HomeMy WebLinkAboutWWP2701901(25) S-389 1985 Sewer Trunk Replacement Intents & AffidavitsS,� �,��
BEGINNING
OF FILE
FILE TITLE
SewQir �t ., nk
CZepl �
5 - 38Y
ORIGINAL DATE, T Z
REVISION 1 DATE,
TO: Accounts Payable
FROM: Public Works
SUBJECT: Construction CMtteCt CAG 1 CO3�9•p,S
Project Name: /`�85 -f�U .JE/Wm—t" /e'E-A.--, HQti/T
Prim Contractor: �1- �;, ?yL min >'Y4C Oat ylfi
_ DATE RECEIVED DATE EECEIVRD
PRINK CONTRACTOR A SUBCONTRA CTORS INVERT TO PAT AFFIDAVIT OF
PEEVAILINND WAMRS NEICEE PAID
Signed 'Q 1
yG�
,� Pcojeec LnpiN�er
cc: Project File
Form: 2/15/E5
11°68
MAIL TTr. AFFIDAVIT OF
INDUSTRIAL. STATIS?I(lAN WAGES PAID
Uepartnem of Labk i Iaawtcio RECEIVED
F,syloy,r Staada 4% a ON PUBLIC WORKS CONTRACT
/actual wmisiltrat At "Wine p4V41;.,. JAN 7 1986
IRya,pia, NA 98504 Irk ,
11adl7at-+o19 _ ontract Number CAG 048-85 `"'a ;ir vj ft
-��
Date Bid Was Due July 2 1985
Contract Awarding Public Agency Dam Contract Awarded July 19, 1985
city of Renton Dart Work Completed October 1. 1§85
Address 20__0 p11��,t!gnU� �Uth Counts m W'hnch Work Puformed KinS.
Renton Washington 98055 prime Contract- Tri—State construction, inc.
Telephone Number _ 235-2631 Was a Statement of Intent Filed
For th,, project' yes X No L_j
In compliance with RCN' 39.12.040 1, the undersigned. being a duly authorized repro ntative of
Hansen Surveying 2500 Talbot..CZeat Drive So. RenConA 98055
- OraW0Ll1 S.bn,uw' latl,u,
do he•eby cerlifs that the following rates of hourly wage and hourh fringe benefits have been paid to the Iaboren.
workmen and mechanics employed by me upon the project described above and that no laborer, workman or
mechanic has been paid Ins than the `prevailing 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 the project described above and the rate of hourly Ni)
and hourly fringe benefits paid to catch classification.
PITASF. N(3TF.
If apprentices have been employed on this protest,provide this addaional information: name, regiaralom number and
stage of progression.
t tin Ratr rr Rue.1 11. 1'
Hw,y Par tngr Rw,nw P.w
Chain Person I1) $ 8.25 $0.70.
Instrument Person (1) 10.00 1.00
Party Chief (1) 11.50 1.50
va. vn„n Aadmarul s�st, ., veeem Heneen Surveying _
R.4en ww.'
Subscribed and sworn to before me Bs �-.. Owner
X this 6th day of taD1LAXY
7 LAI Lai,Only
t IRnM ce.ofv tM'acm ins,to the aye redo aw fr•nte wmfo�r 1.
a't ,o.daa.aR nqunnrN a RCA, 391.1 n lw.e Ken un fivd
.vase H'N«In ar'Of the ti,oNNW"wnw. rndi.a INUGSTRIAL STATISTICIAN I
in wuh'aa'm DEP. RTMENT OF LABOR AND INDUSTRIES
INSTRUCTIONS: a JAN 10 1986
1. Punuant to RCW 39.12.040 copies of this form must be completed by the contractor and each of his suts
CDnlraclors.
2. Complete this form in triplicate and have it notarised.
3. Submit all forms for approval to.Employment Standards Division,Department 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-
CONTRACTOKS.This is required by law and payments can not lawfully be made until such affidavits arc fled.
