a.
Total All
Employees
By Trade
6b.
Black
(Not of Hispanic
Origin)
6c.
Hispanic
6d.
Asian or
Pacific
Islander
6e.
American
Indian or
Native American
7,
Minority
Percentage
8.
Female
Percentage
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Surveyors
Journey Worker
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Apprentice
Trainee
Sub -Total
0'
0
0
0
0
0
0
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Total Journey Worker
0
0
0
0
0
0
0
0
0
0
0
0-
0
0
0
0
0
0
Total Apprentices
Total Trainees
Grand Total
0
0
0
0
0
0
0
11. Company Official's Signature and Title
/7
12. Telephone Number
(Include area code)
(425) 488-4800
13. Date Signed
01 10-2008
Page
1 of 1
Form CC-257
Rev.Jan.1992
Monthly Employment Utilization Report U.S. Department of Labor
Employment Standards Administration
nffira of Fartaral rnntrart Cmmnlianre Pmorams
This report is required by Executive Order 11246, Sec. 203. Failure to report can result in contracts
being cancelled, terminated or suspended in whole or in part and the contractor may be declared
ineligible for further Government contracts of federally assisted construction contracts.
1. Covered Area (SMSA or EA)
Benson Road
Water Line Relocation
Renton, WA
2. Employers I.D. No.
91-0832021
OMB N0. 1215-01633
Expires: 12/13/92
3. Current Goals
Minority
Female
4. Reporting Period
From 11-01-07
To 11-30-07
Name and Location of Contractor
Meriwether Leachman Assoc., Inc.
11800 NE 160th Street, Bothell, WA 98011
Federal
Funding
Agency
5.
CONSTRUCTION
TRADE
Classifications
6. TOTAL FEDERAL
& NON-FEDERAL
CONSTRUCTION
WORK HOURS
9.
Total
Number of
Employees
10.
Total Number of
Minority Employees
6a.
All
Employees
By Trade
6b.
Black
(Not of Hispanic
Ori in)
6c.
Hispanic
6d.
Asian or
Pacific
Islander
6e.
American
Indian or
Native American
7,
Minority
Percentage
8.Total
Female
Percentage
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Surveyors
Journey Worker
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Apprentice
Trainee
Sub -Total
0
0
0
0
0
0
0'
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Total Journey Worker
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total Apprentices
Total Trainees
Grand Total
0
0
0
0:
0
0
0
11. Company Official's Signature and Title
�f
12. Telephone Number
(Include area code)
(425) 488-4800
13. Date Signed
12-06-2007
Page
1 of 1
Form CC-257
Rev. Jan. 1992
As Of:12/06/07 On:12/06/07 (PRME.2) Time: 12:07 Page: 44
APPLY -A -LINE, INC.
** E.E.O. Summary Report **
From 1111012007 To 1210712007
10ECO2 CECCANTI, INC
4116
BROOKOALE ROAD
EAST
Job Number:
152C2200
BENSON RD
WATERLINEIWTR273344
TACOMA WA 98446
American
Total
Total All
Asian Or
Indian
Total
Number Of
Constr.
Employees
Pacific
Or
Minority
Female
Number
Of Minority
Trade/
By Trade
Black
Hispanic
Islanders
Alaskan
Pcnt.
Pcrt.
Employees
Employees
Class.
M F
M
F
M
F
M F
M
F
M
F M F
WA JOURNEYMAN
Journyman
16.50 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
2
0 0 0
Sub -Total
16.50 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
2
0 0 0
Total Journym
16.50 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
2
0 0 0
Total Apprent
0.00 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
0
0 0 0
Total Trainee
0.00 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
0
0 0 0
Totai New Hir
0.00 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
0
0 0 0
Grand Total
16.50 0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
.00
.00
2
0 0 0
C[Ccli
January 23, 2008
T1
J A N 9 b
Crl'Y Ur HENTON
UTILITY SYSTEMS
Andrew Weygandt
City of Renton PBPW - Water Utilities
Renton City Hall - 5th Floor
1055 South Grady Way
Renton, WA 98057
Re: # 658 — Benson Road Water Line Relocation
Dear Andrew:
Please find enclosed the Certified Payroll Reports for the following week ending dates:
CECCANTI, INC.
11 / 10/07 11 / 17/07 11 /24/07 12/01 /07
12/22/07 *****FINAL******
MERIWETHER LEACHMAN ASSOCIATES
10/27/07 11 / 10/07 11 / 17/07 11 /24/07
12/15/07 12/22/07 12/29/07 01/05/08
INTERWEST DEVELOPMENT NW
10/2 7/07 11 /03 /07 11 / 10/07 11 / 17/07
HOLOCENE DRILLING
10/20/07
STRONG TRUCKING
11 /22/07
12/08/07 12/15/07
12/01/07 12/08/07
01/12/07
Should you have any questions, please contact me at (253) 537-2990 extension 25.
Sincerely,
Ceccanti, Inc.
Kristie Rojas
Project Administrator
CECCANTI INC GENERAL CONSTRUCTION 4110 RROOADAU RD. E. TACOMA WA 00440 (253) 537.2990 FAX 12531537-8043
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: WTR-27-3344
I, BLAKE VERDI, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 4 day of NOVEMBER, 2007 and ending the 10 day of
NOVEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. ee Section 1001 of Title 18 and Secti 31 of Title 31 of the United States Code.
Page 1
CECCANTI, INC. Pay Period Date: 11/10/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/10/07 Job No: 658
Payroll No: 8 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
04
05
06
07 08
09
10
Total Rate Gross Pay
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
0.50
0.50
0.00 0.00
0.00
0.00
1.00 48.26 48.26
Fed W/H
94.08 Gross
1,206.38
3823 215TH ST CT. EAST
538-02-9911 S
0.00
8.00
8.00
8.00 8.00
4.00
0.00
36.00 32.17 1,158.12
FICA
92.29 Taxes
198.73
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
31.54
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.36 Net Pay
976.11
WORKING DU
24.14
Check #:
72766
N.W.F.C.
7.40
Total Job Gross
1,206.38
GUNDERMAN, SHON L
Ex: S-00 C M O
0.00
0.50
0.50
0.00 0.00
0.00
0.00
1.00
42.06
42.06
Fed W/H
212.90 Gross
1,168.76
23814 65TH AVE. CT. EAST
530-39-6733 S
0.00
8.00
8.00
3.00 3.00
8.00
0.00
30.00
28.04
841.20
FICA
89.41 Taxes
316.00
GENERAL LABORER
State W/H
0.00 Deducts
142.65
GRAHAM, WA 98338
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.69 Net Pay
710.11
CHILD SUPP
69.23 Check #:
72791
VACATION
41.00
UNION DUES
30.78
N.W.F.C.
1.64
Total Job Gross
883.26
GUNDERMAN, SHON L
Ex: S-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
212.90 Gross
1,168.76
23814 65TH AVE. CT. EAST
530-39-6733 S
0.00
0.00
0.00
5.00 5.00
0.00
0.00
10.00
28.55
285.50
FICA
89.41 Taxes
316.00
GENERAL LABORER
State W/H
0.00 Deducts
142.65
GRAHAM, WA 98338
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.69 Net Pay
710.11
CHILD SUPP
69.23 Check #:
72791
VACATION
41.00
UNION DUES
30.78
N.W.F.C.
1.64
Total Job Gross
285.50
HELM, JOSHUAH JAMES
Ex: M-01 N M O
0.00
0.00
0.00
0.00 0.00
0.00
3.00
3.00
35.73
107.19
Fed W/H
150.66 Gross
1,322.01
1318 EAST 35TH STREET
539-78-3747 S
0.00
0.00
0.00
0.00 0.00
7.00
0.00
7.00
23.82
166.74
101.13Taxes
268.49
APPRENTICE/OPERATOR
State
0FICA
Deducts
36.43
TACOMA, WA 98404
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.70 Net Pay
1,017.09
WORKING DU
26.43 Check #:
72799
N.W.F.C.
10.00
Total Job Gross
273.93
MARANA, WILLIAM T
Ex: S-00 A M O
0.00
0.50
0.50
0.00 0.00
0.00
0.00
1.00
33.35
33.36
Fed W/H
161.36 Gross
922.58
5932 SOUTH PARK
538-98-3721 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
22.23
889.22
FICA
70.57 Taxes
245.62
o)
2ND PERIOD APP(70/o
State W/H
0.00 Deducts
26.62
TACOMA, WA 98408
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.69 Net Pay
650.34
WORKING DU
18.42 Check #:
72816
N.W.F.C.
8.20
Total Job Gross
922.58
Page 2
CECCANTI, INC. Pay Period Date: 11/10/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/10/07 Job No: 658
Payroll No: 8 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions Totals
Employee
Work Class
04
05
06
07 08
09
10 Total Rate Gross Pay
PAYNE, CHERYL
Ex: -01 C F 0
0.00
0.00
0.00
0.00 0.00
0.00
0.00 0.00 0.00 0.00
Fed W/H
57.48 Gross
547.45
9904 23RD AVE CT. S. K171
514-62-4858 S
0.00
0.00
0.00
2.00 5.00
0.00
0.00 7.00 22.81 159.67
FICA
4188 Taxes
107.04
LB/FLAGGER
State
. Deducts
41.17
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
7.68 Net Pay
399.24
VACATION
23.00 Check #:
72827
UNION DUES
17.25
N. W. F. C.
0.92
Total Job Gross
159.67
PUGH, TROY KENNETH
Ex: S-01 C M
0
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
123.48 Gross
876.44
2728 5TH AVE. NE
533-02-0277
S
0.00
2.00
0.00
0.00 1.00
1.00 0.00
4.00
24.64
98.56
FICA
67.05 Taxes
201.72
APT. #4
FLAGGER
State W/H
0.00 Deducts
59.97
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
11.19 Net Pay
614.75
VACATION
33.50 Check #:
72831
UNION DUES
25.13
N.W.F.C.
1.34
Total Job Gross
98.56
RUTLEDGE, ZANDRA M
Ex: S-01 B F
0
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
33.53 Grass
387.77
4702 SO WARNER APT. C
538-82-9687
S
0.00
0.00
0.00
2.00 5.00
0.00 0.00
7.00
22.81
159.67
FICA
29.66 Taxes
68.87
FLAGGER
State W/H
0.00 Deducts
30.43
TACOMA, WA 98409
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
5.68 Net Pay
288.47
VACATION
17.00 Check #:
72839
UNION DUES
12.75
N.W. F.C.
0.68
Total Job Gross
159.67
TALLENT, RALPH JAY
Ex: M-04 C M
0
0.00
0.50
0.50
0.00 0.00
0.00 0.00
1.00
48.26
48.26
Fed W/H
156.92 Gross
1,206.38
PO BOX 1252
551-33-8411
S
0.00
8.00
8.00
8.00 8.00
4.00 0.00
36.00
32.17
1,158.12
FICA
92.28 Taxes
261.56
EXCAVATOR/BACKHOE 3
E Equipment ment Usa a
q P 9
State W/H
Local W/H
0.00 Deducts
0.00
94.52
MILTON, WA 98354
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.36 Net Pay
850.30
CHILD SUPP
63.00 Check #:
72845
WORKING DU
24.12
N. W. F. C.
7.40
Total Job Gross
1,206.38
Page 3
CECCANTI, INC. Pay Period Date: 11/10/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/10/07 Job No: 658
Payroll No: 8 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee Work Class
04
05
06
07 08
09
10 Total Rate Gross Pay
VANLANDINGHAM, JASON EDWA Ex: M-01 C M O
0.00
0.50
0.50
0,00 0.00
0.00
0.00 1.00 45.83 45.84
Fed W/H
167.53 Gross
1,267.85
12206 221 ST AVE. CT EAST 537-13-3579 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00 40.00 30.55 1,222.01
FICA
96.99 Taxes
278.21
GENERAL LABORER
State W/H
0.00 Deducts
73.41
BONNEY LAKE, WA 98391
Local W/H
0.0o Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.69 Net Pay
916.23
VACATION
41.00 Check #:
72848
UNION DUES
30.77
N.W. F.C.
1.64
Total Job Gross
1,267.85
VILLALON, CRUZ
13106 119TH ST. CRT. E.
PUYALLUP, WA 98374
Ex: M-01 H M O 0.00
555-82-4128 S 0.00
EXCAVATOR/BACKHOE 3
0.50
8.00
0.50
8.00
0.00 0.00
8.00 2.50
Other Job Pay
0.00 0.00
0.00 0.00
Equipment Usage
Total Job Gross
1.00
26.50
48.26
32.17
48.26
852.52
900.78
Fed W/H
FICA
State W/H
Local W/H
Wcomp /Sdi
WORKING DU
N. W. F. C.
87.47 Gross
68.92 Taxes
0.00 Deducts
0.00 Add-O
9.19 Net Pay ay
18.03 Check #:
5.50
900.78
165.58
23.53
.
711.6767
72852
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M
O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
112.11 Gross
830.96
10402 140TH AVENUE EAST
534-96-9686
S
0.00
2.00
0.00
0.00 1.00
1.00 0.00
4.00
22.81
91.24
FICA
63.56 Taxes
186.19
FLAGGER
State W/H
0.00 Deducts
56.39
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
10.52 Net Pay
588.38
VACATION
31.50 Check #:
72851
UNION DUES
23.63
N. W. F. C.
116
Total Job Gross
91.24
WESTHOFF, BRANDON A
Ex: S-00 C M
O
0.00
0.00
0.00
0.00 0.00
0.50 0.00
0.50
34.22
17.11
Fed W/H
142.41 Gross
886.79
32831 17TH AVENUE SW
539-94-0605
S
0.00
0.00
0.00
0.00 0.00
6.00 0.00
6.00
22.81
136.86
FICA
67.85 Taxes
221.79
FLAGGER
State W/H
0.00 Deducts
61.76
FEDERAL WAY, WA 98023
Local W/H
0.00 Add-Ons
5.42
Other Job Pay
Wcomp/Sdi
11.53 Net Pay
608.66
VACATION
34.50 Check #:
72857
UNION DUES
25.88
N. W. F. C.
1.38
Total Job Gross
153.97
Page 4
CECCANTI, INC. Pay Period Date: 11/10/07 Certified Payroll Report Contract#: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/10/07 Job No: 658
Payroll No: 8 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
04
05
06
07 08
09
10
Total Rate Gross Pay
Deductions Totals
WILHELM, MARK E
Ex: M-00 C M O
0.00
0.50
0.50
0.00 0.00
0.00
0.00
1.00 51.99 52.00
Fed W/H
185.80 Gross
1,438.40
28209 SE 430 STREET
535-88-4993 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00 34.66 1,386.40
FICA
110.03 Taxes
309.55
FOREMAN
State W/H
0.00 Deducts
36.97
ENUMCLAW, WA 98022
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.72 Net Pay
1,091.88
WORKING DU
28.77
Check #:
72861
N.W.F.C.
8.20
Total Job
Gross
1,438.40
Page 5
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the I I day of NOVEMBER, 2007 and ending the 17 day of
NOVEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
J I � t-1
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or cnminal prose tion. See Section 1001'o?TitIA and Section 231 of Title 31 of the United States Code.
Page I
CECCANTI, INC. Pay Period Date: 11/17/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/17/07 Job No: 658
Payroll No: 9 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
11
12
13
14 15
16 17 Total
Rate Gross Pay
BRADSHAW, JOSEPH D
Ex: S-00 B M O
0.00
0.00
0.00
1.50 0.00
0.00 4.00 5.50
42.06 231.33
Fed W/H
195.85 Gross
1,100.57
1773 106TH ST SOUTH
539-88-0513 S
0.00
0.00
0.00
8.00 5.00
5.00 0.00 18.00
28.04 504.72
FICA
84.19 Taxes
292.23
FLAGGER
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
65.34
TACOMA, WA 98444
Wcomp/Sdi
Add-Ons
12.19
0.00
Other Job Pay
Net Pay
743.00
VACATION
36.50 Check #:
72888
UNION DUES
27.38
N. W. F. C.
1.46
Total Job Gross
736.05
D
0.00
0.00
0.00
0.00 0.00
0.00
2.50
2.50
64.34
160.85
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
0.00
0.00
1.50 0.00
0.00
11.00
12.50
48.26
603.25
Fed W/H
176.77 Gross
1,729.20
3823 215TH ST CT. EAST
538-02-9911 S
0.00
0.00
6.00
8.00 8.00
8.00
0.00
30.00
32.17
965.10
FICA
132.29 Taxes
324.09
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
43.59
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.03 Net Pay
1,361.52
WORKING DU
34.59
Check #:
72894
N.W.F.C.
9.00
Total Job
Gross
1,729.20
HASSON, KENNETH M
Ex: M-03 C M O
0.00
0.00
0.00
1.50 0.00
0.00
0.00
1.50
48.26
72.39
Fed W/H
93.19 Gross
1,069.66
12332 85TH AVENUE SOUTH
535-74-6766 S
0.00
0.00
0.00
8.00 5.00
5.00
0.00
18.00
32.17
579.06
FICA
81.83 Taxes
185.87
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
27.91
SEATTLE, WA 98178
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
10.85 Net Pay
855.88
WORKING DU
21.41 Check #:
6.50
72923
N.W.F.C.
Total Job
Gross
651.45
HELM, JOSHUAH JAMES
Ex: M-01 N M O
0.00
0.00
0.00
0.00 0.00
1.50
5.00
6.50
35.73
232.25
Fed W/H
177.58 Gross
1,470.89
1318 EAST 35TH STREET
539-78-3747 S
0.00
0.00
0.00
0.00 8.00
8.00
0.00
16.00
23.82
381.12
FICA
112.53 Taxes
308.31
APPRENTICE/OPERATOR
State W/H
0.00 Deducts
40.31
TACOMA, WA 98404
Local W/H
o.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
18.20 Net Pay
1,122.27
WORKING DU
29.41 Check #:
10.90
72926
N.W.F.C.
Total Job
Gross
613.37
HUGHES, MICHAEL E.
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
281.83 Gross
1,622.53
201 117TH STREET EAST
539-62-9003 S
0.00
0.00
0.00
0.00 0.00
3.00
0.00
3.00
35.66
106.98
FICA
124.12 Taxes
421.15
OP/TRUCK FOREMAN
State W/H
0.00 Deducts
41.56
TACOMA, WA 98445
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.20 Net Pay
1,159.82
WORKING DU
32.46
Check #:
72933
N.W.F.C.
9.10
Total Job
Gross
106.98
Page 2
CECCANTI, INC. Pay Period Date: 11/17/07 Certified Payroll Report Contract#: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/17/07 Job No: 658
Payroll No: 9 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
11
12
13
14 15
16 17
Total
Rate
Gross Pay
D
0.00
0.00
0.00
0.00 0.00
0.00 2.50
2.50
44.46
111.15
MARANA, WILLIAM T
Ex: S-00 A M O
0.00
0.00
2.50
1.50 0.00
0.00 11.00
15.00
33.35
500.26
Fed W/H
261.40 Gross
1,322.77
5932 SOUTH PARK
538-98-3721 S
0.00
0.00
8.00
8.00 8.00
8.00 0.00
32.00
22.23
711.36
FICA
101.19 Taxes
379.14
2ND PERIOD APP(70%)
E Equipment ment Usa a
q p 9
State W/H
Local W/H
0.00 Deducts
0.00
36.36
TACOMA, WA 98408
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.55 Net Pay
907.27
WORKING DU
26.46
Check #:
72944
N.W. F.C.
9.90
Total Job Gross
1,322.77
D 0.00
0.00
0.00
0.00 0.00
0.00
5.00
5.00
45.62
228.10
PUGH, AMY S
Ex: S-00 C F
O 0.00
0.00
0.00
0.00 0.00
0.00
12.00
12.00
34.22
410.64
Fed W/H
138.85 Gross
872.55
1607 9TH AVENUE SE
539-15-8606
S 0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
FICA
66.75 Taxes
214.45
FLAGGER
State W/H
0.00 Deducts
47.44
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
8.85 Net Pay
610.66
VACATION
26.50 Check #:
72957
UNION DUES
19.88
N. W. F. C.
1.06
Total Job
Gross
638.74
D 0.00
0.00
0.00
0.00 0.00
0.00
5.00
5.00
49.28
246.40
PUGH, TROY KENNETH
Ex: S-01 C M
O 0.00
0.00
1.00
4.00 3.00
3.50
12.00
23.50
36.96
868.56
Fed W/H
466.79 Gross
2,174.48
2728 5TH AVE. NE
533-02-0277
S 0.00
0.00
1.00
2.00 8.00
6.00
0.00
17.00
24.64
418.88
FICA
166.35 Taxes
656.68
APT. #4
FLAGGER
State W/H
0.00 Deducts
126.20
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
23.54 Net Pay
1,391.60
VACATION
70.50 Check #:
72959
UNION DUES
52.88
N. W. F. C.
2.82
Total Job
Gross
1,533.84
REYNOLDS, ROGER ALAN
Ex: M-00 C M
O 0.00
0.00
0.00
1.50 0.00
0.00
0.00
1.50
48.26
72.39
Fed W/H
194.16 Gross
1,093.79
5707 114TH AVE. CT. E.
537-58-0223
S 0.00
0.00
0.00
8.00 5.00
5.00
0.00
18.00
32.17
579.06
FICA
83.68 Taxes
288.86
OPERATOR/G2
State W/H
0.00 Deducts
28.49
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
11.02 Net Pay
776.44
WORKING DU
21.89 Check #:
72961
N.W. F.C.
6.60
Total Job
Gross
651.45
Page 3
CECCANTI, INC. Pay Period Date: 11/17/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/17/07 Job No: 658
Payroll No: 9 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
11
12
13
14 15
16
17
Total
Rate
Gross Pay
D
0.00
0.00
0.00
0.00 0.00
0.00
2.50
2.50
64.34
160.85
TALLENT, RALPH JAY
Ex: M-04 C M O
0.00
0.00
0.00
1.50 0.00
0.00
11.00
12.50
48.26
603.25
Fed W/H
287.63 Gross
1,729.20
PO BOX 1252
551-33-8411 S
0.00
0.00
6.00
8.00 8.00
8.00
0.00
30.00
32.17
965.10
FICA
132.28 Taxes
434.94
EXCAVATOR/BACKHOE 3
Equipment Usage
State W/H
Local W/H
000 Deducts
106.59
MILTON, WA 98354
Wcomp/Sdi
. Add-Ons
15.03
0.00
Other Job Pay
Net Pay
1,187.67
CHILD SUPP
63.00 Check #:
72972
WORKING DU
34.59
N. W. F.C.
9.00
Total Job Gross
1,729.20
TRUDEAU, DOUGLAS JAMES
Ex: M-04 C M
O
0.00
0.00
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
70.06 Gross
980.85
1602 9TH AVENUE SE
022-52-5649
S
0.00
0.00
0.00
0.00
0.00
8.00 0.00
8.00
22.81
182.48
FICA
75.03 Taxes
158.77
FLAGGER
State W/H
0.00 Deducts
73.39
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
13.68 Net Pay
748.69
VACATION
41.00 Check #:
72973
UNION DUES
30.75
N. W. F. C.
1.64
Total Job Gross
182.48
D
0.00
0.00
0.00
0.00
0.00
0.00 2.50
2.50
61.10
152.75
VANLANDINGHAM, JASON EDWA Ex: M-01 C M
O
0.00
0.00
0.00
0.00
2.00
0.00 11.00
13.00
45.83
595.80
Fed W/H
266.39 Gross
1,726.15
12206 221 ST AVE. CT EAST
537-13-3579
S
0.00
6.00
6.00
4.00
8.00
8.00 0.00
32.00
30.55
977.60
FICA
132.05 Taxes
414.31
GENERAL LABORER
State W/H
0.00 Deducts
85.04
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
15.87 Net Pay
1,226.80
VACATION
47.50 Check #:
72975
UNION DUES
35.64
N.W. F.C.
1.90
Total Job Gross
1,726.15
D
0.00
0.00
0.00
0.00
0.00
0.00 2.50
2.50
64.34
160.85
VILLALON, CRUZ
Ex: M-01 H M
O
0.00
0.00
0.00
1.50
0.00
0.00 11.00
12.50
48.26
603.25
Fed W/H
169.77 Gross
1,439.67
13106 119TH ST. CRT. E.
555-82-4128
S
0.00
0.00
6.00
8.00
7.00
0.00 0.00
21.00
32.17
675.57
FICA
110.12 Taxes
291.92
EXCAVATOR/BACKHOE 3
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
35.99
PUYALLUP, WA 98374
Wcom/Sdi
p
A-Ons
12.03
0.00
Other
Job Pay
Ne t Pay
1,111.776
WORKING DU
28.79
Check #:
72979
N.W.F.C.
7.20
Total Job Gross
1,439.67
Page 4
CECCANTI, INC.
4116 BROOKDALE ROAD EAST
Pay Period Date:
11/17/07
Week Ending:
11/17/07
Payroll No:
9
Certified Payroll Report
Contract #: WTR-27-3344
Job No: 658
Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions Totals
Employee
Work Class
11
12
13
14 15
16
17 Total Rate Gross Pay
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M O
0.00
0.00
1.00
4.00 3.00
0.00
0.00 8.00 34.22 273.76
Fed W/H
2O0.80 Gross
1,185.72
10402 140TH AVENUE EAST
534-96-9686 S
0.00
0.00
1.00
5.00 8.00
5.00
0.00 19.00 22.81 433.39
FICA
90.70 Taxes
306.52
FLAGGER
State W/H
0.00 Deducts
80.55
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.02 Net Pay
798.65
VACATION
45.00 Check #:
72978
UNION DUES
33.75
N. W. F.C.
1.80
Total Job Gross
707.15
D
0.00
0.00
0.00
0.00
0.00
0.00 5.00
5.00
45.62
228.10
WESTHOFF, BRANDON A
Ex: S-00 C M
O
0.00
0.00
2.50
1.50
0.50
0.50 12.00
17.00
34.22
581.74
Fed W/H
339.31 Gross
1,653.81
32831 17TH AVENUE SW
539-94-0605
S
0.00
5.00
8.00
8.00
8.00
8.00 0.00
37.00
22.81
843.97
FICA
126.51 Taxes
485.53
FLAGGER
State W/H
0.00 Deducts
105.63
FEDERAL WAY, WA 98023
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
19.71 Net Pay
1,062.65
VACATION
59.00 Check #:
72984
UNION DUES
44.27
N.W. F.C.
2.36
Total Job Gross
1,653.81
D
0.00
0.00
0.00
0.00
0.00
0.00 2.50
2.50
56.08
140.20
WHITE, JARED D
Ex: S-02 C M
O
0.00
0.00
2.50
0.00
0.00
0.00 11.00
13.50
42.06
567.81
Fed W/H
289.34 Gross
1,605.29
350 B RYAN ROAD
538-06-0032
S
0.00
0.00
8.00
8.00
8.00
8.00 0.00
32.00
28.04
897.28
FICA
122.81 Taxes
428.20
GENERAL LABORER
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
247.47
BUCKLEY, WA 98321
Add-O
.
Other
Job Pay
Wcomp /Sdi
16.05 Net Pay ay
929.6262
CHILD SUPP
161.53 Check #:
72987
VACATION
48.00
UNION DUES
36.02
N. W. F. C.
1.92
Total Job Gross
1,605.29
D
0.00
0.00
0.00
0.00
0.00
0.00 2.50
2.50
69.32
173.30
WILHELM, MARK E
Ex: M-00 C M
O
0.00
0.00
0.00
3.00
0.00
0.00 11.00
14.00
51.99
727.86
Fed W/H
363.43 Gross
2,148.92
28209 SE 430 STREET
535-88-4993
S
0.00
6.00
6.00
8.00
8.00
8.00 0.00
36.00
34.66
1,247.76
FICA
164.39 Taxes
545.34
FOREMAN
State W/H
0.00 Deducts
53.50
ENUMCLAW, WA 98022
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
17.52 Net Pay
1,550.08
WORKING DU
43.00 C
#:
72989
N. W. F. C.
10.50heck
Total Job Gross
2,148.92
Page 5
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADM I N do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 18 day of NOVEMBER, 2007 and ending the 24 day of
NOVEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. gee Section 1001 of Title 18 and Section nof Title 31 of the United States Code.
Page 1
CECCANTI, INC. Pay Period Date: 11/24/07 Certified Payroll Report Contract#: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/24/07 Job No: 658
Payroll No: 10 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
18
19
20
21 22
23
24
Total Rate Gross Pay
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
1.50
2.00
0.00 0.00
0.00
0.00
3.50 48.26 168.91
Fed W/H
54.27 Gross
940.99
3823 215TH ST CT. EAST
538-02-9911 S
0.00
8.00
8.00
8.00 0.00
0.00
0.00
24.00 32.17 772.08
FICA
71-98Taxes
135.43
EXCAVATOR/BACKHOE 3
State
0.00 Deducts
24.32
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
9.18 Net Pay
781.24
WORKING DU
18.82 Check #:
73018
N. W. F. C.
5.50
Total Job Gross
940.99
HELM, JOSHUAH JAMES
1318 EAST 35TH STREET
TACOMA, WA 98404
D 0.00
Ex: M-01 N M O 3.00
539-78-3747 S 0.00
APPRENTICE/OPERATOR
6.00
2.00
8.00
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00 0.00
Other Job Pay
0.00 0.00
0.00 0.00
0.00 0.00
Total Job Gross
6.00
5.00
8.00
47.64
35.73
23.82
285.84
178.65
190.56
655.05
Fed W/H
FICA
State W/H
Local W/H
Wcomp/Sdi
WORKING DU
N. W.F.C.
182.04 Gross
113.88 Taxes
0.00 Deducts
0.00 Add-Ons
12.34 Net Pay
29.76 Check #:
10.60
1,488.75
308.26
40.36
0.00
1,140.13
73047
HOLDEN, RICHARD L.
