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HomeMy WebLinkAboutWTR2703551_8f TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: R.L. Alia Company CONTRACT NO. CAG-11-044 PO# 18/0001754 COPY ESTIMATE NO. 1 PROJECT: Benson Road 16" Water Main Replacement Project Closing Date: 06/28/2011 1. CONTRACTOR EARNINGS THIS ESTIMATE $170,895.36 2. SALES TAX @ 9.50% $16,235.06 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $187,130.41 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $0.00 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $162,350.59 6. SUBTOTAL - CONTRACTOR PAYMENTS $162,350, 7. RETAINAGE ON PREVIOUS EARNINGS 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE 9. SUBTOTAL - RETAINAGE 10. SALES TAX PREVIOUSLY PAID 11. SALES TAX DUE THIS ESTIMATE 12. SUBTOTAL - SALES TAX $0.00 $8,544.77 $8,544.77 $0.00 $16,235.06 $16,235.06 * (95%x LWE 1) ** (RETAINAGE 5%) GRAND TOTAL: $187,130,41 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 8). ACCOUNT # 425.455595.018.595.34.63.000 RETAINED AMOUNT (Line 8): ** ACCOUNT # 425.455595.018.595.34.63.000 CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION 1, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESC ED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I M AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID ZLAIM / Signed: $178,585.65 # 1 $8,544.77 # 1 TOTAL THIS ESTIMATE: $178,585.65 $8,544.77 $187,130.41 -1171Z J �` '� j✓�.� '7 / 2Ut( Printed On: 07/07/2011 City of Renton Public Works Department Page 1 Printed On: 07/07/2011 Project: Benson Road 16" Water Main Replacement Project Contractor: R.L. Alia Company Item Description No. City of Renton Public Works Department Contract Number. CAG-11-044 Pay Estimate 1 Closing Date: 06/28/2011 Unit Est. Unit Previous Previous This Quantity Price Quantitv Amount Quantity Page 1 This Total Total 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $39.000.00 0.00 $0.00 0.50 $19,500.00 0.50 $19.500.00 002. Traffic Control Lump Sum 1 $25.000.00 0.00 $0.00 0.10 $2,500.00 0.10 $2,500.00 003. Trench Excavation Safety Systems Lump Sum 1 $2,000.00 0.00 $0.00 0.13 $260.00 0.13 $260.00 i 004. Construction Surveying, Staking, and As-Buills Lump Sum 1 $2,000.00 0.00 $0.00 0.50 $1,000.00 0.50 $1,000.00 ' 005. Temporary Erosion and Sedimentation Control Lump Sum 1 $2,000.00 0.00 $0.00 0.50 $1,000.00 0.50 $1,000.00 006. Site Specific Potholing Each 10 $200.00 0.00 $0.00 3.00 $600.00 3.00 $600.00 Furnish and Install 16" CI 52 DI Water Pipe & Fittings w/ 007. Polywrap Linear Fool 1520 $125.00 0.00 $0.00 920.88 $115,110.38 920.88 $115,110.38 008. Furnish and Install 16' Gale Valve Assembly Each 5 $5,000.00 0.00 $0.00 3.00 $15.000.00 3.00 $15,000.00 009. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 60 $200.00 0.00 $0.00 9.00 $1,800.00 9.00 $1,800.00 i 010. Furnish and Install Fire Hydrant Assembly Each 2 $2,000.00 0,00 $0.00 0.00 $0.00 0.00 $0.00 011. Furnish 8 Install 3/4" Water Service Connection Each 4 $1,500.00 c 0.00 $0.00 0.00 $0.00 0.00 $0.00 012. Connection to Existing Water Main - Benson Rd. Each 1 $5,000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 013. Connection to Existing Water Main - Grady Way Each 1 $5,000,00 0.00 $0.00 0.75 $3.750.00 0.75 $3,750.00 014. Connection to Existing Water Main - S. 5lh Street Each 1 $5,000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 i 015. Connection to Existing Water Main - Service Linen Each 1 $5.000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 016, Connection to Existing Water Main - S. 4th Street Each 1 $5.000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 017, Cut, Cap, and Block Existing Water Main Each 3 $400.00 0.00 $0.00 3.00 $1,200.00 3.00 $1.200.00 018. Abandon Existing Manhole In Place Each 1 $100.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 Removal and Replacement of Unsuitable Foundation 019. Material Ton 50 $1.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 020. Select Imported Trench Backfill Ton 900 $1.00 0.00 $0.00 80.98 $80.98 80.98 $80.98 021. Crushed Surfacing Top Course & Crushed Rods Backrill Ton 350 $20.00 0.00 $0.00 262.85 $5.257.00 262.85 i $5,257.00 3" Depth Temporary Hot Mix Asphalt (HMA) for Trench 022. Patching - Ton 190 $100.00 0.00 $0,00 38.37 $3,837.00 38.37 $3,837.00 023. H.M.A. Class /V PG 64-22 for Roadway Restoration Ton 805 $180;00 0.00 $0.00 0.00 $0.00 0.00 $0.Cq 024. Removal and Replacement of Concrete Curb and Gutter Llnear Foot 45 $50.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 Replace Traffic Loop Sensor, Pavement Markings, Extruded 025. Curbing, and Traffic Buttons Lump Sum 1 $25,000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 026. Concrete Driveway and/or Sidewalk Restoration Square Yard 10 $100.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 027. Property & Landscape Restoration Lump Sum 1 $5,000.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 Printed On: 07/07/2011 City of Renton Public Works Department Project: Benson Road 16" Water Main Replacement Project Contract Number. CAG-11-044 Contractor: R.L. Alia Company Pay Estimate 1 Closing Date: 06128=11 Item Description Unit Est. Unit Previous Previous This No. Quantity Price Quantity Amount Quantity Subtotal $0.00 9.5% Sales Tax $0.00 TT Total 1 $0.00 Page 2 T1us Total Total Amount Quantity Amount $170.895.36 $170,895.36 $16,235.06 $16,235.06 $187,130.41 $187,130.41 717/zo1! ���a� T ck�t -� 2-C) Q TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: R.L. Alia Company CONTRACT NO. CAG-11-044 PO# 18/0001754 ESTIMATE NO. 3 PROJECT: Benson Road 16" Water Main Replacement Project Closing Date: 09/06/2011 1. CONTRACTOR EARNINGS THIS ESTIMATE $163,875.77 2. SALES TAX @ 9.50% $15,568.20 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $179,443.97 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $301,894.97 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $155,681.98 6. SUBTOTAL - CONTRACTOR PAYMENTS $457,576.95 7. RETAINAGE ON PREVIOUS EARNINGS 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE 9. SUBTOTAL - RETAINAGE 10. SALES TAX PREVIOUSLY PAID 11. SALES TAX DUE THIS ESTIMATE 12. SUBTOTAL - SALES TAX $15,889.21 $8,193.79 $30,189.50 $15,568.20 $24,083.00 $45, 757.70 * (95% x LINE 1) (RETAINAGE: 59/.) GRAND TOTAL: $527,417.64 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455596.018.595.34.63.000 $171,250.18 # 3 RETAINED AMOUNT (Line 8): ** ACCOUNT # 425.455596.018.595.34.63.000 $8,193.79 # 3 TOTAL THIS ESTIMATE: CHARTER 116, LAWS OF 1965n� CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID CLAIM Signed: �Wgu- 664 / $171,250.18 $8,193.79 179,443.97 Printed On: 09/09/2011 City of Renton Public Works Department Page 1 Printed On: 09/09/2011 City of Renton Public Works Department Page 1 Project: Benson Road 16" Water Main Replacement Project Contractor: R.L. Alia Company Item Description No. Contract Number. CAG-11-044 Pay Estimate 3 Closing Dale: 09/06/2011 Unit Est. Unit Previous Previous This This Total Total titm , 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $39,000.00 0.75 $29,250.00 0.15 $5,850.00 0.90 $36.100.00 002. Traffic Control Lump Sum 1 $25,000.00 0.60 $15.000.00 0.20 $5,000.00 0.80 $20,000.00 003. Trench Excavation Safely Systems Lump Sum 1 $2,000.00 0.90 $1,800.00 0.10 $200.00 1.00 $2,000.00 004. Construction Surveying, Staking, and As-Buills Lump Sum 1 $2,000.00 0.60 $1,000,00 0.00 $0.00 0.50 $1,000.00 005. Temporary Erosion and Sedimentation Control Lump Sum 1 $2,000.00 0.50 $1,000.00 0.30 $600.00 0.80 $1,600.00 006. Site Specific Potholing Each 10 $200.00 8.00 $1.600.00 4.CO $800.00 12.00 $2,400.00 Furnish and Install 16" CI 52 DI Water Pipe & Fittings w/ 007. Polywrap Linear Foot 1520 $125.00 1520.00 $190,000.00 0.00 $0.00 1520.00 $190,000.00 008. Furnish and Install 16" Gate Valve Assembly Each 5 $5,000.00 5.00 $25,000.00 0.00 $0.00 5.00 $25,000.00 009. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 60 $200.00 2C.30 $4,000.00 8.50 $1,700.00 28,50 $5,700.00 010. Furnish and Install Fire Hydrant Assembly Each 2 $2,000.00 230 $4,000.00 0.00 $0.00 2.00 $4.000.00 011. Furnish & Install 3/4" Water Service Connection Each 4 $1,500.00 ON) $0.00 4.00 $6,000.00 4.00 $6,000.00 012. Connection to Existing Water Main - Benson Rd. Each 1 $5,000.00 0.00 $0.00 1.00 $5,000.00 1,00 $5,000.00 013. Connection to Existing Water Main - Grady Way Each 1 $5,000.00 0.75 $3.750.00 0,25 $1,250.00 1.00 $5,000.00 014. Connection to Existing Water Main - S. 5th Street Each 1 $5,000.00 0.00 $0.00 1.00 $5,000.00 1.00 $5.000.00 015. Connection to Existing Water Main - Service Linen Each 1 $5,000.00 0.00 $0.00 1.00 $5,000.00 1.00 $5,00M)o 016. Connection to Existing Water Main - S. 41h Street Each 1 $5,000.00 0.00 $0.00 1.00 $5,000.00 1.00 $5,000.00 017. Cut, Cap, and Block Existing Water Main Each 3 $400.00 8.00 $3,200.00 0.00 $0.00 8,00 $3,200.00 018. Abandon Existing Manhole In Place Each 1 $100.00 0.00 $0.00 1.00 $100.00 1.00 $100.00 Removal and Replacement of Unsuitable Foundation 019, Material Ton 50 $1.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 020. Select Imported Trench Baddill Ton 900 $1.00 80.98 $80.96 0.00 $0.00 80.98 $80.98 021. Crushed Surfacing Top Course & Crushed Rock Backfill Ton 350 $20.00 1204.61 $24,092.20 379.24 $7,584.80 1583.85 $31,677.00 3" Depth Temporary Hot Mix Asphalt (HMA) for Trench 022. Patching - Ton 190 $100.00 140.11 $14,011.00 24.35 $2,435.00 164,46 $16,446.00 023, H.M.A. Class' PG 64-22 for Roadway Restoration Ton 805 $180.00 0.DO $0.00 477.00 $85,860.00 477.00 $85,860.00 024. Removal and Replacement of Concrete Curb and Gutter Linear Foot 45 $50.00 0.00 $0.00 82.00 $4,100.00 82.00 $4,100.00 Replace Traffic Loop Sensor, Pavement Markings, Extruded 025. Curbing, and Traffic Buttons Lump Sum 1 $25,00&00 0.00 $0.00 0.00 Saw 0.00 $0.00 026. Concrete Driveway and/or Sidewalk Restoration Square Yard 10 $100.00 0.00 $0.00 33.00 $3,300.00 33.00 $3,300.00 027, Property & Landscape Restoration Lump Sum 1 $5,000.00 0.00 $0.00 0.50 $2,500.00 0.50 $2,600.00 COt Change Order #1 Lump Sum 1 $16.595.97 1 0.00 $0.00 1.00 $16,595.97 1.00 $16,595.97 I Printed On: 09/09/2011 City of Renton Public Works Department Project: Benson Road 16" Water Main Replacement Project Contract Number. CAC-11-044 Contractor. R.L. Alla Company Pay Estimate 3 Closing Date: 09/06/2011 Item Description Unit Est. Unit Previous Previous This No. Quantity Price Quantity Amount Quantity Subtotal $517,784.18 9.5% Sales Tax $30,189.50 TT Total $347,973.68 Page 2 This Total Total Amount Quantity Amount $163,875.77 $481.659.95 $15,568.20 $45,757.70 $179,443.97 $527,417.65 CITY OF RENTON Public Works Department CONTRACT CHANGE ORDER AGREEMENT CONTRACT: CAG 11-044 — Benson Road 16" Water Main Replacement Project C.O.# 1 CONTRACTOR: R.L. Alia Company SUMMARY OF PROPOSED CHANGE: Provide all labor, equipment, subcontracting, bonding, insurance for the complete work required for the extra work as outlined below: ITEM Additional Quantities Under This Change Order Unit Quantity Unit Total Price C01 Change order for delay, downtime, and redesign due to LS 1 $16,595.97 $16,595.97 mismarked and mislocated utilities in Main Ave. S., breaking and hauling off excavated material from extra depth pavement section beyond 12", shift hour reduction for River Days, and additional ductile iron water main fittings. Subtotal $16,595.97 9.5% Sales Tax $1,576.62 Total $18,172.59 ORIGINAL CONTRACT AMOUNT CURRENT CONTRACT AMOUNT ESTIMATED NET CHANGE THIS ORDER ESTIMATED CONTRACT TOTAL AFTER CHANGE $591,738.00 $591,738.00 $18,172.59 $609,910.59 Cost Allocation Water Utility 425.455596. 5 .34.63.000 $18,172.59 SIGNATURES: Contractor: Project Engine Approved By: (Water Utility Supervisor) Date: 1 /I Date: Date: HAFile Sys\WTR - Drinking Water Utility\WTR-27 - Water Project Files\WTR-27-3551 - Benson Rd 16in Water Main Replacement\Construction Contract\Pay Estimates\ChangeOrder 1_09-06-11. DOC/AW ah u r TO: Nis" IA FINANCE DIRECTOR PUBLIC WORKS ADMINISTRATOR CONTRACTOR: R.L. Alia Company CONTRACT NO. CAG-11-044 PO# 18/0001754 ESTIMATE NO. 4 PROJECT: Benson Road 16" Water Main Replacement Project Closing Date: 10/03/2011 1. CONTRACTOR EARNINGS THIS ESTIMATE $125,508.20 2. SALES TAX @ 9.50% $11,923.28 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $137,431.48 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $457,576.95 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $119,232.79 6. SUBTOTAL - CONTRACTOR PAYMENTS 7. RETAINAGE ON PREVIOUS EARNINGS 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE 9. SUBTOTAL - RETAINAGE 10. SALES TAX PREVIOUSLY PAID 11. SALES TAX DUE THIS ESTIMATE 12. SUBTOTAL - SALES TAX (95% x LINE 1) ** (RETAINAGE: 59/.) FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455596.018.595.34.63.000 RETAINED AMOUNT (Line 8): ** ACCOUNT # 425.455596.018.595.34.63.000 CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION $24,083.00 $6,275.41 $45,757.70 $11,923.28 GRAND TOTAL $131,156.07 # 4 $6,275.41 # 4 TOTAL THIS ESTIMATE I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF V� PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID CLAIM / Signed: ����, l:�tttp/ QC+c�3K(- $576,809.74 30, 358.41 $57,680.97 $664, 849.12 $131,156.07 $6,275.41 $137,431.48 C�Gfi �rZolt /D/�/2o// Printed On: 10/05/2011 City of Renton Public Works Department Page 1 Printed On: 10/05/2011 City of Renton Public Works Department Page 1 Project: Benson Road 16" Water Main Replacement Project Contractor. R.L. Alia Company Item Description No. Pay Estimate 4 Unit Est. Unit Quantity Price 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 002. Traffic Control Lump Sum 1 003. Trench Excavation Safety Systems Lump Sum 1 004. Construction Surveying, Staking, and As-Builts Lump Sum 1 005. Temporary Erosion and Sedimentation Control Lump Sum 1 006. Site Speck Potholing Each 10 Furnish and Install 16" Cl 52 DI Water Pipe & Fittings w/ 007. Polywrap Linear Foot 1520 008. Furnish and Install 16' Gate Valve Assembly Each 5 009. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 60 010. Furnish and Install Fire Hydrant Assembly Each 2 011 Furnish & Install 3/4" Water Service Connection Each 4 012. Connection to Existing Water Main - Benson Rd. Each 1 013. Connection to Existing Water Main - Grady Way Each 1 014. Connection to Existing Water Main - S. 5th Street Each 1 015. Connection to Existing Water Main - Service Linen Each 1 016. Connection to Existing Water Main - S. 4th Street Each 1 017. Cut, Cap, and Block Existing Water Main Each 3 018. Abandon Existing Manhole In Place Each 1 Removal and Replacement of Unsuitable Foundation 019. Material Ton 50 020. Select Imported Trench Backfill Ton 900 021. Crushed Surfacing Top Course & Crushed Rock Backfill Ton 350 3" Depth Temporary Hot Mix Asphalt (HMA) for Trench 022. Patching Ton 190 023. H.M.A. Class A' PG 64-22 for Roadway Restoration Ton 805 024. Removal and Replacement of Concrete Curb and Gutter Linear Foot 45 Replace Traffic Loop Sensor,Pavement Markings, Extruded 025. Curbing, and Traffic Buttons Lump Sum 1 026. Concrete Driveway and/or Sidewalk Restoration Square Yard 100 027. Property & Landscape Restoration Lump Sum 1 C01 Change Order #1 Lump Sum 1 $39,000.CC $25,000.00 $2,000.00 $2,000.00 $2,000 OC $200 CC $125 CC $5, 000 OC $200 CC $2, 000. CC $1,500 CC $5,000.00 $5,000.00 $5,000.00 $5,000.00 $5,000,00 $400.00 $100.00 $1.00 $1.00 $20.00 $100.00 $180.0C $50.00 $25,000.00 $100.00 $5,000.0C $16,595.97 Contract Number. Closing Date: Previous Previous Quantity Amount CAG-11-044 10/03/2011 This Quantity This Amount Total Quantity Total Amount 0.90 $35,100.CO 0.00 $0.00 0.90 $35,100.CO 0,80 $20,000,00 0,20 $5,000.00 1.00 $25,000.00 1.00 $2,000.00 0.00 $0.00 1.00 $2,000.00 0.50 $1,000.00 0.00 $0.00 0.50 $1,000.00 0.80 $1,600.00 0.20 $400.00 1.00 $2,000.00 12.00 $2,400.00 0.00 $0,00 12.00 $2,400.00 1520.00 $190,000.00 0.00 $0.00 1520.00 $190,000.00 5.00 $25,000.00 0,00 $0.00 5.00 $25,000.00 28.50 $5,700.00 0.00 $0.00 28.50 $5,700.00 2.00 $4.000.00 0.00 $0.00 2.00 $4,000.00 4,00 $6,000.00 0.00 $0.00 4.00 $6.000.00 1.00 $5,000,00 0.00 $0.00 1.00 $5,000.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 1.00 - $5,000.00 0,00 $0.00 1.00 $5,000.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 8.00 $3,200.00 0.00 $0,00 8.00 $3,200.00 1.00 $10&00 0.00 $0.00 1.00 $100.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 80.98 $80.98 0.00 $0.00 80.98 $80.98 1583.85 $31.677.00 0.00 $0.00 1583.85 $31,677.00 164.46 $16,446.00 0.00 $0.00 164.46 $16,446.00 477.00 $85,860.00 514.49 $92,608.20 991.49 $178,468.20, 82.00 $4,100.00 0.00 $0.00 82.00 $4,100.00 0.00 $0.00 1.00 $25,000.00 1.00 $25,000.00 33.00 $3,300.00 0.00 $0.00 33.00 $3,300.00 0.50 $2,500.00 0.50 $2,500.00 1,00 $5,000.00. 1.00 $16,595.97 0.00 $0.00 1.00 $16,595.97 Printed On: 10/05/2011 City of Renton Public Works Department Page 2 Project: Benson Road 16" Water Main Replacement Project Contract Number. CAG-11-044 Contractor. R.L. Alia Company Pay Estimate 4 Closing Date: 10103/2011 Item Description Unit Est. Unit Previous Previous This This Total Total No. Quantity Price Quantity Amount Quantity Amount Quantity Amount Subtotal $481,659.95 $125.508.20 $607,168.15 9.5% Sales Tax $45,757.70 $11,923.28 $57,680.97 TT Total $527.417.65 $137,431.48 $664,849.12 ���� a�fi ,' 20 �� TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: R.L. Alia Company CONTRACT NO. CAG-11-044 PO# 18/0001754 -fft, VAN�li ESTIMATE NO. 5 PROJECT: Benson Road 16" Water Main Replacement Project Closing Date: 11/15/2011 1. CONTRACTOR EARNINGS THIS ESTIMATE $21,840.55 2. SALES TAX @ 9.50% $2,074.85 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $23,915.40 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $576,809.74 5.* EARNINGS DUE CONTRACTOR THIS ESTIMATE $21,840.55 6. SUBTOTAL - CONTRACTOR PAYMENTS 7. PREVIOUS RETAINIAGE (TRANSFERED TO BOND) $30,358.41 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE $0.00 9. SUBTOTAL - RETAINAGE 10, SALES TAX PREVIOUSLY PAID $57,680.97 11. SALES TAX DUE THIS ESTIMATE $2,074.85 12, SUBTOTAL - SALES TAX $598,650.29 $30,358.41 $59,755.83 * (95% x LINE 1) ** (RETAINAGE: 5%) GRAND TOTAL: $688,764,53 FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455596.018.595.34.63.000 $23,915.40 # 5 v IThe contractor posted a retainage bond prior to this pay estimate. Therefore, the City is not witholding I further retainage on the vroiect. All previous retainage has been transferred to the bond. TOTAL THIS ESTIMATE: CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED. THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESC D HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNP OBLIGATION AGAINST THE CITY OF RENTON, AND TH I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY TO S IOC Signed: $23,915.40 $23,915.40 &/eU. �% i2v �I 40/2oi/ Printed On: 11/18/2011 City of Renton Public Works Department Page 1 Printed On: 11/17/2011 City of Renton Public Works Department Page 1 Project. Benson Road 16' Water Main Replacement Project Contractor: R.L Alia Company Item Description No. Pay Estimate Unit Est Quantity 5 Unit Price Contract Number: CAG-11.044 Closing Date: 11115f2011 Previous Previous This Quantity Amount Quantity This Amami Total Quantity Total Amount ITEM 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $39,000.00 0.90 535,100.00 0.10 $3,900.00 1.00 $39.000.00 002. Traffic Control Lump Sum 1 $25,000.D0 1.00 $25.000.00 0.00 $0.00 1.00 $25.000.00 003. Trench Excavation Safety Systems Lump Sian 1 $2.000.00 1.00 $2,000.00 0.00 $0.00 1.00 $2.000.00 004, Construction Surveying, Staking, and As-Builts Lump Sum 1 $2.000.00 0.50 $1,000.00 0.00 $0.00 0.50 $1.000.00 005. Temporary Erosion and Sedimentation Control Lump Sum 1 $2,000.00 1.00 $2,000.00 0.00 $0.00 1.00 $2.000.00 006. Site Specific Potholing Each 10 $200.00 12.00 52,400.00 0.00 $0.00 12,00 $2,400.00 Furnish and Install 16" Cl 52 DI Water Pipe & Fittings w/ 007. Poiywrap Unear Foot 1520 S125.00 1520.00 $190,000.00 0.00 $0 00 1520.00 5190.000.00 008. Fumish and Install 16' Gate Valve Assembly Each 5 $5.000.00 5.00 $25.000.00 0.00 $0.00 5.00 $25,000.DO 009. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 60 $200.00 28.50 $5.700.00 0.00 50.00 28.50 $5,700.00 010. Furnish and Install Fire Hydrant Assembly Each 2 $2.000.00 2.00 $4.000.00 0.00 50.00 2.00 54,000.00 011. Furnish & Install 314' Water Service Connection Each 4 $1,500.00 4.00 56.000.00 0.00 $0.00 4.00 $6,000.00 012. Connection to Existing Water Main - Benson Rd. Each 1 55,000.00 1.00 55.000.00 0.00 $D.00 1.00 $5,000.00 013. Connection to Existing Water Main - Grady Way Each 1 55,000.00 1.00 $5,000.D0 0.00 $0.00 1.00 55.000.00 014. Connection to Existing Water Main - S. 51h Street Each 1 $5,000.00 1.00 $5,000.00 0.00 $0.00 1.00 55,000.00 015, Connection to Existing Water Main - Service Linen Each 1 $5.000.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 016. Connection to Existing Water Main - S. 4th Street Each 1 55,000.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 017. Cut. Cap, and Block Existing Water Main Each 3 $400.00 8.00 $3.200,00 0.00 $0.00 8.00 $3,200.00 018. Abandon Existing Manhole In Place Each 1 $io0.00 1.00 $100.00 0.00 $0.00 1.00 $100.00 Removal and Replacement of Unsuitable Foundation 019. Material Ton 50 $1.00 0.00 $0.00 0.00 $0.00 0.00 SO.00 020. Select Imported Trench Backfi8 Ton 900 $1.00 50.98 $80.98 0.00 $0.00 80.98 $80.98 021. Crushed Surfacing Top Course & Crushed Rock Backfill Ton 350 $20.00 1563.85 531,677.00 G.00 So.00 1583.85 $31.677.00 3" Depth Temporary Hot Mix Asphalt (HMA) for Trench 022. Patching Ton 190 $100.00 164.46 $15,446.00 13.96 $1,396.00 178.42 $17,842.00 023. H.MA. Class %' PG 64-22 for Roadway Restoration Ton 805 $180.00 991.49 $176,468.20 0.00 $0.00 991.49 $178.468.20 024. Removal and Replacement of Concrete Curb and Gutter Linear Foot 45 $50.DO 82.00 54,100.00 0.00 $0.00 82.00 54,100.00 Replace Traffic Loop Sensor.Pavement Markings, Extruded 025. Curbing, and Traffic Buttons Lump Sum 1 $25,000.00 1.00 $25,000.00 0.00 $0.00 1.00 $25,000.00 Printed On: 11117/2011 City of Renton Public Works Department Page 2 Project: Benson Road IF Water Main Replacement Project Contractor: R.L. Alia Company Item Description No. 026. Concrete Driveway and/or Sidewalk Restoration 027. Property 8. Landscape Restoration C01 Change Order#1 CO2 Change Order #2 Subtotal 9.5% Sales Tax TT Total Pay Esbmale Unit Est. 5 Unit Price Square Yard 1GO $100.00 1 Lump Sum 1 $5,000.00 Lump Sum 1 $15,595.97 Lump Sum 1 $16.544.55 Contract Number. CAG-11-044 Closing Date: 11/15QG11 Previous Previous This This Total Quantity Amount Quantity Amount Quantity 33.00 S3,300.00 0.00. $0.00 33.00 1.00 S5,000.00 0.00 $0.00 1.00 1.00 $16,595.97 0.0o $0.00 1.00 0.00 $0.00 1.00 S16,544.55 1.00 $607,168.15 $21.840.55 $57,680.97 $2,074.85 $664,849.12 $23,915.40 Taal $3.300.00 $5,000.00 $16,595.97 $16,544.55 $629,008.70 $59,755.83 $688,764.53 .(/) /;i rA0v. 1%,2,ol1 7 /1,1&il CITY OF RENTON Public Works Department CONTRACT CHANGE ORDER AGREEMENT CONTRACT: CAG 11-044 — Benson Road 16" Water Main Replacement Project C.O.# 2 CONTRACTOR: R.L. Alia Company SUMMARY OF PROPOSED CHANGE: Provide all labor, equipment, subcontracting, bonding, insurance for the complete work required for the extra work as outlined below: ITE Additional Quantities Under This Change Order Unit Quantity Unit l otai trice CO2 Change order for delay and downtime for sawcutting extra LS 1 $16,595.97 $16,544.55 depth asphalt and for breaking rock. Subtotal $16,544.55 9.5% Sales Tax $1,571.73 Total $18,116.28 ORIGINAL CURRENT ESTIMATED NET ESTIMATED CONTRACT CONTRACT CHANGE THIS CONTRACT TOTAL AMOUNT AMOUNT ORDER AFTER CHANGE $591,738.00 $609,910.59 $18,116.28 $628,026.87 Cost Allocation Water Utility 425.45559 95.34.63.000 $18,116.28 SIGNATUR Contractor: i Project Engi Approved B (Water Utility Supervisor) C:\Documents and Settings\Gary\Local Settings\Temporary Internet Fi1es\0LK13\Change0rder2_11-15-11.DOC/AWah Date: �l-Ib-11 Date: /I 7 Date: 01941( AGENDA BILL SCHEDULE AGENDA BILL TITLE PREPARED BY: �►�O l�l i0 . U Extension: xQ d CCD"zz-� vvvut-, DEADLINE/DATE ACTION be) � a GREGG'S SIGNATURE TRANSMIT TO CLERK VIA Electronic Agenda Bill Process �ac�a�a COUNCIL MEETING DATE a ho )0')01 a Referred to `- - Committee COMMITTEE MEETING DATE (e-mail Committee Report to Teresa who will final it and send it up to Julia) COMMITTEE Time: Place: COUNCIL MEETING REPORTED OUT USA\17Misc \Forms\AB-Schedule\tp CITY OF RENTON COUNCIL AGENDA BILL Submitting Data: Public Works Dept/Div/Board.. Utility Systems/Water Utility Staff Contact....... Andrew Weygandt, x7208 Subject: Final Pay Estimate — CAG-11-044 (WTR-27-3551) Benson Road Water Main Replacement Project Exhibits: Pay Estimate #6 (Final) Notice of Completion of Public Works Contract Al #: For Agenda of: February 6, 2012 Agenda Status Consent ................ Public Hearing...... Correspondence... Ordinance............ Resolution............ Old Business......... New Business....... Study Sessions....., Information.......... ►:l Recommended Action: Approvals: Council Concur Legal Dept.......... Finance Dept...... X Fiscal Impact: Expenditure Required... $1,095.00 (final pay est. only) Transfer/Amendment....... Amount Budgeted........ $1,500.00 (final pay est. only) Revenue Generated......... Total Project Budget..... $900,000.00 (Acct. 425/45596) City Share Total Project.... 100% SUMMARY OF ACTION: On April 18, 2011, Council awarded the construction contract to R.L. Alia Company. Construction started on May 30, 2011, and the project was substantially completed on September 14, 2011. The original contract amount was $591,738.00 and the final contract amount is $689,859.53. The 17% increase in cost of $98,121.53 is due to authorized construction change orders for additional work to resolve unanticipated changes in field conditions. The extra work included the removal and disposal of thicker asphalt and concrete pavement than anticipated, breaking through native hardpan materials with special rock drilling equipment, and the replacement of additional asphalt pavement. The Water Utility has budgeted sufficient contingency funds in the total project budget to cover the additional work, and the low bid was about $123,000 below the engineer's estimate. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate in the amount of $1,095.00, and release the retainage bond after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WTR - Drinking Water Utility\WTR-27 - Water Project Files\WTR-27-3551- Benson Rd 16in Water Main Replacement\Construction Contract\Pay Estimates\Revised-agenda-bill-final-payment.doc/AWah It TO: FROM: FINANCE DIRECTOR. PUBLIC WORKS ADMINISTRATOR CONTRACTOR: R.L. Alia Company CONTRACT NO. CAG-11-044 PO# 18/0001754 ESTIMATE NO.. 6 (Final) PROJECT: Benson Road 16" Water Main Replacement Project Closing Date: 01/04/2012 1. CONTRACTOR EARNINGS THIS ESTIMATE $1,000.00 2. SALES TAX @ 9.50% $95.00 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $1,095.00 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $629,008.70 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $1,000.00 6. SUBTOTAL -CONTRACTOR PAYMENTS 7. PREVIOUS RETAINIAGE (TRANSFERED TO BOND) 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE 9. SUBTOTAL - RETAINAGE 10. SALES TAX PREVIOUSLY PAID 11. SALES TAX DUE THIS ESTIMATE 12. SUBTOTAL - SALES TAX * (95% x LINE 9) ** (RETAINAGE: 5%) FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455596.018.595.34.63.000 $0.00 $0.00 $59,755.83 $95.00 GRAND TOTAL $1,095.00 # 6 (Final) The contractor posted a retainage bond prior to this pay estimate. Therefore, the City is not witholding further retainage on the project. All previous retainage has been transferred to the bond. TOTAL THIS ESTIMATE CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHORIZED TO AUTHENTIC TE AND CERTIFY TO SAID CLAIM Signed: �60Gta. C 1 a�/ 7k4- 75, 2O iZ $630,008.70 $0.00 $59,850.83 $689,859.53 $1,095.00 $1,095.00 Tom' 04111— A6 i% z5% Iz Printed On: 01/24/2012 City of Renton Public Works Department Page 1 Printed On: 01/24/2012 City of Renton Public Works Department Page 1 _ Project: Benson Road 16" Water Main Replacement Project Contractor. R.L. Alia Company Item Description No. Pay Estimate Unit Est. Quantity 6 (Final) Unit Price Contract Number. Closing Date: Previous Previous Quantity Amount CAG-11-044 01/04/2012 This Quantity This Amount Total Quantity Total Amount ITEM __. ........... 001. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $39,000.00 1.00 $39,000.00I 0:00' $0.00 1.00 $39,000.00 002. Traffic Control Lump Sum 1 $25,000.00 1.00 $25,000.00 � 0.00: $0.00 1.00 $25,000.D0 003. Trench Excavation Safety Systems Lump Sum 1 $2.000.00 1.00 $2,000.00 :.- 0:0q $0.00 1.00 $2,000.00 004. Construction Surveying, Staking, and As-Builts Lump Sum 1 $2,000.W 0.50 $1,000.00 -. 0:50. $1,000.00 1.00 $2,000.00 005. Temporary Erosion and Sedimentation Control Lump Sum 1 $2,000.W 1.00 $2,000.00 0:00 $0.00 1.00 $2,000.00 006. Site Specific Potholing Each 10 $2W.00 12.00 $2 400 00.. 0.00 $0.00 12.00 $2,400.00 Furnish and Install 16" Cl 52 DI Water Pipe & Fittings w/ 007. Polywrap Linear Foot 1520 $125.00 1520.00 $190000.00 ; 0.00 $0.W 1520.00 $190,000.00 008. Furnish and Install 16' Gate Valve Assembly Each 5 $5,000.00 5.00 $25,000.00:- � �: 0.00 $0.00 5.00 $25,000.W 009. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 60 $200.00 28.50 $5,700.00 ; ', 0.00 $0.W 28.50 $5,700.00 010. Furnish and Install Fire Hydrant Assembly Each 2 $2,000.00 2.W $4,000.W -- � 0.00 $0.W 2.00 $4,000.00 011. Furnish & Install 3/4" Water Service Connection Each 4 $1,500.00 4.W $6,000.00. 0.00 $0.00 4.00 $6,000.00 012. Connection to Existing Water Main - Benson Rd. Each 1 $5,000.00 1.00 $5.000:00 ,0.00 $0.00 1.00 $5,000.00 013. Connection to Existing Water Main - Grady Way Each 1 $5,000.00 1.00 $5.000.00 0.00 $0.00 1.00 $5,000.00 014. Connection to Existing Water Main - S. 5th Street Each 1 $5,000.D0 1.00 $5,000.00 ` 0.00 $0.00 1.00 $5,000.00 015. Connection to Existing Water Main - Service Linen Each 1 $5,000.00 1.00 $5,000.00. 0.00 $0.00 1.00 $5,000.00 - 016. Connection to Existing Water Main - S. 4th Street Each 1 $5,000.00 1.00 $5,000.00 . 0.00. $0.00 1.00 $5,000.00 017. Cut, Cap, and Block Existing Water Main Each 3 $4D0.00 8.00 $3,200.00;. 0.00 $0.D0 8.00 $3,200.00 018. Abandon Existing Manhole In Place Each 1 $100.00 1.00 $1D0.00-:.`�'-0.00 $0.00 1.00 $100.00 Removal and Replacement of Unsuitable Foundation 019. Material Ton 50 $1.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 020. Select Imported Trench Backfill Ton 900 $1.D0 80.98 $80.98 1 0:00 $0.00 80.98 $80.98 021. Crushed Surfacing Top Course & Crushed Rock Ball Ton 350 $20.D0 1583.85 $31 677.00 : - 000- - $0.00 1583.85 $31,677.00 3" Depth Temporary Hot Mix Asphalt (HMA) for Trench 022. Patching Ton 190 $100.00 178.42 $17,842.00 -A00- $0.00 178.42 $17,842.00 023. H.M.A. Class /2' PG 64-22 for Roadway Restoration Ton 805 $180.00 991.49 $178 468 20 0.00 $0.00 991.49 $178,468.20 024. Removal and Replacement of Concrete Curb and Gutter Linear Foot 45 $50.00 82.00 $4 1 DO 00 :: 0.00: $0.00 82.00 $4,100.00 1 Replace Traffic Loop Sensor,Pavement Markings, Extruded+ 'n' 025. Curbing, and Traffic Buttons Lump Sum 1 $25,000.00 1.00 $25,000.00;,;;.:: _;,. r;QrOQ, $0.00 1.00 $25,000.00 P.sinted On: 01/24/2012 City of Renton Public Works Department Page 2 Project: Benson Road 16" Water Main Replacement Project Contractor. R.L. Alia Company Item Description No. 026. Concrete Driveway and/or Sidewalk Restoration 027. Property & Landscape Restoration C01 Change Order#1 CO2 Change Order#2 Subtotal 9.5 % Sales Tax TT Total Contract Number. CAG11-044 Pay Estimate 6 (Final) Closing Date: 01/04/2012 Unit Est Unit Previous Previous This Quantity Price Quantity Amount Quantity Square Yard 100 $100.00 '33.00 $3,300.00 0.00 Lump Sum 1 $5,000.00 1,00 $5.000.00 `. -: 0.00. Lump Sum 1 $16,595.97 1.00 $16,595.97, 0.00 Lump Sum 1 $16,544.55 1.00 $16.544.55��, -0.00. $629,008.70 $59.755.83 $688,764.53 This Total Total mount Quantity Amount $0.00 33.00 $3,300.00 $0.00 1.00 $5,000.00 $0.00 1.00 $16.595.97 $0.00 1.00 $16,544.55 $1,000.00 $630,008.70 $95.00 $59, 850.83 $1,095.00 $689.859.53 NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Name'& Address of Public Agency City of Renton 1055 S Grady Way Renton, WA 98057 UBI Number: 177000094 Contractor's UBI Number: Date: . IDepartment Use Only Assigned to: Date Assigned: Notice is herehv given relative to the completion of contract or proiect described below 600149378 02/08/2012 Project Name Contract Number FcAG-1 Job Order Contracting Benson Road 16" Water Main Replacement Project 1-044 ❑ Yes ❑ No Description of Work Done/Include Jobsite Address(es) Benson/Main Ave. from Renton City Hall to S. 4th Street. Approximately 1,520 linear feet of 16-inch ductile iron water pipe with fittings, valves, and fire hydrant assemblies. Removal and replacement of asphalt concrete pavement, asphalt overlay, traffic loop system, pavement striping, extruded curbing, lane markers, curbs, gutters, and sidewalk. Contractor's Name Telephone Number R.L. Alia Company 425-226-8100 Contractor Address 107 Williams Ave. S. Renton, WA 98055 If Retainage is Bonded, List Surety's Name (or attach a copy) North American Specialty Insurance Company Surety Agent's Address 2233 112th Ave NE Bellevue, WA 98004 Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted 04/18/2011 105/18/2011 109/14/2011 102/06/2012 Contract Amount Additions ( + ) Reductions (- ) Sub -Total Amount of Sales Tax Paid at 9.500% (It various rates apply, please send a breakdown) TOTAL Please List all Subcontractors Below: $ 540,400.00 $ 89,608.70 Liquidated Damages $ 0.00 $ 0.00 Amount Disbursed $ 689,859.53 $ 630,008.70 Amount Retained $ 0.00 $ 59,850.83 $ 689,859.53 TOTAL $ 689,859.53 NOTE: These two totals must be equal Subcontractor's Name: UBI Number: Affidavit ID (if known) Stripe Rite, Inc. 601048084 373643 National Concrete Cutting, Ie. 600195813 369256 R. L. Alia Company 600149378 369183 Hot Mix Pavers, Inc. 600310693 369023 Woodworth & Company 602870349 367810 M.T. Electric, Inc. 601289414 361069 P.R. Systems, Inc. 601303110 353884 ASPI, Land Surveyors 1 601778199 345907 F215-038-000 11-2010 REV 31 0020e (11/9/10) Continued on page 2 Please List all Subcontractors Below: Subcontractor's Name: IUBI Number: I Affidavit ID (if known) Comments: RETAINIAGE BOND Contact Name: Natalie Wissbrod Title: Accounting Assistant Email Address: nwissbrod@rentonwa.gov Phone Number: 425-430-6919 Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Submitting Form: Please submit the completed form to all three agencies below. For a faster response, please submit by e-mail. TQ-Washington State Department of Revenue Washington State y Department of Labor and Industries Washington State Employment Security Department Public Works Section PO Box 47474 "fir .,,' Contract Release PO Box 44274 _ Specialized Collections Unit PO Box 9046 Olympia WA 98504-7474 Olympia, WA 98504-4272 Olympia WA 98507-9046 (360)725-7588 (360)902-4754 (360) 902-9780 FAX (360) 664-4159 FAX (360) 902-6897 Fax (360) 902-9287 PWC@dor.wa.gov ContractRelease@lni.wa.gov publicworks@esd.wa.gov For tax assistance or to request this document in an alternate format, visit http://dor.wa.gov or call 1-800-647-7706. - Teletype (TTY) users may call (360) 705-6718. F215-038-000 11-2010 REV 31 0020e (11/9/10) CITY OF RENTON COUNCIL AGENDA BILL Al #: Recommended Action: Approvals: Council Concur Legal Dept.......... Finance Dept...... X Fiscal Impact: Expenditure Required... $1,095.00 (final pay est. only) Transfer/Amendment....... Amount Budgeted........ $1,500.00 (final pay est. only) Revenue Generated......... Total Project Budget..... $900,000.00 (Acct. 425/45596) City Share Total Project.... 100% SUMMARY OF ACTION: On April 18, 2011, Council awarded the construction contract to R.L. Alia Company. Construction started on May 30, 2011, and the project was substantially completed on September 14, 2011. The original contract amount was $591,738.00 and the final contract amount is $689,859.53. The 17% increase in cost of $98,121.53 is due to authorized construction change orders for additional work to resolve unanticipated changes in field conditions. The extra work included the removal and disposal of thicker asphalt and concrete pavement than anticipated, breaking through native hardpan materials with special rock drilling equipment, and the replacement of additional asphalt pavement. The Water Utility has budgeted sufficient contingency funds in the total project budget to cover the additional work, and the low bid was about $123,000 below the engineer's estimate. STAFF RECOMMENDATION: Accept the project, approve the final pay estimate in the amount of $1,095.00, and release the retainage bond after 60 days, subject to the receipt of all required authorizations. H:\File Sys\WTR - Drinking Water Utility\WTR-27 - Water Project Files\WTR-27-3551 - Benson Rd 16in Water Main Replacement\Construction Contract\Pay Estimates\Revised-agenda-bill-final-payment.doc/AWah TO: FINANCE DIRECTOR FROM: PUBLIC WORKS ADMINISTRATOR CONTRACTOR: R.L. Alia Company CONTRACT NO. CAG-11-044 PO# 18/0001754 ESTIMATE NO. 6 (Final) PROJECT: Benson Road 16" Water Main Replacement Project Closing Date: 01/04/2012 1. CONTRACTOR EARNINGS THIS ESTIMATE $1,000.00 2. SALES TAX @ 9.50% $95.00 3. TOTAL CONTRACT AMOUNT THIS ESTIMATE $1,095.00 4. EARNINGS PREVIOUSLY PAID CONTRACTOR $629,008.70 5. * EARNINGS DUE CONTRACTOR THIS ESTIMATE $1,000.00 6. SUBTOTAL - CONTRACTOR PAYMENTS 7. PREVIOUS RETAINIAGE (TRANSFERED TO BOND) 8. ** RETAINAGE ON EARNINGS THIS ESTIMATE 9. SUBTOTAL - RETAINAGE 10. SALES TAX PREVIOUSLY PAID 11. SALES TAX DUE THIS ESTIMATE 12. SUBTOTAL - SALES TAX * (95% x LINE 1) ** (RETAINAGE: 5%) FINANCE DEPARTMENT ACTION: PAYMENT TO CONTRACTOR (Lines 5 and 11): ACCOUNT # 425.455596.018.595.34.63.000 $0.00 $0.00 $59,755.83 $95.00 GRAND TOTAL: $1,095.00 # 6 (Final) The contractor posted a retainage bond prior to this pay estimate. Therefore, the City is not witholding Further retainage on the project. All previous retainage has been transferred to the bond. TOTAL THIS ESTIMATE CHARTER 116, LAWS OF 1965 CITY OF RENTON CERTIFICATION I, THE UNDERSIGNED DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST THE CITY OF RENTON, AND THAT I AM AUTHORIZED TO AUTHENTIC�jTE AND CERTIFY TO SAID CLAIM Signed: N6��4z. �I( a�/ 7h-A- 25) le $630,008.70 $0.00 $59,850.83 $689,859.53 $1,095.00 $1,095.00 l/L¢1L i1,z51IZ Printed On: 01/24/2012 City of Renton Public Works Department Page 1 Printed On: 01/24/2012 Project: Benson Road 16" Water Main Replacement Project Contractor. R.L. Alia Company Item Description No. City of Renton Public Works Department Contract Number. Pay Estimate 6 (Final) Closing Date: Unit Est. Unit Previous Previous Quantity Price Quantity Amount Page 1 CAG-11-044 01 /04/2012 This This Total Total Quantity Amount Quantity Amour ITEM D01. Mobilization, Demobilization, Site Preparation & Clean-up Lump Sum 1 $39,000.00 1.00 $39,000.00 '. 0.00 $0.00 1.00 $39,000.00 002. Traffic Control Lump Sum 1 $25,000.00 1.00 $25,000.00 0:00 $0.00 1.00 $25,000.00 003, Trench Excavation Safety Systems Lump Sum 1 $2.000.00 1.00 $2,000.00 :0.00. $0.00 1.00 $2.000.00 004. Construction Surveying, Staking, and As-Builts Lump Sum 1 $2,000.00 0.50 $1,000.00. 0:50 $1,000.00 1.00 $2,000.00 005. Temporary Erosion and Sedimentation Control Lump Sum 1 $2,000.00 1.00 $2.000.00 O;lH1 $0.00 1.00 $2,000.00 006. Site Specific Potholing Each 10 $200.00 12.00 $2 400 00..' 0 00' $0.00 12.00 $2,400.00 Furnish and Install 16" Cl 52 DI Water Pipe & Fittings w/ 007. Polywrap Linear Foot 1520 $125.00 1520.00 $190,000.00:-: ':-.0.00 $0.00 1520.00 $190.000.00 008. Furnish and Install 16' Gate Valve Assembly Each 5 $5,000.00 5.00 $25,000.00' :. 0.00 $0.00 5.00 $25,000.D0 009. Concrete for Thrust Blocking, Dead -Man Anchor Blocks Cubic Yard 60 $200.00 28.50 $5,700.00 - '- 0.00 $0.00 28.50 $5,700.00 010. Furnish and Install Fire Hydrant Assembly Each 2 $2,000.00 2.00 $4,000.00.'• ::0.00 $0.00 2.00 $4,000.00 011. Furnish & Install 3/4" Water Service Connection Each 4 $1,500.00 4.00 $6,000.00 _ 0.00 $0.00 4.00 , $6,000.00 012. Connection to Existing Water Main - Benson Rd. Each 1 $5,000.00 1.00 $5,000.00 ' ' �0.00. $0.00 1.00 $5,000.00 013. Connection to Existing Water Main - Grady Way Each 1 $5,000.00 1.00 $5,000.00: _ D.DO $000 1.00 $5,000.00 014. Connection to Existing Water Main - S. 5th Street Each 1 $5,000.00 1.00 $5,000.00 -'. D.00 $0.00 1.00 $5,000.00 015. Connection to Existing Water Main - Service Linen Each 1 $5,000.00 1.00 $5,000.00 _ 0.00 $0.00 1.00 $5,000.00 016. Connection to Existing Water Main - S. 4th Street Each 1 $5,000.00 1.00 $5,000.00 0.00. $0.00 1.00 $5,000.00 017, Cut, Cap, and Block Existing Water Main Each 3 $400.00 8.00 $3,200.00:. '"1:0.00' $0.DO 8.00 $3,200.00 018. Abandon Existing Manhole In Place Each 1 $100.00 1.00 $100.00 -- . 0.00 $0.00 1.00 $100.00 Removal and Replacement of Unsuitable Foundation 019. Material Ton 50 $1.00 0.00 $0.00 -•0.00 $0.00 0.00 $0.00 020. Select Imported Trench Backfill Ton 900 $1.00 80.98 $80.98 $0.00 80.98 $80.98 021, Crushed Surfacing Top Course & Crushed Rock Backfill Ton 350 $20.00 1583.85 $31,677.00 D Q0:. $0.00 1583.85 $31,677.00 3" Depth Temporary Hot Mix Asphalt (HMA) for Trench 022. Patching Ton 190 $100.00 178.42 $17,842.00 : - 0 Q0 $0.00 178.42 $17.842.00 023. H.M.A. Class 'A' PG 64-22 for Roadway Restoration Ton 805 $180.00 991,49 $178,468 20 -0 00. $0.00 991.49 $178,468.20 024. Removal and Replacement of Concrete Curb and Gutter Linear Foot 45 $50.00 82.00 $4 100 00 ..: 0.00: $0.00 82.00 $4,100.00 Replace Traffic Loop Sensor,Pavement Markings, Extruded 025. Curbing, and Traffic Buttons Lump Sum 1 $25,000.00 1.00 $25 000 00 _ 0 00 $0.00 1.00 $25,000.00 Printed On: 01/24/2012 City of Renton Public Works Department Page 2 Project: Benson Road 16" Water Main Replacement Project Contractor. R.L. Alia Company Item Description _ No. Pay Estimate Unit Est Quantity 6 (Final) Unit Price 026. Concrete Driveway and/or Sidewalk Restoration Square Yard 100 $100.00 027. Property & Landscape Restoration Lump Sum 1 $5.000.00 COI Change Order #1 Lump Sum 1 $16,595.97 CO2 Change Order #2 Lump Sum 1 $16.544.55 Subtotal 9.5% Sales Tax TT Total Contract Number. Closing Date: Previous Previous Quantity Amount CAG-11-044 01/042012 This Quantity This Amount Total Quantity Total Amount *33.00 $3,300.00 ; -. 0.00, $0.00 33.00 $3,300.00 1.00 $5,000.00 0.00 $0.00 1.00 $5,000.00 1.00 $16,595.97.:0.00 $0.00 1.00 $16,595.97 1.00 $16 544 55 0.00, $0.00 1.00 $16,544.55 $629.008.70 $1,000.00 $630,008.70 $59,755.83 $95.00 $59,850.83 $688,764.53 $1,095.00 $689,859.53 '000 /z f 5T NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Name & Address of Public Agency City of Renton 1055 S Grady Way Renton, WA 98057 UBI Number: 177000094 Contractor's UBI Number: Date: Assigned to: Date Assigned: Use Notice is herebv Qiven relative to the completion of contract or project described below 600149378 02/08/2012 Project Name Contract Number TCAG-11-044 Job Order Contracting Benson Road 16" Water Main Replacement Project ❑ Yes ❑ No Description of Work Done/Include Jobsite Address(es) Benson/Main Ave. from Renton City Hall to S. 4th Street. Approximately 1,520 linear feet of 16-inch ductile iron water pipe with fittings, valves, and fire hydrant assemblies. Removal and replacement of asphalt concrete pavement, asphalt overlay, traffic loop system, pavement striping, extruded curbing, lane markers, curbs, gutters, and sidewalk. Contractor's Name Telephone Number R.L. Alia Company 425-226-8100 Contractor Address 107 Williams Ave. S. Renton, WA 98055 If Retainage is Bonded, List Surety's Name (or attach a copy) North American Specialty Insurance Company Surety Agent's Address 2233 112th Ave NE Bellevue, WA 98004 Date Contract Awarded Date Work Commenced Date Work Completed Date Work Accepted 04/18/2011 105/18/2011 109/14/2011 102/06/2012 Contract Amount Additions ( + ) Reductions (- ) Sub -Total Amount of Sales Tax Paid at 9.500% (If various rates apply, please send a breakdown) TOTAL Please List all Subcontractors Below: $ 540,400.00 $ 89,608.70 Liquidated Damages $ 0.00 $ 0.00 Amount Disbursed $ 689,859.53 $ 630,008.70 Amount Retained $ 0.00 $ 59,850.83 $ 689,859.53 NOTE: These two totals must be equal TOTAL $ 689,859.53 Subcontractor's Name: UBI Number: Affidavit ID (if known) Stripe Rite, Inc. 601048084 373643 National Concrete Cutting, Ic. 600195813 369256 R. L. Alia Company 600149378 369183 Hot Mix Pavers, Inc. 600310693 369023 Woodworth & Company 602870349 367810 M.T. Electric, Inc. 601289414 361069 P.R. Systems, Inc. 601303110 353884 ASPI, Land Surveyors 601778199 345907 F215-038-000 11-2010 REV 31 0020e (11/9/10) Continued on page 2 Please List all Subcontractors Below: ISubcontractor's Name: IUBI Number: IAffidavit ID (if known) I Comments: RETAINIAGE BOND Contact Name: Natalie Wissbrod Title: Accounting Assistant Email Address: nwissbrod@rentonwa.gov Phone Number: 425-430-6919 Note: The Disbursing Officer must submit this completed notice immediately after acceptance of the work done under this contract. NO PAYMENT SHALL BE MADE FROM RETAINED FUNDS until receipt of all release certificates. Submitting Form: Please submit the completed form to all three agencies below. For a faster response, please submit by e-mail. Washington State Department of Revenue Public Works Section Washington State Department of Labor and Industries Contract Release a Washington State Employment Security Department .? Specialized Collections Unit PO Box 47474 PO Box 44274 PO Box 9046 Olympia WA 98504-7474 Olympia, WA 985044272 Olympia WA 98507-9046 (360)725-7588 (360)9024754 (360) 902-9780 FAX (360) 664-4159 FAX (360) 902-6897 Fax (360) 902-9287 PWC@dor.wa.gov ContractRelease@lni.wa.gov publicworks@esd.wa.gov For tax assistance or to request this document in an alternate format, visit http://dor.wa.gov or call 1-800-647-7706. Teletype (TTY) users may call (360) 705-6718. F215-038-000 11-2010 REV 31 0020e (11/9/10) s Y�o 7101 CITY OF RENTON Public Works Department CONTRACT CHANGE ORDER AGREEMENT CONTRACT: CAG 11-044 — Benson Road 16" Water Main Replacement Project C.O.# 1 CONTRACTOR: R.L. Alia Company SUMMARY OF PROPOSED CHANGE: Provide all labor, equipment, subcontracting, bonding, insurance for the complete work required for the extra work as outlined below: ITEM Additional Quantities Under This Change Under Unit quantity Unit i otaI Frice C01 Change order for delay, downtime, and redesign due to LS 1 $16,595.97 $16,595.97 mismarked and mislocated utilities in Main Ave. S., breaking and hauling off excavated material from extra depth pavement section beyond 12", shift hour reduction for River Days, and additional ductile iron water main fittings. Subtotal $16,595.97 9.5% Sales Tax $1,576.62 Total $18,172.59 ORIGINAL CONTRACT AMOUNT CURRENT CONTRACT AMOUNT ESTIMATED NET CHANGE THIS ORDER ESTIMATED CONTRACT TOTAL AFTER CHANGE $591,738.00 $591,738.00 $18,172.59 $609,910.59 Cost Allocation Water Utility 425.455596. .5 .34.63.000 $18,172.59 CIL`PIATI IDEC. Contractor: Project Engine Approved By: (Water Utility Supervisor) Date: Date: Date: HAFile Sys\WTR - Drinking Water Utility\WTR-27 - Water Project Files\WTR-27-3551 - Benson Rd 16in Water Main Replacement\Construction ContractTay Estimates\ChangeOrderl_09-06-11.DOGAW ah CITY OF RENTON Public Works Department CONTRACT CHANGE ORDER AGREEMENT CONTRACT: CAG 11-044 — Benson Road 16" Water Main Replacement Project C.O.# 2 CONTRACTOR: R.L. Alia Company SUMMARY OF PROPOSED CHANGE: Provide all labor, equipment, subcontracting, bonding, insurance for the complete work required for the extra work as outlined below: ITE Additional Quantities Under This Change Order Unit Quantity Unit 1 otal rritce CO2 Change order for delay and downtime for sawcutting extra LS 1 $16,595.97 $16,544.55 depth asphalt and for breaking rock. Subtotal 116,544.55 9.5% Sales Tax $1,571.73 Total $18,116.28 ORIGINAL CURRENT ESTIMATED NET ESTIMATED CONTRACT CONTRACT CHANGE THIS CONTRACT TOTAL AMOUNT AMOUNT ORDER AFTER CHANGE $591,738.00 $609,910.59 $18,116.28 $628,026.87 Cost Allocation Water Utility 425.45559 95.34.63.000 $18,116.28 SIGNATUR Contractor: Project Engi Approved B (Water Utility Supervisor) C:\Documents and Settings\Gary\Local SettingslTetnporary Internet Files\OLK131ChangeOrder2_11-15-11.DOC/AWah Date: �l-lb-Il Date: // r Date: 1\1f 94 ii Amber Hoffman From: Andrew Weygandt Sent: Wednesday, January 25, 2012 3:16 PM To: Amber Hoffman Subject: CO's Attachments: 3551_PayEstimate5.pdf; 3551_PayEstimate3.pdf Change orders are at the end of the pay estimates. Also, in addition to the change orders on the project, we had and additional 1,243 tons of crushed rock used as trench back fill due to poor existing soils and an extra 186.5 tons of HMA for additional paving adjacent to the project area to improve the quality of site restoration. -Andrew Andrew Weygandt, PE Civil Engineer City of Renton Public Works I Water Utility 1055 S. Grady Way, 5th Floor Renton, WA 98057 P: (425) 430-7208 F: (425) 430-7241 d vm A ((CLERS I, WA 98021 �. W. N-0183553 FICE: (425) 481-9101 Phone: F_ _ DELIVERY TICKET 1@7 t V Nr-WAY s �� a i, «j iI ooyo c. —yu— vvy a., oeame ACCOUNTING (206) 762-2566 CONCRETE ..,NTON (Plant 17024 Valley Hwy., Tukwila FAX (206) 762-2358 14) H us RENTON (Plant #14) 915 Houser Way N., Renton ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000 TICKET TIME AM LEAVE PLANT ARRIVE JOB 1 BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER • • • •.00 7�_�,00:7!tfi L:Y' E:MV 1 kCJPJMEIJ"fl=al_ SUFdI F liaf�[iEi.0t1 r;y� READY MFX FUEL. C;0RC1'Hl4RGE. 2. 00 I _ N 1:100` 0, M i Iv I"I-441 9 YES JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER • WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: • • ❑ YES 1: gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ YES J JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1/3 load ❑ WAITING FOR TRUCK TO UNLOAD El PUMP BLOW -BACK El NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, STRENGTH. WATER ADDED AT IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE V: UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACEDISCOLORATIONPRINT NAME DATE BATCH DATA: TICKET TOTAL REV06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%s) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed.. it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof. without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not limited to, drivers, quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merino Construction Company, Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage. personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless. and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from, rest#ting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include. as to all Clairns, demands, losses, and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorneys fees and other costs incurred by Seiler to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6. WASH OUT AREA. it will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback. will be borne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned concrete due to clean up process. 8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job. delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM, UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees; agents, contractors or subcontractors. Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seiler warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranti s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to. Purchaser for any consequential damages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty. shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seiler in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved, the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein. title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss, Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death, and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned Tong -sleeved shirt, full-length trousers. and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled. remove to fresh air. Get medical attention if irritation persists. Wash wet concrete. mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. In case of eye contact. flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR. CEMENT OR CEMENT MIXTURES. Truck Driver User Disp Ticket Num Ticket ID Time Date 464 9920 user 271870 95460 14:05 6/7/11 Load Size Mix Code Returned Qty Mix Age Seq Load ID 7.00 CY CL3K W 96965 Material Description Design Qty Required Batched % Var % Moisture Actual Wat Spec.Grav STSND B335 STATE SAN 1423 Ib 10374 Ib 10360 Ib -0.14% 3.98% A 49 gl 1.06 GR34 B335 3/4" AGG 1929 Ib 13544 Ib 13560 Ib 0.12% 0.30% M 5 gl 2.67 CEM 1-II CERT# 2009-11 450 Ib 3150 Ib 3140 Ib -0.32% 3.15 SLAG SLAGCERT#08-M 80 Ib 560 Ib 570lb 1.79% 2.25 WRDA64 GRACE WATER F 21.20 oz 148.40 oz 147.00 oz -0.94% 1.10 WATER WATER 1 230 Ib 468 Ib 464 Ib -0.91% 56 gl 1.00 H2O WATER 3 50 % # 468 Ib 460 Ib -1.76% 55 gl 1.00 Actual Num Batches: 1 Load 28563 Ib Design W/C: 0.434 Water/Cement: 0.434 T Design 192.9 gl Actual 165.0 gl To Add: 27.9 gl Slump: 3.00 in # Water in Truck: 0.0 Ib Adjust Water: 0.0 Ib / Load Trim Water: -30.0 Ib / CY DELIVERY TICKET b 1 VNEWAY i1 iLc iriam xi it oow E. maryinai vvy o., Oeaaie ACCOUNTING (206) 762-2566 CONCRETE <WILA (Plant 1 W. Valley Hwy., Tukwila FAX (206) 762-2358 RENTON (Plant #14) 14) 915 Houser Way N., Renton ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000 TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # - CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER • PRODUCT • • •• JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER • WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: • ❑ YES gals. to full load ❑YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ JOB NOT READY ❑ LACK OF HELP CI ADDING WATER WHEEL BARROW JOB ❑ YES ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN _ DRAWBRIDGE gals. to 1 /3 load ❑ WAITING FOR TRUCK TO UNLOAD El PUMP BLOW -BACK ❑ NONE n WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERUNO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE DISCOLORATION PRINT NAME DATE BATCH DATA: TICKET TOTAL REV 06/08 NBF CUSTOMER COPY 10. 11 12. 13. 14. TERMS, CONDITIONS AND WARNINGS CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery' (C,O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terns of payment specified in this Contract. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due Invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof. without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance, with the laws of the State of Washington, STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. TAXES. All federal, state and local taxes, assessments. fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. SCHEDULING. Changes or variations from ongir,al delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including. but not limitedoo, drivers, quality assurance personnel or sales representatives). DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the. delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size arid weight of trucks, damage to the premises and/or adjacent property, or personal injury rnay occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify. hold harmless. and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from. resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false. groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injuryto persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For. the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly ,naives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further. the indemnification obligation under this Agreement shall not be limited in any way by any limitation of-, the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include, as to all claims, demands, losses, and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seiler to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such counsel vvill be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback.. will be borne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned concrete due to clean up process. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM. UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in v , Unq within tvventy-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Stiller for further inspection, and testing. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors. Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptances or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. WARRANTY. Seiler warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance ill, accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such cons?rurnon materials, „P "n2r t"ev be warranties of fitness or warranti s of merchantability. Purchaser's exclusive rernedy for breach of this warranty shall be to require Seller, at Seller's option, to retwid the puichase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials No consequentia! damages maybe claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchaser for any consequential damages incurred by PUrchaserin connection with this Contract, including without limitation. Purchaser's lost profits. Purchaser's good will, acid any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seiler. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for cornmencing claims under this Contract against Seller for any reason, including bre.nch of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing saithln three (3) working days after discovery or when discovery should have been made. Th.e written claim shall include the reason(s) and gronnds for the claim and the dollar am o_rnt or relief sought. FAILURE OF PURCHASER, TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY "HRCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. TITLE AND RISK OF LOSS. Unless otherwise expressly stated nerein. t:tle to the materials sold `,e r .ender st all tell am ,wah 5 -.r until Seller, has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purch iser upon delivery of the same. at trl, pia,:1: of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible fot oomph ince ,mt'a all rrovernmentai regulations and orciirianc.. s v:iith regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, inducing de_,th. and property damage ansrin from the sforacic, use or handling of said materials. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wes: waterprac ' gig .es• a fully buttoned long-slaeved shirt, full-length, trousers. and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use vvaterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is metaled, remove to fresh air. Get meaical attention it initation persists. Wash wet concrete, mortar, cement. or cement admixtures from your skin with fresh. clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing. Seek immediate rnedical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), year swtabie NIOSH,MSHA-approved respirator. If,, case of eye contact, flush with plenty of water for at least 15 minutes Consult c� physician immediately. KEEP OUT Cfr REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH ;NET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. DELIVERY TICKET 19�STONEWAY M ILL (Plant #11) 3tR43 L. Marginal vvy s., Beattie ACCOUNTING (206) 762-2566 CONCRETE , _XWILA (Plant #12) 17024 W. Valley Hwy., Tukwila RENTON #14) 915 Houser Way N., Renton FAX (206) 762-2358 ACCOUNTING: 9125 TENTH AVENUE SOUTH (Plant CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & ORDER DESK (425) 226-1000 SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # ,..I ) CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER • PRODUCT • • • cl,_ : W51., I C.CIMME i L.:i Al_ -,RNA 5 ENV I R01*4MENTAL. SURCHORGE" JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER REMIT PAYMENT T• SALES TAX 9125 10th WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY:SEATTLE WA BALANCE FORWARD YES � 1: TERMS •N REVERSE TOTAL• gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ YES ❑ JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1 /3 load ❑ WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE PRINT NAME DATE DISCOLORATION BATCH DATA: er'ial De5cr1 ption De41 n c1t' �;; f Required Batched vdr` moisture ►M:tual Witt e. 71� 3.69% A 8335 STATE SA 3 b 3694 1b 3 220 Ib lE 91 _. 4 8335 314' AB6 1929 lb 48-3r lb 4840 lb 0. Ir,% 0. 30% 9 2 91 l� I-lI MRT# 6 -11 45Q lb 1125 lb 1120 lb -0.44: / ,G SU46CERT111IN--0 801b 20 1b &11b 10.ee% 4164 BRACE WATER R 21.i'4 oz 53.00 oz 57.00 oz 7.55% IN+TcR WATER 1 230 1b 173 lb 166 lb --4. 20 gI WATER 3 V5 i 173 1b 176 1b 1.79% 21 gI ktuai N+m Batches: 1 Lead Total-, 10246 lb Design W/C: 0.434 Water Cesent: 0.429 T Design Water: 6& 9 gl Actlj31 Water: 59.2 gl To fWd: `r.7 el Tris Water:-38.0 1b/ CY TICKET TOTAL REV06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2, TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1,25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not limited to, drivers, quality assurance personnel or sales representatives), 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company. Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Setter has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seiler assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage. personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from, resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false. groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's Indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts. or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include.. as to all claims, demands, losses, and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK, Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback, will be borne by the Purchaser. An additional charge. at Seller's discretion, will be added for returned concrete due to clean up process. i3. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM, UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents. contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranty s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages rnay be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to. Purchaser for any consequential damages incurred by Purchaser in connection with this Contract, including without limitation, Purchasers lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty. shah be as fellows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing. within three (3) working days after discovery or when discovery should have been made. The written claim, shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death, and property damage arising from the storage, use or handling of said materials. 16, CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers, and tight fitting eye protection when working with these materials. if you have to stand in wet concrete, use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled, remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing' can be as serious as direct contact. so promptly rinse wet concrete, mortar. cement or cement mixtures from clothing, Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. In case of eye contact, flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR. CEMENT OR CEMENT MIXTURES. <... .—, _ .... ...... ____ _ .. ... _ _ DELIVERY TICKET iJKWILA (Plant.#12) 17024 W. Valley Hwy., Tukwila ACCOUNTING. (206) 762-2566 ETE RENTON (Plant #14) 915 Houser Way N., Renton FAX 206 762-2358 ( ) 125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & S• EATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000 --KET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER N0. PROJECT PLANT # I;-'t K CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. PEI JOB ADDRESS _ COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIALJNSTRUCTIONS Me: Ae,_ ,l % ,Ids ❑ VISA ❑ MASTERCARD ❑ DISCOVER • ® •.. DESCRIPTION 471 JOB TOTAL SLUMP SPACING ORDERED BY SUB -TO TAIL TRUCK -NO. ; _ 'f3RIVER REMIT PAYMENT TO SALES TAX WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: SEATTLE, WA BALANCE FORWARD ❑ YES 1 - TERMS • gals. to full load ❑YES REASON FOR DELAY TIME: gals. to 2/3 load El YES [IJOB NOT READY Ll LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ ARRIVED JOB EARLY '"❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals_. to 1/3 load ❑ WAITING FOR TRUCK T6 UNLOAD ❑ PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE -WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, STRENGTH. WATER ADDED AT IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE DISCOLORATION PRINT NAME DATE — — — ------------------- BATCH DATA: L❑I2,S t'lit}yi0€! 11 �2�¢jA1 L�Ci RequfirSd ?"am -heel r s ftis re ktual wat i s IL`A 14423 iLbL ,r�14 lbw! 31S@ ?n' 4 16 U; }L�t]3rr B335 3.1 p AM i. i b t03 7-, �.ry�_&� !u_ ri8-37 lb 4A,4 i b C ffi:- �. fit, ix �•� CEPT# a--11 4`5 lb 1125 1b 1i2ib -0 44% 3LAXERTM-l• B@ `b EB@ zl 1is 12, t �I d RFt`tCE �IEI:. 21.2161 0z 5 . 0z 57. Dz ,.�5�5y�� 'i . - WPTE> 230 7 b t 3 I t; IE,E :.6 _i. E0.''t• 1uti A ER 3 59 x 4 1b 176 ?b i.7-0 :.at tta Batches: 'd Taal. 18�246 tbLDe; .irn W/C. 0.4.4 Water'f „Dents 0,40 { I'a.?slgn gat€r: H'.9 gt P,r_'tf,aI Water: JQ.L a: _o Add: 9. r n TICKET TOTAL REV 06/08 NBF IWOI^C COPY STONEWAY TTLE (Plant #11 /� 1) 3803,E. Marginal Wy S., Seattle CONCRETE i uKWILA (Plant #12) 17024 W. Valley Hwy., Tukwila RENTON (Plant #14) 915 Houser Way N., Renton ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. DELIVERY TICKET ACCOUNTING (206) 762-2566 FAX (206) 762-2358 SALES & ORDER DESK (425) 226-1000 TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. I ORDER NO. IPROJECT PLANT # CUSTOMER NAME JOB ADDRESS MAP ZONE SPECIAL INSTRUCTIONS CUSTOMER P.O. I JOB NO. I DELIVERY TICKET NO. COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE CARD # EXP. / ❑ VISA ❑ MASTERCARD ❑ DISCOVER 3OP_►7`.:; ENV i RnNt*11"IV T F �(.._ ►,.1RCF�ARGE N����� V JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. I DRIVER WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: ❑ YES gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load [I JOB NOT READY El LACK OF HELP El ADDING WATER [:1 WHEEL BARROW JOB El YES ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1/3 load ❑ WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). CUSTOMER SIGNATURE 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE DISCOLORATION PRINT NAME DATE BATCH DATA: Isterial Lrescri tion Design 9tj Required €itched 5TSND B335 STATE SA i 423 1 b 2952 lb c" lb BR34 8335 3/4` I 1929 1b 3870 lb 39N 1b CEN I-l1 CERT# 0,W-11 450 Ib 900 lb 898 lb SI Ar % AGCERT#@8-0 80 I b 160 lb 170 l b WPDA6+ GRk-E LITER R 21.20 oz. 42.lie oz 42.00 oz WATER WATER 1 230 I b ! 4QI 16 134 lb H2O HATER 3 50 It 11 140 1b 144 lb Actual Num Batches: 1 Load Total: 8181 lb Design W/%:: 0.434 IJatvt,%Cesent: 0.434 T Tr'is Water:-:.50.0 !b� b Y V3r moisture Actual flat -1.07x 3.58% H 13 gl - 1. 30% 0, 30% N 1 91 � -1.11x 6. 25% -0.94% -4. 16 g1 2, g5x 17 91 Design Water: 55.1 gl Actual Biter: 47.2 gl To Ado, :.j g TICKET TOTAL REV 06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are `Collect On Delivery" (C,O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller, This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS, 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including. but not limited to, drivers, quality assurance personnel or sales representatives), 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller; to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Sellermakes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seiler assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage. personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless. and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from. resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnify specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seiler harmless shall include, as to all claims, demands, losses, and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party ciaim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6. WASH OUT AREA. it will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback, will be borne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned concrete due to clean up process. 8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is. at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM, UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing, 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warrantir s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material. or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liabie to, Purchaser for any consequential damages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein. title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death, and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers. and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled, remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact. so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. In case of eye contact, flush with plenty of water for at least 15 minutes. Consult a physician immediately, KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. `rt -�Ccf I'Y OF May17.2O11 Richard L. /Hia Rl./4iaCompany 1O7Williams Avenue Suutl DELIVERY TICKET STONEWAY0 1 U&lwianT-xi iTeoua t. marg nai vvy a., aeame ACCOUNTING (206) 762-2566 CONCRETE uKWILA (Plant #12) 17024 W. Valley Hwy., Tukwila FAX (206) 762-2358 RENTON (Plant #14) 915 Houser Way N., Renton ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & ORDER DESK (425) 226-1000 SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) []CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER • DESCRIPTION • 7•�• WSDOT COMMERCIAL �f WV EI RONMENTAI_ SURCHARGE JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER • SALES TAX WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: BALANCE • El YES TOTAL AMOUNT gals. to full load El YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB El YES ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1 /3 load El WAITING FOR TRUCK TO UNLOAD El PUMP BLOW -BACK ❑NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK, SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE DISCOLORATION PRINT NAME DATE BATCH DATA: i TICKET TOTAL REV 06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS 1. CREDIT Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C,O,D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2, TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice. the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller, This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not limited to, drivers, Quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight Of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses. and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from, resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete. a Division of Gary Merlino Construction Company. Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it tinder the Washington State Industrial Insurance Act. Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include, as to all claims, demands, losses. and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees. court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Seller's tender of defense Linder this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such Counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6, WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site, An additional charge will be made Per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when PUMP Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback, will be borne by the Purchaser. An additional charge. at Seller's discretion, will be added for returned concrete due to clean up process. 8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM, UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchase,,, its employees, agents, contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready rnixed concrete test specimens tested for acceptance in accordance with ASTM will rneatthe design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranties of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 11 LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to. Purchaser for any consequential damages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14, CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved, the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold Linder this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss, Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death, and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers, and tight fitting eye protection when working with these materials. If you have to stand in wet concrete. use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled, remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing, Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. In case of eye contact, flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. cie, r> 4 ve tests performed by manufacturer of membrane roofing system. roofing system, from the ICC-ES. nance manuals. "h DELIVERY TICKET 19) STONEWAYAl ILe!riane s i it cow a. niargmai vvy a., aeawe ACCOUNTING (206) 762-2566 CONCRETE _.<WILA (Plant #12) 17024 W. Valley Hwy., Tukwila FAX (206) 762-2358 ACCOUNTING: 9125 TENTH AVENUE SOUTH RENTON (Plant #14) 915 Houser Way N., Renton CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & ORDER DESK (425) 226-1000 SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # 1 Y CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS I i`.rcily ElVISA ElMASTERCARD ElDISCOVER • �•�• DESCRIPTION • I:h1�l7r� F__NY T RoraMFA'JTNL. 11RcNc)R1137E. JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER • WATER ADDED ON -SITE CYLINDERS 1 AUTHORIZED BY: BALANCE FORWARD ❑ YES r: gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ YES ❑JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1 /3 load ❑ WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE PRINT NAME DATE DISCOLORATION BATCH DATA: Material Description beSI. Required Rat si 1 far 001Lure Actual Wat STSND 8335 STATE SA i= 1484 lb 1W 1b 2.43% 4.10% A 7 gl GP34 B335 3/4° AGG 1 ;~ 1935 lb 1%0 lb 1.30% 0.3h M I al `. CE119 1-11 CERT1 2N9-11 je lb ' 450 lb 460. lb 2.22% SLAG SLAGEER908-0 80 lb 80 lb 80 lb 0. RP.i)A64 GRWA WATER R 21.20 ez 21.20 oz 21.00 o; -0.34% WATER WATER 1 236 lb 's 66 lb 58 lb-12.07% 7 91 f 1,120 WATER 50 % # 66 lb 66 lb 0.06% 8 gl Actual Nus Batches: 1 Load Total: 4145 lb Design W/C: 0.434 Water/Cement., 0.4c'6-t ;; 8esign Water: ; 7.6.81 Actual: Water: 10.0 ql To f1d4: 4.5 gl brio Water:-30.0 141. CY TICKET TOTAL REV06/08 NBF CUSTOMER COPY 44, TERMS, CONDITIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at tiro sole option of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Sutler's dispatch office and no other Seller's agent (including. but not limited to, drivers, quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries wilt be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company. Inc. (Seller) to make use pf a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from. resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Martino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees, For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include. as to all claims, demands, losses, and liability to which it applies, Seller's personnel related costs, reasonable attorneys fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Sellers tender of defense under this Agreement. the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site, An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or biowback, will be borne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned concrete due to clean up process. 8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Pu€chaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM. UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10. NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11, ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranti s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material. or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 13, LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to. Purchaser for any consequential darnages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seiler for any reason, including breach of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warrar4y, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) arid.Qrounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death, and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers, and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. if you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled, remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar. cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. In case of eye contact. flush with plenty of water for at least 15.minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. t r Decant Facility e for the above project. ma Eductor Decant rill cover, Division 44 • DELIVERY TICKET STONEWAY 19)CONCRETE TTLE (Plant #11) 3803 E. Marginal Wy S., Seattle ACCOUNTING 206 762-2566 ( ) i uriWILA (Plant #12) 17024 W. Valley Hwy., Tukwila RENTON #14) 915 Houser Way N., Renton FAx (206) 762-2358 (Plant SALES & ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E.. Maple Valley ORDER DESK (425) 226-1000 SEATTLE, WA 98108 • (200 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM .1 DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA []MASTERCARD ❑ DISCOVER QUANTITY O DESCRIPTION • CODE 140) i Hui W 1! .P41 I Il SUPI :11F11 '1_rF I'Ei11)Y jail. X F 11Et_-SIJKIIf) PGE y JOB TOTAL SLUMP SPACING ORDERED BY SUB -TOTAL TRUCK NO. DRIVER 7 REMIT PAYMENT SALES TAX • 9125 1 SEATTLE, WA BALANCE FORWARD WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: '�❑ YES 108 TERMS •� TOTALN REVERSE • gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ YES❑ JOB NOT READY - LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1/3 load ❑ WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK Ell NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). , 6 MINUTES PER CUBIC YARD NOTFOR CO NSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE PRINT NAME DATE DISCOLORATION BATCH DATA: l5eiCYlption De51 gn Qty RegUii*d A-atehe f' x Uri poi tuk'Y- Actrlal Wat 4458 I395 lb cB.35 11) 2"Q1 8.1E% 1.- >• M 5 gi @. E-.N A I 1 '@ A45B 1955 lb 399 lb 352@ lb A. Alit q -IT CERTLW9-11 45@ lb IN 1b 950 lb } 5.56%-. - 5li1Li�ERT B(}-@ 8@ lb lu 1b' ` lib lb 12.5th \ 6,WATER R 21 o2 ... 42 0.— of -0. 9�4� - - WR . 1 43@ lb ?'". �' 353 1b -a lb 2.@4% 4, 91 WATER 2 # lb 1t t.111 1a1 Nue Batches: I � -d TGtal: 8253 lb Design W/C: 0.434 Watery Ceoerrt: 0.407 T Design Water: 55.1 gl h: + „1 LI tf, :fit 5 ai T-i Pd-!: 5.6 g. ri-!% Water:-27.@ 1b/ CY a e TICKET TOTAL f REV 06/08 NBF CUSTOMER COPY • - .y TERMS, CONDITIONS AND WARNINGS 1, CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment iinust be set for -tin :n this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C.O.D4. Purchaser agrees upon request io furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credif department may review a"d approve or disapprove any credit terms of payment specified in this Contract, 2, TERMS OF PAYMENT. All invoices are due for payment by the; t3fh day after the date of invoice. Service charge:; of one and one-q.:artcr percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed. it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties, Should legal action be Initiated to collect this invoice, ther prevailing party shall be entitled to recover reasonable attorney fees and costs, inctuding appeals. bankruptcies, and post judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance %0th the laws of the State of Washington. STONEWAy CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. - 3. TAKES. All federal. state and local taxes, assessments: fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or, variations from original delivery request shall be conveyed through 5 ler's dispatch office and no other Seller's agent (Including, but not limited to, drivers, duality assurance personnel, or sales representatives). 5, DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unss otherwise noted. Signed Purchaser Has requested Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the deliver] of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and w#qht of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of thi path requested. Seller has Curtner advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at thA risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks berorpe damaged, disabled or stuel: as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to,,indemnify, hoIF bormfess, and defend Seller from any claims, demands, fosses, arfd liabilities to or by third parties arising from. resulting from, or connected with the use of the requested path for -the deliveryof materials whether such claims may prove to be true or false. groundless of fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by Or resulting from the concurrent negligence of (a) Stoa eway Concrete. a Division of Gary Morino Construction Company, Inc, or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of thg Purchaser, or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunih' that may be granted It under thr Washington State Industrial Insurance Act, Titfe 51 li This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the incernnification obligation wider this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compel sation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of Indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include, as to all claims, demands, losses, and liability to v:21-ch it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurea by Seller to enforce and establish its right under this Agreement. Upon Seller's tender at defense under this Aglement, the Purchaser agrees to appoint counsel of Sellers choice to defend against third party claim(s). Such counsel twill be at the sole expense of the Purchaser. Seller iE�mot responsible for means and methods of placement of ready rnixed concrete or aggregate products on a project. 6. WASH OUT AREA. It will be the Purchaser's responsibility to provide al;uitable area for trucks fo rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller hoods no responsibility or oblig,ation of communicatiA to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate pour requested. It is the respoi s bility of Pump Company to notify Purchaser of all holds and releases in servire. Standby charges incurred during Puryp mpar�y clean up blowback, will be borne by ±he Purchaser. An additional charge. at Sellers discretion, will be added for returned concrete due to cler ip proress_ M _ 8. '''-POSNT L rACCEPTAMCE. the: Buyer's point of ta{ioQ ]sill the tuck Chute. Seller wii_ of accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circotn 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete esting, iriclu ing concrete s11fVlz-testu;lQ;) ! acceptance, shall be if) accordance with ASTM. UBC and ACI and that Selier will be provided with a copy of all test results within three (3) working days of the performance bf said tes(s. 's 10. NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify SPIIer in writing wiihin twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, arid to make them available to Seller for further inspection and testing. 1 1. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors.. Purchaser accepts the concrete as delivered and .valve- al: ri_iht to reject, revoke acceptance or ;assert any claim tar breach of any warranty and Seller is not responsible for strength or properties o4 the concrete. 12, WARRANTY. Seiler warrants that the compressive strength of ready rnixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Cortr!ct .Seller warrants the aggregate material Sold under this Contract meets the description, and specifications for the same set forth in this Contract. No other warranties, express or implied are made smith respect to suc-h construction rrateriais, whether they re warranties of fitness or warrantie s of merchantability. Purchaser's exclusive remedy for breach of this warranty shalt he to requv- S:ylfec at 'Seller s elution, to refund the purchase price, to repair said material. or to provide Purchaser with a conforming replacement for any non -conforming materials. No coosequen(ial. damages inay be claimed by Purchrasei against Seller in connection ;with any breach of this Agreement or breach of warranty herein. THE. PRECEEDING WARRAfvrY IS IN LIEU OF ANr) SELLER HEREB`r EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PAR] ICI_ILAR PURPOSE 13. LIMITATION ON DAMAGES. Selle, :.assumes no responsibility for, and sl-ia l not be liable to, Purchaser for any consaquen-ial darnages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's Lost profits, Purcl ase/s good will, and ;any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14 CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under- this Contract. against Seiler for any reason, including breach of contract or breach of warranty. shall be as follouws% Notice of claims against Seller for any reason, including but not limited to, breach of contract or v;an anty, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been inade. The written claim shall rnciude the renson(s) and grounds for the claim and the doflar amount or relief sought. FAILURE OF PURCHASER, TO GIVE SUCH NOTICE WITHIN THREE (3,: WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM_ It a dispute arises and cannot be resolved. the parties Involved agree to binding arbaration through non -legal personnel. 15, TITLE AND RISK OF LOSS, Unless otherwise expressly stated herein. title to the materials sold hereunder shall remain with Seller until Seller, has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Pi.nchaser union delivery of the same. at tht place of delivery designated herein. Thereafter, in addition to assOrrnng all risk of loss. Purchaser shall be responsible for (:on'ipliance witri all gm emmental reg, rations and ordinances wrtn regard to storage or placement of the same acid shall indemnify and hold Seiler harmless against air r,Iaims for personal m1m ies, including death, rind property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact wilt) eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers. and tight fitting eye protection when working with these materials. If you have to stand in wet concrete use .waterproof boots that are tight at tops and high enough to keep concrete from flowing into then). If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled. remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement. or cement admixtures from your skin with fresh. clean ,eater immediately after contact. Indirevt contact through clothing' can be as serious as direct contact, so promptly rinse wet concrete, mortar. cement or cement mixtures from clothing, Seek in)rnediaie medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. ).^✓hen exposed to concrete, dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. In case of eye contact, flush with plenty, of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY I.JSE OR COME INTO CONTACT WITH WET (t.1NHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. ,4. I DELIVERY TICKET IUNLWAT LC lnaIu N 11) JOVJ C. IVIGry1r1A1 VVy 0., OUdiLW ACCOUNTING (206) 762-2566 CONCRETE i uKWILA (Plant #12) 17024 W. Valley Hwy., Tukwila RENTON FAX (206) 762-2358 ACCOUNTING: 9125 TENTH AVENUE SOUTH (Plant #14) 915 Houser Way I Renton CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & ORDER DESK (425) 226-1000 SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER • PRODUCT D DESCRIPTION I ZINEU.110"] TAX AMOUNT WSDOT COVIr�'IF_'RC I AZ. CLASS EtJV I N! 1I Ii IF'F! i'i tl ;I Ii(,HfaRr; JOB TOTAL SLUMP SPACING ORDERED BY f TRUCK NO. DRIVER • WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: • • ❑ YES 1: • gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ YES ❑JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1/3 load El WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK El NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, STRENGTH. WATER ADDED AT IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE PRINT NAME DATE DISCOLORATION BATCH DATA: Material Description Design Oty Required hatched % Var Moisture Actual W'1% ST£1dL= 8335 STATE SA 1'42.'f 1 b 2975 1 b I b 4. 49% 4. 32% A 15 g 1 DR34 B335 314" AG6 1924 lb 3870 lb 38N lb 0.27% 0.3€% M I a' CEM I- I I tERT# 20A9-11 450 lb 900 lb 9@0 lb 8. 60% SLAG SLAIDIR308-0 80 lb 160 lb 1 Q lb 0. 010% .WRDA64 GRACE WATER P. 21.20 oz 42.40 oz 42.00 oz -0.94£ WATER WATER 1 230 lb 159 lb 156 lb-1.611' R21111 ATER 3 50 % 1 159 lb 150 lb -5.36% lg gl ktual Flux Batches: 1 Land Total: 8c"09 lb Design W/C: 0.434 Water/Cecil 0.4-54 T Design Water: 5S5.1 gi Actual Water: 53.4 g1 To 1. 7 Tria Water: 0.0 ib,` Ct TICKET TOTAL REV 06/08 NBF _ CUSMMER COPY TERMS, CONDITIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract, 2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed. it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller, This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. SCHEDULING, Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not limited to, drivers, quality assurance personnel or sales representatives). DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result, Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses, and/or damage to -Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from, resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundiessor fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injuryto persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include. as to all claims, demands, losses, and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company cleanup, or blowback, will be borne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned cdflerete due to clean up process. 8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM, UBC and ACl and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors, Purchaser accepts the concrete as delivered and waives ail right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12, WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranti s of merchantability. Purchasers exclusive remedy for breach of this warranty shall be to require Seiler. at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection Evith any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL. IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchaser for any consequential damages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seiler, 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contractor warranty, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of toss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death. and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length^ trousers, and tight fitting eye protection when working with these materials. if you have to stand in wet concrete. use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: if dust is inhaled, remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact th}iough clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. in case of eye contact, flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. 10 o7�e— A S oci.- Lo A S ",, e¢-vO s s As ` `1 o L4 Lu c channel and vegetation maintenance around each basin and cleanup. Construction will occur in 2011, if pc work within the permit time limitat allowable permit time limitations. The Contractor will need to comply N Approval, and Army Corps of Engine The estimated project cost is $75,00( The City reserves the right to reject Bid documents will be available Jul; for this project are available on-line bq://www.bxwa.com. Click on" "Projects Bidding". (Note: Bidders automatic email notification of futui Questions about the project shall be 1055 Grady Way, Fifth Floor, Rent A certified check or bid bond in accompany each bid. The City's Fair Practices, Non-Dis Published: Daily Journal of Daily Journal of DELIVERY TICKET L�97'CONCRETE "" ""aig .. ""Y - — . ACCOUNTING 206 7 ( ) 62-2566 'uKWILA (Plant #12) 17024 W. Valley Hwy., Tukwila RENTON (Plant #14) 915 Houser Way N., Renton FAX (206) 762-2358 ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000 TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER DESCRIPTION UNIT PRICE• •� JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER • WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: •• -• ❑ YES •• - gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load El YES ❑JOB NOT READY El LACK OF HELP El ADDING WATER El WHEEL BARROW JOB ❑ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. t0 1/3 load WAITING FOR TRUCK TO UNLOAD --'PUMP BLOW -BACK El NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE -WARNING- RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, STRENGTH. WATER ADDED AT IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE PRINT NAME DATE DISCOLORATION ----- ---------- BATCH DATA: CKET TOTAL r REV06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms. all deliveries cinder this Contract are "Collect On Delivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Setter to determine Purchaser's financial condition. Sellers obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.250/5) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed. it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof. without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals. bankruptcies. and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle. King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal. state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not limited to, drivers, quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company. Inc (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and vveight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seiler assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage. personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnity. hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from, resulting from. or connected with the use of the requested path for the delivery of materials whether such claims ma,. prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete. a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include, as to all claims. demands, losses. and liability to which it applies, Seller's personnel related costs, reasonable• attorney's fees, court costs, and all other claim -related expenses, including attorney's fees arid other costs incurred by Seiler to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party ciaim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site An additional charge will be made per load if a wash out area is not provided. 7 PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the, responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback. will be borne by the Purchaser. An additional charge. at Seller's discretion, will be added for returned concrete due to clean up process. 8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be. in accordance with ASTM. UBC and AC and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11 ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and(orforeign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors. Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the corpressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials. whether they be warranties of fitness or warranties of merchantability. Purchasers exclusive remedy for breach of this warranty shall be to require Seller. at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential darnages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE, 13, LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchaser for any consequential damages incurred by Purchaser in connection with this Contract, including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved, the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible, for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death. and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes ano skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers, and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at tops arid high enough to keep concrete from flowing into there. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled. remove to fresh air. Get medical attention if irritation persists. Wash wet concrete. mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar. cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete, When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSHlMSHA-approved respirator. in case of eye contact, flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. 4P9WH.D. FOWJUN::::::VCOPO Box 160, Bellevue, WA 980 Invoice Number 12922118 BEWH # 012830 Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009-0160 Phone 425-746-8400 • Fax 425-641-8885 Bellevue Branch 13440 SE 30th St Bellevue, WA 98005 (425) 746-8400 Fax (425) 641-8885 To: Ship to: TALBOT RD S & GRADY WAY 1/4 1 R L ALIA CONSTRUCTION RENTON WA 98057 107 Williams Ave S Order# Inv Date: Order Writer: Renton WA 98057-2149 03605288 06/01/11 PATRICK BEAGLE Terms: Due: 7 PO/JOB: FOB: H. D. FOWLER COMPANY Ship Via: PACIFIC LOGISTICS BENSON ROAD WATERMAIN Qty Qty Part# Unit Extended T Line Ship'd BO'd UoM Description Price Price X INSTALL 16" CL.52 DI WATER PIPE AND FITTINGS WITH POLY Q WRAP 0L J 119 I 20 0 EA 16" MEGA LUG RET GLAND #1116 122.740/1 2, Is Is BID ITEM #17 CUT, CAP AND BLOCK LBS) SADDLE r SOCKET, PAINTED SOCKET, PAINTED I JASON I Serving the Pacific Northwest since 1911 www.hdfowler.com AABCO BARRICADE COMPANY INC. 4025 80th St. S.W. • Mukilteo, WA 98275 Seattle (206) 363-6212 • Everett (425) 353-5619 Toll -Free (800) 559-6212 E-mail: info(a-)aabcosign com Web: www.aabcosion.com Customer Name & Address: ALIA CONSTRUCTION CO. 107 WILLIAMS AVENUE SOUTH RENTON, WA 98055 Invoice Date: 07/15/11 Customer ID: 1001 INVOICE 89222 SIGN SHOP • ROAD SAFETY PRODUCTS - RENTAL & SALES SINCE 1978 J U L 2 0 2 01 1 Job Infomation: S 4TH ST & MAIN ST RENTON P.O. Number: Job ID: Ordered By: KI M Contract ID: 26710 For Period: From: 06/20/11 To: 07/15/11 Slip #115009 Charge Dates Sign Stand For 36" & 48" Signs PD D Rate From Thru 0.75 06/20/11 06/24/11 Slip #115009 Charge Dates 48" Be Prepared To Stop WOOD 5/8 PD D Rate From Thru 1.75 06/20/11 06/22/11 Slip #115015 Charge Dates PD Rate From Thru 30x24 Detour W/Arrow Up 5/8 WOOD D 0.60 06/22/11 07/15/11 Slip #115015 Sign Stand For 30" & Under Sign Slip #115015 48x30 Road Closed WOOD 5/8 Charge Dates PD Rate From Thru D 0.40 06/22/11 07/15/11 Charge Dates PD Rate From Thru D 1.75 06/22/11 06/24/11 CHG Days QTY Used 10 5 CHG Days QTY Used 1 3 CHG Days QTY Used 4 24 CHG Days QTY Used 4 24 CHG Days QTY Used 1 3 Slip #115015 Charge Dates CHG Days 48" Road Closed Ahead WOOD 5/8 PD p Rate From Thru QTY Used 1.75 06/22/11 06/24/11 1 3 Slip #115096 Charge Dates 3-WAY Led Lite/w (D)Batteries PD D Rate From Thru CHG QTY Days Used 0.35 06/28/11 06/29/11 20 2 Slip #1150960 Charge Dates TRAFFIC BARREL W/TIRE RING PD p Rate From Thru CHG QTY Days Used 0.45 .45 06/29/11 06/29/11 40 1 ....Continued on Next Page.... Use Qty 10 Total Use Qty 1 Total Use Qty 4 Total Use Qty 4 Total Use Qty 1 Total Use Qty 1 Total Use Qty 20 Total Use Qty 40 Total We Invoice on the 15th and at End of Job (E.O.J.) - Terms Net 30 INTEREST AT THE RATE OF 1.5 PERCENT PER MONTH APPLIES TO ALL PAST DUE ACCOUNTS ALL ACCOUNTS SUBJECT TO MASTER CREDIT TERMS AND CONDITIONS Not responsible for placement of rental equipment 37.50 5.25 57.60 38.40 5.25 5.25 14.00 18.00 +a' S dic ?n Iop Tod ST..-A r7-r `f�a $/0-) 1 wind, heat, freezing, and similar detrimi 2 related handling. Where necessary, pla 3 transported in closed vehicles, plants sl 4 sweating. When transported in open ve 5 other suitable cover material. 6 7 9-14.6(4) Tagging 8 nts delivered as a single unit �e clearly marked an �Poregated .a DELIVERY TICKET 197 ury WAY I" `1l.— r I '' �o,,.� `. n y a ly ." Jca — <WILA (Plant 17024 W. Valley Hwy., Tukwila ACCOUNTING (206) 762 2566 CONCRETE RE" NTON (Plant #14) 14) 915 Houser Way N., Renton FAX (206) 762-2358 ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000 TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS ❑ VISA ❑ MASTERCARD ❑ DISCOVER • PRODUCT • • • JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER • WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: _ • • ❑ YES gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ YES ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN n DRAW BRIDGE gals. to 1 /3 load ❑ WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP Ci WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING- RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, STRENGTH. WATER ADDED AT IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. --------------------------------------------- SURFACE PRINT NAME DATE DISCOLORATION BATCH DATA: TICKET TOTAL REV 06/08 NBF CUSTOMER COPY TERMS, eOND)TIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must beset forth in this Contract. In the absence of any such credit termsi,all deliveries under this Contract are "Collect On belive." (C.O.D.). Purchaser agree:;. upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seittr°s obligation to perform under this Contract is, subject to the condition precedent that Seiler shall have thirty (30) :days from receipt of the executed Contract from Purchaser so that Seller's credit de6artmettt may review and approve or disapprove any credit terms of payment specified in this Contract. 