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Home My WebLink AboutWWP2701901(29) S-389 1985 Sewer Trunk Replacement Certified Payioll 1+ BEGINNING OF FILE FILE TITLE � qps SCwe�- �runK Rem klw.� � 5 - 3dY Cer � � � le� 'u.w ol.MT ii V De l,eOe $T AT cMENT OF COMPLIANCE Fare.Awnh— n, uaieal Who ..oaw yunmw I).,. Oct. 9. 1985 - 1 Arlene Whitworth _ Payroll Clerk ao hnby one' (N.n. I pwmn p.rgl ll'tTiS n+Tkn f r e v the payment Of M.Persona.mpl.y.,l b,Tri-State Construction, Inc. ens �.:this do,,.,the P aYmll period me commenc�nE on ion -a„d r..1. ..I �aay of Cct "Q$ a+f ending the.9yry of Oct- 19§. It Peron[ employe. on ,e,d protect h..e been paiid..Ote full weakly wage.earned, the,no r,b.,,.h...been or wilt be mid.rI%"dm<"y Or Ihd"r'tly to or on Mehl(of.,,a Tri_ Cate ConetructioT n,, Inc. _tram the fwl weekly r.l..earned by Any Person,rid the,no a.duauon.nave been made either d,nelly re twmecllY from the full.......Wild DY en;'loon.nine,then permissible drdon,on...defined In Regulations, Pan d 129 CFR Salaam A), atued by the Secnwn of LAW,antler the Copeland Act as em.rd" (43 Sat 449 61 Stu 105. 72%let %?;76 Sat 39;40 U S(: 226e), and da.c-,txd halo.: Withholdino S FICA Taxes Meru r•a;mid a h2pn'ecrental Pension (15) IT That .oY pay,olts otherwise under this tonu.ct regahed Ip be sohm,t'ed far lht a6o,e period am coma and ternpl.1e; the, be ..ge me,1.,I.borer.-mlcMma..named Mere",arc not I.W.tban the .pp l¢a b le a,.'. rate, conlsined , n r..R deletm,narton rncnrparated lot.In,tvototc,, 'het the c1.aUfaahona.el forth thert,n for earn L[onr Or mechen,c Cntr form-I'll'be work he vadomrod (II That any apprentices employed in the above Period are"Wv mgneenA In A bona red pprenece an,P Pro Tam rqutend With A Sat. .ppnmm.ahrP a[eocY WCognl.re by :be Norew of APPnntit.,h,p and i, Unv.d St.,..U.,.nmee,of "her,n,If n.wen aecognued nguncy..rga m A$1.1e. ...regutrnd.I,, he suns.of A, r it,eshrp and Training, Untied twos D.P.rlmen'of Lehr (41 Th,: (A) 1171ERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS In add"mn w the they,ho,111..ge.ales Pa,,to...h laborer or mechna fisted m the.have n(erenced Pep I ill. Petra.or. o, (si b nge .n.du. .. I"t.d m the'."lean he er Wan or.,II be..as m•pomp".to program. for'he berehl at[mph employe![, e.o.pl ..noted .SecUpn 4(o)be&.. (h) WHERE FRINGE.BENEFITS ARE PAID IN CASM �- Each Latimer or mecham, listed In the skive nferenrea'.'nii has teen PaW, md"."d an he Phyroll, ant on,:e..than the.am of the.pPhc.ble basic hourly.age ram plus the.moues of'he"w".4 Inn[. bane("..A 11s1e,d in the.nmwct, e.ce11.e noted in section 4{1)below lei EXCEPTIONS LXCl PTION(CRIf q EXPLANATION r- 4 Arlene Whitworth payroll Clerk n i r ..,. e c .....,c•. o., o. _ ..[ .. ,.rt.r[» , (ages G e..On<,nuiN,l raOt[[v iPw Vf[cf[cu>v�.�ra9r sass[•, .C. sE<'�C-r b. O. �r(�, ->� .oc[ farm RN-1e1 vaur ww<eA.s...0 rp rise b ..e rwou ease,u,..or oocwhn • • uuuu •p TRI-STATE CONSTRUCTION, INC" • 9,39 108T11 AVENUE N. E- - • BELLEVUE, WASHINGTON • PERIOD ENC 1N0. 10109;85 FORM WH-347 REPORI PAVkr, NO • JOB ti0 0548 1985 CBD SEWER TRUNK REPLACE S. TOBINIHHATTUCK AVE S • RENTON, WA CONTRACT NO CAG 048-85 1. OTHER TOTAL YMdW HOURS .1ORKE0 DEDUCT • �, - pAO TOTAL GROSS RATE OF FICA TAX STATE S. 6 37 t54. 33 NAME, ADDRESS AND /i 4' 9 (> 7 HOURS WAGES PAY. 81 55 SSN OF EMPLOYEE l ' '2 - • GLICK, DUANE R. 8. 0 O 0 8. 0 8 0 0 0 24. 0 382. 36 15 94 00 34 4 , 0 0 0 2 O 1. 0 0 0 --- 71. 00 32 Ot NET PAY 299 96 11213 - 127 AVENUE N. E ___ ___ ___ ,,rRKLAND, WA 98033 -8"0 0 0 10 0 .. 0 0 O 27. 0 _ ___.... ________ OCCUPATION PIPELAVEti f-OREMAN 440 _.___.-__..___ ---.-- ------ _ 40, 27 g,v 64-8753 __ __________. ..2. 59 _____ ____. ---- . 0 8. 0 !39 44 17 43 P INGREE DAVIDvF 0 0 0 p , O " p " p .00 - pp 6 CC 24 AVE. N. W 0 n -0 0 Q0 9 83 Nrr rAV °'4 t7 SEATTLF, WA 98177 0 _.0 0 8. 0 O . O B. 0 ---------------- ___ _._.._____ 4. 63 107. 7F ;.i5-44 3564 OCCUPATION SERVICE OILER t.70 576 ^- _- -�C-_ 54. 20 __ __ -- _... `_ _ .0 8. 0 8 0 . 0 0 16. 0 247, 04 1� 44 HARRISON, PHII D 0 ,p 0 --- 42 64 pp d5 OG ..- • p 0 0 3. 0 1 0 ?3 95 -... 3817 EVANSTON N 8304 - NET PAv. SEA, TLE, WA 98103 0 " 0 " 0 it. 0 9 0 0 O 20 D "- --- ` • ..__________. 3 30,E 3E �, i_4015 JCCI.PAT LJN Fif EI_AVER 440 ________. . - •2 85 r : 158. 34 48. 0 .._769 04 ..- .. ___—__.___ ___._ 164. 37 - tn5 40 • TOTALS FOR JOa. 054C _.._7_0 00 b5 79 �" wi°a FAY 5s 0 -------------- ,ete ,.fV that the PaYroli is correct and than the I he�e`v cr ;,s contained herein are not less than ar �_^ containeA In the wage determination aP retary of Labor as salted h the Coab ct r" • dec. 5`0 .donned by each such laborer ,d the work Pc to said . . ... • amcchlnic cotica'r to the waB 1frolepi�tfortlt • P,',"Ons aPP o n • U.S OEw NRTNENT OF LABOR STATEMENT OF COMPLIANCE B��ea a�..�xA ...sink •01 o p waue.1. 1ON D.Ia Oct. 9, ].985 I. Arlene Whitworth _ Payroll Clerk do hereby aster (N•ne or fitip,-n (1)TnAt 1 par[.�JQQ)peryiye////��rr(/pa`y/{1em of he puforo employed b3.TIi-S tilts Construction, Inc. the _l9/f LSD n that d.rtog me 1.11.11 Period commenting Pn roe JMdn of Oat. Iflui ld�y x Y� ' IIJU and ending the.9.Y1hy of Oct. . IqO. all Person. employed fin ..,it PI.lec, have been paid In, full weekly wage.earned. in.,no rebates have been or will he made either directly or indirectly to or on behalf of soil ri- State nst Coruction, InC. Iron the full.eekly w.ges..mail by.ray person And that no deductions have r ..eco been male.,her directly.rtiMireclly from the full wages eamcd by any person,other then permissible deduction%6%defined inRegWv.ena. Part 3(29 CFR Subtitle A), i...ad by ,he Seceaw, of Labor under the Copeland Ayr as amended fig St., 949 63 Slat 108. 72 St., 967. 26 St., 351, 40 U S C 21,1a), tied desonbad belo.: Withholding & FICA Taxes Medical Aid s cupplemental Pension Xis' (2) That Any Payroll. otherwise under in,.contract required to be submitted for the above Penal art contact find complete; that the wage rates for Lboren o.mech.nin conl.ined theram ate not less than the Applicable wage rates convened in any wage determination incorporated into the contra"; that the classifications at forth therein for each labour.f inecran,c con- form.,in the work he Performed (3) 'rant.ray aPPrennces m-Played in the above period air duly regnlercd in A bond Gde.ppn.nce.nlP Program reVuemd with A State GIRimmticeship agency recognized by the Bureau of Appneticestnp and Tta.ning. Unread Stares OF,.oment of L.bo,,or if tin such ,c.Rnt,.d agency exists in A SI.m. .re mi,cimned.,in the Bureau of and Traunng, United Sues Department of Labor. (a) That: (.) WHERE FRINGE BENEFITS ARE PAID TO APPPOVED FLANS, FUNDS,OR PROGRAMS In.ddle.n to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced pap roll. Payments of fringe benefits a> listed in the rontract have risen or will ber made to apprcpnne Program. f.r,he benefit of such<mpiuraes. except as noted in Section a(c)below (b) WHERE FRINGE BENEFITS ARE.PAID IN CASH []- E.rh Latium, or rim.h.ri,c listed in the above referenced Payroll has been paid a indicated on the payroll, ur.t not los than the auto of ins applicable basic hour,,wage .,a plus the amount of me requtrad fringe benefits.A lured in the c.nnAcl,except as noted in sectlon a(c)below ( I EXCEPTIONS EXCEPTION'CRAFT) F%PEANATION ,OCT, 1 4 1883 Arlene Whitworth, Payroll Clerk »c aur�c...ol. or a AT• Y s . So .a IcA - ")afppCrl.m•vt 11C3[CV i.0 VA.l 3EC TIpw pd� OF "TLC la•nC 3[C rfov rr.11 .r iirk E"3' .1 nE�B. rr_.s . [3 V.I.WN440 nnu FVAcwu TNla FOR'."r9c"T FAow T-..vary of p.cuwwT. TRI-S#ATE CONSTRUCTION. INC aaa- • 959 I08TH AVENUE N, E. BELLEVUE, WASHINGTON • PERIOD FNDINO 10/0q/E"_ FOPM WH-347 REPORT • .0B NO 0546 PA'/RXL NO 1965 CDC, SEWER TRUNK REPLACF • 5, TOBIN/SHATTUCK AVE S . RENTON, WA. CONTRACT Nn CA;; 048-85 • • HG't}RS WORKED , • NAME, ADURE55 AND y ll DAY r ,,, - TUTAL 3R039 FATE .'� c 'CtA W/4+ SATE S. I., A OTHER TOTAL. 6SN OF EMPLOYEE 17 -d /u3 47 3 6� 7. HOURS NABE5 PAY TAx D€iDUCI • OLV'K, DUANE R. 6. 0 0 . 0 9. 0 3. ' 0 O 24 0 282. 56 15 94 at 55 6 37 154 J3 • IL213 127 AVENUE N,E. . 0 ,0 0 2.0 1 O . 0 . 0 3. 0 71. 73 KIRKt.AND. WA 99039 —-------- 00. . 32 01 00 34 40 • 8 0 0 0 10 0 Y 6 0 l: 17 U '6E1 PAY 501-64 97!;3 'ICCUPAT;ON PIPELAYER FOREMAN ,:�., �b • ------------ ..___._.._.. . __..._____.. ___._._ ....._.... .. _.-_-__ ._._.__..__._.____.,._-. • PINOREE. DAV:D F 0 . 0 0 0 8 0 0 0 a 139 44 17 43 22, 59 1 95 • 19716 - 24 AVE N W 0 . 0 . 0 0 0 0 0 0 00 SEATTL.F, WA 48,77 _.--- ------..__._.__.._-.___ ._._..._._.__..___......_ 00 9 93 00 S 00 • 0 0 0 . 0 a. v 0 . O a. 0 NFi PAY. %R O'd5-44-3564 1t,, :V0ATION XPVICE OILER 057Cr 576`+ • ..__.__._._-_ _ ,.------- HARRISON. PHIL 0 6 0 a a 0 0 16 0 247. 04 15 44 `+4 2" 4 6:= 107. 'fo • 3ai7 EVANSTON N 0304 O 0 +j 3,.0 1 0 O 0 4 7 92 64 SFATTl,.E, WA. 99103 ''a 45 �y; ?R ra• • o D if o eo aLa `r a 5,(-451`: r;i.1;Pt TlC)N r?i't LA'IE� 440 • • TOTA,,� POP 01, 054U 48. 0 '767 C4 15u. ?4 ;➢1: • }. 0 164 37 r i"AY z31 i. • a Iete • that the payroll is correct and tome the -.so I hereby teil'ty inalion • ..ales c0ntsmeIt ine the wa&e In Co"I tesS ntract and' ' " .ate contain 1nffi_ • aP�; _a' of Labor as stated Iab0rer n 0t the Sev , Y by""I msaio de".- • {,,,,coos and Me Wornstotheclass�1D Id. • a mechanic c0i cab a to tM' Iat4� . Pro,,sions app • s • • =IFIEb Wfal v- !E ASAIAL, AA4ilb M. i4 1c: AAYfa, 1G. _g..._ AVE: .� �WED EIIDIA6: DAp7 A; �i1 ST¢T W1> 59YSGf 44 9/26 9/'9 T31 Isiol :1f12 :1713pm4LK r auS C N6 PATE SpM 4�/2d3591 'FJU67EA S P.O. BOA 9K B.N 8.40 17.30 139.64 MrMLE, i; ORS T NB Wm FICA Fey V _.N :. P 616 94 42. s __36 J�._S�_sOt EA ro BBEr� '9.26 E? 6 1159 ".-__"__ -- SN 6.N 15.4411 92.64 WrA NA' 'ES NE AM P3 Nib OI aifi CA -F" _ 33.0 2.51 514�64 3526 1 SIN `Me 'O'./BPS N:' PAY 411pR:. 61 F 2-�`_ "`ass.___ _ ,2•Ns.=s1P 34.29 192.57 Y7 . ___==s =sssssa=ss_s 447/31131K 7Eq$;Ep S 51-_-.___-_-- .51 a.i4 4.51 :7.36N 9:.25 2)Ii - 166L5 DR. bE _____--_,-_---- 9'OglI9t, NO EC Nib P 4A5 6AD56 F:Ixi cry~ SAi CiA£R •,n/DFDS 1E' PAY �--�,:�51 30%14 56.2 151.N SN '400 NSNA:ChS -� -- :2.43 219.95 S O =exams--asszss=m..=sa�ssa:=:Sal _75 3722 - 1.'9r'n 0.. P, 12.Yi _- SN-'6.N 17.43M :W.SR BG.'V4. 4i, REb Nq6 27 AS 6R155 FICA F/y SIN a'}.�B 1.5@_ a6,4 4:-.=43.32 134.N N 6S1€A MTIPM 1E' pAt 4C4:? Y, t g O '"' _ -sue_==s . .52 2:2.64 OQN 411.57 s,sss=s=� 534/64!3163 OpM-01 S 122 S. 132K - _.-________�______ _-4'N 4.0 17.79N 71.16 SEATrLf, MA WS 4R5 u""'. 4f6 Bk755 FICA - FIN "-'SN-_OIAfA 6.0 671.71 eA.46 7OFO6 *7 DAY "MA a MPm:F -s-=a-•sa==-:�sc=saas_Je�47.35s�336.A� 531.Al 435746::134 7827 S. -6* 5'AEE' _- __.__..-.-_T _ N 6.N 6• :6.43N 11L56 T DNS 3.N 6yA Ic �I CA 3_.N _-_F/Y-- 9/y l 0*El MI/BM 73 3OSER+ ENIlA 2 O - '_sas=ss�.¢=�.-_� 0 37•05_@=13.76 477.34 =smssss=_ 52:'41/279C 2;MTOA = ___-_------------_---z_ 66c2 - 241'1,' S y r,I!Add - Pb"A _ FICA 33'81 1•51 61 43.32 ''1 5!4 "In TOTMM *7 PA. )E A.`SEI„g _ -":s'_'�-'°___�.=_u4s=tea N •k' )r.52 173.14 40.ST S ma's=asss:_ass=ss-_ _. =sacs:cT d8/6Bry371 :rVow; S '__-'�___----------- --- 6•0 6•N 15.44N 9i..e4 MRTiF1Ep MVI I L AEWVT -. M4TR"..OE: 'HI-LiW ASNk AAW11610., IW qp.VaS; PAYROLL Rl: .�3 FM iffA E7AI16: Wam P1N L(C: 'WILL SBefT M'1E/Ap8X56/$17':Jd6 -i 3/28 9l29 9/31 18/11 11/82 11183 11/14 HK FA TEE sW BFi AE. WA { :1145'T -AS As YFI:A F/W `S!W 3a.0 2.88 SW.K 41.13 :22.81 .LLB 6�EY '9t/! �� 249/7E/N58 3FERITLVi 6.81 E.18 17.AM E334 RAINIER AWE. m !ES IRS p' NA$ A F,'W 6A355 FICA a%wrLE, X 24.11 2.18 518.78 S/W GM TIrM *T p M 36.81 2N.1p ,88 31.91 1E7.9E 34E.8E AAIIIEL T. 6U_cu SS p 24i5E/477E 3PEAA-1 S _ 6M 5.6 17.1988 11E.74 24W8 RESELL RD. AEE Hn 3- -a5 58355 _ FIrAT_ F,W �T' �• 33.0 i.51 54 3TO ry'i ALS 'ET PAV E27.:8 W,21 :i611 .8d 35.52 184.>: 442.37 ..a , OCT 2 1 S8B5 -LW IFIFD PAYROLL REPORT 9PTRACTOR ME: NI{IRE ASR6kT PRVINS M. IN AMSS: PAK' 1 PAYROLL 40: FOR NEa ENDING: W'S'A8-PROD LOC: Tp61Y STPFF Ton RAY NRE'4O E%'SSt/CLASS *4 3/28 9729 9/31 ISM U702 !B/13 lVN IN ROTE SRO65 ALDER', DWI S p 436129/35% TEWER S A -8.0 8.N 17.38N 13A04 P.D. BOO 935 WE HAS OT 4% GROSS FICA F/N S,Si �OTHER TOUDEES NE' PAY *.ATTU, NA 36.E 1.1 606.94 42.79 136.E .N 14.47 IBA 26 417.68 �r�� a�a�:�a�-•��az�--=�z CEE R. EL:11O501 6 O 536124/5253 LABORER S --_-___-_-_--�- GN 6.N 15.44E 92.64 1159 410m C'.. RE MRES NRS OT 4s GROW FICA ^F/N S/N OTTER WIN NEI PAT PENTOY, lG 33.11 2.SB SIMA A.28 102.E .N 54.29 192.57 3Q,07 NIAAI J. 6ROONE 4 2 ^ 447/38/3186 TEW6TEF 5______.��____ .2 4.0 4.51 17.31E 91.25 '_'711 . 166TH DR. % FED HAS OT HE GROSS FICA F/N S/N OTTER TOT/Om5 NET PAY 9MMSH, NA 46.0@ 4,30 01.74 56.52 151.E .N 12,Q 219.955 561.79 THOMAS L. HINICHS T S 0 531i46646 OPERATOR 5 N6 OR HE WD F1CA__.._ T IN SIN OTHER TOT/BEDS V PAY Ed.-iif it 33.E 1.30 614.41 4132 130 .N 35.52 212.44 N1.57 ir- WILLINl N. 1DlEll 6 O 534/64/3N3 OPERATOR 5 4.0 4.4 17.79E %.16 1256 S. IW WE NRS OT HIS _ SROSS FICA FIN -__S( OTHER TUT/M !ET pay SERTTLE• NA 40.E 6.N 871.71 61.46 22B.N .N 47.35 1&81 534.90 DMPS S. WZl"IE N J .•na:�s�, 53S 6 234 OPERATOR 5 6N 6.00 16.43E 110.56 7827 S •6" S*IEET in HAS OT HAS SPOS9 FICA F!N S/N OTHER TOT/DM K7 PAY TACW, NA 33.00 3.11 691.12 48.13 126.E .N 37.G 213.76 4r,34 JOSEPN J. N6CA N 2 G 531'41/2795 OPERATOR 5 ._.�-�'-____ GIN 6.86 17.43E 114.56 8622 - 240TR S.N. RES HAS OT NG 9m FIDD FIN S/N OTHER T,7IDEO6 NET PAY EOANIOS. NR 33.E 1.31 614.41 43.32 'A.N .N .15.52 173.64 W.57 fEYE A. SELS 538,'694371 LABORER S 6.0 f 6.0 15.44E 92.64 CERTIFIED A9YNXI REPORT CWTAACTOR Nw* ":SINE 1 oHw I9NIN6 Co., IN AODAF9°: pME. 2 PAY01, NO: FOR IEO,94INS: '1801005 POW LQa TOWN STREET wK/Amws/%#/T3,A% m-E 9fM 9/23 136 18/81 glR2 U/q RUM MT ffiPAY gypyr 14719 N.E. 38TN, 1 1814 RES HAS Or 1p5 W" FICA— F/Y S:Y— OT1ER'T0T/0M NET pqr mow, 4R 38.0 2.M `&.M 41.83 12100 .M 61-18 2, .21 3%.19 ME 6 G 249l76/M OPERATOR 6.M 6.M 17.43M 194.58 6334 RAINIER AVE. 50. EE NRS 01 1NiS YAD55 —fldi --FiY S/N —_�—9EATTLE, 7A 29.88 2,00 318.78 36.8I IM.M MEN TOf/DEp6 or DAY a M 31.91 167.92 3Q.66 DANIEL I. YiLSM $ 3 O 534/5614776 OPERATOR S,—^ 6.M 17.79M IW74 244N Rs%u R➢. IES WE OT 1A9 SAGS_ FICA F!Y 5/Y RENT. WA 33.M 1.58 S27.18 44.21 185.M .0 OTHER RtDES MY 35.52 184.73 44e.37 0�* 2 1 19g5 d..a�.......oauocR STATEMENT OF COMPI_IANCF r..m Am....m 4aAtau Date SePt,25 1985 1. Arlene Whitworth Payroll Clerk I Pay car spa`s a, he its �— (U Thar I pry sup,supvi a t )'�ETC hereby state: tits anent or tits vrraant emPlared e)Tri—Stake Con atruct ion, Inc on : that duri.Ig It, P.YroIt period commen<m mon ere I e ]emit l and end:rg the 2 sbb,of cpn{ ¢an the QhLr of G�� 1�5. all P....r' employed on said wee Lt, waif-'earned, that no r,b....have been or well tx pmlett nave been Paid the fall �fate made either dlrtctly or Indirectly to or on behalf of.cad ri— Construct on Inc nam.it full weelrlr.."tc=fur r., Waste earned by any pion and that been made richer directly or mdifectl, from nc Oadde,iona navr the full a n as"'eamed by any Person, other than pe,ml..Ible dedumron. Regulations. Pan ](19 CFR Subppe A). Ia. as dNmed 949 63 Start 10¢, )]Sur 967: 76 S,at 357. 40 U S C Y6c), and destp wbed belo it"surY of Labor order the Copeland Act. a amrndM (4¢ Star Withholding olding& FICA Taxea leRiental Pension (41 In That any Payfotle otherwise under this contract i9merd t° M aubmltled for he aWv iu rite wsp rue'for labounor mech,mo connined tn.erm are not lee.than the °period ercac wade Bete lminaomn In aDp�inht< .se tea cen-it c lnlatny form with the corponted Into the contract: tha, the ciaasifi capons sat fonh therein III,as IT la Wrcr or mrrnamc c r rb he per(otmtd (JI Thu snY appmmme.emp loved in the above paned• , duly repaired m,bona fltle apprcnucrahip on with a Site apu,h Ireeahip d¢eee r ..a,.to a od Y the Elders. of Apprt ,..ship and Tr.tnin¢. Unwed States Depanmam 1 Le M,,or d no such ¢nlsed a n P,o¢ram. ¢Ue od States Department P!Labor ¢ eY es to Skis. are 1.¢iu.nd with the❑urea of Apprcntm 1hp and rummy United (4) That: (a) (WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS `� roll pl.ymentsthe of fpn¢e hourly benefits p,peted P. the tone'sh al nery 01 e been or sill le fun the Bove re(trented far the benef t of to,employee.. ..cept .a noted-I Section 4(c)balur Ppropnne V.Y- (b) WHERE FRINGE DENEFITS ARE PAID IN CASH P'°¢nms ❑- Each L.Wre,or mtehamc listed in the above refemnced payroll has been°cad as Indlurcd o an amoum not lod in the he s al,he apphca6le Lave hourly wr¢e n e plus the amount al the n tenefii •ed theontramt, es°epI as noted I , n the Parma. (ct EXCEPTIONS n section a(t)below 9werd rnn¢e EXCEPTION ICNAr TI Expl— T1ON •wt .�_ , ra Arlene Whitworth Payroll Clerk " _ .�ca ram. o. . ne . •eo pea r[w`.. hue °N'°^'^+•c •roaecu pow w+sss.c� o.. a• oi. , cv .r,o car eo,.n�c:°Y�nacronoA sua„o..ra•cron • •N•]N unu aunt w.'a rwn .onN paacrsv eaow to .w r.o.oo<w[N ra i TRI-STATE tCWSiTRUC.7 ION. INC $PNM 959 .00TM AVENUE v E. • StrLt SVUE, WISHINGTON AX. 4 PERIOD ENDING 09/2.5/E5 FORM WO-347 REPORT ,:OB NO 0548 PAYROLL NO: a 1985 CBI, SEWER TRUNK REPLAC `' 5 T0BIN/3HA'rvP. AVE 9 RENTON t'A • CONTRACT NO CArr. 049--8g YC..'• HOURS WORYf,.,`, • NAME. ADDRES3-DY liNi: -DAY '7 TOTaL 9ROSS RATE OF FICA W!H STATE qiN OF EHPL-OYEi. 4 J6 TOTAL WAGES FAY J 11 ,(A,_ HANSEN, JIM E. TAX JUC:`.0 B 0 6 f _-^ 16 0 279. 04 17 49 ' MU LTEOE WA VIEW 0 0 0 0 0 0 u 00 '` HUKILTEO• WA. 4dd'S .. .__ _ ... ._. .(}p. I9_73 D0 Or ....0_ 0 0 B 0 8. 0 0 0 I6. 0 ..04 :B • CR[ lE s.. NET NAY n 6� r .,� ,„ 49 �76TH PLACE S 0 0 Q 0 1 34 24 KENT WA 4E3D31 - 0 2e21 , i^ U'�i , NET PAY 324. + L'CR i:JAl " 6 rJ 8 F 3 p t3. J o 0 : W __.__.__.. - • 1121'] "v a 6.37.6O i 5 94 i 2'} G? :2 J' AVENUE N E 4 "4: ; 1 K IPYd AND. 0 �� E' 10 2 D G .l 3. 0 7;, 73 WA. 9(UR3 .. ___,. 8 SO 0 i r+ ^. 9 G I C GJ O 43 0 00 5?.- 75 • 'r.C. l.,: ION P E.. NE Fa Al 4601 F ^ v • „ G684 i LACE it �` �_ U ';ti4 0' 1' 79 116 Jt: F t36 ( 4- 76 Ou i _ -♦ 00 .v n:Nt. _.,; ,rc• z Sr. __ LT, gu0vr t] 0 , .35 �� vd_T 4•AY4 `3 U �-,c ,iw 1: 43 2N 1973 >4 AV_ rt W d G 0C� C' ;? 0 4<' S; F' k ' rl _ _ � � Of% F NY r E3. 0 n 7 U 3 00 77 00 9 �q 4 ti:-S7 iTI_),N r , i�� ,Il F'A ti i , ... U 0 NET PA, iy f 3o SC 23 J! a PLA,,F S. L: U 9 A 9 0 0 0 n t< C 569 .;RO. 1:' 79 117 g6 rr9 h3 • .e . WA vu . 00 t0 14 8. 0 b0 S0 30 0 0 32 0 PA 00 . IC`N BA K f r iPk,PA'nt+ u,;. tiF.^ DAY, r79 aA' M��rr a1q • • • • TRI-STATE CONSTRUCTION. INC • 959 108TH AVENUE N. E. IIN{!fA BELLEVUE• WASHINCTCN> • • PERIOC ENDING 09/25/8S FORM Wil-347 REPORT JOB NO. 0546 PAYROLL NC 1985 CBf EWER TFJNK REPi_ArF • • .. TC)B I N'SMATTULN AVE c CONTRACT NO. CAO 048-85 • • . v/ H"s WORKED 1 NAME hDORESS :.4p '�i .. TOTAL ORCSS RATE OF FICA M/H STATE 5 0 I OTHER TOTAL • • SSh .rk" c'7PL,T+HF3 4 7 HOURS WA86"5 FAY 7AX DEL).JL' NOBLE, FOSERT 1, p �0 0 0 12 J ' D `.) t 0 35 3; 7 eh 5 85 4,D 2 4: 2910 - 7u AVENUE S E 0 0 0 0 O 0 0 0 OC 00 00 • • EVEPE7T, GA 98005 __.__..___-_-___-_„---------------________ . 00 4. 22 O O O 2. 0 0 0 2. 0 NET PAY 26 85 534-3F-3804 C7CCtlf'ATIO14 L;E' 730 t- 20;2-'rr C.FJVF 4(A; _ • • ___._._.. __... __.,.__ .._._... _______ _..__._.__.... .._.. 152, 22 -� Q4 1_, 15 44 69 98 41 BEF JC'N{t. . ....___. E. - 8. 7 U 6. b 9 00 3 O 4 e�Mtr 6616 LOWELL. LAR,MEP C 0 C " 0 0 " O . 0 IV • • 40 G EVERET: WA 982"04 '•O :i.4. P._ 0Cr ': O 3:. 0 .aJ PA, "74; 86 5 4?-7!':•. n(��' iWA1j0N M;JDMAN 440 _ _ __. _ .. •• -_ u08L IT _ 13 0 5 0. E. i)__ A14 ')Fi . t 4r 540 >EAHURST Ci 0 0 n '' C 0 00 00 34. 8a 00 • • EVERE".T. WA 98"c;;; --____ ...___..____.__-- -_ ,.. . 8. 'i R :) 0 0 0 9 0 0 0 32. O r a a +5?,. L.:. PA �s'J'ta _ 5 �. O C 4 ] f 'SB- • 9. _ 0 V b 44 WALKER- AR YlE 30014 8 W 53 MIRT p J a 0 • AUBURN. IAA.. 98001 D,- to- 31 a(. - • ---- O 14 0 to c o • 450-39-'9153 0(;CUPAT IUn ,c;.,;� a,•.. _. _. " - - - • TTT�1 FOR ,1(TB 0548 0'� 7. ; �r8`t c1 • • _. _____ - 00 338 17 00 2 1.� 4-'J <289 5 %LTPAY 3:277 ell hereto cert 'that the payroll is correct and complete and tr.- ih t rates contained herein are not I,ss tha:,the t.I apprccr.able rate contains l in the wage determination • • dec,_,.n of the Secretary of Labor s stated in th_Contract Pma¢lons and the work pe/foflfwd by a C,l such lalwrer or mechanic conformstothe classifications set forth in said • • Provisions applicable to the wage rate pa*, V.f.DEPa RTYfn1 OF%.son AeorG wig,...M.L.o'yew Porn W; N STATEMENT OF COMPLIANCE N.dnt ..IN.na ."Rmal D.e Sept, 25r 1985 1. Arlene Whitworth Payroll Clerk loin.ar..an vino ' 'T l a) do hereby state: r Il;Tn 'I pay° .a^^,....NE T"nl of tee.persons ampiny<a b)Tri—State Construction, Inca the 49GCP63 d s ; that during the Payroll period�aing on the 1 Ot py off Cant on lIU andend.ng the 79hh.of Sam—. Tg 5, rill Persons employed On said PWf.n h.re been paid the (,'I weekly wage°a.teed. C a no rebates n.ve been or will be made either directly ,Td.eclly to or On behalf of old rT i_ StateiZw,�Constru — F--- ction, Inc. from m g m any 'bare roll waeklr w. <.eaea by y person. .I no aaaeEr+n.h.ae — -a,.�.. r; been merle either directly or,M,enly from the full wage.gamed by any Person,other then permissible dednel ions as defined To R<gul.unns. Pan 3(29 CFR Subtitle A), issued by the Secret., Of Lebo" under the Copeland Act, as.mend.d (0 Stet 946 63 Siai 108, 72 SIR, %7, 76 St., 367; 40 U S C 2760, and desoibed bel.iI,, _. Withholding 6 PICA Taxes MaA;cal Aid & Sblpplemeltal Pension (�,) (D a RE any psy rolls mhe,rri.e under this Cpnhact "'cited In br submitted for the°Wee period are coned and complete; mechanics c.Fl.,R.d therany,any hot IF.. ban wnage de,.onn....ion ecops.for a W"eted Tinto the centf.t,. the, the cl sdlc.opit 1-1 forth th"elo fe[1 Eachebborer or meehan e c IT form with the work he rfora on performed with uit an,.,,ucte.n•e,ployed in the above period.,a duty mgiatemd m.bona fide aPplthlmeslop Pmpam rep.t<ted Lwith or If no omit n p pncy r<c......d by the Durc' f APpenle,Xhip and T,.ining, United Stets Depmment Of States Department nmenc of Labor agency exists e.State,.re registered with the Bureau of AppmotiaeshiP and Tpnon, , United (d) Th.,: (a) WyFRE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS.OR PROGRAMS r$j In addition to the IT....°...hourly.a Re rates Paid to eacl,[-bull,or meChamc listed a the above reremnced yet. rn II, payment. of fringe benefits as listed to TGe correct hs. been o,wd1 be made to appropriate Progem. for the Lion°(, of Each employee X, a opt aE noted in Section e(c)below If) WIIERE FRINGE BENEFITS ARE PAID IN CASH []- Each L.Wrer or meob.mc fated in ,he above IFFNI nc<d payroll he. hear,paid as indicated so the payroll, an amount benerita unot listed mhhe contacan he isomt.sc-In.1..led basiclicable action hourly 0(c)belowge plus tits amount of the required fringe (c) EXCEPTIONS EXCEPTION(CRAFT) —EXPLANATION S� aroN.T:pE _Arlene Whitworth) payroll Clerk •:E•ai IT AM, OF a r.,e u•a STATEMENTS M•. ayar<cT TIE CO"Tw•c To an n EV<coNrw.CTOA To n cni MiN•C p.'J,ECJTION °Ea ECCT'ON le ir n a oe T TLX IF AND;CcTmN pY OF ITLE yr OF TMa LNi eo°T•TE. Farm`I n/u, poet.,,"Tw. row .N.ac T,.r ......a non'.O.oP cuM a.•. • TRI-STATE CONSTRUCTION, INC IIA11E 959 LOUTH AVENUE N. E. • • PERIOD ENDING: 09/25/85 BELLEVUE, WASHINGTON JOB NO 0548 FORM WH-347 REPORT .'•� 1985 CEO SEWER TRUNK REPLACE PAYR12LL NO: ® ;, ; • • S. TOBIN/SHATTUCK AVE S RENTON, WA. • CONTRACT NO CAG 048-85 • �Nh{I NAME, AD DRESS AND %/ r/ �URDAW�f�.{3EDr . • 5SN OF EMPLOYEE >. .t �3 q/ '-<i i" >.- TOTAL GROSS RATE OF FICA �IM1 < 5 6 7 HOURS WAGES PAY TAX E7ATE S D I OTHER IOTAL till 631 PO, ESS E. TAX • MU POSSESSION VIEW 0 . 0 . 0 8. 0 8. 0 . 0 0 16, 0 279..84 17. 49 OEDUii • MUK ILTEO, WA. 98273 ____0 0 . 0 0 . 0 0 O 0 . d2 3. 71 73, 66 ____________________ _ 00 0 . O . A 8. O 8 .O 0 16. 0 19. 73 O0 . 06 • • 539-36-4533 OCCUPATION TRUJK DRIVER t ' - NET PAY U .._.__-______-_ J02301 __ WIEST, GERHERa _-_-- ___ 12634 S E � 8. O . 0 0 24. 0 419. 76 17. 49 "" � 8031 PLACE 1. 0 0 0 0 O . 0 O 1. O 2b. 24 84, 92 r tir lai 7.3 • KENT.. WA 9803f __-- __..___ 9. 0 . 0 0 8. 0 8. 0 . 0 0 25 D 00 00 - • • --- 26----- OC CVPAT ION TRUCK DRIVER (730-0230, NET PAY. 324. 07 GLICK, DUANE R. ----" 8. 0 8 0 8. 0 8 C -p, 0 0. 0 60 KIRKL - 127 AVENUE N. E . D 0 . 0 1-0_-2_00_. 0_43 0 671� 73 15. 94127. 42 K IRKLAND� WA. 98033 --- -- _ ia7. 42 96 '41 16 501 64-d793 8. 0 a B. O 9. 030. 0 . 0 . 0430 00 50, 01 � • OCCUPATION PIPELAVER FOREMAN 440 .O N[ PA3 93 J dh • JAY G a 8 C 0 __ ______- OE MOMA 6624 - 163 PLACE W. 1. 0 0 0 8 0. 0 -."____ 32 0 569 28 17 79 116 LYNNWOOD, WA, 98037 a.. 0 0 0 3. 0 90 06d OC 9 0 8. 0 ..0 8. 0 10, 0 . 0 . 0 33. 0 45 76 00 •g38-40-3300 OCCUPATION • -,"__,___._.-- OPERATOR GROUP 13(S! NET PAv PINGREE, DAVID F e 0 _.._ 19716 - 24 AVE N. W. U 0 0 0 0 r7 l7. 9:; 65, 42 - 8 0 739 44 • SEATTLE WA. 96177 _ . 0 GO____________________�____0 -- --- �flka 00 9 77 ntf 02g 44-3564 8 0 0 ^v 0 0 00 ` �,'> • • OCCUPATION SERVICE OILER (570-5765) NEI PAY: u.. BUSBY, MIKE F 8. 0 8. U 0 8 0 Q. 0 0 a 32- 0 559. 28 IY 79 42 . 8023 - -. _.._. 37a PLACE S. E. 0 0 0 117. 84 > • SNOOUAIMIE. NA- 98065 0 0 . 0 537 44 'h38 8. O b" 0 0 8. 0 a..0 0 0 3z. a 00 40. 14 OCCUPA- ION BAGKHOE OPERATOR ;ton . 00 24. 0Q • abNq • • • TRI-STATE CONSTRUCTION, INC • 959 I08TH AVENUE N-E_ • PERIOD ENDING 09/25/85 BEL_LEVUE, WASHINQTON • �Jll NO. 0548 FORM WH-347 REPORT 1985 CBD S PAYROLL NO hMNd EWER TRUNK REPLACE • S. TUB IN/SHATTVCK AVE S RENTON, WA • CONTRACT No'. CAG 048-85 • NAME, AOORESS ANP i/ ?l H[]URS WORNEJ , • 5SN OF 'EMPLOYEE '' ,a 4 a • NOBLE, ROBERT L. 1 i ' 3 4 � k 7 TOTAL WAGES RATE OF FICA TW/HAX STATE 5 0 0 0 _ 0 : U 1 0 WAGES PAY O OTHER TOTAL �IIII f) 2930 - 78 AVEMM S E. 0 0 2. 0 35. 32 TAa • EVERETT, WA 96205 0 0 0 0 17..66 5.L35 DEDUCT •__________ _..._________._....____________ 40 B. 4' 00 539-32-3804 OCCUPATION ' 0 . 0 2. D . 0 C 2. 0 2. 22 QO• - _.,-___ -- _ L /B 730-0720/2-9/GROUP 4 Al , • 41- 1 BE:R JOHN _-.._ _. ___. . NET PA Y, D o 8 0_ S 0 J • 32. 0 6G'6 LOWELL LAp IMER p O 0_ 0 494. QS 8 0 c`Yt:RETT, WA 98204 0 0 q p 0 %. 44 -- ..-__.- • _____ p . 00 b> 9O , -_____ ---_"_...._____ 43 I52. 