Ex: -00 C M
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
110.19 Gross
820.17
33915 TANWAX DRIVE EAST
538-58-8587
S
0.00
3.00
0.00
3.50
0.00
0.00
0.00
6.50
32.66
212.29
FICA
62.74 Taxes
181.78
TD/GROUP 1
State W/H
0.00 Deducts
28.81
EATONVILLE, WA 98328
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
8.85 Net Pay
609.58
WORKING DU
16.41
7.10 Check #:
73052
AFLAC
N.W.F.C.
5.30
Total Job Gross
212.29
D
2.00
0.00
0.00
0.00
0.00
0.00
0.00
2.00
44.46
88.92
MARANA, WILLIAM T
Ex: S-00 A M
O
0.00
2.00
2.00
0.00
0.00
0.00
0.00
4.00
33.35
133.40
Fed W/H
108.56 Gross
711.38
5932 SOUTH PARK
538-98-3721
S
0.00
6.00
8.00
8.00
0.00
0.00
0.00
22.00
22.23
489.06
FICA
54.43 Taxes
172.34
2ND PERIOD APP(70
o
/o)
State W/H
0.00 Deducts
19.82
TACOMA, WA 98408
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
9.35 Net Pay
519.22
WORKING DU
14.22 Check #:
73066
N. W. F. C.
5.60
Total Job Gross
711.38
Page 2
CECCANTI, INC.
4116 BROOKDALE ROAD EAST
TACOMA, WA 98446
253 537-2990
Pay Period Date: 11/24/07
Week Ending: 11/24/07
Payroll No: 10
Certified Payroll Report
Contract #: WTR-27-3344
Job No: 658
Job Name: RENTON WATER LINE RELOCAT
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
18
19
20
21 22
23
24
Total Rate Gross Pay
PAYNE, CHERYL
Ex: -01 C F O
0.00
1.50
0.00
0.00 0.00
0.00
0.00
1.50 34.22 51.33
Fed W/H
65.18 Gross
598.77
9904 23RD AVE CT. S. K171
514-62-4858 S
0.00
8.00
0.00
0.00 0.00
0.00
0.00
8.00 22.81 182.48
FICA
State W/H
45.81 Taxes
119.50
LB/FLAGGER
0.00 Deducts
45.65
TACOMA, WA 98444
Local W/H
o.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
8.51 Net Pay
433.62
VACATION
25.50 Check #:
73075
UNION DUES
19.13
N. W. F. C.
1.02
Total Job Gross
233.81
D
0.00
4.00
0.00
0.00 0.00
0.00
0.00
4.00
49.28
197.12
PUGH, TROY KENNETH
Ex: S-01 C M
O
0.00
4.00
1.50
2.00 0.00
0.00
0.00
7.50
36.96
277.20
Fed W/H
172.33 Gross
1,071.84
2728 5TH AVE. NE
533-02-0277
S
0.00
6.00
6.00
4.00 0.00
0.00
0.00
16.00
24.64
394.24
FICA
81.99 Taxes
266.02
APT. #4
FLAGGER
State W/H
0.00 Deducts
62.66
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
11.70 Net Pay
743.16
VACATION
35.00 Check #:
73080
UNION DUES
26.26
N.W.F.C.
1.40
Total Job Gross
868.56
TALLENT, RALPH JAY
Ex: M-04 C M
O
0.00
1.50
2.00
0.00 0.00
0.00
0.00
3.50
48.26
168.91
Fed W/H
90.57 Gross
940.99
PO BOX 1252
551-33-8411
S
0.00
8.00
8.00
8.00 0.00
0.00
0.00
24.00
32.17
772.08
FICA
72.00 Taxes
171.76
EXCAVATOR/BACKHOE
3
State W/H
0.00 Deducts
87.32
MILTON, WA 98354
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
9.19 Net Pay
681.91
CHILD SUPP
63.00 Check #:
73093
WORKING DU
18.82
N.W.F.C.
5.50
Total Job Gross
940.99
TRUDEAU, DOUGLAS JAMES
Ex: M-04 C M
O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
10.92 Gross
524.63
1602 9TH AVENUE SE
022-52-5649
S
0.00
0.00
7.00
8.00 0.00
0.00
0.00
15.00
22.81
342.15
FICA
State W/H
40.14 Taxes
58.74
FLAGGER
0.00 Deducts
41.17
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
7.68 Net Pay
424.72
VACATION
23.00 Check #:
73094
UNION DUES
17.25
N.W.F.C.
0.92
Total Job Gross
342.15
Page 3
CECCANTI, INC. Pay Period Date: 11/24/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDJob No: 658ALE ROAD EAST Week Ending: 11/24/07 Payroll No: 10 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee Work Class
18
19
20
21 22
23
24 Total Rate Gross Pay
VANLANDINGHAM, JASON EDWA Ex: M-01 C M O
0.00
1.50
2.00
0.00 0.00
0.00
0.00 3.50 45.83 160.41
Fed W/H
111.40 Gross
893.61
12206 221 ST AVE. CT EAST 537-13-3579 S
0.00
8.00
8.00
8.00 0.00
0.00
0.00 24.00 30.55 733.20
FICA
State W/H
68.36 Taxes
188.94
GENERAL LABORER
0.00 Deducts
49.23
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
9.18 Net Pay
655.44
VACATION
27.50 Check #:
73096
UNION DUES
2063.
N.W.F.C.
1.10
Total Job Gross
893.61
VILLALON, CRUZ
Ex: M-01 H M
O
0.00
1.50
1.00
0.00
0.00
0.00 0.00
2.50
48.26
120.65
Fed W/H
66.96 Gross
764.06
13106 119TH ST. CRT. E.
555-82-4128
S
0.00
8.00
4.00
8.00
0.00
0.00 0.00
20.00
32.17
643.41
FICA
58.46 Taxes
132.93
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
19.79
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
7.51 Net Pay
611.34
WORKING DU
15.29
Check #:
73100
N.W.F.C.
4.50
Total Job Gross
764.06
D
0.00
4.00
0.00
0.00
0.00
0.00 0.00
4.00
45.62
182.48
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M
O
0.00
4.00
0.00
0.00
0.00
0.00 0.00
4.00
34.22
136.88
Fed W/H
43.80 Gross
456.22
10402 140TH AVENUE EAST
534-96-9686
S
0.00
6.00
0.00
0.00
0.00
0.00 0.00
6.00
22.81
136.86
FICA
State W/H
34.91 Taxes
83.39
FLAGGER
0.00 Deducts
25.06
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
4.68 Net Pay
347.77
VACATION
14.00 Check #:
73099
UNION DUES
10.50
N.W.F.C.
0.56
Total Job Gross
456.22
D
0.00
4.00
0.00
0.00
0.00
0.00 0.00
4.00
45.62
182.48
WESTHOFF, BRANDON A
Ex: S-00 C M
O
0.00
4.00
0.00
0.00
0.00
0.00 0.00
4.00
34.22
136.88
Fed W/H
138.84 Gross
872.51
32831 17TH AVENUE SW
539-94-0605
S
0.00
6.00
0.00
0.00
0.00
0.00 0.00
6.00
22.81
136.86
FICA
66.75 Taxes
216.11
FLAGGER
State W/H
0.00 Deducts
56.39
FEDERAL WAY, WA 98023
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
10.52 Net Pay
600.01
VACATION
31.50 Check #:
73105
UNION DUES
23.63
N. W. F.C.
1.26
Total Job Gross
456.22
Page 4
CECCANTI, INC.
Pay Period Date:
11/24/07
Certified Payroll Report
Contract#:
WTR-27-3344
4116 BROOKDROAD EAST
Week Ending:
11/24/07
Job No:
658ALE
Payroll No:
10
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
18 19
20
21 22
23 24 Total
Rate Gross Pay
WHITE, JARED D
Ex: S-02 C M O
0.00 1.50
2.00
0.00 0.00
0.00 0.00 3.50
42.06 147.21
Fed W/H
93.06 Gross
820.17
350 B RYAN ROAD
538-06-0032 S
0.00 8.00
8.00
8.00 0.00
0.00 0.00 24.00
28.04 672.96
FICA
62.74 Taxes
164.98
GENERAL LABORER
State W/H
0.00 Deducts
210.76
BUCKLEY, WA 98321
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
9.18 Net Pay
444.43
CHILD SUPP
161.53
Check #:
73108
VACATION
27.50
UNION DUES
20.63
N.W.F.C.
1.10
Total Job Gross
820.17
WILHELM, MARK E
Ex: M-00 C M O 0.00 6.00 1.00 0.00 0.00 0.00 0.00 7.00 51.99 363.93 Fed W/H
263.78 Gross
1,750.33
28209 SE 430 STREET
535-88-4993 S 0.00 8.00 8.00 8.00 0.00 0.00 0.00 24.00 34.66 831.84 FICA
133.90 Taxes
408.03
FOREMAN State W/H
0.00 Deducts
44.43
ENUMCLAW, WA 98022
Local W/H
0.00 Add-Ons
0.00
Other Job Pay Wcomp/Sdi
10.35 Net Pay
1,297.87
WORKING DU
35.03
Check #:
73111
N.W. F.C.
9.40
Total Job Gross 1,195.77
Page 5
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 25 day of NOVEMBER, 2007 and ending the 1 day of
DECEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(�) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
�) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimiA d prosecutioJ. See Section 1001 of Title 18 and Sect n 231 of Title 31 of the United States Code.
Page I
CECCANTI, INC. Pay Period Date: 12/01/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 12/01/07 Job No: 658
Payroll No: 11 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
25
26
27
28 29
30
01
Total Rate Gross Pay
BRADSHAW, JOSEPH D
Ex: S-00 B M O
0.00
0.00
0.00
0.00 0.00
1.50
0.00
1.50 42.06 63.09
Fed W/H
216.88 Gross
1,184.69
1773 106TH ST SOUTH
539-88-0513 S
0.00
0.00
0.00
0.00 3.00
7.00
0.00
10.00 28.04 280.40
FICA
90.63 Taxes
321.36
FLAGGER
State W/H
0.00 Deducts
126.21
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.85 Net Pay
737.12
CHILD SUPP
51.92 Check #:
73128
VACATION
41.50
UNION DUES
31.13
N.W.F.C.
1.66
Total Job Gross
343.49
BURRELL, JOHN W, III
Ex: S-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
248.48 Gross
1,311.06
7904 206TH ST. CT E
531-04-4421 S
0.00
0.00
0.00
0.00 2.00
0.00
0.00
2.00
31.75
63.50
FICA
100.29 Taxes
363.47
TRUCK DRIVER
State W/H
0.00 Deducts
35.04
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.70 Net Pay
912.55
WORKING DU
26.24 Check #:
73133
N. W. F. C.
8.80
Total Job Gross
63.50
HASSON, KENNETH M
Ex: M-03 C M O
0.00
0.00
0.00
0.00 0.00
2.00
0.00
2.00
48.26
96.52
Fed W/H
140.24 Gross
1,383.32
12332 85TH AVENUE SOUTH
535-74-6766 S
0.00
0.00
0.00
0.00 3.00
7.00
0.00
10.00
32.17
321.70
FICA
105.83 Taxes
260.09
EXCAVATOR/6ACKHOE 3
State W/H
0.00 Deducts
36.05
SEATTLE, WA 98178
Local W/H
0,00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.02 Net Pay
1,087.18
WORKING DU
27.65
Check#:
73163
N. W. F. C.
8.40
Total Job Gross
418.22
HELM, JOSHUAH JAMES
Ex: M-01 N M O
0.00
0.00
0.00
0.00 2.00
1.00
0.00
3.00
35.73
107.19
Fed W/H
122.07 Gross
1,131.45
1318 EAST 35TH STREET
539-78-3747 S
0.00
0.00
0.00
0.00 8.00
8.00
0.00
16.00
23.82
381.12
FICA
86.56 Taxes
223.65
APPRENTICE/OPERATOR
State W/H
0.00 Deducts
31.62
TACOMA, WA 98404
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.02 Net Pay
876.18
WORKING DU
22.62 Check #:
73166
N.W. F.C.
9.00
Total Job Gross
488.31
NEIL, BRADLY J
Ex: M-01 C M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
151.62 Gross
1,328.41
2724 22ND CT. SE
531-06-1655 S
0.00
0.00
0.00
0.00 0.00
2.00
0.00
2.00
33.21
66.42
FICA
101.63 Taxes
255.20
EXCAVATOR/BACKHOE OV
State W/H
0.00 Deducts
34.58
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
1.95 Net Pay
1,038.63
WORKING DU
26.58 Check #:
73188
N. W. F. C.
8.00
Total Job Gross
66.42
Page 2
CECCANTI, INC.
Pay Period Date:
12/01/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
12/01/07
Job No:
658
Payroll No:
11
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
25
26
27
28 29
30 01
Total
Rate
Gross Pay
PAYNE, CHERYL
Ex: -01 C F
O
0.00
0.00
0.00
0.00 0.00
0.50 0.00
0.50
36.96
18.48
Fed W/H
140.75 Gross
945.52
9904 23RD AVE CT. S. K171
514-62-4858
S
0.00
0.00
0.00
0.00 0.00
8.00 0.00
8.00
24.64
197.12
FICA
72.33 Taxes
226.60
LB/FLAGGER
State W/H
0.00 Deducts
72.50
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.52 Net Pay
646.42
VACATION
40.50 Check #:
73192
UNION DUES
30.38
N. W. F. C.
1.62
Total Job Gross
215.60
PUGH, TROY KENNETH
Ex: S-01 C M
O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
158.47 Gross
1,016.40
2728 5TH AVE. NE
533-02-0277
S
0.00
0.00
2.00
0.00 3.00
0.00 0.00
5.00
24.64
123.20
FICA
77.76 Taxes
249.75
APT. #4
FLAGGER
State W/H
0.00 Deducts
72.50
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.52 Net Pay
694.15
VACATION
40.50 Check #:
73198
UNION DUES
30.38
N.W.F.C.
1.62
Total Job Gross
123.20
REYNOLDS, ROGER ALAN
Ex: M-00 C M
O
0.00
0.00
0.00
0.00 0.00
1.50 0.00
1.50
48.26
72.39
Fed W/H
260.51 Gross
1,359.19
5707 114TH AVE. CT. E.
537-58-0223
S
0.00
0.00
0.00
0.00 3.00
7.00 0.00
10.00
32.17
321.70
FICA
103.98 Taxes
378.34
OPERATOR/G2
State W/H
0.00 Deducts
35.47
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.85 Net Pay
945.38
WORKING DU
27.17 Check #:
73200
N. W. F. C.
8.30
Total Job Gross
394.09
TRUDEAU, DOUGLAS JAMES
Ex: M-04 C M
O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
52.95 Gross
866.79
1602 9TH AVENUE SE
022-52-5649
S
0.00
0.00
5.50
0.00 3.00
8.00 0.00
16.50
22.81
376.37
FICA
66.31 Taxes
131.95
FLAGGER
State W/H
0.00 Deducts
68.03
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.69 Net Pay
666.81
VACATION
38.00 Check #:
73212
UNION DUES
28.51
N. W. F. C.
1.52
Total Job Gross
376.37
Page 3
CECCANTI, INC.
Pay Period Date:
12/01/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
12/01/07
Job No:
658
Payroll No:
11
Job Name:
RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
25 26
27
28 29
30
01 Total
Rate Gross Pay
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M O
0.00 0.00
0.00
0.00 0.00
0.00
0.00 0.00
0.00 0.00
Fed W/H
14.71 Gross
262.32
10402 140TH AVENUE EAST
534-96-9686 S
0.00 0.00
0.00
0.00 0.00
6.00
0.00 6.00
22.81 136.86
FICA
State W/H
20.06 Taxes
38.61
FLAGGER
0.00 Deducts
20.59
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
3.84 Net Pay
203.12
VACATION
11.50 Check #: 73217
UNION DUES
8.63
N.W.F.C.
0.46
Total Job Gross
136.86
WESTHOFF, BRANDON A Ex: S-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 Fed W/H
174.48 Gross
1,015.06
32831 17TH AVENUE SW 539-94-0605 S 0.00 0.00 2.00 0.00 3.00 0.00 0.00
5.00 22.81 114.05 FICA
77.65 Taxes
266.48
FLAGGER
State W/H
0.00 Deducts
76.98
FEDERAL WAY, WA 98023
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.35 Net Pay
671.60
VACATION
43.00 Check #:
73222
UNION DUES
32.26
N. W. F. C.
1.72
Total Job Gross
114.05
Page 4
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 2 day of DECEMBER, 2007 and ending the 8 day of DECEMBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
Qe�—Sd
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or crimin rosecution. See Section 1001 of Title 18 and Secti f231 of Title 31 of the United States Code.
Page I
CECCANTI, INC. Pay Period Date: 12/08/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 12/08/07 Job No: 658
Payroll No: 12 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
02
03
04
05 06
07
08
Total Rate Gross Pay
BRADSHAW, JOSEPH D
Ex: S-00 B M 0
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00 0.00 0.00
Fed W/H
159.05 Gross
953.36
1773 106TH ST SOUTH
539-88-0513 S
0.00
0.00
0.00
0.00 8.00
0.00
0.00
8.00 28.04 224.32
FICA
72.93 Taxes
243.35
FLAGGER
State W/H
0.00 Deducts
112.78
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
11.37 Net Pay
597.23
CHILD SUPP
51.92 Check #:
73276
VACATION
34.00
UNION DUES
25.50
N. W. F. C.
1.36
Total Job
Gross
224.32
HASSON, KENNETH M
Ex: M-03 C M
0 0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
96.81 Gross
1,093.78
12332 85TH AVENUE SOUTH
535-74-6766
S 0.00
0.00
0.00
0.00 8.00
0.00
0.00
8.00
32.17
257.36
FICA
83.67 Taxes
191.84
EXCAVATOR/BACKHOE
3
State W/H
0.00 Deducts
28.69
SEATTLE, WA 98178
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
11.36 Net Pay
873.25
WORKING DU
21.89 Check #:
73308
N. W. F. C.
6.80
Total Job Gross
257.36
HELM, JOSHUAH JAMES
Ex: M-01 N M
0 0.00
1.00
2.00
0.00 0.00
0.00
0.00
3.00
38.10
114.30
Fed W/H
127.62 Gross
1,168.40
1318 EAST 35TH STREET
539-78-3747
S 0.00
8.00
8.00
0.00 0.00
8.00
0.00
24.00
25.40
609.60
FICA
89.38 Taxes
231.68
APPRENTICE/OPERATOR
State W/H
0.00 Deducts
32.14
TACOMA, WA 98404
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.68 Net Pay
904.58
WORKING DU
23.34
Check #:
73311
N. W. F. C.
8.80
Total Job Gross
723.90
PAYNE, CHERYL
Ex: -01 C F
0 0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
57.48 Gross
547.44
9904 23RD AVE CT. S. K171
514-62-4858
S 0.00
0.00
0.00
0.00 8.00
0.00
0.00
8,00
22.81
182.48
FICA
41.87 Taxes
107.37
LB/FLAGGER
State W/H
0.00 Deducts
42.96
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
8.02 Net Pay
397.11
VACATION
24.00 Check #:
73338
UNION DUES
18.00
N. W. F. C.
0.96
Total Job Gross
182.48
REYNOLDS, ROGER ALAN
Ex: M-00 C M
O 0.00
0.00
0.00
0.00 2.00
0.00
0.00
2.00
48.26
96.52
Fed W/H
234.37 Gross
1,254.64
5707 114TH AVE. CT. E.
537-58-0223
S 0.00
4.00
0.00
0.00 8.00
0.00
0.00
12.00
32.17
386.04
FICA
95.98 Taxes
343.06
OPERATOR/132
State W/H
0.00 Deducts
32.71
PUYALLUP, WA 98372
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.71 Net Pay
878.87
WORKING DU
25.11 Check #:
7.60
73346
N. W. F. C.
Total Job Gross
482.56
Pine 2
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: WTR-27-3344
1, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 9 day of DECEMBER, 2008 and ending the 15 day of DECEMBER,
2008, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(al WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
GNATURE
V\
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. S Section ] 001 of Title 18 and Section Iof Title 1 of the United States Code.
Page I
CECCANTI, INC.
Pay Period Date:
12/15/08
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
12/15/08
Job No:
658
Payroll No:
65
Job Name
RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
TUE WED THU
FRI SAT SUN MON
Deductions Totals
Employee
Work Class
09 10 11
12 13 14 15 Total
Rate Gross Pay
Total Job Gross
0.00
Page 2
Statement of Compliance
Date: JANUARY 23, 2008 Contract Number: VM-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 16 day of DECEMBER, 2007 and ending the 22 day of
DECEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
NATURE
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. gee Section 1001 of Title 18 and Section 2 1 of Title 31 of the United States Code.
Page 1
CECCANTI, INC. Pay Period Date: 12/22/07 Certified Payroll Report Contract#: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 12/22/07 Job No: 658
Payroll No: 14 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
16
17
18
19 20
21
22
Total Rate Gross Pay
HELM, JOSHUAH JAMES
Ex: M-01 N M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00 0.00 0.00
Fed W/H
104.76 Gross
1,016.00
1318 EAST 35TH STREET
539-78-3747 S
0.00
8.00
0.00
0.00 0.00
0.00
0.00
8.00 25.40 203.20
FICA
77.72 Taxes
195.83
APPRENTICE/OPERATOR
State W/H
0.00 Deducts
28.30
TACOMA, WA 98404
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.35 Net Pay
791.87
WORKING DU
20.30 Check #:
73546
N. W. F. C.
8.00
Total Job
Gross
203.20
Pugs 2
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 10 / 27 / 07
NAME OF SUBCONTRACTOR
10-011 a0F41i1ITMWill 1Y]
Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 21 st Day of October , 2007 and ending
on the 27th Day of October , 2007.
SIGNED:
Authorized Representative
M
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
[NOV - a 2ou7
P--EF-CEIVED
Y:
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 11 / 10 / 07
NAME OF SUBCONTRACTOR
DATE: November 15, 2007
Meriwether Leachman Associates. Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 4th Day of
on the 10th Day of November , 2007.
7'�
SIGNED: 4'2
„_
4Z
Authorized Representative
TITLE:
ON
November , 2007 and ending
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 11 / 17 / 07 DATE: November 20, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 11" Day of November , 2007 and ending
on the 17`h Day of November , 2007.
�D
y
SIGNED: /'�
Authorized Representative
TITLE: V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
DEC - g 2007
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 11 / 24 / 07 DATE: November 29, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-
During the period commencing on the 18th Day of
on the 24th Day of November , 2007.
SIGNED: A4'9_�Xz
�
Authorized Representative
Ifs
November , 2007 and ending
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 12 / 01 / 07 DATE: December 6, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 25" Day of November , 2007 and ending
on the 1 " Day of December , 2007.
SIGNED: A4'Maz
Authorized Representative
TITLE: V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 12 / 08 / 07
NAME OF SUBCONTRACTOR
DATE: December 13, 2007
Meriwether Leachman Associates. Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 2n" Day of December , 2007 and ending
on the 8" Day of December , 2007.
/lD `1az
SIGNED: /�—
Authorized Representative
TITLE:
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 12 / 15 / 07 DATE: December 20, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
RECEIVED
DEC 2 1 2007
BY:�_
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 9`h Day of December , 2007 and ending
on the 15th Day of December 2007.
SIGNED: A�4 D
Authorized Representative
TITLE: V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
RECEIVED
JAN - 3 2008
'3Y:
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 12 / 22 / 07 DATE: January 2, 2008
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 16'h Day of December , 2007 and ending
on the 22nd Day of December , 2007.
cc�Q ��
SIGNED: /1
Authorized Representative
TITLE:
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 12 / 29 / 07 DATE: January 2, 2008
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
-��lllx�i�►[�1►�1:3 �
During the period commencing on the 23" Day of December , 2007 and ending
on the 29'h Day of December , 2007.
D
u�
SIGNED: ��
Authorized Representative
TITLE: V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 01 / 05 / 08 DATE: January 10, 2008
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 30" Day of December , 2007 and ending
on the 5" Day of January , 2008.
AJ�04Z
SIGNED:
Authorized Representative
TITLE: V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 01 / 12 / 08
NAME OF SUBCONTRACTOR
DATE: January 17, 2008
Meriwether Leachman Associates. Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 6" Day of January , 2008 and ending
on the 12" Day of January , 2008.
SIGNED: A�AZAWZ
Authorized Representative
TITLE:
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
Statement of Compliance
Date: NOVEMBER 2, 2007 Contract Number:
1, Tanya Johnson, Payroll Admin do hereby state.
(1) That 1 pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 21 day of OCTOBER, 2007 and ending the 27 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interwest Development NW, Inc. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat, 967, 76 Stat. 357, 40 U.S.C. 276c), and described below:
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period arc duly registered in a bona tide apprenticeship program registered with it State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
( X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced pay roll. payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit ofsuch employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
( X) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
!ci EXCEPTIONS
EXCEPTION (Craft)
EXPLANA f1ON
t1 MARKS
NAME AND TITLE:
Tanya Johnson, Payroll Admin
SIG TURE
The willful falsification of anv of the above statements may subject the contractor or subcontractor to civil or criminal pros tgion. See . [ion 100 of 71 ) R and Sccn n 231 of Title 31 of the United States Code.
Page I
Interwest Development NW, Inc.
Pay Period Date:
10/27/07
Certified Payroll Report
Contract#:
1425 22ND Street NW,
Week Ending:
10/27/07
Job No:
07-460
Suite E
Payroll No
6
Job Name:
Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
21
22
23
24 25
26 27
Total
Rate
Gross Pay
Bohren, LaRae M
Ex: -01 F O
0.00
0.00
0.00
0.00 1.50
0.00 0.00
1.50
28.50
42.75
Fed W/H
2O8.73
Gross
1,193.46
2501 David Ct E
532-84-5480 S
0.00
4.50
0.00
0.00 4.00
0.00 0.00
8.50
19.00
161.50
FICA
93.13
Taxes
303.64
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
Fife, WA 98424
Local W/H
0.0o
Add-Ons
24.00
Other Job Pay
Wcomp/Sdi
1.78
Net Pay
913.82
Check #:
77942
Cam
, 1 `�L
Total Job Gross
204.25
Bohren, LaRae M
Ex: -01 F 0
0.00
0.00
0.00
0.00 2.00
0.00 0.00
2.00
54.93
109.86
Fed W/H
2O8.73
Gross
1,193.46
2501 David Ct E
532-84-5480 S
0.00
4.00
0.00
0.00 0.00
0.00 0.00
4.00
36.62
146.48
FICA
93.13
Taxes
303.64
KC Tr & Trlr 03/07
Frin a Ad ustme
g
3.00
18.00
State W/H
Local W/H
0.00
0.00
Deducts
0.00
Fife, WA 98424
Add-Ons
24.00
Other Job Pay
Wcomp/Sdi
1.78
Net Pay
913.82
Check #:
77942
Total Job Gross
274.34
BRAUDWAY, DENNIS E
Ex: M-00 C M 0
0.00
000
000
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
191.10
Gross
1,454.85
P. O BOX 983
536-46-6696 S
0.00
000
1 25
0.00 0.00
0.00 0.00
1.25
36.62
45.78
FICA
111.65
Taxes
30434
KC Tr & Trlr 03/07
Frin a Ad ustme
g
0.12
0.16
State W/H
Local W/H
0.00
0.00
Deducts
6.00
GRAHAM, WA 98338
'Health Fringe
2.87
3.59
Wcomp/Sdi
1.59
Add-Ons
10.75
Dom - 24203 69830TH AVE E
Other Job Pay
Short Term
6.00
Net Pay
1,155.26
Check #:
77947
GRAHAM, WA 98338
Total Job Gross
45.94
*Non -cash benefits
3.59
DETRICK, CRAIG J
Ex: M-00 M 0
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
288.54
Gross
1,397.80
331 MAIN ST
538-74-0508 S
0.00
0.00
2.75
0.00 0.00
0.00 0.00
2.75
36.62
100.71
FICA
112.56
Taxes
402,80
KC Tr & Trlr 03/07
Frin e Ad ustme
g
3.00
8.25
State W/H
Local W/H
0.00
0.00
Deducts
0.00
BUCKLEY, WA 98321
Wcomp/Sdi
1.70
Add-Ons
73.50
Other Job Pay
Net Pay
1,068.50
Check #:
77961
Total Job Gross
108.96
LACY, DARRYL R
Ex: M-02 C M 0
0.00
000
000
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
131.62
Gross
1,418.70
2213 E 67TH ST
532-88-4720 S
000
0.00
1 75
0.00 0.00
0.00 0.00
1.75
36.62
64.09
FICA
96.42
Taxes
229.81
KC Tr & Trlr 03/07
Fringe Adjustme
0.66
1.16
State W/H
Local W/H
0.00
0,00
Deducts
170.08
TACOMA, WA 98404
'Health Frin e
g
2.34
4.10
Wcomp/Sdi
1.77
Add-Oay
11.89
Other Job Pay
Net Pay
1,030.70
HEALTH COV
164.08
Check #:
77983
Short Term
6.00
Total Job Gross
65.25
'Non -cash benefits
4.10
Page 2
Interwest Development NW, Inc
Pay Period Date:
10/27/07
Certified Payroll Report
Contract#:
1425 22ND Street NW,
Week Ending:
10/27/07
Job No:
07-460
Suite E
Payroll No
6
Job Name:
Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Employee
Work Class
21
22
23
24 25
26 27
Total
Rate
Gross Pay
Deductions
Totals
LENSS, GARY DEAN
Ex: -02 M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
2O4.61
Gross
1,214.61
1030 S 63RD ST
537-58-7353 S
0.00
4.25
0.00
0.00 0.00
0.00 0.00
4.25
18.00
76.50
FICA
96.87
Taxes
303.10
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
TACOMA, WA 98408
Local W/H
0.00
Add-Ons
51.75
Other Job Pay
Wcomp/Sdi
1.62
Net Pay
963.26
Check #:
77986
`
Total Job Gross
76.50
LENSS, GARY DEAN
Ex: -02 M O
0.00
0.00
0.00
0.00 0.00
1.25 0.00
1.25
54.93
68.66
Fed W/H
2O4.61
Gross
1,214.61
1030 S 63RD ST
537-58-7353 S
0.00
4.00
0.00
4.50 0.00
0.00 0.00
8.50
36.62
311.27
FICA
96.87
Taxes
303.10
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
29.25
State W/H
0.00
Deducts
0.00
TACOMA, WA 98408
Local W/H
o.00
Add-Ons
51.75
Other Job Pay
Wcomp/Sdi
1,62
Net Pay
963.26
Check #:
77986
Total Job Gross
409 18
PATTERSON, CHRIS M, MR.