2. TERMS OF PAYMENT. Ail invoices are due for payment by the 3Gth day after the date of invoice. Service ciliarges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days of older. If a service charge is assessed. it must be pEA in order to maintain an open, account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice. the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcles, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle. King County. Washington at the sole option of Seller. This agreement shall be construed and enforced in .accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS, 3. TAXES. All federal, state and local taxes, assessments, fees, dyties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery regwest shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not,h0iitedto, drivers, quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway, Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of Mucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised .that It is their policy that deliveries requiring Sellers trucks travel beyond the nearest highway to obtain access to the job site are at the riWof the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and thireparties for property damage. personal injuries, truck towing and winching expenses, andJor.d mage to Sellers irAcks should the trucks become damaged, disabled or stuck as a result of Seller risking use of 1ha path requested+or-1pr thet4 livery of materials and t t'ess to the project F'rit tras also a0te" to.indemnify, trold harmless, and defrfrtd Seller from �rry claims, derrrands, Ipsses, and' R9bf7itfes 3cr�Qrbythird party' s aflsfng from. resulting from, or Annecfed talth�the use of We reque9[e©fieth for the delivery of materials whether such Claims may pfrr4fa be tote or isi3, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injuryto persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Mertino Construction Company, Inc, or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives &fit hnmunity that may be. granted it under tine Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser s,employeee against Purchaser. Further, the inderm. iff�ation obligation under this Agreement shall not be limited in any way by any limitation on the amourtt,or type of dayaa�es l- mpensWimi +at''Oienefits payable to or for anyhBtlyd party under Workers compensation acts, disabilitybenefit acts, or their employee benefit acts. This promise of indernftity. speoiflcalljy,appflbs In the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include, as to all claims dgip�s, losses, and liability to which it applies. Seller's personnel related costs, reasonable attorney's fees. court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Seller's tender of defense'utiter Pin counsel of Seller's choice to defend against third party claim(s). Such counsel will be at the sole expense of the Purchaser. Seller ls•not responsible for means and methods of p 6c dtn+riw concrete or aggregate products on a projr�t. 6. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and el an before leaving the job site. An additional charge will be made per load if a wash out area is not provided. ' 7. PUMP HOLDS AND BLOWBACK. Baiter holds no responsibility qr obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done'tre rile best of Seller s abj)}ty, noting Purchaser may not receive original rate of pour requested, It is the responsibility of Pump Company to notify Purchaser of all holds and release`s in service. Standby charges incurred during Pump CorKip i! clean up, or blowback, will be borne jay the Purchaser. An additional charge, at Seller's discretion, will be added for reton urned ocrtlte due to q w process. 8. POINT OF ACCEPUNCE The BUyer's point of fs ;at the truck ftlte.- Seiler will not accept responsibility fair physical changes of the concrete caused by job delays, delivery systems, placing equipment, or„cfeum WO beysCtlxt r tjr oor;t 61.1 9, READY MIX CONCRETE TESTIN& Purchaser agreas thatall crate a tes q including concrete strength testing for acceptance, shall be in accordance with ASTM, dx . UBC and ACI and that Seller will 48 provide(! with copy of alFeeCt vrtittt$t three i;24}'wotkinikdays of the performance of said tests. 10. NOTIFICATION OF DEFICIENT CONCRETE COMPRESu1VE S . TESZREJ�ULTS. purchageragrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test spe�eirTib them avallgble to Seller for further inspection and testing. 11, ADDITION OF WATER AND/OR FOREIGN MATtAIAt. if w;tltef'W1dW_orejgn materie'isadd#; to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors. Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test Specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seiler warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whetner they be warranties of fitness or warranty s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PREC:EED(NG WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTAB.IL!" AND OF FITNESS FOR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchgser foreny consequential damages incurred by Purchaser in connection with this Contract. including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach, by Seller or breach of warranty by Seller. 14, CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty. shall be as follows: Notice of claims against Seller for any reason, incttiding but not limited to, breach of contract or warranty, roust be given to Seiler in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. if a dispute arises and cannot be resolved, the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall renain with S-Mier until Seller' has rer_e ved full payment for the sarne. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same. at the pi;c e crf delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the sameand shall indemnify and hold Seller harmless against all claims for personal injuries, including death. and property damage arising front the storage, use or handiing of said materials. 16. CONCRETE WARNINGS. Injurious to eyes_ Causes skin irritation. Avoid contact with eves and skin. Wear waterprtmi gloves, a fully buttoned long-sleeved shirt, full-length trousers. and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use orate: proof boots that are tight at tops and high enough to keep concrete from flowing Into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled. remove to fresh air. Get medical attention If irritation persists. Wash wet concrete, mortar, cement. or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfit. Avoid breathing dust from cutting or grinning hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSHiMSHA-approved respirator. In case of eye contact. flush with pienty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT Oy- REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COMF INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR; CEMENT OR CEMENT MIXTURES. 13 I C� -,� cV LvAsiellO GUIDELINES FOR U 1. Use SURE STOP 3S trademmrkTytono, materials voids the -' Utilize only ~pr`",lubricants (such as -' —~ NOT ever p'a or on the gasket p 4' Bell cleanliness ioNN - - .-I- -- ' - DELIVERY TICKET 5T01VEWAYu It I LC iriam si it oauo r. marginai vvy a., aeanie ACCOUNTING (206) 762-2566 CONCRETE TUKWILA (Plant #12) 17024 W. Valley Hwy., Tukwila FAX (206) 762-2358 RENTON (Plant #14) 915 Houser Way N., Renton ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000 TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXP. SPECIAL INSTRUCTIONS El VISA ❑ MASTERCARD ❑ DISCOVER • PRODUCT DESCRIPTION • JOB TOTAL SLUMP SPACING RDERED BY OSALES TRUCK NO. DRIVER • TAX WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: BALANCE FORWARD LI YES TOTAL AMOUNT gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑JOB NOT READY ❑ LACK OF HELP ADDING WATER El WHEEL BARROW JOB ❑ YES ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1/3 load El WAITING FOR TRUCK TO UNLOAD El PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, STRENGTH. WATER ADDED AT IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck rate. SURFACE PRINT NAME DATE DISCOLORATION BATCH DATA: TICKET TOTAL REV 06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS 1. CREDIT. Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On gelivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals, bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. . 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including. but not limited to, drivers, quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property. or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seller has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal 'injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify, hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third parties arising from, resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence -of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligehee of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act. Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser. Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's comperfsation alcts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include. as to all claims, demands, losses. and liability to which it applies, Seller's personnel related costs, reasonable attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party ciaim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for mend methods of placement of ready mixed concrete or aggregate products on a project. 6. WASH OUT AREA. It will be the Purchaser's responsibility to provide a suitable area ftSr trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the beat of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback, will be botne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned concrete due to clean up process. & POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstanccs:beyond our control. 9. READY MIX CONCRETE TESTING, Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM. UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10. NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not, responsible for strength or properties of the concrete. 12, WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract mbets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranti s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price, to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seiler in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOIR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchaser for any consequential damages incurred by Purchaser in connection with this Contract. including without limitation, Purchaser's lost profits; Purchaser's good will.. and any injury to person or property proximately resulting from any breach by Seller or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, including breach of contract or breach of warranty, shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death, and property damage arising from the storage, use or handling of said materials. 16. CONCRETE WARNINGS. injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers, and tight fitting eye protection when working with these materials. if you have to stand in wet concrete, use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. if you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled. remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar. cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator. in case of eye contact, flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. qj DELIVERY TICKET STONEWAY- {i 1 Lt Irian[ s i i) aouo L. iwargmai vvy o., oeawe ACCOUNTING (206) 762-2566 _.<WILA (Plant #12) 17024 W. Valley Hwy., Tukwila CONCRETE RENTON (Plant #14) 915 Houser Way N., Renton FAX (206) 762-2358 ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES & ORDER DESK (425) 226-1000 SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. TICKET TIME AM LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT PM DATE CUSTOMER NO. ORDER NO. PROJECT PLANT # CUSTOMER NAME CUSTOMER P.O. JOB NO. DELIVERY TICKET NO. JOB ADDRESS COLLECT ON DELIVERY (C.O.D.) ❑ CASH ❑ CHECK # ❑ CHARGE MAP ZONE CARD # EXR SPECIAL INSTRUCTIONS I ;;-r I 't F! "IF` i J- ir.ic, -1F! r?; I ,T',I IC" rl- ; ' I4, `q I I l ❑ VISA ❑ MASTERCARD ❑ DISCOVER QUANTITY U.M. PRODUCT ••• • Wipol, COMMERCIAL. CA -arc: F_-N , I RONMFrlTI1 L.. SURCHAR 3E JOB TOTAL SLUMP SPACING ORDERED BY TRUCK NO. DRIVER 7 WATER ADDED ON -SITE CYLINDERS AUTHORIZED BY: _ • • ❑ YES gals. to full load ❑ YES REASON FOR DELAY TIME: gals. to 2/3 load ❑ JOB NOT READY ❑ LACK OF HELP ❑ ADDING WATER ❑ WHEEL BARROW JOB ❑ YES ❑ ARRIVED JOB EARLY ❑ TRAFFIC ❑ TRAIN ❑ DRAW BRIDGE gals. to 1/3 load ❑ WAITING FOR TRUCK TO UNLOAD ❑ PUMP BLOW -BACK ❑ NONE ❑ WAITING ON PUMP ❑ WASH PUMP ❑ OTHER ADDITION OF WATER WILL REDUCE - WARNING - RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE, IRRITATION TO A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL STRENGTH. WATER ADDED AT SKIN AND EYES OR PERSONAL PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE CUSTOMER'S OWN RISK. SEE REVERSE (16) AGREEMENT ACCESS ON BACK (5). 6 MINUTES PER CUBIC YARD NOT RESPONSIBLE FOR COLOR CUSTOMER SIGNATURE UNLOADING TIME INCLUDED. VARIATION OR Additional unloading time charged at current hourly truck --------------------------------------------- SURFACE rate. DISCOLORATION PRINT NAME DATE BATCH DATA: TICKET TOTAL REV 06/08 NBF CUSTOMER COPY TERMS, CONDITIONS AND WARNINGS ' i. CREDIT Condition precedent to Seller's obligation to perform any and all credit terms of payment must be set forth in this Contract. In the absence of any such credit terms, all deliveries under this Contract are "Collect On Delivery" (C.O.D.). Purchaser agrees upon request to furnish Seller such information as is reasonably necessary for Seller to determine Purchaser's financial condition. Seller's obligation to perform under this Contract is subject to the condition precedent that Seller shall have thirty (30) days from receipt of the executed Contract from Purchaser so that Seller's credit department may review and approve or disapprove any credit terms of payment specified in this Contract. 2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day after the date of invoice. Service charges of one and one -quarter percent (1.25%) per month will be payable on all past due invoices of thirty (30) days or older. If a service charge is assessed, it must be paid in order to maintain an open account. Purchaser shall make all payments due hereunder in lawful money of the United States and in accordance with the terms hereof, without any retention and without regard to any agreement Purchaser may have with other parties. Should legal action be initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including appeals. bankruptcies, and post -judgement collection efforts. Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS. 3. TAXES. All federal, state and local taxes, assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by Purchaser. 4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispatch office and no other Seller's agent (including, but not limited to, drivers, quality assurance personnel or sales representatives). 5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a Division of Gary Merino Construction Company, Inc. (Setter) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the boundaries of the nearest traveled public highway. Seller has advised that due to the size and weight of trucks, damage to the premises and/or adjacent property, or personal injury may occur and that trucks may become damaged, disabled or stuck if Seller makes use of the path requested. Seiler has further advised that it is their policy that deliveries requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site are at the risk of the Purchaser and that Seller assumes no liability for property damage or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage, personal injuries, truck towing and winching expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stuck as a result of Seller making use of the path requested or for the delivery of materials and access to the project site. Purchaser also agrees to indemnify. hold harmless. and defend Seiler from any claims, demands, losses, and liabilities to or by third parties arising from, resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false, groundless or fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete.. a Division of Gary Merlino Construction Company, Inc. or its agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. This waiver does not permit a direct action by the Purchaser's employees against the Purchaser, Further, the indemnification obligation under this Agreement shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty to defend, indemnify and hold Seller harmless shall include, as to all claims, demands, losses, and liability to which it applies, Seiler's personnel related costs, reasonable attorneys fees. court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this Agreement, Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party ciaim(s). Such counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project. 6, WASH OUT AREA. it will be the Purchaser's responsibility to provide a suitable area for trucks to rinse and clean before leaving the job site. An additional charge will be made per load if a wash out area is not provided. — - 7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of communication to Purchaser when Pump Company holds or releases orders. Service to Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser of all holds and releases in service. Standby charges incurred during Pump Company cleanup, or blowback, will be borne by the Purchaser. An additional charge, at Seller's discretion, will be added for returned concrete due to clean up process. 8. POINT CIF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job delays, delivery systems, placing equipment, or circumstances beyond our control. 9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM, UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests. 10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient concrete corpressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing. 11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. If water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees, agents, contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and Seller is not responsible for strength or properties of the concrete. 12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design strength for the mix design sold under this Contract. Seller warrants the aggregate material sold under this Contract meets the description and specifications for the same set forth in this Contract. No other warranties, express or implied, are made with respect to such construction materials, whether they be warranties of fitness or warranter s of merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller, at Seller's option, to refund the purchase price; to repair said material, or to provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY iS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OF MERCHANTABILITY AMD'MFiTNESS FOR ANY PARTICULAR PURPOSE. 13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchaser for any consequential damages incurred by Purchaser in connection with this Contract. including without limitation, Purchaser's lost profits, Purchaser's good will, and any injury to person or property proximately resulting from any breach by Seiler or breach of warranty by Seller. 14. CLAIMS AND BACK CHARGES. Purchaser's exclusive procedure for commencing claims under this Contract against Seller for any reason, Including breach of contract or breach of warranty. shall be as follows: Notice of claims against Seller for any reason, including but not limited to, breach of contract or warranty, must be given to Seller in writing withi e (3) working days after discovery or when discovery should have been made. The written claim shall include the reasons) and grounds for the claim and the dollar aMOLirqp relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS RIGHT TO LATER MAKE ANY SUCH CLAiM. if a dispute arises and cannot be resolved. the parties involved agree to binding arbitration through non -legal personnel. 15. TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein, title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death. and property damage arising from the storage, use or handling of said materials. 16, CONCRETE WARNINGS. Injurious to eyes. Causes skin irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length trousers, and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at tops and high enough to keep concrete from flowing into them. If you arefinishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled, remove to fresh air. Get medical attention if irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing can be as serious as direct contact, so promptly rinse wet concrete, mortar. cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS), wear suitable NIOSH/MSHA-approved respirator, In case of eye contact.. flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR, CEMENT OR CEMENT MIXTURES. Truck Driver User Disp Ticket Num Ticket ID Time Date 999 user 284044 101969 12:36 8/17/11 Load Size Mix Code Returned Qty Mix Age Seq Load ID 6.00 CY CL3K W 103593 Material Description Design Qty Required Batched % Var % Moisture Actual Wat Spec.Grav STSND B335 STATE SAN 1423 Ib 8933 Ib 8960 Ib 0.30% 4.43% A 48 gl 1.06 GR34 B335 3/4" AGG 1929 Ib 11609 Ib 11640 Ib 0.27% 0.30% M 4 gi 2.67 CEM 1-II CERT# 2009-11 450 Ib 2700 Ib 2690 Ib -0.37% 3.15 SLAG SLAGCERT#08-OF 80 Ib 480 Ib 490 Ib 2.08% 2.25 WRDA64 GRACE WATER F 21.20 oz 127.20 oz 126.00 oz -0.94% 1.10 WATER WATER 1 230 Ib 381 Ib 382 Ib 0.32% 46 gl 1.00 H2O WATER 3 50 % # 381 Ib 372 Ib -2.31% 45 gl 1.00 Actual Num Batches: 1 Load 24542 Ib Design W/C: 0.434 Water/Cement: 0.434 T Design 165.4 gl Actual 142.1 gl To Add: 23.3 gl Slump: 3.00 in # Water in Truck: 0.0 Ib Adjust Water: 0.0 Ib / Load Trim Water: -30.0 Ib / CY RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (BLACK RIVER QUARRY SITE) NO SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: QL— At4lr Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE IRIVEIIS TRUCK # I TIME I MATERIAL GROSS i TARE NET I NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 112% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 1 g 4 6 12 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE IRIVERIS TRUCK # I TIME I MATERIAL ( GROSS I TARE NET NET T/YDS I PRICE ( SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. I RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 18 4 6 6 6 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: IaAT.7Tai Scaleperson: F11 CASH ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS I TARE NET I NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N01 8 4 7 4 6 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: -_ _-_-_- Customer: Address: Delivery Address: Special Instructions: Hauler's Name: CASH Phone: Scaleperson: CHARGE TRUCK # I TIME I MATERIAL GROSS TARE NET NET T/YDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 84653 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: CHARGE TRUCK # I TIME I MATERIAL GROSS TARE NET NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 18 4 7 4 5 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: CASH Phone: Scaleperson: C CHARGE TRUCK # I TIME I MATERIAL I GROSS i TARE I NET NET TNDS 1 PRICE 1 S RIVERIGNATUE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 NO- 18 4 3 0 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: - — ---- — ---� Customer: _ _ CL Phone: Address:- 11 Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET T/YDS PRICE DRIVER'S SIGNATURE c, Subtotal DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. I RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 1$ 8 Q (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: Phone: Scaleperson: ❑ CASH ❑ CHARGE DRIVER'S TRUCK# I TIME I MATERIAL GROSS TARE NET NET TNDS PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1i2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 18 4 9 O 7 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: ` Delivery Address: Special Instructions: Hauler's Name: f l yY IO 1; ❑ CASH Phone: Scaleperson: CHARGE TRUCK# TIME MATERIAL GROSS TARE NET NETTNDS PRICE DRIVER'S SIGNATURE rA Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 NO-1 8 4 0 4 0 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS I PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No g 4 9 6 2 (BLACK RIVER QUARRY SITE) SITE PHONE: 1206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: 711 CASH Phone: Scaleperson: CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total I NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1i2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 NO- 18 4 912 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: _ ..- Customer: ; i- i -i 11 Ji Address: Delivery Address: r Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: �f1if ❑ CHARGE TRUCK # I TIME I MATERIAL GROSS I TARE I NET NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S Tax SIGNATURE: ___ Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N O " 84848 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _ Phone: Address: F Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE l Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. If e label of a nationally acturer's name, tification shall be Inal module and the )el with an indelible ink )ly of separate sections, together in a weathertight RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (BLACK RIVER QUARRY SITE) N-0184976 SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK# TIME MATERIAL GROSS TARE NET NETTYDS PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (BLACK RIVER QUARRY SITE) NO-184945 SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: __ Phone: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1i2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS - 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N� 18 4 9 9 3 (BLACK RIVER (QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date Customer: Address: Delivery Address: Special Instructions: Hauler's Name: Phone: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 njo 1.8 tJ 2 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Phone: Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH CHARGE TRUCK k l TIME I MATERIAL GROSS I TARE I NET I NET T/YDS I PRICE I SIGNATURE Subtotal I DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. - RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 85035 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _. Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET T/YDS PRICE DRIVER'S SIGNATURE I 2 L< C t Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N� 1 S 510 5 BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: CASH Phone: _ Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE NET NET T/YDS PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N� 18 5 0 3 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _ Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE I NET NET TNDS I PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. _ RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (BLACK RIVER QUARRY SITE) No SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _ __—_— _ Phone: Address: Delivery Address: If � �l�.l �/ '�c-f` � �l Special Instructions: //jj ,, Hauler's Name: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS I TARE I NET I NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. \ Q� � C ' 1 i I t CONTRACTORS LIC. NO. - NA-TI-01 '212KB RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° 18 5 6 5 8 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date Customer: Phone: Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: 14 l�l CASH ❑ CHARGE TRUCK # I TIME I MATERIAL GROSS TARE NET NET TNDS I PRICE I CDR'^ER'�sc Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 112% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N018 5 6 2 2 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: Phone: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # I TIME I MATERIAL GROSS I TARE I NET I NET TNDS I PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. Date Customer: RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (BLACK RIVER QUARRY SITE) N-0185759 SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Phone: Address: \ Delivery Address: Special Instructions: Hauler's Name: 7 " Scaleperson: ❑ CASH ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N018 5 9 2 5 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Customer. ____ _ ___ ___ ___ ► -__ Phone: Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE Y Subtotal DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 112% per month. Annual finance charge of 18%. ` RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° 18 6 0 0 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _— Phone: Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: 71 CASH CHARGE TRUCK # I TIME I MATERIAL GROSS I TARE NET NET T/YDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 112% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS ~ 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No ' 85098 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: 7 CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE NET ( NET TNDS I PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. , + ; ' RENTON CONCRETE RECYCLERS r 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 18 5 2 4 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: TRUCK # I TIME I MATERIAL DRIVER'S SIGNATURE ❑ CASH GROSS Phone: Scaleperson: ❑ CHARGE TARE I NET I NET TNDS I PRICE Subtotal Tax Total DRIVER'S NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N-0 185244 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL GROSS I TARE NET I NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N o' 8 5 3 3 5 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _ Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: CHARGE TRUCK # I TIME I MATERIAL GROSS TARE I NET NET TNDS I PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: it is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1i2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS r 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 1 S 5 2 9 9 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET T/YDS PRICE DRIVER'S SIGNATURE i �l Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (�� 18 5 3 6 9 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: CASH Phone: Scaleperson: CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE I NET NET T/YDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° 18 5 4 3 2 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date Customer: r Phone: Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH P CHARGE TRUCK # I TIME I MATERIAL GROSS TARE I NET NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. r Delivery Address:' Special Instructions Hauler's Name: r Scalf ❑ CASH CHARC TRUCK # TIME MATERIAL GROSS TARE NET 1 IN JL�J I Date RENTON CONCRETE RECYCLERS ' 3 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 'q8 3 8 9 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Customer: _ Phone: --- Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE I NET I NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1J2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE a tee'' TRUCK # I TIME I MATERIAL I GROSS I TARE I NET I NET T/YDS I PRICE I IRIIERS SIGNATURE Subtotal DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 1 S%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° 18 4 3 8 9 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS I PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N018 4 3 6 7 (BLACK RIVER QUARRY SITE) SLTE-PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _ Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL GROSS I TARE I NET ( NET T/YDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. A RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 1 8 4 5 1 7 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: _ - Phone: _ Address: Delivery Address: Special Instructions: Hauler's Name: Scaleperson: ❑ CASH _� CHARGE TRUCK# TIME MATERIAL GROSS TARE NET NETT/YDS PRICE DRIVER'S SIGNATURE �7 Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° 18 4 6 8 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Phone: Address: !! Delivery Address: -- Special Instructions: Hauler's Name: Scaleperson: CASH CHARGE TRUCK # I TIME I MATERIAL I GROSS I TARE I NET I NET TNDS I PRICE Subtotal DRIVER'S Tax SIGNATURE: Total DRIVER'S NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. PPMO RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 NO- 18 4 612 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS I TARE NET NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1i2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON WA 98 , 055 NO185849 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK# TIME MATERIAL GROSS TARE NET NETT/YDS PRICE DRIVER'S SIGNATURE Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. and in f the plant d. d/or to which it ient, you are ation, other than communication ,ged and/or (ies) to which it :cipient, you are ication, other than s communication RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 • PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 N° 18 613 3 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _.. Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE NET NET TNDS I PRICE I SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PfT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No 18 5 7 3 8 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL GROSS I TARE I NET NET TNDS I PRICE I SIGNATURE DRIVER'S SIGNATURE: Subtotal I Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1J2% per month. Annual finance charge of 18%. �� � � � Z.Z RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 ' PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 ��0 18 3 g -� 2 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: _ Special Instructions: Hauler's Name: __ ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL l GROSS I TARE I NET I NET TJYDS I PRICE I SIDG►JATURe Subtotal DRiVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a .ate of 1 1i2% per month. Annual finance charge of 18%. -� i.��� Ste„ Dat Total pages 1� Project Estimator 'T o' ,wcr Extension - I Concrete: Injunousjo eyes.Causes skin iritaflon.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete. mortar, cement or cement mixtures can cause skin imitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discomfort In rase of eye contact. flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or acme into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. El possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned. hereby INDEMNIFY the Other additions seller and z employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by x Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. CUSTOMER/OFFICE 3273861 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. and RELEASE the seller and its employees from j L,I_ any liability. 4040 KERSEY WAY AUBURN, WA 98092 Signature of Owner or its Agent 253-839-E101 Signature of Owner or its Agent _ WGDELTKT090408 Leave Plant Arrive Job Sit Start Discharge Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code TICKET NO. Driver Co. Proj. No. Load Qty Delivered Qty OrderQty Load Size Prod. No, Description Delivery Address Date p Zone Scale Time: Price Amount Slump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Check Truck Gross Weight Tare Weight Trailer Trailer Taken by # RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 Na 18 4 4 f 8 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS I TARE I NET I NET TNDS I PRICE SIRIVERS IGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 112% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No " 84625 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE TRUCK # I TIME I MATERIAL I GROSS TARE I NET I NET TNDS I PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 112% per month. Annual finance charge of 18%. ICON Materials F°. O. Box 88050 ' Tukwila, WA 98138 Aggregate Operations: (253) 839-2101 / FAX: (253) 946-1383 Asphalt Operations: (206) 575-3200 / FAX: (206) 575-3207 ICONM**982CF SOLD TO ADDRESS Date: 6(�'- I I *'a� JOB NO. P.O. NO, CONT. NO. PIT SITE TRUCK NO. TIME ICON CHARGE I C.O.D. ITEM NO. ITEM NO. 5/8"-0" Top Course Concrete Sand Washed 1 1/4"-0" Base Course Mason Sand 2 1/2"-0" Crushed Ballast 3/8" Pea Gravel 1 1/4"-0" Crushed Recycle 7/8" Aggregate Pit Run 1 1/2" Drain Rock GROSS WEIGHT LBS. TRUCK WEIGHT LBS. NET WEIGHT LBS. Quantity Price AMOUNT TAX Driver TOTAL Received By It is specifically agreed that ICON MATERIALS, will not be liable for any damage to shrubbery, flo rs. 202685 city sidewalks, roadway or private property in delivering material listed above on these premises. , t: �-- z2 There are three basic s • Step 1 - Data C 0 Step 2 - Data P • Step 3 - Consti Developing a Construction Pollution Prevention Plan (S ICON Materials P. O. Box 88050 ' Tukwila, WA 98138 Aggregate Operations: (253) 839-2101 / FAX: (253) 946-1383 Asphalt Operations: (206) 575-3200 / FAX: (206) 575-3207 ICONM**982CF SOLD TO ADDRESS Date: JOB NO. P.O. NO. CONT. NO. PIT SITE TRUCK NO. TIME ICON CHARGE I C.O.D. ITEM NO. ITEM NO. 5/8"-0" Top Course Concrete Sand Washed 1 1/4"-0" Base Course Mason Sand 2 1/2"-0" Crushed Ballast 3/8" Pea Gravel 1 1/4"-0" Crushed Recycle 7/8" Aggregate Pit Run 1 1/2" Drain Rock GROSS WEIGHT LBS. TRUCK WEIGHT LBS. NET WEIGHT LBS. Quantity Price AMOUNT TAX Driver TOTAL Received By It is specifically agreed that ICON MATERIALS, will not be liable for any damage to shrubbery, flowers, 202685 city sidewalks, roadway or private property in delivering material listed above on these premises. fn �� �J- \-la LA )n,\` (9 �„�5 F, � � -,'� j ((� --; Concrete: Injuri?4s to eyesAauses skin imtabon.Contains Portland Cement. Read 'ibe following warning before using: Contact with wet. unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt full-length trousers and tightfitting p;,o protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high en yrh to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash or, imr idiately with fresh, dean water. Indirect contact through dothirg is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfort In case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of chi!dr;.a! User agrees to convey this warning to all persons who may use or corn into contact wib wet (unhar<<. ned) orr -^f, ,..,_,.1, cement or cement mixtures. Aggregates: Prolonged inhalators of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also. Asphaft may cause severe bums. Wear protective safety gear 0o ng sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release CUSTOMER/OFFICE 3276063 reducedssirength.ouyersagentagreestoacceptresponsibilityforreducedstrength duetowateraddedabovedesign. The operator of this piece of heavy equipment In presenting this RE- LEASE to you for your signature, isofthe opinion that the operation ofthis Unloading & Standby Excess unloading will be machinery in theco manner required to perform our contract with you may charged at posted truck time rates. Truck standby time charged at posted truck time rates. Arrived at ob with inch slump. l p F possibly cause damage to the premises or property. It is our wish to help you In everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is [he return of the purchase price. In no taken seller of it contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be Received X b appurtenances, at: made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from 4040 KERIsEY WAY The addition of any extra products to our mixer may void any warranty any liability. AUBURN, WA 98092 expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. O 6 l Signature of Owner or its Agent �� oryndwre ur VWller or Rs rayenr NWGDELTKTO90408 Leave Plant Arrive Job Site Start Diseharg Finish Discharger Leave Job Site Arrive Plant Drivers' Comments Company/ Order No. Cust. N(P3,,, ,L Customer Job Customer r-i-c.,1�'_,-'" Delivery Instructions Customer PO/ Phase Code Tloy%F,6 �F Delivery Address 7 ) fljL(S Load Qty Delivered Qty Order Qty ProductCode UOM Productpescripbon Tr}.r .IJir?- I!E11 !tit! #111! IIliltl it Driver Co. Proj. No. Date Map Zone Scale Time: UnitP6 a Amount Load Size Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE truck Gross Weight Tare Weight Trailer Check # ronc7rete.:7,.o.oeyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mxures can cause skin imitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully-buttared, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately wit fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfort.ln rase of eye oontacL flush with plenty of water for at least 15 minutes. Consult physician imrnediatey. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your heallh. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt em>lts puisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customers own risk Additional water added to concrete will Property Damage Indemnification & Release Ctrs 0ME R 3276063 reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment In presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. possibly cause damage to the premises or property. It is our wish to help you ineveryway that we can, tut In order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is the return of the purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all daims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received -it appurtenances, at: warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume by X T. f 1 C [jr.,Tespo�iP¢iIy for WWdamage beyond the curb line. Buyer's Agent;rec$fpt of product and approval of any added items. and RELEASE the seller and its employees from L ✓ c ` P Yees 40 t 0 j E- RSEY WAY SE The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any AIJLAU RN v WA 98092 personal injury incurred by you while adding additional products to our ; '53)—FjIJ C. 1 b'i 1 mixer. Signature of Owner or its Agent Signature of Owner or its Agent _. WGD.ELTKTD.90. !IIIII rfLeave Plant Arrive Job Sitei Start Discharg Finish Discharge Leave Job Site Arrive Plant I����IIJill � ���I 1III(II�1II1)111 I i #11 Drivers' Comments Company/ Customer PO/ Order No. Cust. N 0 - , Customer Job Phase Code TICKET NO. Driver Co. Proj. No. �tZt>r. W Customer R 1 A YC;0MAhdY 411-Ple"ry Address Date Map Zone Delivery Instructions _ Scale Time; Load Qty DeliveredQty PrderQty Prod�I tC�de UOM Produ.Gt)e�riRti Unit Price Amount -, 1 7 fi n u-�I..ri --' —.,1 .1. ;*:. Gross i ai,e Net 1`ri; - 4e-i-,80 22580 2:'410,0 F-IJEL. C' 1-rlr-: LLIDOD C9UNT : I C/N ,.h Load Size Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plant Sales Tax { TOTAL DUE Truc ross eight Tare Weight Trailer Trailer Taken by Check # �-Ww� � � � � �a--s- amp -ram -� r_������ rete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, ISIFardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serous eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-fitbng eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials. wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medics attention if you have persistent or severe discorifort.in case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cernent or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance funies. Avoid breathing franes. Also, Asphalt may cause severe bums. Wear protective safety gear king sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release CUSTOMER 3276287 reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slutnp: E-1 possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but In order to do this, the operator is asking Limited Warrarrtv The only liability of the seller for Added gal water,at customer request. Test cylinders taken that you sign this RELEASE. In consideration of the performance of the seller of its contract with me, I the undersigned, hereby INDEMNIFY the product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, "F Other additions ` seller and its employees for any damage and for all daims to the prenrses, building, utility pipelines or cables, telephone lines, driveway or other incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be Received by X appurtenances, aL made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. Buyer's Argent receipt of product and approval of any added items. and RELEASE the seller and its employees from ICON MATERIALS The addl ion of any extra products to our mixer may void any warranty any liability. 4�4 ► KERSEY WAY : E expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our AUBURN, WA 98092. mixer. Signature of Owner or its Agent 253_839-2101 Signature of Owner or its Agent —nis— Leave Plant Arrive Job Si Start Discharge' Fih Discharge Drivers' Comments Company/ Order No. Cust. No. Customer Job f-)1_ T A 6Q 1 Customer TA COMPANY Delivery Instructions Load Qty Delivered Qty OrderQty Product .r, 1.1.E4 �. GDrrive Iant Leave Job Site Arrive Plant Customer PO/ Phase Code TICKETNO. ArNSnM 1309.3890 Delivery Address VARIOUS LOCATIONS fmal L fl I .iLJ i i 1 x Driver Co. Proj. No. Date 06/28/11 Map Zone F F Scale Time: 1 3 : 39 Unit Price Gross 'rare Net Irk: 45680 22400 23280 FUEL CHG Trlr: LOAD L,OUNT 1 C/N: Load Size Prod. No. Description Slump Type CC Use Haul (.�V. Pit/Plant Sales Tax TOTAL DUE Trps;k / fi t Grpsej4 ht Tare Weight Trailer Trailer Taken by Check # ar.-sas�a-=r_r_r.ar_r•�aar_r_ir_r_��r s �;1 �Z Z umicanon: ror the following products:I >ofing,.ofcolor specified, including T-shape4 )ata: For qualified Installer and manufacture reports: Based on evaluation of comprehen by a qualified testing agency, for component jadon Reports: For components of membrai I Concfe'te: Injurious to eyes.Causes skin-Atatioa.Colrtains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid oontact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe dismrnfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or came into contact with wet (unhardened) concrete, mortar, cement or cement mixtures.' Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned. cod with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release CUSTOMER/OFFICE 3277057 reduceitsstrength.Buyeisagent agrees toaccept responswilityforreducedsuength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. possibly cause damage to the premises or property. It is our wish to help you in everyway that we can. but in order to do this, the operator is asking Limited Warran The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consderation of the performance of the product defect is the return of the purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all claims to the premses, incidental or consequential damages resulting from the use of the products or arising out of breach of any Received building, utility pipelines or cables, telephone lines, driveway or other appurtenances, at warranty. All claims for damages or shortages must be �:�-. - by x�✓_ made within 24 hours of dellvery.We do not assume -�= responsibility for any damage beyond the curb line. Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from , ... The addition of any extra products to our mixer may void any warranty any liability. 4040 I /ti ( � FRSEY . expressed or implied by the seller. The seller accepts no liability for any ._ personal injury incurred by you while adding additional products to our AUBURN, WA 9 mixer. Signature of Owner or its Agent `53--839- 21 01 of Owner or its Agent SignatureAt (yWGDELTKTO90400 Leave Plant Arrive Job Site Start Discharge Finish Discharge Leave Job Site Arrive Plant lill IIII III ���� III ����III Jill Drivers' _ a Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Driver Co. Proj. No. AL: I A Date Customer Delivery Address %� "yi' . ` I;`•I Map zone Delivery Instructions Scale Time: Load Qty Delivered Qty OrderQty ProductCode UOM Product Description Unit Price Amount f - Trlr. LOAD Load Size Prod, No. Description Slump Type Cc Use Haul lid. Pit/@Ia,01' Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 -Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 NO- 18 5 0 0 4 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: ❑ CASH Phone: Scaleperson: ❑ CHARGE '0s -�4= -2-z C� L,o lit tx TRUCK# TIME I MATERIAL GROSS TARE NET NETT/YDS PRICE DRIVER'S SIGNATURE M s IS I A/ s �oPy• - Subtotal DRIVER'S Tax SIGNATURE: Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. -Concrete: Injurious to eyes.Causes skin imtabon.Contains Portland Cement. Read the following warning before using: Contact with wet, CJvTOPMEFi/OFFICE unhardgped concrete, mortar, cement or cement mixtures can cause skin imitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt fuiNength trousers and tightfitbrg eye protection when waking with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through dothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe 3277063 discornfordn case of eye contact, flush wiUn plenty of water for at least 15 minutes. Co nwft physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use a ne cainto contact with wet (unhardened) concrete, mortar, cement a cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphaft may cause severe turns. Wear protective safety gear (kxg sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buy&s agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with in slump. EJ possibly cause damage to the premises or property. It is our wish to Culp you in every" that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders taken that you sign this RELEASE. In consideration of the performance of the product defect is fhe return of the purchase price. In no event shall the seller be liable for any direct, indirect, Other seller of its contract with me, I the undersigned, hereby INDEMNIFY the seller and its employees for any damage and for all dams to the premises, incidental or consequential damages resulting from additions building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be Received appurtenances, at: made within 24 hours of dehve We do not assume by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent . t iWGDELTKTo904Q8 Leave Plant Arrive Job Sitq Start Discharge,, Finish DischargeLeave Job Site Arrive Plant Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Customer Delivery Address Delivery Instructions Load Qty Delivered City Order Qty ProductCode UOM Product Description FUEL- Cf Ir, responsibility for any damage beyond the curb line. TCON , 4040 KERSEY WAY SE AUBURN, WA 98092 253-839--2101 Driver Co. Proj. No. [late 07COL, .: m Zane F F Scale 1,3 s 5b Time: , Unit Price Amount Load Size Prod. No. Description Slump Type CC Use Haul Cd. PiUPlant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin imitabon.Contains Portland Cement. Read the following warning before using: Contact with wet, unharde2td cunaete;mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, fulPength trousers and tight -idling eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are light at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 9 you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or came into contact with wet (unhardened) concrete, mortar, cement or cernent mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery. y in the manner required to perform our contract with you may Arrived at job with inch slump . � possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent N W G D E LTKTO90408 Leave Plant Arrive Job Sit Start Discharg ei Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Company/ Customer PO/ Order No, Cust. No. Customer Job Phase Code TICKET NO Customer Delivery Address Delivery Instructions Load Oty Delivered Qty OrderQty Product Code UOM Product Description CUSTOMER/OFFICE 3402023 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for productdefect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount Load Size Prod. No, Description Slump Type CC Use Haul Qd. Pit/Plant Sales Tax TOTALDUE Truck Gross Weight Tare Weight Tmlailer Trailer Taken by Check # Cond"rete: Injt*us to eyes.Causes skin imtabon.Contains Portland Cement. Read the following warning before using: Contact with wet, CUSTOMER unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fuly-buttoned, long -sleeve shirt, full-length trousers and tight-filting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are light at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe 3402360 discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physidan immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing furnes. Also, Asphalt may cam severe bums. Wear protective safety gear (Io g sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer'sagentagreeato accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. , LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby. machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal pvatgi, ` stomer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is the return of the purchase price. In no +_ taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all dams to the premises, incidental or consequential damages resulting from _ building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be by X made within 24 hours of delivery.We do not assume 1. COPresponsibility for Thy damage beyond the curb line. Buyer's Agent reipt of,pfoduct and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. 