2Z e. G B 0 D --- 00 a3 4t-7101 OCCJPATION MUDMAN 44 L 8 0 0 0 32. 0 34 63 00 40 OC • SMITH ROBERT NET PAY, 341. 86 UO2 SE*A"ST e. 0 8. C 0 8. 0 80 0 U 32 00600 • EVEPETT, WA 98203 _0 0 0 O p 0 0 0 494. Q080 b.. 44 73.. 5T .._. 7. 41 • --� '--�- 135. 81 8 0 8 0 '-' 00'tQ l2'�0844 OCCUPATION ' 0 8 0 8, 0 0 0 32 0 34. 83 Q0 MANHOLE MAN 490 40. 00 • HARRISON, FHtL _._._ NE) PAY. 338. 2. e 0 617 3817 EVANSTON N , a304 0 8 C 8 p V. V _-.__--.- U 0 40. p 617 60 a o s :D as SEATT'Lt. WA 987U3 -- O 0 138 93 9 �0 ..._ ' e. 0 8 0 8, 0 8. 5 0, 0. 00 ,.,.. b.,4 52-402`' OCCUPATION PIPELAYER 94U O . 0 40. 5 44. 36 46 WALKER ARTIS - - NET PAY 385 Be 0 0 8 0 d. 30014 S W. -..-_._ ..__�6.__ ____.__ 3q tl SE COURT 0 . 0 i J359. 04 0 0 tl O 359. 04 4 . _. . _. • AUBURN, WA. 98001 - . 0 0 0 . O 00 54• __. e ---- 00 -- U'A TUN LABORER 44U 00 30 00 TOTALS P3R. JOB 1�.y8 --__.._ -.. NET PAY 299. 06 Will 7 S 199 61 B51 n4 66 47 .521. 2E • -- 00 270 Sq • heresy cerr,fy that the,,:;roll Is correct and complete _ ___ NET PAY 3277. 65 and the wage rates CUnl3ined h(rein are not liss than the -'- - --- - • appreciable rate Contalne`t in the '.vage determination decision of the Secretary of Labor as stated in the Contract • Provisions and the work parfom.ed by eccn such lrborer • or mechanic conformstothe classifications set forth in said Provisions applicable to the wage ratwpald. • /j a. . • Ynha • C r p 1985 CERTIFIED W41EL J[PW ANEc COFIAACIIp AW: NI-LNE WAKT Pwlw,M, 14 Imo: 1(1 R PAYRIILI,101 ..;. FOR 1EER DOM '*MW PRW LOCI TWO SLEET TOR PF' NAK A0f SSPS51/CLAS6 N-f 5/14 9/15 9/16 9l17 9/18 91t9 9/a NRS Allm Sim J" 1, ARTIER S 0 1.0 1.0 533/211/0314 TEA1S^EA 6.11^ 0.0 17.49M 16616 25/6 EOom W& N.E. is WE M HE W" FICA F/N S/N MWA TDTMDS IET PM REMI , NA 32.0 W411 113134 71.96 324.0 .6 5.96 417.E 115.48 vs:�arsrssv�sassaaa�sa+e+acaaaaaacmaxu,.smss=r._�amzsm==zczsaaa�.a.csx�<�z 114OTNY J. coin N 0 1.6 1.0 5V/7W7976 LgWV Sy 2.90~La 15.40 146.68 7217- ON WL S.Y. a IN OT 46 sm FICA FIR SIR (BEER TOTIOM WT Ak SEATTLE, W, 32/1 23.2 IQL% 19.73 2re.11 .p 84.88 446.6i W.T au.m--was=s=esas:sss s-.�:.-.c_ac. saa<_zar_aa.essczx___ ROM L. DIX" N 0 531124!6196 OWKTOA 5 - 9.0 6.0 17.790 155.66 BW Cmsm RD. In HRS _M He �am _ FICA `YFlu SIN O IER TODDEDS C PAY SMfip4lSN, N9 24,110 16.9 969.55 66.36 223.0 .0 41.69 331E 636.50 JAG SII:ESDTE N 2 0 �,51 „b 492i4615468 OPEAATOR 5__--__�_�__._,�__ 8.0 &a 17.43" 1%51 6616 - 21ST ST. N,6. Is N56 OT 46 am FICA PIN Stu ORER TOTIE85 NET Xi MNALLUP, IN 24./P 16.50 94%w 66.9' 20.11 .M 41.d9 3/6.66 641.27 aasomz��m��r_cs=za:.srac-ssco_saasmasrm�a.��-w:�asm:.a_-aza�aa--s��.-..._.c, NIRM J. 6BOW N 2 0 44T;36/3186 IMTEA S- 50 S.M 17.30 M91 2711 - 1667N M. SE E6 NT6 m WE 61m63� FIOA'T F/11 SW �0 WO TOTMOS IEi PA, S awgi. 8A 28A 1M 138173 r,55 361.66 .w 16.21 474.75 90.% smmaac�.va<+..v_.cmam---smmssana a:sszxsssasa_am..mva+asszassz.-�+sasa-ass>_ WILLIM N. L" 5 0 534/64/7663 OPERATOR 6 4,16 4.0 17.7W 71.16 056 S. 13M Als m 0T HIS 8iUs FICA F/N Sib OKI TOTIOM LET My SEATTLE, WR 46.0 .w 111.66 SL 17 id&N .0 41.17 259.34 452.26 a=mnw.:muasa�sc�a� va�mauce�s svmxam.s�asmsc-___+azw NVIAN N. *LEM S 0 539;IB12317 TDISTER S�- 5.0 5.0 17.49W 67.45 +.0. B01 69 ` 46 NIS O!N%' &M56 FICA v~ F!N-� S/N MIER TM/OE06 IV PAY 155aai 11A 32.0 17.M 1IB143 77.58 3I2.* .N 13.65 4/126 697.17 EZ.'u9YissfrJyq�C33C 'Fa ^�'��.+�� :y,9Lyi�f4_sib9>iC�9�J L��=-=-= JAG N. NEWILL f 0 .31 .30 54dz24;13w {AWN 5� �_�� &0 LOS 17.*M 162.SI CEIMF!EO PAYROLL AMT COFIAACTO!NYEt HItIIE AtART PAVING m., IN a", PCs 2 PAYMU 10: FOR NEEN ENDING, fa RAW LOCI TNIY iTEFT MTL PAY P1E-AODP%/554/CLfiS *4 9/14 9/13 9/16 9117 9/If 9/19 9121 No TE am IA624 NE 3611H 41149 IFS NIB m INS SIDE FICA FIN SIN 07NER TOT/DENS NET PAY BaLME• WA 32.N 17.4 1116.M 78.83 315.0 .M 51.43 443.46 663.34 WAR. Poem S O .31 ,S0 .Q..��sa� 533114/69% TmKTm -- _ 8.911 8.0 17.490 1510* 6413 1161X NE YIIILLPAB, RA REG WAS (IT HIS SW FICA Fry S.N DEFIER 79TIDM NET PAY 18.5114�,19 3@63 32AN � � .89 i4.10 422,63 719.36 RIDW AO,ATHIEZ - �aaa=�"'�,�=•"'=a-.�'3E=:oaaa�asa�e:mom®tea SS O 334/41/9t61 LAMA 541 Sp. 'EADERSYI In WE O1 46 BAOSSy_-FIIA r.ry DEAT SIN OfAEA TOT/DEDE 'ET PAY TIE. ;r, 24.M !,,.So 8&18 57.37 219.M .M PWR1 C 94E1 2 O N SSSr?4:?419 OPARt(1t S 8.40 4.61 18.79110 A64.41 P.O. BOX 39V RD 415 Ot HE DROSS FICA FIN _ 6!Y --- __- FEBENY, WY, IM DEFIER T91/OEOS NET poV 32.M 19.M 1241.54 81.09 311.0 .M 2.49 451.58 797,)6 AOER7 C. SNFY, 1P. S O 533/72/6235 OPERATOR 5 0.N U.79M 142.32 31, CM M. 59. REE HE OT HIS`;m F ICAI FIN S/Y OTNE1 MT/DEPS YET PAr REHTOI. w 32.0 16.80 t198.53 7.45 31E.N .M NNYY 8. SNI711 N 4 O %4/72/37N M^7ER S 7.0 7.4 11.38M 121.66 2577 6TH M. 1E7 DE6 � m � �____FIFA G/N S/Y SEATTLE, mA 32.M 11.M 920.28 SFICA 188.M OIIEA i8F74EI15 *7 PAY le .M 12.M 257.45 671.93 . wur.ap«piss.tint.« STATEMENT O F COMPLIANCE N.:r••e.,..._n> ..Ral Dist. Oct. 2, 1985 1. Arlene Whitworth Payroll Clerk do hereby ate: t Neme of.;........... f n (1,That I p. P.—it,the Pa t of:he tenon.employed b;Tri—State Construction, Inc. the CBo .i.LE. p 1,.. Ihot v.8 the payroll period commencing on the 26t?hy of Sect. 19m tEinf e _ I1U and.nd.ng the ndfsy of Oct. 11 5, all persons employed on said project here boon paid lh� h.tl weekly wages earned, tha;n,rebates have been or will be made eHhut directly of indirectly to or on behalf of aid rT i— SLnte Construction, Inc. from the full weekly.a..•.eared by any penes and that no deductions her. i .. been made either directly or ndnenly from the full w - :earned by any pris t ed on. he,then permissible deduolton...deltn n Regulations. Pan d(29 CFR Subtitle A), issued L�•:he Secntsry of Labor under the Copeland Act. As amended (e9 Star 945.63 Stsr 108, 72 Stst 967.76 Slat 0S7: 40 U S C I%6c), and described below: Withholding 6 FICA Taxes Medical aid & Supplemental Pension (� (2) That any payroll,othrfwue under this contrail r.,uved to be aubmiued for the ADD..period are c.Tnc,and complete; the,the wage .tea for tabors'.., mechanics c.tsined therein are not! as than the applicable waR rates contained in any wage detetminmon Ir ......tsd into the contf+rtq that the clesuLuuone art f.nh th.-.n for each labour or mechanic con form with the wort he performed. (11) That any.ppnnuce.amploy.d I.the above period are duly '.emend i..bone fide appnnbn.htp WogTam repalered with a State apprenticeship agemy cognized by the Bureau III 1 Apprenticeship and TT.arng. United States Dep......of Labor,or t(no such n,t.,aed gency esim in.Stale, .re ngnteted with the Oucnu.I AppremmeaMp and Tnnmp United States D..........1 Law, (a) Thais Ia) fp"'�ERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS,OR PROGRAMS ,+_ - In addue.to the baste hourly w.ge rites paid r.each I.borer or mechanic listed in the above Tef.nnced pay roll. payments of 4inge benefit, as listed in the co nine,have been or will be made to appropriate Programe for the ben.fl of such employer., ascapt to Intact in Section qc)hetow (b) WHERE FRINGE BENEFITS ARE PAID IN CASH (� Each L.bnfv or mechanic listed In the above .ele.encW Payroll his been paid Act indicated on the payroll. tent not ins than the so.of'he applicable b.,¢hourly wage .to plus,he emounl of'hen,—Ned tone. benefits as fined to the r—ract,except as noted in section e(c)below (0 EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION •eat.... ties. Nfi itworth, Payroll Clerk .wi n ".a .0 el,C1 r+.1 D.0 rO.. a�DC C v�'L on C01-NAL on SECUTION«ITC,ICM1Ov Dt OCt AI Ta.e 4 AND.eCT ON tit OFp T.e 1+ Of Tit. vw+TrD.To Jce Perm WN-]Y rt nI ry se.rue Too.yew pu..... .....wr.taw y.er oppw.Nn • • TRI-STATE CONSTRUCTION. 114C. • 959 1081H AVENUE N E BEL_EVUE, WASHINCTON �e PEPInf, ENDIN2. 20i(1G/nJ rO+IM WYf,L!47 REPORT PAYROLL NO: fl • JDa NO. O^,49 !I • i995 COD SEWER TRVNK REPLACE S. TOBIN/SHATTOCK AVE 9 • RENTON, wA • 7GNTR4CI NO CAC '348"-85 H0UPS WORKED x r;CA W/H STATE > 0 _ OTHER TOTAL • • NAME. ADDRESS ARID DAV!x ��7 TOTAi GROSS RATE E OF ❑EDUG; r. TAX r ..3 d3G 9- 3SN OF ERpLOVEE t e 3 4 7r NOtfpS 63' 6 P15 1;O 44 Y�dw 8 0 S 0 el 0 8 0 per" �0 0 40 0 637. 60 25 9A • CLICK, D'Ja4E P _.. ..0._ r} :. 0 C 0 2. 0 47 82 • 3v 2 _z1a - 227 AVEN".,E r: E �- _ �0 4e 3a � -` _. . ._.__ NET PA-' 494. 47 KTRKLAND: WA 98033 • 4 0 9. 0 80 8. 0 9. 0 0 0424 • 90I b4 E753 :C"UPAT ION PIPE AYFR FOREMAN 44t, B 0 139 44 1", 43 • 26 15 ,971t . 4 AVE ^4 W 1 ? �. _1 C + 4i 00 id 0% Os NET k AV l05 • ^25-44 ':JS64 UCC'W.a. .Gt: i Rv IGE OILER tS t a "4f __ ._______.. _._... .._ Y.. _... __ __ _.__ • 3 '' r (. ? F3 '. 494 3' 1"! 44 t� BERG JOHN t (+ "0 • 82"S " rIWFLL LARI !l '+ 34 B: NFr 3 lS F OC - -- "-- uc. FAY 33aF,JEPFTf, WA . s7 G ., 3.; 0 • ^+ .O?-7102 I,CCJJPATTON MUOMAN 440 ....._.._._ _ ..__..._ - _ -169.. — _- . G 3 p 404 DCi 15 44 Si' " • c c '-7.5 d:f L+ 0 h S J....6. U 0 • 5:3Y-32-`3844 OCCUPATION MANHQLE MAN 44G 6 .i3 • (1 30 G 463 20 25 04. A • 1.. ___,._... .__..._ 36 2 • � 04: '�• rxtq ch u e o 19i+ CO 95a eo J o0 • -� '" `�- .-'`1- U 13 40 Ot,)0J NET PAY '4 3L7 Tt �.. �lA 9F ,5` • A O G 0 0 0 D �..' • q}b 42-"8�a OCCUr ATION ESTIMATOR . .. . ...____..___.._... .. FOR iMi "tA` 3 • 3 f] 73 1' 176 41 6... 00 00„p,i W that the n`poll is herein turrett and�+Dlete NET PAY2654 64 I hereby • •• _;CJn:2m.7 herein are not t„Ss lha""the 3`3. G ar=• Cont:ino'+ 4r the wary cF W..0 4s _...._ ... iuN • RT, • a,.,:,r is Ccnfa,astoM-dass,hcsiioosse[torth in yi prov,,:cns znp'"icahle to the wage rate A • f. 7 t�:.A►nn� • • TRI-STATE CONSTRUCTION. INC. • !'• B59 1061H AVENUE N. E. PERIOD ENDING: 10e 02/85 EELLEVUE, WASHINGTON jar, NO. 0548 FORM WH-347 REPORT • 1985 COD SENER TRUNK REPLACE PAYROLL NO: S. TO@INISHATTUCK AVE S • RENTON, WA • CONTRACT NO CAG 048-85 NAME, ADDRESS AND HdtS WO"ED • SSN OF EMPLOYEE DAY>AL ,7 V/ Pal r70TAL GROSS RATE OF FICA GLICK. DUANE R. 4 5. E 7 . WAQES PAY TAX STATE S. D. I. OTHER TOT.._ • 1!213 127 AVENUE N E. ®. D b 0 8 0 8 b B G U 0 40 G b37 60 t5 94 KIRKLAND, WA 1. 0 0 0 . 0 1 0 120. 44 DEDUCT 98033 _____-----__ 0 0 2 0 47 82 '-' 230 99 501-64-8753 OCCUPATION BP IPELAY£RBFOREMAN 440 0 42.0 O0 48' 32 JO • P _--------, __.____.__ NET PAY. 454.43 I NGREE, DAMP � _____., ________ 8 4 43 .9716 - C4 AVE _ .� 1 U 0 v O 0 O C. 134 �q -__..___ ___ ___ __-_.__ • ___ 3EATTLF.� WA. 9E1.. - 0 1 v^ 39 74 1. 9. 0 . 00 • 025-44----- 0 0 0 0 6 . 0 9. 0 12 p7 . 0U OCCUPATIt7N SERVICE :LEP r570-5765> DENG JOHN _..___.._...___..-_ NET PAY 8. 0 B O __ _.___.__________.O� 1U5. 39 C A O 0 G 0 -_--__.-____-.__ , 681b LOWELL. 1.AR[MER O 32 O 494 08 15 44 _��__^_-�� EVERETT. NA. 98204 0 V � 0 O q 0 81 15 �, 42 '-'-'^ - 163 a; 5'1-42-7101 OCCUPATION, 8 0 0 0 0 S O . O O 32 0 , OO 34. B3 00 4U. OU _______ M11 .:N 440 SMITH ROOERT _.• -_._ ___ 7 PAY d30. 6. . ._ --...__- __________,- 00_____ .402 9EAHURBT 8. O 8. 0 G 8 8 O O 32. 0 494 08 t.'�qq-___^ __.-_.___._ _._ ___ .. ...____ . • .a EVERETT. WA- 4Sd,0'r C. 0 '- 0 . 0 0 B/ 57 42 -'_ . Ou 539 32-3844 OCCUPATION. 0 0 32 0 34.83 . Oil MANHOLE MAN 440 4� 00 8, U __.__ . ,.__-- HARRIaON� PHIL '�--'� --------------4304 0 463. 20 ______- .,._-. SEAT T,,.E.. WA 98IO3 0 0 0 (11 O 0 0 00 06. 22 - t69 33 '334-52--4015 - 0 8. 0 8, 0 8 O 6. 0 0 , 0 30. 0 00 3` 66 . CC' . OCCUPATION. PIPELAY£R 440 3: SG NET PA 1ODLE. PAUL A -.� . .._-_.._ ..___ 4 R C ____..___.__..__._oo_.- 9 87 .84U5 60TH PLACE N E U u 0 ...____._. _________- U O D 8. U t40 00 95v OO l_____._ .. .__-.__. U 0 ..__.________ 'I 3EATTLE• WA. 96d5E• U 0 0 0 0 0 36 24 ,..> Owl' ---- --- ., 9e It 516----r--- @. el 0 O 8 U . UO OCCUVATIgl4 ESTIMATOR . 00 __„__________ .__YET PAY- 140 02 _____- ._--__. _ TOTALS FOR -�-..-.____.._. _____._____ • JOI3 U548 ____.. 150 O 2418 40 cgl 4.' ____ ___.,.___.___ 1 hereby Certify that tlu payroll Is Correct and complete -- • and ha ,. atea Conhined herein are not lou tha.,the 153 0 00 176 :d LO 176. 4: _. apprecC.ae!o rate contained in the 'wage dGermin.ton NET PAY 1654. 64 "" decis^n of the Secretary�Ialm►�hy,Ry..-,gC•dra� . Provs ons and the wwk pedomud by c__.. ;uch 'iabprer _---� ----"--"'- --- ____.________ ar mzet+anic con`wms to the clauifiatons sat foM in said ..__-_----_ Pm1swns applicable to the wage rate • -- Latina STATEMENT Awrnva U.S.DEPARTMENT oe Rwc•»o»wa otu+mR STATEMENT OF COMPLIANCE B.uan Iwme4 No a•-WINg Do,. Oct. 2, 1985 i. Arlene Whitworth Payroll Clerk do ha..by stale. e.ny) 17T7T Inc. (1)Tyra,1 p or eupervue the pit t of mepersona e.Pl.,.d b,Tri—State Construction, On the 1 ' :N.•t during the payroll period comma m¢on�.hav26tb+y of Sept. 19U ..it adding aNe`.Char of Oat. Il persons employed on said on,arl nave bean paid the full weekly wages earned, that no rebates have been o,will be made either directly of indirectly to or on beha, et•aid ri— State Corset ruction, Ina. fwm the lull weekly wages tamed by any O.,aon and that no deduct...,have 1 m ut..mmeto. been made ether directly or indirectly from the full wages tamed by any Person, other than Permissible deductions as defined in Regulation. Pad 3(29CFR SNbulle A). issued sUry by the Se . of Labor under the Cop.und Act, a.amended (48 Star "S 63 Sur 108. 72 Sur 967, 76 Su, 357.40 U S C. 276U, and described below: Withholding FICA Taxes M d' al Aid s, supplemental Pension (§) (2) That .ray payrolls mherwue and.,to,. contract rr,.,,.d,n be .ubmivad rot the above period are enact and complel.. ,hot the wage ..le.for labor...o.mechanics contained therein are not Its.then the applicable wage rates conumed n. any wage determination i orporated into the contrec4 %bar the cl.asd,e.00ns aa, forth lher.m for each laborer or mechanic can form with the work he pef6mnned. (3) That any pprenhcee em,1.,.d In the .brave period are duly registered in a bons fide apprenticeship progum registered With a State apprenticeship agency recolnl4td by the Bureau of Apprenticeship and Training. United Stales Department 01 Lahr,o,if no such recognised....cy..lots in.State. are registered with the Bureau of Apprenticeship and Training.United State.D...nmenr of Labor (4) not: (a) "ERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS,OR PROGRAMS In eddibon,o,he basic hourly wage rates Paid,.each❑borer or mech.nm listed in the above nIso e.d pay. roll. p.,.onto of fringe benefit. ag listed In the contras have been or will be made to S,prop..r.programs for the benefit of such employees. except as noted in Section 4(c)below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH [�- E.ch Law",or mechanic listed in the above referenced payroll has been paid as indicated on the payroll. n amours,our less thin the a of the apphe.ble bar.,hourly w.R.r.,.pto.,he.moum of th.,e9wred fringe benefits as listed in the contramt. a%,ept as noted in section 4(c)below (c) FXCFPTIONS EECEPTIDN(CRAFT) EAPLANATIDN itEu.Rna Arlene Whitworth, Payroll ClerkWhitworth, Payroll Clerk +„•R .Luau• .» or . . e +. •soap. u,cc• •.c co»�R•c•oR o�soacoR+v.c+oR r a.a o+cis u,„.. ooze e�aoR»•cc sc<�ro» o t _. .�.0 bra.WN-261 1yw au.i... •»u.o.......c+.. a..N T».me•,o.cocoa,..'. (\2 ) §! � � LJ ! , !|t� � \ \ q | lit ' � R (° ` ^ � � �• � / I | li| j ( } � § | ) • | ]! j !� � ! @a ! ' ! l . ri�ancamm �ermcormls moll l.��s ®� can c.■ c.. on ..../�� ■ Diu=iiii■. .■ C. s:::• '��' ■ ■ ■ oA. } �� 1 (� T mnlract haw peen«wll a maa o (c)bet nG pogrom,a«tha WnMt w wU enWnYee[.ueeq n nose In Shan Hq Eelouc rr s syraa.ry ) fllaY (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 00 harwby atab: --Each yp«[r Of mechanic Inde0 In IM soove refenu n0 payroll has bean paw, as (1)Thad pas« p b Nrw Me paythant:.Bla IM�cated on thusLnyrG. than the snlount not ins t the sun, of tM spo"Iffa base: pelsella MhapM6�/ h«rny wall mts pus tally amount of tan laRWnd annals benafll. b Irttm In Iha on that IUe.R.sr rS�—. ( convect saeapt-a nota0 m Sect.1(c)bsi . OJaln.r aeltlI (e) EXCEPTIONS k CA"'_1 that aumi tlr WFnn PRhdd od,, rc M m teas y OR,of__ z.1 19-'Iv and andmgtha 11—"any_ ----yi In._ EXCEPTION ICRAf7) EXPLANATION wl parwm amPloyad On lua Protect nave Dean PwO ma full Real"rages aemaA,that no'wasO� haaal been«rw OR Raw,wtW Itil.ctty«mCimtly G Or on Was"of haw DQ� — M1'eelr.nr —_ from:M fug waaa•Y rVa soma by am/ pupa ntl that all dedu<tans na a Daan mate altar binNy« IM�rwYy from the lull sera"hued"rry parson,rhr than Pannrarda bebuclldnla A.aaun: in Regulations. Part 3 (79 CM SubtRG A), IbusC by One Ssoretary of Lap«undar the Cupwan"' Act as amanded(/8 SW.948,63 Stiff- IDB,77 SUL 967.76 SUL 357,10 U.S.C. 776c),W a scnbe0 below 4 LC1q T w e�. IAA�1) f — (I) That any Wyhols MMrwu unar inn CGba[t ywouW to be subnuNM IOr Ins aMve z �_- W" an carat and compiwa; that tn.rep rwr 1«Immaent or mechanics Cbntel hem•. en not less then the applK.bG.,,rate.cO.Wa In any rap Marrmnatg neat n . t w wto the contract:then tha cammftetibn.we ford,mersln am fan 40onr«IMt3nnK mnaomr rtn Out evra ha waorn�f. (3) That any apphinbc. employed in tM atonal perlola ere dub reglstreO In . bona FOR apl)"d whip program rawntarm In . sta apprrrlw.Mlp ypmry ramalnlaW by pn Surru of Appremv:esn.p and Tmmng,Untied States Oepeflnnw OI libOr,«II no each recollwad apncy "ate m a SIR" are raal-wred wan the Bureau Of AppenvGNip aM Trwning,UnNs a Stable Uwart ment of tabor. (1) Than. 111111[AND l"UT gggyal (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PRO FUU/S r r .L / —In &M-OOn W the baLp huurty sage nGs Plead to arch all « TuL wL/11L I.IrnUTlg1 OF ANa' of TII[ AWv[ i n slay WV ME poNTaAR011 nN(hanK q w16ppNrb.dTOR Tp pYll G GWYMI R, µ( a[GTlrl labl > TTIl 14 NID Intad In the a0u" refsranrad Payroll, pymanl. of Innge brleaiG as Imewd In W bl W TITL[al >TN[IINITtp ilATb COOL WMK M00,o ,w PAYROLL s„Arw eun.0 H.µR10fS (Fr MM.•aCM►'I OPtbIW Una;Sea ladrudion, Farm Wl43A7 IRN.) Hare ar c°HrR�cr°R p Aa PRYR°LL RO. ( roR wQlt rR01(!,'r �I�T Y C NO. J °I m oar ale art a � m S .m m RaYc ADV*M MR �E' t 4 S S ...r amHL�lolu con w mftno.rawsa ! �., c tRIR S 4-. 1 c l i Du OF Pa. "11°YiA larn m i i B' o Howe•oRllm rArM oar I O nrw HOTo (>�J oTHa noucrroe 0 I � h a alo l c.bd 9I.1� b.l�S 5 4; sb33 334 d'i �canK .S� to ° I 1 a�wo i • (f Y � � & 4� I'sb� "t8139'Ss.ES 19G� 8 �° as5+s oar 7y 0 o I� • TI s s rplr wwltr fi;ca, - IONWRLY WL I�PURCHASE THIS FORM DIRECTLY FROM THE SUPT, OF DOCUMENTS Y.L.OEIMTMENT OF LAIPA — ......oNOY.a,n�oY STATEMENT OF COMPLIANCE 1...Lr We Dare Sept. 18 1985 1, Arlene Whitworth Payroll �Clerk Now. Pr.p.,ory he (t 1,I do hereby aura: f q�Thpu��1 par or..per frP In<Payment the Person]employed b,Tri—State Construction, Ina. me /y�J RD i �/�-;that during -- "•rrPr e.. _ ,,,, •n IROud,aawo.ki g,.'.Payroll period commencing on rhe,�r,�Ay of_apt. 'r85 ..d loth."m,j&th, or sett. 1985, mi P.raon] employed im, s.m Project n..e been p.,u he mu weekly wage.earned, mar no r,bar,.ble been or w,ll be made either directly or tnduer'ly to or on behalf of said Tri— State Construction, Inc. from the full weekly U'On O.rm.rr directly .1 term wages earned by any Paolo and Ih•1 no deducions have been male ei,n<r dire 3( or FR Sct:.both.he full aimed by any person. ether In.n Permuslble deductions A defined m Hegulumne. Puy 3(39 CFR SuU r:!e A). uaued br the Secrctuy or La Frt under the Copeland Act. A]amended pe Star 948 63 SUI 108, )I St.,. 967. 76 St.t 157;40 V S.0 276c), and described below: Withholding IFICA Taxes M rl' 1 Aid � c pp mental Pension f4) (2) Thu am payroll,Otherwise under this chntran required,n be submitted for the above mu the..g. nr.s for Lborersor mechanics contained therein are not less man Ina sophc.bl.r e ar a.e correctn and cem^I.n, wage date be......n i orpor.rcd Into the chntraa; mat me cbudaslionS set roan me,e,n for each hor or mechsnm rot farm dah the work he perorate (3) TTn on' apprtntiees Implored in the•Love period are doll 111.1e1ed rn A bone fide.PP re nt,ceship Program vg,a to red with a Air apor Ir Onprenticeship enticeship •gencY recognised by the Bure.0 of APpnr,,,,%hip and Training. Vnuad States DePanmen,or Stabte sucs D.P.rrmen,of Labs. ed.,en,Asia,.in.State, are regwercd with the Bureau of APPrcin,Iesh,P and Training Untied (4) Thu! (a) rayW�HERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS ;, In addition to the basic hourly wage rate%paid to each laborer or mechanic listed in the above referenced Pap roll, p•Ymenu of hinge benelW A listed in the 1o01111 hove been or will be made to appmp,A,,Droir.m, for the benefit of such employees. e.cepl a]noted In Section 41c)below (b) WHERE FRINGE BENEFITS ARE PAID IN CASH C Each L.borer or mechanic listed in the above referenced D.yroll he. been held as ind,gted on In. pitymll. an tent not less than the benefits sum of the.PPiicable bear,hou rly wage tote plus the.mount of hereq.a listed in the conlr.,t.except as solid,n Section ale)below uved range (c) EXCEPTIONS EXCCOTION(CRAFT) EXPLANATION P[M.w.s Arlene Whites rtn_Pa roll Clerk ` e�w LFLL MINAJ, a i hf ir,e ..hY[rr.'T"g", . S e1[Cr LYC CPY rwaC TO.O.aLee......... COp]O.<wIM,N.L`PPO4CC�tiON 4]LL.CCiIOM ,J9� 01 ♦� L[ IC.4p 1LCii0Y,et OF l.,ZC al OF tJ tN(VN�t[O]rifts Far.WH44 unu Rung"I'INrs low Or A a ILi Is.. ins avPi,or oowMar ea TRI-STATE CONSTRUCTION, INC 959 IOSTH AVENUE N. E PERIOD ENDING 09/19/85 BELLEVUE, WASHINGTON JOB NO 054E FORM WH-347 REPO•'T S k!t�li 1985 CBD SEWER TRUNK REPLACE. FAYROLL NO • `' TOBIN/SHATTUCK AVE S. RENTON. WA CONTRACT NO CAG 046-85 • • NAMC- ADDRESS AM 'r""/ HOURS WORKED SSN OF EMPLOYEE , '� DAYTJ2 �/j �'� -i�TDTAL CROSS RATE OF FICA N/H STATE 9. U..I. OTHER 7DTAI,,. • HgNSFN. JIM E 1 d 3 4 5 6 7 HOURS WAGES PAY TAX 631 POCK 8 0 B O 9 0 9 0 S C! 0 0 40 0 699 EO 1r 49 DE-7i �.ESS ION VIEW VC 130 56 9 (.'7 ,o., ,s • C 0 4 0 G ..0 C ... , ,_• MUKIL.TEO. WA. 99273 ----- 8. 0 8, 0 0 S O 8. 0 0 0 4 ; O - 49. 32 . O0 00 539 35-q533---- OCCUPATION: TRUCK DRIVER. (730-0230) NET PA'e 510 4` TEST GERHERD _.__ 2634 S- E, 27bTH PLACE 0 9. 0 A O B. 0 0 0 co 0 699 60 iJ. 49 147 B7 _ �-„ • ENT, WA. 98031 0 G 0 2. Q 0 ..0 0 " 0.. 52. 47 .. 9 d 10 6 • -`e`4'"S 0-._8-O 10 0 c 0 _ _�__ ------ 00 53 02 00 0� ` + 535-26-0039 OCCUPATION TRUCK DRIVER ( 730-0230) NET PAY: 541 45 � %'ORTER LARRY M 0 0 1344 PORTER STRFE3 0 C 4 Q Cl O O O S 141 Pa 17 e,6 ''8. 52 �.e • U - 1G i 3° • ENUI'ILLAW. WA. 4802 v O r_ 0qq 2 . 0 _ 0 r 4 0 4 O 0 0 9 0 9 74 00 00. 331 44-6448 OCCVPATION: LIB 73C-0720/R-9/GROUP 4(A) .:.a.:�+[30 _L, NET PAY: 101 '29 vLICK DUANE R __ .__ O S 0 8. 0 B 0 8 C U O 40. 4 637. 60 . -- - AVENUE: N. F. 0 L C 0 p O 1�7 4 0 Z a . .. • KIRKLRKLAND, WA 0 0 15 94. 9SO3J -_.3_0.. 71. 73Go S. 0 9. 0 9. 0 10. 0 9 0 O S0. O1 00 53 7� 541-64-5753 OCCUPATION PIPELAYER FOREMAN 44C 0 43 C NET PAY CAE NOVA _. . .. .._ _. _ _ - .. __.,. • 8 O [1 .__._ ._..__ ._....___ .. W O U J 0 U 0 O 4r] 0 731 h0 17 117 00 4634 U.3 PLACE '+ LYNNWOOD, WA. 99C'37 0 0 0 00 • 9ON S O OPERATOR 8 O 8 0 0 0 40 0 . O0 30. OC; 8, 0 . 00 30 17 538-4U-3--- OCCUPATION: ppERAT3R GROUP 1341) NET PAY. 505. 16 • NEWELL A W FRANM. ___ ... ___.__ ----------- p "-11 �UV IH 1n9. #.:� B 0 (� O 0 B O 1.3- 04 15. 73 2 09 5 >FATTLE. WA. 98178 4 " 0 U G O O 10 2 . 70 36 O: . 0 0 O 9 0 - 0 O O 9. O UO 11 47 . 00 6 75 533 26-3694 OCCUPATION 864 OILER 302 NET PAY,. 126 ^R t�.. TRI-STATE CONSTRUCTION, INC • 959 IOSTH AVENUE N. E • BELLEVUE, WASHINGTON PERIOD ENDIN4 09/18/85 FORM WH-347 RFPORT • 4OR NO 0546 PAYROLL NO I* Y • 1985 CBD SEWER TRUNK REPLACE. S. TOBIN/SHATTUCK AVE S RENTON, WA • CONTRACT NO. CAC, 048-85 • y� S KE yN ��,// • �MY4 NAME, ADDRESS AND 9� /�7 'gyp DAY fA Y/1, XJ-TOTAL GROSS RATE OF FICA WIN STATE S. D. I. OTHER TOTAL �aN SSN OF EMPLOYEE 1 e 3 4 5 6 7 HOURS WAiES PA, TA1 DEDUCT PINGREE. DAVID F 0 8 C O 0 C. O O 8 0 129 44 .l 43 I9 07 . " 5 36 75 • _9716 - 24 AVE. N W 0 0 0 . 0 0 0 0 0 . 00 9EATTLC, WA. 98177 ---------------------- ----------------- 00 9 83 00 6 00 O 8. 0 0 0 0 0 0 8. 0 NET PAY'. 102 69 - 025-44-3564 OCC 'ATION SERVICE OILER (570-5765) • BUSBY. MIKE F S. 0 e 0 e O 8 O 8 0 0 0 40. 0 711 60 1? 79 147 33 0 ::. :=36 - MN� 8023 - 372 PLACE. S.E, . 0 0 0 QQ ,.Q '. Q 0 _. . 0 00. SNOOUALMIE. WA. 98065 .___..____.--__-_.------.--------------- 00 50 1'j 00 30 00 • 8 0 8. 0 8 0 8, 0 8 0 0 O 40 0 NE' PA, 474 Ca'_ - 537-44-3638 3CCUPATION BACKHOE OPERATOR 302 . NOBLE. ROBERT L 0 O 0 2 0 8 0 0 0 10 0 116 60 17 66 37 15 54 6'4 2`J!C ?E AVENUE S. E . ,. 0 . 0 }. C 1 ` , 0 1 0 49 r. EVERETT. WA. 90Z05 ---.._C_-_- _.__--.-_.- _____--_- OO 14. 46 OD 00 • 2. 0 9 0 1'1 0 11 0 NET PA,v 148. 85 - 539-32-3804 OCCUPATION LIS 730-0720/2-0/GROUP 4 W 1..04-div fQ'e/vcx- • WE:GELT, TERRY i_ 0 0 0 a 5 0 0 0 16. 0 247 04 15. 44 51 60 4 14 9a 13 - 1105 MAPLE R '0 C p.�n 74 EVERETT. WA 9R201. .-__.__.. .___--.._�._�__._....------_.__--_--- 4. 0000 20. 00 00 22 31 • 0 0 0 9 5 8. 0 0 O 17 5 NET PAY 18365 - 533•64-1693 OCCUPATION PIPELAYER OROUP 3 • C,CRw JOHN 3 1:1 e 0 8 0 H 0 J 40 0 h11 b(i it 44 114 42 9 .1 - 6816 LOWELL LARIMER 0 2. 0 0 - O `. 0 . 0 . 0 2 0 46_32 EVERETT, WA.. 98s04 ---.___----------.------_..__--_-.__.,_..__.___ 00 46. at OO 52 DC • e. 0 10 O e. 0 8. 0 e 0 0 O 42 0 NFI PAY 440 46 - � .. � 531-42-7101 UCCUPATION MUDMAN 440 • SMITH. ROSERT a v 8 G 9 t, 2 O P 0 . 0 0 40 0 _ 7 60 1:, 44 .24 55 - 3402 SEAHURST O 2- 0 . 0 0 0 0 O 2, 0 4o 3Z EVERETT, WA. 9620;7 -._.__ _..___..______.___._.__.._....___... ______.__.__... 00 46 81 00 52 511 • 9. 0 10, 0 e. 0 8 0 S 0 O 0 42. 0 PAT PAY 43C. 30 - 539-32-3844 OCCUPATION MANHOLE MAN 440 • - • • TRI—STATE. CONSTRVCT?ON, INC. ql 959 1081H AVENUE N E. • BELLEVLE.. WAskiwv NJ PLRTOD ENDING. 09/,18/85 rORM 604-347 REPORT 1NH�M N0 0548 PAYRDLL NO • 19S5 COD SEWER TRUNK REPLACE. S TOBIN/SHATT'}CK AVE S RENTON, WA CONTRACT NO CAC 048-8` �/ HOURS WORMED • NYa NAME. ADDRESS AND %�G � ,.,fDA)JKy /E� �/./' /— TOTAL GROSS RATE OF FICA W/H STATE S D OTHER TOTAL SSN OF 1:mPL0YEE 1 6 7 HOURS WAGES PAY TAX fill ROSFR TS, ,/ERRY 0 0 0 0, t 5 0 0 0 13. 0 227 37 17. 49 DEDUCT P. 0. BOX 773 9 98 3 i,t 29 02 SULTAN, WA. 98294 ____Q_ _ 0 0 0 0 . O 0 • --_______. _—_____ —_ 00 16 03 GO 00 0 0 . 0 g 0 AIL b O 13 b NET PAY: 198 35 539-36-9178 OCCUPATION: N/U TRUCK i TRAILER �R HAR PHI R IEON, 8 0 8. O 8 0 8. 0 0 3:. 