Ex: S-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0-00
0.00
0.00
Fed W/H
255.57
Gross
1,321-90
3040 DIVISION ST.
532-90-6990 S
0.00
0.00
1.75
0.00 0.00
0.00 0.00
1.75
36.62
64.09
FICA
102.47
Taxes
359.65
KC Tr & Trlr 03/07
Fringe Adjustme
0.72
1.26
State W/H
0.00
Deducts
132.40
ENUMCLAW, WA 98022
'Health Fringe
2.28
3.99
Local W/H
0.00
Add-Ons
23.46
Other Job Pay
Wcomp/Sdi
1.61
Net Pay
853.31
Gam. Fixe
126.48
Check #:
77ggg
Short Term
5.92
Total Job Gross
65.35
'Non -cash benefits
3.99
TESTER, JAMES L
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
137.24
Gross
1,257,36
34705 52nd AVE SO
539-56-5257 S
0.00
7.00
4.00
0.00 0.00
0.00 0.00
11.00
22.79
250.69
FICA
89-29
Taxes
228.08
Grp 1 Truck Driver
State W/H
0.00
Deducts
101.44
AUBURN, WA 98001
Local W/H
0.00
Add-Ons
11.25
Other Job Pay
Wcomp/Sdi
1.55
Net Pay
939.09
HEALTH COV
98.73
2.71
Check #:
78014
Total Job Gross
250.69
Vision Ded
TESTER, JAMES L
Ex: M-00 C M O
0.00
000
000
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
137.24
Gross
1,257.36
34705 52nd AVE SO
539-56-5257 S
0.00
000
475
4.50 0.00
0.00 0.00
9.25
36.62
338.74
FICA
89.29
Taxes
228.08
KC Tr & Trlr 03/07
Health Fringe
3.85
35.62
State W/H
0.00
Deducts
101 A4
AUBURN, WA 98001
Local W/H
0.00
Add-Ons
11.25
Other Job Pay-
Wcomp/Sdi
1.55
Net Pay
939.09
HEALTH COV
98-73
Check #:
78014
Vision Ded
2.71
Total Job Gross
338.74
*Non -cash benefits
35.62
Page 3
Statement of Compliance
Date: NOVEMBER 9, 2007 Contract Number:
I, Tanya Johnson, Payroll Adtnin do hereby state:
(1) That I pay or supervise the payment of the persons employed by Interest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 28 day of OCTOBER, 2007 and ending the 3 day of NOVEMBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interest Development NW, Inc. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat, 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below:
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recogmzed by the Bureau of Apprenticeship and Training, United States Department of
Labor. or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and 'I'raining, United States Department of Labor.
(4) That:
(a) WHERE. FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
( X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE: FRINGE BENEFITS ARE PAID IN CASH
( X) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
XPI ANA I ION
REMARKS
NAME AND TITLE
Tanya Johnson, Pavr011 Adrnin
SIGNATURE
J\I\ 'eb*jyus'p�
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pr secution. S ection n8 and Sect n 231 of Title 31 of the Iinited States Code
I'age I
Interwest Development NW, Inc. Pay Period Date: 11/03/07 Certified Payroll Report Contract#:
1425 22ND Street NW, Week Ending. 11/03/07 Job No: 07-460
Suite E Payroll No: 7 Job Name: Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee Work Class
28
29
30
31 01
02
03
Total Rate Gross Pay
LENSS, GARY DEAN Ex: -02 M O
0.00
0.00
000
0.00 0.75
7.00
0.00
7.75 27.00 209.25
Fed W/H
218.13
Gross
1,268.68
1030 S 63RD ST 537-58-7353 S
0.00
000
2.00
2.00 5.25
0.00
0.00
9.25 18.00 166.50
FICA
State W/H
101.02
Taxes
320.90
Grp 1 Truck Driver
Local W/H
0.00
0.00
Deducts
0.00
TACOMA, WA 98408
Wcomp/Sdi
1.75
Add-Ons
51.75
Other Job Pay
Net Pay
999.53
, � �,'�'1 l �
Gross
375.75
Check#:
7$072
Total Job
LENSS, GARY DEAN Ex: -02 M O 0.00 0.00 0.00 0.00 0.00 1.50 0.00
1.50 54.93 82.40
Fed W/H
218.13
Gross
1,268.68
1030 S 63RD ST 537-58-7353 S 0.00 0.00 4.00 4.25 2.75 0.00 0.00
11.00 36.62 402.83
FICA
101.02
Taxes
320.90
KC Tr & Trlr 03/07 Fringe Ad ustme
9 �
3.00 37.50
State W/H
Local W/H
0.00
0.00
Deducts
.
TACOMA. WA 98408
Wcomp/Sdi
1 75
Add-Ons
51.75
Other Job Pay
Net Pay
999.53
Check #:
78072
Total Job Gross
522.73
(utr
Statement of Compliance
Date: NOVEMBER 16, 2007
1, Tanya Johnson, Payroll Admin do hereby state:
Contract Number:
(1) That 1 pay or supervise the payment ofthe persons employed by lnterwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 4 day ol'NOVEMBER, 2007 and ending the 10 day of NOVEMBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interest Development NW, Inc. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108. 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276e), and described below:
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract, that the classifications set forth therein f'or each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency cot is in a State, are registered with the Bureau of Apprenticeship and Training. United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFIT S ARE PAID TO APPROVED PLANS.. FUNDS, OR PROGRAMS
( X) In addition to the basic hourly wake rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees. except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
( X) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract. except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANA PION
REMARKS
NAME AND TITLE
Tanya Johnson, Payroll Admin
SIGNATURE
The willful falsification of arty of the above statements may subject the contractor or subcontractor to civil or criminal prose ution. See Se n 1 I of Tit 8 and Section 31 of Title I of the United States Code.
Puge /
Interwest Development NW, Inc.
Pay Period Date: 11/10/07
Certified Payroll Report
Contract#:
1425 22ND Street NW,
Week Ending: 11/10/07
Job No
07-460
Suite E
Payroll No:
8
Job Name
Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
04 05
06
07 08
09 10
Total
Rate
Gross Pay
Bohren, La Rae M
Ex: -01 F O
0.00 0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
307.07
Gross
1,522.29
2501 David Ct E
532-84-5480 S
0.00 0.00
0.00
0.00 2.25
0.00 0.00
2.25
19.00
42.75
FICA
State W/H
122.70
Taxes
431.52
Grp 1 Truck Driver
Local W/H
0.00
0.00
Deducts
0.00
Fife, WA 98424
Wcomp/Sdi
1.75
Add-Ons
81.75
-�
Other Job Pay
Net Pay
1,172.52
Check #:
78115
Total Job Gross
42.75
Bohren, LaRae M
Ex: -01 F O
0.00 0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
307.07
Gross
1,522.29
2501 David Ct E
532-84-5480 S
0.00 8.25
7.25
0.00 0.00
0.00 0.00
15.50
36.62
567.62
FICA
122.70
Taxes
431.52
KC Tr & Trlr 03/07
Frin e Ad'ustme
9
3.00
46.50
State W/H
Local W/H
0.00
0.00
Deducts
0.00
Fife, WA 98424
Wcomp/Sdi
1.75
Add-Ons
81.75
Other Job Pay
Net Pay
1,172.52
Check #:
78115
Total Job Gross
614 12
CLARK, CHARLES F
Ex: M-01 C M O
000 000
000
0.00 0.00
000 0.00
000
0 00
0 00
Fed W/H
218.98
Gross
1.551.00
913 132ND ST
567-49-4772 S
000 000
000
0.00 2.25
0.00 0.00
2 25
1800
40 50
FICA
State W/H
125.19
Taxes
345.96
Grp 1 Truck Driver
Local W/H
0.00
0.00
Deducts
0.00
TACOMA, WA 98445
Wcomp/Sdi
1.79
qdd-Ons
85.50
'Ckcc�'/
Other Job Pay
Net Pay
1,290.54
� I
�
Total Job Gross
4050
Check #:
78125
l
CLARK, CHARLES F
Ex: M-01 C M O
0.00 0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
218.98
Gross
1,551.00
913 132ND ST
567-49-4772 S
0.00 8.25
6.25
0.00 0.00
0.00 0.00
14.50
36.62
531.00
FICA
125.19
Taxes
345.96
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
43.50
State W/H
Local W/H
0.00
0.00
Deducts
0.00
TACOMA, WA 98445
WcomplSdi
1-79
Add-Ons
85.50
Other Job Pay
Net Pay
1.290.54
Check #:
78125
Total Job Gross
574.50
HORGAN, WADE W
Ex: M-06 C M O
000 000
000
000 0 00
000 0.00
0.00
0.00
0.00
Fed W/H
58.87
Gross
1,021.26
26611 MERIDIAN AVE E
502-82-1546 S
000 0.00
2.00
0.00 0.00
000 0.00
2.00
18.00
36.00
FICA
State W/H
79.33
Taxes
139.92
Grp 1 Truck Driver
Local W/H
0.00
0.00
Deducts
0.00
GRAHAM, WA 98338
Wcomp/Sdi
1.72
Add-Ons
15.75
Other Job Pay
Net Pay
897.09
Check #:
78146
O+Ock
��
Total Job Gross
36.00
Page 2
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 11/10/07
Week Ending: 11/10/07
Payroll No. 8
Certified Payroll Report
Contract #:
Job No: 07-460
Job Name Waterline Relocation
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
04
05
06
07 08
09 10
Total Rate
Gross Pay
HORGAN, WADE W
Ex: M-06 C M O
0.00
000
0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00
Fed W/H
58.87
Gross
1,021.26
26611 MERIDIAN AVE E
502-82-1546 S
0.00
000
5.25
0.00 0.00
0.00 0.00
5.25 36.62
192.26
FICA
State W/H
79.33
Taxes
139.92
KC Tr & Trlr 03/07
Fringe Ad ustme
9 �
3.00
15.75
Local W/H
0.00
0.00
Deducts
.00
GRAHAM, WA 98338
Wcomp/Sdi
1.72
Add-Ons
15.75
Other Job Pay
Net Pay
897.09
Check #:
78146
Total Job Gross
208.01
LENSS, GARY DEAN Ex: -02 M O 0.00 000 0.00 0.00 0.00 0.00 0.00
0.00 0.00 000 Fed W/H
172.68
Gross
1,081.65
1030 S 63RD ST 537-58-7353 S 000 0.00 0.00 0.00 2.50 0.00 0.00
2.50 18.00 45.00
80 11
Taxes
261.23
Grp 1 Truck Driver
StateFICA W/H
Deducts
0.00
TACOMA, WA 98408
Local W/H
0.00
Add-Ons
57.00
Other Job Pay
Wcomp/Sdi
1.44
Net Pay
877.42
Check #:
78155
O� \ Total Job Gross
45.00
WEAVER, DANIEL PAUL
Ex: -01 M O 000 000 000 000 0.00 0.00 000
0.00 0.00 0.00 Fed W/H
236.79
Gross
1,272.70
11704 101 ST AVE E
537-82-9726 S 0.00 000 000 000 2.25 0.00 000
2.25 18.00 4050 FICA
State W/H
101.72
Taxes
340.22
Grp 1 Truck Driver
0.00
Deducts
0.00
PUYALLUP, WA 98373
Local W/H
0.00
Add-Ons
57.00
Other Job Pay
Wcomp/Sdi
1.71
Net Pay
989.48
Check #:
78185
Total Job Gross
40.50
Page 3
Statement of Compliance
Date: NOVEMBER 23, 2007 Contract Number:
I, Tanya Johnson. Payroll Admin do hereby state:
(1) That I pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the I I day of NOVEMBER, 2007 and ending the 17 day of NOVEMBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interwest Development NW, Inc. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland yes ame d. 948.63 Slat. 108, 72 Slat. 967; 76 Slat. 357; 40 U.S.0 276c)_ and described below:
1
:3d
r✓ r -.1 I
(2) 1 ptry roll. will tiise under this contract required to be submitted for the above period are correct and complete: that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determi n incorporate o the contract; that the classifications set birth therein for each laborer or mechanic conform with the work he performed
(3) That any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE. FRINGE 1ENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
( X I In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WIIERL ERINOF BENEFITS ARE PAID IN CASH
( X) Lach laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
a Imed in the contract, except as noted in Section 4(c) below.
(c) tiXCl;'P'rlltr<,�
EXCEPTION (Craft)
REMARK~
NAME AND TFITF. SIGNATURE
Tanya Johnson. Payroll Admin
The willful talsitication of anv of the above statements may subject the contractor or subcontractor to civil or criminal pros cation. See tion IOPI of
FXPLANATION
8 and SectioA231 ofTitle 31 of the l:mted States Code.
Pate l
Interwest Development NW, Inc. Pay Period Date: 11/17/07 Certified Payroll Report Contract#:
1425 22ND Street NW, Week Ending: 11/17/07 Job No: 07-460
Suite E Payroll No: 9 Job Name. Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAl
Deductions
Totals
Employee
Work Class
11
12
13
14 15
16
17
Total Rate Gross Pay
Bohren, LaRae M
Ex: -01 F O
000
0.00
0.00
0.00 0.00
0.00
000
0.00 0.00 0.00
Fed C
FICA
172.98
Gross
2501 David Ct E
532-84-5480 S
0.00
0.00
0.00
1.00 0.00
0.00
000
1.00 19.00 19.00
72.00
Taxes
215.17
210.00
Grp 1 Truck Driver
Local W/H
0.00
Deducts
Add-Oay
8.25
36.65
Fife, WA 98424
Other Job Pay
Wcomp/Sdi
1.37
Net Pay
736.65
�^-�.
J
�\ \,t--
Check #:
78198
Total Job Gross
19.00
Bohren, LaRae M
Ex: -01 F O 0.00
0.00
000
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
142.82
Gross
915.57
2501 David Ct E
532-84-5480 S 0.00
000
0.00
5.75 0.00
0.00 0.00
5.75
36.62
210.57
FICA
State W/H
72.98
0.00
Taxes
217.17
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
17.25
Local W/H
0.00
Deducts
Add-Ons
0.00
38.25
Fife, WA 98424
Other Job Pay
Wcomp/Sdi
1.37
Net Pay
736.65
Check #:
78198
Total Job Gross
227.82
COLLINS III, ROBERT E
Ex: M-00 C M O 0.00
0-00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
FICA
98.54
Gross
915.19
10121 83rd AVE CT E
277-64-5264 S 0.00
0.00
2.00
2.50 0.00
0.00 0.00
4.50
22.56
101.52
State W/H
77.21
0.00
Taxes
177.05
Grp 1 Truck Driver
P
Local W/H
0.00
Deducts
Add-Oy
7.43
101.43
PUYALLUP, WA 98373
Other Job Pay
Wcomp/Sdi
1.30
Net Pay
832.14
HEALTH COV
7.43
Check #:
78211
``Ie
Total Job Gross
101.52
COLLINS III, ROBERT E
Ex: M-00 C M O 0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
FICA
98.54
Gross
915.19
10121 83rd AVE CT E
277-64-5264 S 0.00
0.00
4.00
2.75 0.00
0.00 0.00
6.75
36.62
247.19
State W/H
77.21
0.00
Taxes
177.05
KC Tr & Trlr 03107
Fringe Adjustme
0.13
0.88
Local W/H
0.00
Deducts
Add-Ons
7.43
101.43
PUYALLUP, WA 98373
Other Job Pay
'Health Fringe
2.86
19.37
Wcomp/Sdi
1.30
Net Pay
832.14
HEALTH COV
7.43
Check #:
78211
Total Job Gross
248.07
'Non -cash benefits
19.37
LENSS, GARY DEAN
Ex: -02 M O 0,00
0.00
000
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
FICA
130.98
Gross
923.08
1030 S 63RD ST
537-58-7353 S 0.00
0 00
2 75
2.00 0.00
0.00 0.00
4.75
18.00
85.50
State W/H
74.34
000
Taxes
206.60
Grp 1 Truck Driver
Local W/H
000
.
Deducts
Add-O
0.00
48.75
75
TACOMA, WA 98408
Other Job Pay
Wcomp/Sdi
1.28
Net Paayy
.
765.23
Check #:
78240
\ e-
Total Job Gross
85.50
Page 2
a
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 11/17/07
Week Ending: 11/17/07
Payroll No: 9
Certified Payroll Report
Contract #:
Job No: 07-460
Job Name Waterline Relocation
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
11
12
13
14 15
16 17
Total Rate
Gross Pay
LENSS, GARY DEAN
Ex: -02 M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00
Fed W/H
130.98
Gross
923.08
1030 S 63RD ST
537-58-7353 S
0.00
0.00
4.00
4.25 0.00
0.00 0.00
8.25 36.62
302.12
FICA
State W/H
74.34
0.00
Taxes
206.60
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
24.75
Local W/H
0.00
Deducts
Add.-Ons
0.00
48.75
TACOMA, WA 98408
Other Job Pay
Wcomp/Sdi
128
Net Pay
765.23
Check #:
78240
Total Job Gross
326.87
RICE, GWYNN E
Ex: S-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0,00
0.00
0.00
0.00
Fed W/H
72.79 Gross
918.45
8504-194th St E
531-36-3563 S
0.00
0.00
3.50
0.00 0.00
0.00 0.00
3.50
36.62
128.17
FICA
State W/H
62.25 Taxes
0.00
136.21
KC Tr & Trlr 03/07
'Health Fringe
3.28
11.48
Local W/H
Deducts
0.00
334.34
SPANAWAY, WA 98387
Wcomp/Sdi
Add-Ons
1.17
0.00
Other Job Pay
Net Pay
447.90
401 K Emplo
229.61 Check #:
98.73
78257
HEALTH COV
Short Term
6.00
Total Job Gross
128.17
'Non -cash benefits
11.48
TESTER, JAMES L
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
88.46 Gross
946.53
34705 52nd AVE SO
539-56-5257 S
0.00
4.00
0.00
0.00 0.00
0.00 0.00
4.00
22.79
91.16
FICA
State W/H
64.40 Taxes
000
154.35
Grp 1 Truck Driver
Local W/H
0.00 Deducts
Add-o.00
10
3.
AUBURN, WA 98001
Other Job Pay
Wcomp/Sdi
1.49 Net Pay
687.60
HEALTH COV
98.73 Check #
78269
Short Term
6.00
-
Vision Ded
2.85
Total Job Gross
F
91.16
Page 3
2-,()'c2°-?6vtl
U.S. Department of Labor
Employment Standards Administration
Wage and Hour Division
PAYROLL
(For Contractor's Optional Use; See Instructions, Form WH-347 Inst.)
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
4P
Rev. April 2006
NAME OF CONTRACTOR OR SUBCONTRACTOR ® ADDRESS 3719 70TH AVE E BLDG B OMB No.: 1215-0149
HOLOCENE DRILLING INC FIFE WA 98424 Expires: 04/30/2009
PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO.
1 INITIAL 10/20/2007 WATERLINE RELOCATION CITY OF RENTON CAG-07-140
(1)
NAME, ADDRESS, AND
SOCIAL SECURITY NUMBER
OF EMPLOYEE
(2)
6 6
z 3 0
(3)
WORK
CLASSIFICATION
(4)DAY AND DATE
(5)
TOTAL
HOURS
(6)
RATE
OF PAY
(7)
GROSS
AMOUNT
EARNED
(a)
DEDUCTIONS6II
(9)
NET
WAGES
PAID
FOR WEEK
S
M
T
W
T
F
S
0 14
15
16
17
18
19
20
FICA
WITH-
HOLDING
TAX
OTHER
TOTAL
DEDUCTIONS
HOURS
WORKED EACH DAY
JAY A GRAHAM
OWNER
0
Z]
-
s
0
s
0
s
0
s
0
s
0
s
0
s
0
s
The Copeland Act (40 U.S.C. 3145) requires contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee during the
preceding week." U.S. Department of Labor (DOL) Regulations 29 CFR Part 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project, accompanied by
a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper Davis -Bacon prevailing wage rate for the work performed. Compliance
with these requirements is mandatory. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
We estimate that it will take an average of 56 minutes to complete this collection of information, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. If you have any comments regarding these estimates or any other aspect of this collection of information, Including suggestions for reducing this burden, send them to the Administrator, Wage and
Hour Division, ESA, U. S. Department of Labor, Room S3502, 200 Constitution Avenue, N. W., Washington, D. C. 20210.
Date 12/04/2007
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
DONNA THRALL ADMINISTRATIVE ASSISTANT
l
❑ — Each laborer or mechanic listed in the above referenced payroll has been paid,
as indicated on the payroll, an amount not less than the sum of the applicable
(Name of Signatory Party) (Title)
do hereby state:
basic hourly wage rate plus the amount of the required fringe benefits as listed
in the contract, except as noted in Section 4(c) below.
(1) That I pay or supervise the payment of the persons employed by
HOLOCENE DRILLING INC
on the
(c) EXCEPTIONS
EXCEPTION (CRAFT)
EXPLANATION
(Contractor or Subcontractor)
WATERLINE RELOCATION CITY OF Renton ; that during the payroll period commencing on the
(Building or Work)
14 day of 10 2007 and ending the 20 day of 10 2007
all persons employed on said project have been paid the full weekly wages earned, that no rebates have
been or will be made either directly or indirectly to or on behalf of said
HOLOCENE DRILLING INC
from the full
(Contractor or Subcontractor)
weekly wages earned by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part
3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948,
63 Start. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below:
FIT
FICA
MED
REMARKS.
(2) That any payrolls otherwise under this contract required to be submitted for the above period are
correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the
applicable wage rates contained in any wage determination Incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor, of if no such recognized agency exists in a
State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
NAME AND TITLE
SIZTURE
— in addition to the basic hourly wage rates paid to each laborer or mechanic listed in
DONNA THRALL
ADMINISTRATIVE ASSISTANT
/`IJ1
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
the above referenced payroll, payments of fringe benefits as listed In the contract
have been or will be made to appropriate programs for the benefit Of Such
SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE
31 of THE UNITED STATES CODE.
employees, except as noted in Section 4(c) below.
' U.S. G. P.0.1997 519.861
Dcpartmcnt of Labor and Industries
Employment Standard s Program
PO Box 44510
t7lytnpja WA 985044510
(360)902-5316
CERTIFIED PROJECT PAYROLL
PtujM X laoie County Project or Contraalt
Benson Road Water Une, Relocatla King WTR-27-3344
Project Address City state
3ubcuntsactor
21
Benson Road Renton WA
Awarding Agency Name Phone Company Naema phana
FaTthe wtokendjn : 1 City of Renton Strong Trucking, inc. (253�_ 77-0691
_
Month Day Year � Addreas City Stara ZIP+4 Addrass City State ZIPFJ
11 / 22 / 07 1055 South Grady Way Renton WA 96055 PO Sox 1706 Milton WA 98354
av and Date Deductions i
Work Classification Name g Sun Man Tue, Wed Thu Fri Sat Total Rate Gross
and and go Amount Withhold L&I hladiu
to �I 19 19 2D 21 Zi 1 Ilouiy of Pay
a
S.oc Sec4 of Employee Address o� FAmed -ia8 Tax an NET
i
Hours Worked Each Day FICA WAGES
Driver
Aaron Strong
OT
i aw
I
0A0
PO Box 1709
S
25.79
43.00
0.33
6.03
S 333,84
RG
;,QO
6,30
10.�0
39.62
534-Q-1522
Milton, WA98.3M
d16.0L
Drlver
Trever Tobel OT
i
0.00
0.00
�
36001 3E Country Road �
S
23.79
0.00
4.42
6.03
S 379.77
4.00
6.50
10.50
39.62
531 �92-5915
Ravensdale. WA 98051 RG
416-01
oT
0,00
0.00
S
S
RG
0 �
0.00
,
a
OT
0.00
0.00
'S
S
RG
I
000
0.00
OT
0.00
o_oo
S
RG
0.00
0.00
OT
0.00
--
0,00
S
S
RG
l 0,00
0,00
TOT
0.00
0,00
3
f
s
I
S
$
RG
J
I 0.00
0.00
r
oT
I
0.00
o.Go
I
I
$
RG
!
r
I
0.00
i
0.00
OT l
I
_
0, 00
0.00
RG
i
0.00
0.00
t
ar
j
0.00
0.00
S
RG
*.00
;
O.00
F700-065-000 certified project paroii 10-01 Enfloyee Besr )%Distribution and SipiaUrre Cerdficatftm on Reverse
Dgnrtmaat orLax"Irdastrie3
Eraploymot Star&-& Prcvwn
Otympia%% 9SJOI-4510
(I)
AFFIRMATION
Today's Date Mama Of signatory party Title
12'07?21707 Aaron Strong President
The above iignatoryy pays or sttperviws (Xnme of um tractor or subcontractor)
[lie payment of the perscAm employrd by, Stron "fruckin , Inc.
Name of building or work projr ct Payroll period stnnrRg Payroll period coding
Denson Walar Line Rcclosalion I l/ 16MG7 I I V22!2007
All persons employed on above project have been paid the bill +rcckly wages earned, that no rebates have/will he made either directly or indirectly to or on behalf of
the above contractor or subcontractor from the weekly wages earned by any person and that no deduolion have been made either directly or indirectly from the full
tva es earned by any person, other thtmissible deilvction
(2) That any payroll odic revise inder this contract required to be submitted for the above period art) corToct and complete, that the wage rates for laborers or mecl=ic9 contained therein Oro
nor less Ihon rho applicable wage rates contained in any wage determination incorpotatod into t1w contract, that the classifications get forth therein for oath laborer or mochrnic
conforms with the wark he periormed.
(3) That arty- apprentices employed in the above period are duly registered in a bona fide apprenticeship pmgram registered "ith a State apprcnticuship agvncy.
That
(•I) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ' to addition to the basic hourly Svage rates paid to each l Oborer or mechanic listed in
the abovo referenced payroll, payments of fringe benefits as listed below have been ar will be tttade to appropriate programs for Eire bertotits of such employees.
The wlttful faMfleatlon of any of the above statements may subject fie contractor to civil or MmInatl prwecutlon,
Print or type llama of signatory Title Signature
Aaron Strong President—'-5—"'
BENEFIT DISTRIBUTION (Please report in "per how" terms)
P700-065 backer 10-01
CECCliNT1
January 23, 2008
Andrew Weygandt
City of Renton PBPW - Water Utilities
Renton City Hall - 5th Floor
1055 South Grady Way
Renton, WA 98057
Re: # 658 — Benson Road Water Line Relocation
Dear Andrew:
RECEIVED
JAN 2 5 20Gd
CITY OF RENTON
UTILITY SYSTEMS
Please find enclosed the Certified Payroll Reports for the following week ending dates:
APPLY A LINE
12/02/07
Should you have any questions, please contact me at (253) 537-2990 extension 25.
Sincerely,
Ceccanti, Inc.
Kristie Rojas
Project Administrator
CECCANTI INC GENERAL CONSTRUCTION 4110 BROOXDALE RD.1. TACOMA WA 98440 (253) 531-2000 fAX (253) 537.0043
APPLY -A -LINE, INC.
JOB: 152C2200
BENSON RD WATERLINEkWTR273344
Certified
Payroll Report
175 ROY ROAD SW BLDG C
RENTON,
KING, WA
PACIFIC, WA 98047
J08l658
For Week Starting: 11I26/2007
Ending: 12IO2/2007
Contract No:
WTR-24-3344
Page: 1
--------------------------------------------------------------------------------
FFIC CONTROL
-- -------------------------
Tax.Gross
ffV
Non -Table
Job Classification
Hours
Worked Each Day
Tot Ded's
Name & Address Mon.
Tue.
Wed. Thu. Fri.
Sat. Sun.
Total
Hourly
Gross
Net Pay
Exmp,Soc.Sec.f,Minority 26
27
28 29 30
1 2
Hours
Rate
Pay
--------
Deductions ---------
Check No.
------------------------------------------------------------------------------------------------------------------------------------
WA JOURNEYMAN P .00
.00
.00 .00 .00
.00 .00
.00
.00
.00
Fed. WIT
219.96
1196.99
0 .00
.00
.00 .00 .25
.00 .00
.25
38.08
9.52
FICA
91.57
.00
S .00
.00
.00 .00 8.00
.00 .00
8.00
25.38
203.04
Worker Cmp
1.58
349.02
LLOYD 8 BRUNER
EMPLOYER
PAID BENEFITS
..........
