HomeMy WebLinkAboutWWP2700369(8) SAN-1 San. ,Sewer Projects 1984 San. Sewer Rehab. ev. Wages g
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FILE TITLE
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/ �BEGINNING
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931.i
U.S. OEPARTMENTOF-LABOR MONTHLYEYPLOrMENT ' Cr[afOAA43Yl E.. I N_ ,s tAik+i+,w,.nww
EmploymaRt54rWara[AOm,mpraaoR,OFCr,P uTiuZAnON gEPORt w'Noaf• (RaY te,rlpyt N/pair.}p} .I[ypp i �M,r,t p'tWI t.n Nµ.,.n COnI•kll a'rW GKfIYV )FNR VTlMIP NO
Lfr^^^4w ry.+MAEW'n MW M R'pR.M RV fO,Nrkik Mr M Ok4rIC•nNplN br IueYr Gpyk,1,,,Nr1 91-0714103
tw•rnu.,Nor.,.r.ur[NO caMtnKPPn COnNKN
NAYEE-NO LOCAT,ON OF CONTPAC1Da -f[OERAt
Ae:Maplevood Sanitary Sever M.A. Segale. Ina, I"O
P.D. boxHA05 .(,ENCY
Tukwila,
9 WA 8188
6 WORK HOURS OF EMPLOYMENT IFatlarai•Non•F@yagp
L E@ Q b M [ [ TOTAL TOTAL
AYEbCAN NUA[REa Of NUIMFa O(
CON$f RUCT,ON TOLI All RACK A4AN OR MOnN OR MINDartY fEM4E LYPLOTEt$ YINORI TV
TRADE CLASSO,CAT,QA$ fWLOvtE3 INOI PI N:so AN1C PAPRC nAs.AN afPCENTAGt RERCENTAG[ fANLOrffS
SI TRAD` ;NrMytnrt O•gnt IS�ANO(RS
Jw•Kr+mAn 15.0 6.5
Uf'ERATOH aPPRENTIC.E i
P (,tU ERS TRA,NEE
SU@TOt4l
1
TEAMST F.AS APPaE+tncE
MUNFE
SUB-TOTAL
1.AHORERS
AFPAtRmt
TanM[E �
Su@401A1
ARPRENT,CE
•RAIN[[
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Sue IaIAL
1 TOTAL JOURNEY WORKER6 ...)
TOTAL APPRENTICES
TOTAL TRAINEES
GRAND TOTAL
11 COMPANY OFFICIAL'S SIfiNATURE AND TRLC ,1 TELEPHONE NUMBER ImgnO!sres coot) +) DATE SIGNED PAGE
Paercll Processor T06) sn-3zou
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KEw»m14SRE00n.OFCC�YE4PlOY4ENt
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MInY.e1EN Id IWII1d YONInIIyn1 )[YIt OIIAS�O AO )�4'AAEN14flA�j r NEIpNI'.Y4111400
f t . ✓�7� ENNOpItY
NAYf ANO...ATION OF CONT I�OB PE
AF/Q3 I _Wlf �. iN04
324-BS
iEO/RAI
FLNOINO
r--��WORK HOUR E4P /�. ' i AGENCY
CONS RAOO[TIOh C aTOT 4 ----'�k--- LOYUENT(Fe *'81 NOn.FBNEEI� K�L J(J�//p
W4iECAhOp E4010Y ES 14AC1 W M
I__BT TRAII INOIVI ASIAH AY )J 4 _ �N.EMMV OrlB.nl HISPANIC V OR INOIiAN AN I E {O
��Iq'IP}y wr �� 4 Y ACIFIC AUS4 NN W%ORgY IN TOTAL TOiAI
APPIEEMh" �. /� N f IStAN0ER5 PEACENTA FEMALE 4"UER Of
hATr E!) GF PERCEh)wGE E4nlOrf ES I Y14USERof
hOfiav
EYFT .�_... - EMPLOYEE
OT$ - _ -� y� I 4 f I
APoRENTiIE � I
ae�-
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_BAINEE -
— SOB.TOTAI -
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A"EHbCE
a"'Fe
SuB•TOTA, _
TAN JOURNEY WORKERS
AL APPRENTICES
7G /Aj/ Q
AL TRAINEES
0 iRIE 'J
[ TEIEP"ON�UMB IIneIYW EIN eoBP) /S/
A.Z GG j 7'- q DATE SIGNED
3Jod REyE
1OF _ [
r.o.. .<•u. ! o.♦.<.NCN1 een ter+ucl rw.ao
2
Vito D. Graziano __._ Payroll Slmerr;}.o.L_� de Arny.I.a:
-- 1.•..,er•Id..1«r P...p fir...•)
(n TA«1►•1�•••w^:•e Ne form•"1.1 Nr wlwo twvlard by_ M.A. Segale• 1No.
fR•.u•.ur«•r.uwoa.«)
N, Mapla/oGd SaM«SB%,pBr _see,detiSIS.P•r^u wd.dnocieq,«tb 30 tha d.p RF
Jte 85 6t July..a"died tb 85
01►r..w.t
i•p1.n.ad p.eir<t M.e S..w►•;d IAr 1.11 r.ell)-.p.rer•ed.NN r...rblr+I..w be.w-01 b mdr ehl..dbrrti).r I.
n<d1 a o.n bAJf d•eid_., M.A. SLgale• Im. fsn is.gal rrelir r.p.i.mrd U, or Pm.R
Uet w",no;.n.M..br.mdr etN.l dln..1)a iM:nttl)4a Ne f.11.•tr•o•..r/y o)wu.t,ml.o tA.n prrm:o:Olt d.•
:.n.<./•f•nd i.RrtuL':.n.,Pen)(2t CIA S.M:IIr A).I...d►1 the S.wbry.r L.br.d..let Cep.l.nd Aci.e•••wrndd
12 S.I.FU;1/Sul.))/; dd O.S.C. nsq..nd dt.tdd•d bl.�.
--_. Withtaldirls__--- --
FCIA
Mad Aid
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etr ••.r•1« b4«o•.• nr<A.mr♦< nl.;.d Nr•t:w.e leu.\•n IAr.pPl:t•lie.;[r u'r.om•rod a•q wtr deln.wm.'ww
•rye...d Iw.e.Ae.em.•t..Un Ur d•oi1•.«io.v11.AMA IMvin Ier ot A Lb•n s nrtAoa l.nfe.n rill•the ..'\M peJ..wwd.
1))TA...1 •P«r^"^•..npbpd iw N. •b.r M^d•n/d)up•'od In.bn.f.de .pp..n.:n A:p p.p•m•a:und rnA a
N• .M••^�'•e.A:P•[•^•r 'rr.l^iud M Nr H«rw N AppnM•r..A:p •nd T'•iwinR. U..•..d A•b.Dt1•••'^•^•e1 Lb.,«If w w<•
t•trdo/N•w<1 .•uu in•A•a, •n ..V+•oJ rIN tb Burro d Apm.nbcr.Ml end T... U.,•d Sul.+Drp«In..nt N L•Iw.
Nt TA.c
(•1.[MERE •RING[ BENEFITS ARE PAID TO APPPOVED F LAMS, FUNDS.OR PROGRAMS
�• Iw•dd'...n a Nr M+:c As«11 ••te r.'e•pid b e.cA 1+b..•e..md•••:<1.•I.d.w d.. •w.. ..fr.....d pygll.Nln•nn
a Idnp 4n.4'••.Lad.w IAr a mo<.A•..►rrn.•rUl b w•/r.e•PP•ap•.•1.PnV•.n+le•.M bwd•1 el w<A e.wplry•
(\)WERE FRINGE BENEFITS ARE PAID IN CASH
I�. E.^bb•o«'.r1A•wn I.nd in the.\..r u4vwcrd P•In11 An U...p.ld.. :wlrt•'rd..lAr P9rs11, en•room wN
a bo N•n IM ..w d IAt .PPN.•Nr lui<Aw.l)r•tr u'r PW. IM •wom d N.utund L:.p\rnAa•o lnod.n he
r.m.«t..•••PI•.o.d iw•re.:.n d(A MI.r.
W EXCEPTIONS ---
•.n•
•.< r.P rnrl
Vito D. Grazianct Payroll SuPervisor
TAe rJla IJoIn•..r•d/•1 d IA. •1m.r .• •'..rw...y wt.rtl Mr Ir...r.«..r.b.^.I+n«a n.d«r.:•.•wsl P'+•r•.r....
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FORM PPPPOv(D
/ OMw NOW 42131
US DEPARTMENT OF TRANSPORT ATION qL.0. SCON,ROL SVMSOL
FEDCRML Nr4NWY`I ADMINISTPgl 10N
nn0.]a I6
PE DE HAL AID HIGHWAY CONSTRUCTION FEDERAL AID PRoncT No.
CONTRACTOR'S SEMIANNUAL TRAINING REPORT
e4
INSTRUCTIONS. This reporr,a to be completed by the Lontuctor semi.mnually for ea.lt tndladual emplol:d on this
conDalt fblrhldiltlf our subcO)Irarl3 u.ldn o NVu.hm rec'ehnd Im..iug AApq llrr rciH.rviHF pcN,4 a.rder the trarimlg
4xcw111-IIJ 11 fanachlnntl 2 F11PA1 6-4 1.711 Th, tepon is to be submitted by the 2011,of d¢ month following the
reporting penod,fl(dj•20.mad Jmlwm'201 The original of this report Is to be furnished to the trainee and Iwo
copies submitted to the State Wgllway Depanlacm,
F.NAME OF CONTRACTOR 14 DDPe55
M.A. Segale, Inc, P.O. Box b805O
Tukwila. WA 98188
I N6M(OF TRAINEE =2A.St 2RADORF55John K McDonough 7705 - 20th SN
Edmonds. WA 98020
] OE DF TRAINEE • SOUAL SFCURrtv NDE.efR S 1MPLOYa(ST FTU5 P[IILC'A O.I L/
Ixgele 533-62-9747
aRER HIRE 0UIGRADC
t EINNIC 4wOW DISIGNATION KVIECA O\'EI
AM9 RICAN BEARISH EN
O RORO 0ORIENTAL ❑ NDI AN iJ AMERICAN pJ OTHER
).sUMMAR+OF PREVIOUS IRAIwNG MITIH.11D1'\TAVDTIPI OR"TNAI31]G xeCkIIED BT TRAIAEC 0THTER
(D\TRACI.T I".\CLR APPROILD>H AIA/XG PR(p;NAflS/
Unkowns
a 166 CLRSSIFICATION OF TRAINEE —I0 DATE TRRINING 10 TYF(OF ON 1Nf qa TRAINING
STARTED ON TNIj ICIII(A ll\lI
Apprenti<-' 1F_
T cr
_- _ �AFP fvLV5N1! r3OTNfR
IN.ITRLRUUNS 4nc s,101,alol.,.1 .-
yMu+ngllcrdl,�1„rnling p:rnrd.Ind d¢haln odnu'nctl
Liner June 'it) 1k, 30.as apphvbhe in Eolonun 1 Ohio It blow.