At All III. AFFIDAVIT OF
I\Dt tiI RI Al. STATISTN(A\
Department of Labor 6 Industries s548 WAGES PAID
tmpl.,mtat Shadards Dii,moi O\ PUBLIC WORKS CONTRACT,
t.eaeral Administration Building
I lhmpia. %%+ 9R104
,2061 751,4019
Corona Number CAG 048-85
Date Bid Was Due JU1Y 2. 1985
Contract Awarding Public Agn:cy Date Contract Awarded JULY 19, 1985 _
City of Renton
-- Dare Work Completed October 7, 1985
Address 200 Mill Avenue c_oui-h
County in Which Work Performed Kina _
Renton, Na hip 98055
Prime Comractm Tri-State Construction, Inc.
Tslcphone \umber �
AA'as a Statement of Intern Fled
For this project? Yes LN No
In complianx with RCW 39.12.040 i, the undersigned. being a duly authorized representative of
Tri-State Constructicili, Inc`959-108 Ave, N.S., Bellevue._Mh. 98004
do hereby certif-v that the following rates of hourly wage and hourly fringe benefits have been paid to the laborers.
-:orkmcn and mechanics employed by me upon the proje,t described above and that no laborer workman or
mechanic has been paid less than the "prevailing rate of wage" as determined by the Industrial Statistician of the
Department of labor and Industries.
rtl below each classification of labor employed by you upon the project described above and the rate of heurl) pay
and hrsurl) fringe beteftts paid to each classification.
PLF,A.SF NOTE:
H opperw�<.+, w s I, k,.mple+vd ws tYi+project,pr. At this addili n 41 snlormxtion: name, registratum number and
alga. rat pre ries"m
fMr kur av, d Ibw•L
IL.an, I`„ Irinar W-6., r..d
Per attached.
be awch Addnxwu�Shern u+ tieatcd
Tri- tote Construction, Inc.
—ica.+no . n 7.w
Subscribed and sworn to before men President
1 L�kl
this 13th day of December ,
Lai 1W tab
nswi ionhr+gee CW 391Inxpr hao teharm,..ran
Iu she prera,liry .eer repu�rtmenn d ar:W t9.1:INp pour hrtn vinrrcd
\man Pubbc m aM rot the Stitt d wash.adtm4 raiwert
�d a'nangrm INDUSTRIAL .STATISTICIAN
1)' ARTMENT OF LABOR AND INDUSTRIES
INSTRUCTIONS DEC 31 1985
a, j; oat.
I. Puruant to RCW 39.12.040 copies of this form must be completed by the contractor and each of his sub-
contractor.
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 99504.
C Mail an apprmxd 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 arc filed.
411M aYwlrya Itaa; Vial. :�a. ,
o.t, i
Nr.
`t=s Effective QU 6E9lff,55}p/ON• 5E�!'FYUf WISHiMn pi 9,pp
❑e 1 1984 it
Landscaper
Fla9Person Ra tFfoo rly Frin a (4)
Laborer e 1 8enri g Est.
PipelaYer 10•78(52 3•q It-� Zm,�.
14.96(5) 43(3) (5� 10
Lead Mechanic 15• 3.43(3) (5 4
Mechanic OPeratur, OH, Under 6 Yda. 18.09 (5 3.43 f3) (5) 10
ShOvel/BackhPatrol Grader p 17.79 4.18
Tracto
oe
17.79
scraper4.18 1
r 0ackhoeApt I der 3 Y9h 17.79 4.18 6
Pr., Over 60 S.