90.92
15837 118TH IN SE
HRS & GROSS
THIS JOB
8.25
.....
212.56
DUES CHECK
35.91
847.97
YELM WA 98597
EXPENSE &
PER DIEM THIS
JOB
.....
'.00
041641
S-0,514-04-3729,White Male
TOTAL
.....
303.48
------------------------------------------------------------------------------------------------------------------------------------
MASTER TRF CTRI STPR P .00
.00
.00 .00 .00
.00 .00
.00
.00
.00
Fed. WIT
253.42
1330.84
0 .00
.00
.00 .00 .25
.00 .00
.25
42.56
10.64
FICA
101.81
.00
S .00
.00
.00 .00 8.00
.00 .00
8.00
28.38
227.04
Worker Cmp
1.61
396.77
STEVEN R HENRY
EMPLOYER
PAID BENEFITS
..........
90.92
26125 - 121ST CT E
HRS & GROSS
THIS JOB
8.25
.....
237.68
DUES CHECK
39.93
934.07
BUCKLEY WA 98321
EXPENSE &
PER DIEM THIS
JOB
.....
.00
041652
S-0,540-86-2328,White Male
------------------------------------------------------------------------------------------------------------------------------------
TOTAL
.....
328.60
41
Washington
Date: 12/6/07
I, _DeAnna Pierick Payroll Administrator do hereby state:
(Name of Signatory Party) (Title)
(1) That I pay or supervise the payment of the persons employed by
Apply -A -Line, Inc. on the SEE ATTACHED
(Contractor or Subcontractor) (Building or Work)
project; that during the payroll periods commencing on the 26"' day of
November, 2007, and ending the 2nd day of December, 2007, all persons
employed on said project have been paid the full weekly wages earned, that no rebates
have been or will be made either directly or indirectly to or on behalf of said
Apply -A -Line, Inc . from the full weekly wages earned by any person and that
(Contractor or Subcontractor)
no deductions have been made either directly or indirectly from the full wages earned
by any person, other than permissible deductions as defined in Regulations, Part 3 (29
CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and
described below:
per attached
(2) That any payrolls otherwise under this contract required to be submitted for the
above period are correct and complete; that the wage rates for laborers or
mechanics contained therein are not less than the applicable wage rates
contained in any wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the
work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona
fide apprenticeship program registered with a Slate apprenticeship agency
recognized by the Bureau of Apprenticeship and Training, United States
Department of Labor, or if no such recognized agency exists in a State, are
registered with the Bureau of Apprenticeship and Training, United States
Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS
OR PROGRAMS
® - In addition to the basic hourly wage rates paid to each laborer or
mechanic listed in the above referenced payroll, payments of fringe benefits
as listed in the contract have been or will be made to appropriate programs for
the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
0 - Each laborer or mechanic listed in the above referenced payroll has
been paid, as indicated on the payroll, an amount not less than the sum of the
applicable basic hourly wage rate plus the amount of the required fringe
benefits as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION CRAFT
EXPLANATION
Painters Local 1982
Traffic Control Striper
231 Burnett Ave. N
Renton WA 98055
Fringe - $11.02/Hour "
*Journe man/Master Traffic Control Striper
Health & Welfare - $5.32
Apprentice 88% - $10.36
Pension - $5.50
Apprentice 73% - $9.54
Apprentice Training - $0.20
Apprentice 60% - $8.82
Apprentice 60% - 500 - 1000 Hours
(Apprentices receive % of pension)
Health and Welfare only $5.32
Apprentice 60% - below 500 Hours
Western WA Painters Trusts
No Fringe
P.O. Box C-34143
Seattle, WA 98124-1143
REMARKS
As of 06/04/07
..S ('ER1'IfIEDSrATGMFNI, KNO\V
FVEREADT
CONTENTS THEROr AND 1'T IS IRUETO MY
WLEDGE.
NAME AND TITLE SIGNATURE
DeAnna Pierick, Payroll Administrator
The willful falsification of any of the above statements may subject the
contractor or subcontractor to civil or criminal prosecution. See section 1001
of Title 18 and section 231 of Title 31 of the United States Code.
CECCIINTI
October 15, 2007
Andrew Weygandt
City of Renton PBPW - Water Utilities
Renton City Hall - 5th Floor
1055 South Grady Way
Renton, WA 98057
Re: # 658 — Benson Road Water Line Relocation
Dear Andrew:
RECEIVED
OCT 16 2007
CITY OF RENTON
UTILITY SYSTEMS
Please find enclosed the Certified Payroll Reports for the following week ending dates:
CECCANTI, INC.
09/22/07
09/29/07
10/06/07
MERIWETHER LEACHMAN ASSOCIATES
09/22/07
09/29/07
Should you have any questions, please contact me at (253) 537-2990 extension 25.
Sincerely,
Ceccanti, Inc.
Kristie Rojas
Project Administrator
CECCANII INC GENERAL CONSTRUCTION 4110 BROOIIDAU RD. E. TACOMA WA 0844812531537-2990 FAX 12531537-0943
Statement of Compliance
Date: SEPTEMBER 26, 2007 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 16 day of SEPTEMBER, 2007 and ending the 22 day of
SEPTEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Laoor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE —�
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of i e 31 of the United States Code.
Pag" /
CECCANTI, INC.
Pay Period Date:
09/22/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
09/22/07
Job No:
658
Payroll No:
1
Job Name:
RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security SUN
MON
TUE
WED THU
FRI SAT
Employee
Work Class
16
17
18
19 20
21 22
Total
Rate
Gross Pay
Deductions
Totals
HUGHES, MICHAEL E.
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
319.72 Gross
1,774.09
201 117TH STREET EAST
539-62-9003 S
0.00
0.00
0.00
1.50 0.00
6.50 0.00
8.00
35.66
285.28
FICA
135.73 Taxes
471.80
OP/TRUCK FOREMAN
State W/H
0.00 Deducts
45.31
TACOMA, WA 98445
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.35 Net Pay
1,256.98
WORKING DU
35.51 Check #:
9.80
71812
N. W. F. C.
Total Job Gross
285.28
MARANA, WILLIAM T
Ex: S-00 A M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
194.70 Gross
1,055.96
5932 SOUTH PARK
538-98-3721 S
0.00
0.00
0.00
8.00 0.00
0.00 0.00
8.00
22.23
177.84
FICA
80.78 faxes
290.51
o)
2ND PERIOD APP(70/o
State W/H
0.00 Deducts
30.11
TACOMA, WA 98408
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.03 Net Pay
735.34
WORKING DU
21.11 Check #:
9.00
71823
N. W. F. C.
Total Job Gross
177.84
RUTH, DUSTIN J
Ex: S-99 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
0.00 Gross
1,331.90
1130 GOLF CLUB ROAD
539-90-1863 S
0.00
0.00
0.00
0.00 3.50
0.00 0.00
3.50
28.04
98.14
FICA
101.89 faxes
116.77
APT.
FLAGGER
State W/H
0.00 Deducts
79.67
LACEY, WA 98503
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.88 Net Pay
1,135.46
VACATION
44.50 Check #:
71843
UNION DUES
33.39
N. W. F. C.
1.78
Total Job Gross
98.14
TALLENT, RALPH JAY
Ex: M-04 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
237.35 Gross
1,528.10
PO BOX 1252
551-33-8411 S
0.00
0.00
0.00
8.00 8.00
8.00 0.00
24.00
32.17
772.08
FICA
116.90 Taxes
369.28
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
102.57
MILTON, WA 98354
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.03 Net Pay
1,056.25
CHILD SUPP
63.00 Chuck #:
71852
WORKING DU
30.57
N.W.F.C.
9.00
Total Job Gross
772.08
Pine 2
CECCANTI, INC. Pay Period Date: 09/22/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 09/22/07 Job No: 658
Payroll No: 1 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee Work Class
16
17
18
19 20
21
22 Total Rate Gross Pay
Deductions Totals
VANLANDINGHAM, JASON EDWA Ex: M-01 C M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00 0.00 0.00 0.00
Fed W/H
180.78 Gross
1,356.16
12206 221ST AVE. CT EAST 537-13-3579 S
0.00
0.00
0.00
8.00 8.00
8.00
0.00 24.00 28.55 685.20
FICA
103.74 faxes
299.54
GENERAL LABORER
State W/H
0.00 Deducts
80.56
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.02 Net Pay
976.06
VACATION
45.00 Chuck #:
71854
UNION DUES
33.76
N. W. F. C.
1.80
Total Job Gross
685.20
WHITE, JARED D Ex: S-02 C M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
350 B RYAN ROAD 538-06-0032 S 0.00 0.00 0.00 8.00 8.00 8.00 0.00 24.00 28.04 672.96
GENERALLABORER
BUCKLEY, WA 98321
Other Job Pay
Total Job Gross 672.96
Fed W/H
220.99
Gross
1,331.90
FICA
101.89
Taxes
337.90
State W/H
0.00
Deducts
80.56
Local W/H
0.00
Add-Ons
0.00
Wcomp/Sdi
15.02
Net Pay
913.44
VACATION
45.00
Check #:
71865
UNION DUES
33.76
N. W. F. C.
1.80
WILHELM, MARK E
Ex: M-00 C M O 0.00 0.00 0.00 0.00 1.00 0.00 0.00 1.00 51.99 51.99 Fed W/H
250.79 Gross
1,698.35
28209 SE 430 STREET
535-88-4993 S 0.00 0.00 0.00 8.00 8.00 8.00 0.00 24.00 34.66 831.84 FICA
129.92 faxes
396.07
FOREMAN State W/H
0.00 Deducts
43.17
ENUMCLAW, WA 98022
Local W/H
0.00 Add-Ons
0.00
Other Job Pay Wcomp/Sdi
15.36 Net Pay
1,259.11
WORKING DU
33.97
Chuck #:
71867
N. W. F. C.
9.20
Total Job Gross 883.83
Page 3
Statement of Compliance
Date: OCTOBER 10, 2007 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 23 day of SEPTEMBER, 2007 and ending the 29 d:ry of
SEPTEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SI E
q�
L.
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Secti n 1001 of Title 18 and Section 231 of Tie of the United States Code.
Page I
CECCANTI, INC. Pay Period Date: 09/29/07 Certified Payroll Report Contract#: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 09/29/07 Job No: 658
Payroll No: 2 Job Name: RENTON WATER LINE FELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions Totals
Employee
Work Class
23
24
25
26 27
28
29
Total Rate Gross Pay
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
0.00
0.00
0.00 2.00
0.00
0.00
2.00 48.26 96.52
Fed W/H
43.42 Gross
868.60
3823 215TH ST CT. EAST
538-02-9911 S
0.00
0.00
0.00
8.00 8.00
8.00
0.00
24.00 32.17 772.08
FICA
66.44 Taxes
118.54
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
22.57
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
8.68 Net Pay
727.49
WORKING DU
17.37 Check #:
71889
N.W.F.C.
5.20
Total Job
Gross
868.60
MARANA, WILLIAM T
Ex: S-00 A M O 0.00 0.00 0.00 0.00 2.00 0.00 0.00
2.00 33.35 66.70 Fed W/H
125.23 Gross
778.07
5932 SOUTH PARK
538-98-3721 S 0.00 0.00 8.00 8.00 8.00 8.00 0.00
32.00 22.23 711.37 FICA
59.52 Taxes
196.10
o
2ND PERIOD APP(70 /o) Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
22.34
TACOMA, WA 98408
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
11.35 Net Pay
559.63
WORKING DU
15.54
Check #:
71938
N.W.F.C.
6.80
Total Job Gross
778.07
PAYNE,CHERYL
9904 23RD AVE CT. S. K171
TACOMA, WA 98444
PUGH, TROY KENNETH
2728 5TH AVE. NE
APT. #4
PUYALLUP, WA 98373
Ex: -01 C F O 0.00 0.00 0.00
514-62-4858 S 0.00 0.00 8.00
LB/FLAGGER
Ex: S-01 C M O 0.00 0.00 0.00
533-02-0277 S 0.00 0.00 1.00
FLAGGER
0.00 0.00 0.00 0.00
6.00 0.00 0.00 0.00
Other Job Pay
Total Job Gross
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
Other Job Pay
Total Job Gross
0.00 0.00 0.00 Fed W/H
116.79 Gross
849.68
14.00 22.81 319.34 FICA
65.01 Taxes
194.15
State W/H
0.00 Deducts
66.24
Local W/H
0.00 Add-Ons
0.00
Wcomp/Sdi
12.35 Net Pay
589.29
VACATION
37.00 Check #:
71952
UNION DUES
27.76
N.W.F.C.
1.48
319.34
.00 .. Fed
1 655.14
1.00 24.64 64 24.64 64 FICA
126.611 Taxes
465.87
State W/H
0.00 Deducts
95.78
Local W/H
0.00 Add-Ons
0.00
Wcomp/Sdi
17.88 Net Pay
1,093.49
VACATION
53.50 Check #:
71956
UNION DUES
40.14
N.W.F.C.
2.14
I•zK.-V
Page 2
CECCANTI, INC. Pay Period Date: 09/29/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 09/29/07 Job No: 658
Payroll No: 2 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
23
24
25
26 27
28
29
Total Rate Gross Pay
TALLENT, RALPH JAY
Ex: M-04 C M O
0.00
0.00
0.00
0.00 2.00
0.00
0.00
2.00 48.26 96.52
Fed
186.13 Gross
96
1,234.30
PO BOX 1252
551-33-8411 S
0.00
0.00
8.00
8.00 8.00
8.00
0.00
32.00 32.17 1,029.44
FICA
C
State W/H
86.13 Taxes
0.00
292.32
EXCAVATOR/BACKHOE 3
Local W/H
Deducts
0.00
92.32
MILTON, WA 98354
Wcomp/Sdi
Add-Ons
11.35
0.00
Other Job Pay
Net Pay
799.34
CHILD SUPP
63.00 Check #:
71971
WORKING DU
22.52
N.W.F.C.
6.80
Total Job Gross
1,125.96
VANLANDINGHAM, JASON EDWA Ex: M-01 C M
O
0.00
0.00
0.00
0.00 2.00
0.00
0.00
2.00
42.83
85.66
Fed W/H
127.25 Gross
999.27
12206 221 ST AVE. CT EAST
537-13-3579
S
0.00
0.00
8.00
8.00 8.00
8.00
0.00
32.00
28.55
913.61
FICA
State W/H
76.45 Taxes
0.00
215.04
GENERAL LABORER
Local W/H
Deducts
0.00
60.87
BONNEY LAKE, WA 98391
Wcomp/Sdi
Add-Ons
11.34
0.00
Other Job Pay
Net Pay
723.36
VACATION
34.00 Check #:
71973
UNION DUES
25.51
N.W.F.C.
1.36
Total Job Gross
999.27
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M
O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
180.49 Gross
1,104.48
10402 140TH AVENUE EAST
534-96-9686
S
0.00
0.00
1.00
0.00 0.00
0.00
0.00
1.00
22.81
22.81
FICA
State W/H
84.50 Taxes
0.00
278.01
FLAGGER
Local W/H
Deducts
0.00 Add-Ons
69.82
0.00
PUYALLUP, WA 98374
Other Job Pay
Wcomp/Sdi
13.02 Net Pay
756.65
VACATION
39.00 Check #:
71976
UNION DUES
29.26
N.W.F.C.
1.56
Total Job
Gross
22.81
WHITE, JARED D
Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H
66.50 Gross
672.96
350 B RYAN ROAD
538-06-0032 S 0.00 0.00 8.00 8.00 0.00 8.00 0.00 24.00 28.04 672.96 FICA
State W/H
51.48 Taxes
0.00
126.00
GENERAL LABORER
Local W/H
Deducts
0.00
42.97
BUCKLEY, WA 98321
Wcomp/Sdi
Add-Ons
8.02
0.00
Other Job Pay
Net Pay
503.99
VACATION
24.00 Check #:
71983
UNION DUES
18.01
N.W.F.C.
0.96
Total Job Gross 672.96
Page 3
CECCANTI, INC. Pay Period Date: 09/29/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 09/29/07 Job No: 658
Payroll No: 2 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
23
24
25
26 27
28
29 Total Rate Gross Pay
Deductions Totals
WILHELM, MARK E
Ex: M-00 C M O
0.00
0.00
0.00
0.00 2.00
0.00
0.00 2.00 51.99 103.98
Fed W/H
144.13 Gross
1,213.10
28209 SE 430 STREET
535-88-4993 S
0.00
0.00
8.00
8.00 8.00
8.00
0.00 32.00 34.66 1,109.12
FICA
92.80 Taxes
248.28
FOREMAN
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
31.06
ENUMCLAW, WA 98022
Add-O
.
Other Job Pay
Wcomp /Sdi
11.35 Net Pay ay
933.7676
WORKING DU
24.26 Check #:
71985
N. W. F. C.
6.80
Total Job Gross
1,213.10
Page 4
Statement of Compliance
Date: OCTOBER 10, 2007 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 30 day of SEPTEMBER, 2007 and ending the 6 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
RLMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SI
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 ofTitleA 1 of the Unr a States Code.
Page J
CECCANTI, INC. Pay Period Date: 10/06/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/06/07 Job No: 658
Payroll No: 3 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
30
01
02
03 04
05
06
Total Rate Gross Pay Deductions Totals
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
1.50
1.00
1.50 1.50
1.50
0.00
7.00 48.26 337.82 Fed W/H
156.82 Gross
1,624.64
3823 215TH ST CT. EAST
538-02-9911 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00 32.17 1,286.82 FICA
124.28 I -axes
296.79
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
41.90
SPANAWAY, WA 98387
Local W/H
0.00 Adci-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.69 Net Pay
1,285.95
WORKING DU
32.50
Check #:
72019
N. W. F. C.
9.40
Total Job Gross
1,624.64
MARANA, WILLIAM T
5932 SOUTH PARK
TACOMA, WA 98408
Ex: S-00 A M O
538-98-3721 S
2ND PERIOD APP(70%)
0.00
0.00
1.50
8.00
1.00
8.00
1.50 1.50
8.00 8.00
Other Job Pay
1.50 0.00
8.00 0.00
Equipment Usage
Total Job Gross
7.00
40.00
33.35
22.23
233.47
889.22
1,122.69
Fed W/H
FICA
State W/H
Local W/H
Wcomp/Sdi
WORKING DU
N. W. F. C.
211.38 Gross
85.89 Taxes
0.00 Deducts
0.0o Add-Ons
15.69 Net Pay
22.45 Check #:
9.40
1,122.69
312.96
31.85
0.00
777.88
72071
PAYNE, CHERYL
Ex: -01 C F
O
0.00
0.50
0.50
1.00 1.00
1.00 0.00
4.00
34.22
136.88
Fed W/H
166.69 Gross
1,049.28
9904 23RD AVE CT. S. K171
514-62-4858
S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
22.81
912.40
FICA
80.27 1-axes
261.64
LB/FLAGGER
State W/H
0.00 Deducts
78.77
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.68 Net Pay
708.87
VACATION
44.00 Check #:
72085
UNION DUES
33.01
N.W.F.C.
1.76
Total Job Gross
1,049.28
PUGH, TROY KENNETH
Ex: S-01 C M
O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
173.87 Gross
1,078.00
2728 5TH AVE. NE
533-02-0277
S
0.00
1.00
0.00
0.00 0.00
0.00 0.00
1.00
24.64
24.64
FICA
82.46 Taxes
270.20
APT. #4
FLAGGER
State W/H
0.00 Deducts
74.30
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.87 Net Pay
733.50
VACATION
41.50 Check #:
72088
UNION DUES
31.14
N.W. F.C.
1.66
Total Job Gross
24.64
Page 2
CECCANTI, INC.
Pay Period Date:
10/06/07
Certified Payroll Report
Contract#:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/06/07
Job No:
658
Payroll No:
3
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
30
01
02
03 04
05
06
Total
Rate
Gross Pay
RUTLEDGE, ZANDRA M
Ex: S-01 B F O
0.00
0.00
0.00
0.00 0.00
0.50
0.00
0.50
34.22
17.11
Fed W/H
119.64 Gross
861.09
4702 SO WARNER APT. C
538-82-9687 S
0.00
0.00
0.00
0.00 0.00
8.00
0.00
8.00
22.81
182.48
FICA
State W/H
65.88 Taxes
197.70
FLAGGER
0.00 Deducts
65.34
TACOMA, WA 98409
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.18 Net Pay
598.05
VACATION
36.50 Check #:
72095
UNION DUES
27.38
N.W.F.C.
1.46
Total Job Gross
199.59
TALLENT, RALPH JAY
Ex: M-04 C M O
0.00
1.50
1.00
1.50 1.50
1.50
0.00
7.00
48.26
337.82
Fed W/H
261.49 Gross
1,624.64
PO BOX 1252
551-33-8411 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
32.17
1,286.82
FICA
124.28 Taxes
401.46
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
104.90
MILTON, WA 98354
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.69 Net Pay
1,118.28
CHILD SUPP
63.00 Chuck #:
72102
WORKING DU
32.50
N.W.F.C.
9.40
Total Job Gross
1,624.64
VANLANDINGHAM, JASON EDWA Ex: M-01 C M O
0.00
1.50
1.00
1.50 1.50
1.50
0.00
7.00
42.83
299.83
Fed W/H
195.33 Gross
1,441.88
12206 221 ST AVE. CT EAST
537-13-3579 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
28.55
1,142.05
FICA
110.30 Taxes
321.33
GENERAL LABORER
State W/H
0.00 Deducts
84.20
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.70 Net Pay
1,036.35
VACATION
47.00 Check #:
72104
UNION DUES
35.32
N. W. F. C.
1.88
Total Job Gross
1,441.88
WHITE, JARED D
Ex: S-02 C M O 0.00 0.00 1.00 1.50 1.50 1.50 0.00
5.50 42.06 231.33
Fed W/H
170.17 Gross
1,128.61
350 B RYAN ROAD
538-06-0032 S 0.00 0.00 8.00 8.00 8.00 8.00 0.00
32.00 28.04 897.28
FICA
86.33 Taxes
269.04
GENERAL LABORER
State W/H
0.00 Deducts
67.18
BUCKLEY, WA 98321
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.54 Net Pay
792.39
VACATION
37.50 Check #:
72114
UNION DUES
28.18
N.W.F.C.
1.50
Total Job Gross
1,128.61
Page 3
CECCANTI, INC. Pay Period Date: 10/06/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/06/07 Job No: 658
Payroll No: 3 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions Totals
Employee
Work Class
30
01
02
03 04
05
06 Total Rate Gross Pay
WILHELM, MARK E
Ex: M-00 C M O
0.00
1.50
1.00
1.50 1.50
1.50
0.00 7.00 51.99 363.95
Fed W/H
263.79 Gross
1,750.35
28209 SE 430 STREET
535-88-4993 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00 40.00 34.66 1,386.40
FICA
133.90 Taxes
413.38
FOREMAN
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
44.40
ENUMCLAW, WA 98022
A-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.69 Net Pay
1,292.577
WORKING DU
35.00 Check #:
72116
N. W. F. C.
9.40
Total Job Gross
1,750.35
P(Igk! -I
Department of Labor & Industries
Employment Standards Section
P.O. Box 44510
Olympia, WA 98504-4510
(360) 902-5316
CERTIFIED PROJECT PAYROLL
Project Name: County: Project or Contract #
Prime Contractor ❑ Benson Road Water Line Relocation King WTR-27-3344
Subcontractor W
Project Address: City: State
Renton WA
Awarding Agency Name: Company Name:
For the week ending: City of Renton Meriwether Leachman Associates, Inc.
Month Day Year Address City State ZIP+4 Address City: State ZIP+4
09 / 22 / 07 1055 South Grady Way Renton WA 98055 11800 NE 160`h Street Bothell WA 98011-4156
Day and Date
Work Classification
Name $, Sun Mon Tue Wed Thu Fri Sat
Total Rate of Gross NET
and
Soc. Sec. # of Employee
and
Address 16 17 18 19 20 21 22
Amount
Hours Pay Earned Withhold- Ind. WAGES
FICA
Hours Worked Each Day
ing tax Ins.
Survey
Palmer, Colin S.
OT
Chain Person
23006 - 27th Ave SE, #12-301
208.00
15.91
37.44
0.41
154.24
RG
26.00
537-54-4527
Bothell, WA 98021
258-49-7231
8.0
8.0
Survey
Bystron, Robert J.
OT
Instrument Person
17407 NE 45th St., #162
RO
18.25
539-86-8012
Redmond, WA 98052
Survey
Benedict, Greg S.
OT
Party Chief
7406 - 47th Ave. NE #G2
540-86-4860
Marysville, WA 98270
Rc
28.00
Survey
Woelke, Alexander R.
°T
Party Chief
1006 W Emerson St, Apt 1
602-09-4710
Seattle, WA 98119
RO
17.00
Survey
Bystron, Robert J.
OT
Chain Person
17407 NE 45th St., #162
136.88
10.47
24.64
0.38
101.38
539-86-8012
Redmond, WA 98052
Rc
7.5
7.5
18.25
Survey
Woelke, Alexander R.
OT
Chain Person
1006 W Emerson St, Apt 1
602-09-4710
Seattle, WA 98119
Rc
17.00
Survey
Braun, Robert A.
OT
Party Chief
8403 NE1315t PI.
356.50
27.27
64.17
0.79
264.27
539-62-6994
Kirkland, WA 98034
Rc
8.0
7.5
15.5
23.00
Employee Benefits Distribution and Signature Certification on Reverse
MLA Job 7647
(1)
AFFIRMATION
Today's Date
Name of Signatory Party
Title
September 27, 2007
I
Michael R. Leachman
Vice President
The above signatory pays or supervises (Name of contractor or subcontractor)
the payment of the persons employed by: MLA, Inc.
Name of building or work project
Payroll period starting
Payroll period ending
Benson Road Water Line Relocation
09 / 16 / 07
09 / 22 / 07
All persons employed on above project have been paid the full weekly wages earned, that no rebates have/will be made either directly or indirectly to
or on behalf of the above contractor or subcontractor from the weekly wages earned by any person and that no deductions have been made either
directly or indirectly from the full wages earned by any person, other than permissible deduction.
(2) That any payroll otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or
mechanics contained therein are not less then the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set
forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.
(4) That:
WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS * In addition to the basic hourly wage rates paid to each laborer or
mechanic listed in the above referenced payroll, payments or fringe benefits as listed below have been or will be made to appropriate programs for the benefits of such
employees.
The willful falsification of any of the above statements may subject the contractor to civil or criminal prosecution.
Print or type name of signatory
Title
Signature�%�K/�-7
Michael R. Leachman
Vice President
BENEFIT DISTRIBUTION (Please report in "per hour" terms)
Craft/Trade
Hourly Total Benefit Credit
Hourly Pension
Hourly Medical
Hourly Vacation
Survey Party Chief
0.00
0.00
0.00
0.00
Survey Instrument Person
0.00
0.00
0.00
0.00
Survey Chain Person
0.00
0.00
0.00
0.00
Department of Labor & Industries
Employment Standards Section
P.O. Box 44510
Olympia, WA 98504-4510
(360)902-5316
CERTIFIED PROJECT PAYROLL
Project Name: County: Project or Contract #
Prime Contractor ❑ Benson Road Water Line Relocation King WTR-27-3344
Subcontractor W
Project Address: City: State
Renton WA
Awarding Agency Name: Company Name:
For the week ending: City of Renton Meriwether Leachman Associates, Inc.
Month Day Year Address City State ZIP+4 Address City: State ZIP+4
09 / 29 / 07 1055 South Grady Way Renton WA 98055 11800 NE 1601h Street Bothell WA 98011-4156
Day and Date
Work Classification
Name 9 Sun Mon Tue Wed Thu Fri Sat Gross
Total Rate of
NET
and
Soc. Sec. # of Employee
and Amount
Address 23 24 25 26 27 28 29 Hours Pay Earned
Withhold- Ind. WAGES
FICA
Hours Worked Each Day
ing tax Ins.
Survey
Palmer, Colin S.
or
Chain Person
23006 - 27th Ave SE, #12-301
RG
26.00
537-54-4527
Bothell, WA 98021
258-49-7231
Survey
Bystron, Robert J.
or
Instrument Person
17407 NE 45th St., #162
RG
18.25
539-86-8012
Redmond, WA 98052
Survey
Benedict, Greg S.
or
Party Chief
7406 - 47th Ave. NE #G2
540-86-4860
Marysville, WA 98270
RG
28.00
Survey
Woelke, Alexander R.
°T
,?O
Party Chief
1006 W Emerson St, Apt 1
602-09-4710
Seattle, WA 98119
RG
17.00
Survey
Bystron, Robert J.
oT
Chain Person
17407 NE 45th St., #162
539-86-8012
Redmond, WA 98052
RG
18.25
Survey
Woelke, Alexander R.
or
Chain Person
1006 W Emerson St, Apt 1
129.50
9.91
23.31
0.36
95.93
602-09-4710
Seattle, WA 98119
RG
7.0
7.0
18.50
Survey
Braun, Robert A.
or
Party Chief
8403 NE131s' Pl.
161.00
12.32
28.98
0.36
119.35
539-62-6994
Kirkland, WA 98034
RG
7.0
7.0
23.00
Employee Benefits Distribution and Signature Certification on Reverse
MLA Job 7647
(1)
AFFIRMATION
Today's Date
Name of Signatory Party
Title
October 2, 2007
Michael R. Leachman
Vice President
The above signatory pays or supervises (Name of contractor or subcontractor)
the payment of the persons employed by: MLA, Inc.