HOURSOf June 30
TRAINING OATH to Bri. q_ O H 1S H __ H_ It _
PRUVIDE0 DURINU 17.5
11 REPORT PF RIOD
P wovr DCD 17.5 —_-
10 DAI(
To
co MPtc It IRE 5,962.5
13 APPROVED
PROGRAM
11.TERMINATION 01 THAIAI\G I%AS I RAIMAUIPPRION JOCO1117.1.IIOA(11'APPNOI'F'UPNOGRAII I LFLAIC RI ASDY{'(1„
ITkuI\A IIIIV,
1SjV IIM{FAR[D S+ I411RE AIIIIILI 10 ("1 TRACTOR HI PNI 31l1 IATIl 1, 16 DATE
�ylf{.C<9 - Parvoll Processor
15 w1.O.T A INM0 S+ Yo\t I AI A III 4IIJ 11, 314 Tl lnra1R.I N1I NV A%, 11 DATE
refnP.•11D
IA:. 1-0SI SCPIFA IEE1 'POET I! Rq�tirylipwal PFp
ROUTING - REOUEST
Piee�e
READ To
HANDLE '
APPROVE
_..--
FORWARD _
RETURN _
KEEP OR DISCARD
REVIEW WITH ME
DFI1 Finn
/y
10R." OVLO
OMP NO.OAA aiH
US.DEPARTMENT OF TRANSPORTfTION ;EPc�*$CON T ROL SYMBOL
f EDERAL HN H W^y ADMINIST RAT IUN
NIwTb li
FEDERAL AID HIGHWAY CONSTRUCTION fEDERAL-AIDPRO)ECTMO, p�v 2
CONTRACTORS SEMIANNUAL TRAINING REPORT
INS.KL TIONS, nits report is to be completed by the umbactm semian uilly for Each Illdwidual employe)ml Wts
contract(uxllNJi,g my NlbcOninii under it R8D lot wened iratoinA during The reporij./g period under,/11e Raining
ecio janI uion(aTLRch,runt 2 FHPAf d-4-l.2N. nit report is to be wbrri by the 20th of the month follow t ing h
Ep e
repotting period,/July 20.and laitimiy 20). The original of this report is to be furnished I.the lumee and two
copieswbnnued to the Slate Highway Department
t NAMEOF CONTRACTOR " "(,Eq sl 88050
H.A. Segale, IM. 7W(wila, WA 98188
a.NAME Oi TwuNEE '!A SER al KDORESS
7705 - 206th SW
John K. lk-,L gh am QP FdtoEds, WA 98020
).ADI Of TRAINEE A SOCI ALSECURITV HUMSER 6.EMPLOYEE STATUS/CAECA ONE;
legal 533-62-9747 '
KI in Hlw[ Q L+PawwDE
i.ETHNIC cROu1 Oe$IGNAtiOM JCHECR ONEj
AME wICNN YNNISM �OTHEA
❑NFGRO ❑ORIENTAL Q MDIAN QAMEAICw-
).6uMwAwvOIPRfVIOU$TRAmING ifA'TLKAll(ANT AAD TYIl Uf iKA1N1NG KL'C'!/IEO RI TRA/NLEUN OTHER
COV TOO A('n L NUlR API'K O 1'1 D TR AIN IN PR OC R A US)
LA'itllrMl
• IOB CLILSS1 f I C A l 1 ON Oi lRUN(E 1DATETEDOM THIS ID ICIIt.CF4.\f/NE 100 TRAINING
JyntYentice EP111E %4 APPRENTICESHIP ❑OTHER
REgtITING PERIODS
INSTRII(TIONS'One r.ruLA LOW nn is to be ..... l<J fur each succaedwg repurUng peril,)uIW tlw form wblmt d.
EDier June 30.Ik(.30.is:ippinAble in c,AunuG A Ulm 11 bell,..
HOURS Oi June3
TRAINING DATA q ba It_ TS
PROV IDE D OURING
11, REPOAT PERIOD 27.0
27.0
PROVIDED
TO GATE
AS MAIM-NO TO
COMPLETE THE 5973.0
IS APPAOYEO
PROGRAM _
P.l`RMIMwTIOM I/F TRAINING MAS TLAIMINATLO PK/OR TO COAIPLL7)U.V OF APPNO't I)PNOGKAAI EXPLAIN KEARON FOL
TERUIN'A710Nt
TSR R AVww[O f• S�.\A IAROTIT WCU\'TRACTOR'SKIIRl�J\'MTiIE/ IE.OATf
. PORi REVLLw(D Er tSN.\A/UMf.ANO TIILIW SIAT!//IG 'AI OEI N'IALI tT.DAT[
i
I--
Wiw f 78) IaQa
Jry. t •AE V10US EOrtIONS AAF OSSOEETE
--- - ----- -----
..a.a .,...... aar.wt 011,
ee.r..rr no..rt.
J • b-99_A"
Derr June 27, 1985
Rebecca A. Duerst Payroll Processor do herey.l.Ir:
M....M r4a.N.r PuV) (Tula)
(q Tl,•I 1 pap er saperria the M/menl d Ue preen.eeerlyed by
H.A. Se^ale• Inc.
(Cab..N.o a,Ae..u.uu)
Use Maplewood Sanitary Sewer :thatd.ry she 1-1-11 Period(oaeaeatitt ee the If,th dap of
Ov,Nme an oral)
June ,39 85 ad[Mint if.22 nd 41.f June . to 85 If pal•+m•
mplc7.e an.aid pre)ee,to...goes.Paid the fall Ou gory-age.earned.ch.,n.Ngo.N.care►sea or.HI►e.sod.either th"01,or iq-
mn11 t.or an 1,half of aid M.A. Segaler Inc. form the Vol a.eeSl,wag.lama goy•nT prow
IC........•r ..A.........
)
it rh..goo dedueuon.No,"gores..d.eilhe.4med1 or ieAi•.rO,frsm the full wa[,...m.d by an,poww,oche.,has Werni+ubte de-
as d.lmed in Rrtul•+ion.. Pan S(79 CFR Sugo.i U.A). trained y the Se[rebry of Labor swan IS,C.prlad Ari. as.-end"
e{SNI. 018.43 SW )W.77 SI.,. 947:76 Seat.ill. .p U.S C. 776t}rd dar.ihre brae
Withholding; _
FICA
Med Aid
17)Th.. •.. P•.•oll..0,......mar•IN'. ..NNat required m k ahmn.ed for ch, star..w,.ed.rr c non and tempter.: that IN.
.{. .ate.I., bte.rr. or m.th.nia remained chalet"are not lass than the o"Istable er p w a••Ira ont.. d to y wage e.Nw.wben
e N..n.4 m1. the remnn,rh•r she ergo ailoraum•son 1.4%IbN.a lo,r•c11 Isobars,a mrtbnia rrnbrm-.IN the weA he Prrb.mrd.
Il)Th., ant aDD•eaGcn.nployrd in use ago.re Pr-ad are duty re{iue..e ta nr In. a lode appeice.h,p premsm registered wal,
are .ppsm.rr chip agent,•eropiaed goal the Bureau Of ApPNnn[etAip and Tuinin{ United Sore.D.psnmenr el L•tow,re,11 an...It
retnurd agency rv... on.Soo, a. rug..re,N .iU chi Sure...1 Appesnutr.hrp and L•,met.United Sot,.D,pa,lme•l el Easier.
(a)Th..:
(a)ONE RE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS
Ea. In.de....or to the torsos hourly wage.arse paid In seth 6bo.er or meeha•[ liu.d on he abase rde,enrrd P•Y.oll.Nlmem•
of Lm{e bml.ra a•coal.n ch.,.nnan he..ben er quill be mad. Ise.PP•ep...,e Prep...car-he toearhr el+eeh.mPtey-
.... ...Op1 as wud in lrebm e(c)goal..
(go)"ERE FRINGE BENEFITS ARE PAID IN CASH
• Ear%law...a me"..n, lined in the aW.. If, :ad p,.Nll N..tire.p.id a..d.o1,d an IN,pa,.all,an...n1 net
a le IN..the • el the .PPhr.tl.bur hourly hourly go,rate pbn,he amount of the egm,rr4 Inn{e bra.hu.+listed.n the
r a,Nr1.r•r.P as wt.a in..airs q.;t..l... '
(a)EXCEPTIONS
are I.e,a.frrae.l •••_
P sea• __
•... t.O tN.a aaw.ro.a
2ehec al A. Duty st Payroll Pt^ r
yh• -•I(w Idu4.us,of.r,of Me.1-.1 . . m.r wyen Nr• o • r aub........•N....I r........I p u•rrvum
S.r Srr a^ IMI .r y•,.,)S wdSen.w )JI.I TIIr l/.I Is,Un.ue Srae.Code_
D. . 879 e...a .N_I ... e..a....
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Date:
Project..;{ C,1, J ,.v aV-/ e.. CAC No. CA X' C57-f''�
7"'
This Is to certify that the prevailing wages have heen paid to
our employees and our subcontractors' employees for the mon O.
of !/..GG_, in accordance with the Intents to Pay
Prevailing Wage wed with the Wasnington State Department of
Labor G Industries.
/-dLS4%--z
Company;Nape _
r
Title
ORIGINAL DATE:
REVISION 1 DATE:
TO: Accounts Payable
FROM: Public Works
SUBJECT: Comstructim Contract CAC
Project Name:
Prim Contractor:
DATE "
DATB WECEIV®
RIME CONTRACTOR t SUN OWTRACT)RS INTENT '1'O PAT A►PI DAVIT OP
RNAILIIIG WAGES WAGES PAID
Signed
Project Engineer
cct Project File
Form: 2i15;85
pF AA•
A
THE CITY OF RENTON
MUNICIPAL BUILDING 200 MIu AVF fD IIE01TM4,IBASN 911B56
auk g PARSARA Y. SHINPUCH, MAYOR • VIIP HA91M: DtVIStON
(206) 275-2618
4b�rr00tLE° MEMORANDUM
tp vino Lee. Pub. WV.s. .r-ordinator DATE t+/IU/85
SUBJECT Prins Contractor 6 Subcontractor Li Stin^. for vAl: Contrast
1 Invl, non+• thrn+Igh the •ongtriwtion r»ntract ful, and find
1 +k. not I'll, a Pxmnl 11 -tic + ` till -1 IA Contractor c
Srbrontrartot for till, follrA+inq mntrartrrs-
1. A I I a Co. CA`7= 021-9S
2. Attert,M Paintinq 024-14S
A. Ford rnnstrurtion U)TR4
4. Ge Ico Gtout inq 025-R9
5. Grant con%t fart♦rn ORO-R4
R. Grant cons t c ur tU on 0RI-R4
7. N. L. Jacobson Con^.l tact ton
04R-04 + Y�
L. Jgrob5on +'onst rust,too 047-R4
n, IL L. Jarobaon V• nstrnrtion
I I`. Lary Nrrlino 'nn•:trurt ion 040-94
I1. Rr•tiablr Stel,l Fabricators: 067-94
Finer vnq hr 11+o•1 tnitiatr the prorvrrlure, t would "'Pr-ciate
:,.ur ht 1:• in obtaining thr proper data for mY files.
I'bmk You.
OF RR•
z PUBLIC WORKS DEPARTMENT
RICHARD C HOUGHTON • DIRECTOR
e MUNICIPAL BUILDING 200 MILL AVE SO RENTON.WASH.98055
S �P 206 235.2563
�drEO SEPt��
BARBARA Y. SHINPOCH gene In, Ig9i
MAYOR
MEMORANDUM
TO: R. Bergstrom
-ROM: R. Houghton
SUBJECT: Construction Contracts - Prime and Subcontractor Listings
(ref, Intent to Pay and Wages Paid Affidavits)
The attached June 10, 1985 memo from Gloria is self-explanatory.