4040 KERSEY WAY SE: - expressed or implied by the seller. The seller accepts no liability for any AUBURN, Wit 9809 personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent 53-839101 . Signature of Owner or its Agent . Ar t TKI0.9U.401f --or I Itp� it Leave Plant Arrive Job Sit Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers' -- � - Comments Company/ ONerlyq. Cust. Nt. 31 Customer Job Customer .! T q COMPANY Delivery Instructions Customer PO/ Phase Code TICKETNO. Driver 130959E2- Delivery Address = t I ON 3 Load Qty DeliveredOty OrderOty ProductCode UOM Product Description (.7 Y" Q fa S T.@. Y` e N e t r,k e 46080 t_�^380 23700 Load Size Prod. No. Description Truck Tare Weight Trailer Trailer Slump Type CC Use Haul Check # Co. Proj. No. gib. Date 0h ` .. - Map Zone Scale 00 Time: Unit Price Amount Pit/Plant Sales Tax TOTAL DUE ohm RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 No , 8 5J 6 q 2 (BLACK RIVER QUARRY SITE) SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date:._ t Customer: ''' " `' i-- Phone: Address: Delivery Address: Special Instructions: a 1 Hauler's Name:' Scaleperson: ❑ CASH CHARGE TRUCK k l TIME I MATERIAL I GROSS I TARE I NET NET TNDS I PRICE SIGNATURE Subtotal DRIVER'S SIGNATURE Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RENTON CONCRETE RECYCLERS 22121 17th Ave. S.E., Suite 117 - Bothell, WA 98021 PIT SITE: 500 MONSTER RD. S.W. RENTON, WA 98055 (BLACK RIVER QUARRY SITE) NO-185866 SITE PHONE: (206) 772-2278 BUSINESS OFFICE: (425) 481-9101 Date: Customer: Address: Delivery Address: Special Instructions: Hauler's Name: Phone: Scaleperson: CASH ❑ CHARGE TRUCK # TIME MATERIAL GROSS TARE NET NET TNDS PRICE DRIVER'S SIGNATURE i Subtotal DRIVER'S SIGNATURE: Tax Total NOTICE: It is specifically agreed that this company shall not be in anyway responsible for damage to customer's property, resulting in deliveries beyond curb line. TERMS: NET 15 DAYS from the end of the month. A finance charge will be assessed on all past due accounts at a rate of 1 1/2% per month. Annual finance charge of 18%. RECEIVE[ SEP 0 8 CITY OF RENTON UTILITY SYSTEMS Contractor in obtaining the permit it necessary — All work is to be completed no later than August directed. to be performed in accordance with the 2010 Wasl ition (VVSDOT) Standard Specifications for Road, E - General Conditions The City will have staff from it site :ind available to address any questions or prc for the work. ent for the work performed on this contract will be n Force Account Basis As Per The 2010 Washingtc Transportation Standard Specification; Division 1 Contractor to pay the State Prevailing Wages to Intents to pay prevailing wages and affidavits of v work in accordance with the applicable RCWs an 747 Market Street, Room 620 1 Tacoma, Washir www.cityvttacoma.orb P ' .. 1 ( i > L11_ ,,, �nft�fitc Pa��d C�11211t Reo N f01ong worming before using: Contact with wet, C S? JNE;° �:_� A _ - _�._a a_e....�am� ee ,.�, w �a-;eyedam�e AvodcAnt2rtVldh _,AMA _ _ eyes and skin. Wt� waterproof gloves, a ", uttoned. kxx,-sleeve shrt, fulNength Imusers and tight-fi�ng eye protection when working with these materials. If you have to stand in vtrrt ete, use waterproof boots Prat are tight at the top and high enough to keep concrete from flowing into thern. If frtishing mwete, wear knee pads to protect knees. After contact wdh any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothng. Seek immediate medical attention if you have persistent or severe discornfort.ln case of eye contact, flush with plenty of water for at least15 minutes. Consult physician immediately. KEEP out of reach of children! User 3407283 agrees to convey this warning to all persons who may use or canna into oontact with wet (unhardened) concrete, mortar, cement or cement mixtures. Ag-gre-gates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (kmg sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Amved at job with inch slump. F-1 possbly cause damage to the premises or property. It is our wish to help YOU ineveryway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is [he return of the purchase price. In no taken seller of Its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all claims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be by X y made within 24 hours of deliver Wed t —._. Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent . Start Discharg Finish Discharge Leave Plant Arrive Job Sit . Drivers' Comments and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent _............. ......_ GD.FITKI0909p Leave Job Site Arrive Plant fi Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKETNO. Customer Delivery Address Delivery Instructions Load Qty Delivered Qty Order Oty ProductCode UOM Product Description y. ono ...- responsibility for any damage beyond the curb line. CON MATERIALS i115 SOUTH 96TH SEATTLE, WA 8108 206-767-2521 Unit Price Load Size Prod. No. Description Slump Type CC Use Haub Col. Pit/Plant Truck rare Weight Trailer Trailer Sales Tax TOTAL -DUE Amount frrfr•�i��r•�rrrr�r•sr!•r•t•r_r_����i��������� Concrete: Injurious to eyes.Causes skin imtaton.Contains Portland Cement. Read the following warning before using: Contact with wet, CUSTOMER unhardened concr*-Imatar, dlTne nt or cement mDtres can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothing. Seek immediate medical attention if you have persistent or severe ®� discomfat.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or came into contact with wet (unhardened) concrete, mortar, a rrrent or cement mixtures. 242 Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt ernts nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe burns. Wear protective safety gear (long sleeves, pants and gloves). If timed, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE- Unloading & Standby Excess unloading will be due to water added abovedesign. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. E-1 possibly cause damage to the premises or property. It is out wish to help you in everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is he return ofthe purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, seller and is employees fa a and for all claims to the erases, incidental or consequential damages resulting from Other additions building, utility elines or �les�, telephone lines, driveway, or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be by X,7f ces, made within 24 hours of delive We do not assume Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any. liability. Signature of Owner or its Agent Signature of Owner or its Agent _._.._ GDELTKTO90.40$ Leave Plant Arrive Job SRI Start Discharg,'l Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Company/ Order No. Cust. No. Customer Job r=t!_ T 1 60031 a Customer COMPANY Delivery Instructions Load Qty Delivered Qty OrderQty Produi Gross Tare Net Trk: -444,20 -24340 16780 irIr,. responsibility for any damage beyond the curb line. .CON MATERIALS 1.115.SOUTH 96TH SEATTLE, WA 98108 206-767-2521 Customer PO/ Phase Code TICKETNO. Driver Co. Proj. No. 44 DFNITPI, J 531931 17 Delivery Address Date V A H UUJ L0L.ri!-IONS Map zone Scale Time: to (';OLD, —MIX FUEL GHG LOAD LOUNT : 1 C/N: Load Size Prod. No. Description Slump Type CC Use Hag Col. Pit/P12nt Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*1O4PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton _____.___ Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity uantit Date Transmittal Letter September 12, 2011 Attention: Andrew Weygandt Re: Benson Road 16" WM Job Number: 1 17 Tickets: BI #23 - HMA (495.49 Tons - Miles Resources 9/12/11) �� i� FA*i� �t,�►� LL Signature 9/12/2011 Sumner Plant 6:54:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD 0i 100831 Pounds Tons Metric Gross 79620 39.81 36.12 Tare 30780 15.39 13.96 Net 48840 24.42 22.15 Product : 135 HMA Class 1 /2" 24.42 Ton Ordered 0.00 Received 24.42 Remaining -24.42 Carrier : 51520 MILES RESOURCES LLC Vehicle: 85 MILES RES TR#85 Today: 24.42 Loads: 1 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 6:58:00 am rrF's¢sF Location: 300 Customer: 51520 MILES RESOURCES LLC Order: 11047 ALIA BENSON RD W 100832 Pounds Tons Metric Gross 79920 39.96 36.25 Tare 30760 15.38 13.95 Net 49160 24.58 22.30 Product : 135 HMA Class 1/2" 24.58 Ton Ordered 0.00 Received 49.00 Remaining -49.00 Carrier : 51520 MILES RESOURCES LLC Vehicle: 86 MILES RES TR#86 Today: 49.00 Loads: 2 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 7:14:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order: 11047 ALIA BENSON RD Pounds Tons Metric Gross 105560 52.78 47.88 Tare 39340 19.67 17.84 Net 66220 33.11 30.04 Product : 135 HMA Class 1/2" 33.11 Ton Ordered 0.00 Received 82.11 Remaining -82.11 Carrier : 51520 MILES RESOURCES LLC Vehicle: 93-161 93-161 Today: 82.11 Loads: 3 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 7:23:00 am Location: 300 100834 Customer: 51520 MILES RESOURCES LLC Pounds Tons Metric Order : 11047 Gross 105780 52.89 47.98 ALIA Tare 39060 19.53 17.72 BENSON RD Net 66720 33.36 30.26 . M Product : 135 HMA Class 1/2" 33.36 Ton Ordered 0.00 Received 115.47 Remaining-115.47 Carrier : 51520 MILES RESOURCES LLC Vehicle : 91-162 91-162 Today: 115.47 Loads: 4 Received. Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 7-32-00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD 6 100836 Pounds Tons Metric Gross 104760 52.38 47.52 Tare 39400 19.70 17.87 Net 65360 32.68 29.65 Product 135 HMAClass 1/2" 32.68 Ton Ordered 0.00 Received 148.15 Remaining-148.15 Carrier : 51520 MILES RESOURCES LLC Vehicle : 84-154 84-154 Today: 148.15 Loads: 5 Received. Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 7:49:00 am (�� Location: 300 100837 Customer: 51520 MILES RESOURCES LLC Pounds Tons Metric Order : 11047 Gross 105300 52.65 47.76 ALIA Tare 37340 18.67 16.94 BENSON RD Net 67960 33.98 30.83 Product : 135 HMA Class 1/2" Carrier : 51530 MILES SAND & GRAVEL Vehicle : 758T 758T MILES S&G Received: 33.98 Ton Ordered 0.00 Received 182.13 Remaining-182.13 Today: ! 182.13 Loads: 6 Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 1OO84G 9:22:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Pounds Tons Metric Order: 11047 Gross 78380 39.19 35.55 ALIA Tare 30700 15.35 13.93 BENSON RD Net 47680 23.84 21.63 P.O. : Product : 135 HMA Class 1/2" 23.84 Ton Ordered 0.00 Received 205.97 Remaining-205.97 Carrier: 51520 MILES RESOURCES LLC Vehicle : 86 MILES RES TR#86 Today: 205.97 Loads: 7 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 9:32:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD E 100847 Pounds Tons Metric Gross 79400 39.70 36.02 Tare 30700 15.35 13.93 Net 48700 24.35 22.09 Product 135 HMA Class 1/2" 24.35 Ton Ordered 0.00 Received 230.32 Remaining-230.32 Carrier 51520 MILES RESOURCES LLC Vehicle : 85 MILES RES TR#85 Today 230.32 Loads: 8 Received. Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 100"9 9:40:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Pounds Tons Metric Order : 11047 Gross 105460 52.73 47.84 ALIA Tare 39240 19.62 17.80 BENSON RD Net 66220 33.11 30.04 P.O. : Product : 135 HMA Class 1/2" 33.11 Ton Ordered 0.00 Received 263.43 Remaining-263.43 Carrier : 51520 MILES RESOURCES LLC Vehicle: 93-161 93-161 Today: 263.43 Loads: 9 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 9:56:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD W 100851 Pounds Tons Metric Gross 105460 52.73 47.84 Tare 38920 19.46 17.65 Net 66540 33.27 30.18 Product : 135 HMA Class 1/2" 33.27 Ton Ordered 0.00 Received 296.70 Remaining-296.70 Carder : 51520 MILES RESOURCES LLC Vehicle: 91-162 91-162 Today: 296.70 Loads: 10 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 100852 10:05:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Pounds Tons Metric Order : 11047 Gross 105100 52.55 47.67 ALIA Tare 39260 19.63 17.81 BENSON RD Net 65840 32.92 29.86 P.O. : Product : 135 HMA Class 112" 32.92 Ton Ordered 0.00 Received 329.62 Remaining-329.62 Carrier : 51520 MILES RESOURCES LLC Vehicle : 84-154 84-154 Today: 329.62 Loads: 11 Received: Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant 11:05:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD P.O. : Product : 135 HMAClass 1/2" Carrier : 51520 MILES RESOURCES LLC Vehicle: 86 MILES RES TR#86 Received: Pounds Tons Metric Gross 79600 39.80 36.11 Tare 30640 15.32 13.90 Net 48960 24.48 22.21 24.48 Ton Ordered 0.00 Received 354.10 Remaining-354.10 Today: 354.10 Loads: 12 Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant �ILES� 11:08:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order: 11047 ALIA BENSON RD P.O. : Product : 135 HMA Class 1 /2" Carrier : 51530 MILES SAND & GRAVEL Vehicle: 758T 758T MILES S&G Received: 100859 Pounds Tons Metric Gross 104840 52.42 47.55 Tare 37300 18.65 16.92 Net 67540 33.77 30.64 33.77 Ton Ordered 0.00 Received 387.87 Remaining-387.87 Today: 387.87 Loads: 13 Weighmaster: Nick - WM # 645 9/12/2011 Sumner Plant MILB� 11-27:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD P.O. Product : 135 HMA Class 1/2" Carrier : 51520 MILES RESOURCES LLC Vehicle 85 MILES RES TR#85 Received 100863 Pounds Tons Metnc Gross 79720 39.86 36.16 Tare 30640 15.32 13.90 Net 49080 24.54 22.26 24.54 Ton Ordered 0.00 Received 412.41 Remaining-412.41 Today: 412.41 Loads: 14 Weighmaster Nick - WM # 645 9/12/2011 Sumner Plant Location: 300 Customer: 51520 MILES RESOURCES LLC Order: 11047 ALIA BENSON RD P.O. : Product : 135 HMA Class 1/2" Carrier: 51520 MILES RESOURCES LLC Vehicle : 93-161 93-161 Received: `11::;.� Pounds Tons Metric Gross 104640 52.32 47.46 Tare 39220 19.61 17.79 Net 65420 32.71 29.67 32.71 Ton Ordered 0.00 Received 445.12 Remaining 445.12 Today: 445.12 Loads: 15 Weighmaster: Nick - WM # 645 9/12/2011Sumner Plant 11:56:00 am Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD P.O.: Product : 135 HMA Class 1/2" Carrier : 51520 MILES RESOURCES LLC Vehicle: 91-162 91-162 Received: 100867 Pounds Tons Metric Gross 105300 52.65 47.76 Tare 38800 19.40 17.60 Net 66500 33.25 30.16 33.25 Ton Ordered 0.00 Received 478.37 Remaining-478.37 Today: 478.37 Loads: 16 Weighmaster: Nick - WM # 645 9/12/2011 �MILBS� Sumner Plant 1 03=00 pm Location: 300 Customer: 51520 MILES RESOURCES LLC Order : 11047 ALIA BENSON RD 97 100882 Pounds Tons Metric Gross 64820 32.41 29.40 Tare 30580 15.29 13.87 Net 34240 17.12 15.53 Product 135 HMA Class 1 /2" 17.12 Ton Ordered 0.00 Received 495.49 Remaining-495.49 Carrier : 51520 MILES RESOURCES LLC Vehicle 86 MILES RES TR#86 Today 495.49 Loads: 17 Received: Weighmaster: Nick - WM # 645 ����� ����3 P. IVr1qq Q. 1997 NDS — National Desigrn Ciro oj'Auhunr Mute Rimer Stone Pump Station 06OW-1 Maittrenance and Repair Project Contrar t Documents Page 212 Section 06090 Wood and Plastic Fastenings Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Ve Concrete: Injurious to eyes.Causes skin irtitation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cernent mixtures can cause skin initatkxn, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wetconcrete, use waterproof boots that are tight at the top and high enough to keep concrete fran flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention I you have persistent or severe discornfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Cmwft physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete. mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your heath. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emts nuisance fumes. Avoid breathing hones. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, caul with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. possiblycause damage to the premises or property. itis our wish to help you in every" that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contact with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent NWGDELTKT090408 Leave Plant 1 Annie Job Sit Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code Delivery Address TICKET NO. Load Qty Delivered Qty OrderQty Product Code UOM Product Description Load Size Prod. No. Truck Gross Weight Tare Weight Trailer Trailer Slump Type CJSTOME:R/OFRCE 3404148 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delnvery.We do not assume responsibility for any damage beyond the curb line. Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Check # Concrete: Injurious to eyes.Causes skin initation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-frmrg eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear kneepads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through dothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 6 you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement m xtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyers agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE - due to water added abovedesign. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. E-1 possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other bRyceivedX appurtenances, at: Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent NWGDELTKT090408 Leave Plant Arrive Job Site Start DischargeI Finish Discharge Leave Job Site Arrive Plant Drivers' — - — Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO Customer Delivery Address Delivery Instructions Load Qty DeliveredQty OrderQty ProductCode UOM Product Description 30PEkPHVE i/dil CUSTOMER/OFECE 3404145 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. Driver Co. Proj. No. Date Map Zone $tale Time: Unit Price Amount Al 0 •` Load Size Prod. No. Description Slump Type CC Use Ha4 Cd. IAVRIant Sales Tax TOTALDUE Truck Gross Weight Tare Weight Trailer Trailer . � 1. Concrete: Injurious to eyes.Causes skin irritabon.Contains Portland Cement. Read the following warning before using: Contact with wet, CU i! OVIER/CiFFICE unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt full-length trousers and tight -fitting eye protection when waking with tinese materials. If you have to stand in wet=concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, weAr knee pads to prated knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe 3404139 dism7fort.ln case of eye contact, flush wit plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this waning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cemena t cement matures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health, Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. a possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is he return of the purchase price. In no taken seller of its contract with me, I the undersigned. hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and Its employees for any damage and for all claims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be b y X made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from I LL6i4 h1H i L R I AL The addition of any extra products to our mixer may void any warranty any liability. 1115 SOUTH '�6TH expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our SEATTLE , WA 98108 mixer. Signature of Owner or its Agent 206-767-2541 _ _.--- GDELTKT09040 Signature' Finish Discharge Leave Job Site Arrive Plant Leave PlantArn a Job Sit Start Discharge r Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKETNO, Customer Delivery Instructions Load Qty Delivered Qty OrderQty ,,. .--;,JId1 . c Load Size Prod. No. Description Truck Gross Weight Tare Weight Delivery Address Product Code UOM Product Description Trailer Trailer Slump Type CC Use f i��lil�iifi�tili;llii,�l►li�lhi �iiitl #jlii�l, Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount Haul Col. Pit/Plant Sales Tax TOTAL DUE Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin imtation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -filling eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flaring into them. If finishing concrete, wear knee pads to prated knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is•as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention tt you have persistent or severe discornfat.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or oement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing hirnes. Also, Asphalt may cam severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyers agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this Arrived at ob with inch slump. machinery in the mariner required to perform our contract with you may 1 _ p F possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added watt r at customer est. Test cylinders that you n this RELEASE. In consideration of the yI taken sellof its contract with me, I the undersigned, hereby INDEMNIFY the Other additions i seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other bRYceivedX t: appurtenances, a Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any wananty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent 4 Og 40 Leave Plant 1 Arrive Job Sit Start Discharge Finish Discharge Leave Job Site Arrive Plant Drivers' Comments _- Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Customer Delivery Address Delivery Instructions Load Qty Delivered Qty Order Qty ProductCode UOM Product Description tir=oss 1 ar-e Net 151880 r.:_;1880 C16000 C'USTOMER/OF iCE 3404133 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. rOnl MATERIALE� 1115 SOUTH 96TH SEATTLE, WA 98108 206-•767­252r 1 r S 1 J c ... 4 0 ,7' Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount :rrtr;,r� y � • ' • �� iFif y_ � • f� Aye i 0• Load Size Prod. No. etlicription Slump Type CC, Use Haul, Col. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # A16 Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, SUST Off t:F 'OFFICE unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, fulNength trousers and tight-ftrg eye protection when working with these materials. If you have to stand in wbt concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flow!rg into them. If flnishirg concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physidan immediately. KEEP out of reach of children! User 3404130 agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing times. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece, of heavy equipment in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. El possibly cause damage b the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the productdefectisthereturn the purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liablble for any direct, indirect, Other additions seller and its employees for any damage and for all claims to the prernses, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be by X made within 24 hours of delrve We do not ass me Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. not­ made and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent . Signature of Owner or its Agent ___ NWGDELTKT090408 Leave Plant '-Air" Job Site Start Discharge Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer Job Load Qty Delivered Qty Order Qty Customer PO/ Phase Code Delivery Address F! I_ H L. 1 t-i TICKET NO 53192406 for any damage beyond the curb line. CON MATE R I.AL 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 I��I��NII��II�N�pl�Nl Driver Co. Proj. No. Date Map Zone .ry tt Scale Time: 1 ' SIJi-Lki-'rtu1E 112" PG 64-22 i � eSJy ID tt �r��r,r.ltrtttt t Load Size Prod. No. Description Slump Type CC Use Haul Col. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Check # ohm Concrete: Injurious to eyes.Causes skin imtaton.Contains Portland Cement. Read the following warning before using: Contact with wet, 'CUSTt7iV EPiOFFICE unhardened concrete, mortar, cement or cement mixtures can cause skin imitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User 3404124 agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement orbit res. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emus nuisance fumes. Avoid breathing kimes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipmenL in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. E-1 possibly cause damage to the premises or property. It is our wish to help you i n everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for request. Test cylinders Added gal water at customer that you sign this RELEASE. In consideration of the performance of the product defect is the return of the purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and ifs employees for any damage and for all claims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be by X d th' 24 h f d l W d Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent TKTO9pgp Leave Plant f Arrive Job Site start Discharge Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code Delivery Address TICKETNO. ductCod Load Qty Delivered Qty Order Qty Proe UOM Product Description Load Size Prod. No. Description ma a wh In ours o e rvery. e o not assume responsibility for any damage beyond the curb line. CON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 Driver Co. Proj. No. Date 'hap Zone t� !vale Time: Unit Price Amount Slump Type CC Use Haul Cd. Pit'Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -felting eye protection when working with these materials. If you have It stand in wet concrete, use waterproof boots that are tght at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 9 you have persistent or severe discomfordn case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing hones. Also, Asphalt may cause severe bums. Wear protective safety gear (big sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customers own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contact with you may Arrived at job with inch slump, possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contact with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent tiWGDELTKIO9040 Leave Plant Arrive Job Site Start Discharge Finish Dischargel Leave Job Site Arrive Plant Drivels' — - - Comments Company/ Order No. Cust. No. Customer Job Customer Delivery Instructions Customer PO/ Phase Code Delivery Address TICKET NO. CUSTOMER/OFFICE 3404120 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delnvery.We do not assume responsibility for any damage beyond the curb line. ICON MATERIAL'S- 1115 SOUTH 96TH SEATTLE, WA 98108 206-767--2521 Driver Co. Proj. No. Date Map Zone Scale r Tarr,-: 10 : 53 Load Qty Delivered Qty Order Qty ProductCode UOM Product Description Unit Price Amount il_dPERPHVE 11 4 6 ---,4- �c Gt'oss Trk: 55660 Trlr: r Loa r,e r . Ao. scription Slump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # F10T01c Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin initafif on, severe chemical bums a serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-fiitirg eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe disconrfort.ln case of eye contact flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or corn into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Probnged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphaft may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buye(s agent agrees to accept responsibifity for reduced strength The operator of this piece of heavy equipment in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this Arrived at job with inch slump. machinery in the manner required to perform our contract wit you may p possibly cause damage to the premises or property. It is our wish to help Test cylinders you in everyway that we can, but in order to do tins, the operator is asking Added grahw rr at customer request. Y that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent NWGDELTKT090408 Leave Plant 1 Arrive Job Site Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Company/ Order No. Cust. No. Customer Job Customer Delivery Instructions Load Qty Delivered Qty Order Qty Product Gross Tare Net TI 51860 :_-3880 8000 TrIr: Customer PO/ Phase Code Delivery Address TICKETNO. CUS X OMEHJ®FFICE 3404114 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. !.CON MATERIALS 1.115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 Driver Co. Proj. No. Date Map Zone Scale Time: Ulm Product Description Unit Price ._�1.117FPPPQF t, /;='rr PG 64--22 %,,f,tiitrra',, ,� 'trrrrl>ttt' Coa ¢e Prod. No. scription 'Y ' ' " Slump Type CC Use Haul Col. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # r•ars-ran.r•a�aaaa�ar_aa�r.�a��r.a�������� ��������� Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following waming before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through dothinq is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention it you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing furnes. Also, Asphalt may cause severe bums. Wear protective safety gear (bug sleeves, pants and gloves). If burned, cod with water and see a physidan. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. El possibly cause damage to the premises or property. It is our wish to help you it everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the perfom ante of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agepf receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent NWG-DELTKTO9040 g Finish Discharge Leave Job Site Arrive Plant Leave Plant 1 Arrrve Job Sit Start Discharge - — . Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO Customer Delivery Instructions Load Qty Delivered Qty Order -City Delivery Address ProductCode UOM Product Description CUSTOMEE'/0MCE 3404108 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delwery.We do not assume responsibility for any damage beyond the curb line. ICOfti .MATERIAL S 1115 SOUTH 961-H SEATTL_E, WA 98108 206-767--2521 iiwi�H�wpiH�pi�Napir{aid Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount `�,i;rrrrrti�r .•*••• �A lY ��iY • fL s Cry • : Yl • • � Kri ��rl;rsrtt�t� Load5iie Prod. No. Description Slump Type cc Use Haul Co. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # FI0T0t;_ fi t• �i 11 �-Mmv� � �.=W E Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixhtres can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with V S '' ' ®r� J'��Fj�' eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand, in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrdte, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothltg. Seek immediate medical attention if you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately KEEP out of reach of children! User 3404106 agrees to convey this waning to all persons who may use or come into contact with wet (unhardened) concrete. mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (bng sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce Itsstrength.Guyersagentagreestoacceptresponsbllityforreducedstrength The operator of this piece of heavy equipment. In presenting mis Kt- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby Arrived at job with inch slump. E-1 machinery in the manner required to perform our contract with you may possibly cause damage to the premises or property. It is our wish to help time charged at posted truck time rates. you In everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at stoma r request. Test cylinders taken that you sign this RELEASE. In consideration of the pedom�ance of the seller of its contract with me, I the undersigned, hereby INDEMNIFY the product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, Other additions �, seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines driveway or other incidental or consequential damages resulting from the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be by X made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its ern to ees from p y 1 L UtV MA f E R I AL ti The addition of any extra products to our mixer may void any warranty any liability. 1 1 1 S SOUTH 96TH expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our SEATTLE, WA 98108 mixer. Signature of Owner or its Agent 206-767-2.,C 2 1 Signature of Owner or its Agent NWGDELTKT090-40$ Leave Plant Arrive Job Site Start Discharge) Finish DischargeLeave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code TICKETNO. Driver Co. Proj. No. Delivery Address Date Map Zone 1 , Scale Time: Load Qty Delivered City Order Qty C Load Size Prod. No. Description _ RIO o .( gross Weight Tare Weight Trailer Trailer Slump Type unit i PIG 64 - `4t e� W Y`• ++ • A RRR"' Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Check # Amount ter_ 111w�r.� -ow ohm� ���� Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mbdures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, fulHength trousers and tight-filting eye protection when working with these materials. If you have to stanti in wet concrete. use waterproof boots that are tight at the top and high enough to keep concrete from flaying into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials. wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothing. Seek immediate medical attention if you have persistent or severe discornfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to dl persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health, Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safely gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyers agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE- d ue to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contact with me, I the undersigned. hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, i1 building, utility pipelines or cables, telephone lines, driveway or other Received t appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or Its Agent Leave Plant Arrive Job Sit Start Dlscharg Finish Discharge Leave Job Site Drivers' Comments Order No. Cust. No. Customer Delivery Instructions CUS T OMENOFFICE 3404105 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. NWGDELTKM90400 Arrive Plant t2 ply I t Company/ Customer PO/ Customer Job Phase Code TICKET NO. Driver Co. Proj. No. Load Qty Delivered Qty Order Qty Delivery Address Date Map Zone I Scale Time: ProductCode UOM Product Description Unit Price Amount JlJ1-Grti'1•t'✓C 1 i �. f'lJ 4:i`i'--CC.' ,• Z �yrtirrtflts�x f "i: Load Size Prod. No. Description Slump Type CC Use Haut Cd. Pit/Plant Sales Tax TOTALDUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin imitation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-fibng eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flovving into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe disconrfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health, Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance furnes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. El possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by -- Buyer's Agent'i'eceipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent WGDFLTKTO90408 Leave Plant Pkirrive Job Site Start Discharg� Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer Job Customer PO/ Phase Code Delivery Address Load Qty Delivered Qty Order Qty Product Code Load Size Prod. No. Description UOM TICKETNO Product Description CUSTOMEIRJOFFICE 3404201 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable. for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. ..CON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 Driver Co. Proj. No. Date Map zone Scale r Tine. 14 109 Unit Price Amount ��mrsm a r►rrr� fi�rr�rbltl��iY, Slump Type CC Use Haul Co. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin inibbon.Contains Portland Cement. Read the following warning before using: Contact with wet. unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when waking with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothing. Seek immediate medical attention if you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this waning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your heath. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing times. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. possiblycause damage to the premises or property. It is our wish to help you n everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utlity pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X — — Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability, for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent _NWGDELTKTO9040 Leave Plant Arrive Job Site Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers' Comments _- Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Customer Delivery Address Delivery Instructions Load•Qty Delivered Qty OrderQty Product Code UOM Product Description CUS 6OMER/OffiCE 3404193 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defectisfhe return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the pproducts or arising out of breach of any warranty. All cue ims for damages or shortages must be made within 24 hours of delwery.We do not assume responsibility for any damage beyond the curb line. ICON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 I�tl�II�M�lq�lll��l�lll�l���l `117' p±l 1 i,=. rY r-1r 7:,4 Driver Co. Proj. No. Date Map Zone Scale rule: Unit Price Amount `}t t117ll1rlt' •mot` 10 ',lrrlltit11�11� Load Size Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # --ate-sImlt MW.�� �lMt te 1=111 -="= spa-ar_�iMlaiMl-��a_�� ��imi � ��-� � � � Concrete: Injurious to eyes.Causes skin imitation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin imitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-fitbng eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials. wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfortln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement m bktures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your heath. Measures to control fugitve dust should be taken Wien handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment. in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. possjbty case damage to the premises or property. It is our wish to help you In everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contact with me, I the undersigned, hereby INDEMNIFY the Other additions---. seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. CUSTOMER/OFFICE 3404157 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. and RELEASE the seller and its employees from CON MATERIALS any liability. 1115 SOUTH 96TH Signature of Owner or its Agent SEATTLE, WA 98108 206-767-2521 . Signature of Owner or its Agent WGDELTKT09040§ . 91 Start Discharg Finish Discharge Leave Job Site Arrive Plant Leave Plant Arrive Job Sit Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Load Qty Delivered Qty Company/ Customer PO/ Customer Job Phase Code TICKET NO. Driver Co. Proj. No. Delivery Address Date Map zone Scale Tire: Order Qty Product Code UOM ProductDescription Unit Price Amount .._, Nat ' nr 1 /2" FAG 64--2c Load Size Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-fithng eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician Immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement mixures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (Io g sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. E-1 possibly cause damage ro the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me. I the undersigned, hereby INDEMNIFY the Other additions �~ \'�, seller and its employees for any damage and for all daims to the premises, building. utility pipelines or cables, telephone lines, driveway or other Received -- appurtenances, at: bX Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from ON an liability CUSTOMER/OFFICE 3404175 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty e only liability of the seller for product defect is the Threturn of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. ate-i i L k!r-,L.S y 1 115 SOUTH ` 6TH SEATTL..E, WA 98108 Signature of Owner or its Agent 206-767--2521 Signature of Owner or its Agent _ _..NWGDELT 40 .,90. Leave Plant Arrive Job Sit Start Discharg Finish Discharges Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code TICKETNO Load Oty Delivered Qty OrderQty Driver Co. Proj. No. Delivery Address Date knt i l L, , i l Map Zme Scale Time: ` ProductCode UOM ProductDescription Unit Price Amount 1/ 2 " FAG 6 c Load Size Prod. No. Description Slump Type CC Use Hauf Cd. Pit/Plant Sales Tax TOTAL DUE Weight Tare Weight Trailer Trailer Check # Concrete: Injurious to eyes.Causes skin imtabon.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, Dement or cernent mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt full-length trousers and tight-frfling eye protection when working with these materials. If you have to stand in wet concrete. use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 6 you have persistent or severe dtscornforLIn case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this job with inch slump. machinery in the manner required to perform our contract with you may Arrived at l p El possibly cause damage to the premises or property. It is our wish to help you in everyway that we can. but in order to do this, the operator is asking Added gal water at custome quest. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions \ seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other bRyceivedX� appurtenances, at: Buyer's Agent 7Lmeipt-of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for arty personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or l__its Agent WGDELTKT09040$ Leave Plant Arrive Job Sit Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers' Comments CUSTOMER/OFFICE 3404181 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is fhe return of the purchase price. In no event shall the seller be liable for any direct, indirect, - incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the qurb line. MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767--2521 Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Driver Co. Proj. No. Customer c Delivery Address Date Map Zone Delivery Instructions = h l- 'AL 1 t t Scale F: Time: 1 L .., 1 Load Qty Delivered Qty Order Qty ProductCode UOM Product Description Unit Price Amount E,.. CLi 7 t3f. 00 tit •o S Terre Net Load Size Prod. No. ' scription L r�lSlump Type CC Use Haul Cd. Pit/Plant Sales Tax 531 TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # H ,T01, 1 Concrete: Injurious to eyes.Causes skin initation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt fulNength trousers and light -filling eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothing. Seek immediate medical attention 9 you have persistent or severe discomfort. In case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or came into contact with wet (unhamened) concrete, mortar, oement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health Measures to control fugmve dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe turns. Wear protective safety gear (brig sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agentagrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE - due to water added above design. LEASE to you for your signature. is of the opinion that the operation of this Arrived at job with inch slump. machinery in the manner required to perform our contract with you may 1 p possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDENNIFY the Other additions seller and its employees for any damage and for all dams to the premises, building, utility pipelines or cables, telephone lines. driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability Signature of Owner or its Agent Signature of Owner or its Agent NWGDELTKT090408 Leave Plant Arrive Job Site Start Discharge Finish Discharger Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Load Qty Delivered Qty Company/ Customer Job Customer PO/ Phase Code TICKETNO. Delivery Address Order Oty ProductCode UOM ProductDescription CUSTOMER/OFFICE 3404160 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. CON MATERIALS .its SOUTH 96TH SEATTLE, WA 98108 206-767-252t Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount ``ti�rrrrrrrriii Load Size Prod. No. Description Slump Type CC Use Haul Col. PWF`Tant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, oernent or cement mixtures can cause skin irritation, severe chemicai bums or serious eye damage. Avoid contact wit eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, fulNength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 6 you have persistent or severe ci scomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physidan immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement sutures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your heath. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this job with inch slump. machinery in the manner required to perform our contract with you may Arrived at 1 P � Possibty cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this. the operator's asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent Leave Plant Arrive Job Site Start Discharg� Finish Discharge Leave Job Site Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Load Qty Delivered Qty Load Size Prod. No. Company/ Customer Job Order Qty Customer PO/ Phase Code Delivery Address NWGDELe Plant Arrive Plant) TICKETNO Product Code UOM Product Description CUSTOMER/OFFI.CE 3404165 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. ICON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 806-767-2521 Driver Co. Proj. No. Date Map Zone S61e F' Time: 0 9 ; 3- 6 Unit Price Amount 1 i71Ff- 0()rJP- 1 . Slump Type CC Use Haul Cd Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mxtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt fulNength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfort.ln case of eye contact flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement mixures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also. Asphalt may cause severe bums. Wear protective safety gear (long sleeve;;, pants and gloves). If burned, 000l with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE - due to wafer added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. E-1 possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for al dams to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received a appurtenances, at: by X - Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent NWGDELTKTO90408 Leave Plant 1 Arrive Job Sit Start Dscharg Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Customer Delivery Instructions Load Qty Delivered Qty CUST0N11EF1J0FF;CE 3404178 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. ICON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 IIpI�N�I��IIIIUWI�III(IIR�In(�� Driver Co. Proj. No. Delivery Address JJ 1 Ia 4to4 Date Map Zone Scale Time: I Order Oty ProductCode UOM ProductDescripti—on Unit Price Amount Load Size Prod. No. Description Slump Type CC Use nt Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # i1r_�lk'tl�.: Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight-fitbrg eye protection when woddrg with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or arse into contact with wet (unhardened) concrete, mortar, cement or cernent mbMres. Aggre-gates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (lag sleeves, pants and glares). If burned, cool with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this job with inch slump. machinery in the manner required to perform our contract with you may Arrived at d p � possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance ofthe taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received „ z iJ ( appurtenances, at: by x Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signa ture ure of Owner or its Agent NWGDELIKI09D408 Leave Plant Arrive Job Sit Start Discharg Finish Discharge Leave Job Site Arrive Plant Drivers Comments _ Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code Customer Delivery Address Delivery Instructions C1JST0MEPj0 FICE 3404186 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. ICON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98106 206-767-2521 TICKETNO. Driver Load Qty Delivered Qty Order Qty ProductCode UOM Product Description Date Map Stale Time: Unit Price Load Size Prod. No. Description Slump Type CC Use Haul. Co- Fit/Plant Sales Tax TOTALDUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Co. Proj. No. Zone Amount Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly, rinse these materials from clothing. Seek immediate medics attention t you have persistent or severe cl soornfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, Cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (kxhg sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this job with inch slump. machinery in the manner required to perform our contract with you may Arrived at 1 p � possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility, pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent . 9 _ . _ g NWGDELe Plant Leave Plant Arrive Job Sit Start Dischar Finish Dischar e, Leave Job Site Arrive Plant Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO Customer Delivery Address Delivery Instructions Load City Delivered Qty Order Qty Product Code UOM Product Description 16. 00 134. lib 1. L (Gross Tare Net I rk : 55660 23660 32000 . Tr. lr: Js. CUSTOMEPJOFFICE 3404199 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for productdefectis he return of the purchaseprice. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. CON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98106 206-767—E521 Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount III nAp r-nuIN-r: 9 CZN: Load Size Prod. No. Description Slump Type CC Use Hain Cd. Pit/Plant Sales Tax _ Check TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by # aaaaas-a_.aaa�.