17.794.16 3
Doz eratat° , 9 1
Motor Aerator, r� Under 45 YdsR• 17.79 4.18
Patrol and Under 17.7g 4.18 6
Roller 0 Grader Opr.,Non_ 17, 4.18 6
Tractor Perator, plant Fin' 43 2
/Backhoe p Mix ish 17.43 4.18
Oiler pr„ Materials 17• 4• 8
43 4. 18
Roller Operator, 60 11.P. 6 Under 17 43 4.18 1
Foreman Other than Plant Mix 17,13 4.18 5
4.18 6
LOWboy Trailer 18.59 1
Dumpate,Du Nster• 15 12 Yards actIr 50 - 100 Tons 17.66 4.18 10
Yards 17.3E 3.66
Cement Mason 3.66 2
17•49 7
'NOTES 3.66 7
(1) Hourl 17.86
(2) FPPli able es Include vacation 3•45 2
rin fund
(31 Labo dcLdurer Innefits do not include vacation and dues deduction where
(4) EstimatOur eement gs igned fwas do not include fund and dues
(5) trust Live IUl1b-&a °W wv rkers hPe borer s lA Aal (at $0.02) Per
Increase ages decreased
Bill P7o. 440•
d $0.20. d 50.20 438•
health and welfare
' an Egan!pPUenom�Y Em4loyer'
MAIL. TO: AFFIDAVIT OF
IN INISTRIAI. STATISTC LAN \ a
DepartmeFwpMymem Stardard of I-abor 611'1lttdwlrir. 1tGv�14{�Ly - WAGES PAID
fenera ON PUBLIC WORKS CONTRACTl AJminiatratinn Building lL��
Ohnspia. NA 99504
12161 791-44119 apCUO'+.INL-
t9+"A� oa31 Contract Number CAC 048-85
Date Bid Was Due July 2, 1985
Contract Awarding Public Agency Date Contract Awarded July 191 1985
City of Renton Date Wort Comp October 28, 1985
— Completed
Address 200 Mill Ave. So.
Renton, WA 98055 County in Which Work Performed K1ttg
-- Prime Contractor Tri-State Construction
Telephone Number 235-2631
Was a Statement of Intent Filed
For this project? Yes 0 No ❑
In compliance with RCW 39.12.040 1, the undersigned, being a duly authorized representative of
�lppkk1I ff"u,,
Hi-Line Asphalt&i g., Inc., P.O. Box 68279, Seattle, WA. 98188
-- .. Manua.v a.hwnaaavl IANrvI
do hereby certify that the following rates ofbourly wage and hourly fringe benefits have been paid to the laborers,
workmer, and mechanics employed by me upon the project described above and that no laborer, workman or
mechanic has been paid less than the"prevailing rate of wage"as determined by the Industrial Statistician of the
Department of Labor sad Industries.
List below each classification of labor employed by you up,m the project described above and the rate of hourly pay
and hourly fringe benefits paid to each classification.
PLEASE NOTE
If apprentices base been employed net this project,prmide [his additional information:name,registration number and
singe of progression.
n
Nx„ d Nu, oshoot
f q^zed V.,. Irinee Bristol,
a Paid
z5
Rafters 15.44
Paving Machine Ofvrestor 17-,'+ i.
Viler tkk.ator 17.45
Screed Operator 17.79
Truck 6 Trailer - lb to 20 yds 17.49 3.66
Wheeler Driver - 10 yds 17.38 11
Nut. Attach Addnlmal station as Naaded
It.-Line Asphalt Paving Co., Inc.
Subscribed and sworn to before me tc ns+
By�c�r� J ItSecretacv
11 ffiki
ins - day of
Is— - _ n.a tlr oar.
I herch)C<illO 111Y18CMrd111a IO Ihr wae(fa1R axd rililRe beltAla a-'eta\cow"
to the peplhna..ar rertaseatm.al RCW 3912M Ilea boost"i issi.