Please arrange for your project engineers to prepare the required list-
ings on the forms provided for that purpose.
Return them to me A,S.A.P.
VL:pmp
Attachment
Date: S
P roj ec�y'i'+� i �L��. CAG No. dS7—,9y
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of in accordance with the Intents to Pay
Prevailing Wage filed with the Washington Stdte Department of
Labor 6 Industries.
Cowany N ae i
By
Title i✓ /
� Date. ifs/8.f
Isroj ec 6
-1 .yy�{.�r CAC No.
i
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of'7 .vG.V In accordance with the Intents -o Pay
Prevailing Wage filed with the Washington Sta•e Department of
Labor S Industries.
�41C e✓ .✓.t��Go.
Compani me
I By
/
�— Title,q AI's.Q. � �k
� Date:
Projecr ���G.��. CAG No. Aa"7-y�
This Is to certify that the prevailing wages have been paid to
our a ployees and our subcontractors' employees for he month
of 4,ds L-R= in accordance with the intent:. a Pay.
PrevailingW a filed with the Washington State Department of
Labor G Industries.
1-1-1Z, v.9Cod.So.✓ 7i4 [�wS .Tdc
Company Name T
Title q-
" .1 tt'��' Date:
....,fycs.
F rojec ,d CAG No.
"his Is to certify that the prevailing wages have been paid to
uur ployees and our subcontractors' employees for the month
of ( ___s _ in accordance with the Intents to Pay
Y rdVailing y6ge filed with the Washington State Departmcit of
Labor b Industries.
Company
TItle,n �✓ E
Dox, March 5 a 1985 contract hew been or will bs made to approM+te programs for the benefit of such
<mplge ,except as noted In Sechan i(c)below.
1. John R. Ewing President n
_
nor•,.ar uanYeN (b) WHERE FRINGE BENEFITS ARE PAID 114 CASH
do hereby Hiles [� —fach laborer or mechanic listed -.n the above relit!n td payroll has been pan), AS
Indicated On the payroll, an ammmt nor less than Me sum of Ple Appp:eble beak
(1)That 1 Psi Or wpeTdse the Payr•ent Of the penons amplsyed by_ John R.L.Ewinc houry wege rats pus the amount of the t<puuad fit^ge benefits as Iktel n the
contract except as noted in Section a(c)below.
a Associates an the Renton Sanitary Sewer Rehab, _
Ifweracur w.vasam..Tro.i--- - n came ar wort, (c) EXCEPTIONS
that ouing the payro0 period mmmeMlnt on tM_.IFS —
January 85 l5t' 'anua ry 5 EXCEPWR (CRAFT) EXPLANATION
day M 19 eM endhy the Mayd 198_—_ .— __..._._..
elf PONIO 11 employed Go said OroyM'eve been paid the fits weekly.ekes earned,that rro rebates
haws by Or wall be made e0#1 directly or indirectly to Or On behalf Of NM n/a
John R, Ewing_6_Associates hom tfe than
rcaniN�Ter..wxemaewn --
weekly wales reamed by enY Person had that no deductions navy Men made either d:rwctly or _—_—
indirMy fr,sm the full wags esmed by any person, on,,r than pem,isubls us'ucl"s as defined
in RegO tiona, Part 3 (29 CFR Sub-T'e A), Issued by the Secretary of Labor order the Copeland
Act.as amended(e8 Stat.9e8.63 Stet, 108.72 Site-967;76 Stot. 357;40 U S.C. 2761),aM de --
seribnd belowr.
n/a
nEYAPIea
(2) That any peYTo11s othenMes under thN contract required b M submitted for the Jfwve
Period se Coned and comClale, that tte wage rafts for laborers Or mechanks cunte:ned therein
are not lass than the applicable wake rates contained In any wage detemdnabon incor,oated Into
the conttect that the ElaS1if,x!;on1 it truth therein for each laborer or mechaak conform with the
wod he performed.
(3) That any APPle,'Ces employed In The above period are duty registered In a tome pde
apprentkeeMp prr•g,em reg3lered with i Stets epprentkeship agency recogHns! by !!,a Bureau
of AppnMkeship and Tralni,,g United States Depannent of Labor,or If Im such rmv,, A agency
uhfs in a Stete,ere 11114red will.the P,eau of Apprenikestllp end Training,United Etd!es Depart
ment of tabor.
(4) That: ---
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,DR PROGRAMS _John R. Ewing, President
iN[ MLeYk W',FI Q OF ANY Or 111E xaJYE ATt.ENTS YAY SUTACT (IONTRACTOR
($—In addition to the Msk hourly wage rates peed To each laborer or mechanic Olt suacdrtTwaoN 10 cTr, de CMM�NAL IRINFCu1TCN SEE a[CTION leel OF nnE re ANO
listed In the above refem Dayroll,red a ak[Ttprn 231 Of1HlG JI Of INS UNIT[O STATES COOE.
P Yrn<nts o1 binge berlefts as NSted In the
Dab March 5. 1985 _ contract nave been or WI Be male to appropr•ate programs for the bareM of such
Nnplo)geee,except as"led In Secton a(c)helow.
1, _oiaa Ra_Ewing____ presidznt _
fnama ee°+eanase.y 1»lyl !Ttdi (b) "ERE PRINCE BENEFITS ARE PAID IN CASH
dO IINtEy SIdt1. —Each Iaborw q m home Nsted in the abeee referencced payroll has Lean paid, as
Indicated on the Parrot, an amount not less than the sum of the applicable task
(I)That I pay q wpaTNse bt wymem of Me IN rsons employed by_._ John$ hour rats
Eu�1nc ty waQe pew the amount of l�: rpuired Ir•.nge benefits as listed in the
contract,except as noted In Section a(c)below.
& Aeaociatea _ nn the Renton Sanitary Sewer F.ehab.
Kenrrair lr au•ua.Irsswj� tewMNra»w•` -- --- (CI
EXCEPTIONS
--_:that during the payroll perlad commencin on the I c th___
January Bc. 31 st Tanuar c EXCEPTION (CRAFT) EXPLANATION
day d _ , 19_, and en 11h, the_day d Y 19.$-.�
all persons"Plnyed pat said project have Deer NW the full waekty wages earned,that no retatee --
hew been or♦na be made Sahel,direetfy q Irrdixly to or on Mhalf of Said n/a
John R. ETcinr e Associates
_. _.-. Imm the fuX
weeky Vied" earned by arty piu,n Sul that 11 dedrxtga have Mess made 'har directly w
r ;(ectly from IM full wages eamed by arty M+sa., other then pthmissple dedu:• ;"a•defined
in Rag Wehona. Pan 3 (29 CFR Subtle A), Naued by fta Secretary of tsbor under the Copeland
Act.as amended(48 Start.9E8.63 Set. to&72 Star,%1:76 Stat 357:40 US.C. 276c),and M-
scribed Oehw:
n/a
(2) Tilt e.
ro peyrals otn<rwlae ender this cM::+.an required to M wbmrited for the aMy1
period are coded and 10mp'e11: that the rage rates toe laborera w mechanics contained therein
are not less ft..the arplic'2 a waae ulna contained i� any wag. drtaminabon Inc Orpoaled Into
the contract,that Set t:dh therein for each taborer_. mach c conform with the
work he",for•rM.
(3) That any apprndlcee enplovW In the at-•ue pedM are duty regoleeed in a Mna fide
a ,irt4eship prcgom regratered vnth a Sep •pVre.nk,Wp agency recognired by the BoEeau
LI Appre.Dceah�p end Training,Uuited Sbtee Dapadment ot Labor,w U no such recogntrW agecry
edsts in a Slate,al,!reg,stered.dh Ma Bureau of Apprinticesfdn and Traioing,hinted States Depart
-
nentollabor.
(t) That:
(a) WHERE rRINGF BCNEEITS ARE PAID TO APIWOVED PIANS, FUNDS, OR PROGRAMS —John P. Ewing. President
In addrtWO to If11 M91C hOYd ARE, 0tM 1NE WIINL rAtSIDGTIOII OF AN' OF THE ABOVE ATEME"IS MAY SGBJECT CONTRACTOR
— ypeed t0 laCh IbMra( q mlChanK Oa EVBCOIdRAC10t TO CIVLL OR CRl.'NAL Fri"
SECUTON. SEE Se CTIDN toil OF WILE It AND
baled In the aMY1 letter.ed rayroll, payments of fringe bene6h A] Valid in the aELl1pN}]I q llleE al OF laf UNrTED atArLa COOC. - __
Den March 5, 1985 contract have been or will be made to appropriate programs for the benefit of such
amploye",except as rested In Section e(c)below.
1, John R. Ewiii_ _ President
pr.ma ct allows"wen ("Iss" (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
do hem"auto: —Each hl,arer or machenic listed in the sboae referenced payroll has L.an paid, as
Indicated on the payroll, on eciount not ins than the sum of the inpli(dbte baec
(1)That I soy or supervise the payment of Me persons employed by--John R_Ewing_ hourly wage rate plus the am:uct of the required fringe benefits as listed in (he
Contract,except as noted in Section d(c)below.
6 Aseo a tv W r l pith Renton Sanitary Rehab. __
s Sewer (a) EXCEPTIONS
;that during the payroll period comm. leing on the let --
day of February _ 85 15t February 85 EXCEPTION (Cli EXPLANATION
Y .� 19.—�and andingtM_idly of_. 19_—.
all paraoos empbyed on sold prclact have been pald the full weekly wag""mod,that no rebates
haw been or wifl be made either directly or Indirectly to or on MMIf of sand n/a
John-R. Evvin a 9s socia tes from the fun
(Cenlnatar a"..bian..aMt �—
weekly wages lamed In sy parson and that no deductions have been made either directly or —
Indirecly from the fill wag"eamed by any person,other pion pem,' ible deductions of defined
In lhlj lationa, Part 3 (29 CFR Subtfle A), Issued by the Secretary of labor under the Cupelend _
Act•as amended(48 Stab 9".63 Stet. 108,72 Sut 967;76 Sul.357;40 U.S.C.276c),and do — -- --
unbed bodies
n/a
(2) That any payrolls otherwlse under ThIs Contract Mqulred to be submitted for the above
period ore correct and complete; that the wage rates for IaMrera or mechanics contained theraln
are not:ass than the applicable wage rates contained In any wage er!ermloahon incorporated into
the COntrMi;tht:.•11 CIassiritationl eat fnr(h therein for each laborer .r mlHhank conform with the
work he parfcrmed.
(3) That any apprenaices employed in the above period are duty iegieteret In a Mna Ido
.r,prentke,hip program registered with a BUT, apprenficashlp agency recog^lao• by the Bureau
of Apprenbceship and Training,United Stdtes Department of labor,or if no such re.Aniaed agency
exists in a Stab.are registered with the Dunau of Apprenticeshlp and Training,United States Depart
ment of labor. ---- --- —
(Q That: NAME allo TEL[ S.G RE
(a) WNFRE FRINGE DENFTITS ARE PAD TO APFROVFD FiANS. FUNDS,OR PROGRAMS John R. Ewingr Pre s(de nt ON Ce�
1NE WIWL FeLS1E1GT10N OF MY OF THE ABOVE aTEY[Ni$ MAY enB1F(.i LC�
® —In edditiOn To (M ba::C IM'lnY Naga repot pall t0 each taborer Or mechanic OR aOACOHEMtlOR TO MIL OR CRIMINAL 1•RCSECUTION. SCE sl S'IJN IWI Oe TALE
thi ed in the atwve refhenced payroll• payments of fringe Mnefits m listed In this SEi 211 Or TinE 31 or THE UNITCO STATES COOS.