�aa--aaaar-asap—�aaa���a ���a�aaa� Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to s4:nd in wet ccncrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention ff you have persistent or severe discornfordn case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to ell persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing ftanes. Also, Asphalt may cause severe bums. Wear protective safety gear (lag sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. possibly cause damage to the premises or property. it is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the perfomtance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent _ _. NWGDELTKTO90408 Leave Plant 1 Arrive.Job Sit $tart Dfscharg Finish Discharger Leave Job Site Arrive Plant Drivers' Comments CUSTOMER/OFFIC7 3404316 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Driver Co. Proj. No. Customer Delivery Address Date Map zone Delivery Instructions Scale Time: Load Qty Delivered Qty OrderQty ProductCode UOM Product Description Unit Price Amount ',atttlli/1�� t J 1A !L rr� +elaaaatt.: Load Size Prod. No. Description Slump Type CC Use Haut Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned. long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear krtee pads to protect knees. After contact with any of these materials, wash off immediately wit fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discornfort.in case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may he hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing hmres. Also. Asphalt may rase severe bums. Wear protective safety gear (brig sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customers own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this with inch slump. machinery in the manner required to perform our contract with you may Arrived at d p El possibly cause darnaJe to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contest with me, 1 the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for arty personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Leave Plant Arrive. Job Site Start Discharg Finish Discharge Drivers' Comments Company/ Order No. Cust. No. Customer Job Customer Delivery Instructions Delivered Oty OrderOty and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent __....._.___... NWGDELTKTO90.408 Leave Job Site Arrive Plant Customer POi Phase Code Delivery Address Pii_ HL_ i H TICKET NO. CUSTOMER/OFFICE 3404334 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. t 161i�i ill�� �il�l j;��� i�il� �I�I� �li�;,I�'�;@ i ��f!• Driver Co. Proj. No. UOM Product Description Unit xr, SUF'E;E?PAVE:. 1:.`„ PG 64-..,:2 Date Map Zone Scale Time: Load Size Prod. No. Descri tion + p � Slump Type CC Use Haul Cd. Pit/Plant Sales Tax ' TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # r_ter_����i��� r_� Concrete: Injurious to eyes.Causes skin iritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cernent or cament mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a 4 illy -buttoned, long -sleeve shirt, full-length trousers and tight fitting eye protection when working with these materials. If you have to stand in wet come%, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothN. Seek immediate medical aftenbon ff you have persistent or severe discDrnfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or came into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing furnes. Also, Asphalt may case severe bums. Wear protective safety gear (tire sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contact with you may Arrived at job with inch slump. a possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal wale, at custo Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me,1 the undersigned, hereby INDEMNIFY tie Other additions seller and its employees for any damage and for all darns to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by x Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Leave Plant Arrive Job Sit Start Discharg Finish Discharge Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Company/ Customer Job Load Qty Delivered Oty OrderQty Load Size Prod. No. Description and RELEASE the seller and its employees from [."ON any liability. 1.115 CUST0t,4ER/GFF1CF 3494317 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited WamanN The only liability of the seller for product defect is he return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. MATERIALS SOUTH 96TH Signature of Owner or Its Agent SEATTLE., WA 98108 206—•767--2521 Leave Job Site Arri�; Plant' i i I��1111111111�III�INM�IINII Customer PO/ Phase Code TICKETNO. Driver Co. Proj. No. Delivery Address Date Map Zone Scale Time: ProductCode UOM Product Description Unit Price Amount Slump Type CC Use HatA,Cd `�tir11rrrr►rl► �l '4 I Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when waking with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discomfordn case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health Measures to control fugbe dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing times. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE' due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this job with inch slump. machinery in the manner required to perform our contract with you may Arrived at J p a possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contact with me. I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines a cables, telephone lines, driveway or other Received by x appurtenances, at: Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability e Signature of Owner or its Agent CUST©MERiOFFICE 3404204 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. R: . Signature of Owner or its Agent _ ._ GDELTKT090408 t • G Q t .tart Discharg Finish Discharge Leave Job Site Arrive Plant Leave Plant Arri3e Job SiSit ! r Drivers' Comments + Order No. Cust. No. Customer Delivery Instructions Load Qty Delivered Qty Company/ Customer PO/ Customer Job Phase Code TICKET NO Delivery Address ctCode UOM ProductDescript OrderOty Produion Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount \ttfltltlf� a Kg�••�Al ••e V i =.H x :: t �• 1L W. l w .• R O •• t Load Size Prod, No. Description 7 Slump Type CC Use Haul Col. Pit/Plant Sales Tax �s TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by - Check # Ta R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: G]PANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Re: Job Number: Transmittal Letter September 13, 2011 Andrew Weygandt Benson Road 16" WM These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval X For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy to: Signature Yary Pankiewicz Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, CUSTOM ERiOFFICE unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Weer waterproof gloves, a fully -buttoned, long -sleeve shirt, full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing s as dangerous so promptly rinse these materials from clothing. Seek immediate medical atenbon if you have persistent or severe 3 4 0 7 5 4 7 discornfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons Who may use a come into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cruse severe bums. Wear protective safety gear (Iong sleeves. pants and gloves). If burned, cod with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE- Unloading & Standby Excess unloading will be due to wateradded above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contact with you may time charged at posted truck time rates. Arrived at job with inch slump. El possibly cause damage to the premises or property. It is our wish to help —f— you n everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water dt customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is the return of the purchase price. In no taken seller of its contact with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions J seller and its employees for any damage and for all daims to the premises, incidental or consequential damages resulting from j building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received / appurtenances, at: warranty. All claims for damages or shortages must be b �y , pP made within 24 hours of deliver We do not ass me Buyer's Agent receipt of and approval of any added items. The addition of any extra-broducts to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. responsibility for any damage beyond the curb line. and RELEASE the seller and its employees from N 1'ii i h c. k I f-ii_'S any liability. 1 115 SOUTH 96TH SEATTLE, WA 98108 Signature of Owner or its Agent 2112116_7E7_.2521 . _ or itAgent _ DELTKT09040� . Signature of Owner _ _ Start_ Discharge Finish e Plant Discharge Leave Job Site Arrive Leave Plante Arrive Job Sit�s I . Drivers' - -I Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKETNO. Customer Delivery Instructions Delivery Address Load Qty Delivered Qty Order Qty Product Code UOM Product Description Load Size Prod. No. Description Slump Type NVII�NMN�IAI�11;��9� Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount CC Use Hat8Ccl. Pit/Plant Sales Tax TOTAL DUE Truck Q3ross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, CUSTOMER/OFFICE unhardened mnc4te, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirt, fulNength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete. wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect oontad through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discomfortln case of eye contad, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User 3407535 agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement a oernent mixtures. Aggreclates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugiWe dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing k rtes. Also, Asphaft may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. a possibly cause damage to the premises or property. It is our wish to help you in everyway that we can. but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at oust request Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is the return of the purchase price. In no taken seller of is conhact with me, I the undersigned. hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and is employees for any damage and for all claims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any. Received y , _ _ appurtenances, at: warranty.;.')All imsfordamagesorshortagesmustbe b y X made within 24 h f A.] W. d t Buyer's Agent receipt The addition of any exb expressed or implied by personal injury incurred mixer. approval of any added items. r ducts to our mixer may void any warranty e seller. The seller accepts no liability for any by you while adding additional products to our and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent rgnaure o wrier . or its Agent g ___... DELTKTQ90.40 Leave Plant Arrive Job Site Start Discharg Frnfsh Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Customer ours o e Nary. a ono assume responsibility for any damage beyond the curb line. i.;UN 1'*441ERIALS 1.115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 Company/ Customer PO/ Cust. No. Customer Job Phase Code TICKET NO. Driver Co. Proj. No. Delivery Instructions Load Qty Delivered C ty Order Qty Delivery Address Date . 'J�_,'�, +_:_,: _.: _. •_!i a� � � 1 Map Zone scale Time: ProductCode UOM Product Description Unit Price Amount �itllrrrrJJ, j4 JJJJJtlttlll, Load Size Prod. No. Description Slump Type CC Use Hauf Cd. PiUPlant Sales Tax TOTALDUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # ova-��aa-asr•as-a•��a��r•a�������-����-��� ��������� a-3 77 314' SPLICE HOLES IN CHANNEL 1' 1 &W 0.! RAIL AND SPLJCE PLATE, FOR 5W CARRIAGE BOLTS � I � I 314' • 7 POST SOLT SLOT IN CHANNEL Pour "- RAIL AND SPLICE PLATE, FOR S/B' BUTTON HEAD BOLT W7 7137 OVAL ' GRIP AND RECESSED NUT I i tT Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixtures can cause skin irritation. severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long oleeve shirt, rulHength trousers and tight-fdbng eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention lt you have persistent or severe discomfort.ln case of eye contact. flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or anent mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (lag sleeves, pants and gloves). If burned. coat with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment. in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Amved at job with inch slump. a possibly cause damage to the premises or property, it is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all dams to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received _ appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any extra products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Signature of Owner or its Agent t I�WGDELTKTO90408 Leave Plant Arrive Job Sitj Start Discharge) Finish Discharge Leave Job Site I Arrive Plant Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Customer Delivery Address Delivery Instructions Load Qty Delivered Qty Order Qty Load Size Prod. Truck Gross Weight Tare Weight ProductCode UOM Product Description Slump Type Trailer Trailer Taken CUSTOMERiOFRCE 3404297 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount '•'1 Use Haul Col. PittPiant Sales Tax TOTAL DUE Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cement or cement mixhires can cause skin initation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, longsleeve shirt, fulNength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe disco nfort.in case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cone into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also. Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contract with you may Arrived at job with inch slump. possibly cause damage to the premises or property. It is or wish to help you in everyway that we can, but in order to do this, the operator is as" Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me. I the undersigned. hereby INDEMNIFY the Other additions ~ �\ seller and its employees for any damage and for all claims to the premises, 1� building, utility pipelines or cables. telephone lines, driveway or other Received appurtenances, at: by Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from The addition of any abhor products to our mixer may void any warranty any liability. expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our _ mixer. Signature of Owner or its Agent Signature of Owner or its Agent ____... GDELTKT090408 Leave Plant Arrive Job Sit9 Start Discharge Finish Discharge Leave Job Site I Arrive Plant Drivers' Comments _ Order No. Cust. No. Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code Delivery Address Load Qty Delivered Qty OrderQty ProductCode Liras_ Tare C/rl , TICKETNO CUSTOMER/OFFICE 3404265 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is hereturnofthepurchaseprice.Inno event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delrvery.We do not assume responsibility for any damage beyond the curb line. Driver Co. Proj. No. Date Map Zone Scale Time: UOM Pro —du ctDescription L C„ F`G,4— Unit Price Amount ,rtt U 1)r ,,,I `` � • Q i • 7V rt �V� Load Size Prod. No. Description Slump Type CC Use Haul Cd. PittRant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin iritation.Contains Portland Cement. Read the following waming before using: Contact with wet, CUSTOMER/OFFICE unhardened concrete, mortar, cement or cernemt mixtures can cause skin iVitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, longLdeeve shirt. fulklength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wef ooncrete, usd waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials. wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 9 you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for a at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User F 0 4 2 8 2 agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement a ixtu cement mres. 3 �A Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and glove;;). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buye(s agent agrees to accept responsibilityfor reduced strength The operator of this piece of heavy equipment in presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. possibly cause damage to the premises or property. It is our wish to help you n everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect is the return of the purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all dims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be b y X F� made within 24 hours of delive We do not as m Buyer's Agent receipt of product and approval of any added items The addition-bf-any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent gl r Finish Discharge' Leave Job Site Leave Plant ArriveJobSite Start Discharge, • Drivers' Comments Company/ Order No. Cust. No. Customer Job Customer Delivery Instructions Customer PO/ Phase Code Delivery Address Arriv Plan su e responsibility for any damage beyond the curb line. SON i : _. _ -- .115 SOUTH 96TH SEATTLE, WA 98108 206-767--2521 TICKETNO. Driver Co. Proj. No. Load Oty Delivered Qty OrderQty ProductCode UOM ProductDescription rh8'1r;'11 Date Map Zone Scale Time: Unit Price Amount ,`' I I ;I I r a 1 1 r7' , ` (t�� tom, •';�`� � J •Cy J � Load Size Prod, No. Description Slump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # i;'c` Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, oUSTOMEcRiJFFICr unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully -buttoned, long~sleeve shirt, fulNength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from dothing. Seek immediate medical attention if you have persistent or severe 3404264 discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (kxg sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release d B r re uceRsstrength. uye sagent agrees toaccept responsibility forreducedsuength The operator of this piece of heavy equipment, In presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby Arrived at job with inch slump. machinery in the manner required to perform our contract with you may possibly cause damage to the premises or property. It is our wish to help time charged at posted truck time rates. you in everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for defect fhe Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance d the product is return of the purchase price. In no taken seller of its contract with me. I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables. telephone lines, driveway or other incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages be Received appurtenances, at: must maA. within W h f d 1 W d t by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void arty warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent ure of Owner or its Agent ..__--NyyGDELTKT090408 Leave Plant Arrive Job Sit Start Discharge Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Company/ Customer PO/ Order No. Cust. No. Customer Job Phase Code TICKET NO. Customer Delivery Address VARIOUS LIDCi-�VIC Delivery Instructions Load Qty DeliveredQty Order Qty ProductCode UOM P-rod uctDescription •ar,oss Tare Net Tr-Ir . ours o e Ivery. e o no assume responsibility for any damage beyond the curb line. ILOiv MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 U1-'t RPPV, 1 / 1-'ti 64- f- / bj - Load Size Prod. No. Description Slump Type Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount ',�•ttttrrrrrrr� e?&e el �''rrrrrtttt�� CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin imtaton.Contains Portland Cement. Read the following warning before using: Contact with wet, CUS ± OMER/pFFICE unhardened concrete, mortar, cement or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, a fully-buttongd, long -sleeve shil-CfulNength trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet cahcrete, use waterproof boots that are tight at the top and high enough to keep concrete from flawing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe 3404278 discomfort.in case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or aurae into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Acl-greciates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken Men handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (kxg sleeves, pants and gloves). If turned, cod with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reducedssuength.Buyersagentagreestoacceptresponsibilityforreducedstrength due to water added above design. The operator of this piece of heavy equipment, in presenting this RE- LEASE to you for your signature, is of the opinion that the operation of this Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby Arrived at job with inch slump. El machinery in the manner required to perform our contract with you may possibly cause damage to the premises or property. It is our wish to help time charged at posted truck time rates. you in everyway that we can, but in order to do this, the operator is asking Lim Warranty The only liability of the seller for is the Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the productdefect product return of the purchase price. In no taken seller of its contract with me, I the undersigned, hereby INDEMIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other incidental or consequential damages resulting from the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages must be d th' ')A h f d I W d t by X ! �f Buyer's Agent'receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. Signature of Owner or its Agent Leave Plant Arrive Job Sit . Start Discharge Drivers' Comments Order No. Cust. No. Customer Delivery Instructions and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent MWGDELTKT090408 Finish Discharge Leave Job Site Arrive Plant Company/ Customer Job Load Qty Delivered Qty Order Qty Trk: TrIr,e LOAD COUNT: Load Size Prod. No. Description Weight Tare Weight r- ma a wi m ours o e every. a ono assume responsibility for any damage beyond the curb line. ICON MATERIALS 1115 SOUTH 96TH SEATTLE, WA 98108 206-767-2521 Customer PO/ Phase Code TICKETNO. Driver Co. Proj. No. Delivery Address Date Map Zone ProductCode UOM Product Description FIG 64- ,_ ,._ Slump Type CC Use Hatf Cc Trailer Trailer Taken by Check # Scale Time: Sales Tax TOTAL DUE ANN Concrete: Injurious to eyes.Causes skin irdtabon.Contains Portland Cement. Read the following warning before using: Contact with wet, CUSTOMENCIFFiCE unhardened concrete, mortar, cement or cement mixtures can cause skin irtitation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear waterproof gloves, p fully-buttonQd, long sleeve shirt,'full-length trousers and tight -fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are fight at the top and high enough to keep concrete from floMng into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention 6 you have persistent or severe discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician irmnediatey. KEEP out of reach of children! User 3404292 agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement mixtures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing flames. Also, Asphalt may cause severe bums. Wear protective safety gear (lag sleeves, pants and gloves). If burned, cod with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce itsstrength.Buyersagentagreestoacceptresponsibilityforreducedstrength The operator of this piece of heavy equipment, In presenting mis ttt- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required th perform our contract with you may time charged at posted truck time rates. Amved at job with inch slump. E-] possibly cause damage to the premises or property. It is our wish to help you in everyway that we can. but in order to do this, the operator is asking Limited Warranttyy The only liability of the seller for Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the product defect isihereturnofthe purchase price. Inno taken seller of its contract with me, I the undersigned, hereby INDEMNIFY the event shall the seller be liable for any direct, indirect, Other additions seller and its employees for the consequential damages resulting from any damage and for all claims to the premises, incidental building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any Received appurtenances, at: warranty. All claims for damages or shortages mustbe made within 24 hours of deliver W. d n t by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent Leave Plant ' Arrive Job Site Start Dischar Finish Dischar a Leave Job Site Drivers' Commerits Company/ Order No. Cust. No. Customer Job Customer Customer PO/ Phase Code Delivery Address Arrive Plant y. e o o assume responsibility for any damage beyond the curb line. I CcifJ rr1HTE R T AL.''J 1115 SOUTH 96TH SEATTLE, Wit 98108 206-767-2521 TICKETNO. Driver Co. Proj. No. Date vt�p Zone Delivery Instructions Scale Time: 1 Load Qty Delivered Qty Order Oty ProductCode UOM Product Description Unit Price Amount �rrrrrrtr+�� t + • �• •,•A. �. Load Size Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plint Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet, CUST F unhardened concrete, mortar, cement or cement mixtures can cause skin irritatan, severe chemical bums or serious eye damage. Avoid contact with �� E a,�O `� i�i E eyes and skin. Wear waterproof gloves, a fuljy-buttoned, Igng sleeve .flirt, fulNength trousers and light -filing eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are fight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear knee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe 3404299 discorrfortln case of eye contact flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement matures. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health, Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (Io g sleeves, pants and gloves). If burned, cool with water and see a physician. Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, In presenting this RE- Unloading & Standby Excess unloading will be due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this charged at posted truck time rates. Truck standby machinery in the manner required to perform our contract with you may time charged at posted truck time rates. Arrived at job with inch slump. possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Limited Warranty The only liability of the seller for Added gal water at customer request. Test cylinders 4en that you sign this RELEASE. In consideration of the performance of the its with me, I the undersigned, hereby INDEMNIFY the product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, Other additions 1 seller of contact seller and its employees for any damage and for all claims to the premises, incidental or consequential damages resulting from building, utility pipelines or cables, telephone lines, driveway or other the use of the products or arising out of breach of any warrant All claims fordama es orshorta esmustbe Received ' < , t..�� y` b x appurtenances, at: made within 24 hours of deli ery.We do not assume y responsibility for any damage beyond the curb line. Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from 1 CON MA i E1 I AL S The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any any liability. 1115 SOUTH 96TH personal injury incurred by you while adding additional products to our SEATTLE, WA 98108 mixer. Signature of Owner or its Agent 5 _, 206-767-2��1 . Signature of Owner or its Agent ___ __ WGMTKT0.9.04➢ Leave Plant Arrive Job Site Start Discharg� Finish Discharge) Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No. Customer Delivery Instructions Load Qty Delivered Qty GV-0SS Trk: 555E0 Tv, I r : Company/ Customer PO/ Customer Job Phase Code Order Qty Delivery Address Product Code TICKETNO. UOM Product Description Driver Co. Proj. No. Date Map Zone Scale Time: Unit Price Amount LOAD COUNT: 2 Load Size Prod. No. Description Slump Type CC Use Haul MCd. PiuPlant Sales Tax TOTAL DUE f3ross Weight Tare Weight Trailer Trailer Taken by Jfrlo 1 L.. Check # �.t., - � - Lti _ r-4 � ���. f - l r �- _� �' �� -11 __*51_ _ � Concrete: Injurious to eyes.Causes skin irdtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cernerit or cement mixtures can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear Aerproof gloves, a fully -buttoned, to g-sleeve shirt, full-length trousers and tight -fitting eye protection when workirg with these matenals. If you have to staid in :xt mncrete, use waterproof boots that are fight at the top and high enough to keep concrete from flowing into them. If finishing concrete, wear illnee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention I you have persistent or severe discornfordn case of eye contact, flush with plenty of water for at least 15 minutes. ConwIt physidan immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or come into contact with wet (unhardened) concrete, mortar, cement or cement aftres. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cue severe bums. Wear protective safety gear (lag sleeves, pants and gloves). If burned, cool with water and see a physician. i Water added at customer's own risk Additional water added to concrete will Property Damaglndemnification & Release reduce its strength.Buyer's agent agrees to accept responsibility for reduced strength The operator of thl -ftce of heavy equipment, in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this Arrived at job with inch slum . machinery in the manner required to perform our contract with you may p possibly cause damage to the premises or property. It is our wish to help you in everyway that we can. but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the taken seller of its contract with me. I the undersigned, hereby INDEMNIFY the Other additions seller and its employees for any damage and for all claims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner of its Agent Signature of Owner or its Agent NWGDELTKT090408 __._ - Leave Plant Arrive Job Site Start Discharg Finish Discharges Leave Job Site Arrive Plant Drivers' Comments Company/ Order No. Cust. No. Customer Job Customer Delivery Instructions Customer PO/ Phase Code TICKET NO Delivery Address Load Qty Delivered Qty OrderQty ProductCode UOM Product Description CUSTOMEIR'OFFiCE 3404548 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of delivery.We do not assume responsibility for any damage beyond the curb line. Driver Co. Proj. No. Date Map zone Scale Time: Unit Price Amount Load Size Prod. No. Description Stump Type CC Use Haul Cd. Pit/Plant Sales Tax TOTAL DUE Truck Gross Weight Tare Weight Trailer Trailer Check # ohm Concrete: Injurious to eyes.Causes skin imtation.Contains Portland Cement. Read the following warning before using: Contact with wet, unhardened concrete, mortar, cemerR or cement mixhtres can cause skin irritation, severe chemical bums or serious eye damage. Avoid contact with eyes and skin. Wear wArproof gloves, a fully-butoned, long -sleeve shirt full-length trousers and tight -filling eye protection when working with these materials. If you have to stand in wok rpncrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them. Iffinishing concrete, wear Llee pads to protect knees. After contact with any of these materials, wash off immediately with fresh, dean water. Indirect contact through clothing 6 as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe discomfort h case of eye contaft flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User agrees to convey this warning to all persons who may use or cane into contact with wet (unhardened) concrete, mortar, cement or cement rnixbres. Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health. Measures to control fugitive dust should be taken when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective safety gear (long sleeves, pants and gloves). If bummed, coal with water and see a physician. Water added at customers own risk. Additional water added to concrete will Property Damage Indemnification & Release reduce its strength.Buyer s agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment. in presenting this RE - due to water added above design. LEASE to you for your signature, is of the opinion that the operation of this machinery in the manner required to perform our contact with you may Arrived at job with inch slump, possibly cause damage to the premises or property. It is our wish to help you in everyway that we can, but in order to do this, the operator is asking Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the perfomhance of the taken seller of its contract with me. I the undersigned, hereby INDEMNIFY the Other additions seller and Its employees for any damage and for all daims to the premises, building, utility pipelines or cables, telephone lines, driveway or other Received appurtenances, at: by X Buyer's Agent receipt of product and approval of any added items The addition of any extra products to our mixer may void any warranty expressed or implied by the seller. The seller accepts no liability for any personal injury incurred by you while adding additional products to our mixer. and RELEASE the seller and its employees from any liability. Signature of Owner or its Agent Signature of Owner or its Agent WGDELTKT09040$ Leave Plant Arrive Job Site Start Dischargq Finish Discharge Leave Job Site Arrive Plant Drivers' Comments Order No. Cust. No Customer Delivery Instructions Company/ Customer PO/ Customer Job Phase Code Delivery Address TICKET NO Load Qty Delivered CIty OrderQty ProductCode UOM Product Description u C'CSTOMER/JFFiCE 3404545 Unloading & Standby Excess unloading will be charged at posted truck time rates. Truck standby time charged at posted truck time rates. Limited Warranty The only liability of the seller for product defect is the return of the purchase price. In no event shall the seller be liable for any direct, indirect, incidental or consequential damages resulting from the use of the products or arising out of breach of any warranty. All claims for damages or shortages must be made within 24 hours of dellvery.We do not assume responsibility for any damage beyond the curb line. Driver Date Map Scale Time: Unit Price Load Size Prod. No. Description Slump Type CC Use Haul,Cd. PiUPlant Sales Tax .J TOTALDUE Truck Gross Weight Tare Weight Trailer Trailer Taken by Check # IF Co. Proj. No. Zone R cot Aha Company GENERALCONTRACTORS AUG 2 6 PUMPING STATIONS 107 WILLIAMS AVENUE SOUTH _ ROAD CONSTRUCTION RENTON, WA 98055 E-MAILADDRESS: GMANK@RT k,41ACCOM - CONCRETE STRUCTURES (425) 226-8100 OFFICE UNDERGROUND UTILITIES (425) 226-8649 FAX LARGE DEWATERING EQUIPMENT August 24, 2011 City of Renton 1055 South Grady Way Renton, WA 98057 Re: Benson Road Water Main Project Bid Item No. 11 ATTN: Andrew Weygandt Dear Andrew, Alia excavated/backfilled 4 each. Alia piped 2 each. City of Renton piped 2 each (oversized 1 ''/2" — 2" water services. Would have been change order to Alia). Alia expended labor and equipment to assist beyond normal scope for connection to Linen Company and connection to 24" at 4TH & Main. Alia's contribution to the 2 each connections at least equals City of Renton's contribution to 2 each large water services. Therefore bid item No. 11 should pay Alia 4 each at full bid price. Mark Weatherbee should confirm this. Let me know. Thank you, R. L. Alia Co any) Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC' 104PT R co .4 a Company GENERAL CONTRACTORS PUMPING STATIONS 107 WILLIAMS AVENUE SOUTH ROAD CONSTRUCTION RENTON, WA98055 E-MAILADDRESS: GJPANK@RLALIA.COM CONCRETE STRUCTURES (425) 226-8100 OFFICE UNDERGROUND UTILITIES (425) 226-8649 FAX LARGE DEWATERING EQUIPMENT August 24, 2011 City of Renton 1055 South Grady Way Renton, WA 98057 Re: Benson Road Water Main Project Added Work ATTN: Andrew Weygandt Dear Andrew, Attached are invoices for materials only used at 5TH & Main connection and at 4TH & Main connection. As you can see the total comes to $1,179.79. Please include for payment on the next pay estimate. Thank you, R. L. Alia C pany) Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC' 104PT Coversheet R. L. Alia Company Work for City of Renton Benson Road WM LABOR Foreman Operator Pipelayer Truck Driver Carpenter Flagger Laborer 29% markup COMPANY EQUIPMENT 200 Komatsu 200 Komatsu 938 Loader 580 Case 10 CY Dump Truck 1-Ton 3/4 Ton pickup JD 160 Mecahnic 1-Ton Sweeper 150 CFM Compressor SUCONTRACTORS 21 % markup 12% markup MATERIALS. RENTALS, OTHER H. D. Folwer Inv. No. 2977766 H. D. Fowler Inv. No. 2977581 H. D. Folwer Inv. No. 2977873 21 % markup Total Hrs/Units Rate Subtotal Total $62.60 $0.00 $60.50 $0.00 $50.24 $0.00 $55.92 $0.00 $58.67 $0.00 $42.06 $0.00 $49.36 $0.00 $0.00 0.00 $0.00 $64.86 $0.00 $10.00 $0.00 $8.66 $0.00 $25.70 $0.00 $35.96 $0.00 $12.39 $0.00 $1.40 $0.00 $9.90 $0.00 $17.00 $0.00 $15.05 $0.00 $8.14 $0.00 $0.00 0.00 $0.00 $0.00 $0.00 0.00 $0.00 0.00 $0.00 1 $269.85 $269.85 1 $352.59 $352.59 1 $352.59 $352.59 $975.03 204.76 $1,179.79 $1,179.79 H.D. FOWLER COMPANY PO Box 160, Bellevue, WA 98009-0160 Invoice Number 12977766 To Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009-0160 Phone 425-746-8400 • Fax 425-641-8885 Marysville Branch COPY 6016 29th Drive NE Marysville, WA 98271 MAWH (360) 651-2400 Fax (360) 658-5305 # 012830 �111111111111'11'1111111111111111111111111111111111111Jill 1111111 1 R L ALIA CONSTRUCTION 107 Williams Ave S Renton WA 98057-2149 Ship to: HD Fowler Company - Marysville 4/4 Marysville WA 98271 Order# Inv Date: Order Writer: 03703895 08/16/11 PATRICK SLAGLE Terms: NE 11 U I H HHUX Due: 09/10/11 PO/JOB: FOB: H. D. FOWLER Ship Via: WILL CALL BENSON ROAD WATERMAIN Qty Qty Part # Unit Extended T Line Ship'd BO'd UoM Description Price Price X 10" WEDGE ACTION MJ RETAINER GLAND FOR DIP 53.970 269.85 Sub total 269.85 Freight 0.00 Tax 0.00 Grand Total 269.85,, BILL Serving the Pacific Northwest since 1911 www.hdfowler.com I TO OUR CUSTOMERS: THESE ARE THE TERMS AND CONDITIONS OF SALE UNLESS STATED OTHERWISE ON FACE OF THIS OFFER: a. This offer will remain open for fifteen days. b. Terms of payment are net cash, due on the 10th of the month following date of shipment. c. Prices quoted are f.o.b. point of origin of shipments. d. Prices are based on current published freight rates and are subject to adjustment if freight rates are increased. e. Prices do not include excise, sales or use taxes and such taxes shall be added thereto. f. Prices include domestic packing for commercial truck shipment only. 2. Fowler's offer herein is subject to approval by our Credit Department after buyer's acceptance. 3. Shipment or delivery dates are estimates of our suppliers and are computed from the time of settlement of all details and receipt of full approval of drawings, where drawing approval is required. 4. The seller will not be liable for any failure or delay in making shipment or delivery caused by any contingency beyond his control, or the control of his suppliers or manufacturers, with whom he has contracted to cover this offer: such contingencies include but are not limited to: labor conditions, material shortages, carrier delays, acts of God, fire, weather, accidents, embargoes, war, insurrection, riots, Government regulations, or other causes beyond the control of seller, its suppliers and manufacturers. The non-occurance of the above -listed contingencies with respect to the seller, its suppliers and manufacturers, is a basic assumption of this offer. In no event will the seller be liable for consequential damages. 5. When materials are sold f.o.b. shipping point or f.o.b. shipping point freight allowed, our responsibility for loss or damage in transit terminates upon acceptance of material by the carrier. When sold f.o.b. destination. our responsibility for loss or damage terminates upon tender of delivery by the carrier. Upon receipt of shipments, it shall be the buyer's responsibility to inspect materials and secure written acknowledgement from delivering carrier for any loss or damage. Claims for shortages, other than loss in transit, must be made to us in writing within five (5) days after receipt of shipment. 6. Any contract resulting from the Buyer's offer may be terminated by the buyer only upon written consent of our home office and on terms which will indemnify Fowler against loss. 7. Material may not be returned without our written consent. Standard items normally carried in our stock, returned in a new condition, will be credited less Fifteen percent (15°,b) to cover handling costs. Special items manufactured to order may not be returned. All returned material must be shipped freight prepaid and the risk of loss will remain with the buyer until the seller receives the goods. 8. If buyer fails to comply with terms of payment or sale, or if buyer's financial responsibility becomes impaired or unsatisfactory to us, we reserve the right to withhold further deliveries on partially filled orders and to require payment in advance or satisfactory security or guarantee that invoices will be paid when due. Buyer agrees to accept and pay for partial shipments. The buyer will be liable for late fees on past due accounts at a per annum rate which may vary up to the maximum allowed by the law. For Washington, Oregon and Hawaii late fees will be 180/6 per annum. 9. In the event any balance due is turned over to an attorney for collection whether against buyer or through lien foreclosure, buyer shall pay all such attorneys' fees, costs and disbursements including, but not limited to, title reports, filing fees and the like. Jurisdiction shall be in the state of Washington. If suit is brought venue shall be in KING County, WA. Collection agency fees not to exceed 350/b shall be paid by buyer. The company shall also be entitled to its reasonable attorney's fees and actual cost for post judgment collection. 10. THE SELLER MAKES NO WARRANTY OF MERCHANTABILITY OF THE GOODS, OF THEIR FITNESS FOR ANY PARTICULAR PURPOSE, NOR SHALL FOWLER BE REQUIREDTO HOLDTHE GOODS FREE OFTHE CLAIM OF ANY THIRD PERSON BY WAY OF PATENT OR TRADE -MARK INFRINGEMENT, EXCEPT UNDER THE CONDITIONS AND TO THE EXTENT, IF ANY, THATTHEY ARE WARRANTED BY THE MANUFACTURER, WHOSE WARRANTY WILL BE FURNISHED UPON WRITTEN REQUEST. The seller will not be liable for any breach of such warranty unless and until it is first given a reasonable opportunity to inspect the material alleged to be defective and the installation and use made thereof. In no event will the seller be liable for consequential damages. 11, This offer, when accepted, supersedes all previous representations, promises, agreements or understandings, written or otherwise and is intended by the parties as a complete and exclusive statement of the terms of the agreement. Any modification of the terms of this agreement must be in writing signed by the party against whom such modification is to be enforced. 12. No field supervision is included unless otherwise stated. 13. Any statement contained on any purchase order or other document that is not approved or acknowledged, in writing, by H.D.Fowler Inc. is not considered a part of this agreement. L H.D. FOWLER COMPANY PO Box 160, Bellevue, WA 98009-0160 Packing Slip 2977581 Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009-0160 Page 1 Phone 425-746-8400 • Fax 425-641-8885 Bellevue Branch (Same as above) TO: R L ALIA CONSTRUCTION Ship to: HD Fowler Company - Bellevue 107 Williams Ave S 13440 SE 30th St Bellevue WA 98005 Renton WA 98057-2149 Order#: Inv Date: Order Writer: (425) 226-8100 Terms:NET LOTH PROX 03700968 08/16/11 JOSEPH PEDERSON FOB: H. D. FOWLER Ship Via: PO/Job: WILL CALL BENSON ROAD WATERMAIN Line Qty Qty UoM Part # Unit Extended T Ship'd BO'd Description Price Price x 1 1 1 EA IFZWARGO 352.590 352.59 24" WEDGE ACTION MJ RETAINER GLAND FOR DIP SIGNATURE: Sub -Total 352.59 Freight PRINTED NAME: RICK Tax Serving the Pacific Northwest since 1911 Grand Total 352.59 www.hdfowler.com TO OUR CUSTOMERS: THESE ARE THE TERMS AND CONDITIONS OF SALE UNLESS STATED OTHERWISE ON FACE OF THIS OFFER: a. This offer will remain open for fifteen days. b. Terms of payment are net cash. due on the 1 Oth of the month following date of shipment. c. Prices quoted are f.o.b, point of origin of shipments. d Prices are based on current published freight rates and are subject to adjustment if freight rates are increased. e. Prices do not include excise, sales or use taxes and such taxes shall be added thereto. f. Prices include domestic packing for commercial truck shipment only. 2. Fowler's offe, herein is subject to approval by our Credit Department after buyer's acceptance. 3. Shipment or delivery dates are estimates of our suppliers and are computed from the time of settlement of all details and receipt of full approval of drawings, where drawing approval is required. 4. The seller will not be liable for any failure or delay in making shipment or delivery caused by any contingency beyond his control, or the control of his suppliers or manufacturers, with whore he has contracted to cover this offer: such contingencies include but are not limited to: labor conditions, material shortages, carrier delays, acts of God, fire, weather, accidents, embargoes, war, insurrection. riots, Government regulations, or other causes beyond the control of seller, its suppliers and manufacturers. The non-occurance of the above -listed contingencies with respect to the seller, its suppliers and manufacturers, is a basic assumption of this offer. in no event will the seller be liable for consequential damages. 5. When materials are sold f.o.b. shipping point or f.o.b. shipping point freight allowed, our responsibility for loss or damage in transit terminates upon acceptance of material by the carrier. When sold f.o.b. destination, our responsibility for loss or damage terminates upon tender of delivery by the carrier. Upon receipt of shipments, it shall be the buyers responsibility to inspect materials and secure written acknowledgement from delivering carrier for any loss or damage. Claims for shortages. other than loss in transit, must be made to us in writing within five (5) days after receipt of shipment. 6. Any contract resulting from the Buyer's offer may be terminated by the buyer only upon written consent of our home office and on terms which will indemnify Fowler against loss. 7. Material may not be returned without our written consent. Standard items normally carried in our stock, returned in a new condition, will be credited less Fifteen percent (15%) to cover handling costs. Special items manufactured to order may not be returned. All returned material must be shipped freight prepaid and the risk of loss will remain with the buyer until the seller receives the goods. 8. If buyer fails to comply with terms of payment or sale, or if buyer's financial responsibility becomes impaired or unsatisfactory to us, we reserve the right to withhold further deliveries on partially filled orders and to require payment in advance or satisfactory security or guarantee that invoices will be paid when due. Buyer agrees to - accept and pay for partial shipments. The buyer will be liable for late flees on past due accounts at a per annum rate which may vary up to the maximum allowed by the law, For Washington, Oregon and Hawaii late fees will be 18% per annuni. 9. In the event any balance due is turned over to an attorney for collection whether against buyer or through lien foreclosure: buyer shall pay all such attorneys' fees, costs and disbursements including, but not limited to, title reports, filing fees and the like. Jurisdiction shall be in the state of Washington. If suit is brought venue shall be in KING County, WA. Collection agency fees not to exceed 35% shall be paid by buyer. The company shall also be entitled to its reasonable attorney's fees and actual cost for post judgment collection. 10. THE SELLER MAKES NO WARRANTY OF MERCHANTABILITY OF THE GOODS, OF THEIR FITNESS FOR ANY PARTICULAR PURPOSE; NOR SHALL FOWLER BE REQUIRED TO HOLD THE GOODS FREE OFTHE CLAIM OF ANY THIRD PERSON BY WAY OF PATENT OR TRADE -MARK INFRINGEMENT. EXCEPT UNDER THE CONDITIONS ANDTOTHE EXTENT, IF ANY: THATTHEY ARE WARRANTED BYTHE MANUFACTURER. WHOSE WARRANTY WILL BE FURNISHED UPON WRITTEN REQUEST. The seller will not be liable for any breach of such warranty unless and until it is first given a reasonable opportunity to inspect the material alleged to be defective and the installation and use made thereof. In no event will the seller be liable for consequential damages. 11. This offer, where accepted; supersedes all previous representations, promises, agreements or understandings, written or otherwise and is intended by the parties as a complete and exclusive statement of the terms of the agreement. Any modification of the terms of this agreement must be in writing signed by the party against whom such modification is to be enforced. 12. No field supervision is included unless otherwise stated. 13. Any statement contained on any purchase order or other document that is not approved or acknowledged, in writing; by H.D.Fowler Inc, is not considered a part of this agreement. H.D. FOWLER COMPANY PO Box 160, Bellevue, WA 98009-0160 Packing Slip 2977873 Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009-0160 Page 1 Phone 425-746-8400 • fax 425-641-8885 Bellevue Branch (Same as above) To: R L ALIA CONSTRUCTION Ship to: HD Fowler Company - Bellevue 107 Williams Ave S 13440 SE 30th St Bellevue WA 98005 Renton WA 98057-2149 Orderft: Inv Date: Order Writer: (425) 226-8100 Terms:NET LOTH PROX 03700968 08/17/11 JOSEPH PEDERSON FOB: H. D. FOWLER Ship Via: PO/Job: WILL CALL BENSON ROAD WATERMAIN Line Qty Qty UoM Part # Unit Extended T Ship'd BO'd Description Price Price x 1 1 EA IFZWARGO 352.590 352.59 24" WEDGE ACTION MJ RETAINER GLAND FOR DIP C v .J , - C i % C - ) SIGNATURE: Sub -Total 352.59 Freight PRINTED NAME: RICK Tax Serving the Pacific Northwest since 1911 Grand Total 352.59 www.hdfowler.com 'TO OUR CUSTOMERS: THESE ARE THE TERMS AND CONDITIONS OF SALE UNLESS STA'-ED OTHERWISE ON FACE OF f `-IiS OFFER: a. This offer will rernain open for fr€teen days. o. "terms of o,iyment are net cash, nue on tiie 10th of the month following date of shipment. c. Prices quoted are f.c.b, point of origin of sh;pnnents. d. Pikes are his ed on current pubiished freight rates and are subject to adjustment if freight rates are increased. e. Prices do not include excise, sales or use'axes and such taxes shall be added thereto. Prices include dnrrestic packing for comnlercjal truck shipment only. 2, Fokvler's offer herein is subject to approval by our Credit Department after buyer's acceptance. 3. Shinment or delivery dates are estimates of out- suppliers and are computed from the time of settlement of all details and receipt of full approval of drawings, where drawing approval is required. 4. The seller will not be liable for any failure or delay in making shipment or delivery caused by any contingency beyond his control, or the control of his suppliers or manufacturers, with whom he has contracted to cover this offer: such contingencies include but are not limited to- labor conditions, material shortages. carrier delays, acts of God, tire, weatho[, accidents. embargoes, war. insurrection, riots, Government regulations. or other causes beyond the ccntrol of seller. its suppliers and manufacturers. The non-occurance of the above -€fisted contingencies with respect to the seller, its suppliers and manufacturers, is a basic assumption of this offer. In no event will.the seller be liabi-_ for consequential damages. 5. When materials are sole f.o.b. shipping point or f.o.b. shipping point freight allowed, our responsibility for loss or damage in transit terminates upon acceptance of material by the carrier. When sold f.o.b. destination, our responsibility for loss or damage terminates upon tender of delivery by the carrier. Upon receipt of shipments, it shall be thr: buyer's responsibility to inspect materials and secure written acknowledgement from delivering carrier for any loss or damage. Claims `:cr � hortages, other than loss in transit, must be made to us in writing within five (5) days after receipt of shipment. 