0 494 08 19 .id 112 85 =q 3917 EVANSTON TON N N3C:4 D 5 0 1 0 5 0 C 0 20.' 6G: SEATTLE, WA, 98103 _ —5 57. 90 534-52-4013 6 5 a OCCUPATION PIPELAVER 44U O 9. 5 a 0 0 34, 5 NET PAY. 349 30 . .J L .L6 ART IS O 8 0 H 0 0 C _ -... .Ci 0 :h. 0 239 36 ]4 96 20 66 7 82 62. 8J AUBUR S W 51. CUOR7 O 5 U 00 . O _C . 5 11. 22 014 0 6 9 8 0 0 0 AUBURN, WA. 98001 --__ _—_. __--0---O 16. 5 , 00 17 67 00 20 63 ' 450^38' 253 OCCUPA7CON LABORER 440 NET PAY 107. 78 TOTALS FOR JOB J548 391. 0 4497 41 1204 94 94 2e 2101 05 11IIIIY! 15. 5 272 89 • 00 484. 42 . 00 317. 57 a 406. 5 NET PAY: 4769. 24 -- --------------------- 1 herehv certify that the payroll is correct and complete a and ..,ates contained barren are not::sstha'!'thn apc:r. :�ic rate containol In the wage "Itmarndion de_.. : i of the Secretory cl Labo•is stated in lh Ce.,tract PmVIE1011s and the wwk,._rimmed by such hoofer • or mechanic eonfmmstothe elalsilicatlona set forth in said Provisions applicable to t^ vaga me piaa4 • • • a • • • V.S.OEPaq TYENT Oi LA¢ON Farm Apprev.e r.am NO Nove plvumN STATEMENT OF COMPLIANCE e.aot eu„..No .1 01003 Dare Sept. 18g� I. Arlene Whitworth payroll Clerk e.norm mom.m!P rn dal., yatata (U Thal 1 ay or super the try Timor of the person i employed byTrl—State Construction. Inc. /� qq '1 Ire LZ..`��20/l 411/ _: m.,during me Payroll Pmlu_ d c m¢on a �jy a _— n ld..l1a uuo rut pQ commencing of Sept. 19U and ending the_UW of Sept_. IWS, all person. than ect OR veld protect nave been paid the full weekly w.¢n earned, that on rebates nave been It-111 be made either directly or .directly m Or on behalf of .,it ri— StateIca.Const,.. a. ruction, Inc. from th mu e weekly wages wined by any person and that no deductions nave been made either directly or,indirectly from the full.......Third by any Person. the,than Permissible elect."....as defined in Regulations. P•11 3 (29 CFR Subtitle A), issued by the Secrcl.,y of labor under,the Copeland Act. as amended (11 Su• 948 63 Star 108. 12 Star 96'. 76 Star 3S7,40 U S.0 2760, and described below: Withholdin4 & FICA Taxes M d' al Aid A, SUprlefeental Pension (�.) (2) That any payrolls otherwise under this c.atrxCI required to her Submitted for the since Mind a„correct and mmpl<tei that he wage rhea f.,IaMren.t mechanic.Contained ".,in ve.1 let, than the applicable w.¢e rile. c.ntamed 1a any wage determination Ineo.....tail int. the contract: that the.laaa,.C.t)on. at forth therein for each labored er mechanic coo farm with the media he Performed (3) That tiny.Pp„nuces employed in Is .boct,period a,. duly r<¢catered In.bona DO.aPpnmmexhip program,egiate„d wIm a State apprenticeship agency recognised bl the 6u„au Of Apprenticeship ..it Training. United Scales DeP•t.In,of Labor,or If no Such recognised...Rcy euus In a State. ...re,,.t..d with the Bure.0 of ApPrN,tice,hlp and T„tom¢, United States Department of Labor (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FINDS.OR PROGRAMS 1n adtl,.,.to the hasm hourly wage n,e.paid 1.e.ch labor.,or meCname..,ed In the abpv<referenced pay roll. Payment- of [,I.,. benefit. a lived a ,he contract nave been or..It be made to appropriate D",am. for the benefit or such employees. except a,noted In Section 4(c)below flat WHERE FRINGE BENEFITS ARE PAID IN CASH n Each Litton-,or mechanic listed in the above referenced payroll has been paid as indicated on the Payroll. an tent not lens than the x.m.f the applicable toxic hourly wage'.IS plan the.mood of Ibis no—md fringe heneflu as listed In the contract except am noted in senron 4(c)bcloa to EXCEPTIONS EXCEPTION(CRAFT) E x PLANATION Ir It I si4. —.,wwC rtene Whitworth, Payroll Clerk CA[+tie L eA_one•noN oe . . na THE AeOTc BT..e..IN -T , wA<TON on sit ate oNr tic TOR To VIL OR CM V.N.L PNOI.C.T,ON v SEC SECTION Ira. OP T,T.E?S .NC SECT�ON a)Y OO f� a at O. TIC VN,TEOna TAIFa COO[ Party tryfAa/,Iran weeNa.[aim I.M.pIA[p TLT rain.. IN.slo".oe oocvtENT. • TRI-S-iATE CONSTRUCTION, 1Nt, • 959 108TN AVENUE N E • PERIOD ENDING O9f1®J85 BELLEVUE. WASHINGTON.J08 NO 0548 EORFI WN-347 REPOT • 1985 COD Ei r'WEP TRUNK REPLACE PAYROLL NO. q S. TOBIN,IHATT JCR FVE S • • RE1.'TuN. WA Cnl'ITRACCY NO CAG 048-89 • NAME, ADDRESS AND HOURS WORKED • / - SS'N M , �!7 �p. DAYS0 /,.; EMPLOYEE 1 2 3 b/ '"IpTAL QROES RATE Of�• HANSEN JISIEN •'1cW 8- 0 8 0 @. (} S 0 e (. 6!) 7J HUUR WA9FS 'Av PI. WJH h1ATE • MVKIL TEU. 0 U '� 0 0 �� 11 ,w ------------------------------ 53936-9533 0c'Ul1PAT ION: TRUCK DRIVER• - ----- rrr . J WIEBT O ___GERNEN - " _-.. .._ nr . in?634 5 E. V 8 0 d. V d (: 8 0 ._._ -_ - .. .- "-___.._. - • KENt, WA 98031F+ FLnc1 0 . 0 - 0 0 8. 0 0 7 42 0 659. 47 147 fj- 53tJ_a6_ppbq 0 B O 8. b 10. O 8. 0 0 0 42 0 0U OCCUPATION TR'fCK DRIVER t?30-02.p1 -11, • uURTER. LARRVRY M " ''-'-- - -- ---- __ • .34.e PORTER PC.E, U 4 0 4 0 4 J G '__._... .._- . 0., _ & is i 1 a-C# i n6 RNWM(:L AW, Wp. 41,r�a2 - 0 is O 0 G 0 5� .31 -44-614E' 0 0 0 4 0 4. 0 U 0 00 9 74 _.,. U4CtJPA(ION L/8 730 0720/2-910R 8 0 Of. • LIi.:K s SANE k '.c i ✓L r_ NL 1271 127 A�L+,A N E i 7 N 0 0 4G ti nlr _. _ . . _. ..... -_ - • IPKLAND; WA. a 0 V 2 C. tJ '.� ',0 )_ =y,2 _..._ ._ • 8 33 -- _ -_._.__.. U 3 f' !1 l3 2T 4e p ._.. 501 -64--8753 ,7!J(:iJs°ArBp 9u0� 8. 0 :O, O 9. 0 0 0 43. C 00 5' C7 0„ • __._.__-. I. EL.AYE,P Pi)RFMAN 440 / 11 .: b S 0 8 ;i fd • fn#WC#00. WA. N0 0 0 0 0 f -. 4u i1 711 6G 8 0 O 000 538 40-3O0U OCCUPATION 8 .0 ATO 8 0 :3. T+ 0 U 4 50 17 OPERATOR 6F0UP 13(I. !)fJ .'3!: ')0 • E'WELL tk h RA"Jp -_ .- _ .. .- ..__ _ NET PAY 505 �?ii JtJ 11! '29 tt,g 0 0 b 0 O 0 - S'cATT..E� WA ➢8.,r, (1 0 1 0 tJ `� 8 0 ( q> 04 _? 1,n - .__.._.. . .. _. • • 53:)-28-36-- ' 0 0 0 9 0 0 0 0 0.4 Q0 GC;.I CATION. 86h p!LEP 302 9 0 11 47 006.. iF . ..__ -.._ _ _. NET. PAY 12e 7Q • • • lu, • • i • • • • • IRI-STATE CONSTRUC(IUN, INC • 109 10FFOTH AVENUE N E. PERIOD ENDING 0g1I8/85 BELLEVUF: WA,'HINCTON • /OR NO. 0548 KDRM WH-34,7 4�PART • 1"5 COD SERER TRUNK REPLACE. PAYROLL NO y S. TOBIN/SHATTUCK AVE • • RENTON, .iA C.ONTPACT No CAG 048-85 • NAME, ADDRESS AND j q,. 5 WORKED • "aid OF EMPLOYEE; i`' �� /(' DA Y�144 fJ'TUTAL GROSS RATE OF FICA •• °INGR£E, DAVID T a 4 d b 3 H OURS WAGES C SEATT E- aWAAVg83?7MI 0 S. 0 0 0 p ? 139 44 .; 0 8 0 0 0 __ OC 029 44 3564 OCCUPATION 0 U . 0 B. 0 SERVICE OILER C570-5?65` • BUSH '!Kr _._ _.... _.._. . - ._ _..__. . h • GU3 372 PLACE E _ a ca � � 4a D 7 u ro ..s <_. 0 0 p 7+� _.. a I4 9#.iCIQIMLM TEs t4A 98t>65 0 C Co .`3. -44--36-18 [ICCUPAT10% BBACAHOE OPERATORS0 00 ':'9�r FS e'IFh JF a u 0 30.7 ' 0 9 JcRE'I WA 9F3209 _ 00 53+ J 38a4 OC vpATIOM pH 73p_720/2�g�GRAUP 4.A1 11 O • WFIGIL* TF,ARv _. _ L.:,��pTY :aFT ., 14F' r3`.: •n • vrpfWA 9drU ._.. c L 74 74 � 64-1693 01I 0 9 5 E l � Jcl oQ OCIOPATiON P a T. S 01, �. F ELA`!ER CROUP i - VuR 7 WA 482a4 • 5 r i'; O 8U BHo .. ""_..____.____.__...__ 00 as iii OCCUPATION MUDMAN 440 0 0 42 0 ::U ea .0 �' y e i r,0 • n4 8 0 �� 0 8 0 B 0 S- 0 0 0 42 O 00 46 8i STAG 3� '+944 .'l('(VPAT.ON 0'v %: DU -. .. MAlaFrE]LE MAN 440 • , .. . _.. .___.._ - NET PAY -, .._. • �/II • TRI-STATE CONSTRUCTION, INC • 9.4 1061H AVENUE N E . d�4M BELLEVVF• WASHINJTM, PERIOD ENDING 09f19M FORM WH-747 RERCOT JOB NO; 05ft PAYROLL NO. 1499 COD SEWED TRom REPLACE. 5 TOBIN'SHATTVCK AVE 5. RENTON, WA CONTRAC' "7 CnG 04t3-e5 • WYJRS WORKS% y� . + raA�F ,.MAOI71�16 E N£ X,X i%l y fit i"'✓ I/./- TOTAL GROSS RATE OF FICA W"H STATE S ❑ i OTHER TOTAL �„� �BF� F. lEFPI" '' 4 h HGl'R3 WAGES "A', TAT EiT ntic 8 a 5 0z O 0 13 0 227 37 49 v ->9 >, C.! ;?a Or BOX 773 0 0 0 0 0 0 G 0 00 j)J TAN. WA 99214 00 16 03 . 00 0❑ • 0 _ Q.._._..0_a_0:._5 .O_.._,.0____0 13. 0 CI ' 198. •539-3b 9178 MWATION Nft, TRUCK & TRAILER Opp NEi i PAY 35 • .iARF QSON PNIL S 0 q 0 0 8 0 a 0 0 0 32 0 494 .IS 15 44 1.2 85 20s rE. •i9: VAN?,r9N N 43:;4 5 o Q t ` (i U 0 9 5 • cat, L;EAr-LE- WA_ 9bt'J3 ------- -.....____......: 00_: .. L • � 38 91 00 13 73 �.4 8 S L; 4 9. 0 0 0 34 5 NE. PA'Y 349 534-bt-4015 OCCUPATION PFPECAYER 440 ' • N, . r !k i :` a .l ? _... t : 030 _t4. y.. ._ JC=44 W 31 _ 0 '20 h3 :. bi „k,BURN WA 3 DO 17 h7 p0 20 6:1 43G 3 0 q 3 8 9 O 0 O 0 i6. S NET PA" 187 '8 t3 °•25 OCCUPATION aaG +1•• .. tfv - 21C, 00 4H4 4r2 tt0 31'7 b7 • • • + • . I hereby certify that the pzyroll is toned and complete and _.ates contained herein are not I. i'.i rile api.-- —ole me contained in the wa-..:. d:;am,; ,,dn • dec- :n of tha Seeretmyol Laboras stated,•,,t L<..uact Proaions and the wwk,..rfomned by c...., such iaoorer or m:chanit confanns tothe classifications set forth in said Provisions applicable 1p the wage rate paid. • • • • • 0— M- DAN_ bm been or As;DE maaa ee.Ptl lone. p•g me,fm the(leave(a.Isb.mPly.w nofta Section up)woe A � Mary M. Mittel bookkeeper r except es (Mars a,ewtary wino iray (b) "ERE FRINGE BE.:EFRS ARE PAID M CalL1 do hereby at" C] -Each laborer Or macnanic listed in the aDora ahrenc.d payfolt hea been pad.w Hi-Line Asphalt IMicate t on the payroll.on amount r lea then the sum k ry rvia of the applicable basic (1y Thet I p or supe the payment of the aft.s employed by r1oI1M wrap raft phn,the amount of The n uimd Mnge beneRb as listed in the contract,Accept Iw pt ten In Section!(c)(noon. Pavans Co., Inc. ___O1� %� rcww.lt>er ar,�tacT.n t.unurid er werV (c) EXCEPTIONS Mat dung the pa roll PWW C•Ia•flaf"M tM "de L.Ie-11. ..19a_5_am eMIK M. So Ma .u. b? ----- Exc[rrroa (CR/� EXPLAMATHM _— an pot x %arltpley. said 0 M s potlect pare bean paid the full Beaky wragtl a Mat ro nWtea h- .been or we be made either directly or Irduactly Oo be M belo of MAN \ Hi-Line Asphalt Paving Co.a Inc. _ front the fun - ---- (Cant. weekly wages Mma l by any person and that no dtdtllbons hate beef)made either directly M iedireetfy Ndn the nap wage, w.ned by an, eson, offer than permissible dMucTOM at; defined in Regulatons.Part 3(29 CFR Subtitle A),resurrect by the Sacrtaty of tabor under the Copeland Act,an amended(w State 9/8,63 SUE 106. 72 StaE 957;76 Staff. 357;40 U.S.C. 2760,and descnbad -- -""—' belor Fed. W/H ----- FICA — Ned Aid -- Union -- (2) That any Mmlls otherwM under Me contact MuuM to be subm.tted for the above eEMAIIA. wort an comet(and complete;that the wage rates for laborer,or mechan"contamM Merven are not Ins than the applicable wags r .n contained m any wage deNrm.nabon iocorporstM into the conracc that the cllS4fiCations MH forttr Martin for each laborer or mechanic conform with the Anne ne partamM. (3) That any apprentices employed m the above Detlod an duty revverd in A bona fide apprenticeship program reg6tNM wort,a SUN apprenticeship agency recognrzM by the Bureau of Appnnbcahrp and Tminmg, United Stales Department of taw, or If no such recognino agency ants in a State, an regIsterM wAh the Bureau of Appmnbcesnip and T,s.,.. , Unaed Stater De^admen of tabor. (!) That ME AND iiTl afcfstn" !?dry W. `Mitte• J (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PUNS,FUNDS,OR PROGRAMS Bookkeeper / THE Vii FALSInCAOOn Or ANY a THE AWYr M1TaTtMEFTS V SUaa6T THE CONTMacTOe OR -In addlbon to the basic hourly wage rat,pad to Mon rah ter or me-.hank listed in 511%'ONTIUcTW To CIVIL 00 CAIMINK;r pSECOTI0.,iEE SECT" a Ora TITLE la AND SECTION tit a the above mfemn payroll, payments of fringe baner as listed in the contract TTTTE 31 a THE OmTED STATU Cape. I m • LERTIFIEL APYRC11 EPW PAGE: . OWTRCFOR WE: HI-LINE ASPHALT PAVING CC., IN AMESSt PAYROLL NO: FOR YED(ENDING: 9!15185 PAW LOCI S> lrbw•..."- TOW STREET TOT. PAY • NAIEIAWRE55/SSI/CLA65 N-E 9/24 8125 813 8127 8'M 9/29 8/38 WS RATE GROSS 1 �• • .70141 3. W2ER S n sM 3.88 533/28/131, TFARSTEP S 6.0 &M 17.490 218.63 • 228 EMM A.E. N.E. RE6 NIPS OT 116 SMSS FICA F/N S/R -__OTHER TOT/0E'S NET OM 0 RENTON NA 4&M 9.51 C.87 65.42 248.w .M 13.82 327.24 SM.63 • TFNOTHY J. CAISEY' _ -- N 0 I.M 1.0 • • STB/78/7976 LABORER 5 &M &M 15.444 146.68 I•i 4 7211 - 12TH AVE. S.N. 15 H6 01 H5 SM95 FICA F'8 S/M OTHER TAT/3g NET FAY • SEATTLE, NA 44.48 4.61 691.68 48.76 12&M .M 67.2A 244.14 447.64 • RAYOND L. 0i M N L 1.50 1.51 53712418196 OPERATOR S ---_-_�-&M &M 17.79M 182.35 0 • we CARLSM M. RE: HRS 01 HRE 6MS5 FICA F/N _S/N OTHER 7T/DEDS NE7 PRY • 3"ISH. NR 0.0 7.M 898.39 63.33 19618 .0 4E.38 W_71 MU • JAM GILLESPIE -- N 2 0� _2_"_._ 218 Y=s�aa 4%/46/51M OPERAiuR S A.OR &N 17.43M !91.73 6MB - 21S' ST. N.E. RES HE "HE SM55 FICA F/N SM OTHER 'OT/CER6 NET PAY PUYALLUP, WA 48.0 ...59 898.56 63.35 183.M .M 47.92 2%.27 684.23 • _ __-��_-.___- �-_-_�_-_--_=�,a=-..___z-�==__=__ate_ HIM :. SMM6 TN 2 C 4.M -'.4.00 . 44713113M6 TEAPS'ER ----_ 3.0 &M 17_30 156.42 • 271i - 166TH D& SE As HE UT hR MOSS FIM FIN S/M OTHER TOT/OEDS NET PAY • %%MSH. NA 41.M 24.2 IM21 91.31 32&0 .M t&82 437.33 857.98 • t NOM Y. !CLEAN S ] :.5c 1.51 539118,23:7 7MrER S &M &M 17.49M 179.27 • ML BOY 665 Fr.HAS OT HE am _ FICA F/N S/M'OTIEM TOTIM.DS NET FAY I55RGNIy wA 3&59 5.51 774.85 54.62 192.M .M 12.29 251.92 515.97 i • TMBI.'S N. KAM 4 L .50 .54 -__________- m58/67L' TEX,--; S 8.0 B.M 17.49M 153.64 RT L &I1 120 RES HE �__ 'LTA am ._-rr, Fi'. S;N OTHER TOT/OED6 NET RAY 'ri5HQ1� 4A Q.M 5.51 ML 94 98.1! 1T1.4 .M 2.4 241.71 581.23 ,'AM f. NEWALL > 1.51a 1.W • 54=4/1368 OPM-U S - ._�v iM &M 17.43M 17&66 0 • MrlF;U Para:OW mITm,m WE: N:-ODE OHLT MVDE M, IN ate; NMEt 2 -'YML Ct FOR NO ENDING: 1MMS MW LM; • TC9iN STIFF':' • "lFJ461ESS!SSf CjM N{ IU24 6/25 &'2S 6/27 1/28 8/29 8/3e M"L aar --- IN RATE am ..624 38"- 6:64? AES RA.S CT i64S _---- - • SAE, MA 4&M 7,M � F/M 5/r DTNEA TOTIMM NET Ay 655.33 66.56 223.M ,66 • " AID x lav S — _ 4&37 329.95 52A 38 aM EA • 534.41:9:61 sBcAEF S ---- • _ &M @.M 15.440 :69.64 • SEarn,E, MR y&M '0F,... FiJ Slit 6TiEa ^,u�iLEp$ NET OaY •ml6 3B S6 u Im" M 14.31 3M.;1 4P.63 SMIEY R a a 2.M a.Al &26 6.M :a.73M 266.69 A.L. 6L3 39Y REE W6 6T Nys 46.M 9.56 6i3.37 7i.66 Z&A6 S/M unfEA TD?IOE05 NET A7Y ALEEST 36EY ___�<==�=3p_ 'M 4&% 31&62 67L53 .- 3351;E16235 O.ERaTpA, g ---_---- ----56 _ &M &M 17.79M 162.35 • 3:7 CE3aR atE. SC. RES HE 07 Na3 —`—____. ----•—.-- AENT(64 iG MISS FICA F!M S/M C!EA TOTIMM NET AaY • 46.M 7.M 696.A6 63.34 23&M .M 46.38 347.12 'impa myci NEW, VAC cwwcF00 WE1 wI-L*ASi W WAS CT4., I0 Af DRM: PM90LL MO: FUR WEEK EMPE: 9,VtM PU AT- M{ A24 &F am 8Y27 028 gin 8,36 .. , • 5332170.714 TUIVEF 5 LN &00 I7.490 2'.&63 • 25M EMM. WOE. M.E. AE6 ws O1 HE MIN F1CA F,w vw O71E11 TOTIMM 1ET PLY • A wP M W 9.50 T%V 6142 2K00 .M 13.82 321.24 6ML63 • TIP AP73. f:AV>F7- s.>O_�-.__-ate :_-_ _-._�=��.-i.i1 :.M-ate:= =-.a=__ • SM7017A LOW 5 LO L• 15.410 146.66 '4 7207 - in ME. &w. PR Mi6 C, HIS SCOT FICA F,'6 SYw GNU MliUM TET PAY • fiEATiLE, 401 KM- 4.01 691.6A 4L7fi 120.00 .01 67.28 24,04 447.64 • WINK L. MM ! C i.50 1.56 • 5372M6198 OP M'% 5 i - LN �LM 17.790 102,35 • • 802 C7MISM Fo. WG MPS 7 A9 qMS Fi"A F/HT--51I1 OTIE6 TMOM fV POY 96d0Y79k 43 M.00 7.00 89L39 63.33 19&M .M 46.38 W0 71 3%.60 • 49&4154M OPEMIV S L■ • 0 17.430 Al.T3 • 6000 - 2;5- 9T. YE. 0 96 17T 46 6W FICA-� Fl0 sm OT1E1 MUMS MET NAY • Ounu1f, a: KM &9P 89L56 Q.M ilk.00 .00 R.92 294.27 644,29 �`.. • d7AP1 3. 6M3di M 2 0 4.M 4.01 • • 44V3073W TEW-ti S 10 10 IMW 1%4E. • 271i - 160,N. Si PIS W. T MPS vas Fly Fiw M OW TDTJM 6 *1 PAY • 300011. MA M.M 24.51 '.295.21 91.31 YL M .• t802 437.33 857.M • WA M Y. IktEP1 8.00 17.4900 179.1'7 • • P.0. IDII TC ws 46 OT H0 60AL'i FICA F/0 5!0 OTO MT7IIEDS *7 MY 19'aw WA 39.50 S.hl 774.0 54.0 192.M .06 2.29 2%92 515.97 • • TMpalS k "T0 X O ----....�.-...^-Y_.._ .59 ____-� • 535150/072L TEPtrV 5 e.M 6.M 11.490 i53.04 • AT 5, ow 121 I6 MAS OT m &v% FIM FN SN mw Y97pm c P7Y • vow 1A KM &50 M.94 58.11 17i.0 .4 12.70 241.71 M1.23 • �:��_.,,.-�-:sum-�_=u-w:��„=::::zz�=,�.r-_.-__-�s��:.__��.a==._: • 9'"4v2viAl AWN 5 &M L00 17.43M 17&66 • C • \QFiIFIEC PQYtR1 IERORT LG`WOF Ott N"-._Ili WA&T PRYING W Ogffr 2.� IN ADDIM: • • RP?ROtI NO: FOR km EMIRS: 44i1i Aw L@: TOBIN STC- • • TOTL PRY MW40DRESSIGN ASS N{ 8/94 8125 1126 D/27 9126 8/29 8131 MRS RRTi 811059 • • ------------ lli. :462v N: 38TN RIM BEG No OF NRS vA"% PMA F/N S/N OTTER TOT/OEM NET MR • BE: EAF, W 41.11 7.12 Zi.33 AM 223.18 .w 46.37 32A 5S sma • RILYIIRD ROOAI61E2 5 0� L11 2.N y • • S34/41/9161 JAWIEP. 5 &N 8.18 :5.4W 169.94 SN SO. IE3m1 NEE W5 O' NR4 wm FICAOf!fP. 101:73E0.� IV, PAr • Sim, 04LN &M 731.0 SP.13 17&M .M 71.34 311.37 437.a; • 535i34,2,A OPERATOR S &w_____ 8'00 _6.i981 -A'65 • • R.O. BOE IS& IET3 ARS m NNE 62105E FICA FIN SIN OTTER TOT!MM NET PRr FEXWL WY, W 41.N i SP ih9.3? ?1.86 ?a.* .!8 48.9E 346.82 672.M • WBEPi C.'itE�'. 'R. S • 1.57 1.51 i,.. : 535i T2t623' OPFR41T1N S &18 &W 17.7911 W-M • 317 CEOR9 M. SL RED HIS OT M wm FICA F/R SIN TER TOT/OEDS NET PRY RdT01. W 4LU 7.11 89&41 63.34 23&M .N 46.38 AM? 551.6E • _:.::...v�_:_m-,=c.�,_=r�vvv:�-.�.=�z;z::v.��-�_�@:��nv.>__=-s.�::�v:.:=�>n��vv.�.-�_. • • • • • • • M4.. • • • • • • • • • • • L'Me hays been o'wall be media To appropriate programs to,the benem of such empicow I. • Mary We Mittel Bookkeeper ycM as rored In Seenona(c)belper. - INw w I—,Turn" artw (b) "ERE FRINGE BENEFITS ARE aME, IN CASH do hereby site —Each Iatgrer Of mechanic fished In the aspire referenced Payroll has been paw,as HS-Line AS halt ndlcaled on the payroX. ar 8"'t not ley tnsn the sum of the•pppubN basic (1) Thad I Rey or supsrvlse the paymell of to persons employed by � hourly Wage rota WILS the amwrlt of the renuired fringe benefits as listed in Ni Paving Co., Inca mMrK%exrept as noted in Section a(c)TWIDW. en theKmtiavw wecwnsdcn —_-,e��iamis6..on;n.-----� (c) E%CEPTIONS —.__�tlwt dunry IM Payroll period commencing on the 19;,and ending the --day of _.19. cluprim (Cairn FAWN ..� all or'tofla elflpiol.d on Said project Naw been paw the foil Am id,wages euRM,that ffa reBatee _._------_.__ ___._.— n peen OF WAX be made either direfel OF irdin tty tow on behad of said Hi-Line Asphalt Paving Co., Inc. tom the full weekly wages earned by any person and that rro deductions have been made either dincUy or,indirectly tom the full wages earned by any grain, oter than permissible deductions as defined m "'—"---- '-"'"-- -Regulations.Pan Port 3(29 CFR Subtitle A).Issued by the Secretary of Labor under the Copeland Art,AF amended (48 Star. 948, 63 Slat. tog, 72 Stat.967 76 Slat. 357: 40 U S.C. 226c).Ann dcribed below' es Fed. 'd1H -__._—__._._-.- ._--------- PICA _--- - Y:ed Aid Union (2) That any payrolls otherwge under INS Lori reou,ed b be submitted for the shoes -- penOd are COrrect and COmplelej that the Wage fatale for laborer,Of mechanics Contained therein are not less than the applicable wage rates conturead in ant wage determination Incorporated Into the Contract:that the cUSSIfIca110nS Set Nith therein for each aboref Ur michamC Conform.,in the wore he Performed, (3) That any apprentices employed In t-,e Move panod an duly regirerd In a tpna fide apprenhcesmp program registered wrth a State apprentirnhip agency recognzed by the Bureau of Apprenlicesbp and Trmring, United Slates oepermort of labor,or If no Such recognized agency exists In a Stdta, a" registered Wit the sumo Of Apprenlmyhip and framing, United States I Department of labor. t (A) That AME aN0 M UGNATURE �:ary W, Sitte' �'� y , (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLA.IS.FUNDS,OR PRCGRAMc Bookkeeper Ili —in addlbon f0 the GHIc hourly wit 0[ea THE WILLFUL FALSIFICATIONeap in FALSIFICATION Or ANY Of THE V[ETAtCYfNtS IfJSUBJECTY SUBJECT'ME CON11yCTOP ON a 8 Paid to each laboror or nteChanK 141edFALSIFICATIONSUBCONTRACTOR TO CIVIL ON CRIMINAL PROSECUTION.y(E yEc NON the Of Ilil F ter AND SfCbON)IL OF the above referenced payroll, payments of fringe benefits as listed in the contract TITLE 31 OF THE UNITED STATES CODE "' "'"""m a LIMPPAYROLL wwt rMo Yolk OMLOM (Fw c"Irac OY•Q><I•RM use S••Iro ram 4uction.Fo WN'u?WAL) w.•wttY ti w,w MI�YE O rom MCTpI [� pR itIKOYfRIS1m MI.O ...•ou[ro. p IC —mC. 3 c oc£ W~ t ,.v- S- O1 m w e•. wte m � m - w¢woRts{.MG y... S - O�OM m wl"• cC lMWWI qqgg ae ft �7I p[YRO�tI a 3 CU•FIICAfAiM O y M•1�• r •110YRE MM ', wWCf Q• 5 MOY�•�OM®fM10R[ N4 gOIOIIM �[��P p[pfi�pq' Wf11, ' S t' t7 74 !4a 12 eo3 Ida' fd 7 L 00 3.3 k 6 i "Crn 13.�y �0 1 `otter" ' 1 3 5tYl v 37 1150§ ( 0 I3k1 e 1885 • r••r wYa[r WM- [oYMtRtt •Ol IM--PURCHASE THIS FORM DIREMY FROM THE SUPT. OF DOCUMENTS r Data contract new been or«m hemade to appnpMte fogranis for the benefit of such I wovlwal.aaCapd as noted In Sact on A(c)baba. �jTmo (p) WHERE fPtNOE BENEFITS ME PAID IN CASH do hereby fU[e. --Each laborer or n hafuc list" In the above mfenrc" payroll has own paw, ss 1"wal" on the payroll. an amount not Ins Man the sum of the spol"oN b1K (1)That I pay or wpennse the payrnent of Mt persons amPloied by hourly rays rate plus the amount of the re,.mo fangs benefits ss hated In the 1 ` mnvset eaceyt n noted In Section 4(c)belor. �Qlt Sec- __ on the �.a11=1' I �•�T v.'f. _ tCaabate/r sreurereNn 1 MaaM � (U IXCEPFIONS that during Me n Yroll lrrkA 00rh M 09 en the_L_ _ EXCEPTION (CRAM EXPLANATION of---f�} 19�_, and ending the�. day of - Aq _t 193-. 111 persons arnpby"oh Yd pnoleLt love been pW the full wky rages Yin", that no nbetae naw bawl of rill M male agMr ouwty or IndrrKdy to or fin behalf of east _? .�r\` . _fron,the Full (cwr.aT««rrowaweerl rwAy win earned by any MM. sha Mat no d"odors%haw Dean made either drawly oI nquMy arum the full wyn win" by any pnfon, otter than Peme«ole rt"udon as Yfulso in Regulatwns. Pad 3 (29 CPR Subtitle A), haw"by the SacrWry of Ubor under the Copelan, Ad,as amwwwl (48 Slat.gee.61 Stuart. 108.72 SYa.967,76 Star. 357.w U S.0 276c),and ea ecnMd flsbr. (2) That any payrolls oMeraise -,der this Mntrad noulr" to be subrnlRad for the above parq an carrot and complete. th, Iha rigs ratty for ISMrM of Ihecnenka writs-n"lhtnln we not lease than the applicable type rates contained in any wage determination oeorporated into Ma rnnlr art;that the c1anificatwnf an Foot Men"for sach labour or mscfunw conform riot the wom M pMormad. (3) The any apprwtwes tmplW" in the abum period lie duly regntered in a bans fide apprenlkn�up pnogram ragHaered ninth a State appr«dKeihlp agewy recogrund by M! Bureau of ApprenlKnhlp and Tmmng,Unit"State.Depart rent of bebr,or if raw sucb moognu"."p exists n a State,are ngnlarsd wan the Bureau of AppanUonlop and Tralnm&JnItad States Gaped merit of Eabw. (4) That INYp Mo WFUL (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PEAKS, fUNDS, OR PROGRAMS T(/y1�/e�syy I t/1G�pN of NIy on Teri AapVt RA IBNTg easy ydli d That CON" M —In adddwrn to the bfic Holiday wage rates Yid to aaph ISCuth or mecMnlc �II�>•t1�g �7M 1�11r1 lD ATwT[fat<X A rf 1KTMN Nn 0 nytia as AM lift" In Me above mlemriced YYnolI. wyment. of hinds Mnevits n list" in BN �...� }��ar vo• PAYROLL •++•��•''•'r'E w Mo reu w.�•a (im C,,VKW,OpW"UK Sa Wwj&.UE E•al NI4347 ML) xMa a tprt•Tcrf• ••��°A 'M•e• `-1ti �C�\ W� Q�,? .Q�e � 3O0oQ A'v�i1 Sw SfG G S wr.p�•0. -- n••DQ Me `Jr .S�rPG � � Vy'J'cl$' 1 o — w 3 N aO 5 Mplw M � �r< IR IIw mo.`.cu�...u�rs e� u,a�na .m wwaw ana r...r w•.m p anmT• ,@4�f O ygratal®•ilaT TM O Il7S 14J St ed - I L,I I.ce s370 & z -- a • fr' ( .J ) .L fiDv u5 eb 0 �cwnK- Sti•�^ � � • f( Y 15-fr1 0 64 I - I-6 3 i 1v 6 nr awr ivw-r•aEwT M I4-wulau*E TINE IaIIY gEE^M11 IEar THE AIR.01 fIDCUEIFIETE d| | 7 0 § jai , � $ ! , `!' ��l• �| � j '| | | •:|| : �! . ' � fJ || | / / �� _kN is §,| U.S.0......vWTO,X.so. STATEMENT OF COMPLIANCE e.a..�rea,•..�x, ..atoa, w.0[aNO+W,1 P.�waN Data Seot. 11, 1985 I Arlene Whitworth payroll Clerk e�hrnoT e.�e IN.b o,watwmn Prb� 171 (1)Thal 1 pay or perm the p+)'men,at the Persona amps„yell b..Tri-State Construction, Inc. ,he LI, r. ��'� I' .C:.n.1.�pa.1�� — n iMJ a w ww r,a V that dunng the payroll penod conmiming On the Jye.v of Sept. p ISej and ending Pei]t1Ny of Sant" 1985 aB peroona on said employ" proiea h.ve been paid the ,sail weekly wages earned, the,no r.be,..here been or will be made.,the,directly or Indirectly to or on behalf of said TrL- State Construction, Inc. from!he full weekly wages-.mad by any".on and mat no d.ducl,..have w . been made e,the•dtreell,er IMi eclly from m.full wages earned by any pence. other than pennua,hl.d.d.11,1n.as d.ftned in Ragubtyo.. Par. 3 In Cleft Sobtltle A). i...ed by the Serial-,, of Labor under,he Copeland Act, as amended (48 Star 948 63 St., 108. 12 Stet 967; 76 Star 357;40 U S C 316C). and descnbed below: Withholding & FICA Taxes Medical aid a. Supplemental Pension O (2) That any paymlla otherwise Oehler this contract ,.,wired to be,submTled for 16e•bnvjr paned art coned and centria; the'the wog.rates for labors....mechanics I.m.lned Ill...are no, leas man the .Ml,cribl. w.gr .are. Dent... in any wage delemrmaunn tr,corpenUd into the cw_.aq 14.1 the cI.m tic.vons... forth therein for each I.Mrer or mech.nta con- Inrm will,the work he pelf.-red (3) That an, epprenhc-.employed in the above parmd•e du(y rc,,stend m. bona fide•ppreNicramp PioVam ngiateted With . $1.1. .pp,en11ceship agency recoRniied b� the Bureau of Apprenticeship and Teeming. United States Department or Labor.or If he such mwgnued ag.AO e,,at,in is Sister.arc rep rd.hed with the B.....of Apprent i<efhtp and Tnm1ag. United States D.P.nmed of Labor (a) That: (at IVNERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS '_X In addlt.on to the has,,Nourly wage eel's D.id to each laborer or mac ham'Itstnd in the above referenced Pap 11. pay Tanis of fringe benefits as listed In the conu.a have been or will be made to appiepriahr pmgnms .or me benefit of such employees. 1.1111 as noted In S,01on a(,)below (b) WHERE FRINGE BENEFITS ARE PAID IN CAS11 _1 E.,h Laborer or -hran,, listed .. he .bov rofvtncM pnyrnll has been Daid •a indicated on the payroll. n amount not Iasi then the sum of the.p1l ic.bla belle hourly wage isle PIn%the amount 01 me Tells red fret gx benefits as lived in the contract, except a.noted In section A(c)below (0 FIC!'PTIONS EXCEPTION(CRAFT) EXPLANATION c.r.wa Arlo <. , ,ir v-•_i:, F`3 :__ K c;C�t.IC*Et C[-r�e.