--- --- -- - ---- --
U.S.OEPARiMENTOFEASOR NoNTHty EMPLOYMENT - IewaAeauuAlRaA.a,aA, .. Ecuea`wira.cF •Mw•,w.n.u,
E Vloyme•i SiFnd Ids Al an,uralon,OFCCP ( UTIurATIONREPORT -I-
le .w!a w N Vr E,.c 1 PO a 11246 S IO>I (�da- w I c;�bwR n w�rirunB fy p lMnnYtesiu Tai'"-- — MINORITY:—_— FROM. 12 Er1
1a• •rNe,lwrt, ,N or w•Pr kN MWar Y„ uW dpm , ybe,cl.rN mo'&t•1
I,mA cur« u wMr«nolIN«ar u,R a a •ana , I _ __ 91-1_08_13_32 _ FEMALE: TO E_
NAME AND LOCATION OF CONTRACTOR FURRAL
FUNO,NG
Civil Engineers-Land Surveyors, Inc. AULNCY
John R. Ewing & Associates
622 S Central, Kent, WA 98032
S C WORK HOURS OF EMPLOYMENf(f ed...I6 Nun Fnde,A A 10
TOTAL TOTAL
CONSTRUCTION TOTAL ALL BLACK ASIANON AMENICAN NUMBER OF NUMELR OF
EMPLOYEES 01*1 u1 NISPAN:C PACIFIC ININAN MINORITY
TRADE Clmda+.ma BYTRADE Ibp."r 0, "I MINORITY fEWIE EWLOYEES
Nna 6LANOENS ALASKAN PERCENTAGE PERCENTAGE EMPLCYEES
NATIVE
F M F Y f M 0 — M f M f
-
AMRENf ICE
TRAINEE
PE�PLS- _ SUS TOTAL 5 2
APPRENTICE
Survey TRAINEE
Party Chief SUBTOTAL 13.5 2
APPRENTICE
TRAINEE
Chaintran SUBTOTAL 13.5 _ _ _- 2
APPRENTICE
TRAINEE
Drafter EUE-TOT AL �1.5 i
Ju xq wu•.Lar -
APPRENTICE
TRAINEE
SUS TOTAL -
TOTAL JOURNEY WORKERS
TOTAL APPRENTICES
TOTAL TRAINEES
GRAND TOTAL 33.5 7
1L;ANY0 ICIAL'SSIGNAT EANOTITLE 1) TELEPHONE NUMB PAGEER 14W.&W...W.I 17 �TES.GNEU-President (206)852-6633 January 28, 1985 �ofOMBVALNO.N 7!6 R/ (
I. C JSf IRw.aNV
January 28 1985
Bete. 1_ contrail have been a Mn M made to ippmpnate programs for IFe benefit of such
emdr<es,except as noted In Secton A(c)below.
I, John R, Ewing_ _ _ ___ president
M.-pi wn•atwr padH ftlpst — (E) WHERE FRINGE BENEFITS ARE PAID IN CASH
do hereby state:
[] --Fah labor"a mecFank hated in tree•bore re+erenp.A pay.on nas been paid, as
Indicated on the payroll. an amount not was B.an the sum cf the•ppi+abte bask
(t rhat i pay cr super+tse the payment of the persons employed by ahn R_ , Ewing_ tcody wage rote ;,as the amount of the n9..nd fringe Mnsili HE I tin t +
contract earpt as noted in Section A(r)below.
& Associates _ _ 0HIM Renton Sanitary Seiner Rehab.
ICMncts--w we�e�vsnn Ieerwrlaw w,fo (e) I.XCEPT10NS
- ;that during the payroll period lvint n ing on the__ 16[
day of necember __, III am pndingthe l5didli December,tg 84 EXCEPTION (CRAFT) EXPLANATION
all persons u Pbyed on Raid pnject fare Deere Paid the fun weekly wages samW,that no rebate
be"Men or win he made either directly or Indirectly to or on behalf of sild NIA
--John R. Ewing.-II, Associates-- _,_. _from the ten
anA
rc,,,ln,;rer> wwraeew _
warrh wages earned by any person eat that not deduction,hose been made either dlmelf
Indirectly from the Icil wages erned by any person, othar than lemGanMe deductions ,defines _--
in R+gulauons, Part 3 (29 CFR c IDtitie A), Issued by the Serenely of Labor under the Copeland
Ad,as amended (eb Stet 918.63 Stat. t08,72 Start.967;75 Rtat.357;40 WS.C. 276e),am de- -- — ---
scobed below.
N/A
atrAars - -.
II) That any payrdla .nervdse under Thin contract required to M wDrnitted for the rtwve
period are coned and complete; th-t tat wage rotes for triturate or mechanics ecrwl,Inad ibenln
am not less than the applicab!e wage re x mntalned in any wage dele rination Incorporated Into
the aontre-l;that the dassi Bratbns and fn:.h therein for each Inborer M mehhank conform with the
work he:adorned.
(3) TFat any apprenticee employed In Pe above period are duly rrip temal In a bona fide
appentkesNp program nglateled with a State apprsntkeship agency re+obrtrad by the Bureau
of Apprenticeship am Tm;nin&United E-Fes DepeMxM of Labor,or It no s_,1 mcogntred yrncy
exists In a State,are registered with the DmeR i of Apt 01ceship and Tralning.L' !led States Depart
hell of labor.
(e) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS John R_Ewint Preetde nt
THE ari FRLSrneA'" OF ANT of THE A.. .'we.TS MAY sllelecr Hit rR.+ctOR
(� —in addition to the bask boudy wage rates paid to each laborer a mechanic OR SUACdQMOIOR TO avlL OR NINAL ,+,WCUTIpN. SEE SELtION 1001 Or is "0
Rated in the above refererced payroll, payments of fringe benefits as listed in D.a SetTON ryl Or 71"1 Sa Or THE u.!H 3 Z'Avts.oOC
ar&
- Y ^ _ - I� Y.IYYaO��.�V:.}•fie Lti1�.{.1F._%AheWeii} -
Dabs Jan"s y 28e 1985 contract he" been or will be mode to epproprtne progams for the Eenelit or such
ompoyeas,escept as noted In Section 4(c)below.
f John R. Ewing _J —_President
a+ _
Mw fW sWrnwy ;—ft (Tale sb) WHERE FRINGE BENEFITS ARE PAID IN CASH
de they data: ❑ —Each laborer or rnechsnk fisted In the sbOm payroll has been pall,as
irdwated on the peyroA, an amount net less t^sn the sum of the applicable bask
(1)That I pay 01 wPeMse I'e payment of the parsons employed by John R_Ewing t�rty wail me pros the oma0nt of the re otned Mnge teneRtf as Fated In the
ecntract e.cept as noted in Section 4(c)below.
fk Associates Atha Renton Sanitary Sewer Rehab.
(C '.A>«sua'e.arenan- IawWaa ar warp------- (e) E1(CEPFIONS
that during the payroll period commerNing on fed_ 16 th
day of December _. 198;_ and nex+Stlr3 l etdayol December 19.84 EXCEPTION_(CRAFT)— _EXPLANATION
all IMPSOM emptuyed an mid project tM Men ,ald the full wMaVy wag"earned,that no rebates
haw been Or wffl be roads e4he,dlrecty or Ird'voety to or on beheN at seed N/A
.Lgitn 1 Ewingb Asociate
tcwsn�no-«.—ws
weekly wean earned by any person and Drat M dMuctbrn tAse Man mMe~directly W
ihr lireclly frwn Ins fulf*egos"mall by any person, other than pe isskM deductions as defined
In Regvlseons. Part 3 (29 CFR S.MW4 A), bunt by the Saera"of Labor under the OopsUrat
Act,a am«rded (48 Stat.948.63 Stat. 108,72 Slat, %7; 76 Slat 357;40 U S.C.276c),and 0►
scribed below.
N/A
(2) That an hall
Y payrolls otlHrwHa under lhla ter,lract u'red to be wt-nittsd M the above I
period am totted and cumI)ION, that tl a WOO rates for Monet or mechaMo contained therein
art not tess than the applicable wage raves contained In any waga detarmbutbs I,ccrpows d into
the aontnct;that the tlaswficaltons eat fnM lhemin for each laW,rT or mechank conform w th the
work he performed.
(3) that any apprentices employed in the above period ant dgy �rgblemd In a bona Ede
app,entkeahip props. mglste,ed with A Stets epp ,Ytictsh-p ssewy resopind y The lHueau
el APprwfbce.hip and Trale"g.United Stales Cep+deco•1 of L bor,or If no.each recWlnUed ea-ncy
exists in a Stan.sm ndfstemd with the Pereau of App2. eaahip n.d Training,lfnttM States DEDSN-
meet of Lebo'. ----- --
(4) That MME ANO nTa;
(a) WHERE FRINGE BENEFITS ARE PAID TO A ROVED MANS, runDS, OR PROGRAMS John R. Fain . President
THE w11PUL fAts LGTIOII W ANY oY THE ASOY( AI(.rtNTS MAY SUeIE[T T niAx-t.B
In addIB011 10 the MEIC ItCurly walls MIH pall to wXh IutNIM Or TN14r4t 1Vr(,M rla[14H TO .IHE ON EAiNNMI PRCief U11ON, Ut e( THOIS IMI O( 18 ASO
tMed In the above rafemn^ed payroll, papnards of Frye benefits ag„flsted In the �orf 231 W 71Tt.E it W THE UNINO s1A7Es coo[ _ _—
us DEPARTMENT OF tA90R PAYROLL I.— A,%-n
.AGE MID XDUP DIY+sIDN Bu�M qu,py qq µg1091
(For Wntractor's Optional UA;See Instruction, Form WH—U7 Inst.)