6 Any contract resulting from the Buyer's offer may ne terminated by the buyer only upon written consent of our come office and on terms which will indemnify Fowler against loss. 7. Materai may not be returned without our written consent. Standard items normally carried in our stock, returned in a new condition, will be credited less Fifteen percent (15%) to cover handling costs. Special items manufactured to order may not be returned. All returned material must be shipped freight prepaid and the risk of loss will remain vvith the buyer until the seller receives the goods. 8 if r;uyer fans to comply with terms of payment or sale, or if buyer's financial responsibility becomes impaired or unsatisfactory to us we reserve the right to withhold further deliveries on partially filled orders and to require payment i , advance or satisfactory security or guarantee that invoices will be paid when due. Buyer agrees to accept and pay for partial shipments. The buyer will be liable for late fees on past due accounts at a per annum rate which may vary up to the maximum allowed by the law. For Washington. Oregon and Hawaii late fees will be 13 � per annum. 9. In the event any balance due is turned over to an attorney for collection whether against buyer or through lien foreclosure, buyer shall pay all such attorneys' fees, costs and disbursements including, but not limited to, title reports, filing fees and the like. junsdiction shail be in the state of Washington. If suit is brought venue shall be in KING County, WA. Collection agency fees not to exceed 35%' shall be paid by buyer. The company shall also be entitled to its reasonable attorneys fees and actual cost for post judgment collection. 10. THE SELLER MAKES NO WARRANTY OF MERCHANTABILITY OF THE GOODS, OF THEIR FITNESS FOR ANY PARTICULAR PURPOSE, NOR SHALL FOWLER BE REQUIRED TO HOLD THE GOODS FREE OFTHE CLAIM OF ANY THIRD PERSON BY WAY OF PATENT OR TRADE -MARK INFRINGEMENT, EXCEPT UNDER THE CONDITIONS ANDTOTHE EXTENT, IF ANY, THATTHEY ARE WARRANTED BYTHE MANUFACTURER, WHOSE WARRANTY WILL BE FURNISHED UPON WRITTEN REQUEST. The seller will not be liable for any breach of such warranty unless and until it is first given a reasonable opportunity to inspect the material alleged to be defective and the installation and use made thereof. In no event will the seller be liable for consequential damages. 11. This offer, when accepted. supersedes all previous representations, promises, agreements or understandings, written or otherwise and is intended by the parties as a complete and exclusive statement of the terms of the agreement Any modification of the terms of this agreement must be in writing signed by the party against whom such modification is to be enforced. 12. No field supervision is included unless otherwise stated. 13. Any statement contained on any purchase order or other document that is not approved or acknowledged, in writing, by H.D.Fowler Inc. is not considered a part of this agreement. R cot Aha Company� GENERAL CONTRACTORS PUMPING STATIONS 107 WILLIAMS AVENUE SOUTH ROAD CONSTRUCTION RENTON, WA 98055 E-MAIL ADDRESS: GJPANK@RLALIA.COM CONCRETE STRUCTURES (425) 226-8100 OFFICE UNDERGROUND UTILITIES (425) 226-8649 FAX LARGE DEWATERING EQUIPMENT August 24, 2011 City of Renton 1055 South Grady Way Renton, WA 98057 Re: Benson Road Water Main Project Added Work ATTN: Andrew Weygandt Dear Andrew, Attached are invoices for mega lugs only used at Linen Company connection. As you can see the total comes to $537.01. Please include for payment on the next pay estimate. Thank you, R. L. Alia C mpai�y Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC* 104PT 09/23/2011 02:38 FAX 380 435 4012 CASCADE SURVEYIN CASCADE SURVEYING & ENGINEERING, INC. 105 E. Division - P. O. Box 326 • Arlington, WA 98223 (360) 435-5551 • fax: (360) 435-4012 www, ca sca desu rvevi nQ. com SURVEYOPS ENGINEERS PLANNERS 0001/002 s R. L. Alia Company Work for City of Renton Benson Road WM Materials Only - Linen Company Connection LABOR Foreman Operator Pipelayer Truck Driver Carpenter Flagger Laborer 29% markup COMPANY EQUIPMENT 200 Komatsu 200 Komatsu 938 Loader 580 Case 10 CY Dump Truck 1-Ton 3/4 Ton pickup JD 160 Mecahnic 1-Ton Sweeper 150 CFM Compressor SUCONTRACTORS 21 % markup 12% markup MATERIALS, RENTALS, OTHER H. D. Fowler, #2979343, 12" Retainer H. D. Fowler, #2979343, 8" Retainer 21 % markup Total Hrs/Units Rate Subtotal Total $62.60 $0.00 $60.50 $0.00 $50.24 $0.00 $55.92 $0.00 $58.67 $0.00 $42.06 $0.00 $49.36 $0.00 $0.00 0.00 $0.00 $64.86 $0.00 $10.00 $0.00 $8.66 $0.00 $25.70 $0.00 $35.96 $0.00 $12.39 $0.00 $1.40 $0.00 $9.90 $0.00 $17.00 $0.00 $15.05 $0.00 $8.14 $0.00 $0.00 0.00 $0.00 $0.00 $0.00 0.00 $0.00 0.00 $0.00 1 $78.61 $78.61 10 $36.52 $365.20 0.00 $443.81 93.20 $537.01 $537.01 H.D. FOWLER COMPANY PO Box 160, Bellevue, WA 98009-0160 COPY Invoice Number 12979343 PAWH # 012830 Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009-0160 Phone 425-746-8400 • Fax 425-641-8885 Pacific Branch 1417 Thornton Avenue SW Pacific, WA 98047 (253) 863-8600 Fax (253) 863-8681 To: Ship to: HD Fowler Company - Pacific 2/4 1 R L ALIA CONSTRUCTION 107 Williams Ave S Pacific WA 98047 r e nv Date: Order Writer: Renton WA 98057-2149 03705956 08/18/11 Jeffrey Emory erms: NET 10TM PROX FOB: H. D. FOWLER Due: 097 107 1 Ship Via: WILL CALL F, BENSON ROAD WATERMAIN Qty Qty Part # Unit Extended T Line Ship'd BO'd UoM Description Price Price X LESS ACCESS (64 LBS) 2 2 0 EA 8" MJ 90 ELL,DI,AWWA C153,C/L,LESS ACCESS (68 80.000 160.00 LBS) 3 1 0 EA 12" WEDGE ACTION MJ RETAINER GLAND FOR DIP 78.610 78.61 - 5 1 0 EA 12" GASKET AND T-BOLT KIT FOR C153 MJ 19.560 19.56 FITTINGS 6 10 0 EA 8" WEDGE ACTION MJ RETAINER GLAND FOR DIP 36.520 365.20 , 7 4 0 EA 8" GASKET AND T-BOLT KIT FOR C153 MJ FITTINGS 13.800 55.20 5�-L'1S; aj Sub total 755.88 Freight 0.00 Tax 0.00 Grand Total 755.88 ZITO Serving the Pacific Northwest since 1911 wvvw.hdfowler.com R. C�-t Aha GENERAL. CONTRACTORS 107 WILLIAMS AVENUE SOUTH RENTON, WA 98055 (425) 226-8100 OFFICE (425) 226-8649 FAX August 24, 2011 Company City of Renton 1055 South Grady Way Renton, WA 98057 PUMPING STATIONS ROAD CONSTRUCTION E-MAILADDRESS: GJPANK@RLALIA.COM CONCRETE STRUCTURES UNDERGROUND UTILITIES LARGE DEWATERING EQUIPMENT Re: Benson Road Water Main Project Added Work ATTN: Andrew Weygandt Dear Andrew, There were 2 separate pot holes performed at 5TH & Main for the purpose of possible redesign — 12" to 10". The combined total of the attached is $1,011.28 ($457.44 + $553.84). Please include for payment on the next pay estimate. It would be okay to pay these under bid item # 6 or per the attached on a change order. Thank you, R. L. Alia C Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC' 104PT R. L. Nlia Company Work for City of Renton Benson Road WM Pothole existing WM at 5th & Main for redesign connection - 10" LABOR Foreman Operator Pipelayer Truck Driver Carpenter Flagger Laborer 29% markup COMPANY EQUIPMENT 200 Komatsu 200 Komatsu 938 Loader 580 Case 10 CY Dump Truck 1-Ton 3/4 Ton pickup JD 160 Mecahnic 1-Ton Sweeper 150 CIFM Compressor 21 % markup SUCONTRACTORS 12% markup MATERIALS, RENTALS, OTHER 21 % markup Total Hrs/Units Rate Subtotal 1.5 $62.60 $93.90 1.5 $60.50 $90.75 $50.24 $0.00 $55.92 $0.00 $58.67 $0.00 $42.06 $0.00 1.5 $49.36 $74.04 $258.69 75.02 $64.86 $0.00 $10.00 $0.00 $8.66 $0.00 $25.70 $0.00 $35.96 $0.00 $12.39 $0.00 1.5 $10.00 $15.00 1.5 $58.17 $87.26 $17.00 $0.00 $15.05 $0.00 $8.14 $0.00 $102.26 21.47 $0.00 $0.00 0.00 $0.00 0.00 $0.00 $0.00 0.00 $0.00 0.00 08/ 10/11 Total $333.71 $123.73 $0.00 0.00 $457.44 R. L. Alia Company Work for City of Renton Benson Road WM Pothole existing WM at 5th & Main for redesign connection - 12" 08/11/11 LABOR Hrs/Units Rate Subtotal Total Foreman 2 $62.60 $125.20 Operator 2 $60.50 $121.00 Pipelayer $50.24 $0.00 Truck Driver $55.92 $0.00 Carpenter $58.67 $0.00 Flagger $42.06 $0.00 Laborer 1 $49.36 $49.36 $295.56 29% markup $85.71 $381.27 COMPANY EQUIPMENT 200 Komatsu $64.86 $0.00 200 Komatsu $10.00 $0.00 938 Loader $8.66 $0.00 580 Case $25.70 $0.00 10 CY Dump Truck $35.96 $0.00 1-Ton $12.39 $0.00 3/4 Ton pickup 1 $10.00 $10.00 JD 160 2 $58.17 $116.34 Mecahnic 1-Ton $17.00 $0.00 Sweeper $15.05 $0.00 150 CFM Compressor 2 $8.14 $16.28 $142.62 21% markup $29.95 $172.57 SUCONTRACTORS $0.00 $0.00 0.00 $0.00 12% markup $0.00 $0.00 MATERIALS, RENTALS, OTHER $0.00 $0.00 0.00 $0.00 21 % markup $0.00 $0.00 Total $553.84 R. L. Alia Company Work for City of Renton Benson Road WM Pothole existing WM at 5th & Main for redesign connection - 12" 08/11 /11 LABOR Hrs/Units Rate Subtotal Total Foreman 2 $62.60 $125.20 Operator 2 $60.50 $121.00 Pipelayer $50.24 $0.00 Truck Driver $55.92 $0.00 Carpenter $58.67 $0.00 Flagger $42.06 $0.00 Laborer 1 $49.36 $49.36 $295.56 29% markup $85.71 $381.27 COMPANY EQUIPMENT 200 Komatsu $64.86 $0.00 200 Komatsu $10.00 $0.00 938 Loader $8.66 $0.00 580 Case $25.70 $0.00 10 CY Dump Truck $35.96 $0.00 1-Ton $12.39 $0.00 3/4 Ton pickup 1 $10.00 $10.00 JD 160 2 $58.17 $116.34 Mecahnic 1-Ton $17.00 $0.00 Sweeper $15.05 $0.00 150 CFM Compressor 2 $8.14 $16.28 $142.62 21% markup $29.95 $172.57 SUCONTRACTORS $0.00 $0.00 0.00 $0.00 12% markup $0.00 $0.00 MATERIALS, RENTALS, OTHER $0.00 $0.00 0.00 $0.00 21 % markup $0.00 $0.00 Total $553.84 67 �--� Lea'x t�� �� Igo —J,� -71 L T-L,l� R oC.... Aha Company GENERAL CONTRACTORS PUMPING STATIONS 107 WILLIAMS AVENUE SOUTH ROAD CONSTRUCTION RENTON, WA 98055 E-MAIL ADDRESS: GJPANK@RLALIA.COM CONCRETE STRUCTURES (425) 226-8100 OFFICE UNDERGROUND UTILITIES (425) 226-8649 FAX LARGE DEWATERING EQUIPMENT September 21, 2011 City of Renton 1055 South Grady Way Renton, WA 98057 Re: Benson Road Water Main Project — Added Costs ATTN: Andrew Weygandt Andrew, RECEIVED SEP 2 6 2011 CITY OF RENTON UTILITY SYSTEMS Attached is a recap including costs from United Rentals for Arrow Boards and from Aabco Barricade for lighted barrels. The total comes to $571.64. As the overnight detour was unanticipated yet ordered, can we split these costs 50150? Each of us would pay $285.82. Please review and advise. Thank you, R. L. Alia Co pany Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC' 104PT R. L. Alia Company Work for City of Renton Benson Road WM Costs for overnight detour. LABOR Hrs/Units Rate Subtotal Total Foreman $62.60 $0.00 Operator $60.50 $0.00 Pipelayer $50.24 $0.00 Truck Driver $55.92 $0.00 Carpenter $58.67 $0.00 Flagger $42.06 $0.00 Laborer $49.36 $0.00 $0.00 29% markup $0.00 $0.00 COMPANY EQUIPMENT 200 Komatsu $64.86 $0.00 200 Komatsu $10.00 $0.00 938 Loader $8.66 $0.00 580 Case $25.70 $0.00 10 CY Dump Truck $35.96 $0.00 1-Tort $12.39 $0.00 3/4 Ton pickup $1.40 $0.00 JD 160 $9.90 $0.00 Mecahnic 1-Ton $17.00 $0.00 Sweeper $15.05 $0.00 150 CFM Compressor $8.14 $0.00 $0.00 21 % markup $0.00 $0.00 SUCONTRACTORS $0.00 $0.00 0.00 $0.00 12% markup $0.00 $0.00 MATERIALS RENTALS, OTHER United Rentals 1 $330.08 $330.08 Aabco Barricade 1 $142.35 $142.35 0.00 $472.43 21% markup $99.21 $571.64 Total $571.64 RENTAL RETURN INVOICE U United Rentals m 3 00 LIND AVENUE SW RENTON, WA 98055 .-800-UR-RENTS(800-877-3687) 425-656-5940 425-251-9042 FAX unitedrentals.com m WILL CALL 652 SEP 17 2011 3400 LIND AVE SW RENTON, WA 98057-4925 A O h Office: 425-226-8100 Cell: 206-423-3680 i Customer Number 225308 Invoice Date 9/13/11 Rental Out 9/12/11 10:30 AM Rental In 9/13/11 10:30 AM Job Location: WILL CALL RENTON #652, RENT Job Number 8 - RL ALIA CONSTRUC P.O. Number Ordered By RICK/GM Written By UR652VP Salesperson 3986 k RL ALIA CONSTRUCTION \ PAYMENT OF $330.08 DUE ON 10/13/11 107 WILLIAMS AVE S PAYMENT OPTIONS: Check(Mail) - Check(Fax) - Credit Card(Phone) 0 RENTON, WA 9 8 0 5 5 - 214 9 BILLING INQUIRIES: Ph# 800-509-1197 Fx# 209-579-7960 Um REMIT TO: UNITED RENTALS NORTHWEST, INC. FILE 51122 LOS ANGELES, CA 90074-1122 _Please detach and return top portion With payment RENTAL ITEMS: Qty Equipment Description 1 1200909 *ARROW BOARD, SOLAR Make: WANCO Model: WTSP55-LSAC Serial: 5F11S1018B1001292 1 981782 *ARROW BOARD, SOLAR Make: ALLMAND BR Model: APF2200 Serial: 0282AB07 1 1201054 *ARROW BOARD, SOLAR Make: WANCO Model: WTSP55-LSAC-09 l Serial: 5F11S1013B1001295 'SALES/MISCELLANEOUS ITEMS: i Qty Item 1 ENVIRONMENTAL CHARGE COMMENTS/NOTES: CONTACT: JASON MCGOVERN CELL#: 206-423-3680 Day Week 4 Week Amount 100.00 250.00 555.00 100.00 100.00 250.00 555.00 100.00 100.00 250.00 555.00 100.00 Rental Subtotal: 300.00 Price Unit of Measure Extended Amt. [ENV/MCI] 1.440 (EA) EACH 1.44 Sales/Misc Subtotal: 1.44 Agreement Subtotal: 301.44 Tax: 28.64 Total: 330.08 THIS INVOICE IS ISSUED SUBJECT TO THE TERMS AND CONDITIONS OF THE RENTAL AGREEMENT, WHICH ARE INCORPORATED HEREIN BY REFERENCE. A COPY OF THE RENTAL AGREEMENT IS AVAILABLE UPON REQUEST. Page: 1 5.1.15W 1 MB 0.390 41045S21.p07 2 of 2 AABCO BARRICADE COMPANY INC. 4025 80th St. S.W. • Mukilteo, WA 98275 Seattle (206) 363-6212 • Everett (425) 353-5619 Toll -Free (800) 559-6212 E-mail: infoCcbaabcosign.com Web: www.aabcosign.com Customer Name & Address: ALIA CONSTRUCTION CO. 107 WILLIAMS AVENUE SOUTH RENTON, WA 98055 Invoice Date: 09/15/11 Customer ID: 1001 INVOICE 89734 SIGN SHOP • ROAD SAFETY PRODUCTS • RENTAL & SALES SINCE 1978 Ep 2 Job Infomation: S 4TH ST & MAIN ST RENTON P.O. Number. - Job ID: s. Ordered By: KI M Contract ID: 26710 For Period: From: 08/16/11 To: 09/13/11 Slip #115015 Charge Dates PD Rate From Thru 30x24 Detour W/Arrow Up 5/8 WOOD D 0.60 08/16/11 09/13/11 09/13/11 09/13/11 Slip #115015 Charge Dates PD Rate From Thru Sign Stand For 30" & Under Sign D 0.40 08/16/11 09/13/11 09/13/11 09/13/11 Slip #115683 Charge Dates PD Rate From Thru 48" Abrupt Lane Edge WOOD 5/8 D 1.75 09/02/11 09/13/11 Slip #115683 Charge Dates PD Rate From Thru 48" Rough Road WOOD 5/8 D 1.75 09/02/11 09/13/11 09/13/11 09/13/11 Slip #115697 Charge Dates PD Rate From Thru 3-WAY Led Lite/w (D)Batteries D 0.35 09/12/11 09/13/11 Slip #1156970 Charge Dates PD Rate From Thru TRAFFIC BARREL W/ TIRE RING D 0.45 09/13/11 09/13/11 BASE .... Continued on Next Page.... CHG Days QTY Used 4 29 -3 0 CHG Days QTY Used 4 29 -3 0 CHG Days QTY Used 2 12 CHG Days QTY Used 3 12 -2 0 CHG Days QTY Used 25 2 CHG Days QTY Used 25 1 Use Qty 4 1 Total Use Qty 4 1 Total Use Qty 2 Total Use Qty 3 1 Total Use Qty 25 Total Use Qty 25 Total Total Rent R&M 42.00 63.00 17.50 11.25 249.75 We Invoice on the 15th and at End of Job (E.O.J.) - Terms Net 30 INTEREST AT THE RATE OF 1.5 PERCENT PER MONTH APPLIES TO ALL PAST DUE ACCOUNTS ALL ACCOUNTS SUBJECT TO MASTER CREDIT TERMS AND CONDITIONS Not responsible for placement of rental equipment INVOICE 09704 Page 2 SIGN SHOP • ROAD SAFETY PRODUCTS • RENTAL & SALES AABCO BARRICADE COMPANY INC. SINCE 1978 4025 80th St. S.W. • Mukilteo, WA 98275 Seattle (206) 363-6212 • Everett (425) 353-5619 Toll -Free (800) 559-6212 E-mail: infoanaabcosign.com Web: www.aabcosiqn.com Invoice Date: 09/15/11 Customer ID: 1001 Contract ID: 26710 For Period: From: 08/16/11 To: 09/13/11 Miscellaneous Notes, Charges, and Credits Date Description 09/12/11 115697 6 day Minimum $52.50 09/13/11 1156970 6 clay Minimum $67.50 09/12/11 B 1ST DAY CHG ON BARRELS $2.50EA 09/13/11 LOST 1 EA 30" SIGN STAND 09/13/11 LOST 1 EA 32X24 DETOUR UP 09/13/11 LOST 1 EA 48" ROUGH ROAD End of Job.... Amount Remaining Minimum 35.00 Remaining Minimum 56.25 62.50 31.50 59.75 88.50 Total Miscellaneous 333.50 Sales Tax 55.41 TOTAL INVOICE 638.66 NEED A TRAFFIC CONTROL PLAN CALL AABCO WE ARE HERE FOR YOU AABCO NOW HAS A FULL LINE OF SAFEY PRODUCTS AND NEW SEATTLE LOCATION THANK YOU FOR YOUR BUSINESS f 4 We Invoice on the 15th and at End of Job (E.O.J.) - 1T(=� ms Nat 30 INTEREST AT THE RATE OF 1.5 PERCENT PER MONTH APPLIES TO ALL PAST DUE ACCOUNTS ALL ACCOUNTS SUBJECT TO MASTER CREDIT TERMS AND CONDITIONS Not responsible for placement of rental equipment /�. c Aha Compan�f GENERALCONTRACTORS 107 WILLIAMS AVENUE SOUTH RENTON, WA 98055 (425) 226-8100 OFFICE (425) 226-8649 FAX November 4, 2011 City of Renton 1055 South Grady Way Renton, WA 98057 PUMPING STATIONS ROAD CONSTRUCTION E-MAILADDRESS: GJPANK@RLALIA.COM CONCRETE STRUCTURES UNDERGROUND UTILITIES Re: Benson road WM Project — Sawcutting Sawcut Issue ATTN: Andrew Weygandt Dear Andrew, I am not in agreement with your allowance for the saw cut issue. LARGE DEWATERING EQUIPMENT t1�pi 9 to des NOV 0 7 2011 CITY OF RENTON UTILITY SYSTEMS As no information as to the depth of the asphalt was provided with the project, and coupled with the City of Renton Standards (provided with the project) which state arterials are to be 8" thick asphalt, I cannot come to the conclusion that you have, that Alia should have anticipated and funded in its bid sawcut costs up to 10" in depth. It also needs to be conceded by Renton that coupled with any saw cut compensation are the costs to provide traffic control, flagging, vacuuming slurry and Alia supervision allowance for the time spent sawing the thick asphalt. To hold your proposal to $2,760 of sawcut costs should allow Alia to present the associated costs (mentioned above)that were part of the sawcut costs. These costs are attached for your review and comment. Applying the same % allowed in change order No. 2 results in our request for $2,028.43. Thank you, R. L. Alia Company Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC" 104PT R. L. Alia Company Work for City of Renton Benson Road WM Per/Day Costs related to flagging LABOR Foreman Operator Pipelayer Truck Driver Carpenter Flagger LaborerNacuum 29°% markup COMPANY EQUIPMENT 200 Komatsu 200 Komatsu 938 Loader 580 Case 10 CY Dump Truck 1-Ton 3/4 Ton pickup JD 160 Mecahnic 1-Ton Cones & Signs 150 CFM Compressor 21 % markup SUCONTRACTORS 12% markup MATERIALS, RENTALS, OTHER 21 % markup Total Hrs/Units Rate Subtotal Total 2 $62.60 $125.20 $60.50 $0.00 $50.24 $0.00 $55.92 $0.00 $58.67 $0.00 8 $42.06 $336.48 8 $49.36 $394.88 $856.56 248.40 $1,104.96 $64.86 $0.00 $10.00 $0.00 $8.66 $0.00 $25.70 $0.00 $35.96 $0.00 $12.39 $0.00 2 $1.40 $2.80 $9.90 $0.00 $17.00 $0.00 1 $100.00 $100.00 $8.14 $0.00 $102.80 21.59 $124.39 # f -No k, t W-V - � z ;to A�Lvo- :-- /5-7. $0.00 $0.00 0.00 $0.00 0m $0.00 $0.00 $0.00 0.00 $0.00 0.00 $0.00 $1,229.35 it NYS x i I X is ?o skcot Aha Company GENERAL CONTRACTORS PUMPING STATIONS 107 WILLIAMS AVENUE SOUTH ROAD CONSTRUCTION RENTON, WA 98055 E-MAILADDRESS: GJPANK@RLALIA.COM CONCRETE STRUCTURES (425) 226-8100 OFFICE UNDERGROUND UTILITIES (425) 226-8649 FAX LARGE DEWATERING EQUIPMENT October 4, 2011 City of Renton 1055 South Grady Way 0 C T 0 5 Z Renton, WA 98057 CITY OF`u UTILITY r=!IS Re: Benson Road Water Main Project — Added Costs ATTN: Andrew Weygandt Andrew, Attached is a recap including costs incurred to place beauty bark at Linen Company. As you can see the total comes to $759.96. Please include this for payment on the next pay request. Thank you, R. L. Alia Company, l Richard L. Alia, President CONTRACTOR'S LICENSE NUMBER RL-AL-IC' 104PT R. L. Alia Company Work for City of Renton Benson Road WM Beauty Bark all of Linen Co. LABOR Foreman Operator Pipelayer Truck Driver Carpenter Flagger Laborer 2 each 29% markup COMPANY EQUIPMENT 200 Komatsu 200 Komatsu 938 Loader 580 Case 10 CY Dump Truck 1-Ton 3/4 Ton pickup JD 160 Mecahnic 1-Ton Sweeper 150 CFM Compressor 21 % markup SUCONTRACTORS 12% markup MATERIALS, RENTALS, OTHER Carpinito 21 % markup Total Hrs/Units Rate Subtotal Total $62.60 $0.00 $60.50 $0.00 $50.24 $0.00 1 $55.92 $55.92 $58.67 $0.00 $42.06 $0.00 6 $49.36 $296.16 $352.08 102.10 $454.18 $64.86 $0.00 $10.00 $0.00 $8.66 $0.00 3 $25.70 $77.10 1 $35.96 $35.96 $12.39 $0.00 $1.40 $0.00 $9.90 $0.00 $17.00 $0.00 $15.05 $0.00 $8.14 $0.00 $113.06 23.74 $136.80 $0.00 $0.00 0.00 $0.00 $0.00 $0.00 7 $19.95 $139.65 $0.00 0.00 $139.65 29.33 $168.98 $759.96 10 Carpinito Brothers, Inc. 1148 N. Central Avenue 92 14 Kent, WA 98032 (253) 854-5692 or (206) 623-8103 D TE 1 SOLD TO: SHIP TO: �i s SALESMAN CASH ICHARGE RESALE TERMS QUANTITY OUANTI P0. #/AUTHORIZATION # ORDERED SDESCRIPTIUN TOTAL HIPPED PRICE ...................... ......................................................................................................................... ' ( ..).t1 . �'.� ......................... q, ....i...... t4J.y..u�.r. .................... ....... ...1�..... ....................... .�.....'.....�.. .................. - _ SUB TOTAL Received by 1 G Customer agrees not t °�Pold Carpinito Brothers, Inc. responsible for any % Tax damages caused by their truck driving over property at customer's request. Customer is liable for towing cost should the truck get stuck on customer TOTAL AMOUNT property. All accounts are due net 10th, past due accounts subject to 2% r finance charge plus collection expenses and reasonable attorney fees. CB-03 Transmittal Letter June 10, 2011 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT JUN 1 4 2011 (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM CITY OFRENTON ............ __. UTILITY Y4Tp__AS To: City of Renton Attention: Andrew Weygandt Attached ❑ ❑ Shop Drawings ❑ ❑ Copy of Letter ❑ ❑ Total Quantity ❑ Re: Benson Road 16" Job Number: We are sending you Under Separate Cover via: --- _.............. --- - Prints ❑ Plans ❑ Other: Change Order ❑ Samples Reproducible ❑ Specification -_----- _.__ ... . Quantity Date DWG. # Description 1 Certified Payroll -?;1 - Alia These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints Drli PAMKlf-wi(,z Signature c'a Statement of Compliance Date: *JNE 7, 2011 Contract Number: CAG-I1-044 1, GARY J PANKIEWIC4 ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 1 day of JUKE, 2011 and ending the 7 day of JUNE, 2011, 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 R.L. ALIA COMPANY 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 persort 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 FED WHG MED AID UNION BENEFITS (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 SIGNATURE GARY J PANKIEWICZ, ACCOUNTANT 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 8 and Section 231 of Title 31 of the United State ode. Page I R.L,7ALIA COMPANY PW.-Period Date: 06/07/11 Certified Payroll Report Contract #: CAG-11-044 107 WILLAIMS AVE S Week Ending: 06/07/11 Job No: 06-11 Is Payroll No: 5 Job Name: BENSON ROAD 16" WM REPL PENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 01 02 03 04 05 06 07 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 142.38 0.00 848.16 107 WILLIAMS AVE S ***-**-1869 S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 63.00 252.00 700.00 0.00 0.00 SUPERINTENDENT 2,520.00 5.78 0.00 1,671.84 RENTON, WA 98057 Check#: 84003 ALIA, VITO R Ex: S-00 C M O 0.00 0.00 0.00 0.00 10904 325TH AVE SE * *-**-5554 S 8.00 8.00 8.00 0.00 GROUP 3 LABORER ISSAQUAH, WA 98027 BRUNELLE, WILLIAM H. Ex: S-00 C M O 0.00 0.00 0.00 0.00 1819 KENT DES MOINES RD ***-**-5742 S 0.00 0.00 0.00 0.00 TRUCK DRIVER, T & T DES MOINES, WA 98198 DOUGLASS, TOM R Ex: M-05 C M O 0.00 0.00 0.00 0.00 3220 121ST PL SE ***-**-5585 S 0.00 0.00 0.00 0.00 OPERATOR UNDER 3 YDS EVERETT, WA 98208 GALLACHER, JOEL L Ex: M-01 C M O 0.00 0.00 0.00 0.00 714 191 ST PL SW ***-**-1199 S 0.00 0.00 0.00 0.00 CARPENTER LYNNWOOD, WA 98036 HUTCHINS JR., JOHN O. Ex: S-00 C M O 0.00 0.00 0.00 0.00 4012 97TH DR SE *-**-8753 S 0.00 0.00 0.00 0.00 TRUCK DRIVER, T & T EVERETT, WA 98205 0.00 0.00 0.00 0.00 0.00 0.00 69.96 0.00 282.64 0.00 8.00 8.00 40.00 30.96 1,238.40 224,98 77.60 0.00 1,238.40 20.10-110.00 955.76 Check#: 84004 0.00 0.00 0.00 0.00 0.00 0.00 77.43 0.00 358.25 0.00 4.00 0.00 4.00 31.87 127.48 257,98 4.20 0.00 1,370.40 18.64 0.00 1,012.15 Check #: 84006 0.00 0.00 0.00 0.00 0.00 0.00 85.61 0.00 1,047.23 0.00 8.00 0.00 8.00 35.24 281.92 134.80 42.92 0.00 1,515.32 18.90 765.00 468.09 Check #: 84007 0.00 0.00 0.00 0.00 0.00 0.00 116.13 0.00 644.07 0.00 8.00 0.00 8.00 47.80 382.40 509.04 0.00 0.00 2,055.40 18.90 0.00 1,411.33 Check #: 84008 0.00 0.00 0.00 0.00 0.00 0.00 72.03 0.00 328.65 0.00 8.00 0.00 8.00 31.87 254.96 234.08 4.00 0.00 1,274.80 18.54 0.00 946.15 Check #: 84010 Nuke 2 R.L. ALI"OMPANY 107 WILLAIMS AVE S 1b T2ENTON, WA 98055 425 226-8100 Pay Perktl-Date: 06/07/11 Week Ending: 06/07/11 Payroll No: 5 Certified Payroll Report Contract #: CAG-11-044 +*P " Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 01 02 03 04 05 06 07 Total Rate Total Gross State Oth Ded Net Chk LYCKSELL, LEITH W Ex: S-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 1.00 1.00 53.62 0.00 83.82 0.00 392.92 912 E 54TH STREET -"-4345 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.75 1,483.63 286.29 167.28 0.00 CEMENT MASON 1,483.63 20.60 -165.07 1,090.71 TACOMA, WA 98404 Check #: 84013 SCOTT, KIMBERLY A. 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 69.98 0.00 374.88 P. O. BOX 516-"-"-3470 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 207.20 77.60 0.00 LABORERlTCS/ESC LEAD 1,238.40 20.10 0.00 863.52 STANWOOD, WA 98292 Check #: 84021 Page 3 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention Re: Job Number: June 17, 2011 Andrew Weygandt Benson Road 16" Water Main - - ------ - ---- - -- - - -- - - We are sending you _ ............ Attached 1 ❑ Under Separate Cover via: _ -- -- ... _._....................................... ❑ Shop Drawings ❑ Prints ❑ Plans I ❑ Other: ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification ___.... ... .... Quantity Date DWG. # 4 Description -- __ ..... .... _ _. _....._............... ...... _.... ... _.... ........ .-__-- 1 Certified Payroll ;-2 - Alia 1 Certified Payroll Week Ending 6/4/11 - ASPI JUN 2 n n UTILITY SYSTElVIS These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval ;J For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ ....."... _____.,------- _.__.._._ .._ _ PRINTS RETURNED AFTER LOAN Comments: _ __....._...____—_._ .__ . _. Copy to. - 7&'D PANXQEwi(Z Signature .Date: DUNE 14, 2011 I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: Statement of Compliance 14 14 Contract Number: CAG-11-044 (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 8 day of JUNE, 2011 and ending the 14 day of DUNE, 2011, 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 R.L. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT 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 1 and Section 231 of Title 31 of the�d States Code. Page / K.L AURA UUMf ANY f' nod Date: 06/14/11 Certified Payroll Report Contract #: CAG-11-044 107 WILL AIMS AVE S Week Ending: 06/14/11 Job No: 06-11 Payroll No: 6 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 08 09 10 11 12 13 14 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 142.38 0.00 848.87 107 WILLIAMS AVE S '-"-1869 S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 63.00 252.00 700.00 0.00 0.00 SUPERINTENDENT 2,520.00 6.49 0.00 1,671.13 RENTON, WA 98057 Check #: 84064 ALIA, VITO R 10904 325TH AVE SE ISSAQUAH, WA 98027 HUTCHINS JR., JOHN O. 4012 97TH DR SE EVERETT, WA 98205 LYCKSELL, LEITH W 912 E 54TH STREET TACOMA, WA 98404 Ex: S-00 C M O 0.00 0.00 0.00 0.00 "'-"-5554 S 8.00 8.00 8.00 0.00 GROUP 3 LABORER 0.00 0.00 0.00 0.00 0.00 0.00 69.97 0.00 242.22 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 1,238.40 20.10-150.43 996.18 Check #: 84065 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 74.73 0.00 343.84 "'-"-8753 S 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 31.87 254.96 246.03 4.10 0.00 TRUCK DRIVER, T & T 1,322.60 18.98 0.00 978.76 Check #: 84072 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 80.80 0.00 536.46 -"-"-4345 S 8.00 8.00 8.00 0.00 0.00 8.00 0.00 32.00 35.75 1,144.00 272.88 163.20 0.00 CEMENT MASON 1,430.00 19.58 0.00 893.54 Check #: 84075 SCOTT, KIMBERLY A. 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 69.96 0.00 374.86 P. O. BOX 516--"-3470 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 207.20 77.60 0.00 LABORER/TCS/ESC LEAD 1,238.40 20.10 0.00 863.54 STANWOOD, WA 98292 Check #: 84083 Pine 2 CERTIFIED PAYROLL REPORT Department of Labor and Industries W P am Prevatltng age rogr s. PO Box 44540 s Contractor Pro eci Name County Project or Contract# Olympia WA 98504-4540 Mf , , Prime I �\i, C �� ri— (360)902-5335 r—y Project Address CiN State Subcontractor ✓U' Awarding Agency Name n � Phone_ ��� I� C rgpan y Phone For th Week ndin Address City State ZIP+4 Address Ci State ZIP+4 45 �lie_� ►� lac �Ver�+ �;1.- ',� o- ►l� I ca"e I�-v� 3 ��+i- ,titer 1� 9&05 -� t In,, Lay Year I Day and Date Deductions Work Classification Name ` Sun Mon Tue Wed Thu Fri Sat ;Tot]al and Sec!! of Employee and Rate ouSoc Address o °L Total of Gross Amount UsWithold- Li NET Hours Worked Each Day Hours Pav Earned Benefits" FICA init Tax Other WAGES 1. 14Ci o l m�p,s, eh.,d�r`� `ram OT %, I 0 —0� D3Z�J ~~TWA} Aa- RG 2. 4q o r Mai � 4-V i ;e Sit oT RG pp -���I"11C(0 5 T O 3. RG 4 OT RG 5 OT RG 6 OT RG 7 OT RG 8 OT RG 9 OT RG 10. OT RGt F700-065-000 certified payroll report 05-09 Ensplovee Benefits Distribution and Signature Certification on Reverse Side Prevailing Wage Program ..PO Boa 44540 Olympia WA 98504-4540 T Printed name of party signing this report The pasty signing this report pays or supervises the payment of the persons employed by: Project Name: � � C V'_P'CL4 (Name of contractor or subcontractor) Title For thi week For ('e tq eftl gl "USUAL BENEFITS" DISTRIBUTION (Please report in "per hour" terms) Work Classification Total Hourly "Usual Benefits" (A+B+C+D+E) (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Program I . $ 0.00 2. $ 0.00 3. $ 0.00 q. $ 0.00 5. $ 0.00 6. $ 0.00 7. $ 0.00 g. $ 0.00 9. $ 0.00 10. $ 0.00 The party signing below AFFIRMS the following: (1) All information contained in this Certified Payroll Report, including any addenda, is correct and complete (2) The wage rates for workers, laborers or mechanics as reported above are not less than the applicable wage rates contained in any wage delermination related to the contract; and the classifications as reported above for each worker, laborer or mechanic conform with the actual work performed by such worker, laborer or mechanic. (3) The payments of usual benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (4) All persons employed on the above -referenced project(s) have been paid the full weekly wages earned, and no rebates have been or will be made either directly or indirectly to or on behalf of the above -named contractor or subcontractor from the weekly wages earned by any person. No deductions, other than those which are legally permissible, have been made by any person either directly or indirectly from the full wages earned. (5) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council Falsification of any of the above statements is a violation of RON' 39.12.050 subject to prosecution, sanctions, and penalties. Print or type name of a signing his report Tle $�gnaturc h-AL F700-065.000 ccnified payroll rcpon backer 05-09 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity Re: Job Number: Transmittal Letter June 28, 2011 Andrew Weygandt Benson Road 16" Water Main We are sending you - Under Separate Cover via: Prints ❑ Plans Change Order ❑ Samples Reproducible ❑ Specification ❑ Other: Quantity Date DWG. # Description 1 Certified Payroll �3 ncoclitcrk JUN 3 0 20111 CITY OF RENTON iUTILITY SYSTE99-- These are transmitted as checked below .... ........... . _ _....... .._ _._ ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval [� For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN ....................... Comments: Copy to: 71)f'IU;R ! 1/441EWItL Signature era f r, Statement of Compliance 1te: JUNE 21, 2011 1,, GARY J PANKIEWIC2, ACCOUNTANT do hereby state: Contract Number: CAG-I1-044 (1) That 1 pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 15 day of DUNE, 2011 and ending the 21 day of JUNE, 2011, 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 R.L. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 O 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 GARY J PANKIEWICZ, ACCOUNTANT 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 T' a 18 and Section 231 of Title 31 of the United States Code. M Page J R.L*1-IA COMPANY Pap Period Date: 06/21/11 Certified Payroll Report Contract #: CAG-11-044 107 WILLAIMS AVE S Week Ending: 06/21/11 Job No: 06-11 Payroll No: 7 Job Name: BENSON ROAD 16" WM REPL �REMN rON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 15 16 17 18 19 20 21 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 142.38 0.00 849.83 107 WILLIAMS AVE S *-**4869 S 0.00 0.00 0.00 0.00 0.00 4.00 4.00 8.00 63.00 504.00 700.00 0.00 0.00 SUPERINTENDENT 2,520.00 7.45 0.00 1,670.17 RENTON, WA 98057 Check #: 84086 ALIA, VITO R 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 69.98 0.00 392.66 10904 325TH AVE SE ' *-"-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 0.00 845.74 ISSAQUAH, WA 98027 Check #: 84087 Ex: M-05 C M O 0.00 0.00 0.00 0.00 0.00 2.00 0.00 2.00 52.86 0.00 89.60 0.00 391.45 DOUGLASS, TOM R 3220 121ST PL SE -*'-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 7.00 39.00 35.24 1,480.08 145.37 44.62 0.00 OPERATOR UNDER 3 YDS 1,585.80 21.48 90.38 1,194.35 EVERETT, WA 98208 Check #: 84091 Ex: S-01 C M O 0.00 0.00 0.00 0.00 0.00 2.00 0.00 2.00 52.86 0.00 85.61 0.00 464.36 HAWLEY, SYD R 4518 131ST PLACE NE *-*'-1257 S 4.00 8.00 8.00 0.00 0.00 8.00 8.00 36.00 35.24 1,374.36 276.43 81.48 0.00 PIPELAYER LAB GRP IV 1,515.32 20.84 0.00 1,050.96 MARYSVILLE, WA 98271 Check #: 84093 Ex: S-02 C M O 0.00 0.00 0.00 0.00 0.00 2.00 0.00 2.00 47.80 0.00 77.43 0.00 485.64 REED, RONALD W 22810 30TH AVE S --'*-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 31.87 1,370.41 222.41 4.20 0.00 UNIT B-103 TRUCK DRIVER, GROUP 1,370.41 21.10 160.50 884.77 DES MOINES, WA 98198 Check #: 84105 Ex: S-01 C F O 0.50 0.00 0.00 0.00 0.00 3.00 0.00 3.50 46.44 0.00 79.16 0.00 433.25 SCOTT, KIMBERLY A. P. O. BOX 516 * *-**-3470 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,400.94 247.83 84.40 0.00 LABORERrrCS/ESC LEAD 1,400.94 21.86 0.00 967.69 STANWOOD, WA 98292 Check #: 84106 Page 2 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton July 1, 2011 �e � EUI V to JUL 0 6 2011 CITY OF RENTON UTILITY SYSTEMS Andrew Weygandt Benson Road 16" Water Main ❑ Other: These are transmitted as checked below w._._....-. --_ ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ ........ --- ------ .__._. __.______ .................. PRINTS RETURNED AFTER LOAN __ _..__.._........ Comments: __ ___.._._.... Copy to _ __....__.. ------------------- ___........... __-._ _._------- D!'yn ?ANmF-W'CL Signature Statement of Compliance Date: JUNE 28, 2011 Contract Number: CAG-11-044 ' I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16 WM REPL, that during the payroll period commencing on the 22 day of JUKE, 2011 and ending the 28 day of JUNE, 2011, all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of said R.L. ALIA COMPANY from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages eamed 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 Star. 357; 40 U.S.C. 276c), and described below: FICA FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT SIGNATURE k The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution See Section 1001 of le 18 and Section 231 of Title 31 of the United States Code. Page / R.CgALIA COMPANY 107 WILLAIMS AVE S _ RENTCN, WA 98055 425 226-8100 Pay Period Date: 06/28/11 Week Ending: 06/28/11 Payroll No: 8 Certified Payroll Report Contract #: CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 22 23 24 25 26 27 28 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 142.38 0.00 1,259.14 107 WILLIAMS AVE S *-**-1869 S 4.00 4.00 8.00 0.00 0.00 8.00 8.00 32.00 63.00 2,016.00 700.00 0.00 0.00 SUPERINTENDENT 2,520.00 16.76 400.00 1,260.86 Check #: 84113 RENTON, WA 98057 ALIA, VITO R Ex: S-00 C M O 0.00 0.00 10904 325TH AVE SE *-**-5554 S 8.00 8.00 GROUP 3 LABORER ISSAQUAH, WA 98027 BRUNELLE, WILLIAM H. Ex: S-00 C M O 0.00 0.00 1819 KENT DES MOINES RD *-**-5742 S 0.00 8.00 TRUCK DRIVER, T & T DES MOINES, WA 98198 DOUGLASS, TOM R Ex: M-05 C M O 0.50 0.00 3220 121 ST PL SE ***-**-5585 S 8.00 8.00 OPERATOR UNDER 3 YDS EVERETT, WA 98208 HAWLEY, SYD R Ex: S-01 C M O 1.00 0.50 4518 131ST PLACE NE ***-**-1257 S 8.00 8.00 PIPELAYER LAB GRP IV MARYSVILLE, WA 98271 JAMES, JAMEL A Ex: S-03 B M O 0.00 0.00 26857 15TH AVENUE SOUTH ***-**-3757 S 0.00 0.00 GRP 3 LABORER DES MOINES, WA 98198 0.00 0.00 8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 0.00 0.00 0.00 8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.96 0.00 392.64 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 1,238.40 20.10 0.00 845.76 Check #: 84114 0.00 1.00 0.00 1.00 47.80 0.00 74.72 0.00 344.94 8.00 8.00 8.00 32.00 31.87 1,067.65 246.04 4.10 0.00 1,322.61 20.08 0.00 977.67 Check # 84117 0.00 0.00 0.00 0.50 52.86 0.00 87.10 0.00 330.68 0.00 8.00 8.00 40.00 35.24 1,436.03 138.76 43.59 0.00 1,541.75 21.23 40.00 1,211.07 Check #: 84119 0.00 0.50 0.00 2.00 52.86 0.00 85.62 0.00 464.65 0.00 8.00 8.00 40.00 35.24 1,515.32 276.43 81.50 0.00 1,515.32 21.10 0.00 1,050.67 Check #: 84121 0.00 0.00 0.00 0.00 0.50 0.50 37.29 0.00 29.14 0.00 218.69 4.00 0.00 0.00 8.00 8.00 20.00 24.86 515.85 31.13 39.78 0.00 515.85 10.30 108.34 297.16 Check #: 84124 Page 2 R.L. AE4ACOMPANY Pay P..3ii0d Date: 06/28/11 Certified Payroll Report n. uY` ,.`. 107 WILLAIMS AVE S Week Ending: 06/28/11 Job No: 06-11 Payroll No: 8 Job Name: BENSON ROAD 16" WM REPL _ RENTON, WA 98055 425 226-8100 Hours Other Job Pay FICA Local Tot Ded # Exemptions Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 22 23 24 25 26 27 28 Total Rate Total Gross State Oth Ded Net Chk NESS, JANICE M Ex: S-04 N F O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.23 0.00 30.77 1302 E YESLER WAY -"-7829 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 24.86 198.88 0.00 15.52 0.00 90% APPRENTICE 198.88 4.02 B-3 Check #:0. 8411011 SEATTLE, WA 98122 REED, RONALD W 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 72.02 0.00 455.13 22810 30TH AVE S '-"-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 31.87 1,274.80 198.51 4.00 0.00 TRUCK DRIVER, GROUP 1,274.80 20.10 .50 7 UNIT B-103 Check 8419. DES MOINES, WA 98198 SCOTT, KIMBERLY A. Ex: S-01 C F O 1.50 1.50 0.50 0.00 0.00 1.00 0.50 5.00 46.44 0.00 83.08 0.00 458.27 0.00 P. O. BOX 516 '-"-3470 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,470.60 265.25 87.34 LABORER/TCS/ESC LEAD 1,470.60 22.60 0.00 1,012.33 Check #: 84134 STANWOOD, WA 98292 TAYLOR, TARLUS Ex: M-06 B M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.47 0.00 61.55 7928 48TH AVE S -"-2062 S 0.00 8.00 8.00 0.00 0.00 0.00 0.00 16.00 24.86 397.76 0.00 31.04 0.00 LAB. GRP 2, FLAGGER 397.76 8.04 0.00 336.21 Check #: 84108 SEATTLE, WA 98118 Page 3 a R.L. ALIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 06 RENTON, WA 98055 From period end date: 06/01/11 To period end date: 06'30/11 Job number: 06-11 BENSON ROAD 16" WM REP!_ Work hours of employment Hispanic White Black Asian Pacific American Other(2 or Minority Female Total # Total # Islander Indian more) % % Employees Minority EEO Class / Work Class Sex Total M 48.0 0.0 48.0 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 CARPENTERS M 8.0 0.0 &0 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 CEMENT MASON M 73.0 0.0 73.0 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 LABORERS/FLAGGERS M 196.5 0.0 160.0 36.5 0.0 0.0 0.0 0.0 10.0% 46.2% 3 2 JOURNEYMAN F 168.5 0.0 168.5 0.0 0.0 0.0 0.0 0.0 1 0 LABORERS/FLAGGERS M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 APPRENTICE F 8.0 0.0 0.0 0.0 0.0 0.0 8.0 0.0 1 1 Subtotal: M 196.5 0.0 160.0 36.5 0.0 0.0 0.0 0.0 11.9% 47.3% 3 2 F 176.5 0.0 168.5 0.0 0.0 0.0 8.0 0.0 2 1 EQUIPMENT OPERATORS M 89.5 0.0 89.5 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 PIPELAYERS M 80.0 0.0 80.0 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 TRUCK DRIVERS M 135.0 0.0 135.0 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 Journeyman total: M 582.0 0.0 545.5 36.5 0.0 0.0 0.0 0.0 4.9% 22.5% 10 2 F 168.5 0.0 168.5 0.0 0.0 0.0 0.0 0.0 1 0 Apprentice total: M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 F 8.0 0.0 0.0 0.0 0.0 0.0 8.0 0.0 1 1 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 48.0 0.0 48.0 0.0 0.0 0.0 0.0 0.0 0.0% 0.0% 1 0 F 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 Job total: M 630.0 0.0 593.5 36.5 0.0 0.0 0.0 0.0 5.5% 21.9% 11 2 F 176.5 0.0 168.5 0.0 0.0 0.0 8.0 0.0 2 1 Printed by GJP as of 06130111 11:24:10AM Page 4 -rimR.L. ALIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 06 RENTON, WA 98055 From period end date: 06/01/11 To period end date: 06/30/11 Job number: 06-11 BENSON ROAD 16" WM REPL Hispanic White EEO Class / Work Class Sex Total Title Work hours of employment Black Asian Pacific Islander /L--Telephone: Signature American Other(2 or Minority Female Total # Total # Indian more) % % Employees Minority �— 3c.�, I I Date Signed Printed by GJP as of 06130111 11:24: /OAM Page 5 Tr nsmitt I Letter July 11, 2011 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 RECEIVED ED Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Andrew Weygandt CITY OF RENTON Re: Benson Road 16" \A/8'1e�%§YTEMS ._.. ❑ Attached ❑ Shop Drawing El Copy of Letter ❑ Total Quantity Job Number: We are sending your El Under Separate Cover via: s 1 ❑ Prints ❑ Plans ❑ Change Order ❑ Samples ❑ Reproducible ❑ Specification .......... .. _ These are transmitted as checked below ...... . , �_..d ..._ ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval ❑ For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution I ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments ........ __....._. v . /rani 1) I` A►4 K) F-W 1(z Signature Statement of Compliance Date: JULY 5, 2011 Contract Number: CAG-I1-044 - 1, GARY-J PANKIEWICZ ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16' WM REPL, that during the payroll period commencing on the 29 day of JUNE, 201 land ending the 5 day of JULY, 2011, 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 R.L. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 Page 1 R.L. ALIA COMPANY Pay Period Date: 07/05/11 Certified Payroll Report Contract#: CAG-11-044 107 WILLAIMS AVE S Week Ending: 07/05/11 Job No 06-11 ,RENTON, WA 98055 Payroll No: 9 Job Name: BENSON ROAD 16" WM REPL 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Employee Social Security Work WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Class 29 30 01 02 03 04 05 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O ***-**-1869 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 142.38 0.00 1,257.47 107 WILLIAMS AVE S S 8.00 8.00 8.00 0.00 0.00 0.00 4.00 28.00 6300 1,764.00 700.00 0.00 0.00 SUPERINTENDENT 2.,520.00 15.09 400.00 1,262.53 RENTON, WA 98057 Check #: 84173 ALIA, VITO R Ex: S-00 C M O 0.00 0.00 0.00 0.00 10904 325TH AVE SE * -**-5554 S 8.00 8.00 8.00 0.00 GROUP 3 LABORER ISSAQUAH, WA 98027 BRUNELLE, WILLIAM H. Ex: S-00 C M O 0.00 1.00 0.00 0.00 1819 KENT DES MOINES RD-**-5742 S 8.00 8.00 8.00 0.00 TRUCK DRIVER, T & T DES MOINES, WA 98198 DOUGLASS, TOM R Ex: M-05 C M O 0.00 1.00 0.00 0.00 3220 121ST PL SE *-**-5585 S 8.00 8.00 8.00 0.00 OPERATOR UNDER 3 YDS EVERETT, WA 98208 HAWLEY, SYD R Ex: S-01 C M O 0.00 0.00 0.00 0.00 4518 131ST PLACE NE -*"-1257 S 8.00 6.50 8.00 0.00 PIPELAYER LAB GRP IV MARYSVILLE, WA 98271 JAMES, JAMEL A Ex: S-03 B M O 0.00 1.50 0.00 0.00 26857 15TH AVENUE SOUTH -**-3757 S 8.00 8.00 8.00 0.00 GRP 3 LABORER DES MOINES, WA 98198 0.00 0.00 0.00 0.00 0.00 0.00 55.98 0.00 297.20 0.00 0.00 8.00 32.00 30.96 990.72 163.06 62.08 0.00 990.72 16.08 0.00 693.52 Check#: 84174 0.00 0.00 0.00 1.00 47.80 0.00 60.33 0.00 262.51 0.00 0.00 8.00 32.00 31.87 1,067.65 182.30 3.30 0.00 1,067.65 16.58 0.00 805.14 Check #: 84177 0.00 0.00 0.00 1.00 52.86 0.00 78.66 0.00 967.24 0.00 0.00 8.00 32.00 35.24 1,180.54 116.30 38.95 0.00 1,391.98 18.33 715.00 424.74 Check #: 84179 0.00 0.00 0.00 0.00 0.00 0.00 60.73 0.00 301.53 0.00 0.00 8.00 30.50 35.24 1,074.82 166.30 59.18 0.00 1,074.82 15.32 0.00 773.29 Check #: 84181 0.00 0.00 1.00 2.50 37.29 0.00 50.21 0.00 329.88 0.00 0.00 8.00 32.00 24.86 888.75 87.06 66.94 0.00 888.75 17.33 108.34 558.87 Check #: 84184 Page 2 r\.L.,T/iClN T ray- ua[e: U//UO/l "I Certified Payroll Report Contract#: CAG 11-044 107 WILLAIMS AVE S Week Ending: 07/05/11 Job No 06-11 Payroll No: 9 Job Name: BENSON ROAD 16" WM REPL ,O RENTN., WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 29 30 01 02 03 04 05 Total Rate Total Gross State Oth Ded Net Chk LYCKSELL, LEITH W Ex: S-00 C M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 64.64 0.00 411.62 912 E 54TH STREET ***-**-4345 S 0.00 0.00 8.00 0.00 0.00 0.00 8.00 16.00 35.75 572.00 201.38 130.56 0.00 CEMENT MASON 1,144.00 15.04 0.00 732.38 TACOMA, WA 98404 Check # 84187 NESS, JANICE M Ex: S-04 N F O 0.00 0.00 0.00 0.00 1302 E YESLER WAY -**-7829 S 0.00 0.00 0.00 0.00 B-3 90% APPRENTICE SEATTLE, WA 98122 REED, RONALD W Ex: S-02 C M O 0.00 0.50 0.00 0.00 22810 30TH AVE S -**-5585 S 8.00 8.00 8.00 0.00 UNIT B-103 TRUCK DRIVER, GROUP DES MOINES, WA 98198 SCOTT, KIMBERLY A. Ex: S-01 C F O 0.00 1.00 0.00 0.00 P. O. BOX 516 *-**-3470 S 8.00 8.00 8.00 0.00 LABORER/TCS/ESC LEAD STANWOOD, WA 98292 TONSGARD, KENNETH A Ex: S-00 N M O 0.00 0.00 0.00 0.00 P. O. BOX 1301 *-**-7739 S 0.00 0.00 0.00 0.00 OPERATOR UNDER 3 YDS SNOHOMISH, WA 98291 0.00 0.00 1.00 1.00 37.29 0.00 13.35 0.00 35.33 0.00 0.00 8.00 8.00 24.86 236.17 0.00 17.46 0.00 236.17 4.52 0.00 200.84 Check #: 84189 0.00 0.00 0.00 0.50 47.80 0.00 58.98 0.00 379.80 0.00 0.00 8.00 32.00 31.87 1,043.74 140.74 3.25 0.00 1,043.74 16.33 160.50 663.94 Check #: 84195 0.00 0.00 0.00 1.00 46.44 0.00 44.61 0.00 200.64 0.00 0.00 0.00 24.00 30.96 789.48 94.97 48.50 0.00 789.48 12.56 0.00 588.84 Check #: 84196 0.00 0.00 0.00 0.00 0.00 0.00 65.20 0.00 316.69 0.00 0.00 8.00 8.00 35.24 281.92 203.91 32.84 0.00 1,154.11 14.74 0.00 837.42 Check #: 84197 Purr 3 Transmittal Letter July 15, 2011 R.L. Alia Company 107 Williams Avenue South He `• Y � Renton, WA 98057 Contractor License # RLALIC*104PT JUL 1 2011 (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM CITY OF RENTON To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: V9 Attached ❑ Under Separate Cover via: --..._..__.....__.._�. ___._......._..._........._......_........_._...... _ .......... ..... _........._..... ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Other: ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification _. ........ ..................... _....... ._ These are transmitted as checked below :. _ .. _.... _ ❑ For Approval _.. ___, -... _... __ ❑ Approved as Submitted ❑ Resubmit [#] copies for approval r For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested u ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN T)Ad)1) FAN)Zif ,,u.t Signature Date: JULY 12, 2011 Statement of Compliance'! Contract Number: CAG-11-044 I, GARY J PANKIEWIC2, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 6 day of DULY, 2011 and ending the 12 day of JULY, 2011, all persons employed on said project have been paid the full weekly wages eamed that no rebates have been or will be made either directly or indirectly to or on behalf of said RL. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT SIGNATURE If ` 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 and Section 231 of Title 31 of the United States Code. Page R.L. ALIA COMPANY Pay Period Date: 07/12/11 Certified Payroll Report Contract #: CAG-11-044 107 WI! LAIMS AVE S Week Ending: 07/12/11 Job No: 06-11 ' Payroll No: 10 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 06 07 08 09 10 11 12 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L 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 56.50 0.00 272.40 107 WILLIAMS AVE S '-'�-1869 S 6.00 6.00 6.00 0.00 0.00 6.00 6.00 30.00 25.00 750.00 200.00 0.00 0.00 SUPERINTENDENT 1,000.00 15.90 0.00 727.60 Check #: 84200 RENTON, WA 98057 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.96 0.00 292.64 ALIA, VITO R Ex: S-00 C M O 10904 325TH AVE SE "'-"-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 -100.00 945.76 Check #: 84201 ISSAQUAH, WA 98027 0.50 0.50 0.00 0.00 0.00 0.00 0.00 1.00 47.80 0.00 74.72 0.00 345.45 BRUNELLE, WILLIAM H. Ex: S-00 C M O 1819 KENT DES MOINES RD -"-5742 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 31.87 1,322.60 246.03 4.10 0.00 TRUCK DRIVER, T & T 1,322.60 20.60 0.00 977.15 Check #: 84204 DES MOINES, WA 98198 DOUGLASS, TOM R Ex: M-05 C M O 0.00 0.50 0.50 0.00 0.00 0.00 0.00 1.00 52.86 0.00 82.62 0.00 986.65 3220 121ST PL SE -"-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.24 1,462.46 126.87 41.56 0.00 OPERATOR UNDER 3 YDS 1,462.46 20.60 715.00 475.81 Check #: 84205 EVERETT, WA 98208 HAWLEY, SYD R Ex: S-01 C M O 0.00 0.50 0.50 0.00 0.00 0.00 0.00 1.00 52.86 0.00 82.63 0.00 446.00 4518 131ST PLACE NE -"-1257 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.24 1,462.46 263.21 79.56 0.00 PIPELAYER LAB GRP IV 1,462.46 20.60 0.00 1,016.46 Check #: 84207 MARYSVILLE, WA 98271 JAMES, JAMEL A Ex: S-03 B M O 1.00 1.00 1.00 0.00 0.00 1.00 0.50 4.50 37.29 0.00 65.67 0.00 435.27 26857 15TH AVENUE SOUTH '-"`-3757 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 24.86 1,162.21 152.57 86.34 0.00 GRP 3 LABORER 1,162.21 22.35 108.34 726.94 Check #: 84210 DES MOINES, WA 98198 I'ggr 2 R.L:is&EIA COMPANY PgZ?eriod Date: 07/12/11 Certified Payroll Report Contract #: CAG-11-044 107 WI;,LAIMS AVE S Week Ending: 07/12/11 Job No: 06-11 Payroll No: 10 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 06 07 08 09 10 11 12 Total Rate Total Gross State Oth Ded Net Chk LYCKSELL, LEITH W 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 80.79 0.00 435.15 912 E 54TH STREET -"4345 S 0.00 0.00 8.00 0.00 0.00 4.00 0.00 12.00 35.75 429.00 272.88 163.20 0.00 CEMENT MASON 1,430.00 18.28 -100.00 994.85 Check #: 84213 TACOMA, WA 98404 NESS, JANICE M Ex: S-04 N F O 0.50 0.50 1.00 0.00 1302 E YESLER WAY -"-7829 S 8.00 8.00 8.00 0.00 B-3 90% APPRENTICE SEATTLE, WA 98122 NESS, JANICE M Ex: S-04 N F O 0.00 0.00 0.00 0.00 1302 E YESLER WAY -"-7829 S 0.00 0.00 0.00 0.00 B-3 90% APPRENTICE SEATTLE, WA 98122 REED, RONALD W Ex: S-02 C M O 0.00 0.50 0.50 0.00 22810 30TH AVE S '-"-5585 S 8.00 8.00 8.00 0.00 UNIT B-103 TRUCK DRIVER, GROUP DES MOINES, WA 98198 SCOTT, KIMBERLY A. P. O. BOX 516 STANWOOD, WA 98292 TONSGARD, KENNETH A P. O. BOX 1301 SNOHOMISH, WA 98291 0.00 0.00 0.00 2.00 37.29 0.00 37.92 0.00 145.20 0.00 0.00 0.00 24.00 24.86 671.23 43.76 50.46 0.00 671.23 13.06 0.00 526.03 Check #: 84198 0.00 0.00 0.00 0.00 0.00 0.00 11.24 0.00 30.78 0.00 8.00 0.00 8.00 24.86 198.88 0.00 15.52 0.00 198.88 4.02 0.00 168.10 Check #: 84199 0.00 0.00 0.00 1.00 47.80 0.00 74.72 0.00 470.38 0.00 8.00 8.00 40.00 31.87 1,322.60 210.46 4.10 0.00 1,322.60 20.60 160.50 852.22 Check #: 84220 Ex: S-01 C F O 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.50 46.44 0.00 15.31 0.00 52.02 "-"-3470 S 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 30.96 270.90 15.94 16.50 0.00 LABORER/TCS/ESC LEAD 270.90 4.27 0.00 218.88 Check #: 84221 Ex: S-00 N M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 81.15 0.00 414.66 "`-7739 S 8.