Name of building or work project
Payroll period starting
Payroll period ending
Benson Road Water Line Relocation
09 / 23 / 07
09 / 29 / 07
All persons employed on above project have been paid the full weekly wages earned, that no rebates have/will be made either directly or indirectly to
or on behalf of the above contractor or subcontractor from the weekly wages earned by any person and that no deductions have been made either
directly or indirectly from the full wages earned by any person, other than permissible deduction.
(2) That any payroll otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or
mechanics contained therein are not less then the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set
forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.
(4) That:
WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS * In addition to the basic hourly wage rates paid to each laborer or
mechanic listed in the above referenced payroll, payments or fringe benefits as listed below have been or will be made to appropriate programs for the benefits of such
employees.
The willful falsification of any of the above statements may subject the contractor to civil or criminal prosecution.
Print or type name of signatory
Title
Signature 11�Z D^4 ��
Michael R. Leachman
Vice President
/�-
BENEFIT DISTRIBUTION (Please report in "per hour" terms)
Craft/Trade
Hourly Total Benefit Credit
Hourly Pension
Hourly Medical
Hourly Vacation
Survey Party Chief
0.00
0.00
0.00
0.00
Survey Instrument Person
0.00
0.00
0.00
0.00
Survey Chain Person
0.00
0.00
0.00
0.00
CECCIINTI
November 15, 2007
Andrew Weygandt
City of Renton PBPW - Water Utilities
Renton City Hall - 5th Floor
1055 South Grady Way
Renton, WA 98057
RE: #658 — Benson Road Waterline Relocation
Dear Andrew:
RECEIVED
NOV 1 9 2007
CITY OF RENTON
UTILITY SYSTEMS
Please find enclosed the Monthly EEO Reports for the following months of.
CECCANTI, INC.
09/07
10/07
MERIWETHER LEACHMAN ASSOCIATES
09/07
10/07
Should you have any questions, please contact me at (253)537-2990 extension 25.
Sincerely,
Ceccanti, Inc.
Kristie Rojas
Project Administrator
CECCANTI INC GENERAL CONSTRUCTION 4116 BROONOA11 RD.1. TACOMA WA 9844012531531.2990 fAX 12531537-0943
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 11
TACOMA, WA 98446
From period end date: 09/01/07 To period end date: 09/30/07
Job number: 658 RENTON WATER LINE RELOCAT
Hispanic White
EEO Class / Work Class Sex Total
Work hours of employment
Black Asian
Pacific
Islander
American
Indian
Other(2 or
more)
Minority
%
Female
%
Total #
Employees
Total #
Minority
M
23.5
0.0
23.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
2
0
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
APPRENTICE OPERATOR
M
42.0
0.0
0.0
0.0
42.0
0.0
0.0
0.0
100.0%
0.0%
1
1
APPRENTICE
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
FLAGGER
M
4.5
0.0
4.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
2
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
FLAGGER
M
1.0
0.0
1.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
1
0
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Subtotal:
M
5.5
0.0
5.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
3
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
FORMAN
M
67.0
0.0
67.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
2
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
LABORER
M
106.0
0.0
106.0
0.0
0.0
0.0
0.0
0.0
0.0%
11.7%
2
0
JOURNEYMAN
F
14.0
0.0
14.0
0.0
0.0
0.0
0.0
0.0
1
0
OPERATOR
M
85.5
0.0
85.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
3
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
OPERATOR
M
1.5
0.0
1.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
1
0
APPRENTICE
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Subtotal:
M
87.0
0.0
87.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
4
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Journeyman total:
M
263.0
0.0
263.0
0.0
0.0
0.0
0.0
0.0
0.0%
5.1 %
9
0
F
14.0
0.0
14.0
0.0
0.0
0.0
0.0
0.0
1
0
Apprentice total:
M
43.5
0.0
1.5
0.0
42.0
0.0
0.0
0.0
96.6%
0.0%
2
1
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Trainee total:
M
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
0
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
No work class total:
M
24.5
0.0
24.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
3
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Job total:
M
331.0
0.0
289.0
0.0
42.0
0.0
0.0
0.0
12.2%
4.1 %
14
1
F
14.0
0.0
14.0
0.0
0.0
0.0
0.0
0.0
1
0
Printed by KMP as of 11115107 2: 07:03PM Page 3
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 11
TACOMA, WA 98446
From period end date: 09/01/07 To period end date: 09/30/07
Job number: 658 RENTON WATER LINE RELOCAT
Work hours of employment
Hispanic White Black Asian Pacific American Other(2 or Minority Female Total # Total #
EEO Class / Work Class Sex Total Islander Indian more) % % Employees Minority
Title
Signature
Telephone:
ells 1"
Date 5�ignecr
Printed by KMP as of 11115107 2:07:03PM
/ ag" /
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 11
TACOMA, WA 98446
From period end date: 10/01/07 To period end date: 10/31/07
Job number: 658 RENTON WATER LINE RELOCAT
Hispanic White
EEO Class / Work Class Sex Total
Work hours of employment
Black Asian
Pacific
Islander
American
Indian
Other(2 or
more)
Minority
%
Female
%
Total #
Employees
Total #
Minority
M
9.5
0.0
9.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
1
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
M
23.5
6.5
17.0
0.0
0.0
0.0
0.0
0.0
27.7%
0.0%
3
1
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Subtotal:
M
33.0
6.5
26.5
0.0
0.0
0.0
0.0
0.0
19.7%
0.0%
4
1
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
APPRENTICE OPERATOR
M
188.5
0.0
0.0
0.0
188.5
0.0
0.0
0.0
100.0%
0.0%
1
1
APPRENTICE
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
FLAGGER
M
80.5
0.0
78.5
0.0
2.0
0.0
0.0
0.0
2.1 %
16.6%
5
1
JOURNEYMAN
F
16.0
0.0
16.0
0.0
0.0
0.0
0.0
0.0
1
0
FLAGGER
M
38.5
0.0
38.5
0.0
0.0
0.0
0.0
0.0
76.7%
76.7%
1
0
NO WORK CLASS
F
127.0
0.0
0.0
127.0
0.0
0.0
0.0
0.0
1
1
Subtotal:
M
119.0
0.0
117.0
0.0
2.0
0.0
0.0
0.0
49.2%
54.6%
6
1
F
143.0
0.0
16.0
127.0
0.0
0.0
0.0
0.0
2
1
FORMAN
M
206.5
0.0
206.5
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
2
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
LABORER
M
405.0
0.0
377.5
27.5
0.0
0.0
0.0
0.0
4.7%
30.8%
4
1
JOURNEYMAN
F
180.5
0.0
180.5
0.0
0.0
0.0
0.0
0.0
1
0
OPERATOR
M
408.0
0.0
408.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
4
0
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
OPERATOR
M
6.0
0.0
6.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
1
0
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Subtotal:
M
414.0
0.0
414.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
5
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
SHOP MAINTENANCE
M
3.0
0.0
3.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
1
0
NO WORK CLASS
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
TRUCK DRIVER
M
83.5
83.5
0.0
0.0
0.0
0.0
0.0
0.0
100.0%
0.0%
1
1
JOURNEYMAN
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
TRUCK DRIVER
M
28.5
0.0
0.0
0.0
0.0
0.0
28.5
0.0
100.0%
0.0%
1
1
APPRENTICE
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Printed by KMP as of 11115107 2:07:29PM Page I
CECCANTI, INC.
Monthly Employment Utilization Report
1.Covered Area (SMSA or EA): 2. Employers I. D. No.: Federal Funding Agency:
3. Current Goals 4. Reporting Period Name and Location of Contractor: CECCANTI, INC.
Minority: 0.00 From Period: 4116 BROOKDALE ROAD EAST
Female: 0.00 To Period: 11
TACOMA, WA 98446
From period end date: 10/01/07 To period end date: 10/31/07
Job number: 658 RENTON WATER LINE RELOCAT
Hispanic White
EEO Class / Work Class Sex Total
Work hours of employment
Black Asian Pacific
Islander
American Other(2 or Minority Female Total # Total #
Indian more) % % Employees Minority
Subtotal:
M
112.0
83.5
0.0
0.0
0.0
0.0
28.5
0.0
100.0%
0.0%
2
2
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Journeyman total:
M
1,193.0
83.5
1,080.0
27.5
2.0
0.0
0.0
0.0
8.1%
14.1%
17
3
F
196.5
0.0
196.5
0.0
0.0
0.0
0.0
0.0
2
0
Apprentice total:
M
217.0
0.0
0.0
0.0
188.5
0.0
28.5
0.0
100.0%
0.0%
2
2
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
Trainee total:
M
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0%
0.0%
0
0
F
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
No work class total:
M
71.0
6.5
64.5
0.0
0.0
0.0
0.0
0.0
67.4%
64.1 %
6
1
F
127.0
0.0
0.0
127.0
0.0
0.0
0.0
0.0
1
1
Job total:
M
1,481.0
90.0
1,144.5
27.5
190.5
0.0
28.5
0.0
25.7%
17.9%
25
6
F
323.5
0.0
196.5
127.0
0.0
0.0
0.0
0.0
3
1
Title
Telephone:
Date Signed
Printed by KMP as of 11115107 2: 07:29PM Page 2
Monthly Employment Utilization Report U.S. Department of Labor
Employment Standards Administration
Office of Federal Contract ComDliance Proorams
This report is required by Executive Order 11246, Sec. 203. Failure to report can result in contracts
being cancelled, terminated or suspended in whole or in part and the contractor may be declared
ineligible for further Government contracts of federally assisted construction contracts.
1. Covered Area (SMSA or EA)
Benson Road
Water Line Relocation
Renton, WA
2. Employers I.D. No.
91-0832021
OMB NO. 1215-01633
Expires: 12/13/92
3. Current Goals
Minority
Female
4. Reporting Period
From 09-01-07
To 09-30-07
Name and Location of Contractor
Meriwether Leachman Assoc., Inc.
11800 NE 160th Street, Bothell, WA 98011
Federal
Funding
Agency
5.
CONSTRUCTION
TRADE
Classifications
6. TOTAL FEDERAL & NON-FEDERAL
CONSTRUCTION
WORK HOURS
9.
Total
Number of
Employees
10.
Total Number of
Minority Employees
6a.
Total All
Employees
By Trade
6b.
Black
(Not of Hispanic
Origin)
6c.
Hispanic
6d.
Asian or
Pacific
Islander
6e.
American
Indian or
Native American
7,
Minority
Percentage
8.
Female
Percentage
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Surveyors
Journey Worker
45.0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
Apprentice
Trainee
Sub -Total
45.0
0
0
0
0
4
0
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Total Journey Worker
45.0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
Total Apprentices
Total Trainees
Grand Total
45.0
0
0
0
0
4
0
11. Company Official's Signature and Title
„X A /I^
/7
12. Telephone Number
(Include area code)
(425) 488-4800
13. Date Signed
10-02-2007
Page
1 of 1
Form CC-257
Rev. Jan. 1992
Monthly Employment Utilization Report
U.S. Department of Labor
Employment Standards Administration
Offire of FpdPral Cnntrart Comnliance Proorams
RECEIVED
NOV - 9 2007
This report is required by Executive Order 11246, Sec. 203. Failure to report can result in contracts
being cancelled, terminated or suspended in whole or in part and the contractor may be declared
ineligible for further Government contracts of federally assisted construction contracts.
1. Covered Area (SMSA or EA)
Benson Road
Water Line Relocation
Renton, WA
2. Employers I.D. No.
91-0832021
OM 215-01633
Expi
3. Current Goals
Minority
Female
4. Reporting Period
From 10-01-07
To 10-31-07
Name and Location of Contractor
Meriwether Leachman Assoc., Inc.
11800 NE 160th Street, Bothell, WA 98011
Federal
Funding
Agency
5.
CONSTRUCTION
TRADE
Classifications
6. TOTAL FEDERAL
& NON-FEDERAL
CONSTRUCTION
WORK HOURS
9.
Total
Number of
Employees
10.
Total Number of
Minority Employees
6a.
Total All
Employees
By Trade
6b.
Black
(Not of Hispanic
Origin)
6c.
Hispanic
6d.
Asian or
Pacific
Islander
6e.
American
Indian or
Native American
7,
Minority
Percentage
8.
Female
Percentage
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Surveyors
Journey Worker
4.0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
Apprentice
Trainee
Sub -Total
4.0
0
0
0
0
2
0
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Journey Worker
Apprentice
Trainee
Sub -Total
Total Journey Worker
4.0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
Total Apprentices
Total Trainees
Grand Total
4.0
0
0
0
0
2
0
11. Company Official's Signature and Title
/l
12. Telephone Number
(Include area code)
(425) 488-4800
13. Date Signed
11-08-2007
Page
1 of 1
Form GG-257
Rev. Jan. 1992
CECC11
November 15, 2007
T1RECEIVED
NOV 1 9 2007
CITY OF RENTON
UTILITY SYSTEMS
Andrew Weygandt
City of Renton PBPW - Water Utilities
Renton City Hall - 5th Floor
1055 South Grady Way
Renton, WA 98057
Re: # 658 — Benson Road Water Line Relocation
Dear Andrew:
Please find enclosed the Certified Payroll Reports for the following week ending dates:
CECCANTI, INC.
10/13/07 10/27/07
10/20/07 11/03/07
MERIWETHER LEACHMAN ASSOCIATES
10/06/07 10/20/07
10/13/07 11/03/07
INTERWEST DEVELOPMENT NW
09/22/07 10/06/07 10/20/07
09/29/07 10/13/07
DEWATERING SERVICES
10/20/07
11/03/07
Should you have any questions, please contact me at (253) 537-2990 extension 25.
Sincerely,
Ceecanti, Inc.
Kristie Rojas
Project Administrator
CECCANTI INC GENERAL CONSTRUCTION 4118 BROOIIBALE RD. E. TACOMA WA 00446 ( 253 j 53 7-2090 FAX ( 253) 531-0943
Statement of Compliance
Date: NOVEMBER 14, 2007 Contract Number: WTR-27-3344
I, BLAKE VERDI, PROJECT ADM1N do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 7 day of OCTOBER, 2007 and ending the 13 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 Aitic 31 of the United States Code.
Vi
Page I
CECCANTI, INC. Pay Period Date: 10/13/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/13/07 Job No: 658
Payroll No: 4 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
07
08
09
10 11
12 13 Total
Rate Gross Pay
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
1.50
1.50
3.50
0.00 0.00
0.00 1.50 8.00
48.26 386.08
Fed W/H
164.06 Gross
1,672.89
3823 215TH ST CT. EAST
538-02-9911 S
0.00
16.00
8.00
8.00 0.00
0.00 8.00 40.00
32.17 1,286.81
FICA
127.98 Taxes
308.07
EXCAVATOR/BACKHOE 3
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
43.08
SPANAWAY, WA 98387
Wcom/Sdi
p
A-Ons
16.03
0.00
Other Job Pay
Ne t Pay
1,3211.774
WORKING DU
33.48 Check #:
72177
N. W. F. C.
9.60
Total Job Gross
1,672.89
HELM, JOSHUAH JAMES
Ex: M-01 N M
O
0.00
0.00
0.00
0.00 1.00
0.00
2.00
3.00
35.73
107.19
Fed W/H
164.95 Gross
1,417.29
1318 EAST 35TH STREET
539-78-3747
S
0.00
0.00
0.00
0.00 8.00
0.00
0.00
8.00
23.82
190.56
FICA
108.42 Taxes
291.07
APPRENTICE/OPERATOR
State W/H
0.00 Deducts
38.94
TACOMA, WA 98404
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
17.70 Net Pay
1,087.28
WORKING DU
28.34 Check #:
72214
N.W. F.C.
10.60
Total Job Gross
297.75
MARANA, WILLIAM T
Ex: S-00 A M
O
1.50
1.50
3.50
0.00 0.00
0.00
1.50
8.00
33.35
266.82
Fed W/H
219.72 Gross
1,156.04
5932 SOUTH PARK
538-98-3721
S
8.00
8.00
8.00
8.00 0.00
0.00
8.00
40.00
22.23
889.22
FICA
88.43 Taxes
324.17
2ND PERIOD APP(70/o
o)
State W/H
0.00 Deducts
32.71
TACOMA, WA 98408
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.02 Net Pay
799.16
WORKING DU
23.11 Check #:
9.60
72233
N. W. F. C.
Total Job Gross
1,156.04
MILES, JOSEPH M
Ex: S-00 C M
O
0.00
1.50
0.00
0.00 0.00
0.00
0.00
1.50
47.63
71.45
Fed W/H
467.87 Gross
2,112.94
6120 84TH STREET EAST
535-88-3902
S
0.00
8.00
0.00
0.00 0.00
0.00
0.00
8.00
31.75
254.00
FICA
161.63 Taxes
651.36
DOZER D9 AND
UNDER/T
State W/H
0.00 Deducts
134.06
PUYALLUP, WA 98371
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
21.86 Net Pay
1,327.52
CHILD SUPP
78.69 Check #:
72239
WORKING DU
42.27
N.W.F.C.
13.10
Total Job Gross
325.45
PAYNE, CHERYL
Ex: -01 C F
O
0.00
1.00
3.50
0.00 0.00
0.00
1.50
6.00
34.22
205.32
Fed W/H
178.09 Gross
1,094.91
9904 23RD AVE CT. S. K171
514-62-4858
S
8.00
8.00
8.00
7.00 0.00
0.00
8.00
39.00
22.81
889.59
FICA
83.76 Taxes
276.87
LB/FLAGGER
State W/H
0.00 Deducts
80.56
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.02 Net Pay
737.48
VACATION
45.00 Check #:
72249
UNION DUES
33.76
N.W.F.C.
1.80
Total Job
Gross
1,094.91
Page 2
CECCANTI, INC.
Pay Period Date:
10/13/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/13/07
Job No:
658
Payroll No:
4
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
07
08
09
10 11
12 13
Total
Rate
Gross Pay
PUGH, TROY KENNETH
Ex: S-01 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
2O3.13 Gross
1,195.04
2728 5TH AVE. NE
533-02-0277 S
1.00
3.00
0.00
1.00 0.00
0.00 1.00
6.00
24.64
147.84
FICA
91.43 Taxes
309.91
APT. #4
FLAGGER
State W/H
Deducts
82.35
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.35 Net Pay
802.78
VACATION
46.00 Check #:
72253
UNION DUES
34.51
N.W.F.C.
1.84
Total Job Gross
147.84
RUTLEDGE, ZANDRA M
Ex: S-01 B F O
0.00
1.00
2.00
0.00 0.00
0.00 1.50
4.50
34.22
153.99
Fed W/H
165.26 Gross
1,043.58
4702 SO WARNER APT. C
538-82-9687 S
8.00
8.00
8.00
7.00 0.00
0.00 8.00
39.00
22.81
889.59
FICA
79.83 Taxes
259.61
FLAGGER
State W/H
0.00 Deducts
77.87
TACOMA, WA 98409
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.52 Net Pay
706.10
VACATION
43.50 Check #:
72260
UNION DUES
32.63
N.W.F.C.
1.74
Total Job Gross
1,043.58
TALLENT, RALPH JAY
Ex: M-04 C M O
1.50
1.50
3.50
0.00 0.00
0.00 1.50
8.00
48.26
386.08
Fed W/H
273.55 Gross
1,672.89
PO BOX 1252
551-33-8411 S
8.00
8.00
8.00
8.00 0.00
0.00 8.00
40.00
32.17
1,286.81
FICA
127.98 Taxes
417.55
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
106.08
MILTON, WA 98354
Local W/H
o.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.02 Net Pay
1,149.26
CHILD SUPP
63.00 Check #:
72268
WORKING DU
33.48
N.W.F.C.
9.60
Total Job Gross
1,672.89
VANLANDINGHAM, JASON EDWA Ex: M-01 C M O
1.50
1.50
3.50
0.00 0.00
0.00 1.50
8.00
42.83
342.66
Fed W/H
2O6.03 Gross
1,484.68
12206 221STAVE. CT EAST
537-13-3579 S
8.00
8.00
8.00
8.00 0.00
0.00 8.00
40.00
28.55
1,142.02
FICA
113.58 Taxes
335.64
GENERAL LABORER
State W/H
0.00 Deducts
85.96
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.03 Net Pay
1,063.08
VACATION
48.00 Check #:
72270
UNION DUES
36.04
N.W.F.C.
1.92
Total Job Gross
1,484.68
Puke
CECCANTI, INC.
Pay Period Date:
10/13/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/13/07
Job No:
658
Payroll No:
4
Job Name:
RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
07
08
09
10 11
12 13
Total
Rate
Gross Pay
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
FICA
180.94 Gross
1,106.31
10402 140TH AVENUE EAST
534-96-9686 S
1.00
2.00
1.00
1.00 0.00
0.00 1.00
6.00
22.81
136.86
State W/H
84.65 Taxes
0.00
280.94
FLAGGER
Local W/H
Deducts
0.00 Add-Ons
82.35
0.00
PUYALLUP, WA 98374
Other Job Pay
Wcomp/Sdi
15.35 Net Pay
743.02
VACATION
46.00 Check #:
72273
UNION DUES
34.51
N.W.F.C.
1.84
Total Job Gross
136.86
WHITE, JARED D
Ex: S-02 C M O
1.50
1.50
3.50
0.00 0.00
0.00 1.50
8.00
42.06
336.48
Fed W/H
252.54 Gross
1,458.08
350 B RYAN ROAD
538-06-0032 S
8.00
8.00
8.00
8.00 0.00
0.00 8.00
40.00
28.04
1,121.60
FICA
State W/H
111.55 Taxes
0.00
380.11
GENERAL LABORER
Local W/H
Deducts
0.00 Add-Ons
85.97
0.00
BUCKLEY, WA 98321
Other Job Pay
Wcomp/Sdi
16.02 Net Pay
992.00
VACATION
48.00 Check #:
72281
UNION DUES
36.05
N.W.F.C.
1.92
Total Job Gross
1,458.08
D
0.00
0.00
2.50
0.00 0.00
0.00 0.00
2.50
69.32
173.30
WILHELM, MARK E
Ex: M-00 C M O
1.50
1.50
4.00
0.00 0.00
0.00 1.50
8.50
51.99
441.93
Fed W/H
FICA
326.61 Gross
2,001.63
28209 SE 430 STREET
535-88-4993 S
8.00
8.00
8.00
8.00 0.00
0.00 8.00
40.00
34.66
1,386.40
State W/H
153.13 Taxes
0.00
496.78
FOREMAN
Local W/H
Deducts
0.00 Add-O
50.25
ENUMCLAW, WA 98022
Other Job Pay
Wcomp/Sdi
17.04 Net Paayy
4.0
1,45.60
WORKING DU
40.05 Check #:
72283
N.W.F.C.
10.20
Total Job Gross
2,001.63
Pulse 4
Statement of Compliance
Date: NOVEMBER 14, 2007 Contract Number: WTR-27-3344
1, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That 1 pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 14 day of OCTOBER, 2007 and ending the 20 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
O Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
9,
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. ee Scction 1001 of Title 18 and Sec ton 2 f Title 31 of the United States Code.
Page
CECCANTI, INC.
Pay Period Date:
10/20/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/20/07
Job No:
658
Payroll No:
5
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Employee
Work Class
14
15
16
17 18
19 20
Total
Rate
Gross Pay
Deductions
Totals
BOGUE, ERIC J
Ex: S-02 C M O
0.00
0.00
0.00
0.00 1.50
0.00 0.00
1.50
42.83
64.25
Fed W/H
11.09 Gross
292.65
12212 132ND AVE E
531-92-6002 S
0.00
0.00
0.00
0.00 8.00
0.00 0.00
8.00
28.55
228.40
FICA
22.39 Taxes
36.65
GENERAL LABORER
State W/H
0.00 Deducts
17.01
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
3.17 Net Pay
238.99
VACATION
9.50 Check #:
72306
UNION DUES
7.13
N.W.F.C.
0.38
Total Job Gross
292.65
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
3.50
2.00
1.50 1.50
0.00 0.00
8.50
48.26
410.21
Fed W/H
168.73 Gross
1,697.03
3823 215TH ST CT. EAST
538-02-9911 S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
32.17
1,286.82
FICA
129.83 Taxes
314.76
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
43.65
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.20 Net Pay
1,338.62
WORKING DU
33.95 Check #:
72312
N.W.F.C.
9.70
Total Job Gross
1,697.03
DEWAR, GERALDINE
Ex: S-01 C F O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
30.11 Gross
364.96
PO BOX 725
534-60-0705 S
0.00
0.00
8.00
8.00 0.00
0.00 0.00
16.00
22.81
364.96
FICA
27.91 Taxes
63.36
FLAGGER
State W/H
0.00 Deducts
28.64
RENTON, WA 98057
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
5.34 Net Pay
272.96
VACATION
16.00 Check #:
72287
UNION DUES
12.00
N. W. F.C.
0.64
Total Job Gross
364.96
HEAVENS, GEORGE
Ex: S-09 B M O
0.00
0.00
0.00
1.50 2.00
0.00 0.00
3.50
34.22
119.77
Fed W/H
2.78 Gross
667.21
7227 SOUTH 135TH STREET
539-52-1358 S
0.00
0.00
8.00
8.00 8.00
0.00 0.00
24.00
22.81
547.44
FICA
51.04 Taxes
63.00
FLAGGER
State W/H
0.00 Deducts
49.23
SEATTLE, WA 98178
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
9.18 Net Pay
554.98
VACATION
27.50 Check #:
72289
UNION DUES
20.63
N.W.F.C.
1.10
Total Job Gross
667.21
Pugs 2
CECCANTI, INC. Pay Period Date: 10/20/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/20/07 Job No: 658
Payroll No: 5 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
14
15
16
17 18
19
20
Total
Rate
Gross Pay
HELM, JOSHUAH JAMES
Ex: M-01 N M
O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
123.86 Gross
1,143.37
1318 EAST 35TH STREET
539-78-3747
S
0.00
0.00
0.00
0.00 0.00
7.00
0.00
7.00
23.82
166.74
FICA
State W/H
87.47 Taxes
0.00
226.35
APPRENTICE/OPERATOR
Local W/H
Deducts
0.00
31.85
TACOMA, WA 98404
Wcomp/Sdi
Add-Ons
15.02
0.00
Other Job Pay
WORKING DU
Net Pay
22.85 Check #:
885.17
N.W.F.C.
9.00
72334
Total Job
Gross
166.74
JONES, ROBERT M
Ex: M-00 C M
O
0.00
0.00
0.00
0.00 1.00
0.00
0.00
1.00
34.22
34.22
Fed W/H
FICA
24.53 Gross
399.18
320 SO DIVISION STREET
516-74-6024
S
0.00
0.00
0.00
0.00 8.00
8.00
0.00
16.00
22.81
364.96
State W/H
30.54 Taxes
0.00
60.74
FLAGGER
Local W/H
Deducts
0.00 Add-Ons
30.43
0.00
AUBURN, WA 98001
Other Job Pay
Wcomp/Sdi
5.67 Net Pay
308.01
VACATION
17.00 Check #:
72294
UNION DUES
12.75
N.W. F.C.
0.68
MARANA, WILLIAM T
5932 SOUTH PARK
TACOMA, WA 98408
PAYNE,CHERYL
9904 23RD AVE CT. S. K171
TACOMA, WA 98444
Total Job Gross 399.18
Ex: S-00 A M O 0.00 3.50 1.50 0.00 1.50 0.00 0.00 6.50 33.35 216.79
538-98-3721 S 0.00 8.00 8.00 7.50 8.00 8.00 0.00 39.50 22.23 878.10
2ND PERIOD APP(70%)
Other Job Pay -
Total Job Gross 1,094.89
Ex: -01 C F O 0.00 5.00 2.00 2.00 3.00 0.00 0.00 12.00 34.22 410.64
514-62-4858 S 0.00 8.00 8.00 8.00 8.00 8.00 0.00 40.00 22.81 912.40
LB/FLAGGER
Other Job Pay
Total Job Gross 1,323.04
Fed W/H
2O4.43
Gross
1,094.89
FICA
83.77
Taxes
303.56
State W/H
0.00
Deducts
31.10
Local W/H
0.00
Add-Ons
0.00
Wcomp/Sdi
15.36
Net Pay
760.23
WORKING DU
21.90
Check #:
72346
N.W.F.C.
9.20
Fed W/H
235.13
Gross
1,323.04
FICA
101.21
Taxes
353.70
State W/H
0.00
Deducts
93.08
Local W/H
0.00
Add-Ons
0.00
Wcomp/Sdi
17.36
Net Pay
876.26
VACATION
52.00
Check #:
72358
UNION DUES
39.00
N. W. F. C.
2.08
Page 3
CECCANTI, INC. Pay Period Date: 10/20/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/20/07 Job No: 658
Payroll No: 5 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
14
15
16
17 18
19
20 Total Rate Gross Pay
Deductions Totals
PUGH, TROY KENNETH
Ex: S-01 C M 0
0.00
0.00
1.00
0.00 4.50
0.00
0.00 5.50 36.96 203.28
Fed W/H
215.45 Gross
1,244.32
2728 5TH AVE. NE
533-02-0277 S
0.00
1.00
3.50
1.00 4.00
3.00
0.00 12.50 24.64 308.00
FICA
95.19 Taxes
326.34
APT. #4
FLAGGER
State W/H
0.00 Deducts
84.16
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.70 Net Pay
833.82
VACATION
47.00 Check #:
72362
UNION DUES
35.28
N.W.F.C.
1.88
REYNOLDS, ROGER ALAN
5707 114TH AVE. CT. E.