MME OF WMRACT011 Imo, OR CuscDE AADTW ADOR[SS
PAtAOLL RO ... L p Fq1� T -T- MQIECl MO LOGTIDM-
U m N)ow AND GAn ISl �M m w j �y m
.AYE.ADDPEsa..VID � I a. - TOTAL Mn I OROfA O�IID11010 1E
SOCIAL SCCUMTY NMMAEA CIA6MEEG1E0rE G � nOU11Y 01 P.\Y AIIOYNT MII14 rI, DTNG TDEM AND
OC EYPLOYEC I o r--J--.L�l�L�l----. FMMm ••• Nlw MDLpIMO / I� FDR wEEA
g j O i MOW YYDRRED GDM DAr TA% -h
,
01
I 74
D — --{— -- —
s
F, - - L
I
EDRM wH,NT Q,") - FORMEPu SOL IPA—PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS
S DEPARTMENT OF LABOR n 5
A INIIILY[MYLDYMf JiFILMALE
I,51 Fdl A41 LmalmBO OTCCP UTILIZATIONRLPOBT ]] 15-g4
41NORITV fROMu91 181332 �. .... To 11 30-84
NAME AND LOCATION Of LONTRACTOH rL
f11W NG
Civil Engineers-Land Surveyors, Inc. AGLI.CY
,John A. Ewing & Associates
622 S Central, Kent, WA 98032 T _
6. WOItK ROURS Oi EMPLOYMLNT tf ed.,,1 b .,Im feCuall B. In
CONSLRBCfION TOTA.ALL BLACK ASIAN Oft AMLHICAN NUMBEH Of NUMBER of
TflAOE Oa,"I.'I . Ea'YLOI FLS 14u,.1 RISPAN,C PACIFIC INDIAN MruCF`ITY FEMALE EMP.OVEIS MINO ITES
TY
a'/TRADE /x.yvn¢Oapnl 6LANGEIIS ALASF.AN PERCENTAGE rERCENTAGE EMPLO
XAr VE
M F LI F M F M i M F M f Y f
APPREN:Ict
I HA.NEE
PLS SUPTOTAL 3 i
APPfi"':T,IF
Survey THA.r,E,
Party Chief SUS TOTAL .0 1
v wan
AF'^.ENTICE
THA',CE
Chamman xre-TOTAL 10 1
APPn I`'TICL
THAINLL
SW°IOTAL
_. .._ _ _ ___
AP:,<F N11C1
IH^C:L C
SI a ILITAL
TOTAL JOURNEY WOHKERS
TOTAL APPRLNJ ICt S
TOIAL IRAIN317S
GP A' TOTAL _ 23 3
IIip� l IIL.AL r:TU L: III•f 11 TELLPUONLejrt•. RR,elude i.0 o!U 13 AIL SIGNED - PAUL .--
�'{Pl\Yfy/fl -President (Z06)852-6633 I January 26 1985 �_
- -O -- ---
DIV HDV TL Ao.ua,uvB - - -"----- "---
fORMCC35)IR 9n
Debt January 28. 1985 eortract r<w been Or All be made to Tppropnate p,,aams for the benett of such
I. Joha R, Ewing_ president ethyl:, s,except as noted In Section 4(c)-ttur. .
--ovii,na a epaun, .,arty) Owq (b) "SRE FRINGE BENEFITS ARE PAID IN CASH
do hereby gate: (� —Each laborer or mnhan!c listed In the above fnarenced pey'oIl idea:Peen paid.as
Indkated on MA payroll, an amount naE less than the Sum of the app cION< bash;
(I)That I pay or wperi the payment of the persons employed by_ John R.._FUwL4ff'_ hourly wage rate plus the ameLn n the rr,,:rad fi 3e hene0h n listed in the
coc\ract,except as noted it Sechan 4(c)below.
& Associates Renton SanitarySewer Rehab.
on tlr---- - ----
RwwNeaweAa (c) EXCEPTIONS
that during the pay-0 period commencing on tha__ I nth_
November 84 30t November 84 D(CEmom (CRAFT) ExMAutT10H
,'I of_—._._._ t9._., aM easing t�M_hdey dl/. trio a r __
Ia persons employed on felt er dire hux bNn paid the art woolly wages earned,trio M rebetn
have been or will M mete either dheHty or InCvactly to pr m behalf of uW N/A
John R. Ewin�t� Associates _ fro tea full
lro�rnaw m..ecm lu.!M_ _ m
."Idy mg1s gamed by ary pinion and D,Ht M dedo:Abns hex bon mede either dire.-Illy Or
intro rty from the fu'I wages eanea by amy p.rsan,otter C'nn pemrysige dwfu.bons as defined
In Reg,'etkna, Part A (29 (FR aanRle A), is:+ved by the Seneinyr of labor Imilei the Coperand
Act.as amended (4a Slat 9'.8.63 Stet 101K 72 Stn.%7;76 Stat 357;40 U.S.C.2)Ee),and da.
r-ribed below:
N/A -- --- ..----- — -- ..
s
(2) That •`y payrolls otheMlee under IfJf<¢ntAtt feG• .4 to be Wt.nlMed ear\he DMx
per'od an cepact and complete;that fro wage rates for latwren v m<thanks<,a ta'ri d therein
am rot!"a then the eppprat'e wage Pates car,ta:ned In any wage date ;.wbon jr arpaated 1,10
Na conbatt:that the r:assiO+aUo^S W f-.E1h UY'eIA for each 111-Ifer or iaevhank ccnfcrta.th Use
a'.a he p:.rcrmM.
(3) T' d any aFp'•'16 of employed in IFe save peeled are d.ly iegistae,rl In a twna fide
prertkrhip ping em reti>tned with a State a;prantkeshlp eaeml •acognind by the a,-TO
cf Appmnti•:'ship and Tai,'•a,Wend Stales Depsdmerd of labor,or if ro such rrngob+d agency
<Alsle In a Slate,ere ragMe:ed with\ta P.Jreau o/Appnnt:CW'p• d Tmining.U+qed e_t*+es DR put.
?ant oft,Or.
(4) a) N o Ano„.-
(
(a) WHERE FCIH N
GE I` LFl TS ABL PAID TO F PROVED(Y.ANS, /l'•'105,CR -Y1 :;,!aS —John R. Ewlng, President II _
AA !I addition to the bask hoori THa wLFpL FAlai .?'•04 OF ANY OF THE APJ I .OM[Jh a MAY I.T!f i N 410e
r] ( '+lije fates paid t0 <FCfI Idf:oPM or m.-!',H C oA su iANT OR a CIVL ON MAHMt 1 'AKUNCN. SCE S Q.ON ib,l W Ala ANp
listed In the ebose We ected payroll, paA.nerds of 1de,,, beuo Ets agJ:aed In the •Lorli'N her or TINF •r OF THE eNOT(O STATES Coot.
n
Doe 1 ne L9_ 19a5_
E Reh...a A n ._ __31avC..0 Pc......' ____-_ ac '�r.eb. vu.
IR•wr.Ire.r,.rI M•rf) IT,r I•)
Ill T1.•l 1 Pn or wpe..;.e Ibe 1»Twa1J.( he peens employed b Seeale, Inc.
fc......,e,of .............
en tNe Maplewood Sanicarc Sever _:the,dr.r:,t the p•n•1(inerted cen.ne•rist«rw ?t d.Y.1
1e.11d..a of...a)._ _
1. _.1t-4,,�•nd ordin.tM-4-4t*do,N „ dl.......
.•ol.erd on.•-d pmlrcl h...both pud.he hilt.eetlT rq•...-co, IN.,he.rD+v.ho.e bee..,.11 M..do ei,Afr d��rcUY se en
on feet .❑of fed u,A $g1,11e. In:• _,__—__ Im-the fu11 .r't1Y up.:.mrd bl +nl D^fnn
_._. (C......I.,of ......r....o.l
e+d IN., no e.eua.ena bore been fn.d.either.effetely,.1 in4,•ecll7 I•..the felt ...•a r m.d by one penow,.,No,Ih.n f•m.lfsble de
d... of defined.n Rt.el Mion.. Pon S(„CPR Ubnty.A). 1. ..d by 1%. S. ...In,of Lob n under the C.,,l.rd Art. o.—.dfd
(do 51.1 I's 63 Sul tN,72 51.1. 167;76 11.1.377; 40 U.S C 776e), end drfcnbed t.fil
'Withholding
FICA
:led Aid
(7)T)„I mr Per Lilo eU v.1.'wdrl Ih1. reel nrt Ielolled 1. be ..1—M Id to,1M obi.•pr^od.. ...IcI end clef+ felt. IN., tb
.........In. bbo....of—fh.....tnnbmre Ihe,fr-.re ifel Ire.then 1%. .1111ubl. ..tt 'all..c........I in or, -.t.dell m-n+t...
for oryerol. e d....the cnlucl,the,IN. ....to le ,rt Ihe.•mHoptee fach limbo—of in.ch.me ,.of.— .i1h 1 M. �nr.he p-Iif d
E1)TD., .nY pt..ed In IN, .bo.r Puied air dine.ealuoed in a Done fide opp-ot,refh.p p,.r.on.•:.tied fah re
fltlt .PR•enbufMp feel re eoffnued by the B..e+u let AP,,,n,.crahip end T..mm. Un,l.d I'll V.P.n.".e1 L+bo.or J no ...N
e..xtnu.d offence r.....m.Sine, ors opflrred .tth 1%.0.,e•o.l Apprtnl•c eoh.P and Lunm., Unn.d SI.1t.at,— —, of L.M,
/tl TD•t.
(al WHERE FRINGE RENEI ITS ARE PAID TO APPROVED PLANS, IUNDS.OR PROGRAMS
In+dd,l..1e In.btu,booel...te role.pud 1.r ch I.bov1 a —hon. I-I.d.n he +Mee ••Ire •ewe—H.
L b dl pgnems
el eo.. enl ,.of conflicten.1e 1n the cont h..e b o•-JI he n•dr 1e µ.PmpnurP....... le. he ..1%
.... ..<. ..,Mltd 1n Semi.qr)Won
(b)IFHLRE FRINGE BENEFITS ARE PAID IN CASH
�. E.rh 1+be,e.e•mrchm.c fined In he litho..111. ,—.d f.,,.It he, ben pud a. hd,cu .n.d the paY•e 11, if net
I...Ihe.fh. • of the opp Lcohle bast No.fly .Re rut pl.f Ih.o�noam of the tq.ntd Irm.r brmLu If�L urd^nIn,
..mnc1, e.rTf.f.end.n...fnn id We.
(r)EACEPT10N5
reel..• _�� .�. �._._. �__ __�
son.. ....,.yea
Reh:—c.. A. Duerr[ Vr`.:
.f fine,or fh. .be.. ....ern, .,. s,eu y:, n.leer•.«err«...n..he owl.....w.n,1 .....,,.«
... ..... ).Ol .1 T•,It 1. ed S.u.w M.1 T,Nr It.1 1.,Vmrea S1.1re Cledr
.... 879 .....e....—fe..... .....r.a. — __
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..eSt_woae -- -- ••'oaa .• _t Nr Vert �— .«rw•Ir «wuw
1 Curial _ 6-8-85 ??
.Ie n�lgga -------
Vito D. Graziano _ Payroll SuDerVlsOr _ do h...byy vista.
IN•.•.I•./n•,v.H.IeI traj.)
(1) M.1 1►9 at •'pe,.:+r the P•P•rnt at the I,....n•s mptosd by_ M.A. Segale, Inc.
¢..,..e.......be......ur)
Via Meplewood Sanitary Sewer : IN.%d mn.M �
storing it.p.),en period aome ].n the day.l
Juror 65 Bth June 85
.J19 a.d rdmt Iloo dy el 19 III Poo...,
Wood M..d Project My bare pld the (dt.cell] •....•.sled. Net.r..bate.he.,be..e, .It be..de isl,"brr[IIP e, No.
behalf at..td M.A. Segale, Inc._ (,em Ite Idl .welly.00pa lame/by asp Pee..e
ttaw......r v
/IMt woo ded.nto..Na.e ben m./r♦IINu 6,e[III-I mesa O1)from the full.....a mrd by......a a.,.,he,Iboon pe .s.blr IN,
rti.nst..d.rened t.RrryOIU.e..Pan 3("CF)f 3uM.11e A), luaVol by IM Se n,t.ry of L.bar.dv.he Copeland Aci. as . -Ild
31.9. 918-/3 SW in ))SIa. 967{yd 3,at.JIM /0 U.S.C. Asp, .rid dr.I,:bed bete_:
WithholdiN
FICA
------ ---- Mad Aid
1))Th., .q pe,..u..ur._i.e and.,'hit a .aI .ey.{,ea N be..bm.ud I.,INe ab...Ie. d Is"a ...r. .nd aomDle,r. tMt IM
o .rMmc+ronb:nrd th.......no, lest.then the .rplvoopl,.........I.n,...ad I.a., .ge eel......b.n
o,pe•e,ee Iwm the.o.I..rt,IN.t Ur el•atiUl•tiona IV,Ionh INrvm I.,e.[h loop.,,,eI.n.h.nla tanfo.m_.th the ..,I he ,.Ia. &
(I)Th., .n, •DP enure.,mplo, rd in IN, ebc..D.,i./."duty.en.,e,.e In.ten.Code .Pp anti,eabp prePoom,,'..Tale..,h .