Nwar\I4Nc to and lo,the Store at of w N'�shmaaal,resd,ng
asnaaaasw. INDUSTRIAL STATISTICIAN
DEPARTMENT OF LABOR AND INDUSTRIES
INSTRUCTIONS: MY 3 ft,
N Date
L Pursuant to RCW 39.12.040 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 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 payeriattts can not lawfully be made until such affidavits are filed.
if ors, Aw..t.t iris• 'roan Sara .®..
u r
MAIL Ta. Statement of
INDUSTRIAL STATISTICIAN INTENT TO PAY
Department of Labor ! Industies r , PREVAILING WAGES
Employment Standards Division (public Works Contract)
General Administration Building
Olympia, WA 08504 _
(206) 763.4019
#548 - Contract Number CAB 048-85
Date Bid Was Due July 2. 1985
Contract Awarding Public Agency Date Contract Awarded July 19, 1985
f`ityof Rantr,n County in Which Work Performed- KiII9
Address Tnn Mill Ave_ So_ Location Within County Sn_ Tnhin St-/Shattuck
pant-on Washington 98055 Prime Contractor Ave. 80.Tri_State on,
Phone_235-2fi31 Contractors Registration Certificate No, TINISTC-35610-Inc.
Do You Intend To Use Subcontract "? Yes i_'i No Wi
In compliance with RCW 39.12.040 1, the undersigned. being a duty authorized representative of
T '-Sta nna n,ctinn Tne- 959 - ]nA Avenue N.R.. Bellevue. WA. 98004
lcw iwi e m iteeet.., iAdd—,
do hereby certify that the following rates of hourly wage and hourly fringe benefits will be paid to all
laborers.workmen and mechanics employed by me upon the public works project described ahirve and that
no laborer,workman or mechanic will be paid le-- than the"prevailing rate of wage"as determined by the
Industrial Statistician of the Department of Loos and Industries.
PLEASE NOTE:: If apprentices are to he used they must be registered with the State Apprenticeship
Council or they must be paid prevailing journeyman wages.
caAPr RRTIMATEO NUMBER RATE OF RATE OF HOURLY
Of WORKERS HOURLY PAT FRINGE BENEFITS
Per attached list.
✓fte, F
Ntrrr.: Attach Additional Sheets ae Needed. Tri-..tate onstruction, Inc..._,
" Ir„my.n N.m.l
—"— m troller
Subscribed and sworn to before me ITllw
this -14SIL- day of -�7Y13f For 1. a 1 U., Oni,
.—, —
J APPROVED j4
Department of Labor & Industries
Industrial Statistician
A'Ma,,MMir in aM(w the State.f W,Io oei.rend
I+r in Wa.hoyto, .
Hv Date .JUL 2 J FA
BEFORE.FINAL SETT,F,MENT can he made on anv Ito Wic%orks project,the prime contractor and each
and every subcontractor most submit form 1.1-700, 'Affidavit Cd Wages Paid" to the officer charged with
the disbursement of public funds. EACH AFFIDAVIT OF WAGES PAID MUST RE CERTIFIED RY
THE INDUSTRIAI. STATISTICIAN OF THE DEPARTMENT OF LABOR AND INDUSTRIES BE-
FORE IT IS SUBMITTED Tn 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 accordance with the prefiled statement
or statemel_s of intent to pay prevailing wages on file with the public agency.
VOMPLF.TF. AND MAIL EN,rIRF. SET FOR APPROVAL T0:
Employment Standards Division. Department of LalNv and Industries.
General Administration Building. Olympia. Washington 98504
PONTRACTORS, DISTRIBUTE APPROVED STATEMENTS AN FOLLOWS:
I PINK COPY) ORIGINAL CONTRACT AWARDINGAGENCY
GREEN t'OPYI DUPLICATE INDUSTRIALSTATM. MAN IRetntled by Deiwn.wl
1m,t-E coPY1 TRIPLICATE-PRIME CONTRACTOR
,YELLOW COPY)QUADRUPLICATE-SUBCONTRAQn1R
W.]iPA IMrnt N ry IIAkN lir AA �r
MAIj..T9r' ... Statement of
INDUSTRIAL STATISTICIAN INTENT TO PAY
Department of Labor At Industries PAYMENT RECEIV PREVAILING WAGES
Employment Standards Divcnou (Public Works Contract)
General Administration Building
Olympia. WA 98004 ,�i- 1 )_ ICE
"LOB) 753-4019
U E°Y
#548 ` ` Contract Number CAR 048-85 _
Date Bid Was Due July 2. 1985
Contract Awarding Public .Agency Date Contract Awarded Tuly 19. 1985
rav ne Qentnn County in Which Work Performed_Kim
Address Onn Mil : Roe- c.._ Location Within County Big- Tnhin At /ct.attuck
nnntnn shin 7rT inn 98o55 Prime Contractor 80.