(�yP "PI-STATE 7ONSTRUCTION isi0 • • 959 IOBTH AVENUE N E PERIOD ENDING 09/11/85 FORMEk.1-347A EPOSHINGT RT� JOB NO, 0546 1985 CBD SEWER TRUNK REPLACE PAYROLL. NC S. TOBIN/SHATTVCK AVE 6 • PENTON, WA. CONTRA^,T N17 CA. 048-95 . NAME, ADDRESS ANL �9 y� 9 sAY5f7 9/ :, _.SSN OF EMPLOYEE 1 �3 1 /b T17 0 TOTAL CROSS RATE OF F1::A W/H STATE S. D. i. OTHER TOTAL • HANSEh. JlM E P. 0 82 8 U 0 U 850 60 7 H0UR8 WAGES PAY TAX DEDUCT 631 POSSESSION VIEW 0 41 O 699. 60 17 49 ,47 .,, 9 y, ti r ,,. h•. 5 5 O S O O G 1 5 39 3b 2')_ MUM ILTEO, WA 93775 ._-_._____ ___.__ .._.____. , • 8 5 8 5 8. 0 8. 5 8. 0 oO_.41_5 - NET PAY. 539-36----- OCCUPATION- TRUCK DRIVER t------- WBOY 533, 69 DQ WIEST' CERHERD _�________.__.__-______- _ _ 8 0 8 0 8 0 8 0 8 :• 0 0 4G 0 699. 60 17. 49 1.7634 S E. 276TH PLACE 0 1 O C 1 0 5 252 20 9 99 7_:5 00 kENT, WA 9VC31 O 2 S 65 b0 O G 4 0 8. 0 9. 0 8. 5 0 O 4Q. 5 00 GO • -938_26-0059 OCCUPATION. TRUCK DRIVER (730 0--30) NET PAY `49 DO _...____._ .. __-.__-___ GL.ICK DUANE P _.__._,._ ___._____._.__._ ...__.__ • 0 8 0 S 8 5 8 0 C s0 ^• b37 nu 15. 94 162 93 1:�13 s7 AVENUE N E 3 0 2 U 0 3 5 I C n n > eit 7 NI RNLAh0� WA 98033 33 • 9 0 10 0 e [i ! 5 9. 0 O 0 47. 5 50t-64-8753 OCCUPATION. PIPEL,AYER FOREMAN 440 NET PAY 3;; J2 -- -------------------- __ DE Nr- JAY 80 b B ' 4 f) fl ,t �; n 40 0 .. ._.____.___...__` __._..,......_.- . . 6t.4 16,1 PLACE S w. 5 2 0 G n 0 :3 O 141 89 9 16 23..._.-... I YNNNUOi'• WA 8, 5 R. 5 8 C IC i) 8 U 0 0 43. O 00 32 25 538-40-330C OCCUPATION OPERATOR. GR[)UP 13(I) NET PAY. 551 7g . ' •• NE WE l iR , 4 r�'4w > u E r3 . .4 33 4 � B 1 > ' 4 I O :EAT L_ WA 95i1 ? S ' .- � _., 53'3�-28-3694 9 O 9. O 8.. 0 10 O 8 5 0 0 44 5 •� `J0 3.:'1. 3{3 OCCUPATION 866 OILER 302 NET PAY- 506 -,a, � PINGREE UAV[D Y -_.---__ _____ _,__-____...._--._..___ 1971E d4 At,[- (� 0 O 17 d9 22 99 w != 0 8 O O O r1 _8,-V 0_ r33 or)02q •94-35c. OCCUPATION SERVICE OILER :570 57651 NET PAY yq, - • IRI-STATE CONSTPUCTION. INC • 959 108TH AVENUE N E BELLE'VUE, WASHINGTON • PERIOD ENDING 09/11/85 FORM WH-34' REPORT JOB NO 0548 PAYROLL NO: 000, �G�u 1985 CBO SEWER TRUNK REPLACE. • S TOBIN/SHATTUCK AVE S. RENTON, WA ". �GNTRACI NO CAG 048-85 URs KEn NAME, ADDRESS AND gl9 10 911 DAY4f y/ 9/7 ?If' TOTAL GROSS RATE OF FICA W/H STATE S. D. I. OTHER TOTAL. • Mtie; SSN OF EMPLOYEE I 2 3 6 7 HOURS WAGES PAY TAX DEDUCT h USBY, MIKE F. 3 0 8 0 8 0 8 0 8 0 9 0 40. 0 711 60 17 79 05 176. 70 4 4b 274 72 �� 80@3 - 372 PLAC[ - _ 3N000ALMIE. WA 78065 ____i____9__.__�-_G_�_._..... � C.. -3-0 80 00 55 81 00 32 25 • e 5 85 8.0 to 8. 0 0 043. 0 NET PAY 51693 537-44-3638 OCCUPATION- BACKHCE OPERATOR 302 • --------- --------------------- I- ___..___-___._,..___ -_..-_._ ________________ __ .___.____--__..__,-- -------------------- WEIGELT, TERRY L. 8 0 8. 0 8 0 8. 0 8 0 0 0 40. 0 617, 60 15 44 160 8- 11 -1 287. 00 11Ow MAPLE 1 5 I. 0 4. 0 5 0 0 7 5 173. 70 • EVERET'. WA. 98201 __--___ _-____._ ___.___________________ 00 55. 79 00 59. 38 9 5 9. 5 8 O 12. 0 3. 5 . 0 0 47 S - NET PAY. 504 30 Wk�w 533-6=-1693 OCCUPATION PIPELAYER GROUP 3 . _________ _____._..-_-_--__--__ _ ._-._-_-..,_. _____.... ____ __ .._______-___-____._-______-..___._____-__..__.____ .__.____ _._._.__.._ . ...__._ 3ERi:. JOHN C 4 0 6 0 0 0 0 0 12 0 185. ?S - 15. 44 30 44 7 78 61 28 • 6816 LOWE'.L LARIMER 0 O O 0 0 0 0 0 00 ' BVERETT. WA 982"A4 .__.__.._..___.. .------------ -. __......_..._ _... . _ 00 1.3 06 00 Y5 OG 0 4 0 8 0 0 C 0 0 12 0 NET PAY; 124. 00 531-42-7101 OCCUPATION, MUDMAN 440 • --------------- .._.--...------------ ---- . __._____-__-_.. 7^ 'T4 ROBERT C 4 O 8. 0 C 0 0 U 12 0 185. 28 15 44 32. 84 ,2 �0 63 68 . 34C," `_'EAHUPET . 0 0 0 0 0 0 0 0 00 EVERETT, WA 98207 UO 13 06 00 15. 00 •0 4 O 8 0 . 0 0 0 0 12. 0 NET PAY. 121 60 '061 539-32--3844 OCCUPATION. MANHOLE MAN 440 • _ __.__-__. ._..___. . ___.-. ..._._.____._..__. . .___.__--__}__.__ .. _ _ ,JENSON. GARY 8 0 8. 0 e 0 0 " O 24 0 370 56 15¢ 44 92 4'' - � 159 33705 PLAZA ROAD 1 0 1 0 0 0 O ] 2 0 46 32 • BLACK DIAMOND, WA. ?UUl -...-..___.__.. __.___ _.__.._..._.. __._ 00 .29 4' ;10 32 Ot, 9 0 9 0 8 0 0 0 0 - 0 176 0 NET PAY; 256 91 535-70-7035 OCCUPATION. PIPELAYER 440 -- _-__.,___...__-____ __ • .----__ -------------_..__ .._---______-_________--__._ __...____-__-__--_-.__ Nbk1 ROBERTS. JEP3Y p C 8 0 8 J F G _ n '38 5 673 3/ 17 49 99 r_0 9 04 156 64 F O 8OT 773 0 Q '+ [. 5 17 1., SULTAN, WA 98294 -_.___. ___... _._.____ _ _._ ..__ 00 48. 40 00 CO i 8 0 8. 5 8. 0 8. 0 6 5 0 0 39. 0 NET PAY 529 85 539.36-9178 OCCUPATION N/V TRUCK & TRAILER OPP . 9��M • %-uw • TRI-STATE CONSTRUCTION, INC • • 959 1081H AVENUE N. E BELLEVUE, WASHINGTON PERIOD ENVING 09/11/85 FORM WH--347 REPCRI JOB NO 0548 i.•YROLL NO: OF �q• I�S!l CBD SEWER TRUNK REPLACE. S.. TOBIN/SHATTUCK AVE &. . RENTON, WA • .ONTRACT NO CAG 046-aS • • 140O RS WORKED DAY ��G g�7 Y� TOTAL GROSS RATE OF FICA W/H STATE S D, I. OTHER TOTAL NAME, ADDRESS AND �p QU uk NM SRN OF EMPLOYEE It 3 4'"' 5 6 7 HOURS WAGES PAY TAX • HARRISCN, PHIL 8 0 8. 0 8. 0 a 0 9 O O 0 40 0 617 60 IS 44 DEDUCT • 185 Or ]O 66 306. 56 yJyl 3817 EVANSTON N ::304 1 0 1 5 0 3 0 S C� 0 6 0 138 96 • SEATTLE, WA 98103 ___________.___-______. ____-_-___.---- 00 53. 34 00 5'. 5C 9. 0 9. 5 S. 0 it. 0 a . 0 0 46 O NET FAV. 450. 00 534-52-4015 OCCUPATION. PIPELAYER 440 ------------------- ____--____.___-_____-__ • TOTALS FOR JOB. OSi-' v 414 5 6934 33 1575 64 - _^104u 7e-- 259669 • 38. 0 932 13 _ gflu� OL 452 5 00 554 6' 00 342 20 • NET PAY'. 5269. 77 • • • • • s 1 hereby certify that the p;:;roil is correct and complete • • and m:wage rates contained herein are W less than the appreciable rate containel it the •.va,,e determination q decision of the Secretary of labor as stzted in lha Contract • • Provisions and the work pad .ad by eccn such laborer or mechanic conforms to the Classifications aetforth in said Previsions applicable to the wage rate paid. • took • • • • • • • • • • • ape+a.•xpT.Mrb eo.no.w STATEIAENT OF COMPLIANCE Y'n.Awro..e gudOt r ..N. .b81PfJ Date t. L1 1 a5 I Arlene Whittarorth payroll Clerk n,Th.,I n•he "7Ti -- de hereby stare. pyyviae the Pgme tot the poaon in. �yj�ip��R/ 7 'emDlend hyTri—State Construction, Inc, on 19U •red end , Ps'-d commen<)ng on m� 5tb•y of ing ro. _ _. 11Y1s) awing the aryroll of c....� I995 cam all persons employed on aid prolent here been Paid the full weakly wegea amad, the'no r,be,..h.v.been or v111 M made either dinec,ly or Mircdly on behalf N behalf of end );— State Construction, Inc, I Icee:n<m.a•meeom..Rlo. from the full reekl9 r.gea--,read by•nY Person end that co d.du[eons have hall mad.sill,,directly or lOdl,enly from he fullwege•Ranee by any prison.ether"An P-1I...bit deductions a d"thed 948 6in l Slat latio108,P 3 6 at•967.6 5al CFR it 351; 49 U S C sd ]]6c), .red-he Sitchit-lY of deacnhad Latin, under,he Co peland A,,, as smended (ag 514. — 4i;thholdin Taxes L-mid %, cuoolemen Sal Pena ion (Iy) (2) That any""'I'o'hervlaa uncle, this <O.tr.ct that'he we" was for IAbo......meeM1.Nes eomeinM rlh<rchad arc not bbe.irh.nlf,thepph vhr. — wage tletennbetmn Inca wild see CO,Tecl and coon Pill.; form with the work h 'Onaad into the vonlr.u: lust as el...if".tiona an forth Ulan r' .. ..,ea c mesa sly e perierm•d )r each letronr c Mmi <n, wish)54,en wpc t cah�e'pinYed In,h< ebv:ve wnpd arc duly regletved m a lwna fide apprctnweshlp Pmpam regienretl Lehr,O.I(no such re a 6,t<Y rceeRRnlxd by he Bureau of Ai9rcotices!IiD and Tnimng. United Sna+Depaxmem Of Stun Depo,meu of Leber <d agency et• n•Srne, ue half"stated with,he Burand of A (e) That: M.mnncnnip and Tr•In:nR, United (s) WIIERE FRINGE BENEFITS ARE PAW DO APPROVE PLANS, FUNpS.OR PROGRAMS 79 In eddlbon ,,the ba.ic h.lidy wage nn.Paid in•"It abdrcr or me listed 1.the Above rchnettd p• roll. payment. of in-" benefi's n r.led In In- [,,rims have heel o wd1 be malt 'of'be lmeefit of such employees, except a need in Section e(c'i below ,o aDr)prate Program• (b) 41cERE PRINCE:UENEPiTS ARE PA!U IN CASH `I Each L.bo,a or machamc listed in in, .hove ref-,enced pnv,oll has been paid sa )n,h<eted on the ant not te.. the ehr sum OE,hR eppli[eble b..lc y,. we%o r.,e Dlu,the-mount of there bane4b.s listed in the contract, e. ` wY,ell, Cepl a soled in se<Ir )rcl below Vwred fnng ([) EXCEPTIONS EXCEPTION(CRAFT) E%pIANATOM �rle_ne Whitworth, Payrolls t R � • .<6_. < Clerk � a, ; 2 .O•) ff 1:<r OiOvr pre +~ , r -,` T4.R•)'ORO e�w, n+.n w slN•84 Wien euwci..a.inn rosy o�weenr .wox .a pR OpCWeM Ta A' TRI-STATE CONSTRUCTION, INC 959 108TN AVENVE N E. SELLEVUE= .IASHXNQtGN • PERIOD FNLINO 09/11 �" FORM NH-3a7 REPORT y JOB NO. O�4e - PAYROLL. No 6 ' 1"5 CBD SEWER TRUNK REPLACE 5 TO6204f8HATTUCK AYE S. REN77N, n. �/ ems a • NAME Or 4ND %V %76 f�l DAY S . ! eyM� .OTA, CRUS3 RAIE. 3F 91CA :4/N STAT'E S. O. I OTyER TOTAL Y4M SfiN G EMPLOYEE 1 2 ] 5 J76 7 HOURS HAQES PAY TAN OEOUC" WANvEN ;It' F F. O 8 0 8 0 3 U C C 41 G 69's b0 17 49 "9 205 T 1. 631 PGa:aESE,IUN VIEW 5 5 0 d 0 0 0 1. 5 39 36 :43 _ �w MUKII.TEG. 6'A 9C:75 .-_---_____._ .__.__ _._.... ___.... ._ _..... 1)4 5W -! �, � • 8 5 8, 5 8 0 8 5 8 0 O / A 5 • 539 3b-9533 OCCUPATION TRUCK DRXVER (730 0?301 NE pti 533 G - ----------- WIEST 4ERHE9D 8 0 8 Q e 0 A r 0 0 0 40 Cl 699. 6C 17 49 152 20 1d034 S E 27hT.i 1".,ACE O C C) p 3 Cl 5 s5 nn • RENT, ,I„ 98tr,;;. -__._.___ ______ ...... _ -...__.__. __ __ r,Q 53. 99 ILNk 8. 0 9. 0 e 0 9 0 9. 5 - 0 • S.-t5-n6-0p59 fN 'jPATIGN TRo :K CRIVCR :790 OZ337 _-_.___ — ___ _.._... _--_._ _.. . ._..___ --_____._ _ x_ICK naAN!c P g O 9 rl t? 0 8 0 8 0 0 G 40 C, 63 ',O 94 1 a -.. . _ ...___. • 1. 13 - 117 AVE VE N E 1. 0 d Q 0 ;{ 7 a 0 0 7 q 17u 3 ; KIRKL.AND. NA. 9"'•.:3;:i .. ___._..__.__,..__.__.______-__, . . . .....__.._ ..._._._--_-. sJ -- tiv a J 1(, 0 t1. J 11 5 Y U 0 0 47 501-b4-8753 OCCUPATION. PIPELAYER FOREMAN 440 nc l4mmA ,JAY r, 3. 0 0 8 0 G 0 6 ,7 U 0 40 0 61) 17 74 141 0':' t,4 163 Pt..Ac r !} 4 vn. .. C f2 u l t` 0 :3 1 0C not V"W4J lx}, :FP. + 1. IJJ , 1.. er 8 5 �• 5 8. C 10, 11 s3.. 0 C 0 43 0 N£T PA 551 - OPERATOR ^uROU�' fat [ i S ) _ '7 4C) 0 S_ f t3 J94 33 U 4A N)"44 ,� A. ION1dF.. �1,-r'f7 31. 5 !15.1 'CAI n I r7 n 0 a Cl ,39 04 17. 43 ... r .._.,.__..._ t `t O ) 3 0 8 Ct - i5� 7i7o4 10N s5pv,CE QX1t'R C147 b7651 �4 • 1 • TRi-STATE UONSTRUCTION, INC ' • 959 100TN AVENUE N. E. /�1j JOB NO C$48 REVUE OGTOtPERIL i ENDINv JY/ii/y5 $OMWH 347RkPR • 1988 COD SEWER TRUNA REPLACE. PAYROLL NO. S. TOBIN/EHATTtJCK AVE 3 RENTON, WA • . . 8SNHOURS"NORKFD OF EppL(rtFf.ADDRESS AND 'ljq f)i!! DAY,p/f t/ 7 r/f TOTAL 6ROfZD RATE OF FItA W/Az 074fR TO ig(,STATE • PUUSSBY MI FF I 2 3 4 A 7 NOVRE WAGES PAY 43 0 c C :T C 8 l i,. n .3 4, 711 6 *J073 - 37r r LPi f •;{ F: c ) f) 17 j9 1'E,. 70 ._�, A 0 5 6- 5 8, 0 30 0 O. 0 0 0 43 O S- v • $37-44-3638 OCCUPATION _.__..- BACXYE OPERATOR 302 NET r'AV 5:6 93 C B Q 8 0 9 0 0 _.__......._ ._.._ _.._.. ___.. i7.03 tAFLE 40 b17. LO 15 44 SbG 82 11 01 -a '•:FgE' ..,. _ _ S O 4 ^ . 7 5 173 70 N 00 NEi iAy .04 3O 11. 1t 7i01 >l:"Up (ON MV[,MAN 44( tET PAY ,14 It . • • TRI-STATE CONSTRUCTION. INC. 959 1081H AVENUE N F BELLEVUE, WASHINOTON PERIOD ENDING. 09%11/85 FORM Wt4--?47 REPORT JOB NO 0548 PAYROLL NO: IT95 CBD SEWER TRUNK. REPLACE S. T08IN/'-HA7TUC9 AVE S. PENTON. WA • CONTRACT NO: CAG 048-8` • HOURS WORKED • NNME, AOORE88 AND �/q �j� 9f� DAY � Y/7 � TOTAL OROSS RATE OF FICA W/H STATE S D I. OTHER ;OTA!_ SSN OF EMPL(GYEE Y 2 6 � 4 6 7 HOURS WAGES PAY TAX DEDUC, • � . _ 4ARRISON- PHIL B 0 9. 0 9 0 c7 0 H J 0 O 4.i7. 0 617. 60 15 44 185 06 66 'O6 • 3817 EVANSTON N. , M304 1. 0 1, O d O 5 O 0 6 0 136 96 • 3EAT,;-E, AA. '7SiO3 ____, ISCi :34 UO 9.. 0 9 5 8 0 11, 0 S S . 0 0 46. 0 Ni: "tY 450. 00 • 534•52-40t3 OCCUPATIrN PIPELAYER 440 • _________.__ _ .__-__-___-____._-_..___.__..__.____..__ Tt1TAi.r FOR JOB. 0548 414: n 6934 33 1595 04 Ir4 70 ag96 6� 1�1 1,0 �JC QU _Cc 4n2, 5 ,.:r..7, PAY 5269. 77 t MrebY certify that the payroll is correct and complete I e'A in the e determination • and tr:•Nz a rotes contained herein are a lass tCootract 39P- able rate Secretary alal of Labor ss stated in lh.Coo tract deci_ •r of the vrork performed by e,.c'r such laborer Pmvs:ons and the Wssluationssetwhlnsaid • • a mechanic coi wbk o the Wage rate provisions app ^ / NNN r . t Fero A+Drs•me u.s.DEP.RTMENt V1 aAeon STATEMENT OF COMPLIANCE e.dvl ear•.nr. alno<e x.ae•«o wgP.o�vuip« Dale Sept 4 1285 Pa roll Clerk de hereby•tile: I Arlene Whitworth Y m•r,r 1.„... "Tristate Conatruction, inc. oo IU Thu i par per. a tM D•vment of to<v<s.�ne emplaved t r----f�na,o.or• m. the / CBD : that daring the Payroll paring emnmen<Ine on he•jZtlrr of Auy. (Rai ln�nl rr�a.•1 GG 11 and endure the tt}NaY of Sept, lY-'S .I1 po+orot empiored on aid Dropect have from, paid the tail weedy w.ee.earned,that no rebates Mve been in.,If ba made either directly or itWirec,ly to or on behalf of old rl— State Construction, Inc. from the full morality wagev earned by any person and that no deductions have — ,,,.,,:r..,�r,n—a,--- been made either dire.tly er tM'ireniy (rem the lull--I'-limed by any person, other then permissible dedutmordi as defined in eg San IOSP2 S3(19 CF 6 Ste ltte A). is 5 C IM, the h).rend dte+tnhad Wow:Labor nder the Copeland All as timer dad pg St., Withholding & FICA Taxes M d' 1 Aid SuopLePl�tal _Pena ion (�5) Tl That any payroll,otAe.wiae under this contract required to De +oh n,.4 for the above period ancormic,and complete: w.'a isms for ain not leas than hFrore..or mechanic. contained Ih.—d the apphc.bl. area rates contained In any oremiloation . orp nittO into the Contract: that the ctssstftcalions set forth therein for each laborer of mechanic con lot...,ith the wads he performed (3) That any apprentice,employed In the above period... dole registered in a boom fide apprenticeship Program registered +rth . Stain apPnmtn,mh.p agency ....{nosed by the Bureau of Appre n"Ilr p and Training, United St...D,padmanl cl Labor•nl it no avch tecoentred agency all.in•Slate.are'canto off with the Bureau of ApPmnhoealp and Tmmng,UnMed State.D<P.nment of Labor. (d) Th.v (a) e11ERF.FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS.OR PROGRAMS (� In addition to the b•.ic hourly wage rate:Paid to e.oh I•I o e,or mechanic listed in the•b,ve referenced pay for Ili,benefit- of...h.mployee..•..lap,daannoted ontract have Wen or n Secmion e(c))below will be made to• u Drognm+ fb) gas, '<E FRINGE BENEFITS ARE PAID IN CASH Each La`omr,or reachanie listed in the above referenced payroll has been paid as Ir'.oted on the psvroll. an lint not I,..than.e sum of tM.PDL<able basic he i-11-ago rile plug the•m<�nt of the ragaivid Inope benef,,as listed in the contract.e.c.P,a+noted in section d(N below t<1 EXCEPTIONS f s[EPTION(CRAFT) EEPIaNATION Ar nneM Writarorth- PaLrroll clerk y na t,.< a o•�.,...[, r Par.W".3"...... .0 nc�•fa.«ra.......E e.vv .... ...e,nT.o<oocw..T+ • i TRI-STATE CONSTRUCTION. INC 959 10GTH AVENUE N E JIMr 8EL.£vue, WASHINOTCW ....,r PERIOD ENDING: 09.'04J89 FORM WH-347 REPORT NO 3543 PAYROLL NO r/ e71 1995 C8C SEWEP TRUNK REPLACE 5 TOBIN,SHAT TOOK AVE 5 PENTQN, Wn S CONTRACT NO, CAL 049--95 • NOURS WIRt KED r, NAME, AbOR£SS ANC _ OAYr;,, - TOTAL GROSS RATE OP FICA W." STATE S D I OTHFA TOTAL 95N OF EMPLC+CE 3 4 7 HOURSA WAGES P , tA4 DfiOUC" • hANSEN J1M E 0 9 a 8 0 O U C.' 16 0 279 p4 17 49 50 95 3 76 e" POSSESSION VIEW O . 5 . O O . 0 O . O 5 13, 12 " .IL7EO. WA. 9827! _.__.-_.__--_--_-----_---___._----_..-_----_— 00 2U 65 00 GC 0 8. 5 8. 0 0 O . 0 0 16 5 NE' PAY -17 60 539-36-9533 OCCUPATION TRUCK ORIVER (730-0230• WIEST. DERHERb 0 8 0 if. O B 0 ,+ (i 0 32 0 SS9. bO f" 49 .,3 99 ; 1v ?2634 5 £ 276TH PLACE . 0 1 0 O 1. 5 0 ^s 0 2.5 65. 59 KENT, WA. 98031 ---- ___..__-__..-_---..__.. __---------- ----- 04 44, 08 Oro uG O 9 0 8. 0 9. 5 •3. 0 0 O 34. 5 NF.T PAY'. 404. 21 • 539--26-0059 OCCUPATION TRUCK OF SUER (71('-11'Ar, ti1Ri'T, LYLE D 0 G 0 U 0 U S. 0 149. 00 745 00 29. 1t 148 C'a C9 RT. 21 bOX 47£ 0 O 0 0 . fl 0. 00 MO.YROE, WA 98272 ------------ ------ ___ 00 10 50 CO B OO 0 8 U 0 0 J . O _O 8. 0 NET PAY. 49 91 53V-44-687T OCCUPATION: SUPERVISOR 440 PORTER, ;.ARRY M 0 O 2 0 O 0 C 2. 0 '> 1-- 17 bt• 7 1" rNM 1344 PORTER STHCFT U O O O . O 0 0 0 00 1• • ENUMCLAW. WA. m - .. -_.-____....__-_____ 00 2 III QU 00 . O O 2 0 0 0O 0 ;'. 0 r1£.T PAY 25 64 531-44-6140 0(CJPATION L!8 730-n720?9-910Pt7UP 4(4', . ; +.-.� .,e. ;,..�. _.DUANE R C 8 0 'a 0 i? 0 8. 0 O J 32 0 9t'7 08 15 94 114 0' ._.._ f .. ....__-_. 18 k` 1213 - 127 AVENUE N E _ 0 1 5 0 '^ . _O 0 0 6 5 1`. 42 v SRKLAND, WA.! 9A033 _____________. ___.. ___ 0046 92 V, 48 13 `i 0 9 5 8 0 13. 0 8 0 . 0 C 'S. 5 NET PAY 44n 6t r•r 501-o4-9753 QXupATtON PIPELAYER FOREMAN 440 .•rr NOMA JAY b 0 3. 0 8 0 0 0 0 C In G 284 h4 17 79 50 ... 3 57 • 1.y24 - 163 PLACE S W. O 5 0 0 O O 0 5 S3 34 LYNNWOOP WA. 980E+7 ____,_____.__._---_-----_,..__ ------ 00 20 ?4 00 11 0 a 5 8. 0 O 0 U U 16 5 NET PA', z.., 539-40-3300 OCCUPATION OPERATOR OROUP 1'?' 1 ' y� 0 TRI-STATE CONSTRUCTION, INC. 959 108TH AVENUE N E. • BELLEVUI:., WASHINGTON • PERIOD ENDING; 09/04/85 FORM WH-347 REPORT JOB NO 0548 PA`rROLL NO. ® • I9£5 CBD SEWER TRUNK REPLACE. • 5 TOBINISHATTUCK AVE S RENTON, WA • CONTRACT NO; LAC 04r3-c: 6 HOURS tr ED +vAME. ADORE9P AND 9( "' DAY'r, •' TOTAL 0Rt733 RATE OF FICA W/H 97A!£ _8 D I OTHER TO7.�.:. • SN Or- EORESv,E ei i .flWELL. JR , W. FRANK 1 3 4 _ 6 7 HOURS WAGES PAY TAX DEDUCT b 9�C 8 0 8 O tU 0 O 24 0 411. 12 17 12 80 24 6 02 t3e. 3' •ell SOUTH 129. N12 __�____._. _.__0_.. _5 0 0 0 2. 0 St. 3W Q 7EATTLE, WA 98173 -_ _____________________ . 00 32 61 00 . 19 50 0 8. 5 a 0 9 5 0 0 0 26 O NET PAY . • 533-38-36w, OCCUPATION 866 FILER 302 _. . 324 1': ^SBY, MIKE F _.. 0 8 C 8 0 6 0 „ 0 0 32 0 553 28 1' 7% 117 ?9 86 19, •023 - 372 PLACE 5 E. 0 . S . 0 1. 5 ^. O Q O 2 O 53. 17 " • N?70UALMtE. WA 96069 --- _________ --------------- 00 43 90 `.. . 0 8 5 S, ri 9. 5 O . 0 0 34 C' 25. 50 • 937-44-3630 OCCUPATION RACKHOE OPEAATOP 30? NET PAY. 429 2F. WE1G'ELl , TERRY L. _ ._ _. . ..___. . 0 6 6+ 8. 0 8 :i 8 0 u 0 32 0 494 08 5 44 11(t5 MAPL1`¢ 11 1 6 6 9p G l O,Ti . 0 1. n O 4 5 O J O 6. O 538, 96 • EVERETT. NA. 98201 ------------------------ ------------------- . 00 44. 63 . 00 47. 50 . 0 9. 5 B. 0 1.. 5 8, 0 0 0 38. 0 • 533-64-1693 OCCUPATION P!PELAYER GROUP WET PAY 420 95 _. . __... ..4 • B JFR3 0 8 5 8. 0 0 0 0 0 1h 0 279 84 17 49 29 98 9 7, _ .S _'21L 0 , TT,3 O 9 0 9 O 0 .Q . g 13. 12 1lLTAN. WA. %}294 4 J 8 5 B O 0 0 (' 0 16. n OO 00 g3 • 9 ?';--9175 OCCUPATION. N/U TRUCK t< rRAIj FR rJPR NET PAY' 238. 66 p r rv. PHIL O t9 0 8 0 0 8 0 0 0 24. 0 570 56 15. 44 67 71 5 'i 132 •.d17 EVANSTON N , R304 O 1 0 0 0 . O . O O 10 23� ib • EATTLE, WA 93103 __ ___-_____,. _. ____ .__ 0 9 0 3 0 0 8 0 0 0 25.. C 2/ 76 00 31 25 534--`i2-401it, OCO'JPA!ION�. PIPELAYER 440 NET PAY. 2bl 21 • T(;'ALS FOR JOB ;548 234. 0 3943, 44 767. 59 58 28 .. .._133;: 03 • 21 5 527, 47 0 ------ 00 314 73 00 191 43 5 5 _t,kenW witiM.lbat thc.palrep is cone-t and complete NET PAY: 3136 BF • ,a - rd the wage rates contained herein are ncE less than the - ---_.._..__ _..__.__. _ ., -.Me rate container in the sa ; determination • 'the Secretary 6Labor as statza in th Ccntract and lM work perMrmed by e.._„ iuch labor" or me:.nzmc conf rritstotte classifications set forth in said • Pmvisrons a:,piiceble to the waite,rote 9a. • • • u.«^«PwoTYov.w Lee', STATEMENT OF COMPLIANCE ao..n APp.e.w BvAarr Xu.eru Na. rb R10E1 Dare Sent 4 1985 I. Awlene Whitworth r ,l Payroll Clerk (11 That I Pay or aop.r a m , nr do nog hr:um� ae/A/ arm.nl or me vet amplored nyTr1—Stake Constructs the /�� ri ` .Ana . Inc_on that do.m the ' °1,�p rgt 1. nrYl 8 Payroll Period ommencmg on lM1[]�ULY.( +CI,r� end endm rAt —gu8' ehlay af_ $ebt. i�s all persona eIy or tl on nitl -,our hove been paid i full w eeYlY ages a netl, that no rebates hove been or wrll be made either dirtctl State cone tru r°'ind"gear to°'°^beheu of a.;e ri— CtlOu, Inc, from the full weekly water e.rn.d by any Person and In.,no deducr.on.here t e^ run na a.l been maae courtr m.ealr or;ndvecUy from'he roll bee, eith Part ](7o CFR Si,ti, le A wage.nmetl by ant Person the Se"'.1 .1 Labor, "he''he'Pennlblble d.d°or,on..e defined 948 6J Sbt IN, y1 Stu. W. 16 Slat J57.)a0 U 5 C 63]6c), and described below;nder the Copelo.i Act a amenGed !OS Rtu. WithhAdin4 6 FICA Taxes ------ Merl' al Ails cS„P19 mental Pension (1s) (1) That any Patrol is othe,..,vnd.r tote cpmnn th.t the w.ee area for bborers or mechanics CPnr.ined rthem'ergd to ot Is..than theh. pliea bl Peri.d a ect and compdom: fomr with ethenwo5rk h<COrponled into the contrvc- that the clnaiflcati°m set forth the0em•fee e.cb I.boner-1 s ecn sec Poe De tors ed IJ) Thal an, appremioes .`eMyrd I' 'he e a by eriord-Ne.� registered in.bona r;de apprcmrceshrP protr.m r.t;lt.r.d with • Stale pPnenrecOaM1iP . Labor.or d no mcn r Kn I..A We"ealu.to♦Srae. bat PPnenliceahlp and Ti Vmred State• Department of States Depaninlol of Labor neRnre Id with the all'...of APLrenticeshrP and Tr.inin8, United That! b) Ar11ERE FRINGE.BENEFITS ARE PAID TO t1 wrr'1,1 PLANS. FUNDS.OR PROGRAMS 7 In.Adirion In the b..it nou.ly ..e^rat a Paid Io aeh laborer nr mech..5c Jilted in the above referenced pa . roil. y.......of fein8e benefit. • .ud in rAO r.nntract Aave been e.wdl be made to I.,the heneftt f..,h emplon u. F v t n p,,Op,,.,, Y ' v nn.d m Section e(0)below proerema (bi "ERE FRINGE BENEFITS ARE""tN CASH f:ach Laborer or mech.nm listed In in' ebove referenced Payroll has been Ovid a :ndmated on the P.yroll, uN,nor lee.than the sum of the epphcable nevi,beu.ly wage rate plus the amours'PI the benefit mn s as Lsled in the coct, ar c.P'as n°led in section d(c)below re9uired R;n Re (i EXCEPTIONS EXCEPTION tCRAf TI EXPLANATtON I Arlene_Whtwrorth, Pa roll Clerk n C�rE ]n ........ .....n Cs' s[6 ea6C Ti Cv�epr]Oe •`wCC ] ^� ] C' ' •Lr' C•• CCr.rC•v e,E<' ..,[°CCv•P.0 To C • � rir. ]. be wE°L,v rEn S..rC]r agrw wX•1M rveu ep.cwue Two eoaw pr as It` ..ow r• •+e OVPT,oat oo w..ervn Tat-St4TE co{BTFucixm.. :rr 9M tOOTX AVIMVE M E PtliOD EIOINIB' J9/Oupy PgNf A9e-r REM11� Jtl NO 05440 V4PRait NO .f s LBO 7 IA11 !VEAL[ S. . IDBFV/&MT4XM AK S _ FFNTON. W LONtaALT W. CAp C49-d5 NO.M! WLNEp NA14L. Apppptl AM M. TGTK tlOBa BAIL OF F1G WX 474M EL.1. . OTh1t iRTK fill s9N aF JXVLOVEE 1 - ] i e Y NDws woes PAv TAX DK04T MNLEW JIM E 0 d 3 0 XD 0 D 0 Ib 0 271 B4 11 A9 y; yy 3 76 15 u 631 POLSEELIOM VIEW 0 0 0. 0 0 .0 - .5 13.12 - I11alILM. W. a S ----_--------------------.--------- _tl m es 00 W O a y a c 0 0 U 0 to 4 NET PAv 21) 60 5T-36-1333 LCCIMAit4IM rR A 041v[a 1100-02]0. .. _ - .. ------.------- - _ _- .. _ -• _ _ v J4 .TE1.63T. EMERa 0 g 0 e.0 a 3 O D 0 ]2.0 i]a eq 126 4o iCE 90 ;61 Cb ]4 S. E. 216TM1 PL.KE .0 -- .D J_0 _0_ w u -- 65.19 XEML . 9Bp31 ______________�.__�_a__-_______-___ _ p0 4A ON, .00 OQ 0 9 0 a.O N,y 0.0 D 0 _9 3 W, P41 44 21 53p-26^Ws9 pLLWAT1p1. TR�----- ----- V- ------ NIPST. RUX D. U9 00 Ta5 00 2< tt qo AT 2. 80A qw, .0. 3.3__0._._- ._.4_.,u. C --- _:N! A11111Q. W 9a212 0 '8.a 0 0 0- 0 0 6 0 30 0 00 S]2.44-AV7 OCCUPATION. p SAV100R 440 MET PAv 44 91 __.._.. _. - _-__ _ ___ _.__- .. - __. __. _. _ _. . .____ __ ___ PORTER LMP• N D 0 2 0 D J U U 2 0 39 31 V 66 :] ,o �_- i.6a ..N 1344 PORTER STREE: 0 O _0_. .0. .0 _O .0 .0... LwncLPN. w. 94R>Z2 -------------__------------------_- .AD w 2 +5 oo gg 0 0 2.0 0 0 .0 .0 2,0 NET PAY 25-14 131-44-614a WCWATIWp L/a_]209220/.tw9[aam84u1.�.,.D,,, ._..---------_-..._-----------_---_-----------.....______________---------.----------.------------ _-------.______-__-____-____ C_1cX. pU4E R D a 0 a 0 0 C a 0 0 0 = 0 3t0 w 13 04 114.d) 8 -2 219.a4 I1213 - 127 AvgN ME 0 :.3 _.a 5.0. 0 C .0 c 3. AS G Klft D, X, A1033 ------------------------_----____- 00 46 92 C 46 13 •. 0 9 3 0.0 13 0 a 0 0 n 5 NET PAv 446 66 ,..1; 901-44-61s3 WP14PAtION. PIPELAYEL FOORMA14 NO ---------------------------------------------- -..---------------------------.__-__________--- _____-_-_ ---------------- ta CE WMA. JAY 0 C a 0 0.0 0 0 0 0 16 0 4 64 {] 19 39 8e 34 6624 - lb] PLACE 3-N. .0 y .0 .0 Iz _0 .0. .5 .3.34 LYMNMOOO. w. M37 -------------------------------- 00 20 94 00 U.ly O 0.5 0.0 .0 0 0 .0 16.A NET PAv 211 62 33 40-3000 OCCVATION OPEAA700 pap► 1311J _. ii nTF rON9"AT I LN ... it= . AYEw( N F 2EL.L:t.E. WRNtt10TLN PERIOD EMINO 0,/04/e3 FCJtN wl-J♦] PEPD PA LL NO JOB NO ONB PPYRO • 19B! Cab 'T E ' i RfiPL.CE TJOSY1iwrTA. AVEV 3 RENTON. W N6yRS NORAED` NANE. MME95 NIf. - .:L DAI+.. MA, woo PATE ;w FIU .1. STATE B D t DTKO TOTAL SSN JF ErPIO'.EE 1 2 J ♦ a WII'A > PO WR49 � T.. wvAI WLiEL- JR N r..w 0 4 0 d 0 g 0 0 0 0 24 0 411 1[ .> 11 00 2a _. r 139 J> 3711 SOUTH 39. P12 .0 .! 0 ♦ _p.__.O .O 1L - $i.O4 WATTLE, W Nl>0 --_..___.__—____--______________---- 00 ]2 ht OC 19 50 0 S.! B 0 9 ! 0 .0 0 2e 0 fEr a.v M4 la !]]-28-]69J OLCUPAT3M ih4 o1LFP ... . ...... . .. .. ..J.. ^ --------------------- __.. ...___ _ __ _ 0 �0y. n;.E F 0 i 1 . R 0 J J 1: : !ev :b e C. :vJ23 P1.ACS' u.E.. _ 0. .O .L .9 1 L.. !].]: lM OB4MlM1EP1. W. 98065 r 00 ♦] 90 00 25.90 0 005 g 0 95 g 0 0 0 0 R 0 NET PAP alp 22 !]>-------- O--------- -ALAWE ------QPKRAT1P J02 WICEL?. TERPv i 0 a 0 0.0 g O 4 J2 : av♦ OS U as it < e FC 2:2 ev fivEREtT. W 98201 ____0_______ Op as q 0047 50 .0 9.! B.o l2.! B 0 0 0 38 0 I(T PLY 420 9! !]]-69-t,93---- ODCU------ Pt------ AOI.P 3 o 0 SEP 'i, JE.mr 0 9 0 0 l 3 l + Ic ' 'a 59 .> Oa w i8 ] `i '.. iC %'LtMI. W 98294 _ ..__ OO 20 59 OO (p 0 •.! g 0 0 0 0 0 11 ! NET PAY 2]B ee .. e` ..... 0 NPPR I::ON. PNIL 0 g 0 g 0 g 0 0 0 :♦ 1370 Se {: a♦ .t 1]$ y 1104? WAT LE. MAINi N.. P]0♦ 0 0 0 0 -- .0 _0- 3.0 21.14 w SE.TT:l. W 91100 - - _- W 21 le o0 J: :] 0 9 0 g.0 O g 0 0 0 21 : NE• op gel 21 !]a-02----- OLCV P1- APO ----- -- -- --- ..._. _ ----------- ... t]twl5 cpR :OB OlaB � _ � - � 2N O ]vU as 'R Y.i .•0 {lJY J ]t.] !2zw 00 ]t♦ TJ 00 Iv1 b 255 ! NEr r.v 31]S M 1 be"certify that the pa/raft Is ctnee't and complete 11 I and the wage rates cont]ircd herein are not less than the appreciabte rate cvrn-n: -^ the'. , determination decision of the Secretary c.I'�r as sated in th-Ccotract Prm;rs{ons and the work.:_rfomlcd by e=n such iaborer rA mectranic conforms to thJ classifications ad"in said { Provisions applicable the wage rate y id. 7 __ ._. .. _ _ . Y.S- pARTIIENT Or 1-90. A°kieb.. ..c+ ..O.ov•awnoN STATEMENT EMEHT OF COMPLIANCE ..1Irse tress' nbrer, V He "-Eta°' Aug. 28, 1985 Payroll Clerk Azlene Whitworth Y mnertby.,,le ef1j""^'°the yTri-state construction, Inc. i U Tha I V+.