IV ..py,enUuahop•ten"..eopnued by the B noa er App,enbeetXip .Id T..inmp U.JI,d Sut..Dep.rtm,n,of L.bal,as If.w end,
.o.vrd I.•4ne,.re ntis.ore .ilh he Bureau et App.Innle aN,p end T......I,U..Id S,.I..D.p..Imem or L.pae.
p)TN.c
oo YNERC FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS
In ad6„an 1.1%,b•+i[ba,,,ly ..te Ole.O.,d to oeh l.ba,.,.,mr.hoonl[ I..Ied In he .No.r.dr.....e n•Ymll.pymeau
of bent.benrNU..I..,d..Ito........Noe b.n e,rUl be made to epp,epn.,.p,oPoom•too the banebl at M"N emrley-
........pl a.rated:n See'...Q[)►est-
IW.HERE FRINGE BENEFITS ARE PAID IN CASH
'�- Et,%I.W.-a.urea%.. bud en the solve.,vinrilred D.,mll No.b...P•.d as I.6.a.e an the pooy.oll. a .m...t sal
I...shoos the stun el Ilea arphaablr b...% .ay..]e Fur P$a.IN. • aunt of.N.e,yu«ed Inns,brnehl..111.lee m she
eamr.sl,r•a spa .+nerd is.eeUan d(e)Mbr.
I[)EXCEPTION&
ua[.no_frrJO a✓..Vane.
.-e.q.a
Vito D. Graziano, PoyLoll SupevisOr P�
,ear wb.0 a.. ...►..........re e..a«.,.m...l r_.......w
r S.e.,M fla0t.I T,III 19 end brie..))f at 7.11,31.1 the Uw..d]4ee•Cook,
'_:::. 879 ..e... ..p.I.e_. ... a..e...t.
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Date:
Project. N�,,.R. :4 F. .. • cr CnL No.
This Is to certify that the prevaili- wages have been laid t
our engloyees and our subcontractors .W loyees for the month
of In in accordance with the Intents to Pay
Prevai Ing Wage filed with the Washington State Department of
Labor 6 Industries,
Company Name
Dy_L_� _
Title
Date: 1;w, Z
Project P mw, CAG No. !,S F ,
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of ' _ In accordance with the intents to Pay
Prevail Ing Vage� with the Washington State Department of
tabor a Industries.
Company Name
7 /
By
Title
t� (� Date:
Projec t_lq�i�ARr}i 1p CAG No.
R6 N A(i — 2t=w1 rp ni
This is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of �; a., in accordance with the Intents to Pay
lln9 a
Prevaige with the Washington State Department of
Labor 6 Industries.
rC�LC ���—men I--ini
Company Na rSh/�/G
Nam -4A G
BY
Title Yees ,pEtir
✓'
Date:
Project CAG No. >'�!
This Is to certify that the prevailing wages have been paid to
our employees and our subcontractors' employees for the month
of //''��� , r ,',';,�. . In accordance with the Intents to Pay
Pre�iling Wage' filed with the Washington State Department of
Labor G Industries.
Company Name
By --
Title
U.S.-DEPARTMENT OF LABOR MONTHLY EMPLOYMENT 1 cuvaxmwutA a.a�wl
En1YloYnN111$bndarJt AdminnlraTNm,OFCCP UTILI2ATIDN REPURT
Yaw::.Wla..4,�—,ew E:kw�.,'�a�ii 7.i-s«ioi.�.,___I_ MINORITY: A
FROM
T[uu1�IurN.wd.IHlwuldu,WWid uuMN u,my.n•naln..oxnK�f tun N .a �xy iLw.o.—irq�ow y110,_I3}; FfMALE-- TOi-31-85 AL_NAME AND LOCATION OF CONTRACTOR
IL OEN
Engineers- F'INUING
CivU En
8 Land Surveyors, Inc, AULNCY
John P, Ewing & Associates
s --- --------- 622 S Central Kent, WA 98032
-' rz i-
IlL WORK HOUR OF fMYtOVME NT IFedmal&Nun FLvMrat)
tW
Ga
CONSTflOCTIOM TOTAL ALL BLACK ASIAN ON AM[HICAN ). a TOTAL TOTAL
iflAt]E 'Mvlc•bon EMPLOYEES INul el HISPANIC PACIFIC INUTAN NU IbL It OF NUNbE N OI
NY TRADE Tbyu4 Uupd LSLANOEN$ (At
MINORITY FEMALE EMPLOYEES ""NUxITY
A LASKAN PERCENTAGE PERCENTAGE EMPLOYFtS
JATIVE
JwureY..Wlu _• ---.-_ ____ _._�f_, A F M F 4
A"ENTICE - -- -- -_ -- -
T:TAINEE
PLS_-- a sue TOTAL .5
APPRENTICE
Survey TRAINEE
Party Chiet_ SUBTOTAL 4.5
APPRENTICE
TRAINEE
Chainman SUa-TOTAL 4.5
-
_ _
APPRENTICE
TRAINEE
Drafter __ _ SUB TOTAL ,5
APPRENTICE -
TRAINEE
5EI6 TOTAL TCTALJOUflNtYV.,f.KENS -
TUTAL APPHL'NTICLS
TUTAL TRA:NLES
GRANDTOTAL 10,0
11 COMPANY OF Ill.'S SIGNAlUHE ANO LTLE -T -
117.TE LEPYtONE NU.ABER IJr - UK.oyl _ ,... - _ - - )
CATESr4'.FO IPAI.E ._
V}_/W_�J-�y�.�'F►��_ Yre sident I _ _(206)852-6633
OA`b AP OVAL NO URT]fa V - -_—._ ---__ ___. _ 3�5-85
FORM CC 2Sa
DEPARTMENT—O"F LA808
Fmylaynwnl AKA NA
t -- AnnnrybaLon IMONIHLYEWLOY —
ly HNo'rNN aey f.«u[w<�.n,.II OFCCPON TEPORT
WNi ICmwiu M.0 paq�ly,IM -' __
r I CPC.[ w[w,ww M wNel<O�E 303�Jwi w Iw+.l<w�.,y II M< f x w f
[Mr M<OM aal[a11NM<IIY,_W[I JAI<MIM[Onl,a<Ip A[, unliKlilp xy w. -�
Y W OgWN,MI`MN<Wr f lW<Oq M)19 NU-"�'-- NI ,` •1
a�Pn somnN<. NORIY�
--___ FROM 2_1_85
- -- _ 91-1081- "---- -
NAME AND lCIC4110NUI CUNTRACTON f[MALE. TO 2 28_85
C"" En ... — — -
gineere-Land S 'I!.:RAL
a----- John R, "In is °e Pora, Inc, TI•'•L,NL.
- -------------- R 6 Associates 622 S A(,L vtr
WORK NGURS - Central, Kent, WA Bi-----__ OF EMPLOYMENT �- --_�_ �- _98032
CONSTRUCTION Bu IFNI<rAly Nun;< - "-
TOFALALL ULAc, (k _—_--- (w _ WIY) -- '
TRADE GNR,1¢a1,pA EM/tUYEt9 _`-
-
BYTHAOE INp vI ASIAN OH ----
ILwanxU. H'S/ANIC YA[_If IC '"I"I NN Y _ TOTAL 1
d IUTAL
-- -' 1SLANDENS (AI NUMal I OF NI IMYfHO1
-_--"- M F ALAptA M'NORITY ftWtE F M NAIIYEN v(HCENTAGE PEHG(N/AGE CMPLOVt($ Al*-OMIT,
F
APPRENTICE -_- M -�— M fMYLOYffs
Sur,, "_ /
Y TRAINEE M F
_-Party Chief sutl-TO lAL 8,0 M F
APPHENTICE
___ "ha in elan RAiNEE
TOTAL 8.0
__.
APPNt NTICE - -
TRAINEE
F.nµineer SUB TOTAL rpr4L 1,25 '
APPRCNTICE -
11AINEE
_ SUtl TOTAL
"PRENTICE•
TRAINEE
SUBTOTAL
I O'
•AL_�uHNEY WORKC H$ -- - -
1 OTAL APPRENTICES
TOTAL TRA,NEES -
G RA N(I)TO TT�AA LL
PA ///
11 tGMV _ 25
)C-At
I E 9CNAh/HE ANO r.T11LE 1 _
-- - �Il Tf LkPNUNC NUMBER Halu;N<m<yyl _
U 047E LC' "-- - Preaienf - � -
99
_ NEp 12061852.6633 PALE
d - -
7313
MAIL fQ Statement of
INDUSTRIAL STATISTICIAN IiAYMENT RECEIVED INTENT TO PAY
Department of Labor A Industries PREVAILING WAGES
Employment Standards Division JUN ig 1905
(Public Worts CoalneU
General Administration Building
Olympia, WA P8501 .ai ESK
12041 753.4019 "! "sA we
Contract Number P-O- 4 36989
Date Bid Was Due S111185
Contract Awarding Public Agency Date Contract Awarded_6/11/85
City of_RenL4a._ County in Which Work Performed King -
Address 200 Mill Ave. So. Le,.tion Within Count% ,Aapleunod S.alrary_ ec. Rent
Renton. yA_Q¢055 _ Prime Contractor n• A. Seattle, Inc_
Phone—.-- ___ Cont:aLlur's Registration Certificate P.>223--01-SE-GA-A-A312NO
Do You Intend To Use SubrcmtractorsT Yee l_I Nr 'L
In compliance with RCW 39.12040 1, the undersigned, being a duly authorized representative of
M- A. Segatee Tar. P_ n_ Ro. SROSO _yla YA_.98IRg,__
tr,*% or a 9ulamR , tAdd.,
do hereby certify that the following rates of hourly' wage and hourly fringe benefits will he paid to all
laborers,workmen and mechanics employed by me upon the public works project described above and that
To laborer,workman or mechanic will he paid les.a than the"fo-Vil ling rate of wage" as determined by the
Industrial Statistirian of the Department of Labor and Industries.
PLEASE NOTE: If apprentices are to he used they must he registered with State Apprenticeship
Council or they must be paid prevailing journeyman wages.