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 35.24 281.92 274.39 40.88 0.00 OPERATOR UNDER 3 YDS 1,436.03 18.24 0.00 1,021.37 Check #: 84222 Page 3 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Re: Job Number: We are sending you ❑ Attached ❑ Under Separate Cover via: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification Transmittal Letter ly 22, 2011 RE Li V t JUL 2 6 20'1 1 CITY OF RENTON UTILITY SYSTEMS Andrew Weygandt Benson Road 16" Water Main ❑ Other: These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval ❑ For Your Use ❑ As Requested ❑ For Review and Comment ❑ FOR BIDS DUE: Comments: Copy to ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ Revise and Resubmit/Work May Not Proceed ❑ PRINTS RETURNED AFTER LOAN �Au I n ?AN x*wI tL Signature Statement of Compliance`'''`'" Date: JULY 19, 2011 1, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: Contract Number: CAG-1 1-044 (1) That 1 pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 13 day of JULY, 2011 and ending the 19 day of DULY, 2011, all persons employed on said project have been paid the full weekly wages eamed that no rebates have been or will be made either directly or indirectly to or on behalf of said RL. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT SIGNATURE The w iIIful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution See Section 1001 of Title 18 d Section 231 of Title 31 of the United States de Page I R.L. ALIA COMPANY ,dr Pay Period Date: 07/19/11 Certified Payroll Rep©ft Contract #: CAG-11-044 107 Wi-LA1MS AVE S Week Ending: 07/19/11 Job No: 06-11 Payroll No: 11 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 13 14 15 16 17 18 19 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L 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 56.50 0.00 274.93 107 WILLIAMS AVE S *-**4869 S 4.00 8.00 8.00 0.00 0.00 8.00 8.00 36.00 25.00 900.00 200.00 0.00 0.00 SUPERINTENDENT 1,000.00 18.43 0.00 725.07 RENTON, WA 98057 Check #: 84251 ALIA, VITO R Ex: S-00 C M O 0.00 0.00 0.00 0.00 10904 325TH AVE SE-**-5554 S 8.00 8.00 8.00 0.00 GROUP 3 LABORER ISSAQUAH, WA 98027 DOUGLASS, TOM R Ex: M-05 C M O 0.00 3.00 1.00 0.00 3220 121ST PL SE `-**-5585 S 8.00 8.00 8.00 0.00 OPERATOR UNDER 3 YDS EVERETT, WA 98208 HAWLEY, SYD R 4518 131 ST PLACE NE MARYSVILLE, WA 98271 0.00 0.00 0.00 0.00 0.00 0.00 69.97 0.00 392.65 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 1,238.40 20.10 0.00 845.75 Check #. 84252 0.00 0.00 0.50 4.50 52.86 0.00 109.52 0.00 436.65 0.00 8.00 8.00 40.00 35.24 1,647.47 208.59 53.77 0.00 1,938.20 24.77 40.00 1,501.55 Check #: 84256 Ex: S-01 C M O 0.00 3.50 1.00 0.00 0.00 0.00 0.50 5.00 52.86 0.00 94.57 0.00 520.57 `-**4257 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.24 1,673.90 316.07 87.32 0.00 PIPELAYER LAB GRP IV 1,673.90 22.61 0.00 1,153.33 Check #: 84258 JAMES, JAMEL A Ex: S-03 B M O 26857 15TH AVENUE SOUTH-"-3757 S GRP 3 LABORER DES MOINES. WA 98198 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.47 0.00 184.28 8.00 8.00 0.00 0.00 0.00 0.00 0.00 16.00 24.86 397.76 14.39 31.04 0.00 397.76 8.04 108.34 213.48 Check #: 84246 LYCKSELL, LEITH W Ex: S-00 C M O 0.00 2.00 1.00 0.00 0.00 0.00 0.00 3.00 53.62 0.00 89.88 0.00 598.98 912 E 54TH STREET *-**-4345 S 8.00 8.00 4.00 0.00 0.00 4.00 0.00 24.00 35.75 1,018.88 313.10 175.44 0.00 CEMENT MASON 1,590.88 20.56 0.00 991.90 TACOMA, WA 98404 Check #: 84263 Page 2 R.L. ALIA COMPANY 1-07-'%NTLLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay Period Date: 07/19/11 Certified Payroll Report ' ` 4''` Contract#: CAG-11-044 Week Ending: 07/19/11 Job No: 06-11 Payroll No: 11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 13 14 15 16 17 18 19 Total Rate Total Gross State Oth Ded Net Chk MARTINEZ, AMADEO P Ex: S-00 H M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 33.71 0.00 167.60 12623 BRIDGEPORT WAY SW *-**-6871 S 0.00 8.00 8.00 0.00 0.00 8.00 0.00 24.00 24.86 596.64 75.27 46.56 0.00 # 84 LAB. GRP 2, FLAGGER 596.64 12.06 0.00 429.04 LAKEWOOD, WA 98499 Check #: 84245 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.23 0.00 30.77 PALMESE, EDWARD Ex: S-07 C M O 955 EDMONDS AVE NE * *-**-3609 S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 24.86 198.88 0.00 15.52 0.00 LAB. GRP 2, FLAGGER 198.88 4.02 0.00 168.11 RENTON, WA 98056 Check #: 84223 Dom- 7910 BIRCH BAY DRIVE, APT #9 BLAINE, WA 98230 REED, RONALD W Ex: S-02 C M O 0.00 2.00 0.50 0.00 0.00 0.00 0.50 3.00 47.80 0.00 80.13 0.00 500.89 22810 30TH AVE S -**-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 31.87 1,418.21 234.36 4.30 0.00 UNIT B-103 TRUCK DRIVER, GROUP 1,418.21 21.60 160.50 917.32 DES MOINES, WA 98198 Check #: 84270 0.00 3.50 0.00 0.00 0.00 1.50 1.00 6.00 46.44 0.00 85.71 0.00 474.94 SCOTT, KIMBERLY A. Ex: S-01 C F O P. O. BOX 516 *-**-3470 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,517.04 276.86 89.26 0.00 LABORER/TCS/ESC LEAD 1,517.04 23.11 0.00 1,042.10 STANWOOD, WA 98292 Check#: 84249 Pagr ; Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Re: Job Number: — ------- -------- We are sending you ❑ Attached ❑ Under Separate Cover via: .. ............. — ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification July 29, 2011 Andrew Weygandt Benson Road 16" Water Main Quantity 1 Date DWG. # C'arfifiPri Pavrnll zR - Alia Mact-rintinn UTILITY SYS i Elms y� Signature ❑ Other: Statement of Compliance Date: JULY 26, 2011 Contract Number: CAG-11-044 1, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16 WM REPL, that during the payroll period commencing on the 20 day of JULY, 2011 and ending the 26 day of JULY, 2011, 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 RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT 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 and Section 231 of Title 31 of the United States de. M Page I R.L'aA'1A COMPANY P -�:;riod Date: . 07/26/11 Certified Payroll Report contract u: UAl3-11-U44 10� " LAIMS AVE S Week Ending: 07/26/11 Job No: 06-11 ' Payroll No: 12 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 20 21 22 23 24 25 26 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L 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 56.50 0.00 276.60 107 WILLIAMS AVE S *-**-1869 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 25.00 1,000.00 200.00 0.00 0.00 SUPERINTENDENT 1,000.00 20.10 0.00 723.40 Check #: 84272 RENTON, WA 98057 ALIA, VITO R 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.98 0.00 392.66 Ex: S-00 C M O 10904 325TH AVE SE *-**-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 0.00 845.74 Check #: 84273 ISSAQUAH, WA 98027 BRUNELLE, WILLIAM H. 0.00 0.00 0.00 0.00 0.00 1.00 0.00 1.00 47.80 0.00 74.73 0.00 344.17 Ex: S-00 C M O 1819 KENT DES MOINES RD ***-**-5742 S 4.00 0.00 0.00 0.00 0.00 8.00 8.00 20.00 31.87 685.21 246.04 4.10 0.00 TRUCK DRIVER, T & T 1,322.61 19.30 0.00 978.44 DES MOINES, WA 98198 Check #: 84276 DOUGLASS, TOM R 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.50 52.86 0.00 81.13 0.00 304.74 Ex: M-05 C M O 3220 121ST PL SE *-**-5585 S 8.00 8.00 0.00 0.00 0.00 8.00 8.00 32.00 35.24 1,154.11 122.90 40.88 0.00 OPERATOR UNDER 3 YDS 1,436.03 19.83 40.00 1,131.29 Check #: 84277 EVERETT, WA 98208 HAWLEY, SYD R 0.00 0.00 0.00 0.00 0.00 0.00 1.50 1.50 52.86 0.00 84.13 0.00 454.54 Ex: S-01 C M 0 4518 131ST PLACE NE *-**-1257 S 8.00 4.00 0.00 0.00 0.00 8.00 8.00 28.00 35.24 1,066.01 269.82 80.52 0.00 PIPELAYER LAB GRP IV 1,488.89 20.07 0.00 1,034.35 Check #: 84279 MARYSVILLE, WA 98271 LYCKSELL, LEITH W 0.50 0.00 0.00 0.00 0.00 0.50 2.00 3.00 53.62 0.00 89.89 0.00 598.55 Ex: S-00 C M O 912 E 54TH STREET ***-**-4345 S 0.50 0.00 0.00 0.00 0.00 8.00 8.00 16.50 35.75 750.75 313.10 175.48 0.00 CEMENT MASON 1,590.88 20.08 0.00 992.33 Check #: 84285 TACOMA, WA 98404 Page 2 R.L. ALIAZOMPANY Pay Pe4fi�We: 07/26/11 Certified Payroll Report Contract#: CAG-11-044 `'dYSLV 107w-14,LLAIIvIS AVE S Week Ending: 07/26/11 Job No� -11 Job Name: BEN ROAD 16" WM REPL Payroll No: 12 RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 20 21 22 23 24 25 26 Total Rate Total Gross State Oth Ded Net Chk REED, RONALD W 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 72.02 0.00 544.63 22810 30TH AVE S *-**-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 31.87 1,274.80 198.51 4.00 0.00 UNIT B-103 TRUCK DRIVER, GROUP 1,274.80 20.10 250.00 730.17 DES MOINES, WA 98198 Check #: 84292 SCOTT, KIMBERLY A. Ex: S-01 C F O 1.50 0.00 0.00 0.00 0.00 1.00 1.50 4.00 46.44 0.00 52.48 0.00 250.68 P. O. BOX 516 * *-**-3470 S 8.00 0.00 0.00 0.00 0.00 8.00 8.00 24.00 30.96 928.80 129.80 54.34 0.00 LABORER/TCS/ESC LEAD 928.80 14.06 0.00 678.12 STANWOOD, WA 98292 Check #: 84293 TONSGARD, KENNETH A Ex: S-00 N M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 79.65 0.00 406.17 P. O. BOX 1301 ***-**-7739 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 35.24 563.84 267.78 40.20 0.00 OPERATOR UNDER 3 YDS 1,409.60 18.54 0.00 1,003.43 SNOHOMISH, WA 98291 Check #: 84294 Pa c 3 R.L. ALIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 07 RENTON, WA 98055 From period end date: 07/01/11 Job number: 06-11 EEO Class / Work Class Sex To period end date: 07/31/11 BENSON ROAD 16" WM REPL Hispanic White Total Work hours of employment Black Asian Pacific Islander American Indian Other(2 or more) Minority % Female % Total # Employees Total # Minority M 134.0 0.0 134.0 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 CEMENT MASON M 74.5 0.0 74.5 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 LABORERS/FLAGGERS M 279.0 24.0 160.0 95.0 0.0 0.0 0.0 0.0 30.8% 27.8% 4 2 JOURNEYMAN F 107.5 0.0 107.5 0.0 0.0 0.0 0.0 0.0 1 0 LABORERS/FLAGGERS M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 APPRENTICE F 43.0 0.0 0.0 0.0 0.0 0.0 43.0 0.0 1 1 Subtotal: M 279.0 24.0 160.0 95.0 0.0 0.0 0.0 0.0 37.7% 35.0% 4 2 F 150.5 0.0 107.5 0.0 0.0 0.0 43.0 0.0 2 1 EQUIPMENT OPERATORS M 183.0 0.0 151.0 0.0 0.0 0.0 32.0 0.0 17.5% 0.0% 2 1 JOURNEYMAN F 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 PIPELAYERS M 146.0 0.0 146.0 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 TRUCK DRIVERS M 251.5 0.0 251.5 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 Journeyman total: M 934.0 24.0 783.0 95.0 0.0 0.0 32.0 0.0 14.5% 10.3% 10 3 F 107.5 0.0 107.5 0.0 0.0 0.0 0.0 0.0 1 0 Apprentice total: M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 F 43.0 0.0 0.0 0.0 0.0 0.0 43.0 0.0 1 1 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 134.0 0.0 134.0 0.0 0.0 0.0 0.0 0.0 0.0% 0.0% 1 0 F 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 Job total: M 1,068.0 24.0 917.0 95.0 0.0 0.0 32.0 0.0 15.9% 12.4% 11 3 F 150.5 0.0 107.5 0.0 0.0 0.0 43.0 0.0 2 1 Printed by GJP as of 07/28/11 11:28:OOAM Page 3 R.L. ALIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 07 RENTON, WA 98055 From period end date: 07/01/11 To period end date: 07/31/11 Job number: 06-11 BENSON ROAD 16" WM REPL Hispanic White EEO Class / Work Class Sex Total Title: Work hours of employment Black Asian Pacific Islander Telephone: Si ature American Other(2 or Minority Female Total # Total # Indian more) % % Employees Minority Date Signed Printed by GJP as of 07/28/11 11:30:20AM Page 4 Transmittal Letter August 8, 2011 R.L. Alia Company 107 Williams Avenue South I _AVE Renton, WA 98057 ° ' � It Contractor License # RLALIC*104PT AUG o 9 2a 11 (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM CITY OF REN C{'J To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you Attached ❑ Under Separate Cover via: _ .._.._....___. ._.. __ ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Other: ❑ Copy of Letter ! ❑ Change Order ❑ Samples ❑ Total Quantity i ❑ Reproducible ❑ Specification n nnfiiv rlaifCc MAdG ft These are transmitted as checked below ❑ For Approval ❑ Approved Submitted ❑ Resubmit for as [#] copies approval 9 For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ i Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy to: 1/fib I� I A►J��€�.ic� i Signature 't. Statement of Compliance Date: AUGUST 2, 2011 r- I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: Contract Number: CAG-11-044 (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 27 day of JULY, 2011 and ending the 2 day of AUGUST, 2011, all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of said R.L. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 taborer 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 SIGNATURE ` GARY J PANKIEWICZ, ACCOUNTANT 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 I nd Section 231 of Title 31 of the United Stales Code. 0 Page l R.L. ALIA COMPANY Pay Period Date: 08/02/11 Certified Payroll Report "`'" Contract #: CAG-11-044 107 WILLAIMS AVE S Week Ending: 08/02/11 Job No: 06-11 - Payroll No: 13 Job Name: BENSON ROAD 16" WM REPL Fc'ENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 27 28 29 30 31 01 02 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L 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 56.50 0.00 273.26 107 WILLIAMS AVE S *-**-1869 S 8.00 8.00 8.00 0.00 0.00 4.00 4.00 32.00 25.00 800.00 200.00 0.00 0.00 SUPERINTENDENT 1,000.00 16.76 0.00 726.74 RENTON, WA 98057 Check #: 84361 ALIA, VITO R 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.97 0.00 392.65 Ex: S-00 C M O 10904 325TH AVE SE *-**-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 0.00 845.75 ISSAQUAH, WA 98027 Check #: 84362 BRUNELLE, WILLIAM H. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 72.02 0.00 327.73 Ex: S-00 C M O 1819 KENT DES MOINES RD *-**-5742 S 2.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 31.87 63.74 234.08 4.00 0.00 TRUCK DRIVER, T & T 1,274.80 17.63 0.00 947.07 DES MOINES, WA 98198 Check #: 84365 DOUGLASS, TOM R 1.00 0.00 0.50 0.00 0.00 1.00 0.00 2.50 52.86 0.00 87.10 0.00 330.81 Ex: M-05 C M O 3220 121ST PL SE ***-**-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.24 1,541.75 138.76 43.60 0.00 OPERATOR UNDER 3 YDS 1,541.75 21.35 40.00 1,210.94 EVERETT, WA 98208 Check #: 84366 HAWLEY, SYD R 0.50 0.50 0.00 0.00 0.00 0.00 0.00 1.00 52.86 0.00 82.62 0.00 444.95 Ex: S-01 C M O 4518 131ST PLACE NE *-**4257 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 35.24 898.62 263.21 79.56 0.00 PIPELAYER LAB GRP IV 1,462.46 19.56 0.00 1,017.51 MARYSVILLE, WA 98271 Check #: 84368 LYCKSELL, LEITH W 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 80.79 0.00 534.70 Ex: S-00 C M 0 912 E 54TH STREET *-**-4345 S 0.00 0.00 0.00 0.00 0.00 3.00 2.00 5.00 35.75 178.75 272.88 163.20 0.00 CEMENT MASON 1,430.00 17.83 0.00 895.30 TACOMA, WA 98404 Check #: 84374 Page 2 R.L'a,ALIA COMPANY Pr Period Date: 08/02/11 Certified Payroll Report Contract #: CAG-11-044 107 WILLAIMS AVE S Week Ending: 08/02/11 Job No: 06-11 . , 11 Payroll No: 13 Job Name: BENSON ROAD 16" WM REPL ANTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 27 28 29 30 31 01 02 Total Rate Total Gross State Oth Ded Net Chk REED, RONALD W Ex: S-02 C M O 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.50 47.80 0.00 73.38 0.00 551.48 22810 30TH AVE S "'-"'-5585 S 8.00 8.00 8.00 0.00 0.00 4.00 0.00 28.00 31.87 916.26 204.48 4.05 0.00 UNIT B-103 TRUCK DRIVER, GROUP 1,298.70 19.57 250.00 747.22 Check #: 84381 DES MOINES, WA 98198 SCOTT, KIMBERLY A. Ex: S-01 C F O 1.50 1.00 0.00 0.00 P. O. BOX 516-"-3470 S 8.00 8.00 8.00 0.00 LABORERfTCS/ESC LEAD STANWOOD, WA 98292 0.00 0.50 0.50 3.50 46.44 0.00 79.16 0.00 433.26 0.00 8.00 8.00 40.00 30.96 1,400.94 247.83 84.42 0.00 1,400.94 21.85 0.00 967.68 Check #: 84382 Page 3 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425)226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton August 12, 2011 AUG 16 2011 Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: Description l^....L:C:-J n-....-II -I n ?Pt4-j6 ,jivt. Signature Statement of CompAi&"s Date: AUGUST 9, 2011 Contract Number: CAG-11-044 I, GARY J PANKIEWIC4 ACCOUNTANT do hereby state: (I) That I pay or supervise the payment of the persons employed by RL.. ALIA COMPANY on the BENSON ROAD 16 WM REPL, that during the payroll period commencing on the 3 day of AUGUST, 2011 and ending the 9 day of AUGUST, 2011, 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 RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 SIGNATUREIle GARY J PANKIEWICZ, ACCOUNTANT 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 16 and Section 231 of Title 31 of the United States o 16 Page l R.L. ALIA COMPAN'G4i: 1G7 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay Period Date: r;;=08/09/11 Week Ending: 08/09/11 Payroll No: 14 Certified rRayroll Report Contract#: CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 03 04 05 06 07 08 09 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L 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 56.50 0.00 264.07 107 WILLIAMS AVE S *-**-1869 S 8.00 2.00 0.00 0.00 0.00 0.00 0.00 10.00 25.00 250.00 200.00 0.00 0.00 SUPERINTENDENT 1,000.00 7.57 0.00 735.93 Check #: 84387 RENTON, WA 98057 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.96 0.00 292.64 ALIA, VITO R Ex: S-00 C M O 10904 325TH AVE SE ***-**-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 -100.00 945.76 Check #: 84388 ISSAQUAH, WA 98027 0.00 0.00 1.00 0.00 0.00 0.00 0.00 1.00 52.86 0.00 88.61 0.00 1,011.15 DOUGLASS, TOM R Ex: M-05 C M O 3220 121ST PL. SE *-**-5585 S 8.00 8.00 8.00 0.00 0.00 5.00 8.00 37.00 35.24 1,356.74 142.73 43.96 0.00 OPERATOR UNDER 3 YDS 1,568.18 20.85 715.00 557.03 Check #: 84391 EVERETT, WA 98208 0.00 0.00 1.00 0.00 0.00 0.00 1.00 2.00 53.62 0.00 86.86 0.00 479.02 LYCKSELL, LEITH W Ex: S-00 C M O 912 E 54TH STREET *-**-4345 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.75 1,537.26 299.70 171.36 0.00 CEMENT MASON 1,537.26 21.10 -100.00 1,058.24 Check #: 84399 TACOMA, WA 98404 1.00 0.00 1.50 0.00 0.00 0.00 0.00 2.50 46.44 0.00 48.53 0.00 225.64 SCOTT, KIMBERLY A. Ex: S-01 C F O P. O. BOX 516 *-**-3470 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 30.96 859.14 112.38 51.42 0.00 LABORER/TCS/ESC LEAD 859.14 13.31 0.00 633.50 Check #: 84407 STANWOOD, WA 98292 Page 2 Transmittal Letter August 19, 2011 R.L. Alia Company 107 Williams Avenue SouthI v Renton, Co tractor Lis ese # RLALIC*104PT AUG 2 a 2�I (425) 226-8100 FAX (425) 226-8649 oily OF RENTON Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM TILITY SYSTEM`:; To: City of Renton Attention: Re: Job Number: Andrew Weygandt Benson Road 16" Water Main Quantity Date DWG. # Description 1 Certified Payroll #11 - Alia These are transmitted as checked below �❑ ❑ For Approval ❑ Approved as Submitted Resubmit [#] copies for approval For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: N,;h Copy to: Statement of Compliance "'-f I I I ` a rww" ' Date° *AUGUST 16, 2011 Contract Number: CAG-11-044 1, GARY J PANKIEWIC4 ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 10 day of AUGUST, 2011 and ending the 16 day of AUGUST, 2011, all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of said RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 Page / R.L. ALIA COMPANY--4 1M 107 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay Period Date: 08/1sy11r1; Week Ending: 08/16211' Payroll No: 15 Certified Payroll Report Contract#: CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Employee Social Security Work Class WED 10 THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits 11 12 13 14 15 16 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L 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 56.50 0.00 269.92 107 WILLIAMS AVE S ***-**4869 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 2500 600.00 200.00 0.00 0.00 SUPERINTENDENT RENTON, WA 98057 1.,000.00 13.42 0.00 730.08 Check #: 84442 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.98 0.00 392.66 ALIA, VITO R Ex: S-00 C M O 10904 325TH AVE SE ***-**-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 3096 1,238.40 224.98 77.60 0.00 ISSAQUAH, WA 98027 GROUP 3 LABORER 1.,238.40 20.10 0.00 845.74 Check #: 84443 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 72.03 0.00 329.69 BRUNELLE, WILLIAM H. Ex: S-00 C M O 1819 KENT DES MOINES RD ***-**-5742 S 8.00 0.00 8.00 0.00 0.00 8.00 8.00 32.00 3187 1,019.84 234.08 4.00 0.00 TRUCK DRIVER, T & T 1.,274.80 19.58 0.00 945.11 DES MOINES, WA 98198 Check #: 84445 0.00 0.00 0.00 0.00 0.00 2.50 0.00 2.50 37.29 0.00 27.74 0.00 85.50 DENIS, ELVA Ex: M-03 B M O 22816 28TH AVE SOUTH ***-**-4121 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 24.86 490.99 12.56 35.90 0.00 APT #307 LAB. GRP 2, FLAGGER DES MOINES, WA 98198 490.99 9.30 0.00 405.49 Check #: 84446 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 97.56 0.00 1,050.14 DOUGLASS, TOM R Ex: M-05 C M O ***-**-5585 3220 121ST PL SE S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.24 1,409.60 166.51 48.34 0.00 OPERATOR UNDER 3 YDS 1,726.76 22.73 715.00 676.62 EVERETT, WA 98208 Check #: 84447 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 79.65 0.00 380.70 HAWLEY, SYD R Ex: S-01 C M O ***-**-1257 4518 131ST PLACE NE S 8.00 0.00 0.00 0.00 0.00 8.00 8.00 24.00 3524 845.76 250.00 77.60 0.00 PIPELAYER LAB GRP IV MARYSVILLE, WA 98271 1.,409.60 19.06 -45.61 1,028.90 Check #: 84449 Page 2 R.L. ALIA COMPANY -, ,:,;; Pay Period Date: 08/16/11'-8,. ,w Certified Payroll Rejid# Contract #:' - ,CAG-11-044 G-111 ... 107 WILLAIMS AVE S Week Ending: 08/16/11 Job No: RENTON, WA 98055 Payroll No: 15 Job Name: BENSON ROAD 16" WM REPL 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Employee Social Security Work WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Class 10 11 12 13 14 15 16 Total Rate Total Gross State Oth Ded Net Chk HOFFMAN, PAUL A Ex: M-00 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.50 37.29 0.00 12.29 0.00 39.62 DMB #24519916 OLD OWEN RD ***-**-8804 S 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 24.86 217.53 6.56 16.50 0.00 MONROE, WA 98212 FLAGGER 217.53 4.27 0.00 177.91 Check #: 84450 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 57.62 0.00 246.72 HUTCHINS JR., JOHN O. Ex: S-00 C M O 4012 97TH DR SE ***-**-8753 S 8.00 0.00 0.00 0.00 0.00 8.00 8.00 24.00 31.87 764.88 170.34 3,20 0.00 TRUCK DRIVER, T & T 1,019.84 15.56 0.00 773.12 LAKE STEVENS, WA 98258 Check #: 84451 LYCKSELL, LEITH W 912 E 54TH STREET TACOMA, WA 98404 McGOVERN, JASON T 114 244TH ST NW STANWOOD, WA 98292 REDWOOD, DANIEL 1622 113TH DR SE LAKE STEVENS, WA Ex: S-00 C M O 1.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 53.62 0.00 83.82 0.00 557.47 ***-**-4345 S 8.00 8.00 8.00 0.00 0.00 8.00 0.00 32.00 35.75 1,197.63 286.29 167.28 0.00 CEMENT MASON 1,483.63 20.08 0.00 926.16 Check #: 84454 Ex: M-01 C M O 0.00 0.00 0.00 0.00 *-**-9952 S 0.00 0.00 0.00 0.00 FORE MAN/SUPERINTENDE Ex: S-00 C M O 0.00 0.00 0.00 0.00 ***-**-6920 S 0.00 0.00 0.00 0.00 OPERATOR,GROUPI 0.00 0.00 0.00 0.00 0.00 0.00 85.88 0.00 360.21 0.00 8.00 8.00 16.00 38.00 608.00 178.19 77.60 0.00 1,520.00 18.54 0.00 1,159.79 Check #: 84455 0.00 0.00 0.00 0.00 0.00 0.00 63.71 0.00 308.21 0.00 8.00 8.00 16.00 35.24 563.84 197.30 32.16 0.00 1,127.68 15.04 0.00 819.47 Check #: 84459 REDWOOD, TRAVIS Ex: M-01 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.50 48.31 0.00 74.16 0.00 253.45 5829 60TH DRIVE NE ***-**4852 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 32.21 539.52 147.08 78.58 0.00 LAB. GRP 5 LEAD PIP 1,312.56 18.79 -65.16 1,059.11 MARYSVILLE, WA 98270 Check #: 84460 P(IgC 3 R.L. ALIA COMPANY aw 107 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay Period Date: 08/16/11 `- • ;' Certified Payroll RepOrt_,t -0 Contract#: CAG-11-044 Week Ending: 08/16/11 Job No: 06-11 Payroll No: 15 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Employee Social Security WED Work THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Class 10 11 12 13 14 15 16 Total Rate Total Gross State Oth Ded Net Chk REED, RONALD W 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 43.22 0.00 136.32 P. O. BOX 985 ***-**-5585 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 31.87 509.92 79.16 2.40 0.00 TRUCK DRIVER, GROUP 764.88 11.54 0.00 628.56 ROY, WA 98580 Check #: 84461 Page a Transmittal Letter r_. August 26, 2011 r� R.L. Alia Company fji 107 Williams Avenue South AUG 3 0 201� Renton, WA 98057 Contractor License # RLALIC*104PT G►N OF SEtiION (425) 226-8100 FAX (425) 226-8649 U-T;LjTY SYSTEMS Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: These are transmitted as checked below\\\ ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval F For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy to: /�U 1 Q �►4NIC l (i �� �2 Signature Statemenf d-cdrtipliance Date: AUGUST 23, 2011 t • 1, GAILY J PANKIEWIC4 ACCOUNTANT do hereby state: Contract Number: CAG-11-044 (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 1 B' WM REPL, that during the payroll period commencing on the 17 day of AUGUST, 2011 and ending the 23 day of AUGUST, 2011, 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 R.L. ALIA COMPANY 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 persort 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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) REMARKS NAME AND TITLE OARY J PANKIEWICZ, ACCOUNTANT SIGNATURE Me willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution See Section 1001 I L EXPLANATION 8 and Section 231 of Title 31 of the United States Code, Page I R.C. ALIA-t s33 ANY Pay Periq }41' 08/23/11 Certified Payroll Report Contract#: CAG-11-044 107 WILLAIMS AVE S Week Ending: 08/23/11 Job No: 06-11 RENTON� WA 98055 Payroll No: 16 Job Name: BENSON ROAD 16" WM REPL 425 226-8100 # Exemptions Hours Social Security WED THU FRI SAT SUN MON TUE Other Job Pay FICA Local Tot Ded Employee Work Class 17 18 19 20 21 22 Job Gross Fed W/H Union Benefits 23 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 107 WILLIAMS AVE S ***-**-1869 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 2500 400.00 56.50 200.00 0.00 269.40 SUPERINTENDENT 0.00 0.00 RENTON, WA 98057 1.,000.00 12.90 0.00 730.60 Check #: 84465 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.97 0.00 392.65 ALIA, VITO R 10904 325TH AVE SE Ex: S-00 C M O '**-*'-5554 S GROUP 3 LABORER 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 3096 1,238.40 224.98 77.60 0.00 ISSAQUAH, WA 98027 1.,238.40 20.10 0.00 845.75 Check #: 84466 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 BRUNELLE, WILLIAM H. Ex: S-00 C M O 1819 KENT DES MOINES RD ***-*'-5742 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 3187 73.37 0.00 336.76 TRUCK DRIVER, T & T 764.88 240.06 4.05 0.00 DES MOINES, WA 98198 1.,298.70 19.28 0.00 961.94 Check #: 84468 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 33.71 0.00 DENIS, ELVA Ex: M-03 B M O ***-**4121 22816 28TH AVE SOUTH APT #307 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 24.86 596.64 23.13 46.56 115.46 0.00 LAB. GRP 2, FLAGGER DES MOINES, WA 98198 596.64 12.06 0.00 481.18 1. Check #: 84463 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.50 52.86 0.00 81.13 0.00 305.26 DOUGLASS, TOM R 3220 121ST PL SE Ex: M-05 C M O *'*-**-5585 S 8.00 OPERATOR UNDER 3 YDS 8.00 8.00 0.00 0.00 8.00 8.00 40.00 3524 1,436.03 122.90 40.88 0.00 EVERETT, WA 98208 1.,436.03 20.35 40.00 1,130.77 Check #: 84469 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 81.13 0.00 HAWLEY, SYD R Ex: S-01 C M O ***-**-1257 4518 131ST PLACE NE S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 2400 35.24 845.76 256.60 78.58 435.59 0.00 MARYSVILLE, WA 98271 PIPELAYER LAB GRP IV 1.,436.03 19.28 0.00 1,000.44 Check #: 84471 Pu} r R.L. ALIA COMPANY 107 WILLAIMS Pay Period, DaIPQ8/23/11 Certified Payroll Report ntract #: CAG 11-044 Week Ending 08/23/11 Job No: 06-11 RENTGIV, WA 98055 Payroll No: 16 Job Name: BENSON ROAD 16" WM REPL ` 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Employee Social Security Work WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Class 17 18 19 20 21 22 23 Total Rate Total Gross State Oth Ded Net Chk HOFFMAN, PAUL A Ex: M-00 C M 0 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.50 37.29 0.00 60.73 0.00 283.10 DMB #24519916 OLD OWEN RD **'`-**-8804 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 24.86 615.29 122.08 80.54 0.00 MONROE, WA 98212 FLAGGER 1,074.75 19.75 0.00 791.65 Check #: 84472 1.00 0.50 0.00 0.00 0.00 0.00 1.00 2.50 53.62 0.00 88.37 0.00 589.53 LYCKSELL, LEITH W Ex: S-00 C M 0 912 E 54TH STREET ***-*"-4345 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 3575 1,564.07 306.40 173.41 0.00 CEMENT MASON 1.,564.07 21.35 0.00 974.54 TACOMA, WA 98404 Check #: 84477 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 85.88 0.00 360.73 McGOVERN, JASON T Ex: M-01 C M 0 114 244TH ST NW ***-**-9952 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 38.00 912.00 178.19 77.60 0.00 FOREMAN/SUPERINTENDE 1,520.00 19.06 0.00 1,159.27 STANWOOD, WA 98292 Check #: 84478 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.23 0.00 35.47 PRENTISS, MICHAEL Ex: M-00 B M 0 2840 SOUTH OTHELLO STREET ***-**-9516 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 24.86 198.88 4.70 15.52 0.00 LAB. GRP 2, FLAGGER 198.88 4.02 0.00 163.41 SEATTLE, WA 98108 Check #: 84464 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 81.13 0.00 415.68 REDWOOD, DANIEL Ex: S-00 C M 0 1622 113TH DR SE ***-**-6920 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 35.24 845.76 274.39 40.88 0.00 OPERATOR, GROUP I 1,436.03 19.28 0.00 1,020.35 LAKE STEVENS, WA Check #: 84482 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 74.16 0.00 319.10 REDWOOD, TRAVIS Ex: M-01 C M 0 5829 60TH DRIVE NE ***-**-4852 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 32.21 773.04 147.08 78.58 0.00 LAB. GRP 5 LEAD PIP 1,312.56 19.28 0.00 993.46 MARYSVILLE, WA 98270 Check #: 84483 Page 3 R.L. ALIA COMPAMV3l. t 107 WILLAIMS AVE S - RENTGN, WA 98055 ` 425 226-8100 Pay Period, Date!s:,,0fi11 Week Ending: 0 /23/11 Payroll No: 16 Certified PdMfi Report `CortPW,#: CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Employee Social Security WED THU FRI SAT SUN MON TUE Other Job Pay Job Gross FICA Fed W/H Local Union Tot Ded Benefits Work Class 17 18 19 20 21 22 23 Total Rate Total Gross State Oth Ded Net Chk REED, RONALD W Ex: S-02 C M O 0.00 ***-**-5585 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68.42 0.00 P. O. BOX 985 S 6.00 8.00 8.00 0.00 0.00 0.00 0.00 22.00 3187 701.14 182.57 3.80 522.84 0.00 TRUCK DRIVER, GROUP ROY, WA 98580 1.,211.06 18.05 250.00 688.22 Check #: 84484 Page 4 Transmittal Letter R F- C -1 ber 6, 2011 R.L. Alia Company 107 Williams Avenue South SEP 0 7 2011 Renton, WA 98057 Contractor License # RLALIC* 104PT CITY OF RENTON (425) 226-8100 FAX (425) 226-8649 UTILITY SYSTEMS Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you . Attached ❑ Under Separate Cover via ...__m----- ... ............ _ ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Other: ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification Quantity 1 Date DWG. # Description ._ __ t________ __ __. _ __ _ . _._ ........._: _. ........ 1 Certified Payroll #13 - Alia �1— Monthly Utilization Report - August 2011 - Alia These are ti ti nsml" ecked below ❑ For Approval ❑ „Approved as Submitted ❑ Resubmit [#] copies for approval �ff For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested __ ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ __..._._._..._..___......... For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: _ _ ,._. ❑ ....... __._.... .... _ ___.__..._._ ___ .____..___...__._____.. PRINTS RETURNED AFTER LOAN _._,.R__ ___�_......... _ ............. ..,_ Comments: )y to JAy ij� �ANIc�>_i,+�cZ _ ___ Signature Statement of Compliance -Date: AUGUST 30, 2011 Contract Number: CAG-11-044 I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 24 day of AUGUST, 201 land ending the 30 day of AUGUST, 2011, 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 RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT 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 an Section 231 of Title 31 of the United States Code. W R.L. ALIA COMPANY ' "" rr-, Pay Period Date: 08/30/11- - r,.-� Certified Payroll Repot Contract #: CAG-11-044 107 WILL AIMS AVE S Week Ending: 08/30/11 Job No: 06-11 Payroll No: 17 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 24 25 26 27 28 29 30 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 113.00 0.00 721.15 107 WILLIAMS AVE S *-**-1869 S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 50.00 400.00 600.00 0.00 0.00 SUPERINTENDENT 2,000.00 8.15 0.00 1,278.85 Check #: 84539 RENTON, WA 98057 ALIA, VITO R 10904 325TH AVE SE ISSAQUAH, WA 98027 DICKMEYER, STEVEN M 13818 SE 161ST PLACE RENTON, WA 98058 DOUGLASS, TOM R 3220 121 ST PL SE EVERETT, WA 98208 LYCKSELL, LEITH W 912 E 54TH STREET TACOMA, WA 98404 MAYER, EDWARD 3114 S NORMAN SEATTLE, WA 98122 Ex: S-00 C M O 0.00 0.00 0.00 0.00 ***-**-5554 S 8.00 8.00 8.00 0.00 GROUP 3 LABORER Ex: S-01 C M O 0.00 0.00 0.00 0.00 *-**-7176 S 0.00 0.00 0.00 0.00 LABORER 0.00 0.00 0.00 0.00 0.00 0.00 69.96 0.00 392.64 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 1,238.40 20.10 0.00 845.76 Check #: 84540 0.00 0.00 0.00 0.00 0.00 0.00 36.24 0.00 115.59 0.00 8.00 8.00 16.00 40.09 641.44 71.31 0.00 0.00 641.44 8.04 0.00 525.85 Check #: 84543 Ex: M-05 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 91.60 0.00 349.74 ***-**-5585 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 35.24 1,409.60 150.66 45.63 0.00 OPERATOR UNDER 3 YDS 1,621.04 21.85 40.00 1,271.30 Check #: 84544 Ex: S-00 C M O 1.00 0.00 0.00 0.00 * *-**-4345 S 8.00 8.00 8.00 0.00 CEMENT MASON 0.00 0.00 0.00 1.00 53.62 0.00 91.40 0.00 609.88 0.00 0.00 8.00 32.00 35.75 1,197.63 319.81 177.49 0.00 1,617.69 21.18 0.00 1,007.81 Check #: 84552 Ex: S-06 B M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.23 0.00 30.77 *-**-3113 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 24.86 198.88 0.00 15.52 0.00 LAB. GRP 2, FLAGGER 198.88 4.02 0.00 168.11 Check #: 84488 Page 2 R.L. ALIA COMPANY Pay Period Date: 08/30/11 Certified Payroll Report Contract #: CAG-11-044 107 WIL.LAIMS AVE S Week Ending: 08/30/11 Job No: 06-11 - Payroll No: 17 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 24 25 26 27 28 29 30 Total Rate Total Gross State Oth Ded Net Chk NESS, JANICE M Ex: S-04 N F O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.24 0.00 30.78 1302 E YESLER WAY -"-7829 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 24.86 198.88 0.00 15.52 0.00 B-3 90% APPRENTICE 198.88 4.02 0.00 168.10 Check #: 84487 SEATTLE, WA 98122 SCOTT, KIMBERLY A. Ex: S-01 C F O 0.00 1.00 1.50 0.00 P. O. BOX 516 '"-"-3470 S 0.00 8.00 8.00 0.00 LABORER/TCS/ESC LEAD STANWOOD, WA 98292 0.00 0.00 0.00 2.50 46.44 0.00 81.78 0.00 719.62 0.00 0.00 0.00 16.00 30.96 611.46 259.44 86.36 0.00 1,447.38 20.67 271.37 727.76 Check #: 84560 ` R.L. ALIA COMPA� JI 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 08 RENTON, WA 98055 From period end date: 08/01/11 Job number: 06-11 EEO Class / Work Class Sex To period end date: 08/31/11 BENSON ROAD 16" WM REPL Hispanic White Total Work hours of employment Black Asian Pacific Islander American Indian Other(2 or more) Minority % Female % Total # Employees Total # Minority M 90.0 0.0 90.0 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 CEMENT MASON M 155.5 0.0 155.5 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 FOREMAN/SUPERINT. M 40.0 0.0 40.0 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 LABORERS/FLAGGERS M 291.5 0.0 233.0 58.5 0.0 0.0 0.0 0.0 15.4% 23.3% 5 3 JOURNEYMAN F 88.5 0.0 88.5 0.0 0.0 0.0 0.0 0.0 1 0 LABORERS/FLAGGERS M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 APPRENTICE F 8.0 0.0 0.0 0.0 0.0 0.0 8.0 0.0 1 1 LABORERS/FLAGGERS M 16.0 0.0 16.0 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 307.5 0.0 249.0 58.5 0.0 0.0 0.0 0.0 16.5% 23.9% 6 3 F 96.5 0.0 88.5 0.0 0.0 0.0 8.0 0.0 2 1 EQUIPMENT OPERATORS M 241.0 0.0 241.0 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 PIPELAYERS M 113.5 0.0 113.5 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 TRUCK DRIVERS M 148.5 0.0 148.5 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 Journeyman total: M 990.0 0.0 931.5 58.5 0.0 0.0 0.0 0.0 5.4% 8.2% 14 3 F 88.5 0.0 88.5 0.0 0.0 0.0 0.0 0.0 1 0 Apprentice total: M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 F 8.0 0.0 0.0 0.0 0.0 0.0 8.0 0.0 1 1 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 106.0 0.0 106.0 0.0 0.0 0.0 0.0 0.0 0.0% 0.0% 2 0 F 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 Job total: M 1,096.0 0.0 1,037.5 58.5 0.0 0.0 0.0 0.0 5.6% 8.1 % 16 3 F 96.5 0.0 88.5 0.0 0.0 0.0 8.0 0.0 2 1 Priiued w GJP as of 09/01111 1: 37.45PAf Page 2 ` R.L. ALIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 08 RENTON, WA 98055 From period end date: 08/01/11 To period end date: 08/31/11 Job number: 06-11 BENSON ROAD 16" WM REPL 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: Telephone: ignature —/ —%/ Date Signed Printed by GJP as of 09/01/11 1:37:45PM Page 3 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity Transmittal Letter September 9, 2011 Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you ❑ Under Separate Cover via: ---... ........ _..........--- ❑ Prints ❑ Plans ❑ Change Order ❑ Samples ❑ Reproducible ❑ Specification These are transmitted as checked below ❑ Other: ❑ _--------____��___.__ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed j❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments SEP 1 5 Copy :to; DAyiy �/�if4K-1FLj Signature -:r -ten+ of Statement of Compliance Date: SEPTEMBER 6, 2011 Contract Number: CAG-11-044 1, GARY J PANKIEWICT ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16 WM REPL, that during the payroll period commencing on the 31 day of AUGUST, 2011 and ending the 6 day of SEPTEMBER, 2011, 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 RL. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 SIGNATURE GARY J PANKIEWICZ, ACCOUNTANT 1 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 St—afft Code. 1 H Page l R.L.,ALIA,GOMPANY 107 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay^ pgriol iPate: 09/06/11 Week Ending: 09/06/11 Payroll No: 18 Certified Payroll Report Contract #: CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 31 01 02 03 04 05 06 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 113.00 0.00 725.64 107 WILLIAMS AVE S -" --1869 S 8.00 0.00 4.00 0.00 0.00 0.00 0.00 12.00 50.00 600.00 600.00 0.00 0.00 SUPERINTENDENT 2,000.00 12.64 0.00 1,274.36 Check #: 84566 RENTON, WA 98057 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55.98 0.00 297.20 ALIA, VITO R Ex: S-00 C M 0 10904 325TH AVE SE ' *-**-5554 S 8.00 8.00 8.00 0.00 0.00 0.00 8.00 32.00 30.96 990.72 163.06 62.08 0.00 GROUP 3 LABORER 990.72 16.08 0.00 693.52 Check #: 84567 ISSAQUAH, WA 98027 BRUNELLE, WILLIAM H. Ex: S-00 C M O 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 47.80 0.00 61.67 0.00 268.50 1819 KENT DES MOINES RD -*'-5742 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 31.87 278.86 188.27 3.35 0.00 TRUCK DRIVER, T & T 1,091.54 15.21 0.00 823.04 Check #: 84569 DES MOINES, WA 98198 DICKMEYER, STEVEN M Ex: S-01 C M O 0.00 0.00 1.00 0.00 0.00 0.00 0.00 1.00 60.13 0.00 75.89 0.00 325.30 13818 SE 161ST PLACE '-**-7176 S 8.00 0.00 8.00 0.00 0.00 0.00 8.00 24.00 40.09 1,022.30 233.35 0.00 0.00 LABORER 1,343.02 16.06 0.00 1,017.72 Check #: 84565 RENTON, WA 98058 DOUGLASS, TOM R Ex: M-05 C M O 0.00 0.00 2.00 0.00 0.00 0.00 0.00 2.00 52.86 0.00 53.76 0.00 183.61 3220 121ST PL SE *-'*-5585 S 4.00 0.00 8.00 0.00 0.00 0.00 8.00 20.00 35.24 810.52 50.22 26.83 0.00 OPERATOR UNDER 3 YDS 951.48 12.80 40.00 767.87 Check #: 84570 EVERETT, WA 98208 HOFFMAN, PAUL A Ex: M-00 C M O 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 46.39 0.00 54.20 0.00 238.26 DMB #24519916 OLD OWEN RD *-'*-8804 S 0.00 0.00 8.00 0.00 0.00 0.00 4.00 12.00 30.96 394.72 104.77 64.04 0.00 FLAGGER 959.37 15.25 0.00 721.11 Check #: 84573 MONROE, WA 98212 Puler 2 R.C. ALIAt3 'MPANY Pay Period: 09/06/11 ��� Certified Payroll Report ; Contract CAG-11-044 �.. 107 WILLAIMS AVE S Week Ending: 09/06/11 Job No: Job Name: 06-11 BENSON ROAD 16" WM REPL • Payroll No: 18 RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 31 01 02 03 04 05 06 Total Rate Total Gross State Oth Ded Net Chk HUTCHINS JR., JOHN O. Ex: S-00 C M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 58.96 0.00 253.27 4012 97TH DR SE *-**-8753 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 31.87 254.96 176.32 3.25 0.00 TRUCK DRIVER, T & T 1,043.74 14.74 0.00 790.47 Check #: 84574 LAKE STEVENS, WA 98258 KELLY, WILLIAM 0.00 0.00 1.00 0.00 0.00 0.00 0.00 1.00 37.29 0.00 36.86 0.00 181.74 Ex: S-00 C M 0 PO BOX 1967 -**-0195 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 24.86 236.17 83.66 49.48 0.00 LAB. GRP 2, FLAGGER 652.58 11.74 0.00 470.84 Check #: 84564 MARYSVILLE, WA 98270 LYCKSELL, LEITH W 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 64.64 0.00 412.28 Ex: S-00 C M 0 912 E 54TH STREET *-**-4345 S 8.00 0.00 6.00 0.00 0.00 0.00 8.00 22.00 35.75 786.50 201.38 130.56 0.00 CEMENT MASON 1,144.00 15.70 0.00 731.72 Check #: 84577 TACOMA, WA 98404 NESS, JANICE M 0.00 0.00 1.00 0.00 0.00 0.00 0.00 1.00 37.29 0.00 20.37 0.00 57.79 Ex: S-04 N F 0 1302 E YESLER WAY *-**-7829 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 24.86 236.17 3.55 27.16 0.00 90% APPRENTICE 360.47 6.71 0.00 302.68 B-3 Check #: 84563 SEATTLE, WA 98122 REDWOOD, TRAVIS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 62.33 0.00 258.18 Ex: M-01 C M 0 5829 60TH DRIVE NE * *-**-4852 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 32.21 257.68 115.67 65.00 0.00 LAB. GRP 5 LEAD PIP 1,103.20 15.18 0.00 845.02 Check #: 84583 MARYSVILLE, WA 98270 REED, RONALD W 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 47.80 0.00 56.73 0.00 204.73 Ex: S-02 C M 0 P. O. BOX 985 *-**-5585 S 0.00 0.00 8.00 0.00 0.00 0.00 0.00 8.00 31.87 278.86 130.78 3.10 0.00 TRUCK DRIVER, GROUP 1,003.90 14.12 0.00 799.17 Check #: 84584 ROY, WA 98580 f� R.L. ALIA COMPAN;, 9_ 107 WILL) AVE RENTON, WA 98055 425 226-8100 PayPeriod-Dateag p6/11 C@Itlfl@CI p I1fOII R@p01't "^Cgritrabt#: CAG-11-044 Week Ending: 9/06/11 Job No: 06-11 Payroll No: 18 Job Name. BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 31 01 02 03 04 05 06 Total Rate Total Gross State Oth Ded Net Chk SCOTT, KIMBERLY A. Ex: S-01 C F O 0.00 0.00 4.00 0.00 0.00 0.00 0.00 4.00 46.44 0.00 63.41 0.00 -16.39 P. O. BOX 516 ."`-"-3470 S 0.00 4.00 8.00 0.00 0.00 0.00 0.00 12.00 30.96 557.28 178.17 65.00 0.00 LABORER/TCS/ESC LEAD 1,122.30 15.70 -338.67 1,138.69 STANWOOD, WA 98292 Check #: 84585 Puxr 4 Transmittal Letter September 16, 2011 R.L. Alia Company �`''" 107 Williams Avenue South GLIVE Renton, WA 98057 SEP 1 9 2011 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 CITY OF HLIVTOIV Email: GIPANK@RLALIA.COM or DPANK@RLALIA.COM UTILITY SYSTEMS To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you I� Attached ❑ Under Separate Cover via: ___......_._..._._.._._....._-....... .__._..................... .............................................................. ................ .._........._ ....... _...... ❑ Shop Drawings ❑ Prints i ❑ ❑ Copy of Letter ❑ Change Order ❑ ❑ Total Quantity ❑ Reproducible El ....... _.. .... Quantity Date DWG. # Plans Samples Specification r)Pcrrintinn ))A\�I'D f AN1L1�1..itCL _ __.... Signature nr(ftt Statement of Cumnliance` Date: SEPTEMBER 13, 2011 Contract Number: CAG-11-044 I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 7 day of SEPTEMBER, 2011 and ending the 13 day of SEPTEMBER, 2011, 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 RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT 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 d Section 231 of Title 31 of the United States Code. 5 Page R.L. ALIA COMPANY Pay Periodfk-q:�l�09/13/11 Certified ftyroll Report Contract#: CAG-11-044 107 WILLAIMS AVE S Week Ending: 09/13/11 Job No: 06-11 Payroll No: 19 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 07 08 09 10 11 12 13 Total Rate Total Gross State Oth Ded Net Chk ALIA, RICHARD L Ex: S-99 C M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 113.00 0.00 728.74 107 WILLIAMS AVE S ***-**4869 S 0.00 4.00 4.00 0.00 0.00 0.00 0.00 8.00 50.00 400.00 600.00 0.00 0.00 SUPERINTENDENT 2,000.00 15.74 0.00 1,271.26 RENTON, WA 98057 Check #: 84590 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.96 0.00 292.64 ALIA, VITO R Ex: S-00 C M O 10904 325TH AVE SE ***-**-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 -100.00 945.76 ISSAQUAH, WA 98027 Check #: 84591 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 73.38 0.00 335.47 BRUNELLE, WILLIAM H. Ex: S-00 C M 0 1819 KENT DES MOINES RD ***-**-5742 S 0.00 4.00 0.00 0.00 0.00 0.00 0.00 4.00 31.87 127.48 240.06 4.05 0.00 TRUCK DRIVER, T & T 1,298.70 17.98 0.00 963.23 DES MOINES, WA 98198 Check #: 84593 DAZA, JULIO Ex: M-04 H M 0 0.00 0.00 0.00 0.00 PO BOX 69093 *-**4029 S 0.00 0.00 0.00 0.00 LAB. GRP 2, FLAGGER SEATTLE, WA 98168 DICKMEYER, STEVEN M Ex: S-01 C M 0 0.00 0.00 0.00 0.00 13818 SE 161ST PLACE -**-7176 S 8.00 8.00 0.00 0.00 LABORER RENTON, WA 98058 DOUGLASS, TOM R Ex: M-05 C M 0 0.00 0.00 0.00 0.00 3220 121ST PL SE *-**-5585 S 8.00 8.00 0.00 0.00 OPERATOR UNDER 3 YDS EVERETT, WA 98208 0.00 0.00 0.00 0.00 0.00 0.00 11.23 0.00 30.77 0.00 8.00 0.00 8.00 24.86 198.88 0.00 15.52 0.00 198.88 4.02 0.00 168.11 Check #: 84587 0.00 1.00 0.00 1.00 60.13 0.00 94.00 0.00 428.36 0.00 8.00 8.00 32.00 40.09 1,343.02 313.53 0.00 0.00 1,663.75 20.83 0.00 1,235.39 Check #: 84594 0.00 0.00 0.00 0.00 0.00 0.00 81.13 0.00 978.67 0.00 0.00 0.00 16.00 35.24 563.84 122.90 40.88 0.00 1,436.03 18.76 715.00 457.36 Check #: 84595 Page 2 R.L. ALIA COMPAN t,'W Pay Period Date:' �W63411 Certified PAWOft Report Cbntroc(,#: CAG-11-044 107 WILLAIMS AVE S Week Ending: 09/13/11 Job No: 06-11 Payroll No: 19 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 07 08 09 10 11 12 13 Total Rate Total Gross State Oth Ded Net Chk GALLACHER, JOEL L Ex: M-01 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 108.02 0.00 599.23 714 191 ST PL SW -**-1199 S 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 47.80 382.40 473.19 0.00 0.00 CARPENTER 1,912.00 18.02 0.00 1,312.77 LYNNWOOD, WA 98036 Check #: 84596 0.00 0.00 0.00 0.00 0.00 2.50 2.00 4.50 37.29 0.00 75.75 0.00 350.83 HOFFMAN, PAUL A Ex: M-00 C M O DMB #24519916 OLD OWEN RD ***-**-8804 S 4.00 4.00 0.00 0.00 0.00 8.00 0.00 16.00 30.96 650.97 161.99 91.20 0.00 FLAGGER 1,340.84 21.89 0.00 990.01 MONROE, WA 98212 Check #: 84598 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.50 53.08 0.00 81.48 0.00 340.50 JOHNSTON, DALE D Ex: M-03 C M O 17017 102ND AVE SE *-**-5149 S 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 35.39 309.66 145.17 95.58 0.00 CARPENTER 1,442.14 18.27 0.00 1,101.64 SNOHOMISH, WA 98296 Check #: 84600 0.00 0.00 0.00 0.00 0.00 1.50 0.00 1.50 37.29 0.00 14.39 0.00 47.89 JONES, ROBERT M Ex: M-00 C M O 320 S DIVISION STREET -**-6024 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 24.86 254.82 10.29 18.44 0.00 LAB. GRP 2, FLAGGER 254.82 4.77 0.00 206.93 AUBURN, WA 98001 Check #: 84588 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 72.71 0.00 375.63 LYCKSELL, LEITH W Ex: S-00 C M O 912 E 54TH STREET ***-**-4345 S 8.00 4.00 0.00 0.00 0.00 8.00 0.00 20.00 35.75 715.00 237.14 146.90 0.00 CEMENT MASON 1,287.01 18.88 -100.00 911.38 TACOMA, WA 98404 Check #: 84602 0.00 0.00 0.00 0.00 0.00 1.50 0.00 1.50 37.29 0.00 14.39 0.00 61.59 MCNERNEY, EDWARD H Ex: S-00 C M O 13717 LINDEN AVE N -**-9870 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 24.86 254.82 23.99 18.44 0.00 #226 LAB. GRP 2, FLAGGER 254.82 4.77 0.00 193.23 SEATTLE, WA 98133 Check #: 84589 Pg4e 3 R.L. ALIA COMPANY "111 :.: Pa Period Date: 09/13i1r' Contract . y ���: Certified Payroll Re0ort cAG-1l-oaa -,ht 107 WILLAIMS AVE S Week Ending: 09/13/11 Job No: 06-11 RENTON, WA 98055 Payroll No: 19 Job Name: BENSON ROAD 16" WM REPL 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 07 08 09 10 11 12 13 Total Rate Total Gross State Oth Ded Net Chk REDWOOD, DANIEL 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 84.12 0.00 432.65 1622 113TH DR SE ***-**-6920 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 35.24 281.92 287.61 42.24 0.00 OPERATOR, GROUP 1 1,488.89 18.68 0.00 1,056.24 LAKE STEVENS, WA Check #: 84607 REDWOOD, TRAVIS 5829 60TH DRIVE NE MARYSVILLE, WA 98270 SCOTT, KIMBERLY A. P. O. BOX 516 STANWOOD, WA 98292 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 76.89 0.00 330.43 ***-**-4852 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 32.21 257.68 154.32 80.54 0.00 LAB. GRP 5 LEAD PIP 1,360.88 18.68 0.00 1,030.45 Check #: 84608 Ex: S-01 C F O 0.00 0.00 2.50 0.00 0.00 3.50 2.00 8.00 46.44 0.00 97.52 0.00 548.68 ***-**-3470 S 0.00 0.00 3.00 0.00 0.00 8.00 8.00 19.00 30.96 959.76 329.30 98.00 0.00 LABORER/TCS/ESC LEAD 1,726.02 23.86 0.00 1,177.34 Check #: 84610 TONSGARD, KENNETH A Ex: S-00 N M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 84.13 0.00 432.66 P. O. BOX 1301 ***-**-7739 S 0.00 0.00 0.00 0.00 0.00 8.00 0.00 8.00 35.24 281.92 287.61 42.24 0.00 OPERATOR UNDER 3 YDS 1,488.89 18.68 0.00 1,056.23 SNOHOMISH, WA 98291 Check #: 84611 MIL, e 4 Department of Labor and Industries PROJECT PAYROLL tmployment Standards Section Contractor " PO Box 44510 Olympia WA 98504-4510 Subcontractor � Project Name County Benson Road 16" Water Main Replacement Kin P roject or Contract # CAG+11-044 Project Address City State ZIP + 4 For the week ending. Awarding Agency Name City of Renton Company Name P.R. Systems, Inc. Month Day Year 9/3/2011 Address City State ZIP+4 1056 S Grady Way Renton WA 98066 Address 8351 30th Ave NE City State ZIP +4 Lace , WA 98516 Work Classification and Soc. Sec. # of Employee Name and Address 3m 8 � a an ate Total Hours Rate of Pay Gross Amount Earned Deductions NET WAGES Sun on ues a urs n at FICA With - Holding Tax L & I 28 29 1 30 31 1 2 3 Hours Worked Each Day Rotomill Operator .6601 M-0 Riley Borden RG 8 8 $ 4990 $ 399.20 $ - $ 399.20 $ 30.54 $ 24.00 $ 1.43 $ 343.23 OT 0 $ 74 85 8 Grade Checker '•4332 M-0 Fredy Medrano RG 8 8 $ 4712 $ 376.96 $ - $ 376.96 $ 28.84 $ 22.00 $ 1.43 $ 324.69 OT 0 $ 70 68 8 Sweeper Operator '-7292 S-2 Mirka, Hank RG 4 4 $ 4712 $ 188.48 $ 318,06 $ 606.54 $ 38.75 1 $ 40.00 1 $ 1.25 $ 426.54 OT 3 3 S 7068 7 RG 0 $ $ $ — $ — — — $ OT $ OT 0 0 RG 0 $ $ $ $ $ $ $ OT 0 0 RG 0 $ $ $ $ $ $ $ OT 0 0 RG 0 $ $ $ $ $ $ $ OT 0 0 23 Department of Labor and Industries AFFIRMATION Employment Standards Section PO Box 44510 Olympia WA 98504-4510 Date: 9/5/2011 1, Laurel Henn, Title: Contract Administrator t— or.1y,rory am+» Do hereby state (1) That I pay or supervise the payment of the persons employed by P. R. Systems, Inc. (cow.cto. o, .uec ormec�oo on the Benson Road 16" Water Main Replacement; that during the payroll period commencing on the 28th day of August, (t.0dinp to work) 2011 and ending the 3rd day of September 2011 all persons employed on said 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 said P. R. Systems, Inc. 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 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 Star 967, Stet. 357, 40 U S C 276c), and described below FICA, WITHHOLDING and L&I (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 being performed (3) That any apprentices employed in the above period are duly registered in a bona ride apprenticeship program 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 benefits of such employees ® (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 plus the amount of the required fringe benefits. i ne winrui faismcatlon of any of the above statements may subject the contractor to civil or criminal prosecution. Print or type name of signatory Title Signatur Laurel Henn Contract Administrator BENEFIT DISTRIBUTION Craft Total Benefit Credit Pension Medical Vacation Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC* 104PT (425) 226-8100 FAX (425) 226-8649 Email: G]PANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity September 23, 2011 SEP 2 6 2011 CITY OF REN I ON Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you ❑ Under Separate Cover via: ❑ Prints ❑ Plans ❑ Change Order ❑ Samples ❑ Reproducible ❑ Specification .............. _.... . uantlty! Date DWG. # Descripth .... __- ------ 4 . _.