+^r Sup m,M v.Ymenr of,be person+ampiored h Inc°.or• w. .ne /'7r r7R(' •.. : mer dune,\hePayroll P,nM commarm:nt on b.$2rday of Auc. ill"'mdma. M) C IIU and acidic, e28tby of Aujxa . 145 ell perwne employed .n +aid prolec, nee' De., paid IN- I"' weekly •alas earned. the,en r,be,,.here Man or will M winds either dlneclly a,,Mi.rUlt In or up -hall of said Tri- State Constructir,, , Inc. from the full...lily..to earned by any pecan And-he'no dedae Unna Ms. been made either d,nc:ly or redtr110Y from use full ..V..erred by any person. .,he,than permmiMe deductions as defined n M,uimm�e. Part 1 (29 CFR Su6utle A), issued by the Se cot tar, of Labor under the Copeland Ac as emended (e8 Slat 9e8 63 Sue 108. 77 Star %7. 76 Su, 357: e0 V S C 1'6c), and de°cuMd Mlr-: withholding & FICA Taxes MpAicalAid 6 suoolemental Pension_(_ _ (2) That Any pa,y,oll.o,h.,.e under this conv.ct 1.,.,-4 In be aaMdprd lw the °lore Penod• cnren end:mnpN\es ,het IN. .e,. n,..for laborer.or ow h.nio c.h,.,e.4 ourrgbaese catnm• the.e Inch \haSiete for --V"Ina oonnecled i °.Y ..p de,.rmpin,on , ch"Iftrrd Into Ili-cenvecl; -he ar con torm.Uh,ha weft he performed (l) That any eppnnt,,..a apioyed In Ihe .bole pent .re do, r".su r,d,n A bon.hda prepam rcti+tend Nth A St... .pprenuce.h,p genc. .....nt..d by the Bunw of Ant nhce+bip and Tn,nnl, Veiled 5ufea Department-I L.bor,or if an.ugh ncowieed t,teey..,at.in.Sn,e.........red.dh in.Bvr...of A,ienuveahp an'TnwnL U.0r d Slate°Depnnsient of Law, (e) That: (a) MTIERE FF.' BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS _K In.M,, the basic heurl;rate sae pod to ear,t.tncer or mech.n:^listed in Ihe eboll relereneed pry- roll. 'a n al IRn,. listed in Ihe nob."h.ve Men or..If M m.de In eppmPu.,.proPam. for\he'- .o, of such emylayeea, wept as noted in Sectiarr.(c)haluw th, *HERE F'RINOb.BENEFITS ARE PAID IN CASH d on the __.. ..aft Labo rtt r or I lea.than In,listed n al,he it"lliable basicehourlyr wage plusen a,he aamount afethe re rived fringe benaf t..a anted n,he cone.,, s...p\ar noted In+ec\ion eir)Imlo. t rcl EXCEPTIONS EXCEPTION[CRAFT) EXPLANATION rwa.f lane wh ,ox[h, Payroll ic_Cler . tic . is .. e�.•NA4,via n_.. .. -�_. r .0 c . .. •+_� .c s_n _+ca_..m an • f � • iR[-BTAia CS'k•1gTRVi:IfJN, !NC � 959 108TH AVENUE N. E. •Mf<i; ®ERM ENDING 0fr:'28fPS BRRMEr 34WAREPORr •jcli NU 0548 1985 COO SEWER TRUNK REPLACE. FAYRO:_L NO. S TOBINI$MATTUCK AVE B. • RENTM, MA ., .. CONTRACT NO. CAG 048-85 • NAME, ADMESE: AN[ 89k OF EWLDYEF �� 2� ! DAB'' :d "yy' �s.- 'fOTAL GRUrS PATE OF Fir, 4 S 6 7 ^FOURS r. S Warr + i D ! '.•F=£ _-AL tLZ1G. RO$ERT MA,.E.. PAY fAx � � - '� .f 20TA? MAPLE VAIt_F_'Y RD SE 4 0 9. 0 . 0 2 O 4. 0 6 0 12. 0 2S4. 2F !B 09 63 49 DE00CT KAPL£ VALLEY, wA 9l30y3 " O 0 G 7 3 69 100 66 • - P • 535 26._.8504 OCU1PATgON 4M0 0 4 C C it 16. 0 21 54 00 6 +4ANSWN ilm E ...._. . ...... _._. ........_. P • :31 PUSSFS51UN v1Ew $. J 0 a 0 !'. R U 0 24. 0 0 . C v 0 1 0 26 24 *9 y,. G 3 i.�: ray fVJFI IL TEL}: LtA 4f?2yc -_ '1 . i,34 E i!7E' n, �• .+ :q A L 0. b 4Ci • r.. ,. it • v. 0 _z.'„aw 1�,3 PI,.«�, ' s ,. r '' ti p `-+. `� O J 24 G 406 9h 1 99 . .._.. _ ._. .... __.. YY\ l Y • sake - 7RI-STATE CONSTRUCTION, INC. 959 IOSTH AVENUE N. E. BELL.EVUE: WASHINGTON • PErtIOD FNOIN6 OB/:9€gS;JO9 NJ 0548 FOPM WH-247 REPORT _ 1 a85 CBD SEWER TRUNK REPLA(,E. PAYROL:_ •V;1 ® � S. TOSINlSHATTVCK AVE S- . . RENTON, WA. CONTRACT N4. CA: 048-85 MOURS WORKED NAME. ADDRESS ',NG f r /f. 'j- f/Q, OAYJ/ A� I/.-7 CRC53 RAT_ OF Fi:,tA • SSN OF EMPLOYEL. 1 2 ..1 .Z'. A3 A%y �. ViA�,- E w/H STATL 5 01 HER TOTAL.• WEL.L, dR. � W PRANK 8 p a © 0 B U 850 60 7 HOURS WALES P4Y TAX DEDUCT 5711 SM)TH 129, M12 1 0 0 1 r 3 5 O . V 40. 0 683. Z4 17, 13 , 10. t9 SEATTLE, WA 96I78 -- - 0 0 4 0 102 78 1" 57 288. 31 90 _8 0 `9 9 5--©O 14..._ 00 59 g5 00 33. 00 • 53d 8 jc94 UCt; PATICiN 96 : OILEA 302 4 u _ 1a-I S.. NET FAY 4" £ • F3NQ3rFE DAdID F .. __.,.__._B J 0 0 n 9 0 . 4 B. 0 t9 44 17 43 -___... i ATT 24 AVE N. W. 1 Q 0 0 Q p p 0 32 3A 2. VO S;. 34 ■ SEAT I i P IJA. 99177 _.._.._ ____. 00 0 f'r 0 ;1. 5b 00 F, �8 02 i i'64 DC 'P l ION �EF.VICE 6[LEE (brt, .iJb5; J � C N- _ cT PA., BUSBY, MIKE F 8Q.^,:3 V a 8 0 8 0 @. 4 O 0 4i1 O 713 60 17. 79 _.----- -----... a .. PLAG4 ^NOObALMIE, wA 990e,5 t_J_._ $ 1. 0 t 0 . 5. C 0 4. 0 Sob 75 1-7J,. 37 10. 1^I 287. 4$ • .___-.----___-_- 0p 9 0 B a ! U 4 C 8 S U C 44 p 5' '9 4. � h n 7C 44 Ski JL.:/PAT]ON' BAGKFiOE OPERATOR $?? TEpw 10$ MAvi F. 8. � f 5 E 0 0 44 617 LU ;$. 44 '� O0 47 4, 9 9 4 _ 333 h'^'J )F.�vPAT ION, PiPE!_kVEA CROUP NE T i 441 JENSON 6AR•i --. ..._ ..._- .. .__._._ s"tJry5 'LAlc. RO€,:` � 0 _.._U B. 5 9. 0 O O lb O 24 04 .. 2.i. 44 ail. C4 a•: S L.ACI +P CN? rv_ y2)C. 1 U ?.3 ib ,lJ.x H4 1 li 1 6 4l?t; 20 91 S 1 V !f �l --_-- -4 _-- .__._ a-..._-�_ R013F.H JERRV _.__.,._._--_,...__._._.._. U 0 0 49 O 769 00 17. 99 . -_-_0 D B11X 773 , �.w 46 - ___._.... "dLTAN, WA. 99?94 —_Q_ O _,,.-i- � . UO if, t't iHb. 9U i 8 0 R O 0 a4 539 1a-9178 OC, �3� r in 0 1. 0 0 O 44. f.r .g r10 r10 AT'.ON pF 1 'RLk.k < TAA-1 Eh C-Fk NFI' -hP Sf7:" 6,: • • TRI—STATE CONSTRUCTION, INC. '. � 959 1081H AVENUE N E BELLEVVE. WASHINQTON • PERTOP F`fi1TNG 08/F^9/95 FOR" WH-347 RFPORT AM tot' 01448 PA'ROLL NC >� ' 1985 (:SB SEWER TRJNK REPLACE • 9. TOBINl-�,HATTUCK AVE. S. :. RENTON, WA. ' CONTRACT NO CAG 048.-85 • 40a S WORv.cp, rr NAME. ADDRESS AND ' r'r �,. ra:Vqf.. .,s. •i s —Tt7fi Ai. GRL > R.:iF > ._£, W!:1 _,ATE v I Tir'iw • 83N Or EM UR PLOYEF 1 2 3 4 9 ti 7 M08 WA41ES :.AY rAk tFUJ'_'T • HARRISON. PHIL 8. 0 4 0 . 0 U 0 . O 12. 0 185. 28 15. 44 2;% 02 2 78 52. 8" 3817 EVANSTON N , 0304 l 0 0 a 0 . O 0 . 0 9 . O;s • FATTl E, WA 9R 03 -- — ___.. - .__._____..., o0 13. 06 00 to 00 • 0 ) 1 r C C 110 NET PA! t32 4;:7F. 1015 r CUPATICN PIfF: A S.R 440 r , • PERRY. ROBER'T ®_. 0 5. 0 . 0 O . 0 0 0 :. . o 194 48 €r.-9A 23. 7-7I L._.__3..U1 ._.,....... _....,. qa :I21 — 247TH S E . O O 0 0 0 0 . 0 U 00 /4��G • MCINR`JE. WA 'N3D72 ..- .. .___.__—_.. —___ _____._.__. r,+I 57 • 0 11 G ) G �i C7 7., p , 51 ..A,;,,' 6F'i`+ G3U"AT iOPa L :,(3'v+7EN n; r e •.._ :. • 1840E, PAOL A 8. 0 8. C8. 0 b 0 R 0 J C 40. 0 9S0 00 950. 00 181 M16 1 44 '- 01 4£RTTi.E, WA `>di 59 ..___ .. .___«__.. .___...._._.__......._._.._...,... 00 h6 90 7't • He nG 9.r1 9v a s c aaoo K',. 516-3J 'drl6" _ X �0'7i.f'rf1 E "d'1A T1J17 _. :A)V7d3:. 4e sa TCTALS FTIR .JOti. JSaO 34. O 862 5E3 . .._ ..__...._. no ."70 95^ • 445. 0 „r1 "�a p.:. c • y' a • f hereby certify that the payroll 13 correct and complete • • and the wyge rates contained herein are not less than the appreasble rate containeC in the wage determination • deci;bn of the Secretary of labor as stated in th. Cc�,tract • Prnmsions and the work performed by ecc,i such laborer or mechanic conforms to the classifications set forth in said • Provisions apptict o the wage rat d, • • • S-389 1985 Sewer Trunk Replacement Cert'i f i ed Payroll �.12 us.Rt+.eT.(Mi er l..(oR s.,ne Ar�n..e *cos.ND»w+wv,PD» STATEMENT OF COMPLIANCE � R.da.,RJ...•N...e(uu Aug, 28, 1985 1 Aron Nhitl+orth Pavr011{C1erx `" "twr«.P•rr`I Tri-Stnte Conatruction, Inc. (L1 TMT I p.Y or auy.n»r tM Payment PF the pa r.ana rmpl arM DY— ate CC 1M .4 : ID.t d+nn(N<P.po11 pbncd[ome•anon(on the•iJAyr+9 of�Slf( u•IJr ar a 1� .nd rndnt Nr2Qfraby pl _ny+a- Itias at Pa»an. tm-0MY'ed an and Deepu hire been pond thr lull verY1Y•Ms»ma.,Art w,»bn.a hit'.Men",.111 ba mrM nUn dur.!IY ar iiWverhY tP w on 1'.h.1l of.nd Tri- - Si8ta Conatzuction, Inc. Boer TM full•u.rklS carps e.n,rd by cony Pe»0^and IMt ra deduc Uen.1»ve beeb nYM nba tltbatp or md"wi,from thr fu41 w.pw<.mad by.nT pebon,o<h<r IAM Jon¢:ntMe dedu.Lem n defined U Rr(u4eerta. P.M 112, CYR Sublitt. A), »w.4 by TW Sece<Mry of Lit" under the Co"<I<nd An. .a rmendN IN Stn DJ!"1$1.1 Im 12 It., AL lb AN 1ST. to U S C 2760, aM dna:Md beta*,: Nithholdlna s FICA Taxer MeM;Lill a;d-�a.�yi�l Real Pension (�yZ ❑) TIN I.,Pt)•aile oU+erw».pond., wil rantncr".'ied 1.M wdnrtted for lh . an,vrd.rc cnr.en.nd l.pin.; Ill.,Ill.,1%..•.p»IN Iw MDw<»w mNMnio<01...I"tM»m.,I +IX 1... N.n rh, apPbcrblr m.(e ,nra """1" in III vrn defr,minalPn uMnrpe.N.d IMo Th.rentr¢t. 0.1 rh.Ct..aifrcatians set Mrth Ueretn Ivr each Mbar.,e,me<Mmr eon torn.'Ph,br«ork fie p<rtbrmed Eit 'Mon.IV ipDmnl¢n IlIrw.d l.T.aw i.prnad.,,duly ..(»,e»d,n a non.W..pprcnclC<.h,0 Rw(»n repnrnd Mttn . St.,. .pp»nttca.MP .pl„Y ,e,.(n eed D, tM Burr.0 of App»nlice.hip .Ad T»4nta( Vn11W Saba Dp+ttmerll of L.mr,uv it n0 WDvh..Vlr<d.p"e9<.Mle 1,.S,.te .rc r<Rlabrcd v,tb N.aorrw of APr»wcaaMP.Id T»font., United SMM.Mv.rtmrm a(L.M, IA Thn' »�. WHERE FRINGE L.NF.FITS ARE PAID TO APPROVFD PLANS. FUNDS.OR PROGRAMS In.ddl!mn t„th.b...r hourly w.A.ui<x Pnd<e e.,b Mbon,1,m«hmm lubd m the.Dove re(ercnced =41. pgmem.e(Ili.V 6en.ht. I. 4'..d 1h lM rehnbcr h..r been or vat be..it.M aPp»Pri.0 prvyam. I.,U,MnnLt IT hn,fi.mpto..... I.<.pt.a nalyd m 6ecu0n Ilel Delov A lit RF FRINGE BENEFITS ARE PAID IN CAST} E.,% tad+n•, 0,n.chm:c Ifa,.d m U. llw.<-(.none"P.iroll hilt Dean p.W.1 iIa".t.d on the P.vroO. .mo»m n*t MN IMn the mm of 1A..PC MC.bl<Nem hoo),v.(<rate p10.III.movm of vh<"'P"I d I'l-0 IvneOq at paled m rhn C,mearl. ,l,",o rto,ed m ucli"n J4')Mlov I w. FPTIONS (YfEPTIo"(CArF}I 11VLAMATI0M L� tyrhne Mrt: tfiorth, Payroll .Clerk i • • • 7AI-STATE CONSIRUCTIOb. INC. • 959 IQSTH AVENUE N-E. BELLEVUE, wm NINCTON • PERIOD ENDTN4 08/2F; 95 FORM WH-347 REPCRT "!a JOB NO 05413 PAYRCLL NO 1985 CBD SEWE.4 TRUNF REPLAC= !: S T08'N/SHA*TUCK AVE e • RENTON, WA. �iWNI CONTRACT NO CAO 048-35 • • y, ,� N1�.1RS Wi KEQ • NAMF, AIIURE66 ANI, - �� 7 /f GAY"">A J'�3 yyy ij TOTAL GROSS RATE JF FICA W;H STATE S. b I. OTHER TOTAL LZISSN OF OBEFmPRtIYEE 1 2 3 4 5 6 Y HOURS NAPES PAY TAX IIEDVCT • ELZIC. ROBERT 4 C 4 O . 0 2. 0 4, 0 0 0 I4. 0 253, 26 IR 09 63, 48 3 64 100, 66 • 20707 MAPLE VALLEY r.0 SE 0 . 0 0 2 0 . 0 , 0 . 0 2. 0 54. 27 MAPLE VALLEY, WA fir;6__.____-_. _..._-_ ..__ JO ": 54 00 11 45 • 4. 0 4 0 O 4 0 4. 0 0 0 14. 0 NET PAY 06 3.' • 535-26-8564 olZ UPATION MECHANIC ( '0-0460 6 5625) 2 - -- ------- --------- ----- • 631pN, JtM E. a 0 g. 0 . 0 g 0 0 O 74. 0 439 76 17 44 99. 84 5 73 137 O` • MUA LTEL `3SION VIEW f 0 G 0 0 0 . 0 0 26 24 -- MUKILTEL, 'A 98275 _____._ -. ,71 49 00 OC • O O 8. 0 NET PAY ace R- • 90 c o ,:so 5'•" 'it 'a5 + '' j AT I6N TkU K 0k11E6 1130-0730) WIE67. <.`ERH276 2 5 8. 0 1 0 1 0 8. 0 0 . 0 40. 0 199. 60 17 49 195 49 11, 01 26q. ti9 12634 S E 276TH PLACE 2 5 0 1 5 1. 9 2 0 O 0 7 g 396 76 0 KENT, WA 96Q31 l 0- 0_.__9 5--4___5 l 0 o. _._ QC' ,.7 • 0 0 0 4 7 5 '- Co GCi 53g-26-0059 p'.-UPATION TRUCK DRIVEN t720--02J0� NET PAY 626 6 • • HIRST L.YLE 0, O 0 0 g 0 9 0 0 0 lb 0 298 00 745 00 58 22 3 Tl 102.. 94 PT 2 BOX 47S 0 0 0 0 . 0 0 O 0 00 • •.ONROE. WA ?8"".' ._____..O O _0__ tl B. 0 0 16 0 00 ;,1 00 20 0C • 'i • 538-44-6Si7 � ,.!f AT ION. GSUPERVISORR 440 NET RAY ------------- 11213 Q1/ANE p 9. 0 1. 0 3 0 g 0 1, 0 . 0 . 0 40 O 215 19 15. 94 174 76 11. 35 307 aes • 13213 127 AVENUE N. E. 2 0 1. 0 3 0 2. 0 1. 0 O 0 9 O 215, 14 00 K[PkIANO WA C8'.".33 _...._. . __ t)% 00 __ .. 61 pq • 19 O 9 I 13 O 30 co 9 Cl 0 -0 44 O NET PA'. 545 ;. •1+01-64--5-'53 7.:;.'..)PAT'IOK F'I('ELAVE'A FOREMAN 440 . • -- DE - JAY 0 g 0 Q 0 WO 8. 0 0 0 24 0 426. 96 17 79 g7. 78 6 05 14T. 46 •6624 343 PLACE S W 3. 0 Q 0 1 0 . G 0 0 2. 0 93 3g vNNWO^D WA. 4803- 90 G _0 9...._ _0 3_. __ -.._. G 26 O 00 34 00') 00 14 5B • 0 U •a rY 3g 4G d iC0 CC�-. AT ION r1PERATOR GROUP I3i t) NET PAY 332 kit ------------------- • • • 0,4i • • • • • i�Y� • TRI-STATE CONSTRUCTION, tNC- • 959 1GSTH AVENUE N. E. BELLEVUE, WASHINGTON • PFR;OD ENDING 08/28/8, FORM WH--347 REPORT • JOB NO. L1546 PAYROLL NO 40, 1985 CBC SEWER TRUNK REPLACE • S TOBIN/SHATTIICK AVE S. • FENTON, WA. " CONTRACT NO CAG 048-85 • • / 1.7 HOURS WORKEF' _, NAME, ADDRESS AN1 1 ,2 °>r DA�4 $ OF EMPLOYEE 1 53 �� ".,-TOTAL GROSS RATE OF FICA W/H STATE S D. I OTHER TOTAL NEWELL, JR. , W •. 3 5 6 7 HOURS WAGES PAY TAX• . FRANK 80 8. 0 8 O 8. 0 8 0 0 O 40. 0 685, 20 17. 13 184. 37 10- 19 DEDUCT 5711 SOUTH 129, 012 1 0 . 0 1. 5 1. 5 O G 0 4. 0 t02. 76 288. 31 . SEATTLE, W4 9g178 ___..___ - 00 59 59 ---..... --------- 00 _ 33, 00 • 9. 0 8. 0 9 5 9 5 8. U 0 0 44. 3 • 533-28-364+ OCCUPATION 866 OILER 302 NET PAY 499 67 --------------- �_�__ 0 0 r NOREE, DAVID F ___________ ____________.____.___ 0 0 0 8. 0 1 44 17. 43 32 36 2. 00 52. 34 14716 - 24 AVE N W. 2. 0 0.- 0 0 0 0 . 0 1. 0 26 2b 19 • SEATTL.E• WA 99177 _. __._._..----- ------.-------------- 11 50 UO 6 48 00 . 025 4-1 J52,4 ', n 0 0 0 9. p i,C'CUFAT I,] u SERVICE OILER (57C-5765/ NE' P?i' 113. 25 BUSBY. MItIE F .._ __________.__.___ __. _-....___. 8 0 8. 0 e 0 B. O 8 0 0 0 40. 0 711 60 17. 79 10 19 A Y287 4`.- BC23 -- 372 PLACE S. E 1. 0 5 1. 0 1. 0 5 0 0 4 0 t06 75 186 97 • SNOOUALMIE WA 92065 - -.-. ___ ._-- 00 57 67 • 9 U 0 5 9 � 9 0 8 5 O 0 44 O 00 33 00 537-44-36Je OCCUPATION BACKHOE. OP,.RATOR 30Z NE', PA, 530 90 • . . -- _____________ ------------- ------- W 16 LT', TERRY L, 8 0 8. 0 8. 0 8 0 8, 0 0 0 40. 0 617 60 15. 44 _.__._._._________9_8s�____- 1105 MAPLE 1, 5 0 123 09 <'..i_ 65 • 5 . O . :a 0 0 2 ^ 57. 90 EVF.RETL WA ?82)l __ _..._._ _ - 00 . -----_..._- 47 6P Oo • 9 5 B J 8 0 8 U H 5 0 C= 42 5 53. 13 533-�64-1693 Uf;CLrPAT ION. PIPEt AYER GROUP 3 NET oAt' ..;, ;-, • 0- JENSON. GARY 8. 5 16 0 . O 16 0 247. 15 44 60. 04 3. 86 103 84 5 33709 PLAZA ROAD 0 U � 9 5 0 O 1 C 23 36 �' • DLACK CIAMOND. WA. 990t-- • • .._. _.-. ._-. 13 N O 0 8 5 a ? 20. 81 O 0 0 00 5"-70 - 035 - f7CC UPAT ION F:PFLAVER 44C � NET PAV le.b 36 50_.______ __ . • R08ERTS, JERRV - __.____ __ _____ 0.. ._.: _ ___. 8 O 0 1b 0 37. 0 0 0 44 0 769 96 17. 49 122_i6_-._ l0. I4 18b. 40 P. 13 BOX 773 0 . 0 . O . 0 O O 0 O . 00 SILTAN. WA 98244 -- -.. _ . 94 29 00 • 8. 0 8. 0 O 16 0 12 0 0 0 44 0 cn • �39--3b 4178 .. CUPATION. N/U TRUCK 7 TRAILER ORR NET pF,,; 582 --___ -__._..._ __ --.____,_-______ • • • • • • • TRI—STATE CONSTRUCTION, INC • 939 IOB1H AVENUE N. E. PERIOD ENDING 08!26/85 BELLEVUE, WASHINGTON • • JOB NO. 0548FORM REPORT 1785 CBD SEWER TRUNK REPLACE PA1RJt ` NO S. TOBINISHATTUCK. AVE B. - • • RENTON, WA. Nti�p CONTRACT NO. CAG 048-85 • • HOURS W KED , y.y NAME. ADDRESS AND '�i C+� Fl e DA �/� c�y ��-- ''• SSN OF EMf"�OYEE �+ s3 %yl, +� TOTAL GROSS RATE CF FICA WYH1 3 4 3 6 7 HOURS WAGES PAY TAX STATE S. D I OTHER DEDUCT .• 3817 EVA TON 8. 0 4�0 0 _ Q . 0 12. 0 185. 28 15 44 T22. 02 OE5UCT SEAT LE, WA N , c3Q4 O 0 0 O O _0_ 0 O 00 2 78 52 86 •$EATtLE, WA 981U3 --- _ • 8 0 4. 0 . O 0 e 0 0 12 0 _ 00 - ----52-4015 OCCUPATION. Picc 13. 06 00 to QO YrfNwa --` L ---- 440 NET PAY 32 41 • • PERRY ROiIERT -._______ __._ __.___.._____________.______.__ 8 O 3. 0 0 0 q 3. 01- 12NR WA, 9 S E . O 0 U 0 . 0 _ O 0 13 0 194 48 /,/,8. ? 23 77 MONROE, WA. 98272 . AO iyl,PG 40 a9 • O U 0 0 ) 0 13 U r)r O 531 82-6739 OCCUPATION LABCRER 0 NET FAV 153 "' • NOBLE PAUL A 8. 0 8. 0 8 0 8. 0 8. 0 O 0 40 0 950 00 950. 00�8406 ATT 69TH PLACE N. E 0 0 0 0 0 0 O 181. 46 1. 44 _ ---849 6r.: • SEA7TLE. WA. 98 00 ..�8 - 0 • ..._ 66 90 8. L 8 0 R. O 8 0 8 G C 0 40 0 0.? ub ^_ 516 3 —9R&3 OCCUPATION ESTIMATOR NET PAY ' 'UO • -: • • TOTALS COP — ..____. .. __..._._..___._—___. :... O JOB. 0348 ___. _._________._ _ 411. 0 7235. 38 1620. 87 • 34. 0 862 58 9�. OS 2561 00 • __.._.___44j 000 570 Be 00 2-4 Po NET PAY 5536. , ... • • • t Ueteby certify that the payroll IS correct and complete • and thz viz a rates contained herein We net less than the appreciable rate eontaine•. in the wale determination • • deei;@n of the Secretary of Lat:or as staled in th_CO draCt Provisions and the work i;.:rforried by such laborer or mechanic conforms to the classifications set forth in said • • Provisions applicable to the wage rate pSid. • G� ,.z7t • u�ai..r.....wr...aR STATEMENT OF COMPLIANCE P.s,nn &rJP-.Anna. No..bRtO% r,n AuO. 21 1985 I Arlene Whitworth payroll Clerk %roam.a a..•n �.-rr� eo nenby Ares: to m that 1._.. �p'py°'a/pe•°�ee 1I It"'�mtnr of be Immune..,I....byTri�..Construction, In,_ nv Ji i_ftu.4. tnu aunne me pty.ou Denod c .enanp on me,uyy pion , of A,+q• vQ$ and enarne 112, Qar of Aug. 1985 . at persona employed an said prone have been paid the IWI weekly vase...med. the,no Itbate.h..e been or will be made either drnctlY or i.dirtelly in or on behalf of..,it Tri— S tate Construction, Inca ( wn te.l from:ht full w<kIY wegw gamed by enY Peen....it the,no deductions h.,,.peen made either dinclly.1 ed,la,11, Lom the full--I'-nmrd by any",son, "he'then Per"I.iblt deduction.A.defined n Reeubtmn.. Pan 3(29 CFR Subtitle A), uaued by the Se "" of Labof under the Copeland Act, n amended (AS Star 948 63 Star 108- 12 SW 96t.76 St., 357:40 U S C 1176c)• and de.c abed below: Withholding 6 FICA Taxes ±m_M a: pension (4) (2) Th., any 0e11111.-the"..under thi. ,oatliil required to be the the w... rue.for laborer.or nechanlea bnbinad r,herem are ter leas theultidn t the eppl¢.b period m co act andN Ian• to— ItlermmuA a ierpon4d into the aontnct• that the c I&ez,f3car Iona set forth them.for each labors,o mmh.nm< e than ettn,rot what rot pedonnea r o Litill ,St.an. pm.t",,.h, e'9'-Yd.m he red b fie nod ve Juh 19111m it in.ban.tide aPOnm¢eahtp p,opam m%I.tercd . Sne< pp.enneeahr0 .Ser,[Y ecoRniaed by the Bureau of A Lebor,m If no such nco6ni"d n8enby e.pta in a State.arc rc .grcnh theM1 iD end Tv ln,np, Unned ante.DepaNm nit pf Ste..Definition.,of Labor ee<nd with the a.m..of Apprcnrirexhip and TreiN.L United (A) The: (0) III•XE FRINGE BENEFITS ARE PnID TO APPROVED PLANS, FUNDS. OR PROGRAMS '} edn-.,,n e. 'he balm hourly wage r.,es paid ro each Iehon,or meohanrc L.:e l in,he above rcfennced pay roll. Payments of Irin[e benefits ea listed in the ....rear have been or will be made tD eppropn...prop.m In,1%.benefit of such emploree., -1-ld ..noted in S<dlon Ale)below (b) R'HERE FRINGE BENEFITS ARP PAID IN CASH EacF Lebnn ce mechen,c IunJ in the dove rn fercnetd payroll Ma been peJ a mJmeed on the D0m1l. um nut I.sn than the sum p! he aPDlinble bona hturlr wage rare plus the nmtanr of therpmnd(,in" bene(NS o LarW m tMr omtncr. eectpt As noted,n aecllon A[c)below al EXCEPTIONS FAC6PTION(CRAFT) — FRPLAXATIpN rte.•,w.a .I. u I L Arlene Whittnrorth, Payroll Clerk •..E ,_n,� ,., .. �ooe�.cao.•,.:ry _t_.� �wenrz.. oe.>.��e�Tt..ci . ..,�.`ea[>w:roe...antes-•o.:. weN q,m lX•)4 r,ral evacwu[*,.n n.a.awe e..e raga T.,A v•..Da eecwwn 0 ' , • • TAI-STATE CONSTRUCTION, IfwC • �. 959 IOBIH AVENUE N. E I�YMd WA LEVUE. M 109TON 4��G =FIOD ENDIN0 08l21 l89 FORM tMi-347 REPORT • JOB NO' U--;j PAYROLL NO +S !9B5 COD SEWER TRUNK REPLACE 5. TOBIN/SHATTVCM AVE S PENTON, WA CONTRACT NU CA6 048-85 �/ h�(� �� • w NAME: AADHE98 AND y� 4. f ft'"l+f"//rr 6,`7 f�F TOTAL CROSS RATE OF PTCA W/H STATE S. D i OTHER TOTAL • SSN OF EMPLOYEE t 3 4 5 e 7 HOURS WAGES PAY TAX DEDUCT £ 2 LZIG. ROBERT O ^0 4 0 4 0 4 0 0 I? O 217 06 18 OY 68. 52 3. 88 137 6C 20707 MAPLE VALLEY RD BE O O 0 1 5 1 0 1 4 0 4. 0 100 54 • KAPLE VALLEY. WA. 98038.._---_---_.-------------------------------- 04 22. 84 . 00 12 76 - 0 . 0 4 0 5 5 5. 0 1 5 0 16 0 NET PAY- 217, 82 535-26-8564 OCGUPAI ION MECHANI. (570-0460 6 5625r • ______-______._-__-._-_-__-__-_.-____-_-___._-_-._-_ .-___..-__-_-_.___-__.-_____'_____'___-_____ .__.---_._--___--___.___..--.----__.____.__-...,.._.__._-.. HANSEN, JIM E 8 0 0 0 0 O O 4 8 0 139 92 1 43 24 73 1 79 36 40 6Jl i-JHSESSION VIEW 0 0 O O 0 0 0 . 0 00• MUN!LTEO. WA 99275 __----- . ______.-.. ------------------- 00 9 89 00 00 8 0 U 0 0 . 0 . 0 0 8 0 NET PAY. 103 52 539-36-9933 OCCUPATION TRIICt( DRIVER (110-0230) WIEST GLRHERII O O 0 0 0. 0 H O 0 O 0 C 40 0 699 h0 17 4a 165 1� 12634 S E 2761H PLACE 4 0 0 0 0 0 0 0 4 0 104. 94 • WENT, WA. 98031 --__--__ -_._-_-._ ____-__.__________,__--- 00 $6 72 . 00 00 12, 0 8, 0 8. 0 8, 0 8. 0 0 0 44 O NET F4V $7`.. 44 $39-26—("9 ^rrL.p AT I ON TRUX'K DRIVER (730-'>23q/ AIRS' L,YLE D 8 O 9 0 8 0 H. 0 H. 0 0 G 40 C, 745 00 '45 J., 4' z4 Ji 4t RT, 2• BOX 47E O O O O 0 . 0 u 0 00 Mhti4• MONROE, WA 98272 ----------------------------- --...___,_.__.__ 00 52 $2 00 30. 00 8. O 8 0 H 0 8 0 H 0 0 0 40 0 NET PAY 497 -,7 5'37- 44-6877 OCCIMATION- SUPER,'I`CR 440 P OP TEN LARRV r 0 4 G 0 C U 4 0 /0 64 1) t 1344 PORTER STREET 0 G 0 O O . O 0 0 . oil - • ENUMCL.AW. WA. 98022 ________ _____-_-_____-___--__-_..___-_- 00 5 15 . 00 GO • 0 4 0 0 0 0 0 0 4 0 NET PAY' 4$ 4' :�..�. 531-44-h145 ;Yle"PATION trB 4(A, 4L.11M D�ANE I( 8 0 9 0 ,? is C 6 0 0 0 40 0 617 60 l`,,. 4: 143 Di lU ee r,64 11$13 -- 197 AVENUE N, E 6 0 . O . O 0 . 0 D 0 6.0 138.96 . • HIRILLANO. WA 98033 _____-_-_._-___._____.__.___._._--------------- 00 33 34 . 00 S7 30 14, 0 8. 0 8, 0 8 O 8 0 O 0 46 0 NET PAY 492, 0'5 501-64--8753 DCCtIPAT ILN PIPE-AVER 440 • • • TRI-STATE Q.ASTRUCTION, INC. 959 10@TH AIENUE N. E • BELLEVUE %*GHlNGTON PERIOD ENDING: 08/21/65 FORM WH-347 REPORT WNNN JOB ;NO: 0549 PAYROLL NO: 0S • 1985 CSD SEWER TRUNK REPLACE. • S TOBIN/SHATTUCK AVE S RENTON, WA CONTRACT NO: CAB 048-85 • • 00d0 NAME, ADDRESS AND �� WJKE ,{ • SSN OF EMPLOYEE g '�?e "'� 7 `�d TOTAL GROSS RATE OF FICA W/H STATE S G OTHER TOTAL 1 2 3 4 5 6 7 HOURS WAGES PAY TAX DEGUC7 �N� DE ,SOMA. JAY G 8 0 8 0 B C 8 0 S O 0 0 40 0 711 b0 17 79 6624 - 163 PLACE S. W ^ 0 . 0 .0 5 , 0 0 . 5 - 1160 120 74 9 .38 211. 61 • • LYNNWOOO, WA. 90037 _______________._________.________________ 00 51 13 _. . . - 8 0 e. 0 8. 0 8. 0 e. 5 0 . 0 40. 5 . 00 30. 38 538-40-3300 OCCUPATION OPERATOR GROUP 13!1) NET PAY: 513. 33 • • ______--__________ __-_.__.-. -..__ NEWELL, JR. . ..W. FRANK @. 0 8. O 8. 0 S. 0 8 'T C 0 40 0 685 20 17 13 170 55 -_ _-----_ 9-73 263 71 •PIN; 5711 SOUTH 1a9, N12 2 0 O O G O U 0 2 0 31 39 • SEATTLE, WA. 98178 l-_____...-__-_-. .____...._______ __-____-_ DO 51 93 10. 0 8 0 8. 0 e. 0 e. 0 0 0 42. 0 00 31, 50 533-20-3694 OCCUPATION B66 OILER -102 NET PAY 472. Be • DAV10 F 0 8 0 0 13 0 ) 0 0 8. 0 9 44 43 ,9 • 19716 24 AVE. N. W . 0 2. 0 5Z Z4 So • SEATTLE, WA. 96177 ----0--x0-------0-----O-----0 O 10-0_ 00 12 81 00 7. 72 . SE U25-44-3564 OCCUPATION SERVICE OILER (570-t76y) NET PAX 128. 26 11 MIKE F -- - 52 8 0 8 0 8 0 8 0 9 0 U 0 40. 0 711 7 S 1 01 9 36 :7a=. SF •MI�Yk 602:e 372 PLACES. E J4. O O O O 5 O 0 9 13. 34 ' SNMkML.MIE. WA 98065 -____..._.________....__.__._ 1 ..... __ 00 51 1t 00 0. 0 8. 0 8. O 9. O 8 5 0 0 40. 5 30. 38 537-44-3638 OCCUPATION BACKHOE OFERAT 307 NET PAY 482 Oti WEIGEL.T. TERRY F 0 8 0 8. 1 8. 0 S. ) 0 0 40. 0 617 60 1 44 12 3105 MAPLE 6 ar , n, 3. O O G O 0v U ,i. O 69 46 • EVERETT, WA. 98201 -__._.._______..._.____..____.________________ 00 48. 44 11. 0 6. 0 8. O 8. 0 8 0 0 0 43. 0 DO 53, 75 533-64-1693 OCCUPATION PIPELAYER GROUP 3 NET PAY 448. 51 • tiAFiP If AN. M1KE __. .._._.... . _..._._ ._ _ U D 0 8 0 _ n c :) " . P 41 WA. Ig 12304 - 5 AVE. SO U J 0 0 0 1 278 SS 1 43 .38 63 8 3 . 0 . p . 5 13. C7 • EVERETt. WA 98204 --- ____.______,_.__ _ . Q ..- O _-__ - . f 8. 0 8. 5 U___ 00 20 58 O 165 - 00 12 38 5,39-66-278S OCCUPATION. OPERATuR 30m NET PAY: 216. 54 • • • N�N� • • • • NYNG - • • TRI-STATE CONSTRUCTION, INC. • • 959 108TH AVENUE N. E pYYM BELLEV(,+., WASHINGTON a uu PERIOD ENDING: 00/21/85 FORM WH347 REPORT • • JOB NO. 0548 PAYROLL NO: 1985 CBD SEWER TRUNK REPLACE 5 TOBIN,SHATTUCK AVE S RENT3N, WA • CONTRACT NO: CAG 048-85 • / 5 KED. �r1w NAME, ADDRESS AND FIq flJo !/y* DA'r ,,J- Ntt 1I7 'Y/8 TOTAL GrOSS RATE OF FICA W/H STATE S O. 1. OTHER TO TA:_ fill • SSN OF EMPLOYEE 1 2 3 4 b . WF HOURS GES PAY TAX L'L I'.- • JENSON: 6ARY 8. 0 8 C B. 0 B 0 _ C - 0 40 0 617. 60 15. 44 145 54 33705 PLAZA ROAD 3. 0 O O 0 0 O . 0 3. 0 69. 48 BLACK DIAMOND, WA. 9801----------------------------------------- . 00 48 44 00 53. 75 • 11. 0 8. 0 e. 0 B. 0 8. 0 0 0 43. O NET PAY: A29, 34 535-70-7035 OCCUPATION PIPELAYER 440 • ROBERTS. JERRY 8 0 8 0 8 0 8. 0 4. 5 0 0 36 5 638. 39 17.49 90 !0 8. 57 :44. 60 • P O. BOX 773 0 . 0 . 0 . 5 . 0 0 . 0 5 13, 12 - � �• SULTAN, WA 98294 _ -_____-___-____.._____...____________.__ 00 45. 93 . 00 . 00 • B O 8. 0 8, C S. 5 4. 5 0 . 0 37. 0 NET PAY. 506, 91 • 539-36-917S OCCUPATION N/U TRUCK A TRAILER OPR NOBLE, FAOL A 6 0 8. 0 B 0 8 0 e J 0 C 40. 0 97 00 950 00 181 46 f 34 241 i HJ 18406 - 00TH PLACE N. E . 0 . 0 . 0 O 0 0 0 0 00 SEATTLE, WA 98155 ___._ _ _ __.,....._._._ .__._.___.__-- . 00 66. 98 . 00 . 00 • • 8. 0 8. 0 8 0 B O S. 0 0 0 40. 0 NET PAY: 700 !? 516-3?-91B63 OCCUPATION. ESTIMATOR • TOTALS FOR JOB. 0548 -_ 444 5 7940. 1.� 1627 10 10i zw 2_6-, 13 ab6 0 647, 95 00 598. 79 . 00 339. 92 • 470 5 "JET PAY'. 5820. 97 • • 1 hereby eeriiW that the pc aoll is correct and complete and& , atei CGntSin_d herein are not less than the apvc,mble rate cent:mc+ in the wage determination • • dEc!-';nof the$CVE'-'�• 'Labor as sleted in the CC-Araet Provisions and the wcrk . riomred by ELai such laborer or mechanic conforms to the classifications set forth In said • provisions applicable tothe wage ratepaid. uexic.u��vYmi MY ROLL OWuu M hw �O w v WK SM EMT WNJd)MJ MM Vr ti YIIAI 4r1 V mM�uLYM G�ML'1? VIML � 'a MIw�O��yp1 rY� re w Meln.o ,..\ aw �w Mrs nr 'V 1.5 4 4 I If 3`i - ii/ti /j Y i ZS 1 5 i140. j l 1.' 6dL. - •M � 1 I MIRII wu��iui_r.w Ll p Iw./NRtl r MIS IMM WREMY INpI M MMI. q�'NN(MY$ \ \ � . , ! � ! || | }|!| § § ; fill 4 . ' /! R 2 ) ] §\ a2 ! 2 | `|f I!'% � IljIR \ „� j /\ \\ ) \ ~© | / 22 lit psi §d [5 EenA Aw•r..o u.x OE..RT.(N*Or.gQq STATEMENT OF COMPLIANCE R.d..rar.A.N. E.R.091 weaf•.o....ya...O. D,te Aug. 21, 1985 l Arlene Wh ittRo rth Payroll Clerk do he.. ....E: 'l, "' ° F (Tii-State Constrction, Inc.Trio,Trio,(I I T I Pay the Da'Yment of rh<per[on•employed h u Y�.ATirai es, .]e mq ,he � �f mat during The p.,r U p.nna vommec-ing airs me_15.thY ct Aug. n -]t� m ISU end eA..A,thi.—qay of AUge IS85. .11 P....A, TAPI.Yed on said Project have been paid the full weekly ..V.e.rtrcd, the'AT rebates bave ben or will be m.de either directly., ..