CRAPr RRTIMATIm 41 MEER RATE.01' RATt OF 1101'RLl'
or WORRE" m1URI.Y PAY FRINGE aENEFn'9
Motor Patrol Grader (1) 17.79- 4.16=
Roller Oper. on Plant Mix (2) 17.43' 4.16
Roller Oper. on Other than Plant Mix (1) 17.13" 4.16'
Screedman b Paver Operator (2) 17.79, 4.16'
umo Trucks: 5 to 4 Incl. 12 Yds. (6) 17.38 3.64
Dump Trucks: 16 thru 20 Yds. (2) 17.49 3.64'
Laborer (1) 14.96% 3.43"
Raker (1) 15.44., 3.43''
223-01-3E-GA-LM-A372N0
Nola. Attach Additional Sheers as Needed
By Secretary
Subscribed and sworn to before me 'new'
this —1et1L_ day of June Far L It I fee Ouly
19 85 APPROVED
7 7 Department of Labor & Industries
_ br / Industrial Statistician
1VNv,P4h4r.nand/ the State.(R'ash,,W..nud
in,M Warhalstoa
By _.. ___. _ Date JUL 1 1985
BEi )RE FINAL SETTLEMENT can be made on RON public works project,the prime contractor and each
and every subconuactor must submit form LI-700-7''Affidavit of Wages Paid"to the officer charged with
the disbursement of public funds. EACH AFFIDAVIT OF WAGES PAID MUST BE CERTIFIED BY
THE. INDUSTRIAL STATISTICIAN OF THE DEPARTMENT OF LABOR AND INDUSTRIES BE-
17007 IT IS SUBMITTED TO SAID OFFICER,
PROGRESS PAYMENTS: Each voucher claim submitted to an owner by a com.actor for payment on a
project es'.lmate shall state that prevailing wages have been paid in accordance with the prefiled statement
or statements of intent to pay prevailing wages on file with the public agency.
COMPLETE AND MAIL. ENTIRE SET FOR APPROVAL TO:
Employment Standards Division. Department of Labor and Industries.
General Administration Building, Olympia, Washington 95604
CONTRACTORS. DISTRIBUTE APPROVED STATEMENTS AS FOLLOWS:
(PINK COPY) ORIGINAL CONTRACT-AWARDING AGENCI'
1GRERN COPY) DCPLICATr--I.NDOSrR1AL STATISTICIAN tReWned by Departmatio
(BLUE COPY) TRIPLICATE-PRIME CONTRACTOR
IYELIA'N COPYI QUADRUPLICATE-SUBCONTRACTOR
u m'n I.—m P.,n.Yl sf11 r
t
ORIGINAL. DATE:
REVISION DATE:
TO: Accounts Payable
FROM: Public Works
SUBJECT: Construction Contract CAG
Project Vane:
Prime Contractor:
JA1;LlZ
E RECEIVED DATK RECEIVPD
PVIME CONTRACTOR SUDCON^RACTORS Kr PAT WAGRS `I KACBS PAIU
I
Signed _
Project Engineer
cc: Project File
Fora: 2/15/85
MAIL M AFFIDAVIT OF p
INDUSTRIAL STATISTICIAN WAGES PAII)AYMENT RECEIVED
Npartment of Labor & Industries -
Empinyrasem Standards Disision ON PUBLIC WORKS CONFRA&} 4 0 i 1�i'0
General .Administration Building
Olynlais, WA 98504
(21111ol75144119 CAC 057-84
Contract Number _.
Date Bid Was Do, _ 8/31/84
Contract Awarding Public Agency Dale Contract Awarded 10/11/84
CITY OE' RENTON 5/6/85
200 MILL AVE. S. KINDate Work Completed G
Address County in Which Work Performed —
—R�'1T RENTON, WA, TO N
235-2631 L. mion Within Count)
Telephone Number — W'ss a statement of Intent Filed? Yn N,
In compliance with RCW 39.12.040 1, the undersigned, beinst a duly authorized representative of
LAKERIDGE PAVING COMPANY P.O. BOX 5.130 KENO, WA. 98064
lCwnas w S.a,n.avl (AElrsl
du hereby certify that the following rates of hourly wage and hourly fringe benefits have been paid to the laborers,
workmen and mechanics cmploved by me upon the project described above and that no laborer, workman or
mes'hanic has been paid less than the "prevailing rate of wage" its determined by the Industrial Statistician of the
Department of Labor and Industries.
List below each classification of labor employed by you upon the project described above and the rate of hourly pay
and hourly fringe benefits paid to each classification.
Plies" Note
If apprentices have been employed on this project,provide this additional information,name,registration number and
stage of progression
[nit R.I.at Rue nt limtah
Itars Pay irw9- armpit Rid
TRUCK DRIVERS (5-12 YDS) 17.38
OPERATORS (GRP 1) 18.23 q tf
LABORERS (GRP I) 14 1., 3.43
Na. Attach AddRamal Slxeu o Naded LAKERIDGE. PAVING CO.
Subscribed and sworn to before me B).
n ,
this (., day of . ; .—.
i
19 7�y, u, ter Only
-t/ i I I With ce+ti4 out am dtna.old wane t—ssa fnrye hrtwGn h,"vory
1 i
) ' , ' a � — b Ine prn'uLoe vµo rrgrlrm+mu ofRCw )v IL0W kere 4 a asufed.
Na,r,FuN,c re a fths Sua or wysmrynm.rcod,Ni UsiDl15TR1AL .S'fAI'ISTICIAN
in wula'sia INSTRUCTIONS. Rr, J
D..: UN Z 4 1985
J
U
I. Punuant to RCW 39.121140 copies of this form must be completed by the contractor and each of his sub-
contractors.
2. Complete this form in triplicate and have it notarized.
3 Submit all forms for approval to Employment Standards Division,Department of Labor and Industries General
Administration Building. Olympia. Washington 985W.
4 Mail an approved copy to the Contract Awarding Public Agency
CONTRACTORS ARE RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of the SUB.
CONTRACTORS.This is required by law and payments can not lawfully be made until such affidavits are filed.
�►s
"'us, Aaur.w .a. t.rn 9a st
MAIL TO: ""•a AFFIDAVIT OF
INDA I. STATISTICIAN WAGES PAID PAYMENT D./aufuh*MhgPraal oflahm A lnduslrim+ MENT RP;EIVFII
F4nfdaynhhwl Standards Dbision e' ON PUBLIC WORKS CONTRACF
General AdrninictrAtion Building JU"1 i
fNrmpla, W'A 99504
t206i 753.4019
Contract Number C A C. 059 — 84
Dale Bid Was Due 8/31/84
Contract Awarding Public Agency Dale Contract Awarded 10/11/84 _
—.=ity. of 1.ofn¢
Date Work Completed 5/1 1 -
'85
Address 2n0--k1iii ^♦ County to Which Work Performed
'ter^us--W. 98055 Location Within County Renton
Telephone Number . (',k - 23� — "3,1 Was a Statement of Intent Filed' Yes No L)
la compliance with RCW 39.12.040 I, the undersigned, being a duly authorized repvxcntative of
_ shamrock ement 'rinisiiul- lnc 17317 S.E. Lake Moneysuith dd. Au'ourn. Wri. 98002
(casua a at,Sawa.war) tAdderal
do hereby certify that the following rates of hourly wage and hourly fringe benefits have been paid to the laborers,
workmen and mechanics employed by me v Am the project described above and that no laborer, workman or
mechanic has been paid Icu than the "prev�ang rate of wage' as determined by the Industrial Statistician of the
Department of Labor and Industries.
List below each classification of labor employed by you upon t project described above and lb rate of hourly pay
and hourly fringe benefits paid to each classification.
Please Note
If apprentices have been employed on this project,provide this additional information:name,registration number and
stage of progression.
.raft Rau of hue.d ❑meh
llaarp Pat Fringe &aorta Paul
ProL6 a.An
Nose Attach Addnwnal Sheets as Nadad '
Shamrock C�cnt Filtiahin& Inc.
._t IcaSprq normal
Subscribed and sworn to before me s_
this day of
19" / _„ tar ue oat,
/ ( I haraay art:ry that acaadiad as the aaya ra W gad novae to _eag acor n
M ,r tAatOaf naaa ragalrsmiu d RCW;J9.tloa Ar+a Inaa uW ed
Nast, hlrr in and rw the Store awash F nAmg
in waYosir. INDI SIRIAL STA'fI.S'FICTAN
1: » OF LABOR AND,IC1 x S,I I"S
INSTRUCTIONS: ay he � 19�
I. Pursuant m RCW 39.12.040 copies of this form must be completed by the contractor and each of his sub-
contraclom
2. Complete this form in triplicate and have it notarised.
3. Submit all forms for approval to:Employment Standards Division,Departmem of Labor and Industries,General
Administration Building, Olympia, Washington 98504.
4. Mail an approved copy to the Contract Awarding Public Agency
CONTRACTORS ARE RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of the SUB-
CONTRACTORS.This is required by law and payments can not lawfully be made until such affidavits are filed.
emu+
uwam Asthma d war Jahn Qum
•m cIL TO: AFFIDAVIT OF
Is DUSTRIAL STATIWIC1AN "` 19b1 WAGES PAID
Ikprlamet of IJhor i Industries
lmglaytnand Standard. 1)....ion ON PUBLIC WORKS CONTRACT
Gener d Administration Bu
Olympia, tgEIVED
t2061 75140t9 IAN 5 Contract Number CAG 057-84
7 198,r Pyt►1G ENT REGfIVED
t:npyMlyrvl r$IM4xq$yt yi Date Bid %a. Do, OD/3//ap y
Contract Awarding Public A nlyl" 10 11 U C
Date Comracr Awarded I I84
CITY OF RENTON
--- Date Work Completed 12 1 2 84'__�U-kSAC
,Addreay 200 Mill Street
-- County in Which Work Performed King
Renton, We 98255 _ n Rento
_ Luca...n Withi'a County --
Telephone Number 2 5-2631 _
Was a Statement of Intent Filed' Yes 1<.i No .
In compliance with RCW 39.12.040 I, the undersigned, being a duty authorized representative of
TUNNEL SYSTEMS, INC. 7205 NE 150th BOTHELL, WA 9f011
tcntrww,a SuWwn,a.vl laeei�l — — ---
do hereby certify that the following rates of hourly wage and hourly fringe benefits leave been paid ,o the laborers,
workmen and mechanics employed by me upon the project described above and that no labor,r, workman to
mechanic has been paid less than the "prevailing rate of wage"as determined by the Industrial St .to,;cisn of the
Department of labor and Industries.
List below each classification of labor employed by you upon the project di, . tied above and the r: a of hourly pay
and hourly fringe benefits paid to each classification.
Please Note
If apprentices hare been employed on this project,provide this additional information:native,regislr+ .ion number and
stage of progression.
Cnn MN W k,i, or li.Htl .1I
IMerlr Par a •'nee Warfn rind
C;eratcr Croup 3 Fcraman $17.93 . . C•$t—reT'
.._'c;urei' ':;r.:l�:"eL $+il':1"tr /7 ytrP —3':1'•1 Jr�/ 3
\..m Uuah AJYaoiul Sbem as Re.VeJ
TUN. EL SYSTEMS, INC.
%L .,k.m l
Subscribed and sworn to before me By President
Ilnkl
this _ t __ d,y of Dece=ber
LAI Lr Gib
1 herebt ccruf)that a.dly to ibe aye ma and f,,.,bus:Go aeon v am
is the iror ,Ii a aye nyuinnena of RCW 39.12 W hit been wmmd
\"wan Pubix m.w ro.Ne Sumo!w'a.hi»pm,rca:J:ria
v us,yrm INDUSTRIAL STATISM IAll
DF: ITMENT OF LABOR AND [ND 7RIES
INSTRUCTIONS. JAN f 1995
I Pursuant to RCW 39A2040 copies of this form mist be cumpl:ted by the contractor and c.ch of his sub.
cunlractors.
2. Complete this form in triplicate and have it notarited.
3. Submit all forms for approval to: Fmployment Standards Division,Department of Labor and Inds:tries.General
Administration Building, Olympia, Washington 9h504.