PUYALLUP, WA 98372
RUTLEDGE, ZANDRA M
4702 SO WARNER APT. C
TACOMA, WA 98409
RUTZ, LAWRENCE 0
9613 AURORA AVE NO.
#21
SEATTLE, WA 98103
Total Job Gross
511.28
Ex: M-00 C M 0 0.00 0.00 4.00 0.00 0.00 0.00 0.00 4.00 48.26 193.04
537-58-0223 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 32.17 257.37
OPERATOR/G2 I
Other Job Pay 1
Total Job Gross 450.41
Ex: S-01 B F 0 0.00 3.50 2.50 2.00 0.00 2.50 0.00 10.50 34.22 359.31
538-82-9687 S 0.00 8.00 8.00 8.00 0.00 8.00 0.00 32.00 22.81 729.92
FLAGGER I
Other Job Pay
Total Job Gross 1.089.23
Ex: S-01 C M 0 0.00 0.00 0.00 0.00 3.00 0.00 0.00 3.00 34.22 102.66
533-52-3769 S 0.00 0.00 0.00 0.00 8.00 8.00 0.00 16.00 22.81 364.96
FLAGGER i
Other Job Pay
Total Job Gross 467.62
Fed W/H
270.57
Gross
1,399.43
FICA
107.05
Taxes
391.48
State W/H
0.00
Deducts
36.30
Local W/H
0.00
Add-Ons
0.00
Wcomp/Sdi
13.86
Net Pay
971.65
WORKING DU
28.00
Check #:
72363
N.W.F.C.
8.30
Fed W/H
176.67
Gross
1,089.23
FICA
83.32
Taxes
274.19
State W/H
0.00
Deducts
76.09
Local W/H
0.00
Add-Ons
0.00
Wcomp/Sdi
14.20
Net Pay
738.95
VACATION
42.50
Check #:
72368
UNION DUES
31.89
N. W. F. C.
1.70
Fed W/H
45.51
Gross
467.62
FICA
35.77
Taxes
87.62
State W/H
0.00
Deducts
34.01
Local W/H
0.00
Add-Ons
0.00
Wcomp/Sdi
6.34
Net Pay
345.99
VACATION
19.00
Check #:
72293
UNION DUES
14.25
N.W.F.C.
0.76
Pave 4
CECCANTI, INC.
Pay Period Date:
10/20/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/20/07
Job No:
658
Payroll No:
5
Job Name:
RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
14 15
16
17 18
19
20 Total
Rate Gross Pay
TAAMU, USOALII FAIUMU
Ex: S-01 AM 0
0.00 0.00
0.00
0.00 0.00
0.00
0.00 0.00
0.00 0.00
Fed W/H
81.43 Gross
707.12
105 WELLS AVENUE SOUTH #B
535-64-7566 S
0.00 0.00
0.00
0.00 2.00
0.00
0.00 2.00
22.81 45.62
FICA
54.09 Taxes
145.88
FLAGGER
State W/H
0.00 Deducts
55.50
RENTON, WA 98055
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
10.36 Net Pay
505.74
VACATION
31.00 Check #: 72372
UNION DUES
23.26
N. W. F. C.
1.24
Total Job Gross
45.62
TALLENT, RALPH JAY
Ex: M-04 C M 0
0.00
3.50
2.00
1.50 1.50
0.00 0.00
8.50
48.26
410.21
Fed W/H
279.58 Gross
1,697.03
PO BOX 1252
551-33-8411 S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
32.17
1,286.82
FICA
129.83 Taxes
425.61
EXCAVATOR/BACKHOE
3
State W/H
0.00 Deducts
106.65
MILTON, WA 98354
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.20 Net Pay
1,164.77
CHILD SUPP
63.00 Check #:
72373
WORKING DU
33.95
N.W.F.C.
9.70
Total Job Gross
1,697.03
VANLANDINGHAM, JASON EDWA Ex: M-01 C M 0
0.00
3.50
1.00
1.00 0.00
0.00 0.00
5.50
45.83
252.07
Fed W/H
161.81 Gross
1,229.68
12206 221 ST AVE. CT EAST
537-13-3579 S
0.00
8.00
8.00
8.00 0.00
8.00 0.00
32.00
30.55
977.61
FICA
94.07 Taxes
268.39
GENERAL LABORER
State W/H
0.00 Deducts
67.14
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
12.51 Net Pay
894.15
VACATION
37.50 Check #:
72374
UNION DUES
28.14
N.W.F.C.
1.50
Total Job Gross
1,229.68
VILLALON, CRUZ
Ex: M-01 H M 0
0.00
0.00
2.00
2.50 3.50
2.50 0.00
10.50
48.26
506.73
Fed W/H
258.24 Gross
1,793.53
13106 119TH ST. CRT. E.
555-82-4128 S
0.00
0.00
8.00
8.00 8.00
8.00 0.00
32.00
32.17
1,029.44
FICA
137.20 Taxes
412.31
EXCAVATOR/BACKHOE
3
State W/H
0.00 Deducts
45.97
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.87 Net Pay
1,335.25
WORKING DU
35.87 Check #:
72378
N.W.F.C.
10.10
Total Job Gross
1,536.17
Page 5
CECCANTI, INC.
Pay Period Date:
10/20/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/20/07
Job No:
658
Payroll No:
5
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
14
15
16
17 18
19 20
Total
Rate
Gross Pay
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M O
0.00
0.00
1.00
0.00 0.00
0.00 0.00
1.00
34.22
34.22
Fed W/H
FICA
114.66 Gross
841.16
10402 140TH AVENUE EAST
534-96-9686 S
0.00
0.00
2.50
1.00 0.00
3.00 0.00
6.50
22.81
148.27
State W/H
64.34 Taxes
0.00
190.51
FLAGGER
Local W/H
Deducts
0.00 Add-Ons
61.78
0.00
PUYALLUP, WA 98374
Other Job Pay
Wcomp/Sdi
11.51 Net Pay
588.87
VACATION
34.50 Check #:
72377
UNION DUES
25.90
N. W. F. C.
1.38
Total Job Gross
182.49
WESTHOFF, BRANDON A
Ex: S-00 C M O
0.00
0.00
0.00
0.00 4.50
0.00 0.00
4.50
34.22
153.99
Fed W/H
189.69 Gross
1,075.92
32831 17TH AVENUE SW
539-94-0605 S
0.00
0.00
1.00
3.00 2.00
0.00 0.00
6.00
22.81
136.86
FICA
State W/H
82.31 Taxes
0.00
286.53
FLAGGER
Local W/H
Deducts
. Add-.
77.89
FEDERAL WAY, WA 98023
Other Job Pay
Wcomp/Sdi
14.53 53 Net Pay Pay
711.50
0
VACATION
43.50 Check #:
72382
UNION DUES
32.65
N.W. F.C.
1.74
Total Job Gross
290.85
WHITE, JARED D
Ex: S-02 C M O
0.00
3.50
1.00
1.00 1.50
0.00 0.00
7.00
42.06
294.42
Fed W/H
242.02 Gross
1,416.02
350 B RYAN ROAD
538-06-0032 S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
28.04
1,121.60
FICA
State W/H
108.33 Taxes
0.00
366.03
GENERAL LABORER
Local W/H
Deducts
0.00
245.68
BUCKLEY, WA 98321
Other Job Pay
Wcomp/Sdi
Add-Ons
15.68 Net Pay
0.00
804.31
CHILD SUPP
161.53 Check #:
72384
VACATION
47.00
UNION DUES
35.27
N. W. F. C.
1.88
Total Job Gross
1,416.02
D
0.00
3.00
0.00
0.00 0.00
0.00 0.00
3.00
69.32
207.96
WILHELM, MARK E
Ex: M-00 C M O
0.00
4.00
3.50
2.00 2.00
3.00 0.00
14.50
51.99
753.86
Fed W/H
413.26 Gross
2,348.22
28209 SE 430 STREET
535-88-4993 S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
34.66
1,386.40
FICA
State W/H
179.64 Taxes
0.00
612.11
FOREMAN
Local W/H
Deducts
o.00 Add-Ons
58.47
0.00
ENUMCLAW, WA 98022
Other Job Pay
Wcomp/Sdi
19.21 Net Pay
1,677.64
WORKING DU
46.97 Check #:
72386
N.W.F.C.
11.50
Total Job Gross
2,348.22
Page 6
Statement of Compliance
Date: NOVEMBER 14, 2007 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 21 day of OCTOBER, 2007 and ending the 27 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE r
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 2 f Title 31 of the United States Codc.
Page I
CECCANTI, INC. Pay Period Date: 10/27/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/27/07 Job No: 658
Payroll No: 6 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
21
22
23
24 25
26
27
Total Rate
Gross Pay
Deductions Totals
D
0.00
2.50
0.00
0.00 0.00
0.00
0.00
2.50 64.34
160.85
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
4.00
1.50
1.00 0.00
0.00
0.00
6.50 48.26
313.69
Fed W/H
184.81 Gross
1,761.36
3823 215TH ST CT. EAST
538-02-9911 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00 32.17
1,286.82
FICA
134.74 Taxes
335.93
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
45.04
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.38 Net Pay
1,380.39
WORKING DU
35.24 Check #:
72491
N.W.F.C.
9.80
Total Job
Gross
1,761.36
HELM, JOSHUAH JAMES
Ex: M-01 N M O 0.00 0.00 0.00 0.00 0.00 2.50 0.00 2.50 35.73 89.33 Fed W/H
154.23 Gross
1,345.84
1318 EAST 35TH STREET
539-78-3747 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 23.82 190.56 FICA
102.96 Taxes
274.23
State W/H
APPRENTICE/OPERATOR
0.00 Deducts
37.12
TACOMA, WA 98404
Local W/H
0.00 Add-Ons
0.00
Other Job Pay Wcomp/Sdi
17.04 Net Pay
1,034.49
WORKING DU
26.92
Check #:
72525
N. W.F.C.
10.20
Total Job Gross 279.89
HUGHES, MICHAEL E.
Ex: M-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fed W/H
321.95 Gross
1,783.01
201 117TH STREET EAST
539-62-9003 S 0.00 0.00 0.00 0.00 0.00 3.00 0.00 3.00 35.66 106.98 FICA
136.41 Taxes
474.74
State W/H
OP/TRUCK FOREMAN
0.00 Deducts
45.47
TACOMA, WA 98445
Local W/H
0.00 Add-Ons
0.00
Other Job Pay Wcomp/Sdi
16.38 Net Pay
1,262.80
WORKING DU
35.67
Check #:
72532
N.W. F.C.
9.80
Total Job Gross 106.98
D
0.00
1.00
0.00
0.00 0.00
0.00 0.00
1.00
44.46
44.46
MARANA, WILLIAM T
Ex: S-00 A M
O
0.00
4.00
1.50
1.00 0.00
0.00 0.00
6.50
33.35
216.78
Fed W/H
218.33 Gross
1,150.46
5932 SOUTH PARK
538-98-3721
S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
22.23
889.22
FICA
88.01 Taxes
322.21
2ND PERIOD APP(70
u
/o)
Equipment Usage
State W/H
Local W/H
0.00 Deducts
0.00
32.49
TACOMA, WA 98408
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.87 Net Pay
795.76
WORKING DU
22.99
Check #:
72543
N.W. F.C.
9.50
Total Job Gross
1,150.46
PAYNE, CHERYL
Ex: -01 C F
O
0.00
4.00
0.00
1.00 0.00
0.00 0.00
5.00
34.22
171.10
Fed W/H
143.88 Gross
958.05
9904 23RD AVE CT. S. K171
514-62-4858
S
0.00
8.00
4.50
8.00 8.00
6.00 0.00
34.50
22.81
786.95
FICA
73.29 Taxes
230.35
LB/FLAGGER
State W/H
0.00 Deducts
70.71
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
13.18 Net Pay
656.99
VACATION
39.50 Check #:
72565
UNION DUES
29.63
N. W. F. C.
1.58
Total Job Gross
958.05
Page 2
CECCANTI, INC.
Pay Period Date:
10/27/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
10/27/07
Job No:
658
Payroll No:
6
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN MON
TUE
WED THU
FRI
SAT
Employee
Work Class
21 22
23
24 25
26
27 Total
Rate Gross Pay
Deductions
Totals
PUGH, TROY KENNETH
Ex: S-01 C M O
0.00 7.50
0.00
0.00 0.00
0.00
0.00 7.50
36.96 277.20
Fed W/H
320.18 Gross
1,650.88
2728 5TH AVE. NE
533-02-0277 S
0.00 2.00
1.00
1.00 1.00
1.00
0.00 6.00
24.64 147.84
FICA
126.29 Taxes
466.00
APT. #4
FLAGGER
State W/H
0.00 Deducts
104.73
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
19.53 Net Pay
1,080.15
VACATION
58.50 Check #:
72569
UNION DUES
43.89
N. W. F. C.
2.34
Total Job Gross
425.04
RUTLEDGE, ZANDRA M
Ex: S-01 B F
O
0.00
0.50
1.50
1.00
0.00
0.00 0.00
3.00
34.22
102.66
Fed W/H
112.51 Gross
832.59
4702 SO WARNER APT. C
538-82-9687
S
0.00
8.00
8.00
8.00
0.00
5.50 0.00
29.50
22.81
672.90
FICA
63.69 Taxes
187.89
FLAGGER
E Equipment ment Usa a
p p 9
State W/H
Local W/H
0.00 Deducts
0.00
62.67
TACOMA, WA 98409
Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
11.69 Net Pay
582.03
VACATION
35.00 Check #:
72576
UNION DUES
26.27
N. W. F. C.
1.40
Total Job Gross
775.56
D
0.00
2.50
0.00
0.00
0.00
0.00 0.00
2.50
64.34
160.85
TALLENT, RALPH JAY
Ex: M-04 C M
O
0.00
4.00
1.50
1.00
0.00
0.00 0.00
6.50
48.26
313.69
Fed W/H
296.20 Gross
1,761.36
PO BOX 1252
551-33-8411
S
0.00
8.00
8.00
8.00
8.00
8.00 0.00
40.00
32.17
1,286.82
FICA
134.74 Taxes
447.31
EXCAVATOR/BACKHOE
3
State W/H
0.00 Deducts
45.05
MILTON, WA 98354
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
16.37 Net Pay
1,269.00
WORKING DU
35.25
Check #:
72583
N.W.F.C.
9.80
Total Job Gross
1,761.36
D
0.00
1.00
0.00
0.00
0.00
0.00 0.00
1.00
61.10
61.10
VANLANDINGHAM, JASON EDWA Ex: M-01 C M
O
0.00
4.00
1.50
0.00
0.00
0.00 0.00
5.50
45.83
252.07
Fed W/H
218.66 Gross
1,535.20
12206 221 ST AVE. CT EAST
537-13-3579
S
0.00
8.00
8.00
8.00
8.00
8.00 0.00
40.00
30.55
1,222.03
FICA
117.45 Taxes
351.65
GENERAL LABORER
State W/H
0.00 Deducts
83.27
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
50.46
Other
Job Pay
Wcomp/Sdi
15.54 Net Pay
1,150.74
VACATION
46.50 Check #:
72585
UNION DUES
34.91
N. W. F. C.
1.86
Total Job Gross
1,535.20
Page
CECCANTI, INC. Pay Period Date: 10/27/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/27/07 Job No: 658
Payroll No: 6 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Employee
Work Class
21
22
23
24 25
26 27 Total
Rate
Gross Pay
Deductions Totals
D
0.00
2.50
0.00
0.00 0.00
0.00 0.00 2.50
64.34
160.85
VILLALON, CRUZ
Ex: M-01 H M O
0.00
4.00
1.50
1.00 0.00
0.00 0.00 6.50
48.26
313.69
Fed W/H
322.58 Gross
2,050.88
13106 119TH ST. CRT. E.
555-82-4128 S
0.00
8.00
8.00
8.00 8.00
0.00 0.00 32.00
32.17
1,029.45
FICA
156.89 Taxes
498.84
EXCAVATOR/BACKHOE 3
Equipment Usage
State W/H
Local W/H
0.00 Deducts
o.00
52.62
PUYALLUP, WA 98374
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
19.37 Net Pay
1,499.42
WORKING DU
41.02 Check #:
72589
N.W.F.C.
11.60
Total Job Gross
1,503.99
VILLANOVA, CHRISTOPHER J
10402 140TH AVENUE EAST
PUYALLUP, WA 98374
Ex: S-01 C M
534-96-9686
FLAGGER
O
S
0.00
0.00
7.50
2.00
0.00
1.00
0.00 0.00
1.00 0.00
Other Job Pay
0.00 0.00
1.00 0.00
Equipment Usage
Total Job Gross
7.50
5.00
34.22
22.81
256.65
114.05
370.70
Fed W/H
FICA
State W/H
Local W/H
Wcomp/Sdi
VACATION
UNION DUES
N. W. F. C.
216.59 Gross
95.54 Taxes
0.00 Deducts
0.00 A-Ons
16.36 Net Pay
49.00 Check #:
36.77
1.96
1,248.91
328.49
87.73
0.00
832.69
72588
WESTHOFF, BRANDON A
Ex: S-00 C M
O
0.00
0.00
2.50
0.00 0.00
0.00 0.00
2.50
34.22
85.55
Fed W/H
238.64 Gross
1,271.72
32831 17TH AVENUE SW
539-94-0605
S
0.00
0.00
3.50
0.00 0.00
0.00 0.00
3.50
22.81
79.84
FICA
97.29 Taxes
352.80
FLAGGER
State W/H
0.00 Deducts
90.42
FEDERAL WAY, WA 98023
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
16.87 Net Pay
828.50
VACATION
50.50 Check #:
72594
UNION DUES
37.90
N.W.F.C.
2.02
Total Job Gross
165.39
D
0.00
1.00
0.00
0.00 0.00
0.00 0.00
1.00
56.08
56.08
WHITE, JARED D
Ex: S-02 C M
O
0.00
4.00
1.50
0.00 0.00
0.00 0.00
5.50
42.06
231.33
Fed W/H
240.27 Gross
1,409.01
350 B RYAN ROAD
538-06-0032
S
0.00
8.00
8.00
8.00 8.00
8.00 0.00
40.00
28.04
1,121.60
FICA
107.78 Taxes
363.59
GENERAL LABORER
State W/H
0.00 Deducts
244.80
BUCKLEY, WA 98321
Local W/H
0.00 Add-Ons
75.00
Other Job Pay
Wcomp/Sdi
15.54 Net Pay
875.62
CHILD SUPP
161.53 Check #:
72597
VACATION
46.50
UNION DUES
34.91
N. W. F.C.
1.86
Total Job Gross
1,409.01
Page 4
CECCANTI, INC. Pay Period Date: 10/27/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 10/27/07 Job No: 658
Payroll No: 6 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED
THU
FRI
SAT
Deductions Totals
Employee
Work Class
21
22
23
24
25
26
27
Total Rate
Gross Pay
D
0.00
1.50
0.00
0.00
0.00
0.00
0.00
1.50 69.32
103.98
WILHELM, MARK E
Ex: M-00 C M O
0.00
4.00
1.50
1.00
0.00
0.00
0.00
6.50 51.99
337.94
Fed W/H 283.28 Gross 1,828.32
28209 SE 430 STREET
535-88-4993 S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00 34.66
1,386.40
FICA 139.87 Taxes 439.18
State W/H 0 00
FOREMAN
ENUMCLAW, WA 98022
Other Job Pay
Total Job Gross
1.828.32
Deducts 46.18
Local W/H 0.00 Add-Ons 0.00
Wcomp/Sdi 16.03 Net Pay 1,342.96
WORKING DU 36.58 Check #: 72599
N.W.F.C. 9.60
Page 5
Statement of Compliance
Date: NOVEMBER 14, 2007 Contract Number: WTR-27-3344
I, KRISTIE ROJAS, PROJECT ADMIN do hereby state:
(1) That I pay or supervise the payment of the persons employed by CECCANTI, INC. on the RENTON WATER LINE RELOCAT, that during the payroll period commencing on the 28 day of OCTOBER, 2007 and ending the 3 day of NOVEMBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said CECCANTI, INC. from the full weekly wages earned by any person and
that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as
amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
FICA
FEDERAL WITHHOLDING
LABOR & INDUSTRIES
UNION DUES & VACATION
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
() Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
KRISTIE ROJAS, PROJECT ADMIN
SIGNATURE
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Sectionfl2l of Title 31 of the United States Code.
Page 1
CECCANTI, INC. Pay Period Date: 11/03/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/03/07 Job No: 658
Payroll No: 7 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
28
29
30
31 01
02
03
Total
Rate
Gross Pay
Deductions Totals
D
0.00
0.00
1.00
1.00 0.00
0.00
2.00
4.00
64.34
257.36
CAMPBELL, CHAD ALLEN
Ex: M-05 C M O
0.00
1.50
4.00
4.00 1.00
0.50
12.00
23.00
48.26
1,109.98
Fed W/H
408.01 Gross
2,654.16
3823 215TH ST CT. EAST
538-02-9911 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
32.17
1,286.82
FICA
203.04 Taxes
633.42
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
66.50
SPANAWAY, WA 98387
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
22.37 Net Pay
1,954.24
WORKING DU
53.10 C
#:
72640
N.W.F.C.
13.40heck
Total Job
Gross
2,654.16
HELM, JOSHUAH JAMES
1318 EAST 35TH STREET
TACOMA, WA 98404
Ex: M-01 N M O 0.00
539-78-3747 S 0.00
APPRENTICE/OPERATOR
0.00
0.00
0.00
0.00
0.00 0.00
0.00 0.00
Other Job Pay
0.00 3.00
8.00 0.00
Total Job Gross
3.00
8.00
35.73
23.82
107.19
190.56
297.75
Fed W/H
FICA
State W/H
Local W/H
Wcomp/Sdi
WORKING DU
N.W. F.C.
159.59 Gross
105.69 Taxes
0.00 Deducts
0.00 Add-Ons
17.37 Net Pay
27.63 C
10.40heck #:
1,381.57
282.65
38.03
0.00
1,060.89
72673
HOLDEN, RICHARD L.
Ex: -00 C M
O
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Fed W/H
175.85 Gross
1,257.93
33915 TANWAX DRIVE EAST
538-58-8587
S
0.00
0.00
0.00
0.00
0.00
2.50
0.00
2.50
32.66
81.65
FICA
96.23 Taxes
285.10
TD/GROUP 1
State W/H
0.00 Deducts
39.52
EATONVILLE, WA 98328
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
13.02 Net Pay
933.31
WORKING DU
25.17
Check #:
72678
N. W. F. C.
7.80
AFLAC
6.55
Total Job
Gross
81.65
D
0.00
0.00
1.00
1.00
0.00
0.00
4.00
6.00
44.46
266.76
MARANA, WILLIAM T
Ex: S-00 A M
O
0.00
1.50
4.00
4.00
1.00
4.00
12.00
26.50
33.35
883.80
Fed W/H
457.39 Gross
2,039.80
5932 SOUTH PARK
538-98-3721
S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00
22.23
889.24
FICA
156.04 Taxes
637.64
2ND PERIOD APP(70/o
o)
State W/H
0.00 Deducts
55.28
TACOMA, WA 98408
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
24.21 Net Pay
1,346.88
WORKING DU
40.78 Check #:
72691
N. W. F. C.
14.50
Total Job Gross
2,039.80
Page 2
CECCANTI, INC. Pay Period Date: 11/03/07 Certified Payroll Report Contract #: WTR-27-3344
4116 BROOKDALE ROAD EAST Week Ending: 11/03/07 Job No: 658
Payroll No: 7 Job Name: RENTON WATER LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
28
29
30
31 01
02
03
Total Rate
Gross Pay
Deductions Totals
D
0.00
0.00
0.00
0.00 0.00
0.00
3.50
3.50 45.62
159.67
PAYNE, CHERYL
Ex: -01 C F O
0.00
1.00
2.50
0.50 0.00
0.00
12.00
16.00 34.22
547.52
Fed W/H
286.45 Gross
1,528.35
9904 23RD AVE CT. S. K171
514-62-4858 S
0.00
8.00
8.00
8.00 0.00
0.00
0.00
24.00 22.81
547.44
FICA
116.92 Taxes
421.91
LB/FLAGGER
State W/H
0.00 Deducts
99.36
TACOMA, WA 98444
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
18.54 Net Pay
1,007.08
VACATION
55.50 Check #:
72701
UNION DUES
41.64
N.W.F.C.
2.22
Total Job
Gross
1,254.63
D
0.00
0.00
0.00
0.00
0.00
0.00
6.00
6.00
49.28
295.68
PUGH, TROY KENNETH
Ex: S-01 C M
0
0.00
0.00
0.00
1.00
2.00
3.00
12.00
18.00
36.96
665.28
Fed W/H
413.32 Gross
1,983.52
2728 5TH AVE. NE
533-02-0277
S
0.00
1.00
0.00
0.00
4.00
3.50
0.00
8.50
24.64
209.44
FICA
151.74 Taxes
586.77
APT. #4
FLAGGER
State W/H
0.00 Deducts
116.36
PUYALLUP, WA 98373
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
21.71 Net Pay
1,280.39
VACATION
65.00 Check #:
72705
UNION DUES
48.76
N.W.F.C.
2.60
Total Job
Gross
1,170.40
RUTLEDGE, ZANDRA M
Ex: S-01 B F
O
0.00
1.00
4.00
4.00
0.50
4.00
0.00
13.50
34.22
461.97
Fed W/H
247.96 Gross
1,374.37
4702 SO WARNER APT. C
538-82-9687
S
0.00
8.00
8.00
8.00
8.00
8.00
0.00
40.00
22.81
912.40
FICA
105.15 Taxes
370.98
FLAGGER
State W/H
0.00 Deducts
95.77
TACOMA, WA 98409
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
17.87 Net Pay
907.62
VACATION
53.50 Check #:
72713
UNION DUES
40.13
N.W.F.C.
2.14
Total Job
Gross
1,374.37
D
0.00
0.00
0.00
0.00
0.00
2.00
0.00
2.00
64.34
128.68
STUBBS, BRIAN JAMES
Ex: S-00 C M
O
0.00
0.00
0.00
0.00
0.00
12.00
0.00
12.00
48.26
579.12
Fed W/H
443.74 Gross
2,026.78
PO BOX 401
533-94-0548
S
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
FICA
155.05 Taxes
617.00
EXCAVATOR/BACKHOE
OV
State W/H
0.00 Deducts
51.44
SOUTH PRAIRIE, WA 98385
Local W/H
0.00 Add-Ons
0.00
Other
Job Pay
Wcomp/Sdi
18.21 Net Pay
1,358.34
WORKING DU
40.54 C
#:
72718
N.W.F.C.
10.90heck
Total Job Gross
707.80
Pine 3
CECCANTI, INC.
Pay Period Date:
11/03/07
Certified Payroll Report
Contract#:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
11/03/07
Job No:
658
Payroll No:
7
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
28
29
30
31 01
02
03
Total
Rate
Gross Pay
D
0.00
0.00
1.00
1.00 0.00
0.00
0.00
2.00
64.34
128.68
TALLENT, RALPH JAY
Ex: M-04 C M O
0.00
1.50
4.00
4.00 1.00
0.50
0.00
11.00
48.26
530.86
Fed W/H
348.00 Gross
1,946.36
PO BOX 1252
551-33-8411 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
32.17
1,286.82
FICA
148.90 Taxes
514.59
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
112.54
MILTON, WA 98354
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
17.69 Net Pay
1,319.23
CHILD SUPP
63.00 Check #:
72719
WORKING DU
38.94
N. W. F. C.
10.60
Total Job
Gross
1,946.36
D
0.00
0.00
1.00
1.00 0.00
0.00
2.00
4.00
61.10
244A0
VANLANDINGHAM, JASON EDWA Ex: M-01 C M O
0.00
1.50
4.00
4.00 1.00
0.50
12.00
23.00
45.83
1,054.11
Fed W/H
465.00 Gross
2,520.56
12206 221 ST AVE. CT EAST
537-13-3579 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
30.55
1,222.05
FICA
192.82 Taxes
680.19
GENERAL LABORER
State W/H
0.00 Deducts
120.00
BONNEY LAKE, WA 98391
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
22.37 Net Pay
1,720.37
VACATION
67.00 Check #:
72721
UNION DUES
50.32
N.W. F.C.
2.68
Total Job
Gross
2,520.56
D
0.00
0.00
0.00
0.00 0.00
0.00
2.00
2.00
57.10
114.20
VAZQUEZ, FELIPE
Ex: S-00 H M O
0.00
0.00
0.00
0.00 0.00
0.00
4.00
4.00
42.83
171.32
Fed W/H
282.95 Gross
1,448.96
1604 WEST JAMES PL
645-76-7476 S
0.00
0.00
0.00
0.00 0.00
0.00
8.00
8.00
28.55
228.41
FICA
110.84 Taxes
409.32
APT.263
PIPELAYER/GRADECHECK
State W/H
0.00 Deducts
83.26
KENT, WA 98032
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.53 Net Pay
956.38
VACATION
46.50 Check #:
72658
UNION DUES
34.90
N. W. F. C.
1.86
Total Job
Gross
513.93
D
0.00
0.00
1.00
1.00 0.00
0.00
4.00
6.00
64.34
386.04
VILLALON, CRUZ
Ex: M-01 H M O
0.00
1.50
4.00
4.00 1.00
4.00
12.00
26.50
48.26
1,278.89
Fed W/H
557.19 Gross
2,951.75
13106 119TH ST. CRT. E.