&I"tly In or on behalf nl+.,d rT i- State Co:latrvetion, Inc. Iwm he full...Rly wages earned by any parson and that.w deduction.hv.e f .e . .......r) been toads,either directly or indirectly!torn the full wages e4med by any person, other than permissible deductions a]defined ,A Regulation). Pan 3(2q CFR Subtitle A). issued by the Secmta,y of Labe, uncle,,the C.pEt.nd All. as.mended (48 Star Oi g 61 Slat Joe. Sta+ %7;76 Slat W. 40 U S C 2761), and described below: Withholding & FICA Taxes M,Pairtsl Aid & Supplemental Pension (2) That by D.ynall+.thnwne uMer this eomeer. r".,,Ed.A As.uAno,N,,d for the ahoy Period are ate. , it mpl.ley ,he, ..,.Area fo,l.borcAor me<Mnic.con,sined Ihem,A.•e nit,lee.than the applicable wits. n wage P,em.A.t An 1A,Aonu.,ed into the contra,, in., ,he cbxaf.uuona a.. brio therein In'each Iaborcr or mecNmC con form.,to the walk he De rormed (1) That any•pph nnns employed In the above Perlud are duly .........d in.bona fide appn.ttcrahip prsAn registered with a Slate .pprenti,eship agency r c......d by the Notes.i Ala A At pdDrcrm the Bored f...n.ng.1 Uex l Bed Tr mmp Unitter ed Laboge..f An such recognized agency assets in•Sr.A, are A w. ,,re^ States Dapanment of Latour. tat That: t.) MIIERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS ( In add.Lan,o the has„hourly we,,ales paid m each laborer as,mocha:I Mitred A the abuve rr IA,r.c1d P•Y- N,B. p.,,A,, of fit.,, benefit. as listed in .he contract have been or.,It be made m eppmpn...Atug,am. I., he benefit.(such emDlaYeta, --'All as noted m Section 4(c)below (b) WBER£FRINGE:BENEFITS ARE.PAID IN CAS14 Eseh Lebo,,o .,be.,, lsted m the awve mfe.rneed P.YAll he. been pain as indicated on the Payroll, out less then.hex of the.PPlle.ble basic hourly wage rate plus the amount of the required frin Ee ben,!_a+1.E,E4 m.he cnnipect, es,",as noted to section a(1)below FXC EI'VOIS E XCEFTION(CRAFT) EXPLANATION • • n _e Ar. P6Ne.�nf -Es� Arlenea Whitworth, Payroll Clerk — r�, _ _ l+.r,C•. :•r • : ♦CE I[]oa:[TLE T,u O&CCT1<• 3'or , ••.1 1.r J' .[ 5 Cyr'_ Ce u,Nxl [e_t[C- :`.u>B EaSECTION 1CDi r TITLE . •v0 E<E�ON a . Oi a r,[]�O[ T q.m Wf.;M,.nu r_q+a.E+NA rpwaE ton]': �+ roar +NE f.1E,oe.0Cw[.Y. TRI-STATE C'I94STRUCTION: I"1[ u� 959 1081H AVENUE N E. �YYr BELLEVUE, WASHINGTON YII@Y PERIOD ENDING 08/21/85 FORM WN-347 REPORT JOB NO. 0546 PAYROLL NO. 41. - 1985 COD SEWER TRUNK REPLACE S TOBIN/SHATTUCK AVE S RENTON, WA. ' CONTRACT NO. CA& 048-85 HOURS WORKED NAME ADDRESS AND DAY�� F�,. d� j��' TOTAL GROSS RATE OF FICA W/H STATE S. D 1. OTHER TOTAL SSN OF EMPLOYEE 1r 2 �3 4r# �` - 16 7 HOURS WAGES PAY TAX DEOUC, • CL.710. PORERT 0 0 4 ? 4 0 4 0 0 O 12. 0 217. 08 IB 09 68 52 3. 85 107 00 d07O7 MAPLE VALLla RQ ,E 0 Q i. 5 1 0 5 . 0. 4..0. IDS. 54 MAPLE VALLEY, WA 98038•___.------ .. ___.-___ ------------ 0O 2;t. S4 00 12. 56 0 0 4 0 5 5 5 0 1 5 0 16 0 NET PAY. :217 S2 535-26-8564 OCCUPATION. MECHANIC (570-0460 & 5625) .. . -.____... _ ____ _-_.....___.________.____. .___.._______ , _. .___._e. _.-._... ..___... ..__... __.. :iANSEN ,_IM Z 8. 0 0 0 0 0 - 0 . 0 8 0 139, 92 17. 49 24. 73 1. 78 36 40 E.31. POSSESSION VIEW . 0 - O . 0 0 0 .0 .Q O. . OQ "RIKILTEO, WA 98275 ----------------- . 00 9 89 DO 00 8 0 0 0 0 0 0 0 8. 0 NET PAY. 103 52. 53li-3,9S33 OCCUPATI^N TRUCK DRIVER (730'-:`,r 'h'f E"fl :AHERO n U o G ^,.. 0 8 0 0 C, 4C 0 69Y ',O 17. 49 164 1P 1l' i" ':?t lU 12634 `'. E 276TH PLACE 4 J 0 .. L _ C 0 4 0 134 94 KENT, WA. 980Ji ----__. _.___ .__. _ . ...__._.-.___.____.._ . DO 56. 72 00 OU 12, 0 8 0 8 0 8 (' l (1 0 44 O NF.T '.'r,v 'S 7:: 44 538-26-0059 OCCUPATION.' TRUCK DRIV1,A : 130-0230) ,IIPST f 'r1.E :1 8 Cl, /? E C, S 0 4i; i, 745 00 745 00 14•. ..-+ nT �^,, t3�x v7F 0 0 _ . 0 0 0 . O 0 _ 00 -.. MONR:3F WA 9827C _. __. -------- 00-.__..._,. __ ._...._ 00 52 5?' JO 8. 0 8 0 8 0 9 0 O 0 O 40. ) NE: Win'• 4t,_. _ 9fia 44--k:e77 OCCUFArit7N: SUPt:RV1�,QR 440 0 G 0 C C 0 00 _.. __. _. . __. ....._..._. _ 00 5 l5 •)0 0 4. 0 O 0 0 0 . O 4 O NET : A.+'•;. 514H OCCUPATION: Lib 730-0720/2--9/GROUP 4(A) a -( - ,3 ._k. .. -0 0 4G {^_ t' 7 E,t' ._ 15 44 h \._-_ 1t2 _,_! AVFNy A- N E 6. J 0 0 0, (I 0 t. S 138. 9b KTRKLaN;O, rA. 9J,"23 __.._._._----- -- .. ___- . ._- ---------- 00 53. 34 Ord Sr 7W 14, 0 8. 0 8 0 S. D P 0�� 0 . 046. 0 NE1 PAY 4S'2 1) 5'01-l.4-8753 OCCUPATION PIPF_L_AYER 440 N it 1RI-S1ATE CONSTRUCTION. INC . 959 106TH AVENUE N. E BELLEVUE, WASHINCTON yl ljr PERIOD ENDING. 08/21/85 FORM WH-347 REPORT _ • JOB N0. 0548 PAYROLL NO. 0;5 1985 CBD SEWER TRUNK REPLACE S. TOBIN/SHATT'JCK AVE RENTON• WA • CONTRACT NO. CAG 049395 • � HOS NAME. ADDRESS AND 6�? i1 'i/]tURDAY4:f E/,' -ei7 ' /,j TOTAL GROSS RATE OF FICA W/H STATE S. D I. OTHER TOTAL �•� SSN OF EMPLOYEE 1 2 3 4 5 6 HOURS WAGES PAY TAX DEDUC:' . DE NOMA, JAY G. 8 0 8. 0 8 0 8. 0 8. 0 0 0 40 0 711. 60 17 79 120 -74 9 30 211 61 6624 - I63 PLACE S. W. C ✓ . 0 0 - 5 '' . V . 5 1A. 34 LYNNWOOD WA. 98037 ________._.__.._--_____-_-..______._--_______ . 00 51 1i 00 30 98 8. 0 e O pa 8. 0 8. 5 0 . 0 40. 5 NET PAY 513. 33 030-40-3300 OCCUPATION OPERATOR GROUP 13(1) NEWE.a JR sa . kN'J4 a. 0 c1 J 8 C, B 0 8. 0 0 C, 40 0 685.. 20 ,.+ 170 55 v -:'3 !,'? 71 ►�fik 5711 SOUTH 1:9, M12 2 0 O 0 G 0 0 0 2. 0 51 39 SEATTLE, WA. 98178 --------.------------------------------- 00 51 93 00 31 50 10. O £ 0 8. C 8.. 0 8 J t5 4c! O NET PAY 47.. 88 533-28-3b44 OC'.:JPATION. 8436 OILER 302 'INGF. ,.. CAVID " 0 O 0 0 0 0 O 0 & 0 139, 44 1 ' 43 3q 96 _' 38 6-, 4' S'EATT,.F, WA 991'> -_._.. ..__.__________.,_________ 00 13 8t 00 7, 72 0 t0 0 0 0 0 0 0 t0 0 NET PAY 125 26 325-44-3564 OCCi1PATION: SERVICE. OILER t570-57P51 FUSSY. MIKE '- a 8. 0 e 0 8 0 H Q 0 0 40 0 711. 60 1➢ 79 152 O1 9 3r 242 Be :7'2 PLACI, 9 E: O -' . 0 O 5 C' 0 . 5 1? 74 ;N00i ALMi F. WA. 98n6^. __ __ _ 00 51 it OL 350 38 B. 0 8. 0 8 0 a. 0 A. 5 0 . 0 40. 5 NEr PAY 48_ !, 527-44 J638 0CC11?AT7ON LACKHOE OPERATOR 30: 7F26 .' 8 :3. ,5 H L r 0 „ A 0 L1:' 60 15 44 42 _ IiOt, MAP.@ . 0 0 0 0 1.) 3 0 69 48 EPL 1. WA. iN:;'s'.. ._....- ..____._ 00 4£. 44 00 1 i. 0 B t! 8 0 8. 0 8. 0 . 0 0 43. 0 NET PAY 440 51 •La :5_0 t4...:v973 0f:C_YAIIJN. PAP"SLAYER GROUP 3 y4r♦I) 6 Be 4 , .3P 6:= ':..I:RE1Y WA v , 'or' _. .___._ _._..__ ._ _.__ .._...___. ._____.. 00 20 58 00 iR 38 0 0 0 Ia. 0 B. 5 0 16 5 NET PAY ?16 54 5C C:QVA,TON OPERATOR 302 i • • • TRI-STATE. CONSTRUC1101.. ;W 959 106TH AVENUE N. E. PERIOD ENDING. 08/21/03 FORM W1-347AREPORT •• • 40B NO, 0546 PAYROL.i. NO �,y' • 1985 C8D SEWER TRUNK REPLACE. 6 TOBIN/SHATTOCK AVE S. PENTON. WA. CONTRACT NO CAG 058-85 Y 8 WORKED Fr 3SN O AEMPLOf AND f�q Jl+ �7jI DA'M�� 1�� '.'�r/J TOTAL GR089 RATE Of Ff"P 4iJr4 S'A7L 7 li. �7(H[�t f+`k: • SSM OF EMPI_QYEF" 2 3 ,SOURS WAGES PA, 1At OE L•}i- i�,� 1ENSON, GARY' 8 0 8 0 S 0 6 7 8. 3 G O 0 61% 6� 15 44 145 S4 7 46 257 6<• • 3S?05 PLAZA. lOAU 3..0. 0. . 0 . 0. 0 . 0 _ s 0 69. 48 BLA+ 'K DIAMOND- WA. 9801-.-_.____-___----.,.—__---------------- -__ _ 00 46 44 00 53. 75 11. 0 8. 0 8 0 a 0 8.0 0 t. 43 0 NET PAYS 429 39 535-70-7035 OC.'ilPAT ION. PIPELAYER 440 1P F.OBERTS, .'ERR, 8 0 9 0 8 0 8 0 4 5 0 .'@ 5 �138 39 ;7 49 q0 /p • 0 BOX '73 0 G :] . 5 . t° 0 c "MAN. :,, 9@a 44 00 4t3 �3 r3' ._ 1;r� 0U 6 0 S r� ✓; G 8. S 4 5 U 0 37 J NET PAV- 54@ v; • 539-36--917E OCCUPATION M/'U TRUCE & TRAILER 3PR Lt�c PAIL. A _ c c '3 9 0 6 0 H O cr 40 t7 950 �3f, 7' ;ai 'H1 46 J4Of 60iH Pi E N E 1 C 1, ,;, �df •�: • !}t:A71L E. WA. 9815fi ____ ,.,__._,_._ 00 66 48 00 00 H l5 to 0 K. 0 8. 0 8 0 0 Q 40 0 • 516 _:-98t.3 OC C'JPA1 ION F:57IIM110R NETPAY . ,i :. 7�i41 r_ 1r. t 1'? . .1 ... .era' L7 • A •s' 1 herthv -N th:!t rhn -co is conaet and complete arry I'vem LK I---.,the.the 1+•. al !h- . _ .c`mmQb.un • do ;:asst: °r Ccdract •ire a_:; riwwf by e.a.sach Tabora orr _r-.uc contorrnstothe CluffiifiC&b"Od"011 in laid • Pmisions appl"bls to the!ua{e,"I"poid. :ILw UwACE aro OF LA" ai PAYROLL rr,,, wPfa..a (FK CoRtr•does Opww Uw,Sea Instruction, Form WM—U7 Inst.) 1MYF OI COrtTU1LlMLi4 imjmc IrRat'rM AD EW ��- M11rML rM rQR OrMMO � raa[cr Mt0 lOGT101r __.__ (n O� OI '� OaY NO Oat• T _��T- � ,. K' , ,:. K IAL MOIM•L alr0 60CIAt KCURrtY MVYaOr a ttA4rrv.A•TrM I am 1M4 Ml1• .rlr YnII4 er•� ow Or EYftp - MOIIM OI M1 PM O rOUa•rOIR1•wr F1Hr MKprp 1 WHO M O r I O i O roar wn-vr �vt+• .. r�arrav bE .a PURCHASE THIS FORM OIRECTLY FROM THE SUM OF DOCUMEMTS Date_!_- _____ to Arad nave Oven or will be made to appmpmte programs for the benaht or such xnployess,asi as noted In Section a(c)below. I' (TNNr - (b) WHERE FRINGE BENEFITS ARE PAID IN •SH Y,Nleh fun,. do hereby,stab: --Each laborer or marchanle Mated i, the oban hwforansd payroll has been pied. as Indicated on IN, payrdl, an amount non Mu than the sum of the Applicable basic (1)That'pay or superviea the payment of no parsons employed by noury wage to Pius the amount Of the moliued Imnge benefits o' IHted In the contort...,act•E noted m Section!(a)bek.. _. on i4uns.r w-weram.anor, tsatlaala«wso (c) EXCEPTIGNS .:that during the panWl pxtoo comrMmHing On Ne ' F7(CEPTWN ICRAfT1 ea EXPLANATION day of ` 19—_, and ending da____ y ol__.—_._—.19—� - — al, persons is,pioyad on Yid project have been pea the Nil weekly wag"worried.that no rabatea how,been or Will be made whiter directly or indirectly m or On behalf of few !ram the full _ ILarIrM••er ru.M W be y wag" earned by any paum,h and then n4 dedU iivis he.b"n made luthM dilK(IY OI Indlrocly from the full way"ssmed by any potion, Other than perm-"Ible deductions as defied In Regulations Pont 3 (79 CFR Subtitle A). Issued by the Secretary of labor under the Copoi Act.as i mxnud(e8 Scat 9e8,63 SIN. 108,72 Sbt.967 75 Stat. 357:b U.S.C.276c).and do Knbed b,lwr: aulAao (2) That �ny payrolls otnemse under the Uaitrac1 reculred to be submitted fa the ,MVe per" an c«rxt and compNte; that the wyo rat"for 4b"en or mectonlw contil rid nowsm are nut It.M m the applicable wawa rotes contained In any wege detxmlMlwn ueorponted Into the contract;th H the clnslfkatwna sal fond BNraln 1*1 each lebefer or mi channc conform win the work M pMa�fed. (3) That .ray appmrnLces omployed in the soon period xe oily ngletxed In a bona how apprenbceshIp program registerso with a Stab apprantk"hlp agar recognized by the Bureau of Apprxtrce3l p and Training,Umled Stiles Department of"bor,or If no such moognumd agents salsb in a State one registered with the Bureau:f Apprenticeship sol Training.United States Doped meat of labor. (4) That. Ec�—D nyu NOIMIYAE (a) W IERE FRINGE BENEFITS ARE PAID TO AN`OVED PUNS. FUNDS,OR %IOGNAMS Nc rKSUIUt10N pre .1 n1 THE AWK 7,�R YAw SVQICT THE COMT to--in ,dditlon tp the ba3le hourtY wagw nl" paid to waeM1 NbMar er rMCMme ANyllY.lox lO tlwll Ox GnYN4! MLeEI:Y eFE la,sted In the ebon nbreoced pwmotl, payments of Irmile teneflb as baled ran Be lei of TIME 31 OF THE UNITED AGTES CeOL nwu u-3Tr. -0 m ua evlussrt a wo PAYROLL awl IYY IW PAeI Y Y�M•�1-•Ife (far G•nG•ato/s ONMM UM,Sr IMrvaslm�,farm Wit-J•]MM.) ww a anr+os a sumnlns .oa•m MAgI•4 i I?�Vl pO,i Y- tf!•4C'q M•L M•o•YO , bl 'C i" � � a- lwwl _Yq a� �R� � s+ Wr\YMn•11Y�1 �r� _ .. I� I ] I' u�4lirr SILL !� O s•wort• S AI��MOIM ql� Illy. WY !IY wYl•I• 1»+ y w� �� IV•m jy iJ • • � 15 I471a �031 r I wr P.wr rn-ro T ms raw Nllcrnr mow r E sWr.a oDcuYom j $ all I § � fez ( ! ,! �� :•| | |! � � \ ! 4 )\ \ i! | ' \1 I NSW7 cvnify RAI IM Pa1n0 N CNlect mo CaRRWM _ Ad Ma w.Ii MUS CwtliNd MMln 4M apt less IN,fM _ TRI-STATE CONSTRUCTION. INC aw-ekbie rate c4Atamel in It,wage oet,,..w,n 959 IOBTH AVENUE N.E. d"'"of Secretary of L4tot as statM.l the Q,,U t BELLEVUE. MASHINSTa}F_____..__...__. _ _ _._... -_Rowaia0 ano tM Kwa RHIOMnetl Munmh WSaM PERIOD ENDING 08/14/63 FORM WH-347 REPORT � 1 & NBC '4lwttf 4MlaMMwE JOB NO. 0548 PAVAQJ. NO: •� R4ApO4 Mto fM"a Nte ip, 1985 CBD SEWER TRUNK REPLACE S TOBIN/SHATTUCK AVE S RENTON, W - - CONTRACT NO CAD 048-05 - 7q STj HOPRS 71 ?v KE NAME, ADDRESS AND '` r 7/a ell, TOTAL GROSS RATE OF FICA N/H STATE B.D. I. OTHER TOTAL SSN OF EMPLOYEE 1 2 3 4 5 6 7 HOURS WAGES PAY TAX DEDUCT WIEST. GERHERD B 0 8.0 8 0 a a 0 0 0 40.0 699 60 17.49 166.64 !0.77 258.96 12634 S.E 276T4 GLACE 1. 0 1.0 1.O 2.5 1.0 .0 .0- 6. 3,-170 55 ----- ------ ---- --.---_ _____ RENT. WA. 98031 -----------____------ .00 61.35 .00 .00 9.0 9.0 9,0 10. 5 9,0 .0 .0 4i.5 NET PAY: 611. 19 538-26-0059 OCCUPATION- TRUCK DRIVER (730-0230) _--------------_----------------------------------------------------------------------------------------------»-__..-__-_______ HIRST. LYLE O a 8.0 8.0 B.0 e 0 .0 0 AO 0 745,00 745.00 145.54 9.27 257.33 AT 2, BOX 47E .0 0 O -.0 . . 0- :0-_--r0- MONROE, NA 98272 -------------- .00 a2.a2 .OU 30.00 9.0 ILO 8.0 9.0 9.0 .0 .O 40.0 NET PAY; 467.67 532-44-6877 OCCUPATION SUPERVISOR MO . _ __ ____.___� ,_.__...__ __ _------ -----------------------------------------------_____________.-__--____-___-__-__-__-_-_______-___-_-__-__-----______-___--__----__ GLICK, DUANE R. 8.0 8.0 B 0 8.0 8.0 0 0 40.0 617.60 13. 44 150.65 t0.89 273.26 112t3 - 127 AVENUE N E. 1.0 1.0- 1,0 2.0 -Q.0 O 0-7;0"-'166:ft-__----_-_------_ KIRKLAND, WA. 98033 ------- _____-_---- .00 34.97 .00 04.73 9.0 9 0 9.0 10.0 10.0 .0 .O 47.0 MET PAY: 304,46 501-64-9753 OCCUPATION' PIPELAYER MO - - ------------ ..___ -. ---------------------------------------------------------------_.----------Y,-----..__-__--_-_____-________--__-__,_--___-__-_____ JOHNSON, RALPH W 0 0 0 0 4.a 0 0 4.0 55.00 550,00 7,92 14 It 94 16405 BURKE AVENUE NORTH .0 .O - 0 O 0 10 :10 _..0-.-__.._..00._._ ..T_-__- SEATTL.E. WA. 96133 -------------------------_--------z_ .00 3.00 W .00 .0 .0 .0 .0 4.0 .0 0 4 O NET PAY: 43.06 506-10-f 776 OCCUPATION- CIVIL ENGINEER - .___. _.._... _ _____________.._______-___---_-__--_-__._-____...._______-__-__-_--___-_-______-__-__---_-__ ___ ____-___--__ OE NO1A, JAY G. a a B 0 8.0 8 0 0 0 40 0 711.60 17.79 124 48 9 50 216. 78 6624 - 163 PLACE S,4. .0 .-0 ':O- 1.0 LYNt4100D, MA 99037 ---__-___--_-__ ____�_-�.__�- .00 $2.05 .00 30.75 B.O 8.0 B.0 9.0 8.0 .0 .O 41.0 NET PAY 521 51 538-40-3300 OCCUPATION'. AERATOR "" t3CI-1__.__��._____._. _______________________________________________________--__-_--__-____--___-__-__-__-_____--__--___--_--__---_-_-__-___-____-__- NEWELL. JR- W FRANK 8.0 8.0 a 8 0 8.0 0 .0 40.0 485 20 17. 13 194.92 10,00 2B2. 10 5711 SOITN 129, 412 :3 -.5 5 1,5 .6---.Q._..$--ay--p;q4-- SEATTLE, WA. 96178 ------------------------ .00 64.N .00 32.63 8. 5 9.5 9.5 9.3 0.5 .0 .O 43.6 NET PAY 492.96 533-28-3694 OCCUPATION- 666 OILER 302..... ----------------------------------------------.-------------------__----__-.-____ --------------------------------------- TRI-STATE CONSTRUCTION, INC 959 10STH AVENUE N.E BELLEVUE, HASH INGTON '- PERIOD ENDING: 08/14/85 FORM W11-347 REPORT JOB NO 0548 PAYROLL NO: .. 1985 CBD SEWER TRUNK REPLACE..-. 5. TOBIN/SHATTUCN AVE S. RENTON. WA CONTRACT NO CAC C48-85 MO RS WO KEp A/ NAME. ADDRESS AND �n 7/3 DAV� 4A TOTAL GROSS RATE OF FICA W/N STATE S.D. I. OTHER TOTAL SSN OF EMPLOYEE 1 2 4 5 6 7 MOURB MOUES PAY TAX DEDUCT PINGREE, DAVID F 8 0 .0 0 O .0 0 .0 B.0 139.44 17. 43 26.46 1.97 43 56 19716 - 24 AVE. N.W. 5 -0"".0-.-_..0--_:t_-,-o-..-_-0-- .$-.--12-07._ ..__._. SEATTLE. WA. 98177 ______--_-_- ------- .00 10 75 .00 6. 38 a .0 0 O .0 .O .0 8.! NET PAW. 106.95 025-44-3564 OCCUPATION' SERVICE OILER f570-5765> _-..- .________.._.._ _. _.. _.__.. __. -------------_--------------------__________-__.-_______-______________-____-_ _________--_________-__-_-______________ BUSBY. MIKE F. 9,0 9,0 8.0 8.0 8 0 0 .O 40.0 711.60 17 79 156 95 9 50 249.25 am - 372 PLACE 8.E O-- P- 0- 1.-o --.0 ONDSUALMIE. WA. 9B065 -_-_- ___-_____--_____-- .00 S2.OS .00 30.75 9.0 8.0 8 0 9.0 e.0 0 .O 41.0 NET PAY. 489.04 537-44-3628 OCCUPATION: BACKHOP. OPERATOR 302 ___________________________-_______________________________________---_______________---________________---_-________________-__ 1 WEIGCLT. TERRY L. 0 8.0 8.0 B.0 8 0 0 .0 32.0 494.00 15.44 95.05 8.23 188 21 1105 MAPLE ____.._... _.:O'-'r8---:------ _Yb_'-_O'y:'1r--BY:'06_ -1 EVERETT, WA. 98201 '00 40•35 .00 NET PAY 386 93 .O e.5 9.5 10.0 8.5 .0 .0 35.5 533-64-1693 OCCUPATION...TIPELAYER-OROUP-r-----_.--------------- --------------------------------------------------------------------------------------------------------------------------- JENSON. GARY a 8.0 8.0 8.0 8.0 .0 .0 40.0 617.60 15.44 162.26 10 43 260 64 33705 PLAZA ROAD .5 .0 5.0--tt3:'f0"-._.__-- BLACK DIAMOND. WA. 9801-----_- .00 $1.70 .00 56.25 9,5 8.3 B.9 11.0 8.5 .0 .O 45.0 NET PAY: 452.76 533-70-7035 OCCUPATION' PIPELAY'ER'440 __... __. . --------------------------------------------------- ROBERTS, JERRY 8.0 9.0 B 0 8.0 8 0 .0 .0 40.0 6".60 17.49 102.87 9.27 161.46 P. O BOX 777 SULTAN. WA. 9B294 --_-�-- ---'�'�' 00 49.32 .00 .00 8.0 8.0 8.0 B.O 8.0 .0 .0 40.0 NET PAY 538, 14 539-36-9178 OCCUPATION. _-WV-TRUCK'4'MA1LEt4R.-___._.-_.`--�_-. -----------------------------------------------------------________--____-____________________________________-_-_______________ HIRST, DUANE J. 0 0 0 0 3'0 0 0 3.0 49.00 .00 . 1B .70 4.26 .. ROUTE 2. BOX47E _. ___TO.._T O-g .0___r0--�0-_. 9. __. NOIYIOE. WA. 98272 ---__ ^-� . J _.... .: r00 0 .O .0 .0 3.0 .O .0 3.0 1,. NET PAY: 43.74 TOTALS FOR JOB' 0548 367.0 6=4.32 1344.02 90.75 2231.63 .EO r �.Ii 309 S9 a tb d "" ��881�P1F�ti_.. � _.NET PAY. 4678.41 - -- - _ D�eIEP-oTMeuenvuoeA STATEMENT OF COMPLIANCE X.r.,Apprta.d Bu.fen stores.Ne. .,.R109, Dal,Aua_ 14 1 A5 1 Arlene Whitworth INswe A, payroll Clerk T-wete,Y fro M1ertn (I)Thal 1 PA, X Pe. tee rn! �. y states q wymenl or,hepar•on.emP1.y.d b,Tri—St a Construction,mr ,y,�s Pan r, ,, Inc! 0. (Av.din n) that during he Da YI-II Period cuemeneog on the e.,o IrU and ending the" he t4 r nsr Aua bShd.r Dd wua all D...no' em""" on said PI....I have been weekly wage-a-rned. that no tebatc•have been or win be ^ Pod Ike full State made either directly or indirectly a or on behalf of said Tri_ Construction n, Inc. from tM full reeklY rages framed by any Venen.IM that no deduction-M1ne 1 r been made IT rites t1y of md,M,,BY from the (till wages eametl by any Denali. other than m Regul.tune., Part 3(29 CFR Subllla A), I.pu11 by the Secretary of Labor Order.he then 1-mil -t AcI. 9d8 fiJ Slat IUB. R SulPefmn-into detlualam•.aefmm 962;]6 Slat 357. 40 V S C 2:6c), slid Je-Clibed below; a.-vended (.B Star ... Withholding 6 FICA Taxes ental Pension (2) That any P.Yro(I.olAerw,e uowder this contract f in., the w.ge Iat"(r,fare....o.ame[hanlcs conumed thamtn•e no submitted for,n.above Wrlae:a film w to nil "M in,orpunled I.,.the from-',, ,n 11...has,he DPhcabl Milia re conco,and in cpmn an, loan ItM1,M wprY M1a performed U ,h<cbslLc-Irpna !t Instill !herein for.,all law.,p contained ony r xenanlc e Labor,n A h E lie DD P cte[lu e:Dloledr in 'he -Wive Dlnud are dull"legutend m A bona fide-Ppnn^cAk�p pro r n- D Relic c gni.td Itsthe Bureau of A p cngn.a.d agency e...is I.A Sute, are a Pprcnh[nM1lp and Trim.9. United States Depanmrm of Stile.D.parlment of Labor r RiatveOf with the Bureau or A DmIO[nhlp and Tnmin[. United H> That. (A) YWHHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS,OR PROGRAMS In . Paytin,o Ill.basic hourly wag-rates pall to<e[h 1-horer or mtchanlc listed In Ine above referenced Pay. full. l benefit I Icing! ben<Dls as haled m,he c.,Iixcl true Men or r1 11 he merle m apprOVrup for ills benefit of-uch emplo Yae.. eIC.Pt rM note!m Section d([)below fb) WHERE FRINGE.BENEFITS ARE PAID IN CASH Pint... n. a- Ltbo 1,1 !hen Ik Gum in . -bove febrencaJ p.Yloll has been Paid a. indwa,ed on the an!mount nnl Ina than Ike sum of tM appLcable basic hourly wages e en P the•mourn of the. Mnebn ag loud in the mnbact a P-Yroli, (c) EXCEPTIONS adept ea rimed m ua,on i(c1 below gmreJ Lmpe EXCEPTION ICRAPTI EXPLANATION Arlene Whitworth Payroll Clerk p[eeu no..« N 1` .. sea ND°u"—• •_e eo..e».e.o«o«-uaemL«.;.ETL na .aC.:'IN It oe T,rL[IT Or I.[ UMit[E[.... E-rr WN•2M s,/-[, UIIa M••[TNI-aOAy gI1aC Tlv ..,NA TN[tV.". OI DOEVNe �f 1 6RN9'm*h BR1 BR�.,wi w c9m4c1.W cwrow laW w 'wu.uRwre meat m na kss tt�r.m. puedd6isbie retarua wnuirM in the n.{e Cetvtn�n2nn _ TRI-STATE CONSTRUCTION. INC. eecn.�s�w5ecrr..ry ci lA6v Nsa:eo tc.:aact 959 100TH AVENUE N.E. Pt9n mE tM. n polerreC Dy a:::RKA Rtap . BELLE'", .2 INGTd1 .... .. -tRYLNnK mnNrtvt9w CImIK4MrRwlNMinwiO PERIOD ENDING: 00/14/05 FORK N 347 REPORT FwAsiR9 appikaN.NwR1Be nN�ib. JOB No 05" PAYROLL No: t/ t455 coo SEWER TRUNK REPLACE S TOBIN/SHATTUICK AVE S. CONTRA W. CONTRACT N0 CAO 048-65 - NAME. ADDRESS AND 72 or, %w DA+�PE� � '/! TOTAL CROSS RATE OF FICA W/F STATE S.D. 1 CTNER TOTAL SSN OF EMPLOYEE 1 2 3 4 5 6 7 HOURS WAGES PAY TAX DEDUCT WIEST, GERERD 8.0 8 0 8.0 8 0 8 0 0 0 40 0 6" 60 17 49 186 04 10. 77 259 96 1263{ B.E. 276TH PLACE 1.0 1.0 1.0- 2.5 1:0- O O 6 5 170. RENT. W VOD31 __-_-- ____----------- --_____ OO 61 35 -00 NET PAVE 617. 19 9.0 9.U 9,0 10 5 9.0 0 .0 46 ] 538-26-0059 OCCUPATION' TRUCK DRIVER "30-OB30f ________ ___..____________ ______ HIRST, LYLE D. 8 0 8 0 8 0 e c O 0 0 0 40 0 745 00 745.00 1.45 54 9 27 257 33 RT. 2. 001 47E .0 B, .0 .0 _.0-.----0' .0 . _.0_.__�. . ..... .. .__-... _... __.. ._. MONDE, W. 98272 ___________________ _ ____ -_- 8 0 e.0 B.0 e 0 e.0 .0 0 40 0 NET PAY - 407.67 532-44-6877 OCCUPATION SUPERVISOR 440 ___________ __ ______ ___ -_______ ________--------------------------------------------- CLICK, DUANE R. e. 0 8 0 8.0 8 0 8.0 0 0 40 0 617 60 15.N 150 65 t0 89 __ 275 26 11213 - 127 AVENUE N.E 1 O 1-0 1,O to Y:O. . O 0-.7 O- _. KIRKLAND, 98033 --- _----- _______ _________ WA -___ 4 0 9.0 9 n IO.0 10.0 .0 0 47.0 � � » NET Go P10iYM 504.46 1 "1-64-8753 OCCUPAT}%-' -PIPE, ^'9440-__..__... ____._._.._______... -___---- ------------------------------------ ___________________________.________________ ------------ J0HNSON, RALPH W 0 0 0 4 0 0 0 4 0 55 00 550 00 7 92 14 11 94 16405 BURKE AVENUE NORTH -O 0 .. v. 0 ---rO --.0000 ..-__- 9 SEATTLE, W. 98133 ----_�_�______ _-____-__ �___ NET PAY: {3.06 00 10 .0 .0 0 4 0 0 0 4 0 506-I0-1776 OCCUPATION' CIVII ENGINEER ______ ____________ ______---- ---------------------------- DE NOHA, JAY C 8 0 8 0 8 0 8 0 8 0 0 0 40 0 711 60 17 79 124 48 9 50 216 76 6624 - 163 PLACE B.W. O .O .0 10 .0 P 0 1.O 26.69 - - ...._. -. LYN WOO➢, WA. 98037 -------_--_�-�_____- 00 52.65 NET PI01Y'S 521. ]t B.0 9.0 B.0 9.0 8 0 -0 .0 41.0 538-40-3300 'D^ TIONt -OPERATOR OR" 131Ff _____ ____._________ _________________________________________.. __-_____ __________ NEWELL. JN W. FL 8 0 O.0 8 0 8 0 8 0 0 0 40.0 685 20 17 13 184 82 10 OB 282 18 5711 SOUTH-129, 016 5 - .5- -.5 15 - r3---0- 0..'3..0-.___0q:q4 _______ ._. .. .___ _._... __._. SEATTLE, . t78 ________-�_�- ----- / W 9B e, 5 9.5 8.5 9.5 9.5 .0 .0 43.5 >~ ME t i12iY� 492.96 533-20-3694 -OCCUPATION- -866 OILER 302 _. ----------------______.._______________________.._____________-__________________________________----------------------------------- A };• J TRI-STATE CLNSTRUCTION, INC 999 108TM AVENUE N E BELLEVUE. WASHINGTON PEA,^J ENDING 08/14/85 FORM tM-347 REPORT 0'/JOD No Cs 6 PAYROLL NO 1985 r,.p SEW" TRVNR REPLACE I T--a% 511ATTUCA AVE S e ENli} . CONTAwt NO GAO 048-80 / HO RS NO AED NAME- ADDRESS AND �4. 7(j �yj ?'r Y I'/ry / TOTAL GROSS RATE OF FICA Y/N STATE S.O. L OTHER TOTAL SSN OF EMPLOYEE I 7 '! 5 6 7 HOURS WAGES PAY TAX DEDUCT P/NGREE, DAVID F 8 0 0 O 0 0 0 0 8 0 139 44 17.43 26.46 1 97 45. 56 19716 - 24 AVE N Y 5 V O 0 0 0 O .11 I9.07._.____- SEATTLE. WA 98177 ---------------------- ____--- 00 30.75 00 6.38 0. 5 0 0 0 J U 0 8.5 NET PAY: 106.95 025-44-3564 OCCUPATION SERVICE OILER <570-57651 - - -- -- - -----------------..------------------------------------------------------.-_----__--___--____-____-_________-__-_______-_-__-_____ BUSBY. MIKE F 8 0 8 0 8 0 B 0 8 0 0 0 40.0 711 60 17.79 196 95 9. 50 24q 25 8023 - 372 PLACE S.E. 0 0 O : O O 0 0 1.0 - -26-69-_. SNDOUALM19, W 99065 ---------------------------------__---- .00 52 5 .00 30. 75 8 0 0.0 8 0 9.0 8 0 0 0 41.0 NET PAY 499.04 537-44-3639 OCCUPATION BACBIOE OPERATOR 302 --------------------------------------------___ .________--____---_______-___-_-_-__---____________-______--_--______-_____________ NEIQELT, ' RY L 8.0 B 0 8 0 B 0 O 0 32 0 494 OR I5.44 95 05 0.23 188 21 1:05 PWPLL 0 5 3 2 0 5 0 0 3}.5 at.06 EVERETT. NA 98201 ______________________________._-___---- .00 40.55 .00 44.36 O 0 5 8. 5 10.0 0.5 .0 0 35.5 NET PAY. 366,93 533-64-1693 OCCUPATION PIPELAYER GROUP ] -.. ._ ...... ---------------------- .-----------------------_----------------------..._______-____-_____-__-__________-_______----_-_-______----__ JENSON, GARY 0 0 B 0 e 0 e 0 8 0 0 0 40 0 617 60 15 44 162.26 10 43 280 64 33705 PLAZA ROAD 5 5 5 3 O 5 O .0 5.0 ...ITS.00 - BLACK DIAMOND. NA 9801________________________________________ 00 DI 70 .00 56 25 8 5 e-5 e.5 I1 0 8 5 0 0 45 0 NET PAY 452.76 535-70-7035 'CCVPATION PIPELAYER 440 _________________ ._- -------------------------------------_----------------------------------------------------------------.__ ROBERTS, JERRY 8 0 B O 8 0 8 0 B 0 0 0 40 0 699 60 17 49 102 97 9.27 161 46 P 0 BOX 777 0 0 0 O O 0 0 .0 - 00 - .. -._ .,.__.-.-..... - SULTAN NA 98294 ___-_.---------------------------------- -00 49.32 .00 00 0.0 8 0 S.O e,O B.0 0 0 40.0 NET PAN 538 14 534-36-9179 OCCUPATION. H/V TRVCR 6 TRAILER OPR -- - -- ------------------ _ __..______ - NIRBT. OVANE J 0 0 0 0 3 0 0 03 0 46 00 00 15 to 4 26 ROUTE 2, BOX VE 0 0 '0 O O 0 0 - O - .00 - NONROF. w 98272 ------------------------_------------_ .Op 3.311 .OD 00 0 0 0 O 3 0 0 0 3.0 - NET PAY: 43 74 OCCUPATION LABORED _. - _..._. _- . ._____ _L.._�- -- -----------------_.-----------------------------___-------------------------------------------------------------------------------- TOTALS FOR JOB. 0348 367 0 6224 32 134" 02 90 75 2231 83 -80 0 60D.9F...- .00 407 17 Aw NF P*.•. y^1^' 309.89 375.0 .^'<.