4. Mad an approved copy to the Contract Awarding Public Agency
CONTRACTORS ARE RESPONSIBLE FOR OBTAINING AND FILING AFFIDAVITS of the SUB-
CONTRACTORS.This is required by law and payments can not lawfully be made until such afLc ivits are filed
•�r
u.ro+ aaa«n•aye iinui 9s r:
I�
MAIL TIt _ �'v Statement of
INDUSTRIAL STATISTICIAN 1984 INTENT TO PAY
Departmenl or Labor R Industries PREVAILING WA 3ES
kmpluymem Standards Division - 11 (Public Works Contract)
General AdrairdDrstioa Building IVen
Olympia, WAVgsol<PCEIVED Ept� cgc 057-84
I Y061 Taa-sme JAN 71985 PPYp6`?`I jaksA" Dow B-dlWas D r-&-3ilee --
Contract Awardin�.�*" slyanaysmm� ^ t:IrA'Date Contract Awarded 10771/R4 r
CRT OF RfM1- 70,4
y County in Which Work Performed %%(7Nk
Address 200 flit[ Staeet _ Location Within County RfN7pN _
Renton, Ida 98055 _ Prime Contractor IV f j4r/1,7511A' JB-
Phone-35-26f7 Canlractur's Registration Certificate No. 7UNNt.S11793,7
D. Y,w Intamd To Use Subcontractors^, Yes D No 3
In compliance with RCW 39.t2040 1, the undersigned, being a duly authur)xt.' representative of
711AlJ6L SqS70S, 13C. 7205 A't 750th 607NBLL, U4 98611
uaMrss.w subs.., 'Adana)
do hereby certify that the following rates of hourly wage and hourly fringe beneflis will x paid to all
lab�,rers,workmen and mechanics employed by me upon the public works project described above and that
no laborer,workman or mechanic will be paid less than the-prevailing rate of wage"as determined by the
Industrial Statistician of the Department of I.GIwr and Industries.
PLEASE NOTE: If apprentices are to be used they Most be registered with the State Apprenticeship
Council it they must be paid prevailing journeyman wages.
CRA►r ESTIMATED%I'NAIR KATE OF RATE UI HOURLY 1
OF WORKERS HOURLY PAY FRINGE RRNEFIT/a / t
Openuton tnytneea Gnoup 3 Fonenan 1 $17,93 - '$4.61f'
1 17. 43 6�-
Cieneaul LagoAen 7 •-ice:i"ti �3 4,44
/ 3/d•�
Norst: Attach Additional Sheets as Need<d. 7UNNf L SYS76,1S 1 NC _
By d C e to al ant
Subscribed and sworn to before me
this I day of tl.•rem A. For L.a I Us. Only
APPROVED
19 S 4 Depart t of Labor A Industries
Indus statisli " n
Nwa WOI.r and / me suu, W'mA.ns'mn By ute;AN v .jda
rer.d.rir,n N'mA��tun
BEFORE FINAL SETTLEMENT can be made on any public works project,the prime contractor and each
and every subcontractor must submit form L1-700-7"Affidavit of Wages Paid"to the officer charged with
the disbursement of public funds. EACH AFFIDAVIT OF WAGES PAID MUST BE CERTIFIED BY
THE INDUSTRIAL STATISTICIAN OF THE. DEPARTMENT OF LABOR AND INDUSTRIES
BEFORE IT IS SUBMITTED TO SAID OFFICER.
PROGRESS PAYMF NTS: Each voucher claim submitted to an owner by a contractor for payment on a
project estimate shall state that prevailing wages have been paid in Accordance with the prefiled statement
or statements of intent to pay prevailing wages on File with the public agency.
COMPLETE AND MAIL ENTIRE SET FOR APPROVAL TO,
Employment Standards Division, Department ill labor and Industries,
General Administration Building, Olympia. Washington 98504
CONTRACTORS.DISTRIBUTE APPROVED STATEMENTS AS FOLLOWS.
WISH.COPY1 ORIGINAL CONTRACT--AWARDING A(;ENL'1
tGREEN COPYi DUPLICATE--INDUSTRIAL.STATISTICIAN dbauned by N suyoen:l
dILUF COPY) TRIPLICATE-PRIME CONTRAC`Mk
LIYELLOW COPYIQUADRUPLICATir—SUBCONTIAC-MR
u Nl w I
PAYMENT RECEIVED
NAIL TO: NOV 9 1984 statement of
INDUSTRI'L STATISTICIAN INTENT TO PAY
Departmest of Labor A Industries L g I-EW_ E PREVAILING WAGES
Employment Standards Division OLYli W,
(Public Works Contractl
General Administration Building
Olympia. WA 98504 CAC 057-84
(a08) 753-4019 Contract Number
Date Bid Was Due 8/31/84
(oact Awarding Public Atenc) Date Contract Awarded 10/11/84
ai Renton _ County in Which Twit Performed Ydne
Addreaa _ A, Hill - --- location Within County Renton
:.ton. WA. 98C5i
Prime Contractor •
235-2631 �+' •ArJCiif9:i7
Phone ___— Contracba's Regntrauon Certificate No.
[A, You Intend To Ilse Subcontract .e' Yin M No ❑
In compliance with RCt: 39.12.0W I, the undersigned, being a duly authorized representative of
ii.:.. Jacnoson Jr Construction Co. 13747 %_ 17tt K. 8alievue, WA. 98x' ,-
tcmnvtar a areeear+sl ,A,&MH
do hereby certify that the following rates of hourly wage and hourly fringe benefits will be paid to all
labore•i.workmen and mechanics employed by me upon the public works project described above and that
no laborer,workman or mechanic will be paid less than the"prevailing rate of wage"a,determined by the
Indwtrial Statistician of the Department of IatNir and Industries.
PLEASE NOTE: If apprentices are to be used they must he registered with the State Apprenticeship
Council or they most be paid prevailing journeyman wages.
CRAPr 1NTIMAT111 NUMaLa GATE Or RATL Or HOURLY
Or WORaatl HGAIMLY PAY PHING${LNVfla
iC. 3.43—.
3.iJ .
4.
. ,rates 16.925 4.i�
n
Nor1: Attach Additional Sheets as Needed. ii.:,. J. - L o% J C nntru ✓[ „ _____
By -/ , f �OwwrE/_.
Subscribed and sworn to before me
,ry Far L Use tmi.
Vila —Sa da_V Of �'Y .
APPROVED
19 / Department of Labor & Industries
_ Indu [al Sts lisl'cian
s.
a , aM,, ,n and thr S:atr of WWtMion. BY s:P'Qv.la_.1989
M Wwh M'tw.o
BEFORE FINAL SE"PPI r.MENT can be made on any public works project,th-nrime contractor and each
and every subeuntracwr most submit form LI-700-7 "Affidavit of Wages Pak the officer charged with
the disbursement of public fund;. EACH AFFIDAVIT OF WAGES PAID MU,_T BE CERTIFIED BY
THE INDUSTRIAL STATISTICIAN OF THE DEPARTMENT OF LABOR AND INDUSTRIES
BEFORE IT IS SUBMITTED TO SAID OFFICER.
PROGRESS PAYMENTS: Each voucher claim submitted to an owner by a contractor for payment on a
project estimate shall state that prevailing wages have been paid in acc„rdance with the prefiled statement
or statementa of intent to pay prevailing wages on file with the poblit agency.
COMPLETE AND MAIL ENTIRE sE'f FOR APPROVAL TO:
Employment Standards Division, Department of IaMir and Industries.
General Administration Building, Olympia, Washington 9WAM
CONTRACTORS, DISTRIBUTE APPROVED STATEMENTS AS POLLOWS: 1
WINE COPY, ORIGINAL CONTRACT -AWARDING AGENCY
tONEEN COVY, DUPLICATE—INDUSTRIAL STATKI'W1AN IRewMd by Ikparwenu
4WE COPY, TRIPLiCATW-PRIME CONTRACTOR
,.'!'LION' C(,PY)W ADRUPIJCATE—WHCGN IIUCMR J
0
`•I. r0: AFFIDAVIT OF
�`,Dt:,i R!AL SfAlT' SfiCTAN WAGES PAID
seprtman L of b,r d Industries
FMloyaseet Standards Di.ision '•t,` ON PUBLIC V10RILc ('ON:FAr-'
AµAhrsiau.don 3ofiCi pAVMEt+1 RECENEO
_ 'S7-1019
FE� Z Conran NumSe• CAG 057-84 _.
u arylxly w, Dote Bid was Due 8-31-84
Contract Awarding WDIie Agency 10-11-84
Date Ccn[raet Awarder
City of Renton pate wort Cornp!cied _ 12-31-84
Addroa ZOO Mill St.
County %j Kn!ch Rork 'ufo•mcL' King
Renton. RA a8055_
--- — Location Wiey!c County Renton
Te'ephonc Number 235_2550 w _•
es a Sta!emenr of Irten+. Filed" Yes 7C No _
In compliance with RCW ?9.'2.Oa^ 1, the .nderigned, being a du,, ou•'•crzed or
_ John R. Ewing 6 Associates, 622 S Central, Kent, WA 98032
cwu.m a mamn.uo• �ae_�r
do hereby ccrtify that the foffowi"c rates of`cvr'y wage and hour•% frnge bereris have Seen M d to the !abores,
workmen and mechanics employed Sy me uwn the project desc bod aboic .,nd tha' no laborer, workman or
mechanic !es been paid less than thc-preva.'.ng rate or wage" as C.etcamrned by the Industrm' Statistidan of the
Department of Lator and :ndustr.es
List below each elausificat:un of!abor emp' "ce .ry you upon!ht praect de�ribed a, c and 'tie rate of hpur'v rvrs
and howdy fringe benerits paid to each c!a-,sifca,on
Pkase NOW
If apprentices have been employed on this pin:nc, providc•S's additional infurmation-name,registration i,unbcr and
sage of profression.
CM Raw N R.."• 14aw1.
..", '•., few nearer 'W
.19.63 3.76
Survey Partv Chief 10.50 3.14
Chainrnan 9.00 I.G. q
besEter - 11,00-- 4a35 dGL(..
/ 4
S. AftO AeA11.1 tilerb
_ John R. Ewing k Associates
Sub,cribed and sworn to beforc ,:. u, �•J President
T
the "I day of .7PU _
19�era2. � :. ; Lat tar n.r
T` W-"1 !a:•Cr wati'y tAa:..saeoy.,,hc warn,.sad r.f^O1arfYbe.ra.r..w
to rk PeeaaVtgS w[f rs�aeeneea"F RLw 3a,!.ao ins!en' al'..'rE.
aM'n're Su.of w+Wnaton,�ra,�r
," w..t n.»' 'YOU'S,RIAL ST'ATKI11CUN
. .AR?'-T\2 ^F LABOR AND
I%STRL CTIONS:
' Pursuant to RC , 3'+.12.040 cop.cs of thts form ^gust be, sub-
co 'ractore.
Complete this form in trip'icatc and have it notarized.
3. Submit all forms for appmNa'to:Employment Standards Division.DrIsa-mcn- o ' .Sor anC Industries,Genera!
Administration Building, Olvmp:a, Washington 985C4.
4.. Mail an approved copy to the Contract Awarding Public Ags y
CONTRACTORS ARE RESPONS!BLE FOR OBTAINING AND FILING AFFIDAVITS of the SUB-
CONTRACTORS.This is required by law anc payments can not lawfully be made until such a1'idsvits arc filed.
a
/ 6
v
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