555-82-4128 S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
32.17
1,286.82
FICA
225.81 Taxes
807.21
EXCAVATOR/BACKHOE 3
State W/H
0.00 Deducts
73.56
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
24.21 Net Pay
2,070.98
WORKING DU
59.06 Check #:
72725
N.W.F.C.
14.50
Total Job Gross
2,951.75
Page 4
CECCANTI, INC.
Pay Period Date:
11/03/07
Certified Payroll Report
Contract #:
WTR-27-3344
4116 BROOKDALE ROAD EAST
Week Ending:
11/03/07
Job No:
658
Payroll No:
7
Job Name:
RENTON WATER
LINE RELOCAT
TACOMA, WA 98446
253 537-2990
# Exemptions
Hours
Check
Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
28
29
30
31 01
02
03
Total
Rate
Gross Pay
VILLANOVA, CHRISTOPHER J
Ex: S-01 C M
O
0.00
0.00
0.00
0.00 2.00
3.00
0.00
5.00
34.22
171.10
Fed W/H
183.80 Gross
1,117.73
10402 140TH AVENUE EAST
534-96-9686
S
0.00
1.00
0.00
0.00 0.00
3.50
0.00
4.50
22.81
102.65
FICA
State W/H
85.51 Taxes
284.67
FLAGGER
0.00 Deducts
82.35
PUYALLUP, WA 98374
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
15.36 Net Pay
750.71
VACATION
46.00 Check #:
72724
UNION DUES
34.51
N.W.F.C.
1.84
Total Job Gross
273.75
D
0.00
0.00
0.00
0.00 0.00
0.00
6.00
6.00
45.62
273.72
WESTHOFF, BRANDON A
Ex: S-00 C M
O
0.00
0.00
0.00
0.00 0.00
0.00
12.00
12.00
34.22
410.64
Fed W/H
356.87 Gross
1,716.53
32831 17TH AVENUE SW
539-94-0605
S
0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
FICA
131.31 Taxes
508.70
FLAGGER
State W/H
0.00 Deducts
110.09
FEDERAL WAY, WA 98023
Local W/H
Wcomp/Sdi
O.00 Add-Ons
20.52
0.00
Other Job Pay
Net Pay
1,097.74
VACATION
61.50 Check #:
72730
UNION DUES
46.13
N. W. F. C.
2.46
Total Job Gross
684.36
D
0.00
0.00
1.00
1.00 0.00
0.00
0.00
2.00
56.08
112.16
WHITE, JARED D
Ex: S-02 C M
O
0.00
1.50
4.00
4.00 1.00
0.00
0.00
10.50
42.06
441.63
Fed W/H
250.79 Gross
1,451.07
350 B RYAN ROAD
538-06-0032
S
0.00
8.00
8.00
8.00 8.00
0.00
0.00
32.00
28.04
897.28
FICA
111,01 Taxes
376.66
GENERAL LABORER
State W/H
0.00 Deducts
241.24
BUCKLEY, WA 98321
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
14.86 Net Pay
833.17
CHILD SUPP
161.53 Check #:
72733
VACATION
44.50
UNION DUES
33.43
N. W. F.C.
1.78
Total Job Gross
1,451.07
D
0.00
0.00
1.00
1.00 0.00
0.00
4.00
6.00
69.32
415.92
WILHELM, MARK E
Ex: M-00 C M
O
0.00
1.50
4.00
4.00 0.00
0.50
12.00
22.00
51.99
1,143.79
Fed W/H
573.92 Gross
2,946.11
28209 SE 430 STREET
535-88-4993
S
0.00
8.00
8.00
8.00 8.00
8.00
0.00
40.00
34.66
1,386.40
FICA
225.38 Taxes
822.01
FOREMAN
State W/H
0.00 Deducts
72.56
ENUMCLAW, WA 98022
Local W/H
Wcomp/Sdi
0.00 Add-Ons
22.71
0.00
Other Job Pay
Net Pay
2,051.54
WORKING DU
58.96 Check #:
72735
N. W. F. C.
13.60
Total Job Gross
2,946.11
Page .i
Department of Labor & Industries
Employment Standards Section
P.O. Box 44510
Olympia, WA 98504-4510
(360) 902-5316
CERTIFIED PROJECT PAYROLL
Project Name: County: Project or Contract #
Prime Contractor ❑ Benson Road Water Line Relocation King WTR-27-3344
Subcontractor
Project Address: City: State
Renton WA
Awarding Agency Name: Company Name:
For the week ending: City of Renton Meriwether Leachman Associates, Inc.
Month Day Year Address City State ZIP+4 Address City: State ZIP+4
10 / 13 / 07 1055 South Grady Way Renton WA 98055 11800 NE 1601h Street Bothell WA 98011-4156
Day and Date
Work Classification
Name Sun Mon Tue Wed Thu Fri Sat Total Rate of Gross
NET
and
Soc. Sec. # of Employee
and Amount
Address 07 08 09 10 11 1 12 13 Hours Pay Earned
Withhold- Ind. WAGES
FICA
Hours Worked Each Day
ing tax Ins.
Survey
Leachman, Michael R.
oT
Chain Person
15711 - 17151 Avenue SE
64.00
4.90
11.52
0.10
47.48
537-54-4527
Monroe, WA 98272
RG
2.0
2.0
32.00
Survey
Bystron, Robert J.
oT
Instrument Person
17407 NE 45th St., #162
RG
18.25
539-86-8012
Redmond, WA 98052
Survey
Benedict, Greg S.
oT
Party Chief
7406 - 47th Ave. NE #G2
540-86-4860
Marysville, WA 98270
RG
28.00
Survey
Coombes, Douglas J.
oT
Party Chief
12919 - 297th Place NE
61.00
4.67
10.98
0.10
45.25
539-58-0929
Duvall, WA 98019
RG
2.0
2.0
30.50
Survey
Bystron, Robert J.
oT
Chain Person
17407 NE 45th St., #162
539-86-8012
Redmond, WA 98052
RG
18.25
Survey
Woelke, Alexander R.
oT
Chain Person
1006 W Emerson St, Apt 1
602-09-4710
Seattle, WA 98119
RG
18.50
Survey
Braun, Robert A.
°T
Party Chief
8403 NE13151 PI.
539-62-6994
Kirkland, WA 98034
RG
23.00
Employee Benefits Distribution and Signature Certification on Reverse
MLA Job 7647
AFFIRMATION
(1)
Today's Date
Name of Signatory Party
Title
October 23, 2007
Michael R. Leachman
Vice President
The above signatory pays or supervises (Name of contractor or subcontractor)
the payment of the persons employed by: MLA, Inc.
Name of building or work project
Payroll period starting
Payroll period ending
Benson Road Water Line Relocation
10 / 07 / 07
10 / 13 / 07
All persons employed on above project have been paid the full weekly wages earned, that no rebates have/will be made either directly or indirectly to
or on behalf of the above contractor or subcontractor from the weekly wages earned by any person and that no deductions have been made either
directly or indirectly from the full wages earned by any person, other than permissible deduction.
(2) That any payroll otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or
mechanics contained therein are not less then the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set
forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.
(4) That:
WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS * In addition to the basic hourly wage rates paid to each laborer or
mechanic listed in the above referenced payroll, payments or fringe benefits as listed below have been or will be made to appropriate programs for the benefits of such
employees.
The willful falsification of any of the above statements may subject the contractor to civil or criminal prosecution.
Print or type name of signatory
Title
Signature
Michael R. Leachman
Vice President
/I
BENEFIT DISTRIBUTION (Please report in "per hour" terms)
Craft/Trade
Hourly Total Benefit Credit
Hourly Pension
Hourly Medical
Hourly Vacation
Survey Party Chief
0.00
0.00
0.00
0.00
Survey Instrument Person
0.00
0.00
0.00
0.00
Survey Chain Person
0.00
0.00
0.00
0.00
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 10 / 06 / 07 DATE: October 11, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 30`h Day of September , 2007 and ending
on the 6" Day of October , 2007.
u�D ��
SIGNED: /�
Authorized Representative
TITLE: V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 10 / 20 / 07 DATE: October 23, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates. Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 14" Day of
on the 20`h Day of October , 2007.
SIGNED:
Authorized Representative
TITLE:
V.P.
October , 2007 and ending
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
STATEMENT OF NON-PERFORMANCE
PAYROLL NUMBER: 11 / 03 / 07 DATE: November 8, 2007
NAME OF SUBCONTRACTOR: Meriwether Leachman Associates, Inc.
I do hereby confirm that no person(s) were employed on the construction of the
PROJECT NAME: Benson Road Water Line Relocation
PROJECT NUMBER: WTR-27-3344
During the period commencing on the 28`h Day of October , 2007 and ending
on the 3"1 Day of
November 2007.
SIGNED:
Authorized Representative
TITLE:
V.P.
NOTE: This statement is not required to be submitted until after the submission of
the initial Payroll Report. However, it must be completed for each pay period
thereafter when no employees are working on the project. If there were
employees reporting for work during the above period, you must submit a
CERTIFIED PAYROLL.
MLA Job 7647
Statement of Compliance
Date: SEPTEMBER 28, 2007 Contract Number:
I, Tanya Johnson, Payroll Admin do hereby state:
(1) That 1 pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 16 day of SEPTEMBER, 2007 and ending the 22 day of
SEPTEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interwest Development NW, Inc. from the full weekly
wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person. other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of
Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below-
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
( X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
( X) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) F.XCFPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
Tanya Johnson, Payroll Admin
IG TURE
tiTitle 18 and Sectit231 of Title 31 of the United States Code
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pros ution. 7or'�
Page
Interwest Development NW, Inc. Pay Period Date: 09/22/07 Certified Payroll Report Contract #:
1425 22ND Street NW, Week Ending 09/22/07 Job No 07-460
Suite E Payroll No: 1 Job Name Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee Work Class 16
17
18
19 20
21
22
Total Rate Gross Pay
MILLER, DARREL Ex: S-02 C M O 0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00 0.00 0.00
Fed W/H
FICA
231.10 Gross
1,378.33
19414 28th ST. KPS 542-04-5579 S 0.00
0.00
0.00
0.00 1.75
0.00
0.00
1.75 22.56 39.48
104.99 Taxes
338.04
Grp 1 Truck Driver
Local W/H
Deducts
0.00
12ns
LAKEBAY, WA 98349
Other Job Pay
Wcomp/Sdi
Add-O
1.95 Net Pay
0.00
.6
911.06
GAR N
Shorthon TerTerm
123.23 Check #:
6.00
77470
�
Total Job Gross
39.48
Page 2
Statement of Compliance
Date: OCTOBER 5, 2007 Contract Number:
1, Tanya Johnson, Payroll Admin do hereby state:
(1) That 1 pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 23 day of SEPTEMBER, 2007 and ending the 29 day of
SEPTEMBER, 2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interwest Development NW, Inc. from the full weekly
wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of
Labor under the Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below:
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete, that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
( X) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below-
(c) EXCEPTIONS
EXCEPTION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
Tanya Johnson, Payroll Admin
E
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal osecutio ee Sect
n 10 of Title 18 an ST3 T o itle 31 of th nited States Code.
Page I
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 09/29/07
Week Ending. 09/29/07
Payroll No 2
Certified Payroll Report
Contract #:
Job No 07-460
Job Name. Waterline Relocation
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Deductions
Totals
Employee
Work Class
23
24
25
26 27
28
29
Total Rate Gross Pay
CLEMONS, WADE ALVEY
Ex: M-00 C M
0 0.00
0.00
0.00
0.00 0.00
0.00
0.00
0.00 0.00 0.00
Fed W/H
325.91 Gross
1,466.78
315 4TH AVE NORTH
533-72-3393
S 0.00
0.00
3.25
0.00 0.00
0.00
0.00
3.25 25.33 82.32
FICA
111.74 Taxes
439.27
Grp 1 Truck Driver
State W/H
0.00 Deducts
6.00
ALGONA, WA 98001
Local W/H
0.00 Add-Ons
0.00
�
Other Job Pay
Wcomp/Sdi
1.62 Net Pay
1,021.51
T�'''''''-
�
Short Term
6.00 Check #:
77518
\ `
Total Job
Gross
82.32
COLLINS III, ROBERT E
Ex: M-00 C M 0
0.00
0.00
0.00
0.00 0.00
3.50 0.00
3.50
33.84
118.44
Fed W/H
141.78
Gross
1,194.34
10121 83rd AVE CT E
277-64-5264 S
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
9160
Taxes
235.07
Grp 1 Truck Driver
StateFICA W/H
Deducts
7.43
PUYALLUP, WA 98373
Local W/H
0.00
Add-Ons
10.50
Other Job Pay
Wcomp/Sdi
1.69
Net Pay
962.34
�
Total Job Gross
118.44
HEALTH COV
7.43
Check #:
77521
COLLINS III, ROBERT E
Ex: M-00 C M 0
0.00
0.00
0.00
0.00 0.00
3.50 0.00
3.50
54.93
192.26
Fed W/H
141.78
Gross
1,194.34
10121 83rd AVE CT E
277-64-5264 S
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
FICA
91.60
Taxes
235.07
KC Tr & Trlr 03/07
Frin e Ad ustme
9
3.00
10.50
State W/H
Local W/H
0.00
0.00
Deducts
7.43
PUYALLUP, WA 98373
Add-Ons
10.50
Other Job Pay
Wcomp/Sdi
1.69
Net Pay
962.34
HEALTH COV
7.43
Check #:
77521
Total Job Gross
202.76
Ladwig, Stephanie Renee
Ex: S-00 C F O
0.00
0.00
0.00
0.00 0.00
1.00 0.00
1.00
54.93
54.93
Fed W/H
337.94
Gross
1,552.01
8811 159th St East
537-76-3689 S
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
FICA
126.14
Taxes
465.72
KC Tr & Trlr 03/07
Frin e Ad ustme
g
3.00
3.00
State W/H
Local W/H
0.00
0.00
Deducts
1.35
PUYALLUP, WA 98375
Add-Ons
98.25
Other Job Pay
Wcomp/Sdi
1.64
Net Pay
1,183.19
Vision Ded
1.35
Check #:
77549
Total Job Gross
57.93
LENSS, GARY DEAN
Ex: -02 M 0
0.00
0.00
0.00
0.00 4.75
4.00 0.00
8.75
27.00
236.25
Fed W/H
281.47
Gross
1,498.79
1030 S 63RD ST
537-58-7353 S
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
FICA
120.40
Taxes
403.68
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
TACOMA, WA 98408 1
K
Other Job Pay
Local W/H
Wcomp/Sdi
0.00
1.81
Add-Ons
Net Pay
Check #
75.00
1,
7751
551
Total Job Gross
236.25
Page 2
Interwest Development NW, Inc. Pay Period Date: 09/29/07 Certified Payroll Report Contract #:
1425 22ND Street NW, Week Ending 09/29/07 Job No 07-460
Suite E Payroll No 2 Job Name Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
23
24
25
26 27
28 29
Total Rate
Gross Pay
LENSS, GARY DEAN
Ex: -02 M O
0.00
0.00
0.00
0.00 0.00
3.25 0.00
3.25 54.93
178.52
Fed W/H
281.47
Gross
1,498.79
1030 S 63RD ST
537-58-7353 S
0.00
0.00
0.00
0.00 3.25
0.00 0.00
3.25 36.62
119.02
FICA
State W/H
120.40
0.00
Taxes
403.68
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
19.50
Local W/H
0.00
Deducts
Add-Ons
0.00
75.00
TACOMA, WA 98408
Other Job Pay
Wcomp/Sdi
1.81
Net Pay
1,170.11
Check #:
77551
Total Job Gross
317.04
STOWE, JEFFREY STOWE LYNN Ex: M-00 C M O 0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
280.32 Gross
1,622.81
7019 SOUTH THOMPSON 539-56-7887 S 0.00
0.00
3.25
0.00 0.00
0.00 0.00
3.25
27.06
87.95
FICA
tat87
116.25 Taxes
398.32
Grp 1 Truck Driver
Local W/H
0.00 Deducts
185.
TACOMA, WA 98408
Wcomp/Sdi
Add-O
1.75
1.50
Other Job Pay
Net Pay ay
1,040.1212
HEALTH COV
98.73 Check #:
77578
401 K Emplo
Short Term
81.14
6.00
Total Job Gross
87.95
TESTER, JAMES L Ex: M-00 C M O 0.00
0.00
0.00
0.00 0.00
3.75 0.00
3.75
34.18
128.19
Fed W/H
184.61 Gross
1,523.83
34705 52nd AVE SO 539-56-5257 S 0.00
0.00
0.00
0.00 5.25
0.00 0.00
5.25
22.79
119.65
FICA
tate W/H
109.67 Taxes
0.00
295.89
Grp 1 Truck Driver
Local W/H
0.00 Deducts
1.
AUBURN, WA 98001
Wcomp/Sdi
Add-O
1.61
111.25
�
Other Job Pay
HEALTH COV
Net Pay
98.73 Check#:
1,137.75
Vision Ded
2.71
77581
Total Job Gross
247.84
TESTER, JAMES L Ex: M-00 C M O 0.00
0.00
0.00
0.00 0.00
3.75 0.00
3.75
54.93
205.99
Fed W/H
184.61 Gross
1,523.83
34705 52nd AVE SO 539-56-5257 S 0.00
0.00
0.00
0.00 4.25
0.00 0.00
4.25
36.62
155.64
FICA
State W/H
109.67 Taxes
0.00
295.89
KC Tr & Trlr 03/07
Health Fringe
3.02
12.84
Local W/H
Deducts
0.00 Add-PayOns
101.44
11.25
AUBURN, WA 98001
Other Job Pay
Fringe Adjustme
1.40
11.25
Wcomp/Sdi
1 61 Net Pay
1,137.75
HEALTH COV
98.73 Check #:
77581
Vision Ded
2.71
Total Job Gross
372.88
*Non -cash benefits
12.84
/agw 3
Statement of Compliance
Contract Number:
Date: OCTOBER 12, 2007
I, Tanya Johnson, Payroll Admin do hereby state:
(1) That I pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 30 day of SEPTEMBER, 2007 and ending the 6 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interwest Development NW. Inc. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
( X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
(X) Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEPTION (Craft)
REMARKS
NAME AND TITLE SIGNATURE
"Tanya Johnson, Payroll Admin
I he \\ ill ful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pr ecution. See bon 1001
EXPLANATION
a36�u'EA rnerl ors q l
Section)$$ of Title31 ofthe United States Code.
Page 1
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 10/06/07 Certified Payroll Report
Week Ending. 10/06/07
Payroll No 3
Contract #:
Job No
Job Name.
07-460
Waterline Relocation
# Exemptions
Hours
Check Totals
Social Secunty SUN
MON
TUE
WED THU
FRI SAT
06
Total
Rate
Gross Pay
Deductions
Totals
Employee
Work Class 30
O 3.50
01
0.00
02
0.00
03 04
0.00 0.00
05
6,00 0.00
2.50
33.84
10.78
Fed W/H
178 53
Gross
1,391.25
COLLINS IT, ROBERT E
Ex: M-00 C M
4.00
6.00 3.00
0.00 0.00
16.50
22.56
372.24
FICA
107.82
Taxes
288. 00
10121 83rd AVE CT E
277-64-5264 S 0.00
3.50
State W/H
0.00
Deducts
7.4343
Grp 1 Truck Driver
Local W/H
0.00
Add-Ons
25.51
PUYALLUP, WA 98373
Other Job Pay
Wcomp/Sdi
1.65
Net Pay
1,121.33
HEALTH COV
7.43
Check #:
77608
Total Job Gross
383.02
Ex: M-00 C M O 3.50
0.00
0.00
0.00 0.00
3.25 0.00
6.75
54.93
370.78
Fed W/H
FICA
178.53
107.82
Gross
Taxes
1,391.25
288.00
COLLINS III, ROBERT E
10121 83rd AVE CT E
277-64-5264 S 0.00
5.50
3.25
3.75 2.50
0.00 0.00
15.00
36.62
549.31
State W/H
0.00
Deducts
7.43
KC Tr & Trlr 03/07
Fringe Adjustme
1.17
25.51
Local W/H
0.00
Add-Ons
25.51
PUYALLUP, WA 98373
Other Job Pay
*Health Fringe
g
2.65
39.76
Wcom /Sdi
p
1.65
Net Pay
1,121.33
HEALTH COV
7.43
Check #:
77608
Total Job Gross
945.60
*Non -cash benefits
39.76
DETRICK, CRAIG J
Ex: M-00 M O 0.00
0.00
0.00
0.00 0.00
4.25 0.00
4.25
30.00
127.50
Fed W/H
FICA
321.35
121.61
Gross
Taxes
1,381.16
444.69
331 MAIN ST
538-74-0508 S 0.00
4.00
4.25
5.00 7.75
0.00 0.00
21.00
20.00
420.00
State W/H
0.00
Deducts
0.00
Grp 1 Truck Driver
Local W/H
o.00
Add-Ons
208.50
BUCKLEY, WA 98321
Other Job Pay
Wcomp/Sdi
1.73
Net Pay
1,144.97
Total Job Gross
547.50
Check #:
77612
Ex: M-00 M O 0.00
0.00
0.00
0.00 2.00
4.00 0.00
6.00
54.93
329.58
FedFICA Wild
321.35
ss
Taxes
1 381.16
69
DETRICK, CRAIG J
331 MAIN ST
538 74-0508 S 0.00
5.00
3.75
2.25 0.00
0.00 0.00
11.00
36.62
402.83
State W/H
0.00
Deducts
0.00
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
51.00
Local W/H
000
Add-Ons
208.50
BUCKLEY, WA 98321
Other Job Pay
Wcomp/Sdi
1 73
Net Pay
1,144.97
Check #:
77612
Total Job Gross
783.41
Ex: S-00 C F O -1.00
0.00
0.00
0.00 0.00
0.00 0.00
-1.00
54.93
-54.93
Fed W/H
FICA
316.47
120.27
Gross
Taxes
1,374.84
438.74
Ladwig, Stephanie Renee
8811 159th St East
537-76-3689 S 0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
State W/H
0.00
Deducts
1.35
Grp 1 Truck Driver
Local W/H
000
Add-Ons
198.75
PUYALLUP, WA 98375
Other Job Pay
Wcom /Sdi
p
2.00
Net Pay
50
Vision Ded
1.35
Check #:
77637
Total Job Gross
-54.93
Page 2
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 10/06/07 Certified Payroll Report
Week Ending 10/06/07
Payroll No'. 3
Contract #:
Job No.
Job Name
07-460
Waterline Relocation
# Exemptions
Hours
Check Totals
Social Secunty
SUN
MON
TUE
WED THU
FRI SAT
Total
Rate
Gross Pay
Deductions Totals
Employee
Work Class
O
30
1.00
01
0.00
02
0.00
03 04
0.00 0.00
05 06
0.00 0.00 1.00
54.93
54.93
Fed
Gross
1,438.74
Ladwig, Stephanie Renee
Ex: S-00 C F
0.00
0.00
0.00 0.00
0.00 0.00 0.00
0.00
0.00
CA
FICA
120.27
120.00 Taxes
431.35
8811 159th St East
537-76-3689 S
0.00
State W/H
0.00 Deducts
1.35
KC Tr & Trlr 03/07
Fringe Adjustme
g �
3.00
3.00
Local W/H
0.00 Add-Ons
198.75
PUYALLUP, WA 98375
Other Job Pay
Wcomp/Sdi
2.00 Net Pay
1,133.50
Vision Ded
1.35 Check #:
77637
Total Job Gross
57.93
LENSS, GARY DEAN Ex: -02 M O -3.25 0.00 0.00
1030 S 63RD ST 537-58-7353 S -3.25 4.50 0.00
Grp 1 Truck Driver
TACOMA, WA 98408
LENSS, GARY DEAN Ex: -02 M O 3.25 0.00 0.00
1030 S 63RD ST 537-58-7353 S 3.25 3.00 0.00
KC Tr & Trlr 03/07
TACOMA, WA 98408
TESTER, JAMES L Ex: M-00 C M O -3.75 0.00 0.00
34705 52nd AVE SO 539-56-5257 S -4.25 4.75 4.50
Grp 1 Truck Driver
AUBURN, WA 98001
TESTER, JAMES L
34705 52nd AVE SO
AUBURN, WA 98001
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
Other Job Pay
Total Job Gross
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
Fringe Adjustme
Other Job Pay
Total Job Gross
0.00 0.00 5.00 0.00
7.00 5.50 0.00 0.00
Other Job Pay
rp 1 l\ Total Job Gross
�
Ex: M-00 C M O 3.75 0.00 0.00 0.00 0.25 2.75 0.00
539-56-5257 S 4.25 2.00 4.50 2.50 3.00 0.00 0.00
KC Tr & Trlr 03/07 'Health Fringe
Other Job Pay Fringe Adjustme
Total Job Gross
"Non -cash benefits
-3.25 54.93 -17&52
1.25 18.00 -38.02
-216.54
3.25 54.93 178.52
6.25 36.62 228.88
3.00 28.50
435.90
Fed W/H
145.48
Gross
903.86
FICA
78.78
Taxes
225.88
State W/H
0.00
Deducts
0.00
Local W/H
0.00
Add-Ons
126.00
Wcomp/Sdi
1.62
Net Pay
803.98
Check#:
77639
Fed W/H
145.48
Gross
903.86
FICA
78.78
Taxes
225.88
State W/H
0.00
Deducts
0.00
Local W/H
0.00
Add-Ons
126.00
Wcomp/Sdi
1.62
Net Pay
803.98
Check #:
77639
1.25 34.18 -35.06 Fed W/H
158.65 Gross
1,363.35
17.50 22.79 340.05 FICA
100.21 Taxes
260.53
State W/H
0.00 Deducts
101.44
Local W/H
0.00 Add-Ons
48.00
Wcomp/Sdi
1.67 Net Pay
1.049.38
HEALTH COV
98.73 Check #.
77674
Vision Ded
2.71
304.99
6.75 54.93
370.78
Fed W/H
158.65
Gross
1,36335
16.25 36.62
595.08
FICA
100.21
Taxes
260.53
State W/H
0.00
Deducts
101 44
3.02
49.08
Local W/H
0.00
Add-Ons
48.00
0.88
20.25
Wcomp/Sdi
1.67
Net Pay
1,049.38
HEALTH COV
98.73
Check #
77674
Vision Ded
2.71
986.11
49.08
Pagw 3
Statement of Compliance
Date: OCTOBE.R 19, 2007 Contract Number:
I, Tanya Johnson, Pavroll Admin do hereby state-
(1) That I pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation. that during the payroll period commencing on the 7 day of OCTOBER, 2007 and ending the 13 day of OC'TOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interest Development NW, Inc from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Slat. 948.63 Slat. 108, 72 Slat. 967, 76 Slat. 357; 40 U.S.C. 276c), and described below
12) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete. that the wave rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract. that the classifications set forth therein for each laborer or mechanic confumv with the work he performed.
0) That any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recobmized by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recobmized agency exists in a State, are registered with the Bureau or Apprenticeship and 1 raining, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BF.NEFI I'S ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS
( X I In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such cmplovees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
( X I Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll. an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits
as listed in the contract. except as noted in Section 4(c) below.
(c) EXCEPTIONS
EXCEP HON t( raft)
EXPLANATION
REMARKS
NAME AND TITLE
Fanva Johnson, Pavroll Admin
S GNATURE
he willtid lalsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pros cutir ee . ec on 001 of "ft an ion _ I of -title 31 of the United States Code
Interwest Development NW, Inc.