PI=StaCO-COEitraCtYon,
pine 235-2631 -_�- Contractor's Registration Certificate N,,.- Inc.
Do You Intend To Use Subcontractors? Yas ❑ No fill
In compliance with RCW 39.12.040 1, the undersigned, being a duly Authorized representative of
t(ri��ata �natne rt inn Inr-_ Q1; _ 1DA Avainua M_R. Bellevua �_ 98D04
fCmuaae u 8abmnuau�ri O'd4 a)
do hereby certify that the following rates of hourly wage and hourly fringe benefits will be paid to all
laborers,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 Labor and Industries.
PLEASE NOTE: If apprentices are to be used they must be registered with the State Apprenticeship
CGuncii or they must be paid prevailing journeyman wages.
CRAFT EaTIMATED NUMBER RATE OF GATE OF HOURLY
OF wOREEW HOURLY PAY FRINGF eii110`17R
Per attached list.
RFCFi
't,it CUB
291�5�
%J�
lib
Noce Attach Additional Sheets As Needed. Tri-State onstruction, Inc.
ic,.mc.= w�mptmller
Subscribed and sworn to before me maai
this loth day of .Tuly For L& 1 Use Only
19 . R APPROVED
Department of Labor & Industries
A&d _ Industrial Statistician
Notary Public in and t.,the Stet,a(WaJunyton,rend
as in Washuytm
ey Date JUL 2 3 1M
BEFORE FINAL SETTLEMENT can be made on any public works project,the prime contractor and each
and every subcontractor must submit form LI;00-7 "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 INDUSTRINS BE-
FORE 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 accordance with the prefrled 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 98504 CITY OF RENTON
CONTRACTORS,DISTRIBUTE APPROVED STATEMENTS AS FOLLOWS: R E G E�V E D
IPINR COPY) ORIGINAL CONTRACT--.AWARDING AGENCY JUL WARDING
1GREEN COPYI DUPLICATE—INDUSTRIAL STATISTICIAN iRrwoad by Depsamentl
(BLUE COPYI TRIPLICATE—PRIME CONTRACTOR
tYRIAAW COPY)QUADRUPLICATE—SUBCONTRACTOR puRCNASING DEPT.
DEPARTMENT OF LABOR-AND INDUSTRIES `' Statemast of
EMPLOYMENT STANDARDS DIVISION INTENT TO PAY
Olympia,WA986M PREVAILING WAGES
(Public Works Caytrrooki
-„ Contract Arardmg Agency ..._City QP...fIt=n....QQ, 048-85
Contract Number CAGD.48-85
Contract Rid Opcna,g Date July.2, 19.05
... Date Contract A.arded . July 19. 1985
County in Which Work Performed . .King _.._...
STATE OF WASHINGTON ' Location Within County S. TOhen._St.JShAttJAa Ave, S.
Prime Contractor Tel-Sate Const. CIO. Inc.
fount)'of .-..King , Do You Intend To Cu Subcuntractow Ym ❑ fixNo
In compliance with RCW 39.12.040 I, the undersigned, being a duly authorised representative of
DPK Inc 30008 6th Ave SW Federal Way Wa 98023
iCmurror or SuMuea.el.e, +arre.n
do hereby certify that the following rates of hourly wage and hourly fringe benefits will be paid to
all laborers, 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 Labor and Industries.
PLEASE NOTE. If apprentices are to be used they must be registered with the State Apprentice
ship Council or they must be paid prevailing journeyman wages.
I RAPT BATEOF RATE OF NOURLY
HOURLY PAY PRINGN aRNILIM
Operator: Group IL 1 $17.79 $4.16
Laborers: Group III 1 $14.96 $3.43
NoTr. Attarh Add t unal SIhoeta a.Needed. DPK Inc.