- _ 1 Certified Payroll #16 - Alia 1 j Certified Payroll #1 - Miles Resources ❑ Other: These are transmitted as checked below K ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval 19 For Your Use ❑ Approved as Noted ❑ Submit [#I copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints DiNIR PAt 1y-`IFWVZ Signature Date: SEPTEMBER 20, 2011 Statement of Compliance Contract Number: CAG-I1-044 I, GARY J PANKIEWIC4 ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 14 day of SEPTEMBER, 2011 and ending the 20 day of SEPTEMBER, 2011, 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 R.L. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT 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 and Section 231 of Title 31 of the United State de. I `c) Page I R.L. ALIA COMPANY -t 107 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 Employee ALIA, RICHARD L 107 WILLIAMS AVE S RENTON, WA 98057 ALIA, VITO R 10904 325TH AVE SE ISSAQUAH, WA 98027 Pay Period Date: 09/20111' 'iCtt �.@rtlfl@CI Pa�/COli i�epOft ' Contract #: CAG-11-044 Week Ending: 09/20/11 Job No: 06-11 Payroll No: 20 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Work Class 14 15 16 17 18 19 20 Total Rate Total Gross State Oth Ded Net Chk Ex: S-99 C M O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 113.00 0.00 725.12 *-**4869 S 0.00 0.00 0.00 0.00 0.00 0.00 4.00 4.00 50.00 200.00 600.00 0.00 0.00 SUPERINTENDENT 2,000.00 12.12 0.00 1,274.88 Check #: 84661 Ex: S-00 C M O 0.00 0.00 0.00 0.00 * *-**-5554 S 8.00 8.00 8.00 0.00 GROUP 3 LABORER DICKMEYER, STEVEN M Ex: S-01 C M O 0.00 0.00 0.00 0.00 13818 SE 161 ST PLACE *-**-7176 S 8.00 8.00 0.00 0.00 LABORER RENTON, WA 98058 GALLACHER, JOEL L Ex: M-01 C M O 0.00 0.00 0.00 0.00 714 191ST PL SW *-**4199 S 8.00 0.00 0.00 0.00 CARPENTER LYNNWOOD, WA 98036 JOHNSTON, DALE D Ex: M-03 C M O 0.00 0.00 0.00 0.00 17017 102ND AVE SE * *-**-5149 S 4.00 0.00 0.00 0.00 CARPENTER SNOHOMISH, WA 98296 LYCKSELL, LEITH W Ex: S-00 C M O 0.00 0.00 0.00 0.00 912 E 54TH STREET *-**-4345 S 4.00 0.00 0.00 0.00 CEMENT MASON TACOMA, WA 98404 0.00 0.00 0.00 0.00 0.00 0.00 69.98 0.00 392.66 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 1,238.40 20.10 0.00 845.74 Check#: 84662 0.00 0.00 0.00 0.00 0.00 0.00 93.99 0.00 428.81 0.00 0.00 0.00 16.00 40.09 641.44 313.53 0.00 0.00 1,663.74 21.29 0.00 1,234.93 Check #: 84665 0.00 0.00 0.00 0.00 0.00 0.00 108.04 0.00 600.34 0.00 0.00 0.00 8.00 47.80 382.40 473.19 0.00 0.00 1,912.00 19.11 0.00 1,311.66 Check #: 84667 0.00 0.00 0.00 0.00 0.00 0.00 79.99 0.00 334.97 0.00 0.00 0.00 4.00 35.39 141.56 141.19 94.40 0.00 1,415.60 19.39 0.00 1,080.63 Check#: 84670 0.00 0.00 0.00 0.00 0.00 0.00 89.89 0.00 601.04 0.00 0.00 0.00 4.00 35.75 143.00 313.11 175.44 0.00 1,590.89 22.60 0.00 989.85 Check#: 84672 Page 2 R.L. ALIA COMPANY 107 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 REED, RONALD W P. O. BOX 985 ROY. WA 98580 Pay Period Date: 09/20/11 Week Ending 09/20/11 Payroll No: 20 # Exemptions Social Security WED THU Work Class 14 15 Ex: S-02 C M O 0.00 0.00 -"-5585 S 0.00 0.00 TRUCK DRIVER, GROUP Certified Payroll Rep6rt'1`+ Hours FRI SAT SUN MON 16 17 18 19 0.00 0.00 0.00 0.50 0.00 0.00 0.00 8.00 Contract # CAG-11-044 Job No: 06-11 Job Name. BENSON ROAD 16" WM REPL Other Job Pay FICA Local Tot Ded TUE Job Gross Fed W/H Union Benefits 20 Total Rate Total Gross State Oth Ded Net Chk 0.00 0.50 47.80 0.00 77.44 0.00 323.72 3.00 11.00 31.87 374.47 222.41 4.20 0.00 1,370.41 19.67 0.00 1,046.69 Check#: 84678 Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL �` � -------------------------------- Hours -------------------------------- Project Employee Sun Mon Tue Wed Thu Fri Sat Total Rate Amounts ADAMS BOBBY C XXX-XX-1150 M/EX: 114/1 Race/Sex BIM 3814 SOUTH K STREET TACOMA, WA 98408 EEO Class: Journeyman Check # 14563 ASPHALT RAKER Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 32.210 257.68 ASPHALT RAKER Overtime 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 48.315 48.32 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 306.00 BRENDEL KENNETH C PO BOX 289 WILKESON, WA 98396 OIL DISTRIBUTOR OIL DISTRIBUTOR XXX-XX-1057 MAX: S12 Race/Sex C/M EEO Class: Journeyman Check # 14578 Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 31.000 248.00 Adjustment 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 263.50 BUTTS ROBERT A XXX-XX-4936 M/EX: M/1 Race/Sex C/M PO BOX 1752 ORTING, WA 98360 EEO Class: Journeyman Check # 14583 DUMPS <5CY-12 s SOLO Regular 0.00 4.00 0.00 0.00 0.00 0.00 0.00 4.00 30.160 120.64 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 120.64 ****** Liabilities ****** Description Rate Amounts FICA SS 0.06200 FICA Medicare 0.01450 L & I Liability 2.45370 LABORERS - W 5.00000 LABORERS -PE 3.60000 LABORERS-Ap 0A5000 LABORERS -WC 0.06000 LABORERS -LE 0.07000 Other FICA SS 0.06200 FICA Medicare 0.01450 L & I Liability 2A3910 TEAMSTERS - h 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - A 0.25000 Other FICA SS 0.06200 FICA Medicare 0.01450 L & I Liability 2.43910 TEAMSTERS-1- 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - A 0.25000 Other 18.95 4.43 22.09 45.00 32.40 4.05 0.54 0.63 3.82 131.91 16.34 3.82 19.51 67.36 56.40 2.00 169.53 7A8 1.75 9.76 33.68 28.20 1.00 1.48 83.35 ****** Weekly Totals ****** (Week Ending 9/17/11) Gross Deductions Net Pay Federal W/H 214.00 FICA SS 70.35 FICA Medicare 24.29 L & I Deduction 20.07 LABORERS - DED 48.00 LABORERS - DUE 40.81 LABORERS - LOE 1.92 1,674.94 419.44 1,255.50 Hours (Reg/OT): 40.00 18.00 Federal W/H 350.00 FICA SS 78.64 FICA Medicare 27.15 L & I Deduction 23.05 TEAMSTERS - LO 5.45 1,872.36 484.29 1,388.07 Hours (Reg/OT): 31.50 / 23.00 Federal W/H 360.00 FICA SS 94.97 FICA Medicare 32.79 L & I Deduction 28.22 TEAMSTERS-LO 6.64 Other 198.75 2,261.21 721.37 1,539.84 Hours (Reg/OT): 40.00 / 26.25 2 Miles Resources, LLC Page 61 9/21 /2011 7:20:51 AM WWPRCertifiedWithLiab .rpt Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL EmDlovee COYNER GARY L 226 McELROYPLACE PUYALLUP, WA 98371 DUMPS<16/20CY T&TLR DUMPS<16/20CY T&TLR DUMPS<16/20CY T&TLR FISHER TAWNY M 4410 182ND LN SW ROCHESTER, WA 98579 DUMPS<16/20CY T&TLR DUMPS<16/20CY T&TLR GRIZZLE KIM A 104 GASSMAN ROAD CASTLE ROCK, WA 98611 ASPHALT ROLLER ASPHALT ROLLER -------------------------------- Hours -------------------------------- Sun Mon Tue Wed Thu XXX-XX-1367 MAX: M/0 ****** Liabilities -- Pro ect Fri Sat Total Rate Amounts Description Race/Sex C/M EEO Class: Journeyman Check # 14598 Regular 0.00 7.25 0.00 0.00 0.00 0.00 0.00 7.25 31.870 231.06 Overtime 0.00 1.50 0.00 0.00 0.00 0.00 0.00 1.50 47.805 71.71 Adjustment 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,000 15.94 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 318.71 XXX-XX-4410 MAX: S/0 Race/Sex CIF EEO Class: Journeyman Check # 14615 Regular 0.00 8.00 0.00 0.00 0,00 0.00 0.00 8.00 31.000 248.00 Adjustment 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 263.50 XXX-XX-1155 M/EX: S/0 Race/Sex CIF EEO Class: Journeyman Check # 14620 Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 34.330 274.64 Overtime 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 51.495 51.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 326.14 Rate Amounts FICA SS 0.06200 FICA Medicare 0.01450 L & I Liability 2A3910 TEAMSTERS-F 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS -A 0.25000 Other WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2.43910 TEAMSTERS - F 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - A 0.25000 Other WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2.45370 OPER ENG - H& 7.55000 OPER ENG - PE 6.90000 OPER ENG - Ap 0.70000 Other 19.77 4.62 21.34 73.68 61.69 2.19 5.03 188.32 15.81 16.34 3.82 0.05 19.51 67.36 56.40 2.00 4.79 186.08 19.56 20.22 4.73 0.05 22.09 67.95 62.10 6.30 6.43 209.43 ****** Weekly Totals ****** (Week Ending 9/17/11) Gross Deductions Net Pay Federal W/H 227.00 FICA SS 69.60 FICA Medicare 24.03 L & I Deduction 19.91 TEAMSTERS-LO 4.51 Other 53.29 1,657.25 398.34 1,258.91 Hours (Reg/OT): 32.00 / 13.00 Federal W/H 262.00 FICA SS 58.20 FICA Medicare 20.09 L & I Deduction 19.82 TEAMSTERS-1-0 4.44 1,385.73 364.55 1,021.18 Hours (Reg/OT): 40.00 / 4.25 Federal W/H 235.00 FICA SS 53.71 FICA Medicare 18.54 L & I Deduction 14.78 OPER ENG - DUE: 25.57 OPER ENG - LOBE 10.65 1,278.81 358.25 920.56 Hours (Reg/OT): 32.00 / 3.50 2 Miles Resources, LLC Page 62 9/21/2011 7:20:51AM WWPRCertifiedWithLiab .rpt Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL ours-------------------------------- Project Employee Sun Mon Tue Wed Thu Fri Sat Total Rate Amounts HILL GUY XXX-XX-8688 MAX: M/0 Race/Sex C/M 2900 BRIARWOOD COURT SOUTH PUYALLUP, WA 98374 EEO Class: Journeyman Check # 14633 DUMPS <5CY-12 s SOLO Regular 0.00 3.00 0.00 0.00 0.00 0.00 0.00 3.00 30.160 90.48 LOW BOY/EQ TRLR Regular 0.00 5.00 0.00 0.00 0.00 0.00 0.00 5.00 31.000 155.00 PORTAL PAY Overtime 0.00 0.25 0.00 0.00 0.00 0.00 0.00 0.25 13.005 3.25 LOW BOY/EQ TRLR Overtime 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.50 46.500 23.25 LOW BOY/EQ TRLR Adjustment 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 287.48 LEONARD MARK F XXX-XX-1894 M/EX: 114/0 Race/Sex C/M 19121 13TH AVENUE COURT EAST SPANA WAY, WA 98387 EEO Class: Journeyman Check # 14659 SCREEDMAN/SPREADER Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 35.240 281.92 SCREEDMAN/SPREADER Overtime 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 52.860 52.86 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 334.78 MASSIER LARRY M 13208 WALLER ROAD EAST TACOMA, WA 98446 DUMPS<16/20CY T&TLR DUMPS<16/20CY T&TLR XXX-XX-9665 M/DC: M/0 Race/Sex C/M EEO Class: Journeyman Check # 14665 Regular 0.00 6.75 0.00 0.00 0.00 0.00 0.00 6.75 31.000 209.25 Adjustment 0.00 0.00 0.00 0.00 000 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 224.75 ****** Liabilities ****** Description Rate Amounts FICA SS 0,06200 FICA Medicare 0.01450 L & I Liability 2.43910 TEAMSTERS - h 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - P 0.25000 Other FICA SS 0.06200 FICA Medicare 0,01450 L & I Liability 2A5370 OPER ENG - H& 7.55000 OPER ENG - PE 6.90000 OPER ENG - Ap 0.70000 Other WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2.43910 TEAMSTERS - h 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS-P 0.25000 Other 17.82 4.17 21.35 73.68 61.69 2.19 6.03 186.93 20.75 4.85 22.08 6T95 62.10 6.30 4.08 188.11 13.49 13.93 3.25 0.04 16.46 56.84 47.59 1.69 4.74 158.03 ****** Weekly Totals ****** (Week Ending 9/17/11) Gross Deductions Net Pay Federal W/H 165.00 FICA SS 53.05 FICA Medicare 18.31 L & I Deduction 19.23 TEAMSTERS-LO 4.39 1,263.07 259.98 1,003.09 Hours (Reg/OT): 39.75 / 4.00 Federal W/H 264.00 FICA SS 75.85 FICA Medicare 26.19 L & I Deduction 19.84 OPER ENG - DUE 36.12 OPER ENG - LOBE 14.25 Other 142.50 1,806.05 578.75 1,227.30 Hours (Reg/OT): 40.00 / 7.50 Federal W/H 151.00 FICA SS 53.18 FICA Medicare 18.36 L & I Deduction 17.15 TEAMSTERS - LO 3.93 Other 6.33 1,266.30 249.95 1,016.35 Hours (Reg/OT): 31.75 / 7.25 2 Miles Resources, LLC Page 63 9/21/2011 7:20:51AM WWPRCertifiedWithLiab .rpt Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL Employee MATHEWS RONALD G 142 EAST HEIGHTS PLACE SOUTH -------------------------------- Hours -------------------------------- Liabilities Project Sun Mon Tue Wed Thu Fri Sat Total Rate Amounts Description Rate Amounts XXX-XX-0378 MAX: M12 Race/Sex C/M BELFAIR, WA 98528 EEO Class: Journeyman Check # 14668 OPERATOR FOREMAN Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 37.240 297.92 OPERATOR FOREMAN Overtime 0.00 3.50 0.00 0.00 0.00 0.00 0.00 3.50 55.860 195.51 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 493.43 MONTGOMERY CHARLES R XXX-XX-0719 M/IX: M/0 Race/Sex BIM 20315 52ND AVENUE EAST SPANA WAY, WA 98387 EEO Class: Journeyman Check # 14674 SPREADER/TOP/CHIP 1234567 Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 35.240 281.92 SPREADER/TOP/CHIP 1234567 Overtime 000 1.00 0.00 0.00 0.00 0.00 0.00 1.00 52.860 52.86 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 334.78 MULLINS JOSHUA T XXX-XX-6090 MAX: M/1 7806 207TH ST E SPANA WAY, WA 98387 EEO Class: Journeyman DUMPS>16/20CY T&TLR RENTA Regular 0.00 5.50 0.00 0.00 DUMPS>16/20CY T&TLR RENTA Adjustment 0.00 0.00 0.00 0.00 Race/Sex C/M Check # 14676 0.00 0.00 0.00 5.50 31.000 170.50 0.00 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 186.00 FICA SS 0.06200 FICA Medicare 0.01450 L & I Liability 2.45370 OPER ENG - H& 7.55000 OPER ENG - PE 6.90000 OPER ENG - Ap 0.70000 Other FICA SS 0.06200 FICA Medicare 0.01450 L & I Liability 2.45370 OPER ENG - H& 7.55000 OPER ENG - PE 6.90000 OPER ENG - Ap 0.70000 Other WA SUTA 0,06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2.43910 TEAMSTERS - F 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - A 0.25000 Other 30.58 7.15 28.22 86.83 79.35 8.05 4.50 244.68 20.74 4.84 22.08 67.95 62.10 6.30 3.84 187.85 11.16 11.53 2.69 0.03 13.41 46.31 38.78 1.38 7.33 132.62 ****** Weekly Totals ****** (Week Ending 9/17/11) Gross Deductions Net Pay Federal W/H 324.00 FICA SS 91.79 FICA Medicare 31.69 L & I Deduction 23.18 OPER ENG - DUE 43.71 OPER ENG - LOBI 16.65 2,185.39 531.02 1,654.37 Hours (Reg/OT): 40.00 / 15.50 Federal W/H 271.00 FICA SS 76.96 FICA Medicare 26.57 L & I Deduction 20.06 OPER ENG - DUE: 36.65 OPER ENG - LOBE 14A0 Other 1,832.48 445.64 1,386.84 Hours (Reg/OT): 40.00 / 8.00 Federal W/H 81.00 FICA SS 36.45 FICA Medicare 12.58 L & I Deduction 12.79 TEAMSTERS - LO 3.14 867.75 145.96 721.79 Hours (Reg/OT): 31.00 / 0.25 2 Miles Resources, LLC Page 64 9/21/2011 7:20:51AM WWPRCertifiedWithLiab .rpt Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL Employee PETERS JOSEPH S 20 SEAL DR. BR/NNON, WA 98320 ASPHALT ROLLER ASPHALT ROLLER ROMANO ROBERT W 17216 5TH AVE E SPANAWAY, WA 98387 ASPHALT ROLLER ASPHALT ROLLER STRONG CARLETON E 13114 SE 150TH ST RENTON, WA 98058 DUMPS<16/20CY T&TLR DUMPS<16/20CY T&TLR -------------------------------- Hours -------------------------------- Sun Mon Tue Wed Thu XXX-XX-3576 M/IX: S/0 ****** Liabilities ****** Project Fri Sat Total Rate Amounts Description Race/Sex C/M EEO Class: Journeyman Check # 14683 Regular 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 34.330 274.64 Overtime 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 51.495 51.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 326.14 XXX-XX-2104 M/DC: M/2 EEO Class: Journeyman Regular 0.00 8.00 0.00 0.00 Overtime 0.00 1.00 0.00 0.00 XXX-XX-8592 M/IX: S/0 EEO Class: Journeyman Regular 0.00 5.75 0.00 0.00 Adjustment 0.00 0.00 0.00 0.00 Race/Sex C/M Check # 14693 0.00 0.00 0.00 8.00 34.330 274.64 0.00 0.00 0.00 1.00 51.495 51.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 326.14 Race/Sex C/M Check # 14717 0.00 0.00 0.00 5.75 31.000 178.25 0.00 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 193.75 Rate Amounts WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2,45370 OPER ENG - H& 7.55000 OPER ENG - PE 6.90000 OPER ENG - Ap 0.70000 Other WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2.45370 OPER ENG - H& 7.55000 OPER ENG - PE 6,90000 OPER ENG - Ap 0.70000 Other WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0.01450 WA SUTA (EAF) 0.00020 L & I Liability 2.43910 TEAMSTERS-1- 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - A 0.25000 Other 19.57 20.23 4.73 0.06 22.08 67.95 62.10 6.30 5.38 208.40 19.56 20.22 4.75 0.06 22.08 6T95 62.10 6.30 450 207.52 11.63 12.01 2.80 0.04 14.03 48.42 40.54 1.44 6.88 ****** Weekly Totals-... (Week Ending 9/17/11) Gross Deductions Net Pay Federal W/H 257.00 FICA SS 57.36 FICA Medicare 19.80 L & I Deduction 16.30 OPER ENG - DUE: 27.32 OPER ENG - LOBE 11.70 Other 62.50 1,365.69 451.98 913.71 Hours (Reg/OT) 32.00 / 7.00 Federal W/H 181.00 FICA SS 67.73 FICA Medicare 23.38 L & I Deduction 19.84 OPER ENG - DUE 32.25 OPER ENG - LOBE 14.25 1,612.65 338.45 1,274.20 Hours (Reg/OT): 40.00 / 7.50 Federal W/H 148.00 FICA SS 39.14 FICA Medicare 13.51 L & I Deduction 13.62 TEAMSTERS-LO 334 931.80 217.61 714.19 Hours (Reg/OT): 32.00 / 1.25 2 Miles Resources, LLC Page 65 9/21/2011 7:20:51AM WWPRCertifiedWithLiab .rpt Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL ----- -- ------------------------ Hours -------------------------------- Project Employee Sun Mon Tue Wed Thu Fri Sat Total Rate Amounts STRONG CARLETON E XXX-XX-8592 M/IX: S/0 Race/Sex C/M 13114 SE 150TH ST RENTON, WA 98058 EEO Class: Journeyman Check # 14717 YEAGER JOHN C XXX-XX-0339 M/EX: S/0 Race/Sex C/M 13115 SE 149TH ST #8 RENTON, WA 98058 EEO Class: Journeyman Check # 14735 DUMPS<16/20CY T&TLR Regular 0 00 5.50 0.00 0.00 0.00 0.00 0.00 5.50 31.000 170.50 DUMPS<16/20CY T&TLR Overtime 0 00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 46,500 46.50 DUMPS<16/20CY T&TLR Adjustment 0 00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.000 15.50 Other Taxable 0.00 Other Non Taxable 0.00 Project Total 232.50 ****** Liabilities -- Description Rate Amounts WA SUTA 0.06000 FICA SS 0.06200 FICA Medicare 0,01450 WA SUTA (EAF) 0.00020 L & I Liability 2.43910 TEAMSTERS-1- 8.42000 TEAMSTER - PE 7.05000 TEAMSTERS - F 0.25000 Other 137.79 13.95 14.41 3.36 0.04 15.86 54.73 45.83 1.63 828 158 09 ****** Weekly Totals ****** (Week Ending 9/17/11) Gross Deductions Net Pay Federal W/H 147,00 FICA SS 38.83 FICA Medicare 13,41 L & I Deduction 13.43 TEAMSTERS-LO 3.28 924.59 215 95 708.64 Hours (Reg/OT) 31.50 / 1.25 2 Miles Resources. LLC Page 66 9/21 /2011 7:20:51 AM WWPRCertifiedWithLiab .rpt Certified Payroll Transcript Period: 09/11/2011 - 09/17/2011 Job: 11047- BENSON ROAD 16" WATERMAIN REPL Contract: 11047- BENSON ROAD 16" WATERMAIN REPL ******* Liabilities ******** ****** Weekly Totals ****** (Week Ending 9/17/11) Project Total Job Totals Hours Sun Mon Tue Wed Thu Fri Sat Total Amounts Description Rate Amounts Gross Deductions Net Pay Regular 0.00 114.75 0,00 0.00 0.00 0.00 0.00 114.75 3,765.04 WA SUTA 124.73 Federal W/H 3,637.00 Overtime 0.00 12.75 0.00 0.00 0.00 0.00 0.00 12.75 648.76 FICA SS 281.32 FICA SS 1,015.81 Adjustment 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 124.44 FICA Medicare 65.76 FICA Medicare 350.69 Other Taxable 0.00 WA SUTA (EAF) 0.37 L & I Deduction 301.29 Other Non Taxable 0.00 L & I Liability 311.95 LABORERS - DIED 48.00 Project Total 4,538.24 LABORERS - W 45.00 LABORERS - DUE 40.81 LABORERS - PE 32.40 LABORERS - LOE 1.92 LABORERS-Ap - 4.05 OPER ENG - DUE: 201.62 LABORERS -WC 0.54 OPER ENG - LOBE 81.90 LABORERS -LE 0.63 TEAMSTERS - LO 39.12 OPER ENG - H& 426.58 Other 463.37 OPER ENG - PE 389.85 24,186.07 6,181.53 18,004.54 OPER ENG - Ap 39,55 Hours (Reg/OT). 573.50 / 137.50 TEAMSTERS-F 522.06 TEAMSTER - PE 437.12 TEAMSTERS - F 15.52 Other 81.21 2,778.64 2 Miles Resources, LLC Page 67 9/21/2011 7:20:51AM WWPRCertifiedWithLiab .rpt Date 9/21/2011 l Annessa Williams Assist. Contract Adm (Name of Signatory Party) (Title) do hereby state: (1) That I pay or supervise the payment of the persons employed by Miles Resources, LLC on the (Contractor or Subcontractor) Job: 11047- BENSON ROAD 16" WATERMAIN REPL that during the payroll period commencing on the (Building or Work) 11 day of September 2011 and ending the 17 day of September 2011 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 Miles Resources, LLC (Contractor or 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, 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 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 GNA RE Annessa Williams Assist. Contract Adm 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. 1"ransmittal Letter September 30, 2011 R.L. Alia Company N, ~ " 107 Williams Avenue South Renton, WA 98057 O C T 0 3 2011 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 CITY OF RENTON Email: GIPANK@RLALIA.COM or DPANK@RLALIA.COM UTILITY SYSTEMS To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you _- _-----_---_----.______-- 1z4 Attached ❑ Under Separate Cover via: ❑ Shop Drawings ❑ Prints ❑ Plans El Other: El Copy of Letter El Change Order El Samples ❑ Total Quantity ❑ Reproducible ❑ Specification m quantity; Date DWG. # Description 1 Certified Payroll = 17 - Alia 1 (Monthly Utilization Report - September 2011 - Alia These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval bj For Your Use ❑ Apprcved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN .. ._ Comments Copy to: Signature t„+, titaua Statement of Compliance Date: SEPTEMBER27,2011 Contract Number: CAG-11-044 I, GARY J PANKIEWIC4 ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 21 day of SEPTEMBER, 2011 and ending the 27 day of SEPTEMBER, 2011, 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 RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 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 R1:M,1� I« ti NAME AND TITLE GARY J PANKIEWICZ, ACCOUNTANT SIGNATURE a 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 1 and Section 231 of Title 31 of the United-gt`ates Code. II Page I R.L. ALIA COMPANY -107 ',;FJILLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay Period Date: 09/27/11 Certified Payroll Report Contract #: CAG-11-044 Week Ending: 09/27/11 Job No: 06-11 Payroll No: 21 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 21 22 23 24 25 26 27 Total Rate Total Gross State Oth Ded Net Chk ALIA, VITO R Ex: S-00 C M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 69.97 0.00 392.65 10904 325TH AVE SE ***-**-5554 S 8.00 8.00 8.00 0.00 0.00 8.00 8.00 40.00 30.96 1,238.40 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 20.10 0.00 845.75 ISSAQUAH, WA 98027 Check #: 84682 GALLACHER, JOEL L Ex: M-01 C M 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 108.02 0.00 599.75 714 191ST PL SW -**-1199 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 47.80 764.80 473.19 0.00 0.00 CARPENTER 1,912.00 18.54 0.00 1,312.25 LYNNWOOD, WA 98036 Check #: 84687 ODEGARD, ALBERT I 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 28.66 0.00 124.69 27205 118TH STREET SE ***-**-4554 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 31.70 507.20 56.95 31.04 0.00 PIPELAYER LAB GRP IV 507.20 8.04 0.00 382.51 MONROE, WA 98272 Check #: 84694 REED, RONALD W 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 82.82 0.00 357.79 P. O. BOX 985 ***-**-5585 S 0.00 0.00 0.00 0.00 0.00 8.00 8.00 16.00 31.87 509.92 246.32 4.40 0.00 TRUCK DRIVER, GROUP 1,466.03 24.25 0.00 1,108.24 ROY, WA 98580 Check #: 84699 SCOTT, KIMBERLY A. Ex: S-01 C F 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 66.03 0.00 345.53 P. O. BOX 516 * *-**-3470 S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 30.96 247.68 189.78 72.78 0.00 LABORER/TCS/ESC LEAD 1,168.74 16.94 0.00 823.21 STANWOOD, WA 98292 Check #: 84700 Page 2 -J► R.L. PILIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 09 RENTON, WA 98055 From period end date: 09/01/11 Job number: 06-11 EEO Class / Work Class Sex To period end date: 09/30/11 BENSON ROAD 16" WM REPL Hispanic White Total Work hours of employment Black Asian Pacific Islander American Indian Other(2 or more) Minority % Female % Total # Employees Total # Minority M 24.0 0.0 24.0 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 CARPENTERS M 44.5 0.0 44.5 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 CEMENT MASON M 46.0 0.0 46.0 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 LABORERS/FLAGGERS M 221.0 8.0 213.0 0.0 0.0 0.0 0.0 0.0 2.9% 18.8% 6 1 JOURNEYMAN F 51.0 0.0 51.0 0.0 0.0 0.0 0.0 0.0 1 0 LABORERS/FLAGGERS M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 APPRENTICE F 9.0 0.0 0.0 0.0 0.0 0.0 9.0 0.0 1 1 LABORERS/FLAGGERS M 74.0 0.0 74.0 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 295.0 8.0 287.0 0.0 0.0 0.0 0.0 0.0 4.8% 16.9% 7 1 F 60.0 0.0 51.0 0.0 0.0 0.0 9.0 0.0 2 1 EQUIPMENT OPERATORS M 54.0 0.0 46.0 0.0 0.0 0.0 8.0 0.0 14.8% 0.0% 3 1 JOURNEYMAN F 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 PIPELAYERS M 32.0 0.0 32.0 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 TRUCK DRIVERS M 56.5 0.0 56.5 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 Journeyman total: M 454.0 8.0 438.0 0.0 0.0 0.0 8.0 0.0 3.2% 10.1 % 17 2 F 51.0 0.0 51.0 0.0 0.0 0.0 0.0 0.0 1 0 Apprentice total: M 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0% 100.0% 0 0 F 9.0 0.0 0.0 0.0 0.0 0.0 9.0 0.0 1 1 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 98.0 0.0 98.0 0.0 0.0 0.0 0.0 0.0 0.0% 0.0% 2 0 F 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 Job total: M 552.0 8.0 536.0 0.0 0.0 0.0 8.0 0.0 4.1% 9.8% 19 2 F 60.0 0.0 51.0 0.0 0.0 0.0 9.0 0.0 2 1 Printed by GJP as of 09129111 2:56:37PM Page 2 R.L. ALIA COMPANY 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 09 RENTON, WA 98055 From period end date: 09/01/11 To period end date: 09/30/11 Job number: 06-11 BENSON ROAD 16" WM REPL Hispanic White EEO Class / Work Class Sex Total Title: Work hours of employment Black Asian Pacific American Other(2 or Minority Female Total # Total # Islander Indian more) % % Employees Minority 6 Telephone: -5' nature 7-3C--)--I1 Date Signed Printed by GJP as of 09/29/11 2:56:37PM Page 3 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: G)PANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton ------ ----- ____— ------ _..... _. Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity October 7, 2011 OCT 1 1 CITY OF R=;u ; U;`J Attention: Andrew Weygandt Re: First Hill Booster Pump Station Job Number: Wu =rn ca.,ni.,., —.. ❑ Under Separate Cover via: ❑ Prints ❑ Plans ❑ Change Order ❑ Samples ❑ Reproducible El Specification These are transmitted as checked below; ❑ For Approval ❑ Approved as Submitted ❑ TM Resubmit [#] copies for approval 39 For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints �AJIT� ?AAA-lF- ICZ- Signature Date:_, OCTOBER 4, 2011 Statement of Compliance Contract Number CAG-11-044 I, GARY J PANKIEWIC2, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 28 day of SEPTEMBER, 2011 and ending the 4 day of OCTOBER, 2011, all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of said RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT 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 I 8x4d Section 231 of Title 31 of the United StateZNde. Page 1 R.L. ALIA COMPANY Pay Period Date: 10/04/11' Ne,47R'$ Certified Payroll Rep0ft Contract #: CAG-11-044 107 WILLAIMS AVE S Week Ending: 10/04/11 Job No: 06-11 RENTON, WA 98055 Payroll No: 1 Job Name BENSON ROAD 16" WM REPL 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 28 29 30 01 02 03 04 Total Rate Total Gross State Oth Ded Net Chk ALIA, VITO R 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 69.96 0.00 391.60 10904 325TH AVE SE ***-**-5554 S 8.00 8.00 8.00 0.00 0.00 0.00 0.00 24.00 30.96 743.04 224.98 77.60 0.00 GROUP 3 LABORER 1,238.40 19.06 0.00 846.80 ISSAQUAH, WA 98027 Check #: 84753 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 110.05 0.00 613.20 GALLACHER, JOEL L Ex: M-01 C M O 714 191ST PL SW *-**4199 S 8.00 8.00 8.00 0.00 0.00 8.00 0.00 32.00 47.80 1,529.60 482.15 0.00 0.00 CARPENTER 1,947.85 21.00 0.00 1,334.65 LYNNWOOD, WA 98036 Check #: 84758 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 71.64 0.00 215.41 ODEGARD, ALBERT I Ex: M-00 C M 0 27205 118TH STREET SE * *-**-4554 S 0.00 0.00 8.00 0.00 0.00 8.00 0.00 16.00 31.70 507.20 171.07 77.60 0.00 PIPELAYER LAB GRP IV 1,268.00 20.10 -125.00 1,052.59 MONROE, WA 98272 Check #: 84766 0.00 3.50 0.00 0.00 0.00 0.00 0.00 3.50 46.44 0.00 65.16 0.00 336.75 SCOTT, KIMBERLY A. Ex: S-01 C F O P. O. BOX 516 ***-**-3470 S 0.00 8.00 0.00 0.00 0.00 8.00 0.00 16.00 30.96 657.90 185.91 68.88 0.00 LABORER/TCS/ESC LEAD 1,153.26 16.80 0.00 816.51 STANWOOD, WA 98292 Check #: 84772 Page 2 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Re: Job Number: October 14, 2011 Andrew Weygandt Benson Road 16" Water Main We are sending you If Attached ❑ Under Separate Cover via: ❑ Shop Drawings ❑ Prints i ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification ❑ Other: These are transmitted as checked below -- Raw anw=r ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval /21 For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments. CODv to: n U lf] rA lv y- Signature Statement of Comprr' teo Date: OCTOBER 11, 2011 'r d'Sr-0ri� Contract Number: CAG-11-044 I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 5 day of OCTOBER, 2011 and ending the I l day of OCTOBER, 2011, all persons employed on said project have been paid the full weekly wages camed, that no rebates have been or will be made either directly or indirectly to or on behalf of said R.L. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT 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 nd Section 231 of Title 31 of the United States Code. 1 '1 Page I R.L. ALIA COMPANY+; 107 WILLAIMS AVE S Certified RaVroll Report Contract#CAG-11-044 Job No. 06-11 Job Name. BENSON ROAD 16" WM REPL Pay Period Daz p; .0/11/11 Week Ending: 10/11/11 Payroll No: 23 RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 05 06 07 08 09 10 11 Total Rate Total Gross State Oth Ded Net Chk Pagc 2 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GIPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton October 24, 2011 RECE -) OCT 2 5 2011 Attention: Andrew Weygandt UTILITYSYSTEMS Re: Benson Road 16" Water Main Job Number: �..., _.... —_ We are sending you Attached 1 ❑ Under Separate Cover via: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ElSpecific< _......... - ...... ......... . --- ..............._�_ .................... _. . These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ ________...._. Return [#] corrected prints __ ...._ __ _ ... _.-....... __.. ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy Av �� ,A%j 4L A Signature Y Date: OCTOBER 18, 2011 y • Statement of Compliance Contract Number: CAG-11-044 1, GARY J PANKIEWIC7; ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 12 day of OCTOBER, 2011 and ending the 18 day of OCTOBER, 2011, 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 R.L. ALIA COMPANY 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, Part3 (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 FED WHG MED AID UNION BENEFITS (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 taborer 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 O 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 GARY J PANKIEWICZ, ACCOUNTANT 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 18a&dSection231 of Title 31 of the United States Code. 2Q Page I R.L. ALIA COMPANY "n+1 n a jf PaYPerod Date:— 10/13i1> := Paroii iUelJrt Contract» CAG-11-044Certified .1C7 WIL'LAIMS AVE S Week Ending: 10/18/11 Job No 06-11 Payroll No: 24 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 12 13 14 15 16 17 18 Total Rate Total Gross State Oth Ded Net Chk ODEGARD, ALBERT I 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 71.64 0.00 239.89 27205 118TH STREET SE ***-**-4554 S 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 31.70 253.60 171.07 77.60 0.00 PIPELAYER LAB GRP IV 1,268.00 19.58 -100.00 1,028.11 Check #: 84853 MONROE, WA 98272 Pug,, 2 F,P Washington State Department of Transportation Monthly Employment Utilization Report Name and Address of Contractor MT Electric, Inc. 45554 SE North Bend Way North Bend WA 98045 WSDOT Contract Number Federal Aid Number Employer's I.D. Number 91-1505873 Federal Funding Agency Project Description and Location CAG-1 1-044- Benson Rd 16" Water Main Replacement County King Reporting Period From 9/ 1 /201 1 To 9/30/2011 Construction Trade Classifications Total Contract Construction Work Hours Percentages Employees a. Total Work Hours of All Employees By Trade b. Black (Not of Hispanic Origin) C. Hispanic d. Asian or Pacific Islander e. American Indian or Alaskan Native 2. Minority Percentage 3. Female Percentage 4. Total Number of Employees 5. Total Number of Minority Employees M F M F M F M F M F M F M F Journey Worker 24.5 0.0% 0.0% 1 Electrician Apprentice Trainee 49 0.0% 0.0% 2 Journey Worker Apprentice Trainee Journey Worker Apprentice Trainee Journey Worker Apprentice Trainee Journey Worker Apprentice Trainee Total Journey Workers 24.5 1 0.0% 0.0%1 1 Total Apprentices Total Trainees 49 0.0% 0.0% 2 Grand Total 73.5 .0%1 0.0 0 3 Company OfficSi a Titl i� Haile Judge/Office Manager Telephone Number 425-888-5143 Date Signed 3 Page 1 of 1 DOT Form 820- 0 E Revisedl�/99 This form replaces U.S. Dept. of Labor Form CC 257 Certified Pavroll Report Contractor MT ELECTRIC, INC. Project R.L. Alia Company:321 Benson Rd 16" Water Main Replacement Project/Contract # CAG-11-044 45554 SE NORTH BEND WAY 107 Williams Ave South Payroll Number 1 NORTH BEND, WA 98045 Renton WA 98057 For Week Ending 9/25/2011 Hours Worked by Day Work Pay Employee Name ID Classification Type on Tue Wed Thu Fri Sat Sun 19 20 21 22 23 24 25 Timesheet Hours Paid Pay Job Fringe, Total Hours Rate Gross Pay, Ratel Gross Pay Social Medi- Federal State Total Security care Tax Tax Other Deduct Net Pa Adams, Nathan J 1572 321.1.11 Groundsman RT 8.00 8.00 8.00 24.00 24.00 41.06 985.44 0.00 1,599.35 67.17 23.19 280.00 0.00 7.65 378.01 1,221.34 Dendy, Eric 5174 321.2.11 Journeyman RT 8.50 8.00 8.00 24.50 24.50 57.74 1,414.63 0.00 2,280.61 95.78 33.07 485.00 0.00 13.41 627.26 1,653.35 Webb, Jon 5377 321.1.11 Groundsman RT 9.00 8.00 8.00 25.00 25.00 41.06 1,026.50 0.00 1,494.91 62.79 21.68 289.00 0.00 13.58 387.05 1,107.86 Date: Oct-05, 2011 I, Teri Coverdale, Office Manager, do hereby state: (1) That I pay or supervise the payment of the persons employed by MT ELECTRIC, INC. on the project R.L. Alia Company:321 Benson Road 16" Water Mail Replacement; that during the payroll period commencing on Sep-19, 2011 and ending on Sep-25, 2011 all persons employed on the 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 MT ELECTRIC, INC. from the full weekly 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 and 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 13 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 13 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 Remarks Name and Title Signature Teri Coverdale, Office Manager THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR O SU O TR CT T CI IL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. R.L. Alia, Co., Inc. Project No. MT ELECTRICINC Contractor License # MTELEI*0880Q NO ACTIVITY THIS PERIOD Project Name: Benson Road 16" Water Main Replacement Contract No: CAG-11-044 Payroll Week # 2 No work was performed by MT Electric, Inc. for the payroll period commencing on Monday, the 26d' day of September 2011, through week ending Sunday, the 2"d day of October 2011. Authorized Si nature Office Manager/Teri Coverdale Title 10/5/2011 Date 45554 SE North Bend Way, North Bend, WA 98045 425.888.5143-ph 425.888.5148-fx MT Job #321 MT ELECTRICiNC Contractor License # MTELEi*0880Q Project Name: Contract No: Payroll Week # R.L. Alia, Co., Inc. Project No. NO ACTIVITY THIS PERIOD Benson Road 16" Water Main Replacement CAG-11-044 3 No work was performed by MT Electric, Inc. for the payroll period commencing on Monday, the 3`d day of Sunday, the 9`h day of Payroll Admin./ Hailey Judge Title 10/ 13/2011 Date October October 2011, through week ending 2011. 45554 SE North Bend Way, North Bend, WA 98045 425.888.5143-ph 425.888.5148-fx MTJob #321 R.L. Alia, Co., Inc. Project No. MT ELECTRICINC Contractor License # MTELEI*0880Q Project Name: Contract No: Payroll Week # NO ACTIVITY THIS PERIOD Benson Road 16" Water Main Replacement CAG-11-044 4 No work was performed by MT Electric, Inc. for the payroll period commencing on Monday, the 1 Oth day of Sunday, the 16fl' day of Admin./ Hailev JudLye i me 10/20/2011 Date October October 2011, through week ending 2011. 45554 SE North Bend Way, North Bend, WA 98045 425.888.5143-ph 425.888.5148-fx MT Job #321 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM October 31, 2011 °(IVL NOV 0 2 2011 CITY OF RENTON UTILITY SYSTEMS To: City of Renton Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: ,,, �. .. ..................... _.... . .. ..... ...... Quantity Date DWG. # I Description 1 Certified Payroll = 21 - Alia — - - ...... ........................ _...... Monthly Utilization Report - October 2011 - Alia These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval q For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ ._. As Requested .___...__ ❑ Returned for Corrections _..__ _ ❑ Return [#] corrected prints _....___ .............__.... ....__. ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments )'-)AviD ?Pt P4 K i f W Signature Statement of Compliance ,,ate: iJC'TOBER 25, 2011 Contract Number: CAG-I1-044 1, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16' WM REPL, that during the payroll period commencing on the 19 day of OCTOBER, 2011 and ending the 25 day of OCTOBER, 2011, 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 R.L. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT SIGNATURE / L^L'G + The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution See Section 1001 of Tiile 8 and Section 231 of Title 31 of the Uni0 States Code. Z 1 Pegizc I R.L. ALIA COMPANY Pay Period Date: 10/2511'I1a $ Contract #: CAG-11-044 107 WILLAIMS AVE S Week Ending: 10/25/11 Certified Payroll 12epdt Job No: 06-11 Payroll No: 25 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 19 20 21 22 23 24 25 Total Rate Total Gross State Oth Ded Net Chk Page 2 AUr qr �� ; R.L. ALIA COMPANY t:.. 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: R.L. ALIA COMPANY Minority: 0.00 From Period: 107 WILLAIMS AVE S Female: 0.00 To Period: 10 RENTON, WA 98055 From period end date: 10/01/11 Job number: 06-11 EEO Class / Work Class Sex To period end date: 10/31/11 BENSON ROAD 16" WM REPL Hispanic White Total Work hours of employment Black Asian Pacific Islander American Indian Other(2 or more) Minority % Female % Total # Employees Total # Minority CARPENTERS M 32.0 0.0 32.0 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 LABORERS/FLAGGERS M 24.0 0.0 24.0 0.0 0.0 0.0 0.0 0.0 0.0% 44.8% 1 0 JOURNEYMAN F 19.5 0.0 19.5 0.0 0.0 0.0 0.0 0.0 1 0 PIPELAYERS M 24.0 0.0 24.0 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 Journeyman total: M 80.0 0.0 80.0 0.0 0.0 0.0 0.0 0.0 0.0% 19.6% 3 0 F 19.5 0.0 19.5 0.0 0.0 0.0 0.0 0.0 1 0 Apprentice 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 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 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 Job total: M 80.0 0.0 80.0 0.0 0.0 0.0 0.0 0.0 0.0% 19.6% 3 0 F 19.5 0.0 19.5 0.0 0.0 0.0 0.0 0.0 1 0 Title: Telephone: %U _31 ignature Date Signed Printed by GJP as of 1012711 / 10: 00:33AM Page 2 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC* 104PT (425) 226-8100 FAX(425) 226-8649 Email: GIPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Re: Job Number: Transmittal Letter November 4, 2011 NOV 0 7 2011 CITY OF RENTON v I Livid Andrew Weygandt Benson Road 16" Water Main Quantity Date DWG. # Description 1 j Certified Payroll =22 - Alia Copy to: N-410 Ii P44)f,.,i CZ, Signature ❑ Other: r Date: NOVEMBER 1. 2011 Statement ofe-64liance I' R,• ;} ( Contract Number: CAG-11-044 I, GARY J PANKIEWICZ ACCOUNTANT do hereby state: (I) That 1 pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 26 day of OCTOBER, 2011 and ending the 1 day of NOVEMBER, 2011, 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 RL. ALIA COMPANY 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 persons 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT 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 1 nd Section 231 of Title 31 of the Unite Code. ZZ Page I R.L. ALIA13CdMPANY 107 WILLAIMS AVE S RENTON, WA 98055 425 226-8100 Pay Period;@&te:r- 11/01/11 Week Ending 11/01/11 Payroll No: 26 Certified Payroll Report Contract#: CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 26 27 28 29 30 31 01 Total Rate Total Gross State Oth Ded Net Chk Page 2 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC* 104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Transmittal Letter November 11, 2011 NOV 15 2011 Attention: Andrew Weygandt UTILrrY SYSTEMS Re: Benson Road 16" Water Main Job Number: We are sending you ft k I� 2,g , Attached ❑ Under Separate Cover via: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Other: ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible i ❑ Specification These are transmitted as checked below i ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval §2 For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy to: ) P\j I4 Piet 1-1 I:t.,N ('7— Signature Statement of Compliance s Date: NOVEMBER 8, 2011 Contract Number: CAG-11-044 r - I, GARY I PANKIEWICZ ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16' WM REPL, that during the payroll period commencing on the 2 day of NOVEMBER, 2011 and ending the 8 day of NOVEMBER, 2011, all persons employed on said project have been paid the full weekly wages eamed, that no rebates have been or will be made either directly or indirectly to or on behalf of said RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT 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 1 and Section 231 of Title 31 of the United State de. Page I R.L.ALIACOMPANY '+'i1,, Pay Period Date: ` 11l0811{C7c Certified PAyrbfl Report Contract#: . CAG-11-044 107 WILLAIMS AVE S Week Ending 11/08/11 Job No: 06-11 Payroll No: 27 Job Name: BENSON ROAD 16" WM REPL IRENTON WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 02 03 04 05 06 07 08 Total Rate Total Gross State Oth Ded Net Chk Page 2 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton i j Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity November 18, 2011 HLumt, NOV 2 2 2011 CITY OF HLN l ON UTILITY SYST;_MS Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you ❑ Under Separate Cover via: ❑ Prints ❑ Plans ❑ Change Order ❑ Samples ❑ Reproducible ❑ Specification Quantity Date DWG. # Description 1 Certified Payroll #24 - Alia 1 j Certified Payroll w/e 10-30/11 - Stripe Rite ❑ Other: These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval © For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy to: TDA%j ID �"F1N)L►Et��t 2. Signature Statement of Compliance Date: NOVEMBER 15, 2011 I, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: Contract Number: CAG-I1-044 (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 9 day of NOVEMBER, 2011 and ending the 15 day of NOVEMBER, 2011, 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 RL. ALIA COMPANY 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 FED WHG MED AID UNION BENEFITS (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 PLAN$ 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 GARY J PANKIEWICZ, ACCOUNTANT 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 1 and Section 231 of Title 31 oft ed States Code. V4 Page 1 R.L:: ,PEA i:OMPANY 107 WIL'IAIMS AVE S -RENTCN, WA 98055 425 226-8100 ,•6 ;Date: 11 /15/11 Week Ending: 11/15/11 Payroll No: 28 # Exemptions Social Security Work Class .: led Payroll Report Hours WED THU FRI SAT SUN MON TUE 09 10 11 12 13 14 15 Total Contract#: CAG-1 i-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL Other Job Pay FICA Local Tot Ded Job Gross Fed W/H Union Benefits Rate Total Gross State Oth Ded Net Chk Page 2 Department of Labor & Industries PROJECT PAYROLL Prevailing Wage Program Payroll# Project Name: County: Project or Contract #� PO Box 44510 Prime Contractor R.L. Alia Company Benson Rd. 16" Water Main Repl. King Olympia, WA 98504-4510 Subcontractor: Stripe Rite Inc Project Address: City: State: 360-902-5335 Renton WA Awarding Agency Name: Company Name: For Week Ending City of Renton Stripe Rite, Inc. 253-833-0484 Month Day Year Address: City: State ZIP: Address: City: State ZIP: 10/30/2011 1055 S. Grady Way Renton WA 1813137TH AVE_ E SUMNER WA 98390 Employee Employee Day and Date Total Deductions Address & Name & Work Mon Tue Wed Thu Fri Sat Sun Total Pay Gross Amount Hourly W/H Net Soc. Sec., 9 Classification 24 25 26 27 28 29 30 Hours Rate Earned Benefit L FICA - Tax L & I Wages ROBERT WASH OT 0.00 $46.44 $0.00 TRAFFIC CONTROL STRIPE REG 1.00 1.00 $30.96 $30.96 $30.96 $11.94 1 2.37 0.00 0.40 $28.19 XXX-XX-6940 JOURNEYMAN _ _ _ TIMOTHY REES OT 0.00 $31.46 $0.00 T.C. Striper - APP 3 2334-34 REG 1.00 1.00 $20.97 $20.97 $20.97 $10.48 1.60 0.00 0.40 $18.96 XXX-XX-6038 #TBD 75% OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 OT 0.00 $0.00 $0.00 REG 0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 $0.00 Employee Benefits Distribution and Signature Certification on Reverse Department of Labor and Industries Prevailing Wage Program PO Box 44540 Olympia WA 98504-4540 Toda 's Da e Printed name of party signing this report Title Michelle Sweet Payroll Assistant The party signing this report pays or supervises the (Name of contractor or subcontractor) payment of the persons employed by: Stripe Rite, Inc Pc, N� _ r I /� �i For the week starting: For the eek ending: iLl-Inl ( ID �� -/ 1D 30-11 u 111XV,in BENEFIT DISTRIBUTION (Please report in "per hour" terms) Work Classification - - Total Hourly Benefits A+B+C+D+E (A) Hourly Pension (B) Hourly Medical (C) Hourly Vacation (D) Hourly Holiday (E) Approved Apprentice Pr . ` All Traffic Control Stripers 1. Journeyman $ 11.94 $5.88 $5.86 $0.00 $0.00 $0.20 2. App 95% 5834-7000 $ 11.65 $5.59 $5.86 $0.00 $0.00 $0.20 3. App 90% 4667-5833 $ 11.35 $5.29 $5.86 $0.00 $0.00- $0.20 4. App 85% 3500-4666 $ 11.06 $5.00 $5.86 $0.00 $0.00 $0.20 5. App 75% 2334-3499• $ 10.48 $4.42 $5.86 $0.00 $0,00 $0.20 6. App 65% 1167-2333 $ 9.89 $3.83 $5.86 $0.00 $0.00 $0.20 7. App 60% 1001-1166 $ 9.59 $3.53 $5.86 $0.00 $0.00 $0.20 8. App 60% 500-1000 $ 5.86 $0.00 $5.86 $0.00 $0.00 $0.00 9.App 60% 0-500 $ 0.00 $0.00 $0.00 $0,00 $0.00 $0.00 10 Flaggers $ 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 The party signing below AFFIRMS the following: (1) All persons employed on the above -referenced project have been paid the full weekly wages earned, no rebates have/will be made either directly or indirectly to or on behalf of the above -named contractor or subcontractor from the weekly wages earned by any person; and no deductions, other than those which are permissible, have been made by any person either directly or indirectly from the full wages earned. (2) Any payroll report(s) otherwise under this contract required to be submitted for the above period is (are) correct and complete; the wage rates for workers, laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; and the classifications set forth therein for each worker, laborer or mechanic conform with the work performed by such worker, laborer or mechanic. (3) Any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the Washington State Apprenticeship and Training Council. (4) If fringe benefits are paid, in addition to the basic hourly wage rates paid to each worker, laborer or mechanic listed in the above -referenced payroll, payments of fringe benefits as listed above have been or will be made to appropriate approved plans, funds or programs for the benefit of such employees. (5) All information contained in this Certified Payroll Report, including any addenda, is correct. Falsification of any of the above statements is a violation of RCW 39.12,050 subject to prosecution, sanctions, and penalties. Print or type name of party signing this report Title Signature Michelle Sweet Payroll Assistant F700-065-000 certified payroll report backer 04-09 R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC* 104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attention: Re: Job Number: Transmittal Letter November 28, 2011 NOV 2 9 20'k Andrew Weygandt Benson Road 16" Water Main We are sending you Y Attached j ❑ Under Separate Cover via: .� _--------- El Shop Drawings ❑ Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification These are transmitted as checked below ❑ For Approval ❑ Approved as Submitted ❑ Resubmit [#] copies for approval t3 For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN Comments: Copy to: Signature Statement of Compliance . Bate: 'NOVEMBER 22, 2011 Contract Number: CAG-11-044 1, GARY J PANKIEWICZ, ACCOUNTANT do hereby state: (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16" WM REPL, that during the payroll period commencing on the 16 day of NOVEMBER, 2011 and ending the 22 day of NOVEMBER, 2011, 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 R.L. ALIA COMPANY 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 persoq 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 FED WHG MED AID UNION BENEFITS (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 GARY J PANKIEWICZ, ACCOUNTANT 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 a d Section 231 of Title 31 of the United States Code. ZS Page I R.L. ALIA COMPANY '" Pay Period Date: 11122i i I Certified Payroii Repci i 107 WILLAIMS AVE S Week Ending: 11/22/11 Payroll No: 29 Contract#. CAG-11-044 Job No: 06-11 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions Hours Other Job Pay FICA Local Tot Ded Social Security WED THU FRI SAT SUN MON TUE Job Gross Fed W/H Union Benefits Employee Work Class 16 17 18 19 20 21 22 Total Rate Total Gross State Oth Ded Net Chk I'ugc 2 Transmittal Letter R.L. Alia Company 107 Williams Avenue South Renton, WA 98057 Contractor License # RLALIC*104PT (425) 226-8100 FAX (425) 226-8649 Email: GJPANK@RLALIA.COM or DPANK@RLALIA.COM To: City of Renton Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Total Quantity December 2, 2011 Attention: Andrew Weygandt Re: Benson Road 16" Water Main Job Number: We are sending you - _..__._-- ❑ Under Separate Cover via: ...... __.. ❑ Prints ❑ Plans ❑ Change Order ❑ Samples ❑ Reproducible ❑ Specification Signature ❑ Other: rs• ass.c::_ at of Compliance Date: NOVEMBER 29, 2011 I, GARY J PANKIEWIC2; ACCOUNTANT do hereby state: Contract Number: CAG-11-044 (1) That I pay or supervise the payment of the persons employed by RL. ALIA COMPANY on the BENSON ROAD 16 WM REPL, that during the payroll period commencing on the 23 day of NOVEMBER, 2011 and ending the 29 day of NOVEMBER, 2011, all persons employed on >. project have been paid the full weekly wages eameo, cat no rebates have been or will be made either direca) x indirectly to or on behalf of said R.L. ALIA COME. %NY 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 FED WHG MED AID UNION BENEFITS (2) That any payrolls otherwise under this contract r:. ,uired to be submitted for the above period are correct .ad complete; that the wage rates for laborers or mechr::,ics contained therein are not less than the applicable v.-de rates contained in any wage cetermination incorporated into the contract; tl i. the classifications set forth therein for each laborer or .necha%tc 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 exisis in a State, are registered with the Bureau of Apprenti,,cship and Twining, 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 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 GARY J PANKIEWICZ, ACCOUNTANT 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 14 and Section 231 of Title 31 of the Unit States Code. Page l )ate: 11 /29/11 Contract #: CAG- i i -04-, AAPANY ed Payroll Report 107 r ;aIMS AVE S Weei_ --ding: 11/29/11 Job No: 06-11 Payroll No: 30 Job Name: BENSON ROAD 16" WM REPL RENTON, WA 98055 425 226-8100 # Exemptions ue Hours Other Job Pay FICA Local Tot Ded Social �r;unty TJWld" FF.: SAT SUN MON I Job Gross Fv W/H Union Benefits Employee Work Class tL 24 Z3 25 26 27 28 29 Total Rate Total Gross State Oth Ded Net Chk Page 2