Pay Period Date:
10/13/07
Certified Payroll Report
Contract#:
1425 22ND Street NW,
Week Ending:
10/13/07
Job No
07-460
Suite E
Payroll No:
4
Job Name
Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Employee
Work Class
07
08
09
10 11
12 13
Taal
Rate
Gross Pay
Deductions
Totals
COLLINS Ili, ROBERT E
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
238.90
Gross
1,627.90
10121 83rd AVE CT E
277-64-5264 S
0.00
0.00
0.00
5.50 0.00
0.00 0.00
5.50
22.56
124.08
FICA
126.28
Taxes
367.01
Grp 1 Truck Driver
State W/H
0.00
Deducts
7.43
PUYALLUP, WA 98373
Local W/H
0.00
Add-Ons
30.31
Other Job Pay
Wcomp/Sdi
1.83
Net Pay
1,283.77
P,,
HEALTH COV
7.43
Check #:
77701
\c
Total Job Gross
124.08
COLLINS 111, ROBERT E
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
23&90
Gross
1,627.90
10121 83rd AVE CT E
277-64-5264 S
0.00
0.00
0.00
3.00 0.00
0.00 0.00
3.00
36.62
109.86
FICA
126.28
Taxes
367.01
KC Tr & Trlr 03/07
r
Fringe Ad ustme
g
0.35
1.05
State W/H
Local W/H
0.00
0.00
Deducts
7.43
PUYALLUP, WA 98373
Health Fringe
2.65
7.95
Wcomp/Sdi
1.83
Add-Ons
30.31
Other Job Pay
Net Pay
1,283.77
HEALTH COV
7.43
Check #:
77701
Total Job Gross
110.91
'Non -cash benefits
7.95
DETRICK, CRAIG J
Ex: M-00 M O
0.00
0.00
0.00
000 5.00
0.00 0.00
5.00
30.00
150.00
Fed W/H
418.29
Gross
1,834.63
331 MAIN ST
538-74-0508 S
0.00
0.00
0.00
550 0.00
0.00 0.00
5.50
20.00
110.00
FICA
148.09
Taxes
568.32
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
BUCKLEY, WA 98321
Local W/H
0.00
Add-Ons
101.25
Other Job Pay
Wcomp/Sdi
1-94
Net Pay
1,367.56
5ioc�k
�'\
\e
Check #:
77705
Total Job Gross
26000
DETRICK, CRAIG J
Ex: M-00 M O
0.00
0.00
0.00
0.00 0.25
0.00 0.00
0.25
54.93
13.73
Fed WIH
418.29
Gross
1,834.63
331 MAIN ST
538-74-0508 S
0.00
0.00
0.00
4.00 4.25
0.00 0.00
8.25
36.62
302.12
FICA
148.09
Taxes
568.32
KC Tr & Trlr 03/07
Frin e Ad ustme
g �
3.00
25.50
State W/H
Local W/H
0.00
0.00
Deducts
0.00
BUCKLEY, WA 98321
Add-Ons
101.25
Other Job Pay
Wcomp/Sdi
1.94
Net Pay
1,367.56
Check #:
77705
Total Job Gross
341.35
LENSS, GARY DEAN
Ex: -02 M O
0.00
0.00
0.00
0.00 0.00
3.00 0.00
3.00
27.00
81.00
Fed WIH
163.32
Gross
1,069.72
1030 S 63RD ST
537-58-7353 S
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
FICA
84.24
Taxes
249.17
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
TACOMA, WA 98408
Local W/H
0.00
Add-Ons
31.50
Other Job Pay
Wcomp/Sdi
1.61
Net Pay
852.05
Total Job Gross
81.00
Check #:
77730
Page 2
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 10/13/07
Week Ending- 10/13/07
Payroll No 4
Certified Payroll Report
Contract #:
Job No 07-460
Job Name Waterline Relocation
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Deductions
Totals
Employee
Work Class
07
08
09
10 11
12 13 Total
Rate
Gross Pay
LENSS, GARY DEAN
Ex: -02 M O
0.00
0.00
0.00
0.00 0.00
2.50 0.00 2.50
54.06
135.15
Fed W/H
163.32
Gross
1,069.72
1030 S 63RD ST
537-58-7353 S
0.00
0.00
0.00
0.00 8.00
0.00 0.00 8.00
36.04
288.32
FICA
84.24
Taxes
249.17
KC Truck Dr 03/07
Frin e Ad ustme
g
3.00
31.50
State W/H
Local W/H
0.00
0.00
Deducts
0.00
TACOMA, WA 98408
Add-Ons
31.50
Other Job Pay
Wcomp/Sdi
1.61
Net Pay
852.05
Check #:
77730
Total Job Gross
454.97
THOMPSON, BRAD A
Ex: M-01 C M O
0.00
0.00
0.00
0.00 0.00
2.50 0.00
2.50
33.84
84.60
Fed W/H
140.27 Gross
1,227.08
14808 274TH AVE E
532-98-9376 S
0.00
0.00
0.00
0.00 3.50
1.00 0.00
4.50
22.56
101.52
FICA
95.84 Taxes
237.60
Grp 1 Truck Driver
State W/H
0.00 Deducts
199.03
BUCKLEY. WA 98321
Local W/H
0.00 Add-Ons
30.89
Other Job Pay
Wcomp/Sdi
1.49 Net Pay
821.34
\
Garn. Fixe
193.85 Check #:
77759
^c \
Short Term
5.18
�--i
'D
�`.l\ l �
Total Job Gross
186.12
THOMPSON, BRAD A
Ex: M-01 C M O
0.00
0.00
0.00
0.00 0.00
2.00 0,00
2.00
54.93
109,86
Fed W/H
140.27 Gross
1,227.08
14808 274TH AVE E
532-98-9376 S
0.00
0.00
0.00
0.00 3.00
0.00 0.00
3.00
36.62
109.86
FICA
95.84 Taxes
237.60
KC Tr & Trlr 03/07
Frin a Ad ustme
g
1.98
9 93
State W/H
Local W/H
0.00 Deducts
0.00
199.03
BUCKLEY. WA 98321
Other Job Pay
`Health Fringe
1.69
5.07
Wcomp/Sdi
Add-Ons
1.49 Net Pay
30.89
821.34
Garn. Fixe
193.85 Check #:
7775g
Short Term
5.18
Total Job Gross
229.65
'Non -cash benefits
5 07
Page 3
Statement of Compliance
Date: OCTOBER 26, 2007 Contract Number:
I, Tanya Johnson, Payroll Admin do hereby state:
(1) That I pay or supervise the payment of the persons employed by Interwest Development NW, Inc. on the Waterline Relocation, that during the payroll period commencing on the 14 day of OCTOBER, 2007 and ending the 20 day of OCTOBER,
2007, all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Interwest Development NW, Inc. from the full weekly wages earned by
any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the
Copeland Act, as amended (48 Stat. 948.63 Stat. 108, 72 Stat. 967: 76 Stat. 357; 40 U.S.C. 276c), and described below
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage
determination incorporated into the contract, that the classifications set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Framing, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS
1 X) In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
( X I Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate pluS the amount of the required fringe henef its
as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTIONS
HXCE:I' I ION (Craft)
EXPLANATION
REMARKS
NAME AND TITLE
Tanya Johnson, Payroll Admin
SIGNATURE
CAW
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal pros ution lice . non 1001 of Tit I8 and Seen 231 ol`fitic 31 of the United States Code.
Page I
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 10/20/07
Week Ending 10/20/07
Payroll No 5
Certified Payroll Report
Contract #:
Job No: 07-460
Job Name Waterline Relocation
# Exemptions
How•
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee
Work Class
14
15
16
17 18
19
20
Total Rate Gross Pay
Deductions Totals
CLEMONS, WADE ALVEY
Ex: M-00 C M O
0.00
000
0.00
0.00 0.00
0.00
0.00
0.00 0.00 0.00
Fed W/H
287.03 Gross
1,311.29
315 4TH AVE NORTH
533-72-3393 S
0.00
000
0.00
000 2.00
0.00
0.00
2.00 25.33 50.66
FICA
99.86 Taxes
388.49
Grp 1 Truck Driver
State W/H
0.00 Deducts
6.00
ALGONA, WA 98001
Local W/H
0.00 Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
1.60 Net Pay
916.77
Short Term
6.00 Check #:
77783
o
W
Total Job
Gross
50.66
CLEMONS, WADE ALVEY
Ex: M-00 C M O
0.00
0.00
0.00
0.00 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
287.03 Gross
1,311.26
315 4TH AVE NORTH
533-72-3393 S
0.00
0.00
0.00
0.00 2.00
0.00 0.00
2.00
3662
73.24
FICA
99.86 Taxes
388.49
KC Tr & Trlr 03/07
'Health Fringe
3.50
7 00
State W/H
Local W/H
0.00 Deducts
0.00
6.00
ALGONA, WA 98001
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
1.60 Net Pay
916.77
Short Term
6.00 Check #
77783
Total Job Gross
73.24
'Non -cash benefits
7.00
GUNTER, ROBERT
Ex: S-01 C M O
0.00
0.00
0.00
000 0.00
0.00 0.00
0.00
0.00
0.00
Fed W/H
298.53 Gross
1,633.39
10107 SE 269TH
534-94-2702 S
0.00
0.00
2.50
000 0.00
0.00 0.00
2.50
36.62
91.55
FICA
120.37 Taxes
420.67
KC Tr & Trlr 03/07
Fringe Adjustme
0.65
1.63
State W/H
Local W/H
0.00 Deducts
0.00
95.13
KENT, WA 98030
Other Job Pay
'Health Fringe
2.35
5.88
Wcomp/Sdi
Add-Ons
1.77 Net Pay
35.28
HEALTH COV
89.13
1,152.87
Short Term
6.00 Check #
77796
Total Job Gross
93.18
`Non -cash benefits
5.88
HANSEN, CHAD H
Ex: M-01 C M O
0.00
0.00
0.00
000 0.00
0.00 0.00
0,00
0.00
0.00
Fed W/H
77.17 Gross
870.31
13503 20TH AVE CT E
537-04-9437 S
0.00
375
5.50
3.50 0.00
0.00 0.00
12.75
22.56
287.64
FICA
65.33 Taxes
143.76
Grp 1 Truck Driver
State W/H
0.00 Deducts
39.43
TACOMA, WA 98445
Local W/H
0.00 Add-Ons
1.24
Other Job Pay
Wcomp/Sdi
1.26 Net Pay
688.36
�
401 K Emplo
HEALTH COV
21.76
17.67 Check #
77798
/
�\
Total Job Gross
287.64
HANSEN. CHAD H Ex: M-01 C M O 000 000 0.00 0.00 0.00 0.00 0.00
0.00 0.00
0.00
Fed W/H
77.17 Gross
870.31
13503 20TH AVE CT E 537-04-9437 S 000 2 00 400 3.50 0.00 0.00 0.00
9.50 36.62
347.89
FICA
65.33 Taxes
143.76
KC Tr & Trlr 03/07
Fringe Adjustme
0.13
1.24
State W/H
Local W/H
0.00 Deducts
0.00
39.43
TACOMA, WA 98445
Other Job Pay
Health Fringe
2.87
27.27
Wcomp/Sdi
Add-Ons
1.26 Net Pay
1.24
688.36
401 K Emplo
21.76 Check #:
77798
HEALTH COV
17.67
Total Job Gross
349.13
'Non -cash benefits
27.27
Page 2
Interwest Development NW, Inc. Pay Period Date: 10/20/07 Certified Payroll Report Contract#:
1425 22ND Street NW, Week Ending: 10/20/07 Job No 07-460
Suite E Payroll No 5 Job Name Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee Work Class
14
15
16
17 18
19
20
Total Rate Gross Pay
Deductions Totals
Ladwig, Stephanie Renee Ex: S-00 C F O
0.00
0.00
0.00
0.00 1.50
0.00
0.00
1.50 33.84 50.76
Fed W/H
269.31 Gross
1,377.00
8811 159th St East 537-76-3689 S
0.00
0.00
0.00
0.00 2.00
0.00
0.00
2.00 22.56 45.12
FICA
106.68 Taxes
377.68
Grp 1 Truck Driver
State W/H
0.00 Deducts
1.35
PUYALLUP, WA 98375
Local W/H
0.00 Add-Ons
18.75
Other Job Pay
I
Wcomp/Sdi
1.35 Net Pay
1,016.72
7f�
Vision Ded
Check #:
77814
CX___ \ \\e�_
Total Job
Gross
95.88
LENSS, GARY DEAN Ex: -02 M O 0.00
0.00
0.00
0.00 0.00
400 0.00
4.00
27.00
108.00
Fed W/H
260.47
Gross
1,420.80
1030 S 63RD ST 537-58-7353 S 0.00
3.50
5.00
4.50 0.00
000 0.00
13.00
18.00
234.00
FICA
113.97
Taxes
376.21
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
TACOMA, WA 98408
Local W/H
0.00
Add-Ons
69.00
Other Job Pay
Wcomp/Sdi
1.77
Net Pay
1,113.59
Check #
77816
Total Job Gross
342.00
LENSS, GARY DEAN Ex: -02 M O 000
000
000
0.00 2.25
3.50 0.00
5.75
54.93
315.85
Fed W/H
260.47
Gross
1,420.80
1030 S 63RD ST 537-58-7353 S 000
2 00
450
4.50 0.25
0.00 0.00
11 25
36.62
411.98
FICA
113.97
Taxes
376.21
KC Tr & Trlr 03/07
Fringe Adjustme
3.00
51.00
State W/H
Local W/H
0.00
0.00
Deducts
0.00
TACOMA, WA 98408
Add-Ons
69.00
Other Job Pay
Wcomp/Sdi
1.77
Net Pay
1,113.59
Check #:
77816
Total Job Gross
778.83
RICE, GWYNN E Ex: S-00 C M O 0.00
0.00
0.00
0.00 3.00
0.00 0.00
3.00
33.84
101.52
Fed W/H
123.34
Gross
1,211.31
8504-194th St E 531-36-3563 S 0.00
5.25
5.00
4.25 0.00
0.00 0.00
14.50
22.56
327.12
FICA
85.17
Taxes
210.03
Grp 1 Truck Driver
State W/H
0.00
Deducts
407.56
SPANAWAY, WA 98387
Local W/H
0.00
Add-Ons
6.75
Other Job Pay
Wcomp/Sdi
1.52
Net Pay
600.47
401K Emplo
302.83
Check #
77831
HEALTH COV
98.73
Short Term
6.00
Total Job Gross
428.64
RICE, GWYNN E Ex: S-00 C M O 0.00
0.00
0.00
0.00 2.25
0.00 0.00
2.25
54.93
123.59
Fed W/H
123.34
Gross
1,211.31
8504-194th St E 531-36-3563 S 0.00
4.00
4.00
4.00 2.00
0.00 0.00
14.00
36.62
512.68
FICA
85.17
Taxes
210.03
KC Tr & Trlr 03/07
'Health Fringe
3.28
45.92
State W/H
Local W/H
0.00
0.00
Deducts
407.56
SPANAWAY, WA 98387
Other Job Pay
Fringe Adjustme
0.41
6.75
Wcomp/Sdi
1.52
Add-Ons
6.75
401K Emplo
302.83
Net Pay
Check #
600.47
HEALTH COV
98.73
77831
Short Term
6.00
Total Job Gross
643.02
_
`Non -cash benefits
45.92
Pug,, 3
Interwest Development NW, Inc. Pay Period Date: 10/20/07 Certified Payroll Report Contract#:
1425 22ND Street NW, Week Ending 10/20/07 Job No 07-460
Suite E Payroll No 5 Job Name. Waterline Relocation
Auburn, WA 98001-3334
253 939-9787
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI
SAT
Employee Work Class
14
15
16
17 18
19
20
Total Rate Gross Pay
Deductions
Totals
ROTHERMEL, TERRY L Ex: S-01 C M O
0.00
0.00
0.00
0.00 0.00
0.00
0.00
000 0.00 0.00
Fed W/H
326.40
Gross
1,554.07
12410 138TH ST. CT. E 536-62-1489 S
0.00
0.00
1 75
0.00 0.00
0.00
0.00
1 75 22 56 39.48
FICA
121.16
Taxes
449.37
Grp 1 Truck Driver
State W/H
0.00
Deducts
0.00
PUYALLUP, WA 98374
Local W/H
0.00
Add-Ons
29.71
Other Job Pay
Wcomp/Sdi
1.81
Net Pay
1,134.41
��' \
Check#:
77835
Total Job
Gross
39.48
ROTHERMEL, TERRY L Ex: S-01 C M O
0.00
000
0.00
0.00 0.00
7.25 0.00
7.25
54.93
398.24
Fed W/H
326.40
Gross
1.554.07
12410 138TH ST. CT. E 536-62-1489 S
000
000
3.00
0.00 0.00
0.00 0.00
3.00
36.62
109.86
FICA
121.16
Taxes
449.37
KC Tr & Trlr 03/07
Fringe Adjustme
2.31
23.70
State W/H
0.00
Deducts
0.00
PUYALLUP, WA 98374
`Health Fringe
g
2.35
7.05
Local W/H
0.00
Add-Ons
29.71
Other Job Pay
Wcomp/Sdi
1.81
Net Pay
1,134.41
Check #:
77835
Total Job Gross
531.80
'Non -cash benefits
7.05
STOWE, JEFFREY STOWE LYNN Ex: M-00 C M O
000
000
000
000 0.00
0.00 0.00
000
0 00
0.00
Fed W/H
127.50
Gross
980.95
7019 SOUTH THOMPSON 539-56-7887 S
000
000
000
000 2.50
0.00 0.00
2 50
2706
67.65
FICA
67.03
Taxes
195.75
Grp 1 Truck Driver
State W/H
0.00
Deducts
153.78
TACOMA, WA 98408
Local W/H
0.00
Add-Ons
0.00
Other Job Pay
Wcomp/Sdi
1.22
Net Pay
631.42
HEALTH COV
98.73
Check #:
77gg1
401K Emplo
49.05
Short Term
6.00
Total Job Gross
67.65
TESTER, JAMES L Ex: M-00 C M O
34705 52nd AVE SO 539-56-5257 S
Grp 1 Truck Driver
AUBURN, WA 98001
c' v�_R- , \"_
000 000 000 0.00 0.00 4.25 0.00
000 0.00 0.00 0.00 0.00 0.00 0.00
Other Job Pay
Total Job Gross
425 34 18 145 29 Fed W/H
123.77 Gross
1,169,84
000 000 000 CAA
8Taxes
207.79
State
0.00 Deducts
101.44
Local W/H
0.00 Add-Ons
9.00
Wcomp/Sdi
1.60 Net Pay
869.61
HEALTH COV
98.73 Check #:
77844
Vision Ded
2.71
145.29
TESTER, JAMES L Ex: M-00 C M O 0.00 0.00 0.00 coo 000 3.00 0.00
3.00 54.93
164.79
Fed W/H
123.77 Gross
1,169.84
34705 52nd AVE SO 539-56-5257 S 0.00 0.00 0.00 0.00 5.00 0.50 0.00
5.50 36.62
201.41
FICA
82.42 Taxes
207.79
KC Tr & Trlr 03/07
'Health Fringe
3.85
21.18
State W/H
Local W/H
0.00 Deducts
0.00
101.44
AUBURN, WA 98001
Other Job Pay
Fringe Adjustme
1.05
9.00
Wcomp/Sdi
Add-Ons
1.60
9.00
HEALTH COV
Net Pay
98.73 Check
869.61
Vision Ded
2.71 #:
77844
Total Job Gross
375.20
`Non -cash benefits
21.18
Page 4
Interwest Development NW, Inc.
1425 22ND Street NW,
Suite E
Auburn, WA 98001-3334
253 939-9787
Pay Period Date: 10/20/07
Week Ending: 10/20/07
Payroll No 5
Certified Payroll Report
Contract #:
Job No: 07-460
Job Name Waterline Relocation
# Exemptions
Hours
Check Totals
Social Security
SUN
MON
TUE
WED THU
FRI SAT
Employee
Work Class
14
15
16
17 18
19 20
Total Rate
Gross Pay
Deductions Totals
WOOD, PRESTON R
Ex: S-05 C M O
0.00
0.00
0.00
0 00 0,00
0.00 0.00
0.00 0.00
0.00
Fed W/H
101.65 Gross
1,108.83
32707 8TH AVE E.
535-02-4975 S
0.00
9.75
0.00
0-00 0.00
0.00 0.00
9.75 36.04
351.39
FICA
80.38 Taxes
183.55
KC Truck Dr 03/07
Frin a Ad'ustme
g �
0.65
6.34
State W/H
Local W/H
0.00 Deducts
0.00
64.51
ROY, WA 98580
Other Job Pay
`Health Fringe
2.34
22.91
Wcomp/Sdi
_
1.52 Net Pay
867.11
HEALTH COV
58.51 Check #:
6.00
77850
Short Term
Total Job Gross
357.73
'Non -cash benefits
22.91
Page
Certified Payroll Register
Page: 1
Job
Contractor
Customer
Cec �-onri: Cityla� Renton
De -Watering Services, LLC
CECCANTI INC
Job Number:
2007036DW
Wateriine Relocation at
4103 241st Street NE
4116 BROOKDALE RD E
Week Ending: 10/20/2007
Benson Road & 1-405
Arlington, WA 98223
TACOMA,
WA 98446
--- Deductions ---
Soc Sec No. -
Hours Worked This Job ------
--
Gross Pay
Fed.
Local
Check #
Class 10/15
10/16 10/17
10/18
10/19 10/20
10/14
Pay This Job
Fica
Other
Name and Address
Mar Exemp. Mon
Tue Wed
Thu
Fri Sat
Sun
Tot
Rate All Jobs
State
Total
Net Pay
MICHAEL E BOCHENSKI
536-17-5319 R: 0.00
8.00 0.00
0.00
0.00 0.00
0.00
8.00
29.400 279.30
192.23
0.00
5440 KEATING ROAD NW
WELL POINT LABORER
+7.350FR.
93.09
1.37
OLYMPIA, WA 98502
Married 2 0: 0.00
1.00 0.00
0.00
0.00 0.00
0.00
1.00
44.100 1216.85
0.00
286.69
930.16
WHITE Male
+7.350FR. 41hrs
Fringe PREVWAGE
Total
Rate 7.350
7.350
Amount 66.15
66.15
CHRISTOPHER N BURGMEIER 532-74-2968 R: 0.00
8.00 0.00
0.00
0.00 0.00
0.00
8.00
29.400 455.70
368.40
0.00
9314 166th PL NE
WELL POINT LABORER
+7.350FR.
175.92
2.26
REDMOND, WA 98052
Married 2 0: 0.00
5.00 0.00
0.00
0.00 0.00
0.00
5.00
44.100 2299.57
0.00
546.58
1752.99
WHITE Male
+7.350FR. 67.5hrs
Fringe PREVWAGE
Total
Rate 7.350
7.350
Amount 95.55
95.55
GARY H FORS
534-96-9853 R: 0.00
8.00 0.00
0.00
0.00 0.00
0.00
8.00
33.500 519.25
454.02
0.00
3303 EAST BAY DRIVE NW
WELL POINT LABORER-1
+3.250FR.
167.87
1.91
GIG HARBOR, WA 98335
Single 2 0: 0.00
5.00 0.00
0.00
0.00 0.00
0.00
5.00
50.250 2194.25
0.00
623.80
1570.45
WHITE Male
+3.250FR. 57hrs
Fringe PREVWAGE
Total
Rate 3.250
3.250
Amount 42.25
42.25
BJORN K THOMPSON
533-98-0216 R: 0.00
8.00 0.00
0.00
0.00 0.00
0.00
8.00
29.400 455.70
436.28
0.00
5742 HOBSON RD
WELL POINT LABORER
+7,350FR.
158.01
2.17
BOW, WA 98232
Single 1 0: 0.00
5.00 0.00
0.00
0.00 0.00
0.00
5.00
44.100 2065.52
0.00
596.46
1469.06
WHITE Male
+7.350FR. 65hrs
Fringe PREVWAGE
Total
Rate 7.350
7.350
Amount 95.55
95.55
Hours
Pay
Regular 32.00
973.60
Overtime 16.00
736.35
48.00 1,709.95
Certified Payroll Register
Page: 2
Job
Ceccanti: Cit. .' Renton
Waterline Relocation at
Benson Road & 1-405
Contractor
De -Watering Services, LLC
4103 241st Street NE
Arlington, WA 98223
Customer
CECCANTI INC
4116 BROOKDALE RD E
TACOMA, WA 98446
Job Number: 2007036DW
Week Ending: 10/20/2007
I, Deena Jones, Office Assistant, do hereby state:
1] That I pay or supervise the payment of the persons employed by De -Watering Services, LLC on the
Ceccanti: City of Renton that during the payroll period commencing on 10/14/2007 and ending 10/20/2007, all
persons employed on said project have been paid the full weekly wages earned, that no rebates have been or
will be made either directly or indirectly to or on behalf of said De -Watering Services, LLC (Subcontractor) from
the full weekly wages earned by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3
(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63
Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
2] That any payrolls otherwise under this contract required to be submitted for the above period are correct
and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable
wage rates contained in any wage determination incorporated into the contract; that the classifications set forth
therein for each laborer or mechanic conform with the work he performed.
3] That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by
the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized
agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States
Department of Labor.
4] That:
(a) WHERE FRINGE BENEFITS ARE PAID TO .APPROVED PLANS, FUNDS, OR
PROGRAMS
(x) --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above
referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to
appropriate programs for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
---Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the
payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the
required fringe benefits as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTION (CRAFT) EXPLANATION
"*' FRINGES PAID TO DAVIS-BACON PENSION FUND. """"
REMARKS
Name and title
Signature
DEENA JONES, OFFICE ASSISTANT, r e/!i✓GL
The Willful Falsification Of Any Of The Above Statements May Subj ct The Contractor Or SubContractor To
Civil Or Criminal Prosecution. See Section 1001 Of Title 18 And Section 231 Of Title 31 Of The United States.
Certified Payroll Register
Page: 1
Job
Contractor
Customer
Ceccanti: City of Renton
De -Watering Services, LLC
CECCANTI INC
Job Number: 2007036DW
Waterline Relocation at
4103 241st Street NE
4116 BROOKDALE RD E
Week Ending: 11/3/2007
Benson Road & 1-405
Arlington, WA 98223
TACOMA. WA 98446
--- Deductions ---
Soc Sec No. ---------------------- Hours
Worked This Job -----------------------
Gross Pay
Fed. Local Check #
Class 10/29 10/30 10/31
11/01
11/02 11/03 10/28
Pay
This Job
Fica Other
Name and Address - ---
-- Mar -Exemp. Mon Tue Wed
Thu
Fri Sat Sun Tot
Rate
All Jobs
State Total Net Pay
MICHAEL E BOCHENSKI
536-17-5319 R: 8.00 8.00 8.00
0.00
0.00 0.00 0.00 24,00
29.400
926.10
217.09 0.00
5440 KEATING ROAD NW
WELL POINT LABORER
+7.350FR.
100.70 1.37
OLYMPIA, WA 98502
Married 2 0: 1.00 2.00 2.00
0.00
0.00 0.00 0.00 5.00
44.100
1316.28
0.00 319.16 997.12
WHITE Male
+7.350FR. 41hrs
Fringe PREVWAGE Total
Rate 7.350 7.350
Amount 213.15 213.15
Hours Pay
Regular 24.00 705.60
Overtime 5.00 220.50
29.00 926.10
I, Deena Jones, Office Assistant, do hereby state:
1] That I pay or supervise the payment of the persons employed by De -Watering Services, LLC on the
Ceccanti: City of Renton that during the payroll period commencing on 10/28/2007 and ending 11/3/2007, all
persons employed on said project have been paid the full weekly wages earned, that no rebates have been or
will be made either directly or indirectly to or on behalf of said De -Watering Services, LLC (Subcontractor) from
the full weekly wages earned by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3
(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63
Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
2] That any payrolls otherwise under this contract required to be submitted for the above period are correct
and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable
wage rates contained in any wage determination incorporated into the contract; that the classifications set forth
therein for each laborer or mechanic conform with the work he performed.
3] That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by
the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized
agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States
Department of Labor.
4] That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR
PROGRAMS
(x) --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above
referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to
appropriate programs for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
---Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the
payroll, an amount not less than the sum of the applicable basic hourly wade rate plus the amolrnt of the
required fringe Denetits as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTION (CRAFT) EXPLANATION
***' FRINGES PAID TO DAVIS-BACON PENSION FUND. "'"'
REMARKS
Name and title Signature
DEENA JONES, OFFICE ASSISTANT,. y�T9
7
The Willful Falsification Of Any Of The Above Statements May Subject The Contractor Or SubContractor To
Civil Or Criminal Prosecution. See Section 1001 Of Title 18 And Section 2311 Of Title 31 Of The United States.
Certified Payroll Register
Page:
Job
Ceccanti: City of Renton
Waterline Relocation at
Benson Road & 1-405
Contractor
De -Watering Services, LLC
4103 241st Street NE
Arlington, WA 98223
Customer
CECCANTI INC
4116 BROOKDALE RD E
TACOMA, WA 98446
Job Number: 2007036DW
Week Ending: 11/3/2007
--- Deductions --
Soc Sec No. --- -------
----- Hours Worked This
Job -----------------
Gross Pay
Fed.
Local Check #
Class 10/29
10/30 10/31
11/01
11/02
11/03
10/28
Pay
This Job
Fica
Other
Name and Address ---------
Mar -Exemp.---- Mon --
Tue Wed
Thu
Fri
Sat
Sun Tot
Rate
All Jobs
State
Total Net Pay
MICHAEL E BOCHENSKI
536-17-5319 R: 8.00
8.00 8.00
0.00
0.00
0.00
0.00 24.00
29.400
926.10
217.09
0.00
5440 KEATING ROAD NW
WELL POINT LABORER
+7.350FR.
100.70
1.37
OLYMPIA, WA 98502
Married 2 0: 1.00
2.00 2.00
0.00
0.00
0.00
0.00 5.00
44.100
1316.28
0.00
319.16 997.12
WHITE Male
+7.350FR. 41hrs
Fringe PREVWAGE
Total
Rate 7.350
7.350
Amount 213.15
213.15
Hours
Pay
Regular 24.00
705.60
Overtime 5.00
220.50
29.00
926.10
I, Deena Jones, Office Assistant, do hereby state:
1] That I pay or supervise the payment of the persons employed by De -Watering Services, LLC on the
Ceccanti: City of Renton that during the payroll period commencing on 10/28/2007 and ending 11/3/2007, all
persons employed on said project have been paid the full weekly wages earned, that no rebates have been or
will be made either directly or indirectly to or on behalf of said De -Watering Services, LLC (Subcontractor) from
the full weekly wages earned by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3
(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63
Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:
21 That any payrolls otherwise under this contract required to be submitted for the above period are correct
and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable
wage rates contained in any wage determination incorporated into the contract; that the classifications set forth
therein for each laborer or mechanic conform with the work he performed.
3] That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by
the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized
agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States
Department of Labor.
4] That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR
PROGRAMS
(x) --- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above
referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to
appropriate programs for the benefit of such employees, except as noted in Section 4(c) below.
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
---Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the
payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the
required fringe benefits as listed in the contract, except as noted in Section 4(c) below.
(c) EXCEPTION (CRAFT) EXPLANATION
FRINGES PAID TO DAVIS-BACON PENSION FUND. ****
REMARKS
Name and title Signature
DEENA JONES, OFFICE ASSISTANT, " rL
The Willful Falsification Of Any Of The Above Statements May Subject T Contractor Or SubContractor To
Civil Or Criminal Prosecution. See Section 1001 Of Title 18 And Section 31 Of Title 31 Of The United States.