C nY Nall
Subscribed and aworn to before me By
this 2Bt11 dayof August Po.Latu.o.lr
19 65 APPROVED
�J Departasent of Labor 4:Industries
lod rial WA". n
Sumry Rbhr m and(or the Sao of
AUG 2 1 IA
nudv,Q,n K'..h.ngWn. ��1 /I Uale
C .
BEFORE FINAL SETTLEMENT can be�made on an 'rliRtlMUlty"
y 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 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 accordance with the pre-
filed statement or sister Tits of intent to pay prevailing wages on file with the public agency,
COMPLETE ANb MAIL ENTIRE SET FOR APPROVAL TO:
Employment Standards Division, Department of Labor and Industries,
General Administration Building, Olympia, Washington 98.504
CONTRACTORS. DISTRIBUTE APPNOYLD STATF,MENTS AS FOLLOWS-
(
PIN[COPYt ORIGINAL CONTRACT-AWARDING AGENCY
(GREEN COPY) DUPLICATE-INDUSTRIAL STATISTICIAN(Retuned by Depanmmt)
(BLUE COPY) TRIPUCATE- PR(ME CONTRACTOR
IYEtLow COP Y)QUADRLPUCATE-SUBCONTRACTOR
#'r4^ganaan e
MW is
IIIDUM*&kL /MVnCIAN INTENT TO ]PAY
MBartarat of Labs a ladw nee pRBViai rg paw
IOaaMrwwst &aNarde Dfviaw& rAYMjN-i RFUIVED (Public M"jJ&
General AelaniahouraMse
Iso"uig cow
0trimpisJAM 7 RA-,eta AUG Y9 "US CAmtt t: Number_ -.—
LA I FA'. lists bw Wu Due- July 2. IM —
(31sora Awardlag PuYlc APaq Date Contract Awarded_aj',_i7L
QUY of Benton - - ('aunty ja Which Work Perf-emed 31149
Addles 2DD Hill 9Ya- a- Locaom Wfthia COMPLY 4 &MW
-- lfritL--1�O�IAIlOtm 99D55 Prime Contractor�,L1: .-. .
Ph" 235n2631 __- Contractor's Regi.uutwn Certificaw No._1{�-- .-..----
I)a Sou Intend To IS. pupa• :urarv,r.
IN 401111010440 Wilk RLv 3D 12001 L tba un&,,s,9 ed, being a dulY Wthaalaed "Ptm4ntfaa Of
i
Hanson _,j50(] Talbot Crest >k_ !ae RMclaa_ lam_ 9RIISa
do hereby certify that the following ratan of hosuly wage and hourly fringe henefits wdl be paid to all
laburen,.workman aid mechanics emploved by me upon the public works project dutsibed above and tint
no laborer,workman or mechanic wilt be paid less than the-prevafkng rate of wage"u dOl Muted by the
Indrrt" Statistician of the lkpartment of labor and Industries.
PLEAS& NOTE. If apprentaes are to be: used they must be registered with the State Apprealli6idtlp
cil Coun or they mwL be paid prevailing journeyman wages.
gArr setnMATan Nt Mane RAT&Or MATS the aLN1BLY
Or We"&" NMUY►AY cape{ag�P1a
Chain Person 1 $ 8.25 $0.70
Instrtusatt Person 1 10.00 1.00
Party Chief 1 11.50 1.50
Nor; "M h Add ' ;:L�rw w Needal _ Bunsen iurmi�___....
.. /,/�i�J Icaerry xrx
Subscribed and sworn ❑ before me
Fier L a L Us OaU
thin .- ?d.LG- day of _LuGURt. -
APPROYiD
85 ///J Depa uSut of Labor k fMWtriea
P. al t u
Autry ,n a Iu• o) Rh.huMtr. BY
. W W HM Sr
nIsOY a eYuytr. V/f
BE'O FINALJJJJJWI;
itaeerot of s A WAGES PAID MUST BE C BY
THE INDUSTRIAL STATISTICIAN OF THE, DEPARTMENT OF LAWR AND INDUSTRIES
BEFORE IT IS SUBMITTED TO SAID OFFICER.