�}L _NET PAY: 4678,41 --------------------_-----------------------------------------------------------------------------------___-_-__--______----__ Y.1.OEPAATMENT Or N•Op STATEMENT OF...a.wo Nouw olvuma COMPLIANCE Dab AUo. 14._]995 f. Arlene Whitworth Payroll Clerk do nemb INem, rn,i°ry` (1)The]i WY I to DEY nl of Inc pe..... P)oyedbFTri^State Construction, Inc. ° tb /9pJ e;,A7/ ,,a � `L tn4 during Ue payroll yrrioC cOn�mrpcinglon]6e tlaY of AnC1_ n Ipui kiln r4 k1 p I9U and ending the t4tby of Aug. )IyS, tll Pelson. sinvre 10 d On aid ! h.ve been gold the full p,o).. weekly w*Vs tanned Inn no ,hot..have been 01 will he m.de timer directly or Indirectly to aI On behalf of said Tri. State Construn, Inc. pe tree lull weekly (s.pined by.n ( . w e.,ctiotio "Ono y"ft.and That Ib dsdP,I,...have been made.,,he,directly or rid,ectly fro ,m from he full wages named by any person. other than Pet.xlble deducr,nns a.defined R b egutrom, Pan _ (29 CFR Strunale A). I,.uad be the Secretary of Labor under the Copeland Act. as amended (48 Star 948.63$tat 108. 72 Sub 967;26 Sut 3S7;40 U S C 226c), and descubed below: Withholding & FICA Taxes Med3c�a7 raid s C,pplemental pension (4} f2) That my yaYylls c,Anwm under this contract b9uued t0 be submgbd fur the above Period.or corric, cp.,,,,; comp ,e;that the wge ,at..ton I.ho,eyo,mefnanin conlsinert therein are not less than the .M111.6h wgrrat,. coniaan.d In any w.ge detenmms,ion inC.11.111.d into the contrgl; In., he eta+uficnion.act form therom for each l.hpna,or acnaoi,con- torn.'In the•o,g he pwf ine'd. i^ 01 That any aPPrenuces empl.Yad m the above periud are dull regotebd In a b,I. fide appreon,foh,Proyam f,,,ta_d wi]h a Stem avPnenucexhlP p.Pcy recogniit0 by the Bureau of Apprenticeship and Training. United States De,arimem!of Labor.or if no..Oh recav,efd.,.ncy e.uli in.Slats, ate regiateyd wdh the Bureau of Ap,cOrt cesbIp and T.m'oM United States O.P.nm.nl of L.IF r. (e) 7TL: (al My HERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROCRAMS rX In addition to the base hourly wage Islas paid to each Isborer or meclvn,r listed In the above,elerenced pay- roll. payments of 4lnae benelna as tided In the contract hate been or will be In.&le aPpo,p,i.c.",ans. for the benrli,Of.uch employ.... .ac Wi as noted In Section 4(0)below (b) %ffERE FRINGE BENEFITS ARE PAID IN CASH Each Latium,or.,.'hand Ilsbd In the aWve Iefe,encad payroll has beau .,it as InJic.bd on the payInll. unI nut less than me sum of the.PpLc.ble basic hourly wage rate plus the•mourn of the rc9mred hinge benefit.as I,.ICd In the conuacl, r.,.PC as noted In.ec,ien 0(c)b.lpw (Ft EXCEPTIONS EXCEPTION tCRAFTI E%PLANATION au ty0 *.E _Arlene Whitworth, Payroll Clerk I I.,. .`�`:.m pat oe . n -..E .an.E �t C Oa<w.u�.y [CUr�ON yaC—=`E]_.0 r,Or i.,.l OFrr E', .r.. sCCI,ON at OFOT E iJ90.t',, rvnaaC.Ca .OI C CO 1.1 li OF IF v fa.mwN441 I'll., •uPw.sa In's"on.,Was! F•o..rwa su ..OF oocu..ehn Dow— - - " - - ---- contract have been or will ore mods to appri pogroms for:M benefit of sane empby smapt as noted In Ser.hah a(c)below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH do howsby am*: [� --Each yharer or Mosi 11110 In the above relenMW payro)l has boom Peru, as (1)rhat I NY or euparvise the Nyment of the Persons employedmd¢atsd on the payroll, an amount rot was Man la sum of the app,ifi beer, by hourlY wep rate Plus the amount of the required fringe benefits as listed In the tarmwt,except as noted In Salon a(c)before on to ' Ie«s.aaer«wxaA.eee.� tarfwes«.erq (c) EXCEPTIONS that during the psymll period twnmerldny M the day of!' 19— end ending to_day of-- tg EXCEFTION (CRAFT) f EXPLANATION all Demons art Played on s•rd project M"been p"to lull as"ly cages"reed,that no rAAAW --I{ f1NN basin or eul be made lights dIFICHY Of laueeMY to or an behaH o1 YN __.._. from tha full lcomnnor«weaie.ecrn ___ weekly wall" aimed by Any Person and Effort nor deductions haw been made anther dneeeiy or miduaclty,from the full WAS-'earned by any pei other than A n,%ide Oa0ucNu"as"Anetl In Raguytions, PM 3 (29 CFR Subtitle A). Issued by the SecreyrY of Labor under the Coywan,' Act.sa smendud(48 Stat 918.63 Syr TOO,72 Sort 967:76 Star 357.AO U.S.C.276e),end M wtbW beww: (2) That to atleAnu y Payrolls oMerW�ae under Mu [ontraEY rpulrad fa Eli aubmrfyd fur the shove Period an correct and CompMe: that the wage set"for labors,or mNh m,,a wmarned Mahan am not W"than the appllaable Wage rates conyuud In shy Wage determmahon uw pP,~into the mldnct:that the elasalfiuUons set torts therm for each laborer or mecranlc eonlorm with its Worts he worm". (3) That :ny apprentices employed in the abovs onard are duty registered in a bona fide apprentr,"ho program nIPSUI with a State eppromcethlp agency recognized GY Me Bureau of APPIMM-011np and Training.United States Depadmont of labor,or d no such reosgnu:ad adamY exists In a SyH.An register"with the Bureau of Appentiosi and Tralami United Syln Dopon mount of Labor. (4 Tat wuag two—ma gwNY,� (A) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAM`: [mil —Ir1 addition to the basic hourly H o hen *HE MILNL FY.SInuF)dN OF ANY OF ME Assure AT y B YAY Walftr ryrg {gH{IradTa L-I rtY ¢ Paid t- each laborer or m«Mnc z.w niu i�o�iirE unlrtyP srAresec"ooL urf°M.pa[f kcx,eH Moroi a nnE to sew hs!ed In the 'Wi a relarencad PayrWl, "Iments or .„pea baafiy of Iwted In the US OEFAMTMERT OF LA" WA t AND HOUR OMSION PAYROLL N� A� f(l� (Fa COntrada'a Opttunai Use:See Instruction,Fq WWi W Inst.) o 'a a Imm WAM[OF CorrrAAcrOR OR aUKONrMAROR tJ ADM[A iATAOLL M. FOM WCER gFpM -- _•.-nwCCT ANO LOGTION - �- —. 'CR OR cx*ot OT N0. UI PA FMMOCF Me rM OAT AMC OAR tOCN IU N "PORE nowt aq5t' CAr( 1aEE OEM TOM NAMElNAME p/ _ MET AET EM OF MYMOUNT * ®MMMY FICA mo m -INE . RAW alraC119A FM um 1 J i s o a a FORM rca Cklr Wt Is,PURCHASE THUS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS ��,��nYon v uuot PAYROLL row�.uo. V*CaMcM.OMWW Uw.S•Imo,F"W%-M] FEE wa.xwr... s ; _ _ war w tir ewsuo• nnmV �� A11• � Ptr IL .. ! �wur� v.ur ro��n.wt�r-N.RYIbL trot IprrY pR[RLY I1RW it.(A/IF.d OOMtF!!f5 -- ! §• 2 \! " | ! wIs | i / § ` | J & fI §� §! ! y | � � �R■ : \ � /§ j\ , 4 . � [ | ' I /' ■ \ \ ! §w E A , jlitj\ �� US DVMRrMorr OF U\0•w1 PAYROLL P.I.,Alw. 0[WOMDUII DICIMDM \.rn (Fa C•ntrael•Is OptlonM U: 3••ImWclieR,Form WFf-3A7 Insl.) RAMC a corlr•.crD• p MY\D�L ND. IM rQR .IIDIK.r MID l0G IMYL AECIr3C,MID •Z o•M• oaDIICIIDIn Ir* COC14\CCMT'"WHIM .`011R p mm Raw rMlp M CYILOY[t p ClA14ItGTg11 O MOIM•MDIII®CACH MI Hom oFMY G FIfJ1 MOIDIND pnlq � 1mD I O D p p • O s • • raw rH-Nl 11c.)- roMltlur wL ik PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS ...tract have oesn or will be made to epprophate pmgrarea lor the benefit of such empbyess,aaapl a noted In Section 4(c)below. r —s__ 4 M. +r.-a..ro w_ha— — --�— - - rancor (o) WHERE FRINGE BENEFITS ARE PAIL IN GSN do NatgBy ante ® —Each laberar or mscle'ie hated in the sooty hifmnced payroll her oxen paid, as Indicated on the payroll, an amount not+as Man the um of the epPhra011 Mal. (1)Thal 1 pay or supervise the payment cf the persons employed by__—___._---- hourly wells rate pus the amount of the re"umad Imig, Mmdih as listed in the ""'tract,except as oottl In Section e(c)below. on the —_ Ipelwradr r ruewtrrr.n taweea r werio (c) EXCEPTIONS that during the peymll pehed LommeMieg on Me EXCEPTION (CRAFT) EXPLANATION day of 19—_ and ending the _.__.day of__ .�19... --- all persons employed on said projM have Man paid the full weekly wages earned.that no n M hew been Or will be made ether dlractly Or lndiractry b or on behalf of Sale trom the full _ - tr,.rArecae.r wr.r..mn will wag gamed by any person and Mat ho deductions he.been r-ada enthr diracly or IMvemly from the full wages earned by any "anon, other then panhiasdb dedu.temt as defined In Regulations, Part 3 (29 CFR Subtitle A). Issued;by the Secretary of caber under the Cofirl Act.as i m and rd(48 Slat.9e8,63 Slat. IOS.72 SIaE 967.76 Stat.357,e0 U.S.C.276c),and de Knoad below'. ka;z-- (2) That any oil othervne. under this contract re9uHad to be a"il for the above period am coned and complals; that the write Farr for la5orera or mechenW contained therein are rot Nsa than the applicable wage rates conlaeed In am wage deter meation Incorporated Into the contract;that the<WsifleaUone set foM MMIn for each Mboror or mechanic conform with the work he Wormed. (3) net a Iy apprentices employed in the soove panod era duly registered In a bona fide apprsntkvsho program rpetered with a State appremkesMp agency recognized by Me Bureau of Apprenticeship and Tinning,U...ted States Department of Uoor,or If no such racgmzed agana exists In a State,are registered with the Bureau of Apprantuirsnlp and Tralli United States DapsM1 event of labor. (a) That Eu-' D TITUE aaNAnrE (a) III FRINGE BENEFITS ARE PAID TO APPROVED PUNS. FUNDS, OR PROGRAMS wl 1a 51FIutMM oe MY OF THE A►"vl *T4tth MM Ya. Suel[cr THE CONyaKTUR —In addition to the basic Muth w'ega rate wdl to each IaMrsr .r mechanic aMMFMdIon Tofern. Oe .Neel MOU" gN. SEE Ill I--1 4listed In the above raferrinced payroll, For manta of fringe berebta es ILLW in De N al the TITLE al OF THE Off ifaO arAIEa coot C.. 1.h-11.+w. U.&DEPARTYEnT OF IaROR ..at.ao NeuR oral Roa STATEMENT OF COMPLIANCE `°"""0On•'° g..nl w.m.a n. senau Data Aug, 7 1985 1. Arlene Whitworth Payroll Clerk AUG 1 2 IM (h Tbr I pay Or et, n webs P ye the p.rm<m Of the r<rapn,employes nyTri—State Construct i on Inc. the that Ju. to wing an the a ig, hu. lma _.rYl 'nR a payroll Denud cpnmen<,n[an ��JaY a1 A eg fq e IOU and ending the 7fhay nl ranQte r— 1 qs' ' •° paeaone employedsa an tl Drotect ha.e been pad the full wittily --I"called. thr nO rebate.bava been or wdl bre made either dvectl,or in,in,ctlr In Or on behalf Of.ad Tri— Late Construction, Inc. horn the lull weekly wage...reae by any parson and that ne deducvom base cm.I„....Or.....n .,..r been made either dire^lly Pr Ind,r<eUY fmm the full wage,earned by .ray p<raan, other than D<rmt,unle dadii"On,n defined 9ae 6d St.,OIN, 2 Sue2W.W. Stag JSYt)AO V S<C 6116e), and de,cntad beflo,v Eder the eeneland Act. as menace pR St., Withholding 6 FICA Taxes gRlerlental Pena ion (� (2) That any payroll.otherwive under this contact«9utnd'.he.ubmitu0 for the abo'. that th.wags roe.roe 1.,0....Or merMnic.<onrymed Ih<rcm age not Ieea than he Pee,od art car ec.and comp.tit, aRe with the%Or n e p.,fh,,d info the con..cp Inn the cl...ihut.ona an grub bring. felr each Ighl,er O entered m y lean with the aU. he pn"gingi r entering,1 coo- (J) Th.,any aDPrtntaee employee ,r in, aging.,ni are July reg,aa.ed In a b—ii fide appeenecah'P P^,Oath rc4arc^d With a State apprenuceehip agency rccagnlaed by the Bureau of Apprenrlceah.p and Training, United 5tut.Detrainment 01 Labor,oe I m,ucb recognised agency eueb In a Srat.. a rcKL.teeetl air,the Bureau of Apprenu<een'p and Teiining United Stater,Or-1 meat of c.bor r• (A) Th.: Ia) UIIE'RE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. PUNDS.OR PROGRAMS 9 In adddwn eO the bulge nuuely a.,rate,"id m each"fic"nr mech.ma CaeJ In the abo.e rel<rennd pay .-4, p.vment. OI Inrag. benefit. as hated in the<anhact halt been er.,It be made to fur the benefit of such empbpees, a%cept ..norcd to%aactwn<(c)below apprpprute program. (b) RN ERE FRINGE BENEFITS ARE PAID IN CASII 7 Each Lanoret Or ey"hame In•ed,n the allure re4renced a In"I"cum .If the applicable bathe he�dy'le,11 M;bell pu.l a ,mhu,eU en the Pevwll. benefit,aan te b.ted in be<my.0.<acept ae nnteJ in xttfion a(c7 hetow.I .the.muun,Of the rc9a^d fnege EX('EPTION[ E%CE PTiDN 62AFTI — EXPLANATION Arlene >:nitHorth, Pa roll Clerk cparm RN44 nIeei ao..te • 7af-6fAt8 C0N8iRUCiI1�N, . ... 9" JQM ^V&M N.E. • AE1.1-EVUB. WASH I N0 T ON PER10C FNDING 08/07/85 FORM WH-347 REPORT JOF hi 0548 PA','ROIJ. N 8 �; lg65 CAD SEWER TRUNK REP-ACE. S. TOBIN/SHATTVCK AVE S RENTON, WA. • CONTRACT NO CAG 048-85 • HOURS WGRKED • PvAMiS ADCkESS AND b 4/7 DAY, IIA 1 `''� 'OTAL G9ROSS FATE OF FICA W/H STAil, SSN OF EMPLOYEE �1 2 3 4' S '6 7 HOURS WAGES PAY TAX DEDUCT • WIE51� GERHERD 8. 0 8 O 8 0 8 G 8 O C 0 40 D 699 60 17 49 178. 18 10 54 248 22 • 12634 S. E. 276TH PLACE 2. 0 1. 0 0 0 2. 5 0 •? 5. 5 :44 30 _.__,____,._._____ _ __..._ 00 OC• FCENT. WA R8O31 _..._____. .__________ __ 00 59 50 • 10. 0 9 l 6. 0 8. 0 10. 5 0 0 45 5 14ET PA/ 95 b8 • 538-26-0059 OCCUPATION. TRUCK DRIVER (730-0230) -------------- _. ,_ ._______________..._5--__________ ..__....____.____-____.____ • HIAST. LYLE 0 80 8 0 8 0 8 0 8 0 0 0 40. 0 745 00 745 00 145. 4 9 27 257 23 • PT 2, BOX 47F 0 O 0 0 0 0 0 0 00 �II MONROE, WA 18:'--2 _ ...__ .-_._._... «__ ______-___.___ 00 d E. a 8. 0 6. 1. e 0 0 0 4U U '1': PAT +d' • T:C� `,,PFRVIcJR 440 • GLICK. DUANE R 8 0 8. 0 8 0 8 0 S O . 0 0 40. 0 617. 60 15 44 131. 54 10 31 ..y8 3? • 11213 127 AVENUE N F 5 2 5 5 5 5 0 0 4 104 22 K IkhLAND, WA 90!1:3'5 6-i • 8. 5 10 5 8 5 8 5 8 i L 0 44 5 ;;.T ` ..• 4 ` ; 41; • 501-64-8153 1+':C1jFA'f ION PIPELAYER 440 JOHNSON. RA1.PH W 0 0 0 0 4 0 ,_ C 4 0 55- 00 550 00 7 92 ;4 11 94 16405 OURKE AVENUE NORTH 0 0 0 0 O O 0 0 00 • O _ 0 9 :) J _ 4 0 - • 18-I176 J(.CoPA"ION. i'.!VIt. LNGINEER OF NOMA, JAY G 8 0 e 0 8. 0 a a 0 0 40. 0 -11. 60 17 79 133 09 9 73 226 2f • 6624 - 163 PLACE 8 W. 0 1 5 0 . S G 0 0 2. 0 53 37 LYNNWOOD wn 00 S^ 93 �11) • 8 ; 9 `. 6 O 0 1 6 !; .. A.Z. .. PAY • '4311 40-3300 Ili;COPAT. ION OP{:RATOR GROUP :?t • MEWELL� JR. , W. FRANK. uo 8 O 8. 0 8. 0 H 0 "I 1. 40 0 685, 20 11 13 17O. S6 1. 73 263 • 5711 SOUTH 129. 41;' . 5 5 5 0 . 5 0 0 2. 0 51 40 t;F T• F.. 6A g8373 - ,.__...____._. ... _ . .. ..._ __.__ __ ..._. _. _._._ - 00 1 93 C*'1 11 ic: • S 5 8 5 8. F G o. ti 0 u K2 0 NET PAY. 472 ou • 5908d-3694 OCCUPATION. 866 O1L.ER 302 Y • • • s TRI-STATE CONSTRUCTION, INC. • 959 108TH AVENUE N E, • BEL.LEVUE. 44AS14ING TON R C PERIOD ENDING 08/07/85 FORM WH-341 REPORT II• JOB NO 054E PAYROLL NC' S 7 1985 CBD SEWER TRUNK REPLACE. 8 TOBIN/SHATTUCII AVE S. RENTON, WA • CONTRACT NO: DAG 048-85 HOURS WORKED, NAME ADDRESS 4NU ,l r ,1 4 DAV&1 /A, 5 -V TOTAL GROSS RATE OF i ICA W/H STATE S. C I OTHFri `.CAI A,, • SSN OF EMPLOYEE 3 2 3 4 5 h 7 HOURS WAGES PAY TAX DFDUCT • SUSBY. MIKE F. 8. 0 8. 0 8 0 a 8 0 0 0 40, 0 711. 60 17. 79 166. 82 9 73 "1 98 • 8023 - 372 PLACE S E 0 1. 5 0 . 5 0 0 0 2 0 53. 37 SNOGUALMIE WA. 9EI65 _._______._._______.__..__ .__._.___________.___._ 00 53 93 O(: 31 50 9 0 9. 5 8 G 8 5 8 0 0 0 42 0 NET PAY 30< 99 • 537-44-3638 OCCUPATION BACKHOE OPERATOR 302 ------- ______.--_..___...._.,.---------------- -__._______--_.-..__--,__-_-__...__„__--_..-__._---________--___-___-___--___--__-_----__- • WEIOELT, TERRY L 8 0 8 O a 8, 0 8 0 0 0 40 0 617. 60 15. 44 137. 84 10. 31 254. 72. • 1105 MAPLE 5 2 5 5 5 5 O O 4 5 104. 22 EVEPE7T. WA. 9E.'C; _ 00 50 (;c ^� 5J 63 FYX' • 8 5 10. 5 8 5 8. 5 8 5 0 0 44 5 NET PAY 467 l0 533-64-16a3 OCCUPATION PIPELAYER GROUP 3 BERG, JOHN 0 O 0 8, 0 8 O 0 0 16 0 247 04 15, 44 40. 58 3 71 81. 71 • 6616 LOWELL LARIMER 0 . 0 . O 0 . O 0 0 0 00 CVERETT, WA. 98204 _.. . ---- __._.._. ....__.__...._....._---_-___-..._-__. 00 17, 4,7 00 LQ 00 • 0 O 0 C, O 0 0 0 16 0 NET PAY 1b5. 33 t • ?1 42- 7101 OCCUPATION MUONANf440 M _ . ---------------- ------------- _ ._._.___.____.---- -- - - --_.._--_---_____ ____.__-- - ------------___ -----_--_-_____.- g r SMITH. ROBERT 0 . 0 O 3. 0 11 0 .-0 . 0 16.0 247. 04 15. 44 19 72 3. 71 60 8J 5402 SEAMURST 0 . 0 0 . 0 0 . 0 0 0 :O EVERFTT, WA 98;,n . .. _.___.. ... ____.._ .__ _______ 00 r- 47 00 20 00 • 0 1,£T PF,Y !2" 19 • 539-32-3844 UCCUPATION. MANHOLE. MAN 440 ---_- .------------- -_-_ __-. . _._ __. ..-_._ .--______ -_ S HARRIDAN. MIKE 8 0 8 0 B O 8. 3 B. 0 0 0 40 0 697 20 17 43 !80 16 9. 85 275 65 • fill12304 - 57H AVE, SO. O 2, 5 0 0 0 0 . 0 2 5 65. 36 EVERETT WA 99204 - - _-,_ . _ _______ _ ..__..___ ._ 00 53 76 OC 31 88 • 8 0 10. 5 8. C, 8. 0 8. 0 O 0 42 5 NET Pam, 466 91 • 539-66-2YSE OCCUPATION. OPERATOR 302 _._.._..----------- .__.-_...--_-_.---________ • JENSON, GARY 8 0 8. 0 8. 0 8. 0 8. 0 0 0 40. 0 617. 60 15, 44 153. 69 10. 19 268. 95 • 33705 PLAZA ROAD 3 2. 5 5 . 5 . 0 0 0 4. 0 92. 64 BLACK DIAMOND, :aA 9801__._____________.____ _.__.__.___..___._. ____ 00 50. 0- O0 _._. 00 • 8 5 10. 5 8 5 8 5 O 0 0 0 44 0 N6T P.v 441 29 • '..35-70-7035 OCCUPATION PIPEL.. ER 44C -_.._--._--___.__-__.._.___-___.-----„--_-_.-_-_»__-_.-..___-_--__.- -_ ---------------- Is. • 4• 411i • TRI-STATE CONSTRUCTION, INC. • 959 108TH AVENUE N. E. • BEL-LEVUE. WASHINGTON PERIOD ENDING. 08/07/85 FORM WH-347 REPORT • JUR NC; 054F; PA"ROL.L. NO 1985 COD SEWER TRUNK REPLACE. S TOBIN/SHATTUCK AVE S. • RENrON, WA. • CONTRACT NO CAP 048-85 •i1 NAME, ADDRESS AND �ylf.. �� RSAWO, Dj. F%% TOTA- GROSS RATE OF FICA —H STATE S D T OTHER TCITAL • g�i1r SON OF EMPLOYEE 1 2 5 6 7 HOURS WAGES PAY TAX DEDUCT � W • ROVERTS, IFRRV 8. 0 8, 0 8. 0 8 O 8 0 . 0 . O 40 0 699 60 17.49 102. 87 9. 27 161 46 P 0. BO% :73 0 0 O 0 O O . O . 0 00 SULTAN, WA V0204 ----------------- ------_ _. --_ _.-. - 00 4�* 3F' 00 00 _a_ . • 8 0 8 0 8 0 P. 0 a 0 40 'J NET PAY 534. 14 539-36-9178 OCCUPATION. N/U 'rRULK S TRAILER OPR -----------------------__-.._,-------------------------.-------------------------------... ------.------------------------... • NOBLE. PAW_ A. 8 O 8 0 8. 0 8. O 8. 0 0 . 0 40 0 950 00 950. 00 181 46 1. 44 r49. S8 • f�M 18406 - 60TH PLACE N E 0 0 . O 0 0 0 0 . 0 00 SEO rT' .E WA 98:`" - _ ._.-___ .. -._....__ _.___.__._-__ 00 -,. 98 �}v 0n •M1+ • 8. 0 8 O f8 0 8. 0 a 0 0 0 40. 0 J Nf PAY 7v0. 12 • 516-32--9S63 OCCUPATION. ESTIMATOR ------------- _.._...____.___.__._____.__ _ _ ._-__.------- -- TOTALS FOR JOB 0548 476. 0 8301 68 1750 02 107 .3 01 • 27 0 668. 88 • 503. 0 • _. _..____ .. _._......._. __..-_..-_ .__-_--.-- .+ 1 hereto 7e tify that the payroll is arract and comPiete • arx .res conWincd heroin are not less than the • aF ,: contLinnnl in the wage determination dc... .'.:_Secretary of Labor as stated in the CmUraet Pro: ions and the work µ.donned by each such laborer • • or mechanic coMormsto the elassifiatio1152d thinald Proslswm applicable tto the wage Mite pad. 1 �1C�` .ier .imf�-- • U.S.DEPARTMENT OP L.00R awes AWm'eC woe. wo..1.o vmio. STATEMENT OF COM^DANCE Roaaer wre.,.N.. s,1116E3 Der. Aug. 7, 1985 1. Arlene Whitworth Payroll Ci2rk do berth,state: INen.of ai an.terY U1 chat I p+r or%up.rvi.�me p•rmem or Ins tramona!!piuyed bYTri—State Construction, ZnC. 19/I PBD _ — tit pat me ; that d.nne Ire pa,,.It pt riot colmenclng on the yZt.Y of August _ a,were "u and.nditig the:ty3.,of A,tuna1' . .11 parson. o. y1.1.d on a.id Pro,erl hero been paid In. roll weekir wages earned, Chet rw rebares hive been or win br,made either directly pr indirectly 1.or on behalf of aid Tri— State Construction, inc. from the mu Ne.kly w.gaa e.mm by any person and that no dMaauona has. been made either directly of millmetly frcm the Full well.lamed by Ion,per»n, suer the. mwoma,bm deduction.Aa defined n Retul.imn.. Pon 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Ao as amended (48 Slat 949 63 Sut TOP. 22 Smf %7: 76 Sus 357. 40 U S C 2)6c). and desuib rl below: Withholding & FICA Taxes mpai cal Aid & Supplemental pension (k) (2) That an, D+Yrells mb-w,c urNfer this commit m,..,ad to he euhliu,,f Inc the.bona period arc comet arJ c.o,I.te; ,hot the se" is.to,labo,er.o,..Chun". cnm.tn.d Mervin.1.net 1...than this ."Im.blit wq. ratl. eenuu\ad In ." w.Re d.l.—rrmt,.h ....ponied into the contract. that tat.classification% norbirth them!for each losses?of mechanic con farm wire the work he performed (3) That any .PVienbcrs emplsy.d In the above period am dull' reW.iveJ is a horn.tide;T,Pmobce AUP progm!mentered .,in A Snte Appesnticeahip aRencY mcolnli ed by the Bureau of Appmmuc.ship And Training. United Sam.Doper, ant of Lahon ar if no au:h necognised agency crisis in a State. arc registered with the Bureau of Appesouceship and Training United Stalls Depanmem of LAW, (a) That. (a) is bRE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS rZ In addition to rim basic hnutly wepe rams paid to each Iaboret or meshamr listed in the above referenced pap ,.It. mr,onot.of fringe benefits as listed in the r eel have teen u ra will be made to ApProPn.1e progms for the benefit of such eaipl.,em, e.c., ..iwled on,Sect...a(c)but. (b) WHERE FRINGE. BENEFITS ARE:'AID IN CASH Each Laborer or necharin, listed in thr above referenced pe,rotl s been part as indicated on the payroll- as unt rim ids.then In.¢u.of the.pptic•ble tonic hourly wage min plus the amount of'he......ed Inn" benefits as listed in the contract, a....I as tinted in aec.ion a;.-1 bcl w r EXCEPTIONS EXCEPTION ICRAaT\ EXPLANATION rA rlene4-WFh itfiv rth, Fay rollnCleork r l _L[/—tr sac e, n<w a eau r ;. . e •.on clo.tM.)a1 neat rues<w>g Twu roles o�ngc rsr rags\,i.E w ..qr tmcwew-, iAi—SfiAfiE ti£M&iktlGl iiNt, [m. • 959 108TH AV€M)E N. E. • ML.LEVUE, i" ING TON PERIMIFENDINO D8f07f'Y- PORT WH 34:°-REPORT .+OT. 'Ku 1543 PAYP i43b ,. 5 ILL • RENTGN. — • CONTRAC"i t," -A,; 046—F4t i !{AYE Ar:"vz?5 A-,; .r. f 7 PAYl �, ''./ T^YAL �.R`JSa Ri ,E OF FICA WIH • SON OF EMOLOYEC I. 2 J HOU" WAGES PAY TAX • WIEST, $ERHERA e Q Q..Q 6.0 8. 0 8. 0 . 0 O 40 0 699 60 17 49 178. :6 . . - • 12634 S. E.. 276T>, F—.ACE 2 0 1. 0 0 0 ,. 0 4 :!G • t0 f" 9 0 8 0 S 0 10 J �i a7 e • is 20 F Up,+-1,3'. 411+4A gFillck I_r • kIRST L.YLE D 8. 0 8 0 8 0 8 0 S 0 0 . 0 401 O 74^ O0 745 00 145 54 9 2? "+""i • IT OX 47C O 0 O O . 0 0 0 t: cxj toot+M�3 MK.}hlGnF taf 9fSy1.�::♦ ... ... . ........,_...r �.......... fir•. 4A 4..1 • V : . �atiE R FI P R 0 e 0 d q F3 U 0 : 4G 0 1/ 6,' tY. 44 v IQuf ay0 wh Q.Wel _._..,... .__..._Y.._.___.__.. • sttHNSil kA.""ts w v , i C 4 Q 4 .. • _.N•wh A,n lg,P , .. O ,,.• h 4" ea rd C 6 U 8 0 C f'A 79 • �MMY r vr"Ne"ue.•., t31 .a...,..... ._. _ ...____. .. a Y • • s eI ( P£R109 s"of"91 4Bt4?JBS._.. roof* wOF34 • JOH Ne 954C +"iM 1 vg5 CGO .;p WEP -RUNNl RED • $; $4i8liifSiWFiUf:M-AYE i • RENTON...WA • CONTRACT NC. CAG 048-85 HtYjV'i rf2l AL F:ROSS RATE OF FICA W ei .. 1 HE /"� SeiN , r.»✓LV rE'c.. . ':,� 4 j G 7 HOURS WAGES PAY TAX • BUSBY: MIME F. 9. O B. 0 P, 0 8 O so 0 0 40 0 711 th" 17. 79. 166. 62 9 73 261 98 • U003 ` 372 PLA.0 „ F 0 . 5 0 5 C,. 0 J 4, 13 � SNEM9lMlM1E WA "06S 9t. a.., • 6 0 9. 5 e 0 e 5 v ct 4:2 O r;f:.? uAY r__ FW gr,� • 5L' -44'-"s6:Y8 GGCrIf"AT P."N HACMHOE LIPR'iPTOri .30r --------- • WEIGE4T TERRY L 8 :: 8 0 8 E 0 U 8 0 0. r 40 J e.l'- oc. ,ti :3- iJ" L'9 10, 31 254 72 • 1105 MAI :..E _ r 5 5 3 ^ C J 4 5 �4 ,. • 8 5 10 5 8 5 H 5 9 .i 0 44 5 rdFT f-A', 467 11 J.,-i 1 .i4^lcv', .,-.:urA 'ICN t',YELAY-R „POUr' _ Y • DVRO JOHN 0 0 . 0 8. 0 8 O O 0 16 O 247 04 15- 44 40 5e J, 7I 6. • ,.W6 LOWELL. LARIMER 0 :O . O 0 0 O 0 13 . 00 EVFi1ET1, WA. 9H?ry4 no 17 4P Oq 20 TI1? Nt 44 71 e:Ml'u, RUHERT 0 0 is e 0 i3 4 0 0 16, 0 247 G4 15- 44 114 7a 3 7 t c'', a5 • 5402 SEA 1VRST C 0 G 0 ,1 _, 0 i;0 ` V r.VEFC TT, WA. -'fiFkyy ___._...____.________.__• HARRIDAN. MIKE 8 0 8. 0 a. v J O H 0 0 U 40. 0 697 20 17. 4:3 i80 16 ,. 6`i , '': 6'S 1.2304 - 5TH AVE SJ 0 2- 5 , O 0 0 0 O 2 5 65. 36. 10 FVtt0F"TT, .0, "PIDA _____.__.__ CO 33. +c .`•., '31 RA .. . .. . . . t. .. . S JCNSUN, GAP. 8. Cl 6 0 8. 0 8 `. 8. J 00 40. 0 61:, 60 13 44 153 69 + : 1." 33703 PLAZA ROAL1 e 2..5 . 5 50 0 , 0 4. 0 92. 64 Ai M:N F14✓1NtT� WA fxFfOa—___ .�_____�____...___.._____._.__.. ___.___.__ ht1 SO 77 nc 33 fu-) • q 8 ? Air C P,=.' .. 1 1► l; Tki-6TAT£ i..CAft Tfi CjJUN, aw:: _ • 989 1G8Tf4 AVENUE N. E. - 6EiLLEVUE, WASHINGTON • PERMe EN92N0--118Y07f81� FORM tdFf—A47- "PORT 4B a, Pla: :;:; • CBI- SFi,FR TRJNK RLr' ACE n TUSjN/�HAfi Ui14 AVt 5 • RENT(N,t, WA • CONTRACT NO CAG 048-65 • N(R1RS WORxEf _ _ 1 51 TOTAL. GROSS RATE OF FICA N/N - a_ N T 'ERRYE.r` 7 c' 4` 5_.. o ?' ._.tifil7Re *4%@ '- PAY - _.... ..TAX Di-Ov�T • ROBERTS, .TERRY B. O a 0 8 U a 0 e O 0 0 40. 0 699 60 1"' 49 10—" 87 9 :d _ 161. 46 P. O ITOX ;73 a . 0 .0 . 0 .0 t) 0 0 . 00 • a t 0 8. O N 0 6 J v38 .c. -v178 UCCUPATION N V TRUCK & TRAILER OPR -------------- • al l.F PAUL A 8 0 8 0 8 0 a. 0 8. 0 0 40 0 950. 00 950. 00 181. 46 1. 44 249 8R • 1 18406 60TH PLACE' N E . G 0 . 0 0 0 0 0 00 _ ... _._ _ —. "q 66. 99 00 _. 00 r !� I"LiT lI+, ___ ... ._... ._.__....__.____.......__----,__ -__--._.._._.,...,�__.....___ .---_-__----___._�____.,._._..-_.____ _ • TOTA( FOR ,1C8 0548 476 0 8.1JI 68 1750 02 +07. 93 ._— _ .____...iN::r ua • 27. 0 66S 08 • .. ivy., FM- -„I:,. Si • • • 1 hemby certify that the payroll is correct and complete • an?,tho wz.e mtes contained herein are not lass than the • ap,,:c'..ble ;ate contained in the wage deterrmn tion dc_ o,me Sccmtary of Labor as stated in th C"Aract Prn. ;,c,.,:nd the work performed by ezco such laborer • or mechanic conforms to the,;Iassificationse st forth in said Provisions app•icable to the wage rate paid. • S 'mil • • • • S • . urr • a......r.EN.. ueon STATEMENT OF COMPLIANCE eoe.el wen.Nu I.RIOet •ee .R «Wa U11.1c bar.— 2-31-85 1 Arlene Whitworth_ Payroll Clerk do thereby else: ;Mill.el len.rery Oa,rv) I}7e) (1)Thar I pay or+upee ee th<p1.� I of e.to no PCiyed e,Tri—Stater.Constzvctiona Inc. on (Owthe 1Q1,L I; Payroll perod nommeneingron Ihr$=t}Xy Of JD y IRw 91 ` err )9U end Itdrng Ih�l_tiay of July 19U_ aft Persons employee an said protect have been paid the full weekly w<ps tamed.that n9 rebates have been or will be made either directly or Indirectly In or on behalf of and Tri— State C0nstructM 0nI Inc, from the full weekly wage%seemed by any pmaon and th.,no drductinne have been made either directly or indirectly from the full wages earned by any parson.other then permissible deductions as defined in Regulations. Pan 3 (29 CFR Subtitle A) issued be the Secret., of Lahr under the CW.J.hd Act. ..amended (Ag Stai 944 63 Star 109. 72 St., 967;76 St., 357, 90 U 5 C 226c). and described below: Withhcldina 6 FICA Taxes M d' 1 Aid s Suo6lelnental Pension 121 That env p.pMio otherwise under III s contract required to be submitted lot the above Defied as cer m eecl and coplete; In.,the w.ge paten for Winter..,mechani .contained therein are not less than the sopliceble rage totes enntatned 1n any w.ge determination r oorporatnd into the e..nuaeG Inn the cl naficeapn. set forth therein for..tin bberrr or mrch.mc ram form with the work he Performed IT) That any apprentices mnPI-I'd In Ins We.period.re duty mgirtemd in.bun% fide.pprenuce.lnp pmpam registered with . Sure rpprrnuceahip.,.