PROGRESS PAYMENTS. Each voucher claim aubmttted w an owner 1, a contraetot for payment tea a
project estimate shall&tau that prevailing wages have been paid in accordance with Use prefded 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 98604
CONTRACfU1LN. DIPf RIBL'TL APPROVED STATEMENTS AS kOLLOWS
IPINE fOPY ORIGINAL CONTRACT-AWARDING AGENCY
IGRIEN COPYi DUPWCAlVAM L'SCRIAL]TATISTICIAN IRrwred of Depirri.. r
IaU1B COPY) TUIPI.ICATL-PRUNE CONTRACTOR
fYR1.lAw COPY)QUADRUPLICAM-SUBCOWRAC-MR
u tins
t
mile
MAIL T0, ../ Statemeal of
INDI SZNItL STATISTILIAN INTENT TO PAY
Department of Labor a Industries PREVAILING WAGES
Employment Standards Ilninion lPabiie Works Coatrassl
General Administration KASinR ,
Olympia, WA 98501
1206, 753-40111
Contract Number CAG 048-85
Date Bid Wu Due Jaly 2, 1985
Contract Awarding Public Agency Date Contract Awarded JulY 19, 1985
City of Renton County in Which Work Performed King
Address 200 Mill Ave. So- Location Within County Rdnton(SO. Tobin St.)
Renton, WA 98055 Prime Contractor Tri-State Construction
Phone 235-2631 Contractor's Registration Cenifiute No.8ZlN&P265iW
Do You Intend To Use Subcontractors? Ya .�] No 9
In Mmpliallce trith RCW 39.12.040 f, the undersigned, being a drily authorized representative of
Hi-Line Asphalt Paving Co Inc P.O. Bo: 68279 Seattle WA 98188
t omewemn (Add..,
do hereby certify that the following rates of hourly wage and hourly fringe benefits will be paid to all
laborers.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 Labor and Industries.
PLEASE NOTE: if apprentices are to ls, treed they must he registered with the Stale Apprenticeship
Council or they must be paid prevailing journeyman wage&
CRAFT ESTIMATED Nl'MBER RATE OF BATH UP BOL'RLY
OF wORRRRn KOUk ! PAT PRI 11 O BRRM
Laborers 2 14.96 3.43
Rakers 2 15.44
Paving Machine Operator 1 17.43 4.18
Roller Operator 2 17.43
Screed Operator 1 17.79
Truck & Trailer - 16 to 20 yds 4 17.49 3.66
Nr1Ta: Attach Additional Sheets an Needed. Ri-Line Asphalt Paving Co., Inc.liy r � Secretary
Subscribe and sworn
((o'''beeforre come Oka,
th19 -�.1T' day of , Fur I. a 1 L., Oal,
ig s/ APPROVED
Department of Labor & Industries
Industrial Statistician
PLe4r in d Ior the St.0 of W.Atnrton,m d-
Mr r Wea"ate n.
By _ Date ! 2J..19&5_
BEdORE FINAL SETTLEMENT can be made on any public works project,the prime contractor and each
and every subcontractor 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-
FORE 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 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 98,%4
CONTRACTORS, 0111TRIRUTE APPROVED STATEMENTS AS FOLLOWS:
WINK COPY) ORIGINAL CONTRACT—AWARDING AGENCY
IGRRRN COPY) 9UPLICATE—INDUSTRIAL STATISTIMN iftowned by benanwra)
(BLUR COPY) TRIPLICATE—PRIME CONTRACTOR
(YBJAW COPYJ QUADRUPLICATE—SUBCONTRACTOR
ENDING
OF FILE
TITLEFILE I C( 55
se,.,3 Q.4pmw" T� tink
Rep \t�ma.r �.
j - 3 $ 9