—I crcor•nreed .y the Bufeer. Of Arymnrre,.hrp and Training, Uo0ed S,.,,.Department of Labor,or If no such c.,hi..d....0T%bate In.Stare, ate registered with the Bureau of Appmnticeship and Training. United Sit,.,Department of Labor (4) That: (a) WIIERF.FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS nIn addition to the baelc hourly w.ge r.mt paid to..an Isbell,Or mech. : listed in the.Lave referenced pay roll, p.ymenb of fringe hene0le a% Baled 1n the conv.c't have bem o wd m l be made Id.pppnu rora. pgm. fOr the benefit of such employees. e.cepl as noted in Section a(c)below (b) W11ERE FRINGE.BENEFITS ARE PAID IN CASH �• Each L.W o,or mech.mc listed In the above mfer.nced payroll sus been Vaid a,r indlcaud on line p.,.Il, an ant nul less chin the tarn of the appiicabiu bastc hourly wage'ere plus the amount of the I.9ulrOil Innge benefits.s listed in the convazt,incept a%cited in section d(c)below fc) EXCEPTIONS EXCEPTION ICRAOT__ EXPLANATION ...e .-.n r�•_c ate«+Tor- �_ Arlene Whitworth, Payroll Clerk � ___. _sr ue•. o _=..r aeo.c sr+*roe.rrs.r+• s_evecr •..e team a.c.on on sv eeori•a+c•oa in oa cn— +c oscc.:• _.. sce�se<•�o.. .1 or .,.ce r, ••,c Is"'..,III ar nTce 11 o• r«P ,,Teo se+rra Far.RN•2• ran wont«sss r«r.ro.ia m..cl r ..eau n..w.w pa pO,:weN.. . TRI-STATE CONSTRUCTION. INC 959 IJSTH AVENUE N. E. • BELLEVI,W: WASH INGTON • PERIOD ENDING 07/31i85 FORM WH-347 REPORT JUD NG U54E 1965 C61) SEWER TRUNK. REPLACE S TOBIN/SHATTUCK AVE S RENTON. WA • - CONTRAC NO CAG 048-65 • HOURS KEL' . • d Y,9 NAME. ALDRESS �:41' �1 /•, �1l OAY i-K: it / J'.+i fUl Al. GROSS RATE LF F'ICA W/H ST .IE S 1. i 0ii4LR Tug. SSN OF EMPLCY£E 1 2 3 4 1 6 7 HOURS WAGES PAY TAX DE'DULT '1n+ WIEST. GERHE.RD 8 0 8. 0 e 0 8 0 6 0 O 0 40 0 699 60 17 4a ,-- . d2 9 30 399 H4 - 12634 B. F. 276TH PLACE 1 O 0 O 0 O O 0 1 0 26 24 KENT, WA. 96031 .-.______ _...• __.__ ri 5:. 11 00 )<' •v 0 � o ClC� 0d G 0 n 11E7 PA• :_ . . .. 336-26-0059 OCCUPATION. 7RUCA DRIVER i730--1; 30: -RRST, LYLE 0. 8 0 8 O 8. O 8. 0 e 0 0 O 40. 0 74", 00 /4' OO 140 54 9. 27 115" ,3:1 • ' 3 4T 2. ROX 47E O 0 0 0 0 0 O 0 00 WA 78272 _. ____.. _ _._ _- ._... ._ _ _ .. . _. U l JO too O 8 0 8 0 8 0 8. 0 S O 0 O 40 O NET PAY 4v ... • :38-44-6877 OCCUPATION. SUPERVISOR 44U PORTER. LARRV M. O O .0 4.0 4 . 0 0 4 O 70 64 11 66 15. 48 4'+. • 1344 PORTER STREET 0 0 0 0 O 0 0 O 00 • ENUMCL.AW WA 9tx7C2 ------.....------._.. __.,.___. __.__._.__.___. - Of 0 O 0 4. 0 0 0 'D O NET FAe 49 99 531-44-614Ff 7CCUPATIJN L/B 730-0720/S-9/GR3UP 4,A1 O1.ICK. iN1hNE R. 8. 0 8 0 8. 0 O 0 8. 0 0 0 40 0 637 60 15. 44 132 57 9 56 242 P 11$13 - 127 AVENUE k E 3. 0 O O 0 0 O 0 3 0 69 4$ 40 11 WA. 9_�� ;;.. 11 C t3 G F E 0 0 0 0 4;3 i. 74 T G d+, 41":, 17a 301-6k-6'S;,i W': ATiON. P*PE:LAt ER 440 JOHNSON, RALPH W O 0 0 e3.0 9. 0 0 0 16.0 220 00 350 00 31 66 :7 4,' to 16405 BURAE AVENUE NORTH 0 0 0 0 0 O O 0 00 • .,[.i.TTLE. WA 98:1:? ______ _. _.._.. _..._.. _ 00 5' Cil' Uri 0 O,:CUPA'',ION CIVIL LhOI NUR DE NOMA, JAY G. 8 0 $. 0 6 0 8 0 8 O .O J 40, 0 711 60 17 79 124 48 v 50 216. 78 6624, 163 Pi.ACF S W 1. 0 O 0 0 43 0 0 1 0 26 69 • -_YNNWgOR, Wh 930"( ..-..__ ._ .__.___ ._._ _.. . ,__._...____-___ GO 05 00 3J • 9 0 H D 8 C 8 C r 1)O 41 0 '�dE" P � `.,1 ` 1 508'-40.-3.= OCCUPATION, OPERAIOP OROUP 1JiL • TRI-STATE CONSTRUCTION. INC • 959 IOSTH AVENUE N E. ppp BELLEVIIE. WA9HINGTON • PERIOC ENDING 07i31/85 FOAM > '-347 REPORT JOB NO 0548 PAYROLL NO • 1985 CDC SEWER `RUNK REPLACE. S TOBIN•SHATTUCK AVE S • • RENTON. WA. CONTRACT NO CAO 048-85 • • 8 WM4,r) }�+ NAME, AL:IIRE_SS , •-' .•J y:, DAY �+ � .�� '�/,, TOTAL. GROSS RATE OF F::A WH STATE S D 3. OTHER TOTAL SSN OF EMPLOYfi£�., I 2 4 �5 6 7 µOUR:; WAOES PAY TAX DEDUCT • NEWELL, JR , W. FRANK 8 0 e 0 8V0 8. 0 9 0 0 0 40 0 685. 20 17. 13 184,91 10. 08 262 17 ilf $711 SOUTW 129, 012 3 5 0 0 0 0 0 3. 5 89. 93 SEATTI_F WA. 96.79 -'-"'-' - -..._. __.. OO 54. 65 00 3.2 63 • • ! 1 5 8 0 E'. J 9 C, i771 0 43. 5 WET PAS' 492 �5 533-26-3694 OCCUFAi IOW: 866 OILER 30a. _ • PINOREE. DAVID F O O 8 0 0 0 0 0 8 0 139. 44 : i 43 23 33 1. '89 41 30 n■ 19716 - 24 AVE N. W- 0 . O 0 0 0 0 O 0 00 OS " EATTL.e. WA. 961 ..... .._ ._ _.._...._-._. v__.__. .. 00 • 0 0 a 0 0 0 8 0 NET PAY. 98. 14 025 44 J564 OCCUPATION SERVICE OILEP (570 765) _._ ____ __. --- ----- ____.__ __... _._._.. __.. _ • BUSBY tIKE F a 8. 0 8.0 8. 0 8 0 U C 40. 0 711. 60 :7 79 156 "5 9 50 244. 25. 8623 - 372 PLACE S.E 1 0 0 0 O 0 0 0 1 0 26 69 - . SNOOVALMLE, WA 96065 -._a -. �__fl_�_8_c___._ CIO 00 30 7 O �: `., 8 q O 41 NLT PAY- 489. 04 • O`37-44 3638 OCCUPATION RACKHOE OPERATOR 30.' y ai _-__ ____._._---.- ._»__. -_.__.__. --_- ____...__ • NOBLE ROBERT L 0 O C C ^. O O 0 00 17. 66 6. 88 49 1005 2910 - 78 AVENUE. 5 £. U 0 O 1. 'J 0 f! 0 1. 5 39 74 E\'CPr'.TT WA 982f1, _ . . ___. . _...__ ._ . .._ _._ ... „p 2 69 ia� 'P • • (' U I 5 .. 1 . NET PA` r.? 939 3t 3904 7CCUPIT ION. D 130 0 K J--7 140ji 4fA! • WEIOELT, TERRY L - 0 8.0 8 0 8.. 0 8 0 0 0 12 O 494 1)8 15 44 114 45 8. 56 211 4.: �t11 %LOS MAPLE 4 5 0 . 0 O 0 0 0 4. 5 t04 22 WA 98dhi1 - _ _._._ ._ . . - JG • • 4 '. G O F,v J 8 G 00 Cti .. -46. 3 �IL-7 PAY 3811, 3P L 12-t4 16YJ OCCUPATION. PIPEI.AYER GROUP 3 • µARRIGAN, MIKE 8. 0 8 0 8.0 8. 0 8 0 0 40. 0 697. 20 17 43 165 65 9. -30 256 "r0 12304 - 5TH AVE SO, 1 0 0 0 U 0 0 O 1 0 26. 15 e VEPF.T I'. WA 9020,4 .--_. _ __ -_. _ ..__._... ..___.__..... . 00 51 00 '%r' '3J • 9 0 5 -i 6 D 8 t> 8 (; 0 41 O -5 P?- 4r,o 45 • .39-66-2786 CCCUPri.ION OPERATOR 302 -------------- • • • • Ii • • • • TRI—STATE CONSTRUCTION= INC • • 959 108TH AVENUE N. E BELL.E9UF WASHINGTON • . PERIOD ENDING- 07/31/85 FORM WH 347 REPORT PAYRGI. =w. •.,K ,,r08 NO. 0548 1985 G30 3LWER TRUNK R�.PLACE. • S. T0BIN<SHATTL" AVE S. • RENTON, WA. CONTRACT NO CAG 048-85 • • HOURS WORKED - STATE S D. I OTHER TOTAL Z1, DAY;u.f Emir. . /+i 'TOTAL GRLWA RATE O.' FICA TAX DEDUCT • NAME. AV"PLOS AND . .'_ TAX 62 241. 21 SSN Of fNPLOYE£ 1� 2 3 4 9 ~b 7 HOURS WAGES PAY 9. • JENSON, GARY 1 5 8 0 8. 0 8. 0 8. 0 O 0 40 O 634 74 15. 44 133. 72 1 9 O D .0 A O O 1. 9 34 74 45 99 00 51. 88 • 33709 PLAZA ROAD , ---..__ --_---- 00 _ .. NET PAV. 411 13 • 131 Ai X C I AMOND, WA 9801- ...- ; a 0 8. 0 8, 0 e 0 0 O 41 5 • 515-70 7.—' 35 - OCCUPAT BO.N, P IPELA YER 440 __ 110, 950 D 8, 0 8, 0 8 0 6. 0 D 0 40 0 699 60 17 49 '_ — - • r 1 0 0 0 0 P 0 O 1 0 26 -14 n0 • JL i r<r+. .. I- `'� 1� nlF.l PAY 554 95 0 • _ _ a 0 8 0 8 0 8. 0 8 0 0 J 41 O 534 36 -9178 JCC4PATigN: N!U TRUCK L TRAILER OF-R _ .-_--.---08 Se -- . 00 • NO3l t. PAUL A 8. 0 B O 8. 0 0 O 0 0 24 0 570, 00 990 - N PLACE N. E 0 0 0 0 O 0 0 O 40 V' Ct" OO 16404 - &OT • OU NET oAY 470 07 • SE.aT*i F. W4 9615 ' 8 O N 9 O U ll O 0 24. 0 ....____. -_.,..._..___ • 5 J:.-9r3•o3 i;CCUPA- LUrl. ESTIMATOR __ _.. .. 1593. 84 • 4 0 7 TOTALS FOR JOB. <J 19 549 47 l b 47G 12 �,p 3NFi P4 71 • 00 �!4 t34 • 463 U • I ect end complete baby certify that the Payroll Is corr less thall the • (j and the wage ra ate cotes contained ne the in w,&a determ naLlon oY Labor as stated the C0.1tract • appreciable rmane4 such laborer deci_,n of the Secretary c- • Provisions and the work N-rformed y ec tforthlnsaid or mechanic col caC a foottheCwageiticatii(i000nnssCd • provisions aPP I + • u..omanTM(v�ot LAYow STATEMENT OF COMPLIANCE 0.11.1 yer.."al...Rio,) 6(aN0 NOV N Oi V,IiON D.,e 7-31-85 I._ Arlene Whitworth _ _ Payroll Clerk do hereby.,.tat IN.ne of 1(nuorv-arp: .--�1� to Tne,I Pay O me pay, a the per employed byTri—State Construction, Inc, .,�./9ffCPBON Par.., <na .r O[r�,.r) on ! Ida . .al —ram— I,,he payroll perind Commencing on the 2,51A,of July 1� and end,n(ehLi-spay of July I985. all Persons empmy.d as and preien ; .e been paid the full weekly w.ge.earned,that no have been or will be made either du.-Ill or Indrte<Ily to or on behalf of saidTri— State Construction Inc. from the full weekly wages entered by any Person e.d the no deductions have lc.nrr.n.. been made either directly or indirectly from,he full wage-gamed by .ny person .,he,than pmmn.,ble deduction,.a defined m Re(ululon+. Part 3 (29 CFR Subtitle A), owed by the Secretary of Labe,under the Copeland Act as amended (all Ste 948 63 Swi 109.72$tat 967; :6 Slat 357. 40 U S C 276c„ and described below: Withholding & FICA Taxes MnAi cal Aid & suoo igiw-ental Pension ('d) (2) That any payrolls Otherwise under this contract required ,o be subnitted for the above Period arc correct and complete; that the wage rue-fn,labm.e.or mechanics contalned Italia .m not leas than ,he applicable aisle Tat. cwit amed In any wage de,eento.iion inccapenIttod into the Contract; that the ciaxaif icarions set forth theraui In,each laborer or mechanic can form with,he work he Performed (3) The,any apprentice-employed is the above pi nod ore dull registered is.bona fide.pprenhcesh,prat,..reP.t.,d with a State Apprenticeship stency mcognised by the Bureau of AMeent¢esblp and Training. United States Deparimse,of Labor,or if no such recognised agency eaiab,n A 5re., are a,vened with,he Bureau of A,aratlCe.h,p and Tnimnp United States Department of Labor. ld) That: (a) WHERE FRINGE IENEFITS ARE PAID TO APPROVED PLANS. FUNDS.OR PROGRAMS t ay- In Addition to the basic hourly w.ge rate,paid to each labo,et or mechanic listed in the above referenced pay roll payments of fringe hensfic. A. Baled in the conlrael have ben or will be made 1.appropriate Dmr raw. le.,he benefit of ouch employee I. ....p, as noted is Section d(c,below (b) WIIERE FRIN-E BENEFITS ARE PAID IN CASH n- Each Labors,or mech.n,c [.,led . ,he ebeve roleuenc.d payroll has been paid A. in3m.ted on the payroll. n amount n01 lee.than the a of the eppliceb4 basic hourly wage fate plus,he amount of the required frog. Cenefns..listed is the Contract.eacePl as noted m.action a(c)below (<) EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION w w.a-s avt aP ( NE Arlene Whitworth, payroll Clerk It w 'C ,a L,ie,C a 1104 C • Es rN( aaO,X IT l(Ni r, O E Nf: v 110lttr TnE CNr9,Croa Ow S,gCOV C1oa r0 Clv.�O.tnI I.L anO3e C-l'C.a aE 1e,11O1 •e.1 or tie e , .NO el, Oe .,,a„ a 1.E .rar,+ c OOE Party YM.]4 luau evw<wu(ten gown In.....T enact rNt+yaT.or tie ...... • TRI—STATE CONSTRUCTION, !NC. • 959 109TH AVENUE M. E. AELLEVOE, NAtSHINZTTM 9 TOBIN SHATT;'CK AVE Sn • • RENTON, wF CONTRACT NO. CAB 048-61 HOURS pF EtApLO rEe. HOURS WAGES PAY TAX CEOUCT tilt • WIESST7, CERHERV d�0 6 C 6 J 5 0 A C' C '„ 40 O 699 6t.• 11 iti 139 '..I 12634 6 E" 210N Yi A, F 1 0 G O {) v _0 a 1. C. 26 24 .+ 0 a d n Q,. C pis Co 745 149 54... ., .,3 . { ( 2, Lux .lE. �. G .:� 11 4 o 0 Imes , _ _ .. ". _ ,. Lea) • ICJ ,, s. _ . . _ • 1� • 1tlt • TRI-STATE CL*tSTRUCT13N, -N, • 959 I08TH AVENUE N k SELLEVoC, WACHINCTM S TQSIN/BN^TTUCK AVE 5 • RENTON, WA CONTRAC- MC CAQ 049-A5 L.,," JAL SSN OF rtr[PLOYEE 1 2 34 5 6 1 7 H04JRS WAQ" PAY TAX 41EDUCT • MEWE,� W 9RAt4h a R 0 s 0 a 0 8 0 6c 40. 0 6915 20 17 13 194 el 10 08 282. 17 • 13711 SOUTH 129, Ail 0 0 :1 G SZO 03 9 0 0 r. 11 4 41 .'O • C. 'lit 249 25 'Nit • fill TRI—STATE CON$TRLCTILNJ, INC • 959 108TH AVENUE N.. F • BELLEVUE, WASHINGTfN•i • rErk,LL cMiJiNG ,: J1/t+` 717411 l4i+-'.:47 REPORT' •JOB No 0548 PAYROLL NO 1985 cBP ';EWER tR_'NN REPLA"E. S. TO8IN/8H0kTTUCA AW 9. • RENTON, WA. CONTRACT NO CAW 148-85 3 4 5 6 ? HOURS UAOES PAY. C!• .> .,AT:. �, C WPM liih'6' 4 U iA ` ,JA; SSN OP 1P1.17YEE 1 2 - - TAR - OCOrJCT • �tEMSON. 4ARY 9 0 8 0 6 8. 0 H 0 Q . 0 4U. 0 61 60 15 44 133 72 9 b2 241. 21 • 33705 PLAZA AVAL) 1.. ;+ D 0 0 . O C 1 5 34, 14 • 3 9a G 9 535-70-70"!4 OCC'UPA?ION. PIPELAVER" 443 _ . . . . . . • 3 0 9. 0 9 0 a 0 9 0 L O 4C 11 6'i`? SO 17 49 110 9 50 170 09 i O 0 Y."Q 08 !."E El 3h 149 •^J • 1 t"'i certify that the µryrorl is correct and complete • and _e;wntiin<d herein are not less 1,. the . apt -'� �- the ."age determination de. _r:b<C:'_ Pr. ' d in th Cc..tract • rnI' :r_nir.cclfc....stotr•-ci 1>ficaUonsset forth in said •.. Pronsmna ah�he wage rate Pe • i� Fer «Pisa etl U.S. tia..0Mo.DEPARTMENT OF L.ROn STATEMENT OF COMPLIANCE Da....ear...no.a•-Rwu wAa.•wo.ova of varo+ D„< July 24. 1985 L Arlene Whitworth Payroll Clerk _ de hereby.tste. tn•m,et,ua.5ee vo.rt d5 t.�—' (1)That I pay.r a. .ice me pal ant I me persona employed by Tri—State Construction, Inc. a� q//_ --�co-r e,l the fQ�V A-BD during the p.nou period ewnmenaine entneal�tILr of_?1.1y lnv.t 1 U and eeri e%1n.2.4Tdgy c .Tiny Ins. all persons employed on sold Protect have been paid the full weekly .,Re,earned, th.,P.rebates have been o,will be made either directly or ad-inetly to or on behalf of aid r l- St,.ee Construction, Inc. fain me mu weekly wage.earned by any person and that no deductions have ccwnra.ar.r. been made enel,directly o indn.eliy from the lull wages earned by any person, other than Permissible deduction pd.defined In Regubtions. Part )(29CFR Subtitle A). issued by the Secretary of Labor under the Copeland Act, as amen ( 8 Sul. 948 63 Sul 108. 73 Slat 967; 76 Slat 357. 40 U S C 276c). and described below: Withholding & FICA Taxes Medical Aid b Sucolelnental Pension (�,) (2) The, any payrolls '",.Ire under this contract required la be submitted for the above Pell. arc cnrrcct end cemplev; the the wage area For bbercra or mechanics centained therein at, not lees Nan the applicable wale .ales wmuned is any wage determination i o spoled let.inn c.nlac, the, the dunsi Lcutin..a A,, furkh therein for eacF taborer or mechanic can fern with,he work he performed (d) Thu any app.emices employed .n the above period as dv IF registered an.hone fide epp,enlio.htp papam re n.leatl with . Slue apprenticeship agency recognized by the Bureau of Apprephes hip and Trainmg United States Department of Leber,or if no antis recoRuaed agency Ed.la in.S..... tie re.....or wen the Duteau of Aq.rcntiteaF.p and Training. United States Department of Labor (q That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS (� In addition ro the basic hourly wagc ratan paid to each latioler or meahant<listed in the above referenced pay- roll, payments of hinge beeeBla .s linked in the e.ntn,0 have been or will be made to appropriate p",am. for the benefit of ouch employ..., ..cept .a noted in Section Qc)below. (b) O'BE:RE FRINGE BENEFITS ARE PAID IN CASH (^ Each Laburer or mechanie listed in the hove referenced payroll has teen paid as indicated on Ill. Irtnll n..on,no,less than the sum of the applicable basic hourly wage rate plus the amount of the required benefits as listed a the contract......r Aa noted in section a(cl b.l.w (c) EXCEPTIONS EXCEPTION(CRAFT) EXPLANATION s��L •..J T�rAt S�eu♦T„w[ Arlene Whitworth, Payroll Clerk ...« � o.. u.q•r.-., u o r.ra A an.. so•T euar.T5U •p soa,c .. .,rs ..es OR<RuvL OStC�r. - Ea IA['i0.'. v C<T Pau gN•8N unu aunt....rna eo.w n...Eil♦ 1.0....e sure.oe oo cow.Nn • •' TRI-STATE CONSTRUC''ION, INC 959 IOGTH AVENUE N. E BELLEVUF: WASHINGTON P£RiOL ENDING; 07/24/05 FORM WH-341 REPORT • NO, 05" PAYROLL NO • 1985 C8D SEWER TRUNK REPLACE • S. TOPTN'SHAT?L'CK A'E S RENTON, WA. • CONTRACT NO. CAC 048-85 iO"mq IiORfIEp NAME, ADDRESS AND "I 7"j "-je LAY,/ 7L /j1 TOTAL :-ROBS RATE OF FICA WrH STATE S. D I OTHER TOTAL c SSN OF EMPLOYEE 1 2 3 Or b 7 HOURS WAGES "AY TAX LIF.DUPT JOiNSI`t. JERALD 2. 0 L D 4. 0 0 O O 6, 0 114, 34 19. Oa 37. :7 1 54 _ °4 05 • 1 12527-464 AVENUE S. E ) . O O O 1. 0 . O . 0 . O 1. 0 2S 64 ! 1 P. O BOX 1215 --------------.--------------_.------------- 00 10. 22 00 5 00 • NORTH BEND. NA 99045 2. 0 . O . 0 5 0 . O 0 0 7. 0 NET PAY 89 15 • 5!1-32--9757 OCCUPATION. MECHANIC t570-56301 • WIESI. GERHEkO 8. U 8 0 e. 0 . 0 . 0 ..0 . 0 24. a 419. 76 17. 49 77. 99 S. 54 11.3. 07 • 12634 S. E. 276TH PLACE 0 0 0 0 0 . 0 0 0 00 KENT WA. 9BU31 __ .___ .____.__ -__-'- ___ 00 20 52 00 DO • 8. 0 B 0 8. 0 O O 0 0 24 O NET PAY 306 69 • 53t1 54 OCCUPATION TRUCK DRI"FR i730 02-.10' HIRST, LYL_E D, 8. 0 8 0 8, U 0 , U 0 0 24 Q 447. 00 74t, 00 8 3_' 5 5. :54 39 • • RT. 2, BOX 47E O 0 C 0 O 0 0 O 00 MONROE- WA. 98272 -------.------. 00 31. 51 00 30. QO • 8. 0 8. 0 8. 0 0 O 0 0 24 O NET PAY 292 61 • t-.32-44-6871 1CCUPAT ION SUPERVISOR 440 • GLICK DUANE R 4. 0 8. 0 8 0 0 . 3 . 0 0 24. 0 370. 56 15. 44 93. 15 5. 13 iSS. l7 11213 127 AVENUE. N E 1 J 1. 0 O . 0 . 0 0 O 2 0 46. 32 • • KIRKLAND, WA v�31 __-----------------.-.______.-_-_--___ . 00 29 49 00 27 v5 9 0 9 0 8 0 U 0 0 0 26 0 NET PAY 261 11 • _ JOi t -87'_. C...'UV 4. I0.`: PSPELA`IF 440 • JOHNSON, F.ALPH w.. O 0 V . 0 4. 0 0 0 4. 0 110. 00 _50. OO i5 i.. _`,t J. Su • 16405 BURKE AVENUE NORTH O 0 0 O 0 . O . O 0 00 >iEATTLE. WA. 98133 _.___.,-------------..__-_-_-____.-....-___ . _ . 00 7. 76 . DO OJ • 0 O 0 . O a 0 O 8, 0 NET PAY 86. 13 r • tOo-.18-1776 OCCUPATION CIVIL ENGINEER • UE NLIMA. JAY G G. O a 4. ci J C 0 0 24 0 4,4. 96 17. 79 101.39 .. 4 U` :5J 54 • 662.4 - 163 PLACt 9 W 5 5 . O 0 O 0 0 1. 0 26. 68 L.YNNWOOD, WA 9SU 9' --.__. ._...-___ _-__-__ .. -------- . 00R 31. 68 00 2.5 6@ • B 5 e 5 8 0 0 0 0 0 25. 0 NET flAN' 3C�i I • _ _'DU 40-3700 Ch.,.UPATiON OPERATOR GRGUP 13t f , • • • TRi-STATE CONSTRUCTION, INC • 959 108TH AVENUE L C BELLEVVE. W4SHINGTON • • 7ERiOD MING 07/24/80 FORM W-347 REPORT JOB NO: 0540 PAYROLL NO 1965 CID SEWER TRJNA REPLACE • _ Tl_6IPa/SHaTTt1CN AVE RE147.3N. WA • CONTRACT NO CAG 048-83 • ll 'LAME• ADDRESS ANC !; 7,/r 7 / sAV7� E fU /y,p 7�jt TOTAL GR09S RATE OF ✓= (A W!t+ STATE 5 (i OTHER T' TAL . • iSN " EMPLOYEE 1 2 3 4 6 ? HCUR5 WAGE_; PA" TA) D+E,4£a L. JK' . W. FRfd1R D.0 8. 0 8. 0 0 0 . U . J 24 0 411 i2 11 13 Fm. a9 .. _.._: 63 • 5711 SOUTH 129, 412 .: 5 5 O 0 O 0 1. 5 38 55 • SEAT'TLE, WA. 90278 -------.---,.------------ ------------------ . 00 31, 70 00 19, 13 B 5 a B 8. 9 0 0 0 0 25 U. NET PAY- 316. 04 • 3. 26-->b94 OCCUPATION 86b oliER 10c --------------- • PINGREE• DAVID i 0 . O 6 0 O . 0 0 G a 0 139. 44 17, 43 2.1. 33 1. 83 41 30 228 - 176 PLACE 5, 6 0 O 0 0 O O 0• -------- 00 10. 01 00 6 08 • . 0 0 S O 0 - 0 O O 8 0 rIET PAv ?6 14 • % +}-_•;b4 OCCUPATION SERVICE OI t..ER t570-5765• G1JF.IY, MIKL f. 3 0 8 0 a, 0 O a 0 1, 19 117. E16 4i :G'. •12 S023 - 372 ACE C 0 0 0 0 O U C 0 00 SNOOUALMIE, 98365 ---- ..____.__.__..,----.-.,....__._..__.----.____..._ _._.._ 0;. 40 14 00 24 00 ,. 80 a a 0 130 0 0 32 C NET PAY 17986 s.':8 :i:' Y,F.T1,0N 4kC:M.HC4 OPERAr,P 41?'^ �! �M `4OLLL. ni2LRT L 4. G G L D u i± v 4 V 7C, '.,4 1 66 J . 42 1 4e: 8^ 1, • ."910 - 7f; AVFNUE S L J 7 O 0 O 0 O J 'I ^ 172 77 T EVERETT, 'AA. 98?0'.' ___..._..__ ... ...__. ..__.__. ...,. .,__-..- _-__.___._- 0( I1 49 00 7 9 6 0 0 O O ol 7 5 NET PA'4 116 41 • ... . ;i-yf,q i� t�lrr, ;0 3r 71 „aI,1;Pfl01 4,4 : l:k♦GEL I. :i:RNv 0 .. L, v 6 9w 1i05 MAPLE 1 0 1 0 . O O O 0 0 2 II 46 32 • EVEPFTT, WA 98201 __.-------.------...------------------------. 0Il 29 49 00 27, 95 tPl� 9 0 9 0 8 0 O 0 0 6 26 C NET PAY 1"_$ 0d • r + . :.a ;e,• ' q'ION PIPFi_A 07 r9ARRI�.AN- MIKE a i1 8. J 8. G 0 0 J C «4 ; 419 :I« 1' ••3 32823 - 1951H N. F 0 . 0 0 C 0 0 0 0 00 29 49 40 18 00 �� OVVALL. WA Y3n-ro ' 00 8 0 S 0 8 0 0 0 0 0 24 0 NET PA'v 296 . • 534 66-2788 brr;+PAT ION OPERATOR 302 -, ._ 41 • ,1 • � � rR:-srarE coNsrttucTtav, tN;: • 959 108"rH AVENUE N, E. ' SEt.LEVVF. WASHINOTON PERIOD ENnENO, 07/24/95 FORM Wit-347 DEPORT • J"IF NO 0548 PAYROLL NG ® / • I-Of' CFD SEWER 7Ri1NK $E?'LACL S TOBINISIoAT%CK CVE 5 F6NTON. wn. CONTRACT NO. CAC 048-85 . i %RQ 140RNED �/ NAME, ADDRESS AND ,r /): - DAY7 7� 7�j0 71-i TOTAL GROSS RATE r1F FICA Wib 8TA 5 SSN OF EMPLOYEE 2 j~3 4 `S� ' 6 7 HOURS WAGES PAY TAz TE _ - i;THER T[.rar DE fiUC FWJ4S • .. 35705 r. GAR>• 0 0 a.0 . U 0 a 0 BIG 123. 15, 44 _ __6. 96 i 85 d7. 52 .1t111 • 3y707 PLAZA R1k40 0 0 0 ■f BLACX DIMOND, VA 9801--------------------------------_______ 00 9. 71 00 10. 00 • 0 0 80 0 0 O 0 80 - .. HET PAY a600 • _ 53'-70-7035 OCCUPATION PIPELAYER 440 • ._..__. ......___.__. ---..----------------------.________-__ ____ .... __. ..__... RUMERTb. 'lLrRY 0 8 (; 8. 0 0 U 0 O 16 0 R79 W4 17. 49 16. 27 3. 71 39, 71 • P 0 BOX 773 0 O 0 O O 0 . O 0 00 SULTAN. WA. 98294 ___ ..--------------------------- ---------. . Op 19 73 03 00 tl• ��.,. O H el 8 0 0 -. 0 0 0 16 0 NHT PAY'. 240 13 f0 A, r^N N:a TGIICK 6 TRAILER )PP • NWD1L PALL A 0 0 4 0 8. 0 8. 0 O 0 60 0 475 00 950, Oi+ 90 7f ,I 1d4. 94 16406 - LOTH PLACE N E 0 0 O 0 0 0 0 0 00 3EATTl.E, WA. 99155 ----------------- -------- . 00 33. 49 . 00 00 • r` O 4 0 8 0 8 0 0 0 20. 0 NET P`.Y 350 06 ESTIMArUpo ,7TsFFER TS, U:n'.'f 0 ra- :: O 0 0 . 0 . 0 8 : 133.44 16 61; e2 db 1. :9 81. 74 14320 SEATTLL HILL ROAD 0 4 .5 0 0 O O 0 4 5 112, 59 SMHOM15H. WA. 98290 --1 ---.________-_______.___._.__-._-____.--___-. 00 17 24 00 ^0 O 12. 5 0 0 O 0 0 12 5 - NET FAY 164 29 518--30 0907 6CCUPAr It IN WELDER SHUP TOTA,S kU14 „0 0546 278 0 4679 v8 L005. 9. 59 • :5 5 391. S2 • "- 00 371 66 00 183. 7q r• W93 5 NFT PAY J1 05 u • I hereby .erhty that the payroll is correct and comolMe • and the :u;e gates contained herein are not less than the appredabie rate container in the wage determination . decision of the Secretary cl Labor as stated in the Contract • Provisions an Ne wuk _rformed by each such laborer ermechanic conformstolho classif icationssctfotth in said • Provisions applicable to the wage rate pa • �L 7 � • 40 u3.Ot...TNENT OF u[o[ mao♦awo wouN orvinow STATEMENT OF COMPLIANCE Fei qPO"•i° 8,iw Rar•au No.as RI Bel Date JUly 24, 1985 1 __Arlene Whitworth Payroll Clerk Mama of Ise the o,r: ---y r, do hereby e• . . t L rfiat I pay or lop the Payment Or p toyed h.Tri—State ,.e. ' ,---Z:•�-„Construction, Inc, n t R t e payroll Period,ommencmg an the yyyov of JU JV lou end ending theyof .Tn1V 1985, atl person[ -employed on Said ProjeCt mi— bean Paid the hdl weekly wage.earned, that no rebarea have been or will be made either duectly or mduectly to m on bebop of aid Tr1_Mate COnatL action, _nCa from the full weekly wages to mad by any person and that on daduct...h.t. b^en made either dimytly or tndnenit !f,.m the full R...I...... Par, J(29 CFR SuG•iRe A). 'aaueAwl,Rea came.,by any person, other than Vennbsi Gle ecdu�le na an depn<d 948 fiJ&at 108, )2 St.,. %-,;`b Stn: J51:40 Issued u C ly he Svc Jea abed Labor under the Copeland Ac,. a. ode•' (JR Ste, Withholding & FICA Taxes Aledi,'mil Aid & SSitpplemental Pension (IS) (2) Th t '-1 Pq,ollc olherwty under this contract ragweed in be that the ap eetea ro'bhom"o emeehanfca emet.{ned therein suta, a fur the about Period a core.and .plate; wage de: matron o .'o's'ed Into the e..".c.; that the clasatficalsonys[a a lurth thoem bl ea W 1-t-- a' t.umd y berm-'In ebe work he performed a h.nm coo- (J) Thal"1 "Itennce'employed In the.,rove jnm ou are duly' rtgtatered to a bona pd<apprcn!'Ces:�'.P Program registered w a Sate amuRmmesbP agency recognized by the ""a of A,with er f no no"...k" agency ex1.b in a Sate, am ppoenOceahip and Tramv.g, United Smte. Dep.em,,,of State,Department of Lamr mFete Rd with the Uumau of Appmm,Icenb,and Traln.nR, United t0 Th.e (a) WHERE FRINGE BENEFITS ARE PAID TO Al-: PLAN. FUNDS,OR PROGRAMS I uum n add m the ba.,C hourly w.gt rotes paid wref or mechama listed in the abo.e Rferenced forro pay 11txe. Payment',.; f fringe hemepls ae listed in tit nefit of h employees •.<t nave been n, wdl be m ropr ode to approprule pame suc , e...P, as noted m Section J(c)below (bi WHERE FRINGE BENEFITS ARE PAID IN CASH E-ch Litho,-,or me,hantr pared in the .bwve referenced payroll has been paid as inJtcattA on the pavwll. nut to i thin the cum of the.ppa muted bunk hourly wage ra,e plus the amount of:he re9wmJ Rm Re b TKINS as pa�eA m tfie a'ontrum. except ea noted in aecnnn J!a)"Inw E%CF.PTRn'c ERCEPTIOM ICRAfP --� EXPLANATION ArleneM Whitworth, Payroll Clerk ca C�vq on e+ UnOe oe i� at 6 _ cone aamcu+c. sc +e 9v^ fans WN 341 nnu ...cwu[Two aoaat awanv avow +.[auwT, • • TRI-STATE C(N4STRJf.110N, 1AC'. • 959 3087H AVENUE N E. HE"EVVE, WASHIN©TON _.. • PERIOD ENDING 07/24!85 FORM WH-347 REPORT • ,i08 NO. 0548 PAYPOLL NO • ;9s 'R! •,k W='R if'UNR HC'Pi_AC,: � 1 _, fON 1Pi.5aAT fUIN. AVE 5 • `''ENTCN, .a: • CONTRACT NO CA6 040-84 . H(KA15 WORKED NAM[ a iDR ESS ANU an' 7 Ty iDAY, 7,, 7 : 1t DTAf_ Vfti oi. FarE OF Wi. • :,r; i yc �� :. ' o t? l/.I /i& '� HOUR 5 wAi L�_ 'A* �� 37. 27 STA,L 5 L �. drHb� 'OsA� •y �tORU [ c 4 C l v _ 01 TAX i}E DU"T • NE SE. ) i7 h4 U3 r,. 527 BOX AVb t' 0 O i. �S O O O i. O 28- 64 ,Y p9 34 ``'' • i G BOX 1e39 --_ _.:__ ____....._ _. .14 - M�R TN DENS. NA 98045 2 O O 0 5.0 . O _ 0 O 7 0 00 10 22 00 5. 110 _.,i; ooy; .-:.; - - .. NET PA': r,9 SS• � .'Jf TIpni Mff"Ig14'(�. ^in3J, _ W3t:ST 6E 2 0t �4 32034 S E 76 T!', FlLACE 0 0 U 0 0 0 0• KENT, WA 98091 . _- ..__ O UO 00 29, 52 00 • 0 ...4._'] 30a.NET f°Ati'• .7[i ..v ,_: Ui A ON rpl _N ';n L4 r ,U.r ,r)i 69 111� L 9i,d 47e • • d. , • • Ili� • u • • • • • • 1.A, y,i ..1�„sad# . • • • 9ELLEwF. WASHINGTON PERIOL ENI:•ING 07/24/95 FORM W11-".347 REPORT • JOB NQ C548 • B`+ W?. ' .SHIM ` ,oi a:t ViII 1 h Ppv, u • • • • sell • • • • • • • • • • fl�l • • • • • Alit 0 • • TAT-SPATE CONSTRUCTION. N, • - ?5q lCiECTH AVENUE N F 11ELLEYVE, WASHINOTON P 410D ENDING 37,24/85 FORM WH-347 REPORT • 0 WJ 0548 PAYROLL NO 4F� A • CC�NTRA I NZ• i:AG 046-95 �� HQuks WORKED � NAM, AL;C,-ES'-- -4D TOTAL GFI-IE'� RATE OF FICA jTAJE EMPLO*E� 7 HOJPS WAGFS PAY 'AX • ,,kpv " 6 0 C 0 0 u e o 123 t!i� 15 44 t� ;�6 3111`705 PLAZA RuAt• 0 0 0 1. -6 6 o -o OC ------ - ----------- --------- 9 71 00 v 0 C; 0 Lo, Q�l NET PAY 00 o so • • • 1 tiertify certify that the rcll is correct a,.d complete • • and rates c,9-- Perm are not tens than the appreciable rate tort.. Tr,: .:3ge determination dms,on of the Secreiary La.3r as stated in th-Contract • Prorrisions and the work p,rformed by en, such laloone- or mechanic confotmsto the CUUlfications set forth in said Provisions appliubte to the wage rate"d. ENDING OF FILE FILE °'� � 98s Qr ~wvf% %& Rep \�.m�.�•� � ceir S- 3 $ 9